Acute and Critical Care

Original Articles

Pediatrics
Weight variability at pediatric intensive care unit admission and adverse outcomes in critically ill children: Jae Hwa Jung, Yoon Hee Kim, Min Jung Kim, Mireu Park, Hamin Kim, Kyung Won Kim, Myung Hyun Sohn, Soo Yeon Kim; Acute Crit Care. 2025;40(4):605-613. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.001550

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Abstract PDF Supplementary Material: Background
Body weight can fluctuate during critical illness due to factors such as fluid shifts, nutritional status, the type of acute illness, and underlying comorbidities. We investigated the association between acute body weight variability (WV) and clinical outcomes in critically ill pediatric patients.
Methods
We retrospectively analyzed data from patients aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU) of a university-affiliated tertiary hospital between August 2017 and July 2021. WV was defined as the percentage difference between the measured body weight at PICU admission and the usual body weight, obtained either from recent hospital records or caregiver reports. Associations between WV and clinical outcomes, including PICU mortality and ventilator-free days (VFDs), were assessed.
Results
Of the 926 patients, 74 (8.0%) died. Median WV was significantly higher in non-survivors than in survivors (8.7% vs. 0.0%; P<0.001). Increased WV was independently associated with higher mortality (hazard ratio [HR], 1.102; 95% CI, 1.073–1.131) and fewer VFDs (odds ratio [OR], 0.599; 95% CI, 0.524–0.684). Combining WV with Pediatric Index of Mortality 3 score significantly improved mortality prediction over either parameter alone (area under the curve, 0.888; P=0.047).
Conclusions
Higher WV at PICU admission is independently associated with adverse clinical outcomes, including increased mortality and fewer VFDs. WV could complement existing mortality prediction models in pediatric critical care.

Infection
Association between emergency department–to–intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea: Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh; Acute Crit Care. 2025;40(4):548-556. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.003575

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Abstract PDF Supplementary Material: Background
Emergency department (ED) overcrowding poses a global challenge, particularly for critically ill patients requiring intensive care unit (ICU) admission. Although delays in ICU transfer increase mortality in critically ill populations, the optimal timing for septic shock remains uncertain.
Methods
We conducted a target trial emulation using a prospective cohort of 815 septic shock patients from 19 Korean hospitals. Delayed ICU transfer was defined using restricted cubic splines. The primary outcome was in-hospital mortality. Multivariable logistic regression and inverse probability treatment weighting were used to adjust for confounders of age, sex, comorbidities, severity of illness, and mechanical ventilation use. Subgroup analyses were performed to assess the effect across patient characteristics.
Results
The median time of ED-to-ICU transfer was 6.7 hours (interquartile range, 4.7–11.4), and only 7% of patients were transferred within 3 hours. ICU transfer within 3 hours was associated with significantly lower in-hospital mortality (odds ratio, 0.48; 95% CI, 0.24–0.94) compared to later transfers. Mortality risk increased with elapsing time up to 6 hours and then plateaued. The benefit of early ICU transfer was consistent across subgroups but was particularly pronounced in patients requiring extracorporeal membrane oxygenation or continuous renal replacement therapy (P for interaction=0.02).
Conclusions
Early ICU transfer within 3 hours significantly reduces mortality in patients with septic shock, with the greatest benefit observed in those requiring advanced organ support. These findings highlight the need for system-wide strategies to reduce ED boarding time and prioritize timely ICU admission for septic shock management.

Infection
Prognostic value of novel indices combining Shock Index, Reverse Shock Index, age, and oxygen saturation for predicting mortality in COVID-19 patients in Iran at emergency department triage: a cross-sectional study: Mehdi Torabi, Atefe Noroozpour, Neda Naeemi Bafghi, Moghaddameh Mirzaee; Acute Crit Care. 2025;40(3):425-434. Published online August 29, 2025; DOI: https://doi.org/10.4266/acc.005040

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Abstract PDF: Background
The objective of the study was to investigate the role of the Shock Index (SI), the Reverse Shock Index (RSI) along with oxygen saturation in predicting mortality in coronavirus disease 2019 (COVID-19).
Methods
This cross-sectional study was conducted at an academic hospital over a period of 6 months and involved patients over the age of 18 who had been diagnosed with COVID-19 via positive polymerase chain reaction tests. The data were recorded anonymously using a checklist. The study focused on indices such as the SI and RSI, both alone and in conjunction with age and oxygen saturation, to predict hospital mortality. Statistical analysis was conducted using SPSS software.
Results
The study involved 500 COVID-19 patients with a 14.4% mortality rate. Key differences were found between survival and mortality groups in terms of age, vital signs except diastolic blood pressure, length of stay, and a series of laboratory tests. Logistic regression showed gender, oxygen saturation, hemoglobin, direct bilirubin, lactate dehydrogenase, D-dimer, and Age SI/oxygen saturation (SpO2) and RSI×SpO2/Age indices significantly associated with hospital mortality. Receiver operating characteristic analysis indicated Age SI/SpO2 and RSI×SpO2/Age as effective mortality predictors, exhibiting an area under the curve of 0.80 and achieving a sensitivity, specificity, and accuracy of over 70%.
Conclusions
The combination of SI, the RSI along with hypoxia, and age has been identified as a potentially more significant role in ruling out hospital mortality in COVID-19 patients than vital signs alone, given the established role of hypoxia as a major risk factor in such cases.

Nutrition
The impact of enteral feeding intolerance on the prognosis of patients with septic shock in South Korea: Hyun-Jun Park, Yoon Hae Ahn, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2025;40(2):304-312. Published online May 30, 2025; DOI: https://doi.org/10.4266/acc.000700

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Abstract PDF: Background
While enteral feeding intolerance (EFI) is associated with worse clinical outcomes in critically ill patients, the relationship between the number of days of EFI and mortality outcomes remains unclear.
Methods
We retrospectively analyzed adult patients admitted to the medical intensive care unit (ICU) with septic shock at a tertiary referral center. EFI was defined as the presence of vomiting, abdominal distension, pain, diarrhea, or radiographic evidence of ileus. EFI status was assessed daily, and we evaluated the prognostic impact of total number of EFI days during the first 3 days of enteral feeding on clinical outcomes.
Results
A total of 94 patients were included in the analysis, with 77 (81.9%) experiencing EFI. During the first 3 days of enteral feeding, 25 patients (26.6%) experienced EFI for 1 day, 22 patients (23.4%) experienced EFI for 2 days, and 30 patients (31.9%) experienced EFI for all 3 days. The total number of EFI days was identified as an independent risk factor of 90-day mortality (adjusted hazard ratio, 1.400; 95% CI 1.021–1.919). Higher total EFI days was significantly associated with increased ICU mortality (P for trend=0.036), in-hospital mortality (P for trend=0.007), 30-day mortality (P for trend=0.004), and 90-day mortality (P for trend=0.006).
Conclusions
An increase in the total number of EFI days was significantly associated with mortality outcomes in patients with septic shock, suggesting that EFI may serve as a useful indicator for predicting outcomes in this population.

Epidemiology
Comparing single-patient and multi-patient room intensive care units: a multicenter cohort study on architectural differences and clinical significance in South Korea: Daun Jeong, Donghyoun Lee, Kyoung Won Yoon, Hyo Jin Kim, Sun Young Choi, Chi-Min Park; Acute Crit Care. 2025;40(2):160-170. Published online May 28, 2025; DOI: https://doi.org/10.4266/acc.004968

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Background
The design of intensive care units (ICUs) is increasingly acknowledged as a crucial factor affecting patient outcomes. Transitioning from multi-bed patient rooms (MPRs) to single-bed patient rooms (SPRs) aims to improve infection control, patient privacy, and quality of care. However, concerns remain regarding potential patient isolation and reduced staff situational awareness. This study aims to evaluate clinical outcomes in SPR-structured ICUs compared to mixed SPR and MPR ICUs.
Methods
This multicenter retrospective cohort study was conducted across three university-affiliated tertiary hospitals between April 2022 and August 2023. The study population included ICU patients aged ≥18 years, excluding those admitted to cardiac and neonatal ICUs. Outcomes assessed included ICU mortality and severity scores based on Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores.
Results
This study included 3,179 ICU patients across three sites: site A consisted exclusively of SPRs, while sites B and C had mixed SPR and MPR arrangements. ICU mortality rates were 8.3%, 15.2%, and 9.7% for sites A, B, and C, respectively (P<0.001). Propensity score matching and logistic regression analysis demonstrated that SPRs were associated with significantly reduced ICU mortality (adjusted odds ratio, 0.54; 95% CI, 0.40–0.73).
Conclusions
SPRs were associated with a protective effect, reducing ICU mortality. Clinical outcomes in ICUs appear to be influenced by structural design improvements alongside other clinical factors.

Citations

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Survival improvement through well-designed intensive care unit architecture
Dong Hyun Lee
Acute and Critical Care.2025; 40(2): 349. CrossRef

Epidemiology
Trends and management of acute respiratory failure in hospitalized patients: a multicenter retrospective study in South Korea: Won Jin Yang, Yong Jun Choi, Kyung Soo Chung, Ji Soo Choi, Bo Mi Jung, Jae Hwa Cho; Acute Crit Care. 2025;40(2):171-185. Published online May 28, 2025; DOI: https://doi.org/10.4266/acc.004728

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Abstract PDF Supplementary Material: Background
Acute respiratory failure (ARF) is the leading cause of hospitalization and is associated with in-hospital mortality. This study aimed to elucidate the epidemiology and clinical outcomes of ARF.
Methods
We retrospectively screened patients admitted to three hospitals in South Korea between January 2018 and December 2022. We included individuals aged 18 years, diagnosed with either type 1 ARF (arterial oxygen partial pressure [PaO2] <60 mm Hg) or type 2 ARF (arterial carbon dioxide partial pressure (PaCO2) >45 mm Hg) with a pH of <7.35, or diagnosed with the combined-type ARF.
Results
Among the 768,700 hospitalized patients, 33,278 (4.3%) developed ARF. The most common cause of ARF was sepsis (15,757 patients, 47.3%), and the most frequent comorbidity was malignancy (15,403 patients, 43.6%). Among ARF patients, 15,671 (47.1%) required intensive care unit transfer, while 8,980 (27.0%) experienced in-hospital mortality. Over 5 years, the proportion of ARF patients aged 80 years and older has shown a consistent annual increase (coefficient, 0.085 and Ptrend <0.001). Concurrently, the in-hospital mortality rate exhibited an upward trend, increasing from 25.5% in 2018 to 29.3% in 2022 (coefficient, 1.017 and Ptrend<0.001). Among the respiratory support methods used for patients with ARF over the 5-year period, high-flow nasal cannula usage steadily increased (coefficient, 4.137 and Ptrend<0.001), whereas the use of invasive mechanical ventilation declined (coefficient, –0.983 and Ptrend<0.001).
Conclusions
ARF frequency and in-hospital mortality rates are increasing, driven by various etiologies. Despite these trends, research on the epidemiology and individualized treatments for older patients is limited, highlighting the need for nationwide prospective multicenter studies.

Infection
Neutrophil-to-lymphocyte-to-albumin ratio as a prognostic marker for mortality in sepsis and septic shock in Vietnam: Nguyen Van Viet Thang, Le Thi Luyen, Nguyen Thi Tuong Vi, Pham Dang Hai; Acute Crit Care. 2025;40(2):244-251. Published online May 28, 2025; DOI: https://doi.org/10.4266/acc.003576

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Abstract PDF

Background
Sepsis and septic shock are life-threatening global health challenges associated with high mortality rates. Early identification of high-risk patients is critical for improving outcomes. In the present study, the association between the neutrophil-to-lymphocyte-to-albumin ratio (NLAR) and mortality in septic patients was evaluated.
Methods
A retrospective study was performed at a tertiary hospital in Vietnam. Patients ≥18 years of age diagnosed with sepsis or septic shock based on the Sepsis-3 criteria were included. Exclusion criteria included recent corticosteroid use within 7 days, autoimmune diseases, hematological disorders, and active cancer within 5 years. NLAR was calculated from complete blood counts and albumin levels within the first 24 hours of intensive care unit admission. Receiver operating characteristic (ROC) curves were used to determine the predictive ability of NLAR for in-hospital mortality.
Results
The present study included 141 patients with a mean age of 72 years. Non-survivors were significantly older with higher rates of mechanical ventilation. NLAR was significantly elevated in non-survivors compared with survivors (0.88 [0.57–1.24] vs. 0.44 [0.28–0.77], P<0.001). In ROC analysis, the area under the curve for NLAR was 0.70 (P<0.001). Using a cutoff value of 0.56, NLAR showed a sensitivity of 77.8% and a specificity of 61.5% for predicting in-hospital mortality.
Conclusions
Elevated NLAR on admission was associated with a higher mortality rate in sepsis patients. NLAR could be used as an early prognostic marker for sepsis mortality.

Citations

Citations to this article as recorded by

Altered albumin/neutrophil to lymphocyte ratio are associated with all-cause and cardiovascular mortality for advanced cardiovascular-kidney-metabolic syndrome
Xiaoshuang Yin, Jinmei Zou, Jing Yang
Frontiers in Nutrition.2025;[Epub] CrossRef
The Neutrophil-to-Albumin Ratio (NAR) Reflects the Severity of the Post-CABG Inflammatory Response and Is Associated with a Pre-Existing Pro-Inflammatory Monocyte Profile
Mikhail A. Popov, Siarhei A. Dabravolski, Vladislav V. Dontsov, Sergei A. Vzvarov, Evgeniy G. Agafonov, Dmitriy I. Zybin, Alexandra K. Kharabet, Olga V. Radchenkova, Dmitriy R. Saveliev, Victoria P. Pronina, Svetlana S. Verkhova, Nikita G. Nikiforov, Yego
Life.2025; 15(12): 1790. CrossRef
Neutrophil Extracellular Traps in Sepsis and Sepsis-Related Organ Dysfunction
Wenbo Yan, Xiyuan Xu, Xiaojuan Li, Yushu Ma, Lining Guo, Jingping Yang, Zhipeng Jin, Jie Zhang, Tiewei Li
ImmunoTargets and Therapy.2025; Volume 14: 1373. CrossRef

Infection
Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome: Moiz Salahuddin, Rameesha Khalid, Sadaf Hanif, Filza Naeem, Rameen Aijaz, Akbar Shoukat Ali; Acute Crit Care. 2025;40(2):235-243. Published online May 22, 2025; DOI: https://doi.org/10.4266/acc.004008

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Background
The mortality of severe dengue infections is approximately 23%. In the management of dengue shock syndrome (DSS), aggressive fluid resuscitation is recommended. The primary objective of our study was to assess the factors associated with 30-day mortality in DSS patients.
Methods
Adult patients >18 years old, who were admitted with DSS were included. DSS was diagnosed in patients who required vasopressors or had lactic acidosis >4 mmol/L. Patients were divided into three different groups based on cumulative fluid balance at death or extubation: group I (<3.5 L), group II (3.5–8.0 L), and group III (>8.0 L).
Results
A total of 135 patients with DSS was included, with an overall 30-day mortality of 74.8%. The average Sequential Organ Failure Assessment (SOFA) score on intensive care unit admission was 12.2. Mechanical ventilation was required in 112 patients (83.0%), with 61 patients (45.2%) being intubated without a noninvasive ventilation trial. Respiratory failure was the most common reason for requiring intubation (65 patients, 48.2%). In survivors, the median cumulative fluid balance was 1,493 ml (interquartile range [IQR], 0–4,501 ml), whereas that in the mortality group was 7,797 ml (IQR, 3,700–13,600 ml). On multivariate analysis, SOFA score (odds ratio [OR], 1.220; 95% CI, 1.011–1.472; P=0.038) and having received >8.0 L cumulative fluid balance (OR, 6.682; 95% CI, 1.808–24.689; P=0.004) were associated with increased risk of mortality.
Conclusions
DSS patients have high mortality rates. High SOFA scores and >8.0 L cumulative fluid balance may indicate worse outcomes.

Citations

Citations to this article as recorded by

Comment on “Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome”
Hinpetch Daungsupawong, Viroj Wiwanitkit
Acute and Critical Care.2025; 40(4): 630. CrossRef

Pediatrics
Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India: Sudha Chandelia, Sunil Kishore, Maansi Gangwal, Devika Shanmugasundaram; Acute Crit Care. 2025;40(1):113-121. Published online February 28, 2025; DOI: https://doi.org/10.4266/acc.002520

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Abstract PDF: Background
Pediatric acute respiratory distress syndrome (PARDS) has a mortality rate of up to 75%, which can be up to 90% in high-risk patients. Even with the use of advanced ventilation strategies, mortality remains unacceptably high at 40%. Airway pressure release ventilation (APRV) mode is a new strategy in PARDS. Our aim was to evaluate whether use of APRV mode in severe PARDS was associated with reduced hospital mortality compared to other modes of ventilation.
Methods
This was a retrospective comparative study using data from case files in a pediatric intensive care unit of a university-affiliated tertiary-care hospital. The study period (January 2014 to December 2019) covered three years before routine use of APRV mode to three years after its implementation. We compared severe PARDS patients in two groups: The APRV group (who received APRV as rescue therapy after failing protective ventilation); and The Non-APRV group, who received other modes of ventilation.
Results
A total of 24 patients in each group were analyzed. Overall in-hospital mortality in the APRV group was 79% versus 91% in the Non-APRV group. In-hospital mortality was significantly lower in the APRV group (univariate analysis: hazard ratio [HR], 0.27; 95% CI, 0.14–0.52; P=0.001 and multivariate analysis: HR, 0.03; 95% CI, 0.005–0.17; P=0.001). Survival times were significantly longer in the APRV group (median time to death: 7.5 days in APRV vs. 4.3 days in non-APRV; P=0.001).
Conclusions
Use of rescue APRV mode in severe PARDS may yield lower mortality rates and longer survival times.

Trauma
Predictive value of initial lactate levels for mortality and morbidity in critically ill pediatric trauma patients: a retrospective study from a Turkish pediatric intensive care unit: Abdulrahman Özel, Esra Nur İlbeği, Servet Yüce; Acute Crit Care. 2025;40(1):87-94. Published online February 18, 2025; DOI: https://doi.org/10.4266/acc.003528

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Background
This study investigated the relationship between initial lactate levels and both mortality and morbidity in critically ill pediatric trauma patients requiring intensive care.
Methods
This retrospective study at tertiary center’s pediatric intensive care unit from January 2020 to June 2024 aimed to characterize trauma patients and assess admission lactate levels' prognostic value.
Results
A total of 190 critically ill pediatric trauma patients were included in the study. The mortality rate was 7.9%, with most deaths occurring within the first 48 hours of admission. Initial lactate levels ≥6.9 mmol/L demonstrated moderate predictive power (area under the curve [AUC], 0.878) for mortality. Pediatric Risk of Mortality III (PRISM III) score showed good predictive ability (AUC, 0.922), while Pediatric Trauma Scores exhibited variable predictive performance (AUC, 0.863). Higher initial lactate levels were significantly associated with severe brain injury, the need for intubation, and an increased incidence of thoracic or abdominal injuries.
Conclusions
Initial lactate levels and PRISM III score are effective predictors of mortality in critically ill pediatric trauma patients. Lactate levels ≥5 mmol/L upon admission should prompt close monitoring and consideration of aggressive management strategies.

Citations

Citations to this article as recorded by

Beyond survival: Early markers of poor outcome in pediatric trauma
Kubra Boydag Guvenc, Ebru Guney Sahin, Idris Abdullah Yılmaz, Refik Ozturk, Ceyhan Sahin, Fatih Varol, Cansu Durak
The American Journal of Emergency Medicine.2026; 101: 103. CrossRef
Incidence, severity and outcomes of hypoxemia in paediatric emergencies seen at a tertiary hospital in Southern Nigeria
Moses T. Abiodun, Gabriel Oziegbe, Imuwahen A. Mbarie, Wilson O. Osarogiagbon, Collins E. Etin-Osa, Rosena O. Oluwafemi, Godwin E. Okungbowa, Ovonomo Ewhe, Rahmon Olusola, Benjamin Nandom, Adesuwa Kpongo-Ogieva, Jane Aghama, Cyril Oputa
International Journal of Contemporary Pediatrics.2025; 12(8): 1289. CrossRef
Prognostic value of the lactate dehydrogenase-to-albumin ratio for predicting mortality in critically ill pediatric patients: a retrospective cohort study
Ming Liu, Yunpeng Gou, Ping Yang
Frontiers in Pediatrics.2025;[Epub] CrossRef

Surgery
Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea: Jae Hoon Lee, Jee Hee Kim, Ki Ho You, Won Ho Han; Acute Crit Care. 2024;39(4):554-564. Published online November 25, 2024; DOI: https://doi.org/10.4266/acc.2024.00808

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Abstract PDF Supplementary Material

Background
In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs.
Methods
This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality.
Results
Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU.
Conclusions
Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.

Citations

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Long‐Term Outcomes and Predictors in Cancer‐Related Stroke Using the Linked Data Set
Tae Jung Kim, Ji Sung Lee, Mi Sun Oh, Soo‐Hyun Park, Kyung‐Ho Yu, Byung‐Chul Lee, Byung‐Woo Yoon, Sang‐Bae Ko
Journal of the American Heart Association.2025;[Epub] CrossRef
Impact of medical crisis on the critical care system in South Korea
Ye Rim Chang, Jae Hwa Cho, Joongbum Cho, Tae Sun Ha, Bo Gun Kho, Eunhye Kim, Im-kyung Kim, Dong Hyun Lee, Suk-Kyung Hong
Acute and Critical Care.2025; 40(3): 393. CrossRef
Patient outcomes associated with merging two paediatric cardiac intensive care units into one: A retrospective study
Sacha Mairet-Mabboux, Thibault Blache, Anthony Facchin, Catherine Koffel, Arnaud Ferraris, Christopher Blakeley, Vincent Piriou, Roland Henaine, Marc Lilot
Archives of Cardiovascular Diseases.2025;[Epub] CrossRef
The efficacy of intensivist-led closed-system intensive care units in improving outcomes for cancer patients requiring emergent surgical intervention
Eun Young Kim
Acute and Critical Care.2024; 39(4): 640. CrossRef

Rapid response system
Development and implementation of an artificial intelligence–enhanced care model to improve patient safety in hospital wards in Spain: Alejandro Huete-Garcia, Sara Rodriguez-Lopez; Acute Crit Care. 2024;39(4):488-498. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.00759

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Background
Early detection of critical events in hospitalized patients improves clinical outcomes and reduces mortality rates. Traditional early warning score systems, such as the National Early Warning Score 2 (NEWS2), effectively identify at-risk patients. Integrating artificial intelligence (AI) could enhance the predictive accuracy and operational efficiency of such systems. The study describes the development and implementation of an AI-enhanced early warning system based on a modified NEWS2 scale with laboratory parameters (mNEWS2-Lab) and evaluates its ability to improve patient safety in hospital wards.
Methods
For this retrospective cohort study of 3,790 adults admitted to hospital wards, data were collected before and after implementing the mNEWS2-Lab protocol with and without AI enhancement. The study used a multivariate prediction model with statistical analyses such as Fisher's chi-square test, relative risk (RR), RR reduction, and various AI models (logistic regression, decision trees, neural networks). The economic cost of the intervention was also analyzed.
Results
The mNEWS2-Lab reduced critical events from 6.15% to 2.15% (RR, 0.35; P<0.001), representing a 65% risk reduction. AI integration further reduced events to 1.59% (RR, 0.26; P<0.001) indicating a 10% additional risk reduction and enhancing early warning accuracy by 15%. The intervention was cost-effective, resulting in substantial savings by reducing critical events in hospitalized patients.
Conclusions
The mNEWS2-Lab scale, particularly when integrated with AI models, is a powerful and cost-effective tool for the early detection and prevention of critical events in hospitalized patients.

Citations

Citations to this article as recorded by

Bridging the last mile in AI-driven patient safety: the missing link of trainee readiness
Rafay Ullah Khan, Nabiah Shakeel, Mohammed Hammad Jaber Amin
Annals of Medicine & Surgery.2026; 88(1): 1104. CrossRef
Artificial intelligence and pediatric acute kidney injury: a mini-review and white paper
Jieji Hu, Rupesh Raina
Frontiers in Nephrology.2025;[Epub] CrossRef

Epidemiology
Long-term mortality of adult patients with carbon monoxide poisoning presenting to the emergency department in Korea: a population-based cohort study: Sang Hwan Lee, Soo Rack Ryu, Kyung Hun Yoo, Juncheol Lee, Yongil Cho, Tae Ho Lim, Hyunggoo Kang, Jaehoon Oh, Byuk Sung Ko; Acute Crit Care. 2024;39(4):526-534. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.00199

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Background
Carbon monoxide (CO) poisoning can lead to significant morbidity and mortality. However, relatively few studies have investigated its long-term mortality impact. This nationwide population-based cohort study examined the association between CO poisoning and long-term mortality.
Methods
This retrospective study utilized data from the National Health Insurance Service database in South Korea. We compared the patients with CO poisoning to those without CO poisoning. Inverse probability treatment weights were applied to both groups to control for potential confounding factors. Subsequently, mortality was assessed using the incidence rate and Cox proportional hazard ratios.
Results
This study included 23,387 patients with CO poisoning and 359,851 without it. Over a median follow-up period of 7.6 years after CO poisoning diagnosis, the mortality risk was 2.6 times higher in patients with CO poisoning compared to that in the control group. In a long-term follow-up of patients surviving beyond 30 days, mortality remained 2.18 times higher. Additionally, a higher mortality risk was observed in the relatively younger age group (18–39 years) and the group with fewer underlying diseases, as indicated by a Charlson Comorbidity Index score of 0.
Conclusions
CO poisoning is associated with an elevated long-term mortality rate particularly in a relatively young and healthy population.

Citations

Citations to this article as recorded by

Optimizing hyperbaric oxygen initiation time in carbon monoxide poisoning: a 3-hour window enhances neurological recovery via lactate clearance
Dongjun Xu, Xiaoqin Xu, Hui Sun, Jun Xu, Danting Fei, Yaye Shen
Open Medicine.2026;[Epub] CrossRef

Immunology
Serum procalcitonin and C-reactive protein as indices of early sepsis and mortality in North Indian pediatric burn injuries: a prospective evaluation and literature review: Nupur Aggarwal, Durga Karki, Rajni Gaind, Monika Matlani, Vamseedharan Muthukumar; Acute Crit Care. 2024;39(3):350-358. Published online August 30, 2024; DOI: https://doi.org/10.4266/acc.2023.00759

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Background
Delays in diagnosing sepsis in children afflicted with thermal injuries can result in high morbidity and mortality. Our study evaluated the role of the biomarkers Procalcitonin (PCT) and C-reactive protein (CRP) as predictors of early sepsis and mortality, respectively, in this group of patients.
Methods
This was a prospective evaluation of 90 pediatric burn cases treated at a tertiary care burn center in Northern India. Patients, aged 1–16 years, presenting within 24 hours of being burned, with >10% body surface area of burn injury were included in the study. Levels of PCT and CRP were measured on days 1, 3, 5, and 7. Patients were followed until discharge, 30th post-burn day, or death, whichever occurred first.
Results
Sepsis was clinically present in 49 of 90 (54.4%) cases with a median 30% total body surface area (TBSA) of burns. Mortality was seen in 31 of 90 (34.4%) cases with a median of 35% TBSA burns. High PCT and CRP were seen in the sepsis group, particularly on days 3, 5, and 7. PCT was also significantly higher in the mortality group (days 1 and 3).
Conclusions
While PCT was a good early predictor of sepsis and mortality in children with burns, CRP was reliable as a predictor of sepsis only. Both markers, however, can serve as adjuncts to culture sensitivity reports for diagnosing early onset sepsis and initiation of antibiotic therapy in appropriate patients.

Citations

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Research Progress on Immune Inflammatory Response in Severe Burn and the Treatment with Ulinastatin
祺马
Advances in Clinical Medicine.2025; 15(05): 896. CrossRef

Pulmonary
Increased red cell distribution width predicts mortality in COVID-19 patients admitted to a Dutch intensive care unit: Anthony D. Mompiere, Jos L.M.L. le Noble, Manon Fleuren-Janssen, Kelly Broen, Frits van Osch, Norbert Foudraine; Acute Crit Care. 2024;39(3):359-368. Published online August 22, 2024; DOI: https://doi.org/10.4266/acc.2023.01137

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Background
Abnormal red blood cell distribution width (RDW) is associated with poor cardiovascular, respiratory, and coronavirus disease 2019 (COVID-19) outcomes. However, whether RDW provides prognostic insights regarding COVID-19 patients admitted to the intensive care unit (ICU) was unknown. Here, we retrospectively investigated the association of RDW with 30-day and 90- day mortalities, duration of mechanical ventilation, and length of ICU and hospital stay in patients with COVID-19.
Methods
This study included 321 patients with COVID-19 aged >18 years who were admitted to the ICU between March 2020 and July 2022. The outcomes were mortality, duration of mechanical ventilation, and length of stay. RDW >14.5% was assessed in blood samples within 24 hours of admission.
Results
The mortality rate was 30.5%. Multivariable Cox regression analysis showed an association between increased RDW and 30-day mortality (hazard ratio [HR], 3.64; 95% CI, 1.54–8.65), 90-day mortality (HR, 3.66; 95% CI, 1.59–8.40), and shorter duration of invasive ventilation (2.7 ventilator-free days, P=0.033).
Conclusions
Increased RDW in COVID-19 patients at ICU admission was associated with increased 30-day and 90-day mortalities, and shorter duration of invasive ventilation. Thus, RDW can be used as a surrogate biomarker for clinical outcomes in COVID-19 patients admitted to the ICU.

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Red Blood Cell Distribution Width Is Not a Predictor of Hospital Mortality in Elderly and Nonelderly COVID‐19‐Infected Patients: A Prospective Study at a Brazilian Quaternary University Hospital
Helena Duani, Máderson Alvares de Souza Cabral, Carla Jorge Machado, Thalyta Nogueira Fonseca, Milena Soriano Marcolino, Vandack Alencar Nobre, Cecilia Gómez Ravetti, Paula Frizera Vassallo, Unaí Tupinambás, Muhammad Abu Bakr Shabbir
Canadian Journal of Infectious Diseases and Medical Microbiology.2025;[Epub] CrossRef
Association of red blood cell distribution width with short- and long-term all-cause mortality in patients with acute pancreatitis and sepsis
Qingzhou Song, Xuanlin Wu, Firooz Ahmad Taheri, Linghou Meng, Wentao Wang, Xianwei Mo
BMC Gastroenterology.2025;[Epub] CrossRef
Association Between Red Cell Distribution Width and Mortality in Patients with Klebsiella pneumoniae Bloodstream Infection: A Cohort Study
Yingxiu Huang, Ting Ao, Ming Hu, Peng Zhen
Infection and Drug Resistance.2025; Volume 18: 5961. CrossRef

Epidemiology
The impact of age on mortality in the intensive care unit: a retrospective cohort study in Malaysia: Abdul Jabbar Ismail, W Mohd Nazaruddin W Hassan, Mohd Basri Mat Nor, Wan Fadzlina Wan Muhd Shukeri; Acute Crit Care. 2024;39(3):390-399. Published online August 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00640

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Abstract PDF

Background
Age is a significant consideration for intensive care unit (ICU) admission. However, the reported associations between increasing age and mortality vary across studies, and data in the local context of Malaysia are lacking. The objective of the present study was to determine the impact of increasing age on ICU mortality.
Methods
A retrospective cohort study of ICU patients was conducted between January 2020 and November 2023 at a university hospital in Malaysia. Patients were classified into two categories according to age (years) and into four groups according to National Library of Medicine Medical Subject Headings (MeSH): young adult (19–24), adult (25–44), middle age (45–64), and elderly (≥65). The Cochran-Armitage test for trend and Cox proportional hazards regression analyses were performed to evaluate the impact of increasing age on ICU mortality.
Results
A total of 1,661 patients was analyzed. The Cochran-Armitage test showed a significant positive association between ICU mortality rate and age group (Z=−4.86, P<0.01) or MeSH category (Z=−5.36, P<0.01). After adjusting for other confounders, the strongest predictor for ICU mortality in the Cox proportional hazards regression analyses was age, with the elderly age group having the highest adjusted hazard ratio of 4.777 (95% CI, 1.128–20.231; P=0.03).
Conclusions
Age had a significant impact on ICU mortality in our cohort of critically ill patients.

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Intubation in Eosinophilic Lung Disease: Predictors, Outcomes, and Characteristics from a National Inpatient Sample Analysis
Michel Al Achkar, Nadim Zaidan, Chloe Lahoud, Zaineb Zubair, Jessica Schwartz, Erica Abidor, Chris Kaspar, Halim El Hage
Medicina.2025; 61(4): 556. CrossRef
Ranking Nursing Diagnoses by Predictive Relevance for Intensive Care Unit Transfer Risk in Adult and Pediatric Patients: A Machine Learning Approach with Random Forest
Manuele Cesare, Mario Cesare Nurchis, Gianfranco Damiani, Antonello Cocchieri
Healthcare.2025; 13(11): 1339. CrossRef
A retrospective study of multivariable analysis of predictive values of lactate-related ratios on 28-day mortality in intensive care units
Veysel Dinç, Döndü Genç Moralar, Oğuz Özakin, Serpil Şehirlioğlu
Medicine.2025; 104(39): e44605. CrossRef
Early Mortality Prediction in Intensive Care Unit Patients Based on Serum Metabolomic Fingerprint
Rúben Araújo, Luís Ramalhete, Cristiana P. Von Rekowski, Tiago A. H. Fonseca, Luís Bento, Cecília R. C. Calado
International Journal of Molecular Sciences.2024; 25(24): 13609. CrossRef

Nephrology
Incidence of hypothermia in critically ill patients receiving continuous renal replacement therapy in Siriraj Hospital, Thailand: Thonnarat Pornsirirat, Nualnapa Kasemvilawan, Patcharavalia Pattanacharoenwong, Saisunee Arpibanwana, Hatairat Kondon, Thummaporn Naorungroj; Acute Crit Care. 2024;39(3):379-389. Published online August 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00038

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Background
Hypothermia is a relatively common complication in patients receiving continuous renal replacement therapy (CRRT). However, few studies have reported the factors associated with hypothermia.
Methods
A retrospective cohort study was performed in five intensive care units (ICUs) to evaluate the incidence of hypothermia and the predictive factors for developing hypothermia during CRRT, with hypothermia defined as a time-weighted average temperature <36 °C.
Results
From January 2020 to December 2021, 300 patients were enrolled. Hypothermia developed in 23.7% of them within the first 24 hours after CRRT initiation. Compared to non-hypothermic patients, hypothermic patients were older and had lower body weight, more frequent acidemia, and higher ICU and 30-day mortality rates. In the multivariate analysis, age >70 years (odds ratio [OR], 2.59; 95% CI, 1.38–4.98; P=0.004), higher positive fluid balance on the day before CRRT (OR, 1.11; 95% CI, 1.02–1.22; P=0.02), and CRRT dose (OR, 1.003; 95% CI, 1.00–1.01; P=0.04) were significantly associated with hypothermia. Conversely, a higher body weight was independently associated with mitigated risk of hypothermia (OR, 0.89; 95% CI, 0.81–0.97; P=0.01). Moreover, a higher coefficient of variance of temperature was associated with greater ICU mortality (OR, 1.41; 95% CI, 1.13–1.78; P=0.003).
Conclusions
Hypothermia during CRRT is a relatively common occurrence, and factors associated with hypothermia onset in the first 24 hours include older age, lower body weight, higher positive fluid balance on the day before CRRT, and higher CRRT dose. Greater temperature variability was associated with increased ICU mortality.

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Beyond the usual: A focus on infrequent complications of CRRT
Gonzalo Ramírez-Guerrero, Cristian Pedreros-Rosales, David Ballesteros, Mitchell Rosner, Claudio Ronco
Journal of Critical Care.2026; 91: 155270. CrossRef
Development and validation of a LASSO-based predictive model for inadvertent hypothermia in ICU patients
Xueting Wang, Yuxuan Chen, Lan Hua, Dongmei Wang, Xia Zhang, Lianhong Wang
Frontiers in Medicine.2025;[Epub] CrossRef

Neurosurgery
The efficacy of therapeutic hypothermia in patients with poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis: Seungjoo Lee, Moinay Kim, Min-Yong Kwon, Sae Min Kwon, Young San Ko, Yeongu Chung, Wonhyoung Park, Jung Cheol Park, Jae Sung Ahn, Hanwool Jeon, Jihyun Im, Jae Hyun Kim; Acute Crit Care. 2024;39(2):282-293. Published online May 30, 2024; DOI: https://doi.org/10.4266/acc.2024.00612

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Background
This study evaluates the effectiveness of Therapeutic Hypothermia (TH) in treating poor-grade aneurysmal subarachnoid hemorrhage (SAH), focusing on functional outcomes, mortality, and complications such as vasospasm, delayed cerebral ischemia (DCI), and hydrocephalus.
Methods
Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive literature search was conducted across multiple databases, including Medline, Embase, and Cochrane Central, up to November 2023. Nine studies involving 368 patients were selected based on eligibility criteria focusing on TH in poor-grade SAH patients. Data extraction, bias assessment, and evidence certainty were systematically performed.
Results
The primary analysis of unfavorable outcomes in 271 participants showed no significant difference between the TH and standard care groups (risk ratio [RR], 0.87). However, a significant reduction in vasospasm was observed in the TH group (RR, 0.63) among 174 participants. No significant differences were found in DCI, hydrocephalus, and mortality rates in the respective participant groups.
Conclusions
TH did not significantly improve primary unfavorable outcomes in poor-grade SAH patients. However, the reduction in vasospasm rates indicates potential specific benefits. The absence of significant findings in other secondary outcomes and mortality highlights the need for further research to better understand TH's role in treating this patient population.

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Progress of Brain Hypothermia Treatment for Severe Subarachnoid Hemorrhage—177 Cases Experienced and a Narrative Review
Hitoshi Kobata
Therapeutic Hypothermia and Temperature Management.2025; 15(3): 113. CrossRef
State-of-the-art for automated machine learning predicts outcomes in poor-grade aneurysmal subarachnoid hemorrhage using routinely measured laboratory & radiological parameters: coagulation parameters and liver function as key prognosticators
Ali Haider Bangash, Jayro Toledo, Muhammed Amir Essibayi, Neil Haranhalli, Rafael De la Garza Ramos, David J. Altschul, Stavropoula Tjoumakaris, Reza Yassari, Robert M. Starke, Redi Rahmani
Neurosurgical Review.2025;[Epub] CrossRef
Targeted temperature management in acute brain injury
Arjun Joshi, Mark Earl
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Pulmonary
Are sodium-glucose co-transporter-2 inhibitors associated with improved outcomes in diabetic patients admitted to intensive care units with septic shock?: Nikita Ashcherkin, Abdelmohaymin A. Abdalla, Simran Gupta, Shubhang Bhatt, Claire I. Yee, Rodrigo Cartin-Ceba; Acute Crit Care. 2024;39(2):251-256. Published online May 14, 2024; DOI: https://doi.org/10.4266/acc.2023.01046

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Abstract PDF

Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to reduce organ dysfunction in renal and cardiovascular disease. There are limited data on the role of SGLT2i in acute organ dysfunction. We conducted a study to assess the effect of SGLT2i taken prior to intensive care unit (ICU) admission in diabetic patients admitted with septic shock.
Methods
This retrospective cohort study used electronic medical records and included diabetic patients admitted to the ICU with septic shock. We compared diabetic patients on SGLT2i to those who were not on SGLT2i prior to admission. The primary outcome was in-hospital mortality, and secondary outcomes included hospital and ICU length of stay, use of renal replacement therapy, and 28- and 90-day mortality.
Results
A total of 98 diabetic patients was included in the study, 36 in the SGLT2i group and 62 in the non-SGLT2i group. The Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation III scores were similar in the groups. Inpatient mortality was significantly lower in the SGLT2i group (5.6% vs. 27.4%, P=0.008). There was no significant difference in secondary outcomes.
Conclusions
Our study found that diabetic patients on SGLT2i prior to hospitalization who were admitted to the ICU with septic shock had lower inpatient mortality compared to patients not on SGLT2i.

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Sodium-glucose cotransporter-2 inhibitors and sepsis: a story with two tails or with one tail?
Baris Afsar, Rengin Elsurer Afsar, Katherine Tuttle, Krista L. Lentine
Inflammopharmacology.2026;[Epub] CrossRef
Melioidosis in people living with diabetes; clinical presentation, clinical course and implications for patient management
Laura Prideaux, Megan Sandeman, Hayley Stratton, Anthony D Kelleher, Simon Smith, Josh Hanson
Acta Tropica.2025; 263: 107559. CrossRef
High-density lipoprotein: a biomarker and therapeutic target in sepsis
Mohan Li, Marina Barros-Pinkelnig, Sesmu M. Arbous, Christina Christoffersen, Patrick C. N. Rensen, Sander Kooijman
Critical Care.2025;[Epub] CrossRef

Meta-analysis
Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study in South Korea: Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim; Acute Crit Care. 2024;39(1):127-137. Published online February 20, 2024; DOI: https://doi.org/10.4266/acc.2023.01613

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Background
The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis.
Methods
Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models.
Results
The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3–7) and the median PNI score was 39.6 (IQR, 33.846.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5–8; PNI: 35–38) or severe (CONUT: 9–12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0–1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24–1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95–3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09–1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67–2.12; P<0.001).
Conclusions
The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.

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Relationship between the geriatric nutritional risk index and sepsis in elderly critically ill patients: a retrospective cohort study
Yujiao Jin, Tianyun Zhou, Chenshu Hou, Huihui Zhang, Binbin Xu
European Journal of Medical Research.2025;[Epub] CrossRef
Epidemiology and Microbiology of Healthcare-Associated Infections in Neurosurgery Department: A Cross-Sectional Study
Renata Jabłońska, Paweł Sokal, Magdalena Zając, Agnieszka Królikowska, Karolina Filipska - Blejder, Irena Wrońska, Robert Ślusarz
Biological Research For Nursing.2025; 27(4): 544. CrossRef
Prognostic nutritional index as a potential predictor of prognosis in patients with sepsis: a retrospective cohort study
Mingyuan Pan, Zheng Li, Shanfeng Sheng, Xiao Teng, Yuyang Li
Frontiers in Nutrition.2025;[Epub] CrossRef
The J-shaped association between the ratio of neutrophil counts to prognostic nutritional index and mortality in ICU patients with sepsis: a retrospective study based on the MIMIC database
Jiaqi Lou, Hong Kong, Ziyi Xiang, Xiaoyu Zhu, Shengyong Cui, Jiliang Li, Guoying Jin, Neng Huang, Xin Le, Youfen Fan, Sida Xu
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Recurrent Bloodstream Infections Without Sepsis in a Patient With Short Bowel Syndrome on Parenteral Nutrition: A Case of Potential Sepsis Tolerance
Akiva Brin , Sarah Israel , Sigal Matza-Porges , Zvi Ackerman
Cureus.2025;[Epub] CrossRef
Dynamic assessment of clinical scales for predicting mortality in septic patients with prolonged ICU stay
M. Ya. Yadgarov, L. B. Berikashvili, I. V. Kuznetsov, K. K. Kadantseva, A. A. Yakovlev, V. V. Likhvantsev
Messenger of ANESTHESIOLOGY AND RESUSCITATION.2025; 22(4): 6. CrossRef
The impact of the prognostic significance of the CONUT score on critical care patients in the intensive care unit: a descriptive study
Melike Yüksel Yavuz, Hüseyin Döngelli, Mehmet Yavuz, Ceyda Anar, Muzaffer Onur Turan, Bünyamin Sertoğullarından
Nutrición Hospitalaria.2025;[Epub] CrossRef
Can Nutritional Screening Tools Predict the Prognosis of Critically Ill Patients with Sepsis?
Duygu Kayar Calili, Demet Bolukbasi, Seval Izdes
Medicina.2025; 61(10): 1846. CrossRef
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Mengfei Li, Runbing Xu, Yu Wu, Jiajun Pan, Xinyu Zhang, Miao Jiang
Scientific Reports.2025;[Epub] CrossRef
Prognostic Nutritional Index and Urea-albumin Ratio: Novel Mortality Predictors for Critically Ill Sepsis Patients
Tugce Damarsoy, Hasan T Gozdas, Isa Yildiz, Abdullah Demirhan
Indian Journal of Critical Care Medicine.2025; 29(12): 996. CrossRef
Development and validation of a predictive model for in-hospital mortality from perioperative bacteremia in gastrointestinal surgery
Yusuke Taki, Shinsuke Sato, Masaya Watanabe, Ko Ohata, Hideyuki Kanemoto, Noriyuki Oba
European Journal of Clinical Microbiology & Infectious Diseases.2024; 43(11): 2117. CrossRef
Sepsis and Septic Shock Management and Care: A Case Presentation
Myriam Jean Cadet
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Epidemiology
Development of a deep learning model for predicting critical events in a pediatric intensive care unit: In Kyung Lee, Bongjin Lee, June Dong Park; Acute Crit Care. 2024;39(1):186-191. Published online February 20, 2024; DOI: https://doi.org/10.4266/acc.2023.01424; Correction in: Acute Crit Care 2024;39(2):330

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Abstract PDF

Background
Identifying critically ill patients at risk of cardiac arrest is important because it offers the opportunity for early intervention and increased survival. The aim of this study was to develop a deep learning model to predict critical events, such as cardiopulmonary resuscitation or mortality.
Methods
This retrospective observational study was conducted at a tertiary university hospital. All patients younger than 18 years who were admitted to the pediatric intensive care unit from January 2010 to May 2023 were included. The main outcome was prediction performance of the deep learning model at forecasting critical events. Long short-term memory was used as a deep learning algorithm. The five-fold cross validation method was employed for model learning and testing.
Results
Among the vital sign measurements collected during the study period, 11,660 measurements were used to develop the model after preprocessing; 1,060 of these data points were measurements that corresponded to critical events. The prediction performance of the model was the area under the receiver operating characteristic curve (95% confidence interval) of 0.988 (0.9751.000), and the area under the precision-recall curve was 0.862 (0.700–1.000).
Conclusions
The performance of the developed model at predicting critical events was excellent. However, follow-up research is needed for external validation.

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Impacto de la inteligencia artificial en la predicción de eventos críticos en las unidades de cuidados intensivos: implicaciones para la práctica y la toma de decisiones en enfermería
Joao Andrés Cujilan Guamán, Nicole Elizabeth Chele Sudiaga, Víctor Alfonso Gavilanes Burnhan, Jenny Verónica Tacle Flores, Ruth Alexandra Boza Ruiz
Prohominum.2025; 7(2): 209. CrossRef
Impacto de la inteligencia artificial en la predicción de eventos críticos en las unidades de cuidados intensivos: Implicaciones para la práctica y la toma de decisiones en enfermería
Joao Andrés Cujilan Guamán, Nicole Elizabeth Chele Sudiaga, Víctor Alfonso Gavilanes Burnhan, Jenny Verónica Tacle Flores, Ruth Alexandra Boza Ruiz
Más Vita.2025; 7(2): 58. CrossRef

Trauma
Role of platelet-to-lymphocyte ratio at the time of arrival to the emergency room as a predictor of short-term mortality in trauma patients with severe trauma team activation: Jae Kwang Kim, Kyung Hoon Sun; Acute Crit Care. 2024;39(1):146-154. Published online February 15, 2024; DOI: https://doi.org/10.4266/acc.2023.01319

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Abstract PDF

Background
Platelet-to-Lymphocyte ratio (PLR) has been studied as a prognostic factor for various diseases and traumas. This study examined the utility of PLR as a tool for predicting 30-day mortality in patients experiencing severe trauma.
Methods
This study included 139 patients who experienced trauma and fulfilled ≥1 criteria for activation of the hospital’s severe trauma team. Patients were divided into non-survivor and survivor groups. Mean PLR values were compared between the groups, the optimal PLR cut-off value was determined, and mortality and survival analyses were performed. Statistical analyses were performed using SPSS ver. 26.0. The threshold of statistical significance was P<0.05.
Results
There was a significant difference in mean (±standard deviation) PLR between the non-survivor (n=36) and survivor (n=103) groups (53.4±30.1 vs. 89.9±53.3, respectively; P<0.001). Receiver operating characteristic (ROC) curve analysis revealed an optimal PLR cut-off of 65.35 (sensitivity, 0.621; specificity, 0.694, respectively; area under the ROC curve, 0.742), and Kaplan-Meier survival analysis revealed a significant difference in mortality rate between the two groups.
Conclusions
PLR can be calculated quickly and easily from a routine complete blood count, which is often performed in the emergency department for individuals who experience trauma. The PLR is useful for predicting 30-day mortality in trauma patients with severe trauma team activation.

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Takeshi Suzuki, Kenkichi Michimoto, Kentaro Yamada, Khashayar Farsad
Journal of Vascular and Interventional Radiology.2026; 37(2): 107922. CrossRef
Utility of platelet- to lymphocyte ratio as an inflammatory biomarker in major burns. our experience
Dayamí Zaldívar Castillo MD, Néstor Nemer Pérez MD, Carlos Lora Buelvas MD, Adelmo de J González Méndez MD, Freddy J Cruz Reyes MD, Yaqueline Castellanos MD
Journal of Anesthesia & Critical Care: Open Access.2025; 17(1): 1. CrossRef
The predictors of prognostic nutritional index and its association with in-hospital mortality among critically ill geriatric patients
Khalid Elsayed Elsorady, Ahmed Ahmed Mohamed Abotaha, Mohammed Abdelmoaty Ebrahim Shaheen, Hisham Ahmed Hani Mostafa Abdelaziz, Essam Yehia Ali Aggour, Mohamed Elwan Mohamed Mahmoud
Electronic Journal of General Medicine.2025; 22(4): em656. CrossRef
Key laboratory changes in severe trauma, a different pattern for each clinical phenotype
Adrián Marcos-Morales, Jesús Abelardo Barea Mendoza, Marcos Valiente Fernández, Carlos García Fuentes, Fernando Calvo Boyero, Cecilia Cueto-Felgueroso, Judith Gutiérrez Gutiérrez, Francisco de Paula Delgado Moya, Carolina Mudarra Reche, Susana Bermejo Azn
Medicina Intensiva (English Edition).2025; : 502227. CrossRef
Prognostic Value of Inflammatory and Metabolic Biomarkers in ICU-Admitted Trauma Patients: A Retrospective Cohort Study
Hasan Celik, Basak Pehlivan, Veli Fahri Pehlivan, Erdogan Duran
Medicina.2025; 61(9): 1530. CrossRef
Utility of systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio as a predictive biomarker in pediatric traumatic brain injury
Muhammad Arifin Parenrengi, Wihasto Suryaningtyas, Ahmad Data Dariansyah, Budi Utomo, Glenn Otto Taryana, Catur Kusumo, Surya Pratama Brilliantika
Surgical Neurology International.2024; 15: 456. CrossRef

Pulmonary
Early bronchoscopy in severe pneumonia patients in intensive care unit: insights from the Medical Information Mart for Intensive Care-IV database analysis: Chiwon Ahn, Yeonkyung Park, Yoonseok Oh; Acute Crit Care. 2024;39(1):179-185. Published online February 15, 2024; DOI: https://doi.org/10.4266/acc.2023.01165

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Background
Pneumonia frequently leads to intensive care unit (ICU) admission and is associated with a high mortality risk. This study aimed to assess the impact of early bronchoscopy administered within 3 days of ICU admission on mortality in patients with pneumonia using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database.
Methods
A single-center retrospective analysis was conducted using the MIMIC-IV data from 2008 to 2019. Adult ICU-admitted patients diagnosed with pneumonia were included in this study. The patients were stratified into two cohorts based on whether they underwent early bronchoscopy. The primary outcome was the 28-day mortality rate. Propensity score matching was used to balance confounding variables.
Results
In total, 8,916 patients with pneumonia were included in the analysis. Among them, 783 patients underwent early bronchoscopy within 3 days of ICU admission, whereas 8,133 patients did not undergo early bronchoscopy. The primary outcome of the 28-day mortality between two groups had no significant difference even after propensity matched cohorts (22.7% vs. 24.0%, P=0.589). Patients undergoing early bronchoscopy had prolonged ICU (P<0.001) and hospital stays (P<0.001) and were less likely to be discharged to home (P<0.001).
Conclusions
Early bronchoscopy in severe pneumonia patients in the ICU did not reduce mortality but was associated with longer hospital stays, suggesting it was used in more severe cases. Therefore, when considering bronchoscopy for these patients, it's important to tailor the decision to each individual case, thoughtfully balancing the possible advantages with the related risks.

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Bronchoscopy in intensive care: to whom, when, why? (literature review)
O.Yu. Usenko, A.V. Sydiuk, O.Ye. Sydiuk, V.V. Antonenko, S.I. Chechil
EMERGENCY MEDICINE.2025; 21(3): 328. CrossRef
Toilet bronchoscopy in respiratory ICU: a randomized controlled clinical trial
Mohamed F. Abdelghany, Atef F.M. Al Karn, Shaimaa A. Mohammed, Sahar F. Youssif
The Egyptian Journal of Chest Diseases and Tuberculosis.2025; 74(3): 300. CrossRef
Bronchoscopy in Chronic Obstructive Pulmonary Disease
Yang Rui, Zhe Chen, Yuting Wang, Enjian Zhong, Yin Sheng, Tao Li, Tomoya Kawaguchi
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Pulmonary
Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation: Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong, Won Jun Song, Gee Young Suh; Acute Crit Care. 2024;39(1):91-99. Published online January 26, 2024; DOI: https://doi.org/10.4266/acc.2023.00871

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Background
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality.
Methods
We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed.
Results
A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579).
Conclusions
MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

Citations

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Review Article

Ethics
Impact of institutional case volume on intensive care unit mortality: Christine Kang, Ho Geol Ryu; Acute Crit Care. 2023;38(2):151-159. Published online May 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00689

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Abstract PDF

The primary aim of this review is to explore current knowledge on the relationship between institutional intensive care unit (ICU) patient volume and patient outcomes. Studies indicate that a higher institutional ICU patient volume is positively correlated with patient survival. Although the exact mechanism underlying this association remains unclear, several studies have proposed that the cumulative experience of physicians and selective referral between institutions may play a role. The overall ICU mortality rate in Korea is relatively high compared to other developed countries. A distinctive aspect of critical care in Korea is the existence of significant disparities in the quality of care and services provided across regions and hospitals. Addressing these disparities and optimizing the management of critically ill patients necessitates thoroughly trained intensivists who are well-versed in the latest clinical practice guidelines. A fully functioning unit with adequate patient throughput is also essential for maintaining consistent and reliable quality of patient care. However, the positive impact of ICU volume on mortality outcomes is also linked to complex organizational factors, such as multidisciplinary rounds, nurse staffing and education, the presence of a clinical pharmacist, care protocols for weaning and sedation, and a culture of teamwork and communication. Despite some inconsistencies in the association between ICU patient volume and patient outcomes, which are thought to arise from differences in healthcare systems, ICU case volume significantly affects patient outcomes and should be taken into account when formulating related healthcare policies.

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Original Articles

Epidemiology
Risk factors for hospital mortality in intensive care unit survivors: a retrospective cohort study: Luiza Gabriella Antonio e Silva, Claudia Maria Dantas de Maio Carrilho, Thalita Bento Talizin, Lucienne Tibery Queiroz Cardoso, Edson Lopes Lavado, Cintia Magalhães Carvalho Grion; Acute Crit Care. 2023;38(1):68-75. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01375

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Abstract PDF

Background
Deaths can occur after a patient has survived treatment for a serious illness in an intensive care unit (ICU). Mortality rates after leaving the ICU can be considered indicators of health care quality. This study aims to describe risk factors and mortality of surviving patients discharged from an ICU in a university hospital.
Methods
Retrospective cohort study carried out from January 2017 to December 2018. Data on age, sex, length of hospital stay, diagnosis on admission to the ICU, hospital discharge outcome, presence of infection, and Simplified Acute Physiology Score (SAPS) III prognostic score were collected. Infected patients were considered as those being treated for an infection on discharge from the ICU. Patients were divided into survivors and non-survivors on leaving the hospital. The association between the studied variables was performed using the logistic regression model.
Results
A total of 1,025 patients who survived hospitalization in the ICU were analyzed, of which 212 (20.7%) died after leaving the ICU. When separating the groups of survivors and non-survivors according to hospital outcome, the median age was higher among non-survivors. Longer hospital stays and higher SAPS III values were observed among non-survivors. In the logistic regression, the variables age, length of hospital stay, SAPS III, presence of infection, and readmission to the ICU were associated with hospital mortality.
Conclusions
Infection on ICU discharge, ICU readmission, age, length of hospital stay, and SAPS III increased risk of death in ICU survivors.

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O. I. Butranova, S. K. Zyryanov, A. A. Gorbacheva, G A. Putsman
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Trauma
Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma: Kangho Lee, Dongyeon Ryu, Hohyun Kim, Sungjin Park, Sangbong Lee, Chanik Park, Gilhwan Kim, Sunhyun Kim, Nahyeon Lee; Acute Crit Care. 2023;38(1):95-103. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01046

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Abstract PDF: Background
In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE).
Methods
We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs.
Results
The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage.
Conclusions
In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.

Pulmonary
Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure: Türkay Akbaş, Harun Güneş; Acute Crit Care. 2023;38(1):49-56. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01011

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Abstract PDF

Background
The study aimed to describe the clinical course, outcomes, and prognostic factors of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure.
Methods
This retrospective study involved patients with acute hypercapnic respiratory failure due to COPD of any cause admitted to the intensive care unit (ICU) for non-invasive or invasive mechanical ventilation (IMV) support between December 2015 and February 2020.
Results
One hundred patients were evaluated. The main causes of acute hypercapnic respiratory failure were bronchitis, pneumonia, and heart failure. The patients’ mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23.0±7.2, and their IMV rate was 43%. ICU, in-hospital, and 90-day mortality rates were 21%, 29%, and 39%, respectively. Non-survivors had more pneumonia, shock within the first 24 hours of admission, IMV, vasopressor use, and renal replacement therapy, along with higher APACHE II scores, lower admission albumin levels and PaO2/ FiO2 ratios, and longer ICU and hospital stays than survivors. Logistic regression analysis identified APACHE II score (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.017–1.317; P=0.026), admission PaO2/FiO2 ratio (OR, 0.989; 95% CI, 0.978–0.999; P=0.046), and vasopressor use (OR, 8.827; 95% CI, 1.650–47.215; P=0.011) as predictors of ICU mortality. APACHE II score (OR, 1.099; 95% CI, 1.021–1.182; P=0.011) and admission albumin level (OR, 0.169; 95% CI, 0.056–0.514; P=0.002) emerged as predictors of 90-day mortality.
Conclusions
APACHE II scores, the PaO2/FiO2 ratio, vasopressor use, and albumin levels are significant short-term mortality predictors in severely ill COPD patients with acute hypercapnic respiratory failure.

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Construction and validation of a nomogram prediction model for death risk in patients with chronic obstructive pulmonary disease complicated by hypercapnic respiratory failure in the intensive care unit
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RESPIRATORY SUPPORT FOR CHRONIC HYPERCAPNIC RESPIRATORY FAILURE IN THE OUTPATIENT SETTINGS. LITERATURE REVIEW.
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Wenjie Sun, Yeshan Li, Shuxin Tan
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Trauma
Association of Glasgow coma scale and endotracheal intubation in predicting mortality among patients admitted to the intensive care unit: Nader Markazi Moghaddam, Mohammad Fathi, Sanaz Zargar Balaye Jame, Mohammad Darvishi, Morteza Mortazavi; Acute Crit Care. 2023;38(1):113-121. Published online February 22, 2023; DOI: https://doi.org/10.4266/acc.2022.00927

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Abstract PDF

Background
We assessed predictors of mortality in the intensive care unit (ICU) and investigated if Glasgow coma scale (GCS) is associated with mortality in patients undergoing endotracheal intubation (EI).
Methods
From February 2020, we performed a 1-year study on 2,055 adult patients admitted to the ICU of two teaching hospitals. The outcome was mortality during ICU stay and the predictors were patients’ demographic, clinical, and laboratory features.
Results
EI was associated with a decreased risk for mortality compared with similar patients (adjusted odds ratio [AOR], 0.32; P=0.030). This shows that EI had been performed correctly with proper indications. Increasing age (AOR, 1.04; P<0.001) or blood pressure (AOR, 1.01; P<0.001), respiratory problems (AOR, 3.24; P<0.001), nosocomial infection (AOR, 1.64; P=0.014), diabetes (AOR, 5.69; P<0.001), history of myocardial infarction (AOR, 2.52; P<0.001), chronic obstructive pulmonary disease (AOR, 3.93; P<0.001), immunosuppression (AOR, 3.15; P<0.001), and the use of anesthetics/sedatives/hypnotics for reasons other than EI (AOR, 4.60; P<0.001) were directly; and GCS (AOR, 0.84; P<0.001) was inversely related to mortality. In patients with trauma surgeries (AOR, 0.62; P=0.014) or other surgical categories (AOR, 0.61; P=0.024) undergoing EI, GCS had an inverse relation with mortality (accuracy=82.6%, area under the receiver operator characteristic curve=0.81).
Conclusions
A variety of features affected the risk for mortality in patients admitted to the ICU. Considering GCS score for EI had the potential of affecting prognosis in subgroups of patients such as those with trauma surgeries or other surgical categories.

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Liver
Alcohol use disorder in the intensive care unit a highly morbid condition, but chemical dependency discussion improves outcomes: Kristin Colling, Alexandra K. Kraft, Melissa L. Harry; Acute Crit Care. 2023;38(1):122-133. Published online January 10, 2023; DOI: https://doi.org/10.4266/acc.2022.00584

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Abstract PDF

Background
Alcohol use disorders (AUD) are common in patients admitted to intensive care units (ICU) and increase the risk for worse outcomes. In this study, we describe factors associated with patient mortality after ICU admission and the effect of chemical dependency (CD) counseling on outcomes in the year following ICU admission.
Methods
We retrospectively reviewed patient demographics, hospital data, and documentation of CD counseling by medical providers for all ICU patients with AUD admitted to our institution between January 2017 and March 2019. Primary outcomes were in-hospital and 1-year mortality.
Results
Of the 527 patients with AUD requiring ICU care, median age was 56 years (range, 18–86). Both in-hospital (12%) and 1-year mortality rates (27%) were high. Rural patients, comorbidities, older age, need for mechanical ventilation, and complications were associated with increased risk of in-hospital and 1-year mortality. CD counseling was documented for 73% of patients, and 50% of these patients accepted alcohol treatment or resources prior to discharge. CD evaluation and acceptance was associated with a significantly decreased rate of readmission for liver or alcohol-related issues (36% vs. 58%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.27–0.61) and 1-year mortality (7% vs. 19.5%; OR, 0.32; 95% CI, 0.16–0.64). CD evaluation alone, regardless of patient acceptance, was associated with a significantly decreased 1-year post-discharge mortality rate (12% vs. 23%; OR, 0.44; 95% CI, 0.25–0.77).
Conclusions
ICU patients with AUD had high in-hospital and 1-year mortality. CD evaluation, regardless of patient acceptance, was associated with a significant decrease in 1-year mortality

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Health Equity in the Care of Adult Critical Illness Survivors
A. Fuchsia Howard, Hong Li, Gregory Haljan
Critical Care Clinics.2025; 41(1): 185. CrossRef
Comparing Outcomes and Infection Risk in Medical, Surgical, and Trauma Intensive Care Patients with Alcohol Use Disorder
Kristin P. Colling, Alexandra K. Kraft, Melissa L. Harry
Surgical Infections.2025; 26(5): 292. CrossRef
Epidemiology of Substance-Related Admissions to ICUs in the United States
Kelsey Hills-Dunlap, Max McGrath, Ryan Peterson, P. Michael Ho, Tyree H. Kiser, R. William Vandivier, Ellen L. Burnham, Marc Moss, Sarah E. Jolley
Critical Care Medicine.2025; 53(11): e2134. CrossRef
Decisional needs of intensive care unit survivors with alcohol use disorder considering alcohol treatment: A qualitative study
Kelsey Hills-Dunlap, Christopher E. Knoepke, Daniel D. Matlock, Ellen L. Burnham, Marc Moss, Sarah E. Jolley, Caroline K. Tietbohl
Journal of Substance Use and Addiction Treatment.2025; 179: 209798. CrossRef
Identifying excessive chronic alcohol use with phosphatidylethanol in patients with suspected severe injury-results from the IDART study
Benedicte M Jørgenrud, Camilla C Bråthen, Jo Steinson Stenehjem, Thomas Kristiansen, Leiv Arne Rosseland, Stig Tore Bogstrand
Alcohol and Alcoholism.2024;[Epub] CrossRef
Outcomes of traumatically injured patients after nighttime transfer from the intensive care unit
Amy Howk, Devin John Clegg, Jacob C Balmer, Natalie G Foster, Justin Gerard, Anthony S Rowe, Brian Daley
Trauma Surgery & Acute Care Open.2024; 9(1): e001451. CrossRef

Epidemiology
Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience: Edin Botan, Emrah Gün, Emine Kübra Şden, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli; Acute Crit Care. 2022;37(4):644-653. Published online November 11, 2022; DOI: https://doi.org/10.4266/acc.2022.00395

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Abstract PDF

Background
Pediatric intensive care units (PICUs), where children with critical illnesses are treated, require considerable manpower and technological infrastructure in order to keep children alive and free from sequelae.
Methods
In this retrospective comparative cohort study, hospital records of patients aged 1 month to 18 years who died in the study PICU between January 2015 and December 2019 were reviewed.
Results
A total of 2,781 critically ill children were admitted to the PICU. The mean±standard deviation age of 254 nonsurvivors was 64.34±69.48 months. The mean PICU length of stay was 17 days (range, 1–205 days), with 40 children dying early (<1 day of PICU admission). The majority of nonsurvivors (83.9%) had comorbid illnesses. Children with early mortality were more likely to have neurological findings (62.5%), hypotension (82.5%), oliguria (47.5%), acidosis (92.5%), coagulopathy (30.0%), and cardiac arrest (45.0%) and less likely to have terminal illnesses (52.5%) and chronic illnesses (75.6%). Children who died early had a higher mean age (81.8 months) and Pediatric Risk of Mortality (PRISM) III score (37). In children who died early, the first three signs during ICU admission were hypoglycemia in 68.5%, neurological symptoms in 43.5%, and acidosis in 78.3%. Sixty-seven patients needed continuous renal replacement therapy, 51 required extracorporeal membrane oxygenation support, and 10 underwent extracorporeal cardiopulmonary resuscitation.
Conclusions
We found that rates of neurological findings, hypotension, oliguria, acidosis, coagulation disorder, and cardiac arrest and PRISM III scores were higher in children who died early compared to those who died later.

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Arielle Jolly, Ashleigh E. Butler, Simon Erickson, Kristen Gibbons, Kylie Davies, Nick Williams, Yetunde Odutolu, Jacqueline Reid, Kelly Higgins, Linda Thomas, Fenella J. Gill
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Pulmonary
Association between timing of intubation and mortality in patients with idiopathic pulmonary fibrosis: Eunhye Bae, Jimyung Park, Sun Mi Choi, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee; Acute Crit Care. 2022;37(4):561-570. Published online October 28, 2022; DOI: https://doi.org/10.4266/acc.2022.00444

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Abstract PDF Supplementary Material: Background
Delayed intubation is associated with poor prognosis in patients with respiratory failure. However, the effect of delayed intubation in patients with idiopathic pulmonary fibrosis (IPF) remains unknown. This study aimed to analyze whether timing of intubation after high-concentration oxygen therapy was associated with worse clinical outcomes in IPF patients.
Methods
This retrospective propensity score-matched study enrolled adult patients with IPF who underwent mechanical ventilation between January 2011 and July 2021. Patients were divided into early and delayed intubation groups. Delayed intubation was defined as use of high-concentration oxygen therapy for at least 48 hours before tracheal intubation. The primary outcome was intensive care unit (ICU) mortality, and a conditional logistic regression model was used to evaluate the association between timing of intubation and clinical outcomes.
Results
The median duration of high-concentration oxygen therapy before intubation was 0.5 days in the early intubation group (n=60) and 5.1 days in the delayed intubation group (n=36). The ICU mortality rate was 56.7% and 75% in the early and delayed intubation groups, respectively, before propensity matching (P=0.075). After matching for demographic and clinical covariates, 33 matched pairs were selected. In the propensity-matched cohort, delayed intubation significantly increased the risk of ICU mortality (adjusted odds ratio, 3.99; 95% confidence interval, 1.02–15.63; P=0.046). However, in-hospital mortality did not differ significantly between the groups.
Conclusions
In patients with IPF, delayed intubation after initiation of high-concentration oxygen therapy was significantly associated with increased risk of ICU mortality compared to early intubation.

Nephrology
Impact of intradialytic hypotension on mortality following the transition from continuous renal replacement therapy to intermittent hemodialysis: Seong Geun Kim, Donghwan Yun, Jinwoo Lee, Yong Chul Kim, Dong Ki Kim, Kook-Hwan Oh, Kwon Wook Joo, Yon Su Kim, Seung Seok Han; Acute Crit Care. 2023;38(1):86-94. Published online October 26, 2022; DOI: https://doi.org/10.4266/acc.2022.00948

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Background
The transition of dialysis modalities from continuous renal replacement therapy (CRRT) to intermittent hemodialysis (iHD) is frequently conducted during the recovery phase of critically ill patients with acute kidney injury. Herein, we addressed the occurrence of intradialytic hypotension (IDH) after this transition, and its association with the mortality risk.
Methods
A total of 541 patients with acute kidney injury who attempted to transition from CRRT to iHD at Seoul National University Hospital, Korea from 2010 to 2020 were retrospectively collected. IDH was defined as a discontinuation of dialysis because of hemodynamic instability plus a nadir systolic blood pressure <90 mm Hg or a decrease in systolic blood pressure ≥30 mm Hg during the first session of iHD. Odds ratios (ORs) of outcomes, such as in-hospital mortality and weaning from RRT, were measured using a logistic regression model after adjusting for multiple variables.
Results
IDH occurred in 197 patients (36%), and their mortality rate (44%) was higher than that of those without IDH (19%; OR, 2.64; 95% confidence interval [CI], 1.70–4.08). For patients exhibiting IDH, the iHD sessions delayed successful weaning from RRT (OR, 0.62; 95% CI, 0.43–0.90) compared with sessions on those without IDH. Factors such as low blood pressure, high pulse rate, low urine output, use of mechanical ventilations and vasopressors, and hypoalbuminemia were associated with IDH risk.
Conclusions
IDH occurrence following the transition from CRRT to iHD is associated with high mortality and delayed weaning from RRT.

Citations

Citations to this article as recorded by

Cumulative impact of hypotension during intermittent hemodialysis on kidney recovery in critically ill patients with AKI-D
Jae Ho Kim, Joonhee Yoon, Ji-Eun Kim, Seongho Jo, Yuri Lee, Ji Won Kim, Seun Deuk Hwang, Seoung Woo Lee, Joon Ho Song, Kipyo Kim
Journal of Critical Care.2025; 85: 154944. CrossRef
A pilot feasibility study of continuous cardiac output and blood pressure monitoring during intermittent hemodialysis in patients recovering from severe acute kidney injury
Sofia Spano, Akinori Maeda, Joey Lam, Anis Chaba, Atthaphong Phongphithakchai, Yukiko Hikasa, Nuttapol Pattamin, Nuanprae Kitisin, Emily See, Peter Mount, Rinaldo Bellomo
Journal of Critical Care.2025; 88: 155086. CrossRef
A holistic framework for intradialytic hypotension prediction using generative adversarial networks-based data balancing
Hsuan-Ming Lin, JrJung Lyu
BMC Medical Informatics and Decision Making.2025;[Epub] CrossRef
Hemoglobin variability predicts mortality in acute kidney injury patients undergoing continuous renal replacement therapy: a multi-database cohort study
Yumin Huang, Ran Jiang, Kang Liu, Jinghang Li, Rongrong Sheng, Wei Xu, Huijuan Mao, Buyun Wu
Renal Failure.2025;[Epub] CrossRef
Proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy Academy (2023–2024)
William Beaubien-Souligny, Melissa Thompson Bastin, J. Pedro Teixeira, Jorge Cerda, Michael J. Connor, Amanda Dijanic Zeidman, Pranav S. Garimella, Luis Juncos, Arnaldo Lopez-Ruiz, Ravindra Mehta, Thiago Reis, Lilia Rizo-Topete, Samuel A. Silver, J. Ricar
Kidney360.2025; 6(10): 1798. CrossRef
The Relationship between Dialysis Adequacy and Blood Pressure and Number of Intradialytic Hypotensive Episodes in Haemodialysis Patients
Ömer Bingölbali, Semra Oğuz
Black Sea Journal of Health Science.2024; 7(5): 189. CrossRef

Meta-analysis
Comparison of mNUTRIC-S2 and mNUTRIC scores to assess nutritional risk and predict intensive care unit mortality: So Jeong Kim, Hong Yeul Lee, Sun Mi Choi, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2022;37(4):618-626. Published online October 18, 2022; DOI: https://doi.org/10.4266/acc.2022.00612

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Background
Nutritional status is associated with mortality. The modified Nutrition Risk in the Critically Ill (mNUTRIC) score is one of the most commonly used nutritional risk assessment tools in intensive care units (ICUs). The purpose of this study was to compare the mortality predictive ability of the mNUTRIC score to that of the mNUTRIC-S2 score, which uses the Simplified Acute Physiology Score (SAPS) II instead of the Acute Physiology and Chronic Health Evaluation (APACHE) II.
Methods
This retrospective cohort analysis included patients admitted to the ICU between January and September 2020. Each patient’s electronic medical records were reviewed. The model discrimination for predicting ICU mortality was assessed by the area under the receiver operating characteristic (ROC) curve, and a Cox regression model was performed to confirm the relationship between the groups and mortality.
Results
In total, 220 patients were enrolled. The ROC curve for predicting ICU mortality was 0.64 for the mNUTRIC score versus 0.67 for the mNUTRIC-S2 score. The difference between the areas was 0.03 (95% confidence interval [CI], –0.01 to 0.06; P=0.09). Patients with mNUTRIC-S2 score ≥5 had a greater risk of ICU mortality (hazard ratio [HR], 3.64; 95% CI, 1.85–7.14; P<0.001); however, no such relationship was observed with mNUTRIC score (HR, 1.69; 95% CI, 0.62–4.62; P=0.31).
Conclusions
The mNUTRIC-S2 score was significantly associated with ICU mortality. A cutoff score of 5 was selected as most appropriate.

Citations

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Bayesian Analysis of Modified Nutrition Risk in Critically Ill (mNUTRIC) Score for Mortality Prediction in Critically Ill Patients
Raj Kumar, Archana Kumari, Vivek Verma, Jay Prakash, Pradip K Bhattacharya, Shio Priye, Khushboo Saran, Kunal Raj, Bram Rochwerg
Indian Journal of Critical Care Medicine.2025; 29(5): 449. CrossRef
Comparison of mNUTRIC Score and mnutric Score with Albumin in Predicting Outcome in CKD Patients
Venkatesh Dhat, Jainab Bhori, Manish Mali, Mahesh R Jarkad, Aishwarya Chavan, Tushar Warke
Indian Journal of Critical Care Medicine.2025; 29(S1): S259. CrossRef
Predictive value of the mNUTRIC score and survival analysis in critically-ill patients hospitalized in the intensive care unit: A prospective observational study
Harun Tolga Duran, Osman Özgür Kilinç
Medicine.2025; 104(44): e45645. CrossRef
Association between nutritional risk scores and timing of endotracheal intubation in COVID-19-associated acute respiratory distress syndrome: a single-center cohort study in South Korea
Hyojin Jang, Wanho Yoo, Kwangha Lee
Acute and Critical Care.2025; 40(4): 538. CrossRef
Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study
Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim
Acute and Critical Care.2024; 39(1): 127. CrossRef
Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis
Amit Kumar, Archana Kumari, Jay Prakash, Pradip K Bhattacharya, Saket Verma, Priyanka Shrivastava, Khushboo Saran, Kunal Raj, Hemant N Ray
Indian Journal of Critical Care Medicine.2024; 28(5): 495. CrossRef

Infection
The prognostic impact of rheumatoid arthritis in sepsis: a population-based analysis: Lavi Oud, John Garza; Acute Crit Care. 2022;37(4):533-542. Published online October 6, 2022; DOI: https://doi.org/10.4266/acc.2022.00787

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Background
Rheumatoid arthritis (RA) is associated with increased risk of sepsis and higher infection-related mortality compared to the general population. However, the evidence on the prognostic impact of RA in sepsis has been inconclusive. We aimed to estimate the population-level association of RA with short-term mortality in sepsis.
Methods
We used statewide data to identify hospitalizations aged ≥18 years in Texas with sepsis, with and without RA during 2014–2017. Hierarchical logistic models with propensity adjustment (primary model), propensity score matching, and multivariable logistic regression without propensity adjustment were used to estimate the association of RA with short-term mortality among sepsis hospitalizations.
Results
Among 283,025 sepsis hospitalizations, 7,689 (2.7%) had RA. Compared to sepsis hospitalizations without RA, those with RA were older (aged ≥65 years, 63.9% vs. 56.4%) and had higher burden of comorbidities (mean Deyo comorbidity index, 3.2 vs. 2.7). Short-term mortality of sepsis hospitalizations with and without RA was 26.8% vs. 31.4%. Following adjustment for confounders, short-term mortality was lower among RA patients (adjusted odds ratio [aOR], 0.910; 95% confidence interval [CI], 0.856–0.967), with similar findings on alternative models. On sensitivity analyses, short-term mortality was lower in RA patients among sepsis hospitalizations aged ≥65 years and those with septic shock, but not among those admitted to intensive care unit (ICU; aOR, 0.990; 95% CI, 0.909–1.079).
Conclusions
RA was associated, unexpectedly, with lower short-term mortality in septic patients. However, this “protective” association was driven by those patients without ICU admission. Further studies are warranted to confirm these findings and to examine the underlying mechanisms.

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Decreased in-hospital mortality in shock patients with rheumatoid arthritis compared to those without: a retrospective analysis of a critical care database
Jin Wan, Xiaoyu Cao, Yaran Yang
Clinical Rheumatology.2025; 44(2): 615. CrossRef
LGR4 (GPR48): The Emerging Inter-Bridge in Osteoimmunology
Wonbong Lim
Biomedicines.2025; 13(3): 607. CrossRef
Genetic associations between autoimmune diseases and the risks of severe sepsis and 28-day mortality: a two-sample Mendelian randomization study
Xin Tie, Yanjie Zhao, Jing Su, Xing Liu, Tongjuan Zou, Wanhong Yin
Frontiers in Medicine.2024;[Epub] CrossRef
Evolving Paradigms in Sepsis Management: A Narrative Review
Min-Ji Kim, Eun-Joo Choi, Eun-Jung Choi
Cells.2024; 13(14): 1172. CrossRef

Epidemiology
The fourth wave: vaccination status and intensive care unit mortality at a large hospital system in New York City: Pranai Tandon, Evan Leibner, Anna Hackett, Katherine Maguire, Kayla Leonardi, Matthew A. Levin, Roopa Kohli-Seth; Acute Crit Care. 2022;37(3):339-346. Published online August 29, 2022; DOI: https://doi.org/10.4266/acc.2022.00675

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Background
We aim to describe the demographics and outcomes of patients with severe disease with the Omicron variant. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus continues to mutate, and the availability of vaccines and boosters continue to rise, it is important to understand the health care burden of new variants. We analyze patients admitted to intensive care units (ICUs) in a large Academic Health System during New York City’s fourth surge beginning on November 27, 2021.
Methods
All patients admitted to an ICU were included in the primary analysis. Key demographics and outcomes were retrospectively compared between patients stratified by vaccination status. Univariate and multivariate logistic regression was used to identify risk factors for in-hospital mortality.
Results
In-hospital mortality for all admitted patients during the fourth wave was significantly lower than in previous waves. However, among patients requiring intensive care, in-hospital mortality was high across all levels of vaccination status. In a multivariate model older age was associated with increased in-hospital mortality, vaccination status of overdue for booster was associated with decreased in hospital mortality, and vaccination status of up-to-date with vaccination showed a trend to reduced mortality.
Conclusions
In-hospital mortality of patients with severe respiratory failure from coronavirus disease 2019 (COVID-19) remains high despite decreasing overall mortality. Vaccination against SARS-CoV-2 was protective against mortality. Vaccination remains the best and safest way to protect against serious illness and death from COVID-19. It remains unclear that any other treatment will have success in changing the natural history of the disease.

Citations

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Changing epidemiology of SARS-CoV-2 positivity rates in a diverse population of children and adults during variant evolution and progressive vaccination eligibility in New York City
Priya D. Velu, Charlene Thomas, Sophie Rand, Eddie Imada, Claudio Zanettini, Jin-Young Han, Zachary Grinspan, Erika L. Abramson, Luigi Marchionni, Melissa M. Cushing, Karen P. Acker
BMC Infectious Diseases.2025;[Epub] CrossRef
Need for ICU and outcome of critically ill patients with COVID-19 and haematological malignancies: results from the EPICOVIDEHA survey
Tobias Lahmer, Jon Salmanton-García, Francesco Marchesi, Shaimaa El-Ashwah, Marcio Nucci, Caroline Besson, Federico Itri, Ozren Jaksic, Natasha Čolović, Barbora Weinbergerová, Guldane Cengiz Seval, Tatjana Adžić-Vukičević, Tomáš Szotkowski, Uluhan Sili, M
Infection.2024; 52(3): 1125. CrossRef
Clinical outcomes of immunomodulation therapy in immunocompromised patients with severe Covid-19 and high oxygen requirement
Avigayil Goldstein, Ami Neuberger, Yazeed Qassem Darawsha, Khetam Hussein, Tali Shafat, Daniel Grupel, Jacob strahilevitz, Sarah Israel, Ariel Weil, Ronen Ben-Ami, Meital Elbaz, Ronza Najjar-Debbiny, Jihad Bishara, Amir Shlomai, Michal Landes
Scientific Reports.2024;[Epub] CrossRef
Outcomes of Elderly Patients Hospitalized with the SARS-CoV-2 Omicron B.1.1.529 Variant: A Systematic Review
Roxana Manuela Fericean, Cristian Oancea, Akash Reddy Reddyreddy, Ovidiu Rosca, Felix Bratosin, Vlad Bloanca, Cosmin Citu, Satish Alambaram, Neeharika Gayatri Vasamsetti, Catalin Dumitru
International Journal of Environmental Research and Public Health.2023; 20(3): 2150. CrossRef

Infection
Validation of presepsin measurement for mortality prediction of sepsis: a preliminary study: Seung Min Baik, Jin Park, Tae Yoon Kim, Se Hong Choi, Kyung Sook Hong; Acute Crit Care. 2022;37(4):527-532. Published online August 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00150

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Background
Sepsis and septic shock remain the leading causes of death in critically ill patients worldwide. Various biomarkers are available to determine the prognosis and therapeutic effects of sepsis. In this study, we investigated the effectiveness of presepsin as a sepsis biomarker.
Methods
Patients admitted to the intensive care unit with major or minor diagnosis of sepsis were categorized into survival and non-survival groups. The white blood cell count and serum C-reactive protein, procalcitonin, and presepsin levels were measured in all patients.
Results
The study included 40 patients (survival group, 32; non-survival group, 8; mortality rate, 20%). The maximum serum presepsin levels measured during intensive care unit admission were significantly higher in the non-survival group (median [interquartile range]: 4,205.5 pg/ml [1,155.8–10,094.0] vs. 741.5 pg/ml [520.0–1,317.5], P<0.05). No statistically significant intergroup differences were observed in the maximum, minimum, and mean values of the white blood cell count, as well as serum C-reactive protein, and procalcitonin levels. Based on the receiver operating characteristic curve, the area under the curve for presepsin as a predictor of sepsis mortality was 0.764. At a cut-off value of 1,898.5 pg/ml, the sensitivity and specificity of presepsin for prediction of sepsis-induced mortality were 75.0% and 87.5%, respectively.
Conclusions
Early diagnosis of sepsis and prediction of sepsis-induced mortality are important for prompt initiation of treatment. Presepsin may serve as an effective biomarker for prediction of sepsis-induced mortality and for evaluation of treatment effectiveness.

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Efficacy of anakinra in reducing progression to organ dysfunction in patients with pneumonia (INSPIRE): a randomised, double-blind, placebo-controlled, phase IIa trial
Georgios Tavoulareas, Olga Kontakou-Zoniou, Nikolaos Antonakos, Elisavet Tasouli, George Adamis, Nikolaos Kakavoulis, Evangelos Michelakis, Ilias Skopelitis, Konstantina Dakou, Christos Psarrakis, Panagiotis Koufargyris, Myrto Astriti, Styliani Sympardi,
The Lancet Regional Health - Europe.2026; 62: 101573. CrossRef
Impact of nutrition‐related laboratory tests on mortality of patients who are critically ill using artificial intelligence: A focus on trace elements, vitamins, and cholesterol
Dong Jin Park, Seung Min Baik, Hanyoung Lee, Hoonsung Park, Jae‐Myeong Lee
Nutrition in Clinical Practice.2025; 40(3): 723. CrossRef
Predicting outcomes in patients with sepsis-associated encephalopathy using prefrontal functional connectivity analysis
Tae Jung Kim, Jae-Myoung Kim, Ji Sung Lee, Soo-Hyun Park, Jihyun Cha, Hyeon-Min Bae, Sang-Bae Ko
Scientific Reports.2025;[Epub] CrossRef
The Prognostic Utility of Pathophysiologically Distinct Biomarkers for Renal Outcomes in Sepsis: A Prospective ICU Cohort Study
Mert Canbaz, Günseli Orhun, Özlem Polat, İlkay Anaklı, Abdurrahman Fatih Aydın, Serhat Kılınç, Perihan Ergin Özcan, Figen Esen
Journal of Clinical Medicine.2025; 14(15): 5370. CrossRef
Prognostic value of laboratory markers and clinical scores for mortality in intensive care unit patients with sepsis
So-yun Kim, Dukki Kim, Hyekyeong Ju, Song I. Lee, Ying Amanda Wang
PLOS One.2025; 20(12): e0337396. CrossRef
Development and external validation of an artificial intelligence model for predicting mortality and prolonged ICU stay in postoperative critically ill patients: a retrospective study
Dong Jin Park, Seung Min Baik, Kyung Sook Hong, Heejung Yi, Jae Gil Lee, Jae-Myeong Lee
World Journal of Emergency Surgery.2025;[Epub] CrossRef
The Potential Role of Presepsin in Predicting Severe Infection in Patients with Diabetic Foot Ulcers
Eun Yeong Ha, Il Rae Park, Seung Min Chung, Young Nam Roh, Chul Hyun Park, Tae-Gon Kim, Woong Kim, Jun Sung Moon
Journal of Clinical Medicine.2024; 13(8): 2311. CrossRef
Combined estimation of presepsin and gelsolin might improve the diagnostic validity of clinical scoring to predict and stratify sepsis in non-sepsis surgical ICU patient
Hany A. Shehab, Ahmed M Eid, Yehya Shahin Dabour
Egyptian Journal of Anaesthesia.2024; 40(1): 262. CrossRef

CPR/Resuscitation
Association between C-reactive protein-to-albumin ratio and 6-month mortality in out-of-hospital cardiac arrest: Hui Hwan Kim, Ji Ho Lee, Dong Hun Lee, Byung Kook Lee; Acute Crit Care. 2022;37(4):601-609. Published online August 18, 2022; DOI: https://doi.org/10.4266/acc.2022.00542

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Background
The inflammatory response that occurs following cardiac arrest can determine the long-term prognosis of patients who survive out-of-hospital cardiac arrest. We evaluated the correlation between C-reactive protein-to-albumin ratio (CAR) following cardiac arrest and long-term mortality.
Methods
The current retrospective observational study examined patients with post-cardiac arrest syndrome (PCAS) treated with targeted temperature management at a single tertiary care hospital. We measured CAR at four time points (at admission and then 24 hours, 48 hours, and 72 hours after) following cardiac arrest. The primary outcome was the patients’ 6-month mortality. We performed multivariable and area under the receiver operating characteristic curve (AUC) analyses to investigate the relationship between CAR and 6-month mortality.
Results
Among the 115 patients, 52 (44.1%) died within 6 months. In the multivariable analysis, CAR at 48 hours (odds ratio [OR], 1.130; 95% confidence interval [CI], 1.027–1.244) and 72 hours (OR, 1.241; 95% CI, 1.059–1.455) after cardiac arrest was independently associated with 6-month mortality. The AUCs of CAR at admission and 24, 48, and 72 hours after cardiac arrest for predicting 6-month mortality were 0.583 (95% CI, 0.489–0.673), 0.622 (95% CI, 0.528–0.710), 0.706 (95% CI, 0.615–0.786), and 0.762 (95% CI, 0.675–0.835), respectively.
Conclusions
CAR at 72 hours after cardiac arrest was an independent predictor for long-term mortality in patients with PCAS.

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C-reactive protein-to-albumin ratio is associated with mortality after transcatheter tricuspid valve repair
Karl Finke, Laura Marx, Jan Althoff, Thorsten Gietzen, Matthieu Schäfer, Jan Wrobel, Philipp von Stein, Jennifer von Stein, Maria Isabel Körber, Stephan Baldus, Roman Pfister, Christos Iliadis
Clinical Research in Cardiology.2025; 114(7): 892. CrossRef
Biomarkers in Cardiac Arrest: A Narrative Review
Rohin Singla, Chelsey Sidaras, Jignesh K. Patel
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Association of the blood urea nitrogen to serum albumin ratio and 28-day all-cause mortality in patients with cardiac arrest: a retrospective cohort study using the MIMIC-IV database
Gaosheng Zhou, Yayuan Tan, Xueli Li, Yixun Wang, Dingdeng Wang, Min Liu
Frontiers in Cardiovascular Medicine.2025;[Epub] CrossRef
Associations of C-reactive protein/albumin ratio with frailty and the risk of mortality: An observational study
Yaying Xu, Peng Tian, Ying Xu
Medicine.2025; 104(43): e45329. CrossRef
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Ji Ho Lee, Dong Hun Lee, Byung Kook Lee, Seok Jin Ryu
World Journal of Emergency Medicine.2024; 15(3): 223. CrossRef
Inflammatory response after out‐of‐hospital cardiac arrest—Impact on outcome and organ failure development
Asser M. J. Seppä, Markus B. Skrifvars, Pirkka T. Pekkarinen
Acta Anaesthesiologica Scandinavica.2023; 67(9): 1273. CrossRef
Comparison of Prognostic Performance between Procalcitonin and Procalcitonin-to-Albumin Ratio in Post Cardiac Arrest Syndrome
Ju Hee Yoon, Woo Sung Choi, Yong Su Lim, Jae Ho Jang
Journal of Clinical Medicine.2023; 12(14): 4568. CrossRef
C-reactive protein-to-albumin ratio as a biomarker in patients with sepsis: a novel LASSO-COX based prognostic nomogram
Xin Zhou, Shouzhi Fu, Yisi Wu, Zhenhui Guo, Wankang Dian, Huibin Sun, Youxia Liao
Scientific Reports.2023;[Epub] CrossRef

Trauma
C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury: Canan Gürsoy, Güven Gürsoy, Semra Gümüş Demirbilek; Acute Crit Care. 2022;37(3):462-467. Published online August 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00052

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Background
Prediction of intensive care unit (ICU) mortality in traumatic brain injury (TBI), which is a common cause of death in children and young adults, is important for injury management. Neuroinflammation is responsible for both primary and secondary brain injury, and C-reactive protein-albumin ratio (CAR) has allowed use of biomarkers such as procalcitonin (PCT) in predicting mortality. Here, we compared the performance of CAR and PCT in predicting ICU mortality in TBI.
Methods
Adults with TBI were enrolled in our study. The medical records of 82 isolated TBI patients were reviewed retrospectively.
Results
The mean patient age was 49.0 ± 22.69 years; 59 of all patients (72%) were discharged, and 23 (28%) died. There was a statistically significant difference between PCT and CAR values according to mortality (P<0.05). The area under the curve (AUC) was 0.646 with 0.071 standard error for PCT and 0.642 with 0.066 standard error for CAR. The PCT showed a similar AUC of the receiver operating characteristic to CAR.
Conclusions
This study shows that CAR and PCT are usable biomarkers to predict ICU mortality in TBI. When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers will provide more effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.

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Performance and accuracy of blood glucose and neutrophil-lymphocyte ratio as predictors of mortality in children and adolescents with traumatic brain injury
José Roberto Tude Melo, Caio Vinicius de Almeida Chaves, Cindy Kawano, Isabela Zampirolli Leal, Maria Antonia Coladeti Fernandes, Stephannie Monaco Bodra, Jean Gonçalves de Oliveira, José Carlos Esteves Veiga
Child's Nervous System.2026;[Epub] CrossRef
Prognostic value of CAR, FIB-4, and procalcitonin in subdural hematoma: associations with mortality and 90-day functional outcomes running title: CAR, FIB-4, and procalcitonin in SDH outcomes
Tamer Tamdoğan, İlke Tamdoğan
Journal of Health Sciences and Medicine.2026; 9(1): 19. CrossRef
One-Year Mortality After Percutaneous Endoscopic Gastrostomy: The Prognostic Role of Nutritional Biomarkers and Care Settings
Nermin Mutlu Bilgiç, Güldan Kahveci, Ekmel Burak Özşenel, Sema Basat
Nutrients.2025; 17(5): 904. CrossRef
Elevation of C-reactive protein and homocysteine levels as reliable biomarkers for assessing injury severity and prognosis in traumatic brain injury
Zi-Yan Wang, Wei Du, Xian-Zhi Liu, Yuan Li, Jun Liu
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Prognostic value of procalcitonin and IL-6 with a composite model in moderate-severe traumatic brain injury
Xin-meng Li, Zi-wei Liu, Wei-yu Liu, Gao-jian Su, Xian-jian Huang
Journal of Clinical Neuroscience.2025; 140: 111516. CrossRef
Development and validation of a prediction model for pulmonary infection in elderly patients with traumatic brain injury
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Albuminemia as a Potential Predictor of Clinical Outcomes in Patients with Severe Traumatic Brain Injury (TBI)
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Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury
Kathryn S. Gerber, Gemayaret Alvarez, Arsham Alamian, Victoria Behar-Zusman, Charles A. Downs
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Epidemiology
Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit: Song-I Lee, Younsuck Koh, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim; Acute Crit Care. 2022;37(3):372-381. Published online August 4, 2022; DOI: https://doi.org/10.4266/acc.2022.00066

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Background
Korea is rapidly becoming a super aging society and is facing the increased burden of critical care for the elderly people. Traditionally, far-advanced age has been regarded as a triage criterion for intensive care unit (ICU) admission. We evaluated how the characteristics and prognostic factors of very elderly patients (≥85 years) admitted to the ICU changed over the last decade.
Methods
We retrospectively evaluated the data of patients admitted to the ICU over 11 years (2007–2017). The clinical characteristics and outcomes of the very elderly-patients group were evaluated. Factors associated with mortality were assessed by a cox regression analysis.
Results
Comparing the first half (2007–2012) and the second half (2013–2017) of the study period, the proportion of very elderly group increased from 603/47,657 (1.3%), to 697/37,756 (1.8%) (P<0.001). Among 1,294 very elderly patients, 1,274 patients were analyzed excluding hopeless discharge (n=20). The non-surgical reasons for ICU admission (67.0% vs. 76.1%, P<0.001) and the percentage of patients with co-morbidities (78.3% vs. 82.7%, P=0.048) were increased. Nevertheless, the hospital mortality decreased (21.3% vs. 14.9%, P=0.001). High creatinine levels, use of vasopressors and ventilator weaning failure were associated with in-hospital mortality.
Conclusions
The proportion of very elderly people in the ICU increased over the last decade. The non-surgical causes of ICU admission increased compared with the surgical causes. Despite an increasement in ICU admissions of very elderly patients, in-hospital mortality of very elderly ICU patients decreased.

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Epidemiology
Clinical implications of discrepancies in predicting pediatric mortality between Pediatric Index of Mortality 3 and Pediatric Logistic Organ Dysfunction-2: Eui Jun Lee, Bongjin Lee, You Sun Kim, Yu Hyeon Choi, Young Ho Kwak, June Dong Park; Acute Crit Care. 2022;37(3):454-461. Published online July 29, 2022; DOI: https://doi.org/10.4266/acc.2021.01480

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Background
Pediatric Index of Mortality 3 (PIM 3) and Pediatric Logistic Organ Dysfunction-2 (PELOD-2) are validated tools for predicting mortality in children. Research suggests that these tools may have different predictive performance depending on patient group characteristics. Therefore, we designed this study to identify the factors that make the mortality rates predicted by the tools different.
Methods
This retrospective study included patients (<18 years) who were admitted to a pediatric intensive care unit from July 2017 to May 2019. After defining the predicted mortality of PIM 3 minus the predicted mortality rate of PELOD-2 as “difference in mortality prediction,” the clinical characteristics significantly related to this were analyzed using multivariable regression analysis. Predictive performance was analyzed through the Hosmer-Lemeshow test and area under the receiver operating characteristic curve (AUROC).
Results
In total, 945 patients (median [interquartile range] age, 3.0 [0.0–8.0] years; girls, 44.7%) were analyzed. The Hosmer-Lemeshow test revealed AUROCs of 0.889 (χ2=10.187, P=0.313) and 0.731 (χ2=6.220, P=0.183) of PIM 3 and PELOD-2, respectively. Multivariable linear regression analysis revealed that oxygen saturation, partial pressure of CO2, base excess, platelet counts, and blood urea nitrogen levels were significant factors. Patient condition-related factors such as cardiac bypass surgery, seizures, cardiomyopathy or myocarditis, necrotizing enterocolitis, cardiac arrest, leukemia or lymphoma after the first induction, bone marrow transplantation, and liver failure were significantly related (P<0.001).
Conclusions
Both tools predicted observed mortality well; however, caution is needed in interpretation as they may show different prediction results in relation to specific clinical characteristics.

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Characteristics and outcomes in severe and critically ill children with first wave SARS-CoV-2 Omicron infection in Northeast China
Tingting Sun, Yunhan He, Zeyu Wang, Lijie Wang, Chunfeng Liu, Wei Xu, Kai You
Frontiers in Cellular and Infection Microbiology.2025;[Epub] CrossRef
COMPARISON OF PEDIATRIC INDEX OF MORTALITY (PIM)-3 AND PEDIATRIC SEQUENTIAL ORGAN FAILURE ASSESSMENT (pSOFA) SCORES TO PREDICT MORTALITY IN PEDIATRIC INTENSIVE CARE UNIT
ANKIT KUMAR PAWAR, GAURAV KUMAR PRAJAPATI, KANCHAN CHOUBEY, RASHMI RANDA
Asian Journal of Pharmaceutical and Clinical Research.2024; : 81. CrossRef

Infection
In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19: Yong Sub Na, Jin Hyoung Kim, Moon Seong Baek, Won-Young Kim, Ae-Rin Baek, Bo young Lee, Gil Myeong Seong, Song-I Lee; Acute Crit Care. 2022;37(3):303-311. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00017

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Background
Elderly patients with coronavirus disease 2019 (COVID-19) have a high disease severity and mortality. However, the use of the frailty scale and severity score to predict in-hospital mortality in the elderly is not well established. Therefore, in this study, we investigated the use of these scores in COVID-19 cases in the elderly.
Methods
This multicenter retrospective study included severe COVID-19 patients admitted to seven hospitals in Republic of Korea from February 2020 to February 2021. We evaluated patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II score; confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) score; modified early warning score (MEWS); Sequential Organ Failure Assessment (SOFA) score; clinical frailty scale (CFS) score; and Charlson comorbidity index (CCI). We evaluated the predictive value using receiver operating characteristic (ROC) curve analysis.
Results
The study included 318 elderly patients with severe COVID-19 of whom 237 (74.5%) were survivors and 81 (25.5%) were non-survivors. The non-survivor group was older and had more comorbidities than the survivor group. The CFS, CCI, APACHE II, SOFA, CURB-65, and MEWS scores were higher in the non-survivor group than in the survivor group. When analyzed using the ROC curve, SOFA score showed the best performance in predicting the prognosis of elderly patients (area under the curve=0.766, P<0.001). CFS and SOFA scores were associated with in-hospital mortality in the multivariate analysis.
Conclusions
The SOFA score is an efficient tool for assessing in-hospital mortality in elderly patients with severe COVID-19.

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Infection
Comparison of critically ill COVID-19 and influenza patients with acute respiratory failure: Mehmet Yildirim, Burcin Halacli, Mehmet Yasir Pektezel, Berrin Er, Ismail Tuna Geldigitti, Gulay Tok, Ebru Ortac Ersoy, Arzu Topeli; Acute Crit Care. 2022;37(2):168-176. Published online March 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00920

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Background
Coronavirus disease 2019 (COVID-19) is one of the biggest pandemic causing acute respiratory failure (ARF) in the last century. Seasonal influenza carries high mortality, as well. The aim of this study was to compare features and outcomes of critically-ill COVID-19 and influenza patients with ARF.
Methods
Patients with COVID-19 and influenza admitted to intensive care unit with ARF were retrospectively analyzed.
Results
Fifty-four COVID-19 and 55 influenza patients with ARF were studied. Patients with COVID-19 had 32% of hospital mortality, while those with influenza had 47% (P=0.09). Patients with influenza had higher Eastern Cooperative Oncology Group, Clinical Frailty Scale, Acute Physiology and Chronic Health Evaluation II and admission Sequential Organ Failure Assessment (SOFA) scores than COVID-19 patients (P<0.01). Secondary bacterial infection, admission acute kidney injury, procalcitonin level above 0.2 ng/ml were the independent factors distinguishing influenza from COVID-19 while prone positioning differentiated COVID-19 from influenza. Invasive mechanical ventilation (odds ratio [OR], 42.16; 95% confidence interval [CI], 9.45–187.97), admission SOFA score more than 4 (OR, 5.92; 95% CI, 1.85–18.92), malignancy (OR, 4.95; 95% CI, 1.13–21.60), and age more than 65 years (OR, 3.31; 95% CI, 0.99–11.03) were found to be independent risk factors for hospital mortality.
Conclusions
There were few differences in clinical features of critically-ill COVID-19 and influenza patients. Influenza cases had worse performance status and disease severity. There was no significant difference in hospital mortality rates between COVID-19 and influenza patients.

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Narrative review of factors associated with SARS-CoV-2 coinfection in Middle Eastern countries and the need to vaccinate against preventable diseases
Majid Alshamrani, Fayssal Farahat, Ali Albarrak, Aiman El-Saed, Atef M. Shibl, Ziad A. Memish, Mostafa Mousa, Hammam Haridy, Abdulhakeem Althaqafi
Journal of Infection and Public Health.2025; 18(1): 102600. CrossRef
Differences in clinical characteristics between coronavirus disease 2019 (COVID-19) and influenza: a systematic review and meta-analysis
Yingying Han, Jia Guo, Xingzhao Li, Zhuan Zhong
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Global geographic and socioeconomic disparities in COVID-associated acute kidney injury: a systematic review and meta-analysis
Danyang Dai, Pedro Franca Gois, Digby Simpson, Souhayel Hedfi, Sally Shrapnel, Jason Donald Pole
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Comparison of Clinical Characteristics and Outcomes in Intensive Care Units Between Patients with Coronavirus Disease 2019 (COVID-19) and Patients with Influenza: A Systematic Review and Meta-Analysis
Zhuan Zhong, Xin Wang, Jia Guo, Xingzhao Li, Yingying Han
Journal of Intensive Care Medicine.2024; 39(9): 840. CrossRef
Association between PaO2/(FiO2*PEEP) ratio and in-hospital mortality in COVID-19 patients: A reanalysis of published data from Peru using PaO2/(FiO2*PEEP) ratio in place of PaO2/FaO2 ratio
Youli Chen, Huangen Li, Jinhuang Lin, Zhiwei Su, Tianlai Lin
Medicine.2024; 103(40): e39931. CrossRef
Acute kidney injury in patients with COVID-19 compared to those with influenza: a systematic review and meta-analysis
Chiu-Ying Hsiao, Heng-Chih Pan, Vin-Cent Wu, Ching-Chun Su, Tzu-Hsuan Yeh, Min-Hsiang Chuang, Kuan-Chieh Tu, Hsien-Yi Wang, Wei-Chih Kan, Chun-Chi Yang, Jui-Yi Chen
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Manbong Heo, Jong Hwan Jeong, Sunmi Ju, Seung Jun Lee, Yi Yeong Jeong, Jong Deog Lee, Jung-Wan Yoo
Journal of Clinical Medicine.2022; 11(8): 2246. CrossRef

Pulmonary/Policy
Association between the National Health Insurance coverage benefit extension policy and clinical outcomes of ventilated patients: a retrospective study: Wanho Yoo, Saerom Kim, Soohan Kim, Eunsuk Jeong, Kwangha Lee; Acute Crit Care. 2022;37(1):53-60. Published online February 22, 2022; DOI: https://doi.org/10.4266/acc.2021.01389

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Abstract PDF

Background
This study aimed to investigate the association between the Korean National Health Insurance coverage benefit extension policy and clinical outcomes of patients who were ventilated owing to various respiratory diseases.
Methods
Data from 515 patients (male, 69.7%; mean age, 69.8±12.1 years; in-hospital mortality rate, 28.3%) who were hospitalized in a respiratory intensive care unit were retrospectively analyzed over 5 years.
Results
Of total enrolled patients, 356 (69.1%) had one benefit items under this policy during their hospital stay. They had significantly higher medical expenditure (total: median, 23,683 vs. 12,742 U.S. dollars [USD], P<0.001), out-of-pocket (median, 5,932 vs. 4,081 USD; P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (median, 26.0% vs. 32.2%; P<0.001). Patients without benefit items associated with higher in-hospital mortality (hazard ratio [HR], 2.794; 95% confidence interval [CI], 1.980–3.941; P<0.001). In analysis of patients with benefit items, patients with three items (“cancer,” “tuberculosis,” and “disability”) had significantly lower out-of-pocket medical expenditure (3,441 vs. 6,517 USD, P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (17.2% vs. 27.7%, P<0.001). They were associated with higher in-hospital mortality (HR, 3.904; 95% CI, 2.533–6.039; P<0.001).
Conclusions
Our study showed patients with benefit items had more medical resources and associated improved in-hospital survival. Patients with the aforementioned three benefit items had lower out-of-pocket medical expenditure due to the implementation of this policy, but higher in-hospital mortality.

Citations

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Association between health insurance benefit extension policy and long-term outcomes in ventilated pneumonia patients: Analysis of a nationwide dataset
Wanho Yoo, Hyojin Jang, Min Ki Lee, Yeongdae Kim, Son Jungmin, Kim Jinmi, Kwangha Lee
Medicine.2025; 104(38): e44687. CrossRef
The effect of socioeconomic status, insurance status, and insurance coverage benefits on mortality in critically ill patients admitted to the intensive care unit
Moo Suk Park
Acute and Critical Care.2022; 37(1): 118. CrossRef

Infection
Incidence and risk factors associated with early death in patients with emergency department septic shock: Matthew S. Reaven, Nigel L. Rozario, Maggie S. J. McCarter, Alan C. Heffner; Acute Crit Care. 2022;37(2):193-201. Published online February 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00857

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Abstract PDF

Background
Limited research has explored early mortality among patients presenting with septic shock. The objective of this study was to determine the incidence and factors associated with early death following emergency department (ED) presentation of septic shock.
Methods
A prospective registry of patients enrolled in an ED septic shock clinical pathway was used to identify patients. Patients were compared across demographic, comorbid, clinical, and treatment variables by death within 72 hours of ED presentation.
Results
Among the sample of 2,414 patients, overall hospital mortality was 20.6%. Among patients who died in the hospital, mean and median time from ED presentation to death were 4.96 days and 2.28 days, respectively. Death at 24, 48, and 72 hours occurred in 5.5%, 9.5%, and 11.5% of patients, respectively. Multivariate regression analysis demonstrated that the following factors were independently associated with early mortality: age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03–1.05), malignancy (OR, 1.53; 95% CI, 1.11–2.11), pneumonia (OR, 1.39; 95% CI, 1.02–1.88), urinary tract infection (OR, 0.63; 95% CI, 0.44–0.89), first shock index (OR, 1.85; 95% CI, 1.27–2.70), early vasopressor use (OR, 2.16; 95% CI, 1.60–2.92), initial international normalized ratio (OR, 1.14; 95% CI, 1.07–1.27), initial albumin (OR, 0.55; 95% CI, 0.44–0.69), and first serum lactate (OR, 1.21; 95% CI, 1.16–1.26).
Conclusions
Adult septic shock patients experience a high rate of early mortality within 72 hours of ED arrival. Recognizable clinical factors may aid the identification of patients at risk of early death.

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Ji Han Heo, Taegyun Kim, Tae Gun Shin, Gil Joon Suh, Woon Yong Kwon, Hayoung Kim, Heesu Park, Heejun Kim, Sol Han
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Ugo Giulio Sisto, Stefano Di Bella, Elisa Porta, Giorgia Franzoi, Franco Cominotto, Elena Guzzardi, Nicola Artusi, Caterina Anna Giudice, Eugenia Dal Bo, Nicholas Collot, Francesca Sirianni, Savino Russo, Gianfranco Sanson
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Chiwon Ahn, Gina Yu, Tae Gun Shin, Youngsuk Cho, Sunghoon Park, Gee Young Suh
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Qiong Ding, Yingjie Su, Changluo Li, Ning Ding
International Journal of Laboratory Hematology.2022; 44(5): 861. CrossRef

Infection
Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock: Surat Tongyoo, Kamonlawat Sutthipool, Tanuwong Viarasilpa, Chairat Permpikul; Acute Crit Care. 2022;37(1):108-117. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00332

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Abstract PDF Supplementary Material

Background
In septic shock patients with cirrhosis, impaired liver function might decrease lactate elimination and produce a higher lactate level. This study investigated differences in initial lactate, lactate clearance, and lactate utility between cirrhotic and non-cirrhotic septic shock patients.
Methods
This is a retrospective cohort study conducted at a referral, university-affiliated medical center. We enrolled adults admitted during 2012–2018 who satisfied the septic shock diagnostic criteria of the Surviving Sepsis Campaign: 2012. Patients previously diagnosed with cirrhosis by an imaging modality were classified into the cirrhosis group. The initial lactate levels and levels 6 hours after resuscitation were measured and used to calculate lactate clearance. We compared initial lactate, lactate at 6 hours, and lactate clearance between the cirrhosis and non-cirrhosis groups. The primary outcome was in-hospital mortality.
Results
Overall 777 patients were enrolled, of whom 91 had previously been diagnosed with cirrhosis. Initial lactate and lactate at 6 hours were both significantly higher in cirrhosis patients, but there was no difference between the groups in lactate clearance. A receiver operating characteristic curve analysis for predictors of in-hospital mortality revealed cut-off values for initial lactate, lactate at 6 hours, and lactate clearance of >4 mmol/L, >2 mmol/L, and <10%, respectively, among non-cirrhosis patients. Among patients with cirrhosis, the cut-off values predicting in-hospital mortality were >5 mmol/L, >5 mmol/L, and <20%, respectively. Neither lactate level nor lactate clearance was an independent risk factor for in-hospital mortality among cirrhotic and non-cirrhotic septic shock patients.
Conclusions
The initial lactate level and lactate at 6 hours were significantly higher in cirrhosis patients than in non-cirrhosis patients.

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Serum lactate and mean arterial pressure thresholds in patients with cirrhosis and septic shock
Thomas N. Smith, Chansong Choi, Puru Rattan, Laura Piccolo Serafim, Blake A. Kassmeyer, Ryan J. Lennon, Ognjen Gajic, Jody C. Olson, Patrick S. Kamath, Alice Gallo De Moraes, Douglas A. Simonetto
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Hye Sung Kim, Gyeo Ra Lee, Eun Young Kim
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Epidemiology
Prognostic factors of pediatric hematopoietic stem cell transplantation recipients admitted to the pediatric intensive care unit: Da Hyun Kim, Eun Ju Ha, Seong Jong Park, Kyung-Nam Koh, Hyery Kim, Ho Joon Im, Won Kyoung Jhang; Acute Crit Care. 2021;36(4):380-387. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2020.01193

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Background
Pediatric patients who received hematopoietic stem cell transplantation (HSCT) tend to have high morbidity and mortality. While, the prognostic factors of adult patients received bone marrow transplantation were already known, there is little known in pediatric pateints. This study aimed to identify the prognostic factor for pediatric intensive care unit (PICU) mortality of critically ill pediatric patients with HSCT.
Method
Retrospectively reviewed that the medical records of patients who received HSCT and admitted to PICU between January 2010 and December 2019. Mortality was defined a patient who expired within 28 days.
Results
A total of 131 patients were included. There were 63 boys (48.1%) and median age was 11 years (interquartile range, 0–20 years). The most common HSCT type was haploidentical (38.9%) and respiratory failure (44.3%) was the most common reason for PICU admission. Twenty-eight–day mortality was 22.1% (29/131). In comparison between survivors and non-survivors, the number of HSCT received, sepsis, oncological pediatric risk of mortality-III (OPRISM-III), PRISM-III, pediatric sequential organ failure assessment (pSOFA), serum lactate, B-type natriuretic peptide (BNP) and use of mechanical ventilator (MV) and vasoactive inotropics were significant predictors (p<0.05 for all variables). In multivariate logistic regression, number of HSCT received, use of MV, OPRISM-III, PRISM-III and pSOFA were independent risk factors of PICU mortality. Moreover, three scoring systems were significant prognostic factors of 28-day mortality.
Conclusions
The number of HSCT received and use of MV were more accurate predictors in pediatric patients received HSCT.

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Emel Uyar, Gamze Gürsoy, İkbal Ok Bozkaya, Esra Koçkuzu, Serhat Emeksiz, Özlem Arman Bilir, Namık Yaşar Özbek
Pediatric Transplantation.2025;[Epub] CrossRef
Early predictors of mortality in pediatric hematology-oncology patients admitted to the intensive care unit: a retrospective cohort study
Wonjin Jang, Bongjin Lee, You Sun Kim, Yonghyuk Jeon, Chunggang Jung, June Dong Park
Archives of Pediatric Critical Care.2025; 3(2): 80. CrossRef
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Rubén E. Lasso-Palomino, Diego Medina, Alexis Antonio Franco, María José Soto-Aparicio, Eliana Manzi Tarapues, Diana Marcela Muñoz, Edgar Salazar, Jhon López, Angela Devia, Sofía Martínez-Betancur, Jimena Sierra, Anita V. Arias, Inés Elvira Gómez
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Optimum Frequency for Physical Therapy Intervention in Pediatric Patients Undergoing Bone Marrow Transplantation in Acute Care Settings: A Systematic Review
Abigail Myers, Hallie Lenker, Rachel Reoli
Rehabilitation Oncology.2024; 42(4): 164. CrossRef
Elevation of NT-proBNP Levels in Pediatric and Young Adult Hematopoietic Stem Cell Transplant Patients with Endotheliopathy
Kimberly Uchida, Xiaomeng Yuan, Jennifer McArthur, Rebekah Lassiter, Haitao Pan, Dinesh Keerthi, Katherine Tsai, Yvonne Avent, Melissa Hines, Hugo R. Martinez, Amr Qudeimat, Saad Ghafoor
Pediatric Reports.2024; 16(4): 934. CrossRef
Prognostic factors and predictive scores for 6-months mortality of hematopoietic stem cell transplantation recipients admitted to the pediatric intensive care unit
Sarah Schober, Silke Huber, Norbert Braun, Michaela Döring, Peter Lang, Michael Hofbeck, Felix Neunhoeffer, Hanna Renk
Frontiers in Oncology.2023;[Epub] CrossRef
Survival Outcomes of Pediatric Hematopoietic Stem Cell Transplant Patients Admitted to the Intensive Care Unit
Lujain Talib Aljudaibi, Mohamed Salaheldin Bayoumy, Hassan A. Altrabolsi, Abdullah M. Alzaydi, Nawaf Aldajani, Nadia Hammad, Ismail Alzahrani, Marwa Elhadidy, Ibraheem F. Abosoudah
Journal of Applied Hematology.2022; 13(4): 192. CrossRef

Nephrology
COVID-19–induced acute kidney injury in critically ill patients: epidemiology, risk factors, and outcome: Ahlem Trifi, Sami Abdellatif, Yosri Masseoudi, Asma Mehdi, Oussama Benjima, Eya Seghir, Fatma Cherif, Yosr Touil, Bedis Jeribi, Foued Daly, Cyrine Abdennebi, Adel Ammous, Salah Ben Lakhal; Acute Crit Care. 2021;36(4):308-316. Published online November 22, 2021; DOI: https://doi.org/10.4266/acc.2021.00934

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Abstract PDF

Background
The kidney represents a potential target for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Acute kidney injury (AKI) can occur through several mechanisms and includes intrinsic tissue injury by direct viral invasion. Clinical data about the clinical course of AKI are lacking. We aimed to investigate the proportion, risk factors, and prognosis of AKI in critical patients affected with coronavirus disease 2019 (COVID-19).
Methods
A case/control study conducted in two intensive care units of a tertiary teaching hospital from September to December 2020.
Results
Among 109 patients, 75 were male (69%), and the median age was 64 years (interquartile range [IQR], 57–71 years); 48 (44%) developed AKI within 4 days (IQR, 1–9). Of these 48 patients, 11 (23%), 9 (19%), and 28 (58%) were classified as stage 1, 2, and 3, respectively. Eight patients received renal replacement therapy. AKI patients were older and had more frequent sepsis, acute respiratory distress syndrome, and rhabdomyolysis; higher initial urea and creatinine; more marked inflammatory syndrome and hematological disorders; and required more frequent mechanical ventilation and vasopressors. An elevated level of D-dimers (odds ratio [OR], 12.83; 95% confidence interval [CI], 1.9–85) was an independent factor of AKI. Sepsis was near to significance (OR, 5.22; 95% CI, 0.94–28; P=0.058). Renal recovery was identified in three patients. AKI, hypoxemia with the ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen <70, and vasopressors were identified as mortality factors.
Conclusions
AKI occurred in almost half the patients with critical COVID-19. A high level of D-dimers and sepsis contributed significantly to its development. AKI significantly worsened the prognosis in these patients.

Citations

Citations to this article as recorded by

Development of laboratory-based risk scores to predict mortality in patients hospitalized with COVID-19
Mackenzie Scott, Olga Vishnyakova, Lloyd T. Elliott, Gregory Morgan, Selina Casalino, Erika Frangione, Elisa Lapadula, Simona Haller, Shilpa Thakur, Zeeshan Khan, Iris Wong, Romina Nomigolzar, Georgia MacDonald, Saranya Arnoldo, Erin Bearss, Alexandra Bin
LabMed Discovery.2025; 2(4): 100087. CrossRef
Rising deaths due to sepsis and renal failure: a 22-year analysis of mortality trends in the US from 1999 to 2020
Shree Rath, Ahmed Hasan, Neha Waseem, Iffat Ambreen Magsi, Laiba Sultan, Pinkey Kumari, Umama Alam, Zaryab Bacha
International Urology and Nephrology.2025;[Epub] CrossRef
Acute kidney injury in adult patients with COVID-19: an integrative review
Ana Clara Alcântara Mendes Pereira, Jéssica Cristina Almeida, Beatriz Regina Lima de Aguiar, Elaine Barros Ferreira, Priscilla Roberta Silva Rocha
Acta Paulista de Enfermagem.2024;[Epub] CrossRef
Lesão renal aguda em pacientes adultos com COVID-19: revisão integrativa
Ana Clara Alcântara Mendes Pereira, Jéssica Cristina Almeida, Beatriz Regina Lima de Aguiar, Elaine Barros Ferreira, Priscilla Roberta Silva Rocha
Acta Paulista de Enfermagem.2024;[Epub] CrossRef
Clinical Features and Outcomes of Patients With COVID-19 Infection and Acute Kidney Injury Requiring Hemodialysis in an Intensive Care Unit: A Retrospective Study From a Tertiary Care Center in Eastern India
Harsh Vardhan, Megha Saigal, Shyama Shyama, Amresh Krishna
Cureus.2024;[Epub] CrossRef
Impact of COVID-19 in patients hospitalized with stress cardiomyopathy: A nationwide analysis
Adrija Hajra, Aaqib Malik, Dhrubajyoti Bandyopadhyay, Akshay Goel, Ameesh Isath, Rahul Gupta, Suraj Krishnan, Devesh Rai, Chayakrit Krittanawong, Salim S. Virani, Gregg C. Fonarow, Carl J. Lavie
Progress in Cardiovascular Diseases.2023; 76: 25. CrossRef
Prior bariatric surgery and risk of poor in-hospital outcomes in COVID-19: findings from a National Inpatient Sample
Daniel Sungku Rim, Byung Sik Kim, Kavita Sharma, Jeong-Hun Shin, Dong Wook Kim
Surgery for Obesity and Related Diseases.2023; 19(12): 1435. CrossRef
Clinical Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 Patients: A Retrospective Observational Study
Nabil Bouguezzi, Imen Ben Saida, Radhouane Toumi, Khaoula Meddeb, Emna Ennouri, Amir Bedhiafi, Dhouha Hamdi, Mohamed Boussarsar
Journal of Clinical Medicine.2023; 12(15): 5127. CrossRef
Acute Kidney Injury in Coronavirus Disease and Association with Thrombosis
Anand Narayanan, Patrick Cunningham, Malavika Mehta, Theodore Lang, Mary Hammes
American Journal of Nephrology.2023; 54(3-4): 156. CrossRef
Predictive Values of Procalcitonin and Presepsin for Acute Kidney Injury and 30-Day Hospital Mortality in Patients with COVID-19
Sin-Young Kim, Dae-Young Hong, Jong-Won Kim, Sang-O Park, Kyeong-Ryong Lee, Kwang-Je Baek
Medicina.2022; 58(6): 727. CrossRef
HYDROCORTISONE, ASCORBIC ACID, AND THIAMINE THERAPY DECREASE RENAL OXIDATIVE STRESS AND ACUTE KIDNEY INJURY IN MURINE SEPSIS
John Kim, Allan Stolarski, Qiuyang Zhang, Katherine Wee, Daniel Remick
Shock.2022; 58(5): 426. CrossRef

Pulmonary
Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome: Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali; Acute Crit Care. 2021;36(3):223-231. Published online July 30, 2021; DOI: https://doi.org/10.4266/acc.2021.00388

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120 Download
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Abstract PDF

Background
Both coronavirus disease 2019 (COVID-19) and Middle East respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, their ARDS course and characteristics have not been compared, which we evaluate in our study.
Methods
MERS patients with ARDS seen during the 2014 outbreak and COVID-19 patients with ARDS admitted between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared.
Results
Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with high Charlson comorbidity index value of 5 points (P>0.22). COVID-19 patients were older, obese, had significantly higher initial C-reactive protein (CRP), more likely to get trial of high-flow oxygen, and had delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, fraction of inspired oxygen, peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the ICU (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERS patients (P≥0.54) were very high.
Conclusions
Despite some distinctive differences between COVID-19 and MERS patients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19 patients may explain the steroid responsiveness in this population.

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Structure defining of ultrapotent neutralizing nanobodies against MERS-CoV with novel epitopes on receptor binding domain
Sen Ma, Doudou Zhang, Qiwei Wang, Linjing Zhu, Xilin Wu, Sheng Ye, Yaxin Wang, Julie Overbaugh
PLOS Pathogens.2024; 20(8): e1012438. CrossRef
Does COVID-19 Vaccine Impact the Soul? A Pre-post Vaccination Comparison of Health Care Workers’ Infection Control Practices and Perspectives
Imran Khalid, Muhammad Ali Akhtar, Manahil Imran, Maryam Imran, Musaab Ahmed Mujalli, Moayad Sami Qashqari, Abeer N Alshukairi, Amina Nisar, Tabindeh Jabeen Khalid
Infectious Diseases in Clinical Practice.2023;[Epub] CrossRef
Advances in mRNA and other vaccines against MERS-CoV
Wanbo Tai, Xiujuan Zhang, Yang Yang, Jiang Zhu, Lanying Du
Translational Research.2022; 242: 20. CrossRef

Infection
Sepsis-induced cardiomyopathy is associated with higher mortality rates in patients with sepsis: Balaram Krishna J Hanumanthu, Anika Sasidharan Nair, Adarsh Katamreddy, Jason S Gilbert, Jee Young You, Obiageli Lynda Offor, Ankit Kushwaha, Ankita Krishnan, Marzio Napolitano, Leonidas Palaidimos, Joaquin Morante, Seema S. Tekwani, Suchita Mehta, Aanchal Gupta, Harmeen Goraya, Mengyang Sun, Robert T. Faillace, Perminder Gulani; Acute Crit Care. 2021;36(3):215-222. Published online July 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00234

12,186 View
288 Download
34 Web of Science
37 Crossref

Abstract PDF

Background
Patients with sepsis are at risk for developing sepsis-induced cardiomyopathy (SIC). Previous studies offer inconsistent results regarding the association of SIC and mortality. This study sought to assess whether SIC is linked to mortality in patients with sepsis and to evaluate predictors of the development of SIC.
Methods
In this retrospective study, patients admitted to the medical intensive care unit with a diagnosis of sepsis in the absence of acute coronary syndrome were included. SIC was identified using transthoracic echo and was defined by a new onset decline in left ventricular ejection fraction (LVEF) ≤50%, or ≥10% decline in LVEF compared to baseline in patients with a history of heart failure with reduced ejection fraction. Multivariable logistic regression analysis was performed using the R software program.
Results
Of the 359 patients in the final analysis, 19 (5.3%) had SIC. Eight (42.1%) of the 19 patients in the SIC group and 60 (17.6%) of the 340 patients in the non-SIC group died during hospitalization. SIC was associated with an increased risk for all-cause in-hospital mortality (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.15–18.69; P=0.03). Independent predictors for the development of SIC were albumin level (OR, 0.47; 95% CI, 0.23–0.93; P=0.03) and culture positivity (OR, 8.47; 95% CI, 2.24–55.61; P=0.006). Concomitant right ventricular hypokinesis was noted in 13 (68.4%) of the 19 SIC patients.
Conclusions
SIC was associated with an increased risk for all-cause in-hospital mortality. Low albumin level and culture positivity were independent predictors of SIC.

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