Intensive Care Unit Research Articles

Brain health

Damage to the brain can have disastrous and long-lasting consequences. The European Society of Anaesthesiology and Intensive Care (ESAIC) is aware of the importance of taking good care of the brain, both of patients and of anaesthesia and intensive care unit (ICU) caregivers, and has organised a complete learning track on brain health to bring this concern to the attention of practitioners. This learning track included an online Focus Meeting on Brain Health (November 25, 2023). We here provide readers with a digest of the information that was delivered during that meeting in an opinion paper driven by the authors’ own reading of the literature. It is divided according to the meeting's sessions, including how to improve the health of an injured brain, how to keep a young or old brain healthy, how to keep a healthy adult brain unimpaired, how monitoring can impact brain health in the operating room and in the intensive care unit, and how to keep the anaesthesia and ICU caregivers’ brain healthy. Each part is a brief and focused summary. The main delivered messages are that the management of injured brain patients involves an adequate choice of sedation, adequate brain monitoring, and focused attention to specific points depending on the underlying pathology; that several measures can be undertaken to protect the brain of the very young needing anaesthesia; that it is possible to detect older patients at risk of postoperative neurocognitive disorders, and that dedicated perioperative management by a multidisciplinary expert team may improve their outcomes; that apparently healthy adult brains may suffer during anaesthesia; that the electroencephalogram may track peri-operative brain dysfunction, and that female patients should be given special care in this respect; that multimodal brain monitoring helps to detect pathological processes and to maintain brain homeostasis; and that burnout in anaesthesiologists can be effectively fought using personal, organisational, managerial and legal approaches.

Point-of-care ultrasonography in pediatric intensive care units

Bedside ultrasonography, or point-of-care ultrasonography (POCUS), is increasingly becoming widely adopted in pediatric intensive care units (ICU) for procedural interventions and diagnostics. Although vascular access remains one of the primary applications of POCUS in the pediatric ICU, its use for assessing fluid status and responsiveness is growing. POCUS helps identify reversible causes of cardiac arrest, such as pericardial effusion and pneumothorax, although its impact on outcomes is still under investigation. Here, we will review the applications of POCUS in the pediatric ICU, including the general pediatric and cardiac ICUs. We will discuss the up-to-date evidence guiding its use and adoption for critically ill children.

The association between acute kidney injury and dysglycaemia in critically ill patients with and without diabetes mellitus: a retrospective single-center study.

Critically ill patients in the intensive care unit (ICU) often experience dysglycaemia. However, studies investigating the link between acute kidney injury (AKI) and dysglycaemia, especially in those with and without diabetes mellitus (DM), are limited. We used the Medical Information Mart for Intensive Care IV database to investigate the association between AKI within 7 days of admission and subsequent dysglycaemia. The primary outcome was the occurrence of dysglycaemia (both hypoglycemia and hyperglycemia) after 7 days of ICU admission. Logistic regression analyzed the relationship between AKI and dysglycaemia, while a Cox proportional hazards model estimated the long-term mortality risk linked to the AKI combined with dysglycaemia. A cohort of 20,008 critically ill patients were included. The AKI group demonstrated a higher prevalence of dysglycaemia, compared to the non-AKI group. AKI patients had an increased risk of dysglycaemia (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.41-1.65), hypoglycemia (aOR 1.56, 95% CI 1.41-1.73), and hyperglycemia (aOR 1.53, 95% CI 1.41-1.66). In subgroup analysis, compared to DM patients, AKI showed higher risk of dysglycaemia in non-DM patients (aOR: 1.93 vs. 1.33, Pint<0.01). Additionally, the AKI with dysglycaemia group exhibited a higher risk of long-term mortality compared to the non-AKI without dysglycaemia group. Dysglycaemia also mediated the relationship between AKI and long-term mortality. AKI was associated with a higher risk of dysglycaemia, especially in non-DM patients, and the combination of AKI and dysglycaemia was linked to higher long-term mortality. Further research is needed to develop optimal glycemic control strategies for AKI patients.

Use of COVID-19 Personal Protective Equipment (PPE) Among Healthcare Workers in Teaching Hospitals of Khorramabad, Iran

Background and Objective: In light of the pivotal role played by personal protective equipment (PPE) in mitigating the transmission of the novel coronavirus, this study aimed to investigate the utilization of personal protective equipment in the context of the COVID-19 pandemic among medical personnel and students affiliated with Lorestan University of Medical Sciences in the year 2019. Methods: This cross-sectional, descriptive research study collected essential data, encompassing personal characteristics and inquiries concerning the use of personal protective equipment, the extent of their utilization, training regarding proper equipment use, and adherence to health guidelines, including hand hygiene and disinfectant usage. Data were gathered through a questionnaire developed in accordance with international standards, specifically the PPE Safe Survey. The questionnaire was administered to medical staff, including physicians, nurses, and medical students, working in healthcare facilities that admitted COVID-19 patients within the Lorestan University of Medical Sciences, situated in Khorramabad. Results: Our investigation involved a total of 201 participants, comprising 82 (40.8%) males and 119 (59.2%) females. The average age of the participants was 32 years, with an average daily duration of personal protective equipment utilization amounting to 8.9 hours. Notably, 44 (21.9%) participants worked in emergency wards, 63 (31.3%) in general medical wards, 12 (6.0%) in administrative departments, 14 (7.0%) in surgical units, 11 (5.5%) in anesthesiology, 17 (8.5%) in intensive care units, and 40 (19.9%) in miscellaneous contexts. Conclusion: The study findings underscore the imperative need for healthcare professionals to consistently employ suitable personal protective equipment, encompassing face masks, eye protection, gowns, and eye shields. Furthermore, our study highlights the significance of appropriate training and rigorous adherence to equipment utilization protocols during healthcare tasks, coupled with consistent hand hygiene practices in healthcare facilities.

Early identification of non-occlusive acute mesenteric ischemia

Acute mesenteric ischemia (AMI) is insidious in the early stage of the disease, and once ischemia reaches the late stage, irreversible intestinal necrosis and even multiple system organ failure occur, ultimately leading to death. Early diagnosis and intervention are the key to improving the outcome of AMI. Intensive care unit (ICU) patients mostly present with non-occlusive mesenteric ischemia (NOMI) due to hypoperfusion. This article reviews the high risk factors, clinical manifestations, biomarkers, and imaging examinations of AMI in order to provide ideas for clinicians in the early identification of this disease.

Distorted Memory among the Patients in Intensive Care Unit and its Related Factors.

Distorted Memory among the Patients in Intensive Care Unit and its Related Factors.

A Day Saved is a Life Saved: Direct Antimicrobial Susceptibility Testing from Positively Flagged Blood Culture Bottles and their Concordance with the Routine Method.

Sepsis is a major health problem worldwide and is associated with high morbidity and mortality with every hour delay in initiation of therapy. A conventional method of blood culture and Antimicrobial Susceptibility Testing (AST) takes around 48-72 hours. Empirical antibiotics need to be administered until the sensitivity report is made available. It has been estimated that 20-50% of the empirical antibiotics are inappropriate, resulting in prolonged hospital stays, adverse effects, and emergence of drug resistance. Additionally, this also puts an extra financial burden on both the patients and healthcare settings. Performing direct Antimicrobial Sensitivity Testing (dAST) is an important tool to reduce turn-around time (TAT) by at least 18-24 hours, thus reducing morbidity and mortality among critically ill patients. Direct AST (dAST) was performed from the positively flagged blood culture bottles received between December, 2021 to May, 2022 from Intensive Care Units (ICUs) on Mueller- Hinton Agar (MHA) using four drops of withdrawn blood. dAST was performed for six drugs: Ceftriaxone-30 μg (CTR), Piperacillin/Tazobactam-100/10 μg (PIT), Meropenem-10 μg (MRP), Ciprofloxacin-5 μg (CIP), Aztreonam-30 μg (AT), and Colistin (CL). The zone of inhibition was interpreted as per CLSI M100 ed32, 2022 guidelines. A parallel conventional method was also performed to examine for categorical agreement and disagreement. Identification was carried out using MALDI-TOF MS from the colonies that appeared on the dAST plate on the subsequent day. A total of 162 positively flagged blood culture bottles were included in the study. The majority of the Gram-negative organisms were from Enterobacterales (n=109), followed by Acinetobacter spp. (n=28) and Pseudomonas aeruginosa (n=25). Out of the 972 isolate-antimicrobial combinations, overall Categorical Agreement (CA) was seen in 936 (96.3%), whereas disagreement was observed in 36 with minor error (mE) in 21 (2.2%), major error (ME) in 7 (0.7%), and very major error (VME) in 8 (0.8%) when compared to the routine method. Categorical agreement (CA) of > 99% was seen in ceftriaxone (CTR) and ciprofloxacin (CIP). In comparison, the lowest CA was observed with meropenem (MRP) at 92%. Colistin dAST was performed using the E-strip method, and the result obtained was highly convincing, with an overall disagreement of only 1.2%. Rapid dAST from positively flagged blood culture bottles proved to significantly reduce the TAT from the time of sample collection to the first availability of antimicrobial susceptibility report with excellent categorical agreement of > 95% using the conventional disc diffusion method. Results obtained were within the acceptance criteria set by U. S. Food and Drug Administration (FDA) guidelines of > 90% categorical agreement for a new method. We were able to obtain excellent concordance for colistin using the E-strip method. Performing dAST not only saves a "day", but its proper implementation would save a "life".

Comparative analysis of deep learning models for various nonalcoholic fatty liver disease datasets

Fatty liver disease is caused by increased liver buildup or weight above 5-10%. This disorder is widespread in people with diabetes, overweight persons, and metabolic syndrome patients. Clinical decision support systems can improve liver failure diagnosis and prediction to reduce this situation. Many liver failure models have drawbacks, and liver failure prediction is still a problem. This work uses four large open-access critical care patient datasets to create and verify liver failure risk prediction models. This study aims to construct a clinically applicable diagnostic and predictive model that evaluates the probability or risk of liver failure in intensive care unit (ICU) patients using extreme gradient boosting (XGBoost), artificial neural networks (ANN), multi-layer perceptron (MLP), Modular Neural Network (MNN), and generalized feed forward (GFF). We evaluated performance metrics using these models: accuracy, sensitivity, specificity, and predictive accuracy.

Nurses’ Performance about Nasogastric Tube Uses among Patients in Critical Care Units

Nurses’ Performance about Nasogastric Tube Uses among Patients in Critical Care Units

A novel heart rate estimation framework with self-correcting face detection for neonatal intensive care unit

Remote photoplethysmography (rPPG) is a non-invasive method for monitoring heart rate (HR) and other vital signs by measuring subtle facial color changes caused by blood flow variations beneath the skin, typically captured through video-based imaging. Current rPPG technology, which is optimized for ideal conditions, faces significant challenges in real-world clinical settings such as Neonatal Intensive Care Units (NICUs). These challenges primarily arise from the limitations of automatic face detection algorithms embedded in HR estimation frameworks, which have difficulty accurately detecting the faces of newborns. Additionally, variations in lighting conditions can significantly affect the accuracy of HR estimation. The combination of these positional changes and fluctuations in lighting significantly impacts the accuracy of HR estimation. To address the challenges of inadequate face detection and HR estimation in newborns, we propose a novel HR estimation framework that incorporates a Self-Correcting face detection module. Our HR estimation framework introduces an innovative rPPG value reference module to mitigate the effects of lighting variations, significantly reducing HR estimation error. The Self-Correcting module improves face detection accuracy by enhancing robustness to occlusions and position changes while automating the process to minimize manual intervention. Our proposed framework demonstrates notable improvements in both face detection accuracy and HR estimation, outperforming existing methods for newborns in NICUs.

Optimal control for an SIR model with limited hospitalised patients

This paper analyses the optimal control of infectious disease propagation using a classic susceptible-infected-recovered (SIR) model characterised by permanent immunity and the absence of available vaccines. The control is performed over a time-dependent mean reproduction number, in order to minimise the cumulative number of ever-infected individuals (recovered), under different constraints. We consider constraints on non-pharmaceutical interventions ranging from partial lockdown to non-intervention, as well as the social and economic costs associated with such interventions, and the capacity limitations of intensive care units that limits the number of infected individuals to a maximum allowed value. We rigorously derive an optimal quarantine strategy based on necessary optimality conditions. The obtained optimal strategy is of a boundary-bang type, comprising three phases: an initial phase with no intervention, a second phase maintaining the infected population at its maximum possible value, and a final phase of partial lockdown applied over a single interval. The optimal policy is further refined by optimising the transition times between these phases. We show that these results are in excellent agreement with the numerical solution of the problem.

Cardiopulmonary resuscitation employing only abdominal compressions in infants after cardiac surgery: A secondary sub-analysis of the ICU-RESUS study

ImportancePatients with underlying cardiac disease form a considerable proportion of pediatric patients who experience in-hospital cardiac arrest. In pediatric patients after cardiac surgery, CPR with abdominal compressions alone (AC-CPR) may provide an alternative to standard chest compression CPR (S-CPR) with additional procedural and physiologic advantages. ObjectiveQuantitatively describe hemodynamics during cardiopulmonary resuscitation (CPR) and outcomes of infants who received only abdominal compressions (AC-CPR). DesignThis is a sub-group analysis of the prospective, observational cohort from the ICU-RESUS trial NCT028374497. Setting & PatientsA single site quaternary care pediatric cardiothoracic intensive care unit enrolled in the ICU-RESUS trial. Patients less than 1 year of age with congenital heart disease who required compressions during cardiac arrest. InterventionsUse of AC-CPR during cardiac arrest resuscitation. Measurements and Main ResultsInvasive arterial line waveforms during CPR were analyzed for 11 patients (10 surgical cardiac and 1 medical cardiac). Median weight was 3.3 kg [IQR 3.0, 4.0]; and median duration of CPR was 5.0 [3.0, 20.0] minutes. Systolic (median 57 [IQR 48, 65] mmHg) and diastolic (median 32 [IQR 24, 43] mmHg) blood pressures were achieved with a median rate of 114 [IQR 100, 124] compressions per minute. Return of spontaneous circulation was obtained in 9 of 11 (82%) patients; 2 patients (18%) were cannulated for extracorporeal cardiopulmonary resuscitation (ECPR) and 6 (55%) survived to hospital discharge with favorable neurologic outcome. ConclusionsAC-CPR may offer an alternative method to maintain perfusion for infants who experience cardiac arrest. This may have particular benefit in pediatric patients after cardiac surgery for whom external chest compressions may be harmful due to anatomic and physiologic considerations.

Pain Assessment Following Opioid Administration in Aneurysmal Subarachnoid Hemorrhage Associated Headache

Background: Headache is a debilitating complication following an aneurysmal subarachnoid hemorrhage (aSAH). Despite its impact on morbidity and quality of life, limited evidence characterizes the effectiveness of opioids. Objective: The aim of this study was to evaluate opioid associated reduction in pain scores in patients with aSAH-associated headache. Methods: This is a retrospective study of adult patients with an aSAH, Hunt and Hess grades I – III, admitted to a neurosciences intensive care unit. Descriptive and inferential statistics were used to characterize headache treatment strategies and opioid associated reduction in pain scores. Results: Opioids were used in up to 97.6% of patients for the management of aSAH-associated headache. Median reduction in pain after opioid administration was −1 (IQR: -3-0). Correlation between opioid dose and change in pain scores was negligible (rs = .01). Overall, 68.8% of patients were discharged on an opioid analgesic with predictive factors being severe headache (OR 2.52; 1.04 – 6.14) and oral morphine milligram equivalents ≥60 mg per day during the hospital stay (OR 3.02; 1.22 – 7.47). Conclusions: Opioids were associated with a small reduction in pain when assessed via the NRS. An increased opioid dose did not correlate with a greater reduction in assessed pain scores. A high percentage of patients remained on opioids throughout hospitalization and were eventually discharged on an opioid. The impact of discharge opioid prescriptions and risk of opioid persistence creates a cause for concern. It is imperative that we seek improved pain management strategies for aSAH-associated headache.

Association of Resolved Low-Lying Placentation With Risk of Postpartum Hemorrhage

OBJECTIVE: To evaluate whether individuals who have a placenta previa or low-lying placenta that resolves before delivery are at increased risk of postpartum hemorrhage and postpartum hemorrhage–related morbidity. METHODS: This was a prospective, multicenter, 1:3 matched cohort study of pregnant individuals with singleton gestations diagnosed with low placentation by transvaginal scan at 19 to 23 weeks of gestation between January 2021 and December 2023 at nine academic maternity centers (exposed participants). Unexposed participants were those with a normally located placenta, matched in a 1:3 ratio according to parity. Resolution of low placentation was diagnosed when placenta was at 20 mm or more from the internal os. Individuals with fetal anomalies, hematologic disorders, therapeutic anticoagulation, placenta accreta spectrum disorder, vasa previa, persistent low placentation at birth, and delivery at a nonenrolling center were excluded. Primary outcome was postpartum hemorrhage of 1,000 mL or more. Secondary outcomes included postpartum hemorrhage of 1,500 mL or more, use of second-line uterotonic drugs, blood transfusions, additional procedures to control bleeding, intensive care unit admission, and hospital stay for more than 7 days. Multivariable logistic regression adjusted for confounders was used to estimate independent associations with outcomes. RESULTS: The study population included 182 exposed and 589 unexposed participants. Individuals with resolved low placentation had higher rates of smoking (P=.024), prior dilation and curettage (P=.012), posterior placenta (P&lt;.001), and induction of labor (P=.038). Multivariate logistic regression analysis adjusted for confounders showed that exposed people had higher odds of postpartum hemorrhage of 1,000 mL or more (13.2% vs 4.1%, adjusted odds ratio [aOR] 3.1) compared with unexposed people and of use of second-line uterotonic drugs (28.0% vs 12.4%, aOR 2.69) and tranexamic acid (16.5% vs 7.5%, aOR 2.19), as well as hospital stay longer than 7 days (11.5% vs 3.4%, aOR 2.63). CONCLUSION: Individuals with resolved low placentation are at increased risk of postpartum hemorrhage and related complications compared with those who always had a normally located placenta.

Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: a nationwide multicentre population-based cohort study

Mycoplasma pneumoniae infections resurged globally in 2023-2024 after a three-year decline during the COVID-19 pandemic. We explored the incidence and severity of M pneumoniae infections in children and adolescents before, during, and after the pandemic. This nationwide, population-based cohort study included all Danish children and adolescents aged 0-17 years with a positive M pneumoniae PCR test from May 1, 2016, to April 30, 2024. We obtained clinical details for patients hospitalised for 24h or more. Risk ratios for infections, hospitalisations, and disease manifestations in 2023-2024 versus pre-COVID-19 seasons were calculated using Fisher's exact and Pearson's χ2 tests. A season was defined from May 1 to April30. Among the Danish population of 1,152,000 children and adolescents, 14,241 with a positive PCR test for Mpneumoniae were included. In 2023-2024, children and adolescents with a positive PCR rose 2.9-fold (95% CI 2.8-3.1; p<0.0001) compared to the pre-COVID-19 seasons, and hospitalisations rose 2.6-fold (95% CI 2.0-3.3; p<0.0001). Mpneumoniae-induced rash and mucositis increased 5.3-fold (95% CI 1.8-15.3; p=0.0007). In 2023-2024 compared to the pre-COVID-19 seasons, there was no difference in the proportion of hospitalisation (360 [4%] of 8165 versus 230 [4%] of 6009; p=0.09), the median duration of hospital stay (3 days [IQR 2-5] versus 3 days [IQR2-5]; p=0.84), or paediatric intensive care unit admission (14 [4%] of 360 versus 9 [4%] of 230 p=1.00). In Denmark, M pneumoniae infections and hospitalisations increased three-fold in 2023-2024 compared with the pre-COVID-19 seasons, indicating an immunity debt caused by the decline in M pneumoniae during the COVID-19 pandemic. While the severity of M pneumoniae infections did not change in 2023-2024, the five-fold increase in M pneumoniae-induced rash and mucositis in children and adolescents highlights Mpneumoniae as an important pathogen causing mucocutaneous eruptions. Innovation Fund Denmark and Rigshospitalets Forskningsfond.

Planned Home Births in the United States Have Outcomes Comparable to Planned Birth Center Births for Low-Risk Birthing Individuals.

There are lingering concerns in the United States about home birth. We used 2 large (n = 50,043; n = 62,984), national community birth registries to compare maternal and neonatal outcomes for planned home versus planned birth center births. To compare outcomes by intended birth site, we used logistic regressions, controlling for demographic and pregnancy risk variables. Maternal outcomes included intrapartum or postpartum transfer to hospital, hospitalization, cesarean, and hemorrhage; neonatal outcomes included neonatal transfer, hospitalization, neonatal intensive care unit admission, and intrapartum or neonatal death. Analyses were conducted twice, once in each dataset. Individuals who planned home births had a lower incidence of all types of transfers, compared with those who planned birth center births, but in one dataset only, experienced more cesareans [adjusted odds ratio (95% CI): 1.32 (1.02-1.70); 0.95 (0.88-1.03)]. Planned home birth was associated with lower adjusted odds of maternal hospitalization in one dataset but not the other [0.97 (0.54-1.74); 0.85 (0.76-0.95)], and was not associated with hemorrhage. Neonatal outcomes likewise were either not associated with a planned birthplace or suggested home birth was safer: hospitalization [0.77 (0.53-1.11), 0.90 (0.82-0.98)], neonatal intensive care unit admission [0.54 (0.28-1.00), 0.97 (0.86-1.10)]. There was no observable association with intrapartum or neonatal death: 1.07 (0.68-1.67; only calculated once because of small numbers of events). Planned home births are as safe as planned birth center births for low-risk pregnancies. Current guidelines advising against planned home births are not supported by these data.

Rifaximin discontinuation during broad-spectrum antibiotic treatment in critically ill patients with hepatic encephalopathy

Hepatic encephalopathy (HE) is one of the main complications of cirrhosis, characterized by a wide spectrum of neuropsychiatric alterations that lead to an increase in mortality, morbidity and recurrent hospitalizations. Due to the central role in HE pathogenesis of ammonia and other neurotoxins primarily produced by the gut microbiota, the main therapeutic approaches for the treatment of HE are based on the modulation of the gut microbiota. Rifaximin is a non-absorbable broad-spectrum antibiotic, that is effective against ammonia-producing gram-positive, gram-negative, and anaerobic species, approved for the treatment of HE in secondary prophylaxis. The chronic administration of rifaximin in this setting is associated with a lower risk of HE recurrence and mortality, while the role of rifaximin for the treatment of an overt-HE episode in inpatients is still unclear. Limited data exist about the coadministration of rifaximin and broad-spectrum antibiotics commonly used to treat concomitant infections, as patients receiving or recently treated with antibiotics were frequently excluded from clinical trials. In this editorial we comment on the article by Ward et al published in the recent issue of the World Journal of Hepatology . It is a single center, retrospective, quasi-experimental, pharmacist-driven protocol, with the aim to evaluate the feasibility and safety of rifaximin discontinuation in critically ill patients with HE and chronic liver disease receiving broad-spectrum antibiotic therapies in intensive care units. The study revealed no differences between the protocol and control group in terms of primary outcome (days alive and free of delirium and coma to day 14) and secondary outcomes which include: Intensive care mortality, intensive care length of stay, intravenous vasopressor requirement changes and adverse effects rate. Therefore, rifaximin discontinuation during broad-spectrum antibiotic therapy does not appear to negatively impact the clinical status of critically ill liver patients, with a similar safety profile and significant cost savings, as compared to the coadministration of rifaximin and broad-spectrum antibiotics. In agreement with Ward et al , a recently published double-blind, randomized controlled trial provided additional evidence to support the feasibility of withholding rifaximin during broad-spectrum antibiotic therapy in critically ill cirrhotic patients. However, given the limitations of these studies, further multicentric and prospective clinical trials, enrolling a larger sample of non-critically ill patients, are needed to better establish the role of rifaximin in this setting.

Diagnostic value of tissue plasminogen activator-inhibitor complex in sepsis-induced liver injury: A single-center retrospective case-control study

BACKGROUND Sepsis often causes severe liver injury and leads to poor patient outcomes. Early detection of sepsis-induced liver injury (SILI) and early treatment are key to improving outcomes. AIM To investigate the clinical characteristics of SILI patients and analyze the associated risk factors, to identify potential sensitive biomarkers. METHODS Retrospective analysis of clinical data from 546 patients with sepsis treated in the intensive care unit of the 908th Hospital of Chinese People’s Liberation Army Joint Logistic Support Force between May 2018 and December 2022. The patients were divided into the sepsis group (n = 373) and SILI group (n = 173) based on the presence of acute liver injury within 2 hours of admission. We used the random forest algorithm to analyze risk factors and assessed potential diagnostic markers of SILI using the area under the receiver operating characteristic curve, Kaplan-Meier survival curves, subgroup analysis and correlation analysis. RESULTS Compared with the sepsis group, tissue plasminogen activator-inhibitor complex (t-PAIC) levels in serum were significantly higher in the SILI group (P &lt; 0.05). Random forest results showed that t-PAIC was an independent risk factor for SILI, with an area under the receiver operating characteristic curve of 0.862 (95% confidence interval: 0.832-0.892). Based on the optimal cut-off value of 11.9 ng/mL, patients at or above this threshold had significantly higher levels of lactate and Acute Physiology and Chronic Health Evaluation II score. The survival rate of these patients was also significantly worse (hazard ratio = 2.2, 95% confidence interval: 1.584-3.119, P &lt; 0.001). Spearman’s correlation coefficients were 0.42 between t-PAIC and lactate, and 0.41 between t-PAIC and aspartate transaminase. Subgroup analysis showed significant differences in t-PAIC levels between patients with different severity of liver dysfunction. CONCLUSION T-PAIC can serve as a diagnostic indicator for SILI, with its elevation correlated with the severity of SILI.

Risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding

BACKGROUND With the widespread use of hemocoagulase in patients with gastrointestinal bleeding, clinicians have become increasingly concerned about coagulation disorders associated with this medication. Risk factors for hypofibrinogenemia associated with hemocoagulase are poorly understood. AIM To determine risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding. METHODS We performed a retrospective analysis of the medical documentation of hospitalized patients treated with hemocoagulase for gastrointestinal bleeding. Hypofibrinogenemia was defined as a decrease in plasma fibrinogen concentration to less than 2.0 g/L. The included patients were divided into two groups: acquired hypofibrinogenemia group and non-hypofibrinogenemia group. We used logistic regression analysis to identify potential risk factors and established risk assessment criteria by employing a receiver operating characteristic curve. RESULTS There were 36 patients in the acquired hypofibrinogenemia group and 73 patients in the non-hypofibrinogenemia group. The hypofibrinogenemia group showed higher rates of intensive care unit admissions (P = 0.021), more female patients (P = 0.005), higher in-hospital mortality (P = 0.027), larger hemocoagulase doses (P = 0.026), more Packed Red Cells transfusions (P = 0.024), and lower baseline fibrinogen levels (P &lt; 0.000). Binary logistic regression was employed to examine the risk factors associated with acquired hypofibrinogenemia. The analysis revealed that baseline fibrinogen [odds ratio (OR) 0.252, 95%CI: 0.137-0.464, P &lt; 0.000], total hemocoagulase doses (OR 1.074, 95%CI: 1.015-1.137, P = 0.014), and female gender (OR 2.856, 95%CI: 1.015–8.037, P = 0.047) were statistically significant risk factors. CONCLUSION Higher doses of total hemocoagulase, female gender, and a lower baseline fibrinogen level were risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding.

Correlation among anxiety and depression, fear of disease progression, and social support in coronary heart disease

BACKGROUND The mental well-being of individuals with coronary heart disease (CHD) during the intensive care unit (ICU) transition period is a multifaceted and significant concern. In this phase, the individuals might encounter psychological challenges like anxiety and depression, which can impede their recuperation and potentially have lasting effects on their health. AIM To investigate the correlation among psychological factors in CHD patients in the ICU transition period. METHODS A questionnaire survey was conducted with 119 patients admitted to the ICU after coronary artery bypass grafting between March and December 2023. Variations in Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD), Fear of Progression Questionnaire-Short Form (Fop-Q-SF), and Social Support Rating Scale (SSRS) were collected and analyzed among diverse populations. We used Pearson’s correlation analysis to examine the correlation. Multiple linear regression analysis was used to explore whether these indicators influenced depression and anxiety in the patients. RESULTS The total scores for anxiety, depression, fear of disease progression, and social support were (7.50 ± 1.41) points, (8.38 ± 1.62) points, (35.19 ± 8.14) points, and (36.34 ± 7.08) points, respectively (P &lt; 0.05). Multivariate regression analysis showed that both the level of disease progression and social support affected the level of postoperative depression and anxiety in patients. CONCLUSION The anxiety and depression levels were positively related to each dimension of phobia disease progression and negatively related to each dimension of social support among patients with CHD.