Journal of Intensive Care Medicine最新文献

{"title":"Effects of Platelet Transfusion on Sepsis Associated Thrombocytopenia (SAT): A Multicenter Retrospective Chart Review.","authors":"Lu Wang, Wei Pan, Bin Du, Xiang Zhou","doi":"10.1177/08850666261448808","DOIUrl":"https://doi.org/10.1177/08850666261448808","url":null,"abstract":"<p><p>ObjectiveTo investigate effects of platelet transfusion on sepsis associated thrombocytopenia (SAT).MethodsIn this study, 695 SAT patients admitted to Peking Union Medical College Hospital (PUMCH) were enrolled from June 8, 2013 to October 12, 2022. Externally validate was carried out using 2739 SAT patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were divided into 2 groups based on whether platelet transfusion was administered.ResultsAfter propensity score-matching, compared with the control group, the platelet transfusion group had longer mechanical ventilation time (43 vs 169 h, P < 0.05), more expenses (122.29 vs 254.03 thousand yuan [RMB], P < 0.05), longer hospital stays (536 vs 817 h, P < 0.05), longer hospital stays after diagnosis of SAT (384 vs 636 h, P < 0.05), longer ICU stays (133 vs 227 h, P < 0.05), higher mortality (30.1 vs 53.4%, P < 0.05). Effective platelet transfusion rate was 52.51%. Subgroup analysis based on the degree of thrombocytopenia and data analysis from MIMIC-IV further confirmed above results. Contrary to intuition, as the platelet count decreased, the effective platelet transfusion rate tended to decrease. Positive rate of deep vein thrombosis (DVT) was 18.85% in SAT in PUMCH. Compared with the control group, the platelet transfusion group had higher positive rate of DVT (27 / 131 vs 33 / 92, P < 0.05) in subgroup with platelet count [50, 100 × 10⁹/L) in PUMCH.ConclusionsNo benefits from platelet transfusion were observed in SAT. Around 50% of platelet transfusions in SAT were platelet transfusion refractoriness. Platelet transfusion was associated with higher positive rate of DVT in SAT patients with platelet count [50, 100 × 10⁹/L).</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261448808"},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839066","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":"A Lightweight LSTM-Transformer Fusion Architecture for Real-Time Sepsis Mortality Prediction.","authors":"Zekai Yu, Feiwei Qin, Zhu Zhu","doi":"10.1177/08850666261447860","DOIUrl":"https://doi.org/10.1177/08850666261447860","url":null,"abstract":"<p><p>BackgroundAccurate prediction of short-term mortality in sepsis patients is critical for timely clinical decision-making. However, existing deep learning models often focus on static physiological parameters while neglecting the dynamic response to medical interventions, leading to risk underestimation due to the \"masking effect\" of therapeutic measures.MethodsWe propose a lightweight hybrid deep learning framework that integrates dynamic intervention responses to predict 24-h all-cause mortality. Utilizing the MIMIC-IV v3.1 database, we included 13,788 adult sepsis patients. The model employs a dual-branch architecture: a Bidirectional LSTM to capture local temporal trends and a Transformer Encoder to extract global long-range dependencies. Crucially, we constructed a high-resolution feature set that includes vasopressor infusion rates and hourly urine output to quantify physiological feedback to resuscitation.ResultsThe proposed model achieved an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.8139, significantly outperforming seven mainstream baselines, including LightGBM (0.8015), Bi-LSTM (0.7870), and pure Transformer models (0.7704). Feature importance analysis revealed that indicators of treatment response, specifically urine output and norepinephrine dosage, were among the top predictive features, validating the clinical hypothesis that drug dependency and renal perfusion are sensitive markers of prognosis. Furthermore, external validation on the independent multi-center eICU Collaborative Research Database demonstrated robust generalizability: a zero-shot transfer yielded an AUROC of 0.6620, which improved to 0.7347 after lightweight domain adaptation fine-tuning, with a Negative Predictive Value (NPV) of 90.04%, confirming the model's cross-institutional applicability as a reliable rule-out tool.ConclusionOur LSTM-Transformer Fusion architecture effectively captures the complex \"drug-physiology\" interactions with low computational cost. By explicitly modeling the dynamic response to treatment and demonstrating cross-institutional generalizability through external validation on the eICU database, this lightweight model offers a robust and interpretable tool for early warning systems in resource-constrained intensive care environments.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261447860"},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839128","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":"Sex- and Age-Related Differences Among Liver Transplant Patients: A Narrative Review.","authors":"Xueqing Wang, Teresa Pont, Jordi Rello","doi":"10.1177/08850666261447863","DOIUrl":"https://doi.org/10.1177/08850666261447863","url":null,"abstract":"<p><p>Liver transplantation (LT) remains the definitive therapy for end-stage liver disease, yet outcomes are increasingly recognized to depend upon factors beyond disease severity alone. Sex-, gender-, and age-related differences permeate the entire transplant process, from access to long-term survival. Women experience reduced access to LT, including lower listing rates, prolonged waiting times, and elevated waitlist mortality. While some disparities reflect biological differences-such as body size and creatinine levels-gender-related factors, including socioeconomic status, healthcare accessibility, and referral patterns, contribute substantially. Current allocation systems, notably Model for End-Stage Liver Disease scoring system-based algorithms, capture only partially these dimensions. Concurrently, advancing donor and recipient age has reshaped transplant practice, with outcomes more closely tied to physiological reserve than chronological age alone. Beyond recipient characteristics, donor sex and age, together with donor-recipient matching, significantly impact graft survival and post-LT complications through mechanisms involving hormonal signaling, immune competence, and metabolic capacity. Critically, sex, gender, and age operate as intersecting determinants rather than isolated variables. Emerging sex-adjusted allocation models demonstrate improved predictive performance; nevertheless, persistent disparities suggest that structural inequities remain inadequately addressed. This review synthesizes current evidence across the LT continuum and highlights the imperatives to integrate biological and structural determinants into allocation policy, thereby advancing both equity and clinical outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261447863"},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839098","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":"Validation and Early Application of the ProVent Score in a Contemporary ICU Cohort.","authors":"Shihla Shireen Kanamgode, Eric Cucchi, Stephen Anders, Hassan Fouayzi, Allyson L Hughes, Honghuang Lin, Nicholas Bosch, Allan Walkey","doi":"10.1177/08850666261447248","DOIUrl":"https://doi.org/10.1177/08850666261447248","url":null,"abstract":"<p><p>BackgroundProlonged mechanical ventilation (PMV) is associated with poor long-term outcomes. The ProVent14 score was developed to estimate one-year mortality among patients receiving mechanical ventilation for at least 14 days. However, contemporary validation of the model and its performance earlier during mechanical ventilation remain uncertain. We aimed to evaluate the validity of the ProVent14 score in a modern ICU cohort and assess its predictive performance when applied earlier during mechanical ventilation.MethodsWe conducted a retrospective cohort study using the Medical Information Mart for Intensive Care (MIMIC-IV) database (2008-2022). Adult ICU admissions receiving at least seven days of mechanical ventilation were included. Patients with chronic neuromuscular disease, extensive burns, or chronic mechanical ventilation were excluded. Three non-mutually exclusive cohorts were constructed based on duration of ventilation (≥7,≥10, and ≥14 days). Predictors from the original ProVent14 model (age, platelet count, vasopressor use, hemodialysis requirement, and trauma admission status) were assessed at each time point. The primary outcome was one-year mortality from the onset of prolonged ventilation. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was evaluated using the Hosmer-Lemeshow test. <b>Results:</b> A total of 1344, 634, and 249 patients comprised the day-7, day-10, and day-14 cohorts, respectively. One-year mortality ranged from 64% to 67% across cohorts. The ProVent model demonstrated consistent discrimination at day 7, day 10, and day 14 (AUC 0.74, 0.72, and 0.71, respectively) with acceptable calibration (Hosmer-Lemeshow <i>P</i>-values 0.50, 0.18, and 0.21). Model performance remained stable across different study periods. <b>Conclusions:</b> The ProVent score maintains stable predictive performance in a contemporary ICU population. Similar discrimination and calibration at days 7 and 10 suggest that prognostic assessment may be feasible earlier during mechanical ventilation.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261447248"},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839053","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":"End-Tidal CO₂ Monitoring in Critical Illness: Applications in Resuscitation, Shock, and Ventilation.","authors":"Ariella Gartenberg, Aria Fariborzi, Peter Gruber, Alexander Petrie","doi":"10.1177/08850666261447857","DOIUrl":"https://doi.org/10.1177/08850666261447857","url":null,"abstract":"<p><p>BackgroundContinuous end tidal carbon dioxide (ETCO₂) monitoring provides a noninvasive, real-time assessment of ventilation, pulmonary perfusion, and indirectly cardiac output. Although historically limited to anesthetic practice, capnography has emerged as an increasingly valuable physiologic monitoring tool in critical care settings.MethodsA review was conducted using MEDLINE/PubMed and the Cochrane Library from 1988 to 2025 to evaluate the clinical applications of ETCO₂ monitoring in critically ill patients. Eighteen studies met predefined inclusion criteria after screening and were included. Data were narratively synthesized.ResultsETCO₂ monitoring reliably reflects cardiopulmonary resuscitation quality and return of spontaneous circulation. In shock states, low ETCO₂ correlates with elevated lactate, transfusion requirements, and mortality, serving as a rapid bedside marker of systemic hypoperfusion. Dynamic changes in ETCO₂ during passive leg raising may predict fluid responsiveness in septic and cardiogenic shock. In ventilated or sedated patients, capnography enables earlier detection of hypoventilation and airway compromise.ConclusionsETCO₂ monitoring is a physiologically informative, underutilized tool in critical care. When integrated in clinical context, capnography may enhance resuscitation quality, guide hemodynamic management, and improve ventilatory safety. Further prospective studies are needed to establish standardized ETCO₂-guided resuscitation protocols.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261447857"},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839145","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":"Prognostic Value of Scoring Systems in Elderly Sepsis-Associated AKI Patients: A Multicenter Retrospective Cohort Study.","authors":"Hongfei Wang, Nahui Li, Shuying Yang","doi":"10.1177/08850666261446564","DOIUrl":"https://doi.org/10.1177/08850666261446564","url":null,"abstract":"<p><p>BackgroundSepsis-associated acute kidney injury (AKI) in elderly patients carries high mortality risks, yet the comparative performance of severity scores in predicting outcomes remains unclear. This study evaluated the prognostic accuracy of SAPS II, LODS, SAPS III, MELD and Charlson Comorbidity Index for 28- and 90-day mortality in this vulnerable population.MethodsA retrospective multicenter cohort study analyzed 2455 elderly (≥65 years) sepsis-AKI patients from MIMIC-IV and eICU databases. Participants were stratified into survival (n = 1693) and non-survival (n = 762) groups. Receiver operating characteristic (ROC) curves and decision curve analysis(DCA) assessed discriminative power of each predictor for mortality endpoints.ResultsFor 28-day mortality, SAPS II demonstrated superior predictive performance (AUC 0.803, 95% CI 0.782-0.824), followed by LODS (AUC 0.772) and SAPS III (AUC 0.759), all <i>p</i> < 0.001. MELD (AUC 0.626), and Charlson (AUC 0.585) showed modest discrimination. Similarly, SAPS II maintained the highest AUC (0.789) for 90-day mortality, with SAPS III (0.757) ranking second. Charlson again showed limited predictive value (AUCs 0.580-0.575). Decision curve analysis demonstrated the superior predictive utility of SAPS II for both 28-day and 90-day mortality compared to other clinical scoring systems. Observationally, all scores showed higher specificity values (>0.65) than sensitivity values in our dataset. Furthermore, while urinary tract infection was associated with increased mortality in elderly AKI patients, our subsequent analysis demonstrated its limited predictive capacity for 28-day and 90-day mortality outcomes.ConclusionIn our cohort of elderly sepsis-AKI patients, SAPS II demonstrated the strongest observed prognostic performance for both 28- and 90-day mortality compared to MELD, LODS, and Charlson scores. These findings suggest SAPS II may be valuable for risk stratification in clinical decision-making for this high-risk population, though further validation is warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261446564"},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839074","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":"Corticosteroid use and mortality of severe community-acquired pneumonia in children: A propensity score-matched analysis.","authors":"Shinya Miura, Nobuaki Michihata, Toshiaki Isogai, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga","doi":"10.1177/08850666251369428","DOIUrl":"https://doi.org/10.1177/08850666251369428","url":null,"abstract":"<p><p>BackgroundThe role of corticosteroids in the management of severe community-acquired pneumonia (CAP) in children remains controversial, with limited pediatric evidence. Recent studies have suggested that the effect of corticosteroids varies among subgroups, particularly according to cardiovascular status. The present study thus evaluated the effect of corticosteroids on in-hospital mortality in children with severe CAP and described subgroup differences by concomitant organ failure, age, and the microbial diagnosis.MethodsThis retrospective cohort study used a national inpatient database in Japan to identify children under 20 years old admitted with pneumonia between July 2010 and March 2022 who received ventilatory support within the first 2 days of admission. We performed one-to-one nearest-neighbor propensity score matching to compare children who received corticosteroids within 2 days of admission and continued for ≥3 days (steroid group) with those who did not (non-steroid group). The primary outcome was in-hospital mortality, assessed in matched pairs with subgroup analyses.ResultsOf the 11,427 children with severe CAP, propensity score matching yielded 3,081 matched pairs. In-hospital mortality was 1.6% in the steroid group and 1.7% in the non-steroid group (odds ratio, 0.94; 95% confidence interval [CI]: 0.68-1.31; p = 0.72). Among 359 children with cardiovascular compromise, corticosteroid use was associated with a reduced in-hospital mortality (odds ratio: 0.47; 95% CI: 0.26-0.87), whereas among 5,803 children without cardiovascular compromise, it was not (odds ratio: 1.64; 95% CI: 0.99-2.74). Other subgroup analyses showed no significant differences between the groups.ConclusionsCorticosteroid use did not significantly affect in-hospital mortality in children with severe CAP except in those with cardiovascular compromise. These findings suggest caution in the routine use of corticosteroids in this pediatric cohort, especially in those without cardiovascular compromise.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":"41 5","pages":"404-412"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773068","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":"Norepinephrine Dosage and Risk for Atrial Fibrillation in Septic Shock.","authors":"Patrick M Wieruszewski","doi":"10.1177/08850666261442898","DOIUrl":"10.1177/08850666261442898","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"441-442"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674096","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":"Authors' Response to Letter to the Editor.","authors":"Brendan Sweeney, Justin Kim, Ariana Adnani, Huma Saleem, Seda Akben, Yin Rong Alvina Teo, Eduard Shaykhinurov, Maria Wu, Rishika Bheem, Samita Islam, Danielle Davison, Katrina Hawkins, Daniel King, Sasa Ivanovic, David P Yamane","doi":"10.1177/08850666261419717","DOIUrl":"10.1177/08850666261419717","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"444"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157318","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":"Type 2 Myocardial Infarction and Inpatient Mortality in Septic Shock: Insights from a Nationally Representative Sample.","authors":"Boluwaduro Adeyemi, Oluwafunmbi Fatunmbi, Kayode Ogunniyi, Jesus Antonio Galindo Castaneda, Elizabeth Retzer","doi":"10.1177/08850666251368272","DOIUrl":"10.1177/08850666251368272","url":null,"abstract":"<p><p>Type 2 myocardial infarction (type 2 MI) caused by demand ischemia and characterized by an imbalance between myocardial oxygen supply and demand without acute athero-thrombosis, is common in critically ill patients, including those with septic shock. This study aimed to evaluate the relationship between type 2 MI and inpatient mortality in patients hospitalized with septic shock using the National Inpatient Sample (NIS) from 2016 to 2020. A propensity-matched cohort was constructed, consisting of 31,905 hospitalizations with septic shock and type 2 MI (study group) and an equal number without type 2 MI (control group).Overall, type 2 MI was not associated with a statistically significant difference in mortality (27% vs 26.1%, OR 1.05, 95% CI 0.97-1.14, p = 0.23). Subgroup analysis revealed an increased mortality risk in younger patients (aged 18-39) with type 2 MI (OR 1.93, 95% CI 1.09-3.43, p = 0.024). Conversely, patients with coronary artery disease (CAD) and type 2 MI demonstrated a lower mortality risk (OR 0.82, 95% CI 0.70-0.96, p = 0.012). Other comorbidities, including chronic heart failure, tachyarrhythmias, chronic kidney disease, and iron deficiency anemia, did not significantly alter mortality outcomes. These findings suggest that type 2 MI may be correlated with inpatient mortality only in specific subgroups of patients with septic shock, particularly younger patients and those with CAD. Our findings underscore the importance of demographic characteristics and comorbidities as key determinants of outcomes. Further research is needed to elucidate underlying mechanisms and improve clinical management in these populations.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"398-403"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957350","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}