The first 24-h negative fluid balance is related to lower short-term mortality but higher AKI progression in critically ill heart failure: a retrospective cohort study.
W, L., Q, C., T, H., J, L., H, L., & Q, G. (2026). The first 24-h negative fluid balance is related to lower short-term mortality but higher AKI progression in critically ill heart failure: a retrospective cohort study.. Therapeutic advances in cardiovascular disease. https://doi.org/10.1177/17539447261457542
W L, Q C, T H, J L, H L, Q G. The first 24-h negative fluid balance is related to lower short-term mortality but higher AKI progression in critically ill heart failure: a retrospective cohort study.. Therapeutic advances in cardiovascular disease. 2026; doi: 10.1177/17539447261457542
W L, Q C, T H, et al. The first 24-h negative fluid balance is related to lower short-term mortality but higher AKI progression in critically ill heart failure: a retrospective cohort study.[J]. Therapeutic advances in cardiovascular disease. 2026. DOI: 10.1177/17539447261457542.
@article{w2026,
author = {Liu W and Chen Q and Huang T and Liu J and Li H and Guo Q},
title = {The first 24-h negative fluid balance is related to lower short-term mortality but higher AKI progression in critically ill heart failure: a retrospective cohort study.},
journal = {Therapeutic advances in cardiovascular disease},
year = {2026},
doi = {10.1177/17539447261457542},
note = {PMID: 42304606},
}
TY - JOUR AU - Liu W AU - Chen Q AU - Huang T AU - Liu J AU - Li H AU - Guo Q TI - The first 24-h negative fluid balance is related to lower short-term mortality but higher AKI progression in critically ill heart failure: a retrospective cohort study. T2 - Therapeutic advances in cardiovascular disease PY - 2026 DO - 10.1177/17539447261457542 AN - PMID:42304606 ER -
BACKGROUND: Current guidelines lack instruction on fluid administration for patients with critically ill heart failure (HF) in the intensive care unit. OBJECTIVES: This study aims to compare the risk of mortality and acute kidney injury (AKI) outcomes among unlimited intake, restrictive intake, and negative balance. DESIGN: Retrospective cohort study. METHODS: A total of 3267 patients with HF not receiving renal replacement therapy were included from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and were grouped into restrictive fluid intake (the first 24-h fluid intake from 1500 to 2000 mL), negative fluid balance management (the first 24-h net output >1000 mL), and unlimited fluid control groups. The primary endpoint was 28-day mortality, and the secondary endpoints were morbidity of 48-h AKI, 7-day AKI, and AKI progression from 48 h to 7 days. The odds ratio (OR) and the 95% confidence interval (CI) were estimated by multivariable logistic regression, and mediation analyses were performed. RESULTS: Negative fluid balance, not restrictive fluid intake, was correlated to a lower risk of 28-day mortality (OR: 0.750 (0.570-0.987), p = 0.040), 48-h AKI (OR: 0.207 (0.169-0.255), p < 0.001), and 7-day AKI (OR: 0.261 (0.207-0.330), p < 0.001) but was correlated to a higher risk of AKI progression (OR: 2.284 (1.835-2.843), p < 0.001) compared to unlimited fluid control after multivariable adjustment. The 24-h net output mediated AKI incidence and progression. CONCLUSION: Negative fluid balance was related to lower risk of 28-day mortality, 48-h AKI, and 7-day AKI but a higher risk of AKI progression, which requires further clinical trials for validation. The first 24-hour negative fluid balance is related to lower short-term mortality but higher AKI progression in critically ill heart failure: a retrospective cohort studyThe first 24-hour negative fluid balance is correlated to lower 28-day mortality. Acute kidney injury progression should be cautioned in the first 24-hour negative fluid balance. Lower fluid output and more fluid input may prevent acute kidney injury incidence. The first 24-hour net output mainly contributes to the mediation effect.