摘要
Objective:This study aimed to investigate the longitudinal trajectories of cumulative fluid balance(CFB)in intensive care unit(ICU)patients and analyze the relationship between different trajectory groups and the occurrence of pressure injuries(PIs).Methods:In this retrospective longitudinal study,we obtained health-related data from the Medical Information Mart for Intensive Care IV database,including sociodemographic,disease-related variables,and ICU treatment variables.The daily CFB adjusted for body weight was calculated,and the occurrence of PIs during the ICU stay was recorded.A group-based trajectory model was used to explore the different CFB trajectories.Binary logistic regression was used to analyze the relationship between the CFB trajectory group and PIs.Results:Among the 4,294 included participants,we identified four distinct trajectories of CFB in ICU patients:the rapid accumulation group(12.5%),the slow accumulation group(28.5%),the neutral balance group(41.7%),and the negative decrease group(17.3%).After adjusting for some sociodemographic,disease-related variables,and ICU treatment variables,the rapid accumulation group had an OR of 1.63(95%CI:1.30,2.04)for all stages of PIs and an OR of 1.36(95%CI:1.08,1.72)for stage II or higher PIs compared to the neutral balance group.Conclusions:Four unique trajectories of CFB were identified among patients in the ICU,including rapid accumulation,slow accumulation,neutral balance,and negative decrease.Rapid accumulation independently increased the risk of PIs during ICU stay.
目的探讨ICU患者累积液体平衡量(cumulative fluid balance,CFB)的纵向变化轨迹,并分析不同轨迹类型与压力性损伤(pressure injuries,PIs)发生风险之间的关系。方法采用回顾性纵向研究设计,数据来源于第四版重症监护医学数据库,收集社会人口学特征、疾病相关变量及ICU治疗相关变量。对每日CFB根据体重进行校正,并记录患者在ICU期间是否发生PIs。采用基于组的轨迹模型(Group-Based Trajectory Model,GBTM)识别CFB的变化轨迹类型,采用二元Logistic回归分析不同轨迹类型与PIs发生之间的关系。结果共纳入4294例ICU患者,共识别出四种CFB变化轨迹类型:快速积聚组(12.5%)、缓慢积聚组(28.5%)、中性平衡组(41.7%)和负向减少组(17.3%)。二元Logistic回归结果表明,在调整了社会人口学特征、疾病与ICU治疗相关变量后,CFB快速积聚组既是所有分期压力性损伤(OR=1.63;95%CI:1.30,2.04)、也是Ⅱ期及以上分期压力性损伤(OR=1.36;95%CI:1.08,1.72)的独立危险因素。结论ICU患者的CFB变化轨迹可分为快速积聚、缓慢积聚、中性平衡和负向减少。快速液体积聚是ICU患者住院期间发生PIs的独立风险因素。
