SHOCK最新文献

{"title":"Metabolic Syndrome and In-Hospital Mortality in Sepsis: A Multicenter Cohort Study Revealing a Severity-Dependent Survival Advantage Driven by Overweight and Hyperlipidemia.","authors":"Yining Zhang, Guoxiang Liu, Xianxian Yu, Zhaoming Shang, Hui Liu, Huailong Shang, Wenwu Sun, Chao Li, Xiao Cui, Jiameng Chen, Junwei Qian, Wenzhen Zhou, Enqiang Mao, Mingquan Chen, Chengjin Gao","doi":"10.1097/SHK.0000000000002910","DOIUrl":"10.1097/SHK.0000000000002910","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between metabolic syndrome (MetS) and in-hospital mortality in sepsis patients and to determine whether this association varies according to disease severity and individual MetS-related components.</p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Three tertiary hospitals in China.</p><p><strong>Patients: </strong>A total of 2,973 adult patients with sepsis admitted between September 2015 and May 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>MetS was defined according to the criteria of the Chinese Diabetes Society. The primary outcome was in-hospital mortality. Multivariable Cox regression, subgroup analyses, interaction analyses, and Kaplan-Meier survival analyses were performed. MetS was present in 1,309 patients (44.0%). Patients with MetS had a higher in-hospital survival rate than those without MetS (78.4% vs. 72.8%, P = 0.001). After adjustment for potential confounders, MetS remained independently associated with lower in-hospital mortality. A significant interaction was observed between MetS and SOFA-defined severity strata, indicating a severity-dependent association. The survival advantage of MetS was mainly confined to patients with mild-to-moderate sepsis and was primarily driven by overweight and hyperlipidemia. In addition, these two metabolic features were associated with more favorable physiologic profiles, including lower inflammatory burden and better preservation of nutritional and cardiometabolic indices.</p><p><strong>Conclusions: </strong>MetS was associated with lower in-hospital mortality in sepsis, particularly in patients with mild-to-moderate disease severity. This association appeared to be largely driven by overweight and hyperlipidemia, supporting a stage-specific prognostic role of metabolic phenotypes in sepsis.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1107-1113"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520883","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":"Irisin is associated with survival in sepsis and attenuates macrophage pro-inflammatory responses with involvement of AMPK signaling.","authors":"Sejoong Ahn, Ji Hoon Jeon, Minsuk Jung, Jooyun Kim, Bo-Yeong Jin, Yunsang Choi, Jong-Hak Park, Hyeri Seok, Won Suk Choi, Hyeon Soo Kim, Jaroslaw W Zmijewski, Dae Won Park","doi":"10.1097/SHK.0000000000002946","DOIUrl":"10.1097/SHK.0000000000002946","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a leading cause of morbidity and mortality, yet effective targeted therapies remain limited. We evaluated the prognostic significance of irisin, a myokine, in sepsis cohort and examined its immunomodulatory effects on macrophages using a translational approach.</p><p><strong>Methods: </strong>Patients were enrolled in a prospectively collected sepsis registry and biobank. Multivariable Cox proportional hazards model was conducted to assess independent association between irisin and 30-day mortality. Mechanistic studies used macrophages ex vivo and a murine cecal ligation and puncture (CLP) model.</p><p><strong>Results: </strong>Higher serum irisin was independently associated with lower 30-day mortality (adjusted hazard ratio 0.955, 95% confidence interval 0.913-0.999, p=0.044) in patients with sepsis (N=655). Irisin showed modest discrimination for 30-day mortality (AUROC 0.609), with no statistically significant difference from lactate (AUROC 0.652; p=0.145). In vitro , irisin suppressed LPS-induced pro-inflammatory cytokine production, preserved AMPK phosphorylation, attenuated IκBα degradation, and reduced pro-inflammatory markers in macrophages. Several of these cellular effects were attenuated following AMPKα1 depletion. In vivo , irisin improved 7-day survival after CLP (75% vs. 36%, p<0.05) and reduced systemic inflammatory cytokines at 24 hours.</p><p><strong>Conclusions: </strong>Higher serum irisin was independently associated with lower 30-day mortality in patients with sepsis, although its standalone discriminatory performance was modest. Experimental findings further showed that irisin improved survival and attenuated macrophage inflammatory responses, with AMPK signaling contributing to several cellular effects. These findings support further evaluation of irisin as part of integrated prognostic assessment and investigation of irisin-related signaling in sepsis.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184143","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":"Fibrinolytic Activation and Its Association with Mortality After Traumatic and Thermal Injury.","authors":"Amanda M Soo Ping Chow, Tuan D Le, Desiree N Pinto, Melissa McLawhorn, Lauren T Moffatt, Thomas Orfeo, Kalev Freeman, Rachael A Callcut, Mitchell J Cohen, Jeffrey W Shupp, Anthony E Pusateri","doi":"10.1097/SHK.0000000000002948","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002948","url":null,"abstract":"<p><strong>Objective: </strong>Characterize plasma markers of fibrinolytic activation and their associations with mortality in burn and trauma patients from hospital admission through 48 hours.</p><p><strong>Summary background information: </strong>Fibrinolytic activation following burn and non-burn trauma is associated with increased mortality. Whether fibrinolytic activation differs between burn and non-burn injury is unknown.</p><p><strong>Methods: </strong>Adult patients aged 18 years and older who presented to one of two regional trauma centers or one regional burn center within 4 hours of injury were included. Blood was collected at admission and at hours 2, 4, 6, 8, 12, 24, 36, and 48. Plasmin-antiplasmin complex (PAP), D-dimer, and plasminogen concentrations in plasma were determined.</p><p><strong>Results: </strong>Of 590 patients, 58.3% presented with blunt, 27.1% with thermal, and 14.6% with penetrating injury. Admission PAP and D-dimer were higher in trauma (blunt and penetrating groups combined) than in burn patients (p<.001). Non-survivors (injury types combined) had higher PAP and D-dimer and lower plasminogen (p<.001) at admission and over time. After adjusting for age, injury severity and % total body surface area burned, admission PAP ≥1645.6 ng/mL was associated with 7.0 times higher odds for mortality (p=.002) and D-dimer ≥6.5 µg/mL was associated with 5.0 times higher odds for mortality (p=.01). Changes in biomarkers over time were similar between trauma and burn patients.</p><p><strong>Conclusions: </strong>Higher fibrinolytic activation was associated with mortality in trauma and burn patients. Trauma patients had higher fibrinolytic activation markers than burn patients, while patterns of change were similar. Data suggest potential for use of similar resuscitative adjuncts to mitigate early fibrinolytic dysfunction in trauma and burns.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183971","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":"Opsonic Peptide MOP3 Attenuates Ischemic Acute Kidney Injury.","authors":"Megan Tenet, Hui Jin, Monowar Aziz, Ping Wang","doi":"10.1097/SHK.0000000000002949","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002949","url":null,"abstract":"<p><strong>Background: </strong>Renal ischemia/reperfusion (I/R) induced acute kidney injury (AKI) is a common and serious condition characterized by renal dysfunction, inflammation, tubular injury, and cell death. Extracellular cold-inducible RNA-binding protein (eCIRP) is a damage-associated molecular pattern that contributes to inflammation and tissue injury. MFG-E8-derived oligopeptide 3 (MOP3) is an opsonic peptide that binds eCIRP and promotes its phagocytic clearance. Here, we investigated the therapeutic effects of MOP3 in a murine model of renal I/R-induced AKI.</p><p><strong>Methods: </strong>Mice were subjected to 30 minutes of bilateral renal ischemia and treated with MOP3 or vehicle at the onset of reperfusion. Blood and kidney tissues were collected 20 h later. Renal inflammation, kidney function, tubular injury markers, histological damage, and cell death were assessed by RT-qPCR, biochemical assays, Western blotting, hematoxylin and eosin staining, and TUNEL staining.</p><p><strong>Results: </strong>MOP3 treatment reduced circulating eCIRP by 40% and renal IL-6, IL-1β, MIP-2, and KC mRNA expression by 43%, 84%, 73%, and 69%, respectively, compared with vehicle treatment. Serum urea nitrogen, creatinine, and NGAL levels were reduced by 56%, 63%, and 44%, respectively, after MOP3 treatment. MOP3 also decreased renal KIM-1 and NGAL mRNA expression by 88% and 44% and reduced their protein levels by 29% and 45%, respectively. Furthermore, MOP3 attenuated renal tubular injury and decreased TUNEL-positive cells.</p><p><strong>Conclusions: </strong>These findings demonstrate that MOP3 attenuates inflammation, renal dysfunction, tubular injury, and cell death following renal I/R, suggesting that MOP3 may represent a promising therapeutic strategy for ischemic AKI.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184174","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 Simple Platelet-Centered Coagulation-Inflammation Combined Score for Predicting In-Hospital Mortality in Sepsis.","authors":"Xiaoling Li, Ziyang Cao, Zhen Lei, Lihong Liu, Wanqi Sun, Juan Chen, Xiaohong Wang","doi":"10.1097/SHK.0000000000002947","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002947","url":null,"abstract":"<p><strong>Objective: </strong>Accurate mortality prediction in sepsis requires assessing coagulation and inflammatory disturbances, yet existing scores are complex or incompletely capture these interconnected processes. We developed and internally validated a simple score combining inflammatory and platelet-related indicators with clinical parameters to predict in-hospital mortality in sepsis.</p><p><strong>Methods: </strong>This retrospective study included 6175 adults with sepsis from the MIMIC-IV database. Patients were randomly divided into training (n=4322) and validation (n=1853) cohorts. Candidate predictors were screened by least absolute shrinkage and selection operator regression, and final variables entered multivariable logistic regression to construct the Coagulation-Inflammation Combined Score (CICS). Performance was assessed by discrimination, calibration, internal bootstrap validation, and decision curve analysis.</p><p><strong>Results: </strong>Of 6175 patients, 807 (13.1%) died during hospitalization. The final CICS incorporated five routinely available variables: lactate, Glasgow Coma Scale score, age, neutrophil-to-lymphocyte ratio, and platelet count. Discrimination was good, with area under the receiver operating characteristic curve 0.768 (95% CI, 0.747-0.788) in training and 0.806 (95% CI, 0.776-0.835) in validation cohorts, comparable to SOFA (DeLong P=0.526 and P=0.180). Calibration was acceptable (Brier scores 0.102 and 0.091). Bootstrap validation indicated minimal optimism, and decision curve analysis showed exploratory findings across clinically relevant thresholds.</p><p><strong>Conclusions: </strong>The CICS is a parsimonious prognostic score using five routinely available variables from the first 24 hours after ICU admission. It showed discrimination comparable to SOFA, acceptable calibration, and favorable decision-curve performance. CICS should be interpreted as a separate prognostic score for early ICU stratification once first-24-hour data are available, rather than for emergency department triage or ICU admission decisions.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138162","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":"Gut Microbiota Modulation Attenuates Myocardial Ischemia-Reperfusion Injury in Diabetic Mice.","authors":"Kanako Takahashi, Yusuke Yoshikawa, Tomohiro Chaki, Michiaki Yamakage","doi":"10.1097/SHK.0000000000002882","DOIUrl":"10.1097/SHK.0000000000002882","url":null,"abstract":"<p><strong>Background: </strong>The gut microbiome is increasingly being recognized as a regulator of cardiometabolic health; however, whether the microbiome interventions can attenuate myocardial ischemia-reperfusion injury (IRI) in diabetic hearts remains unclear. Therefore, we tested whether fecal microbiota transplantation (FMT) from lean nondiabetic donors could mitigate myocardial IRI in type 2 diabetes mellitus db/db mice and explored candidate taxa associated with protection.</p><p><strong>Methods: </strong>Male db/db mice (type 2 diabetes mellitus model) received a 14-day course of FMT from lean db/m donors or a vehicle after antibiotic pretreatment. Myocardial IRI was induced, and infarct size was quantified. The gut microbiota was evaluated by 16S rRNA gene sequencing.</p><p><strong>Results: </strong>FMT significantly reduced the infarct size as a percentage of the area at risk compared to the IRI group (38.7 ± 13.4% vs. 58.7 ± 4.3%, P = 0.003). Microbiome analysis revealed that among alpha-diversity metrics, only the Simpson index differed between the donor and diabetic groups. In beta-diversity analyses, diabetic mice clustered separately from donor mice, and the microbiome intervention induced a modest but significant shift detected by the presence or absence of Unweighted UniFrac. Differential abundance analysis and exploratory linear discriminant analysis effect size further suggested Akkermansia , particularly A. muciniphila , as a candidate taxon reduced in diabetic mice and partially restored after the FMT intervention.</p><p><strong>Conclusion: </strong>A donor-derived microbiome intervention attenuated myocardial IRI in db/db mice and was accompanied by partial remodeling of the gut microbiota. A. muciniphila emerged as a candidate taxon associated with a reduced susceptibility to IRI in diabetic hearts.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1011-1020"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219585","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":"Alteplase and Methylprednisolone Associated Treatment Modulate Microcirculation and Inflammation in Brain Death Donors.","authors":"Lucas Ferreira da Anunciação, Marina Vidal-Dos-Santos, Caio Medeiros Fernandes, Fernanda Yamamoto Ricardo-da-Silva, Mayara Munhoz de Assis Ramos, Brunella Valbão Flora Agostinho, Pedro Luiz Zonta de Freitas, Ana Cristina Breithaupt-Faloppa, Cristiano Jesus Correia, Luiz Felipe Pinho Moreira","doi":"10.1097/SHK.0000000000002896","DOIUrl":"10.1097/SHK.0000000000002896","url":null,"abstract":"<p><strong>Introduction: </strong>Brain death (BD) triggers systemic inflammation, platelet aggregation, and thrombus formation, which compromise organ quality. This study evaluated the effects of the fibrinolytic alteplase alone and in combination with methylprednisolone, following BD induction.</p><p><strong>Methods: </strong>Wistar rats were randomized into four groups: sham (animals without BD), BD (animals subjected to BD), recombinant tissue plasminogen activator (rTPA) (animals with BD and alteplase treatment), and rTPA + P (animals with BD and alteplase and methylprednisolone treatment). The analyzed parameters included mesenteric microcirculation perfusion, inflammatory mediators, platelet aggregation, coagulation, and histology.</p><p><strong>Results: </strong>Improvements in mesenteric microcirculatory flow following alteplase were observed. This effect is likely related to the modulatory action of alteplase on platelet aggregation, along with an increase in vascular density, which occurred in association with a decrease in endothelin-1 levels. Combined therapy demonstrated an additional beneficial effect by modulating the inflammatory cascade, including significant reductions in Interleukin-6 (IL-6), Interleukin-10 (IL-10), and Vascular Endothelial Growth Factor, as well as improving leukocyte-endothelial interactions in the mesentery. Importantly, alteplase did not cause detectable damage to any of the studied organs.</p><p><strong>Conclusion: </strong>Alteplase treatment prevented platelet aggregation and improved microcirculation. When combined with methylprednisolone, it also modulated the inflammatory response. These findings suggest that alteplase treatment has a potential benefit in maintaining the quality of brain-dead donors.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"984-995"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284361","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":"Shock Synopsis October 2026.","authors":"Daniel Remick","doi":"10.1097/SHK.0000000000002912","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002912","url":null,"abstract":"","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":"66 4","pages":"871-873"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945679","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":"Research Progress of Sepsis Immunotherapy: A Bibliometric Analysis.","authors":"Zixia Wang, Xiangyang Li, Junqiang Zhang","doi":"10.1097/SHK.0000000000002826","DOIUrl":"10.1097/SHK.0000000000002826","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis results in critical organ failure, considerable global mortality, and poses treatment obstacles. The primary issue with its pathophysiology is the improper functioning of the immune system in two phases: initially, there is excessive inflammation, followed by insufficient inflammation. This has generated interest in immunotherapy to restore the immune system to its normal state. This bibliometric analysis mapped the evolving research landscape of sepsis immunotherapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Articles and reviews related to sepsis immunotherapy, published between January 1, 2000, and December 31, 2025, in the Web of Science Core Collection, were retrieved, and bibliometric visualization analysis was performed using tools such as VOSviewer, CiteSpace, Scimago Graphica, Charticulator, and the R package bibliometrix.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A bibliometric analysis of 768 papers (2000-2025) indicates that the domain of sepsis immunotherapy research is seeing rapid expansion and dynamism. The annual publication rate is increasing exponentially, from an average of 11.3 per year (2000-2015) to 69.4 per year (2021-2025), reaching a peak of 79 in 2024. The United States tops the list with 246 articles and an H-index of 55, while China ranks second with 174 publications but exhibits a significantly lower citation impact. The analysis of collaborative networks reveals that the United States serves as a global hub with strong connections to China and European nations, while the European clusters maintain significant interconnections as well. The evolution of keywords delineates four distinct research phases: 2000-2005: focus on anti-inflammatory strategies targeting pivotal mediators such as tumor necrosis factor and cytokines; 2006-2012: shift toward acknowledging clinical complexity and immunosuppression while broadening research at the cellular level; 2013-2018: 2019-2025: in the context of the coronavirus disease 2019 pandemic, a phase of integration and response to emerging challenges marked by diverse clinically oriented advancements in immunomodulation, diagnosis, and integrated management. Journals like Frontiers in Immunology published the most number of articles (58), while the 2016 Sepsis-3 Consensus by Singer et al. was the most cited reference, underscoring its considerable influence. Joint citation analysis revealed that the Global Burden Study 2020 and the Sepsis-3 Consensus by Rudd et al. were the pivotal publications with the highest citation counts and prevalence intensity, respectively, highlighting their significance as foundational sources of information.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This bibliometric analysis shows how quickly research on immunotherapy for sepsis is moving forward. It has gone from focusing on anti-inflammatory strategies to precision treatment methods based on biomarkers. The US is still the best at research results and influence, but the lack of coordination","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"892-911"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345114","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":"Adiponectin, Leptin, and Lipid Profiles Characterize a Metabolic High-Risk Phenotype in ICU Patients.","authors":"Eva Steinacher, Johannes Bernhard, Robert Zilberszac, Christian Hengstenberg, Lorenz Koller, Walter S Speidl, Konstantin A Krychtiuk, Max Lenz","doi":"10.1097/SHK.0000000000002814","DOIUrl":"10.1097/SHK.0000000000002814","url":null,"abstract":"<p><strong>Background: </strong>Critical illness triggers profound metabolic and inflammatory changes, yet interactions between adipokines and lipid metabolism remain poorly understood. This study examined the prognostic value of adiponectin, leptin, their ratio, and standard lipid parameters at intensive care unit (ICU) admission and explored their combined association with 30-day mortality.</p><p><strong>Methods: </strong>In this prospective, single-center study, 224 consecutive ICU patients were enrolled. Adiponectin and leptin were quantified by enzyme-linked immunosorbent assay, and standard lipid parameters, including total cholesterol and triglycerides, were measured at admission in the central laboratory.</p><p><strong>Results: </strong>Adiponectin levels were markedly elevated in nonsurvivors, whereas total cholesterol was significantly reduced (both P < 0.001). Both markers independently predicted 30-day mortality ( P < 0.001). Their combination defined a distinct high-risk phenotype (HALC: high adiponectin, low cholesterol) with a cumulative survival rate below 20%. Compared with patients exhibiting a low-risk phenotype, those in the HALC group had a hazard ratio of 12.888 ( P < 0.001). This finding was independent of age, sex, creatinine, and body mass index. While leptin and triglycerides showed no prognostic association in the overall cohort, both were significantly lower within the HALC group. Integrating adiponectin and cholesterol with the Simplified Acute Physiology Score II score further improved its predictive accuracy (area under the curve 0.85 vs. 0.81, P = 0.039).</p><p><strong>Conclusions: </strong>Adiponectin and total cholesterol are strong predictors of survival and appear to capture complementary aspects of critical illness. Their combination defines a high-risk phenotype with markedly reduced 30-day survival. The HALC profile may improve ICU outcome prediction by capturing metabolic dysregulation not captured by conventional scoring systems.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"941-949"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284993","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}