BACKGROUND Acute respiratory distress syndrome (ARDS), a complex response to various insults, has a high mortality rate. As pulmonary edema resulting from increased vascular permeability is a hallmark of ARDS, management of the fluid status, including the urine output (UO) and fluid intake (FI), is essential. However, the relationships between UO, FI, and mortality in ARDS remain unclear. This retrospective study aimed to investigate the interactive associations among UO, FI, and mortality in ARDS. METHODS This was a secondary analysis of a prospective randomized controlled trial performed at 10 centers within the ARDS Network of the National Heart, Lung, and Blood Institute research network. The total UO and FI volumes within the 24-h period preceding the trial, the UO to FI ratio (UO/FI), demographic data, biochemical measurements, and other variables from 835 patients with ARDS, 539 survivors, and 296 non-survivors, were analyzed. The associations among UO, FI, the UO/FI, and mortality were assessed using a multivariable logistic regression. RESULTS In all 835 patients, an increased UO was significantly associated with decreased mortality when used as a continuous variable (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.98-0.99, P = 0.002) and as a quartile variable (OR of Q2 to Q4: 0.69-0.46, with Q1 as reference). To explore the interaction between UO and FI, the UO/FI was calculated, and a cut-off value of 0.5 was detected for the association with mortality. For patients with a UO/FI ≤0.5, an increased UO/FI was significantly associated with decreased mortality (OR: 0.09, 95% CI: 0.03-0.253, P <  0.001); this association was not significant for patients with UO/FI ratios > 0.5 (OR: 1.04, 95% CI: 0.96-1.14, P = 0.281). A significant interaction was observed between UO and the UO/FI. The association between UO and mortality was significant in the subgroup with a UO/FI ≤0.5 (OR: 0.97, 95% CI: 0.96-0.99, P = 0.006), but not in the subgroup with a UO/FI > 0.5. CONCLUSIONS The association between UO and mortality was mediated by the UO/FI status, as only patients with low UO/FI ratios benefitted from a higher UO.

中文翻译：

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急性呼吸窘迫综合征中尿量与死亡率之间的液体摄入相关性。

背景技术急性呼吸窘迫综合征（ARDS）是对各种侮辱的复杂反应，其死亡率很高。由于血管通透性增加引起的肺水肿是ARDS的标志，因此必须对包括尿量（UO）和液体摄入量（FI）在内的体液状态进行管理。但是，ARDS中UO，FI和死亡率之间的关系仍不清楚。这项回顾性研究旨在调查ARDS中UO，FI和死亡率之间的互动关系。方法这是对美国国家心肺血液研究所研究网络的ARDS网络中10个中心进行的前瞻性随机对照试验的次要分析。在试验前的24小时内，UO和FI的总量，UO与FI的比例（UO / FI），人口统计数据，生化指标，分析了835名ARDS患者，539名幸存者和296名非幸存者的其他变量。使用多变量logistic回归评估UO，FI，UO / FI和死亡率之间的关联。结果在所有835例患者中，当用作连续变量（优势比[OR]：0.98、95％置信区间[CI]：0.98-0.99，P = 0.002）和四分位数时，UO升高与死亡率降低显着相关。变量（Q2与Q4的OR：0.69-0.46，以Q1为参考）。为了探究UO和FI之间的相互作用，计算了UO / FI，并确定了与死亡相关的临界值0.5。对于UO / FI≤0.5的患者，UO / FI升高与死亡率降低显着相关（OR：0.09，95％CI：0.03-0.253，P <0.001）；对于UO / FI比率> 0.5（OR：1.04，95％CI：0.96-1.14，P = 0.281）的患者，这种关联并不显着。在UO和UO / FI之间观察到显着的相互作用。UO / FI≤0.5（OR：0.97，95％CI：0.96-0.99，P = 0.006）的亚组中UO与死亡率之间的相关性显着，但UO / FI> 0.5的亚组中UO与死亡率之间的相关性显着。结论UO / FI的状态介导了UO与死亡率之间的关联，因为只有低UO / FI比的患者才能受益于较高的UO。