ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Intensive Care Cardiovascular Medicine
This article is part of the Research TopicFrom Laboratory Insights to Clinical Strategies in Cardiogenic ShockView all 4 articles
Fluid Balance Trajectories and Prognosis in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Group-Based Trajectory Model Approach
Provisionally accepted
- Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
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Background: Fluid management is crucial in the treatment of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS), yet the optimal strategy remains unclear. This study aims to evaluate the association between fluid balance (FB) trajectories and prognosis in AMI-CS patients. Methods: This study utilized data from the MIMIC-IV database, including patients diagnosed with AMI-CS. A Group-Based Trajectory Model (GBTM) was applied to identify patient groups with similar FB trends. The association between different FB trajectories and patient survival was assessed using Kaplan-Meier survival analysis and Cox regression models. Additionally, subgroup and sensitivity analyses were conducted to validate the robustness of the results. Results: A total of 533 AMI-CS patients were included. The 4-group trajectory model showed good fit (AIC = 19,937.75; minimum AvePP = 0.81). Four FB trajectory patterns were identified: trajectory 1 (stable negative balance), trajectory 2 (rapid decline to negative balance), trajectory 3 (persistent positive balance), and trajectory 4 (high-level decreasing). Kaplan-Meier survival analysis revealed that patients in trajectories 1 and 2 had higher survival rates, while those in the fluid overload group had a significantly higher risk of death compared to the non-overload group. Cox regression analysis further demonstrated that, compared to trajectory 2, trajectory 3 was associated with a significantly increased mortality risk, while trajectory 1 showed no statistically significant difference. Subgroup and sensitivity analyses were consistent, confirming the robustness of the study findings. Conclusion: Among the dynamic FB patterns in AMI-CS patients, stable negative balance or rapid transition to negative balance is associated with the best prognosis. The GBTM approach helps identify different risk strata within the AMI-CS patient population.
Keywords: acute myocardial infarction, Cardiogenic shock, GBTM, Fluid balance, MIMIC database, prognosis
Received: 27 Jul 2025; Accepted: 09 Dec 2025.
Copyright: © 2025 Zhang, Xie, Lin and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qitian Zhang
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