Acute and Critical Care

Review Article

CPR/Resuscitation
Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion: Jooyun Kim, Saeyeon Kim, Ji-Hee Lee, Sua Kim; Acute Crit Care. 2026;41(2):201-212. Published online May 28, 2026; DOI: https://doi.org/10.4266/acc.003425

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Abstract PDF: Shock is a state of circulatory failure characterized by impaired tissue perfusion due to a mismatch between oxygen delivery and consumption. While macrocirculation serves as a conduit to sustain blood flow toward the microcirculatory networks, it is the microcirculation that ultimately ensures the delivery of oxygen and nutrients to maintain cellular and organ function. The maintenance of proper macrocirculation is essential, but it does not necessarily indicate adequate microcirculation or recovery from shock. Thus, assessment of the microcirculation is also required to confirm effective tissue oxygenation. A comprehensive evaluation of both circulatory levels is crucial for accurate diagnosis and prognostication in patients with shock. This review explores a diverse range of clinical, biochemical, and device-based indicators that reflect the perfusion status of patients in shock. By examining their physiological significance and clinical relevance, we aim to provide a comprehensive framework for the hemodynamic assessment of critically ill patients and support the use of multidimensional strategies in shock management.

Original Article

Nutrition
Comparative prognostic performance of nutritional assessment tools in critically ill surgical patients after emergency surgery for sepsis or septic shock: a single-center retrospective study in South Korea: Sung Bak An, Dong Woo Shin; Acute Crit Care. 2026;41(2):399-410. Published online May 28, 2026; DOI: https://doi.org/10.4266/acc.001170

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Abstract PDF: Background
Malnutrition is prevalent in critically ill patients. Although various nutritional assessment tools are used in intensive care units (ICUs), their comparative prognostic performance in critically ill surgical patients requiring postoperative ICU care after emergency surgery for sepsis or septic shock remains uncertain. We compared the performance of four tools in predicting ICU mortality. Methods: We retrospectively analyzed 218 adult critically ill surgical patients requiring postoperative ICU care after emergency surgery for sepsis or septic shock (January 2015–July 2025). Nutritional status was assessed within 24 hours of ICU admission using the Global Leadership Initiative on Malnutrition (GLIM), modified Nutrition Risk in the Critically Ill (mNUTRIC), Nutritional Risk Screening 2002 (NRS-2002), and Malnutrition Universal Screening Tool (MUST). The primary outcome was ICU mortality. Discriminative performance was evaluated using the area under the receiver operating characteristic curve and incremental value over a baseline model (age, sex, Acute Physiology and Chronic Health Evaluation [APACHE] II score, and Sequential Organ Failure Assessment [SOFA] score). Results: The mNUTRIC score showed the highest crude discrimination for ICU mortality, followed by MUST and GLIM, whereas NRS-2002 demonstrated limited discriminatory ability. When added to the baseline clinical model, MUST and GLIM improved mortality prediction, unlike mNUTRIC. Higher risk categories in MUST and GLIM were associated with increased ICU mortality. Conclusions: Prognostic performance varies among nutritional assessment tools. MUST and GLIM provide prognostic information beyond conventional severity scores, whereas the prognostic value of mNUTRIC is largely driven by disease severity, supporting their use for risk stratification in critically ill surgical patients.

ACC review series 2026: sepsis 1

Managing sepsis in the era of precision medicine: a narrative review: Ho Jin Yong, Sung Min Kim, Dohhyung Kim; Acute Crit Care. 2026;41(2):189-200. Published online May 28, 2026; DOI: https://doi.org/10.4266/acc.000884

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Abstract PDF: For decades, the management of sepsis has adopted protocolized care bundles. However, the plateau in global survival rates suggests that the "one-size-fits-all" paradigm exemplified by early goal-directed therapy has reached its limits. The physiological and biological heterogeneity of sepsis necessitates a fundamental shift toward precision medicine. This review examines the transition from empirical resuscitation to individualized care across four critical domains. First, fluid strategy is evolving from aggressive loading to dynamic stewardship. Current evidence favors balanced crystalloids over saline and advocates restrictive dosing guided by dynamic responsiveness indices and venous congestion assessments to prevent iatrogenic harm. Second, hemodynamic support is shifting toward a catecholamine‑sparing strategy. To mitigate the metabolic and immunologic toxicities of high-dose norepinephrine, multimodal vasopressors, such as vasopressin and angiotensin II, are used to target specific biological phenotypes, such as high-renin states. Third, antibiotic management balances rapid administration with rigorous stewardship through pharmacokinetic optimization, including continuous infusions, diagnostic pauses for stable patients, and short-course regimens. Finally, corticosteroid therapy is moving beyond universal debate toward targeted application. Emerging data support their use in specific responder phenotypes, notably severe community-acquired pneumonia and distinct transcriptomic endotypes. In conclusion, modern critical care is moving beyond rigid protocols toward a personalized framework. By integrating bedside biomarkers and clinical phenotypes, clinicians can deliver “the right drug, at the right dose, for the right patient," thereby optimizing outcomes in sepsis and septic shock.

Original Articles

Infection
Early prognostication of septic shock in Korean adults aged 80 years and over: serum albumin combined with Sequential Organ Failure Assessment score: Sang-Min Kim, Seung Mok Ryoo, Woon Yong Kwon, Kyuseok Kim, Tae Ho Lim, Sung Pil Chung, Sung-Hyuk Choi, Won Young Kim; Acute Crit Care. 2026;41(2):304-314. Published online May 11, 2026; DOI: https://doi.org/10.4266/acc.005625

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Abstract PDF Supplementary Material: Background
Septic shock requires careful risk stratification in patients aged 80 and over. Serum albumin levels reflect host status and, when combined with the severity of organ dysfunction, may enhance early prognostication. Here, we evaluated whether combining albumin levels with the Sequential Organ Failure Assessment (SOFA) score upon emergency department (ED) arrival can improve risk classification. Methods: We conducted an observational study from October 2015 to May 2022 using a prospective multicenter registry of septic shock from 12 EDs in the Korean Shock Society. We included 1,300 (18.8%) patients with septic shock aged ≥80 years. The SOFA score was calculated in the ED at the time of septic shock recognition. Patients were divided into three groups according to albumin levels (cutoff, 3.5 g/dl) and the initial SOFA score (cutoff, 7): A, normal albumin with low SOFA score; B, high SOFA with normal albumin or low SOFA with low albumin; and C, low albumin with high SOFA score. The primary outcome was 28-day mortality. Results: Groups A, B, and C included 175, 592, and 533 patients, with 28-day mortality rates of 12.0%, 26.9%, and 49.3%, respectively. Adjusted odds ratios (95% CI) for mortality were 3.02 (1.76–5.18) for group B and 5.80 (3.38–9.97) for group C vs. group A. Conclusions: Combining the SOFA score with the albumin level allows early classification of patients aged ≥80 years with septic shock in the ED, facilitating treatment discussions, particularly decision-making with patients and their families.

Pediatrics
Refining mortality risk stratification in pediatric sepsis: the roles of PELOD-2, vasoactive-inotropic scores, and procalcitonin in a tertiary hospital in Eastern Indonesia: Arya Krisna Manggala, Dyah Kanya Wati, Ida Bagus Gede Suparyatha, I Nyoman Budi Hartawan; Acute Crit Care. 2026;41(2):387-398. Published online April 17, 2026; DOI: https://doi.org/10.4266/acc.002450

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Abstract PDF: Background
Sepsis is a leading cause of mortality and morbidity in children. While the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score is a common predictor of mortality, it does not account for the use of inotropic drugs or sepsis markers, which are addressed by the vasoactive-inotropic score (VIS) and measurements of procalcitonin levels. Combining these components enables faster and more accurate predictions of mortality risks. Therefore, this study aimed to develop a new stratification model of mortality risks by integrating PELOD-2, VIS, and procalcitonin among children with septic shock. Methods: A single-center, three-year, retrospective cohort study was conducted in the pediatric intensive care unit of a tertiary hospital. Children aged 1 month to 18 years and diagnosed with septic shock between 2022 and 2024 received vasoactive and/or inotropic support within 24 hours of diagnosis. PELOD-2 scores and procalcitonin levels were recorded at diagnosis. The cutoff values for PELOD-2, VIS, and procalcitonin were determined using receiver operating characteristic curves. Multivariate analysis was used to generate a final equation and validated with the Hosmer-Lemeshow goodness-of-fit test. Results: A total of 101 children were included, with a mortality rate of 78.2%. The optimal cutoff values were a PELOD-2 score ≥8 (sensitivity, 88.6%; specificity, 72.7%), a VIS score ≥11.5 (sensitivity, 78.5%; specificity, 72.7%), and a procalcitonin level ≥5 ng/ml (sensitivity, 74.7%; specificity, 68.2%). Multivariate analysis revealed significant associations with outcomes: PELOD-2 (adjusted odds ratio [aOR], 12.75; P<0.001), VIS (aOR, 4.686; P=0.02), and procalcitonin (aOR, 4.245; P=0.029). The new mortality risk prediction model achieved a range of 12.8% to 97.39% and exhibited excellent discriminator power (area under the curve, 0.911). The Hosmer–Lemeshow test confirmed good calibration. Conclusions: The new scoring approach that refines stratification of mortality risks by incorporating PELOD-2, VIS, and procalcitonin is a more comprehensive predictor.

Cardiology
Prognostic validation and risk stratification of the Society for Cardiovascular Angiography and Interventions cardiogenic shock classification in a large, real-world intensive care unit cohort in South Korea: Haechan Cho, Jeehoon Kang, Minju Han, Huijin Lee, Hyun-Jai Cho; Acute Crit Care. 2026;41(1):117-125. Published online February 27, 2026; DOI: https://doi.org/10.4266/acc.004500

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Abstract PDF Supplementary Material: Background
Cardiogenic shock (CS) imparts a high mortality rate, yet a standardized classification of its severity remains lacking. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed a five-stage classification scheme to improve risk stratification, but its prognostic value in real-world intensive care unit (ICU) populations is still insufficiently validated. Methods: We retrospectively analyzed 3,074 adults admitted to the medical and cardiovascular ICUs under the Division of Cardiology at a tertiary academic medical center between 2010 and 2019. SCAI shock stages (A–E) were assigned at admission using data on hemodynamic instability, hypoperfusion, clinical deterioration, and refractory shock. The primary outcome was ICU mortality. Results: ICU mortality rates across stages A–E were 0.5%, 4.3%, 5.2%, 18.8%, and 53.2% (P<0.001). Compared to stage A, higher stages were independently associated with mortality (adjusted odds ratio, 3.93–31.58). The discriminatory ability of the SCAI CS classification was moderate (area under the receiver operating characteristic curve [AUROC], 0.787) but improved markedly with the addition of Acute Physiology and Chronic Health Evaluation II scores (AUROC, 0.929). Conclusions: The SCAI CS classification offers clear, incremental risk stratification of ICU mortality. When combined with global severity scores, it provides superior prognostic accuracy, supporting its routine use in the management and study of CS.

Infection
Trajectories of mean arterial pressure/norepinephrine equivalent dose index in patients with septic shock receiving low-dose hydrocortisone: a retrospective cohort study in Thailand: Auttawut Chalermwutanon, Sawangjit Saejaow, Veerapong Vattanavanit; Acute Crit Care. 2026;41(1):107-116. Published online February 9, 2026; DOI: https://doi.org/10.4266/acc.000125

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Abstract PDF Supplementary Material: Background
We aimed to analyze the trajectories of the mean arterial pressure/norepinephrine equivalent dose (MAP/NEQ) index in patients with septic shock treated with low-dose hydrocortisone and to determine the association of these trajectories with mortality. Methods: A retrospective cohort of 203 patients with septic shock receiving low-dose hydrocortisone was examined. MAP and NEQ data were collected from electronic health records, and groupbased trajectory modeling was employed to identify distinct patterns in the MAP/NEQ index over the initial 72 hours of treatment. Univariable and multivariable logistic regression analyses were conducted to assess the associations of MAP/NEQ index trajectories with clinical variables and in-hospital mortality. Results: The overall in-hospital mortality rate was 56.2%. Three MAP/NEQ index trajectory patterns were identified: unchanged (76.8%), gradually increased (14.3%), and rapidly increased (8.9%). The shock reversal rates were 50% for the unchanged group, 89.7% for the gradually increased group, and 100% for the rapidly increased group. Compared with the unchanged group, both gradually and rapidly increased groups were associated with significantly lower mortality, with adjusted odds ratios of 0.15 (95% CI, 0.05–0.40; P<0.001) and 0.29 (95% CI, 0.09–0.92; P=0.035), respectively. Conclusions: In patients with septic shock treated with low-dose hydrocortisone, gradually and rapidly increased MAP/NEQ index trajectories were associated with significantly lower mortality risks and higher rates of shock reversal compared to those with unchanged trajectories. These findings highlight the importance of monitoring the MAP/NEQ index to guide treatment and improve septic shock outcomes.

Review Article

Trauma
Hemostatic resuscitation in patients with trauma-induced coagulopathy: a narrative review: Junsik Kwon, Byung Hee Kang; Acute Crit Care. 2026;41(1):47-57. Published online January 20, 2026; DOI: https://doi.org/10.4266/acc.003525

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Abstract PDF

Hemorrhage remains a leading cause of preventable death in trauma, emphasizing the importance of early bleeding control. In addition to mechanical hemostasis, effective management of trauma-induced coagulopathy (TIC) plays a critical role in improving outcomes. TIC is a multifactorial condition with diverse phenotypes, involving complex pathophysiology. These variations complicate early diagnosis and targeted treatment. In the prehospital setting, phenotype-based management is not feasible; thus, empirical strategies have been adopted. Administration of tranexamic acid and prehospital whole blood transfusion have shown clinical benefit in selected trauma populations. Upon hospital arrival, fixed-ratio massive transfusion protocols and whole blood resuscitation provide broad support for coagulopathic states and have proven effective in reducing early mortality. However, these approaches may not fully account for individual variation in coagulation profiles. Viscoelastic assays allow real-time evaluation of coagulation status and offer the potential for individualized, goal-directed therapy. While some studies suggest improved outcomes with viscoelastic-guided resuscitation, evidence of clear superiority over conventional methods remains limited. Further research is needed to determine the optimal resuscitation strategy and integrate both empirical and precision-based approaches in TIC management.

Citations

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Management of trauma‐induced coagulopathy in the perioperative setting: What is the role of anesthesia?
Angela M. Mitchell, Brennah C. O'Connell, Valerie G. Sams
Transfusion.2026;[Epub] CrossRef

Original Articles

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.

Citations

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Developing consensus-based indicators for intensive care unit capacity and capability in South Korea: a modified Delphi study
Jeehye Lee, Ho Kyung Sung, Min-hwan Oh, Jin Young Kim, KyoungHo Kim, Jae Young Moon
Acute and Critical Care.2026; 41(2): 282. CrossRef

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.

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

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Vitamin B1 and sepsis: a prospective single-center study
Wenbo Yan, Yushu Ma, Jingping Yang, Hongyan Wang, Tiewei Li
Frontiers in Nutrition.2026;[Epub] CrossRef
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
Diagnostic utility of serum prostate-specific antigen and circulating inflammatory markers for differentiating prostate cancer from benign prostatic hyperplasia
Dawei Luo
American Journal of Cancer Research.2025; 15(11): 4765. CrossRef

Cardiology
Clinical decision guidance by an automated, brachial cuff-based cardiac output assessment in patients with shock under treatment: a pilot study in Athens, Greece: Dimitrios Xanthis, Panagiotis Kanatas, Dimitrios Mouziouras, Antonios A. Argyris, Pavlos Vernikos, Georgia Mastakoura, Elpida Athanasopoulou, Theodore G. Papaioannou, Athanase D. Protogerou; Acute Crit Care. 2025;40(2):273-281. Published online May 23, 2025; DOI: https://doi.org/10.4266/acc.001728

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Abstract PDF: Background
Cardiac output (CO) estimation in patients in intensive care units (ICUs) by a non-invasive, automated, oscillometric, cuff-based apparatus (Mobil-O-Graph [MG]) is reproducible with acceptable accuracy versus thermodilution. In this pilot study, we tested the hypothesis that clinical decisions based on the MG device are in agreement with those based on invasive measurements using a Swan-Ganz catheter (SGC). Methods: Hemodynamic monitoring using an SGC and an MG was performed on 20 consenting critically ill patients in shock and under treatment, hospitalized in ICU. Retrospectively, three ICU physicians were asked to determine the need for blood transfusion, inotropes, fluids, diuretics, oxygen, and vasoconstrictive agents. Decisions (defined as “need for action” or “no action”) were based: (i) on SGC-acquired data and standard ICU monitoring (SIM); (ii) on MG-acquired data and SIM; (iii) SIM only. The decisions were compared using Cohen’s kappa agreement coefficient and Wilcoxon’s nonparametric test. Results: The overall number of decisions, as well as the subanalysis of “need for action” decisions, based either on information from an SGC or MG, were comparable. The significant positive kappa agreement coefficients indicated moderate to strong agreement. MG-derived decisions agreed with SGC-derived decisions to a significantly higher degree compared with SIM-based decisions. Conclusions: Clinical decisions in the ICU setting based on MG data were in acceptable agreement with SGC-based decisions. Larger studies are required to confirm this finding. MG devices may provide a simple, operator-independent, low-cost, first-line bedside method for simultaneous continuous monitoring of blood pressure and CO levels in critically ill patients outside the ICU.

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

An optimal risk score for early plasma leakage prediction in adult dengue patients: A multicenter study
Thang Van Dao, Binh Nhu Do, Minh Duc Pham, Tung Huu Ha, Hoang Cong Nguyen, Vinh Hai Vu, Hoa Thi Le, Phuoc Ba Nguyen, Thu Thi Hoang, Duc Minh Cap, Kien Trung Nguyen, Tuyen Van Duong
Acta Tropica.2026; 278: 108110. CrossRef
Integrating structured point-of-care ultrasound into dengue fever management: A mini review and comprehensive clinical guide
Zhi-Yuan Lee, Wei-Ven Chin
World Journal of Critical Care Medicine.2026;[Epub] CrossRef
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

Pulmonary
Using machine learning techniques for early prediction of tracheal intubation in patients with septic shock: a multi-center study in South Korea: Ji Han Heo, Taegyun Kim, Tae Gun Shin, Gil Joon Suh, Woon Yong Kwon, Hayoung Kim, Heesu Park, Heejun Kim, Sol Han; Acute Crit Care. 2025;40(2):221-234. Published online April 30, 2025; DOI: https://doi.org/10.4266/acc.004776

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Background
Patients with septic shock frequently require tracheal intubation in the emergency department (ED). However, the criteria for tracheal intubation are subjective, based on physician experience, or require serial evaluations over relatively long intervals to make accurate predictions, which might not be feasible in the ED. We used supervised learning approaches and features routinely available during the initial stages of evaluation and resuscitation to stratify the risks of tracheal intubation within a 24-hour time window.
Methods
We retrospectively analyzed the data of patients diagnosed with septic shock based on the SEPSIS-3 criteria across 21 university hospital EDs in the Republic of Korea. A principal component analysis revealed a complex, non-linear decision boundary with respect to the application of tracheal intubation within a 24-hour time window. Stratified five-fold cross validation and a grid search were used with extreme gradient boost. Shapley values were calculated to explain feature importance and preferences.
Results
In total, data for 4,762 patients were analyzed; within that population, 1,486 (31%) were intubated within a 24-hour window, and 3,276 (69%) were not. The area under the receiver operating characteristic curve and F1 scores for intubation within a 24-hour window were 0.829 (95% CI, 0.801–0.878) and 0.654 (95% CI, 0.627–0.681), respectively. The Shapley values identified lactate level after initial fluids, suspected lung infection, initial pH, Sequential Organ Failure Assessment score at enrollment, and respiratory rate at enrollment as important features for prediction.
Conclusions
An extreme gradient boosting machine can moderately discriminate whether intubation is warranted within 24 hours of the recognition of septic shock in the ED.

Citations

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Early prediction of renal replacement therapy within 24 hours after septic shock recognition in the emergency department using machine learning: a retrospective analysis of a prospectively collected multicenter registry
Sangun Nah, Tae Ho Lim, Sung Phil Chung, Gil Joon Suh, Sung-Hyuk Choi, Woon Yong Kwon, Won Young Kim, Kyuseok Kim, Sangchun Choi, Je Sung You, Han Sung Choi, Tae Gun Shin, Sangsoo Han
BMC Emergency Medicine.2026;[Epub] CrossRef
Methodological development study: Dynamic mask attention graph neural network for mechanical ventilation in elderly intensive care unit patients
Yi Xie, Ni Xie, Jiao Guo
DIGITAL HEALTH.2025;[Epub] CrossRef

Basic Science and Research
Impact of tadalafil on cardiovascular and organ dysfunction induced by experimental sepsis: Marcelo Almeida Nakashima, Gabrielle Delfrate, Lucas Braga Albino, Gustavo Ferreira Alves, Junior Garcia Oliveira, Daniel Fernandes; Acute Crit Care. 2025;40(1):46-58. Published online February 12, 2025; DOI: https://doi.org/10.4266/acc.002904

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Background
Sepsis is a life-threatening condition that affects the cardiovascular and renal systems. Severe hypotension during sepsis compromises tissue perfusion, which can lead to multiple organ dysfunction and death. Phosphodiesterase 5 (PDE5) degrades intracellular cyclic guanosine monophosphate (cGMP) levels which promotes vasodilatation in specific sites. Our previous studies show that inhibiting cGMP production in early sepsis increases mortality, implying a protective role for cGMP production. Then, we hypothesized that cGMP increased by tadalafil (PDE5 inhibitor) could improve microcirculation and prevent sepsis-induced organ dysfunction.
Methods
Rats were submitted to cecal ligation and puncture (CLP) sepsis model and treated with tadalafil (2 mg/kg, s.c.) 8 hours after the procedure. Hemodynamic, inflammatory and biochemical assessments were performed 24 hours after sepsis induction. Moreover, the effect of tadalafil on the survival of septic rats was evaluated for 5 days.
Results
Tadalafil treatment improves basal renal blood flow during sepsis and preserves it during noradrenaline infusion. Sepsis induces hypotension, impaired response to noradrenaline, and increased cardiac and renal neutrophil infiltration, in addition to increased levels of plasma nitric oxide and lactate. None of these dysfunctions were changed by tadalafil. Additionally, tadalafil treatment did not increase the survival rate of septic rats.
Conclusions
Tadalafil improved microcirculation of septic animals; however, no beneficial effects were observed on macrocirculation and inflammation parameters. Then, the potential benefit of tadalafil in the prognosis of sepsis should be evaluated within a therapeutic strategy covering all sepsis injury mechanisms.

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Role of vascular smooth muscle cell pathobiology in sepsis‑induced vasoplegia (Review)
Hang Ruan, Xiao-Yan Shen, Shi-Yan Liu, Shu-Sheng Li
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Protective Effects of Pentoxifylline on Peripheral Microcirculatory Dysfunction and Renal Cortical Oxygen Deficiency in a Rat Model of LPS‐Induced Sepsis
Bülent Ergin, H. Rob Taal, Deniz Erol Kutucu, Wijnie van Dam, Aysegul Kapucu, Sinno S. H. P. Simons, Can Ince, Irwin K. M. Reiss
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Nutrition
Higher caloric intake through enteral nutrition is associated with lower hospital mortality rates in patients with candidemia and shock in Taiwan: Chen-Yu Wang, Tsai-Jung Wang, Yu-Cheng Wu, Chiann-Yi Hsu; Acute Crit Care. 2024;39(4):573-582. Published online November 20, 2024; DOI: https://doi.org/10.4266/acc.2024.00843

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Abstract PDF

Background
Candidemia is associated with markedly high intensive care unit (ICU) mortality rates. Although the Impact of Early Enteral vs. Parenteral Nutrition on Mortality in Patients Requiring Mechanical Ventilation and Catecholamines (NUTRIREA-2) trial indicated that early enteral nutrition (EN) did not reduce 28-day mortality rates among critically ill patients with shock, the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend avoiding EN in cases of uncontrolled shock. Whether increased caloric intake from EN positively impacts clinical outcomes in patients with candidemia and shock remains unclear.
Methods
We retrospectively collected data from a tertiary medical center between January 2015 and December 2018. We enrolled patients who developed shock within the first 7 days following ICU admission and received a diagnosis of candidemia during their ICU stay. Patients with an ICU stay shorter than 48 hours were excluded.
Results
The study included 106 patients, among whom the hospital mortality rate was 77.4% (82 patients). The median age of the patients was 71 years, and the median Acute Physiology and Chronic Health Evaluation II score was 29. The Cox regression model revealed that a higher 7-day average caloric intake through EN (hazard ratio, 0.61; 95% CI, 0.44–0.83) was significantly associated with lower hospital mortality rates. Our findings suggest EN as the preferred feeding route for critically ill patients with shock.
Conclusions
Increased caloric intake through EN may be associated with lower hospital mortality rates in patients with candidemia and shock.

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Importance of Enteral Feeding: Enhancing Patient Care through Interventional Radiology
Abdifatah Omar, Hyeonseon Kim, Michelle Mai, Michelle Bae, Aaron Maxwell, Daehee Kim
Seminars in Interventional Radiology.2025; 42(01): 002. CrossRef
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 and Critical Care.2025; 40(2): 304. CrossRef

Guideline

Meta-analysis
Early management of adult sepsis and septic shock: Korean clinical practice guidelines: Chul Park, Nam Su Ku, Dae Won Park, Joo Hyun Park, Tae Sun Ha, Do Wan Kim, So Young Park, Youjin Chang, Kwang Wook Jo, Moon Seong Baek, Yijun Seo, Tae Gun Shin, Gina Yu, Jongmin Lee, Yong Jun Choi, Ji Young Jang, Yun Tae Jung, Inseok Jeong, Hwa Jin Cho, Ala Woo, Sua Kim, Dae-Hwan Bae, Sung Wook Kang, Sun Hyo Park, Gee Young Suh, Sunghoon Park; Acute Crit Care. 2024;39(4):445-472. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.00920

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Abstract PDF Supplementary Material

Background
Despite recent advances and global improvements in sepsis recognition and supportive care, mortality rates remain high, and adherence to sepsis bundle components in Korea is low. To address this, the Korean Sepsis Alliance, affiliated with the Korean Society of Critical Care Medicine, developed the first sepsis treatment guidelines for Korea based on a comprehensive systematic review and meta-analysis.
Methods
A de novo method was used to develop the guidelines. Methodologies included determining key questions, conducting a literature search and selection, assessing the risk of bias, synthesizing evidence, and developing recommendations. The certainty of evidence and the strength of recommendations were determined using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Draft recommendations underwent internal and external review processes and public hearings. The development of these guidelines was supported by a research grant from the Korean Disease Control and Prevention Agency.
Results
In these guidelines, we focused on early treatments for adult patients with sepsis and septic shock. Through the guideline development process, 12 key questions and their respective recommendations were formulated. These include lactate measurement, fluid therapies, target blood pressure, antibiotic administration, use of vasopressors and dobutamine, extracorporeal membrane oxygenation, and echocardiography.
Conclusions
These guidelines aim to support medical professionals in making appropriate decisions about treating adult sepsis and septic shock. We hope these guidelines will increase awareness of sepsis and reduce its mortality rate.

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Review Article

Cardiology
Left ventricle unloading during veno-arterial extracorporeal membrane oxygenation: review with updated evidence: Yongwhan Lim, Min Chul Kim, In-Seok Jeong; Acute Crit Care. 2024;39(4):473-487. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.00801

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Abstract PDF

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to treat medically refractory cardiogenic shock and cardiac arrest, and its usage has increased exponentially over time. Although VA-ECMO has many advantages over other mechanical circulatory supports, it has the unavoidable disadvantage of increasing retrograde arterial flow in the afterload, which causes left ventricular (LV) overload and can lead to undesirable consequences during VA-ECMO treatment. Weak or no antegrade flow without sufficient opening of the aortic valve increases the LV end-diastolic pressure, and that can cause refractory pulmonary edema, blood stagnation, thrombosis, and refractory ventricular arrhythmia. This hemodynamic change is also related to an increase in myocardial energy consumption and poor recovery, making LV unloading an essential management issue during VA-ECMO treatment. The principal factors in effective LV unloading are its timing, indications, and modalities. In this article, we review why LV unloading is required, when it is indicated, and how it can be achieved.

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Original Article

Epidemiology
Pediatric septic shock estimation using deep learning and electronic medical records: Ji Weon Lee, Bongjin Lee, June Dong Park; Acute Crit Care. 2024;39(3):400-407. Published online August 1, 2024; DOI: https://doi.org/10.4266/acc.2024.00031

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Abstract PDF

Background
Diagnosing pediatric septic shock is difficult due to the complex and often impractical traditional criteria, such as systemic inflammatory response syndrome (SIRS), which result in delays and higher risks. This study aims to develop a deep learning-based model using SIRS data for early diagnosis in pediatric septic shock cases.
Methods
The study analyzed data from pediatric patients (<18 years old) admitted to a tertiary hospital from January 2010 to July 2023. Vital signs, lab tests, and clinical information were collected. Septic shock cases were identified using SIRS criteria and inotrope use. A deep learning model was trained and evaluated using the area under the receiver operating characteristics curve (AUROC) and area under the precision-recall curve (AUPRC). Variable contributions were analyzed using the Shapley additive explanation value.
Results
The analysis, involving 9,616,115 measurements, identified 34,696 septic shock cases (0.4%). Oxygen supply was crucial for 41.5% of the control group and 20.8% of the septic shock group. The final model showed strong performance, with an AUROC of 0.927 and AUPRC of 0.879. Key influencers were age, oxygen supply, sex, and partial pressure of carbon dioxide, while body temperature had minimal impact on estimation.
Conclusions
The proposed deep learning model simplifies early septic shock diagnosis in pediatric patients, reducing the diagnostic workload. Its high accuracy allows timely treatment, but external validation through prospective studies is needed.

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Comparison of Pediatric Risk of Mortality-III, Phoenix Sepsis, and pediatric Sequential Organ Failure Assessment scores for predicting septic shock in Vietnamese children with sepsis
Khai Quang Tran, Ngan Tuong Thien Pham, Tri Duc Nguyen, Quan Minh Pham
The Brazilian Journal of Infectious Diseases.2026; 30(1): 104612. CrossRef
Aligning prediction models with clinical information needs: infant sepsis case study
Lusha Cao, Aaron J Masino, Mary Catherine Harris, Lyle H Ungar, Gerald Shaeffer, Alexander Fidel, Elease McLaurin, Lakshmi Srinivasan, Dean J Karavite, Robert W Grundmeier
JAMIA Open.2025;[Epub] CrossRef

Review Article

Basic Science and Research
Sex or gender differences in treatment outcomes of sepsis and septic shock: Seung Yeon Min, Ho Jin Yong, Dohhyung Kim; Acute Crit Care. 2024;39(2):207-213. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2024.00591

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Abstract PDF

Gender disparities in intensive care unit (ICU) treatment approaches and outcomes are evident. However, clinicians often pay little attention to the importance of biological sex and sociocultural gender in their treatment courses. Previous studies have reported that differences between sexes or genders can significantly affect the manifestation of diseases, diagnosis, clinicians' treatment decisions, scope of treatment, and treatment outcomes in the intensive care field. In addition, numerous reports have suggested that immunomodulatory effects of sex hormones and differences in gene expression from X chromosomes between genders might play a significant role in treatment outcomes of various diseases. However, results from clinical studies are conflicting. Recently, the need for customized treatment based on physical, physiological, and genetic differences between females and males and sociocultural characteristics of society have been increasingly emphasized. However, interest in and research into this field are remarkably lacking in Asian countries, including South Korea. Through this review, we hope to enhance our awareness of the importance of sex and gender in intensive care treatment and research by briefly summarizing several principal issues, mainly focusing on sex and sex hormone-based outcomes in patients admitted to the ICU with sepsis and septic shock.

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Matthew McGovern, Lynne A. Kelly, Rebecca Finnegan, John F. Murphy, John Kelleher, Ashanty M. Melo, Catherine M. Greene, Eleanor J. Molloy
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Phytotherapy Research.2026; 40(6): 3150. CrossRef
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Harjinder Singh, Radhika Sheth, Mehakmeet Bhatia, Abdullah Muhammad, Candi Bachour, David Metcalf, Vivek Kak
Spartan Medical Research Journal.2024;[Epub] CrossRef
Impact of metabolic syndrome on cardiovascular, inflammatory and hematological parameters in female mice subjected to severe sepsis
Leonardo Berto-Pereira, Raquel Pires Nakama, Lucas Felipe dos Santos, Aparecida Donizette Malvezi, Isabella Ramos Trevizani Thihara, Lucas Sobral de Rossi, Fabricio Seidy Ribeiro Inoue, Wander Rogério Pavanelli, Priscila Cassolla, Phileno Pinge-Filho, Mar
Biochemical and Biophysical Research Communications.2024; 739: 150966. CrossRef

Original Articles

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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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; 34(2): 967. CrossRef
Association Between Gliflozins Use and Outcomes in Adults with Sepsis: A Multicenter Retrospective Cohort Study Among Veterans
Justine Tang, Bocheng Jing, Krystal Karunungan, Anusha Badathala, Arthur Wallace, Matthieu Legrand
Annals of Intensive Care.2026; 16: 100021. CrossRef
Pleiotropic mechanisms and translational trajectory of SGLT2 inhibitors in sepsis-induced cardiomyopathy: Navigating the evidence hierarchy
Xinge Zhang, Liuyi Ren, Min Li, Xiangyu Li, Bimin Feng, Shurong Wang, Xuping Yang, Yilan Huang
European Journal of Pharmacology.2026; 1023: 178858. 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

Immunology
Patterns of inflammatory immune responses in patients with septic shock receiving vitamin C, hydrocortisone, and thiamine: clustering analysis in Korea: Seung-Hun You, Oh Joo Kweon, Sun-Young Jung, Moon Seong Baek, Won-Young Kim; Acute Crit Care. 2023;38(3):286-297. Published online August 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00507

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Background
Sepsis is characterized by heterogeneous immune responses that may evolve during the course of illness. This study identified inflammatory immune responses in septic patients receiving vitamin C, hydrocortisone, and thiamine.
Methods
This was a single-center, post-hoc analysis of 95 patients with septic shock who received the vitamin C protocol. Blood samples were drawn on days 1–2, 3–4, and 6–8 after shock onset. Group-based multi-trajectory modeling was used to identify immune trajectory groups.
Results
The median age was 78 years (interquartile range, 70–84 years), and 56% were male. Clustering analysis identified group 1 (n=41), which was characterized by lower interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-10 levels, and these levels remained stationary or mildly increased until day 7. Conversely, group 2 (n=54) expressed initially higher IL-6, TNF-α, and IL-10 levels that decreased rapidly by day 4. There was a nonsignificant increase in lymphocyte count and a decrease in C-reactive protein level until day 7 in group 2. The intensive care unit mortality rate was significantly lower in group 2 (39.0% vs. 18.5%, P=0.03). Group 2 also had a significantly higher decrease in the mean (standard deviation) vasopressor dose (norepinephrine equivalent: –0.09±0.16 μg/kg/min vs. –0.23±0.31 μg/kg/min, P<0.001) and Sequential Organ Failure Assessment score (0±5 vs. –4±3, P=0.002) between days 1 and 4.
Conclusions
There may be different subphenotypes in septic patients receiving the vitamin C protocol.

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Systematic review, meta-analysis, and meta-regression of the association of serial leukocyte counts in critically ill patients and mortality
Nishkantha Arulkumaran, Fiona Dewar, Gareth Ambler, Maria Del Pilar Arias Lopez, Claudia Dos Santos, Jan J. De Waele, Jeffrey Lipman, José-Artur Paiva, Jean-Francois Timsit
Annals of Intensive Care.2026; 16: 100054. CrossRef
Vitamin C for sepsis: from mechanisms to individualized therapy
Yang Xiao, Fang Gong, Lina Zhang, Chunmei Gui
Frontiers in Medicine.2025;[Epub] CrossRef
Micronutrients as therapy in critical illness
Christian Stoppe, Ellen Dresen, Angelique de Man
Current Opinion in Critical Care.2024; 30(2): 178. CrossRef
Novel cortisol trajectory sub-phenotypes in sepsis
Fei Leng, Zhunyong Gu, Simeng Pan, Shilong Lin, Xu Wang, Ming Zhong, Jieqiong Song
Critical Care.2024;[Epub] 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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Predictors of Mortality and In-Hospital Outcomes After Gastrointestinal Bleed in Patients With Rheumatoid Arthritis and Atrial Fibrillation on Long Term Oral Anticoagulants: A Propensity Score Matched Analysis
Nameer Ascandar, Abhinav Singh, Ian Lancaster, Shaival Thakore, Michael Schandorf-Lartey, Jeffrey P. Steinhoff
Cardiology in Review.2026;[Epub] CrossRef
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

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
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
A Simple Admission-Based Score for Early Mortality Risk Stratification in Non-Shock Sepsis: A Pilot Study
Simona Maria Borta, Romana Olivia Popetiu, Larisa Alexandra Rus, Anamaria Vîlcea, Cristina Maghera, Renata Padurean, Dragoş Vasile Nica, Adrian Silviu Crişan
Diagnostics.2026; 16(11): 1623. 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

Infection
Ability of a modified Sequential Organ Failure Assessment score to predict mortality among sepsis patients in a resource-limited setting: Bodin Khwannimit, Rungsun Bhurayanontachai, Veerapong Vattanavanit; Acute Crit Care. 2022;37(3):363-371. Published online August 4, 2022; DOI: https://doi.org/10.4266/acc.2021.01627

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Background
Some variables of the Sequential Organ Failure Assessment (SOFA) score are not routinely measured in sepsis patients, especially in countries with limited resources. Therefore, this study was conducted to evaluate the accuracy of the modified SOFA (mSOFA) and compared its ability to predict mortality in sepsis patients to that of the original SOFA score.
Methods
Sepsis patients admitted to the medical intensive care unit of Songklanagarind Hospital between 2011 and 2018 were retrospectively analyzed. The primary outcome was all-cause in-hospital mortality.
Results
A total of 1,522 sepsis patients were enrolled. The mean SOFA and mSOFA scores were 9.7±4.3 and 8.8±3.9, respectively. The discrimination of the mSOFA score was significantly higher than that of the SOFA score for all-cause in-hospital mortality (area under the receiver operating characteristic curve, 0.891 [95% confidence interval, 0.875–0.907] vs. 0.879 [0.862–0.896]; P<0.001), all-cause intensive care unit (ICU) mortality (0.880 [0.863–0.898] vs. 0.871 [0.853–0.889], P=0.01) and all-cause 28-day mortality (0.887 [0.871–0.904] vs. 0.874 [0.856–0.892], P<0.001). The ability of mSOFA score to predict all-cause in-hospital and 28-day mortality was higher than that of the SOFA score within the subgroups of sepsis according to age, sepsis severity and serum lactate levels. The mSOFA score was demonstrated to have a performance similar to the original SOFA score regarding the prediction of mortality in sepsis patients with cirrhosis or hepatic dysfunction.
Conclusions
The mSOFA score was a good alternative to the original SOFA core in predicting mortality among sepsis patients admitted to the ICU.

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Meron H. Biza, Chernet T. Mengistie, Biruk T. Mengistie, Mikiyas G. Teferi, Tsion K. Admas, Nardos B. Feleke, Gadissa B. Tafa, Finot Debebe, Tigist Worku
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Chi-Yung Cheng, Ting-Hsuan Hsu, Yu-Lun Hung, Ting-Yu Hsu, Fu-Jen Cheng, Hsiu-Yung Pan, Chun-Hung Richard Lin, I-Min Chiu
BMC Emergency Medicine.2026;[Epub] CrossRef
Validation of the Modified Sequential Organ Failure Assessment Score for Early Clinical Deterioration in Prehospital Patients with Seizures: A Multicenter Cohort Study
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Erik Alonso, Raúl López-Izquierdo, Emma Bourke-Matas, Michael Eichinger, Carlos del Pozo Vegas, Bas de Groot, Isabel de la Torre, Begoña Polonio-López, José Luis Martín-Conty, Ancor Sanz-García, Francisco Martín-Rodríguez
eClinicalMedicine.2025; 90: 103674. CrossRef
SOFA in sepsis: with or without GCS
Lu Wang, Xudong Ma, Guanghua Zhou, Sifa Gao, Wei Pan, Jieqing Chen, Longxiang Su, Huaiwu He, Yun Long, Zhi Yin, Ting Shu, Xiang Zhou, Yongjun Liu, Yan Kang, Jing Yan, Erzhen Chen, Bin Xiong, Bingyu Qin, Kejian Qian, Wei Fang, Mingyan Zhao, Xiaochun Ma, Xi
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Effects of prior antiplatelet and/or nonsteroidal anti-inflammatory drug use on mortality in patients undergoing abdominal surgery for abdominal sepsis
Se Hun Kim, Ki Hoon Kim
Surgery.2023; 174(3): 611. CrossRef

Case Report

Cardiology
Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report: Sangshin Park, Min Kim, Dae In Lee, Ju-Hee Lee, Sangmin Kim, Sang Yeub Lee, Jang-Whan Bae, Kyung-Kuk Hwang, Dong-Woon Kim, Myeong-Chan Cho, Dae-Hwan Bae; Acute Crit Care. 2024;39(1):194-198. Published online May 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01158

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The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.

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Alessio Giordano, Letizia Canu, Manuela Mastronardi, Luisa Petrone, Clotilde Sparano, Mauro Marzano, Carlo Bergamini, Paolo Prosperi
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Qi Wang, Jiayan Xin, Xiaoqiong Cui, Liya Hu, Meng Ning, Wenqing Gao, Yingwu Liu
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Original Articles

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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Using machine learning techniques for early prediction of tracheal intubation in patients with septic shock: a multi-center study in South Korea
Ji Han Heo, Taegyun Kim, Tae Gun Shin, Gil Joon Suh, Woon Yong Kwon, Hayoung Kim, Heesu Park, Heejun Kim, Sol Han
Acute and Critical Care.2025; 40(2): 221. CrossRef
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Eszter Varga, Sándor Somodi, Máté Molnár, Dóra Ujvárosy, Krisztina Gaál, Attila Vaskó, Zoltán Szabó, Ildikó Bácskay, István Lekli, Adina Fésüs
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Gianni Turcato, Arian Zaboli, Lucia Filippi, Paolo Ferretto, Daniela Milazzo, Michael Maggi, Alessandro Cipriano, Massimo Marchetti, Lorenzo Ghiadoni, Christian J. Wiedermann
Biomarkers in Medicine.2025; 19(13): 529. CrossRef
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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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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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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.

Citations

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Prediction of 28-day mortality risk in patients with sepsis and underlying liver cirrhosis: the combined predictive value of INR and lactate and nomogram development
Ying Yang, Qian Chen, Tianyang Chen, Qian Wang
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Evaluating the role of high-dose intravenous thiamine supplementation for lactate clearance in patients with cirrhosis and sepsis
Radiya Ali, Angel Yazdi, Keegan Collins, Danielle Guffey, Tianshi David Wu, Rebecca Kessinger, Ali Omranian, Meghna Vallabh
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Hepatology Communications.2024;[Epub] CrossRef
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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

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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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Mohamad Ghazal, Shayhaan Shaikh, Zachary Daniel, Omar Daghstani, John Musumeci, Abhinay Gajjala, Scott H. Beegle, Mikhail Torosoff
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Quantitative assessment and prognostic value of myocardial work indices in sepsis-induced cardiomyopathy patients with left ventricular systolic dysfunction
Xu Yanping, Yang Xiaojuan, Wu Jiali, Yang Xue, Pan Lu, Wang Xiaohong, Yang Ying, Wang Ying, Cao Wei, Na Lisha
Cardiovascular Ultrasound.2026;[Epub] CrossRef
Macrophage C3aR1 Mediates Sepsis‐Induced Myocardial Injury by Triggering Neutrophil Necroptosis
Jianbo Xu, Zhilei He, Rubing Zhang, Chaonan Peng, Ziteng Cai, Xinyue Zhao, Weiqun Wang
Journal of Cellular and Molecular Medicine.2026;[Epub] CrossRef
Regulation of mitochondrial fission by Drp1 in cardiomyopathy: possible mechanisms linking cellular processes to cell death
Nandini Dubey, Pranav Panchbhai, Gauri Chaturvedi, Satnam Singh, Ahsas Goyal, Neeraj Parakh, Rajiv Narang, Sudhir Kumar Arava, Arvind Kumar, Mayank Yadav, Harlokesh Narayan Yadav
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Yang Yu, Decui Pei, Jia Liu, Keming Chen, Wenjing Zhang, Heying Zhong
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European Journal of Heart Failure.2025; 27(1): 174. CrossRef
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Journal of Clinical Medicine.2025; 14(3): 986. CrossRef
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Frontiers in Immunology.2025;[Epub] CrossRef
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Journal of Clinical Personalized Medicine.2025; 04(02): 1232. CrossRef
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Current Computer-Aided Drug Design.2025; 21(4): 503. CrossRef
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Journal of Inflammation Research.2025; Volume 18: 6025. CrossRef
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The Egyptian Journal of Critical Care Medicine.2025;[Epub] CrossRef
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Critical Care Medicine.2025; 53(11): e2294. CrossRef
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Catalina Paraschiv, Denisa Oana Nicolaescu, Mihaela Roxana Popescu, Carmen Cristina Vasile, Emanuel Moisa, Silvius Ioan Negoita, Serban Mihai Balanescu
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Journal of Clinical Medicine.2025; 14(24): 8714. CrossRef
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International Journal of General Medicine.2025; Volume 18: 7579. CrossRef
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The Journal of Infectious Diseases.2024; 229(4): 1178. CrossRef
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Biomarkers in Medicine.2024; 18(4): 145. CrossRef
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Medicine.2024; 103(28): e38348. CrossRef
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Mostafa El Mokadem, Sameh El Maraghi, Rania El Hosseiny, Amr Moawad, Ahmed Yassin
Journal of Cardiovascular Echography.2024; 34(3): 114. CrossRef
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Song Shen, Jianhui Li, Zhonghai Wei, Yihai Liu, Lina Kang, Rong Gu, Xuan Sun, Biao Xu, QiaoLing Li
Biology Direct.2024;[Epub] CrossRef
Early management of adult sepsis and septic shock: Korean clinical practice guidelines
Chul Park, Nam Su Ku, Dae Won Park, Joo Hyun Park, Tae Sun Ha, Do Wan Kim, So Young Park, Youjin Chang, Kwang Wook Jo, Moon Seong Baek, Yijun Seo, Tae Gun Shin, Gina Yu, Jongmin Lee, Yong Jun Choi, Ji Young Jang, Yun Tae Jung, Inseok Jeong, Hwa Jin Cho, A
Acute and Critical Care.2024; 39(4): 445. CrossRef
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Cureus.2024;[Epub] CrossRef
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Daniela Urina Jassir, Antoine H. Chaanine, Sapna Desai, Indranee Rajapreyar, Thierry H. Le Jemtel
The American Journal of Medicine.2023; 136(1): 27. CrossRef
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IJU Case Reports.2023; 6(1): 26. CrossRef
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Immunopharmacology and Immunotoxicology.2023; 45(4): 469. CrossRef
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International Immunopharmacology.2023; 115: 109716. CrossRef
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International Journal of Molecular Sciences.2022; 23(9): 4688. CrossRef
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Annals of Intensive Care.2022; 12(1): 112. CrossRef
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Review Articles

Meta-analysis
The efficacy of vitamin C, thiamine, and corticosteroid therapy in adult sepsis patients: a systematic review and meta-analysis: Manoj Kumar Reddy Somagutta, Maria Kezia Lourdes Pormento, Muhammad Adnan Khan, Alaa Hamdan, Namrata Hange, Manish KC, Sukrut Pagad, Molly Sanjay Jain, Sivasthikka Lingarajah, Vishal Sharma, Jaspreet Kaur, Bernard Emuze, Erkan Batti, Obumneme Jude Iloeje; Acute Crit Care. 2021;36(3):185-200. Published online June 30, 2021; DOI: https://doi.org/10.4266/acc.2021.00108

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Abstract PDF Supplementary Material

Previous studies have suggested favorable outcomes of hydrocortisone, ascorbic acid (vitamin C), and thiamine (HAT) therapy in patients with sepsis. However, similar results have not been duplicated in sequential studies. This meta-analysis aimed to reevaluate the value of HAT treatment in patients with sepsis. Electronic databases were searched up until October 2020 for any studies that compared the effect of HAT versus non-HAT use in patients with sepsis. Data from 15 studies (eight randomized controlled trials [RCTs] and seven cohort studies) involving 67,349 patients were included. The results from the RCTs show no significant benefit of triple therapy on hospital mortality (risk ratio [RR], 0.99; P=0.92; I²=0%); intensive care unit (ICU) mortality (RR, 0.77; P=0.20; I²=58%); ICU length of stay (weighted mean difference [WMD], 0.11; P=0.86; I² =37%) or hospital length of stay (WMD: 0.57; P=0.49; I²=17%), and renal replacement therapy (RR, 0.64; P=0.44; I²=39%). The delta Sequential Organ Failure Assessment (SOFA) score favored treatment after a sensitivity analysis (WMD, –0.72; P=0.01; I²=32%). However, a significant effect was noted for the duration of vasopressor use (WMD, –25.49; P<0.001; I²=46%). The results from cohort studies have also shown no significant benefit of HAT therapy on hospital mortality, ICU mortality, ICU length of stay, length of hospital stay, the delta SOFA score, the use of renal replacement therapy, or vasopressor duration. HAT therapy significantly reduced the duration of vasopressor use and improved the SOFA score but appeared not to have significant benefits in other outcomes for patients with sepsis. Further RCTs can help understand its benefit exclusively.

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María Slöcker-Barrio, Jesús López-Herce Cid, María José Solana-García
Nutrients.2025; 17(7): 1222. CrossRef
MiR-143-5p serves as a diagnostic biomarker in patients with sepsis and regulates sepsis-induced inflammation and cardiac dysfunction
Yaqi Wu, Le Gu, Xu Huang
Hereditas.2025;[Epub] CrossRef
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Huoyan Liang, Qingqing Mu, Wenju Sun, Liming Liu, Simin Qiu, Zili Xu, Yuqing Cui, Yan Yan, Tongwen Sun
Frontiers in Nutrition.2023;[Epub] CrossRef
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Frontiers in Medicine.2022;[Epub] CrossRef
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Deven Juneja, Ravi Jain
Indian Journal of Critical Care Medicine.2022; 26(2): 224. CrossRef
Is it time to reconsider the administration of thiamine alone or in combination with vitamin C in critically ill patients? A meta-analysis of clinical trial studies
Nafiseh Shokri-mashhadi, Ali Aliyari, Zahra Hajhashemy, Saeed Saadat, Mohammad Hossein Rouhani
Journal of Intensive Care.2022;[Epub] CrossRef
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Arnav Agarwal, John Basmaji, Shannon M. Fernando, Fang Zhou Ge, Yingqi Xiao, Haseeb Faisal, Kimia Honarmand, Mathieu Hylands, Vincent Lau, Kimberley Lewis, Rachel Couban, François Lamontagne, Neill K. J. Adhikari
NEJM Evidence.2022;[Epub] CrossRef
Unanswered questions on the use of hydrocortisone, ascorbic acid, and thiamine therapy in sepsis and septic shock
David Ragoonanan, Nicolas Tran, Veeshal Modi, Paige Morgan Nickelsen
American Journal of Health-System Pharmacy.2022; 79(19): 1626. CrossRef
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Ching-Chi Lee, Jen-Chieh Lee, Chun-Wei Chiu, Pei-Jane Tsai, Wen-Chien Ko, Yuan-Pin Hung
Infection and Drug Resistance.2022; Volume 15: 5387. CrossRef
The impact of vitamin C-containing treatment on the mortality of patients with sepsis: A systematic review and meta-analysis of randomized controlled trials
Ching-Yi Chen, Chien-Tung Chiu, Ho-Sheng Lee, Chih-Cheng Lai
Journal of Infection and Public Health.2022; 15(12): 1514. CrossRef
Role of high dose vitamin C in management of hospitalised COVID-19 patients: A minireview
Deven Juneja, Anish Gupta, Sahil Kataria, Omender Singh
World Journal of Virology.2022; 11(5): 300. CrossRef
Current role of high dose vitamin C in sepsis management: A concise review
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World Journal of Critical Care Medicine.2022; 11(6): 349. CrossRef
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John Kim, Allan Stolarski, Qiuyang Zhang, Katherine Wee, Daniel Remick
Shock.2022; 58(5): 426. CrossRef
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Stefanie Vandervelden, Lina Wauters, Jan Breuls, Steffen Fieuws, Philippe Vanhove, Ives Hubloue, Magali Bartiaux, Jacques Creteur, François Stifkens, Koen Monsieurs, Didier Desruelles, Elisa Panada
PLOS ONE.2021; 16(11): e0259699. CrossRef
Hydrocortisone, ascorbic acid, and thiamine (HAT) for sepsis and septic shock: a meta-analysis with sequential trial analysis
Weilan Na, Huili Shen, Yichu Li, Dong Qu
Journal of Intensive Care.2021;[Epub] CrossRef

Infection
Up-to-date information on polymyxin B-immobilized fiber column direct hemoperfusion for septic shock: Chieko Mitaka, Makio Kusaoi, Izumi Kawagoe, Daizoh Satoh; Acute Crit Care. 2021;36(2):85-91. Published online April 4, 2021; DOI: https://doi.org/10.4266/acc.2021.00150

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Abstract PDF

Endotoxin adsorption therapy by polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) has been used for the treatment of septic shock patients. Endotoxin, an outer membrane component of Gram-negative bacteria, plays an important role in the pathogenesis of septic shock. Endotoxin triggers a signaling cascade for leukocytes, macrophage, and endothelial cells to secrete various mediators including cytokines and nitric oxide, leading to septic shock and multiple organ dysfunction syndrome. PMX-DHP directly adsorbed not only endotoxin but also monocytes and anandamide. It reduced blood levels of inflammatory cytokines such as interleukin (IL)-1, IL-6, tumor necrosis factor-alpha and IL-17A, adhesion molecules, plasminogen activator inhibitor 1, and high mobility group box-1. As a result, PMX-DHP increased blood pressure and reduced the dose of vasoactive-inotropic agents. PMX-DHP improved monocyte human leukocyte antigen-DR expression in patients with severe sepsis and septic shock. A post hoc analysis of EUPHRATES (Evaluating the Use of Polymyxin B Hemoperfusion in Randomized Controlled Trial of Adults Treated for Endotoxemia and Septic Shock) trial has shown that PMX-DHP significantly reduced 28-day mortality compared with the control group in septic shock patients with endotoxin activity assay level between 0.60 and 0.89. Longer duration of PMX-DHP may be another strategy to bring out the beneficial effects of PMX-DHP. Further studies are needed to confirm the efficacy of PMX-DHP treatment for septic shock.

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Case Report

Gastroenterology
Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock: Saad Saffo, James Farrell, Anil Nagar; Acute Crit Care. 2021;36(3):264-268. Published online March 11, 2021; DOI: https://doi.org/10.4266/acc.2020.01067

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Esophageal perforations occur traumatically or spontaneously and are typically associated with high mortality rates. Early recognition and prompt management are essential. We present the case of a 76-year-old man who was admitted to the medical intensive care unit with fulminant Clostridium difficile colitis, shock, and multi-organ failure. After an initial period of improvement, his condition rapidly deteriorated despite aggressive medical management, and he required mechanical ventilation. Radiography after endotracheal intubation showed interval development of pneumomediastinum and bilateral hydropneumothorax with tension physiology. Chest tube placement resulted in the drainage of multiple liters of dark fluid, and pleural fluid analysis was notable for polymicrobial empyemas. Despite the unusual presentation, esophageal perforation was suspected. Endoscopy ultimately confirmed circumferential separation of the distal esophagus from the stomach, and bedside endoscopic stenting was performed with transient improvement. Two weeks after admission, he developed mediastinitis complicated by recurrent respiratory failure and passed away. This report further characterizes our patient’s unique presentation and briefly highlights the clinical manifestations, management options, and outcomes of esophageal perforations.

Citations

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Current approach for Boerhaaves syndrome: A systematic review of case reports
Ippei Yamana, Takahisa Fujikawa, Yuichiro Kawamura, Suguru Hasegawa
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Original Articles

CPR/Resuscitation
Measurement of mean systemic filling pressure after severe hemorrhagic shock in swine anesthetized with propofol-based total intravenous anesthesia: implications for vasopressor-free resuscitation: Athanasios Chalkias, Anastasios Koutsovasilis, Eleni Laou, Apostolos Papalois, Theodoros Xanthos; Acute Crit Care. 2020;35(2):93-101. Published online April 20, 2020; DOI: https://doi.org/10.4266/acc.2019.00773

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Background
Mean systemic filling pressure (Pmsf) is a quantitative measurement of a patient’s volume status and represents the tone of the venous reservoir. The aim of this study was to estimate Pmsf after severe hemorrhagic shock and cardiac arrest in swine anesthetized with propofol-based total intravenous anesthesia, as well as to evaluate Pmsf’s association with vasopressor-free resuscitation.
Methods
Ten healthy Landrace/Large-White piglets aged 10–12 weeks with average weight 20±1 kg were used in this study. The protocol was divided into four distinct phases: stabilization, hemorrhagic, cardiac arrest, and resuscitation phases. We measured Pmsf at 5–7.5 seconds after the onset of cardiac arrest and then every 10 seconds until 1 minute postcardiac arrest. During resuscitation, lactated Ringers was infused at a rate that aimed for a mean right atrial pressure of ≤4 mm Hg. No vasopressors were used.
Results
The mean volume of blood removed was 860±20 ml (blood loss, ~61%) and the bleeding time was 43.2±2 minutes while all animals developed pulseless electrical activity. Mean Pmsf was 4.09±1.22 mm Hg, and no significant differences in Pmsf were found until 1 minute postcardiac arrest (4.20±0.22 mm Hg at 5–7.5 seconds and 3.72±0.23 mm Hg at 55– 57.5 seconds; P=0.102). All animals achieved return of spontaneous circulation (ROSC), with mean time to ROSC being 6.1±1.7 minutes and mean administered volume being 394±20 ml.
Conclusions
For the first time, Pmsf was estimated after severe hemorrhagic shock. In this study, Pmsf remained stable during the first minute post-arrest. All animals achieved ROSC with goal-directed fluid resuscitation and no vasopressors.

Citations

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Diagnostic value of gasp frequency combined with echocardiography for assessing cardiac arrest and myocardial function during cardiopulmonary resuscitation in rats
Chunyan Zhang, Dongqing Shi, Rong Hao, Qian Wang, Fangfang Li
Journal of Cardiothoracic Surgery.2026;[Epub] CrossRef
COMPARISON BETWEEN ACTIVE ABDOMINAL COMPRESSION-DECOMPRESSION CARDIOPULMONARY RESUSCITATION AND STANDARD CARDIOPULMONARY RESUSCITATION IN ASPHYCTIC CARDIAC ARREST RATS WITH MULTIPLE RIB FRACTURES
Zhichu Dai, Sisen Zhang, Hongyu Wang, Liwei He, Jiankun Liao, Xuanyu Wu
Shock.2024; 61(2): 266. CrossRef
Effects of Vasopressin Receptor Agonists during the Resuscitation of Hemorrhagic Shock: A Systematic Review and Meta-Analysis of Experimental and Clinical Studies
Eleni Laou, Nikolaos Papagiannakis, Androniki Papadopoulou, Theodora Choratta, Minas Sakellakis, Mariachiara Ippolito, Ioannis Pantazopoulos, Andrea Cortegiani, Athanasios Chalkias
Journal of Personalized Medicine.2023; 13(7): 1143. CrossRef
Hemodynamic Effects of Cardiovascular Medications in a Normovolemic and Hemorrhaged Yorkshire-cross Swine Model
Jacob H Cole, Scott B Hughey, Phillip G Geiger, Kamala J Rapp-Santos, Gregory J Booth
Comparative Medicine.2022; 72(1): 38. CrossRef
Determinants of venous return in steady-state physiology and asphyxia-induced circulatory shock and arrest: an experimental study
Athanasios Chalkias, Eleni Laou, Nikolaos Papagiannakis, Giolanda Varvarousi, Dimitrios Ragias, Anastasios Koutsovasilis, Demosthenes Makris, Dimitrios Varvarousis, Nicoletta Iacovidou, Ioannis Pantazopoulos, Theodoros Xanthos
Intensive Care Medicine Experimental.2022;[Epub] CrossRef
Assessment of Dynamic Changes in Stressed Volume and Venous Return during Hyperdynamic Septic Shock
Athanasios Chalkias, Eleni Laou, Nikolaos Papagiannakis, Vaios Spyropoulos, Evaggelia Kouskouni, Kassiani Theodoraki, Theodoros Xanthos
Journal of Personalized Medicine.2022; 12(5): 724. CrossRef
A Critical Appraisal of the Effects of Anesthetics on Immune-system Modulation in Critically Ill Patients With COVID-19
Athanasios Chalkias, Erin F. Barreto, Eleni Laou, Konstantina Kolonia, Marc H. Scheetz, Konstantinos Gourgoulianis, Ioannis Pantazopoulos, Theodoros Xanthos
Clinical Therapeutics.2021; 43(3): e57. CrossRef
Resuscitative Effect of Centhaquine (Lyfaquin®) in Hypovolemic Shock Patients: A Randomized, Multicentric, Controlled Trial
Anil Gulati, Dinesh Jain, Nilesh Radheshyam Agrawal, Prashant Rahate, Rajat Choudhuri, Soumen Das, Deba Prasad Dhibar, Madhav Prabhu, Sameer Haveri, Rohit Agarwal, Manish S. Lavhale
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A Multicentric, Randomized, Controlled Phase III Study of Centhaquine (Lyfaquin®) as a Resuscitative Agent in Hypovolemic Shock Patients
Anil Gulati, Rajat Choudhuri, Ajay Gupta, Saurabh Singh, S. K. Noushad Ali, Gursaran Kaur Sidhu, Parvez David Haque, Prashant Rahate, Aditya R. Bothra, Gyan P. Singh, Sanjiv Maheshwari, Deepak Jeswani, Sameer Haveri, Apurva Agarwal, Nilesh Radheshyam Agra
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CPR/Resuscitation
Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards: Chul Park; Acute Crit Care. 2019;34(3):212-218. Published online August 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00598; Correction in: Acute Crit Care 2020;35(3):228

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Abstract PDF

Background
Peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is a rare, however, potentially preventable type of cardiac arrest. Limited published data have described factors associated with inpatient PICA and patient outcomes. The aim of this study was to identify risk factors associated with PICA among hospitalized patients emergently intubated at a general ward as compared to non-PICA inpatients. In addition, we identified a difference of clinical outcomes in patients between PICA and other types of inpatient cardiac arrest (OTICA).
Methods
We conducted a retrospective observational study of patients at two institutions between January 2016 to December 2017. PICA was defined in patients emergently intubated who experienced cardiac arrest within 20 minutes after ETI. The non-PICA group consisted of inpatients emergently intubated without cardiac arrest. Risk factors for PICA were identified through univariate and multivariate logistic regression analysis. Clinical outcomes were compared between PICA and OTICA.
Results
Fifteen episodes of PICA occurred during the study period, accounting for 3.6% of all inpatient arrests. Intubation-related shock index, number of intubation attempts, pre-ETI vasopressor use, and neuromuscular blocking agent (NMBA) use, especially succinylcholine, were independently associated with PICA. Clinical outcomes of intensive care unit and hospital length of stay, survival to discharge, and neurologic outcome at hospital discharge were not significantly different between PICA and OTICA.
Conclusions
We identified four independent risk factors for PICA, and preintubation hemodynamic stabilization and avoidance of NMBA were possibly correlated with a decreased PICA risk. Clinical outcomes of PICA were similar to those of OTICA.

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Epidemiology
Characteristics, management and clinical outcomes of patients with sepsis: a multicenter cohort study in Korea: Kyeongman Jeon, Soo Jin Na, Dong Kyu Oh, Sunghoon Park, Eun Young Choi, Seok Chan Kim, Gil Myeong Seong, Jeongwon Heo, Youjin Chang, Won Gun Kwack, Byung Ju Kang, Won-Il Choi, Kyung Chan Kim, So Young Park, Sang Hyun Kwak, Yoon Mi Shin, Heung Bum Lee, So Hee Park, Jae Hwa Cho, Beongki Kim, Chae‐Man Lim; Acute Crit Care. 2019;34(3):179-191. Published online July 1, 2019; DOI: https://doi.org/10.4266/acc.2019.00514

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Background
Mortality rates associated with sepsis have increased progressively in Korea, but domestic epidemiologic data remain limited. The objective of this study was to investigate the characteristics, management and clinical outcomes of sepsis patients in Korea.
Methods
This study is a multicenter retrospective cohort study. A total of 64,021 adult patients who visited an emergency department (ED) within one of the 19 participating hospitals during a 1-month period were screened for eligibility. Among these, patients diagnosed with sepsis based on the third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were included in the study.
Results
Using the Sepsis-3 criteria, 977 sepsis patients were identified, among which 36.5% presented with septic shock. The respiratory system (61.8%) was the most common site of infection. The pathogen involved was identified in 444 patients (45.5%) and multi-drug resistance (MDR) pathogens were isolated in 171 patients. Empiric antibiotic therapy was appropriate in 68.6% of patients, but the appropriateness was significantly reduced in infections associated with MDR pathogens as compared with non-MDR pathogens (58.8% vs. 76.0%, P<0.001). Hospital mortality was 43.2% and 18.5% in sepsis patients with and without shock, respectively. Of the 703 patients who survived to discharge, 61.5% were discharged to home and 38.6% were transferred to other hospitals or facilities.
Conclusions
This study found the prevalence of sepsis in adult patients visiting an ED in Korea was 1.5% (15.2/1,000 patients). Patients with sepsis, especially septic shock, had a high mortality and were often referred to step-down centers after acute and critical care.

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Closed intensive care units and sepsis patient outcomes: a secondary analysis of data from a multicenter prospective observational study in South Korea
Kyeongman Jeon, Jin Hyoung Kim, Kyung Chan Kim, Heung Bum Lee, Hongyeul Lee, Song I Lee, Jin-Won Huh, Won Gun Kwack, Youjin Chang, Yun-Seong Kang, Won Yeon Lee, Je Hyeong Kim
Acute and Critical Care.2025; 40(2): 209. CrossRef
Evaluating the diagnostic performance of adult sepsis event criteria in the emergency department: impact of including isolated serum lactate elevations
Hyojun Park, Ryoung-Eun Ko, Hyo-Seok Oh, Jae Young Moon, Youjin Chang, Gee Young Suh
Journal of Intensive Care.2025;[Epub] CrossRef
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The Korean Journal of Internal Medicine.2025; 40(6): 990. CrossRef
The 6-hour window: is the sepsis transfer guideline enough?
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Regional Adherence to Early Sepsis Management Bundle and Associated Mortality in Hong Kong Between 2009–2018
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Open Forum Infectious Diseases.2025;[Epub] CrossRef
Early Versus Delayed Norepinephrine Initiation in Septic Shock: A Systematic Review and Meta-Analysis of Randomized and Observational Studies
Chibuzo C Manafa, Oluwayemisi E Ekor, Akintunde C Akinboboye, Okelue E Okobi, Gift Ojukwu, Osemwegie O Ugbo, Michael U Mochu, Emasenyie Isikwei, Sergio Hernandez Borges, Miguel Diaz-Miret
Cureus.2025;[Epub] CrossRef
Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study
Sang Won Park, Na Young Yeo, Seonguk Kang, Taejun Ha, Tae-Hoon Kim, DooHee Lee, Dowon Kim, Seheon Choi, Minkyu Kim, DongHoon Lee, DoHyeon Kim, Woo Jin Kim, Seung-Joon Lee, Yeon-Jeong Heo, Da Hye Moon, Seon-Sook Han, Yoon Kim, Hyun-Soo Choi, Dong Kyu Oh, S
Journal of Korean Medical Science.2024;[Epub] CrossRef
Deficits in blood culture collection in the emergency department if sepsis is suspected: results of a retrospective cohort study
Charlotte Berninghausen, Frank Schwab, Alexander Gropmann, Bernd A. Leidel, Rajan Somasundaram, Lydia Hottenbacher, Petra Gastmeier, Sonja Hansen
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ChatGPT Predicts In-Hospital All-Cause Mortality for Sepsis: In-Context Learning with the Korean Sepsis Alliance Database
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Healthcare Informatics Research.2024; 30(3): 266. CrossRef
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Jiwon Lee, Hee-Ju Kim
Clinical Nursing Research.2024; 33(8): 610. CrossRef
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Critical Care.2024;[Epub] CrossRef
Challenges of implementing the hour-1 sepsis bundle: a qualitative study from a secondary hospital in Indonesia
Priyo Sasmito, Satriya Pranata, Rian Adi Pamungkas, Etika Emaliyawati, Nisa Arifani
Acute and Critical Care.2024; 39(4): 545. CrossRef
Early management of adult sepsis and septic shock: Korean clinical practice guidelines
Chul Park, Nam Su Ku, Dae Won Park, Joo Hyun Park, Tae Sun Ha, Do Wan Kim, So Young Park, Youjin Chang, Kwang Wook Jo, Moon Seong Baek, Yijun Seo, Tae Gun Shin, Gina Yu, Jongmin Lee, Yong Jun Choi, Ji Young Jang, Yun Tae Jung, Inseok Jeong, Hwa Jin Cho, A
Acute and Critical Care.2024; 39(4): 445. CrossRef
Platelet indices in critically ill septic patients as a predictor of mortality
Rehab Salah Taha, Mohamed Elsayed Afandy, Abdelaziz Hamid Elbadawi, Mohamed Samir Abd El Ghafar
Egyptian Journal of Anaesthesia.2023; 39(1): 56. CrossRef
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Hyung-Jun Kim, Dong Kyu Oh, Sung Yoon Lim, Young-Jae Cho, Sunghoon Park, Gee Young Suh, Chae-Man Lim, Yeon Joo Lee
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Shock.2023; 59(3): 360. CrossRef
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Clinical and Experimental Emergency Medicine.2023; 10(2): 157. CrossRef
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Pulmonary
Use of extracorporeal membrane oxygenation in patients with acute high-risk pulmonary embolism: a case series with literature review: You Na Oh, Dong Kyu Oh, Younsuck Koh, Chae-Man Lim, Jin-Won Huh, Jae Seung Lee, Sung-Ho Jung, Pil-Je Kang, Sang-Bum Hong; Acute Crit Care. 2019;34(2):148-154. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00500

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Abstract PDF

Background
Although extracorporeal membrane oxygenation (ECMO) has been used for the treatment of acute high-risk pulmonary embolism (PE), there are limited reports which focus on this approach. Herein, we described our experience with ECMO in patients with acute high-risk PE.
Methods
We retrospectively reviewed medical records of patients diagnosed with acute highrisk PE and treated with ECMO between January 2014 and December 2018.
Results
Among 16 patients included, median age was 51 years (interquartile range [IQR], 38 to 71 years) and six (37.5%) were male. Cardiac arrest was occurred in 12 (75.0%) including two cases of out-of-hospital arrest. All patients underwent veno-arterial ECMO and median ECMO duration was 1.5 days (IQR, 0.0 to 4.5 days). Systemic thrombolysis and surgical embolectomy were performed in seven (43.8%) and nine (56.3%) patients, respectively including three patients (18.8%) received both treatments. Overall 30-day mortality rate was 43.8% (95% confidence interval, 23.1% to 66.8%) and 30-day mortality rates according to the treatment groups were ECMO alone (33.3%, n=3), ECMO with thrombolysis (50.0%, n=4) and ECMO with embolectomy (44.4%, n=9).
Conclusions
Despite the vigorous treatment efforts, patients with acute high-risk PE were related to substantial morbidity and mortality. We report our experience of ECMO as rescue therapy for refractory shock or cardiac arrest in patients with PE.

Citations

Citations to this article as recorded by

Spinal Epidural Abscess Complicated by Saddle Pulmonary Embolism
Jeffrey Bortman, Jamel Ortoleva, Alexandros Karavas, David Guez, Chadi Tannoury
JBJS Case Connector.2026;[Epub] CrossRef
Management of Pulmonary Embolism: A Single-Center Experience
R. Holt Hammons, Sibu P. Saha
Southern Medical Journal.2025; 118(1): 14. CrossRef
Surgical Embolectomy for tPA Refractory Pulmonary Embolism Requiring VA-ECMO: A Case Report and Literature Review
Olga Gomez Rojas, Moustafa Younis, Mindaugas Rackauskas, Philip Hess, William Ricks, Mohammad Aladaileh, Biplab K. Saha
SN Comprehensive Clinical Medicine.2025;[Epub] CrossRef
The use of Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) for Acute High Risk Pulmonary Embolism: A Systematic Review
Rohit Munagala, Humail Patel, Pranav Sathe, Avneet Singh, Mangala Narasimhan
Current Cardiology Reviews.2025;[Epub] CrossRef
Successful Surgical Embolectomy Following Veno-Arterial Extracorporeal Membrane Oxygenation in a Taxi Driver With High-Risk Pulmonary Embolism: A Case Report
Yoh Arita, Kota Takaki, Hironori Orihashi, Katsukiyo Kitabayashi, Nobuyuki Ogasawara
Cureus.2025;[Epub] CrossRef
Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: an overview of current practice and evidence
Samir Ali, Christiaan L. Meuwese, Xavier J. R. Moors, Dirk W. Donker, Anina F. van de Koolwijk, Marcel C. G. van de Poll, Diederik Gommers, Dinis Dos Reis Miranda
Netherlands Heart Journal.2024; 32(4): 148. CrossRef
Integration of Extracorporeal Membrane Oxygenation into the Management of High-Risk Pulmonary Embolism: An Overview of Current Evidence
Romain Chopard, Raquel Morillo, Nicolas Meneveau, David Jiménez
Hämostaseologie.2024; 44(03): 182. CrossRef
Evidence-Based Management of Massive and Submassive Pulmonary Embolism
Sara Al-Juboori, Tareq Alzaher, Hashem Al Omari, Sufyan Al Gammaz, Mazen Al-Qadi
JAP Academy Journal.2024;[Epub] CrossRef
Mechanical Support in High-Risk Pulmonary Embolism: Review Article
Amer N. Kadri, Razan Alrawashdeh, Mohamad K. Soufi, Adam J. Elder, Zachary Elder, Tamam Mohamad, Eric Gnall, Mahir Elder
Journal of Clinical Medicine.2024; 13(9): 2468. CrossRef
Acute Pulmonary Embolism: Evidence, Innovation, and Horizons
Stanislav Henkin, Francisco Ujueta, Alyssa Sato, Gregory Piazza
Current Cardiology Reports.2024; 26(11): 1249. CrossRef
Clinical characteristics and short-term outcomes of patients with critical acute pulmonary embolism requiring extracorporeal membrane oxygenation: from the COMMAND VTE Registry-2
Kensuke Takabayashi, Yugo Yamashita, Takeshi Morimoto, Ryuki Chatani, Kazuhisa Kaneda, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kitae Kim, Moriaki Inoko, Toru Takase, Shuhei Tsuji, Maki Oi, Takuma Takada, Kazunori Otsui, Jiro Sakamo
Journal of Intensive Care.2024;[Epub] CrossRef
Extracorporeal membrane oxygenation for large pulmonary emboli
Timothy J. George, Jenelle Sheasby, Rahul Sawhney, J. Michael DiMaio, Aasim Afzal, Dennis Gable, Sameh Sayfo
Baylor University Medical Center Proceedings.2023; 36(3): 314. CrossRef
Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association
Joshua B. Goldberg, Jay Giri, Taisei Kobayashi, Marc Ruel, Alexander J.C. Mittnacht, Belinda Rivera-Lebron, Abe DeAnda, John M. Moriarty, Thomas E. MacGillivray
Circulation.2023;[Epub] CrossRef
Life-threatening pulmonary embolism: overview and management
Nizar Osmani, Jonathan Marinaro, Sundeep Guliani
International Anesthesiology Clinics.2023; 61(4): 35. CrossRef
Extracorporeal Membrane Oxygenation for Pulmonary Embolism: A Systematic Review and Meta-Analysis
Jonathan Jia En Boey, Ujwal Dhundi, Ryan Ruiyang Ling, John Keong Chiew, Nicole Chui-Jiet Fong, Ying Chen, Lukas Hobohm, Priya Nair, Roberto Lorusso, Graeme MacLaren, Kollengode Ramanathan
Journal of Clinical Medicine.2023; 13(1): 64. CrossRef
Pulmonary ECMO-ism: Let’s add PEA to ECPR indications
Zachary Shinar, Alice Hutin
Resuscitation.2022; 170: 293. CrossRef
Combined use of extracorporeal membrane oxygenation with interventional surgery for acute pancreatitis with pulmonary embolism: A case report
Ling-Ling Yan, Xiu-Xiu Jin, Xiao-Dan Yan, Jin-Bang Peng, Zhuo-Ya Li, Bi-Li He
World Journal of Clinical Cases.2022; 10(12): 3899. CrossRef
Pulmonary Embolism Complicated With Cardiopulmonary Arrest Treated With Combination of Thrombolytics and Aspiration Thrombectomy
Taylor C. Remillard, Zain Kassam, Maks Coven, Aditya Mangla, Zoran Lasic
JACC: Case Reports.2022; 4(10): 576. CrossRef
Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery: A case report
Pei-Yu Hsu, En-Bo Wu
World Journal of Clinical Cases.2022; 10(15): 5111. CrossRef
Percutaneous mechanical thrombectomy and extracorporeal membranous oxygenation: A case series
Haytham Mously, Jamal Hajjari, Tarek Chami, Tarek Hammad, Robert Schilz, Teresa Carman, Yakov Elgudin, Yasir Abu‐Omar, Marc P. Pelletier, Mehdi H. Shishehbor, Jun Li
Catheterization and Cardiovascular Interventions.2022; 100(2): 274. CrossRef
Clinical Experiences of High-Risk Pulmonary Thromboembolism Receiving Extracorporeal Membrane Oxygenation in Single Institution
Joonyong Jang, So-My Koo, Ki-Up Kim, Yang-Ki Kim, Soo-taek Uh, Gae-Eil Jang, Wonho Chang, Bo Young Lee
Tuberculosis and Respiratory Diseases.2022; 85(3): 249. CrossRef
Management of High-Risk Pulmonary Embolism: What Is the Place of Extracorporeal Membrane Oxygenation?
Benjamin Assouline, Marie Assouline-Reinmann, Raphaël Giraud, David Levy, Ouriel Saura, Karim Bendjelid, Alain Combes, Matthieu Schmidt
Journal of Clinical Medicine.2022; 11(16): 4734. CrossRef
Optimal reperfusion strategy in acute high-risk pulmonary embolism requiring extracorporeal membrane oxygenation support: a systematic review and meta-analysis
Romain Chopard, Peter Nielsen, Fabio Ius, Serghei Cebotari, Fiona Ecarnot, Hugo Pilichowski, Matthieu Schmidt, Benedict Kjaergaard, Iago Sousa-Casasnovas, Mehrdad Ghoreishi, Rajeev L. Narayan, Su Nam Lee, Gregory Piazza, Nicolas Meneveau
European Respiratory Journal.2022; 60(5): 2102977. CrossRef
Venoarterial Extracorporeal Membrane Oxygenation in High-Risk Pulmonary Embolism: A Case Series and Literature Review
Zied Ltaief, Ermes Lupieri, Jean Bonnemain, Nawfel Ben-Hamouda, Valentina Rancati, Sabine Schmidt Kobbe, Matthias Kirsch, Jean-Daniel Chiche, Lucas Liaudet
Reviews in Cardiovascular Medicine.2022;[Epub] CrossRef
Use of extracorporeal membrane oxygenation in high‐risk acute pulmonary embolism: A systematic review and meta‐analysis
Luca Baldetti, Alessandro Beneduce, Lorenzo Cianfanelli, Giulio Falasconi, Luigi Pannone, Francesco Moroni, Angela Venuti, Stefania Sacchi, Mario Gramegna, Vittorio Pazzanese, Francesco Calvo, Guglielmo Gallone, Matteo Pagnesi, Alberto Maria Cappelletti
Artificial Organs.2021; 45(6): 569. CrossRef
Institutional Experience With Venoarterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism: A Retrospective Case Series
Maxwell A. Hockstein, Christina Creel-Bulos, Joshua Appelstein, Craig S. Jabaley, Michael J. Stentz
Journal of Cardiothoracic and Vascular Anesthesia.2021; 35(9): 2681. CrossRef
Venoarterial Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism-Related Cardiac Arrest: A Systematic Review*
John Harwood Scott, Matthew Gordon, Robert Vender, Samantha Pettigrew, Parag Desai, Nathaniel Marchetti, Albert James Mamary, Joseph Panaro, Gary Cohen, Riyaz Bashir, Vladimir Lakhter, Stephanie Roth, Huaqing Zhao, Yoshiya Toyoda, Gerard Criner, Lisa Moor
Critical Care Medicine.2021; 49(5): 760. CrossRef
Adult Langerhans histiocytosis with rare BRAF mutation complicated by massive pulmonary embolism
Salma Hassan, Christina Fanola, Amy Beckman, Faqian Li, Andrew C. Nelson, Michael Linden, Joan D. Beckman
Thrombosis Research.2020; 193: 207. CrossRef
Efficacy and safety of extracorporeal membrane oxygenation for high-risk pulmonary embolism: A systematic review and meta-analysis
Matteo Pozzi, Augustin Metge, Anthony Martelin, Caroline Giroudon, Justine Lanier Demma, Catherine Koffel, William Fornier, Pascal Chiari, Jean Luc Fellahi, Jean Francois Obadia, Xavier Armoiry
Vascular Medicine.2020; 25(5): 460. CrossRef
Evidence-Based Minireview: Advanced therapies and extracorporeal membrane oxygenation for the management of high-risk pulmonary embolism
Radhika Gangaraju, Frederikus A. Klok
Hematology.2020; 2020(1): 195. CrossRef

Infection
Relationship between low hemoglobin levels and mortality in patients with septic shock: Sung Min Jung, Youn-Jung Kim, Seung Mok Ryoo, Won Young Kim; Acute Crit Care. 2019;34(2):141-147. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00465

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Abstract PDF Supplementary Material

Background
Hemoglobin levels are a critical parameter for oxygen delivery in patients with shock. On comparing target hemoglobin levels upon transfusion initiation, the correlation between the severity of decrease in hemoglobin levels and patient outcomes remains unclear. We evaluated the association between initial hemoglobin levels and mortality in patients with septic shock treated with protocol-driven resuscitation bundle therapy at an emergency department.
Methods
Data of adult patients diagnosed with septic shock between June 2012 and December 2016 were extracted from a prospectively compiled septic shock registry at a single academic medical center. Patients were classified into four groups according to initial hemoglobin levels: ≥9.0 g/dl, 8.0−8.9 g/dl, 7.0−7.9 g/dl, and <7.0 g/dl. The primary endpoint was 90-day mortality.
Results
In total, 2,265 patients (male, 58.3%; median age, 70.0 years [interquartile range, 60 to 78 years]) with septic shock were included. For the four groups, 90-day mortality rates were as follows: 29.1%, 43.0%, 46.5%, and 46.9% for ≥9.0 g/dl (n=1,808), 8.0−8.9 g/dl (n=217), 7.0−7.9 g/dl (n=135), and <7.0 g/dl (n=105), respectively (P<0.001). Multivariate logistic regression showed that initial hemoglobin levels were an independent factor associated with 90-day mortality and mortality proportionally increased with decreasing hemoglobin levels (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.36 to 2.61 for 8.0−8.9 g/dl; OR, 1.97; 95% CI, 1.31 to 2.95 for 7.0–7.9 g/dl; and OR, 2.35; 95% CI, 1.52 to 3.63 for <7.0 g/dl).
Conclusions
Low hemoglobin levels (<9.0 g/dl) were observed in approximately 20% of patients with septic shock, and the severity of decrease in these levels correlated with mortality.

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Journal of Korean Medical Science.2026;[Epub] CrossRef
Platelet-lymphocyte ratio and its dynamic changes predict mortality in septic acute kidney injury patients: a retrospective multi-center study using U.S. database and Chinese hospital data
Caihong Liu, Xue Tang, Wei Wei, Yongxiu Huang, Mingjing Guan, Jinglei Ren, Binyu Yang, Ping Fu, Ling Zhang, Yuliang Zhao
PeerJ.2026; 14: e20522. CrossRef
Development of Machine Learning Models to Predict 28-Day Mortality in Patients with Sepsis-Associated Liver Injury
Yupeng Li, Junyi Fan, Kamiar Alaei, Maryam Pishgar
BioMedInformatics.2026; 6(1): 4. CrossRef
Construction and validation of a predictive model for mortality risk in patients with Staphylococcus aureus bloodstream infection
Donghao Cai, Tongjie Chen, Jinhong Jiang, Xiaojing Hong, Hui Li, Junqing Tan, Song Li, Shaoqin Lai, Xiaojun Li, Aiwen Li
BMC Infectious Diseases.2026;[Epub] CrossRef
Predictors of Mortality in Medical ICU Patients: A Retrospective Study in a Tertiary Care Center in Jordan
Tarek Gharibeh, Munir Abu-Helalah, Hussam Alshraideh, Manar Abu Awwad, Zaid Al Bzour, Majd Abuzayed, Luma Taweel, Zahraa Al-Fayyadh, Bushra Wraikat, Yomna Alfaqeeh, Layan Aburumman
Journal of Clinical Medicine.2025; 14(12): 4039. CrossRef
Recommended Hematocrit in Patients With Sepsis: An Observational Study
Shih‐Hong Chen, Linyi Chen
Health Science Reports.2025;[Epub] CrossRef
Septic shock in oral cancer
Ezhilarasi SUNDARAM, Uma S. PAL, Ranjeet SINGH, Tanvi VINARKAR
European Journal of Oral and Maxillofacial Surgery.2025;[Epub] CrossRef
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Zhe Xu, Ruguo Zhang, Qiuhan Chen, Guoxuan Peng, Shanpeng Luo, Chen Liu, Ling Zeng, Jin Deng
BMC Geriatrics.2025;[Epub] CrossRef
Association of hemoglobin level trajectories with clinical outcomes in patients with sepsis or shock: a retrospective observational study
Jingjing Huang, Dengxiu Zou, Quan Wang, Yuchen Liu, Kexin Zhang, Shiya Liu, Sufang Huang
BMC Infectious Diseases.2025;[Epub] CrossRef
Prognostic value of hemoglobin in patients with sepsis: A systematic review and meta-analysis
Jin Zhu, Yanyan Dong, Pengda Liao, Xin Yin, Jianzhuo He, Liheng Guo
Heart & Lung.2024; 64: 93. CrossRef
Acute blood loss anemia in hospitalized patients is associated with adverse outcomes: An analysis of the Nationwide Inpatient Sample
Dhweeja Dasarathy, Amy H. Attaway
The American Journal of the Medical Sciences.2024; 367(4): 243. CrossRef
Ceftriaxone-induced severe hemolytic anemia, renal calculi, and cholecystolithiasis in a 3-year-old child: a case report and literature review
Enfu Tao, Huangjia Zhou, Meili Zheng, Yisha Zhao, Junfen Zhou, Junhui Yuan, Tianming Yuan, Changhua Zheng
Frontiers in Pharmacology.2024;[Epub] CrossRef
Postoperative pneumonia after femoral fracture surgery: an in-depth retrospective analysis
Mohammad Hamdan, Bassem I. Haddad, Jamil Almohtasib, Mira Eid, Tasneem Jamal Al-Din, Hashem A. Rayyan, Ahmad M. Altantawi, Abdussalam S. Akaheal, Mohammad Ali Alshrouf
BMC Musculoskeletal Disorders.2024;[Epub] CrossRef
Relationship between the magnitude of haemoglobin changes and long-term mortality in patients with sepsis: a retrospective cohort study
Wen-Ming Shao, Lu-Wei Ye, Lu-ming Zhang, Yu-Long Wang, Hui Liu, Dan He, Jia-Liang Zhu, Jun Lyu, Haiyan Yin
BMC Infectious Diseases.2024;[Epub] CrossRef
Association between red blood cells transfusion and 28-day mortality rate in septic patients with concomitant chronic kidney disease
Lei Chen, Honglei Lu, Chenwei Lv, Haibin Ni, Renjun Yu, Bing Zhang, Xingxing Hu
Scientific Reports.2024;[Epub] CrossRef
Exploring a global interpretation mechanism for deep learning networks when predicting sepsis
Ethan A. T. Strickler, Joshua Thomas, Johnson P. Thomas, Bruce Benjamin, Rittika Shamsuddin
Scientific Reports.2023;[Epub] CrossRef
Blood count derangements after sepsis and association with post-hospital outcomes
Scott J. Denstaedt, Jennifer Cano, Xiao Qing Wang, John P. Donnelly, Sarah Seelye, Hallie C. Prescott
Frontiers in Immunology.2023;[Epub] CrossRef
Potential therapeutic effect of Carica papaya leaves extract on immune response, biochemical and hematological mechanisms on cecal ligation and puncture model of sepsis in rats: an in vivo study
Juveria Usmani, Mohd Wasim, Mohd Nazam Ansari, Mohammed Jaseem Hassan, Manju Sharma, Razi Ahmad
3 Biotech.2023;[Epub] CrossRef
Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Myeong Namgung, Chiwon Ahn, Yeonkyung Park, Il-Youp Kwak, Jungguk Lee, Moonho Won
Clinical and Experimental Emergency Medicine.2023; 10(2): 157. CrossRef
Predictive Rule for Mortality of Inpatients With Escherichia coli Bacteremia: Chi-Square Automatic Interaction Detector Decision Tree Analysis Model
Yudai Nakanishi, Sayato Fukui, Akihiro Inui, Daiki Kobayashi, Mizue Saita, Toshio Naito
Cureus.2023;[Epub] CrossRef
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Sayato Fukui, Akihiro Inui, Takayuki Komatsu, Kanako Ogura, Yutaka Ozaki, Manabu Sugita, Mizue Saita, Daiki Kobayashi, Toshio Naito
Cureus.2023;[Epub] CrossRef
Applying artificial neural network in predicting sepsis mortality in the emergency department based on clinical features and complete blood count parameters
Beata Pui Kwan Wong, Rex Pui Kin Lam, Carrie Yuen Ting Ip, Ho Ching Chan, Lingyun Zhao, Michael Chun Kai Lau, Tat Chi Tsang, Matthew Sik Hon Tsui, Timothy Hudson Rainer
Scientific Reports.2023;[Epub] CrossRef
Preexisting Clinical Frailty Is Associated With Worse Clinical Outcomes in Patients With Sepsis*
Hong Yeul Lee, Jinwoo Lee, Yoon Sun Jung, Woon Yong Kwon, Dong Kyu Oh, Mi Hyeon Park, Chae-Man Lim, Sang-Min Lee
Critical Care Medicine.2022; 50(5): 780. CrossRef
Clinical assessment of neutrophil gelatinase-associated lipocalin as a potential diagnostic marker for neonatal sepsis: a prospective cohort study
Dina Midan, Fady El-Gendy, Dalia Abo ELAlla, Mayada Kotb
Annals of Medicine.2022; 54(1): 1725. CrossRef
A Decrease in Hb and Hypoproteinemia: Possible Predictors of Complications in Neonates with Late-Onset Sepsis in a Developing Country
Na Cai, Wei Liao, Zhiqiang Chen, Min Tao, Sheng Chen
International Journal of General Medicine.2022; Volume 15: 6583. CrossRef
Impact of 1-Hour Bundle Achievement in Septic Shock
Byuk Sung Ko, Sung-Hyuk Choi, Tae Gun Shin, Kyuseok Kim, You Hwan Jo, Seung Mok Ryoo, Yoo Seok Park, Woon Yong Kwon, Han Sung Choi, Sung Phil Chung, Gil Joon Suh, Hyunggoo Kang, Tae Ho Lim, Donghee Son, Won Young Kim
Journal of Clinical Medicine.2021; 10(3): 527. CrossRef
The Effect of Haematocrit on Measurement of the Mid-Infrared Refractive Index of Plasma in Whole Blood
David J. Rowe, Daniel R. Owens, Suzanne L. Parker, Saul N. Faust, James S. Wilkinson, Goran Z. Mashanovich
Biosensors.2021; 11(11): 417. CrossRef
Early Hemoglobin Status as a Predictor of Long-Term Mortality for Sepsis Patients in Intensive Care Units
Desheng Qi, Milin Peng
Shock.2021; 55(2): 215. CrossRef
Effect of Meeting the 1-Hour Bundle Target on Outcomes in Septic Shock
Degu Regasa, Tadele Shiberu
Bulletin of Pioneering Researches of Medical and Clinical Science.2021; 1(1): 29. CrossRef
Immature granulocyte and mean platelet volume as a predictor of 30-day postoperative mortality in patients with sepsis caused by peritonitis
RudiHartono Sinaga, Arie Utariani, Puspa Wardhani, Hardiono Hardiono
Bali Journal of Anesthesiology.2020; 4(4): 166. CrossRef

CPR/Resuscitation
Utility of the early lactate area score as a prognostic marker for septic shock patients in the emergency department: Gina Yu, Seung Joon Yoo, Sang-Hun Lee, June Sung Kim, Sungmin Jung, Youn-Jung Kim, Won Young Kim, Seung Mok Ryoo; Acute Crit Care. 2019;34(2):126-132. Published online April 12, 2019; DOI: https://doi.org/10.4266/acc.2018.00283

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Abstract PDF

Background
The current Surviving Sepsis Campaign guidelines recommend the remeasurement of lactate levels if the initial lactate level is elevated; however, the prognostic value of lactate kinetics is limited and inconsistent. We attempted to determine the efficacy of the lactate area score (calculated from repeated lactate measurements during initial resuscitation) as a prognostic marker of septic shock in the emergency department (ED).
Methods
We performed a retrospective study of adult patients with septic shock in the ED of a single tertiary medical center. Serial lactate levels were measured five times within 12 hours. We also compared the initial lactate level, maximum lactate level, and lactate area score. The lactate area score was defined as the sum of the area under the curve measured at 2, 4, 6, and 12 hours following the initial measurement.
Results
A total of 362 patients were enrolled in this study, and the overall 28-day mortality was 31.8%. The lactate area score of serial lactate levels as well as the initial (median [interquartile range], 4.9 [3.4 to 10.5]; P=0.003) and maximum (7.3 [4.2 to 13.2]; P<0.001) lactate levels were significantly higher in the non-survivor group. However, in multivariate analysis, only the lactate area score (odds ratio, 1.013; 95% confidence interval, 1.007 to 1.019) was significantly associated with 28-day mortality.
Conclusions
The early lactate area score may be a possible prognostic marker for predicting the 28-day mortality of adult septic shock patients. Further prospective interventional studies should be conducted to validate our results.

Citations

Citations to this article as recorded by

Evaluation of Hypoxia Markers in Critically Ill Patients Categorized by Their Burden of Organ Dysfunction: A Novel Approach to Detect Pathophysiological and Clinical Relevance in a Secondary Analysis of a Prospective Observational Study
Franz-Simon Centner, Kathrin Brohm, Sonani Mindt, Evelyn Jaeger, Bianka Hahn, Tanja Fuderer, Holger A. Lindner, Verena Schneider-Lindner, Joerg Krebs, Michael Neumaier, Manfred Thiel, Jochen J. Schoettler
International Journal of Molecular Sciences.2025; 26(2): 659. CrossRef
Lactate: A key regulator of the immune response
Alba Llibre, Salih Kucuk, Atrayee Gope, Michelangelo Certo, Claudio Mauro
Immunity.2025; 58(3): 535. CrossRef
Clinical and microbiological characteristics of bacteremia in pediatric intensive care unit: a retrospective analytical observational study
Junli Shan, Yan Gao, Jiaqi Su, Rui Xu, Chen Zhang, Yanan Fu, Guan Wang
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Early lactate dynamics for short-term mortality in emergency department sepsis
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Using time-course as an essential factor to accurately predict sepsis-associated mortality among patients with suspected sepsis
Shih-Chieh Yen, Chin-Chieh Wu, Yi-Ju Tseng, Chih-Huang Li, Kuan-Fu Chen
Biomedical Journal.2024; 47(3): 100632. CrossRef
Association between normalized lactate load and in-hospital mortality in patients with acute myocardial infarction
Yue Wu, Nannan Huang, Tienan Sun, Biyang Zhang, Shiyu Zhang, Pengyu Zhang, Chunxia Zhang
International Journal of Cardiology.2024; 399: 131658. CrossRef
Electrochemical Detection of Biomarkers Via Affinity Binding with Functionalized Nanocomposite for Assessment of Tissue-Perfusion
Ariadna Schuck, Minhee Kang, Yong-Sang Kim
Journal of Electrical Engineering & Technology.2024; 19(5): 3309. CrossRef
Role of lactate level in predicting admission need to intensive care unit and short term outcomes in patients with acute gastrointestinal bleeding
Hekmat Nashat Shawky, Hala Mostafa Kamel, Zain Elabdeen Ahmed Sayed, Hossam Mahmoud Abdelwahab
The Egyptian Journal of Internal Medicine.2024;[Epub] CrossRef
Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis
Binlu Zhu, Ruixi Zhou, Jiangwei Qin, Yifei Li
Biomedicines.2024; 12(2): 447. CrossRef
Mortality Prediction by Kinetic Parameters of Lactate and S-Adenosylhomocysteine in a Cohort of Critically Ill Patients
Jochen J. Schoettler, Kathrin Brohm, Sonani Mindt, Evelyn Jäger, Bianka Hahn, Tanja Fuderer, Holger A. Lindner, Verena Schneider-Lindner, Joerg Krebs, Michael Neumaier, Manfred Thiel, Franz-Simon Centner
International Journal of Molecular Sciences.2024; 25(12): 6391. CrossRef
Prognostic Value of Admission Lactate Levels in Critically Ill Patients: A Comparative Study With Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II Scores
Abhijeet Kumrawat, Sunita Gupta, Harmanjeet S Dhillon, Purva Kumrawat
Cureus.2024;[Epub] CrossRef
Serial evaluation of the serum lactate level with the SOFA score to predict mortality in patients with sepsis
Heemoon Park, Jinwoo Lee, Dong Kyu Oh, Mi Hyeon Park, Chae-Man Lim, Sang-Min Lee, Hong Yeul Lee
Scientific Reports.2023;[Epub] CrossRef
Increased normalized lactate load is associated with higher mortality in both sepsis and non-sepsis patients: an analysis of the MIMIC-IV database
Han Chen, Shu-Rong Gong, Rong-Guo Yu
BMC Anesthesiology.2022;[Epub] CrossRef
An integrated wearable microneedle array for the continuous monitoring of multiple biomarkers in interstitial fluid
Farshad Tehrani, Hazhir Teymourian, Brian Wuerstle, Jonathan Kavner, Ravi Patel, Allison Furmidge, Reza Aghavali, Hamed Hosseini-Toudeshki, Christopher Brown, Fangyu Zhang, Kuldeep Mahato, Zhengxing Li, Abbas Barfidokht, Lu Yin, Paul Warren, Nickey Huang,
Nature Biomedical Engineering.2022; 6(11): 1214. CrossRef
Association between normalized lactate load and mortality in patients with septic shock: an analysis of the MIMIC-III database
Han Chen, Shu-Rong Gong, Rong-Guo Yu
BMC Anesthesiology.2021;[Epub] CrossRef
Mortality prediction using a novel combination of biomarkers in the first day of sepsis in intensive care units
Junkun Liu, Chengwen Bai, Binbin Li, Aijun Shan, Fei Shi, Can Yao, Yu Zhang, Jin Wang, Weibu Chen, Manying Xie, Dehui Deng
Scientific Reports.2021;[Epub] CrossRef
A Graphene-Based Enzymatic Biosensor Using a Common-Gate Field-Effect Transistor for L-Lactic Acid Detection in Blood Plasma Samples
Ariadna Schuck, Hyo Eun Kim, Júlia Konzen Moreira, Priscila Schmidt Lora, Yong-Sang Kim
Sensors.2021; 21(5): 1852. CrossRef
Usefulness of presepsin in predicting the prognosis of patients with sepsis or septic shock: a retrospective cohort study
Jeong Suk Koh, Yoon Joo Kim, Da Hyun Kang, Jeong Eun Lee, Song-I Lee
Yeungnam University Journal of Medicine.2021; 38(4): 318. CrossRef
Non-enzymatic lactic acid sensor based on AuPtNPs functionalized MoS2 nanosheet as electrode modified materials
Haolin Xiao, Liangli Cao, Huishan Qin, Shanshan Wei, Miao Gu, Feijun Zhao, Zhencheng Chen
Journal of Electroanalytical Chemistry.2021; 903: 115806. CrossRef
Early lactate area scores and serial blood lactate levels as prognostic markers for patients with septic shock: a systematic review
Rozita Khodashahi, Soroush Sarjamee
Infectious Diseases.2020; 52(7): 451. CrossRef
Recent lactate findings: is repeated serum lactate testing necessary in septic shock patients?
Moo Suk Park
Acute and Critical Care.2019; 34(2): 155. CrossRef

Infection
Application of Sepsis-3 Criteria to Korean Patients with Critical Illnesses: Jae Yeol Kim, Hwan Il Kim, Gee Young Suh, Sang Won Yoon, Tae-Yop Kim, Sang Haak Lee, Jae Young Moon, Jae-Young Kwon, Sungwon Na, Ho Geol Ryu, Jisook Park, Younsuck Koh; Acute Crit Care. 2019;34(1):30-37. Published online January 29, 2019; DOI: https://doi.org/10.4266/acc.2018.00318; Correction in: Acute Crit Care 2019;34(2):172

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Abstract PDF

Background
The 2016 Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM) task force for Sepsis-3 devised new definitions for sepsis, sepsis with organ dysfunction and septic shock. Although Sepsis-3 was data-driven, evidence-based approach, East Asian descents comprised minor portions of the project population. Methods: We selected Korean participants from the fever and antipyretics in critically ill patients evaluation (FACE) study, a joint study between Korea and Japan. We calculated the concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria and evaluated mortality rates of sepsis, sepsis with organ dysfunction, and septic shock by Sepsis-3 criteria using the selected data. Results: Korean participants of the FACE study were 913 (383 with sepsis and 530 without sepsis by Sepsis-2 criteria). The concordance rate for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria was 55.4%. The intensive care unit (ICU) and 28-day mortality rates of sepsis, sepsis with organ dysfunction, and septic shock patients according to Sepsis-3 criteria were 26.2% and 31.0%, 27.5% and 32.5%, and 40.8% and 43.4%, respectively. The quick Sequential Organ Failure Assessment (qSOFA) was inferior not only to SOFA but also to systemic inflammatory response syndrome (SIRS) for predicting ICU and 28-day mortality. Conclusions: The concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria were low. Mortality rate for septic shock in Koreans was consistent with estimates made by the 2016 SCCM/ESICM task force. SOFA and SIRS were better than qSOFA for predicting ICU and 28-day mortality in Korean ICU patients.

Citations

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HYPOTENSION AT THE TIME OF SEPSIS RECOGNITION IS NOT ASSOCIATED WITH INCREASED MORTALITY IN SEPSIS PATIENTS WITH NORMAL LACTATE LEVELS
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Case Report

Cardiology
Acute fulminant myocarditis following influenza vaccination requiring extracorporeal membrane oxygenation: Youn-Jung Kim, Jun-Il Bae, Seung Mok Ryoo, Won Young Kim; Acute Crit Care. 2019;34(2):165-169. Published online November 7, 2018; DOI: https://doi.org/10.4266/acc.2017.00045

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Abstract PDF

The inactivated influenza vaccination is generally safe with mostly mild side effects. We report a rare but fatal adverse event following influenza vaccination. A previously healthy 27-yearold woman who received the influenza vaccination 3 days before presenting to the emergency department had rapidly aggravating dyspnea and mental deterioration. She was diagnosed as having acute fulminant myocarditis with refractory cardiogenic shock, which was successfully managed with veno-arterial extracorporeal membrane oxygenation. The cardiac function of the patient recovered in 3 weeks.

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Fatemeh Sadat Tabatabaei, Melika Shafeghat, Amirali Azimi, Ashley Akrami, Nima Rezaei
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Clinical Manifestations and Adverse Cardiovascular Events in Patients with Cardiovascular Symptoms after mRNA Coronavirus Disease 2019 Vaccines
William D. Kim, Min Jae Cha, Subin Kim, Dong-Gil Kim, Jae-Jin Kwak, Sung Woo Cho, Joon Hyung Doh, Sung Uk Kwon, June Namgung, Sung Yun Lee, Jiwon Seo, Geu-ru Hong, Ji-won Hwang, Iksung Cho
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Active surveillance for adverse events of influenza vaccine safety in elderly cancer patients using self-controlled tree-temporal scan statistic analysis
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Wen-Hwa Wang, Kai-Che Wei, Yu-Tung Huang, Kuang-Hua Huang, Tung-Han Tsai, Yu-Chia Chang
Drugs & Aging.2023; 40(2): 145. CrossRef
Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology
Kamron Reza Hamedi, Gannett Loftus, Lawson Traylor, Richard Goodwin, Sergio Arce
Vaccines.2023; 11(2): 362. CrossRef
Myocarditis and autoimmunity
Akira Matsumori
Expert Review of Cardiovascular Therapy.2023; 21(6): 437. CrossRef
Cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) imaging in the diagnosis and follow-up of patients with acute myocarditis and chronic inflammatory cardiomyopathy
Federico Caobelli, Jordi Broncano Cabrero, Nicola Galea, Philip Haaf, Christian Loewe, Julian A. Luetkens, Giuseppe Muscogiuri, Marco Francone
The International Journal of Cardiovascular Imaging.2023; 39(11): 2221. CrossRef
Clinical Syndromes Related to SARS-CoV-2 Infection and Vaccination in Pediatric Age: A Narrative Review
Maria Vincenza Mastrolia, Camilla De Cillia, Michela Orlandi, Sarah Abu-Rumeileh, Ilaria Maccora, Valerio Maniscalco, Edoardo Marrani, Ilaria Pagnini, Gabriele Simonini
Medicina.2023; 59(11): 2027. CrossRef
Acute Lymphocyte Myocarditis Associated with Influenza Vaccination
Ryo Nakamura, Shin-ichi Ando, Seiya Kato, Toshiaki Kadokami
Internal Medicine.2022; 61(15): 2307. CrossRef
Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination
Dongngan T. Truong, Audrey Dionne, Juan Carlos Muniz, Kimberly E. McHugh, Michael A. Portman, Linda M. Lambert, Deepika Thacker, Matthew D. Elias, Jennifer S. Li, Olga H. Toro-Salazar, Brett R. Anderson, Andrew M. Atz, C. Monique Bohun, M. Jay Campbell, M
Circulation.2022; 145(5): 345. CrossRef
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Farah Naghashzadeh, Shadi Shafaghi, Atosa Dorudinia, Seyed Alireza Naji, Majid Marjani, Ahmad Amin, Arezoo Mohamadifar, Sima Noorali, Babak Sharif Kashani
ESC Heart Failure.2022; 9(2): 1483. CrossRef
Myocarditis following COVID-19 vaccination in adolescents and adults: a cumulative experience of 2021
Onyedika J. Ilonze, Maya E. Guglin
Heart Failure Reviews.2022; 27(6): 2033. CrossRef
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Da-Eun Roh, Hyejin Na, Jung-Eun Kwon, Insu Choi, Yeo-Hyang Kim, Hwa-Jin Cho
Children.2022; 9(5): 693. CrossRef
Cardiac Adverse Events after Vaccination—A Systematic Review
Kanak Parmar, Sai Subramanyam, Gaspar Del Rio-Pertuz, Pooja Sethi, Erwin Argueta-Sosa
Vaccines.2022; 10(5): 700. CrossRef
A case of myocarditis after COVID-19 vaccination: incidental or consequential?
Leona S. Alizadeh, Vitali Koch, Ibrahim Yel, Leon D. Grünewald, Daniel Mathies, Simon Martin, Thomas J. Vogl, Dominic Rauschning, Christian Booz
Heliyon.2022; 8(6): e09537. CrossRef
COVID-19 Vaccination and the Rate of Immune and Autoimmune Adverse Events Following Immunization: Insights From a Narrative Literature Review
Naim Mahroum, Noy Lavine, Aviran Ohayon, Ravend Seida, Abdulkarim Alwani, Mahmoud Alrais, Magdi Zoubi, Nicola Luigi Bragazzi
Frontiers in Immunology.2022;[Epub] CrossRef
COVID-19 vaccination and carditis in children and adolescents: a systematic review and meta-analysis
Oscar Hou In Chou, Jonathan Mui, Cheuk To Chung, Danny Radford, Simon Ranjithkumar, Endurance Evbayekha, Ronald Nam, Levent Pay, Danish Iltaf Satti, Sebastian Garcia-Zamora, George Bazoukis, Göksel Çinier, Sharen Lee, Vassilios S. Vassiliou, Tong Liu, Gar
Clinical Research in Cardiology.2022; 111(10): 1161. CrossRef
Myopericarditis after vaccination, Vaccine Adverse Event Reporting System (VAERS), 1990–2018
John R. Su, Michael M. McNeil, Kerry J. Welsh, Paige L. Marquez, Carmen Ng, Ming Yan, Maria V. Cano
Vaccine.2021; 39(5): 839. CrossRef
Sipuleucel-T Associated Inflammatory Cardiomyopathy: A Case Report and Observations from a Large Pharmacovigilance Database
Melissa Y.Y. Moey, Rahim A. Jiwani, Kotaro Takeda, Karyn Prenshaw, R. Wayne Kreeger, John Inzerillo, Darla K. Liles, C. Bogdan Marcu, Bénédicte Lebrun-Vignes, D. Lynn Morris, Sivakumar Ardhanari, Joe-Elie Salem
ESC Heart Failure.2021; 8(4): 3360. CrossRef
Myocarditis following COVID-19 vaccination
Elisabeth Albert, Gerard Aurigemma, Jason Saucedo, David S. Gerson
Radiology Case Reports.2021; 16(8): 2142. CrossRef
Myocarditis and Other Cardiovascular Complications of the mRNA-Based COVID-19 Vaccines
Mahesh K Vidula, Marietta Ambrose, Helene Glassberg, Neel Chokshi, Tiffany Chen, Victor A Ferrari, Yuchi Han
Cureus.2021;[Epub] CrossRef
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Han W. Kim, Elizabeth R. Jenista, David C. Wendell, Clerio F. Azevedo, Michael J. Campbell, Stephen N. Darty, Michele A. Parker, Raymond J. Kim
JAMA Cardiology.2021; 6(10): 1196. CrossRef
Acute myocarditis following Comirnaty vaccination in a healthy man with previous SARS-CoV-2 infection
Anna Patrignani, Nicolò Schicchi, Francesca Calcagnoli, Elena Falchetti, Nino Ciampani, Giulio Argalia, Antonio Mariani
Radiology Case Reports.2021; 16(11): 3321. CrossRef
Myocarditis and pericarditis after vaccination for COVID‐19
Blake Hudson, Ryan Mantooth, Matthew DeLaney
JACEP Open.2021; 2(4): e12498. CrossRef
Myocarditis, Pericarditis and Cardiomyopathy After COVID-19 Vaccination
Salvatore Pepe, Ann T. Gregory, A. Robert Denniss
Heart, Lung and Circulation.2021; 30(10): 1425. CrossRef
Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19
Eveline Y. Wu, M. Jay Campbell
Current Cardiology Reports.2021;[Epub] CrossRef
Hemodynamic Collapse After Influenza Vaccination: A Vaccine-Induced Fulminant Myocarditis?
Nobutaka Nagano, Toshiyuki Yano, Yugo Fujita, Masayuki Koyama, Ryo Hasegawa, Jun Nakata, Ryo Nishikawa, Naoto Murakami, Takefumi Fujito, Atsushi Mochizuki, Hidemichi Kouzu, Atsuko Muranaka, Nobuaki Kokubu, Tetsuji Miura
Canadian Journal of Cardiology.2020; 36(9): 1554.e5. CrossRef
Fatal influenza myocarditis with incessant ventricular tachycardia
Nidhi Saraiya, Supriya Singh, Marilou Corpuz
BMJ Case Reports.2019; 12(7): e228201. CrossRef

Original Article

Infection
Implications of Plasma Renin Activity and Plasma Aldosterone Concentration in Critically Ill Patients with Septic Shock: Kyung Soo Chung, Joo Han Song, Won Jai Jung, Young Sam Kim, Se Kyu Kim, Joon Chang, Moo Suk Park; Korean J Crit Care Med. 2017;32(2):142-153. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00094

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Abstract PDF Supplementary Material

Background
The renin-angiotensin-aldosterone system is closely associated with volume status and vascular tone in septic shock. The present study aimed to assess whether plasma renin activity (PRA) and plasma aldosterone concentration (PAC) measurements compared with conventional severity indicators are associated with mortality in patients with septic shock.
Methods
We evaluated 105 patients who were admitted for septic shock. Plasma levels of the biomarkers PRA and PAC, the PAC/PRA ratio, C-reactive protein (CRP) level, and cortisol level on days 1, 3, and 7 were serially measured. During the intensive care unit stay, relevant clinical information and laboratory results were recorded.
Results
Patients were divided into two groups according to 28-day mortality: survivors (n = 59) and non-survivors (n = 46). The survivor group showed lower PRA, PAC, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score than did the non-survivor group (all P < 0.05). The SOFA score was positively correlated with PRA (r = 0.373, P < 0.001) and PAC (r = 0.316, P = 0.001). According to receiver operating characteristic analysis, the areas under the curve of PRA and PAC to predict 28-day mortality were 0.69 (95% confidence interval [CI], 0.58 to 0.79; P = 0.001) and 0.67 (95% CI, 0.56 to 0.77; P = 0.003), respectively, similar to the APACHE II scores and SOFA scores. In particular, the group with PRA value ≥3.5 ng ml^-1 h^-1 on day 1 showed significantly greater mortality than did the group with PRA value <3.5 ng ml^-1 h^-1 (log-rank test, P < 0.001). According to multivariate analysis, SOFA score (hazard ratio, 1.11; 95% CI, 1.01 to 1.22), PRA value ≥3.5 ng ml^-1 h^-1 (hazard ratio, 3.25; 95% CI, 1.60 to 6.60), previous history of cancer (hazard ratio, 3.44; 95% CI, 1.72 to 6.90), and coronary arterial occlusive disease (hazard ratio, 2.99; 95% CI, 1.26 to 7.08) were predictors of 28-day mortality.
Conclusions
Elevated PRA is a useful biomarker to stratify the risk of critically ill patients with septic shock and is a prognostic predictor of 28-day mortality.

Citations

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Novel aspects of the renin-angiotensin-aldosterone system in septic shock
Christopher L Schaich, Ashish K Khanna, Mark C Chappell
Current Opinion in Physiology.2026; 47: 100894. CrossRef
The Importance of Plasma Renin Concentrations in Intensive Care Patients with Circulatory Shock
Yasemin Bozkurt Turan, Sait Karakurt
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Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion
Jooyun Kim, Saeyeon Kim, Ji-Hee Lee, Sua Kim
Acute and Critical Care.2026; 41(2): 201. CrossRef
Shock prediction with dipeptidyl peptidase-3 and renin (SPiDeR) in hypoxemic patients with COVID-19
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Critical Care Medicine.2024; 52(3): 509. CrossRef
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Christopher L. Schaich, Daniel E. Leisman, Marcia B. Goldberg, Micheal R. Filbin, Ashish K. Khanna, Mark C. Chappell
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Critical Care Explorations.2024; 6(8): e1134. CrossRef
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Annals of Intensive Care.2024; 14(1): 79. CrossRef
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Annals of Laboratory Medicine.2024; 44(6): 497. CrossRef
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Case Report

Pulmonary
Termination of Idiopathic Sustained Monomorphic Ventricular Tachycardia by Synchronized Electrical Cardioversion during Pregnancy: Sungmin Lee; Acute Crit Care. 2018;33(1):46-50. Published online February 20, 2017; DOI: https://doi.org/10.4266/acc.2016.00115

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Abstract PDF: The most common cardiac complications detected during pregnancy are an arrhythmia. However, idiopathic continuous monomorphic ventricular tachycardia (VT) during pregnancy is unusual. A 31-year-old pregnant woman presented at 20 weeks of gestation with progressive palpitation and episodes of agitation. An initial 12-lead electrocardiogram (ECG) showed normal sinus rhythm. However, 30 minutes after presenting at the emergency room, she complained of chest pain. A subsequent ECG showed wide complex monomorphic VT. We attempted to administer an antiarrhythmic drug, but the patient refused any medication because of concerns regarding possible adverse effects on the fetus. Therefore, we performed synchronized electrical cardioversion eight times. After the eighth synchronized cardioversion at 200 J, the ECG showed successful restoration of sinus rhythm. The condition of the fetus was monitored via ultrasonography and cardiotocography, and no adverse events were observed. We present the case of a successful synchronized electrical cardioversion performed in a woman at 20 weeks of gestation because of sustained symptomatic VT.

Review Article

Cardiology/Infection
How Do I Integrate Hemodynamic Variables When Managing Septic Shock?: Olfa Hamzaoui, Jean-Louis Teboul; Korean J Crit Care Med. 2016;31(4):265-275. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00927

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Abstract PDF

Hemodynamic management of sepsis-induced circulatory failure is complex since this pathological state includes multiple cardiovascular derangements that can vary from patient to patient according to the degree of hypovolemia, of vascular tone depression, of myocardial depression and of microvascular dysfunction. The treatment of the sepsis-induced circulatory failure is thus not univocal and should be adapted on an individual basis. As physical examination is insufficient to obtain a comprehensive picture of the hemodynamic status, numerous hemodynamic variables more or less invasively collected, have been proposed to well assess the severity of each component of the circulatory failure and to monitor the response to therapy. In this article, we first describe the hemodynamic variables, which are the most relevant to be used, emphasizing on their physiological meaning, their validation and their limitations in patients with septic shock. We then proposed a general approach for managing patients with septic shock by describing the logical steps that need to be followed in order to select and deliver the most appropriate therapies. This therapeutic approach is essentially based on knowledge of physiology, of pathophysiology of sepsis, and of published data from clinical studies that addressed the issue of hemodynamic management of septic shock.

Citations

Citations to this article as recorded by

Enhancement in Performance of Septic Shock Prediction Using National Early Warning Score, Initial Triage Information, and Machine Learning Analysis
Hyoungju Yun, Jeong Ho Park, Dong Hyun Choi, Sang Do Shin, Myoung-jin Jang, Hyoun-Joong Kong, Suk Wha Kim
The Journal of Emergency Medicine.2021; 61(1): 1. CrossRef

Original Article

Infection/Hematology
The Prevalence and Significance of Overt Disseminated Intravascular Coagulation in Patients with Septic Shock in the Emergency Department According to the Third International Consensus Definition: Byuk Sung Ko, Hyun Young Cho, Seung Mok Ryoo, Myung Chun Kim, Woong Jung, Sung Hyuk Park, Chang Min Lee, Won Young Kim; Korean J Crit Care Med. 2016;31(4):334-341. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00339

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Abstract PDF

Background
The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock.
Methods
We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality.
Results
Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]).
Conclusions
Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.

Citations

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A comparison of disseminated intravascular coagulation scoring systems and their performance to predict mortality in sepsis patients: A systematic review and meta-analysis
Girum Tesfaye Kiya, Gemeda Abebe, Zeleke Mekonnen, Edosa Tadasa, Gedion Milkias, Elsah Tegene Asefa, Mehmet Baysal
PLOS ONE.2025; 20(1): e0315797. CrossRef
Disseminated intravascular coagulation, associated factors and clinical outcomes among critically Ill septic adults admitted to a tertiary hospital in Ethiopia: A prospective longitudinal study
Girum Tesfaye Kiya, Zeleke Mekonnen, Elsah Tegene Asefa, Gedion Milkias, Edosa Tadasa, Edosa Kejela, Iyasu Demeke, Aragaw Fiseha, Gemeda Abebe, Kovuri Umadevi
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Case Reports

Genetic
Lethal Hyperammonemia due to Ornithine Transcarbamylase Deficiency in a Patient with Severe Septic Shock: Ji An Hwang, Joo Han Song, Young Seok Lee, Kyung Soo Chung, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Joon Chang, Moo Suk Park; Korean J Crit Care Med. 2016;31(2):140-145. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.140

12,015 View
91 Download
1 Crossref

Abstract PDF

Severe hyperammonemia can occur as a result of inherited or acquired liver enzyme defects in the urea cycle, among which ornithine transcarbamylase deficiency (OTCD) is the most common form. We report a very rare case of a 45-year-old Korean male who was admitted to the intensive care unit (ICU) due to severe septic shock with acute respiratory failure caused by Pneumocystis jiroveci pneumonia. During his ICU stay with ventilator care, the patient suffered from marked hyperammonemia (>1,700 μg/dL) with abrupt mental change leading to life-threatening cerebral edema. Despite every effort including continuous renal replacement therapy and use of a molecular adsorbent recirculating system (extracorporeal liver support–albumin dialysis) to lower his serum ammonia level, the patient was not recovered. The lethal hyperammonemia in the patient was later proven to be a manifestation of acquired liver enzyme defect known as OTCD, which is triggered by serious catabolic conditions, such as severe septic shock with acute respiratory failure.

Citations

Citations to this article as recorded by

Emerging neurological and cognitive symptoms in patients with late-onset ornithine transcarbamylase deficiency: a narrative review
Laura Konczal, Gregory M. Enns, Andrea L. Gropman, Daniel Garcia, J. Lawrence Merritt II, Greta Wilkening
Metabolic Brain Disease.2026;[Epub] CrossRef

Cardiology
Use of Polymyxin B Hemoperfusion in a Patient with Septic Shock and Septic Cardiomyopathy Who Was Placed on Extracorporeal Membrane Oxygen Support: Sun Hye Shin, Hyun Lee, Aeng Ja Choi, Kylie Hae Jin Chang, Gee Young Suh, Chi Ryang Chung; Korean J Crit Care Med. 2016;31(2):123-128. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.123

22,690 View
195 Download

Abstract PDF: Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.

Trauma/Surgery
Secondary Abdominal Compartment Syndrome Recognized in Operating Room in Severely Injured Patients: Seok Hwa Youn, John Cook-Jong Lee, Kyoungwon Jung, Jonghwan Moon, Yo Huh, Younghwan Kim; Korean J Crit Care Med. 2016;31(1):58-62. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.58

36,158 View
98 Download

Abstract PDF: For trauma patients with severe shock, massive fluid resuscitation is necessary. However, shock and a large amount of fluid can cause bowel and retroperitoneal edema, which sometimes leads to abdominal compartment syndrome in patients without abdomino-pelvic injury. If other emergent operations except intraabdomen are needed, a distended abdomen is likely to be recognized late, leading to multiple organ dysfunction. Herein, we report two cases of a 23-year-old woman who was in a car accident and a 53-year old man who was pressed on his leg by a pressing machine; severe brain swelling and popliteal vessel injury were diagnosed, respectively. They were both in severe shock and massive fluid resuscitation was required in the emergency department. Distended abdomen was recognized in both the female and male patients immediately after neurosurgical operation and immediately before orthopaedic operation in the operating room, respectively. Decompressive laparotomy revealed massive ascites with retroperitoneal edema.

Cardiology/Thoracic surgery
Extracorporeal Membrane Oxygenation for 67 Days as a Bridge to Heart Transplantation in a Postcardiotomy Patient with Failing Heart and Mediastinitis: Hyoung Woo Chang, Yang Hyun Cho, Suhyun Cho, Kiick Sung, Pyo Won Park; Korean J Crit Care Med. 2015;30(4):295-298. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.295

6,387 View
60 Download

Abstract PDF: We report a case of successful heart transplantation after 67 days of support with venoarterial extracorporeal membrane oxygenation (ECMO) in a patient who underwent surgery for type A aortic dissection and myocardial infarction complicated by irreversible myocardial damage and a deep sternal wound infection. During ECMO support, left heart vent and distal limb perfusion were performed. Mediastinitis was treated with mediastinal washout and irrigation. Multiple complications from peripheral ECMO were successfully managed.

Original Article

Pulmonary
The Prognostic Factors of Pneumonia with Septic Shock in Patients Presenting to the Emergency Department: Jong Won Kim, Jin Joo Kim, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, In Cheol Hwang, Sang Hyun Han; Korean J Crit Care Med. 2015;30(4):258-264. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.258

19,668 View
214 Download
10 Crossref

Abstract PDF

Background
Pneumonia is the most common cause of death among patients with infectious disease in Korea. However, studies of pneumonia with septic shock in patients presenting to the emergency department are limited. The aim of this study was to investigate the prognostic factors associated with pneumonia with septic shock in patients presenting to the emergency department.
Methods
From January 2008 to September 2014, patients with pneumonia with septic shock admitted through the emergency department were retrospectively examined.
Results
Of the 561,845 patients who visited the emergency department, 398 were admitted for pneumonia with septic shock. The 28-day mortality rate in these patients was 36.4%. The independent prognostic factors were old age (>70 yrs) (odds ratio [OR], 2.42; 95%, confidence interval [CI], 1.35–4.32), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.04; 95% CI, 1.01–1.08), leukopenia (OR, 3.63; 95% CI, 1.48–8.94), prolonged PT-INR (OR, 2.53; 95% CI, 1.41–4.54), and hypoxemia (OR, 2.88; 95% CI, 1.30–6.38).
Conclusions
A poor prognosis of patients with pneumonia is associated with old age (>70 yrs), increased APACHE II score, leukopenia, prolonged PT-INR, and hypoxemia.

Citations

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Case Report

Infection
Toxic Shock Syndrome following Tattooing: Ki Young Jeong, Kyung Su Kim, Gil Joon Suh, Woon Yong Kwon; Korean J Crit Care Med. 2015;30(3):184-190. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.184

42,406 View
132 Download
9 Crossref

Abstract PDF

Toxic shock syndrome (TSS) is a rare but life-threatening illness that is mainly caused by toxigenic strains of Staphylococcus aureus. Although TSS is classically known to be associated with tampon use, the number of TSS cases with non-menstrual causes such as skin and soft tissue infection has been increasing. Tattooing can result in several complications such as localized and systemic infections, inflammatory skin eruptions and neoplasms. We recently experienced a 26-year-old man diagnosed with typical TSS following tattooing. He complained of fever, chills and erythematous rash at tattoo site. Subsequently, the patient developed sign of shock. The skin cultures on the tattoo site were positive for methicillin-sensitive Staphylococcus aureus. The patient was successfully treated with vasopressor infusion and intravenous antibiotics and was discharged without complications. On discharge from the hospital 7 days later, desquamations on the tattoo site, fingers and toes were observed.

Citations

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Skin biopsy PCR enables rapid diagnosis of tattoo-associated staphylococcal toxic shock syndrome
Justin Destoop, Sonia Senoune, Aurianne De-Waard, Grégory Dubourg, Nadim Cassir
International Journal of Infectious Diseases.2026; : 108808. CrossRef
Gram-Negative Bacteremia With Atypical Neurologic Presentation Following Tattoo Application
Adedolapo O Ojo, Desiree Marquez-Santos, Radmehr Rahemipour, Aniqa Aftabi, Alberto Meléndez-Garcia, Saira Shahab, Richard Steward
Cureus.2025;[Epub] CrossRef
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Kristin Schreiner, Marek Balikowski
Forensic Science, Medicine and Pathology.2025; 22(1): 332. CrossRef
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Takuya Kubo, Tetsuya Yumoto, Hideharu Hagiya, Koji Iio, Hiromichi Naito, Atsunori Nakao
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Jordi Rello, Sofia Tejada, Laura Campogiani, Adenike G. Adebanjo, Antonella Tammaro
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Jordi Rello, Sofia Tejada, Laura Campogiani, Adenike G. Adebanjo, Antonella Tammaro
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Tattoo-associated complications and related topics: A comprehensive review
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Ralf Dieckmann, Ides Boone, Stefan O. Brockmann, Jens A. Hammerl, Annette Kolb-Mäurer, Matthias Goebeler, Andreas Luch, Sascha Al Dahouk
Deutsches Ärzteblatt international.2016;[Epub] CrossRef

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