SHOCK最新文献

{"title":"AKAP1-stabilized TIMP-4 attenuates Ang-II-induced oxidative stress and inflammation in vascular smooth muscle cells by inactivating the NF-κB signaling.","authors":"Yongxin Han, Xuejun Wu, Xin Shi, Guoliang Zhang, Xiaohan Wang, Chuanle Wang, Hua Zhou","doi":"10.1097/SHK.0000000000002557","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002557","url":null,"abstract":"<p><strong>Background: </strong>Oxidative stress and inflammation are key factors contributing to the complex pathogenesis of abdominal aortic aneurysm (AAA). Tissue inhibitor of metalloproteinases-4 (TIMP-4) expression is reduced in AAA patients. In this study, we investigated the impact of TIMP-4 on the phenotype alterations induced by angiotensin II (Ang-II) in human vascular smooth muscle cells (VSMCs).</p><p><strong>Methods: </strong>The expression profiling of TIMP-4 and A-kinase anchoring protein (AKAP1) in AAA samples was analyzed using the GSE7084 and GSE140947 datasets. Levels of TIMP-4 and AKAP1 in Ang-II-exposed VSMCs and AAA tissues and serum samples were detected. RNA immunoprecipitation (RIP) experiment and mRNA stability analysis were used to examine the interaction between AKAP1 and TIMP-4 mRNA. The impact of the AKAP1/TIMP-4 cascade on Ang-II-induced VSMC phenotype alterations was determined by evaluating cell viability, apoptosis, oxidative stress, and inflammation.</p><p><strong>Results: </strong>TIMP-4 and AKAP1 levels were decreased in Ang-II-exposed VSMCs. Increased TIMP-4 expression protected VSMCs against Ang-II-evoked growth impairment in vitro. Moreover, TIMP-4 upregulation diminished Ang-II-evoked oxidative stress and inflammation in VSMCs. Mechanistically, RNA binding protein (RBP) AKAP1 stabilized TIMP-4 mRNA to elevate TIMP-4 expression. TIMP-4 reduction partially abrogated AKAP1-driven suppression on oxidative stress, inflammation, matrix metalloproteinase (MMP9) expression, and nuclear factor kappa B (NF-κB) pathway activation in Ang-II-exposed VSMCs. Additionally, TIMP-4 and AKAP1 levels were downregulated in AAA patients in their AAA tissues and serum samples. TIMP-4 and AKAP1 had good diagnostic values for AAA with high Area under the ROC curve (AUC).</p><p><strong>Conclusion: </strong>Our study provides evidence for the role of the AKAP1/TIMP-4/NF-κB pathway in Ang-II-induced VSMC inflammation and oxidative stress.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449972","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":"Seasonal differences in burn injuries and outcomes among adults and older adults at a Canadian provincial burn center.","authors":"Maria Fernanda Hutter, Diana Julia Tedesco, Fadi Khalaf, Marc G Jeschke","doi":"10.1097/SHK.0000000000002556","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002556","url":null,"abstract":"<p><strong>Background: </strong>The literature provides hints of seasonal influences on burn injury occurrence and outcomes in temperate climates. Still, data for geographic regions experiencing significant changes in climate throughout the year is scarce. Especially the influence of seasonal differences in burn incidence and outcomes for older adults (≥60 years old), a particularly vulnerable patient cohort with increased mortality and morbidity compared to adults (18-59 years old), has not been investigated so far. Since burns pose a significant public health concern, we aimed to understand seasonal burn injury admission patterns and outcomes to utilize them for targetable prevention measures and effective resource allocation.</p><p><strong>Methods: </strong>This retrospective single-center cohort study examined data from adult burn patients (≥18 years) with reported %TBSA (Total Body Surface Area) treated between 2006 and 2020 at a provincial burn center in Ontario, Canada. Patients were stratified based on age group: adults (18-59 years) and older adults (≥60 years) Demographic data, comorbidities, and clinical outcomes were compared.</p><p><strong>Results: </strong>A total of 2445 eligible patients were enrolled in this study. Most burn injuries occurred in Summer, in which the burn patient population was also significantly younger compared to Winter. Summer admissions showed a greater median %TBSA. In contrast, length of stay per %TBSA (LOS:TBSA) revealed a shorter hospitalization in Summer compared to Winter. However, mortality did not show differences across seasons.</p><p><strong>Conclusion: </strong>Seasonal variations in the incidence and severity of burn injuries, along with associated fluctuations in LOS:TBSA, exist between age groups. This understanding can assist in tailoring burn prevention programs and aid in anticipating the types of burn injuries that may occur during specific times of the year to enhance patient care strategies.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450093","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":"PTP1B and zonulin failed to predict the modification of muscle mass in critically ill patients with septic shock.","authors":"Lemaitre Caroline, Demailly Zoé, Clavier Thomas, Girault Christophe, Béduneau Gaëtan, Carpentier Dorothée, Antoine Marchalot, Bôle-Feysot Christine, Grange Steven, Richard Vincent, Coëffier Moïse, Tamion Fabienne","doi":"10.1097/SHK.0000000000002561","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002561","url":null,"abstract":"<p><strong>Background: </strong>Proteolyse is one of the causes of loss of lean body mass, and depend of insulin. Proteintyrosine phosphatase 1B (PTP1B) and intestinal permeability (evaluated by zonulin) contribute of insulin metabolism. The objectives were to explore the relationship between PTP1B, Zonulin level and body composition during septic shock in humans.</p><p><strong>Material and methods: </strong>Prospective study including patients admitted to intensive care unit (ICU) for septic shock. Blood samples were collected on days 1 (D1) and 4 (D4) for study expression of PTPT1b (PCR) and zonulin. Muscle mass was evaluated by Fat-Free Mass (FFM) (by Bioelectrical impedance analysis) and rectum femoris cross-sectional area by ultrasound.</p><p><strong>Results: </strong>We included 52 patients with a mean IGSII 53 [39-65], and a mortality in ICU of 32%. Between D1 and D4, aera of right quadriceps muscle (ARQ) and average of quadriceps muscles (AAQ) decreased (p = 0.002 and 0.009 respectively). We observed no modification in FFM. Median of PTP1b at D1 was 5.03 [2.36-10.96]. Median of plasmatic zonulin at D1 was 156.6 ng/ml [56.3-277.9]. We did not find any correlation between PTP1b, zonulin expression and muscle composition. The mortality rate was more important in patients with a low average quadriceps thickness (QT) or quadriceps area (QA) (p < 0.01), and tendency for patients who had an elevated zonulin in admission. By contrast, we did not observe significant associations between fat-free mass and PTP1B and mortality at D28.</p><p><strong>Conclusion: </strong>We observed a trend of correlation between the whole blood PTPN1 gene expression at D1 and D4/D1 TLQ, because this is the only data which has a potential to address the relationship body mass change and proteolysis.Keys words: Body composition, malnutrition, PTB1B, septic shock, Zonulin.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450092","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 Differences in Sepsis-Related Acute Respiratory Distress Syndrome and Other Short-Term Outcomes among Critically Ill Patients with Sepsis: A Retrospective Study in China.","authors":"Hui Zhao, Bin Yang, Hong-Kai Dai, Cheng Li, Hang Ruan, Yong-Sheng Li","doi":"10.1097/SHK.0000000000002555","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002555","url":null,"abstract":"<p><strong>Background: </strong>The evidence of sex disparity in acute respiratory distress syndrome (ARDS) is scarce and varies widely.</p><p><strong>Objective: </strong>This observational, retrospective study aimed to determine the effect of sex on the sepsis-related ARDS and other short outcomes in critically ill patients with sepsis.</p><p><strong>Methods: </strong>A total of 2111 adult patients with sepsis who were admitted to three central intensive care units (ICUs) of Wuhan Tongji Hospital between 2012 and 2022 were included in our analysis. Sex was considered as an exposure factor, with sepsis-related ARDS as the primary outcome, and in-hospital mortality, invasive mechanical ventilation(iMV) support, septic shock, and other complications as secondary outcomes.</p><p><strong>Results: </strong>Among the 2111 enrolled patients, 1287 were males (61%) and 824 were females (39%). The incidence of sepsis-related ARDS was higher in males compared to females (P = 0.001), as well as in-hospital mortality (P = 0.009). Multivariate logistic analysis demonstrated that male sex remained independently associated with an increased risk of sepsis-related ARDS (adjusted odds ratio(aOR) = 1. 493[1.034-2.156], P = 0.032). Propensity score matching analysis also indicated that males had 58% higher odds of developing sepsis-related ARDS (aOR = 1.584 [1.022-2.456], P = 0.040). Regarding secondary outcomes, male sex was identified as a risk factor for in-hospital mortality (aOR = 1.536 [1.087-2.169], P = 0.015) and iMV support (aOR = 1.313 [1.029-1.674], P = 0.028) in the fully adjusted model. Sensitivity analysis that included postmenopausal females and age-matched male counterparts showed that male sex still remained to be a risk factor of developing sepsis-related ARDS (aOR = 1.968 [1.241-3.120], P = 0.004).</p><p><strong>Conclusion: </strong>Male sex was identified as an independent risk factor for sepsis-related ARDS and in-hospital mortality among critically ill patients with sepsis. Given the retrospective design of this study, the relationship between sex and sepsis-related ARDS requires further validation through large-scale randomized controlled trials in the future.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450094","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":"MECHANICAL LEFT VENTRICULAR UNLOADING IN CARDIOGENIC SHOCK TREATED WITH VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION: A SYSTEMATIC REVIEW AND META-ANALYSIS.","authors":"Yuki Kotani, Taihei Yamamoto, Takatoshi Koroki, Takahiko Yaguchi, Yuta Nakamura, Mayuko Tonai, Toshiyuki Karumai, Pasquale Nardelli, Giovanni Landoni, Yoshiro Hayashi","doi":"10.1097/SHK.0000000000002463","DOIUrl":"10.1097/SHK.0000000000002463","url":null,"abstract":"<p><strong>Abstract: </strong>Objective : To evaluate if mechanical left ventricular unloading could reduce mortality in patients with cardiogenic shock undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods : We searched MEDLINE, Embase, and the Cochrane Library for randomized controlled trials and propensity score-matched studies published until December 20, 2023. The primary outcome was mortality at the longest follow-up. We used a Mantel-Haenszel random effects meta-analysis and reported the pooled results with a risk ratio (RR) and 95% confidence interval (CI). The review protocol was registered on PROSPERO International prospective register of systematic review (CRD42024498665). Results : We identified two randomized controlled trials and 11 propensity score-matched studies, totaling 9,858 patients. Mechanical left ventricular unloading was significantly associated with reduced mortality at the longest follow-up (RR, 0.89; 95% CI, 0.84-0.94; P = 0.0001; moderate certainty of evidence), which was confirmed in studies using intra-aortic balloon pump. Benefits of mechanical unloading were also observed in terms of successful VA-ECMO weaning (RR, 1.15; 95% CI, 1.02-1.29; P = 0.02; low certainty of evidence) and favorable neurological outcome (two studies; RR, 2.45; 95% CI, 1.62-3.69; P < 0.0001; low certainty of evidence), although we observed an increased incidence of major bleeding (RR, 1.27; 95% CI, 1.02-1.59; P = 0.03; low certainty of evidence) and hemolysis (RR, 1.49; 95% CI, 1.10-2.02; P = 0.01; moderate certainty of evidence). Conclusions : Among adult patients with cardiogenic shock treated with VA-ECMO, mechanical left ventricular unloading was associated with reduced mortality, which was confirmed in studies using intra-aortic balloon pump as an unloading device.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"182-188"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081392","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":"FUNCTIONAL IMMUNOPHENOTYPING FOR PRECISION THERAPIES IN SEPSIS.","authors":"Mahil Rao, Patrick W McGonagill, Scott Brackenridge, Kenneth E Remy, Charles C Caldwell, Richard S Hotchkiss, Lyle L Moldawer, Thomas S Griffith, Vladimir P Badovinac","doi":"10.1097/SHK.0000000000002511","DOIUrl":"10.1097/SHK.0000000000002511","url":null,"abstract":"<p><strong>Abstract: </strong>Sepsis remains a significant cause of morbidity and mortality worldwide. Although many more patients are surviving the acute event, a substantial number enters a state of persistent inflammation and immunosuppression, rendering them more vulnerable to infections. Modulating the host immune response has been a focus of sepsis research for the past 50 years, yet novel therapies have been few and far between. Although many septic patients have similar clinical phenotypes, pathways affected by the septic event differ not only between individuals but also within an individual over the course of illness. These differences ultimately impact overall immune function and response to treatment. Defining the immune state, or endotype, of an individual is critical to understanding which patients will respond to a particular therapy. In this review, we highlight current approaches to define the immune endotype and propose that these technologies may be used to \"prescreen\" individuals to determine which therapies are most likely to be beneficial.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"189-201"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772138","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":"VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION IMPROVES OUTCOMES IN TRAUMA PATIENTS SUFFERING RESPIRATORY FAILURE.","authors":"Elizabeth K Powell, Richard Betzold, Daniel T Lammers, Jamie Podell, Ryan Wan, William Teeter, Ronald D Hardin, Thomas M Scalea, Samuel M Galvagno","doi":"10.1097/SHK.0000000000002491","DOIUrl":"10.1097/SHK.0000000000002491","url":null,"abstract":"<p><strong>Abstract: </strong>Introduction: Veno-venous extracorporeal membrane oxygenation (VV ECMO) improves hypoxemia and carbon dioxide clearance in patients with severe respiratory derangements. A greater understanding of the potential benefits of VV ECMO in trauma patients could lead to broader adoption. We hypothesize that trauma patients who receive VV ECMO have improved mortality outcomes when compared to those receiving conventional ventilator management given the rapid stabilization VV ECMO promotes. Methods: We performed a single-center, propensity score-matched cohort study. All trauma patients from January 1, 2014, to October 30, 2023, who were placed on VV ECMO or who would have met institutional guidelines for VV ECMO but were managed with conventional ventilator strategies were matched 1:1. The primary outcome analysis was survival at hospital discharge. Significance was defined as P < 0.05. Results: Eighty-one trauma VV ECMO patients and 128 patients who received conventional management met criteria for inclusion. After matching, VV ECMO and conventional treatment cohort characteristics were similar in age and mechanism of injury. Matched ISS, SI, lactate levels, and frequency of traumatically brain injured were also similar. Finally, respiratory parameters including preintervention, pH, partial pressure of carbon dioxide, lactate levels, and oxygen saturation were similar between matched groups. VV ECMO patients had higher survival rates at discharge when compared to the matched conventional treatment group (70% vs. 41%, P < 0.001). Corresponding hazard ratio for VV ECMO use was 0.31 (95% CI 0.18-0.52; P < 0.001). The odds ratio of mortality in matched trauma patients who receive VV ECMO versus conventional treatment was 0.29 (95% CI 0.14-0.58; P < 0.001). Conclusion: VV ECMO may represent a safe, alternative treatment approach for appropriately screened trauma patients with acute respiratory failure; however, further studies are warranted.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"248-254"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507131","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":"PANAXADIOL SAPONIN ALLEVIATES LPS-INDUCED CARDIOMYOPATHY SIMILAR TO DEXAMETHASONE VIA IMPROVING MITOCHONDRIAL QUALITY CONTROL.","authors":"Zhaoyun Yang, Yan Gao, Dongyang Li, Lijing Zhao, Yanwei Du","doi":"10.1097/SHK.0000000000002449","DOIUrl":"10.1097/SHK.0000000000002449","url":null,"abstract":"<p><strong>Abstract: </strong>Septic cardiomyopathy is linked to a dysregulation in mitochondrial integrity and elevated mortality rates, for which an efficacious treatment remains elusive. PDS is a panaxadiol saponin extracted from ginseng stem and leaf. This study identified the protective effects of PDS and DEX in LPS-induced cardiomyopathy and explored the mechanism of them treating LPS-induced cardiomyopathy from the perspectives of mitochondrial quality control. DEX and PDS enhance antioxidant defense by degrading Keap1 to activate Nrf2; activate mitochondrial occurrence protein PGC-1α and fusion protein OPA1, Mfn1, and Mfn2 expression; and inhibit phosphorylation of mitochondrial fission protein Drp1, aiming to maintain normal structure and function of mitochondrial, thereby preserving oxidative phosphorylation capacity. In summary, our findings highlighted the protective efficacy of PDS and DEX in maintaining mitochondrial in LPS-induced cardiomyopathy, and mechanism improving mitochondrial quality control at least in part by promoting Nrf2 activation.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"282-291"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044159","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":"CONTINUOUS KIDNEY REPLACEMENT THERAPY DOSAGE AND MORTALITY IN CRITICALLY ILL PATIENTS: A RETROSPECTIVE COHORT STUDY USING MARGINAL STRUCTURAL MODEL.","authors":"Maria Luiza Medeiros Faria, Alexandre Braga Libório","doi":"10.1097/SHK.0000000000002435","DOIUrl":"10.1097/SHK.0000000000002435","url":null,"abstract":"<p><strong>Abstract: </strong>Background : Continuous kidney replacement therapy (CKRT) is a crucial intervention for hemodynamically unstable patients with acute kidney injury (AKI). Despite the recommendations to offer a CKRT dose of 20 to 25 mL/kg/h, the optimal CKRT dose remains uncertain, especially whether low-dose CKRT is associated with poor outcomes. This study investigated the association between low CKRT dosage and 90-day mortality using a marginal structural model (MSM). Methods : Using the MIMIC-IV database, adult patients who received CKRT for more than 24 h were included. Data on time-fixed and time-dependent variables were collected. Patients were categorized based on CKRT dose thresholds of 13 and 20 mL/kg/h. Results : Among the 1,329 patients, the 90-day mortality rate was 49.6%. The median age of the patients was 62 years (IQR: 52-72). Changes in CKRT dosing during treatment were frequent. Patients with a reduced delivered CKRT dose (<20 and <13 mL/kg/h) generally exhibited low values during the initial days of CKRT, with an increase in the delivered CKRT dose. After adjusting only for baseline variables (traditional Cox regression model), patients receiving CKRT doses <13 mL/kg/h had significantly greater 90-day mortality (HR: 1.70, 95% CI 1.16-2.49) than those receiving CKRT doses ≥13 mL/kg/h. However, after adjusting for time-dependent variables, the CKRT dose was not significantly associated with mortality at either the 13 or 20 mL/kg/h threshold. Additionally, there were no significant associations between the delivered CKRT dose and 90-day mortality within the range of 5 to 40 mL/kg/h. Conclusion : This study highlights the impact of methodological approaches on the association between CKRT dose and mortality and that with personalized adjustments, there may not be a lower limit of the unsafe CKRT dose. However, lower CKRT doses were initially associated with higher mortality, and adjusting for time-dependent variables nullified this association.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"202-209"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073813","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":"PREDICTING UNPLANNED TRAUMA INTENSIVE CARE UNIT ADMISSIONS FOR INITIAL NONOPERATIVE, NON-ICU PATIENTS.","authors":"Tyler Zander, Melissa A Kendall, Emily A Grimsley, Shamir C Harry, Johnathan V Torikashvili, Rajavi Parikh, Joseph Sujka, Paul C Kuo","doi":"10.1097/SHK.0000000000002490","DOIUrl":"10.1097/SHK.0000000000002490","url":null,"abstract":"<p><strong>Abstract: </strong>Introduction: Unplanned intensive care unit (ICU) admissions are associated with increased morbidity and mortality. This study uses interpretable machine learning to predict unplanned ICU admissions for initial nonoperative trauma patients admitted to non-ICU locations. Methods: TQIP (2020-2021) was queried for initial nonoperative adult patients admitted to non-ICU locations. Univariable analysis compared patients who required an unplanned ICU admission to those who did not. Using variables that could be known at hospital admission, gradient boosting machines (CatBoost, LightGBM, XGBoost) were trained on 2021 data and tested on 2020 data. SHapley Additive exPlanations (SHAP) were used for interpretation. Results: The cohort had 1,107,822 patients; 1.6% had an unplanned ICU admission. Unplanned ICU admissions were older (71 [58-80] vs. 61 [39-76] years, P < 0.01), had a higher Injury Severity Score (ISS) (9 [8-13] vs. 9 [4-10], P < 0.01), longer length of stay (11 [7-17] vs. 4 [3-6] days, P < 0.01), higher rates of all complications, and most comorbidities and injuries ( P < 0.05). All models had an AUC of 0.78 and an F1 score of 0.12, indicating poor performance in predicting the minority class. Mean absolute SHAP values revealed ISS (0.46), age (0.29), and absence of comorbidities (0.16) as most influential in predictions. Dependency plots showed greater SHAP values for greater ISS, age, and presence of comorbidities. Conclusions: Machine learning may outperform prior attempts at predicting the risk of unplanned ICU admissions in trauma patients while identifying unique predictors. Despite this progress, further research is needed to improve predictive performance by addressing class imbalance limitations.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"240-247"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507125","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}