SHOCK最新文献

{"title":"Multi-Center Machine Learning-Based Prediction of Mortality in ICU Patients with Hypocalcemia.","authors":"Liangpeng Xie, Linxuan Jiang, Mingxuan Xiao, Jiaowen Sheng, Xin Li, Chang Zhang","doi":"10.1097/SHK.0000000000002680","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002680","url":null,"abstract":"<p><strong>Background: </strong>Hypocalcemia occurs frequently in intensive-care units (ICUs) and is independently associated with excess mortality. Conventional severity scores-such as APACHE II and SOFA-assign fixed weights to a limited set of variables and therefore fail to capture the nonlinear, high-dimensional physiology characteristic of hypocalcemic patients. Although machine-learning (ML) approaches can enhance risk stratification, no interpretable model tailored to this cohort has been available.</p><p><strong>Methods: </strong>We harmonised de-identified data from MIMIC-III, MIMIC-IV and two Grade III Level A hospitals in China, generating a multicentre cohort of 13,979 adult ICU admissions with total serum calcium < 2.12 mmol L-1. MIMIC-IV records were randomly divided into a training set (n = 7,749) and an internal-validation set (n = 1,550). External validation employed MIMIC-III (n = 4,771) and the Chinese multicentre dataset (n = 209). Predictors were filtered with least-absolute-shrinkage-and-selection operator (LASSO) regression and applied to eight ML algorithms: logistic regression, k-nearest neighbors (KNN), support-vector machine, decision tree, random forest, artificial neural network, eXtreme Gradient Boosting (XGBoost) and LightGBM. Model discrimination, calibration and clinical utility were quantified using the area under the receiver-operating-characteristic curve (AUC), F1-score, sensitivity, specificity, calibration plots, decision-curve analysis (DCA) and clinical-impact curves (CIC). SHapley Additive exPlanations (SHAP) were used for interpretability, and the final model was deployed as a public web application.</p><p><strong>Results: </strong>LASSO retained 20 predictive variables; is_noninvasive_ventilator and hospital length of stay were the most influential in SHAP analysis. XGBoost provided the highest discrimination (AUC = 0.914; F1 = 0.844), surpassing logistic regression (AUC = 0.896; F1 = 0.829), LightGBM (AUC = 0.909; F1 = 0.816) and conventional ICU scores. Calibration curves, DCA and CIC confirmed consistent performance and superior net benefit across internal and external validation cohorts.</p><p><strong>Conclusions: </strong>We present and externally validate an interpretable, high-performance ML model that predicts in-hospital mortality in hypocalcemic ICU patients more accurately than established scoring systems. The SHAP-enabled web interface provides real-time, patient-specific risk estimates, facilitating data-driven clinical decisions within the early, critical window of ICU care.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144744620","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":"Role of Ifi204 in Modulating NF-κB Pathway and Myocardial Protection in Ischemia-Reperfusion Injury.","authors":"Zhi Xing, Shajidan Abudureyimu, Palida Abulaiti, Yu Wang, MaoLin Lyu, Ying Gao","doi":"10.1097/SHK.0000000000002677","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002677","url":null,"abstract":"<p><strong>Abstract: </strong>Ischemia-reperfusion (I/R) injury remains a major contributor to myocardial damage, significantly impacting cardiovascular morbidity and mortality. This study identifies key genes and pathways involved in I/R-induced myocardial injury through differential gene expression (DEG) analysis and weighted gene co-expression network analysis (WGCNA). Functional enrichment analyses, including Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Disease Ontology (DO), highlight the involvement of immune response and oxidative stress pathways in I/R injury. Machine learning approaches, such as LASSO, Support Vector Machine Recursive Feature Elimination (SVM-RFE), and Random Forest (RF), were employed to identify feature genes predictive of I/R progression, with Ifi204 emerging as a critical factor. The role of interferon-induced protein 204 (Ifi204) in myocardial protection during I/R injury was further explored using a heart-specific Ifi204 knockout (KO) mouse model. The effects of Ifi204 deficiency on myocardial injury, inflammation, and oxidative stress were assessed. Notably, heart-specific Ifi204 KO mice demonstrated reduced myocardial infarct size, improved heart function, and lower serum markers of myocardial injury, including creatine kinase (CK), lactate dehydrogenase (LDH), and cardiac troponin T (cTnT). These mice also exhibited attenuated oxidative stress and suppressed NF-κB signaling, as evidenced by reduced malondialdehyde (MDA) levels and increased superoxide dismutase (SOD) activity. Furthermore, overexpression of Ifi204 in primary cardiomyocytes enhanced the inflammatory response via NF-κB activation, leading to increased secretion of pro-inflammatory cytokines, such as TNF-α and IL-6. These effects were mitigated by NF-κB inhibition, suggesting that Ifi204 modulates inflammation through NF-κB signaling. This study provides new insights into the molecular mechanisms underlying myocardial I/R injury and positions Ifi204 as a potential therapeutic target for cardiovascular diseases.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776088","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":"Tissue perfusion and fluid responsiveness assessment in critically ill patients. A feasibility pilot study using the IKORUS urothelial plethysmography device.","authors":"Adrian Wong, Rory McDonald, Nurul Liana Roslan, Kate Bramham, Sam Hutchings","doi":"10.1097/SHK.0000000000002672","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002672","url":null,"abstract":"<p><strong>Background: </strong>Accurate assessment of tissue perfusion is challenging. Commonly used markers like lactate levels and central venous oxygen saturation are indirect, intermittent, and provide a global picture of circulatory status which may not reflect perfusion at the organ level. The urethral perfusion index (UPi), measured through a specialized urinary catheter, is a novel technique that offers continuous, real-time monitoring of perfusion in a central tissue bed, potentially providing more immediate and targeted clinical information.</p><p><strong>Objectives: </strong>1. To assess the correlation between changes to left ventricular outflow tract velocity time integral (LVOT VTi) and UPi following a fluid challenge.2. To assess the relationship between UPi and other markers of tissue perfusion.</p><p><strong>Design: </strong>Interventional, feasibility pilot study.</p><p><strong>Setting: </strong>Single-centre, study conducted at a tertiary-level institution in the United Kingdom. All patients were mechanically ventilated adults, whom the primary clinical team thought would benefit from a fluid challenge.</p><p><strong>Intervention: </strong>A fluid challenge (FC) was defined as a 250 ml bolus of crystalloid solution.</p><p><strong>Main outcome measures: </strong>Focused transthoracic echocardiogram measured LVOT VTi and UPi, measured pre- and post-FC.</p><p><strong>Results: </strong>There were no reported complications associated with device use or insertion. Mean duration of data recorded was 19 hours and the Signal Quality Index of the UPi trace was high (93%). There was a moderate positive correlation between the time matched values of UPi and LVOT VTi (Spearman r = 0.55, p < 0.0001), R2 value of 0.272. However, there was no discernible correlation seen between change in UPi and VTi following fluid (Spearman r = 0.24, p = 0.14). Patients with below-average UPi at baseline had evidence of poorer systemic tissue perfusion, as measured by lactate concentration and capillary refill time, and received more vasoactive drugs.ConclusionUPi may be a marker of tissue perfusion in a diverse group of critically ill patients. With further evaluation it may, therefore, present a future therapeutic target. Although there is some relationship between LVOT VTi and UPi, it is not precise enough to be used as a marker of fluid responsiveness.Trial registration: London Southeast Research and Ethics Committee (22/LO/0911).</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144744623","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":"Macrophages in Septic Cardiomyopathy: Heterogeneity, Function, and Therapy.","authors":"Keke Wu, Yuliang Ma, Yuchen Wang, Rong Wei, Dandong Fang, Weiqin Li","doi":"10.1097/SHK.0000000000002683","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002683","url":null,"abstract":"<p><strong>Abstract: </strong>Sepsis is a life-threatening condition characterized by multiple organ dysfunction resulting from a dysregulated host immune response to infection. Septic cardiomyopathy (SCM), one of the most severe complications of sepsis, manifests as myocardial tissue injury and functional impairment and serves as a primary contributor to mortality in septic patients. Macrophages, pivotal innate immune cells in the heart, are classified into distinct subsets based on their developmental origins and microenvironmental cues. The dual roles of macrophage subsets-mediating both injury and protection-during the pathogenesis of SCM remain under active investigation. This review delineates the heterogeneity of macrophage subsets in sepsis and their cardiac implications, with a focus on elucidating the molecular mechanisms underlying macrophage-mediated cardiac injury (e.g., secretion of myocardial depressant substances, inflammatory responses, induction of mitochondrial dysfunction, mediation of ferroptosis) and protective processes (e.g., anti-inflammatory responses, phagocytic repair). These insights aim to provide a theoretical foundation for developing targeted immunomodulatory therapies and precise interventions directed at the cardiac immune microenvironment.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699394","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":"Novel Susceptibility Genes for Sepsis Revealed by a Cross-Tissue Transcriptome-Wide Association Study.","authors":"Linfeng Tao, Ning Zhu, Yue Zhu, Chao Li, Yiyuan Pan, Yan Chen, Jun Liu","doi":"10.1097/SHK.0000000000002652","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002652","url":null,"abstract":"<p><strong>Background: </strong>Sepsis, a life-threatening syndrome triggered by a dysregulated host response to infection, continues to impose a substantial global health burden. Advances in genomics and transcriptomics now enable systematic exploration of sepsis pathogenesis at the genetic level. The integration of genome-wide association studies (GWAS) and transcriptome-wide association studies (TWAS) offers a powerful framework to identify causal genetic variants and delineate molecular mechanisms underlying sepsis susceptibility and clinical outcomes.</p><p><strong>Methods: </strong>A cross-tissue TWAS was implemented using UTMOST to integrate sepsis GWAS summary statistics with transcriptomic data from the Genotype-Tissue Expression version 8 (GTEx v8) project. Candidate genes were validated through complementary approaches: FUSION, FOCUS, and MAGMA. Tissue-specific and pathway enrichment analyses were applied to prioritize sepsis-associated genes and characterize their functional roles in disease-relevant biological processes. Bayesian colocalization and two-sample Mendelian randomization (MR) analyses were employed to infer putative causal relationships between prioritized genes and sepsis risk.</p><p><strong>Results: </strong>Four genes-ZCCHC4, PDGFB, C18orf54, and ATG4B-demonstrated significant associations with sepsis susceptibility in cross-tissue analyses. Two-sample MR provided evidence for causal effects of genetically regulated expression of these genes on sepsis risk. Bayesian colocalization identified shared causal variants between sepsis-associated loci and expression quantitative trait loci (eQTLs), implicating dysregulation of inflammatory and autophagy pathways in sepsis pathogenesis.</p><p><strong>Conclusion: </strong>Our results highlight the efficacy of cross-tissue TWAS in mapping sepsis-associated loci and elucidating the genetic architecture underlying sepsis susceptibility. These prioritized loci constitute compelling targets for functional validation and represent actionable candidates for therapeutic intervention in sepsis.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699396","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":"Advances in Research Pertaining to Biomarkers for Myocardial Injury in Sepsis.","authors":"Liu Yang, Jun-Kai Feng, Peng-Xin Gong, Li-Nong Yao, Pu Li","doi":"10.1097/SHK.0000000000002678","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002678","url":null,"abstract":"<p><strong>Abstract: </strong>Sepsis is a life-threatening syndrome characterized by acute organ dysfunction caused by a dysregulated host response to infection, often complicated by multi-organ injury. Myocardial injury occurs in approximately 40% of patients with sepsis, and failure to promptly recognize and manage this condition may result in missed treatment windows, disease exacerbation, and increased mortality. Sepsis-induced myocardial injury is reversible, and early diagnosis coupled with timely intervention can significantly reduce mortality. However, due to the unclear underlying pathophysiology and the absence of a definitive gold standard for diagnosis, conventional biomarkers of myocardial injury offer limited diagnostic utility. Emerging biomarkers such as high-mobility group box 1 protein (HMGB1), microRNAs, and growth differentiation factor-15 (GDF15) are currently being explored to understand their potential role in early detection and prognostic assessment. In this review, recent research advances in both traditional and novel biomarkers associated with sepsis-induced cardiomyopathy have been summarized, providing insights into their clinical applications and future research directions.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699390","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":"HISTONE LACTYLATION IN IMMUNE CELLS AND ITS PREDICTIVE ROLE IN SEPSIS PROGRESSION: A PROSPECTIVE OBSERVATIONAL STUDY.","authors":"Yuqian Guo, Lihua Chu, Weiwei Shui, Huiyi Hu, Liman Hao, Dongdong Wang, Sengwen Song, Xiangming Fang, Guohao Xie","doi":"10.1097/SHK.0000000000002659","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002659","url":null,"abstract":"<p><strong>Background: </strong>Sepsis, a life-threatening condition caused by infection, induces dysregulated immune responses. Lactylation is a lactate-derived post-translational modification with roles in various cellular processes. We investigated lactylation levels in the immune cells of patients with sepsis and evaluated their association with disease progression.</p><p><strong>Methods: </strong>In this prospective cohort study, blood samples were collected on days 1 and 3 from 58 intensive care unit patients, including critically ill controls and sepsis patients (survivors and non-survivors). Biochemical and clinical data were analyzed, and immune cells were isolated to measure pan-lysine lactylation (Pan Kla), H4K5la, and H3K56la levels using flow cytometry.</p><p><strong>Results: </strong>Patients with sepsis exhibited significantly elevated neutrophil H4K5la levels compared with critically ill controls on day 1 (231.6 [174.9 - 361.9] vs. 127.5 [69.4 - 168.9] mean fluorescence intensity [MFI], P < 0.0001); similar trends were observed in monocytes, B cells, and T cells. Multivariate analysis identified neutrophil H4K5la levels as an independent predictor of sepsis. The combination of day 1 neutrophil H4K5la and C-reactive protein (CRP) levels improved diagnostic performance (area under the receiver operating characteristic curve = 0.902 [95% confidence interval, 0.795 - 0.964]). On day 3, non-survivors showed lower lactylation levels than survivors (monocyte Pan Kla: 79.8 [54.9 - 106.1] vs. 133.2 [112.3 - 259.2] MFI, P = 0.0334; T-cell H3K56la: 15.5 [8.2 - 28.1] vs. 37.2 [23.9 - 71.4] MFI, P = 0.0143).</p><p><strong>Conclusions: </strong>Immune cell lactylation may serve as a biomarker for sepsis progression. The combination of neutrophil H4K5la and CRP enhances early diagnostic accuracy; reduced lactylation on day 3 may indicate poor prognosis.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643353","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":"Question regarding image manipulation in the following manuscript*. Mechanisms of the beneficial effects of hypertonic saline solution in acute pancreatitis. Shock 34(5):p 502-507, November 2010. | DOI: 10.1097/SHK.0b013e3181defaa1 pubmed: 20351627.","authors":"Marcel Cerqueira Cesar Machado","doi":"10.1097/SHK.0000000000002670","DOIUrl":"10.1097/SHK.0000000000002670","url":null,"abstract":"","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776087","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":"Beyond acute kidney injury, traumatic rhabdomyolysis associated to hemorrhagic shock is responsible for multiple-organ failure in a rat model.","authors":"Thibault Martinez, Elisabeth Laemmel, Benjamin Bergis, Mathilde Rustin, Alice Huertas, Anatole Harrois, Nicolas Libert","doi":"10.1097/SHK.0000000000002668","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002668","url":null,"abstract":"<p><strong>Introduction: </strong>In severe trauma patients, rhabdomyolysis (RM) and hemorrhagic shock (HS) usually coexist but combined impact of RM and HS has rarely been analyzed. In this study, we aimed to explore simultaneous exposure to RM and HS to investigate our hypothesis that double insult is responsible for multi-organ failure leading to excess mortality.</p><p><strong>Methods: </strong>88 anesthetized male rats were subjected to glycerol-induced RM (three increasing doses of glycerol from 2 to 8 ml/kg) and/or controlled HS (target hypotension = 35 mmHg). Survival time and blood pressure were monitored. Analyses of serum biomarkers for the heart, brain, liver, and kidneys, along with cytokine measurements and histological examinations of the kidneys, liver, and intestine, were conducted.</p><p><strong>Results: </strong>The co-occurrence of RM and HS led to precocious and dose-dependent mortality compared to groups with only one injury. This double insult was accompanied by severe, multi-organ damage marked by histological lesions in the kidneys, liver, and intestine, which were associated with elevated corresponding biological parameters. Moreover, biomarkers for the brain (NSE, protein S100) and heart were increased in cases of dual insult. Lastly, HS and RM association was responsible for intense lactic acidosis and an explosive secretion of pro-inflammatory cytokines.</p><p><strong>Conclusions: </strong>We developed a rat model to study the synergistic effects of RM and HS, showing that combined injuries caused RM dose-dependent mortality, multi-organ damage and severe inflammation. Further research is needed to elucidate the underlying pathophysiological mechanisms of this synergy.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699392","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 Between Cuff Leak Test Results and Reintubation Risk: A Retrospective Analysis.","authors":"Jiawang Cao, Qing Liu, Zhaojin Wang, Yanmei Gu","doi":"10.1097/SHK.0000000000002674","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002674","url":null,"abstract":"<p><strong>Background: </strong>Post-extubation airway obstruction represents a significant complication in critical care, potentially necessitating reintubation and prolonging intensive care unit (ICU) stay. The cuff leak test (CLT) is commonly used to predict post-extubation stridor and reintubation risk, but its clinical utility remains controversial. This study evaluated the relationship between CLT results and reintubation risk in a large cohort of critically ill patients.</p><p><strong>Methods: </strong>This single-center, retrospective, descriptive study analyzed 742 adult patients admitted to the medical and surgical ICUs who underwent mechanical ventilation for ≥24 hours between January 2020 and December 2024. The primary outcome was reintubation within 48 hours of planned extubation. Quantitative cuff leak volume measurements were performed pre-extubation, with leak volume expressed as absolute values and percentage of tidal volume. Multivariable logistic regression was used to identify independent predictors of reintubation, including CLT results and patient characteristics.</p><p><strong>Results: </strong>Of the 742 patients studied, 68 (9.2%) required reintubation within 48 hours. Patients with a cuff leak volume < 110 mL or < 15% of tidal volume had significantly higher reintubation rates (18.7% vs. 7.1%, p < 0.001). After adjusting for confounding variables, a positive CLT (defined as cuff leak volume < 110 mL) remained independently associated with reintubation (adjusted OR 2.86, 95% CI 1.65-4.97, p < 0.001). Other significant independent predictors included prolonged intubation (>7 days), female sex, body mass index >30 kg/m2, and traumatic or difficult intubation. Combining CLT results with these clinical risk factors improved prediction accuracy (AUC 0.82, 95% CI 0.76-0.87).</p><p><strong>Conclusion: </strong>A positive cuff leak test is independently associated with increased reintubation risk in critically ill patients. The predictive accuracy is enhanced when CLT results are combined with clinical risk factors. These findings suggest that CLT should be incorporated into extubation decision-making, particularly for patients with additional risk factors for post-extubation airway complications.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699391","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}