{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T19:57:48Z","timestamp":1785700668888,"version":"3.56.0"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Xuzhou City Top Clinical Medical Expert Teams Recruitment Project","award":["2025TD07"],"award-info":[{"award-number":["2025TD07"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis is a leading cause of ICU mortality, and sepsis-associated acute kidney injury (SA-AKI) significantly elevates the risk of death. This study investigated the relationship between early cumulative fluid balance and the outcomes of severe SA-AKI (SS-AKI) and 30-day mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from the MIMIC-IV 3.1 database, including adult septic patients who met the Sepsis-3.0 diagnostic criteria and were admitted to the ICU for the first time between 2008 and 2019. The restricted cubic spline (RCS) model was used to analyze the nonlinear relationship between cumulative fluid balance during the first three days after ICU admission and the risk of SS-AKI. Multivariable logistic regression, Cox proportional hazards models, and propensity score matching (PSM) were employed to evaluate the effects of cumulative fluid balance on SS-AKI occurrence and 30-day mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2074 septic patients, 1009 (48.7%) developed SS-AKI. These patients had more severe illness and a significantly higher 3-day fluid balance. After adjusting for confounders, sensitivity analyses demonstrated a robust positive association between cumulative 3-day fluid balance and SS-AKI risk (OR = 1.043, 1.069, and 1.088), while the cumulative 3-day fluid balance was identified as a predictor of 30-day mortality (HR\u2009=\u20090.989, 1.003, 1.017). RCS analysis revealed a nonlinear relationship, with an inflection point at 5.21 L at Day 3. When the cumulative fluid balance exceeded this threshold, the risk of SS-AKI increased significantly. Subgroup analyses showed consistent associations across sex, age, ethnicity, diabetes status, and vasopressor use. After PSM, patients with cumulative 3-day fluid balance exceeding 5.21 L remained at significantly higher risk for SS-AKI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In septic patients, cumulative fluid balance during the first three ICU days is nonlinearly associated with SS-AKI risk. When cumulative fluid balance exceeds approximately 5.21 L at Day 3, the risks of both SS-AKI and 30-day mortality increased.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666261446558","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:11:30Z","timestamp":1785424290000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Nonlinear Impact of Cumulative Fluid Balance on Severe Acute Kidney Injury During the First Three ICU Days in Sepsis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8725-0728","authenticated-orcid":false,"given":"Deyang","family":"Xi","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Xuzhou Central Hospital, Southeast University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinshuang","family":"Yang","sequence":"additional","affiliation":[{"name":"Beijing Ditan Hospital Xuzhou Hospital (Xuzhou Seventh People's Hospital)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shucun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Xuzhou Central Hospital, Southeast University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunyang","family":"Li","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Xuzhou Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3668-5140","authenticated-orcid":false,"given":"Wenjing","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Xuzhou Central Hospital, Southeast University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30696-2"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32989-7"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-024-01336-9"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-016-0323-6"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006769"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc13072"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.7560"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.981578"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2024.2441393"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-022-01040-6"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2025.1509180"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-022-01899-x"},{"key":"e_1_3_3_14_2","article-title":"Sepsis associated acute kidney injury","volume":"364","author":"Poston JT","year":"2019","unstructured":"Poston JT, Koyner JL. Sepsis associated acute kidney injury. Br Med J. 2019;364:k4891.","journal-title":"Br Med J."},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2012080800"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2021.05.020"},{"issue":"1","key":"e_1_3_3_17_2","article-title":"Revisiting post-ICU admission fluid balance across pediatric sepsis mortality risk strata: A secondary analyses from a prospective observational cohort study","volume":"6","author":"Atreya MR","year":"2023","unstructured":"Atreya MR, Cvijanovich NZ, Fitzgerald JC, et al. Revisiting post-ICU admission fluid balance across pediatric sepsis mortality risk strata: A secondary analyses from a prospective observational cohort study. Res Sq. 2023;6(1):e1027.","journal-title":"Res Sq"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-023-01178-x"},{"issue":"10","key":"e_1_3_3_19_2","article-title":"A higher fluid balance in the days after septic shock reversal is associated with increased mortality: An observational cohort study","volume":"2","author":"van Mourik N","year":"2020","unstructured":"van Mourik N, Geerts BF, Binnekade JM, et al. A higher fluid balance in the days after septic shock reversal is associated with increased mortality: An observational cohort study. Crit Care Explor. 2020;2(10):e0219.","journal-title":"Crit Care Explor"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002189"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2016.07.058"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-1085-4"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-021-01489-1"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2014.11.016"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006394"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-021-02735-7"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-024-05653-w"},{"issue":"1","key":"e_1_3_3_28_2","article-title":"Fluid resuscitation in sepsis: The great 30mL per kg hoax","volume":"12","author":"Marik PE","year":"2020","unstructured":"Marik PE, Byrne L, van Haren F. Fluid resuscitation in sepsis: The great 30mL per kg hoax. J Thorac Dis. 2020;12(Suppl 1):S37\u2013S47.","journal-title":"J Thorac Dis"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-086367"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.21037\/tp-23-619"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1193-6"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1177\/0885066618823183"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000001869"},{"issue":"11","key":"e_1_3_3_34_2","article-title":"Accuracy of International Classification of Diseases, 10th revision codes for identifying sepsis: A systematic review and meta-analysis","volume":"4","author":"Liu B","year":"2022","unstructured":"Liu B, Hadzi-Tosev M, Liu Y, et al. Accuracy of International Classification of Diseases, 10th revision codes for identifying sepsis: A systematic review and meta-analysis. Crit Care Explor. 2022;4(11):e0788.","journal-title":"Crit Care Explor"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1177\/08850666231192371"}],"container-title":["Journal of Intensive Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08850666261446558","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08850666261446558","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08850666261446558","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T19:43:49Z","timestamp":1785699829000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08850666261446558"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":34,"alternative-id":["10.1177\/08850666261446558"],"URL":"https:\/\/doi.org\/10.1177\/08850666261446558","relation":{},"ISSN":["0885-0666","1525-1489"],"issn-type":[{"value":"0885-0666","type":"print"},{"value":"1525-1489","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]},"article-number":"08850666261446558"}}