Frontiers in Medicine最新文献

{"title":"POEMS syndrome misdiagnosed as liver cirrhosis: a case report.","authors":"Jiajing Xing, Weiwei Niu, Zhixin Feng, Hong Zhang, Shuohui Li, Fanhao Lu, Feng Gao, Limin Shi, Na Wang","doi":"10.3389/fmed.2026.1815406","DOIUrl":"https://doi.org/10.3389/fmed.2026.1815406","url":null,"abstract":"<p><p>POEMS syndrome is a rare multisystem paraneoplastic disorder characterized by polyneuropathy and monoclonal plasma cell proliferation, often leading to delayed diagnoses due to variable clinical manifestations. A 62-year-old woman presented with persistent bilateral eyelid edema as the initial symptom and abdominal distension as the predominant complaint. She was misdiagnosed with liver cirrhosis and remained undiagnosed for 6 years. Multidisciplinary evaluation revealed monoclonal IgA <i>λ</i> protein, markedly elevated vascular endothelial growth factor, and neurophysiological evidence of peripheral neuropathy, consistent with POEMS syndrome. Treatment with lenalidomide and dexamethasone, along with supportive care, led to improvement in abdominal distension and bilateral lower limb edema. This case underscores the need to consider POEMS syndrome in patients with unexplained eyelid edema accompanied by multisystemic manifestations. Given its potential to mimic other conditions, such as cirrhosis-as highlighted by this patient's prolonged misdiagnosis-prompt and accurate recognition is essential to guide appropriate management, prevent irreversible organ damage, and improve long-term outcomes.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1815406"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of endoscopic intervention with mortality in gastrointestinal bleeding after open-heart surgery: a propensity-score cohort study.","authors":"Hailin Du, Yamei Sun, Guoyan Bai, Jie Zhang","doi":"10.3389/fmed.2026.1713252","DOIUrl":"https://doi.org/10.3389/fmed.2026.1713252","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative gastrointestinal bleeding (GIB) after open-heart surgery is associated with increased mortality, yet the prognostic impact of endoscopic intervention remains uncertain.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of adults who developed GIB within 30 days after open-heart surgery (2017-2024). Patients were categorized into endoscopy and non-endoscopy groups, and propensity-score full matching was used to balance baseline covariates. The primary outcome was 30-day all-cause mortality; secondary outcomes were 1-year all-cause mortality, major postbleeding in-hospital complications (including acute myocardial infarction, acute respiratory distress syndrome, and other serious postoperative events), and postbleeding hospital length of stay.</p><p><strong>Results: </strong>Of 712 patients screened, 271 were included (endoscopy <i>n</i> = 68; non-endoscopy <i>n</i> = 203). After balancing baseline covariates, lower 30-day mortality was observed in the endoscopy group compared with the non-endoscopy group (adjusted mortality 26.5% vs. 49.8%; hazard ratio [HR] 0.54; 95% CI 0.32-0.91; <i>P</i> = 0.021, using a time-dependent Cox model). A similar pattern was observed at 1 year (HR 0.52; 95% CI 0.32-0.84; <i>P</i> = 0.007). No statistically significant difference was observed in major postbleeding in-hospital complications (odds ratio 1.86; 95% CI 0.94-3.68; <i>P</i> = 0.082, with residual uncertainty regarding potential harm) or prolonged length of stay (geometric mean ratio 1.17; 95% CI 0.99-1.39; <i>P</i> = 0.070). Endoscopy was associated with a higher cumulative incidence of discharge, accounting for death as a competing event (subdistribution HR 1.53; 95% CI 1.14-2.07; <i>P</i> = 0.005).</p><p><strong>Discussion: </strong>Among clinically eligible patients with postoperative GIB after open-heart surgery, lower 30-day and 1-year mortality rates were observed in those undergoing endoscopic intervention, whereas no statistically significant differences were observed in major postbleeding in-hospital complications or hospital length of stay. Given the retrospective nature of the study, these results should be considered hypothesis-generating rather than confirmatory, serving as a basis for future prospective investigations.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1713252"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"675-nm diode laser as an adjuvant treatment for telogen effluvium: case series.","authors":"Angelica Ruiz Dueñas, Luis Enrique Sanchez Dueñas, Miroslaba Rodríguez Puente, Nicole Orendain Koch","doi":"10.3389/fmed.2026.1753577","DOIUrl":"https://doi.org/10.3389/fmed.2026.1753577","url":null,"abstract":"<p><strong>Background: </strong>Telogen effluvium (TE) is a diffuse, non-scarring alopecia that can have a significant impact on quality of life. Although often self-limited, many patients seek therapies that speed recovery. Photobiomodulatory benefits of the 675-nm diode laser are also well established in treating other hair disorders, but there is limited evidence in TE.</p><p><strong>Methods: </strong>We performed a retrospective case series of 13 patients diagnosed with TE at a Dermatologic Laser Center in Mexico. The patients received adjuvant treatment with 675-nm diode laser therapy.</p><p><strong>Results: </strong>Of the 13 patients, 69% had chronic TE. Among those with a positive baseline pull test, 72% became negative at follow-up. Pruritus improved in 83% of symptomatic patients, and trichodynia resolved in 75%. No adverse events occurred.</p><p><strong>Conclusion: </strong>675-nm diode laser seems to be a safe, well-tolerated, and potentially effective adjuvant therapy for TE. Controlled studies are needed to confirm efficacy and establish standardized protocols.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1753577"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Pulmonary <i>Mycobacterium avium</i> complex mimicking recurrent tuberculosis in a patient with suspected pneumoconiosis and destroyed lung diagnosed by bronchoalveolar lavage fluid targeted next-generation sequencing.","authors":"Chao Xie, Lei Zha, Liqin Zhang","doi":"10.3389/fmed.2026.1832417","DOIUrl":"https://doi.org/10.3389/fmed.2026.1832417","url":null,"abstract":"<p><p>A 42-year-old man, a coal miner with a history of pulmonary tuberculosis, dust exposure, and suspected pneumoconiosis, presented with cough, purulent sputum, and intermittent fever for more than 1 month. Routine sputum bacterial and fungal cultures, as well as acid-fast bacilli smears, were persistently negative. Chest computed tomography revealed markedly distorted bilateral lung architecture with patchy and nodular opacities, multiple irregular cavitary lesions, emphysema, pulmonary bullae, and mediastinal lymphadenopathy. To obtain a definitive diagnosis, a bronchoscopy was safely performed under strict asepsis and painless anesthesia. The procedure showed inflammatory bronchial changes and narrowing of the right upper lobe posterior and dorsal segmental bronchi due to external compression. Targeted next-generation sequencing (tNGS) of the bronchoalveolar lavage fluid on the MGI VisionSeq 1000 platform detected <i>Mycobacterium avium</i> complex (349 sequence reads, 53.4% relative abundance). The patient's condition improved rapidly following a targeted multidrug regimen (clarithromycin, rifampicin, ethambutol, and amikacin) combined with supportive pneumoconiosis care. This case highlights the vital role of tNGS in differentiating nontuberculous mycobacterial disease from recurrent tuberculosis in patients with complex structural lung damage, enabling timely and precise intervention.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1832417"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of influencing factors for postoperative prognosis of patients with knee osteoarthritis.","authors":"Zemiao Liu, Deheng Liu","doi":"10.3389/fmed.2025.1686941","DOIUrl":"https://doi.org/10.3389/fmed.2025.1686941","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the influencing factors of postoperative prognosis in patients with knee osteoarthritis (KOA) and to construct and validate a Nomogram prediction model.</p><p><strong>Methods: </strong>A total of 260 patients who underwent KOA surgical treatment and were admitted between January 2021 and May 2023 were selected. The patients were divided into a training set (<i>n</i> = 182) and a validation set (<i>n</i> = 78) in a ratio of 7:3 by the complete randomization method. Relevant factors influencing postoperative prognosis were screened out through univariate analysis and multivariate logistic regression analysis. A Nomogram prediction model was constructed, and the model was validated and evaluated using the concordance index (C-index), calibration curve, and decision curve analysis (DCA).</p><p><strong>Results: </strong>The results of the multivariate logistic regression analysis showed that VAS score, ROM, time to first ambulation after surgery, CRP, erythrocyte sedimentation rate, IL-6, and knee circumference were independent influencing factors affecting postoperative prognosis (all <i>P</i> < 0.05). The receiver operating characteristic curves showed that in the training set and the validation set, the area under the curves of the Nomogram model for predicting poor prognosis after KOA surgery were 0.938 (95% CI: 0.871-1.000) and 0.873 (95% CI: 0.806-0.941), respectively, and the sensitivities and specificities were 0.786, 0.925 and 0.718, 0.933, respectively. The constructed Nomogram prediction model had good discrimination. The calibration curve showed good consistency, and DCA analysis indicated that the model had clinical application value.</p><p><strong>Conclusion: </strong>VAS score, ROM, time to first ambulation after surgery, CRP, erythrocyte sedimentation rate, IL-6, and knee circumference affect the postoperative prognosis of KOA. The constructed Nomogram prediction model has high accuracy and clinical application value.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1686941"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical predictive modeling for post-ERCP cholangitis in biliary stricture patients.","authors":"Bensong Duan, Weixin Ye, Yuping Shi, Suhong Yi, Dadong Wan, Yang Jiang, Liqian Xuan, Jiangfeng Hu","doi":"10.3389/fmed.2026.1738706","DOIUrl":"https://doi.org/10.3389/fmed.2026.1738706","url":null,"abstract":"<p><strong>Aim: </strong>The objective of this study was to predict the occurrence of post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis (PEC) in patients with biliary stricture.</p><p><strong>Method: </strong>We collected clinical data and procedural records from 1,606 patients who underwent ERCP for biliary stricture over the last 10 years. Of these, 1,281 patients were randomly allocated to the training or validation group and 325 patients enrolled in other hospitals as an external validation set. LASSO logistic regression analysis was used to identify independent risk factors and establish a predictive model for PEC. The performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves and calibration curves. At the same time, decision curve analysis (DCA) is used to determine the net benefit threshold of prediction.</p><p><strong>Results: </strong>The findings indicated that age, albumin levels, etiology of biliary stricture, stenosis site, diabetes, digestive tract reconstruction, obstruction length and the use of cholangioscopy may be factors that influence postoperative biliary tract infection in patients with biliary stenosis. The nomogram exhibited a higher net benefit in decision curve analysis. The calibration curve shows a strong agreement between expected and observed results.</p><p><strong>Conclusion: </strong>The proposed nomogram exhibits robust predictive performance. This tool can assist healthcare professionals in minimizing the risk of PEC in patients with biliary stricture undergoing ERCP.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1738706"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical data analysis research on tuberculosis based on machine learning.","authors":"Rongrong Kang, Huanqing Liu, Qian Lei, Tingting Li","doi":"10.3389/fmed.2026.1785419","DOIUrl":"https://doi.org/10.3389/fmed.2026.1785419","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) remains a global health challenge, with heterogeneous treatment outcomes despite standardized protocols. Traditional statistical models struggle with high-dimensional clinical data, necessitating advanced machine learning (ML) approaches.</p><p><strong>Objective: </strong>To analyze clinical data from 467 pulmonary TB patients and construct a predictive model using multiple ML algorithms.</p><p><strong>Methods: </strong>A prospective cohort of 467 patients (218 intervention, 249 control) was enrolled from Xi'an Chest Hospital. Medical ratio features (ALT/AST, CD4/CD8) and polynomial interaction terms (e.g., RBC × ALT) were constructed. Recursive feature elimination (RFE) selected 60 predictive factors from an expanded 80-dimensional feature space. Fourteen ML algorithms were systematically compared, with hyperparameters optimized via grid search. Performance was assessed using five-fold cross-validation <i>R</i> ², RMSE, and MAE.</p><p><strong>Results: </strong>LightGBM achieved the highest initial predictive performance (<i>R</i> ² = 0.1829, RMSE = 139.23). Following hyperparameter optimization, Random Forest attained a marginally improved <i>R</i> ² of 0.1867 with comparable error metrics and enhanced clinical interpretability, serving as the final reference model. Feature engineering expanded the feature space from 33 to 80, with 60 optimal features retained.</p><p><strong>Conclusion: </strong>The optimized Random Forest model (<i>R</i> ² = 0.1867) demonstrates moderate accuracy and clinical interpretability, supporting its potential as a decision-support tool for TB treatment optimization. Pharmacist-led therapeutic drug monitoring (TDM) further enhances individualized therapy. Future work requires multi-center validation and radiomics integration to improve predictive performance in severe cases.</p><p><strong>Clinical trial registration: </strong>Registration Platform: Chinese Clinical Trial Registry [https://www.chictr.org.cn/], identifier [ChiCTR2300074328].</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1785419"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of an improved Xiao-Xu-Ming-Tang traditional Chinese medicine hot compress for preventing catheter-related bladder discomfort: a multicenter, randomized, double-blind, controlled trial.","authors":"Yujing Han, Zhihua Mi, Guanghui An, Bin Yang, Huixing Zhang, Dongmei Hong","doi":"10.3389/fmed.2026.1799106","DOIUrl":"https://doi.org/10.3389/fmed.2026.1799106","url":null,"abstract":"<p><strong>Objectives: </strong>Catheter-related bladder discomfort (CRBD) occurs in 47-95% of patients recovering from general anesthesia, causing discomfort and increasing the risk of postoperative delirium. Xiao-Xu-Ming-Tang is a traditional Chinese medicine (TCM) concoction that has <i>demonstrated efficacy</i> in relieving urinary symptoms. Thus, we propose the use of this improved traditional Chinese medicine concoction in the form of a hot compress as an inexpensive, effective, and simple intervention for preventing postoperative CRBD.</p><p><strong>Methods: </strong>This was a multicenter, randomized, double-blind, controlled study. Ninety patients who underwent transurethral ureteral laser lithotripsy at three centers were included. Patients were randomly divided into two groups: the Chinese medicine (CM) group and the control group (salt packet (SP) group), at a ratio of 1:1. In the CM group, a hot compress (40-45 °C) of improved Xiao-Xu-Ming-Tang mixed with salt was placed above the pubic symphysis immediately after intubation. In the control group, one-tenth of the improved Xiao-Xu-Ming-Tang and salt mixture was used.</p><p><strong>Results: </strong>The <i>primary endpoint</i> is the incidence of moderate or severe CRBD at 30 min after surgery. The secondary endpoints are the incidence of moderate-to-severe CRBD, the Numerical Rating Scale (NRS) Pain score, the incidence of skin discomfort above the pubic symphysis, and the vital signs (the blood pressure, heart rate, and oxygen saturation), and patient satisfaction after surgery.</p><p><strong>Discussion: </strong>The aim of this trial was to evaluate the effect and safety of a hot compress of an improved Xiao-Xu-Ming-Tang powder and salt mixture for moderate and severe CRBD. These findings may provide a basis for the prevention of CRBD in clinical practice.</p><p><strong>Clinical trial registration: </strong>http://itmctr.ccebtcm.org.cn/, Identifier: ITMCTR2025000321.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1799106"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The post-pandemic transformation in Pathophysiology teaching strategies.","authors":"Huiling Lu, Xin Li, Lingli Zhang, Min Xin, Qiuhui Wu, Zhen Wu, Huimin Peng, Jian Chen, Ningxia Zhu","doi":"10.3389/fmed.2026.1738205","DOIUrl":"https://doi.org/10.3389/fmed.2026.1738205","url":null,"abstract":"<p><p>The pandemic has fundamentally altered the way that medical students acquire knowledge, making blended learning the predominant student-centered teaching model. This approach has demonstrated positive effects on developing key competencies in clinical medical students. Furthermore, research indicates that case-based learning (CBL) and integrated teaching are beneficial attempts to achieve the above educational goals. In this study, students from the grades of 2020 and 2021 were provided with Massive Open Online Course (MOOC) resources. A blended learning approach combining CBL with cross-chapter integration in Pathophysiology was implemented to construct an effective post-pandemic teaching model, with the aim of enhancing the comprehensive abilities of medical students. Results showed that this case-based, integrated blended teaching model led to an increase in final exam scores, particularly in the proportion of high-scoring students across both cohorts. A significant score improvement was also observed in integrated module assessments. Survey results revealed that most students agreed the new model enhanced their self-directed learning, motivation, and classroom engagement, supporting personalized learning and knowledge integration. Consequently, this model may serve as a valuable template for post-pandemic course design in local medical universities.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1738205"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between pulse pressure levels and mortality in patients with septic shock: a retrospective cohort study.","authors":"Yu Ji, Lisha Huang, Chang Cao, Wenyan Xiao, Tianfeng Hua, Min Yang","doi":"10.3389/fmed.2026.1770215","DOIUrl":"https://doi.org/10.3389/fmed.2026.1770215","url":null,"abstract":"<p><strong>Objective: </strong>Research on the impact of Pulse Pressure (PP) levels on Septic Shock patient prognosis is relatively limited. This study aims to analyze data from septic shock patients to investigate the prognostic effects of maintaining different PP levels during the early resuscitation phase.</p><p><strong>Methods: </strong>Data were extracted from the MIMIC-IV 3.1 database and septic shock patients meeting inclusion and exclusion criteria were collected from the Second Department of Critical Care Medicine at the Second Affiliated Hospital of Anhui Medical University. Patient information was gathered, and the average PP over the first 24 h in the ICU (PP₂₄ _<i>h</i> ) was calculated. The optimal PP cutoff points were determined using X-tile software, and patients were divided into three groups based on PP₂₄ _<i>h</i> . Propensity score matching (PSM) was applied to adjust for confounding factors, and results outcomes were compared across groups. Subgroup analyses explored variations in results among different populations, and multivariate logistic regression further assessed the relationship between PP and outcomes. Finally, local data were used for generalizability assessment of the primary findings on 28-day mortality.</p><p><strong>Results: </strong>PP_24h maintained within 40-70 mmHg exhibited significantly higher survival rates. Subgroup analysis suggested that age significantly influenced the PP-mortality relationship: among elderly patients (>65 years), PP_24h > 70 mmHg was associated with the highest mortality risk, whereas in younger patients (≤65 years), PP_24h < 40 mmHg posed the greatest risk. Univariate and multivariate logistic regression confirmed that PP_24h > 70 mmHg or < 40 mmHg were independent risk factors for 28-day mortality in septic shock patients.</p><p><strong>Conclusion: </strong>In our study, maintaining PP levels between 40 and 70 mmHg during early resuscitation was associated with significantly lower 28-day mortality in septic shock patients. Our exploratory findings suggest that hemodynamic management strategies might need to consider patient age. Future studies are needed to investigate whether targeting an upper PP limit in elderly patients or avoiding low PP in younger patients could improve outcomes.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1770215"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}