{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:05:28Z","timestamp":1787497528420,"version":"build-2736575974"},"reference-count":29,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81772043"],"award-info":[{"award-number":["81772043"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81971879"],"award-info":[{"award-number":["81971879"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82302413"],"award-info":[{"award-number":["82302413"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,5,3]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis-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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Elevated ePVS was independently associated with SA-ARDS incidence across all models (multivariate OR: 1.56, 95%\u2009CI 1.50 to 1.63; PSM OR: 1.72, 1.63 to 1.81; IPW OR: 1.58, 1.49 to 1.69; p&lt;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%\u2009CI 0.757 to 0.788). SA-ARDS patients exhibited higher mortality (31.8% vs 23.1%, p&lt;0.001), mechanical ventilation (MV) use (82.3% vs 48.4%, p&lt;0.001) and continuous renal replacement therapy (CRRT) requirements (7.7% vs 4.7%, p&lt;0.001). Generalised additive model analysis revealed a significant linear association between ePVS &gt;8.0\u2009dL\/g and SA-ARDS mortality (p&lt;0.001). Although ePVS &gt;8.0\u2009dL\/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 (\u226472\u2009hours), reinforcing ePVS\u2019s 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&lt;0.001), particularly distinguishing mild from moderate cases. Patients with pulmonary infections exhibited higher ePVS than non-pulmonary sources (p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings highlight ePVS is strongly associated with ARDS onset, disease severity and mortality risk, supporting its utility as a prognostic marker in risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003471","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T14:20:18Z","timestamp":1781101218000},"page":"e003471","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Estimated plasma volume for predicting sepsis-associated ARDS risk: a multicentre retrospective cohort study"],"prefix":"10.1136","volume":"13","author":[{"given":"Lina","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8441-6058","authenticated-orcid":false,"given":"Lei","family":"Zong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China"},{"name":"Department of Critical Care Medicine, The Affiliated Hospital of Northwest University, Xi'an No 3 Hospital, Xi'an, Shaanxi, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Pathology, The Affiliated Hospital of Northwest University, Xi\u2019an No 3 Hospital, Xi\u2019an, Shaanxi, 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