Association Between Trajectories of Estimated Plasma Volume Status and All-Cause Mortality in Patients With Severe...

The estimated plasma volume status (ePVS) has been identified as a potential prognostic marker for various critical illnesses. However, its prognostic value, especially regarding the assessment of ePVS changes over time in intensive care unit patients with liver cirrhosis, remains uncertain.

This retrospective cohort study analyzed adult patients with liver cirrhosis in the Medical Information Mart for Intensive Care IV database. We applied group-based trajectory modeling to identify distinct ePVS trajectories, selecting the optimal model based on the Bayesian information criterion, Akaike information criterion, average posterior probability, and clinical interpretability. Kaplan-Meier survival curve was used to compare the mortality in patients with cirrhosis with different ePVS trajectories. Hazard ratios were calculated to elucidate the association between trajectories and prognosis in Cox proportional hazard models. Restricted cubic splines were used to assess the relationship between ePVS and outcomes.

A total of 2,146 patients were included for analysis. Group-based trajectory modeling identified 4 different ePVS trajectories: traj 1 (low-level slow increase), traj 2 (medium-level stable), traj 3 (ascend-descend at moderate high level), and traj 4 (high level down slightly). The Kaplan-Meier analysis showed that the mortality probability of traj 4 was the highest among the ePVS trajectories. After adjusting for demographic characteristics, clinical parameters, comorbidities, and treatment, compared with traj 1, traj 4 remained independently associated with an increased 28-day mortality rate (hazard ratio = 1.65, 95% CI: 1.15-2.38, P = 0.007). The restricted cubic splines analysis showed a significant nonlinear association between ePVS and the risk of death. The subgroup analysis results were generally consistent, and no significant interaction was detected.

Different ePVS trajectories are significantly associated with intensive care unit mortality in patients with liver cirrhosis and may serve as powerful indicators for risk stratification and prognosis assessment in this population.