Journal of critical care最新文献

{"title":"What every intensivist should know about exertional heat stroke","authors":"Niccolò Stomeo ,&nbsp;Laura Leuci ,&nbsp;Paolo Emilio Adami ,&nbsp;Maurizio Cecconi ,&nbsp;Luca Carenzo","doi":"10.1016/j.jcrc.2025.155134","DOIUrl":"10.1016/j.jcrc.2025.155134","url":null,"abstract":"<div><div>Exertional heat stroke (EHS) is a life-threatening condition caused by strenuous physical activity, leading to severe hyperthermia and central nervous system dysfunction. Unlike classic heat stroke, EHS can occur in young, healthy individuals and in temperate climates, when heat production exceeds the body's ability to dissipate heat. Rising global temperatures and increased participation in endurance events are contributing to a growing incidence of EHS. Early recognition and rapid cooling are essential to prevent multi-organ failure and death. Whole-body cold-water immersion is the gold standard treatment, and the principle of “cool first, transport second” is key to improving survival. In-hospital care focuses on continued cooling when necessary and managing complications such as acute kidney injury, coagulopathy, liver dysfunction, and neurological impairment. This review provides intensivists with practical guidance on the pathophysiology, diagnosis, and management of EHS. Given their expertise in critical illness and involvement in prehospital and emergency care, intensivists play a pivotal role in early intervention and reducing morbidity and mortality. As EHS incidence rises, increased awareness and preparedness are essential to ensure timely, effective treatment and improve patient outcomes.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155134"},"PeriodicalIF":3.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-extubation polyuria: characterization of an underrecognized phenomenon in a proof-of-concept study.","authors":"Mateo Orgoroso ,&nbsp;Federico Verga ,&nbsp;Martín Angulo","doi":"10.1016/j.jcrc.2025.155131","DOIUrl":"10.1016/j.jcrc.2025.155131","url":null,"abstract":"<div><h3>Introduction</h3><div>The transition from invasive mechanical ventilation (MV) to unassisted breathing involves significant physiological changes for patients admitted to Intensive Care Units (ICUs). Discontinuation of MV impacts not only the respiratory system, but also affects hemodynamics and fluid balance. We aimed to assess whether urine output changes following extubation.</div></div><div><h3>Methods</h3><div>A prospective study was conducted at CASMU Medical Center (Uruguay). We included adult patients who required invasive MV for 1 to 15 days in the ICU and were subsequently extubated and placed on conventional oxygen therapy. Urine output was documented for the 48 h before and after extubation.</div></div><div><h3>Results</h3><div>The study included 60 patients, with a median age of 58 (32–70) years, that received invasive MV for 3 (2–4) days. Following extubation, diuresis increased from 2.1 (1.4–3.1) L/day to 3.2 (2.3–4.6) L/day (<em>P</em> &lt; 0.001). Polyuria (diuresis &gt;3 L in 24 h) was present in 16 (27 %) patients during MV, compared to 34 (57 %) patients after extubation (<em>P</em> &lt; 0.001). Urine output (relative to pre-extubation values) persisted significantly elevated for up to 30 h after discontinuation of MV. The increase in diuresis following extubation was correlated with the level of positive end-expiratory pressure administered during MV (r_s = 0.368; <em>P</em> = 0.004). Increased diuresis was not associated with hemodynamic or renal function impairment.</div></div><div><h3>Conclusion</h3><div>Discontinuation of MV was associated with a significant increase in urine output. This observed post-extubation polyuria may represent a physiological response to changes in intrathoracic pressure and fluid redistribution, and warrants further research to explore underlying mechanisms.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155131"},"PeriodicalIF":3.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does inspiratory muscle training affect expiratory muscle thickness in respiratory intensive care patients? A pilot randomized controlled study","authors":"Reyhan Kaygusuz Benli ,&nbsp;Barış Yılmaz ,&nbsp;S. Ufuk Yurdalan ,&nbsp;Nalan Adıgüzel","doi":"10.1016/j.jcrc.2025.155125","DOIUrl":"10.1016/j.jcrc.2025.155125","url":null,"abstract":"<div><h3>Background</h3><div>This randomized controlled trial aimed to compare abdominal muscle thickness between intensive care patients and healthy controls, and to evaluate the impact of IMT on expiratory muscle thickness using ultrasound.</div></div><div><h3>Methods</h3><div>In this single-blind randomized controlled trial, 20 post-extubation intensive care patients were randomly assigned to either an a conventional physiotherapy (CP) group or IMT + CP group. Both interventions were applied for five days. An additional 10 healthy individuals served as controls for comparison. Abdominal muscle thicknesses—including external oblique (EOA), internal oblique (IOA), transversus abdominis (TRA), and rectus abdominis (RA)—were measured using ultrasound. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were also recorded.</div></div><div><h3>Results</h3><div>At baseline, healthy controls had significantly higher MIP, MIP% predicted, MEP, MEP% predicted, and RA muscle thickness compared to both patient groups (<em>p</em> &lt; 0.05). Following intervention, both IMT and CP groups showed significant improvements in MIP (p &lt; 0.05), but only the IMT group demonstrated significant increases in MEP, MEP% predicted, IOA, and RA muscle thickness (<em>p</em> &lt; 0.05). The IMT group showed significantly greater improvements in MIP, MEP, IOA, and RA muscle thickness compared to the CP group (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Post-extubation IMT may improve not only inspiratory but also expiratory muscle strength and abdominal wall thickness. These findings suggest that IMT could support weaning processes in intensive care, although larger studies are needed.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155125"},"PeriodicalIF":3.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stratifying risk in ACLF-3 patients: The impact of circulatory and respiratory failure on one-year post-transplant outcomes","authors":"Hannah Wozniak ,&nbsp;Xun Zhao ,&nbsp;Shiyi Chen ,&nbsp;Margaret S. Herridge ,&nbsp;Mamatha Bhat","doi":"10.1016/j.jcrc.2025.155129","DOIUrl":"10.1016/j.jcrc.2025.155129","url":null,"abstract":"<div><h3>Background</h3><div>In patients with Acute-on-Chronic Liver Failure grade 3 (ACLF-3), the number of organ failures (OF) before liver transplant (LT) is associated with poorer outcomes following LT. We hypothesized that ACLF-3 patients with circulatory and/or respiratory failure before LT would experience worse prognosis after LT.</div></div><div><h3>Methods</h3><div>We analyzed ACLF-3 patients from the U.S. Scientific Registry of Transplant Recipients, categorized by OF combinations at the time of LT: 1) circulatory failure with other non-respiratory OF, 2) both circulatory and respiratory failures with other OF, 3) all other OF combinations excluding (1) and (2). Cox regression models assessed one-year mortality, and logistic regression examined one-year functional status.</div></div><div><h3>Results</h3><div>Of 5054 ACLF-3 patients, 14 %(728/5054) died within one-year post-LT. The distribution was: 427 patients had circulatory failure with other OF, 1042 had circulatory and respiratory failure with other OF, and 3357 had all other possible combinations of OFs. Patients with both circulatory and respiratory failures experienced higher post-LT mortality than those with circulatory failure plus other OF (one-year Hazard Ratio (HR) for death: 1.32, 95 %CI: 1.08–1.62, <em>p</em> &lt; 0.01). No differences were found between those with circulatory failure plus other OF and those with OF other than circulatory or respiratory. Patients with OF other than circulatory and respiratory failures had better one-year functional status compared to those with circulatory OF (OR for poor functional status: 0.73, 95 %CI: 0.54–0.98, <em>p</em> &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Specific OF combinations affect post-LT outcomes in ACLF-3 patients. Combined respiratory and circulatory failure at LT time was associated with poorer outcomes, regardless of the number of OF.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155129"},"PeriodicalIF":3.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the influence of communication and team dynamics relating to infection care on intensive care unit patient discussions: Insights from sociograms and team reflexivity","authors":"C. Bonaconsa ,&nbsp;E. Charani ,&nbsp;D. Van den Bergh ,&nbsp;I. Joubert ,&nbsp;M. Mendelson","doi":"10.1016/j.jcrc.2025.155127","DOIUrl":"10.1016/j.jcrc.2025.155127","url":null,"abstract":"<div><div>Background/Introduction: Multidisciplinary Team (MDT) collaboration in intensive care units (ICU) is complex, necessitating structured communication approaches to optimise discussions, including on infection care. Achieving consistency across teams remains a challenge. This study explores how team dynamics and communication influence patient discussions during ICU ward rounds, using sociograms. Method: Observations of ward rounds were conducted in two ICUs at a tertiary hospital in South Africa. Field notes detailed contextual descriptions, team interactions, and activities. Sociograms mapped and quantified communication episodes and team dynamics. Reflexive feedback promoted team self-assessment on communication practices. Data were thematically analysed, complemented by descriptive statistics. Results: Fifty-four hours of observations, covering 273 patient discussions, generated 38 sociograms and documented 1900 communication episodes. Consultants (43 %,821/1900) and registrars (44 %,835/1900) led discussions, with registrars providing structured updates, including on infection care. Infection care constituted nearly one-third of discussions, however input from nurses, pharmacists, and microbiologists was notably limited despite their active roles in infection-related care. Clear, direct communication correlated with task documentation, while unclear communication led 77 % of tasks undocumented. Infection-related actions were clearly communicated in 93 % of cases. Positioning, side discussions, and interruptions affected communication clarity and focus. The process and reflexivity shifted the view of ward rounds, reframing them as adaptable tools for improving patient care. Discussion: Mapping and quantifying interactions shows the distribution of power and influences in patient discussions. Sociograms and reflexive practices aid self-assessment of interactions to improve team dynamics. Structured communication strategies that include key players, can enhance dynamics, infection care and patient outcomes.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155127"},"PeriodicalIF":3.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of SeptiCyte RAPID in critically ill patients with occlusive acute mesenteric ischemia: a pilot study","authors":"Emmanuel Novy ,&nbsp;Denis Cesarini ,&nbsp;Amandine Luc ,&nbsp;Maïa Simon ,&nbsp;Philippe Guerci ,&nbsp;on behalf of the SPASM study group","doi":"10.1016/j.jcrc.2025.155128","DOIUrl":"10.1016/j.jcrc.2025.155128","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155128"},"PeriodicalIF":3.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term mortality after stage 1 acute kidney injury in critically ill patients - an observational cohort study","authors":"Carmen A. Pfortmueller ,&nbsp;Markus Hahn ,&nbsp;Angela Eggimann ,&nbsp;Niklas Rodemund ,&nbsp;Andreas Kokoefer ,&nbsp;Gregor Lindner ,&nbsp;Joerg C. Schefold ,&nbsp;Jan Waskowski","doi":"10.1016/j.jcrc.2025.155130","DOIUrl":"10.1016/j.jcrc.2025.155130","url":null,"abstract":"<div><h3>Background</h3><div>Acute Kidney Injury (AKI) is prevalent in intensive care units (ICU) and is linked with increased mortality. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines define AKI using serum creatinine and urinary output criteria. While moderate and severe AKI according the creatinine criterion correlate with increased mortality, the significance of stage 1 AKI remains debated.</div></div><div><h3>Methods</h3><div>Retrospective cohort analysis from two tertiary care centres in Switzerland and Austria (2013−2021) to investigate the association between stage 1 AKI (KDIGO creatinine criterion) in the first seven days after ICU admission and one-year mortality in adult ICU patients. Data were extracted using standardized protocols. Baseline creatinine was determined using estimation formulas. We applied multivariable regression models adjusted for key confounders and conducted sensitivity analyses.</div></div><div><h3>Results</h3><div>Of 42,446 patients, 4667 (11 %) developed stage 1 AKI, 13 % (<em>n</em> = 5449) moderate/ severe AKI and 32,330 patients no AKI (76 %). Stage 1 AKI associates with one-year mortality (OR 1.6 [95 %CI 1.48; 1.73], <em>p</em> &lt; 0.001) and increases length of stay in ICU (β 1.4 [95 %CI 1.2; 1.5], p &lt; 0.001) and hospital (β 2.7 [95 %CI 2.1; 3.2], p &lt; 0.001). In subgroup-analyses, we observed similar associations in patients with surgery (OR 1.66 [95 %CI 1.45;1.89], p &lt; 0.001) and without surgery (OR 1.61 [95 %CI 1.46;1.78], p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Stage 1 AKI is associated with 1-year mortality in adult ICU patients even in steps below 26.5 μmol/L. This highlights the prognostic significance of subclinical renal injury and underlines the need for increased efforts to diagnose AKI in its full spectrum. The analysis is limited by basing the AKI diagnosis on creatinine criterion.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155130"},"PeriodicalIF":3.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a machine learning model for real-time prediction of invasive mechanical ventilation weaning readiness","authors":"Simone Zappalà ,&nbsp;Vittorio Scaravilli ,&nbsp;Lucrezia Rovati ,&nbsp;Marco Bosone ,&nbsp;Francesca Alfieri ,&nbsp;Andrea Ancona ,&nbsp;Giacomo Grasselli","doi":"10.1016/j.jcrc.2025.155105","DOIUrl":"10.1016/j.jcrc.2025.155105","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop and validate a bedside machine learning (ML) decision support tool for prediction of invasive mechanical ventilation (IMV) weaning readiness.</div></div><div><h3>Methods</h3><div>Adults admitted after 2010 who underwent IMV (&gt;24 h) were included from MIMIC-IV (development and internal validation) and AmsterdamUMCdb (external validation) databases. XGBoost boosted trees approach was used to develop three models predicting IMV weaning readiness within 24, 48, and 72 h by integrating electronic health record data. The areas under Receiver Operating Characteristic (auROC), the Precision-Recall curve (auPR) curves, and performance metrics were assessed. Sensitivity analyses evaluated the impact of gender, ethnicity, age and admission reason on model performance.</div></div><div><h3>Results</h3><div>8565 patients from MIMIC-IV and 2626 from AmsterdamUMCdb were included. In the external validation cohort, the 24-, 48-, and 72-h models had auROCs of 0.847, 0.795 and 0.789, and auPR of 54.17, 54.56 and 59.4, respectively. Sensitivity was &gt;0.75 for all models, but specificity decreased from 0.79 to 0.63 between the 24-h and 72-h models. Lower performances were observed for older (&gt; 60 years) and neurosurgical patients.</div></div><div><h3>Conclusions</h3><div>This study presents three ML models for real-time prediction of IMV weaning readiness, offering a promising approach to enhance clinical decision-making and optimize patient care.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155105"},"PeriodicalIF":3.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144137904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term mortality in ICU patients with hematological malignancies: Impact of organ support duration and ICU length of stay","authors":"Martijn Otten ,&nbsp;Bob J.H. van Kempen ,&nbsp;Brittney van der Woude ,&nbsp;Tariq A. Dam ,&nbsp;Rolf K. Gigengack ,&nbsp;Marcella C.A. Müller ,&nbsp;Armand R.J. Girbes ,&nbsp;Bart J. Biemond ,&nbsp;Harm-Jan de Grooth ,&nbsp;Paul W.G. Elbers","doi":"10.1016/j.jcrc.2025.155122","DOIUrl":"10.1016/j.jcrc.2025.155122","url":null,"abstract":"<div><h3>Background</h3><div>Patients with hematological malignancies face unique challenges due to immunosuppression and treatment-related complications. This study aims to evaluate long-term survival probabilities for ICU patients with hematological malignancy as a function of length of stay in the ICU and organ support duration, compared to non-hematological ICU patients.</div></div><div><h3>Methods</h3><div>In this retrospective multicenter cohort study, patients with hematological malignancies were matched with four controls based on APACHE IV scores and year of admission. Mortality at 1 year following ICU admission was assessed using landmark analyses, stratified by length-of-stay and organ support duration.</div></div><div><h3>Results</h3><div>A total of 2.775 admissions were included (555 hematological malignancy and 2.220 matched controls). One-year mortality for patients with hematological malignancy (matched controls) with ICU length of stay of at least 1, 7 and 14 days was 64 % (43 %), 72 % (42 %), and 74 % (34 %). For those receiving 1, 7 and 14 days of renal replacement therapy 1-year mortality was 79 % (60 %), 79 % (52 %), and 85 % (55 %). For those receiving blood transfusion for 1, 7 and 14 days 1-year mortality was 74 % (47 %), 81 % (51 %), and 86 % (50 %). For those receiving triple organ support for 1,7 and 14 days 1-year mortality was 84 % (54 %), 84 % (51 %), and 94 % (56 %).</div></div><div><h3>Conclusions</h3><div>One-year mortality among patients with hematological malignancy compared to matched controls was higher at the first day of admission and stayed higher for patients who remained in the ICU. The observed one-year mortality seemed to increase with initiation of prolonged renal replacement therapy, blood transfusion and combination of at least 3 organs supported, but not for the other forms of organ support.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155122"},"PeriodicalIF":3.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors associated with acute kidney injury in patients with traumatic brain injury: A systematic review and meta-analysis","authors":"Yiwen Zhang ,&nbsp;Haiqing Diao ,&nbsp;Jiali Ding ,&nbsp;Guangyu Lu ,&nbsp;Shujie Jiang ,&nbsp;Yang Zhang ,&nbsp;Qianxin Wei ,&nbsp;Zhiyao Wang ,&nbsp;Hailong Yu ,&nbsp;Jun Shao ,&nbsp;Yuping Li","doi":"10.1016/j.jcrc.2025.155126","DOIUrl":"10.1016/j.jcrc.2025.155126","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic review and meta-analysis aimed to identify and quantify the risk factors associated with acute kidney injury (AKI) in patients with traumatic brain injury (TBI).</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Web of Science were systematically searched for articles published up to October 2024. Observational studies published in English that reported on risk factors for AKI in TBI patients were included. Data on AKI incidence and risk factors were extracted. A meta-analysis was conducted using a random-effects model when heterogeneity <em>I</em>² &gt; 50 % and a fixed-effects model when <em>I</em>² &lt; 50 %. Risk of bias for studies was assessed using the Newcastle-Ottawa Scale (NOS). Certainty of evidence was evaluated using the GRADE approach.</div></div><div><h3>Results</h3><div>Twenty studies involving 13,115 TBI patients were included in the meta-analysis. The pooled incidence of AKI after TBI was 19 % (95 % CI 16–23). Male gender (odds ratio (OR) 1.43, 95 % CI 1.21–1.70; <em>I</em>² 0 %), diabetes (OR 3.59, 95 % CI 1.74–7.42; <em>I</em>² 0 %), Glasgow Coma Scale (GCS) (mean difference (MD) -0.48, 95 % CI -0.74,-0.23; <em>I</em>² 38 %), GCS ≤ 8 at admission (OR 1.56, 95 % CI 1.28–1.90; <em>I</em>² 0 %), Simplified Acute Physiology Score II (SAPS II) score (MD 4.65, 2.69–6.61; <em>I</em>² 56 %), serum creatinine level at admission (MD 18.17, 95 % CI 1.82–34.51; <em>I</em>² 93 %), hemoglobin (MD -6.82, 95 % CI -12.72, −0.92; <em>I</em>² 79 %), glucose (MD 1.42, 95 % CI 0.64–2.20; <em>I</em>² 0 %), the use of mannitol (OR 2.14, 95 % CI 1.08–4.25; <em>I</em>² 74 %), vancomycin (OR 1.75, 95 % CI 1.35–2.27; <em>I</em>² 0 %) and red blood cell transfusion (OR 3.35, 95 % CI 1.86–6.04; <em>I</em>² 59 %) increased the risk for AKI.</div></div><div><h3>Conclusion</h3><div>These findings highlighted the critical need for proactive surveillance of these risk factors in clinical practice, enabling the development of prediction models to identify TBI patients at high risk of AKI.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"89 ","pages":"Article 155126"},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}