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Use of droxidopa for blood pressure augmentation after acute spinal cord injury: case reports. 急性脊髓损伤后盐酸卓希多巴用于血压升高:病例报告。
IF 1.7
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2022-12-07 DOI: 10.4266/acc.2021.01662
Christopher S Hong, Muhammad K Effendi, Abdalla A Ammar, Kent A Owusu, Mahmoud A Ammar, Andrew B Koo, Layton A Lamsam, Aladine A Elsamadicy, Gregory A Kuzmik, Maxwell Laurans, Michael L DiLuna, Mark L Landreneau
{"title":"Use of droxidopa for blood pressure augmentation after acute spinal cord injury: case reports.","authors":"Christopher S Hong, Muhammad K Effendi, Abdalla A Ammar, Kent A Owusu, Mahmoud A Ammar, Andrew B Koo, Layton A Lamsam, Aladine A Elsamadicy, Gregory A Kuzmik, Maxwell Laurans, Michael L DiLuna, Mark L Landreneau","doi":"10.4266/acc.2021.01662","DOIUrl":"10.4266/acc.2021.01662","url":null,"abstract":"<p><p>Hypotension secondary to autonomic dysfunction is a common complication of acute spinal cord injury (SCI) that may worsen neurologic outcomes. Midodrine, an enteral α-1 agonist, is often used to facilitate weaning intravenous (IV) vasopressors, but its use can be limited by reflex bradycardia. Alternative enteral agents to facilitate this wean in the acute post-SCI setting have not been described. We aim to describe novel application of droxidopa, an enteral precursor of norepinephrine that is approved to treat neurogenic orthostatic hypotension, in the acute post-SCI setting. Droxidopa may be an alternative enteral therapy for those intolerant of midodrine due to reflex bradycardia. We describe two patients suffering traumatic cervical SCI who were successfully weaned off IV vasopressors with droxidopa after failing with midodrine. The first patient was a 64-year-old male who underwent C3-6 laminectomies and fusion after a ten-foot fall resulting in quadriparesis. Post-operatively, the addition of midodrine in an attempt to wean off IV vasopressors resulted in significant reflexive bradycardia. Treatment with droxidopa facilitated rapidly weaning IV vasopressors and transfer to a lower level of care within 72 hours of treatment initiation. The second patient was a 73-year-old male who underwent C3-5 laminectomies and fusion for a traumatic hyperflexion injury causing paraplegia. The addition of midodrine resulted in severe bradycardia, prompting consideration of pacemaker placement. However, with the addition of droxidopa, this was avoided, and the patient was weaned off IV vasopressors on dual oral therapy with midodrine and droxidopa. Droxidopa may be a viable enteral therapy to treat hypotension in patients after acute SCI who are otherwise not tolerating midodrine in order to wean off IV vasopressors. This strategy may avoid pacemaker placement and facilitate shorter stays in the intensive care unit, particularly for patients who are stable but require continued intensive care unit admission for IV vasopressors, which can be cost ineffective and human resource depleting.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"138-143"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9188603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cost-effectiveness of intracranial pressure monitoring in severe traumatic brain injury in Southern Thailand. 泰国南部严重外伤性脑损伤中颅内压监测的成本效益。
IF 1.7
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-02-21 DOI: 10.4266/acc.004080
Jidapa Jitchanvichai, Thara Tunthanathip
{"title":"Cost-effectiveness of intracranial pressure monitoring in severe traumatic brain injury in Southern Thailand.","authors":"Jidapa Jitchanvichai, Thara Tunthanathip","doi":"10.4266/acc.004080","DOIUrl":"10.4266/acc.004080","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a leading cause of fatalities and disabilities in the public health domain, particularly in Thailand. Guidelines for TBI patients advise intracranial pressure monitoring (ICPm) for intensive care. However, information about the cost-effectiveness (CE) of ICPm in cases of severe TBI is lacking. This study assessed the CE of ICPm in severe TBI.</p><p><strong>Methods: </strong>This was a retrospective cohort economic evaluation study from the perspective of the healthcare system. Direct costs were sourced from electronic medical records, and quality-adjusted life years (QALY) for each individual were computed using multiple linear regression with standardization. Incremental costs, incremental QALY, and the incremental CE ratio (ICER) were estimated, and the bootstrap method with 1,000 iterations was used in uncertainty analysis.</p><p><strong>Results: </strong>The analysis included 821 individuals, with 4.1% undergoing intraparenchymal ICPm. The average cost of hospitalization was United States dollar ($)8,697.13 (±6,271.26) in both groups. The incremental cost and incremental QALY of the ICPm group compared with the non-ICPm group were $3,322.88 and -0.070, with the base-case ICER of $-47,504.08 per additional QALY. Results demonstrated that 0.007% of bootstrapped ICERs were below the willingness-to-pay (WTP) threshold of Thailand.</p><p><strong>Conclusions: </strong>ICPm for severe TBI was not cost-effective compared with the WTP threshold of Thailand. Resource allocation for TBI prognosis requires further development of cost-effective treatment guidelines.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"69-78"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India. 急救气道压力释放通气对儿童严重急性呼吸窘迫综合征死亡率的影响:来自印度的回顾性比较分析。
IF 1.7
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-02-28 DOI: 10.4266/acc.002520
Sudha Chandelia, Sunil Kishore, Maansi Gangwal, Devika Shanmugasundaram
{"title":"Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India.","authors":"Sudha Chandelia, Sunil Kishore, Maansi Gangwal, Devika Shanmugasundaram","doi":"10.4266/acc.002520","DOIUrl":"10.4266/acc.002520","url":null,"abstract":"<p><strong>Background: </strong>Pediatric acute respiratory distress syndrome (PARDS) has a mortality rate of up to 75%, which can be up to 90% in high-risk patients. Even with the use of advanced ventilation strategies, mortality remains unacceptably high at 40%. Airway pressure release ventilation (APRV) mode is a new strategy in PARDS. Our aim was to evaluate whether use of APRV mode in severe PARDS was associated with reduced hospital mortality compared to other modes of ventilation.</p><p><strong>Methods: </strong>This was a retrospective comparative study using data from case files in a pediatric intensive care unit of a university-affiliated tertiary-care hospital. The study period (January 2014 to December 2019) covered three years before routine use of APRV mode to three years after its implementation. We compared severe PARDS patients in two groups: The APRV group (who received APRV as rescue therapy after failing protective ventilation); and The Non-APRV group, who received other modes of ventilation.</p><p><strong>Results: </strong>A total of 24 patients in each group were analyzed. Overall in-hospital mortality in the APRV group was 79% versus 91% in the Non-APRV group. In-hospital mortality was significantly lower in the APRV group (univariate analysis: hazard ratio [HR], 0.27; 95% CI, 0.14-0.52; P=0.001 and multivariate analysis: HR, 0.03; 95% CI, 0.005-0.17; P=0.001). Survival times were significantly longer in the APRV group (median time to death: 7.5 days in APRV vs. 4.3 days in non-APRV; P=0.001).</p><p><strong>Conclusions: </strong>Use of rescue APRV mode in severe PARDS may yield lower mortality rates and longer survival times.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 1","pages":"113-121"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nurses' knowledge, attitude, and perceived barriers toward protective lung strategies of pediatrics mechanically ventilated patients in a tertiary care hospital in Pakistan. 巴基斯坦某三级医院儿科机械通气患者肺保护策略的护士知识、态度和感知障碍
IF 1.7
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-02-19 DOI: 10.4266/acc.004761
Tasnim Zainib, Salma Rattani, Nimira Asif, Hussain Maqbool Ahmed Maqbool
{"title":"Nurses' knowledge, attitude, and perceived barriers toward protective lung strategies of pediatrics mechanically ventilated patients in a tertiary care hospital in Pakistan.","authors":"Tasnim Zainib, Salma Rattani, Nimira Asif, Hussain Maqbool Ahmed Maqbool","doi":"10.4266/acc.004761","DOIUrl":"10.4266/acc.004761","url":null,"abstract":"<p><strong>Background: </strong>Protective lung strategies (PLS) are guidelines about recent clinical advances that deliver an air volume compatible with the patient's lung capacity and are used to treat acute respiratory distress syndrome. These mechanical ventilation guidelines are not implemented within intensive care units (ICUs) despite strong evidence-based recommendations and a dedicated professional staff. Nurses' familiarity with clinical guidelines can bridge the gap between actual and recommended practice. However, several barriers undermine this process. The objectives of this study were to identify those barriers and explore the knowledge, attitudes, and behavior of ICU nurses regarding the implementation of PLS.</p><p><strong>Methods: </strong>This was a descriptive, cross-sectional study. The participants were nurses working in the six ICUs of a pediatric tertiary care hospital in Lahore, Pakistan. Using purposive sampling with random selection, the total sample size was 137 nurses. A summative rating scale was used to identify barriers to the implementation of PLS.</p><p><strong>Results: </strong>Overall, the nurses' barrier score was high, with a mean of 66.77±5.36. Across all the barriers subscales, attitude was a much more significant barrier (35.74±3.57) to PLS than behavior (6.53±1.96), perceived knowledge (17.42±2.54), and organizational barriers (7.08±1.39). Knowledge-related barriers were also significantly high. Conclusion: This study identified important barriers to PLS implementation by nurses, including attitudes and knowledge deficits. Understanding those barriers and planning interventions to address them could help to increase adherence to low tidal volume ventilation and improve patient outcomes. Nurses' involvement in mechanical ventilation management could help to safely deliver air volumes compatible with recommendations.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"128-135"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Connective tissue disease is associated with the risk of posterior reversible encephalopathy syndrome following lung transplantation in Korea. 结缔组织病与韩国肺移植后后部可逆性脑病综合征的风险相关。
IF 1.7
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-01-07 DOI: 10.4266/acc.003384
Tae Jung Kim, Hyun Joo Lee, Samina Park, Sang-Bae Ko, Soo-Hyun Park, Seung Hwan Yoon, Kwon Joong Na, In Kyu Park, Chang Hyun Kang, Young Tae Kim, Sun Mi Choi, Jimyung Park, Joong-Yub Kim, Hong Yeul Lee
{"title":"Connective tissue disease is associated with the risk of posterior reversible encephalopathy syndrome following lung transplantation in Korea.","authors":"Tae Jung Kim, Hyun Joo Lee, Samina Park, Sang-Bae Ko, Soo-Hyun Park, Seung Hwan Yoon, Kwon Joong Na, In Kyu Park, Chang Hyun Kang, Young Tae Kim, Sun Mi Choi, Jimyung Park, Joong-Yub Kim, Hong Yeul Lee","doi":"10.4266/acc.003384","DOIUrl":"10.4266/acc.003384","url":null,"abstract":"<p><strong>Background: </strong>Posterior reversible encephalopathy syndrome (PRES) is a rare complication of lung transplantation with poorly understood risk factors and clinical characteristics. This study aimed to examine the occurrence, risk factors, and clinical data of patients who developed PRES following lung transplantation.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 147 patients who underwent lung transplantation between February 2013 and December 2023. The patients were diagnosed with PRES based on the clinical symptoms and radiological findings. We compared the baseline characteristics and clinical information, including primary lung diseases and immunosuppressive therapy related to lung transplantation operations, between the PRES and non-PRES groups.</p><p><strong>Results: </strong>PRES manifested in 7.5% (n=11) of the patients who underwent lung transplantation, with a median onset of 15 days after operation. Seizures were identified as the predominant clinical manifestation (81.8%, n=9) in the group diagnosed with PRES. All patients diagnosed with PRES recovered fully. Patients with PRES were significantly associated with connective tissue disease-associated interstitial lung disease (45.5% vs. 18.4%, P=0.019, odds ratio=9.808; 95% CI, 1.064-90.386; P=0.044). Nonetheless, no significant variance was observed in the type of immunotherapy, such as the use of calcineurin inhibitors, blood pressure, or acute renal failure subsequent to lung transplantation.</p><p><strong>Conclusions: </strong>PRES typically manifests shortly after lung transplantation, with seizures being the predominant initial symptom. The presence of preexisting connective tissue disease as the primary lung disease represents a significant risk factor for PRES following lung transplantation.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"79-86"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of tadalafil on cardiovascular and organ dysfunction induced by experimental sepsis. 他达拉非对实验性败血症致心血管及脏器功能障碍的影响。
IF 1.7
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-02-12 DOI: 10.4266/acc.002904
Marcelo Almeida Nakashima, Gabrielle Delfrate, Lucas Braga Albino, Gustavo Ferreira Alves, Junior Garcia Oliveira, Daniel Fernandes
{"title":"Impact of tadalafil on cardiovascular and organ dysfunction induced by experimental sepsis.","authors":"Marcelo Almeida Nakashima, Gabrielle Delfrate, Lucas Braga Albino, Gustavo Ferreira Alves, Junior Garcia Oliveira, Daniel Fernandes","doi":"10.4266/acc.002904","DOIUrl":"10.4266/acc.002904","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a life-threatening condition that affects the cardiovascular and renal systems. Severe hypotension during sepsis compromises tissue perfusion, which can lead to multiple organ dysfunction and death. Phosphodiesterase 5 (PDE5) degrades intracellular cyclic guanosine monophosphate (cGMP) levels which promotes vasodilatation in specific sites. Our previous studies show that inhibiting cGMP production in early sepsis increases mortality, implying a protective role for cGMP production. Then, we hypothesized that cGMP increased by tadalafil (PDE5 inhibitor) could improve microcirculation and prevent sepsis-induced organ dysfunction.</p><p><strong>Methods: </strong>Rats were submitted to cecal ligation and puncture (CLP) sepsis model and treated with tadalafil (2 mg/kg, s.c.) 8 hours after the procedure. Hemodynamic, inflammatory and biochemical assessments were performed 24 hours after sepsis induction. Moreover, the effect of tadalafil on the survival of septic rats was evaluated for 5 days.</p><p><strong>Results: </strong>Tadalafil treatment improves basal renal blood flow during sepsis and preserves it during noradrenaline infusion. Sepsis induces hypotension, impaired response to noradrenaline, and increased cardiac and renal neutrophil infiltration, in addition to increased levels of plasma nitric oxide and lactate. None of these dysfunctions were changed by tadalafil. Additionally, tadalafil treatment did not increase the survival rate of septic rats.</p><p><strong>Conclusions: </strong>Tadalafil improved microcirculation of septic animals; however, no beneficial effects were observed on macrocirculation and inflammation parameters. Then, the potential benefit of tadalafil in the prognosis of sepsis should be evaluated within a therapeutic strategy covering all sepsis injury mechanisms.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"46-58"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Simulating the effects of reducing transfer latency from the intensive care unit on intensive care unit bed utilization in a Korean Tertiary Hospital. 模拟减少重症监护病房转移延迟对韩国三级医院重症监护病房床位利用率的影响。
IF 1.7
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-02-21 DOI: 10.4266/acc.002976
Jaeyoung Choi, Song-Hee Kim, Ryoung-Eun Ko, Gee Young Suh, Jeong Hoon Yang, Chi-Min Park, Joongbum Cho, Chi Ryang Chung
{"title":"Simulating the effects of reducing transfer latency from the intensive care unit on intensive care unit bed utilization in a Korean Tertiary Hospital.","authors":"Jaeyoung Choi, Song-Hee Kim, Ryoung-Eun Ko, Gee Young Suh, Jeong Hoon Yang, Chi-Min Park, Joongbum Cho, Chi Ryang Chung","doi":"10.4266/acc.002976","DOIUrl":"10.4266/acc.002976","url":null,"abstract":"<p><strong>Background: </strong>Latency in transferring patients from intensive care units (ICUs) to general wards impedes the optimal allocation of ICU resources, underscoring the urgency of initiatives to reduce it. This study evaluates the extent of ICU transfer latency and assesses the potential benefits of minimizing it.</p><p><strong>Methods: </strong>Transfer latency was measured as the time between the first transfer request and the actual ICU discharge at a single-center tertiary hospital in 2021. Computer-based simulations and cost analyses were performed to examine how reducing transfer latency could affect average hourly ICU bed occupancy, the proportion of time ICU occupancy exceeds 80%, and hospital costs. The first analysis evaluated all ICU admissions, and the second analysis targeted a subset of ICU admissions with longer transfer latency, those requiring infectious precautions.</p><p><strong>Results: </strong>A total of 7,623 ICU admissions were analyzed, and the median transfer latency was 5.7 hours. Eliminating transfer latency for all ICU admissions would have resulted in a 32.8% point decrease in the proportion of time ICU occupancy exceeded 80%, and a potential annual savings of $6.18 million. Eliminating transfer latency for patients under infectious precautions would have decreased the time ICU occupancy exceeded 80% by 13.5% points, and reduced annual costs by a potential $1.26 million.</p><p><strong>Conclusions: </strong>Transfer latency from ICUs to general wards might contribute to high ICU occupancy. Efforts to minimize latency for all admissions, or even for a subset of admissions with particularly long transfer latency, could enable more efficient use of ICU resources.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"18-28"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A low preoperative platelet-to-white blood cell ratio is associated with acute kidney injury following cerebral aneurysm treatment in South Korea. 在韩国,术前血小板与白细胞比低与脑动脉瘤治疗后急性肾损伤有关。
IF 1.7
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-02-21 DOI: 10.4266/acc.003120
Seung-Woon Lim, Woo-Young Jo, Hee-Pyoung Park
{"title":"A low preoperative platelet-to-white blood cell ratio is associated with acute kidney injury following cerebral aneurysm treatment in South Korea.","authors":"Seung-Woon Lim, Woo-Young Jo, Hee-Pyoung Park","doi":"10.4266/acc.003120","DOIUrl":"10.4266/acc.003120","url":null,"abstract":"<p><strong>Background: </strong>Inflammation is involved in the pathophysiology of postoperative acute kidney injury (AKI). We investigated whether preoperative platelet-to-white blood cell ratio (PWR), a novel serum biomarker of systemic inflammation, was associated with postoperative AKI following cerebral aneurysm treatment. We also compared the discrimination power of preoperative PWR with those of other preoperative systemic inflammatory indices in predicting postoperative AKI.</p><p><strong>Methods: </strong>Perioperative data including preoperative systemic inflammatory indices and cerebral aneurysm-related variables were retrospectively analyzed in 4,429 cerebral aneurysm patients undergoing surgical clipping or endovascular coiling. Based on the cutoff value of preoperative PWR, patients were divided into the high PWR (≥39.04, n=1,924) and low PWR (<39.04, n=2,505) groups. After propensity score matching (PSM), 1,168 patients in each group were included in the data analysis. AKI was defined according to the Kidney Disease Improving Global Outcomes guidelines.</p><p><strong>Results: </strong>Postoperative AKI occurred more frequently in the low PWR group than in the high PWR group before PSM (45 [1.8%] vs. 7 [0.4%], P<0.001) and after (17 [1.5%] vs. 5 [0.4%], P=0.016). A low preoperative PWR was predictive of postoperative AKI before PSM (odds ratio [95% CI], 3.93 [1.74-8.87]; P<0.001) and after (3.44 [1.26-9.34], P=0.016). Preoperative PWR showed the highest area under the curve for postoperative AKI (0.713 [0.644-0.782], P<0.001), followed by preoperative platelet-to-neutrophil ratio (0.694 [0.619-0.769], P<0.001), neutrophil percentage-to-albumin ratio (0.671 [0.592-0.750], P<0.001), white blood cell-to-hemoglobin ratio (0.665 [0.579-0.750], P<0.001), neutrophil-to-lymphocyte ratio (0.648 [0.569-0.728], P<0.001), and systemic inflammatory index (0.615 [0.532-0.698], P=0.004).</p><p><strong>Conclusions: </strong>A low preoperative PWR was associated with postoperative AKI following cerebral aneurysm treatment.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"59-68"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acute severe hepatitis in children following extrahepatic infection in South Korea: etiology, clinical course, and outcomes. 韩国儿童肝外感染后急性重型肝炎:病因、临床过程和结局。
IF 1.7
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-02-28 DOI: 10.4266/acc.000600
Sanghoon Lee, Young Ok Kim, Seo-Hee Kim
{"title":"Acute severe hepatitis in children following extrahepatic infection in South Korea: etiology, clinical course, and outcomes.","authors":"Sanghoon Lee, Young Ok Kim, Seo-Hee Kim","doi":"10.4266/acc.000600","DOIUrl":"10.4266/acc.000600","url":null,"abstract":"<p><strong>Background: </strong>Acute hepatitis can occur in association with systemic diseases outside the liver. Acute severe hepatitis with markedly elevated transaminase levels following extrahepatic infection has been reported in children. However, research on this condition remains limited. This study aimed to investigate its etiology, clinical course, and outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed data from 2013 to 2020 for children under 12 years old with elevated liver enzymes following systemic infection. Acute severe hepatitis was defined as serum transaminase levels exceeding 1,000 IU/L in the absence of underlying liver disease. We analyzed hepatitis-associated pathogens, liver enzyme trends, and factors influencing recovery.</p><p><strong>Results: </strong>A total of 39 patients were included in this study. The most common age group was 7-12 months (54.8%), and 53.8% were male. Respiratory infections were the most common (61.5%), followed by gastrointestinal infections (23.1%), meningitis (10.3%), and urinary tract infections (5.1%). The median peak alanine transaminase (ALT) level was 1,515.8±424.2 IU/L, with a median time to peak ALT of 4.2±2.3 days from symptom onset. ALT levels normalized within 21 days in 71.8% of patients and within 28 days in 94.9%. Younger age was associated with delayed ALT normalization, whereas hepatoprotective agent use was associated with faster normalization.</p><p><strong>Conclusions: </strong>Acute severe hepatitis can develop following respiratory and other systemic infections. Younger children were more susceptible and had a more prolonged disease course.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 1","pages":"122-127"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transforming rapid response team through artificial intelligence. 通过人工智能改造快速反应团队。
IF 1.7
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2025-02-28 DOI: 10.4266/acc.000425
Kwangha Lee
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