To investigate the predictive value of acute brain lesions (ABLs) for the clinical outcomes and delayed encephalopathy after acute carbon monoxide poisoning (DEACMP). This is a retrospective cohort study, patients with acute carbon monoxide (CO) poisoning were divided into the ABLs group and non-ABLs group. Outcome measures included clinical cure, favorable prognosis, and the incidence of DEACMP. Multivariate logistic regression analysis was used to identify independent predictors of clinical outcomes, and subgroup analyses were performed to clarify the impact of ABLs on clinical outcomes. Multivariate analysis showed that ABLs (clinical cure: adjusted odds ratio [aOR] 0.35, 95

Background Sepsis, characterized by multiple organ failure, is the leading cause of death in intensive care units. Extensive research has highlighted a significant association between sepsis and the gut microbiota (GM). However, the causal relationship between these factors, particularly their impact on 28-day mortality, remains unclear. Methods We conducted a Mendelian randomization (MR) study using genome-wide association study (GWAS) summary statistics. The primary analytical method to establish causality was the inverse-variance weighted (IVW) method, supplemented by four additional MR approaches. Heterogeneity and horizontal pleiotropy were assessed using Cochran’s Q test and the MR-Egger intercept test, respectively. Results The IVW method revealed that seven GM taxa, primarily including class Bacteroidia (OR 1.565, 95% CI 1.161-2.108, P= 0.003), genus Methanobrevibacter (OR 1.347, 95% CI 1.045-1.736, P= 0.022), and others, were positively associated with 28-day sepsis mortality. Conversely, genetically predicted levels of four GM taxa, including class Lentisphaeria (OR 0.751, 95% CI 0.588-0.960, P = 0.022), genus Coprococcus2 (OR 0.537, 95% CI 0.315-0.917, P = 0.023), and others, were negatively associated with 28-day sepsis mortality. Heterogeneity and pleiotropy analyses confirmed the robustness of these findings (all P > 0.05). Conclusion Our MR study provides genetic evidence supporting a causal relationship between GM composition and 28-day mortality in sepsis. These findings suggest potential targets for future microbiome-based therapeutic interventions in sepsis management.

Objective:This study aimed to develop and internally validate an early warning predictive model to identify the risk of critical illness among patients presenting to the emergency department (ED). Methods:A retrospective analysis was conducted using clinical data from 3859 patients admitted between November 1, 2021 and December 31, 2021. Patients were randomly assigned to a training cohort (n = 2,703) and a validation cohort (n = 1,156) in a 7:3 ratio. Fourteen readily accessible physiological indicators obtained during the early stage of emergency department presentation were adopted as predictive parameters. Independent predictors of early critical risk were identified in the training cohort using generalized additive models, stepwise multivariate logistic regression and clinical practical considerations. The resulting model was used to stratify risk levels. Results:No statistically significant differences were observed in in baseline characteristics between the training and validation cohorts (p>0.05). Sex, age, heart rate, respiratory rate, systolic blood pressure, pulse oximetry saturation, level of consciousness, pupil status, mental status, and pain score were identified as independent predictors of critical risk (all p<0.05). Risk stratification using conditional inference trees categorized patients into low-risk (p≤0.129), medium-risk (0.129 0.867) groups. The model demonstrated strong discriminatory ability, with area under the curve values of 0.926 (95% CI: 0.913-0.940) in the training cohort and 0.914 (95% CI: 0.889-0.938) in the validation cohort. Calibration was satisfactory, as indicated by Hosmer-Lemeshow test p-values of 0.318 and 0.654, respectively. Conclusion:The developed predictive model demonstrated good discrimination, calibration, and clinical utility for the early identification of patients at critical risk in the ED setting. All predictors can be obtained during the initial clinical assessment, which facilitates real-time application in triage. This practical accessibility supports the model's potential integration into routine emergency workflows and primary healthcare settings.

Acute respiratory distress syndrome (ARDS) mainly results in severe respiratory failure and significant morbidity. This study decisively investigated the effectiveness and clinical importance of stromal interaction molecule 1 (STIM1) mRNA as an early predictive biomarker for the outcomes and severity of ARDS cases. A total of 72 mechanically ventilated patients were included in the study, consisting of 51 with ARDS and 21 without. The STIM1 mRNA levels in blood and bronchoalveolar lavage fluid (BALF) from these cases were assessed by quantitative reverse transcription polymerase chain reaction (RT-qPCR). Additionally, lung tissues were collected from six patients (three with ARDS and three without) for hematoxylin-eosin staining, immunohistochemistry, and Western blot analysis. A predictive nomogram was constructed using STIM1 mRNA level and assessed for its ability to predict the severity and mortality of ARDS. A higher STIM1 mRNA level was associated with increased ARDS severity and patient mortality. Thus, STIM1 may serve as a novel biomarker for the early prediction of clinical outcomes and disease status of ARDS cases. Additionally, analysis of the GSE database revealed the MAPK signaling pathway as a key mechanism underlying the function of STIM1 in ARDS.

Non-thyroidal illness syndrome(NTIS)is commonly observed in critically ill patients.Sepsis is one of the leading causes of mortality among patients in intensive care units,where the incidence of NTIS is higher than that in general wards.Recently,increasing attention has been paid to thyroid metabolic abnormalities in sepsis patients.This article reviews the pathogenesis and clinical significance of NTIS in sepsis,aiming to offer evidence-based medical insights for future research directions for clinicians.

Sepsis-associated acute lung injury (ALI) is a leading cause of death in sepsis patients, characterized by complex pathogenesis involving inflammatory responses, immune dysregulation, cell death, and coagulation system activation. Despite advancements in critical care, specific drugs or therapies for ALI remain unavailable. Pannexin 1 (Panx1), a widely expressed membrane channel protein, has emerged as a pivotal regulator in the onset and progression of sepsis-induced ALI. During the early stages, Panx1 amplifies inflammatory responses by promoting immune cell activation, chemotaxis, cytokine release, and coagulation. Simultaneously, it contributes to epithelial and endothelial cell damage through apoptosis, pyroptosis, and ferroptosis. Conversely, in the recovery phase, Panx1 plays a reparative role, facilitating inflammation resolution, epithelial cell proliferation, and tissue regeneration. This review highlights Panx1's dual role, presenting it as a promising therapeutic target. Preclinical models have demonstrated a key therapeutic advantage: the potential for stage-specific interventions. This strategy involves pharmacological inhibition to mitigate early-stage damage and potential activation to promote later-stage repair. However, a critical knowledge gap remains in defining the precise therapeutic window for such interventions and translating these findings into clinical practice. By elucidating Panx1's complex mechanisms, we aim to provide a theoretical basis for novel therapeutic strategies, addressing a critical unmet need in sepsis-induced ALI management and improving patient outcomes.

This study aimed to evaluate the effects of coma on the prognosis and delayed encephalopathy in patients with acute carbon monoxide poisoning (DEACMP) and to analyze the predictive factors affecting the prognosis of these patients. Patients with acute carbon monoxide poisoning were divided into comatose and non-comatose groups. The primary outcomes included clinical cure and the occurrence of DEACMP. Multivariate logistic regression analysis was performed to identify independent predictors of clinical outcome. Multivariate analysis indicated that coma (clinical cure: adjusted odds ratio [aOR] 0.24, 95

OBJECTIVE:This study aimed to evaluate the effect of computed tomography (CT) turnaround time (the interval between a patient's initial visit and the availability of the CT results) on diagnostic accuracy, clinical management, and healthcare costs in patients presenting with acute abdominal pain. METHODS:A retrospective cohort analysis was conducted involving adult patients who presented for the first time with acute abdominal pain between January 1 and June 30, 2022. Patients were stratified into two groups based on CT turnaround time, defined as the interval from clinical reception by a physician to the availability of the CT report. The early imaging group (referred to as the "priority examination group") included individuals with a CT turnaround time of less than 30 min, while the delayed/no imaging group comprised those with a turnaround time of 30 min or more, or who did not undergo CT. Outcomes were compared across emergency disease triage levels, focusing on emergency department (ED) length of stay, inpatient length of stay, hospitalization costs, diagnostic accuracy, and clinical outcomes to assess the impact of expedited imaging. RESULTS:Of the 2450 patients identified in the electronic medical record system, 1505 met the inclusion criteria, with 839 assigned to the delayed/no imaging group and 666 to the early imaging group. Following propensity score matching, each group comprised 666 patients. No significant differences were observed between the groups regarding age or symptom onset time (p = 0.283 and 0.753, respectively). Among patients triaged as grade 2 or higher, those in the early imaging group experienced significantly shorter ED stays compared to the delayed/no imaging group (p = 0.004). However, no significant difference in ED stay was observed among grade 3 patients (p = 0.630). In patients classified as grade 2 or higher, the early imaging group exhibited a reduced inpatient length of stay and lower hospitalization costs (p = 0.001, and 0.002, respectively). Among grade 3 patients, the early imaging group incurred significantly lower emergency care costs (p < 0.001). CONCLUSION:Shorter CT turnaround time was associated with improved diagnostic and clinical outcomes among individuals with acute abdominal pain, particularly those with higher triage severity. Early availability of CT reports correlated with reductions in ED and inpatient length of stay and overall hospitalization costs, emphasizing the clinical importance of minimizing diagnostic delays in this population.

Diagnostic checklists have been demonstrated to reduce errors in clinical reasoning. Building on previous validation studies, this research presents the development and clinical application of an etiology-based diagnostic framework for evaluating acute abdominal pain. The framework integrates a structured checklist of abdominal pain etiologies with a process-oriented diagnostic strategy, aiming to enhance diagnostic accuracy and clinical outcomes. This approach also serves as a potential model for the creation of diagnostic tools applicable to other symptom complexes encountered in emergency medicine. A cognitive task analysis (CTA) was conducted with participation from five emergency medicine experts employing a think-aloud methodology. The experts described their diagnostic reasoning processes and queried relevant clinical data to extract foundational diagnostic principles. Based on these findings, a checklist categorizing etiologies of abdominal pain was constructed, drawing from anatomical and diagnostic considerations. The clinical utility of the checklist was evaluated through its application to a representative complex case. The diagnostic checklist was organized into five principal etiological categories: local organ disorders, diseases of adjacent organs, systemic diseases, psychogenic disorders, and gynecological conditions. Its implementation facilitated the accurate identification of atypical acute renal infarction in a diagnostically challenging case, enabling prompt clinical intervention. CTA provides a robust method for modeling expert diagnostic reasoning and supports the development of structured, etiology-based diagnostic tools. This framework enhances diagnostic precision for individuals presenting with acute abdominal pain in emergency settings and may inform the development of similar tools for other clinical presentations.

Objective: To establish a predictive model for early assessment of critical risk in emergency patients and evaluate its clinical clinical benefits. Method: Clinical data of 3859 patients who visited the emergency department at Hebei General Hospital from November 2021 to December 2021 were selected. The enrolled patients were randomly divided into a training set (2703 cases) and a validation set (1156 cases) in a 7:3 ratio. In the training set, a predictive model was established based on the results of multivariate logistic stepwise regression analysis. At the same time, risk levels were divided, and the predictive efficacy and clinical benefits of the predictive model were verified. Result: There was no statistically significant difference in clinical data between the training and validation set (P>0.05), indicating comparability between the two groups. Multivariate logistic stepwise regression analysis showed that Gender, age, HR, R, SBP, SPO2, consciousness, pupil, mental state, and pain score were independent risk factors for early assessment of critical risk (P<0.05), and a predictive model was established based on this. Using conditional inference tree, critical risks are classified into low risk (P≤0.075), medium risk (0.075＜P≤0.656), and high risk (P>0.656). Furthermore, the prediction model was internally validated in both the training and validation sets, with a training set AUC of 0.926 [95% CI (0.912-0.939), P<0.001] and a validation set AUC of 0.911 [95% CI (0.886-0.936), P<0.001], indicating good discrimination of the prediction model; The calibration curve of the training set fits the standard curve, while the calibration curve of the validation set model slightly deviates from the standard curve. In the Hosmer Limeshow test, the results of the two groups were P=0.180 and P=0.546, respectively, indicating good calibration of the predicted model; The DCA curve suggests that both groups of people can achieve good clinical benefits. Conclusion: Establishing a predictive model for early assessment of emergency critical risk is helpful for early identification and intervention of emergency critical patients.

Acute lung injury (ALI) has received considerable attention in intensive care owing to its high mortality rate. It has been demonstrated that the selective alpha7 nicotinic acetylcholine receptor agonist Gainesville Tokushima scientists (GTS)-21 is promising for treating ALI caused by lipopolysaccharides (LPS). However, the precise underlying mechanism remains unknown. This study aimed to investigate the potential efficacy of GTS-21 in the treatment of ALI. We developed mouse models of ALI and alveolar epithelial type II cells (AT2s) injury following treatment with LPS and different polarized macrophage supernatants, respectively. Pathological changes, pulmonary edema, and lung compliance were assessed. Inflammatory cells count, protein content, and pro-inflammatory cytokine levels were analysed in the bronchoalveolar lavage fluid. The expression of angiotensin-converting enzyme (ACE), ACE2, syndecan-1 (SDC-1), heparan sulphate (HS), heparanase (HPA), exostosin (EXT)-1, and NF-κB were tested in lung tissues and cells. GTS-21-induced changes in macrophage polarization were verified in vivo and in vitro. Polarized macrophage supernatants with or without recombination a disintegrin and metalloproteinase-17 (ADAM-17) and small interfering (si)RNA ADAM-17 were used to verify the role of ADAM-17 in AT2 injury. By reducing pathological alterations, lung permeability, inflammatory response, ACE/ACE2 ratio, and glycocalyx shedding, as well as by downregulating the HPA and NF-κB pathways and upregulating EXT1 expression in vivo, GTS-21 significantly diminished LPS-induced ALI compared to that of the LPS group. GTS-21 significantly attenuated macrophage M1 polarization and augmented M2 polarization in vitro and in vivo. The destructive effects of M1 polarization supernatant can be inhibited by GTS-21 and siRNA ADAM-17. GTS-21 exerted a protective effect against LPS-induced ALI, which was reversed by recombinant ADAM-17. Collectively, GTS-21 alleviates LPS-induced ALI by attenuating AT2s ACE/ACE2 ratio and glycocalyx shedding through the inhibition of macrophage M1 polarization derived ADAM-17.

Acute kidney injury (AKI) is a common complication in patients supported by extracorporeal membrane oxygenation (ECMO). Vasoactive-Inotropic Score (VIS) serves as an indicator of the extent of cardiovascular drug support provided. Our objective is to assess the relationship between the VIS and ECMO-associated AKI (EAKI). This single-center retrospective study extracted adult patients treated with ECMO between August 2016 and September 2022 from an intensive care unit (ICU) in a university hospital. A total of 126 patients requiring ECMO support were included in the study, of which 76% developed AKI. Multivariate logistic regression analysis identified VIS-max Day1 (odds ratio [OR]: 1.025, 95% confidence interval [CI]: 1.007-1.044, p = 0.006), VIS-max Day2 (OR: 1.038, 95% CI: 1.007-1.069, p = 0.015), VIS-mean Day1 (OR: 1.048, 95% CI: 1.013-1.084, p = 0.007), and VIS-mean Day2 (OR: 1.059, 95% CI: 1.014-1.107, p = 0.010) as independent risk factors for EAKI. VIS-max Day1 showing the best predictive effect (Area under the receiver operating characteristic curve (AUROC): 0.80, sensitivity: 71.87%, specificity: 80.00%) for EAKI with a cutoff value of 33.33. Surprisingly, VIS-mean Day2 was also excellent at predicting 7 day mortality (AUROC: 0.77, sensitivity: 87.50%, specificity: 56.38%) with a cutoff value of 8.67. In conclusion, VIS could independently predict EAKI and 7 day mortality in patients with ECMO implantation, which may help clinicians to recognize the poor prognosis in time for early intervention.

Objective: This study aimed to investigate the effect of the central venous-to-arterial carbon dioxide partial pressure difference (Pcv-aCO2) on the administration of cardiotonic drugs in patients with early-stage septic shock. Methods: A retrospective study was conducted on 120 patients suffering from septic shock. At admission, the left ventricular ejection fraction (LVEF) and Pcv-aCO2 of the patients were obtained. On the premise of mean arterial pressure >= 65 mm Hg, the patients were divided into two groups according to the treatment approaches adopted by different doctors-control group: LVEF <= 50% and observation group: Pcv-aCO2 >= 6. Both groups received cardiotonic therapy. Results: The two groups of patients had similar general conditions and preresuscitation conditions (P > 0.05). Compared with the control group, the observation group had a higher mean arterial pressure, lactic acid clearance rate, and urine output after 6 h of resuscitation (P < 0.05), but a lower absolute value of lactic acid, total fluid intake in 24 h, and a lower number of patients receiving renal replacement therapy during hospitalization (P < 0.05). After 6 hours of resuscitation, the percentages of patients meeting central venous oxygen saturation and central venous pressure targets were not significantly different between the control and observation groups (P > 0.05). There was no difference in the 28-day mortality rate between the two groups (P > 0.05). Conclusion: Pcv-aCO2 is more effective than LVEF in guiding the administration of cardiotonic drugs in the treatment of patients with septic shock.

BACKGROUND:The aim was to explore the value of combined detection of PCT, CRP, and FIB in differentiating severe pneumonia from viral infection and bacterial infection.METHODS:A total of 100 patients with severe pneumonia admitted to Hebei General Hospital from August 2020 to November 2021 were selected as the research objects, including 50 patients with viral pneumonia (as the viral group, n = 50) and 50 patients with bacterial pneumonia (as the bacterial group, n = 50). At the same time, the clinical data of 50 healthy people in the hospital were selected as the healthy group (n = 50). All the subjects in the three groups were tested for PCT, CRP, and FIB. The difference of each index level among the three groups was compared. The diagnostic efficacy of each index for pneumonia was analyzed by drawing receiver operating characteristic curves, and the independent predictors of pneumonia were determined by logistic regression model.RESULTS:There were no statistically significant differences in gender, age, course of disease, body mass index (BMI), and other general data among the three groups (p > 0.05). Compared with the healthy group, the levels of serum PCT, CRP, and FIB in the viral group and the bacterial group were significantly increased, and the levels of serum PCT, CRP, and FIB in the bacterial group were significantly higher than those in the viral group, and the differences were statistically significant (p < 0.05). The positive rates of FIB, CRP, and PCT in bacterial group and viral group were increased in turn, and the differences were statistically significant (p < 0.05), and the positive rates of combined detection in the two groups were significantly higher than the positive rates of single index detection (p < 0.05). Taking etiological examination as the gold standard, the sensitivity (92.59%) and specificity (90.17%) of the three combined detection methods were significantly higher than those of PCT, CRP, and FIB alone. Kappa test showed that the results of the combined detection and etiological examination were in good agreement (Kappa value = 0.847, p < 0.05). ROC curve analysis showed that the AUC of combined prediction of the three was 0.964, which was higher than that of single detection of 0.859, 0.832, and 0.871. Logistic regression analysis showed that serum PCT, CRP, and FIB were independent predictors of bacterial pneumonia, and the differences were statistically significant (p < 0.05). Pearson's correlation analysis showed that FIB level in the bacterial group was positively correlated with PCT and CRP. PCT was positively correlated with CRP.CONCLUSIONS:Compared with viral pneumonia, the levels of serum PCT, CRP, and FIB in patients with bacterial pneumonia are higher. Biochemical indexes can be used as independent predictors for the diagnosis of bacterial pneumonia, and have high diagnostic value. The combined detection of the three has the highest diagnostic efficiency, which is conducive to the clinical differential diagnosis of the early types of pneumonia infection.

Objectives: This observational study was conducted to investigate capillary refill time (CRT) during the early phase of ICU admission in relationship with microvascular flow alteration and outcome in critically ill patients. Design: Prospective, observational, pilot study. Setting: ICU in a university hospital. Patients: Two hundred eighty-two critically ill adult patients admitted to the ICU. Interventions: None. Measurements and Main Results: All patients underwent simultaneous measurements by CRT and sidestream dark field imaging within 24 hours of ICU admission. Other clinical data such as demographic characteristics, hemodynamics, laboratory values, treatment, and physiologic parameters were also included simultaneously. Microcirculatory measurements were performed at 10.2 ± 5.7 hours after ICU admission. Of the 282 included patients, 106 (37.6%) were female, the median (interquartile range) age was 63 years (53–74 yr), and the median Sequential Organ Failure Assessment (SOFA) score was 5 (2–7). The primary finding was the association between CRT and simultaneous the condition of peripheral circulation (microvascular flow index [MFI]: r = –0.4430, p < 0.001; proportion of perfused vessels: r = –0.3708, p < 0.001; heterogeneity index: r = 0.4378, p < 0.001; perfused vessel density: r = –0.1835, p = 0.0020; except total vessel density: p = 0.9641; and De Backer score: p = 0.5202) in critically ill patients. In addition, this relationship was also maintained in subgroups. Microcirculatory flow abnormalities, 28-day mortality, and SOFA score appeared to be more severe for increasing CRT. In a multivariable analysis, prolonged CRT was independently associated with microvascular flow abnormalities (MFI < 2.6; odds ratio [OR], 1.608; 95% CI, 2.1–10.2; p < 0.001). Similarly, multivariable analysis identified CRT as an independent predictor of 28-day mortality (OR, 1.296; 95% CI, 1.078–1.558; p = 0.006). Conclusions: In our ICU population, a single-spot prolonged CRT was independently associated with abnormal microcirculation and increased mortality.

Background:The benefits of early use of norepinephrine in endotoxemic shock remain unknown. We aimed to elucidate the effects of different doses of norepinephrine in early-stage endotoxemic shock using a clinically relevant large animal model.Methods:Vasodilatory shock was induced by endotoxin bolus in 30 Bama suckling pigs. Treatment included fluid resuscitation and administration of different doses of norepinephrine, to induce return to baseline mean arterial pressure (MAP). Fluid management, hemodynamic, microcirculation, inflammation, and organ function variables were monitored. All animals were supported for 6 h after endotoxemic shock.Results:Infused fluid volume decreased with increasing norepinephrine dose. Return to baseline MAP was achieved more frequently with doses of 0.8 µg/kg/min and 1.6 µg/kg/min (P <0.01). At the end of the shock resuscitation period, cardiac index was higher in pigs treated with 0.8 µg/kg/min norepinephrine (P <0.01), while systemic vascular resistance was higher in those receiving 0.4 µg/kg/min (P <0.01). Extravascular lung water level and degree of organ edema were higher in animals administered no or 0.2 µg/kg/min norepinephrine (P <0.01), while the percentage of perfused small vessel density (PSVD) was higher in those receiving 0.8 µg/kg/min (P <0.05) and serum lactate was higher in the groups administered no and 1.6 µg/kg/min norepinephrine (P <0.01).Conclusions:The impact of norepinephrine on the macro- and micro-circulation in early-stage endotoxemic shock is dose-dependent, with very low and very high doses resulting in detrimental effects. Only an appropriate norepinephrine dose was associated with improved tissue perfusion and organ function.

ABSTRACT:Background: Kidney stiffness could change during kidney disease. We hypothesize that acute kidney injury (AKI) would increase renal stiffness. Therefore, evaluating kidney Young's modulus (YM; a measure of tissue stiffness) using shear wave elastography (SWE) might help to diagnose AKI. Methods: This research was divided into two studies. Study A: Male C57BL/6 mice were used to observe kidney YM changes induced by sepsis-associated AKI, which was established by cecal ligation and puncture (CLP). Study B included 54 consecutive critically ill patients with or without AKI. Changes in renal YM were observed. Results: Study A: CLP mice showed a significantly higher kidney YM compared with the sham group. The YM gradually increased from CLP 0 hours to CLP 24 hours, and presented a fair relationship with the renal tubular injury score ( R2 = 0.71) and serum creatinine ( R2 = 0.73). Study B: YM was easily accessible, and the intraclass correlation coefficient ranged from 0.62 to 0.84. Kidney YM was higher in AKI patients and gradually increased from non-AKI to AKI III patients. Furthermore, the YM in the upper, middle, and lower poles of the renal cortex presented a fair relationship with kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin ( R2 ranging from 0.4 to 0.58), and the areas under the curve of the above five indicators for the diagnosis of AKI were 0.7, 0.73, 0.70, 0.74, and 0.79, respectively. Conclusion: SWE-derived estimates of renal stiffness are higher in AKI patients and sepsis-associated AKI mice. However, it has no advantage over NGAL and KIM-1. Trial Registration: Chinese Clinical Trial Registry No: ChiCTR2200061725. Retrospectively registered July 1, 2022, https://www.chictr.org.cn/showproj.aspx?proj=169359 .