Background This study aimed to evaluate the association between time-of-day differences in blood lipids and acute kidney injury (AKI) in critically ill patients. Methods This study enrolled 3,227 ICU patients. AKI was defined according to the KDIGO 2012 criteria. Cox regression, restricted cubic splines, Kaplan-Meier analysis, and stratified interaction analysis were used to assess the association between daytime/nighttime levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides and AKI. Results Each 1 mg/dL increase in HDL-C was associated with a 0.5% decrease in AKI risk [HR 0.995, 95% CI 0.993–0.998, P < 0.001]. Each 1 mg/dL increase in triglyceride was associated with a 0.1% increase in AKI risk [HR 1.001, 95% CI 1.000–1.001, P = 0.004]. LDL-C exhibited an L-shaped nonlinear relationship with AKI. At or below 47 mg/dL (daytime), 58 mg/dL (nighttime), and 48 mg/dL (overall), lower LDL-C was associated with higher AKI risk, whereas above these thresholds, LDL-C was no longer associated with AKI risk [daytime: HR 0.977, 95% CI 0.964–0.991, P < 0.001; nighttime: HR 0.992, 95% CI 0.985–0.998, P = 0.009; overall: HR 0.987, 95% CI 0.980–0.994, P < 0.001]. Conclusion Higher HDL-C levels were consistently associated with lower AKI incidence within 28 days after ICU admission. Higher nighttime and overall triglyceride levels were associated with higher AKI incidence. An L-shaped nonlinear relationship was observed between LDL-C and AKI risk, with thresholds at 47 mg/dL (daytime), 58 mg/dL (nighttime), and 48 mg/dL (overall). These findings highlight a complex relationship between lipid metabolism and renal outcomes in critically ill patients and warrant confirmation through prospective studies.

Rheumatoid arthritis patients in the ICU face a high risk of mortality. While traditional ICU scoring systems are not specifically designed for the unique pathophysiological profile of RA. This study aimed to develop a machine learning framework to accurately predict 30-day mortality for these patients. Data from 400 RA patients in the MIMIC-IV database were analyzed. LASSO regression identified nine pivotal predictors: age, BUN (urea), PT, respiratory rate, SpO2, glucose, urine output, and coronary artery disease. Six ML models were constructed using SMOTE to handle class imbalance. Performance was evaluated via AUC, sensitivity, and SHAP analysis for interpretability. The LR-SMOTE model demonstrated the best discriminative ability (AUC = 0.69), while the Stacking ensemble achieved the highest sensitivity (0.8). External validation on the eICU dataset yielded an AUC of 0.747 for the LR-SMOTE model. SHAP analysis identified urine output, CAD, and age as the most influential predictors. The machine learning framework demonstrates superior performance compared to most traditional scoring systems, while offering the distinct advantages of easier data acquisition and lower computational complexity. By leveraging readily accessible clinical parameters, it supports proactive, individualized clinical decision-making in the ICU.

The prognostic value of hemoglobin-combined Geriatric Nutritional Risk Index (H-GNRI) in older adult septic patients remain unexplored. This study aimed to investigate the association between H-GNRI and both short-term and long-term mortality in older adult patients with sepsis. This retrospective cohort study analyzed older adult with sepsis from the MIMIC-IV database. Patients aged ≥ 65 years meeting sepsis-3 criteria were included, excluding those with chronic kidney disease or severe liver disease. The H-GNRI scoring system was developed by combining optimal cutoff values for GNRI and hemoglobin determined through X-tile analysis. Propensity score matching (1:1) was performed to minimize confounding. The primary outcome was 28-day mortality. Cox proportional hazards models and ROC analysis were used to evaluate prognostic performance and discriminatory ability. The 28-day mortality rates increased significantly across risk groups (45.0

Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are life-threatening conditions with limited effective pharmacological interventions. Sivelestat sodium, a selective neutrophil elastase inhibitor, has been extensively investigated in ARDS/ALI treatment due to its significant anti-inflammatory properties; however, its therapeutic efficacy remains controversial. As a drug developed and first approved in Japan, most previous meta-analyses have failed to incorporate Japanese literature, potentially introducing substantial language bias. Additionally, Japanese clinical practices may employ different treatment protocols that could offer novel perspectives on sivelestat sodium’s application. This systematic review aims to comprehensively evaluate sivelestat sodium’s efficacy in ARDS/ALI patients by simultaneously including both English and Japanese clinical literature. We will systematically search English databases (Cochrane Library, EMBASE, PubMed) and Japanese databases (Ichushi Web, J-STAGE) for randomized controlled trials comparing sivelestat sodium with placebo or standard therapy in adult ARDS/ALI patients. Two independent reviewers will screen studies, extract data, and assess risk of bias. Primary outcomes include duration of mechanical ventilation and all-cause mortality (28–30 days, ICU, and in-hospital). If sufficient eligible studies are identified, a random-effects model will be employed for meta-analysis. Between-study heterogeneity will be assessed using the I2 statistic, and the certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. This protocol outlines a systematic approach for evaluating sivelestat sodium’s efficacy in ARDS/ALI through the integration of English and Japanese literature. Methodological rigor will ensure high-quality evidence synthesis despite challenges in integrating diverse studies. This research addresses a significant gap, as meta-analyses incorporating Japanese publications have been absent for over a decade. The findings will provide evidence-based guidance for clinical practice, inform individualized treatment strategies, optimize sivelestat administration protocols, and identify directions for future research. PROSPERO CRD420251067146

OBJECTIVES:Most studies on SpO2 exposure patterns focus solely on SpO2 intensity and neglect exposure duration. We systematically investigated the associations between SpO2 exposure patterns and clinical outcomes from both intensity and temporal dimensions in critically ill patients. METHODS:In this retrospective cohort study, 121,758 critically ill patients were analyzed. The patient data were obtained from three databases: SICdb (n = 11,324) for continuous exposure analysis using heatmaps, MIMIC-IV (n = 50,110) for cumulative exposure analysis, and eICU (n = 60,324) for validation. We examined the relationships between SpO2 exposure and 28-day mortality using Cox regression and logistic regression models. Restricted cubic spline analysis was performed using time-weighted SpO2 as a continuous variable to examine the continuous association between SpO2 values and mortality risk. RESULTS:Both analytical approaches revealed a U-shaped relationship between SpO2 and mortality. Heatmap analysis revealed a SpO2 of 93.5-97% as optimal, whereas Cox regression showed that a SpO2 of 96-97% conferred the strongest protection (HR 0.714, 95% CI 0.694-0.733; P < 0.001). Prolonged exposure to SpO2 > 98% had a diminishing effect, whereas SpO2 < 93.5% increased mortality risk (HR 1.236, P < 0.001). External validation confirmed these findings (AUC 0.813). CONCLUSIONS:Our study confirms a U-shaped relationship between SpO2 and outcomes, emphasizing that oxygenation assessments should consider both intensity and duration. A prolonged SpO2 above 98% or below 94% should be avoided in critically ill patients.

OBJECTIVE:Early prediction of long-term outcomes in patients with systemic lupus erythematosus (SLE) remains a great challenge in clinical practice. Our study aims to develop and validate predictive models for the mortality risk. METHODS:This observational study identified patients with SLE requiring hospital admission from the Medical Information Mart for Intensive Care (MIMIC-IV) database. We downloaded data from Fujian Provincial Hospital as an external validation set. Variable selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Then, we constructed two predictive models: a traditional nomogram based on logistic regression and a machine learning model employing a stacking ensemble approach. The predictive ability of the models was evaluated by the areas under the receiver operating characteristic curve (AUC) and the calibration curve. RESULTS:A total of 395 patients and 100 patients were enrolled respectively from MIMIC-IV database and the validation cohort. The LASSO regression identified 18 significant variables. Both models demonstrated good discrimination, with AUCs above 0.8. The machine learning model outperformed the nomogram in terms of precision and specificity, highlighting its potential superiority in risk prediction. The SHapley additive explanations analysis further elucidated the contribution of each variable to the model's predictions, emphasising the importance of factors such as urine output, age, weight and alanine aminotransferase. CONCLUSIONS:The machine learning model provides a superior tool for predicting mortality risk in patients with SLE, offering a basis for clinical decision-making and potential improvements in patient outcomes.

Traditional assessment of preload responsiveness during passive leg raising (PLR) relies on invasive cardiac output monitoring. We hypothesized that the physiological coupling between cardiac output, end-tidal carbon dioxide (EtCO2), and pulse pressure variability (PPV) could provide a reliable non-invasive alternative for predicting preload responsiveness. We conducted a prospective observational study in 71 mechanically ventilated septic shock patients. Pulse index Contour Cardiac Output (PiCCO), arterial pressure, and EtCO₂ were monitored during standardized PLR maneuvers. Cardiac index (CI), arterial pressure, stroke volume variability (SVV), PPV, and EtCO₂ were measured before and after PLR. Patients with a PLR-induced CI increase ≥ 15 https://www.chictr.org.cn/bin/project/edit?pid=46568 .

PurposeThis study aimed to compare the performance of lactate and CO2-derived parameters in predicting major postoperative complications (MPC) after cardiac surgery with cardiopulmonary bypass.MethodsLactate and CO2-derived parameters, including the venous-arterial difference in CO2 partial pressure (Pv-aCO2), the venous-arterial difference in CO2 partial pressure to arterial-venous O2 content ratio (Pv-aCO2/Ca-vO2), and the venous-arterial difference in CO2 content to arterial-venous O2 content ratio (Cv-aCO2/Ca-vO2) at ICU admission, 3 h, 6 h, and 12 h later were collected. Receiver-operating characteristics (ROC) curve analysis was carried out to assess the predictive performance. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of MPC.ResultsMPC occurred in 77 (54.2%) of 142 patients. No significant difference was observed between the MPC and no-MPC groups regarding lactate and CO2-derived parameters. The area under the curves (AUCs) were 0.532 (0.446–0.616) for lactate, 0.559 (0.473–0.642) for Pv-aCO2, 0.617 (0.532–0.697) for Pv-aCO2/Ca-vO2, and 0.625 (0.540–0.705) for Cv-aCO2/Ca-vO2, respectively, and there was no significant difference between the parameters. In the post-hoc analysis, all parameters' AUCs were lower than 0.75 in predicting acute renal failure, and there was no significant difference between these parameters. Cv-aCO2/Ca-vO2 at 12 h yielded the highest AUC of 0.853 (0.784–0.907) in predicting mortality and the highest AUC of 0.808 (0.733–0.869) in predicting delirium. In multivariate analysis, hypertension, surgery duration, and PaO2/FiO2 were identified as independent predictors of MPC, while lactate and CO2-derived parameters lost statistical significance after adjustment for covariates.ConclusionsLactate and CO2-derived parameters cannot be used as reliable indicators to predict the occurrence of MPC after cardiopulmonary bypass. Instead, traditional clinical factors such as hypertension, extended surgical duration, and impaired oxygenation emerged as the most reliable risk indicators.

Objectives: Direct comparison of the long-term effectiveness and safety of biologics for Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is lacking. The study aimed to compare the long-term efficacy and safety of various biologics in the management of CRSwNP. Methods: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from database inception to March 2024, to identify all relevant literature on the use of biologics for CRSwNP. The research protocol was registered on PROSPERO.Two independent reviewers screened the studies, extracted the data, and performed a quality assessment using the Cochrane Risk of Bias tool. Network meta-analysis was conducted using STATA 17.0 and Review Manager (Version 5.3). Results: Six studies with a minimum follow-up period of 52-weeks were analyzed, demonstrating the superior long-term efficacy of dupilumab compared to the other three biologics. The surface under the cumulative ranking curve were 100% for Nasal Polyp Score (NPS), 72.7% for Sino-Nasal Outcome Test-22 (SNOT-22), 94.6% for Visual Analogue Scale (VAS), and 100% for Nasal Congestion Score (NCS). In the comparison of NPS, dupilumab showed improvements of 1.84 (95% Confidence Interval [95% CI 0.78, 2.91]) over mepolizumab and 2.31 (95% CI 0.99, 3.63) over benralizumab. Among the symptom scores evaluated, only dupilumab achieved a significant improvement in NCS compared to benralizumab, with an improvement of 0.74 (95% CI 0.86, 1.19). No significant differences in adverse events was observed between biologics treatment or versus placebo. Conclusion: Treatment with dupilumab in patients with CRSwNP has shown superior long-term efficacy in reducing NPS and various symptom scores compared to other biologics. However, the results should be interpreted with caution due to the heterogeneity of patient characteristics across the included studies (e.g., disease severity, history of surgery, use of oral corticosteroids).

BACKGROUND:It is unclear whether different modes of continuous renal replacement therapy (CRRT) impact post-filter ionized calcium concentrations during regional citrate anticoagulation (RCA) when using calcium-containing replacement fluid. METHODS:This prospective, single-center, observational cohort study will screen all patients receiving CRRT for eligibility. General clinical information will be collected before commencing CRRT treatment. Patients will be randomly assigned to either the continuous veno-venous hemofiltration (CVVH) or continuous veno-venous hemodialysis (CVVHD) group and switch to the alternative mode in the subsequent treatment session. Pre-filter and post-filter ionized calcium, systemic total and ionized calcium, and effluent total calcium will be measured 2 h after the initiation of CRRT. Electrolyte levels, arterial blood gases, hourly citrate dose, and total citrate dose will be recorded every 6 h until the end of CRRT. The primary outcome is the difference in ionized calcium concentrations at each site over time between the two modes. DISCUSSION:This study will build upon clinical practice to explore the differential effects of various CRRT modes on ionized and total calcium in patients undergoing RCA-CRRT with calcium-containing replacement solutions.

The American Heart Association recently introduced the concept of Cardiovascular-Kidney-Metabolic (CKM) syndrome, underscoring the intricate interplay between metabolic, renal, and cardiovascular diseases. The oxidative balance score (OBS) serves as a comprehensive metric to quantify oxidative stress-related exposures. This study investigates the association between OBS and both all-cause and cardiovascular mortality in these individuals. The study cohort analyzed 15,357 CKM patients from the 2003 to 2018 National Health and Nutrition Examination Survey database. Kaplan-Meier survival analysis, multivariable Cox regression models, restricted cubic splines, and subgroup analyses were employed to evaluate the relationship between OBS and mortality risk. There were 1,759 all-cause deaths and 459 cardiovascular deaths. Kaplan-Meier analysis revealed that individuals in the highest quartile of OBS (Q4) had the lowest all-cause and cardiovascular mortality rates, whereas the lowest quartile (Q1) exhibited the highest mortality rates (p < 0.001). In fully adjusted models, multivariable Cox regression showed that each one-unit increase in OBS was associated with a 1.1

Conventional vital signs lack the specificity for intraoperative nociception. The Surgical Pleth Index (SPI), calculated from photoplethysmographic waveforms, provides a quantitative measure of nociceptive status ranging from 0 to 100. Elevated SPI values correspond to increased nociceptive intensity. While some evidence suggests that SPI may help predict pain, its accuracy in forecasting postoperative pain requires further validation. This study aimed to assess the capacity of the Surgical Pleth Index (SPI) to predict moderate to severe pain following surgery. We conducted a systematic literature search across three databases to identify studies investigating SPI’s predictive value for postoperative pain. A random-effects model was applied to pool summary estimates of sensitivity, specificity, and the area under the summary receiver operating characteristic curve (SROC-AUC). Analysis included ten studies encompassing 1,042 patients. Pooled sensitivity and specificity were 0.74 (95% CI: 0.67–0.80) and 0.65 (95% CI: 0.55–0.74), respectively. The SROC-AUC reached 0.76, suggesting a moderate level of predictive accuracy. Significant heterogeneity was observed and not explained by differences in SPI cutoff values. The SPI demonstrates moderate accuracy in forecasting moderate-to-severe postoperative pain and may serve as a useful adjunct to conventional clinical assessment. The Surgical Pleth Index has been suggested as a reliable monitor for nociceptive states. The Surgical Pleth Index (SPI) demonstrated moderate accuracy in predicting moderate-to-severe postoperative pain. Current evidence supports its role as a validated supplementary instrument to guide analgesic administration during surgery. Core Tip: This meta-analysis confirms that the Surgical Pleth Index (SPI) provides moderate predictive accuracy for moderate-to-severe postoperative pain and, as such, has a complementary role in guiding intraoperative analgesia, provided its outputs are interpreted within the context of a comprehensive clinical assessment.

Blood pressure management is crucial in critical care, but relationships between pressure patterns and outcomes remain incompletely understood. We analyzed minute-by-minute blood pressure data to develop and validate a novel index quantifying hypotensive exposure burden. In this retrospective study using the Salzburg Intensive Care Database, 11,059 ICU admissions with continuous invasive arterial monitoring were analyzed. Heatmaps were constructed from high-resolution hemodynamic data to visualize relationships between blood pressure thresholds (52–120 mmHg), exposure durations (5 min–5 h), and mortality. The Hypotensive Exposure Duration Index (HEDI) was developed to quantify cumulative hypotensive burden by integrating exposure across multiple MAP thresholds. HEDI’s prognostic value was evaluated through nine machine learning algorithms. External validation using the eICU database assessed HEDI’s consistency across different populations. Non-survivors showed significantly higher HEDI compared to survivors (0.47 [−0.20, 1.43] vs. −0.15 [−0.41, 0.27], p < 0.001). HEDI demonstrated increasing predictive capability, with AUC values rising from 0.624 at 24 h to 0.700 at 72 h post-admission. The Extra Trees classifier achieved exceptional performance (test AUC: 0.843), with HEDI ranking among the top predictive features. Both internal cross-validation and external validation confirmed the model’s robustness, demonstrating HEDI’s prognostic value across different patient populations, including both patients with and without vasopressor use. HEDI effectively quantifies cumulative hypotensive burden in critically ill patients, demonstrating significant predictive ability for ICU mortality validated across diverse populations.

Invasive aspergillosis (IA) significantly increases mortality in critically ill patients in the ICU and its occurrence is closely related to immunocompromise. Dissemination of IA is easily misdiagnosed and mistreated due to its ability to invade multiple systems throughout the body and lack of typical clinical manifestations. In this case, a 25-year-old previously healthy woman was hospitalized with fulminant myocarditis and treated with veno-arterial extracorporeal membrane pulmonary oxygenation (VA-ECMO) support and intravenous acyclovir, high-dose methylprednisolone, and immunoglobulin. 6 days later, she was successfully weaned from VA-ECMO and underwent cardiac rehabilitation. On day 10, she developed a fever (Tmax 38.3°C) and an irritating cough and began to experience reduced vision over the right eye with eye pain, redness, photophobia, and tearing 2 days later. Administration of levofloxacin eye drops and tobramycin/dexamethasone eye ointment was ineffective. The patient was positive for serum Aspergillus galactomannan antigen. Positron emission tomography/computed tomography (PET/CT) scan showed multiple hypermetabolic cavitary nodules in both lungs (SUVmax3.6) and thickening of the ocular ring wall with hypermetabolism in the right eye (SUVmax3.2). Ophthalmologic examination revealed that her best-corrected visual acuity in the right eye was reduced to light perception with an intraocular pressure of 21 mmHg, and B-scan ultrasonography showed vitreous opacity and retinal edema with mild detachment in the right eye. Metagenomic next-generation sequencing (mNGS) identified a large number of Aspergillus fumigatus sequences in bronchoalveolar lavage fluid, blood, and aqueous humor from the right eye, supporting the diagnosis of pulmonary and ocular involvement due to disseminated IA. Vitrectomy, anterior chamber irrigation, combined with intravenous and intravitreal injections of voriconazole and liposomal amphotericin B eventually cured the patient. This case highlights the importance of early identification and intervention regarding disseminated IA in immunocompromised critically ill patients, especially in the presence of multiple organ involvement.

OBJECTIVE:To visualize the relationship between different combinations of mechanical power exposure intensity-duration and death risk in mechanical ventilation patients using a visualization method. METHODS:Critically ill patients receiving mechanical ventilation were selected from the Medical Information Mart for Intensive Care- IV v1.0 (MIMIC- IV v1.0) database. The patients were divided into four subgroups according to oxygenation index (PaO2/FiO2) including > 300 mmHg (1 mmHg ≈ 0.133 kPa) group, 201-300 mmHg group, 101-200 mmHg group and ≤100 mmHg group. The baseline characteristics, ventilator parameters, and prognostic indicators for different patient populations were collected. For each patient, the mechanical power thresholds from low to high (5-30 J/min, increasing at intervals of 1 J/min) were used to evaluate the different exposures of mechanical power (above the set threshold was recorded as one exposure), and the number of events with different exposure intensity-duration combinations was counted based on their corresponding durations. Based on the 28-day survival/non-survival status, the number of exposures for survivors and non-survivors in each exposure intensity-duration combination was calculated, and the survival odds ratio (OR) for different mechanical power exposure intensity-duration combinations was subsequently computed. Two-dimensional tables were generated with mechanical power exposure duration on the x-axis and exposure intensity on the y-axis, and the heatmap and its corresponding equipotential line view were used to visualize the OR value to assess the risk of death. RESULTS:A total of 5 378 patients receiving mechanical ventilation were enrolled in the study, of whom 2 069 patients in the PaO2/FiO2 > 300 mmHg group, 813 patients in the 201-300 mmHg group, 1 493 patients in the 101-200 mmHg group, and 1 003 patients in the ≤100 mmHg group. The severity scores of patients, including sequential organ failure assessment (SOFA) score and simplified acute physiology score II (SAPS II), gradually increased following the decrease in PaO2/FiO2, and the incidence of co-morbidities also gradually increased. In terms of ventilator parameters, mechanical power was increased gradually with decrease in PaO2/FiO2, measuring 10.4 (7.8, 13.9), 11.3 (8.5, 14.7), 13.6 (10.0, 18.2), and 16.7 (12.5, 22.0) J/min (P < 0.01). In terms of prognosis, 28-day mortality of patients was gradually increased with decrease in PaO2/FiO2 [29.1% (601/2 069), 26.9% (219/813), 28.1% (420/1 493), and 33.3% (334/1 003), respectively, P < 0.05]. In the heatmap, it could be observed that the 28-day death risk of mechanical ventilation patients was gradually increased with increase in mechanical power exposure intensity and long duration, showing two distinct areas: a region near the bottom left corner (representing low mechanical power exposure intensity and short duration) was blue, indicating a greater chance of survival. In contrast, another region near the top right corner (representing high mechanical power exposure intensity and long duration) was red, indicating a higher risk of death. According to the fitted lines of death risk, for the same risk of death, a shorter mechanical power exposure duration was required for higher exposure intensity, while lower mechanical power exposure intensity required a longer exposure duration. The above trend of change was similarly reflected in the overall population and different oxygenation populations. CONCLUSIONS:Cumulative mechanical power exposure to higher intensity and/or longer duration is associated with worse outcomes in mechanical ventilation patients. Considering both the mechanical power exposure intensity and duration may help to evaluate the effectiveness of lung protection in mechanical ventilation patients and guide adjustments in mechanical ventilation strategy to reduce the risk of ventilator-induced lung injury.

Acute kidney injury (AKI) frequently emerges as a consequential non-neurological sequel to traumatic brain injury (TBI), significantly contributing to heightened mortality risks. The intricate interplay of oxidative stress in the pathophysiology of TBI underscores the centrality of the Keap1-Nrf2/HO-1 signaling pathway as a pivotal regulator in this context. This study endeavors to elucidate the involvement of the Keap1-Nrf2/HO-1 pathway in modulating oxidative stress in AKI subsequent to TBI and concurrently explore the therapeutic efficacy of dimethyl fumarate (DMF). A rat model of TBI was established via the Feeney free-fall method, incorporating interventions with varying concentrations of DMF. Assessment of renal function ensued through measurements of serum creatinine and neutrophil gelatinase-associated lipocalin. Morphological evaluation of renal pathology was conducted employing quantitative hematoxylin and eosin staining. The inflammatory response was scrutinized by quantifying interleukin (IL)-6, IL-1β, and tumor necrosis factor-α levels. Oxidative stress levels were discerned through quantification of malondialdehyde and superoxide dismutase. The apoptotic cascade was examined via the terminal deoxynucleotidyl transferase dUTP deletion labeling assay. Western blotting provided insights into the expression dynamics of proteins affiliated with the Keap1-Nrf2/HO-1 pathway and apoptosis. The findings revealed severe kidney injury, heightened oxidative stress, inflammation, and apoptosis in the traumatic brain injury model. Treatment with DMF effectively reversed these changes, alleviating oxidative stress by activating the Keap1-Nrf2/HO-1 signaling pathway, ultimately conferring protection against AKI. Activating Keap1-Nrf2/HO-1 signaling pathway may be a potential therapeutic strategy for attenuating oxidative stress-induced AKI after TBI.