SHOCK最新文献

{"title":"A Bar-Based Nomogram for Predicting Septic Shock in Patients with Acute Pancreatitis Complicated by Sepsis: Development and External Validation.","authors":"Jiajing Xing, Xiaoli Xie, Weiwei Niu, Shuohui Li, Fanhao Lu, Kun Lei, Feng Gao, Shuxian Cheng, Limin Shi, Na Wang","doi":"10.1097/SHK.0000000000002864","DOIUrl":"10.1097/SHK.0000000000002864","url":null,"abstract":"<p><strong>Background: </strong>Septic shock is a common and life-threatening complication in patients with acute pancreatitis (AP) complicated by sepsis, yet rapid and accurate tools for early risk prediction remain limited in clinical practice. This study aimed to develop and externally validate a nomogram incorporating the blood urea nitrogen-to-albumin ratio (BAR) to predict the risk of progression to septic shock in this high-risk population.</p><p><strong>Methods: </strong>In this retrospective multicohort study, a total of 541 patients with AP complicated by sepsis were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and randomly divided into a training set (n = 379) and an internal validation set (n = 162) at a 7:3 ratio. An independent cohort of 295 patients from the Second Hospital of Hebei Medical University was used for external validation. Candidate variables collected within the first 24 hours of intensive care unit admission were screened using least absolute shrinkage and selection operator regression. A multivariable logistic regression model was constructed and visualized as a nomogram. Model performance was assessed using discrimination, calibration, and decision curve analysis.</p><p><strong>Results: </strong>Nine variables were selected to construct the nomogram, with BAR emerging as a key predictor. The model demonstrated good discriminatory performance, with areas under the receiver operating characteristic curve of 0.777 in the training cohort, 0.707 in the internal validation cohort, and 0.832 in the external validation cohort. Calibration curves showed good agreement between predicted and observed risks, and decision curve analysis indicated favorable clinical utility across a wide range of threshold probabilities. Net reclassification improvement analysis in the external validation cohort demonstrated that the BAR-based model significantly improved risk classification compared with the model including blood urea nitrogen alone (NRI = 0.247, 95% confidence intervals 0.008-0.486, P = 0.042).</p><p><strong>Conclusions: </strong>We developed and externally validated a BAR-based nomogram for early and individualized prediction of septic shock in patients with AP complicated by sepsis. This clinically interpretable tool may facilitate early risk stratification and support timely clinical decision-making in the intensive care setting.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"737-752"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779961","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":"Association of Arterial Blood Lactate Trajectories with 7-Day Mortality in Patients with Traumatic Brain Injury.","authors":"Lian Xie, Xuezhi Shi, Jiale Yang, Binli Ma, Gan Lin, Jinhu Li, Kun Wu, Huilin Zhang, Kaiyi Huang, Huasheng Tong","doi":"10.1097/SHK.0000000000002769","DOIUrl":"10.1097/SHK.0000000000002769","url":null,"abstract":"<p><strong>Background: </strong>While lactate has emerged as a promising biomarker for assessing the severity in traumatic brain injury (TBI), it fails to reflect the dynamic change of the disease. Thus, this study aims to investigate the relationship between arterial lactate trajectories and TBI.</p><p><strong>Methods: </strong>TBI patient data were extracted from the Medical Information Mart for Intensive Care IV database. The group-based trajectory modeling was employed to identify subgroups of lactate trajectories. Subsequently, the impact of lactate trajectories on mortality in TBI patients was analyzed using Cox proportional hazards models and doubly robust estimation methods.</p><p><strong>Results: </strong>Among 509 enrolled TBI patients, three lactate trajectories were established using group-based trajectory modeling. Kaplan-Meier analysis revealed that Trajectory 1 had the highest 7-day mortality. Multivariate Cox regression analysis showed that Trajectory 1 was an independent risk factor for 7-day mortality. The doubly robust analysis also similarly demonstrated that Trajectory 1 had a significantly higher mortality risk compared to other groups.</p><p><strong>Conclusion: </strong>Three lactate trajectories were found in TBI patients, and Trajectory 1 was identified as an independent risk factor for mortality. The study emphasizes the importance of dynamic monitoring to facilitate early identification and timely treatment of individuals in Trajectory 1 with potentially poor prognoses.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"619-627"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345088","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":"Inflammatory Cytokine and Chemokine Concentrations Pre- and Post-Ecmo: A Prospective Clinical Study.","authors":"Jeffrey D DellaVolpe, Qianqian Liu, Joel Michalek, Linda E Sousse","doi":"10.1097/SHK.0000000000002799","DOIUrl":"10.1097/SHK.0000000000002799","url":null,"abstract":"<p><strong>Objective: </strong>The expanded use of extracorporeal membrane oxygenation (ECMO) is driven by its documented benefits, including mitigation of hypercarbia, acidosis, and concomitant pulmonary vascular resistance. However, the potential contribution of ECMO to the systemic inflammatory response continues to halt clinical decisions to utilize the strategy. The objective of our study is to evaluate the role of inflammatory cytokines and chemokines in ECMO patients pre-ECMO and up to 48 hours post-ECMO.</p><p><strong>Methods: </strong>Blood samples from consenting adults who received ECMO treatment (either venovenous or venoarterial) were collected pre-ECMO and on day 1 or 2 post-ECMO cannulation immediately. Samples were analyzed by BioPlex assay, where antibodies and red and infrared fluorophores were attached to each surface of a bead, which was combined with the plasma sample. Biotinylated detection antibodies were added to quantify the analytes, and lasers read the color code of each bead and measured the fluorescence of the biotin-bound streptavidin conjugates.</p><p><strong>Results: </strong>Thirty-eight of the 46 analytes measured decreased post-ECMO initiation. The following analytes were significantly decreased between pre- and post-ECMO initiation: interleukin (IL)-16 ( P = 0.027), RANTES ( P = 0.022), IL-8 ( P = 0.022), interferon-gamma ( P = 0.025), and IL-9 ( P = 0.022).</p><p><strong>Conclusions: </strong>We have shown that baseline values of most of the inflammatory cytokines and chemokines are not exacerbated by placement on ECMO. Instead, we provide preliminary evidence that placement on ECMO may attenuate the inflammatory and immune response to cardiopulmonary injury. Further studies will increase the number of subject data analyzed and their timepoints.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"649-655"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345176","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":"Diffuse Correlation Spectroscopy for Noninvasive Monitoring of Peripheral Perfusion During Cardiogenic Shock and VA-ECMO Support: An Experimental Study.","authors":"Hiroki Matsushita, Kenta Ohba, Koki Kurono, Mikie Nakabayashi, Yuki Yoshida, Kei Sato, Hidetaka Morita, Masahiro Otake, Nana Hiraki, Masafumi Fukumitsu, Takuya Nishikawa, Kazunori Uemura, Toru Kawada, Masashi Ichinose, Yumie Ono, Keita Saku","doi":"10.1097/SHK.0000000000002842","DOIUrl":"10.1097/SHK.0000000000002842","url":null,"abstract":"<p><strong>Objective: </strong>In cardiogenic shock (CS), persistent microcirculatory impairment despite improved macrocirculatory parameters is associated with poor outcomes. Therapeutic strategies must therefore address both macro- and microcirculation. Conventional microcirculatory measures have limitations, especially during venoarterial extracorporeal membrane oxygenation support (VA-ECMO). Diffuse correlation spectroscopy (DCS) is a novel optical technique enabling continuous, noninvasive evaluation of microvascular blood flow. This study evaluated DCS for monitoring microcirculation in CS under VA-ECMO.</p><p><strong>Methods: </strong>Seven male beagle dogs (median weight 10.1 kg) underwent CS induction by coronary ligation followed by ventricular fibrillation (VF). VA-ECMO (80-100 mL·kg -1 ·min -1 ) was initiated 5 minutes after VF onset and maintained for 90 minutes under nonpulsatile flow. After stabilization, VA-ECMO flow was reduced from 100 to 30 mL·kg -1 ·min -1 , and mean arterial pressure (MAP) was increased to ≥65 mmHg using vasoconstrictors. Measurements included MAP, cardiac output, and microcirculatory parameters [DCS-derived blood flow index (BFI), perfusion index, skin blood flow, tissue oxygen saturation, mixed venous oxygen saturation, and lactate].</p><p><strong>Results: </strong>Coronary ligation caused progressive declines in MAP, cardiac output, and microcirculatory indices. MAP [median (interquartile range)] was 109.6 (95.8, 119.7) at baseline and 45.7 (26.3, 51.6) mmHg at CS onset. During VF, perfusion index became unmeasurable while BFI rapidly fell to near zero, detecting peripheral flow loss under nonpulsatile conditions. VA-ECMO initiation restored MAP and mixed venous oxygen saturation, with gradual recovery of BFI and skin blood flow. Reducing VA-ECMO flow lowered MAP [64.7 (62.3, 69.9) to 36.4 (34.4, 44.6) mmHg] and BFI [3.6 (3.4, 5.1) to 1.0 (0.8, 1.2) × 10 -9 ·cm 2 ·s -1 ]. Vasopressors increased MAP [83.1 (79.0, 89.1) mmHg] but failed to improve BFI [1.5 (1.3, 2.1) × 10 -9 ·cm 2 ·s -1 ], indicating persistent microcirculatory impairment.</p><p><strong>Conclusions: </strong>DCS continuously detected microvascular changes during CS and VA-ECMO support regardless of pulsatility. DCS may be useful for early identification of microcirculatory dysfunction and optimization of therapy in CS.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"829-840"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521485","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":"Multi-omics biomarkers in post cardiac arrest syndrome: From pathophysiological mechanisms to the potential prognostication.","authors":"Jingrun Yao, Meng Niu, Zhenxia Wang, Yusong Wang, Feng Zhu","doi":"10.1097/SHK.0000000000002933","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002933","url":null,"abstract":"<p><p>Post cardiac arrest Syndrome (PCAS) is a systemic ischemia-reperfusion injury (IRI) that occurs after the return of spontaneous circulation (ROSC), characterized by endothelial dysfunction, systemic inflammatory response syndrome (SIRS), and multiple organ failure (MOF). This review focuses on the pathophysiological mechanisms, dynamic change patterns, and prognostic predictive value of three key categories of biomarkers in PCAS: inflammatory factors, endothelial injury biomarkers, and neuronal injury biomarkers. It covers the dual roles of inflammatory mediators such as Interleukin-6 (IL-6), Interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and procalcitonin (PCT); the early warning value of syndecan-1 (SDC-1), hyaluronic acid (HA), heparan sulfate (HS) and other endothelial injury markers; as well as the prognostic characteristics of neuronal biomarkers including neuron-specific enolase (NSE), s100 calcium binding protein beta subunit (S100-B), Tau proteins, neurofilament light chain (NFL), ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1), and glial fibrillary acidic protein (GFAP). The review proposes that an integrated strategy of multi-omics and multimodal biomarkers can significantly improve the accuracy of prognostic assessment, thereby providing a new theoretical basis and development direction for the early intervention and individualized treatment of PCAS.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866613","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":"Sexual Dimorphism in the Microglial Inflammatory Response After Traumatic Brain Injury.","authors":"Mecca B A R Islam, Zhangying Chen, Kacie P Ford, Hiam Abdala Valencia, Matthew Dapas, Booker T Davis, Steven J Schwulst","doi":"10.1097/SHK.0000000000002931","DOIUrl":"10.1097/SHK.0000000000002931","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is an underrecognized public health threat. Significant long-term complications can occur resulting in motor, cognitive, and behavioral deficits. Trauma occurs predominately in male populations, skewing studies towards men. Creating a critical unmet research need to better understand the pathophysiologic differences in traumatic injury between sexes. Women TBI patients differ in severity and mortality, often suffering from greater long-term neuropsychiatric disorders as compared to men. Sex hormones may account for the observed differences. We hypothesized that microglia would adopt a divergent, sex-dependent, TBI- associated transcriptional profile after TBI.</p><p><strong>Methods: </strong>Young-adult male and female mice underwent a severe TBI via controlled cortical impact or sham injury. Behavioral phenotyping was performed at 30-days post injury to assess anxiety, memory and motor deficits. A second cohort of mice had brains harvested, microglia sorted via flow cytometry, and single- cell RNA sequencing performed.</p><p><strong>Results: </strong>Female mice demonstrated disinhibition of normal anxiety-like and exploratory behavior in comparison to male mice post TBI. Additionally, female TBI mice had attenuation of memory deficits as compared to male TBI mice. Lastly, we observed a marked divergence in the transcriptional profiles of microglia at baseline and after TBI in female mice as compared to male mice.</p><p><strong>Conclusion: </strong>Our data showed a significant difference in anxiety and memory deficits after TBI between male and female mice. Which was associated with a marked difference in the transcriptional profile of microglia between male and female mice. These data suggest that sex needs to be an a priori consideration in clinical TBI trials.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850898","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":"Mesenchymal Stem Cell Secretome Mitigates Inflammatory Endothelial Dysfunction.","authors":"Marissa D Pokharel, Baron K Osborn, Anthony J Saviola, Sean P Maroney, Alyssa Caldwell-McGee, Jillian R Richter, Todd Getz, Mitchell J Cohen, Jessica C Cardenas","doi":"10.1097/SHK.0000000000002928","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002928","url":null,"abstract":"<p><strong>Background: </strong>Endothelial cells (EC) dysfunction and barrier disruption are central drivers of inflammatory lung injury and adverse outcomes, yet targeted therapies remain lacking. We tested the hypothesis that a mesenchymal stem cell (MSC)-derived secretome can directly preserve EC function under inflammatory stress. We evaluated AlloEx (Vitro Biopharma), a Wharton's Jelly MSC-derived secretome enriched in bioactive RNAs, proteins, lipids, and extracellular vesicles with pro-reparative and immunomodulatory activity.</p><p><strong>Methods: </strong>Human lung microvascular endothelial cells (HLMVEC) were exposed to TNFα (4 h) with AlloEx administered 30 min before or after TNFα stimulation. EC thromboinflammatory gene expression was quantified by qPCR. Barrier integrity was assessed by transendothelial resistance (TEER) and VE-cadherin immunofluorescence. Mitochondrial function was evaluated using MitoSOX, TMRM, and mitochondrial fission imaging. Proteomic profiling was performed using trauma patient plasma as a clinically relevant inflammatory stimulus.</p><p><strong>Results: </strong>AlloEx potently suppressed TNFα-induced EC activation, markedly reducing ICAM1, SELE, IL6, NOS3, ANG2, TEK, VEGFA, and F3 expression. Functionally, AlloEx rescued EC barrier integrity, preserving VE-cadherin localization at endothelial junctions and restoring TEER by 79% with pretreatment and 65% with post-treatment. Mechanistically, AlloEx prevented mitochondrial dysfunction, limiting reactive oxygen species generation, preserving membrane potential, and reducing fission. Proteomic profiling demonstrated that AlloEx induced coordinated remodeling of metabolic, vesicular, and inflammatory signaling pathways while suppressing cellular stress and pro-inflammatory signaling.</p><p><strong>Conclusion: </strong>These findings identify MSC-derived secretome therapy as a potent modulator of EC thromboinflammatory activation, barrier integrity, and mitochondrial function. AlloEx represents a promising, clinically translatable strategy to target EC dysfunction in inflammatory lung injury and trauma-associated endotheliopathy.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809103","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-Associated Proteomic Signatures Persist Independent of Injury Severity and Shock Physiology in Acute Trauma.","authors":"Huma S Baig, Christopher Erickson, Sanchayita Sen, Benjamin Ramser, Benjamin Stocker, Christopher Sublette, Teressa Borg, Ava Mokhtari, Rachel Samuel, Jessica Cardenas, Kirk Hansen, Angelo D'Alessandro, Mitchell Cohen","doi":"10.1097/SHK.0000000000002927","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002927","url":null,"abstract":"<p><strong>Background: </strong>Sex-based differences in trauma outcomes are well documented, but the early molecular programs distinguishing male and female responses remain incompletely defined. We hypothesized that biological sex shapes the circulating proteomic and metabolomic response at emergency department arrival and that these signatures interact with age, injury severity, and shock physiology.</p><p><strong>Methods: </strong>Patients meeting the highest level of trauma activation criteria were prospectively enrolled. Blood samples were collected upon arrival to the emergency department within one hour of injury and before transfusion. Plasma proteomics and metabolomics were performed by liquid chromatography-mass spectrometry. Sex differences were assessed by feature-level testing with Benjamini-Hochberg FDR correction. Multivariable linear models adjusted for age, ISS, base deficit, lactate, mechanism, and head/neck injury. Spearman correlations and network visualization integrated omics and clinical variables.</p><p><strong>Results: </strong>Among 292 patients (236 male, 56 female), baseline characteristics were similar. Unadjusted analyses identified 45 proteins and 9 metabolites differing by sex. Female-enriched proteins included PZP, CERU, SHBG, VTNC, ITIH3, and IGHM; male-enriched included FCN3, AMPN, APOD, GELS, NCAM1, ANTR2, MASP1, and GPX3. After adjustment, sex remained independently associated with FCN3, SHBG, PTPRG, CERU, FUCO, PZP, and APOD. Sex-associated metabolite differences were more strongly coupled to injury severity and shock physiology than to sex alone.</p><p><strong>Conclusion: </strong>Male and female trauma patients demonstrate distinct early multi-omic signatures, including sex-associated immune, complement, redox, and metabolic programs that persist after adjustment for injury severity and shock physiology. Sex-informed omics may improve biological endotyping and precision approaches to trauma care.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797734","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 cerebral tissue oxygen saturation with the development of delirium in circulatory shock - a prospective observational cohort study.","authors":"Maria Heliste, Elina Varis, Johanna Hästbacka, Suvi T Vaara, Markus B Skrifvars, Ville Pettilä, Mitja Lääperi, Anne Kuitunen, Annukka Vahtera, Erika Wilkman","doi":"10.1097/SHK.0000000000002925","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002925","url":null,"abstract":"<p><p>Delirium is a frequent neuropsychiatric complication in critical illness associated with increased risk of long-term cognitive impairment and mortality. We hypothesized that lower cerebral tissue oxygen saturation (cStO2) levels measured with near infrared spectroscopy (NIRS) associate with worse outcome, including mortality, and the risk for developing delirium in circulatory shock. We conducted the prospective, observational, multi-center study (ASSESS-SHOCK, ClinicalTrials.gov: NCT03814564), from April 2019 to May 2023. We enrolled adult circulatory shock patients within 24 hours of intensive care unit (ICU) admission. We registered cStO2 continuously for 48 hours using INVOS™ NIRS devices. We calculated the time-weighted mean cStO2 values and areas under the predefined thresholds of 60%, 50%, and 40% respectively. The primary objective was the association of time-weighted mean cStO2 during 0-48 hours with development of delirium during days 1-7. Secondary endpoints were ICU- and 90-day mortality. We included 256 patients, of whom 87 (34%) developed delirium. The 0-48 h mean cStO2 values did not differ between patients with and without delirium: 61.6% (interquartile range [IQR] 57.3 to 67.7) vs 63.1% (IQR 57.7 to 68.1, p=0.716), respectively. Lower time-weighted mean cStO2 during 48 hours was, however, associated with higher 90-day mortality: in non-survivors cStO2 was 60.0% (IQR 52.8 to 64.7) compared to 63.9% (IQR 58.1 to 68.9) in survivors (p<0.001). Conclusions: In circulatory shock, lower mean cStO2 values were not associated with delirium but they were associated with 90-d mortality. NIRS monitoring could serve as an adjunct method for identifying patients at risk for developing adverse outcomes, including mortality. Trial registration: ClinicalTrials.gov Identifier: NCT03814564, registered 15 January 2019. The ASSESS-SHOCK study: Assessment of peripheral perfusion, tissue oxygen saturation, endothelial function, and coagulation disorder in circulatory shock.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797742","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":"Occurrence, Associated Factors, and In-Hospital Outcomes of Acute Kidney Injury in Patients Hospitalized with Hyperosmolar Hyperglycemic State: A Retrospective Analysis of the Nationwide Inpatient Sample (2013-2022).","authors":"Ping Lin, Yun Chen, Yuyun Peng, Zengwei Xu, Jincong Liu, Junde Mo, Liping Chen, Binbin Tian, Xiangdong Zhang","doi":"10.1097/SHK.0000000000002923","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002923","url":null,"abstract":"<p><strong>Background: </strong>Hyperosmolar hyperglycemic state (HHS) is a serious hyperglycemic emergency frequently complicated by acute kidney injury (AKI). However, large-scale national data on AKI occurrence, associated factors, and in-hospital outcomes in HHS patients remain lacking.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 80,557 U.S. hospitalizations for hyperosmolar hyperglycemic state (HHS) between 2013 and 2022, using data from the Nationwide Inpatient Sample. Acute kidney injury (AKI) was identified using ICD diagnosis codes, and associations with demographic, institutional, comorbid, and complication-related factors were assessed through multivariable logistic regression.</p><p><strong>Results: </strong>Within this cohort, 45,202 individuals (56.1%) had documented AKI, with its occurrence increasing from 45.9% in 2013 to 63.6% in 2022. Independent predictors encompassed advanced age, Black or Asian/Pacific Islander race, affiliation with large or teaching hospitals, and geographic location in the South or West. Several comorbidities were significantly associated with increased AKI risk, including deficiency anemia, coagulopathy, diabetes with chronic complications, heart failure, hypertension, fluid and electrolyte disorders, other neurological disorders, paralysis, chronic kidney disease excluding end-stage renal disease and acute pancreatitis. AKI was significantly associated with worse clinical outcomes, manifested as longer median hospital stay (4 vs. 3 days), higher total charges ($35,026 vs. $24,279), greater in-hospital mortality (4.6% vs. 1.3%), and increased utilization of dialysis (1.3% vs. 0.1%) and mechanical ventilation (4.2% vs. 2.0%) (P<0.001).</p><p><strong>Conclusion: </strong>AKI was common among HHS patients and associated with increased mortality and healthcare costs, underscoring the importance of early recognition and targeted intervention.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797821","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}