Journal of Intensive Care Medicine最新文献

{"title":"On the Distribution of Baseline Severity Markers: A Contribution to the Interpretation of Long-Acting Insulin use in Surgical ICU Patients with Type 2 Diabetes.","authors":"Arda Ayten, Mehmet Yildirim","doi":"10.1177/08850666261462868","DOIUrl":"10.1177/08850666261462868","url":null,"abstract":"","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1043-1044"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391053","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 of A Screening Tool to Predict Post Intensive Care Syndrome (PICS) in Critically Ill Adults in a Prospective Cohort.","authors":"Kathryn T Del Valle, Benjamin Re Harris, Matthew Clark, Kemuel Philbrick, Ellie Cipriani, Patrick Cornelius, Allison M LeMahieu, Phillip Schulte, Kelly Sonsalla, Siva Kamal Guntupalli, Andrea Johnson, Kristin Muir, Lioudmila V Karnatovskaia","doi":"10.1177/08850666261425642","DOIUrl":"10.1177/08850666261425642","url":null,"abstract":"<p><p>PurposeSurvivors of critical illness often acquire significant physical, cognitive, and psychological burdens following their intensive care unit (ICU) stay, termed \"post-intensive care syndrome\" (PICS). Screening for PICS is generally not performed outside of research settings largely due to lack of a simple assessment tool and time constraints.MethodsThis was a prospective cohort study at a single academic medical center in the USA. We included adults (18 years or older) who spent greater than 48 h in any ICU within the medical center. Following transfer out of the ICU and at 3 months, psychological, cognitive, and physical functioning were assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, Montreal Cognitive Assessment-blind, and Barthel Index. We compared these validated questionnaires to a brief, 15-item PICS screening tool (5 questions/domain) that was developed by our multidisciplinary study team and administered to study participants after ICU discharge to general care. The primary objectives of this study were to assess the ability of validated screening tools administered at ICU discharge to predict PICS at 3 months and develop a novel screening tool for identifying patients at risk of PICS.Major Findings191 participants completed the initial questionnaire, and 109 (56%) completed the 3-month follow-up. PICS tool scores were compared to 3-month follow-up data from validated questionnaires to evaluate predictive performance. Overall, the screening tool weakly-to-moderately correlated with continuous outcomes of the validated measures at 3-month follow-up. When evaluating sensitivity and specificity for individual domains, the screening tool had an area under curve of >0.7 for all three domains, indicating moderate-to-good sensitivity and specificity.ConclusionsWe developed a brief PICS screening tool that is feasible to use without prior training that modestly predicted the development of PICS following ICU stay.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1013-1021"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369664","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":"Advancing Microcirculatory Therapies in Pediatric Sepsis: Current Opportunities and Future Directions.","authors":"Carolina Casas, Jaime Fernández-Sarmiento, Mauricio Sarta-Mantilla, Hernando Mulett, Lorena Acevedo, Briam Beltrán, Juanita Medina, Clarisel Del Carmen Compres, Piera Nathalie Serrano, María Elvira Sarta-Mantilla, Valentina Pérez, Maria Camila Gomez, Maria Carolina Niño, Cielo Cuadros, Maria José Barrera, Natalia Pedraza-López, Joseph A Carcillo","doi":"10.1177/08850666251340601","DOIUrl":"10.1177/08850666251340601","url":null,"abstract":"<p><p>Microcirculatory dysfunction in pediatric sepsis is a key factor in the development of tissue hypoperfusion and multiple organ failure. Endothelial glycocalyx alteration, increased capillary permeability, and blood flow heterogeneity are common findings in these patients, suggesting that a microcirculation-targeted approach could improve clinical outcomes. In this context, strategies such as resuscitation with balanced solutions have been shown to minimize hyperchloremia and metabolic acidosis, reducing endothelial dysfunction and inflammatory activation. Likewise, correcting hypoalbuminemia has been associated with reduced glycocalyx degradation and improved vascular stability. The use of inotropes and inodilators has shown favorable effects on capillary perfusion and modulation of the inflammatory response, suggesting their potential to optimize tissue oxygenation in septic shock patients. Additionally, fresh frozen plasma may play a role in glycocalyx restoration and endothelial homeostasis regulation, although its impact on pediatric sepsis still requires further clinical evidence. Despite these advances, questions remain regarding the best strategy to evaluate and treat microcirculatory dysfunction in children with sepsis. Identifying specific biomarkers and developing tools for real-time perfusion assessment could allow for more personalized therapies. Further clinical studies are needed to validate the impact of these interventions on pediatric mortality and morbidity. Integrating a microcirculation-targeted approach into pediatric septic shock management protocols represents an opportunity to improve care and outcomes in this vulnerable population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"925-935"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Ultrasound Utility in Predicting Stomach Contents in Patients with Upper Gastrointestinal Bleeding.","authors":"Simon Meredith, Kevin Shayani, Megan Buckley, Dimitre G Stefanov, Zein Kattih, Sara Velichkovikj, Jacob Schwartz, Margarita Oks","doi":"10.1177/08850666261421879","DOIUrl":"10.1177/08850666261421879","url":null,"abstract":"<p><p>BackgroundGastric point of care ultrasound (POCUS) has been used by clinicians to evaluate gastric contents prior to the induction for intubation in the intensive care unit. This is of particular importance as the presence of gastric contents increases the risk of aspiration during induction, which itself carries increased morbidity and mortality. In upper gastrointestinal bleeds (GIB), sonographic assessment prior to evaluation with esophagogastroduodenoscopy (EGD) may be of significant utility both in risk stratification of anesthesia and the clinical concern for ongoing bleeding.<b>Research question:</b> Can gastric POCUS be used to reliably measure gastric contents as compared to the gold standard of EGD in upper GIB?<b>Study design and methods:</b> The primary goal of the study was to compare Esophagogastroduodenoscopy (EGD) stomach content measurement, the gold standard in the diagnosis and potential management of gastrointestinal bleeding, with bedside ultrasound measurement in patients undergoing EGD in all settings. We report the sensitivity, specificity, positive predictive value [PPV] and the negative predictive value [NPV] with their exact 95% confidence intervals (CI). We summarized descriptively the distribution of POCUS measurements, in the cases where the assessment of gastrointestinal content differed between the two methods [specifically detection of contents with ultrasound ie US > 0, but absence of contents on EGD ie EGD=0]. SAS 9.4 (SAS Institute, Inc., Cary, NC) was used for the data analysis.ResultsWhen comparing POCUS measurements to EGD to detect the presence or absence of stomach contents, the sensitivity of the US measurement was 75.0% (95% CI:19.4-99.4), while the specificity was 76.1% (95% CI:61.2-87.4). The negative predictive value (NPV) was 97.2% (95% CI: 85.5-99.9). The positive predictive value (PPV) was 21.4% (95% CI: 4.7%- 50.1%), based on the 14 observations with US > 0. The Median (IQR) of POCUS for these 11 observations were 97.8 (18.7-260.8).<b>Interpretation:</b> Gastric ultrasound may be used for gastric content assessment prior to EGD in cases of suspected GIB. Gastric POCUS has a high negative predictive value to exclude the presence of stomach contents. This may have relevance in critical care settings where a high aspiration risk due to suspected stomach contents may lead to need for airway protection via advanced airway and general anesthesia.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"980-985"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207203","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":"Opioid Escalation in the ICU and 90-Day Readmission After Major Surgery: A Retrospective Cohort Study Using the MIMIC-IV Database.","authors":"Angel G A Prempeh, Allison Tenfelde","doi":"10.1177/08850666261425613","DOIUrl":"10.1177/08850666261425613","url":null,"abstract":"<p><p>BackgroundOpioid stewardship is central to postoperative critical care, yet the prognostic value of short-term opioid dose escalation in the intensive care unit (ICU) remains unclear. In non-ICU settings, escalating opioid requirements have been associated with poorly controlled pain, postoperative complications, and increased readmission rates. Whether similar relationships exist in critically ill postoperative patients has not been established.ObjectiveTo determine whether early postoperative opioid escalation during the first 72 hours after major surgery is associated with 90-day hospital readmission among ICU patients.MethodsThis retrospective cohort study used the publicly available Medical Information Mart for Intensive Care IV (MIMIC-IV, version 3.1) database (2008-2022). Adults aged ≥ 18 years admitted to the ICU after major orthopedic, general, or neurosurgical procedures were included. Opioid escalation was defined as total morphine milligram equivalents (MME) administered during hours 48-71 exceeding twice the MME during hours 0-23 after ICU admission. The primary outcome was all-cause hospital readmission within 90 days of discharge. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), controlling for age, sex, Charlson Comorbidity Index (CCI), and surgical category.ResultsOf 613 patients analyzed, mean (SD) age was 65 (15) years and 342 (55.8%) were male. Opioid escalation occurred in 126 patients (20.6%), and readmission in 229 (37.4%). In multivariable logistic regression adjusted for age, sex, Charlson Comorbidity Index, and surgical category, escalation was not associated with readmission (adjusted odds ratio, 1.05; 95% CI, 0.68 to 1.63; P = .83).ConclusionsIn critically ill postoperative patients, short-term opioid escalation was not associated with 90-day readmission. These null findings suggest escalation may be a poor-quality metric in the intensive care unit due to high baseline opioid exposure and continuous monitoring. Further evaluation in non-intensive care unit settings is warranted.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1008-1012"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147290167","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":"Mean Arterial Pressure to Renal Resistive Index Ratio Predicts Sepsis-Associated Acute Kidney Injury in Intra-Abdominal Infections.","authors":"Guoliang Tan, Yongming Chen, Yanqing Ren, Wei Wang","doi":"10.1177/08850666261421892","DOIUrl":"10.1177/08850666261421892","url":null,"abstract":"<p><p>BackgroundSepsis-associated acute kidney injury (s-AKI) is a frequent and severe complication in patients with intra-abdominal infections, however, early prediction remains challenging. This study aimed to evaluate the predictive value of the mean arterial pressure(MAP) to the renal resistive index(RRI) ratio (MAPRRI) for s-AKI in this population.MethodsIn this single-center, retrospective observational study, 530 patients with sepsis secondary to intra-abdominal infections were enrolled between January 2021 and December 2024. Participants were classified into AKI and No-AKI groups on the basis of the KDIGO criteria. Univariate and multivariate logistic regression analyses were performed to identify risk factors for AKI. Propensity score matching (PSM) was applied to reduce confounding effects. Receiver operating characteristic (ROC) curves were generated to assess the predictive performance of MAPRRI, MAP, and RRI.ResultsAmong the 530 patients, 104 (19.62%) developed AKI. Multivariate analysis revealed that the MAPRRI was an independent predictor of s-AKI (OR 0.861, 95% CI: 0.830-0.893; p < 0.001). After PSM, the MAPRRI remained significantly lower in the AKI group (84.6 vs 87.8, p < 0.001) and predicted s-AKI with an AUC value of 0.821 (95% CI: 0.760-0.881), outperforming MAP (AUC = 0.758, p = 0.003) and the RRI (AUC = 0.708, p < 0.001) alone. The optimal MAPRRI cutoff was 101.3, with 88.5% sensitivity and 68.1% specificity.ConclusionCompared with individual parameters, the MAPRRI is a strong independent predictor of s-AKI in septic patients with intra-abdominal infection and has superior predictive ability. It shows promise for early risk stratification and merits further multicenter validation.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"970-979"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220020","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":"Timing of Loop Diuretic Initiation for De-Resuscitation in Sepsis-Associated Acute Kidney Injury: A Landmark Analysis with External Validation.","authors":"Lujun Shao, Yue Li, Cheng Xu, Huiyu Tai, Li Wang, Jinyu Shi","doi":"10.1177/08850666261493365","DOIUrl":"https://doi.org/10.1177/08850666261493365","url":null,"abstract":"<p><p>BackgroundPositive fluid balance is associated with worse outcomes in sepsis-associated acute kidney injury (SA-AKI), but the optimal timing for active fluid removal (de-resuscitation) is unknown. We examined whether earlier loop-diuretic therapy is associated with lower mortality than later initiation.MethodsUsing MIMIC-IV v3.1, we performed a landmark-anchored cohort analysis informed by the target trial framework, with the 48-h landmark as time zero. Adults with Sepsis-3, Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury within 48 h, a positive 48-h fluid balance and no pre-landmark continuous renal replacement therapy were classified by the timing of the first loop diuretic as early (≤24 h after the landmark) or late (>24 h to 7 days). Outcomes were 28-day (primary), in-hospital and 90-day mortality. Stabilized inverse-probability-of-treatment weighting balanced nine covariates, and odds ratios (ORs) were estimated by weighted logistic regression, with sensitivity analyses, <i>E</i>-values, subgroups and internal validation. External validation used the eICU Collaborative Research Database, with in-hospital mortality as the primary endpoint.ResultsIn MIMIC-IV (1419 early, 1924 late), early de-resuscitation was associated after weighting with lower 28-day mortality (19.9% vs 25.3%; OR, 0.731; 95% CI, 0.619-0.863; <i>P</i> = .0002), in-hospital mortality (OR, 0.680; 95% CI, 0.570-0.811), and 90-day mortality (OR, 0.743; 95% CI, 0.640-0.862). In eICU (537 early, 1057 late), it was associated with lower in-hospital mortality (13.7% vs 18.3%; OR, 0.708; 95% CI, 0.541-0.928; <i>P</i> = .013) and ICU mortality (OR, 0.663; 95% CI, 0.449-0.980). The association was directionally consistent across thresholds, complete-case and continuous-exposure analyses, subgroups, and bootstrap validation.ConclusionsIn this observational analysis with external validation, earlier loop-diuretic de-resuscitation was associated with lower short-term mortality in SA-AKI with fluid accumulation. The findings are hypothesis-generating: a pragmatic randomized trial using the computable phenotype defined here is required to determine whether the association is causal.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261493365"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110902","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":"Use of Chemotherapy and Other Cancer-Directed Therapies in the ICU for Patients with Cancer.","authors":"Dharani K Narendra, Cristina Gutierrez","doi":"10.1177/08850666261486819","DOIUrl":"https://doi.org/10.1177/08850666261486819","url":null,"abstract":"<p><p>The global burden of cancer is rising, and patients with malignancy who are critically ill account for 15%-20% of intensive care unit (ICU) admissions. A common indication for ICU admission is the presence of oncological emergencies that require organ support or close monitoring, while patients receive cancer therapy. The administration of chemotherapy in the ICU for selective patients with malignancy is feasible and is associated with considerable long-term survival and disease-free survival. Newer therapies such as targeted therapies and immunotherapies have significantly improved prognosis in malignancies that were considered terminal, and their use continues to increase exponentially. While indications surrounding chemotherapy treatment in the ICU are well documented, the role of these newer therapies in the setting of oncologic emergencies and critical illness is not well reported. This review summarizes the available evidence regarding the timing and indications for administration of chemotherapy and newer cancer regimens in the ICU for hematological and solid malignancies, its associated complications, emerging therapeutic options, and overall prognosis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261486819"},"PeriodicalIF":2.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074983","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":"The Influence of Chest CT Versus. Chest x-ray on the Management of Critically ill Patients: A Retrospective Study.","authors":"Stanislav Levintas, Avraham Meyer, Elad Dana, Sara Dichtwald","doi":"10.1177/08850666261493453","DOIUrl":"https://doi.org/10.1177/08850666261493453","url":null,"abstract":"<p><p>PurposeCritically ill patients admitted to the intensive care unit (ICU) often require computed tomography (CT) imaging. Previous studies have demonstrated the role of CT in this population in terms of changes in diagnosis and/or management, particularly among subgroups such as septic patients. In this study, we included ICU patients who underwent chest CT due to acute respiratory failure, and examined specifically whether chest x-ray (CXR) identified all findings later seen on CT, whether CT revealed additional diagnostic findings, and, importantly, whether these new findings led to changes in clinical management.MethodsRetrospective data collection from computerized medical systems regarding patients who underwent chest CT during ICU hospitalization with an indication of acute respiratory failure, from January 2020 to January 2023. The cohort included 45 patients who underwent 55 CT scans, which were compared to 55 corresponding chest x-rays. Demographic and in-hospital data were collected, as well as findings from both CT and CXR.ResultsA total of 45 patients undergoing 55 chest CT scans were included. The mean age was 55.24 years (SD = 19.6), and 60% were male. The main reasons for ICU admission were infection/sepsis (48.8%), primary respiratory failure (31.1%), and trauma (13.3%). Chest CT was performed after a median of 5 days [IQR 1-14] from ICU admission. Intravenous contrast was used in 52 cases (94.5%). CT identified new findings contributing to diagnosis in 31 scans (56.4%, 95% CI 43.3-68.6%). These new findings led to changes in clinical management in 17 cases (30.9%, 95% CI 20.3-44.0%), most commonly involving an invasive intervention.ConclusionAmong critically ill ICU patients undergoing evaluation for acute respiratory failure, chest CT contributed to diagnosis in over half of cases and changed patient management in one-third of cases compared with chest x-ray. Further studies are needed to confirm these findings.Registration noNCT07256860.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261493453"},"PeriodicalIF":2.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074961","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":"Association of Early-Onset Atrial Fibrillation and Estimated Atrial Fibrillation Burden with Mortality in Critically Ill Adults: A Landmark Cohort Study.","authors":"Anar Mammadli, Ayse Irem Demirtola, Onur Yildirim, Ardi Rreka, Erdem Diker","doi":"10.1177/08850666261490858","DOIUrl":"https://doi.org/10.1177/08850666261490858","url":null,"abstract":"<p><p>BackgroundNew-onset atrial fibrillation (AF) occurs in 5%-15% of non-cardiac-surgery intensive care unit (ICU) patients and is associated with increased mortality. Most studies classify AF over the entire ICU stay, introducing immortal time bias, and treat AF as binary, ignoring dose-response relationships.AimsTo estimate associations of early-onset AF and estimated AF burden with mortality using a 48-h landmark design.MethodsWe retrospectively analyzed Medical Information Mart for Intensive Care IV adults with at least 48 h of ICU observation whose first informative rhythm record indicated sinus rhythm, excluding cardiac-surgery patients. Early-onset AF and cumulative AF duration were estimated from intermittently charted rhythm records during the first 48 h; follow-up began at the landmark. Cox and logistic regression estimated adjusted associations with 28-day, 1-year, and in-hospital mortality.ResultsAmong 20,925 landmark survivors, 1650 (7.9%) had early-onset AF. After adjustment, early-onset AF was associated with 28-day (HR 1.22, 95% CI 1.10-1.36), 1-year (HR 1.12, 95% CI 1.03-1.22), and in-hospital mortality (OR 1.50, 95% CI 1.31-1.72). Proportional hazards were not met for 28-day mortality: the HR was 1.32 (95% CI 1.17-1.48) during days 0-14 after the landmark and 0.90 (95% CI 0.70-1.16) during days 15-28. Among AF-positive patients, each approximate doubling of estimated AF duration was associated with an 8% higher hazard of 28-day mortality (HR 1.08, 95% CI 1.01-1.16).ConclusionsAmong ICU patients who remained under observation and survived to a 48-h landmark, early-onset AF was associated with higher subsequent mortality, and longer estimated AF duration was modestly associated with mortality among AF-positive patients. These observational findings do not establish benefit from AF-directed treatment or reducing AF duration.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666261490858"},"PeriodicalIF":2.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039195","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}