Journal of Critical Care Medicine最新文献

{"title":"Early outcomes of pediatric heart transplantation: Impact of mechanical circulatory support and perioperative challenges. A single-center retrospective study.","authors":"Muhammad Shahzad, Reem Beheri, Bushra Algethami, Yasser Alheraish, Dimpna Albert, Felix W Tsai, Zohair Alhalees, Khaled Alarwan","doi":"10.62838/jccm-2026-0016","DOIUrl":"10.62838/jccm-2026-0016","url":null,"abstract":"<p><strong>Background: </strong>Pediatric heart transplantation stays the gold standard treatment for end-stage heart failure, but outcomes are influenced by pre-transplant status and bridging strategies, particularly mechanical circulatory support (MCS).</p><p><strong>Objectives: </strong>To evaluate early outcomes following pediatric heart transplantation and assess the impact of pre-transplant MCS on survival and complications.</p><p><strong>Methods: </strong>We retrospectively analyzed all pediatric patients (<14 years) who underwent orthotopic heart transplantation at a single tertiary center between January 2020 and January 2025. Demographics, pre-transplant support, intraoperative data, and early outcomes were collected. Primary outcome was 30-day survival; secondary outcomes included acute rejection, infection, acute kidney injury (AKI), neurologic complications, and ICU/hospital length of stay (LOS). Comparative analyses were performed between patients having ECMO- and ventricular assist devises (VAD) using Fisher's exact and Wilcoxon rank-sum tests. Kaplan-Meier survival estimates were generated.</p><p><strong>Results: </strong>Thirty patients were transplanted (median age 9 years, 63.3% female). Most (96.7%) needed MCS, including 11 ECMO and 18 VAD. Thirty-day survival was 28/30 (93.5%, 95% CI 78-99). Acute rejection occurred in 3 (10%), infections in 4 (13.3%), AKI in 8 (26.7%), with two requiring CRRT, and neurologic complications in 3 (10.3%). Median ICU and hospital LOS were 20 and 37 days, respectively. ECMO patients had longer post-transplant ventilation (12 vs 6 days, p = 0.04) and ICU length of stay (LOS) compared to VAD patients. Total Ischemic time, and CPB times were associated with increased morbidity.</p><p><strong>Conclusions: </strong>Early outcomes after pediatric heart transplantation prove high short-term survival but substantial morbidity. ECMO bridging was associated with greater resource use than VAD. Improving donor heart ischemic time, donor-recipient matching, perioperative management, and early initiation of durable MCS may further improve outcomes.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 2","pages":"291-299"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976247","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}

{"title":"Positive fluid balance is associated with earlier acute kidney injury in COVID-19 patients.","authors":"Rezwan Munshi, Sandra Gomez-Paz, Salman Bhutta, Joshua Fogel, James Pellegrini, Narois Nehru, Eric Lam, Sofia Rubinstein","doi":"10.62838/jccm-2026-0006","DOIUrl":"10.62838/jccm-2026-0006","url":null,"abstract":"<p><strong>Introduction: </strong>Managing fluid balance in COVID-19 patients can be challenging, particularly if acute kidney injury (AKI) develops.</p><p><strong>Aim of the study: </strong>We study the relationship between fluid net input and output (FNIO) in COVID-19 patients with development of AKI, time to development of AKI, in-hospital length of stay (LOS), and in-hospital mortality.</p><p><strong>Material and methods: </strong>Retrospective study of 403 patients with COVID-19. Data for FNIO were from day 1 through day 10 or earlier if AKI occurred.</p><p><strong>Results: </strong>AKI occurred in 22.8%, in-hospital mortality occurred in 26.3%, mean days to AKI were 7.7 (SD=6.3), and mean LOS was 11.5 (SD=13.2) days. In the multivariate logistic regression analyses, increased FNIO mean was significantly associated with slightly increased odds for mortality (OR=1.001, 95% CI:1.0001, 1.0011, p=0.02) but was not significantly associated with AKI. In the multivariate linear regression analyses, increased FNIO mean was significantly associated with lesser days to AKI (B=-6.63*10^-5, SE=<0.001, p=0.003) in the whole sample, greater days to AKI in the subset of those with ICU treatment (B=<0.001, SE=<0.001, p<0.001), while FNIO mean was not significantly associated with LOS.</p><p><strong>Conclusions: </strong>Positive fluid balance was associated with faster onset of AKI and increased mortality. Fluid administration in patients with COVID-19 should be guided by routinely measuring FNIO. A restrictive fluid management regimen rather than usual care should be practiced.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 2","pages":"186-198"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976210","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}

{"title":"Evaluation of muscle strength and renal function in survivors of severe COVID-19: A 12-month follow-up study.","authors":"Roberto Marco, Sayane Marlla Silva Leite Montenegro, Daniela Cassula, Tayline Gabriel, Alessandra Lima da Silva Martins, Rosani Teresa de Siqueira E Silva, Rosilene Motta Elias, Maria Aparecida Dalboni","doi":"10.62838/jccm-2026-0004","DOIUrl":"10.62838/jccm-2026-0004","url":null,"abstract":"<p><strong>Introduction: </strong>Severe COVID-19 is known to cause kidney injury via ACE2-mediated mechanisms, inflammation, and microvascular damage potentially leading to long-term renal impairment. Critically ill patients are particularly vulnerable to muscle loss and sarcopenia due to immobility, poor nutrition, and cytokine storm-induced catabolism. Post-COVID-19 syndrome often includes fatigue, muscle weakness, and reduced quality of life, yet evidence on long-term outcomes remains limited. This study evaluated kidney function, sarcopenia risk, and quality of life 12 months after intensive care unit (ICU) discharge in patients without pre-existing chronic kidney disease (CKD).</p><p><strong>Methods: </strong>This retrospective observational cohort included 82 patients without CKD admitted to the ICU between February 2020 and April 2022 who recovered from severe COVID-19. Data collected included serum creatinine, estimated glomerular filtration rate (eGFR), and sarcopenia risk assessed via the SARC-CalF (SARC-F combined with calf circumference). Functional outcomes were assessed by SF-36, pain by a Visual Analog Scale (VAS), and lower limb strength by the 30-second sit-to-stand test.</p><p><strong>Results: </strong>The mean age was 52 ± 12 years; 90% were male, 46% had hypertension, and 31% diabetes. At 12 months, patients showed low functional scores (SF-36: 47 ± 21), high pain prevalence (VAS: 57%), reduced lower limb strength (sit-to-stand: 8 ± 5 repetitions), and high sarcopenia risk (SARC-F: 46%). Higher sarcopenia scores correlated with poorer physical functioning (r = -0.60; p < 0.001) and greater pain (r = -0.44; p < 0.001). In 49 patients without hypertension, diabetes, or prior acute kidney injury (AKI), creatinine significantly increased (0.95 ± 0.2 to 1.10 ± 0.2 mg/dL; p = 0.007) and eGFR significantly declined (87 ± 22 to 77 ± 18 mL/min; p = 0.001), representing a mean reduction of 10 mL/min.</p><p><strong>Conclusion: </strong>Critically ill COVID-19 survivors experienced significant declines in kidney function, muscle strength, and functional capacity, alongside increased pain 12 months post-ICU discharge. These results underscore the need for multidisciplinary follow-up, incorporating nephrology, physiotherapy, and nutritional support.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 2","pages":"167-175"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976222","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}

{"title":"Predictive value of NLMR, PLR, and ferritin in relation to SOFA, APACHE II, and SAPS II in sepsis patients.","authors":"Oana Coman, Bianca-Liana Grigorescu, Adina Hutanu, Stefania Raluca Fodor, Marius Petrisor, Leonard Azamfirei","doi":"10.62838/jccm-2026-0009","DOIUrl":"10.62838/jccm-2026-0009","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis, a critical topic in the medical field, remains one of the deadliest pathologies in intensive care units. It involves an overzealous immune system, with a hyperinflammatory phase that overlaps with a subsequent hypoinflammatory phase.</p><p><strong>Aim of the study: </strong>To ease the burden on medical systems, this study aimed to assess the predictive value of clinical severity scores (Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the Simplified Acute Physiology Score II (SAPS II)) and inflammatory biomarkers (neutrophile-to-lymphocyte-to-monocyte ratio (NLMR), and platelet-to-lymphocyte ratio (PLR), carboxyhemoglobin (COHb) and ferritin) in predicting outcomes of critically ill intensive care unit (ICU) patients.</p><p><strong>Material and methods: </strong>This prospective, observational study included 101critically ill patients, for whom we assessed the parameters on the first and fifth days after confirmation of either sepsis or septic shock in ICU, according to the Sepsis-3 Consensus.</p><p><strong>Results: </strong>Severity scores showed significant correlations on both day 1 and day 5 across all groups. APACHE II and SAPS II correlated with ferritin on day 5 in sepsis, septic shock, and non-survivors. The severity scores correlated with COHb on day 5 in survivors, and on day 1 in non-survivors. NLMR and PLR correlated consistently across groups, with additional associations between these ratios, ferritin, and COHb, particularly in non-survivors. Regarding mortality, NLMR on day 1 showed only modest predictive value, which declined to non-significant by day 5. In contrast, the SOFA, APACHE II, and SAPS II scores demonstrated good discriminatory ability on both days, confirming their strong and reliable performance in predicting mortality.</p><p><strong>Conclusions: </strong>The study shows that simple cellular ratios and severity scores correlate with ferritin, COHb, and each other, reflecting inflammation, oxidative stress, and organ dysfunction in sepsis. Because these markers are inexpensive and easy to monitor, they may enhance bedside risk stratification, though broader prospective studies are still required.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 2","pages":"215-231"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976230","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}

{"title":"Impact of creatinine measurement methods on eGFR and GFR category assignment.","authors":"Elena-Cristina Preda, Oana Oprea, Zsolt Albert Barabas, Ioana Paula Simion, Ana-Maria Fotache, Minodora Dobreanu","doi":"10.62838/jccm-2026-0007","DOIUrl":"10.62838/jccm-2026-0007","url":null,"abstract":"<p><strong>Background: </strong>Accurate measurement of serum creatinine (SCr) is critical in estimating glomerular filtration rate (eGFR) and classifying kidney function. This study evaluated the analytical differences between the enzymatic and Jaffe methods for SCr measurement and their impact on eGFR estimation using two widely applied equations: CKD-EPI and EKFC.</p><p><strong>Methods: </strong>The study included 427 patients over 40 years old. SCr was measured using both enzymatic and Jaffe methods on the Alinity c platform. eGFR was calculated with the CKD-EPI (2009) and EKFC equations. Agreement between methods was assessed using Bland-Altman and Passing-Bablok regression. eGFR differences were analyzed using the Wilcoxon signed-rank test and multiple linear regression. Agreement in GFR category classification was evaluated using weighted kappa and Kendall's tau.</p><p><strong>Results: </strong>While the mean difference between methods was small, both systematic and proportional biases were statistically significant. eGFR values differed significantly between methods in both sexes (p < 0.01), regardless of the equation used. ΔeGFR was significantly associated with SCr values, but not with age. Although overall agreement in GFR categories was high (kappa > 0.91), method-dependent reclassification of patients was observed, which may influence CKD diagnosis and clinical decision-making.</p><p><strong>Conclusions: </strong>Even minor analytical differences between enzymatic and Jaffe SCr measurements can lead to clinically relevant discrepancies in GFR categorization. These findings highlight the need for harmonization in laboratory methods to ensure consistent reporting and patient management.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 2","pages":"199-206"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976258","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}

{"title":"Venoarterial extracorporeal membrane oxygenation as bridge support for refractory catecholamine-resistant shock and severe lactic acidosis in a patient with metformin exposure and multifactorial contributors: A case report.","authors":"Ans Alamami, Rabee Tawel, Saleh Mahmoud, Shameel Ahammed, Abdurrahmaan Elbuzidi, Nadir Kharma","doi":"10.62838/jccm-2026-0017","DOIUrl":"10.62838/jccm-2026-0017","url":null,"abstract":"<p><p>A 47-year-old male with type 2 diabetes on metformin and hypertension presented with profound hypoxemia, severe metabolic acidosis (pH unrecordable, lactate 17 mmol/L), and progressive cardiac dysfunction in the setting of presumed sepsis. Despite maximal conventional therapy-including mechanical ventilation, broad-spectrum antimicrobials, and high-dose vasopressors-the patient developed refractory shock and multi-organ dysfunction. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated on hospital day 2 as hemodynamic bridge support, combined with continuous renal replacement therapy (CRRT). This intervention facilitated stabilization of hemodynamics, correction of acidosis, and improvement in organ function. The patient was successfully decannulated and survived to discharge, though with residual cardiomyopathy. Lactic acidosis in this case was likely multifactorial, with metformin exposure as one potential contributor amid acute kidney injury, hypoperfusion, and possible septic elements. This report describes the use of VA-ECMO as supportive therapy in a complex, refractory critical illness scenario, highlighting the importance of timely multidisciplinary escalation while emphasizing diagnostic challenges in attributing causality and the need for cautious patient selection in such high-risk interventions.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 2","pages":"300-305"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976288","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}

{"title":"Predictive ability of malnutrition screening tools in enterally fed, mechanically ventilated patients with phase angle inference: A prospective observational study.","authors":"Mahmoud Al-Kalaldeh, Mohammad Abu Sabra, Omar Al-Kalaldeh","doi":"10.62838/jccm-2026-0010","DOIUrl":"10.62838/jccm-2026-0010","url":null,"abstract":"<p><strong>Background: </strong>The prognostic abilities of malnutrition assessment tools for the critically ill are still controversial. This study aimed to assess the predictive ability of MUST, NRS-2002, and NUTRIC tools to predict malnutrition risk for enterally fed, mechanically ventilated patients in intensive care.</p><p><strong>Methods: </strong>In a multicenter, prospective, observational study, patients from five ICU units in Jordan were observed at two stages. During the first 24 hours of admission, MUST, NUTRIC, and NRS-2002 scores were obtained in addition to the demographic and admission characteristics. In the assessment stage, on day 6th of admission forward, the Bioelectrical Impedance Analysis (BIA), including body compositions and Phase Angle (PhA) were assessed. Machine Learning (ML), structural equation modeling (SEM), and area under the curve (AUC) were used for measuring malnutrition estimates.</p><p><strong>Results: </strong>A total of 709 patients were observed. At admission, NUTRIC, MUST, and NRS-2002 were congruent in identifying high malnutrition risk (45.1%, 46.4%, and 53.6%, respectively). In reference to PhA, MUST and NRS-2002 scored higher for sensitivity (77.6%, and 76.8%, respectively) and specificity (93.3%, and 90.7%, respectively). They reported acceptable correlation estimates by SEM (0.65, and 0.70, respectively), and ML (0.90, and 0.91, respectively). Further, MUST was the best to discriminate malnutrition, followed by NRS-2002 and NUTRIC (AUC= 0.76, 0.64, and 0.53, respectively).</p><p><strong>Conclusions: </strong>Alongside validated BIA technology, MUST and NRS-2002 functioned as reliable prognostic indicators of malnutrition risk in the ICU.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 2","pages":"232-242"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976279","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}

{"title":"Echocardiographic factors associated with prolonged duration of inotrope therapy and ICU length of stay in a retrospective study of cardiac surgery patients.","authors":"Kelly Tankard, William Vasquez McTeigue, Matthew Smith, Ariel Mueller, Timothy Houle, Eriberto Michel, Judy Hung, Adam Dalia, Jerome Crowley, Kenneth Shelton","doi":"10.62838/jccm-2026-0013","DOIUrl":"10.62838/jccm-2026-0013","url":null,"abstract":"<p><strong>Introduction: </strong>Post-operative heart failure following cardiac surgery carries risk and can impact patient outcomes. Preoperative echocardiography can be useful for stratifying risk. Although there has been a historical focus on left ventricular ejection fraction (LVEF), the importance of left ventricular (LV) size, as measured by left ventricle end-diastolic diameter (LVEDD), may be an underappreciated echocardiographic factor which can help predict risk in patients undergoing cardiac surgery.</p><p><strong>Aim of the study: </strong>To investigate the association between LVEF and LVEDD with inotrope use, inotrope duration, and intensive care unit (ICU) length of stay (LOS) in patients undergoing cardiac surgery.</p><p><strong>Materials and methods: </strong>Retrospective cohort study including 2,965 adult patients undergoing non-emergent cardiac surgery at a single academic institution between February 2017 and October 2021. Primary outcomes were the use of inotropes and duration of inotrope therapy. The secondary outcome was ICU LOS.</p><p><strong>Results: </strong>In adjusted analyses, a one standard deviation increase in LVEF was associated with decreased odds of inotrope initiation (OR 0.45, 95% CI: 0.41 to 0.50; P < 0.001), while a one standard deviation increase in LVEDD was associated with increased odds of receiving inotropes (OR 1.18, 95% CI: 1.07 to 1.31; P = 0.001). Among those receiving inotropes, a one standard deviation increase in LVEF was associated with a 25% decrease in inotrope hours in adjusted analyses (0.75, 95% CI: 0.68 to 0.82; P < 0.001). An interaction was observed such that LVEDD modified the association between LVEF and ICU LOS (0.98, 95% CI: 0.95 to 0.99; P = 0.03).</p><p><strong>Conclusions: </strong>Preoperative LVEDD, particularly when combined with LVEF, can predict risk after cardiac surgery.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 2","pages":"262-270"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976235","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}

{"title":"Early clinical outcomes and quality of life assessment after HeartMate 3 implantation: A single-centre descriptive study.","authors":"Samuel Michelini, Marius Mihai Harpa, Dan Nistor, David-Emanuel Anitei, Alexandru Stan, Paul Calburean, Emil Marian Arbanasi, Dragos-Florin Baba, Sabrina Mancino, Horatiu Suciu","doi":"10.62838/jccm-2026-0015","DOIUrl":"10.62838/jccm-2026-0015","url":null,"abstract":"<p><strong>Background: </strong>Advanced heart failure remains a leading cause of morbidity and mortality worldwide, with limited access to transplantation, particularly in Eastern Europe. Left ventricular assist device therapy offers improved survival and quality of life for end-stage disease. HeartMate 3, a modern form of mechanical circulatory support, is used as bridge-to-transplant or destination therapy. Despite increasing global experience with the HeartMate 3, clinical data from Romanian centers remain scarce. This study aimed to assess early clinical outcomes, postoperative complications, and quality of life after HeartMate 3 implantation at a single cardiovascular surgery center in Romania.</p><p><strong>Materials and methods: </strong>We conducted a retrospective observational cohort study including 13 patients with Advanced heart failure who underwent HeartMate 3 implantation between September 2023 and March 2025. Preoperative variables (demographics, comorbidities, INTERMACS profile, EuroSCORE II, echocardiographic findings) and postoperative outcomes were analyzed. Quality of life was assessed in 10 surviving patients using a 16-item structured telephone questionnaire addressing physical function, autonomy, social reintegration, and psychological well-being.</p><p><strong>Results: </strong>The cohort was predominantly male (84.6%); mean age 47.2 ± 12.3 years. Implant strategy: bridge-to-transplant 76.9%, destination therapy 23.1%. Early mortality was 23.1% (n = 3), occurring primarily in patients with EuroSCORE II >8% and INTERMACS I-II. The most frequent postoperative complications were significant perioperative bleeding (61.5%) and right ventricular failure (23.1%). Among survivors, all reported improved mobility, greater independence in activities of daily living, and better social reintegration; 7/10 rated overall quality of life as good or excellent. Psychological distress was frequent early after surgery but showed progressive improvement over time.</p><p><strong>Conclusions: </strong>HeartMate 3 implantation resulted in favorable early clinical outcomes and significant improvements in quality of life, aligning with international data. Optimizing outcomes with left ventricular assist device therapy relies on timely referral, rigorous patient selection, and comprehensive postoperative management, including psychological and social support.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 2","pages":"281-290"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976263","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}

{"title":"Prognosis prediction by urinary liver-type fatty acid-binding protein in patients in the intensive care unit admitted from the emergency department: A single-center, historical cohort study.","authors":"Hirozumi Okuda, Hideki Asai, Koji Yamamoto, Keita Miyazaki, Hidetada Fukushima, Keigo Saeki","doi":"10.62838/jccm-2026-0008","DOIUrl":"10.62838/jccm-2026-0008","url":null,"abstract":"<p><strong>Introduction: </strong>Early risk stratification of critically ill patients is essential for optimizing intensive care unit (ICU) resource allocation and treatment decisions. Urinary liver-type fatty acid-binding protein (L-FABP) is a simple, noninvasive biomarker that may provide real-time information on organ dysfunction. However, its prognostic utility in patients admitted to the ICU from the emergency department remains unclear.</p><p><strong>Aim of the study: </strong>The aim of this study was to evaluate the prognostic value of L-FABP levels measured shortly after ICU admission in predicting 28-day mortality among patients admitted from the emergency department.</p><p><strong>Methods: </strong>This single-center retrospective observational study included patients admitted to the ICU between December 2020 and August 2022. Urinary L-FABP concentrations were measured at ICU admission (T0) and 3 hours later (T3). The primary outcome was 28-day in-hospital mortality. Prognostic performance was assessed using receiver operating characteristic curves and Cox proportional hazards models with inverse probability of treatment weighting. Results were compared with Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) scores, and lactate levels.</p><p><strong>Results: </strong>Data of 118 patients were included in the final analysis. Urinary L-FABP levels at T3 showed the highest AUC for predicting 28-day mortality (area under the curve [AUC] = 0.873), compared with APACHE II (AUC = 0.801), SOFA (AUC = 0.753), and the lactate level (AUC = 0.734). An elevated L-FABP (T3) level was independently associated with increased mortality (hazard ratio [HR] = 8.60, 95% confidence interval [CI]: 1.02-72.64, P = 0.047). The T3/T0 ratio showed only modest predictive value (AUC = 0.623).</p><p><strong>Conclusions: </strong>Urinary L-FABP levels measured 3 hours after ICU admission were an independent predictor of short-term mortality. The marker's simplicity and bedside applicability suggest its potential utility not only in ICUs but also in emergency departments and triage decision-making.</p>","PeriodicalId":44227,"journal":{"name":"Journal of Critical Care Medicine","volume":"12 2","pages":"207-214"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976285","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}