Effect of first-day fluid intake after transferring to ICU on 7-day risk for death in patients with chronic liver disease after surgery: a retrospective cohort study based on MIMIC-IV database

ZHAN Zhuo; YANG Chunyong; SHU Xin; ZHU Yiziting; LU Kaizhi; SHAO Jianliang

doi:10.16016/j.2097-0927.202507027

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Effect of first-day fluid intake after transferring to ICU on 7-day risk for death in patients with chronic liver disease after surgery: a retrospective cohort study based on MIMIC-IV database

Clinical Medicine | 更新时间：2025-08-25

- Effect of first-day fluid intake after transferring to ICU on 7-day risk for death in patients with chronic liver disease after surgery: a retrospective cohort study based on MIMIC-IV database
- Journal of Army Medical University Vol. 47, Issue 16, Pages: 1931-1939(2025)
- 作者机构：
  
  陆军军医大学（第三军医大学）第一附属医院麻醉科，重庆
- 作者简介：
  
  LU Kaizhi，E-mail：lukaizhi2010@163.com；
  SHAO Jianliang， E-mail： 654708721@qq.com
- 基金信息：
  
  the National Key Research and Development Program(2018YFC0116700)
- DOI：10.16016/j.2097-0927.202507027
  CLC： R181.32;R472.9;R575
- Received：07 July 2025，
  
  Revised：28 July 2025，
  
  Published：30 August 2025
- 稿件说明：
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占卓,杨纯勇,舒欣,等.慢性肝病患者术后转入ICU首日液体入量对术后7天死亡风险的MIMIC-IV回顾性队列研究[J].陆军军医大学学报,2025,47(16):1931-1939.

ZHAN Zhuo,YANG Chunyong,SHU Xin,et al.Effect of first-day fluid intake after transferring to ICU on 7-day risk for death in patients with chronic liver disease after surgery: a retrospective cohort study based on MIMIC-IV database[J].J Army Med Univ,2025,47(16):1931-1939.
占卓,杨纯勇,舒欣,等.慢性肝病患者术后转入ICU首日液体入量对术后7天死亡风险的MIMIC-IV回顾性队列研究[J].陆军军医大学学报,2025,47(16):1931-1939. DOI：10.16016/j.2097-0927.202507027.

ZHAN Zhuo,YANG Chunyong,SHU Xin,et al.Effect of first-day fluid intake after transferring to ICU on 7-day risk for death in patients with chronic liver disease after surgery: a retrospective cohort study based on MIMIC-IV database[J].J Army Med Univ,2025,47(16):1931-1939. DOI：10.16016/j.2097-0927.202507027.

摘要

目的

慢性肝病患者常表现出独特的血流动力学异常与代谢紊乱，术后液体管理面临诸多挑战，尤其是术后入住重症监护室（intensive care unit，ICU）的重症患者，亟待深入探究术后液体治疗方案与预后之间的关系。

方法

本研究基于MIMIC-IV数据库中2 414名慢性肝病、接受手术治疗，并术后转入ICU的患者，对纳排后最终得到的2 143名患者数据进行回顾性队列研究。采用多变量调整Logistic回归模型，分析术后转入ICU首日液体治疗方案与术后7天死亡风险的关联，并通过限制性立方样条（restricted cubic spline，RCS）分析剂量-反应关系。

结果

多因素分析指出限制性补液为独立保护因素，相较于非限制性补液组，限制性补液显著降低了术后7天死亡率（6.4%

12.4%，

=0.44，95%

：0.22~0.88，

=0.021）。减少了机械通气的使用（42.9%

72.3%，

=0.29，95%

：0.24~0.35，

0.001）和ICU停留时长（1.86 d

3.47 d，

=0.81，95%

：0.78~0.84，

0.001）。RCS曲线显示，术后首日液体入量与术后7天死亡风险呈现J型曲线关系，拐点为1 850 mL，超过该阈值后，术后7天死亡风险随之增加。亚组分析结果表明，限制性补液的保护作用在不同年龄、合并症群体中均呈现出一致性。

结论

慢性肝病患者术后首日采取限制性补液方案可有效降低短期死亡风险，且液体入量与7天死亡风险呈非线性剂量效应关联，液体入量超过1 850 mL时，死亡风险显著升高。

Abstract

Objective‍　‍Patients with chronic liver diseases often exhibit unique hemodynamic abnormalities and metabolic disorders. Postoperative fluid management presents numerous challenges

especially for critically ill patients admitted to the intensive care unit (ICU) after surgery. This study aimed at exploring the relationship between postoperative fluid therapy and prognosis. Methods‍　‍Based on 2 414 patients with chronic liver diseases who underwent surgical treatment and were subsequently transferred to the ICU in the MIMIC-IV database

a retrospective cohort study was conducted on the final 2 143 patients after our inclusion and exclusion criteria. Multivariate adjusted logistic regression model was used to analyze the association between fluid therapeutic regimens on the first day after ICU admission and the risk of 7-day death after surgery. Restricted cubic spline (RCS) was applied to analyze the dose-response relationship. Results‍　‍Multivariate analysis indicated that restrictive fluid resuscitation was an independent protective factor. Compared with the non-restrictive fluid resuscitation group

restrictive fluid resuscitation significantly reduced the 7-day postoperative mortality rate (6.4%

12.4%

=0.44

95%

: 0.22~0.88

=0.021)

decreased the use of mechanical ventilation (42.9%

72.3%

=0.29

95%

: 0.24~0.35

0.001)

and shortened the ICU stay (1.86

3.47 d

=0.81

95%

: 0.78~0.84

0.001). RCS curve showed that the fluid intake on the first postoperative day and the 7-day postoperative mortality risk presented a J-shaped curve relationship

with an inflection point at 1 850 mL. Beyond this threshold

the 7-day postoperative mortality risk was increased. Subgroup analysis results indicated that the protective effect of restrictive fluid resuscitation was consistent across different age and comorbidity groups. Conclusion‍　‍For patients with chronic liver diseases

adopting a restrictive fluid therapy on the first day after surgery can effectively reduce the risk of short-term death. Moreover

there is a non-linear dose-effect relationship between the fluid intake and the 7-day mortality risk. When the fluid intake exceeds 1 850 mL

the risk of death significantly increases.

关键词

Keywords

references

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