Journal of Intensive Care最新文献

{"title":"A pilot multicenter randomized controlled trial on individualized blood pressure targets versus standard care among critically ill patients with shock.","authors":"Rakshit Panwar, Bairbre McNicholas, Ciprian Nita, Alison Gibberd, Amber-Louise Poulter, Marcia Tauares, Lauren Ferguson","doi":"10.1186/s40560-025-00798-8","DOIUrl":"https://doi.org/10.1186/s40560-025-00798-8","url":null,"abstract":"<p><strong>Background: </strong>Minimizing relative hypotension, or mean arterial pressure (MAP) deficit, by targeting patients' own pre-illness MAP (individualized MAP) during vasopressor therapy is a potential strategy to improve outcomes among ICU patients with shock. We conducted a prospective, open label, parallel-group, pilot RCT to assess feasibility and safety of this intervention compared to standard care.</p><p><strong>Methods: </strong>Thirty-seven eligible patients, aged 40 years or older and receiving vasopressor support for shock, were randomly allocated to individualized MAP target (N = 17) or standard MAP target (N = 20) at two multidisciplinary ICUs in Australia and Ireland. Pre-specified endpoints were time-weighted average MAP-deficit (i.e., percentage difference between patients' pre-illness MAP and achieved-MAP), percentage time spent with > 20% MAP-deficit, major adverse kidney events (MAKE-14), 14-day and 90-day all-cause mortality, and cardiovascular adverse events within 28 days of randomization. All comparisons of efficacy outcomes were exploratory.</p><p><strong>Results: </strong>The median MAP-deficit and percentage time with > 20% MAP-deficit with individualized MAP vs. standard MAP were 7% [interquartile range: 2-16] vs. 18% [9-23] (p = 0.048), and 8% [0-43] vs. 53% [14-75] (p = 0.03), respectively. MAKE-14 (2/17 (12%) vs. 4/20 (20%), p = 0.67), 14-day mortality (1/17 (6%) vs. 3/20 (15%), p = 0.61), 90-day mortality (2/17 (12%) vs. 4/20 (20%), p = 0.67) and cardiovascular adverse events were similar for both groups.</p><p><strong>Conclusions: </strong>This pilot RCT demonstrated that an individualized MAP target strategy was feasible to implement. No adverse safety signals were evident. These data and study procedures helped inform the design of a definitive RCT on the question of individualized MAP targets among critically ill patients with shock.</p><p><strong>Study registration: </strong>ACTRN12618000571279.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"29"},"PeriodicalIF":3.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: One-year outcomes in sepsis: a prospective multicenter cohort study in Japan.","authors":"Keibun Liu, Shinichi Watanabe, Kensuke Nakamura, Hidehiko Nakano, Maiko Motoki, Hiroshi Kamijo, Matsuoka Ayaka, Kenzo Ishii, Yasunari Morita, Takashi Hongo, Nobutake Shimojo, Yukiko Tanaka, Manabu Hanazawa, Tomohiro Hamagami, Kenji Oike, Daisuke Kasugai, Yutaka Sakuda, Yuhei Irie, Masakazu Nitta, Kazuki Akieda, Daigo Shimakura, Hajime Katsukawa, Toru Kotani, David McWilliams, Peter Nydahl, Stefan J Schaller, Takayuki Ogura","doi":"10.1186/s40560-025-00799-7","DOIUrl":"10.1186/s40560-025-00799-7","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"28"},"PeriodicalIF":3.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laxative use and 28-day mortality in critically ill sepsis patients: a retrospective cohort study using MIMIC-IV (v3.1).","authors":"Yan Liang, Feiyi Xu, Hao Zhang, Jiang Li, Wei Chen, Qilin Yang, Cheng Lin, Xiaomin Dong","doi":"10.1186/s40560-025-00797-9","DOIUrl":"10.1186/s40560-025-00797-9","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates the impact of four laxatives-Senna, Docusate Sodium, Polyethylene Glycol, and Lactulose on 28-day mortality, ICU-free days, ventilator-free days, bowel recovery, and Clostridium difficile (C-diff) infection in critically ill sepsis patients to identify optimal bowel management strategies for improving survival and recovery.</p><p><strong>Methods: </strong>Using the MIMIC-IV database (v3.1), we analyzed 7163 ICU sepsis patients (median age: 67.5 years; 63% male), assessing 28-day mortality, ICU-free days, vasopressor-free days, ventilator-free days, bowel sound recovery, and C-diff incidence, with propensity score matching and multivariable adjustments for confounders, alongside subgroup analyses by sex, age, Charlson Comorbidity Index, and Sequential Organ Failure Assessment score.</p><p><strong>Results: </strong>Docusate Sodium was associated with significantly lower 28-day mortality (adjusted HR: 0.43; 95% CI 0.36-0.52), more ICU-free days, and better bowel recovery compared to Senna, while Lactulose was linked to higher mortality (adjusted HR: 1.82; 95% CI 1.45-2.27), fewer ICU-free days, and increased C. difficile risk, with subgroup analyses confirming these trends across sex, age, and comorbidity strata.</p><p><strong>Conclusion: </strong>Docusate sodium appears to be a safer and more effective bowel management option for critically ill patients with sepsis. In contrast, the association between lactulose use and adverse outcomes may primarily reflect the severity of underlying liver disease rather than a direct drug effect. These findings underscore the importance of individualized laxative selection based on patients' clinical context in critical care practice.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"27"},"PeriodicalIF":3.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal proteomic analysis of pathophysiology in plasma and bronchoalveolar lavage fluid of patients with ARDS.","authors":"Yumi Mitsuyama, Hisatake Matsumoto, Fuminori Sugihara, Satoshi Fujimi, Hiroshi Ogura, Jun Oda","doi":"10.1186/s40560-025-00793-z","DOIUrl":"10.1186/s40560-025-00793-z","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory distress syndrome (ARDS) remains a significant clinical challenge, and its pathogenesis is not fully understood. Proteomic analyses of plasma and bronchoalveolar lavage fluid (BALF) in patients with ARDS have been performed to uncover diagnostic and prognostic markers, although previous studies have not adequately focused on longitudinal comparison of biomarkers. This study aimed to elucidate the proteomic profiles of patients with ARDS in the acute and subacute phases to better understand the pathophysiological progression of ARDS.</p><p><strong>Methods: </strong>This was a single-center, prospective, observational study of adult patients with ARDS in whom plasma and BALF samples were collected in the acute and subacute phases of ARDS and comprehensive proteins were identified and analyzed by mass spectrometry.</p><p><strong>Results: </strong>Plasma and BALF were collected from 21 ARDS patients and plasma from 24 healthy donors, from which 694 plasma proteins and 2017 BALF proteins were analyzed. Processes related to coagulation and complement commonly activated in plasma and BALF were more pronounced in the acute phase than in the subacute phase. In BALF in the acute phase, pathways related to humoral and immune responses were activated, whereas processes related to chaperones and protein folding were suppressed. IPA analysis showed that B cell receptor signaling was most activated, whereas heat shock protein 90 (HSP90) chaperone cycle, protein folding, and other pathways associated with cellular stress responses and proper protein processing were suppressed. The most activated upstream regulator was interferon gamma (IFN-γ) and the most suppressed was notch receptor 1 (NOTCH1).</p><p><strong>Conclusions: </strong>The proteomics of plasma and BALF from patients with ARDS were compared in both the acute and subacute phases. In BALF in the acute phase, humoral immunity, mainly B-cell receptor signaling, was activated, whereas the HSP90 cycle and protein folding mechanisms were inactivated.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"26"},"PeriodicalIF":3.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute pulmonary edema after subarachnoid hemorrhage: risk factors and comorbidities-an analysis of a nationwide database from the United States.","authors":"Alejandro Pando, Anil Kumar Tenneli, T Pradeep, Priyanka Augustine, Balamurali Krishna, Jeffrey Pradeep Raj","doi":"10.1186/s40560-025-00796-w","DOIUrl":"10.1186/s40560-025-00796-w","url":null,"abstract":"<p><strong>Background: </strong>Acute pulmonary edema (APE) is a rare complication of subarachnoid hemorrhage (SAH) that is associated with increased morbidity and poor clinical outcomes. There is limited literature addressing the incidence and risk factors of this complication, highlighting the need for further investigation as undertaken in the present study.</p><p><strong>Methods: </strong>The 2016 to 2021 National Inpatient Sample (NIS) was used to identify adult inpatients with a primary diagnosis of non-traumatic SAH. Univariate and multivariable analyses adjusting for patient demographics, and comorbidity status, were used to characterize statistical associations with APE.</p><p><strong>Results: </strong>A total of 42,141 patients were identified as having SAH from 2016 to 2021. Of these patients, 960 patients (2.3%) were found to have APE. APE was associated with increased length of stay (20.0 ± 18.9 days vs. 11.6 ± 14.3, p < 0.001), increased total costs ($503,671.3 ± 647,729.9 vs. $238,724.6 ± 328,062.1, p < 0.001), increased number of days from admission to first procedure (3.5 ± 7.3 vs. 1.9 ± 4.9, p < 0.001), increased Elixhauser comorbidity index ≥ 3 (77.5% vs. 66.0%, p < 0.001), and increased mortality (40.2% vs. 22.5%, p < 0.001). After controlling for confounding factors, independent risk factors for APE in patients with non-traumatic SAH included: Coagulopathies (adjusted Odds Ratio [aOR]: 1.57, 95% confidence interval [CI] 1.31-1.89, p < 0.001), Fluid and Electrolyte Disorders (aOR: 2.54, CI 2.13-3.03, p < 0.001), Liver Disease (aOR: 1.37, CI 1.07-1.76, p = 0.013), Obesity (aOR: 1.47, CI 1.19-1.81, p = 0.003), Pulmonary Circulatory Disorder (aOR: 1.72, CI 1.31-2.26, p = 0.001), and Weight Loss (aOR: 1.67, CI 1.36-2.04, p < 0.001).</p><p><strong>Conclusion: </strong>APE after SAH is associated with increased complicated hospital course. Neurosurgeons and Neurocritical care medical professionals should be aware of the comorbidities and factors associated with increased APE after SAH to improve patient outcomes.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"25"},"PeriodicalIF":3.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of prolonged prone positioning on response and prognosis in patients with acute respiratory distress syndrome: a retrospective cohort study.","authors":"Yuhang Yan, Junying Bao, Shumin Cai, Xiangning Zhong, Bingxuan Geng, Jingyi Liang, Zhiya Deng, Zhongqing Chen, Zaisheng Qin, HongBin Hu, Zhenhua Zeng","doi":"10.1186/s40560-025-00795-x","DOIUrl":"https://doi.org/10.1186/s40560-025-00795-x","url":null,"abstract":"<p><strong>Background: </strong>Prone positioning improves outcomes in patients with acute respiratory distress syndrome (ARDS), but the optimal duration in critical care settings remains uncertain. This study aims to evaluate the investigates the impact of prone ventilation duration on clinical outcomes.</p><p><strong>Methods: </strong>This retrospective study was conducted on ARDS patients admitted to the intensive care unit (ICU), Nanfang hospital of Southern Medical University, who received prone positioning. Patients were categorized into two groups: the prolonged prone positioning (PPP) (≥ 16 h) group and the standard prone positioning (SPP) (< 16 h) group. Propensity score matching (PSM) was employed to balance baseline characteristics. Cox proportional hazards, regression models were utilized to evaluate the association between the prone duration and clinical outcomes. Kaplan-Meier survival curves were generated to compare 28-day mortality, with log-rank tests analyzing differences. Restricted cubic spline (RCS) were applied to investigate the time-response between prone duration, PaCO₂, PaO₂, positive end-expiratory pressure, response rate, and 28-day mortality. In addition, the incidence of prone position-related complications was assessed in both groups.</p><p><strong>Results: </strong>A total of 234 patients with ARDS were included, with an overall 28-day mortality of 49.1% (115/234). After PSM, 81 matched pairs were compared. The PPP group had lower 28-day mortality (46.9% vs. 53.1%; hazard ratios (HR): 0.53; 95% CI 0.32-0.85; P = 0.033) and improved prone positioning response rate [70.5% vs. 60.5%; odds ratio (OR): 1.46; 95% CI 1.23-1.89; P = 0.025]. RCS analysis suggested a reduction in mortality with prone durations ≥ 16 h, and longer durations correlated with better prone response. However, no significant association was found between PPP and reduced ICU or hospital length of stay. RCS analysis indicated a gradual decrease in 28-day mortality with increasing duration of prone positioning, and longer duration were associated with a higher likelihood of a prone response. There were no significant differences in prone ventilation-related complications between the two groups.</p><p><strong>Conclusions: </strong>PPP (≥ 16 h) is associated with reduced 28-day mortality and improved response rates in ICU patients with ARDS, without increasing complication risks. Prospective studies are needed to further validate these results.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"24"},"PeriodicalIF":3.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-year outcomes in sepsis: a prospective multicenter cohort study in Japan.","authors":"Keibun Liu, Shinichi Watanabe, Kensuke Nakamura, Hidehiko Nakano, Maiko Motoki, Hiroshi Kamijo, Matsuoka Ayaka, Kenzo Ishii, Yasunari Morita, Takashi Hongo, Nobutake Shimojo, Yukiko Tanaka, Manabu Hanazawa, Tomohiro Hamagami, Kenji Oike, Daisuke Kasugai, Yutaka Sakuda, Yuhei Irie, Masakazu Nitta, Kazuki Akieda, Daigo Shimakura, Hajime Katsukawa, Toru Kotani, David McWilliams, Peter Nydahl, Stefan J Schaller, Takayuki Ogura","doi":"10.1186/s40560-025-00792-0","DOIUrl":"10.1186/s40560-025-00792-0","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a leading cause of death in intensive care units (ICU). Sepsis survivors are often left with significant morbidity, termed post-intensive care syndrome (PICS), impacting post-sepsis life. The aim was to present detailed data on the prognostic and functional long-term outcomes of ICU patients with sepsis in Japan, which is currently lacking and therefore prevents development of targeted solutions.</p><p><strong>Methods: </strong>A multicenter prospective study, involving 21 ICUs in 20 tertiary hospitals in Japan, included all consecutive adult ICU patients between November 2020 and April 2022, and diagnosed with sepsis at ICU admission (Sepsis 3). Follow-ups were performed at 3, 6, and 12 months after hospital discharge by telephone and mail. Primary outcome was death or incidence of PICS, defined by any of physical dysfunction (Barthel Index ≤ 90), cognitive dysfunction (Short Memory Questionnaire < 40), or mental disorder (any subscales for anxiety or depression of Hospital Anxiety and Depression Scale ≥ 8, or Impact of Event Scale-Revised ≥ 25). Secondary outcomes included Quality of Life (QOL), employment, and use of hospital, emergency, rehabilitation, and psychiatric services. A multivariable analysis investigated independent factors associated with each dysfunction at each follow-up.</p><p><strong>Results: </strong>A total of 339 patients were included (median age 74 [67-82] years, 60% male, 77% septic shock, and a median SOFA of 9 [6-12]). Mortality was 23% at hospital discharge, increasing to 37% at 12 months. The rate of death for those who met PICS Criteria at hospital discharge was 89%, with a death or PICS incidence of 73%, 64%, and 65% at 3, 6, and 12 months, respectively. Limited improvements in QOL and return to work (44%), high rates of hospital readmissions (40%), frequent emergency service usage (31%), and low utilization of rehabilitation and psychiatric services (15% and 7%) were identified over the first year. The incidence of any PICS-related dysfunction was consistently an independent factor for the incidence of the same dysfunction at the following follow-ups.</p><p><strong>Conclusions: </strong>This multicenter study identified the distinct realities of post-sepsis life in Japanese ICU patients, highlighting the unique challenges in improving their functions and returning to daily life. Trial Registration University Hospital Medical Information Network UMIN000041433.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"23"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 initial intravenous fluid volume and the composite outcome of hemodialysis dependence at discharge or in-hospital mortality in inpatients with rhabdomyolysis.","authors":"Wataru Yajima, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga","doi":"10.1186/s40560-025-00788-w","DOIUrl":"https://doi.org/10.1186/s40560-025-00788-w","url":null,"abstract":"<p><strong>Background: </strong>Although experts recommend intravenous fluid (IVF) for patients with rhabdomyolysis to prevent renal injury, the optimal IVF volume remains unknown because excessive IVF may lead to organ edema, resulting in organ injury. This study aimed to investigate the association between IVF volume and the composite outcome of hemodialysis dependence or in-hospital death in patients with rhabdomyolysis.</p><p><strong>Methods: </strong>We retrospectively identified patients with rhabdomyolysis admitted to intensive care units and tertiary-care hospitals from July 2010 to March 2022 using the Japanese Diagnosis Procedure Combination database. We divided the patients into those who received at least 3500 mL/day of IVF within 3 days of admission and those who did not. This threshold was defined based on the findings of previous studies. We compared the composite outcome, including hemodialysis dependence at discharge and in-hospital death, between the groups using propensity score overlap weighting.</p><p><strong>Results: </strong>We identified 5392 eligible patients. Of those, 1677 (31.1%) received ≥ 3500 mL/day of IVF, and 3715 (68.9%) received < 3500 mL/day of IVF; the total volumes of IVF within 3 days of admission were 11,039 mL and 4054 mL, respectively. Propensity-score overlap weighting created balanced cohorts, which did not show significant difference in primary composite outcome between the groups (3.4% vs. 3.9%; risk difference [RD] - 0.4, 95% confidence interval [CI] - 1.8 to 0.9, P = 0.53). The proportion of hemodialysis dependence was lower in the IVF ≥ 3500 mL/day group than those in the < 3500 mL/day group (0.4% vs. 1.3%; RD - 0.9, 95% CI - 1.6 to - 0.2, P = 0.02).</p><p><strong>Conclusions: </strong>This retrospective database study found that IVF ≥ 3500 mL/day for patients with rhabdomyolysis was not associated with a reduction in the composite outcome but was associated with a reduction in hemodialysis dependence at discharge. The optimal IVF volume still remains unknown, and further studies are warranted.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"22"},"PeriodicalIF":3.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment effect of intravenous high-dose selenium in sepsis phenotypes: a retrospective analysis of a large multicenter randomized controlled trial.","authors":"David I Radke, Holger Bogatsch, Christoph Engel, Frank Bloos, Patrick Meybohm, Michael Bauer, Anna Lulu Homayr, Christian Stoppe, Gunnar Elke, Matthias Lindner","doi":"10.1186/s40560-025-00790-2","DOIUrl":"https://doi.org/10.1186/s40560-025-00790-2","url":null,"abstract":"<p><strong>Background: </strong>Treatment effect of high-dose intravenous selenium remains controversial in patients with sepsis or septic shock. Here, we reanalyzed data from the randomized placebo-controlled trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT) to reveal possible treatment differences according to established sepsis phenotypes.</p><p><strong>Methods: </strong>In this secondary data analysis of the SISPCT trial all 1089 patients of the original study were included. Patients were assigned to one of the four phenotypes by comparing patient variables with the Sepsis Endotyping in Emergency Care (SENECA) validation cohort. Survival analyses were performed using Kaplan-Meier and log-rank tests.</p><p><strong>Results: </strong>No robust effect of selenium on mortality and other outcome parameters could be determined in any sepsis phenotype. Phenotype frequencies were markedly different in our study cohort compared to previous reports (α: 2.2%, β: 6.3%, γ: 68.0%, δ: 23.4%). Differences in mortality between the respective phenotypes were not significant overall; however, 28-day mortality showed a lower mortality for the α- (20.8%) and β-phenotype (20.3%), followed by the γ- (27.1%), and δ-phenotype (28.5%).</p><p><strong>Conclusions: </strong>Application of the four sepsis phenotypes to the SISPCT study cohort showed discrete but non-significant mortality differences within 28 days. However, beneficial treatment effects of high-dose intravenous selenium were still not detectable after categorizing the SISPCT study cohort according to four phenotype criteria.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"21"},"PeriodicalIF":3.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 alactic base excess on mortality in sepsis patients: a retrospective observational study.","authors":"Jiahui Liu, Yang Chen, Bin Yang, Jiabao Zhao, Qiang Tong, Yuan Yuan, Ye Kang, Tianshu Ren","doi":"10.1186/s40560-025-00789-9","DOIUrl":"https://doi.org/10.1186/s40560-025-00789-9","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a life-threatening condition often associated with metabolic and acid-base imbalances. Alactic base excess (ABE) has emerged as a novel biomarker to assess metabolic disturbances in critically ill sepsis patients, but its prognostic value remains underexplored. We aimed to investigate the relationship between ABE and 30-day/90-day ICU all-cause mortality in a large sepsis cohort in the intensive care unit (ICU) setting.</p><p><strong>Methods: </strong>This study utilised data from a large US ICU sepsis cohort. ABE was calculated as the sum of lactate and base excess (BE) values from the first day of ICU admission. Patients were divided into quartiles based on ABE values. Kaplan-Meier survival analysis, Cox proportional hazards models, and restricted cubic spline analyses were used to examine the associations between ABE and mortality outcomes. The predictive performance of ABE combined with the SOFA score was assessed using the area under the curve, Net Reclassification Improvement, and Integrated Discrimination Improvement.</p><p><strong>Results: </strong>17,099 patients with sepsis were included in this analysis, with median (IQR) age of 67.82 (56.80, 78.04) years and 59.7% males. Our analysis revealed a U-shaped association between ABE and 30-day and 90-day ICU all-cause mortality. Both the lowest (Q1) and highest (Q4) quartiles of ABE were linked to increased mortality risks, with 30-day mortality showing HRs of 1.27 (95% CI 1.13-1.44) for Q1 and 1.17 (95% CI 1.06-1.31) for Q4, while 90-day mortality showed HRs of 1.28 (95% CI 1.16-1.44) for Q1, 1.12 (95% CI 1.02-1.23) for Q2, and 1.22 (95% CI 1.11-1.34) for Q4. ABE demonstrated superior predictive performance for mortality compared to BE and lactate. Incorporating ABE into the SOFA score improved predictive performance, emphasizing ABE's value in better risk stratification. The identified thresholds (2.5 mmol/L for 30-day mortality and 2.2 mmol/L for 90-day mortality) indicate optimal ABE levels that may be associated with improved survival outcomes.</p><p><strong>Conclusions: </strong>ABE demonstrated a U-shaped association with 30-day and 90-day ICU all-cause mortality in critically ill sepsis patients, suggesting its superiority over BE and lactate as a predictive biomarker. Incorporating ABE with the SOFA score may further enhance prognostic predictions. Further studies are needed to determine whether ABE should serve solely as a biomarker for monitoring the clinical course or could also be considered a potential therapeutic target.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"13 1","pages":"20"},"PeriodicalIF":3.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}