{"paper_id":"1dc22f8b-822a-476f-8b1b-6ceaf43976fb","body_text":"Temporal Changes in the Relationship Between Central Venous Pressure and B-Line Score in Patients Undergoing Transurethral Resection of the Prostate: Evidence from a Generalized Estimating Equations Model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Temporal Changes in the Relationship Between Central Venous Pressure and B-Line Score in Patients Undergoing Transurethral Resection of the Prostate: Evidence from a Generalized Estimating Equations Model Qing Liu, Jingwen Wei, Chunyi Yang, Lizhen Wu, Chaoxiu Jiang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7371999/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted 14 You are reading this latest preprint version Abstract Objective: To investigate the correlation between central venous pressure (CVP) and B-line score through dynamic monitoring of the two parameters in patients undergoing transurethral resection of the prostate. Methods: A total of 101 patients who underwent transurethral resection of the prostate were enrolled, with the procedure performed under general anesthesia. B-line score (quantified via transthoracic lung ultrasound), CVP, peak airway pressure (Ppeak), and arterial blood gas parameters, including arterial sodium (Na⁺) and potassium (K⁺) concentrations, hemoglobin (Hb), and PaO₂/FiO₂ ratio, were measured at the following time points: skin incision (baseline, T0), and with irrigation fluid volumes of 5000 mL (T1), 10,000 mL (T2), 15,000 mL (T3), and 20,000 mL (T4). Results: Data were analyzed using a generalized estimating equations model. CVP showed a significant positive correlation with the B-line score (β = 0.449, P < 0.001). With the increase in irrigation fluid volume, there was a significant increase in the B-line score at T2, T3, and T4 (T2: β = 0.785, P = 0.003; T3: β = 1.985, P < 0.001; T4: β = 3.000, P < 0.001). However, the main effect of CVP on the B-line score was not significant (β = 0.077, P = 0.148), and its effect did not show significant changes over time (T1: β = -0.008, P = 0.689; T2: β = 0.017, P = 0.783; T3: β = -0.040, P = 0.559; T4: β = -0.048, P = 0.474). The B-line score's predictive value based on CVP was initially weak at T0 and T1 but significantly increased at T2, T3, and T4, with a corresponding rise in the B-line score. Conclusions: B-line scores increased significantly over time during TURP and were closely associated with multiple physiological parameters. Although CVP was generally positively correlated with B-line scores, its effect varied across different time points, suggesting a time-dependent predictive value of CVP for pulmonary fluid status. Trial registration ChiCTR2200065753, 14/11/2022, Title: “Application of transthoracic lung ultrasound in patients undergoing prostatectomy”. Website: https://www.chictr.ogr.cn. Health sciences/Diseases Health sciences/Medical research Health sciences/Urology central venous pressure B-line score transurethral resection of the prostate temporal changes Figures Figure 1 Introduction Transurethral resection of the prostate (TURP) may cause damage to the prostatic venous sinus, allowing irrigation fluid to enter the circulatory system through compromised blood vessels [ 1 ] . Excessive absorption of irrigation fluid into the bloodstream can lead to circulatory overload, pulmonary edema, and other complications, posing a significant threat to patient safety [ 2 ] . Therefore, close monitoring of irrigation fluid absorption is essential. Central venous pressure (CVP) is an indicator of venous return and right heart preload [ 3 , 4 ] . Although its accuracy is influenced by numerous factors and its performance in predicting fluid responsiveness is limited [ 4 ] , CVP remains widely used for routine volume monitoring in patients undergoing TURP. However, the implementation of CVP monitoring requires central venous catheterization. This technique is an invasive procedure that relies on specific technical skills and equipment, while carrying inherent risks of complications [ 5 ] . Additionally, central venous catheterization increases the incidence of catheter-related infections, elevates healthcare costs, and may reduce patients’ quality of life. Multiple studies have confirmed that the transthoracic lung ultrasound B-line score sensitively reflects interstitial lung pathology and provides intuitive, real-time monitoring of dynamic changes in pulmonary congestion and edema [ 6 , 7 ] . Research indicates that in critically ill patients, the B-line score shows a weak but significant correlation with CVP, while lung ultrasound demonstrates higher sensitivity than CVP in assessing pulmonary fluid status [ 8 ] . As a non-invasive and safe monitoring technique, transthoracic lung ultrasound is simple to learn and suitable for clinical practice [ 9 , 10 ] . This study aims to dynamically monitor the B-line score, CVP, and arterial blood gas analysis in patients undergoing TURP to investigate the correlations between the B-line score and parameters such as CVP and blood gas analysis metrics. Materials and Methods Study Design This trial was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (2022-K124-01) and registered with the Chinese Clinical Trial Registry (ChiCTR2200065753). Participants All enrolled patients were scheduled to undergo TURP at the First Affiliated Hospital of Guangxi Medical University. The inclusion criteria included patients aged 60–85 years old with physical status of I to III according to the American Society of Anesthesiologists (ASA), prostate hyperplasia ≥ grade III, and surgical duration ≥ 1 hour. The exclusion criteria included heart failure, severe arrhythmias, liver or kidney dysfunction, history of lung surgery, electrolyte imbalances, and chest skin infections, defects, or severe scarring. All patients were informed of the study details and procedures prior to participation and provided written informed consent. Anesthesia Management Upon entering the operating room, the patient underwent routine monitoring of electrocardiogram, blood pressure, pulse oxygen saturation, and bispectral index. Anesthesia induction was performed using target-controlled infusion (TCI) of propofol (2.0 to 4.0 µg/ml) and remifentanil (2.0 to 4.0 ng/ml). Once the patient lost consciousness, cisatracurium (0.2 mg/kg) was administered intravenously. Endotracheal intubation was performed 3 to 5 minutes later, and mechanical ventilation was initiated with a ventilator after successful intubation. Ventilator settings included volume control mode, with a tidal volume of 6 to 8 ml/kg, a respiratory rate of 10 to 15 breaths/min, and a fraction of inspired oxygen (FiO₂) of 50–60%. Maintenance of anesthesia was achieved with TCI of propofol (1.0 to 3 µg/ml) and remifentanil (1.0 to 3.0 ng/ml), supplemented with sevoflurane (1–2%), while BIS values were maintained between 40 and 60. After induction, ultrasound-guided right internal jugular vein catheterization (Arrow, 7F, double-lumen) was performed, with catheter depth calculated as: depth (cm) = [patient height (cm) ÷ 10] − 1. The pressure transducer was zeroed at the midaxillary line at the fourth intercostal space and connected to the central venous catheter for continuous CVP monitoring. The patient was placed in the lithotomy position for surgery, with the irrigation bag positioned 70 cm above the bladder and an irrigation flow rate of 200 to 300 ml/min. If CVP reached 10 cmH₂O during surgery, furosemide (10 mg) was administered intravenously. Postoperatively, the patient was transferred to the post-anesthesia care unit for recovery. Transthoracic Lung Ultrasound Examination Method Lung ultrasound was performed using a portable ultrasound device (FUJIFILM Sonosite M-Turbo, equipped with an L38xi convex array probe, frequency 3–8 MHz) by a single qualified anesthesiologist for all patients. The examination followed the classic 8-zone method to systematically evaluate bilateral lung conditions [ 11 ] . Patients were positioned supine, with the chest wall divided longitudinally by the parasternal line, anterior axillary line, and posterior axillary line into anterior (parasternal to anterior axillary line) and lateral (anterior to posterior axillary line) regions. The nipple line (approximately the 5th intercostal space) served as the transverse boundary, dividing each hemithorax into upper and lower zones, yielding a total of 8 examination zones. The probe was placed longitudinally, parallel to the intercostal spaces, avoiding ribs to optimize the acoustic window. Each zone was scanned along the intercostal spaces, observing 2–3 respiratory cycles. The probe angle was adjusted three times to maximize the detection of B-lines, with image depth set to 4–8 cm and gain optimized to visualize the pleural line and B-lines. B-lines were defined as comet-tail artifacts originating from the pleural line and extending vertically to the bottom of the screen. The number and distribution of B-lines in each zone were recorded, and a B-line score was calculated based on the following criteria: no B-lines, 0 points; B-line confluence occupying 50% of the screen, 5 points; 75% of the screen, 8 points; full screen, 10 points. The total B-line score was obtained by summing the scores of all zones. Data collection Lung ultrasound B-line scores, CVP, peak airway pressure (Ppeak), and arterial blood gas parameters, including arterial sodium (Na⁺) and potassium (K⁺) ion concentrations, hemoglobin (Hb), and PaO₂/FiO₂ ratio, were measured at the following time points: skin incision (baseline, T0), and irrigation fluid volumes of 5000 mL (T1), 10,000 mL (T2), 15,000 mL (T3), and 20,000 mL (T4). Additionally, the incidence of transurethral resection of the prostate (TURP) syndrome and postoperative complications, including lethargy, hypoxemia, and delayed recovery, were monitored and recorded. Sample Size Calculation The sample size was calculated to detect the effect of CVP on B-line scores using a Generalized Estimating Equations (GEE) model. Assuming a regression coefficient of 0.48 (B-line score increase of 0.48 points per 1 mmHg increase in CVP), a B-line score standard deviation of 5.5, a CVP standard deviation of 3.8 mmHg, a within-subject correlation of 0.48 across 5 time points, a two-sided α of 0.05, and 80% power, a minimum of 72 patients was required, as estimated using Stata version 18.0. Accounting for a 15% dropout rate, the target sample size was increased to 85 patients. Statistical analysis Statistical analyses were performed using Stata version 18.0 (StataCorp, College Station, TX, USA). Normally distributed continuous data were expressed as mean ± standard deviation ( \\(\\:\\stackrel{-}{x}\\pm\\:s\\) ), while non-normally distributed data were presented as median (interquartile range) [M (IQR)]. Generalized Estimating Equations (GEE) models were employed to analyze: (1) differences in each parameter across different time points; (2) the effects of CVP, Na⁺, K⁺, PaO₂/FiO₂ ratio, Hb, and Ppeak on B-line scores; (3) the main and interaction effects of CVP at different time points on B-line scores. A P-value < 0.05 was considered statistically significant. Result Between December 2022 and October 2024, a total of 106 patients scheduled for TURP were assessed for study eligibility. Of these, 5 patients were excluded for meeting exclusion criteria or declining participation; 3 patients were excluded due to an operative duration of less than 1 hour; and an additional 8 patients were excluded as their intraoperative irrigation volume did not reach 20,000 mL. Ultimately, 90 patients were included in the statistical analysis. The demographic and procedural characteristics of the included patients were as follows: mean age was 69.4 ± 7.7 years, mean height was 165.6 ± 6.7 cm, and mean body weight was 64.6 ± 10.5 kg. The mean duration of anesthesia was 145.5 ± 41.1 minutes, the mean operative duration was 131.7 ± 40.1 minutes, and the mean post-anesthesia recovery time was 77.2 ± 21.6 minutes. The mean intraoperative fluid intake was 697 ± 276 mL, and the mean irrigation volume was 32528 ± 9017 mL. Compared to T0, B-line scores, CVP, and Na + concentration were significantly increased at T2-T4, while K + concentration, PaO₂/FiO₂ ratio, and Hb were significantly decreased at T1-T4, and Ppeak was significantly increased at T1-T4 ( P < 0.05). Compared to T1, B-line scores, CVP, Na + concentration, and Ppeak were significantly increased at T2-T4, while K + concentration, PaO₂/FiO₂ ratio, and Hb were significantly decreased at T2-T4 ( P < 0.05). Compared to T2, B-line scores, CVP, and Ppeak were significantly increased at T3 and T4, while K + concentration, PaO₂/FiO₂ ratio, and Hb were significantly decreased at T3 and T4 ( P < 0.05). Compared to T3, B-line scores, CVP, Na + concentration, and Ppeak were significantly increased at T4, while K + concentration, PaO₂/FiO₂ ratio, and Hb were significantly decreased at T4 ( P < 0.05). (Table 1 ). Table 1 Comparative analysis of parameters across various time points [M (IQR), n = 90] parameters T0 T1 T2 T3 T4 B-line scores 1.0(0.0–2.0) 1.0(0.0–2.0) 2.0(2.0-2.3) ab 3.0(2.0–4.0) abc 4.0(3.0–5.0) abcd CVP(mmHg) 2.5(1.8-4.0) 3.0(2.0–4.0) 5.0(4.0–6.0) ab 7.0(6.0-8.3) abc 9.0(8.0–10.0) abcd Na + (mmol/L) 138(134–141) 138(134–141) 140(135–142) ab 139(136–142) ab 141(137–144) abcd K + (mmol/L) 4.3(4-4.7) 4.2(3.9–4.6) a 4.0(3.7–4.5) ab 3.8(3.5–4.1) abc 3.6(3.2-4) abcd PaO₂/FiO₂ ratio (mmHg) 331(301–358) 314(285–342) a 289(261–316) ab 275(244–299) abc 260(232–288) abcd Hb(g/L) 119(109–130) 116(106–128) a 108(100–122) ab 106(98–120) abc 101(93–114) abcd Ppeak(cmH₂O) 18(17–21) 19(18–22) a 21(19–23) ab 21(19–24) abc 23(21–25) abcd Abbreviations: CVP, central venous pressure; Na + , serum sodium concentration; K + , serum potassium ion concentration; Hb, hemoglobin; Ppeak, peak airway pressure. Notes: T0, skin incision; T1, fluid infusion at 5000 mL; T2, fluid infusion at 10000 mL; T3, fluid infusion at 15000 mL, T4, fluid infusion at 20000 mL. Compared to T0, a P <0.05; compared to T1, b P <0.05; compared to T2, c P <0.05; compared to T3, d P <0.05. The influence of CVP, K⁺, Hb, PaO₂/FiO₂ ratio, and Ppeak on the lung ultrasound B-line score was analyzed using a GEE model. The results demonstrated a significant positive correlation between CVP and the B-line score (β = 0.449, P < 0.001), and between Ppeak and the B-line score (β = 0.559, P < 0.001). Conversely, K⁺ showed a significant negative correlation with the B-line score (β = -3.319, P < 0.001), Hb exhibited a moderate negative correlation (β = -0.177, P < 0.001), while PaO₂/FiO₂ ratio displayed a weak negative correlation (β = -0.037, P < 0.001), and Na⁺ showed a weak positive correlation (β = 0.099, P < 0.001). (Table 2 ). Table 2 Influence of different parameters on B-line score Parameters β coefficient standard error Z value P value 95% confidence interval CVP 0.449 0.019 24.25 < 0.001 0.413, 0.486 Na + 0.099 0.020 5.01 < 0.001 0.060, 0.138 K + -3.319 0.142 -23.36 < 0.001 -3.597, -3.040 PaO₂/FiO₂ ratio -0.037 0.002 -23.26 < 0.001 -0.040, -0.034 Hb -0.177 0.007 -24.40 < 0.001 -0.191, -0.163 Ppeak 0.559 0.024 22.85 < 0.001 -10.238, -8.376 Abbreviations: CVP, central venous pressure; Na + , serum sodium concentration; K + , serum potassium concentration; Hb, hemoglobin; Ppeak, peak airway pressure. Further introducing the interaction term between CVP and time revealed significant changes in the B-line score across T0-T4, particularly a significant increase at T2, T3, and T4 (T2: β = 0.785, P = 0.003; T3: β = 1.985, P < 0.001; T4: β = 3.000, P < 0.001). In contrast, the main effect of CVP on the B-line score was not significant (β = 0.077, P = 0.148), and its effect did not show significant changes over time (T1: β = -0.008, P = 0.689; T2: β = 0.017, P = 0.783; T3: β = -0.040, P = 0.559; T4: β = -0.048, P = 0.474). (Table 3 ). Table 3 Main and interaction effects of CVP at different time points on B-line score Variable β coefficient standard error Z value P value 95% confidence interval Main Effects CVP 0.077 0.053 1.45 0.148 -0.027, 0.180 Time = T1 0.084 0.068 1.24 0.214 -0.048, 0.216 Time = T2 0.785 0.265 2.96 0.003 0.266, 1.304 Time = T3 1.985 0.395 5.03 < 0.001 1.211, 2.760 Time = T4 3.000 0.432 6.94 < 0.001 2.153, 3.848 Interaction Effects Time#CVP T1 -0.008 0.020 -0.40 0.689 -0.047, 0.031 Time#CVP T2 0.017 0.062 0.28 0.783 -0.104, 0.138 Time#CVP T3 -0.040 0.069 -0.58 0.559 -0.175, 0.095 Time#CVP T4 -0.048 0.067 -0.72 0.474 -0.180, 0.084 Constant 0.829 0.180 4.61 < 0.001 0.477, 1.182 Notes : CVP, central venous pressure; T1, fluid infusion at 5000 mL; T2, fluid infusion at 10000 mL; T3, fluid infusion at 15000 mL, T4, fluid infusion at 20000 mL, T0 (skin incision, baseline) is the reference category for time. β coefficients for T1, T2, T3, and T4 represent changes relative to T0. The predictive values of B-line score based on CVP over time, as depicted in the Fig. 1 , indicate a weak influence of CVP at the early time points (T0 and T1). However, as time progressed, the predictive power of CVP significantly increased at time points T2, T3, and T4, with a corresponding marked increase in the B-line score. Discussions In current clinical practice, the transthoracic lung ultrasound B-line technique is primarily applied for real-time monitoring of cardiopulmonary function in critically ill patients, providing objective evidence for clinical decision support and therapeutic efficacy assessment. The transthoracic lung ultrasound B-line score can sensitively reflect pulmonary interstitial lesions and directly indicate pulmonary edema, allowing for dynamic monitoring of acute pulmonary edema and assessment of its severity through B-line score evaluation [ 12 , 10 ] . Furthermore, as a non-invasive and non-irradiating monitoring method, transthoracic lung ultrasound examination is safe, simple to learn, and more suitable for clinical application. This study employed a Generalized Estimating Equation (GEE) model to systematically analyze the relationship between the B-line score and multiple Parameters, including CVP, and to observe their dynamic changes at different time points following TURP. The occurrence of TURP syndrome originates from injury to the prostatic venous sinuses during the procedure, leading to the absorption of large volumes of irrigation fluid into the systemic circulation [ 1 ] . This fluid absorption can result in an elevation of CVP, making CVP monitoring a potential indicator for assessing fluid absorption [ 13 ] . The resultant intravascular volume overload may induce interstitial pulmonary edema [ 14 ] . The presence of B-lines on lung ultrasound is considered a crucial marker for evaluating pulmonary edema. A concurrent rise in B-line scores and CVP suggests fluid overload-induced accumulation of interstitial lung fluid, which compromises alveolar gas exchange and pulmonary compliance, ultimately leading to impaired oxygenation and abnormal respiratory mechanics [ 6 , 10 , 15 ] . In the present study, cumulative intraoperative irrigation volume was positively associated with progressive increases in B-line scores, CVP, arterial blood sodium (Na⁺) concentration, and peak airway pressure (Ppeak), while arterial potassium (K⁺) concentration, oxygenation index (OI), and hemoglobin (Hb) levels showed a significant decreasing trend. Although the increase in arterial Na⁺ concentration reached statistical significance, values remained within the physiological reference range (135–145 mmol/L). The concurrent decline in arterial K⁺ and Hb levels is likely attributable to a dilutional effect due to intravascular volume expansion, with the decrease in Hb also partially related to intraoperative blood loss. Further analysis using the GEE model revealed that CVP, Na⁺, and Ppeak were significantly and positively correlated with B-line scores, suggesting that increased fluid loading, elevated serum sodium, and higher airway pressure may reflect increased pulmonary fluid content, with B-line scores serving as a sensitive indicator [ 10 ] . CVP, as a marker of venous return and preload, indirectly indicates volume overload and may lead to pulmonary interstitial edema, as evidenced by increased B-line counts on lung ultrasound [ 16 ] . Elevated serum Na⁺ levels may be associated with hyperosmolarity or volume expansion, further supporting the influence of fluid status on pulmonary water content. The rise in Ppeak may reflect increased pulmonary stress during mechanical ventilation, indicating that airway pressure may also modulate interstitial fluid distribution [ 17 ] . Conversely, serum K⁺, Hb, and OI were negatively correlated with B-line scores. Hypokalemia may reflect metabolic disturbances or dilutional effects, while a decrease in Hb often indicates hemodilution or anemia, both potentially contributing to pulmonary fluid retention [ 18 , 19 ] . A decline in OI suggests impaired gas exchange, which is closely associated with increased pulmonary water content [ 20 ] . However, when the interaction term between CVP and time was incorporated into the model, neither the main effect of CVP nor its interaction with time reached statistical significance. This indicated that the influence of CVP on B-line scores was not linear or temporally stable but might have varied over time. In the early intraoperative phase, CVP had not been a strong predictor of B-lines; however, with the continued accumulation of irrigation fluid, the predictive relationship between CVP and B-lines had become more pronounced, suggesting a delayed or threshold-dependent effect [ 21 , 22 ] . Potential limitations This study has several potential limitations. First, the GEE model revealed a time-dependent relationship between CVP and B-line scores, but non-significant interaction terms suggest that the model may not have fully captured temporal dynamics or accounted for confounders such as irrigation fluid type or absorption rate. Second, CVP, as an indicator of volume overload, exhibited low sensitivity, potentially failing to accurately detect early intraoperative fluid overload, thus limiting its predictive value for B-line scores. Third, the eight-zone lung ultrasound protocol, although standardized, may have overlooked subtle interstitial fluid accumulation in unassessed regions or been affected by patient positioning during TURP, potentially reducing the sensitivity of B-line detection. Finally, the study may not have fully controlled for intraoperative factors (e.g., anesthetic agents, mechanical ventilation parameters, or preoperative fluid status) influencing CVP and B-line scores, which could introduce bias in the interpretation of results. Conclusions During transurethral resection of the prostate, B-line scores increased significantly over time and were positively associated with CVP, Ppeak, and arterial Na⁺ concentrations, while negatively associated with arterial K⁺, hemoglobin, and PaO₂/FiO₂ ratio. These findings suggest that B-lines may serve as a sensitive indicator of intraoperative pulmonary fluid status; however, the predictive value of CVP varied across time points, indicating its limited utility as a standalone monitoring parameter. Declarations Acknowledgments The study was approved by the ethics committee of the First Affiliated Hospital of Guangxi Medical University (approval number: 2022-K124-01). Funding Qing Liu was supported by the Health Commission of Guangxi Zhuang Autonomous Region Self-financing (No. Z-A20220430). No other external funding or competing interests declared. Contributions Qing Liu and Chaoxiu Jiang wrote the main manuscript text. Qing Liu prepared tables 1-3, figure 1, and revised the manuscript. Qing Liu, Chunyi Yang, and Lizhen Wu contributed to data collection. Jingwen Wei revised the manuscript. All authors reviewed the manuscript. Corresponding author Correspondence to Chaoxiu Jiang. Ethics declarations Ethics approval and consent to participate The study had been performed in accordance with the Declaration of Helsinki. The study protocol was conducted with the consent of the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University in China on 14 November 2022 (approval number: 2022-K124-01). Informed consents to participate in the study had been obtained from all participants or their legal guardian(s). The study was registered at the Chinese Clinical Trial Registry (ChiCTR2200065753). Consent for publication Not applicable. Data Availability statement All data generated or analyzed during this study are included in this published article and its supplementary information files. Competing interests The authors declare that they have no competing interests. References Hahn R G. Fluid absorption in endoscopic surgery[J]. British Journal of Anaesthesia, 2006, 96(1): 8-20. Hawary A, Mukhtar K, Sinclair A, et al. 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B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically III Patients[J]. Journal of Intensive Care Medicine, 2022, 37(1): 21-31. Lichtenstein D. Lung ultrasound in the critically ill[J]. Current Opinion in Critical Care, 2014, 20(3): 315-322. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound[J]. Intensive Care Medicine, 2012, 38(4): 577-591. Gargani L. Lung ultrasound: a new tool for the cardiologist[J]. Cardiovascular Ultrasound, 2011, 9(1): 6. Dietrich C F, Mathis G, Blaivas M, et al. Lung B-line artefacts and their use[J]. Journal of Thoracic Disease, 2016, 8(6): 1356-1365. Hahn R, Berlin ,Tomas, and Lewenhaupt A. Irrigating Fluid Absorption and Blood Loss During Transurethral Resection of the Prostate Studied with a Regular Interval Monitoring (RIM) Method[J]. 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Fluid overload in the ICU: evaluation and management[J]. BMC nephrology, 2016, 17(1): 109. Saugel B, Wildgruber M, Staudt A, et al. Quantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients[J]. Journal of Clinical Monitoring and Computing, 2019, 33(1): 5-12. Kushimoto S, Endo T, Yamanouchi S, et al. Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin definition[J]. Critical Care, 2013, 17(4): R132. Tong Xuan H, Dinh Thi Thu T, Ngo Van D, et al. Successful Treatment of Pulmonary Edema Caused by Transurethral Resection of the Prostate Syndrome[J]. Research and Reports in Urology, 2021, 13: 297-301. Hahn R G, Gebäck T. Fluid volume kinetics of dilutional hyponatremia; a shock syndrome revisited[J]. Clinics (Sao Paulo, Brazil), 2014, 69(2): 120-127. Additional Declarations No competing interests reported. Supplementary Files Rawdatawideformat.xlsx Cite Share Download PDF Status: Published Journal Publication published 02 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 16 Sep, 2025 Reviewers agreed at journal 13 Sep, 2025 Reviews received at journal 12 Sep, 2025 Reviews received at journal 11 Sep, 2025 Reviews received at journal 11 Sep, 2025 Reviewers agreed at journal 10 Sep, 2025 Reviewers agreed at journal 09 Sep, 2025 Reviewers agreed at journal 08 Sep, 2025 Reviewers agreed at journal 08 Sep, 2025 Reviewers invited by journal 08 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Editor invited by journal 21 Aug, 2025 Submission checks completed at journal 20 Aug, 2025 First submitted to journal 20 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7371999\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Article\",\"associatedPublications\":[],\"authors\":[{\"id\":515202370,\"identity\":\"e4d1cc5f-227f-453e-85c2-64cc2c1d4fde\",\"order_by\":0,\"name\":\"Qing Liu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the First Affiliated Hospital of GuangXi Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Qing\",\"middleName\":\"\",\"lastName\":\"Liu\",\"suffix\":\"\"},{\"id\":515202371,\"identity\":\"baa641b0-021a-49cb-9a39-f350ab3f3b21\",\"order_by\":1,\"name\":\"Jingwen Wei\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the First Affiliated Hospital of GuangXi Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jingwen\",\"middleName\":\"\",\"lastName\":\"Wei\",\"suffix\":\"\"},{\"id\":515202372,\"identity\":\"afa02ea8-5fb4-4c6c-9d25-8eebf8fe98da\",\"order_by\":2,\"name\":\"Chunyi Yang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the First Affiliated Hospital of GuangXi Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Chunyi\",\"middleName\":\"\",\"lastName\":\"Yang\",\"suffix\":\"\"},{\"id\":515202373,\"identity\":\"f4e7953f-5fbc-4e8a-aa37-0e05c3f0af9b\",\"order_by\":3,\"name\":\"Lizhen Wu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the First Affiliated Hospital of GuangXi Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Lizhen\",\"middleName\":\"\",\"lastName\":\"Wu\",\"suffix\":\"\"},{\"id\":515202374,\"identity\":\"76aadac2-00ca-4b4c-bda3-a5f8c6c20825\",\"order_by\":4,\"name\":\"Chaoxiu Jiang\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABC0lEQVRIiWNgGAWjYBACxmYwdQDEbGD4YGBTz8/MfPgB0VoYZ1SkJUi2s6UZEGHZATDJzHPmcILBeR4FCXxqmduZnz38UnNHnl8iuU2Ct405z/gwD4MBQ41NNG6HsZkbyxx7Zjiz52CbhGQbW7HZYd4DDxiOpeU24PaLmbRkw2HGDccb2yQM23gYtx3mSzBgbDiMRwv7N5AW+w2HGdskEtskGDc38xhI4NfCYyb5seFwItiWA2cMEjcwE9ZSJs1w7HAy0C/Nlg0VCcYSh4GBnIDHL4b9x7dJ/qg5bNsvkf7w9h+D/3L8/YcPP/hQY4NbSwMoOjCEE3AoBwF5kON+4FEwCkbBKBgFo4ABAMfRXrnDEBY2AAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"the First Affiliated Hospital of GuangXi Medical University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Chaoxiu\",\"middleName\":\"\",\"lastName\":\"Jiang\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-08-14 09:08:34\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-7371999/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-7371999/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1038/s41598-025-34114-z\",\"type\":\"published\",\"date\":\"2026-01-02T15:58:08+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":91504996,\"identity\":\"40c0dd9f-a954-4e8c-9801-12fad6fa015a\",\"added_by\":\"auto\",\"created_at\":\"2025-09-17 08:14:06\",\"extension\":\"jpeg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":174843,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eAdjusted predicted values of B-line score by CVP over time (with 95% confidence intervals)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7371999/v1/8d28493b5cc6d5774cd08a21.jpeg\"},{\"id\":99545515,\"identity\":\"5bc89d3d-49a1-45fd-b830-9d8d04c049f3\",\"added_by\":\"auto\",\"created_at\":\"2026-01-05 16:08:09\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":947803,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7371999/v1/dd9bbdfd-7bce-4b4a-b7de-89e33c97e117.pdf\"},{\"id\":91504995,\"identity\":\"a2527db2-684c-45ef-96f7-b35f7954ae50\",\"added_by\":\"auto\",\"created_at\":\"2025-09-17 08:14:06\",\"extension\":\"xlsx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":31033,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Rawdatawideformat.xlsx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7371999/v1/927c76f7176ca066b1a46954.xlsx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Temporal Changes in the Relationship Between Central Venous Pressure and B-Line Score in Patients Undergoing Transurethral Resection of the Prostate: Evidence from a Generalized Estimating Equations Model\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eTransurethral resection of the prostate (TURP) may cause damage to the prostatic venous sinus, allowing irrigation fluid to enter the circulatory system through compromised blood vessels\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e. Excessive absorption of irrigation fluid into the bloodstream can lead to circulatory overload, pulmonary edema, and other complications, posing a significant threat to patient safety\\u003csup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003e. Therefore, close monitoring of irrigation fluid absorption is essential. Central venous pressure (CVP) is an indicator of venous return and right heart preload\\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e. Although its accuracy is influenced by numerous factors and its performance in predicting fluid responsiveness is limited\\u003csup\\u003e[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e, CVP remains widely used for routine volume monitoring in patients undergoing TURP. However, the implementation of CVP monitoring requires central venous catheterization. This technique is an invasive procedure that relies on specific technical skills and equipment, while carrying inherent risks of complications\\u003csup\\u003e[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]\\u003c/sup\\u003e. Additionally, central venous catheterization increases the incidence of catheter-related infections, elevates healthcare costs, and may reduce patients\\u0026rsquo; quality of life. Multiple studies have confirmed that the transthoracic lung ultrasound B-line score sensitively reflects interstitial lung pathology and provides intuitive, real-time monitoring of dynamic changes in pulmonary congestion and edema\\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e. Research indicates that in critically ill patients, the B-line score shows a weak but significant correlation with CVP, while lung ultrasound demonstrates higher sensitivity than CVP in assessing pulmonary fluid status\\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e. As a non-invasive and safe monitoring technique, transthoracic lung ultrasound is simple to learn and suitable for clinical practice\\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. This study aims to dynamically monitor the B-line score, CVP, and arterial blood gas analysis in patients undergoing TURP to investigate the correlations between the B-line score and parameters such as CVP and blood gas analysis metrics.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStudy Design\\u003c/h2\\u003e\\u003cp\\u003e This trial was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (2022-K124-01) and registered with the Chinese Clinical Trial Registry (ChiCTR2200065753).\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eParticipants\\u003c/h3\\u003e\\n\\u003cp\\u003eAll enrolled patients were scheduled to undergo TURP at the First Affiliated Hospital of Guangxi Medical University. The inclusion criteria included patients aged 60\\u0026ndash;85 years old with physical status of I to III according to the American Society of Anesthesiologists (ASA), prostate hyperplasia\\u0026thinsp;\\u0026ge;\\u0026thinsp;grade III, and surgical duration\\u0026thinsp;\\u0026ge;\\u0026thinsp;1 hour. The exclusion criteria included heart failure, severe arrhythmias, liver or kidney dysfunction, history of lung surgery, electrolyte imbalances, and chest skin infections, defects, or severe scarring. All patients were informed of the study details and procedures prior to participation and provided written informed consent.\\u003c/p\\u003e\\n\\u003ch3\\u003eAnesthesia Management\\u003c/h3\\u003e\\n\\u003cp\\u003eUpon entering the operating room, the patient underwent routine monitoring of electrocardiogram, blood pressure, pulse oxygen saturation, and bispectral index. Anesthesia induction was performed using target-controlled infusion (TCI) of propofol (2.0 to 4.0 \\u0026micro;g/ml) and remifentanil (2.0 to 4.0 ng/ml). Once the patient lost consciousness, cisatracurium (0.2 mg/kg) was administered intravenously. Endotracheal intubation was performed 3 to 5 minutes later, and mechanical ventilation was initiated with a ventilator after successful intubation. Ventilator settings included volume control mode, with a tidal volume of 6 to 8 ml/kg, a respiratory rate of 10 to 15 breaths/min, and a fraction of inspired oxygen (FiO₂) of 50\\u0026ndash;60%. Maintenance of anesthesia was achieved with TCI of propofol (1.0 to 3 \\u0026micro;g/ml) and remifentanil (1.0 to 3.0 ng/ml), supplemented with sevoflurane (1\\u0026ndash;2%), while BIS values were maintained between 40 and 60.\\u003c/p\\u003e\\u003cp\\u003eAfter induction, ultrasound-guided right internal jugular vein catheterization (Arrow, 7F, double-lumen) was performed, with catheter depth calculated as: depth (cm) = [patient height (cm)\\u0026thinsp;\\u0026divide;\\u0026thinsp;10]\\u0026thinsp;\\u0026minus;\\u0026thinsp;1. The pressure transducer was zeroed at the midaxillary line at the fourth intercostal space and connected to the central venous catheter for continuous CVP monitoring. The patient was placed in the lithotomy position for surgery, with the irrigation bag positioned 70 cm above the bladder and an irrigation flow rate of 200 to 300 ml/min. If CVP reached 10 cmH₂O during surgery, furosemide (10 mg) was administered intravenously. Postoperatively, the patient was transferred to the post-anesthesia care unit for recovery.\\u003c/p\\u003e\\n\\u003ch3\\u003eTransthoracic Lung Ultrasound Examination Method\\u003c/h3\\u003e\\n\\u003cp\\u003eLung ultrasound was performed using a portable ultrasound device (FUJIFILM Sonosite M-Turbo, equipped with an L38xi convex array probe, frequency 3\\u0026ndash;8 MHz) by a single qualified anesthesiologist for all patients. The examination followed the classic 8-zone method to systematically evaluate bilateral lung conditions\\u003csup\\u003e[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/sup\\u003e. Patients were positioned supine, with the chest wall divided longitudinally by the parasternal line, anterior axillary line, and posterior axillary line into anterior (parasternal to anterior axillary line) and lateral (anterior to posterior axillary line) regions. The nipple line (approximately the 5th intercostal space) served as the transverse boundary, dividing each hemithorax into upper and lower zones, yielding a total of 8 examination zones. The probe was placed longitudinally, parallel to the intercostal spaces, avoiding ribs to optimize the acoustic window. Each zone was scanned along the intercostal spaces, observing 2\\u0026ndash;3 respiratory cycles. The probe angle was adjusted three times to maximize the detection of B-lines, with image depth set to 4\\u0026ndash;8 cm and gain optimized to visualize the pleural line and B-lines. B-lines were defined as comet-tail artifacts originating from the pleural line and extending vertically to the bottom of the screen. The number and distribution of B-lines in each zone were recorded, and a B-line score was calculated based on the following criteria: no B-lines, 0 points; B-line confluence occupying 50% of the screen, 5 points; 75% of the screen, 8 points; full screen, 10 points. The total B-line score was obtained by summing the scores of all zones.\\u003c/p\\u003e\\n\\u003ch3\\u003eData collection\\u003c/h3\\u003e\\n\\u003cp\\u003eLung ultrasound B-line scores, CVP, peak airway pressure (Ppeak), and arterial blood gas parameters, including arterial sodium (Na⁺) and potassium (K⁺) ion concentrations, hemoglobin (Hb), and PaO₂/FiO₂ ratio, were measured at the following time points: skin incision (baseline, T0), and irrigation fluid volumes of 5000 mL (T1), 10,000 mL (T2), 15,000 mL (T3), and 20,000 mL (T4). Additionally, the incidence of transurethral resection of the prostate (TURP) syndrome and postoperative complications, including lethargy, hypoxemia, and delayed recovery, were monitored and recorded.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eSample Size Calculation\\u003c/h2\\u003e\\u003cp\\u003eThe sample size was calculated to detect the effect of CVP on B-line scores using a Generalized Estimating Equations (GEE) model. Assuming a regression coefficient of 0.48 (B-line score increase of 0.48 points per 1 mmHg increase in CVP), a B-line score standard deviation of 5.5, a CVP standard deviation of 3.8 mmHg, a within-subject correlation of 0.48 across 5 time points, a two-sided α of 0.05, and 80% power, a minimum of 72 patients was required, as estimated using Stata version 18.0. Accounting for a 15% dropout rate, the target sample size was increased to 85 patients.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e\\u003cp\\u003eStatistical analyses were performed using Stata version 18.0 (StataCorp, College Station, TX, USA). Normally distributed continuous data were expressed as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation (\\u003cspan class=\\\"InlineEquation\\\"\\u003e\\u003cspan class=\\\"mathinline\\\"\\u003e\\\\(\\\\:\\\\stackrel{-}{x}\\\\pm\\\\:s\\\\)\\u003c/span\\u003e\\u003c/span\\u003e), while non-normally distributed data were presented as median (interquartile range) [M (IQR)]. Generalized Estimating Equations (GEE) models were employed to analyze: (1) differences in each parameter across different time points; (2) the effects of CVP, Na⁺, K⁺, PaO₂/FiO₂ ratio, Hb, and Ppeak on B-line scores; (3) the main and interaction effects of CVP at different time points on B-line scores. A P-value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 was considered statistically significant.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Result\",\"content\":\"\\u003cp\\u003eBetween December 2022 and October 2024, a total of 106 patients scheduled for TURP were assessed for study eligibility. Of these, 5 patients were excluded for meeting exclusion criteria or declining participation; 3 patients were excluded due to an operative duration of less than 1 hour; and an additional 8 patients were excluded as their intraoperative irrigation volume did not reach 20,000 mL. Ultimately, 90 patients were included in the statistical analysis. The demographic and procedural characteristics of the included patients were as follows: mean age was 69.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.7 years, mean height was 165.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.7 cm, and mean body weight was 64.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.5 kg. The mean duration of anesthesia was 145.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;41.1 minutes, the mean operative duration was 131.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;40.1 minutes, and the mean post-anesthesia recovery time was 77.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;21.6 minutes. The mean intraoperative fluid intake was 697\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;276 mL, and the mean irrigation volume was 32528\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9017 mL.\\u003c/p\\u003e\\u003cp\\u003eCompared to T0, B-line scores, CVP, and Na\\u003csup\\u003e+\\u003c/sup\\u003e concentration were significantly increased at T2-T4, while K\\u003csup\\u003e+\\u003c/sup\\u003e concentration, PaO₂/FiO₂ ratio, and Hb were significantly decreased at T1-T4, and Ppeak was significantly increased at T1-T4 (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Compared to T1, B-line scores, CVP, Na\\u003csup\\u003e+\\u003c/sup\\u003e concentration, and Ppeak were significantly increased at T2-T4, while K\\u003csup\\u003e+\\u003c/sup\\u003e concentration, PaO₂/FiO₂ ratio, and Hb were significantly decreased at T2-T4 (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Compared to T2, B-line scores, CVP, and Ppeak were significantly increased at T3 and T4, while K\\u003csup\\u003e+\\u003c/sup\\u003e concentration, PaO₂/FiO₂ ratio, and Hb were significantly decreased at T3 and T4 (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Compared to T3, B-line scores, CVP, Na\\u0026thinsp;+\\u0026thinsp;concentration, and Ppeak were significantly increased at T4, while K\\u003csup\\u003e+\\u003c/sup\\u003e concentration, PaO₂/FiO₂ ratio, and Hb were significantly decreased at T4 (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eComparative analysis of parameters across various time points [M (IQR), n\\u0026thinsp;=\\u0026thinsp;90]\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eparameters\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eT0\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eT1\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eT2\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eT3\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eT4\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eB-line scores\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.0(0.0\\u0026ndash;2.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.0(0.0\\u0026ndash;2.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.0(2.0-2.3)\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e3.0(2.0\\u0026ndash;4.0)\\u003csup\\u003eabc\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e4.0(3.0\\u0026ndash;5.0)\\u003csup\\u003eabcd\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCVP(mmHg)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.5(1.8-4.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3.0(2.0\\u0026ndash;4.0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e5.0(4.0\\u0026ndash;6.0)\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e7.0(6.0-8.3)\\u003csup\\u003eabc\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e9.0(8.0\\u0026ndash;10.0)\\u003csup\\u003eabcd\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNa\\u003csup\\u003e+\\u003c/sup\\u003e(mmol/L)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e138(134\\u0026ndash;141)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e138(134\\u0026ndash;141)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e140(135\\u0026ndash;142)\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e139(136\\u0026ndash;142)\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e141(137\\u0026ndash;144)\\u003csup\\u003eabcd\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eK\\u003csup\\u003e+\\u003c/sup\\u003e(mmol/L)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4.3(4-4.7)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4.2(3.9\\u0026ndash;4.6)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e4.0(3.7\\u0026ndash;4.5)\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e3.8(3.5\\u0026ndash;4.1)\\u003csup\\u003eabc\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e3.6(3.2-4)\\u003csup\\u003eabcd\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePaO₂/FiO₂ ratio (mmHg)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e331(301\\u0026ndash;358)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e314(285\\u0026ndash;342)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e289(261\\u0026ndash;316)\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e275(244\\u0026ndash;299)\\u003csup\\u003eabc\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e260(232\\u0026ndash;288)\\u003csup\\u003eabcd\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHb(g/L)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e119(109\\u0026ndash;130)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e116(106\\u0026ndash;128)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e108(100\\u0026ndash;122)\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e106(98\\u0026ndash;120)\\u003csup\\u003eabc\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e101(93\\u0026ndash;114)\\u003csup\\u003eabcd\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePpeak(cmH₂O)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e18(17\\u0026ndash;21)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e19(18\\u0026ndash;22)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e21(19\\u0026ndash;23)\\u003csup\\u003eab\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e21(19\\u0026ndash;24)\\u003csup\\u003eabc\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e23(21\\u0026ndash;25)\\u003csup\\u003eabcd\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAbbreviations: CVP, central venous pressure; Na\\u003csup\\u003e+\\u003c/sup\\u003e, serum sodium concentration; K\\u003csup\\u003e+\\u003c/sup\\u003e, serum potassium ion concentration; Hb, hemoglobin; Ppeak, peak airway pressure.\\u003c/p\\u003e\\u003cp\\u003eNotes: T0, skin incision; T1, fluid infusion at 5000 mL; T2, fluid infusion at 10000 mL; T3, fluid infusion at 15000 mL, T4, fluid infusion at 20000 mL. Compared to T0, \\u003csup\\u003ea\\u003c/sup\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05; compared to T1, \\u003csup\\u003eb\\u003c/sup\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05; compared to T2, \\u003csup\\u003ec\\u003c/sup\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05; compared to T3, \\u003csup\\u003ed\\u003c/sup\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.05.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe influence of CVP, K⁺, Hb, PaO₂/FiO₂ ratio, and Ppeak on the lung ultrasound B-line score was analyzed using a GEE model. The results demonstrated a significant positive correlation between CVP and the B-line score (β\\u0026thinsp;=\\u0026thinsp;0.449, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and between Ppeak and the B-line score (β\\u0026thinsp;=\\u0026thinsp;0.559, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Conversely, K⁺ showed a significant negative correlation with the B-line score (β = -3.319, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), Hb exhibited a moderate negative correlation (β = -0.177, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), while PaO₂/FiO₂ ratio displayed a weak negative correlation (β = -0.037, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and Na⁺ showed a weak positive correlation (β\\u0026thinsp;=\\u0026thinsp;0.099, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eInfluence of different parameters on B-line score\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eParameters\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eβ coefficient\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003estandard error\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eZ\\u003c/em\\u003e value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e95% confidence interval\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCVP\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.449\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.019\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e24.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.413, 0.486\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNa\\u003csup\\u003e+\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.099\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.020\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e5.01\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.060, 0.138\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eK\\u003csup\\u003e+\\u003c/sup\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-3.319\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.142\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-23.36\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-3.597, -3.040\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePaO₂/FiO₂ ratio\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-0.037\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.002\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-23.26\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.040, -0.034\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHb\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-0.177\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.007\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-24.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.191, -0.163\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePpeak\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.559\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.024\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e22.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-10.238, -8.376\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAbbreviations: CVP, central venous pressure; Na\\u003csup\\u003e+\\u003c/sup\\u003e, serum sodium concentration; K\\u003csup\\u003e+\\u003c/sup\\u003e, serum potassium concentration; Hb, hemoglobin; Ppeak, peak airway pressure.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eFurther introducing the interaction term between CVP and time revealed significant changes in the B-line score across T0-T4, particularly a significant increase at T2, T3, and T4 (T2: β\\u0026thinsp;=\\u0026thinsp;0.785, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.003; T3: β\\u0026thinsp;=\\u0026thinsp;1.985, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001; T4: β\\u0026thinsp;=\\u0026thinsp;3.000, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). In contrast, the main effect of CVP on the B-line score was not significant (β\\u0026thinsp;=\\u0026thinsp;0.077, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.148), and its effect did not show significant changes over time (T1: β = -0.008, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.689; T2: β\\u0026thinsp;=\\u0026thinsp;0.017, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.783; T3: β = -0.040, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.559; T4: β = -0.048, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.474). (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eMain and interaction effects of CVP at different time points on B-line score\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVariable\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eβ coefficient\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003estandard error\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eZ\\u003c/em\\u003e value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e value\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e95% confidence interval\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMain Effects\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCVP\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.077\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.053\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.45\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.148\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.027, 0.180\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime\\u0026thinsp;=\\u0026thinsp;T1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.084\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.068\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.214\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.048, 0.216\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime\\u0026thinsp;=\\u0026thinsp;T2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.785\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.265\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.96\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.003\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.266, 1.304\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime\\u0026thinsp;=\\u0026thinsp;T3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.985\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.395\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e5.03\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.211, 2.760\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime\\u0026thinsp;=\\u0026thinsp;T4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.432\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e6.94\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e2.153, 3.848\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eInteraction Effects\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime#CVP T1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-0.008\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.020\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.689\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.047, 0.031\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime#CVP T2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.017\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.062\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.28\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.783\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.104, 0.138\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime#CVP T3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-0.040\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.069\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.58\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.559\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.175, 0.095\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTime#CVP T4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e-0.048\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.067\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.72\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.474\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.180, 0.084\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eConstant\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0.829\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.180\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e4.61\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.477, 1.182\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eNotes\\u003c/b\\u003e: CVP, central venous pressure; T1, fluid infusion at 5000 mL; T2, fluid infusion at 10000 mL; T3, fluid infusion at 15000 mL, T4, fluid infusion at 20000 mL, T0 (skin incision, baseline) is the reference category for time. β coefficients for T1, T2, T3, and T4 represent changes relative to T0.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe predictive values of B-line score based on CVP over time, as depicted in the Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, indicate a weak influence of CVP at the early time points (T0 and T1). However, as time progressed, the predictive power of CVP significantly increased at time points T2, T3, and T4, with a corresponding marked increase in the B-line score.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussions\",\"content\":\"\\u003cp\\u003eIn current clinical practice, the transthoracic lung ultrasound B-line technique is primarily applied for real-time monitoring of cardiopulmonary function in critically ill patients, providing objective evidence for clinical decision support and therapeutic efficacy assessment. The transthoracic lung ultrasound B-line score can sensitively reflect pulmonary interstitial lesions and directly indicate pulmonary edema, allowing for dynamic monitoring of acute pulmonary edema and assessment of its severity through B-line score evaluation\\u003csup\\u003e[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. Furthermore, as a non-invasive and non-irradiating monitoring method, transthoracic lung ultrasound examination is safe, simple to learn, and more suitable for clinical application. This study employed a Generalized Estimating Equation (GEE) model to systematically analyze the relationship between the B-line score and multiple Parameters, including CVP, and to observe their dynamic changes at different time points following TURP.\\u003c/p\\u003e\\u003cp\\u003eThe occurrence of TURP syndrome originates from injury to the prostatic venous sinuses during the procedure, leading to the absorption of large volumes of irrigation fluid into the systemic circulation\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e. This fluid absorption can result in an elevation of CVP, making CVP monitoring a potential indicator for assessing fluid absorption\\u003csup\\u003e[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/sup\\u003e. The resultant intravascular volume overload may induce interstitial pulmonary edema\\u003csup\\u003e[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e. The presence of B-lines on lung ultrasound is considered a crucial marker for evaluating pulmonary edema. A concurrent rise in B-line scores and CVP suggests fluid overload-induced accumulation of interstitial lung fluid, which compromises alveolar gas exchange and pulmonary compliance, ultimately leading to impaired oxygenation and abnormal respiratory mechanics\\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eIn the present study, cumulative intraoperative irrigation volume was positively associated with progressive increases in B-line scores, CVP, arterial blood sodium (Na⁺) concentration, and peak airway pressure (Ppeak), while arterial potassium (K⁺) concentration, oxygenation index (OI), and hemoglobin (Hb) levels showed a significant decreasing trend. Although the increase in arterial Na⁺ concentration reached statistical significance, values remained within the physiological reference range (135\\u0026ndash;145 mmol/L). The concurrent decline in arterial K⁺ and Hb levels is likely attributable to a dilutional effect due to intravascular volume expansion, with the decrease in Hb also partially related to intraoperative blood loss.\\u003c/p\\u003e\\u003cp\\u003eFurther analysis using the GEE model revealed that CVP, Na⁺, and Ppeak were significantly and positively correlated with B-line scores, suggesting that increased fluid loading, elevated serum sodium, and higher airway pressure may reflect increased pulmonary fluid content, with B-line scores serving as a sensitive indicator\\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. CVP, as a marker of venous return and preload, indirectly indicates volume overload and may lead to pulmonary interstitial edema, as evidenced by increased B-line counts on lung ultrasound\\u003csup\\u003e[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/sup\\u003e. Elevated serum Na⁺ levels may be associated with hyperosmolarity or volume expansion, further supporting the influence of fluid status on pulmonary water content. The rise in Ppeak may reflect increased pulmonary stress during mechanical ventilation, indicating that airway pressure may also modulate interstitial fluid distribution\\u003csup\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eConversely, serum K⁺, Hb, and OI were negatively correlated with B-line scores. Hypokalemia may reflect metabolic disturbances or dilutional effects, while a decrease in Hb often indicates hemodilution or anemia, both potentially contributing to pulmonary fluid retention\\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/sup\\u003e. A decline in OI suggests impaired gas exchange, which is closely associated with increased pulmonary water content\\u003csup\\u003e[\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003eHowever, when the interaction term between CVP and time was incorporated into the model, neither the main effect of CVP nor its interaction with time reached statistical significance. This indicated that the influence of CVP on B-line scores was not linear or temporally stable but might have varied over time. In the early intraoperative phase, CVP had not been a strong predictor of B-lines; however, with the continued accumulation of irrigation fluid, the predictive relationship between CVP and B-lines had become more pronounced, suggesting a delayed or threshold-dependent effect\\u003csup\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003ePotential limitations\\u003c/h2\\u003e\\u003cp\\u003eThis study has several potential limitations. First, the GEE model revealed a time-dependent relationship between CVP and B-line scores, but non-significant interaction terms suggest that the model may not have fully captured temporal dynamics or accounted for confounders such as irrigation fluid type or absorption rate. Second, CVP, as an indicator of volume overload, exhibited low sensitivity, potentially failing to accurately detect early intraoperative fluid overload, thus limiting its predictive value for B-line scores. Third, the eight-zone lung ultrasound protocol, although standardized, may have overlooked subtle interstitial fluid accumulation in unassessed regions or been affected by patient positioning during TURP, potentially reducing the sensitivity of B-line detection. Finally, the study may not have fully controlled for intraoperative factors (e.g., anesthetic agents, mechanical ventilation parameters, or preoperative fluid status) influencing CVP and B-line scores, which could introduce bias in the interpretation of results.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eDuring transurethral resection of the prostate, B-line scores increased significantly over time and were positively associated with CVP, Ppeak, and arterial Na⁺ concentrations, while negatively associated with arterial K⁺, hemoglobin, and PaO₂/FiO₂ ratio. These findings suggest that B-lines may serve as a sensitive indicator of intraoperative pulmonary fluid status; however, the predictive value of CVP varied across time points, indicating its limited utility as a standalone monitoring parameter.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was approved by the ethics committee of the First Affiliated Hospital of Guangxi Medical University (approval number: 2022-K124-01).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eQing Liu was supported by the Health Commission of Guangxi Zhuang Autonomous Region Self-financing (No. Z-A20220430). No other external funding or competing interests declared.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eContributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eQing Liu and Chaoxiu Jiang wrote the main manuscript text. Qing Liu prepared tables 1-3, figure 1, and\\u0026nbsp;revised the manuscript. Qing Liu, Chunyi Yang, and Lizhen Wu contributed to data collection. Jingwen Wei revised the manuscript. All authors reviewed the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCorresponding author\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCorrespondence to\\u0026nbsp;Chaoxiu Jiang.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics declarations\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEthics approval and consent to participate\\u003c/p\\u003e\\n\\u003cp\\u003eThe study had been performed in accordance with the Declaration of Helsinki. The study protocol was conducted with the consent of the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University in China on 14 November 2022\\u0026nbsp;(approval number: 2022-K124-01). Informed consents to participate in the study had been obtained from all participants or their legal guardian(s). The study was registered at the Chinese Clinical Trial Registry (ChiCTR2200065753).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Availability statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eHahn R G. Fluid absorption in endoscopic surgery[J]. British Journal of Anaesthesia, 2006, 96(1): 8-20.\\u003c/li\\u003e\\n\\u003cli\\u003eHawary A, Mukhtar K, Sinclair A, et al. Transurethral resection of the prostate syndrome: almost gone but not forgotten[J]. Journal of Endourology, 2009, 23(12): 2013-2020.\\u003c/li\\u003e\\n\\u003cli\\u003eMagder S. Central venous pressure: A useful but not so simple measurement[J]. Critical Care Medicine, 2006, 34(8): 2224-2227.\\u003c/li\\u003e\\n\\u003cli\\u003eMarik P E, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares[J]. Chest, 2008, 134(1): 172-178.\\u003c/li\\u003e\\n\\u003cli\\u003eParienti J J, Mongardon N, M\\u0026eacute;garbane B, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site[J]. The New England Journal of Medicine, 2015, 373(13): 1220-1229.\\u003c/li\\u003e\\n\\u003cli\\u003ePicano E, Pellikka P A. Ultrasound of extravascular lung water: a new standard for pulmonary congestion[J]. European Heart Journal, 2016, 37(27): 2097-2104.\\u003c/li\\u003e\\n\\u003cli\\u003eFalcetta A, Leccardi S, Testa E, et al. The role of lung ultrasound in the diagnosis of interstitial lung disease[J]. Shanghai Chest, 2018, 2(5).\\u003c/li\\u003e\\n\\u003cli\\u003eMayr U, Lukas M, Habenicht L, et al. B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically III Patients[J]. Journal of Intensive Care Medicine, 2022, 37(1): 21-31.\\u003c/li\\u003e\\n\\u003cli\\u003eLichtenstein D. Lung ultrasound in the critically ill[J]. Current Opinion in Critical Care, 2014, 20(3): 315-322.\\u003c/li\\u003e\\n\\u003cli\\u003eVolpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound[J]. Intensive Care Medicine, 2012, 38(4): 577-591.\\u003c/li\\u003e\\n\\u003cli\\u003eGargani L. Lung ultrasound: a new tool for the cardiologist[J]. Cardiovascular Ultrasound, 2011, 9(1): 6.\\u003c/li\\u003e\\n\\u003cli\\u003eDietrich C F, Mathis G, Blaivas M, et al. Lung B-line artefacts and their use[J]. Journal of Thoracic Disease, 2016, 8(6): 1356-1365.\\u003c/li\\u003e\\n\\u003cli\\u003eHahn R, Berlin ,Tomas, and Lewenhaupt A. Irrigating Fluid Absorption and Blood Loss During Transurethral Resection of the Prostate Studied with a Regular Interval Monitoring (RIM) Method[J]. Scandinavian Journal of Urology and Nephrology, 1988, 22(1): 23-30.\\u003c/li\\u003e\\n\\u003cli\\u003eMiller W L. Fluid Volume Overload and Congestion in Heart Failure: Time to Reconsider Pathophysiology and How Volume Is Assessed[J]. Circulation. Heart Failure, 2016, 9(8): e002922.\\u003c/li\\u003e\\n\\u003cli\\u003eHua Z, Xin D, Xiaoting W, et al. High Central Venous Pressure and Right Ventricle Size Are Related to Non-decreased Left Ventricle Stroke Volume After Negative Fluid Balance in Critically Ill Patients: A Single Prospective Observational Study[J]. Frontiers in Medicine, 2021, 8: 715099.\\u003c/li\\u003e\\n\\u003cli\\u003eDe Backer D, Vincent J L. Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions[J]. Critical Care (London, England), 2018, 22(1): 43.\\u003c/li\\u003e\\n\\u003cli\\u003eVieillard-Baron A, Matthay M, Teboul J L, et al. Experts\\u0026rsquo; opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation[J]. Intensive Care Medicine, 2016, 42(5): 739-749.\\u003c/li\\u003e\\n\\u003cli\\u003eClaure-Del Granado R, Mehta R L. Fluid overload in the ICU: evaluation and management[J]. BMC nephrology, 2016, 17(1): 109.\\u003c/li\\u003e\\n\\u003cli\\u003eSaugel B, Wildgruber M, Staudt A, et al. Quantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients[J]. Journal of Clinical Monitoring and Computing, 2019, 33(1): 5-12.\\u003c/li\\u003e\\n\\u003cli\\u003eKushimoto S, Endo T, Yamanouchi S, et al. Relationship between extravascular lung water and severity categories of acute respiratory distress syndrome by the Berlin definition[J]. Critical Care, 2013, 17(4): R132.\\u003c/li\\u003e\\n\\u003cli\\u003eTong Xuan H, Dinh Thi Thu T, Ngo Van D, et al. Successful Treatment of Pulmonary Edema Caused by Transurethral Resection of the Prostate Syndrome[J]. Research and Reports in Urology, 2021, 13: 297-301.\\u003c/li\\u003e\\n\\u003cli\\u003eHahn R G, Geb\\u0026auml;ck T. Fluid volume kinetics of dilutional hyponatremia; a shock syndrome revisited[J]. Clinics (Sao Paulo, Brazil), 2014, 69(2): 120-127.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"scientific-reports\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"scirep\",\"sideBox\":\"Learn more about [Scientific Reports](http://www.nature.com/srep/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"Scientific Reports\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Scientific Reports\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"central venous pressure, B-line score, transurethral resection of the prostate, temporal changes\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7371999/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7371999/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eObjective:\\u003c/strong\\u003e To investigate the correlation between central venous pressure (CVP) and B-line score through dynamic monitoring of the two parameters in patients undergoing transurethral resection of the prostate.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods: \\u003c/strong\\u003eA total of 101 patients who underwent transurethral resection of the prostate were enrolled, with the procedure performed under general anesthesia. B-line score (quantified via transthoracic lung ultrasound), CVP, peak airway pressure (Ppeak), and arterial blood gas parameters, including arterial sodium (Na⁺) and potassium (K⁺) concentrations, hemoglobin (Hb), and PaO₂/FiO₂ ratio, were measured at the following time points: skin incision (baseline, T0), and with irrigation fluid volumes of 5000 mL (T1), 10,000 mL (T2), 15,000 mL (T3), and 20,000 mL (T4).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults: \\u003c/strong\\u003eData were analyzed using a generalized estimating equations model. CVP showed a significant positive correlation with the B-line score (β = 0.449, \\u003cem\\u003eP\\u003c/em\\u003e \\u0026lt; 0.001). With the increase in irrigation fluid volume, there was a significant increase in the B-line score at T2, T3, and T4 (T2: β = 0.785, \\u003cem\\u003eP\\u003c/em\\u003e = 0.003; T3: β = 1.985, \\u003cem\\u003eP\\u003c/em\\u003e \\u0026lt; 0.001; T4: β = 3.000, \\u003cem\\u003eP\\u003c/em\\u003e \\u0026lt; 0.001). However, the main effect of CVP on the B-line score was not significant (β = 0.077, \\u003cem\\u003eP\\u003c/em\\u003e= 0.148), and its effect did not show significant changes over time (T1: β = -0.008, \\u003cem\\u003eP\\u003c/em\\u003e = 0.689; T2: β = 0.017, \\u003cem\\u003eP\\u003c/em\\u003e = 0.783; T3: β = -0.040, \\u003cem\\u003eP\\u003c/em\\u003e= 0.559; T4: β = -0.048, \\u003cem\\u003eP\\u003c/em\\u003e = 0.474). The B-line score's predictive value based on CVP was initially weak at T0 and T1 but significantly increased at T2, T3, and T4, with a corresponding rise in the B-line score.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions: \\u003c/strong\\u003eB-line scores increased significantly over time during TURP and were closely associated with multiple physiological parameters. Although CVP was generally positively correlated with B-line scores, its effect varied across different time points, suggesting a time-dependent predictive value of CVP for pulmonary fluid status.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTrial registration\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eChiCTR2200065753, 14/11/2022, Title: “Application of transthoracic lung ultrasound in patients undergoing prostatectomy”. Website: https://www.chictr.ogr.cn.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Temporal Changes in the Relationship Between Central Venous Pressure and B-Line Score in Patients Undergoing Transurethral Resection of the Prostate: Evidence from a Generalized Estimating Equations Model\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-09-17 08:14:01\",\"doi\":\"10.21203/rs.3.rs-7371999/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-09-16T06:24:05+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"52059179717760983756547795808161556546\",\"date\":\"2025-09-13T13:16:46+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-09-12T06:39:49+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-09-11T14:56:46+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-09-11T07:37:21+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"329844486068873384860563796917770024731\",\"date\":\"2025-09-10T09:20:19+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"325578490401185829394516025137489968434\",\"date\":\"2025-09-09T09:01:59+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"103650978354240788323875405031672576878\",\"date\":\"2025-09-08T19:03:26+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"304521301435482642978554991434341965422\",\"date\":\"2025-09-08T16:58:18+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-09-08T16:28:30+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-09-03T11:03:15+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-08-21T12:10:43+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-08-20T05:35:57+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Scientific Reports\",\"date\":\"2025-08-20T05:33:13+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"scientific-reports\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"scirep\",\"sideBox\":\"Learn more about [Scientific Reports](http://www.nature.com/srep/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"Scientific Reports\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Scientific Reports\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"248a6b3d-05f3-4cfa-b6be-5c8a76092fb9\",\"owner\":[],\"postedDate\":\"September 17th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[{\"id\":54722854,\"name\":\"Health sciences/Diseases\"},{\"id\":54722855,\"name\":\"Health sciences/Medical research\"},{\"id\":54722856,\"name\":\"Health sciences/Urology\"}],\"tags\":[],\"updatedAt\":\"2026-01-05T16:06:07+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7371999\",\"link\":\"https://doi.org/10.1038/s41598-025-34114-z\",\"journal\":{\"identity\":\"scientific-reports\",\"isVorOnly\":false,\"title\":\"Scientific Reports\"},\"publishedOn\":\"2026-01-02 15:58:08\",\"publishedOnDateReadable\":\"January 2nd, 2026\"},\"versionCreatedAt\":\"2025-09-17 08:14:01\",\"video\":\"\",\"vorDoi\":\"10.1038/s41598-025-34114-z\",\"vorDoiUrl\":\"https://doi.org/10.1038/s41598-025-34114-z\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7371999\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7371999\",\"identity\":\"rs-7371999\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}