世界危重病急救学杂志(英文版)最新文献

{"title":"Critical care hepatology: A narrative review of current concepts and management.","authors":"Iva Kosuta, Ela Curcic Karabaic, Nina Beluhan, Fran Zlopasa, Jaksa Babel","doi":"10.5492/wjccm.123372","DOIUrl":"10.5492/wjccm.123372","url":null,"abstract":"<p><p>Patients with advanced liver disease requiring intensive care were long considered to have limited benefit from aggressive treatment, given the high associated mortality. Over recent decades, outcomes have improved with advances in liver transplantation, critical care, and a better understanding of multiorgan failure. Acute liver failure and acute-on-chronic liver failure are now recognized as complex multisystem syndromes in which survival is determined not only by hepatic dysfunction but also by extrahepatic organ failure, systemic inflammation, and infection. Critical care hepatology has therefore evolved as a clinical discipline integrating hepatology, intensive care, and transplant medicine. Modern management requires adaptation of conventional intensive care strategies to the distinct pathophysiological features of liver failure syndromes, together with coordinated multidisciplinary care, often delivered within specialized liver intensive care units. Despite substantial progress, important challenges remain, including limitations of current prognostic models, ongoing debate surrounding transplant allocation policies, and complex decisions regarding transplant candidacy and futility. A structured approach to critical care hepatology may improve care integration and outcomes in critically ill patients with liver disease.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"123372"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907287","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":"Dissipation of the mitochondrial proton motive force drives sepsis pathogenesis and explains hyperlactatemia's predictive value in sepsis mortality.","authors":"Jay Pravda","doi":"10.5492/wjccm.120314","DOIUrl":"10.5492/wjccm.120314","url":null,"abstract":"<p><p>Sepsis remains a major cause of global mortality, yet its underlying pathogenesis is still incompletely understood. The current Sepsis-3 definition describes sepsis as a \"<i>life-threatening organ dysfunction caused by a dysregulated host response to infection</i>\", but offers no mechanistic explanation for how infection or inflammation lead to metabolic collapse and organ failure. This work proposes a unifying biochemical model in which sepsis originates as an intramitochondrial disturbance of redox homeostasis triggered by an early hypermetabolic surge in mitochondrial hydrogen peroxide. According to this framework, excess hydrogen peroxide overwhelms mitochondrial reductive buffering systems, leading to aconitase (Krebs cycle) inhibition, impaired NADH and FADH₂ generation, dissipation of the proton motive force, and subsequent failure of oxidative phosphorylation. This sequence provides a coherent explanation for hallmark features of sepsis, including hyperlactatemia, metabolic acidosis, hypothermia, ATP depletion, bioenergetic failure and increased mortality. The model also accounts for interindividual variability in sepsis susceptibility through differences in mitochondrial reductive capacity and offers insight into why animal models fail to translate to humans. Additionally, toxic systemic hydrogen peroxide elevation may contribute independently to sepsis heterogeneity by oxidatively inhibiting multiple enzyme systems and inducing lymphocyte apoptosis, providing a mechanistic basis for immunosuppression and post-sepsis syndrome. Confirming a role for hydrogen peroxide in initiating and perpetuating these events positions impaired mitochondrial redox homeostasis as a central driver of sepsis pathogenesis and generates testable predictions regarding specific therapy and future research.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"120314"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907723","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":"Global evidence on molecular adsorbent recirculating system uses for trauma-induced acute liver failure: A scoping review.","authors":"Marcelo Augusto Fontenelle Ribeiro Junior, Rafael Dib Possiedi, Husna Irfan Thalib, Lucas Fontenelle Vieira, William A Teeter, Thomas M Scalea","doi":"10.5492/wjccm.117566","DOIUrl":"10.5492/wjccm.117566","url":null,"abstract":"<p><p>The molecular adsorbent recirculating system (MARS) is an extracorporeal liver support therapy used in acute liver failure, including cases related to trauma; however, evidence supporting its use in trauma-induced liver dysfunction remains limited. This scoping review aimed to systematically map the available literature on the use of MARS therapy in trauma patients and to identify knowledge gaps to guide future research. The review was conducted according to Joanna Briggs Institute methodology and reported in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, with a protocol prospectively registered in the Open Science Framework. Six electronic databases and two clinical trial registries were searched through December 2025, with additional backward citation tracking. Four observational studies met inclusion criteria, comprising 247 patients treated with MARS therapy, of whom only 11 had confirmed trauma-related acute liver failure. No randomized controlled trials were identified. Trauma-specific outcomes were inconsistently reported, and adverse events were not uniformly documented. Survival and liver function recovery varied across studies, and methodological heterogeneity precluded reliable assessment of clinical effectiveness or safety. Current evidence remains sparse and insufficient to support routine clinical use in trauma populations.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"117566"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907877","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":"Acute intermittent porphyria presenting with rhabdomyolysis and polyneuropathy with severe quadriparesis and respiratory failure: A case report.","authors":"Luka Bielen, Ana Vujaklija Brajković, Ozrenka Zlopaša, Nediljko Šućur, Mila Lovrić, Anja Šitum, Penelope Stein","doi":"10.5492/wjccm.120909","DOIUrl":"10.5492/wjccm.120909","url":null,"abstract":"<p><strong>Background: </strong>Acute intermittent porphyria (AIP) is the most common form of acute porphyria, a group of rare inherited disorders of heme biosynthesis. Severe attacks may be associated with life-threatening complications, including peripheral motor neuropathy, encephalopathy and seizures. Very rarely, an acute AIP attack can be complicated by rhabdomyolysis as illustrated in this case report.</p><p><strong>Case summary: </strong>A 28-year-old female presented with severe abdominal pain and muscle weakness, which progressed to severe rhabdomyolysis and acute kidney injury requiring dialysis. The disease course was further complicated by an acute severe axonal peripheral motor neuropathy with quadriparesis and respiratory muscle weakness requiring prolonged invasive mechanical ventilation. An important clue for diagnosis was red urine without hematuria. The diagnosis was established by the finding of elevated δ-aminolevulinic acid and porphobilinogen in a random urine sample and later confirmed by genetic testing. The patient was initially treated with hemin and parenteral glucose. However, since she needed prolonged treatment, givosiran was commenced and continued after discharge. When the period between givosiran administrations was extended to two months, this led to a new (milder) attack. After 40 months of givosiran treatment and continued physical rehabilitation, the patient is ambulatory and without acute attacks.</p><p><strong>Conclusion: </strong>Our case illustrates that treatment with hemin and givosiran for longer than two years may be needed for neurological recovery after an AIP attack with severe motor polyneuropathy and multisystem involvement.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"120909"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908308","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":"Lactate-to-albumin ratio, C-reactive protein-to-albumin ratio, and prognostic nutritional index in acute and critical care: A focused mini-review.","authors":"Emre Kudu, Mustafa Altun, Sinan Karacabey","doi":"10.5492/wjccm.123634","DOIUrl":"10.5492/wjccm.123634","url":null,"abstract":"<p><p>Risk stratification in acute and critical care increasingly relies on accessible biomarkers that capture multiple dimensions of physiological stress. Albumin-based composite biomarkers have gained attention because serum albumin reflects not only nutritional reserve but also systemic inflammation, hepatic synthetic capacity, endothelial permeability, capillary leakage, and resuscitation-related volume shifts. Among these indices, the lactate-to-albumin ratio, C-reactive protein-to-albumin ratio (CAR), and prognostic nutritional index (PNI) are particularly practical because they combine albumin with markers of tissue hypoperfusion, inflammatory burden, and immune-nutritional status. This focused mini-review presents a narrative synthesis of literature identified through targeted searches of PubMed, Web of Science, and Google Scholar using terms related to these indices and acute or critical care populations. Evidence suggests that elevated lactate-to-albumin and CARs and reduced PNI are generally associated with mortality, organ dysfunction, intensive care requirement, postoperative complications, and prolonged hospitalization in emergency department, intensive care, perioperative, infectious, cardiovascular, respiratory, gastrointestinal, trauma, and oncological settings. However, interpretation is limited by disease heterogeneity, variable sampling times, resuscitation-related albumin changes, hepatic dysfunction, chronic inflammation, inconsistent cutoff values, and the predominance of retrospective and observational evidence. These indices should therefore be interpreted as supportive prognostic markers within the broader clinical context rather than as replacements for clinical judgment or validated prognostic models.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"123634"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907963","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":"Letter to the Editor: Magnesium supplementation in sepsis: A promising metabolic resuscitation strategy.","authors":"Damodar Paudel","doi":"10.5492/wjccm.120168","DOIUrl":"10.5492/wjccm.120168","url":null,"abstract":"<p><p>Sepsis remains a major cause of mortality worldwide despite advances in modern critical care. Elevated serum lactate is a key marker of metabolic dysfunction and is strongly associated with adverse outcomes of sepsis. Magnesium plays a crucial role in mitochondrial function, energy production, and cellular metabolism, and its deficiency is frequently observed in critically ill patients with reduced lactate clearance. The recent randomized controlled trial by Anbarasan <i>et al</i> published in <i>World Journal of Critical Care Medicine</i> provided an important evidence that magnesium supplementation enhance lactate clearance, reduced vasopressor requirements, and shortened both intensive care unit and hospital length of stay of septic patients. Their results are quite promising, but have several limitations. The absence of baseline magnesium measurements makes it difficult to determine whether the observed benefits are resulted from correction of hypomagnesemia or from other pharmacological effects of magnesium. Furthermore, the single-center design with relatively small sample size, and the lack of statistically significant mortality benefit limit the generalizationn of the findings. Overall, magnesium supplementation appears to be a promising, safe, and cost-effective adjunctive therapy for sepsis, large multicenter randomized trials and mechanistic studies are required before recommendation for routine clinical use.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"120168"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908058","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":"Resuscitative endovascular balloon occlusion of the aorta in combat and austere environments.","authors":"Marcelo Augusto Fontenelle Ribeiro Junior, Rafael Dib Possiedi, Karine Matos de Albuquerque, Leticia Stefani Pacheco, Luiza Telles, Sariya Khan, Anaida Xacur-Trabulce, Nicolas de Cesaro Schpchacki","doi":"10.5492/wjccm.123705","DOIUrl":"10.5492/wjccm.123705","url":null,"abstract":"<p><strong>Background: </strong>Non-compressible torso hemorrhage (NCTH) is a leading cause of preventable death in austere environments. Extended evacuation times prioritize far-forward hemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) preserves proximal perfusion, shifting from specialized centers to prehospital combat settings.</p><p><strong>Aim: </strong>To investigate the feasibility, safety, and clinical outcomes of REBOA for NCTH in combat and austere environments.</p><p><strong>Methods: </strong>A PRISMA-ScR-guided scoping review searched five databases, with reference-list screening of included studies and key reviews, of humans receiving REBOA for NCTH in combat, prehospital, or austere environments. Two independent reviewers extracted patient characteristics, procedural parameters, and clinical outcomes. Quality was assessed <i>via</i> Joanna Briggs Institute tools and the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>From 1138 records, 8 studies, met criteria: 35 individually reported cases and 15 eligible cases from one registry cohort, of 50. Because the registry reported aggregate data only, all denominators below refer to the 35 individually reported cases. Casualties were predominantly young men in severe hemorrhagic shock after penetrating or blast injury. Access was <i>via</i> the common femoral artery, percutaneous in 23 of 35 (65.7%), with the balloon in zone 1 in 31 of 35 (88.6%). Survival to transfer or discharge was 91.4% (32 of 35); crude mortality was 8.6% (3 of 35). Complications were access-site thrombosis or limb ischemia in 4 of 35 (11.4%), one balloon rupture, and one reperfusion-related acute kidney injury.</p><p><strong>Conclusion: </strong>REBOA has been utilized in select combat and austere casualties, demonstrating hemodynamic improvement. However, this uncontrolled evidence precludes conclusions regarding efficacy or superiority, thereby not supporting its routine clinical deployment.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"123705"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908027","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":"Methylene blue for treating toxic encephalopathy due to acute nickel poisoning: A case report.","authors":"Rajathadri Hosur Ravikumar, Sayan Nath, Javed Ahsan Quadri, Sulagna Bhattacharjee","doi":"10.5492/wjccm.120702","DOIUrl":"10.5492/wjccm.120702","url":null,"abstract":"<p><strong>Background: </strong>Acute nickel poisoning is a rare clinical entity with no established management guidelines. Diagnosis is often delayed by non-specific clinical presentations that can mimic other common toxidromes, such as organophosphate poisoning.</p><p><strong>Case summary: </strong>A female in her late twenties presented with a Glasgow Coma Scale of 3, profound hypotension, miosis, and hypersalivation following intentional ingestion of an unlabeled toilet cleaner. Initial management for suspected cholinergic toxidrome and corrosive ingestion failed to achieve clinical stability. The patient developed refractory vasoplegic shock and went into a deep coma. Magnetic resonance imaging revealed cytotoxic lesions of the corpus callosum, suggesting toxic encephalopathy. Comprehensive toxicological screening by inductively coupled plasma mass spectrometry confirmed severe nickel toxicity with significantly elevated levels in the blood, urine, and cerebrospinal fluid (55.5 μg/L). Methylene blue, initially administered as a rescue therapy for vasoplegic shock, was associated with a paradoxical spike in urinary nickel excretion (from 8.8 μg/L to 51.9 μg/L) and a rapid decline in serum levels. This biochemical \"washout\" coincided with dramatic neurological recovery from Glasgow Coma Scale of 3 to 15 within 72 hours.</p><p><strong>Conclusion: </strong>Early comprehensive toxicological screening is essential in patients with suspected poisoning by unknown substances. In this case, nickel toxicity was confirmed by prompt screening. In the absence of standard treatment protocols in rare poisoning cases, treatment is largely supportive. The apparent clinical benefit of methylene blue-mediated nickel clearance in this case remains speculative.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"120702"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908074","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":"Prognostic utility of on-admission pulse pressure in hospitalized patients with traumatic brain injury.","authors":"Khalid Ahmed, Ayman El-Menyar, Mohammad Asim, Hisham Al Jogol, Ibrahim Taha, Ahad Kanbar, Basil Younis, Sandro Rizoli, Hassan Al-Thani","doi":"10.5492/wjccm.115627","DOIUrl":"10.5492/wjccm.115627","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality worldwide. Given the pivotal role of proper triage and timely management in patients with TBI, physicians are seeking a readily informative, straightforward tool for evaluating patients in the emergency department.</p><p><strong>Aim: </strong>To evaluate the association between on-admission pulse pressure (PP) and clinical outcomes, including severity of injury, complications, and mortality, among patients hospitalized with TBI.</p><p><strong>Methods: </strong>A retrospective observational study was conducted using data from adult patients with TBI admitted to the Hamad Trauma Center from 2011 to 2021. Patients were categorized into five PP groups at presentation in the emergency department: ≤ 30 mmHg, 31-40 mmHg, 41-50 mmHg, 51-60 mmHg, and > 60 mmHg.</p><p><strong>Results: </strong>A total of 5029 patients with TBI (mean age 33.1 ± 12.6 years; 87% male) were included. Low PP (PP ≤ 30) was significantly associated with younger age; higher injury severity; worse physiological parameters; and increased rates of transfusion, intubation, and acute respiratory distress syndrome (<i>P</i> < 0.001). Mortality was higher in the low-PP group (24%) compared with mid- and high-PP groups (5%-7%, <i>P</i> < 0.001). Bivariate analysis revealed that PP was positively correlated with age (<i>r</i> = 0.21), mean arterial pressure (<i>r</i> = 0.35), and Glasgow Coma Scale score (<i>r</i> = 0.098), and negatively correlated with shock index (<i>r</i> = -0.47), Injury Severity Score (<i>r</i> = -0.115), and blood units transfused (<i>r</i> = -0.18). Multivariable regression identified age, head Abbreviated Injury Scale score, PP, transfused blood units, and acute respiratory distress syndrome as independent predictors of mortality (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Admission PP reflects both hemodynamic stability and injury severity in patients with TBI. Low PP (≤ 30 mmHg) independently predicts higher mortality, whereas moderate PP (41-60 mmHg) is associated with optimal outcomes, suggesting this range represents a potential hemodynamic target. PP is a simple, rapid bedside adjunct marker that may aid early risk stratification and guide timely intervention in the management of TBI.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"115627"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908075","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":"Integrating frailty and acute illness severity scoring for risk stratification in acute geriatric care: Review and practical guide.","authors":"Mae-Jane Khaw, Wei-Ven Chin","doi":"10.5492/wjccm.120866","DOIUrl":"10.5492/wjccm.120866","url":null,"abstract":"<p><p>Managing acute illness in older populations remains a major challenge because of the complex interplay between multimorbidity and reduced physiological reserve. While conventional acute severity scores (<i>e.g.</i>, Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation, and National Early Warning Score) track acute physiological derangements, they often fail to capture the biological heterogeneity seen in geriatric patients. Frailty provides a vital window into the baseline vulnerability of a patient, yet it remains underutilized in acute triage despite its established prognostic value. Current evidence demonstrates that integrating frailty measures, specifically the Clinical Frailty Scale (CFS), with existing severity scores significantly improves mortality prediction and risk stratification in emergency and critical care. This mini-review explores age-related physiological changes as well as the prognostic limitations of standard severity scores while evaluating their integration with validated frailty tools. To bridge current clinical gaps, we propose a practical 4-step clinical triage algorithm integrating a baseline \"Two-Week Rule\" CFS with acute severity scores <i>via</i> a synergistic 2 × 2 risk stratification matrix. By identifying distinct clinical phenotypes, this framework guides precise, person-centered triage, ensuring that treatment escalation and critical care interventions remain medically proportionate to an older adult's attainable functional recovery.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"120866"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907977","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}