{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T21:53:24Z","timestamp":1768946004391,"version":"3.49.0"},"reference-count":28,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T00:00:00Z","timestamp":1768608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Fluid overload in critically ill patients is linked to adverse outcomes. While resuscitation strategies are well established, guidance for the de-resuscitation phase remains limited. This study aimed to identify clinical factors associated with diuretic response and achieving negative fluid balance (FB) in critically ill patients. Methods: We conducted a single-center, retrospective cohort study of ICU patients who received intravenous furosemide between 2017 and 2023. A CHAID (Chi-square Automatic Interaction Detector) decision tree identified clinical variables associated with fluid removal after the first dose, and a mixed-effects model analyzed repeated measurements. Results: The cohort comprised 1764 patients over 6632 ICU days. Mean arterial pressure (MAP) was the strongest predictor of negative FB. MAP \u2264 75 mmHg yielded minimal negative FB (\u221233 \u00b1 1054 mL\/24 h); MAP 75\u201390 mmHg yielded intermediate negative FB (\u2212467 \u00b1 1140 mL\/24 h); and MAP &gt; 90 mmHg produced the greatest negative FB (\u2212899 \u00b1 1415 mL\/24 h; p &lt; 0.001). Secondary associations varied by MAP: creatinine at low MAP, blood urea nitrogen at mid-range MAP, and SOFA score at high MAP, all inversely related to negative FB. In mixed-effects analyses, each 1 mmHg MAP increase was associated with 23.3 mL greater fluid removal (p &lt; 0.001). Independent factors linked to reduced negative FB included vasopressor use (noradrenaline), elevated creatinine, and higher SOFA scores. Conclusions: In this cohort, MAP was significantly associated with the likelihood of achieving a negative fluid balance during de-resuscitation. Conversely, vasopressor use, renal dysfunction, and higher illness severity were linked to reduced diuretic responsiveness. These findings support individualized de-resuscitation strategies.<\/jats:p>","DOI":"10.3390\/jcm15020764","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T08:36:33Z","timestamp":1768898193000},"page":"764","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Parameters Associated with Achieving Negative Fluid Balance in Critically Ill Patients: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5841-8395","authenticated-orcid":false,"given":"Dekel","family":"Stavi","sequence":"first","affiliation":[{"name":"Division of Anaesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel"},{"name":"Gray Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8221-1818","authenticated-orcid":false,"given":"Amir","family":"Gal Oz","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel"},{"name":"Gray Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nimrod","family":"Adi","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel"},{"name":"Gray Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roy Rafael","family":"Dayan","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel"},{"name":"Gray Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2243-6601","authenticated-orcid":false,"given":"Yoel","family":"Angel","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel"},{"name":"Gray Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrey","family":"Nevo","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel"},{"name":"Gray Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nardeen","family":"Khoury","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel"},{"name":"Gray Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Itay","family":"Moshkovits","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel"},{"name":"Gray Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yael","family":"Lichter","sequence":"additional","affiliation":[{"name":"Critical Care Department, University College London Hospital NHS Foundation Trust, 235 Euston Rd, London NW12BU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Wald","sequence":"additional","affiliation":[{"name":"Division of Nephrology, St. Michael\u2019s Hospital and the University of Toronto, 36 Queen St, Toronto, ON M5B 1W8, Canada"},{"name":"Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital, 209 Victoria St, Toronto, ON M5B 1T8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5607-5381","authenticated-orcid":false,"given":"Noam","family":"Goder","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia, Pain Management and Intensive Care, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel"},{"name":"Gray Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Division of Surgery, Tel Aviv Sourasky Medical Center, Weizmann 6, Tel Aviv 6423919, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1056\/NEJMoa010307","article-title":"Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock","volume":"345","author":"Rivers","year":"2001","journal-title":"N. 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