Association between estimated plasma volume status and all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage: analysis of the MIMIC-IV database

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: U-shaped relationship with inflection point at ePVS 3.94

• Primary Outcome: 1-month all-cause mortality: 21%

• Nnt Or Sensitivity: 56% mortality risk reduction per unit ePVS increase below inflection point; 180% increased risk above inflection point

• Confidence Interval: Below inflection: HR 0.44 (95% CI 0.25-0.76); Above inflection: HR 2.80 (95% CI 1.58-4.97)

Clinical Application

ePVS can be calculated from routine laboratory parameters, making it feasible for ICU monitoring Relevant to Australian ICUs managing NSAH patients. Could inform fluid management protocols, though validation needed before implementation in ANZICS guidelines Critically ill patients with non-traumatic subarachnoid hemorrhage in intensive care settings

Abstract

BACKGROUND: The estimated plasma volume status (ePVS) is an independent risk factor for poor prognosis in certain cardiovascular disease populations. However, the relationship between ePVS and prognosis in critically ill patients with non-traumatic subarachnoid hemorrhage (NSAH) remains unclear. This study aims to explore the association between ePVS and all-cause mortality (ACM) in NSAH patients. METHODS: A total of 750 NSAH patients were included in this retrospective study. The primary outcome was 1-month ACM. A Cox proportional hazards model was constructed to examine the relationship between ePVS and ACM in critically ill NSAH patients. A restricted cubic spline model was used to assess the relationship between ePVS and the outcome. RESULTS: In this patient cohort, 1-month, 3-month, and 1-year ACM rates were 21%, 25%, and 29%, respectively. After adjusting for potential confounders, we found a U-shaped relationship between ePVS and 1-month ACM, with an inflection point at 3.94. Specifically, when ePVS is below the inflection point, each unit increase in ePVS reduces the mortality risk by 56% [HR, 0.44 (95% CI 0.25, 0.76)]. However, once the inflection point is surpassed, each unit increase in ePVS increases the mortality risk by 1.8 times [HR, 2.80 (95% CI 1.58, 4.97)]. CONCLUSION: We identified a U-shaped relationship between ePVS and ACM in critically ill patients with NSAH, suggesting both low and high ePVS levels may portend adverse outcomes. Prospective multicenter studies are warranted to validate these findings and elucidate underlying mechanisms.

References

1. 1.Mei, Q., Zhang, J., & Shen, H. (2026). Association between estimated plasma volume status and all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage: analysis of the MIMIC-IV database. Scientific Reports. https://doi.org/10.1097/00006123-200109000-00012