Background/Objectives: Altered level of consciousness (ALC) is a common emergency department (ED) presentation with high mortality. We evaluated etiologies and early ED-course prognostic markers for mortality. Methods: We retrospectively identified adult ED visits with ALC (September 2023–August 2025) and classified etiologies using the ALC-10 framework. Patients transferred directly to other hospitals were excluded because post-transfer outcomes were unavailable; sensitivity analyses were performed. Overall mortality was ED death or in-hospital death, and ED mortality was death during the ED stay. Nested logistic models were prespecified: overall-mortality Model A included age, initial Glasgow Coma Scale (GCS), etiologic category, and ICU admission, and Model B added vasopressor use and mechanical ventilation within 1 h; ED-mortality Model A included age and initial GCS, and Model B added vasopressor use and mechanical ventilation. Results: ALC accounted for 2.85% (2194/76,957) of adult ED visits; 1932 patients were analyzed after excluding 262 transfer-outs. Systemic infection (25.8%) and metabolic causes (23.7%) were most frequent. Observed overall mortality was 23.6% (455/1932), including ED mortality of 6.4% (124/1932); model-based sensitivity analysis estimated adjusted overall mortality to be 23.2% (95% uncertainty interval, 22.9–23.7) among all ALC visits. In adjusted models, older age, lower initial GCS, and vasopressor use were associated with higher odds of both outcomes, while ICU admission and mechanical ventilation were associated with overall mortality. Model B showed improved discrimination (AUC 0.795 overall; 0.869 ED). Conclusions: These findings highlight the prognostic significance of age, initial neurologic status, and etiology. This study may assist in risk stratification and early resource allocation.

In this study, we aimed to investigate the intrinsic brain activity alterations in patients with disorders of consciousness (DOC) using multidimensional resting-state functional magnetic resonance imaging (rs-fMRI) metrics at ultra-high field (7 T) MRI. We enrolled 10 patients with DOC, including those with vegetative state/unresponsive wakefulness syndrome and minimally conscious state, and 11 healthy controls (HCs). We applied various rs-fMRI metrics ranging from neuronal activity to synchronization and coordination of whole-brain activity, including amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), percent amplitude of fluctuation (PerAF), regional homogeneity (ReHo), and degree centrality (DC). Patients with DOC exhibited distinct brain activity patterns compared to HCs. The bilateral inferior temporal gyri showed enhanced activity across various metrics (right: ALFF, ReHo, DC; left: ALFF, fALFF, ReHo), while the right precuneus showed decreased activity in patients with DOC (ALFF, DC, PerAF), compared to HCs. Although an initial inverse relationship was observed between the left putamen and CRS-R total scores in DOC patients, this association did not survive multiple comparisons correction (Bonferroni-adjusted threshold: p < 0.0019). Our findings provide new insights into the neural mechanisms underlying DOC, highlighting the importance of the right precuneus and the bilateral inferior temporal gyri in consciousness level. These results can inform the development of diagnostic and therapeutic strategies for DOC.

Viral load and pathophysiology-based framework in varicella-zoster virus meningitis: Focus on altered consciousness and outcomes.

The present study aimed to discuss the pathophysiology of traumatic brain injury (TBI) in birds, addressing cranial and cerebellar anatomy, followed by the description of the central and peripheral nervous system, the pairs of cranial nerves, exposure of various types of injuries, assessment of levels of consciousness using the ADLN scale and the Glasgow scale. A specimen of Maracanã-nobre (Diopsittaca nobilis) was treated at a private clinic. The bird showed signs of moderate Glasgow suggestive in 10. After initiation of treatment with mannitol infusion at a dose of 10 mL/kg, morphine 2 mg/kg (IM), oxygen therapy 3 L/h and warming in UTA to 31.5 °C, the bird showed an important improvement in the stabilization of its main functions. After 96 hours of hospitalization and other interventions, the patient showed completely satisfactory improvement. Studies on neuropathies involving traumatic brain injury in bird medicine require greater technical knowledge, therefore, there needs to be more research aimed at better protocols and diagnostic methods in the treatment so that there is an increase in the survival of these patients.

Emergency medicine updates: Pediatric brief resolved unexplained event.

This study aimed to examine longitudinally how adolescents’ multicultural acceptance affects community consciousness through peer relationships. Using a balanced panel of 5,507 students from Waves 3–7 of the KELS 2013, a multivariate latent growth model was estimated. The results indicated that multicultural acceptance showed a gradual declining trend, whereas peer relationships and community consciousness showed increasing trends. At the initial level, multicultural acceptance had significant positive effects on the initial levels of peer relationships and community consciousness, and the initial level of peer relationships also had a significant positive effect on the initial level of community consciousness. At the change level, changes in multicultural acceptance had significant positive effects on changes in peer relationships and community consciousness, and changes in peer relationships had a very strong positive effect on changes in community consciousness. Through these findings a longitudinal mediation pathway was supported in which changes in multicultural acceptance, combined with qualitative changes in peer relationships, can lead to changes in community consciousness. The results suggest that schools should structure educational environments that integrate cooperative tasks and institutional support so that multicultural acceptance can transfer into relationship formation through peer interactions.

Appropriate terminology and definitions of neonatal encephalopathy (NE), hypoxic-ischemic encephalopathy (HIE), and perinatal asphyxia (PA) remain controversial. Participant criteria used in therapeutic hypothermia (TH) trials are frequently used as case definitions for NE/HIE/PA but studies are inconsistent. This review aims to assess variations in terminology and case participant criteria between trials for NE/HIE/PA. Search strategy retrieved articles from databases (Embase, MEDLINE, CENTRAL, CDSR and WHO) for randomized controlled trials (RCTs) of interventions for NE/HIE/PA using any definition for NE/HIE/PA. Outcomes were a description of the terminology, definitions, and participant criteria. Two reviewers independently screened results. Qualitative results were synthesized in a narrative summary. The search provided 6768 results. 67 were included in the qualitative synthesis. HIE was the most frequently used term (56/67). NE was the least frequent (16/67). Some of the common inclusion criteria were Apgar scores (63/67), metabolic acidosis (58/67), and reduced level of consciousness (57/67). Most frequently employed exclusion criteria were prematurity (63/67), major congenital abnormalities (62/67), and identification beyond 6 h from birth (62/67). This review identified variations in terminology and in-trial participant criteria between studies. These results will inform a consensus process for developing a definition and case definition of NE/HIE/PA. Our article demonstrated significant variations in the terminology used to describe the condition of NE/HIE/PA, which demonstrates a need for more consistent definitions in terminology. A broad but meaningful definition of the condition would provide an inclusive approach while permitting subclassifications within the condition, and permitting comparisons and benchmarking across different settings. Developing consistency across these areas, as far as possible, would allow improved interpretation of interventions on long-term prognosis and greater generalizability of trial results.

Neurological conditions associated with air entry into the systemic circulation are rare, particularly when compared with other particles. Patients present with an acute decline in the level of consciousness and new focal neurological deficits, often including new hemiparesis. A single seizure may also be a heralding sign. Patients may progress to deep coma. The first line of action, before anything else, is (1) the immediate positioning of the patient in Trendelenburg and in left lateral decubitus; (2) giving oxygen using a closed face mask (10-15 L/min) or high-flow nasal cannulae (up to 60 L/min). We recommend hyperbaric oxygen therapy if facilities can be reached within an 8-hour window. Awakening from coma, improvement of hemiparesis and good functional outcome may occur, but progress is likely to be slow and protracted. The emphasis of this review is on the recognition, immediate and subsequent treatment of air embolism to the brain.

Objective This retrospective study aimed to identify the clinical features and prognostic determinants in intensive care unit (ICU) patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection (BSI) and to establish a personalized risk prediction model. Methods This retrospective cohort study included 185 ICU patients with CRAB-BSI at a tertiary care hospital between 2013 and 2023. Based on 30-day outcomes, patients were categorized into survival and non-survival groups. Independent risk factors for mortality were identified through univariate and multivariate logistic regression analyses. These factors were used to construct a nomogram prediction model. Model performance was evaluated by assessing discrimination using the area under the receiver operating characteristic curve with a calibration plot, and clinical utility via decision curve analysis. Results The 30-day mortality rate among ICU patients with CRAB-BSI was 60.0%. Multivariate analysis revealed that age [odds ratio (OR) = 1.04, 95% confidence interval (CI): 1.02–1.07], impaired consciousness (OR = 5.10, 95% CI: 2.27–11.45), prior corticosteroid use (OR = 5.82, 95% CI: 2.10–16.12), Sequential Organ Failure Assessment (SOFA) score (OR = 1.26, 95% CI: 1.12–1.42), and C-reactive protein (CRP) level (OR = 1.01, 95% CI: 1.01–1.02) were independent risk factors for 30-day mortality. A nomogram incorporating these variables achieved an area under the curve (AUROC) of 0.863 for predicting 30-day mortality risk. The calibration curve indicated excellent concordance between predictions and observed outcomes, and decision curve analysis demonstrated significant clinical net benefit over a wide range of probability thresholds. Conclusion Mortality is high in ICU patients with CRAB-BSI and is significantly associated with age, impaired consciousness, corticosteroid use, SOFA score, and CRP level. The developed nomogram exhibits strong predictive accuracy and may function as a practical tool for quantitative management decisions.

Intoxication with novel psychoactive substances, such as the designer benzodiazepine flubromazepam, can be diagnostically challenging. A man in his late 50s presented with a persistently decreased level of consciousness and extensive multifocal intracerebral ischaemia on an MR brain scan. After excluding multiple causes, a toxicology screen identified flubromazepam use as the likely explanation. This novel psychoactive substance has an elimination half-life of 106 hours and life-threatening side effects, including hypotension and sedative-hypnotic toxidrome. Flubromazepam is increasingly used, with a significant risk of serious toxicity. Physicians should consider novel psychoactive substance toxicity in patients with unexplained neurological presentations, particularly with decreased consciousness and multifocal intracerebral ischaemia.

Dysphagia is a major complication of acquired brain injury (ABI) in children; however, its trajectory and prognostic indicators remain insufficiently characterized. This study aimed to identify predictors of dysphagia and its recovery following pediatric ABI. This retrospective study included all children admitted with ABI to tertiary pediatric rehabilitation center between 2014 and 2017. Data were collected from electronic medical records. One hundred children aged 2:00-17:11 years were included; 61% had dysphagia at admission. Participants with dysphagia received speech-language pathology (SLP) treatment, with a recovery rate of 78.68%. Treatment duration was significantly shorter among children who recovered (36 days) compared with those who did not (136 days; p < 0.001). Dysphagia at admission was associated with mechanical ventilation, duration of unconsciousness, duration of acute hospitalization, CNS tumor etiology, cranial nerve impairment (V, IX, X, XII), voice and speech impairments, and cognitive and behavioral impairments. Logistic regression showed that reduced consciousness, cranial nerve impairment, voice disorders, and CNS tumors explained 70.6% of dysphagia likelihood. Non-recovery was associated with unconsciousness, enteral feeding, hypoglossal injury, and dysphagia severity at admission. Level of consciousness at admission explained 33.7% of recovery likelihood. Dysphagia was highly prevalent among children with ABI. Recovery rates following SLP treatment were high and were associated with level of consciousness at admission to rehabilitation.

Emerging evidence suggests that low-frequency neural oscillations are dynamically regulated by consciousness levels, with the recovery of low cortical activity potentially serving as a neurophysiological substrate for conscious emergence. Targeted enhancement of these low-frequency rhythms in patients with disorders of consciousness (DoC) may constitute a promising neuromodulation strategy to facilitate consciousness recovery in severe brain injury. This study systematically examined the neurophysiological effects of intermittent theta-burst stimulation (iTBS), specifically its potential to enhance low-frequency cortical activity and promote consciousness recovery in patients with DoC. Through multimodal neural assessments, we aimed to elucidate the mechanistic relationship between iTBS-induced neural oscillation modulation and behavioral manifestations of consciousness improvement. This prospective cohort study enrolled 30 patients with DoC, of whom 18 completed the full intervention protocol. Two-way repeated-measures analysis of variance revealed significant group × time interaction effects on the Coma Recovery Scale-Revised (CRS-R) scores, F(1, 16) = 6.543, p = 0.021. Post hoc simple effects analysis demonstrated significant temporal improvement in the active transcranial magnetic stimulation (TMS) group, F(1, 16) = 36.463, p < 0.001, with mean CRS-R scores increased from 9.300 ± 1.320 at baseline to 11.700 ± 1.409 post-intervention (p < 0.001). Conversely, sham stimulation revealed statistically nonsignificant changes (9.845 ± 1.476 versus 10.750 ± 1.575, p = 0.067). Neurophysiological assessments revealed emerging neurophysiological changes in the iTBS group, including enhanced resting-state low-frequency oscillations (delta: 21.642% increase, p = 0.449; theta: 6.800% increase, p = 0.789) and augmented auditory-evoked responses (phrase-level 22.917% increase, p = 0.280; syllable-level: 22.963% increase, p = 0.504), suggesting potential neural plasticity mechanisms that require further validation. Collectively, this study established iTBS targeting the left dorsolateral prefrontal cortex as a clinically effective and well-tolerated neuromodulation approach for consciousness rehabilitation in patients with DoC, with therapeutic effects mediated by iTBS-induced enhancement of thalamocortical low-frequency oscillations. https://www. gov. Unique identifier: NCT03385278. Registered on October 24, 2017.

How can marketers encourage consumers to choose sustainable apparel products? As consumer skepticism toward firms' sustainability efforts increases, it becomes increasingly important to understand the conditions under which consumers are more likely to purchase sustainable apparel products. Our research suggests that employing a simple, low-cost, and subtle nostalgia marketing intervention can offer a promising approach. A field study conducted with a genuinely sustainable activewear brand on social media platforms demonstrates that triggering nostalgic feelings can increase consumers' click-through rates. Four follow-up studies across various product categories, including jeans, running shoes, and activewear, show that nostalgia increases participants' purchase intention for sustainable apparel. Our findings also indicate that this nostalgia-evoked approach is especially effective among consumers with low levels of environmental consciousness, offering valuable insights for marketers seeking to deliver genuinely sustainable apparel products to the market.

Early risk stratification of critically ill patients is essential for facilitating timely interventions in the emergency department (ED). This study assessed whether point-of-care ultrasound (POCUS) parameters – specifically, left ventricular ejection fraction (EF) and inferior vena cava (IVC) collapsibility – contribute prognostic value to established early warning scores, including the rapid emergency medicine score, Modified Early Warning Score (MEWS), and Hypotension, Oxygen saturation, low Temperature, ECG changes, Loss of independence (HOTEL) score, in predicting 6-month mortality. In this prospective, single-center study, 59 nontraumatic adult patients admitted to the ED critical care unit between October 2022 and October 2023 were enrolled. Demographic characteristics, vital signs, and clinical scores (rapid emergency medicine score, MEWS, HOTEL, glasgow coma scale, and Alert, Voice, Pain, Unresponsive [AVPU]) were documented at admission, alongside single-time bedside ultrasound measurements of EF and IVC collapsibility. The primary outcome was 6-month mortality. Six-month mortality was observed in 27 patients (45.8%). Non-survivors exhibited significantly lower systolic blood pressure (median 110 vs 142 mm Hg; P = .021) and elevated respiratory rates (median 22 vs 20 breaths/min; P = .021). Additionally, levels of consciousness were reduced (median glasgow coma scale 13 vs 15; P = .002; AVPU P = .003). The MEWS (median 4 vs 2; P = .004) and HOTEL (median 2 vs 1; p<0.001) scores were notably higher in the mortality cohort. Logistic regression analysis identified HOTEL (OR 4.23; 95% confidence interval 1.80–9.95; P = .001) and MEWS (OR 1.57; 95% confidence interval 1.17–2.12; P = .003) as independent predictors of mortality, whereas EF and IVC collapsibility did not reach statistical significance (P = .307 and P = .084, respectively). It is evident that traditional physiological scoring systems, such as the MEWS and HOTEL, continue to serve as reliable instruments for predicting long-term mortality in critically ill patients in the ED. Single-time measurements of EF and IVC collapsibility at admission did not provide additional prognostic value beyond these scores. Future larger, multicentre studies may help to further clarify whether integrated or repeated point-of-care ultrasound (POCUS) assessments could have a role in risk stratification.

Human herpesvirus 6 (HHV-6) is a neurotropic virus comprising two variants, HHV-6A and HHV-6B. Although HHV-6B is known to cause exanthem subitum in children, the clinical significance of HHV-6A remains poorly understood, particularly in adult and elderly populations. Here, we report a rare case of HHV-6A encephalitis in an immunosuppressed elderly patient. An 89-year-old male patient with chronic inflammatory demyelinating polyradiculoneuropathy was administered immunosuppressive therapy with prednisolone. His consciousness progressively worsened over 4 days. Brain magnetic resonance imaging with fluid-attenuated inversion recovery demonstrated a hyperintense lesion in the left medial temporal lobe. The FilmArray meningitis/encephalitis panel tested positive for HHV-6. Further testing revealed elevated HHV-6A DNA levels in both the cerebrospinal fluid and plasma, confirming the diagnosis of HHV-6A encephalitis. A moderate increase in HHV-6A DNA and a slow clinical course suggest that chromosomally integrated HHV-6 (ciHHV-6) was unlikely. The treatment consisted of tapering prednisolone and initiating foscarnet, which gradually improved the patient's level of consciousness. This case highlights the importance of HHV-6A in the differential diagnosis of encephalitis, particularly in elderly patients receiving immunosuppressive therapy. Early diagnosis using a multiplex PCR panel, combined with prompt initiation of antiviral treatment, may lead to more favorable outcomes. Further studies are required to clarify the pathogenesis, clinical spectrum, and optimal management of HHV-6A-associated central nervous system diseases.

A 73-year-old man developed subacute cognitive impairment, status epilepticus and reduced level of consciousness requiring mechanical ventilation. An MR scan of the brain showed multifocal inflammatory lesions, but with normal cerebrospinal fluid (CSF); blood results showed positive antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies (Abs), but normal complement and urine analysis. Commercial kit for cell-surface antineuronal antibodies, including anti-NMDAR (anti-N-Methyl-D-Aspartate Receptor antibody), anti-LGI1 (anti-Leucine-Rich Glioma-Inactivated 1 antibody), anti-CASPR2 (anti-Contactin-Associated Protein-Like 2 antibody), anti-GABA-BR (anti-Gamma-Aminobutyric Acid Type B Receptor antibody), anti-AMPAR (anti-α-Amino-3-Hydroxy-5-Methyl-4-Isoxazolepropionic Acid Receptor antibody) and anti-DPPX (anti-Dipeptidyl-Peptidase-Like Protein-6 antibody), was negative in serum and CSF. We gave methylprednisolone, plasma exchange, rituximab and cyclophosphamide. However, despite initial improvement, he had five relapses. We reassessed the diagnosis and identified a thymoma; also, research laboratory testing with tissue-based and cell-based assays identified anti-GABA-AR Abs. He improved following thymectomy and with tocilizumab. This case underscores the complexity and varied presentations of anti-GABA-AR encephalitis with thymoma, emphasising the importance of comprehensive antibody testing in making this challenging diagnosis.

This study aimed to develop and validate a machine learning-based model for predicting 24-hour mortality in critically ill patients using prehospital and admission clinical data. We conducted a retrospective cohort study leveraging data from the prehospital emergency electronic medical record, in-hospital triage, and hospital information systems of a tertiary hospital in Changsha between August 2023 and April 2025. A total of 892 adult patients classified as critically ill were included. Nine machine learning algorithms were trained to predict 24-hour mortality, and model performance was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, and F1 score. SHapley Additive exPlanations (SHAP) analysis was employed to interpret feature contributions. Among the nine algorithms, the Random Forest (RF) model exhibited the most stable and robust performance. Using nine selected features-prehospital heart rate, prehospital and admission systolic and diastolic blood pressure, prehospital and admission oxygen saturation, admission respiratory rate, and level of consciousness, the RF model achieved an AUC of 0.985(95%CI:0.976-0.993) in the training set and 0.863 (95%CI:0.766-0.961) in the testing set, demonstrating high accuracy and potential clinical applicability. SHAP analysis revealed that prehospital heart rate, admission respiratory rate, and blood pressure are the strongest predictors of mortality. Finally, the model was deployed as an interactive web-based tool for real-time clinical application. In summary, this study developed a simple, interpretable, and accurate machine learning model for predicting 24-hour mortality in critically ill prehospital patients. The RF-based model can be intended as an exploratory, hypothesis-generating tool and should supplement, not replace, clinical judgment. Further validation in larger, multi-center prospective cohorts with higher event rates is essential to confirm the robustness and real-world applicability of our findings.

This study aimed to develop and validate a machine learning-based model for predicting 24-hour mortality in critically ill patients using prehospital and admission clinical data. We conducted a retrospective cohort study leveraging data from the prehospital emergency electronic medical record, in-hospital triage, and hospital information systems of a tertiary hospital in Changsha between August 2023 and April 2025. A total of 892 adult patients classified as critically ill were included. Nine machine learning algorithms were trained to predict 24-hour mortality, and model performance was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, and F1 score. SHapley Additive exPlanations (SHAP) analysis was employed to interpret feature contributions. Among the nine algorithms, the Random Forest (RF) model exhibited the most stable and robust performance. Using nine selected features-prehospital heart rate, prehospital and admission systolic and diastolic blood pressure, prehospital and admission oxygen saturation, admission respiratory rate, and level of consciousness, the RF model achieved an AUC of 0.985(95%CI:0.976–0.993) in the training set and 0.863 (95%CI:0.766–0.961) in the testing set, demonstrating high accuracy and potential clinical applicability. SHAP analysis revealed that prehospital heart rate, admission respiratory rate, and blood pressure are the strongest predictors of mortality. Finally, the model was deployed as an interactive web-based tool for real-time clinical application. In summary, this study developed a simple, interpretable, and accurate machine learning model for predicting 24-hour mortality in critically ill prehospital patients. The RF-based model can be intended as an exploratory, hypothesis-generating tool and should supplement, not replace, clinical judgment. Further validation in larger, multi-center prospective cohorts with higher event rates is essential to confirm the robustness and real-world applicability of our findings.

To compare the outcome of treatment with extracorporeal therapy (ECT) and medical therapy (MED) in dogs with baclofen intoxication. Multicenter retrospective study between June 1, 2013, and October 31, 2023. Six university teaching hospitals and three private specialty hospitals. Eighty dogs treated for baclofen intoxication. None. Twenty-nine of 80 (36%) dogs required endotracheal intubation, and 18 (23%) required mechanical ventilation (MV). Twenty-one (26%) dogs were treated with ECT, and 59 (74%) dogs received MED. The median estimated maximal exposure dose was 8.3mg/kg (range: 3.6-48mg/kg) in the ECT group and 5.7mg/kg (range: 0.46-132mg/kg) in the MED group (p=0.044). Nine of 21 (43%) dogs treated with ECT had an improvement in their level of consciousness. The mean duration of MV was 20±11h in dogs treated with ECT and 23±23h in dogs treated with MED. The median hospitalization time was 58h (range: 17-124h) in the ECT group and 24h (range: 0.5-188h) in the MED group. Survival was 95% for dogs treated with ECT and 92% for dogs treated with MED. Multivariable Poisson regression modeling was performed, controlling for estimated maximal exposure dose (mg/kg). ECT was associated with a shorter duration of MV (incidence rate ratio [IRR]: 0.76 [95% CI: 0.58-0.99]; p=0.038). However, ECT was associated with longer hospitalization times (IRR: 1.57 [95% CI: 1.45-1.71]; p<0.001). No association was found between the use of ECT and survival (odds ratio: 1.61 [95% CI: 0.16-16.13]; p=0.684). ECT is associated with high survival despite large estimated exposure doses. Although ECT was associated with a shorter duration of MV, no difference was found in survival or hospitalization time.

Sepsis is a life-threatening condition that often leads to severe acute kidney injury (AKI). Continuous kidney replacement therapy (CKRT) can be provided to critically ill patients in resource-rich settings such as intensive care units (ICUs). However, whether different medical staffing levels exert a significant effect on the outcomes of patients with sepsis-associated AKI treated with CKRT is unknown. We aimed to compare the outcomes of patients with sepsis-associated AKI who received CKRT upon admission to an ICU versus a high-dependency unit (HDU), where the staffing intensity is lower than that in ICUs. This retrospective cohort study used data retrieved from the Diagnosis Procedure Combination database and enrolled adult patients with sepsis admitted to an ICU or HDU between April 2018, and March 2023. We identified patients who initiated CKRT on admission and assigned them to the ICU or HDU group. We conducted matching weight analyses using propensity scores to compare the frequencies of in-hospital mortality and complications between the groups. Of 81,934 patients with sepsis, CKRT for severe AKI was initiated in HDUs and ICUs for 1,136 and 4,622 patients, respectively. Patients in the ICU group had higher cardiovascular Sequential Organ Failure Assessment subscores, lower body mass index, worse consciousness levels, and a greater need for mechanical ventilation compared with those in the HDU group. After adjustment, in-hospital mortality did not differ significantly between the ICU and HDU groups (-1.9 percentage points, 95% confidence interval: -5.2 to 1.4). Moreover, significant differences were not observed in complications including gastrointestinal bleeding, infections, thromboembolism, or cerebrovascular events. These findings remained consistent across the subgroup analyses. In this large cohort study, in-hospital mortality or other clinical outcomes did not differ significantly between patients initially treated in ICUs and HDUs. Further investigations are warranted to understand the relevant factors that guide the triage of these patients.