Tang Jia, Wu Changdong, Zhong Zhenguang
Graduate School of Xinjiang Medical University, Urumqi, Xinjiang, China.
Xinjiang Emergency Center, People's Hospital of Xinjiang Uygur Autonomous Region, No. 91, Tian-Chi Road, Tianshan District, Urumqi, 830001, Xinjiang, China.
Neurol Ther. 2024 Jun;13(3):749-761. doi: 10.1007/s40120-024-00612-x. Epub 2024 Apr 18.
Acute ischemic stroke (AIS) significantly contributes to severe disability and mortality among the elderly. This study aims to explore the association between longitudinal fluid balance (FB) trajectories and clinical outcomes in elderly patients with AIS. Our hypothesis posits the existence of multiple latent trajectories of FB in patients with AIS during the initial 7 days following ICU admission.
Patients (age ≥ 65 years) with AIS and continuous FB records were identified from two large databases. Group-based trajectory modeling identified latent groups with similar 7-day FB trajectories. Subsequently, multivariable logistic and quasi-Poisson regression were employed to evaluate the relationship between trajectory groups and outcomes. Additionally, nonlinear associations between maximum fluid overload (FO) and outcomes were analyzed using restricted cubic spline models. To further validate our findings, subgroup and sensitivity analysis were conducted.
A total of 1146 eligible patients were included in this study, revealing three trajectory patterns were identified: low FB (84.8%), decreasing FB (7.2%), and high FB (7.9%). High FB emerged as an independent risk factor for in-hospital mortality. Compared with those without FO, patients with FO had a 1.57-fold increased risk of hospital mortality (adjusted odd ratio (OR) 1.57, 95% confidence interval (CI) 1.08-2.27), 2.37-fold increased risk of adverse kidney event (adjusted OR 2.37, 95% CI 1.56-3.59), and 1.33-fold increased risk of prolonged ICU stay (adjusted incidence rate ratio (IRR) 1.33, 95% CI 1.19-1.48). The risk of hospital mortality and adverse kidney event increased linearly with rising maximum FO (P for non-linearity = 0.263 and 0.563, respectively).
Daily FB trajectories were associated with adverse outcomes in elderly patients with AIS. Regular assessment of daily fluid status and restriction of FO are crucial for the recovery of critically ill patients.
急性缺血性卒中（AIS）是导致老年人严重残疾和死亡的重要原因。本研究旨在探讨老年AIS患者纵向液体平衡（FB）轨迹与临床结局之间的关联。我们的假设是，在入住重症监护病房（ICU）后的最初7天内，AIS患者存在多种潜在的FB轨迹。
从两个大型数据库中识别出年龄≥65岁且有连续FB记录的AIS患者。基于组的轨迹建模确定了具有相似7天FB轨迹的潜在组。随后，采用多变量逻辑回归和准泊松回归来评估轨迹组与结局之间的关系。此外，使用受限立方样条模型分析最大液体超负荷（FO）与结局之间的非线性关联。为了进一步验证我们的发现，进行了亚组分析和敏感性分析。
本研究共纳入1146例符合条件的患者，确定了三种轨迹模式：低FB（84.8%）、FB下降（7.2%）和高FB（7.9%）。高FB是院内死亡的独立危险因素。与无FO的患者相比，有FO的患者院内死亡风险增加1.57倍（调整后的优势比（OR）为1.57，95%置信区间（CI）为1.08 - 2.27），不良肾脏事件风险增加2.37倍（调整后的OR为2.37，95% CI为1.56 - 3.59），ICU住院时间延长风险增加1.33倍（调整后的发病率比（IRR）为1.33，95% CI为1.19 - 1.48）。随着最大FO的增加，院内死亡风险和不良肾脏事件风险呈线性增加（非线性检验P值分别为0.263和0.563）。
老年AIS患者的每日FB轨迹与不良结局相关。定期评估每日液体状态并限制FO对重症患者的康复至关重要。
