Critical Care最新文献

{"title":"Dynamic intra-abdominal organ volume changes in patients with sepsis","authors":"Shunsuke Tagami, Tomoki Wada, Ryota Inokuchi, Wataru Gonoi, Kent Doi","doi":"10.1186/s13054-025-05411-w","DOIUrl":"https://doi.org/10.1186/s13054-025-05411-w","url":null,"abstract":"<p><b>Correspondence</b></p><p>Sepsis is characterized by life-threatening organ dysfunction due to a dysregulated systemic response to infection [1]. Previous studies have documented volumetric changes in single organs during sepsis [2, 3]. However, to our knowledge, no studies have simultaneously measured the volumes of multiple intra-abdominal organs and examined how these volumes change over time. Accordingly, we reviewed the data of 25 patients aged ≥ 16 years with sepsis who underwent at least one non-contrast computed tomography (CT) scan before, during, and after the onset of sepsis. We focused on four organs—the liver, kidneys, adrenal glands, and spleen—and evaluated temporal volume changes using a three-dimensional medical image analyzer (SYNAPSE VINCENT [FUJIFILM, Japan]).</p><p>Among 25 patients, the median age was 73 years [IQR: 64–78] and 68% were male. Peritonitis (36%) was the most common diagnosis, followed by pneumonia (20%), bloodstream infection (16%), and cholangitis (12%). The median SOFA and APACHE II scores at ICU admission were 5 (IQR: 3–8) and 20 (IQR: 18–24), respectively. The median times from the previous CT scan without sepsis before ICU admission and for ICU admission to the closest CT scan after sepsis recovery were 117 (interquartile range [IQR]: 37–170 days) and 56 days (IQR: 43–138 days), respectively.</p><p>Figure 1 shows the temporal changes in organ volumes pre-sepsis onset to after sepsis resolution. Compared with pre-sepsis onset, the liver, adrenal glands, and kidneys had significant volume increases during sepsis when evaluated by Wilcoxon signed-rank test with Bonferroni adjustment (significance at p < 0.017) (liver 16% [IQR: 0–30%], <i>p</i> = 0.015; adrenal glands 14% [IQR: 9–41%], <i>p</i> < 0.01; and kidneys 9% [IQR: 0–23%], <i>p</i> < 0.01, respectively). In contrast, the spleen showed no significant volume change (3% [IQR: − 11 to 23%], <i>p</i> = 0.389). After sepsis resolution, liver, adrenal glands, and kidneys volumes were significantly decreased compared with those at ICU admission (liver 16% [IQR: 2–32%, <i>p</i> < 0.01], adrenal glands 25% [IQR: 12–45%, <i>p</i> < 0.001], and kidneys 11% [IQR: 1–20%], <i>p</i> < 0.01, respectively). The liver and kidney volumes were decreased compared with the baseline levels pre-sepsis onset, while the adrenal gland volumes were significantly smaller than those pre-sepsis (− 5% [IQR: − 13 to − 1%], <i>p</i> < 0.01). The relative organ volumes at ICU admission and the fluid balance 24 h after ICU admission were not significantly correlated when evaluated by Kendall rank correlation.</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"504\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-025-05411-w/MediaObjects/13054_2025_5411_Fig1_HTML.png\" width=\"685\"/></picture><p>Changes in intra-abdominal organ ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"113 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erroneous calibration of esophageal pressure in case of airway closure","authors":"Mattia Docci, Francois Beloncle, Arnaud Lesimple, Thomas Piraino, Davide Raimondi Cominesi, Andrea Restivo, Mayson L. A. Sousa, Emanuele Rezoagli, Alain Mercat, Jean-Christophe Richard, Laurent Brochard","doi":"10.1186/s13054-025-05416-5","DOIUrl":"https://doi.org/10.1186/s13054-025-05416-5","url":null,"abstract":"Airway closure results in a lack of communication between proximal and distal airways unless the airway pressure (Paw) overcomes the airway opening pressure (AOP). This has been described in patients undergoing mechanical ventilation with acute respiratory distress syndrome, obesity, hydrostatic pulmonary edema and during cardiopulmonary resuscitation. In these categories of patients, esophageal pressure (Pes) can guide the personalization of mechanical ventilation and calibration of the esophageal balloon is necessary to obtain reliable Pes measurements. The impact of airway closure has never been envisaged. This study investigated the impact of airway closure on the calibration of the esophageal balloon by the ∆Paw/∆Pes following a positive pressure occlusion test during passive mechanical ventilation. The calibration test was performed in twelve human cadavers with airway closure at end-expiration at different levels of positive end-expiratory pressure (PEEP) and at end-inspiration. The ∆Paw/∆Pes measured at end-expiration and at end-inspiration were significantly different when total PEEP was lower than AOP (estimated means 0.42 [0.40; 0.44] vs. 0.95 [0.92; 0.97], P < 0.001), while this difference was not observed when total PEEP was higher than AOP (estimated means 0.99 [0.92; 1.05] vs. 0.99 [0.92; 1.06], P = 0.854). These results were corroborated by observations during esophageal balloon calibration in two patients requiring Pes monitoring for clinical management. In case of airway closure, compression of the chest is not fully transmitted to the airways. This can lead to a conspicuous underestimation of the ∆Paw/∆Pes and poor reliability of this monitoring technique when the test takes place below AOP. Our results favor a positive pressure occlusion test performed during an end-inspiratory occlusion as the new standard of operative procedures for positioning and calibrating the esophageal balloon.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"479 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SIGH35 and end-expiratory occlusion test for assessing fluid responsiveness in critically ill patients undergoing pressure support ventilation","authors":"Antonio Messina, Lorenzo Calabrò, Francesco Benedetto, Aurora Villa, Guia Margherita Matronola, Andrea Brunati, Jean-Louis Teboul, Xavier Monnet, Maurizio Cecconi","doi":"10.1186/s13054-025-05398-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05398-4","url":null,"abstract":"Assessing fluid responsiveness is problematic for critically ill patients with spontaneous breathing activity, such as during Pressure Support Ventilation (PSV), since spontaneous breathing activity physiologically affects heart–lung interplay. We compared the reliability of two hemodynamic tests in predicting fluid responsiveness in this clinical setting: SIGH35, based on a ventilator-generated sigh applied at 35 cmH2O for 4 s and the end-expiratory occlusion test (EEOT). Prospective study conducted in a general intensive care unit (ICU) and enrolling patients in PSV showing different inspiratory effort [assessed by airway occlusion pressure (P0.1)] and requiring volume expansion (VE). Hemodynamic variables were recorded by means of the MOSTCARE® system, patient received a VE using 4 ml/kg of crystalloids over 10 min and were considered responders if a cardiac output (CO) ≥ 10% was observed. The reliability of SIGH35 and EEOT in discriminating fluid responsiveness was assessed using receiver operating characteristic (ROC) curve approach and the area (AUC) under ROC curves was compared. For the EEOT, we considered the percent changes of CO between baseline the end of the test, while for the SIGH35, the percent changes of pulse pressure (PP) between baseline and the lowest value recorded after SIGH35 application. Sixty ICU patients were enrolled, and 56 patients analysed. The AUC of PP changes after SIGH35 was 0.93 (0.84–0.99) [sensitivity of 93.1% (78.0–98.7%); specificity of 91.6 (73.0–98.9%)]; best threshold − 25% PP from baseline (grey zone − 15%/35%)]; and greater than the AUC of CO changes after EEOT [0.67 (0.52–0.81); sensitivity of 72.4% (54.3–85.3%) specificity of 70.3% (73.0–98.9%)]; best threshold 4% of CO increase from baseline (grey zone − 1%/10%)]. In the subgroup having a P0.1 < 1.5 cmH2O, the AUC of SIGH35 [0.98 (0.94–0.99)] and of EEOT [0.89 (0.72–0.99] were comparable (p = 0.26). In a selected ICU population undergoing PSV, SGH35 reliably predicted fluid responsiveness and performed better than the EEOT, which is, however, still reliable in the subgroup of ICU patients having a small extent of inspiratory efforts.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"3 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytomegalovirus reactivation in the lower respiratory tract as an independent risk factor for mortality in critically Ill patients","authors":"Joong-Yub Kim, Chan Mi Lee, Yoon Hae Ahn, Hong Yeul Lee, Sang-Min Lee, Hyeon Jae Jo, Pyoeng Gyun Choe, Wan Beom Park, Chang Kyung Kang, Jinwoo Lee, Nam Joong Kim","doi":"10.1186/s13054-025-05324-8","DOIUrl":"https://doi.org/10.1186/s13054-025-05324-8","url":null,"abstract":"The clinical significance of cytomegalovirus reactivation in the lower respiratory tract (LRT) of critically ill patients remains unclear. We aimed to investigate the association between cytomegalovirus reactivation detected in LRT and intensive care unit (ICU) prognosis. This study included critically ill patients admitted to a medical ICU at a tertiary referral center in South Korea between January 2021 and June 2023. Cytomegalovirus load in LRT samples collected via bronchoscopy was measured within 7 days of admission. Detection of cytomegalovirus DNA in LRT was defined as reactivation. Associations between cytomegalovirus reactivation and ICU, in-hospital, 30-day, and 90-day mortality were assessed using multivariable Fine-Gray model adjusted for major clinical factors. Of the 322 patients (median age 68 years, 66.8% male), 145 (45%) had cytomegalovirus reactivation in the LRT. Cytomegalovirus reactivation was independently associated with increased ICU (adjusted subdistribution hazard ratio [aSHR], 2.28; 95% confidence interval [CI], 1.46–3.56), in-hospital (aSHR, 2.00; 95% CI, 1.44–2.78), 30-day (aSHR, 2.11; 95% CI, 1.42–3.13), and 90-day mortality (aSHR, 2.05; 95% CI, 1.45–2.88). Anti-cytomegalovirus therapy was significantly associated with reduced ICU mortality in patients with radiologic findings suggestive of cytomegalovirus pneumonia (P for interaction = 0.001), but was linked to increased mortality in patients with positive bacterial cultures (P for interaction = 0.002). Cytomegalovirus reactivation in the LRT is associated with poor outcomes in critically ill patients. Anti-cytomegalovirus therapy was not associated with overall survival outcomes; however, the subgroup with radiologic findings of cytomegalovirus pneumonia suggested benefits, while the subgroup with bacterial co-infections suggested harmful effects. Randomized controlled trials are needed.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"114 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The urea-to-creatinine ratio as an emerging biomarker in critical care: a scoping review and meta-analysis","authors":"Michelle Carmen Paulus, Max Melchers, Anouck van Es, Imre Willemijn Kehinde Kouw, Arthur Raymond Hubert van Zanten","doi":"10.1186/s13054-025-05396-6","DOIUrl":"https://doi.org/10.1186/s13054-025-05396-6","url":null,"abstract":"Severe protein catabolism is a major aspect of critical illness and leads to pronounced muscle wasting and, consequently, extended intensive care unit (ICU) stay and increased mortality. The urea-to-creatinine ratio (UCR) has emerged as a promising biomarker for assessing protein catabolism in critical illness, which is currently lacking. This review aims to elucidate the role of UCR in the context of critical illness. This scoping review adhered to the PRISMA Extension for Scoping Reviews guidelines. A comprehensive literature search was conducted on the 3rd of September 2024, across Embase, PubMed, ScienceDirect, and Cochrane Library to identify studies related to (1) critically ill adult patients and (2) reporting at least a single UCR value. A meta-analysis was conducted for ≥ 5 studies with identical outcome parameters. Out of 1,450 studies retrieved, 47 were included in this review, focusing on UCR's relation to protein catabolism and persistent critical illness (10 studies), mortality (16 studies), dietary protein interventions (2 studies), and other outcomes (19 studies), such as delirium, and neurological and cardiac adverse events. UCR is inversely correlated to muscle cross-sectional area over time and associated to length of ICU stay, emphasising its potential role in identifying patients with ongoing protein catabolism. A UCR (BUN-to-creatinine in mg/dL) of ≥ 20 (equivalent to a urea-to-creatinine in mmol/L of approximately 80) upon ICU admission, in comparison with a value < 20, was associated with a relative risk of 1.60 (95% CI 1.27–2.00) and an adjusted hazard ratio of 1.29 (95% CI 0.89–1.86) for in-hospital mortality. UCR elevations during critical illness potentially indicate muscle protein catabolism and the progression to persistent critical illness, and high levels at ICU admission could be associated with mortality. UCR increments during ICU stay may also indicate excessive exogenous dietary protein intake, overwhelming the body's ability to use it for whole-body or muscle protein synthesis. Dehydration, gastrointestinal bleeding, kidney and liver dysfunction, and renal replacement therapy may also influence UCR and are considered potential pitfalls when assessing catabolic phases of critical illness by UCR. Patient group-specific cut-off values are warranted to ensure its validity and application in clinical practice.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"34 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of preload responsiveness may determine poor clinical outcomes in mechanically ventilated patients with ARDS","authors":"Sebastien Preau, Olivier Pouly, Mehdi Ederkaoui, Arthur Durand, Claire Bourel, Thierry Onimus, Laurine Cadart, Julien Labreuche, Michael Howsam, Raphaël Favory, Alexandre Pierre","doi":"10.1186/s13054-025-05409-4","DOIUrl":"https://doi.org/10.1186/s13054-025-05409-4","url":null,"abstract":"Trial registration: NCT03763773 . Registered 3 December 2018.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"52 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of in-hospital mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI study)","authors":"Jai Shankar, Susan Alcock, Murdoch Leeies, Marco Ayroso, Sarah Unrau, JaeYeon Park, Benjamin Blackwood, Reva Trivedi, Roman Marin, Muhammed Raja, Namita Sinha, Anurag Trivedi, Marco Essig, Douglas Martin, Robert Grierson, Frederick A. Zeiler","doi":"10.1186/s13054-025-05410-x","DOIUrl":"https://doi.org/10.1186/s13054-025-05410-x","url":null,"abstract":"Severe traumatic brain injury (TBI) stands as the leading cause of post-injury hospitalization, disability, and mortality globally. Imaging serves as a cornerstone in the assessment of patients with severe TBI and CT Perfusion (CTP) has emerged as an early prognostic tool. Our study aims to validate CTP features of non-survivable brain injury, upon hospital admission to characterize in-hospital mortality, through a well-powered prospective cohort study. In a prospective cohort study, adult patients with severe TBI were recruited to undergo whole head CTP at the time of their first imaging. Interpretation of the CTP images were conducted by two independent neuroradiologists (JS and ME), blinded to clinical results and each other’s assessment. Non-survivable brain injury was defined as a matched decrease of cerebral blood flow (CBF) and cerebral blood volume (CBV) in the brainstem. The results of CTP were not disclosed to the clinical team providing patient care, and the patients received standard institutional management. The primary outcome was a binary outcome of in-hospital mortality. The primary validity analysis involved calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for features of non-survivable brain injury on admission CTP compared to in-hospital mortality, along with 95% confidence intervals. Out of the 201 patients initially enrolled in the study, 195 patients (mean age 42.9 years; Male- 160, 82%) were included in the final analysis. Among the participants, a total of 55 patients (28.2%) died during their hospital stay. The odds ratio (OR) was highest for the presence of intracranial hemorrhage (ICH) (OR-20.25; 95% CI- 7.08–71.80, p < 0.001) and gun shot wound (GSW) (OR-22.67; 95% CI- 3.66–257.5, p = 0.003), which were independently associated with in-hospital mortality. With every decade of age, there was 1.77 times of (95% CI- 1.37–2.36, p < 0.001) higher odds of in-hospital mortality. Of the 55 patients with in-hospital mortality, 17 (31%) met the criteria of non-survival brain injury on the CTP at the time of hospital admission. Both CTP and CT-angiogram (CTA)A had 100% specificity and PPV. The highest sensitivity of 33% and NPV of 80% was seen with non-survivable criteria of CTP. As a result, this variable exhibited the highest accuracy of 82% with an area under the curve (AUC) of 0.67. The inter-rater reliability for CTP ranged from poor (kappa = 0.07) to fair (kappa = 0.44), indicating variability in agreement between raters. In contrast, the inter-rater reliability for CTA scales ranged from fair (kappa = 0.39) to substantial (kappa = 0.79), suggesting more consistent agreement among raters. CTP was found to be safe as no patients experience any complications associated with CTP. CTP features of non-survivable brain injury showed very high specificity and positive predictive value for diagnosing in-hospital mortality in patients with severe TBI.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"87 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An urgent call to publish COVID-19 trials: a systematic search revealed ZERO studies regarding the incidence of thromboembolic events in SARS-CoV-2 Omicron-infected COVID-19 patients","authors":"Amon Faske, Stefanie Reis, Tamara Pscheidl, Lena Saal-Bauernschubert, Patrick Meybohm, Stephanie Weibel","doi":"10.1186/s13054-025-05395-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05395-7","url":null,"abstract":"COVID-19 has been associated with an increased risk of thromboembolic complications, particularly in hospitalized patients. While early research focused on pre-Omicron variants, the thrombotic risk associated with SARS-CoV-2 Omicron infections remains unclear. Given the evolving nature of the pandemic, it is critical to assess whether current anticoagulation recommendations remain appropriate. We conducted a systematic review of clinical studies to determine the incidence of thromboembolic events in COVID-19 patients infected with SARS-CoV-2 Omicron variants. The main outcome was thromboembolic events within 28 days of infection, using objective diagnostic criteria. We systematically searched the Cochrane COVID‐19 Study Register, covering multiple databases, for studies published between November 30, 2021, and January 31, 2024. Studies were screened independently by two reviewers, and missing data were requested from study authors. Our search identified 7843 records, of which 238 underwent full-text screening. Ultimately, no study met our inclusion criteria due to issues such as lack of Omicron-specific data, inadequate reporting of diagnostic methods, and failure to specify the timing of outcome assessment. Despite contacting study authors, no additional eligible data were obtained. There is currently no high-quality evidence on the incidence of thromboembolic events in Omicron-infected COVID-19 patients. The absence of relevant studies highlights a critical research gap and raises concerns about the applicability of current anticoagulation guidelines. Future studies should stratify outcomes by SARS-CoV-2 variant, ensure transparent reporting, and provide rigorous diagnostic confirmation to guide clinical decision-making.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"26 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procalcitonin levels in septic and nonseptic subjects with AKI and ESKD prior to and during continuous kidney replacement therapy (CKRT)","authors":"North Foulon, Sarah M. Haeger, Kayo Okamura, Zhibin He, Bryan D. Park, Isadore M. Budnick, David Madison, Matthew Kennis, Rachel Blaine, Makoto Miyazaki, Diana I. Jalal, Benjamin R. Griffin, Muhammad Aftab, James F. Colbert, Sarah Faubel","doi":"10.1186/s13054-025-05414-7","DOIUrl":"https://doi.org/10.1186/s13054-025-05414-7","url":null,"abstract":"Procalcitonin is a 14.5 kDa protein used clinically as a marker of sepsis and therapeutic response to antibiotic therapy. However, its utility in critically ill patients with either acute kidney injury (AKI) or end-stage kidney disease (ESKD) who require continuous kidney replacement therapy (CKRT) is unknown. The aim of this study was to determine if plasma levels of procalcitonin could reliably distinguish septic from nonseptic status in patients with AKI or ESKD prior to or during CKRT. Procalcitonin concentrations were measured in plasma of 41 critically ill septic or non-septic subjects with AKI or ESKD prior to CKRT (pre-CKRT) and on days 1, 2, and 3 of CKRT in this retrospective cohort study (n = 111 total plasma measurements). Continuous venovenous hemodialysis was the modality of CKRT in these patients. Sepsis status was stringently defined based on culture results. Effluent procalcitonin levels were ascertained on days 1, 2, and 3 of CKRT to assess the clearance of procalcitonin and effects on plasma levels. 92% (66/72) of the plasma procalcitonin measurements among nonseptic patients with either AKI or ESKD were ≥ 0.5 ng/mL (the diagnostic threshold beyond which bacterial infection is very likely). Prior to CKRT initiation, procalcitonin levels were (median (IQR), ng/mL) 5.6 (1.5–18.9) in nonseptic AKI and 58.1 (6.9–195.5) in septic AKI (P = 0.03) and were 3.3 (1.2–8.3) in nonseptic ESKD and 3.7 (1.4–209.8) in septic ESKD (P = 0.79). However, despite being significantly elevated in septic patients with AKI, substantial overlap among procalcitonin levels was present and ROC curve analysis found no cut point that could reliably separate septic from nonseptic patients. Effluent procalcitonin levels were consistently ~ 20% of plasma levels throughout the course of CKRT (i.e., sieving coefficient was 0.2) suggesting that clearance occurs during therapy. However, plasma procalcitonin levels did not significantly decline during CKRT in either AKI or ESKD. Procalcitonin levels are markedly elevated in nonseptic critically ill patients with either AKI or ESKD and do not effectively distinguish sepsis from nonseptic status prior to or during CKRT. We conclude that procalcitonin testing should be avoided in critically ill patients with kidney failure since results are nonspecific in this population. ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"20 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated antibiotic resistance gene abundance of ICU healthcare workers, a multicentre, cross-sectional study","authors":"Lingtong Huang, Kangchen Li, Chen Peng, Silan Gu, Xiaohan Huang, Chunhua Gao, Xindie Ren, Minghui Cheng, Guojun He, Yinghe Xu, Yongpo Jiang, Hongyu Wang, Mingqiang Wang, Peng Shen, Qianqian Wang, Xuwei He, Lin Zhong, Shengfeng Wang, Nan Wang, Gensheng Zhang, Hongliu Cai, Chao Jiang","doi":"10.1186/s13054-025-05408-5","DOIUrl":"https://doi.org/10.1186/s13054-025-05408-5","url":null,"abstract":"Studies suggest that the colonization of multidrug-resistant organism in the gut of healthcare workers is similar to that of healthy individuals. However, due to exposure to medical environments, is the abundance of antibiotic resistance genes (ARG) in the gut of ICU healthcare workers higher than that of healthy individuals? Prospective, multicentre, cross-sectional study. Eight medical centers in China, recruiting from January 2024 to February 2024. 303 Healthy people (201 ICU healthcare workers and 103 healthy controls) were screened and 290 Healthy people (191 ICU healthcare workers and 99 healthy controls) were included in analysis. Fecal samples were collected and subjected to metagenomic sequencing. We compared the total ARG abundance, ARG diversity, and gut microbiome composition between the two groups. After adjusting for age, sex, and body mass index, ICU healthcare workers exhibited a significantly higher total ARG abundance compared to healthy controls (fold change = 1.22, 95% CI: 1.12–1.34, p < 0.001). The β-diversity of ARG between the two groups differed significantly (p = 0.001). No significant linear or nonlinear relationship was observed between the duration of ICU occupational exposure and ARG abundance (p for overall = 0.96, p for nonlinear = 0.84). In this prospective, multicenter study, we found that ICU healthcare workers exhibit significantly higher gut ARGs abundance compared to healthy controls. Meanwhile, ICU healthcare workers, including physicians, nurses, and nursing assistants, have a different composition of gut ARGs compared to healthy individuals. Trial registration: NCT06228248.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"46 1","pages":""},"PeriodicalIF":15.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}