World journal of emergency medicine最新文献

{"title":"ICU-acquired weakness in critically ill patients at risk of malnutrition: risk factors, biomarkers, and early enteral nutrition impact.","authors":"Qingliu Zheng, Changyun Liu, Lingying Le, Qiqi Wu, Zhihong Xu, Jiyan Lin, Qiuyun Chen","doi":"10.5847/wjem.j.1920-8642.2025.020","DOIUrl":"10.5847/wjem.j.1920-8642.2025.020","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to explore the risk factors associated with intensive care unit-acquired weakness (ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition (EEN) and the role of biomarkers in managing ICU-AW.</p><p><strong>Methods: </strong>This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition (PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.</p><p><strong>Results: </strong>The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation (MV), body mass index (BMI), blood urea nitrogen (BUN), and creatinine (Cr) levels (<i>P</i><0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed (log-rank <i>P</i><0.001). Among biomarkers for ICU-AW, the mean prealbumin (PAB)/C-reactive protein (CRP) ratio had the highest diagnostic accuracy (area under the curve [AUC] 0.928, 95% confidence interval [95% <i>CI</i>] 0.892-0.946), surpassing the mean Cr/BUN ratio (AUC 0.740, 95% <i>CI</i> 0.663-0.819) and mean transferrin levels (AUC 0.653, 95% <i>CI</i> 0.574-0.733).</p><p><strong>Conclusion: </strong>Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 1","pages":"51-56"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190725","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":"Pneumonia caused by co-infection with <i>Pneumocystis jirovecii</i> and <i>Trichosporon coremiiforme</i>.","authors":"Gaofeng Zhu, Linqiang Huang, Wenhong Zhong, Hongke Zeng","doi":"10.5847/wjem.j.1920-8642.2024.202","DOIUrl":"10.5847/wjem.j.1920-8642.2024.202","url":null,"abstract":"","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 1","pages":"99-100"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190732","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":"Early identification of high-risk patients admitted to emergency departments using vital signs and machine learning.","authors":"Qingyuan Liu, Yixin Zhang, Jian Sun, Kaipeng Wang, Yueguo Wang, Yulan Wang, Cailing Ren, Yan Wang, Jiashan Zhu, Shusheng Zhou, Mengping Zhang, Yinglei Lai, Kui Jin","doi":"10.5847/wjem.j.1920-8642.2025.031","DOIUrl":"10.5847/wjem.j.1920-8642.2025.031","url":null,"abstract":"<p><strong>Background: </strong>Rapid and accurate identification of high-risk patients in the emergency departments (EDs) is crucial for optimizing resource allocation and improving patient outcomes. This study aimed to develop an early prediction model for identifying high-risk patients in EDs using initial vital sign measurements.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed initial vital signs from the Chinese Emergency Triage, Assessment, and Treatment (CETAT) database, which was collected between January 1^st, 2020, and June 25^th, 2023. The primary outcome was the identification of high-risk patients needing immediate treatment. Various machine learning methods, including a deep-learning-based multilayer perceptron (MLP) classifier were evaluated. Model performance was assessed using the area under the receiver operating characteristic curve (AUC-ROC). AUC- ROC values were reported for three scenarios: a default case, a scenario requiring sensitivity greater than 0.8 (Scenario I), and a scenario requiring specificity greater than 0.8 (Scenario II). SHAP values were calculated to determine the importance of each predictor within the MLP model.</p><p><strong>Results: </strong>A total of 38,797 patients were analyzed, of whom 18.2% were identified as high-risk. Comparative analysis of the predictive models for high-risk patients showed AUC-ROC values ranging from 0.717 to 0.738, with the MLP model outperforming logistic regression (LR), Gaussian Naive Bayes (GNB), and the National Early Warning Score (NEWS). SHAP value analysis identified coma state, peripheral capillary oxygen saturation (SpO₂), and systolic blood pressure as the top three predictive factors in the MLP model, with coma state exerting the most contribution.</p><p><strong>Conclusion: </strong>Compared with other methods, the MLP model with initial vital signs demonstrated optimal prediction accuracy, highlighting its potential to enhance clinical decision-making in triage in the EDs.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 2","pages":"113-120"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711387","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":"A two-sample Mendelian randomization study on the relationship of body weight, body mass index, and waist circumference with cardiac arrest.","authors":"Tingting Xu, Shaokun Wang, Liqiang Zhao, Jiawen Wang, Jihong Xing","doi":"10.5847/wjem.j.1920-8642.2025.035","DOIUrl":"10.5847/wjem.j.1920-8642.2025.035","url":null,"abstract":"<p><strong>Background: </strong>This study aims to explore the causal relationship of body weight, body mass index (BMI), and waist circumference (WC) with the risk of cardiac arrest (CA) using two-sample Mendelian randomization (MR).</p><p><strong>Methods: </strong>Data were summarized using genome-wide association studies (GWAS). Two-sample MR analyses were performed using the inverse variance weighting (IVW) method, the weighted median method, and the MR-Egger analysis. Heterogeneity test and sensitivity analysis were performed using Cochran's Q test and the leave-one-out method, respectively. The Steiger test was used to detect reverse causality. Bayesian model-averaged MR was used to identify the most influential risk factors.</p><p><strong>Results: </strong>A total of 13 GWAS data were collected for BMI, body weight and WC. IVW analyses showed a positive correlation of body weight, BMI, and WC with CA (all OR>1 and <i>P</i><0.05), with MR-Egger and weighted median methods confirming the IVW findings. No horizontal pleiotropy or heterogeneity was observed. Sensitivity analysis indicated that no single nucleotide polymorphism (SNP) caused significant changes in overall causality. Bayesian model-averaged MR was also used to rank causality based on marginal inclusion probability (MIP), and the corresponding model-averaged causal estimate (MACE) were confirmed, which indicated that WC (GWAS ID: ukb-b-9405) was the highest-ranked risk factor (MIP=0.119, MACE=0.011); its posterior probability was 0.057. A total of 14 sex-specific GWAS data on weight, BMI, and WC were analyzed in relationship with CA, and the MR results showed no significant effects of sex-specific factors.</p><p><strong>Conclusion: </strong>Body weight, BMI, and WC are causally associated with an increased risk of CA, with WC identified as the most important risk factor.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 2","pages":"129-135"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711382","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":"Explosive pleuritis: a rare case of fever and chest pain.","authors":"Muzamil Khan, Ali Pourmand, Melanie Schroeder, Quincy Khoi Tran, James Scott, Amanda Miller, Jalil Ahari","doi":"10.5847/wjem.j.1920-8642.2025.013","DOIUrl":"10.5847/wjem.j.1920-8642.2025.013","url":null,"abstract":"","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 2","pages":"177-179"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711391","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":"Impact of the COVID-19 pandemic on research publications in emergency medicine.","authors":"Syrus Razavi, Arjun Sharma, Cassidy Lavin, Ali Pourmand, Quincy Khoi Tran","doi":"10.5847/wjem.j.1920-8642.2025.022","DOIUrl":"10.5847/wjem.j.1920-8642.2025.022","url":null,"abstract":"","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 2","pages":"168-171"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711442","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":"The role of early changes in routine coagulation tests in predicting the occurrence and prognosis of sepsis.","authors":"Peili Chen, Yan Ge, Huiqiu Sheng, Wenwu Sun, Jiahui Wang, Li Ma, Enqiang Mao","doi":"10.5847/wjem.j.1920-8642.2025.036","DOIUrl":"10.5847/wjem.j.1920-8642.2025.036","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to explore the importance of routine coagulation tests for the early detection of sepsis and to quickly identify patients at a high risk of mortality.</p><p><strong>Methods: </strong>This retrospective single-center study collected data from patients meeting the clinical criteria for systemic inflammatory response syndrome (SIRS) with a confirmed infection source. Patients with coagulation disorders or on medications affecting coagulation were excluded. Patients were divided into sepsis and non-sepsis groups based on a Sequential Organ Failure Assessment (SOFA) score of ≥2. Univariate and multivariate logistic regression identified indicators from routine coagulation tests that predict sepsis. Prognostic roles of coagulation indicators were analyzed within the sepsis group.</p><p><strong>Results: </strong>A total of 512 patients were included, with 396 in the sepsis group and 116 in the non-sepsis group. The predictive factors in the sepsis prediction model encompass fibrin degradation products (FDP), D-dimer, lactate, procalcitonin (PCT) levels and the utilization of mechanical ventilation. Early elevation of FDP and D-dimer levels predicted sepsis onset. The model exhibited an area under the curve (AUC) of 0.943 (95% <i>CI</i>: 0.923-0.963). In the sepsis group, Cox regression analysis revealed an association between prothrombin time (PT) and in-hospital mortality.</p><p><strong>Conclusion: </strong>Abnormal high FDP and D-dimer levels in the early stages of sepsis provide a supplementary method for predicting sepsis. As the disease progresses, prolonged PT in the early stages of sepsis suggests a poor prognosis.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 2","pages":"136-143"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711446","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":"Tracheal intubation in the lateral position in emergency medicine: a narrative review and clinical protocol.","authors":"Ping Cui, Tingting Wen, Bingduo Wang, Shuijing Wu, Shiyu Chen, Xiangming Fang, Tilp Consortium","doi":"10.5847/wjem.j.1920-8642.2025.034","DOIUrl":"10.5847/wjem.j.1920-8642.2025.034","url":null,"abstract":"<p><strong>Background: </strong>Tracheal intubation (TI) is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine. Tracheal intubation in the lateral position (TILP) has been utilized in clinical practice, demonstrating potential advantages in specific scenarios, including emergency settings. However, there is a lack of comprehensive reviews and practical protocols on TILP application. To address this gap, we performed a narrative review, and provided evidence-based recommendations to formulate a practice protocol, to assist clinicians to effectively apply TILP.</p><p><strong>Methods: </strong>We conducted a narrative review of TILP applications and developed recommendations based on clinical research evidence and clinical experience. Delphi method was used among the TILP consortium to grade the strength of the recommendations and to help reach consensus. The practice protocols were formulated as warranted by advancements in medical knowledge, technology, and practice.</p><p><strong>Results: </strong>This narrative review summarized the current evidence on TILP application, highlighting its safety, efficacy, challenges, and potential complications. In total, 24 recommendations and a clinical protocol for TILP application in emergency patients were established.</p><p><strong>Conclusion: </strong>TILP is a valuable technique in emergency medicine. We reviewed its application in emergency settings and formulated recommendations along with a clinical practice protocol. Future studies are needed to evaluate the safety and efficacy of TILP, broaden its scope of application, and explore effective training protocols.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 2","pages":"103-112"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711447","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":"Early peripheral perfusion index predicts 28-day outcome in patients with septic shock.","authors":"Cheng Chi, Hao Gong, Kai Yang, Peng Peng, Xiaoxia Zhang","doi":"10.5847/wjem.j.1920-8642.2024.081","DOIUrl":"https://doi.org/10.5847/wjem.j.1920-8642.2024.081","url":null,"abstract":"<p><strong>Background: </strong>To investigate the prognostic value of the peripheral perfusion index (PPI) in patients with septic shock.</p><p><strong>Methods: </strong>This prospective cohort study, conducted at the emergency intensive care unit of Peking University People's Hospital, recruited 200 patients with septic shock between January 2023 and August 2023. These patients were divided into survival (<i>n</i>=84) and death (<i>n</i>=116) groups based on 28-day outcomes. Clinical evaluations included laboratory tests and clinical scores, with lactate and PPI values assessed upon admission to the emergency room and at 6 h and 12 h after admission. Risk factors associated with mortality were analyzed using univariate and multivariate Cox regression analyses. Receiver operator characteristic (ROC) curve was used to assess predictive performance. Mortality rates were compared, and Kaplan-Meier survival plots were created.</p><p><strong>Results: </strong>Compared to the survival group, patients in the death group were older and had more severe liver damage and coagulation dysfunction, necessitating higher norepinephrine doses and increased fluid replacement. Higher lactate levels and lower PPI levels at 0 h, 6 h, and 12 h were observed in the death group. Multivariate Cox regression identified prolonged prothrombin time (PT), decreased 6-h PPI and 12-h PPI as independent risk factors for death. The area under the curves for 6-h PPI and 12-h PPI were 0.802 (95% <i>CI</i> 0.742-0.863, <i>P</i><0.001) and 0.945 (95% <i>CI</i> 0.915-0.974, <i>P</i><0.001), respectively, which were superior to Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) scores (0.864 and 0.928). Cumulative mortality in the low PPI groups at 6 h and 12 h was significantly higher than in the high PPI groups (6-h PPI: 77.52% vs. 22.54%; 12-h PPI: 92.04% vs. 13.79%, <i>P</i><0.001).</p><p><strong>Conclusion: </strong>PPI may have value in predicting 28-day mortality in patients with septic shock.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 5","pages":"372-378"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11402868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296700","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":"Evolutionary trend analysis and knowledge structure mapping of endothelial dysfunction in sepsis: a bibliometrics study.","authors":"Juexian Wei, Hengzong Mo, Yuting Zhang, Wenmin Deng, Siqing Zheng, Haifeng Mao, Yang Ji, Huilin Jiang, Yongcheng Zhu","doi":"10.5847/wjem.j.1920-8642.2024.083","DOIUrl":"https://doi.org/10.5847/wjem.j.1920-8642.2024.083","url":null,"abstract":"<p><strong>Background: </strong>A pathophysiological feature of septic organ failure is endothelial dysfunction in sepsis (EDS). The physiological and pathological mechanism of sepsis is considered to be vascular leakage caused by endothelial dysfunction. These pathological changes lead to systemic organ injury. However, an analysis using bibliometric methods has not yet been conducted in the field of EDS. This study was conducted to provide an overview of knowledge structure and research trends in the field of EDS.</p><p><strong>Methods: </strong>Based on previous research, a literature search was performed in the Web of Science Core Collection (WoSCC) for publications associated with EDS published between the year 2003 and 2023. Various types of data from the publications, such as citation frequency, authorship, keywords and highly cited articles, were extracted. The \"Create Citation Report\" feature in the WoSCC was employed to calculate the Hirsch index (h-index) and average citations per item (ACI) of authors, institutions, and countries. To conduct bibliometric and visualization analyses, three bibliometric tools were used, including R-bibliometrix, CiteSpace (co-citation analysis of references), and VOSviewer (co-authorship analysis of institutions, co-authorship analysis of authors, co-occurrence analysis of keywords).</p><p><strong>Results: </strong>After excluding invalid records, the study finaly included 4,536 publications with 135,386 citations. Most of these publications originated in the USA, China, Germany, Canada, and Japan. Harvard University emerged as the most prolific institution, while professor Jong-Sup Bae and his research team at Kyungpook National University emerged as authors with the greatest influence. The \"protein C\", \"tissue factor\", \"thrombin\", \"glycocalyx\", \"acute kidney injury\", \"syndecan-1\" and \"biomarker\" were identified as prominent areas of research. Future research may focus on molecular mechanisms (such as as vascular endothelial [VE]-cadherin regulation) and therapeutic interventions to enhance endothelial repair and function.</p><p><strong>Conclusion: </strong>Our findings show a growing interest in EDS research. Key areas for future research include signaling pathways, molecular mechanisms, endothelial repair, and interactions between endothelial cells and other cell types in sepsis.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 5","pages":"386-396"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11402878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296702","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}