Relationship between cumulative fluid balance and the prognosis in the patients with severe acute pancreatitis after continuous renal replacement therapy

Guo Yanmin; Weng Ruixia; Yan Min

doi:10.3969/j.issn.1002-1949.2023.12.005

Abstract：Objective To explore the relationship between cumulative fluid balance and the prognosis in the patients with severe acute pancreatitis(SAP)after continuous renal replacement therapy(CRRT).Methods A total of 102 patients with SAP who received sequential CRRT therapy in the People's Hospital of Suzhou High-tech Zone from January 2018 to May 2023 were selected.According to the clinical outcome within 28 days after treatment,the patients were divided into good grognosis group(n =79)and poor prognosis group(n =23).The clinical data,1,2,3 d after the treatment and total fluid volume were compared between the two groups.Kaplan-Meier method was used to compare the prognosis of patients with cumulative negative fluid balance and positive fluid balance.Multivariate Cox proportional hazard regression analysis was used to analyze the factors affecting the prognosis of patients.After adjusting the confounding covariates,the relationship of cumulative fluid balance and other influencing factors with the prognosis of patients was analyzed.The multiplicative interaction between cumulative fluid balance and other influencing factors was analyzed.A regression model was established and its prediction efficiency was verified.Results The rate of good prognosis in the patients with cumulative negative fluid balance was significantly higher than that of the patients with positive fluid balance(Log-rank χ2 = 46.530,P＜0.001).The increase of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),platelet distribution width(PDW),neutrophil-to-lymphocyte ratio(NLR)and C-reactive protein(CRP)were the risk factors affecting the prognosis of SAP patients,and increased cumulative liquid output and negative liquid balance were protective factors(P＜0.05).After adjusting the confounding covariates,the above variables were still independently correlated with the prognosis of the patients(P＜0.05).Cumulative fluid balance combined with PDW(OR =3.642,95％CI 3.067-4.239,P＜0.001)had the best predictive effect on the prognosis of patients.Multivariate Cox proportional hazard regression model has the higher degree of differentiation and accuracy.Conclusions The state of cumulative fluid balance after CRRT treatment is related to the prognosis of SAP patients,and negative fluid balance is beneficial to the survival of patients.