Journal of Intensive Care最新文献

{"title":"Dose-response relationship of early out-of-bed mobilization with functional decline and adverse events in patients after cardiovascular surgery requiring prolonged intensive care: a retrospective cohort study.","authors":"Kotaro Hirakawa, Kentaro Kamiya, Hiromichi Ueki, Kentaro Hori, Tomohiro Iwakura, Atsuko Nakayama, Mitsuaki Isobe","doi":"10.1186/s40560-026-00892-5","DOIUrl":"10.1186/s40560-026-00892-5","url":null,"abstract":"<p><strong>Background: </strong>Patients requiring prolonged ICU care after cardiovascular surgery are at high risk of functional decline, yet the optimal mobilization dose remains unclear. This study examined the associations between mobilization dose, functional decline at discharge, and adverse events during ICU rehabilitation.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted in a cardiovascular ICU and included 610 patients who underwent cardiovascular surgery and required ≥ 3 days of postoperative ICU care. The cumulative duration of out-of-bed activities at or above standing level (ICU Mobility Scale ≥ 4) was quantified, with 20 min defined as one unit. Patients were categorized into low-dose (< 2 units/day) and high-dose (≥ 2 units/day) groups. The primary outcome was postoperative functional decline, defined as a ≥ 5-point decrease in the Barthel Index at discharge compared with baseline. Adverse events during mobilization were also assessed. Propensity score matching was performed to adjust for baseline differences.</p><p><strong>Results: </strong>After 1:1 propensity score matching, 196 patients were included in each group. Functional decline was more frequent in the low-dose group than in the high-dose group (31.6% vs. 19.9%; odds ratio 2.03; 95% confidence interval [CI] 1.19-3.45; p = 0.009). Adverse events were infrequent (1.2%) and did not differ significantly between groups (incidence rate ratio 0.88; 95% CI 0.43-1.74; p = 0.70). Restricted cubic spline analysis demonstrated a nonlinear dose-response relationship between mobilization dose and functional outcomes.</p><p><strong>Conclusions: </strong>Lower mobilization doses were associated with functional decline, while higher doses were not associated with increased adverse events. Ensuring an adequate mobilization dose may be associated with better preservation of physical function without compromising safety.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156950","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 organ dysfunction during ICU stay and post-intensive care syndrome at 1 year after ICU discharge: a prospective cohort study.","authors":"Mahan Sadjadi, Matteo Marcello, Miles Drammeh, Hendrik Booke, Katarzyna Hognon-Bak, Lisa Aistleitner, Ludwig Maximilian Schöne, Christian Strauß, Moritz J Mertes, Alexander Zarbock","doi":"10.1186/s40560-026-00885-4","DOIUrl":"10.1186/s40560-026-00885-4","url":null,"abstract":"<p><strong>Background: </strong>Post-Intensive Care Syndrome (PICS) affects a substantial proportion of intensive care unit (ICU) survivors. This study investigates whether granular features of the ICU course including organ dysfunction are associated with the prevalence of PICS one year after ICU discharge.</p><p><strong>Methods: </strong>This was a prospective single-center cohort study of 159 adult surgical ICU survivors enrolled between September 2023 and August 2024. Standardized assessments for PICS domains were performed at 3 and 12 months; PICS was defined a priori as impairment in ≥ 2 of 3 domains (physical, cognitive, psychological). ICU exposure data were ascertained retrospectively from electronic health records. We compared baseline, illness severity and ICU-course variables between patients with and without PICS at 12 months. The primary exposure was the burden of critical illness, operationalized as the sum of organ dysfunctions during the ICU stay. Discriminative ability was evaluated across the organ dysfunction count model, a data-driven three-variable model as well as baseline-only and severity-score models as comparators.</p><p><strong>Results: </strong>At 12 months, 49 of 159 patients (31%) met PICS criteria. Baseline demographics and comorbidities did not differ between groups. Patients with PICS had longer and more complicated ICU stays, and more organ dysfunctions. Each additional organ dysfunction was associated with significantly higher odds of PICS (odds ratio [OR] 2.91; bias-corrected and accelerated [BCa] bootstrap 95% CI 1.92-6.00; p < 0.001). The organ dysfunction count demonstrated good discrimination (area under the receiver operating characteristic curve [AUC] 0.83; 95% CI 0.75-0.91; optimism-corrected AUC 0.82), significantly exceeding a baseline-only model containing demographics and comorbidities (AUC 0.60; 95% CI 0.50-0.71; DeLong p < 0.001), as well as outperforming admission Sequential Organ Failure Assessment (SOFA, AUC 0.63), and Acute Physiology And Chronic Health Evaluation II (APACHE II, AUC 0.64) models. An exploratory, data-driven three-variable model yielded an apparent AUC of 0.87 (optimism-corrected 0.83) with borderline calibration.</p><p><strong>Conclusions: </strong>In this exploratory analysis, the breadth of organ system involvement during critical illness, captured by the number of organ dysfunctions, was more strongly associated with PICS at 12 months after ICU discharge and demonstrated greater discriminative ability than any baseline demographics or comorbidities as well as SOFA and APACHE scores. These findings are hypothesis-generating and require external validation before clinical application.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054433","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 new SOFA for sepsis identification and mortality prediction: a multicenter cohort study.","authors":"Lina Zhao, Qian Cui, Jie Liu, Shuoyan Dong, Lei Zong, Fei Yang, Hui Shi, Yunying Wang, Xiaoli Zhao, Haibo Li, Yipeng Fang, Ying Gao, Hanjun Pei, Fuhong Su, Haibo Zhang, Daniel De Backer, Yun Li, Keliang Xie","doi":"10.1186/s40560-026-00891-6","DOIUrl":"10.1186/s40560-026-00891-6","url":null,"abstract":"<p><strong>Background: </strong>The Sequential Organ Failure Assessment (SOFA) score is central to Sepsis-3 criteria. SOFA-2 updates thresholds and incorporates contemporary organ support practices, but its impact on sepsis identification and outcome prediction remains uncertain. This study aimed to compare the diagnostic yield and prognostic performance of SOFA-2 versus SOFA-1 for sepsis identification in critically ill adults.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter cohort study of 11,669 ICU admissions from three tertiary hospitals in China (January 2022-October 2025) and externally validated findings in 29,811 ICU patients from MIMIC-IV. Sepsis was defined by Sepsis-3 using either SOFA-1 or SOFA-2. We evaluated diagnostic agreement, organ dysfunction profiles, and discrimination for ICU mortality.</p><p><strong>Results: </strong>SOFA-2 identified a significantly larger sepsis population than SOFA-1 (49.0% vs. 45.5%, P < 0.001), while maintaining substantial diagnostic agreement with SOFA-1 ( <math><mi>k</mi></math> =0.891-0.908). Compared with SOFA-1, SOFA-2 assigned higher total scores in the mid-to-high range and captured more organ dysfunction. Despite these reclassifications, ICU and hospital length of stay and mortality did not differ significantly between sepsis-SOFA-1 and sepsis-SOFA-2 groups (all P > 0.05). SOFA-2 showed slightly but consistently higher discrimination for ICU mortality than SOFA-1 (internal AUC 0.720 vs. 0.703; external AUC 0.735 vs. 0.722) and clearer mortality gradients in moderate-to-severe dysfunction categories (P < 0.001).</p><p><strong>Conclusion: </strong>The updated SOFA-2 score may identify a moderately larger sepsis population with more advanced organ dysfunction and may provide modestly improved mortality risk stratification compared with SOFA-1, while maintaining substantial diagnostic agreement. These findings suggest that SOFA-2 could be considered for clinical use in ICU sepsis assessment, and the Sepsis-3 SOFA ≥ 2 threshold may not require recalibration when using SOFA-2.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031663","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":"Development of a deep-learning model for classification of intensivists' extubation decisions using ventilator graphic monitor images: a prospective observational study.","authors":"Tatsuya Hayasaka, Masaki Nakane, Yuka Fujiwara, Yoko Yuzawa, Ryuto Yokoyama, Kiyotaka Soekawa, Masahiro Kuroki, Kenya Yarimizu, Yu Onodera, Tadanori Fukami, Hiroaki Toyama","doi":"10.1186/s40560-026-00889-0","DOIUrl":"10.1186/s40560-026-00889-0","url":null,"abstract":"<p><strong>Background: </strong>Timely extubation requires advanced expertise and extensive clinical experience; however, intensive care specialists are scarce globally, and interpreting ventilator graphic monitor waveforms can be challenging for less experienced healthcare providers. Given these challenges, we aimed to develop a deep-learning model to classify extubation decisions by intensivists based on ventilator graphic monitor images obtained at the time of the spontaneous breathing trial (SBT) outcome determination.</p><p><strong>Methods: </strong>This single-center prospective observational study was conducted in the Intensive Care Unit of Yamagata University Hospital between August 2023 and July 2025. Adult patients aged ≥ 20 years who received mechanical ventilation and underwent SAT and SBT using a Puritan Bennett^™ 980 ventilator were included. Ventilator graphic monitor images were acquired at the time of SBT outcome determination using the screen capture function. Four convolutional neural network architectures pretrained on ImageNet (DenseNet121, EfficientNet-B0, MobileNetV3-Large, and ResNet18) were evaluated using transfer learning. This study was divided into four periods, with a threefold cross-validation performed on the first three periods and the fourth period used as an independent test set. Gradient-weighted class activation mapping (Grad-CAM) was performed to visualize the basis for the model decisions.</p><p><strong>Results: </strong>A total of 191 patients were included in the final analysis: 160 (83.8%) in the extubated group and 31 (16.2%) in the non-extubated group. MobileNetV3-Large demonstrated the highest performance, with an area under the curve (AUC) of 0.900 (95% confidence interval 0.807-0.993), sensitivity of 0.900, specificity of 0.727, and accuracy of 0.759. All four architectures exhibited consistently high performance (AUC: 0.827-0.900). The Grad-CAM analysis suggested that the model tended to focus on the entire waveform, including pressure, flow, and volume, in the extubated group while focusing primarily on the flow waveform in the non-extubated group.</p><p><strong>Conclusions: </strong>This study developed a deep-learning model capable of classifying intensivists' extubation decisions from ventilator graphic monitor images with good classification performance (AUC 0.900). As a proof of concept, this approach suggests that waveform-based components of intensivists' decision-making may be approximated from image data, although further validation with larger multicenter datasets is required.</p><p><strong>Trial registration: </strong>The study was registered in the UMIN Clinical Trials Registry (UMIN000051938).</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13383475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015915","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 balance between classical and alternative renin-angiotensin system in ARDS: a narrative review.","authors":"Carlotta Dragoni, Irene Sbaraini Zernini, Alberto Calabrese, Valeria Bianchi, Savino Spadaro, Gaetano Scaramuzzo, Sabino Scolletta, Fabio Silvio Taccone, Filippo Annoni","doi":"10.1186/s40560-026-00886-3","DOIUrl":"10.1186/s40560-026-00886-3","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is a complex inflammatory condition often requiring admission to intensive care. The renin-angiotensin system (RAS) has emerged as a key modulator of lung inflammation, vascular tone, permeability and pulmonary fibrosis in ARDS. Its effect depend on the activated biochemical pathway during the course of the disease: the classical Angiotensin-Converting Enzyme (ACE)/Angiotensin II/AT1R pathway exerts pro-inflammatory, vasoconstrictive and profibrotic effects, whereas the alternative ACE2/Angiotensin 1-7/MasR axis is associated with anti-inflammatory, vasodilatory and antifibrotic properties. Therapeutic research has largely focused on enhancing the alternative RAS to attenuate inflammation and fibrosis; however, emerging evidence suggests that activation of the classical RAS through exogenous angiotensin II administration may provide clinical benefit in selected etiologies of ARDS, potentially by improving systemic hemodynamic stability and modulating pulmonary vascular resistances. This interplay between the two RAS axes underscores the complexity of their role in ARDS pathophysiology and raises the possibility that selective, stage-dependent modulation of both pathways may represent a new therapeutic approach in this context. This narrative review examines the dual influence of RAS pathways in ARDS and explores the potential for targeted therapeutic interventions at different disease stages.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941732","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":"A cumulative-morbidity plasma proteomic architecture of critical-illness susceptibility: a UK biobank proteome-wide study of critical-care exposure, in-hospital death, and sex-specific signals.","authors":"Xingxing Ren, Qingxia Dai, Chaoyuan Jin","doi":"10.1186/s40560-026-00887-2","DOIUrl":"10.1186/s40560-026-00887-2","url":null,"abstract":"<p><strong>Background: </strong>Existing biomarker studies profile plasma during acute illness, leaving pre-illness proteomic susceptibility to critical care largely uncharacterised. We mapped the baseline proteomic architecture of critical-care outcomes in UK Biobank and tested for sex differences.</p><p><strong>Methods: </strong>We performed a proteome-wide association study of 2923 plasma proteins in 53,000 UK Biobank participants linked to Hospital Episode Statistics critical-care records, analysing three outcomes: ever critical-care exposure, prolonged critical care, and in-hospital death during a critical-care hospitalisation. Primary analyses used logistic regression; sensitivity analyses included Cox models, cross-validated LASSO, sex-interaction testing, and reverse-causation proxy analyses.</p><p><strong>Results: </strong>Of 53,000 participants, 2986 had at least one critical-care episode. For ever critical-care exposure, 545 proteins survived Bonferroni correction, led by GDF15 (OR per SD 1.37, 95% CI 1.33-1.42, P = 2.82 × 10⁻⁶⁸). In-hospital death yielded 18 Bonferroni-significant proteins, again led by GDF15. Prolonged critical care showed a markedly attenuated signal. Sex-interaction effects were predominantly stronger in women. An exploratory reverse-causation analysis yielded null estimates, indicating unresolved residual confounding.</p><p><strong>Conclusions: </strong>Baseline plasma proteins measured a median of more than 10 years before any critical-care episode were associated with later critical-care exposure and in-hospital death during a critical-care hospitalisation, with a biologically coherent pattern spanning stress-response, renal, epithelial, inflammatory, and tissue-remodelling pathways and a secondary female-predominant interaction signal among the leading proteins. The incremental discrimination over demographics (ΔAUC 0.040 on a 0.672 baseline) was modest but detectable over a > 10-year horizon. We interpret the signal as a cumulative-morbidity proteomic axis of critical-illness susceptibility rather than as validated isolated pre-morbid biomarkers; reverse-causation risk could not be excluded and external-cohort validation is required.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147930475","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":"Response to \"Predicting high-flow nasal cannula failure: beyond static indices toward dynamic physiologic assessment\".","authors":"Yaxiaerjiang Muhetaer, Shi-Min Zhang, Amanguli Moming, Kai Liu, Ming Zhong","doi":"10.1186/s40560-026-00880-9","DOIUrl":"10.1186/s40560-026-00880-9","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838990","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":"Predicting high-flow nasal cannula failure: beyond static indices toward dynamic physiologic assessment.","authors":"Jay Prakash, Kalavathy Swarna, Bodhisatwa Choudhuri","doi":"10.1186/s40560-026-00876-5","DOIUrl":"10.1186/s40560-026-00876-5","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838985","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":"Drug sequestration and metabolite formation: key pharmacokinetic challenges for levosimendan use during ECMO support in cardiogenic shock.","authors":"Nicolas Tebib, Lucas Liaudet, Zied Ltaief","doi":"10.1186/s40560-026-00884-5","DOIUrl":"10.1186/s40560-026-00884-5","url":null,"abstract":"<p><strong>Background: </strong>In patients with refractory cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) provides temporary circulatory support, but optimal strategies to promote myocardial recovery and facilitate ECMO weaning remain uncertain. Levosimendan is a calcium-sensitizing inotrope and vasodilator that improves cardiac performance and may support cardiac function and shorten the duration of ECMO support.</p><p><strong>Discussion: </strong>The recent multicenter randomized placebo-controlled LEVOECMO trial demonstrated no benefit of early levosimendan infusion on ECMO weaning or clinical outcomes, providing robust evidence against routine and early use. Several pharmacokinetic factors may have attenuated levosimendan efficacy in this setting. Levosimendan is prone to sequestration within the ECMO circuit, particularly early after cannulation. Moreover, its short half life and its reliance on hepatic and intestinal metabolism for the generation of the long-acting active metabolite may limit its effectiveness during the early phase of cardiogenic shock, when high incidence of hepatic dysfunction and mesenteric hypoperfusion may contribute to reduced active metabolite production. In addition, renal replacement therapy is frequently required in ECMO patients and may further reduce plasma concentrations of active metabolites. Taken together, and in the absence of therapeutic drug monitoring, these factors may result in highly variable and unpredictable exposure to active metabolites among patients. These considerations raise the hypothesis that alternative strategies such as delayed initiation with therapeutic drug monitoring might improve exposure to levosimendan and its active metabolites.</p><p><strong>Conclusion: </strong>While recent evidence discourages routine early levosimendan use during ECMO for cardiogenic shock, a personalized, pharmacology-driven approach needs further investigation before a definitive conclusion.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773674","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":"Effect modification by chronic kidney disease on renal outcomes in septic shock patients undergoing high-MAP targeting: a secondary analysis of the OPTPRESS trial.","authors":"Hiraaki Okuzawa, Akira Endo, Tomohiro Akutsu, Keisuke Suzuki, Hiromasa Hoshi, Kazuma Yamakawa, Takashi Tagami, Yutaka Umemura","doi":"10.1186/s40560-026-00882-7","DOIUrl":"10.1186/s40560-026-00882-7","url":null,"abstract":"<p><strong>Background: </strong>The optimal mean arterial pressure (MAP) target for renal protection in septic shock remains unclear. Although higher MAP targets have been suggested to improve renal outcomes in selected patient subgroups, it is unknown whether baseline chronic kidney disease (CKD) modifies the renal response to MAP targeting strategies.</p><p><strong>Methods: </strong>We conducted a post hoc secondary analysis of the OPTPRESS trial, a multicenter randomized controlled trial enrolling patients aged ≥ 65 years with septic shock, comparing high-MAP (80-85 mmHg) versus standard-MAP (65-70 mmHg) targets. The primary outcome was renal replacement therapy-free days (RRT-FD) at 28 days, and the secondary outcome was major adverse kidney events (MAKE) at hospital discharge. Multivariable regression models were used to assess the interaction between MAP targeting strategy and documented history of CKD status. Stratified analysis was subsequently performed within CKD and non-CKD subgroups. Sensitivity analysis using inverse probability of treatment weighting (IPTW) and multiple imputation was conducted.</p><p><strong>Results: </strong>Among 431 patients included in the complete case analysis, 70 had CKD and 361 did not. A statistically significant interaction between MAP targeting strategy and CKD status was observed for RRT-FD (p for interaction = 0.040). In adjusted analyses stratified by CKD status, high-MAP targeting was associated with fewer RRT-FD in patients without CKD (adjusted β, - 3.5 days; 95% CI - 5.94 to - 1.11), whereas no significant association was observed in patients with CKD (adjusted β, + 2.0 days; 95% CI - 4.34 to + 8.35). For MAKE, the direction of effect was consistent with that observed for RRT-FD although statistical significance was not reached in patients without CKD. Sensitivity analysis yielded directionally consistent findings.</p><p><strong>Conclusions: </strong>Documented history of CKD may modify the renal response to high-MAP targeting in elderly patients with septic shock. High-MAP targets were associated with fewer RRT-FD in patients without CKD. Given the exploratory and post hoc nature of this analysis, these findings should be interpreted cautiously and warrant confirmation in prospective studies evaluating individualized MAP targets according to baseline renal function in septic shock.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716931","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}