Acute and Critical Care

Review Article

Infection
Duration of antibiotic therapy: with or without biomarkers?: Gonçalo Sequeira Guerreiro, João Fustiga, Pedro Póvoa; Acute Crit Care. 2026;41(1):1-11. Published online December 29, 2025; DOI: https://doi.org/10.4266/acc.002525

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Abstract PDF: Antimicrobial resistance has emerged as a critical global health challenge. Significant variability in antibiotic prescribing practices underscores the urgent need for high-quality evidence to inform optimal antibiotic prescribing policies. The ideal duration of antimicrobial therapy remains uncertain, and a one-size-fits-all approach is far from ideal. In this review, we examine bacterial growth kinetics and antibiotic pharmacodynamics and explore various strategies for determining the duration of antibiotic therapy: fixed duration, biomarker-guided, clinical course–based, and the more recent double-trigger approach.

Original Articles

Trauma
Predictive value of elevated interleukin-33 levels for multi-organ dysfunction syndrome in trauma patients in South Korea: a prospective observational study: Sanghyun An, In Sik Shin, Myoung Jun Kim, Da Kyung Kim, Md Habibur Rahman, Cheol-Su Kim, Kwangmin Kim; Acute Crit Care. 2025;40(4):594-604. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.002500

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Abstract PDF Supplementary Material: Background
Multi-organ distress syndrome (MODS) causes morbidity in patients with trauma. This study evaluates the effectiveness of interleukin-33 (IL-33), which reflects tissue damage and the inflammatory response, as a MODS indicator in patients with trauma.
Methods
Patients with trauma admitted to our trauma center between July 2022 and July 2023 were included. IL-33 levels were measured in blood samples for 4 days. Correlations with clinical and laboratory indicators, including initial IL-33 levels, were analyzed to identify independent predictors of MODS.
Results
Among the 87 patients enrolled, 20 developed MODS. Initial IL-33 levels were elevated in the MODS group, compared with the non-MODS group. In the non-MODS group, IL-33 levels increased on day 1 and then declined, whereas in the MODS group, IL-33 levels were highest at admission (day 0) and decreased continuously through day 3. In patients with detectable initial IL-33 levels, the measured levels correlated with higher Abbreviated Injury Scale 5 scores and the Injury Severity Score (ISS). A logistic regression analysis revealed the ISS and delta neutrophil index as factors contributing to MODS progression.
Conclusions
The findings suggest that initial IL-33 levels are elevated in the MODS group, compared with non-MODS group, and exhibit a rapidly declining trend, showing an initial association with MODS that was not maintained in a multivariate analysis. These findings suggest that IL-33 might have relevance in assessing trauma severity; however, further validation is required before it can be considered a biomarker for MODS.

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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Abstract PDF

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.

Citations

Citations to this article as recorded by

Prognostic value and nonlinear association of the rdw/albumin ratio with mortality among COVID-19 patients: a MIMIC-IV database analysis
Ping Huang, Qiuyue Yang, Xintong Wang, Qiqi Lai, Jiannan Zhang, Kai Kang, Mingyan Zhao
BMC Infectious Diseases.2026;[Epub] CrossRef
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

Surgery
Biomarkers to predict mortality in patients with Fournier’s gangrene admitted to the intensive care unit after surgery in South Korea: In Sik Shin, Seong Chan Gong, Sanghyun An, Kwangmin Kim; Acute Crit Care. 2023;38(4):452-459. Published online November 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00766

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4 Web of Science
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Abstract PDF

Background
The use of biomarkers to predict patient outcomes may be crucial for patients admitted to the intensive care unit (ICU) following surgery because biomarkers guide clinicians in tailoring treatment plans accordingly. Therefore, we aimed to identify potential biomarkers to predict the prognosis of patients with Fournier’s gangrene (FG) admitted to the ICU after surgery.
Methods
We enrolled patients with FG admitted to our Hospital between January 2013 and December 2022. We retrospectively analyzed patient characteristics, factors related to management, scores known to be associated with the prognosis of FG, and laboratory data.
Results
The study population included 28 survivors and 13 nonsurvivors. The initial serum lactate level taken in the emergency department; white blood cell, neutrophil, and platelet counts; delta neutrophil index and international normalized ratio; albumin, glucose, HCO3, and postoperative lactate levels; and the laboratory risk indicator for necrotizing fasciitis differed between survivors and nonsurvivors. Postoperative lactate and initial albumin levels were independent predictors of mortality in patients with FG. In the receiver operating characteristic curve analysis, the postoperative lactate level was the best indicator of mortality (area under the curve, 0.877; 95% confidence interval, 0.711–1.000). The optimal cutoff postoperative lactate level for predicting mortality was 3.0 mmol/L (sensitivity, 80.0%; specificity, 95.0%).
Conclusions
Postoperative lactate and initial albumin levels could be potential predictors of mortality in patients with FG admitted to the ICU after surgery, and the optimal cutoff postoperative lactate and initial albumin levels to predict mortality were 3.0 mmol/L and 3.05 g/dl, respectively. Large-scale multicenter prospective studies are required to confirm our results.

Citations

Citations to this article as recorded by

Revolutionizing Gangrene Therapy: Nanoparticle-Based Interventions and Biomarker Applications
Elizabeth Rani Edwin, Silpa Jayaprakash, Yamuna Gopi, Praveen Madhaiyan, Punniyakoti V. Thanikachalam, Pavithra Bharathy
Biomedical Materials & Devices.2026; 4(2): 1572. CrossRef
Risk Factors for Mortality in Patients With Necrotizing Fasciitis: A Systematic Review and Meta‐Analysis
Rui Zhang, Zheng Xu, Qi Han, Guosheng Wang, Srijoni Sengupta
International Journal of Clinical Practice.2026;[Epub] CrossRef
A Retrospective Evaluation of Cases of Necrotizing Fasciitis Presenting to the Emergency Department
Gürkan Altuntaş, Mümin Murat Yazıcı, İsmail Ataş, Meryem Kaçan, Özlem Bilir
Hamidiye Medical Journal.2025; 6(2): 78. CrossRef
Integrative Management Strategies for Improved Outcomes in Fournier’s Gangrene: A Case Series Analysis from India
Awadhesh Kumar Pandey, Nasrin Habeeb, Aadithyaraj Kunnummal Thilakan, Rahul Sherkhane, Arun Kumar Dwivedi
Journal of Wound Management and Research.2025; 21(3): 148. CrossRef
Diagnostic Accuracy of Red Cell Distribution Width-Derived Indices for Predicting In-Hospital Mortality in Scrotal Fournier’s Gangrene: A Retrospective Cohort Study
Rıdvan Kayar, Kemal Kayar, İlker Artuk, Samet Demir, Emre Tokuc, Metin Öztürk
Surgical Infections.2025;[Epub] CrossRef
Predictive value of elevated interleukin-33 levels for multi-organ dysfunction syndrome in trauma patients in South Korea: a prospective observational study
Sanghyun An, In Sik Shin, Myoung Jun Kim, Da Kyung Kim, Md Habibur Rahman, Cheol-Su Kim, Kwangmin Kim
Acute and Critical Care.2025; 40(4): 594. CrossRef
Predictors of in-hospital mortality in Fournier gangrene at four Korean tertiary hospitals: a multicenter retrospective cohort study
In Sik Shin, Sung Woo Jang, Chan Hee Park, Jeong Woo Lee, Hui-Jae Bang, Kwangmin Kim
Journal of Acute Care Surgery.2025; 15(3): 99. CrossRef
Risk Factors for Mortality Among Patients With Fournier Gangrene: A Systematic Review
Pavan Shet, Ashmit Daiyan Mustafa, Karan Varshney, Lavina Rao, Sameen Sawdagar, Florence McLennan, Siraaj Ansari, Darshan Shet, Niveshan Sivathamboo, Sian Campbell
Surgical Infections.2024; 25(4): 261. 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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10 Web of Science
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Abstract PDF

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.

Citations

Citations to this article as recorded by

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
Diagnostic Accuracy of Cerebrospinal Fluid Presepsin vs. Procalcitonin in Post-Neurosurgical Bacterial Ventriculitis/Meningitis: A Machine Learning Analytical Approach
Srinivasa Sundara Rajan Radhakrishnan, Veena Kumari Haradara Bahubali, Gyani Jail Singh Birija, Dwarakanath Srinivas, Sudhir Venkataramaiah, Nanda Kumar Dalavaikodihalli Nanjaiah
Journal of Molecular Neuroscience.2026;[Epub] 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
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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
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Egyptian Journal of Anaesthesia.2024; 40(1): 262. CrossRef

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