Characteristics and prognostic factors of adult poisoning patients in the intensive care unit: A retrospective cohort study using the Japanese intensive care patient database.

To evaluate the clinical impact of cardiac surgery-associated acute kidney injury requiring continuous venovenous haemofiltration by assessing its impact on short- and long-term outcomes. Data for all adult cardiac surgeries performed between 2015 and 2024 were retrieved from our institutional database. 1:2 propensity-score matching of patients requiring postoperative haemofiltration and those not requiring haemofiltration was performed based on the EuroSCORE II covariates. In-hospital outcomes (mortality, postoperative complications, postoperative hospitalisation duration) and long-term survival were evaluated. After excluding patients requiring renal replacement therapy preoperatively, 16,681 patients were included. Propensity matching yielded Group H (postoperative haemofiltration, n=510) and Group C (controls, n=1020). Groups had generally similar demographics and preoperative clinical characteristics. Group H exhibited worse in-hospital outcomes compared to Group C. Hospital mortality was significantly higher in Group H (23.1% vs 6.2%, p<0.001), with higher mortality up to five years and poorer long-term survival (HR =1.81 (95% CI: 1.50-2.18), p<0.001). Conditional survival analyses demonstrated that among patients who survived past hospital discharge, long-term survival was comparable between groups (HR 1.23, 95% CI 0.95-1.58, p=0.115). Postoperative AKI requiring haemofiltration is associated with poor outcomes following cardiac surgery. However, in patients surviving the acute postoperative phase, there was no significant difference in long-term survival compared to those who did not require haemofiltration. These findings underscore the importance of early recognition and management of acute kidney injury after cardiac surgery whilst offering a more nuanced understanding of long-term prognosis.

Development and internal validation of machine learning in predicting prognosis of acute kidney injury patients in resource-limited setting.

To analyze the spatiotemporal distribution of preeclampsia and eclampsia in Brazil over 16years. Retrospective study (2008-2023) using nationwide SUS data. Women aged 10-49years with ICD-10 codes O14 and O15 were included. Hospitalization and maternal mortality rates per 100,000 estimated pregnancies; in-hospital mortality; and Disability-Adjusted Life Years (DALYs). Spatial patterns were assessed using Global Moran's I and Local Indicators of Spatial Association (LISA), and trends using Joinpoint and Mann-Kendall tests. Of 877,555 hospitalizations identified, the national rate rose from 38.2 to 86.3 per 1,000 pregnancies (AAPC=5.7%; p<0.001). The Northeast had the highest average rate (74.1) and sustained growth. Spatial analysis revealed significant clustering for hospitalization (Moran's I=0.565) and mortality (Moran's I=0.121), with hotspots in the Northeast and Southeast (Minas Gerais). Eclampsia caused 18.4% of maternal deaths. While national DALY trends were stable, driven by the mortality component (YLL>99%), the Central-West showed a significant decline (tau=-0.55; p=0.0034). DALY rates were highest in the North (mean=8.26) and lowest in the South (mean=3.28). Preeclampsia/eclampsia hospitalizations are rising in Brazil, yet persistent mortality exposes a quality chasm exacerbated by workforce shortages and SUS underfunding. Addressing these inequities requires strengthening surveillance and referral systems to ensure dignified, high-quality care and reduce the disease burden.

The population of elderly patients with asthma is increasing, resulting in serious health problems because of hospitalization and high mortality rate. Furthermore, several recent studies have shown that progressive airflow limitation may worsen cognitive dysfunction and contribute to poor asthma control. Maintaining good respiratory function is therefore important in the elderly in order to achieve a satisfactory quality of life. A 12-week, open-label, cross-over study was conducted in elderly patients with asthma to investigate the effect of 5μg/day tiotropium bromide (TIO) add-on therapy administered using a soft mist inhaler (SMI), in addition to a dosage of 500/20µg/day fluticasone propionate/formoterol fumarate (FP/FM) treatment and to compare the effects of treatment with those following the administration of 500/20 µg/day FP/FM alone. The trial design thus entailed a 4-week run-in period and two 4-week treatment periods. A total of 21 patients aged over 65 years with stable bronchial asthma were recruited in the study. Forced expiratory volume in 1 second values after the treatment period with FP/FM and TIO add-on therapy were significantly higher than those after the run-in period (p < 0.01). TIO add-on therapy FP/FM treatment using an SMI in elderly patients with asthma improved lung function parameters demonstrating, the value of TIO add-on therapy as a treatable traits option for improving quality of life and achieving successful aging in this population.

Annual hospital volume of gastrectomy and gastric cancer mortality - a population-based nationwide study in Finland.

Due to demographic change, the number of geriatric patients is increasing in the surgical field. This poses a major challenge in perioperative medicine. In order to improve patient safety, frailty has become a key element for risk assessment in the perioperative setting. This review aims to summarize the current state of anesthesia in frail patients. Frailty is an independent risk factor for intraoperative and postoperative complications, mortality, and length of hospital stay. The Clinical Frailty Scale has been shown to be a feasible, easy-to-use tool for frailty assessment. Frailty is likely to be modified through targeted preoperative optimization (prehabilitation). This should be carried out on a multidisciplinary basis. During preoperative risk assessment, special attention should be paid to polypharmacy and multimorbidity. Particularly in geriatric patients, maintaining intra- and postoperative homeostasis is essential. Adequate pain management and prevention of perioperative delirium are of utmost importance. Frailty is a common and highly relevant clinical risk factor in the perioperative setting. In future, efforts should focus on identifying methods to improve the status of preoperative frail patients.

Patient-Directed Discharge Among Hospitalized Persons With Opioid Use Disorder in the Fentanyl Era: A Scoping Review.

Evidence regarding the relationship between hospital volume and mortality in burn care remains inconclusive. Therefore, we investigated this association using a comprehensive, nationwide clinical registry with detailed clinical data in Japan. We conducted a retrospective multicenter cohort study using the Japanese Society of Burn Injuries Burn Registry 2011, including 24,065 hospitalized patients with burns. We included acute burn patients with a Burn Index ≥ 10 and excluded those admitted for reconstructive/aesthetic surgery, transferred in or out, presenting with cardiopulmonary arrest on arrival, or with missing key variables. The primary exposure variable was annualized hospital volume of burn admissions, categorized into quartiles. The primary outcome was in-hospital mortality. Adjusted odds ratios (aORs) were calculated using multivariable logistic regression with hospital-clustered robust standard errors, controlling for age, sex, burn size, full-thickness burns, inhalation injury, mechanism, anatomical site, and admission year. Secondary analyses were based on the annual surgical volume, and prespecified sensitivity analyses (tertiles, exclusion of the highest-volume hospital, length of stay ≥3 days, and inclusion of transfer-in cases) assessed the robustness. A total of 2859 patients treated at 105 hospitals met eligibility criteria for primary analysis. Compared with the lowest-volume quartile (Q1), aORs (95% CI) for the mortality were Q2, 1.48 (0.83-2.66); Q3, 1.05 (0.59-1.90); Q4, 1.13 (0.66-1.95); p for trend 0.65. Using surgical volume quartiles, aORs were Q2, 0.81 (0.42-1.56); Q3, 1.05 (0.55-2.02); Q4, 0.73 (0.38-1.42); p for trend 0.30. Sensitivity analyses yielded consistently null findings. In this nationwide registry, we did not find evidence that higher hospital admission rates or surgical volume were associated with in-hospital mortality after risk adjustment. In Japan's current system, volume alone may not confer a survival advantage.

Acute respiratory distress syndrome and acute kidney injury in critically ill patients: A scoping review on this lung-kidney crosstalk.

Multimorbidity, readmissions and mortality among older patients with potentially preventable hospitalisations: a Danish nationwide cohort study.

Frailty and readmission to the ICU are common, and both are associated with worse outcomes. However, there is limited literature that assesses how frailty impacts those patients who require readmission to the ICU during a hospitalization. Therefore, we sought to assess whether the association between ICU readmission and death differ by frailty state. A registry-based study used the Australian and New Zealand Intensive Care Society Adult Patient Database. All adult patients (age ≥ 18 yr) admitted to 203 ICUs in Australia and New Zealand between January 2017 and December 2022 with a documented Clinical Frailty Scale (frailty defined as a score ≥ 5) were included. None. The primary outcome was 60-day mortality. A Cox proportional hazards model, treating time to readmission as a time-dependent covariate and including an interaction term between frailty state and readmission, was used. Regression standardization was used to estimate absolute risk and risk differences, with 95% CIs calculated using a nonparametric bootstrap. A competing risk analysis was conducted, treating in-hospital death without ICU readmission as a competing risk. Secondary outcomes included length of hospital stay and discharge location. Six hundred fifteen thousand seven hundred nineteen ICU admission episodes were analyzed. Of the entire cohort, 19% (115,453) were frail, and 4.1% (25,329) were readmitted to the ICU. By day 60, 2.7% patients had died (16,353) in the hospital. Patients with frailty were at increased risk of both ICU readmission (subdistribution hazard ratio [SHR], 1.10; 95% CI, 1.07-1.14) and death without readmission (SHR, 2.83; 95% CI, 2.72-2.94). Observed 60-day mortality was greatest in frail, readmitted patients (22.7%). The standardized risk increase in 60-day mortality associated with ICU readmission was similar between patients with and without frailty (14.6% [95% CI, 13.7-15.6%] vs. 14.9% [95% CI, 13.4-16.6%]), respectively. This large, multicenter, retrospective study found that ICU readmission was associated with increased 60-day mortality in patients with and without frailty. Readmitted patients with frailty had the greatest risk of 60-day mortality; however, frailty state did not modify the incremental absolute risk of death relative to nonreadmitted patients.

Steroid Therapy in Community-Acquired Pneumonia: An Updated Systematic Review and Meta-Analysis.

The role of systemic therapy in paediatric Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) remains undefined. Management is primarily guided by observational data and variable practice patterns. This systematic review aims to integrate recent evidence and evaluate clinical outcomes associated with systemic therapies in paediatric SJS/TEN. A systematic search of PubMed, Embase and Scopus was conducted from January 1990 to February 2025. Studies were eligible if they included patients (< 18 years) with SJS, SJS-TEN overlap or TEN managed with supportive care alone or systemic therapy (corticosteroids, intravenous immunoglobulin (IVIg), cyclosporin, TNF-α inhibitors or plasmapheresis). Studies without defined diagnoses or outcomes were excluded. Primary outcomes were mortality and length of hospital stay. Risk of bias was assessed using CARE guidelines for case reports and the Joanna-Briggs checklist for observational studies. Studies providing individual-level data were synthesised quantitatively, while aggregated data were described narratively. A total of 260 studies comprising 1608 paediatric patients met inclusion criteria. Most patients received systemic therapy, most commonly corticosteroids or IVIg. Systemic therapy was not associated with a shorter length of stay or reduced mortality rate compared to supportive care alone. Treatment with cyclosporin and TNF-α inhibitors trended towards lower mortality rates, and for cyclosporin, shorter length of stay. However, these findings did not reach statistical significance. Evidence for systemic therapy remains limited by study heterogeneity and small sample sizes. Although emerging targeted therapies show early promise, firm conclusions regarding efficacy cannot be drawn. This highlights the need for further collaborative research.

The transition from hospital to home represents a high-risk "vulnerable period" for patients with heart failure (HF). While numerous transitional care interventions (TCIs) have been developed, their relative efficacy and optimal hierarchy remain uncertain in the context of modern clinical practice. To evaluate and rank the effectiveness of different TCIs in reducing readmissions and mortality and improving quality of life (QoL) in hospitalized HF patients. We updated the 2014 Feltner review by integrating its previously included RCTs with a new systematic search of PubMed, Embase, and Cochrane CENTRAL (November 2013 to January 2025). Interventions were categorized into eight nodes: Home Visiting (HV), Multidisciplinary Clinics (MDC), Telemonitoring (TM), Structured Telephone Support (STS), Pharmacy-led Care (PHARM), Physical Rehabilitation (REHAB), Education (EDU), and Usual Care (UC). A frequentist network meta-analysis was performed using a random-effects model, and interventions were ranked using P-scores. Nineteen trials involving 11,452 patients were included. For all-cause readmission, HV was the only intervention significantly superior to UC (RR 0.67, 95% CI 0.52-0.86) and was ranked highest (P-score = 0.902). For all-cause mortality, HV (P-score = 0.872) and MDC (P-score = 0.556) showed the highest probability of being best. Notably, MDC ranked first for reducing HF-specific readmission (P-score = 0.890), while REHAB and MDC were the most effective for enhancing Quality of Life (SMD ranking). TM showed moderate efficacy in mortality reduction but ranked poorly for readmission prevention. Nurse-led Home Visiting emerged as the highest-ranked strategy for reducing overall hospital utilization and mortality. Multidisciplinary clinics are superior for disease-specific stabilization, while physical rehabilitation is essential for improving functional well-being. A bundled approach integrating these elements should be prioritized in clinical pathways to optimize heart failure care transitions. PROSPERO registration number: CRD420261299376.

BackgroundPopulation aging, coupled with improvements in healthcare, may influence ICU admission trends and care practices among critically ill elderly patients (≥80 years), longitudinal data evaluating this remain limited in China. Our aim was to analyze and compare trends in ICU admissions, clinical outcomes, and resource use among critically ill elderly patients (≥80 years), in comparison with older (65–79 years) and younger (16–64 years) cohorts.MethodsWe retrospectively analyzed ICU patients aged ≥16 years admitted to a tertiary referral hospital in China from January 2014 to December 2021. A total of 31,535 patients were categorized into three age groups: ≥ 80 years (11.5%), 65–79 years (30.7%), and <65 years (57.8%).ResultsICU admission rates for elderly patients declined significantly from 13.2% in 2014 to 9.0% in 2021 (p < 0.001, relative decrease 31.8%), particularly among nonsurgical admissions. Elderly patients had higher comorbidities, greater disease severity scores, but lower daily average TISS-28 scores compared to younger cohorts. They were more likely to receive inotropic/vasopressor support and nutritional interventions, had higher blood loss due to frequent laboratory testing, and required more red blood cell transfusions. However, they were less likely to undergo invasive ventilation. The proportion of elderly patients requiring invasive ventilation decreased significantly over the study period. Despite a higher hospital mortality rate (elderly 14.1%, older 6.1%, younger 3.1%; p < 0.001), elderly patients demonstrated a more significant reduction in risk-adjusted mortality over time compared to younger patients (elderly vs. younger, 12.5% vs. 6.3%, relative reduction per year, p < 0.001).ConclusionICU admission rates for elderly patients are declining, particularly in nonsurgical cases. Less invasive life support modalities have been increasingly utilized in their care. While mortality remains higher among elderly patients, they demonstrate a more significant improvement in survival over time compared to younger cohorts.

Proactive versus Resuscitative Extracorporeal Membrane Oxygenation for Low Cardiac Output Syndrome after Cardiac Surgery.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) frequently coexists with type 2 diabetes mellitus (T2DM) and is associated with substantial short-term mortality. However, patients with AECOPD and metabolic comorbidity represent a clinically heterogeneous subgroup, and admission-based tools with independent validation for early in-hospital mortality risk stratification in this population remain limited. In this multicenter retrospective cohort study, hospitalized patients with AECOPD and concomitant T2DM were consecutively enrolled and divided into a training cohort and an institutionally independent validation cohort from a separate hospital within the same city. Candidate predictors routinely available at admission were evaluated using multivariable logistic regression to develop a parsimonious prediction model for in-hospital mortality. Model performance was assessed in terms of discrimination, calibration, and clinical utility, and compared with established bedside scores, including the quick Sequential Organ Failure Assessment (qSOFA) and BAP-65. Elevated arterial carbon dioxide tension (PaCO₂), procalcitonin (PCT), and D-dimer measured early after admission were independently associated with in-hospital mortality. A simplified model incorporating these three variables demonstrated stable discrimination in both the training and validation cohorts, with an area under the receiver operating characteristic curve of approximately 0.79, and showed good calibration. Decision curve analysis indicated higher or non-inferior net clinical benefit across clinically relevant threshold probabilities compared with qSOFA and BAP-65. In hospitalized patients with AECOPD and T2DM, PaCO₂, PCT, and D-dimer were independently associated with in-hospital mortality. An admission-based model integrating these markers showed promising performance in multicenter data with independent hospital-based validation within the same city. Further validation in geographically distinct populations is needed before broader generalizability can be assumed.

To evaluate the association between sex assigned at birth and outcomes for critically ill patients in India. Retrospective registry-embedded cohort study. Forty-five ICUs that are part of the Indian Registry of IntenSive care (IRIS). We included adult (≥ 16 yr) patients admitted to ICUs in the IRIS. None. The primary exposure was sex at birth, and the primary outcome was ICU mortality. Secondary outcomes included in-hospital mortality, receipt of mechanical ventilation, kidney replacement therapy, and vasopressors. Logistic regression models for the primary and secondary outcomes were adjusted for prespecified baseline covariates. We included 82,151 patients from 45 ICUs. Median (interquartile range) age was 60.0 years (45.0-70.0 yr) and 38.2% (n = 31,409) of the cohort was female. Baseline characteristics were similar. Comparing sexes, ICU mortality (9.5% females vs. 10.3% males; adjusted odds ratio [adjOR], 0.95; 95% CI, 0.90-1.00; p = 0.07) and hospital mortality (19.4% vs. 20.8%; adjOR, 1.00; 95% CI, 0.97-1.03; p = 0.66) were similar. Females less commonly received invasive ventilation (22.2% vs. 26.3%; adjOR, 0.78; 95% CI, 0.75-0.82; p < 0.001), kidney replacement therapy (4.9% vs. 6.3%; adjOR, 0.73; 95% CI, 0.68-0.78; p < 0.001), and vasopressors (19.1% vs. 20.2%; adjOR, 0.95; 95% CI, 0.92-0.99; p = 0.03). In contrast, females more commonly received noninvasive ventilation (11.7% vs. 9.7%; odds ratio, 1.23; 95% CI, 1.18-1.30; p < 0.001). Results of the sensitivity analyses were consistent with the primary findings. In this registry-embedded cohort study, critically ill females less commonly received most types of organ supports, yet had similar adjusted ICU mortality compared with males.

Splenic Angioembolization and Operative Management Rates Across Trauma Center Levels: A National Analysis of Blunt Splenic Injury Outcomes.