30-day Survival Rate Research Articles

Survival of Patients with Solid Tumours and Sepsis Admitted to Intensive Care in a Tertiary Oncology Centre: A Retrospective Analysis.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Patients with cancer are at risk of developing sepsis and requiring intensive care unit (ICU) admission. We aimed to assess survival of patients with a solid tumour admitted to ICU as an emergency with sepsis, and to identify predictors of 90-day survival at admission. We conducted a retrospective cohort survival analysis. We identified adults with a solid tumour admitted to ICU with sepsis between 01/01/2011 and 31/12/2020 at a tertiary oncology centre with two hospitals (London and Surrey, UK). We defined sepsis using the Sepsis-3 definition. The primary outcome was 90-day survival. We used the parametric accelerated failure time model for multivariate analysis to generate acceleration factors (AF). 625 patients were identified and the 90-day survival rate was 59.5%(353/593).Multivariate analysis identified the presence of localized (AF 0.13, 95% CI 0.06-0.25) or regionalized disease (AF 0.21, 95% CI 0.12-0.36) compared to distant metastatic disease, unplanned surgery on the day of admission (AF 0.15, 95% CI 0.07-0.31), lactate (AF 1.25 95% CI 1.15-1.35), Sequential Organ Failure Assessment Score (AF 1.19, 95% CI 1.12-1.27), previous radiotherapy (AF 1.89, 95% CI 1.14-3.125), previous systemic anti-cancer treatment (excluding hormonal therapy) (AF 1.49, 95% CI 0.93-2.38), bacteraemia (AF 0.47, 95% CI 0.27-0.81) and serum albumin (AF 0.94, 95% CI 0.91-0.98) as independent predictors of 90-day survival. This study of solid tumour patients admitted to ICU is one of the largest providing survival data to inform clinicians and patients. This data provides information on factors that should be considered when deliberating the possible outcome of ICU admission for a patient with solid malignancy and sepsis and highlights that the presence of cancer itself should not limit ICU admission for sepsis.

Cardiogenic shock in patients with active onco-hematological malignancies: A multicenter retrospective study.

Onco-hematological (OH) patients face significant cardiovascular risks due to malignancy and drug toxicity. Data are limited on the characteristics and outcomes of OH patients with cardiogenic shock (CS) in intensive care units (ICUs). This multicenter retrospective study included 214 OH patients with CS across 22 ICUs (2010-2021). The objectives were to (i) identify risk factors for 30-day mortality, (ii) describe early and long-term outcomes, and (iii) assess the prognostic impact of malignancy by comparing OH patients to a control group of CS patients. The 30-day survival rate was 44.8%. Multivariate analysis identified previous cardiomyopathy (OR=1.61), acute kidney injury (OR=1.62), lactate levels (OR=1.08 per 1mmol/L), pulmonary embolism (OR=3.04), invasive mechanical ventilation (OR=3.48), and epinephrine use (OR=2.09) as factors associated with 30-day mortality. Among ICU survivors, 54% were alive at 1year with a median left ventricular ejection fraction of 52%. OH malignancy was significantly associated with 30-day mortality (HR 2.54). The prognosis for OH patients with CS in the ICU is poor, with epinephrine use associated with worse outcomes. Further research is needed to refine risk stratification and improve treatments for this population.

Selective Minimally Invasive Strategy for Acute Superior Mesenteric Artery Obstruction.

Acute mesenteric artery obstruction is a severe cause of acute mesenteric ischemia, associated with significant morbidity and mortality. However, there is limited guidance on choosing between traditional and minimally invasive techniques comprehensively. This study introduces a selective, minimally invasive strategy designed to improve the survival and prognosis of patients with acute superior mesenteric artery obstruction. In this prospective, single-arm trial conducted between 2020 and 2023, patients with acute mesenteric ischemia due to acute superior mesenteric artery obstruction were enrolled. A total of 42 patients were included, meeting the predetermined sample size. The primary outcome was the 30-day chronic intestinal failure (CIF)-free survival rate. Based on an algorithm incorporating preoperative radiographic findings, physical signs, and laboratory markers, patients were assigned to one of three therapeutic pathways: traditional laparotomy with thrombectomy, laparoscopy combined with endovascular therapy, or endovascular therapy alone. The CIF-free survival rates at 30 days and 2 years were 71% (30/42) and 60%, respectively. Short-term mortality, including 30-day and in-hospital mortality, was 11.9%, indicating an improvement compared to historical cohorts. The cumulative mortality rates at 6 months, 1 year, and 2 years were 26%, 32%, and 32%, respectively. The primary and assisted patency rates at 1 year were 90% and 97%, respectively. Transition to laparotomy was required in 43% of patients undergoing laparoscopic exploration. Improved blood supply was observed in 73% of the patients who underwent two laparoscopic procedures (15 patients), and bowel resection was avoided in 40% of cases. The median durations of hospitalization and intensive care unit stay were 19 days (IQR 11-31) and 2 days (IQR 0-6), respectively. This selective, minimally invasive strategy for managing acute mesenteric ischemia demonstrated high 30-day CIF-free survival rates and reduced short-term mortality. These findings suggest the potential advantages of this approach in improving outcomes for patients with acute mesenteric ischemia.

Investigation into the influence of mild hypothermia on regulating ferroptosis through the P53-SLC7A11/GPX4 signaling pathway in sepsis-induced acute lung injury

BackgroundSepsis-induced acute lung injury (S-ALI) significantly contributes to unfavorable clinical outcomes. Emerging evidence suggests a novel role for ferroptosis in the pathophysiology of ALI, though the precise mechanisms remain unclear. Mild hypothermia (32–34 °C) has been shown to inhibit inflammatory responses, reduce oxidative stress, and regulate metabolic processes. P53 has been reported to downregulate the transcriptional activity of solute carrier family 7 member 11 (SLC7A11), thereby limiting cystine uptake. This reduction in cystine availability compromises the activity of Glutathione peroxidase 4 (GPX4), a cystine-dependent enzyme, ultimately increasing cellular susceptibility to ferroptosis. However, it remains unclear whether mild hypothermia exerts protective effects through the P53-SLC7A11/GPX4 signaling pathway. This study investigates the influence of mild hypothermia on ferroptosis mediated by the P53-SLC7A11/GPX4 pathway in S-ALI.MethodsThis study utilized both in vivo and in vitro models. In the vivo model, 64 Sprague–Dawley rats were employed, with 40 analyzed for survival outcomes. Sepsis was induced using the cecum ligation and puncture (CLP) method, after which rats were subjected to either normothermic (36–38 °C) or mild hypothermic (32–34 °C) conditions for a duration of 10 h. Twelve hours post-surgery, blood samples, bronchoalveolar lavage fluid, and lung tissue samples were harvested for histological analysis, measurement of inflammatory markers, wet/dry ratios, blood gas analysis, assessment of oxidative stress and ferroptosis, Western blotting, and RT-qPCR analysis. In the in vitro model, RLE-6TN cells were exposed to lipopolysaccharide (LPS) for 24 h under normothermic and mild hypothermic conditions. These cells were then evaluated for cell viability, inflammatory markers, oxidative stress levels, ferroptosis markers, as well as Western blot and RT-qPCR analyses.ResultsCLP-induced sepsis led to elevated levels of inflammatory markers, increased lung injury scores, and heightened oxidative stress markers. These detrimental effects were significantly ameliorated by mild hypothermia. Furthermore, mild hypothermia reversed the modified expression of P53, SLC7A11, and GPX4 signaling molecules. Notably, mild hypothermia also improved the 5-day survival rate of CLP rats.ConclusionMild hypothermia attenuates S-ALI and modulates ferroptosis through the P53-SLC7A11/GPX4 signaling pathway.

Comparative Analysis of Clinical Characteristics and Antimicrobial Resistance Between Acinetobacter baumannii and Other Acinetobacter Species.

Acinetobacter species are major pathogens responsible for hospital-acquired infections. This study aimed to compare the clinical characteristics, outcomes, and antimicrobial resistance between Acinetobacter baumannii (AB) and non-baumannii Acinetobacter (NBA) species. In this retrospective cohort study, we analyzed data from adult patients (aged 18 or older) with Acinetobacter bacteremia treated at two tertiary hospitals from July 2020 to November 2023. Among 260 cases of Acinetobacter bacteremia, 42 (16.2%) involved NBA species. The AB group exhibited higher antimicrobial resistance rates across all tested agents, except for minocycline. Female patients, younger patients, and those with catheter-related infections were more commonly observed in the NBA group than in the AB group, while pneumonia and septic shock were more prevalent in the AB group. In a multivariable analysis of 30-day mortality, factors associated with higher mortality included moderate to severe liver disease, chronic kidney disease, carbapenem resistance, septic shock, and higher Pitt Bacteremia Scores. When stratified by carbapenem resistance (CR) status, only CR-AB exhibited significantly lower 30-day survival rate (33.4%) compared to that of the other groups (non-CR-NBA, 77.3%; CR-NBA, 77.8%; non-CR-AB, 90.1%; p < 0.001). Our findings highlight distinct clinical differences between AB and NBA bacteremia cases; however, the mortality rate for non-CR-AB was comparable to that observed in NBA bacteremia.

Association between red blood cell distribution width-to-albumin ratio and prognosis in post-cardiac arrest patients: data from the MIMIC-IV database.

Cardiac arrest (CA) triggers a systemic inflammatory response, resulting in brain and cardiovascular dysfunction. The red blood cell distribution width (RDW)-to-albumin ratio (RAR) has been widely explored in various inflammation-related diseases. However, the predictive value of RAR for the prognosis of CA remains unclear. We aimed to explore the correlation between the RAR index and the 30- and 180-day mortality risks in post-CA patients. Clinical data were extracted from the MIMIC-IV database. The enrolled patients were divided into three tertiles based on their RAR levels (<3.7, 3.7-4.5, >4.5). Restricted cubic spline, Kaplan-Meier (K-M) survival curves, and Cox proportional hazards regression model were used to explicate the relationship between the RAR index and all-cause mortality risk. Subgroup analyses were also conducted to increase stability and reliability. The receiver operator characteristic (ROC) analysis was used to assess the predictive ability of the RAR index, red blood cell distribution width, and serum albumin for 180-day all-cause mortality. A total of 612 patients were eligible, including 390 men, with a mean age of 64.1 years. A non-linear relationship was observed between the RAR index and 180-day all-cause mortality, with a hazards ratio (HR) >1 when the RAR level exceeded 4.54. The K-M survival curve preliminarily indicated that patients in higher tertiles (T2 and T3) of the RAR index presented lower 30- and 180-day survival rates. An elevated RAR index was significantly associated with an increased 30-day [adjusted HR: 1.08, 95% confidence interval (CI): 1.01-1.15] and 180-day (adjusted HR: 1.09, 95% CI: 1.03-1.16) mortality risk. According to the ROC curve analysis, the RAR index outperformed the RDW and albumin in predicting all-cause 180-day mortality [0.6404 (0.5958-0.6850) vs. 0.6226 (0.5774-0.6679) vs. 0.3841 (0.3390-0.4291)]. The prognostic value of the RAR index for 180-day mortality was consistent across subgroups, and a significant interaction was observed in patients who were white, those with chronic pulmonary disease, or those without cerebrovascular disease. The RAR index is an independent risk factor for 30- and 180-day all-cause mortality in post-CA patients. The higher the RAR index, the higher the mortality. An elevated RAR index may be positively associated with adverse prognosis in post-CA patients, which can remind clinicians to quickly assess these patients.

The prediction value of serum anion gap for short-term mortality in pulmonary hypertension patients with sepsis: a retrospective cohort study.

The relationship between anion gap (AG) and short-term mortality of pulmonary hypertension (PH) patients with sepsis in the intensive care unit (ICU) remains unclear. This study involved a retrospective analysis of incident PH patients with sepsis first admitted to the ICU in the MIMIC IV database (2008 to 2019). Short-term outcomes include in-hospital mortality and 28-day mortality. According to the AG value (17.0 mmol/L), patients were divided into high-AG and low-AG groups. The Kaplan-Meier survival curve was used to compare the cumulative survival rates of the high and low groups using the log-rank test. Multivariable Cox regression analyses were constructed to assess the relationship between AG and short-term outcomes in PH patients with sepsis. A total of 2,012 sepsis patients with PH were included. The in-hospital mortality rates (11.4%) and 28-day mortality rates (12.8%) in the high-AG group were higher than those in the low-AG group (5.0% or 7.2%, respectively; P < 0.001). The Kaplan-Meier curve showed that the in-hospital and 28-day cumulative survival rates were lower in the high-AG group than in the low-AG group (P < 0.001). The multivariable Cox regression analysis confirmed that elevated AG was an independent risk factor of in-hospital mortality, 28-day mortality, and length of stay in the ICU and hospital. The relationship between elevated AG and in-hospital mortality remains stable after subgroup analyses. Elevated serum AG is associated with increased risk-adjusted short-term mortality in PH patients with sepsis, and it may aid clinicians in identifying patients with poor prognosis as early as possible.

Clinical Features of COVID-19 Associated Pulmonary Aspergillosis: A Multicenter, Retrospective Study.

This study was conducted to further understand the clinical characteristics of COVID-19 associated pulmonary aspergillosis (CAPA). In this study, we conducted a multicenter retrospective survey, which included patients with COVID-19 from five hospitals in Zhejiang, China. A total of 197 patients with COVID-19 were included in the study. The detailed clinical data of seven patients with CAPA from COVID-19 onset to 28 days after CAPA were collected and analyzed. In the total of 197 patients, 36 were admitted to the intensive care unit (ICU), 13 received mechanical ventilation; among them, nine received extracorporeal membrane oxygenation (ECMO). All seven cases acquired CAPA in the ICU, six cases during MV, of which five cases received ECMO treatment at the same time, and one case had been off ventilation. The average duration from onset of COVID-19 to CAPA was 25.4 days, from ICU admission to CAPA was 23.4 days, and from MV to CAPA was 22.1 days. All seven patients were diagnosed with CAPA without neutropenia, four with lymphopenia, seven with decreased CD4+ T lymphocyte, and five with decreased CD8+ T lymphocyte. All cases received glucocorticoids before CAPA, with an average duration of 15 days and an average cumulative dose of 762.5 mg prednisolone. In addition, all patients suffered bacterial infections and received antibacterial agents before CAPA, with an average duration of 22.6 days. CAPA was diagnosed according to a positive culture of Aspergillus fumigatus in sputum or bronchoalveolar lavage fluid (BALF) and positive serum 1,3-β-d-glucan in all seven patients; serum galactomannan was positive in three cases. Rhizopus was cultured from BALF of one case during treatment of CAPA. All patients received antifungal therapy, and the 28-day survival rate was 100%. The incidence of CAPA in patients with COVID-19 admitted to the ICU was 19.44%, all patients with CAPA had a history of chronic underlying diseases, and all had a history of high dose glucocorticoid. Patients with CAPA had no specific clinical symptoms and lung imaging manifestations, and diagnosis depended on Aspergillus culture and galactomannan detection. For patients with COVID-19 with these high-risk factors, Aspergillus culture and GM testing should be performed actively to avoid delaying the diagnosis of CAPA.

Relevance of perioperative fluid dynamics in liver transplantation to acute kidney injury and patient outcomes: a cross-sectional survey.

Fluid administration is a critical component of perioperative management for liver transplant recipients, and excessive fluid infusion can lead to acute kidney injury (AKI) and poor patient outcomes. We conducted a cross-sectional survey on the fluid intake and output of adult liver transplant recipients over a 7-day period. The patients were divided into AKI and non-AKI groups. Multivariate logistic regression analyses were used to evaluate the association between fluid balance (FB) and AKI. A Kaplan-Meier survival analysis was performed to determine the survival of the recipient survival at 180 days. A total of 210 liver transplant recipients were included. The peak FB occurred on the second day after transplantation, which was higher than on the seventh day (0.3 [IQR, -0.2 to 0.8] L vs. -0.4 [IQR, -1.0 to 0.3] L, p < 0.001). The highest incidence of AKI was observed on the second day after transplantation and the lowest on the seventh day (52.4% vs. 15.4%, p < 0.001). Multivariate analysis showed that a cumulative FB > 1 L within the first 2 days postoperatively was an independent risk factor for AKI on the second day after liver transplantation (LT) (OR = 2.66, 95% CI, 1.31-5.41, p = 0.007). Survival analysis indicated significant differences in 180-day survival rates among patients with different grades of AKI [94.0% (grade 1) vs. 91.4% (grade 2) vs. 77.8% (grade 3), χ 2 = 12.93, p < 0.001]. There is a significant correlation between post-LT AKI and perioperative FB. Cumulative FB > 1 L in the first 2 days postoperatively is an independent risk factor for AKI on the second day after LT. AKI after LT is associated with a lower 180-day survival rate in patients.

Association between increasing institutional experience with ECPR and outcomes in patients with out-of-hospital cardiac arrest: A nationwide multicenter observational study in Japan (the JAAM-OHCA registry).

To determine the association between institutional experience with extracorporeal cardiopulmonary resuscitation (ECPR) and outcomes after out-of-hospital cardiac arrest (OHCA). We analyzed data from the JAAM-OHCA registry, a nationwide multicenter database containing information on patients who experienced OHCA in Japan between June 2014 and December 2020. The study population consisted of patients with OHCA who were in cardiac arrest on hospital arrival and treated with extracorporeal membrane oxygenation (ECMO). Each patient was assigned a sequential number based on the order of initiation of ECPR at each facility. The primary outcome was 30-day survival and the secondary outcome was the interval between hospital admission and initiation of ECMO. Data for a total of 2,315 patients with OHCA and cardiac arrest on hospital arrival who were treated with ECPR at any of 87 facilities were analyzed. On admission, 1,047 patients had shockable rhythm and 1,268 had non-shockable rhythm. The 30-day survival rate was not significantly associated with the accumulated case volume of ECPR. The interval between hospital arrival and initiation of ECMO decreased significantly with increasing experience of ECPR (p<0.001, Jonckheere-Terpstra test). In non-shockable cases, 30-day survival tended to improve with increasing experience of ECPR (p=0.04, Cochran-Armitage trend test). Increasing institutional experience of ECPR did not significantly improve 30-day survival after OHCA but was associated with a shorter interval between hospital arrival and initiation of ECMO. In patients with non-shockable OHCA, increasing experience of ECPR improved 30-day survival. (246/250 words).

Retrospective Analysis: Exploring Transfusion Thresholds' Impact on Patients with Sepsis and Renal Failure.

Sepsis with renal failure is a common condition in intensive care units (ICUs) and is associated with poor prognosis. A unified consensus on the optimal transfusion hemoglobin concentration threshold is needed to improve outcomes. This study investigated the effects of different transfusion thresholds during hospitalization on the prognosis of patients with sepsis and renal failure. A total of 2,972 patients were included in this study. By using the Medical Information Mart for Intensive Care (MIMIC-IV) database, data from patients with sepsis and renal failure were screened and divided into a low-threshold group (Hb ≤ 7 g/dL) and a high-threshold group (Hb > 7 g/dL) based on the average hemoglobin (Hb) level 24 hours before transfusion. Univariate and multivariate Cox regression analyses and inverse probability weighting were used to compare in-hospital and ICU mortality rates between the two groups. Additionally, 30-day, 60-day, and 90-day survival rates, length of hospital stay, and ICU stay duration were evaluated. Statistically significant differences in baseline characteristics were observed between the two groups. After propensity score matching to eliminate baseline characteristic differences, it was found that among the Cau¬casian population a higher transfusion threshold significantly reduced the risk of in-hospital mortality (HR, 0.774; 95% CI: 0.613 - 0.978, p < 0.05). For patients with sepsis and renal failure, transfusion thresholds should be determined by considering the patient's race to achieve individualized transfusion strategies.

The Value of Heparin Binding Protein in Early Identification of Sepsis-Induced Coagulopathy Disease and Prognosis.

The aim of this study was to explore the value of heparin-binding protein (HBP) in the early recognition of sepsis coagulopathy (SIC) and the prognosis of sepsis patients. A retrospective analysis was performed for 139 patients with sepsis admitted to the Intensive Care Unit (ICU) of Hefei Third People's Hospital from April 2022 through April 2024. The clinical baseline data, disease scores [sequential organ failure (SOFA) score, acute physiology and chronic health status (APACHE II) score, and SIC score], inflammatory markers [HBP, procalcitonin (PCT), and interleukin 6 (IL-6)], coagulation-related indexes [platelet count (PLT), prothrombin time (PT), prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen (Fib), and D dimer (D-D)], and the survival time and 28-day prognosis of all patients were observed. The correlation between HBP and disease scores, inflammatory indexes, and coagulation-related indexes was analyzed. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of HBP for SIC and the value of HBP and SIC score for the prognosis of sepsis, the risk stratification was carried out according to the optimal cutoff value of HBP, the differences in the occurrence of major clinical events under different HBP stratifications were compared, and the Kaplan-Meier survival curve was used to analyze the 28-day cumulative survival rate under different HBP stratifications. Among the 139 patients, 98 developed SIC, 41 did not, 73 died at 28 days, and 66 survived. The disease score, inflammation index, and coagulation-related indexes of the non-SIC group were better than those of the SIC group, and the disease scores, inflammation indexes, and coagulation-related indexes of the survival group were better than those of the death group. Correlation analysis showed that HBP was positively correlated with disease score and inflammation index. Coagulation-related index was positively correlated with PT, APTT, PT-INR, Fib, and D-D, and negatively correlated with PLT, among which HBP had the best correlation with disease score (HBP was best correlated with SIC, SOFA, and APACHE II scores; r = 0.818, 0.847, and 0.829, p < 0.001). ROC analysis showed that HBP had a high efficacy in identifying SIC (AUC = 0.934, sensitivity 96.9%, specificity 87.8%, p < 0.001), and the AUC of HBP and SIC score and their combination for 28-day death prediction were 0.802, 0.773, and 0.844 (p < 0.001), respectively. Compared with the HBP ≤ 118.25 ng/mL group (n = 52), the 28-day mortality rate, SIC incidence, APACHE II, and SOFA scores were higher in the HBP > 118.25 ng/mL group (n = 52) (p < 0.001). Kaplan-Meier survival curve analysis showed that the cumulative survival rate of the HBP > 118.25 ng/mL group was significantly lower than that of the HBP ≤ 118.25 ng/mL group (p < 0.001). HBP has a high predictive value in the early identification of SIC and the prognosis evaluation of sepsis, and patients with sepsis with an early HBP > 118.25 ng/mL in the ICU have a higher risk of SIC and death.

Paracentesis exceeding three liters increases risks of acute kidney injury even in cirrhotic patients with albumin infused refractory ascites.

Cirrhotic patients with refractory ascites exhibit severe portal hypertension and hemodynamic disturbances. The risks associated modest-volume paracentesis (<5L) for refractory ascites remains unclear. We aimed to explore the impact of modest-volume paracentesis in refractory ascites. Cirrhotic patients with refractory ascites undergoing paracentesis <5L with albumin infusion were retrospectively enrolled. Patients were categorized into two groups based on the volume of paracentesis: ≥3L and <3L. Logistic regression analyses were used to determine risk factors for post-paracentesis complications, while Kaplan-Meier analysis was used to assess 28-day survival rates. Among 116 patients, 40 (34.5%) experienced post-paracentesis complications within one week, predominantly acute kidney injury (AKI) (19.8%). Twenty patients had paracentesis ≥3L and 96 patients had <3L. Overall complications were comparable between two groups (50% vs. 31.3%, p=0.109), but ≥3L group had more AKI (40% vs. 15.6%, p=0.013). Additionally, paracentesis ≥3L is an independent risk factor for AKI [Odds ratio (OR)=4.15, p=0.012], while higher MELD scores (OR=1.14, p=0.001) and older age (OR=1.03, p=0.047) are risk factors for overall complications. Furthermore, patients with post-paracentesis complications had significantly poorer 28-day survival. Cirrhotic patients with refractory ascites face a high risk of complications from modest-volume paracentesis, even with albumin infusion. Paracentesis ≥3L increases AKI risks, while higher MELD scores are linked to greater overall complications, leading to poor short-term survival.

Dipeptidyl peptidase-4 inhibitor linagliptin reduces inflammatory response, ameliorates tissue edema formation, and improves survival in severe sepsis.

Excessive inflammation in sepsis causes microvascular dysfunction associated with organ dysfunction and high mortality. The present studies aimed to examine the therapeutic potential of linagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor in a clinically relevant polymicrobial sepsis model in mice. Sepsis was induced by cecal ligation and puncture (CLP). Mice were grouped into: Sham control+vehicle; Group 2: CLP+vehicle; Group 3: CLP+dexamethasone (10 mg/kg, s.c.) given 6 h after CLP; Group 4: CLP+linagliptin (1 mg/kg, s.c.) given 6 h after CLP. The experiment was terminated 24 hours after CLP in two experimental sets. Seven-day survival following CLP was determined in a third experimental set. Treatment with linagliptin inhibited DPP-4 activity, increased the levels of active forms of endogenous gastric inhibitory polypeptide and glucagon-like peptide-1, without affecting the blood glucose levels in CLP mice. Compared to vehicle treatment, administration of linagliptin reduced sepsis-induced tissue hyper permeability as evidenced by a reduction in vascular Evans blue leakage, prevented edema formation in the lung, heart, liver and kidney. Furthermore, linagliptin or dexamethasone reduced sepsis-induced proinflammatory cytokine and chemokine production, such as IL-1β, IL-2, IL-10, IL-23, IL-27, VCAM-1, eotaxin, MDC, MCSF1, GCP-2, and NGAL. Importantly, administration of linagliptin improved the 7-day survival rate following CLP in mice. RNA sequencing in lung and heart revealed that linagliptin attenuated key inflammatory pathways including TNF alpha (via NFκB) and IL6/JAK/STAT3 signaling and activated interferon signaling in the heart. Linagliptin treatment can attenuate the inflammatory response, protect against severe sepsis-induced vascular hyperpermeability, reduce multiorgan injury, and most importantly, improve the survival.

Clinical outcomes following shock team implementation for cardiogenic shock: a systematic review

Abstract Background Cardiogenic shock is a critical cardiac condition characterized by low cardiac output leading to end-organ hypoperfusion and associated with high in-hospital mortality rates. It can manifest following acute myocardial infarction or acute exacerbation of chronic heart failure. Despite advancements, mortality rates remain elevated, prompting interest in multidisciplinary approaches to improve outcomes. This manuscript presents a review focused on the concept of a cardiogenic shock team and its potential impact on patient management and outcomes. Methods A comprehensive search was performed on March 19, 2023, covering PubMed, Web of Science, Scopus, Embase, and Cochrane Library. We included primary studies (prospective and retrospective) only and evaluated their quality using the Newcastle–Ottawa Quality Scale. This review was registered in PROSPERO (CRD42023440354). Results Six relevant studies with 2066 cardiogenic shock patients were included, of which 1071 were managed by shock teams and 995 received standard care. Findings from the reviewed studies indicated the favorable outcomes associated with implementing cardiogenic shock teams. Patients managed by these teams exhibited higher 30-day and in-hospital survival rates compared to those without team intervention. The implementation of cardiogenic shock teams was linked to reduced in-hospital and intensive care unit mortality rates. Additionally, shock team involvement was associated with shorter door-to-balloon times. Conclusion The findings suggest that cardiogenic shock teams play a crucial role in improving patient outcomes through earlier detection and timely interventions. Despite challenges in team implementation, their potential to reduce mortality and improve efficiency in patient care warrants further research and greater integration of multidisciplinary strategies into clinical practice.

Comparison of clinical characteristics and outcomes in candidaemia patients with and without COVID-19: a multicentre retrospective study

BackgroundInvasive fungal infections have been reported as complications with significant mortality and morbidity in patients hospitalized with COVID-19. This study aimed to evaluate the clinical characteristics and outcomes of candidaemia patients with COVID-19 and to investigate the association between COVID-19 and mortality in candidaemia patients.MethodsThis retrospective study included candidaemia patients aged 18 years or older admitted to four university-affiliated tertiary hospitals in South Korea between January 1, 2020, and December 31, 2022. The COVID-19 group comprised patients diagnosed with COVID-19 before the onset of candidaemia. Clinical features and outcomes were compared between the COVID-19 and non-COVID-19 groups. Multivariate logistic regression analyses were performed to identify risk factors related to 30-day mortality.ResultsOf the 355 patients diagnosed with candidaemia, 39 (11.0%) had a prior diagnosis of COVID-19. The COVID-19 group exhibited greater rates of systemic corticosteroid use (20.5% vs. 8.9%, p = 0.042), central venous catheter use (74.4% vs. 57.3%, p = 0.041), and mechanical ventilation (53.8% vs. 31.6%, p = 0.006) before the onset of candidaemia. The COVID-19 group had a greater rate of septic shock at the onset of candidaemia (61.5% vs. 32.0%, p < 0.0001) and a greater 30-day mortality rate (69.2% vs. 50.9%, p = 0.031). K‒M survival analysis revealed that patients in the COVID-19 group had a lower 30-day survival rate than did those without COVID-19 (p = 0.003 by log-rank test). However, in multivariate logistic regression analysis, COVID-19 did not significantly impact 30-day mortality.ConclusionsAccording to multivariate logistic regression analysis, COVID-19 was not an independent risk factor for mortality. However, candidaemia patients with a prior COVID-19 diagnosis were more likely to exhibit critical conditions such as mechanical ventilation and experience poor outcomes. Therefore, clinicians need to monitor and prevent candidaemia in critically ill patients with COVID-19.

D-dimer is a strong predictor of mortality in paediatric hematological-oncological patients with severe infections.

The purpose of this study was to explore the prognostic value of inflammatory biomarkers, including CRP, PCT, IL-6, IL-10,and the thrombotic biomarker D-dimer in predicting the development of severe infections and mortality in children with hematological malignancies. A retrospective observational study was performed from October 2018 to December 2020 at the Children's Hospital, Zhejiang University School of Medicine.It collected clinical data of pediatric patients diagnosed with hematological malignancies who experienced febrile illnesses. Blood samples were obtained within 24 hours of fever onset to test for D-dimer, Fibrinogen, PT, APTT, CRP, PCT and serum cytokine levels. Analysis revealed that with escalating infection severity, biomarkers such as CRP, PCT, IL-6, IL-10 and D-dimer progressively increased. The D-dimer level showed the highest accuracy (AUC of 0.930) in predicting mortality among children with severe infections. The combined analysis of IL-6 and D-dimer significantly improves the accuracy of prognosis in sepsis cases. A 60-day survival rate was lower for patients with D-dimer levels above 1.91 mg/L. In conclusion, D-dimer levels have proven to be a reliable biomarker for predicting mortality in children with hematological malignancies experiencing severe infections.

Risk factors and outcome of Pseudomonas aeruginosa bloodstream infections (PABSI) in hematological patients: a single center retrospective cohort study.

Bloodstream infections caused by Pseudomonas aeruginosa (PABSI) in hematological patients are associated with high morbidity and mortality. We investigated the epidemiology, risk factors, and outcomes of PABSI at our center. All adult hematological patients with PABSI between January 2013 and July 2023 were included. Demographic and clinical characteristics, antimicrobial susceptibilities, antibiotic therapy, fluoroquinolone-prophylaxis, source of infection, and 30-day outcome were recorded. Descriptive statistics, tests for difference, and logistic regression models were performed. Fifty patients with PABSI were identified with a median age of 58.5 years (range 24-78). 37 patients (74%) had severe neutropenia, 20 (40%) received allogeneic HSCT, and 29 (58%) had acute leukemia. A total of 34 (68%) had received timely appropriate anti-pseudomonal antibiotic therapy. The most common presumed cause of PABSI was mucositis (n = 16, 32%), followed by pneumonia (8, 16%) and skin and soft tissue infections (n = 6, 12%). Empirical combination therapy was used in 16 (32%) patients, while targeted combination therapies were used in 27 (54%) patients. P. aeruginosa detection led to treatment change in 31 (62%) cases. The overall 30-day survival rate was 78% (n = 39). Carbapenem-resistance occurred in 34% (n = 17), and multidrug-resistance (MDR) in 20% (n = 10). Prior antibiotic exposure was associated with resistance. Appropriate antibiotic therapy was associated with survival, whereas antibiotic resistance and organ infection were associated with a fatal outcome. Prior antibiotic exposure in hematological patients is associated with resistance in PABSI, which is a major risk factor for a fatal outcome. Antibiotic stewardship efforts should be intensified and fluoroquinolone prophylaxis needs to be reconsidered.

Sex difference in outcomes after coronary artery bypass grafting: follow-up data of the Netherlands Heart Registration.

Controversies exist regarding sex differences in outcomes after coronary artery bypass grafting (CABG). This study assessed sex differences in early and mid-term outcomes after CABG and factors associated with these differences. Outcomes were based on data from the Netherlands Heart Registration (NHR). Data of patients undergoing CABG in the Netherlands between 2013 and 2019 were retrieved from the NHR database. Primary outcomes were early mortality, morbidity and mid-term survival. The population was divided into subgroups based on age (≥ 70years and < 70years). Regression analyses investigated the correlation between sex and both early and mid-term mortality. This study included 41,705 male and 10,048 female patients. Median follow-up was 3.6 (1.8-4.8) years. Female patients were less likely to receive ≥ 2 arterial grafts (15.9% vs 23.2%, p < 0.001), had fewer anastomoses (3.2 ± 1.1 vs 3.5 ± 1.1, p < 0.001), higher 30-day mortality (1.9% vs 1.0%; p < 0.001) and alower mid-term survival rate (91.3% vs 93.1%, p < 0.001). Perioperative complications, including myocardial infarction and stroke, were more common in female patients (all p < 0.001). Women aged < 70years had alower mid-term survival rate than men < 70years (94.5% vs 96.0%, p < 0.001). Cox regression analysis showed that female sex was not significantly associated with mid-term mortality in the total cohort [hazard ratio (HR) 1.03; p = 0.45] but was associated with mid-term mortality in patients aged < 70years (HR 1.19; p < 0.001). Women undergoing CABG in our cohort presented with more complex risk profiles, received different surgical strategies and had worse early and mid-term outcomes compared to men. Female sex was associated with mid-term mortality only in patients < 70years of age.

The endothelial activation and stress index is a potential prognostic indicator for patients with acute pancreatitis managed in the intensive care unit: a retrospective study.

The endothelial activation and stress index (EASIX) serves as a dependable and efficient surrogate marker for endothelial dysfunction, which plays an essential role in the pathophysiology of acute pancreatitis (AP). Hence, we investigated the prognostic value of EASIX in AP. This was a retrospective study, using patient information obtained from the Medical Information Market for Intensive Care-IV (MIMIC-IV) database. EASIX was calculated using lactate dehydrogenase, serum creatinine, and platelet counts obtained during the first measurement within 24 h of admission. Patients were grouped into three cohorts based on log2-transformed EASIX. The main endpoint of the study was 28-day all-cause mortality (ACM) in AP patients, with the secondary endpoint being 90-day ACM. The relationship between EASIX and prognosis in patients with AP was evaluated using Cox proportional hazards models, Kaplan-Meier curves, restricted cubic spline (RCS) curves, and subgroup analyses. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of EASIX compared to other indicators. The study cohort comprised 620 patients in total. Multivariate Cox proportional hazards analysis indicated that an increased log2 (EASIX) was linked to a higher risk of 28-day ACM in AP patients (HR, 1.32; 95% CI: 1.14-1.52; p < 0.001). The risk of 28-day ACM was higher in Tertiles 2 and 3 compared with Tertile 1 [(HR, 2.80; 95% CI: 1.21-6.45); (HR, 3.50; 95% CI: 1.42-8.66)]. Comparable findings were noted for 90-day ACM. Kaplan-Meier curves demonstrated that patients with elevated log2 (EASIX) had lower 28- and 90-day survival rates. The RCS curves suggested a non-linear relationship between log2 (EASIX) and 28- and 90-day ACM. ROC curves indicated that log2 (EASIX) was not inferior to sequential organ failure assessment and systemic inflammatory response syndrome scores in predicting the prognosis of patients with AP. Subgroup analyses demonstrated no interaction between log2 (EASIX) and any subgroup. Elevated EASIX levels were significantly correlated with a heightened risk of 28- and 90-day ACM in AP patients.