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April 10, 2026Scientific ReportsOpen Access

Association between estimated plasma volume status and all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage: analysis of the MIMIC-IV database

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Why the study?

Does estimated plasma volume status affect all-cause mortality in critically ill adult patients with non-traumatic subarachnoid hemorrhage?

Population

Critically ill patients with NSAH

Comparison

Low vs high ePVS levels

Key result

Estimated plasma volume status exhibited a U-shaped relationship with 1-month all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage, with each unit increase above 3.94 associated with a 1.8-fold increased risk of death (HR 2.80).

Authors

QMQing MeiJZJ. ZhangHSH Shen

Discussion

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Member takes

Overview

Warrants caution re ePVS extremes in non-traumatic SAH; extends the mortality signal but should not yet change practice.

Key Points

  • To explore the relationship between estimated plasma volume status and all-cause mortality in critically ill non-traumatic subarachnoid hemorrhage patients.
  • Analyzed 750 NSAH patients from the MIMIC-IV database
  • Constructed a Cox proportional hazards model to evaluate mortality risk
  • Used a restricted cubic spline model to assess ePVS relationship with outcomes.
  • 1-month all-cause mortality was 21%, with 29% at 1-year
  • Found a U-shaped relationship between ePVS and mortality risk
  • Low ePVS reduces mortality risk by 56%, while high ePVS increases risk by 1.8 times.

Study Design

Type

Cohort (n=750)

Multicenter

No

Structured PICO

Does estimated plasma volume status affect all-cause mortality in critically ill adult patients with non-traumatic subarachnoid hemorrhage?

P
Population
750 critically ill adult ICU patients with non-traumatic subarachnoid hemorrhage (NSAH), with ICU stays ≥24 hours and first hospital/ICU admission.
I
Intervention
Estimated plasma volume status (ePVS) calculated using the Duarte formula from hematocrit and hemoglobin within the first 24 hours of ICU admission
C
Comparator
Patients with different levels of ePVS (stratified into tertiles: T1 <3.58, T2 3.59-5.10 [reference], T3 ≥5.11)
O
Outcome
1-month all-cause mortality (ACM)hard clinical

Main Result

Effect estimate: HR 2.80 (95% CI 1.58-4.97)

p-value: p=<0.001

In critically ill patients with non-traumatic subarachnoid hemorrhage, estimated plasma volume status exhibits a U-shaped association with 1-month mortality, suggesting both hypovolemia and hypervolemia portend poor prognosis.

Limitations

  • Absence of imaging validation for diagnostic codes may have resulted in misclassification of non-aneurysmal cases
  • Retrospective single-center observational study susceptible to residual confounding
  • Lack of critical clinical variables such as hematoma burden, hydrocephalus, intraventricular extension, and DCI
  • Severely ill nature of the cohort limits external validity to less acute NSAH populations
  • Single-timepoint ePVS measurement precludes assessment of longitudinal changes
  • Absence of imaging validation for diagnostic codes may have resulted in misclassification
  • Retrospective single-center observational study susceptible to residual confounding and cannot establish causality
  • Lack of critical clinical variables including hematoma burden, hydrocephalus, intraventricular extension, DCI, and treatment modalities

Cite This Study

Mei et al. (2026) conducted a cohort in Non-traumatic subarachnoid hemorrhage (NSAH) (n=750). Estimated plasma volume status (ePVS) was evaluated on 1-month all-cause mortality (per unit increase in ePVS > 3.94) (HR 2.80, 95% CI 1.58-4.97, p=<0.001). Estimated plasma volume status exhibited a U-shaped relationship with 1-month all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage, with each unit increase above 3.94 associated with a 1.8-fold increased risk of death (HR 2.80).

synapsesocial.com/papers/69d893eb6c1944d70ce04e38https://doi.org/10.1038/s41598-026-47116-2
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Association between estimated plasma volume status and risk of sepsis-associated acute kidney Injury: a retrospective cohort study using the MIMIC-IV database2025
  2. 2Estimated plasma volume status (ePVS) is a predictor for acute myocardial infarction in-hospital mortality: analysis based on MIMIC-III database2021 · 20 citations
  3. 3Estimated plasma volume status as a simple and accessible predictor of 28-day mortality in septic shock: insights from a retrospective study of the MIMIC-IV database2024 · 8 citations
  4. 4Association between estimation of pulse wave velocity and all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage: an analysis based on the MIMIC-IV database2024 · 8 citations
  5. 5Non‐Linear Threshold Effect of Dynamic Estimated Plasma Volume Status on Revealing In‐Hospital Mortality Risk in Sepsis2026