Clinical study on the predictive value of clinical and ultrasound indicators for positive fluid balance in the non-resuscitation phase

Yuan Yuan; Wang Xin; Wang Yueguo; Wang Yulan; Sun Jian; Jin Kui

doi:10.3969/j.issn.1002-1949.2025.10.012

Abstract：Objective To evaluate the predictive value of bedside ultrasound and clinical parameters for fluid status in non-resuscitation phase patients undergoing fluid therapy.Methods This study was a prospective observational investigation involving the patients admitted to the Emergency ICU of the First Affiliated Hospital of the University of Science and Technology of China between January 2024 and March 2024.The daily fluid intake and output of patients during the first 6 days of the non-resuscitation phase of fluid therapy were recorded.After adjusting for insensible fluid loss and endogenous metabolic water,the corrected daily fluid intake-output gap(dIOg)and the cumulative fluid intake-output gap(cIOg)over 6 days were calculated.Patients were grouped based on whether the gap was greater than 0.Clinical parameters,laboratory test results,and daily ultrasound parameters were collected to analyze the relationship between cIOg and patient prognosis during the observation period,as well as the predictive value of related parameters for dIOg+.Results A total of 30 patients were included in this study,with 16 in-hospital deaths(53.3%).Among the deceased patients,10(62.5%)had positive cIOg(cIOg+).Logistic regression analysis indicated that cIOg was an independent risk factor for in-hospital mortality.A total of 180 dIOg measurements were performed on 30 patients,among which 99 measurements(55.0%)were dIOg+.In the prediction model for dIOg+,after adjusting for confounding factors in Logistic regression analysis,intrarenal vein flow(IRVF)grading,hepatic vein flow(HVF)grading,and venous excess ultrasound score(VexUS)grading were identified as independent risk factors for dIOg+occurrence.Among the predictors,IRVF had the highest predictive value,with the area under ROC curve(AUC)of 0.78(95%CI 0.72-0.84).In contrast,pulmonary crackles and B-lines were not significantly associated with dIOg+.Conclusions In non-resuscitation phase patients undergoing fluid therapy,the cumulative corrected fluid balance difference is significantly associated with patient mortality.Among the predictors,IRVF has the highest predictive value for the daily corrected fluid balance difference.