ArticleBMJ open respiratory research2026
Estimated plasma volume for predicting sepsis-associated ARDS risk: a multicentre retrospective cohort study.
Article in BMJ open respiratory research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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14 authors.
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Abstract
backgroundSepsis-associated acute respiratory distress syndrome (SA-ARDS) is a lethal complication demanding early predictors. This study assessed estimated plasma volume status (ePVS) for predicting SA-ARDS development.
methodsThis multicentre cohort study analysed 3854 adult patients with sepsis 3.0 from China. The primary outcome was the incidence of SA-ARDS. Multivariate logistic regression, propensity score matching (PSM) and inverse probability weighting (IPW) were used to assess associations between ePVS and SA-ARDS.
resultsElevated ePVS was independently associated with SA-ARDS incidence across all models (multivariate OR: 1.56, 95% CI 1.50 to 1.63; PSM OR: 1.72, 1.63 to 1.81; IPW OR: 1.58, 1.49 to 1.69; p<0.001). Receiver operating characteristic analysis demonstrated a strong discriminative ability of ePVS for SA-ARDS incidence (area under the curve (AUC): 0.772, 95% CI 0.757 to 0.788). SA-ARDS patients exhibited higher mortality (31.8% vs 23.1%, p<0.001), mechanical ventilation (MV) use (82.3% vs 48.4%, p<0.001) and continuous renal replacement therapy (CRRT) requirements (7.7% vs 4.7%, p<0.001). Generalised additive model analysis revealed a significant linear association between ePVS >8.0 dL/g and SA-ARDS mortality (p<0.001). Although ePVS >8.0 dL/g alone showed limited predictive value for in-hospital mortality in SA-ARDS patients (AUC: 0.549), its combination with acute physiology and chronic health evaluation II significantly improved discrimination (AUC: 0.823). This synergistic effect persisted even after excluding early deaths (≤72 hours), reinforcing ePVS's complementary role alongside established severity scores in mortality risk stratification. Stratified analysis revealed ePVS levels strongly correlated with acute respiratory distress syndrome (ARDS) severity (p<0.001), particularly distinguishing mild from moderate cases. Patients with pulmonary infections exhibited higher ePVS than non-pulmonary sources (p<0.001).
conclusionsThese findings highlight ePVS is strongly associated with ARDS onset, disease severity and mortality risk, supporting its utility as a prognostic marker in risk stratification.
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