世界危重病急救学杂志(英文版)最新文献

{"title":"Metabolic footprint of sepsis and septic shock: A narrative review.","authors":"Anjali Mishra, Deven Juneja","doi":"10.5492/wjccm.v15.i2.118428","DOIUrl":"10.5492/wjccm.v15.i2.118428","url":null,"abstract":"<p><p>Sepsis and septic shock are complex, heterogeneous syndromes associated with high morbidity and mortality despite advances in critical care management. Conventional biomarkers used in clinical practice lack specificity and prognostic accuracy to measure and monitor the dynamic metabolic abnormalities occurring in these conditions. Metabolomics, the comprehensive analysis of low-molecular weight metabolites, are powerful tools to define host metabolic responses to infection and inflammation. This review summarizes current concepts in metabolomic research in sepsis and septic shock, highlighting findings from both experimental models and human studies using nuclear magnetic resonance and mass spectrometry-based platforms. Key metabolic alterations involving energy metabolism, amino acids, lipids, mitochondrial function, and \"microbial metabolism\" biota-derived metabolites are discussed in relation to disease severity, organ dysfunction, and clinical outcomes. The integration of metabolomics with clinical parameters and other omics technologies holds promise for improving diagnosis, prognostication, and therapeutic stratification in sepsis, paving the way toward precision medicine approaches in critical care.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 2","pages":"118428"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221133","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":"Sex differences in serious outcomes among critically ill adults following endotracheal intubation.","authors":"Shahan Waheed, Sajid Ali, Nadeemullah Khan, Ahmed Raheem, Sarah Afzal Kothari","doi":"10.5492/wjccm.v15.i2.115099","DOIUrl":"10.5492/wjccm.v15.i2.115099","url":null,"abstract":"<p><strong>Background: </strong>Several studies have reported sex differences in resuscitation outcomes in critically ill adults, but whether these differences are associated with endotracheal intubation practices is not known.</p><p><strong>Aim: </strong>To investigate sex differences in serious outcomes among critically ill adults undergoing endotracheal intubation in the emergency department.</p><p><strong>Methods: </strong>In this observational study, we enrolled all critically ill adult patients who underwent endotracheal intubation in the emergency department from 2016 to 2020. The serious outcomes were defined as mortality within 1 hour post endotracheal intubation, cardiac arrest within 1 hour post intubation, worsening hypotension (systolic blood pressure < 90 mmHg) and oxygen desaturation (< 92%). Variables known or suspected to be associated with serious outcomes were examined with univariate logistic regression. Furthermore, we conducted sensitivity analysis on the patient cohort, incorporating propensity score matching with nearest neighbor methods at a ratio of 1:1 to address baseline variations between male and female participants, using R program software version 4.1.3 with a library (MatchIT).</p><p><strong>Results: </strong>A total of 1021 patients were enrolled in our study, with a median age of 52.2 years (± 17.5). The mean age of the females was 52.2 (± 17.8) years, and that of the males was 52.1 (± 17.3) years. Endotracheal intubation was most frequently observed in males (634; 62%). The frequency of cardiac arrest was 118 (18.6%) males and 77 (19.9%) females, with a <i>P</i> value of 0.612. Similarly, the frequency of hypotension (systolic blood pressure < 90 mmHg) was 225 (35.5%) in males and 154 (39.8%) in females (<i>P</i> = 0.167). This was followed by hypoxia (< 92%), with 85 (13.4%) males and 46 (11.9%) females, with a <i>P</i> value of 0.481. In total, 263 (41.5%) males died in the hospital, whereas 135 (39.1%) females died, <i>P</i> = 0.036. Severe outcomes were observed in 702 (68.8%) patients, 271 (70%) of whom were females, whereas 431 (68%) of whom were men (<i>P</i> = 0.494). After propensity score matching, postintubation hypotension was the most frequent serious event, observed in 304 (39.3%) patients, of whom 154 (39.8%) were females, whereas 150 (39.8%) were males (<i>P</i> = 0.001).</p><p><strong>Conclusion: </strong>The study revealed that females were at greater risk of serious outcomes in critically ill adults post endotracheal intubation than males were in the emergency department.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 2","pages":"115099"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220667","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: Impact of the intensivist at the bedside - the case of rational use of benzodiazepines.","authors":"Wagner Nedel","doi":"10.5492/wjccm.v15.i2.116049","DOIUrl":"10.5492/wjccm.v15.i2.116049","url":null,"abstract":"<p><p>The detrimental effects associated with prolonged benzodiazepine infusion have long been recognized, and precipitated a transformation in the management of sedation and analgesia in critically ill patients. This transformation emphasizes the need to reduce the continuous use of benzodiazepines. Achieving an appropriate sedo-analgesia target tailored to the patient's context requires clinical staff to possess knowledge and considerable experience in this management. The study published in <i>World Journal of Critical Care Medicine</i> by Nestoiter <i>et al</i> exemplified this scenario. The authors identified an association between the continuous use of midazolam and the absence of a critical care team managing patients at the bedside. The use of continuous midazolam, as an indicator of good clinical practice, was associated with unfavorable clinical outcomes, such as increased days in coma and delirium. These results reinforce the fact that effective management of sedation and analgesia is a critical area where the fundamental role of the intensivist in the care of critically ill patients is evident. These findings should not be interpreted in isolation but rather within a set of organizational aspects that characterize a high-performing intensive care unit, such as an adequate patient-to-nurse ratio, the presence of an intensivist-led team, and the development of clinical protocols in sedation and analgesia management.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 2","pages":"116049"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221223","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":"Association of early interleukin-6 level with injury severity and mortality in trauma patients: Systematic review and meta-analysis.","authors":"Ibrahim Al-Hassani, Ayman El-Menyar, Mashhood Naduvilekandy, Ammar Al-Hassani, Hassan Al-Thani","doi":"10.5492/wjccm.v15.i2.118175","DOIUrl":"10.5492/wjccm.v15.i2.118175","url":null,"abstract":"<p><strong>Background: </strong>Polytrauma is associated with the release of various biomarkers, including interleukin (IL)-6, a proinflammatory cytokine with prognostic value.</p><p><strong>Aim: </strong>To evaluate the association between IL-6 measured within the first 24 hours of admission and the injury severity score (ISS) among adult polytrauma patients and to explore the link between early IL-6 levels and in-hospital mortality.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of articles published between 2004 and 2024 in the OVID EMBASE and PubMed databases. The primary outcomes of interest were ISS and all-cause in-hospital mortality. Heterogeneity among the included studies was assessed using the <i>I</i>² statistic. Correlations were performed using Pearson's or Spearman's correlation coefficients. The Newcastle-Ottawa Scale was used to assess bias in the included studies.</p><p><strong>Results: </strong>A total of 1126 studies were screened, of which 15 were selected, yielding 2106 polytrauma patients. The pooled effect size for the correlation between IL-6 and ISS using the Pearson's coefficient was 0.49 [95%CI: 0.36-0.60; <i>I</i>²: 72.2%, <i>P</i> (heterogeneity) = 0.02], while that for studies using the Spearman's coefficient was 0.50 [95%CI: 0.41-0.58; <i>I</i>²: 33.2%, <i>P</i> (heterogeneity) = 0.18]. Six studies indicated that IL-6 levels were significantly elevated in non-survivors compared with survivors.</p><p><strong>Conclusion: </strong>Among polytrauma patients, elevated IL-6 levels within the first 24 hours of admission are associated with higher rates of severe injury and in-hospital mortality. Future research should investigate how early IL-6 levels can be used with other biomarkers to predict injury severity and worse outcomes. Additionally, larger-scale studies should be conducted to assess the tool's validity across a variety of populations.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 2","pages":"118175"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221061","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":"Extracorporeal shockwavelithotripsy <i>vs</i> ureteroscopy for management of acute ureteric colic due to stones: A randomized controlled trial.","authors":"Jaydeep Jain, Shiv C Navriya, Ravi Chandra Chintapalli, Gautam R Choudhary, Mahendra Singh, Deepak P Bhirud, Arjun S Sandhu","doi":"10.5492/wjccm.v15.i2.114619","DOIUrl":"10.5492/wjccm.v15.i2.114619","url":null,"abstract":"<p><strong>Background: </strong>Urolithiasis is one of the most prevalent condition with evolving management strategies. While extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URSL) are common minimally invasive treatments, their comparative efficacy, safety, and impact on quality of life (QoL) require continuous evaluation.</p><p><strong>Aim: </strong>To compare the clinical efficacy, safety, patient satisfaction, and economic outcomes of ESWL <i>vs</i> URSL in the management of lower ureteric stones.</p><p><strong>Methods: </strong>This randomized controlled trial included 240 adult patients with confirmed lower ureteric calculi, allocated equally to ESWL or URSL groups. Baseline characteristics, stone parameters, procedural details, complications, and follow-up outcomes - including stone clearance, pain, QoL, workdays lost, cost, and satisfaction - were systematically analyzed over a 3-month follow-up.</p><p><strong>Results: </strong>URSL demonstrated significantly higher stone-free rates at all time points (<i>e.g.</i>, 95% at 3 months) compared to ESWL (55.83%). While ESWL was associated with fewer complications, it required more sessions and resulted in lower immediate postoperative QoL and higher workdays lost. Conversely, ESWL was more cost-effective and highly satisfactory, with better early pain scores. Stone size and density influenced success, favoring URSL for larger or denser stones. Overall, both modalities are effective, but treatment choice should be individualized based on stone characteristics and patient factors.</p><p><strong>Conclusion: </strong>URSL offers superior stone clearance, particularly for larger stones, with acceptable safety profiles. ESWL remains a viable non-invasive option for smaller stones, providing better QoL recovery and economic benefits. Individualized treatment planning is essential for optimal outcomes.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 2","pages":"114619"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221135","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":"High-flow nasal cannula for hypoxia in the post-anesthetic recovery unit: A systematic review and meta-analysis.","authors":"Cheng Lin, Kevin R Song, Qing Hao Li, Gopakumar S Nair, Sonny Cheng, Kamal Kumar","doi":"10.5492/wjccm.v15.i2.118285","DOIUrl":"10.5492/wjccm.v15.i2.118285","url":null,"abstract":"<p><strong>Background: </strong>Earlier meta-analyses demonstrated conflicting results on whether high-flow nasal cannula (HFNC) reduces rate of intubation in the postoperative period when compared to conventional oxygen therapy (COT). Since then, newer studies have come out, so an updated comparison of these two modalities is warranted.</p><p><strong>Aim: </strong>To determine whether HFNC reduces the rate of reintubation compared to COT.</p><p><strong>Methods: </strong>We conducted a random-effects meta-analysis, searching databases (MEDLINE, EMBASE, Web of Science) to identify randomized controlled trials comparing HFNC with COT on postoperative patient outcomes of interest including reintubation, escalation to noninvasive ventilation, mortality, length of stay, pneumonia, postoperative pulmonary complications, vital signs and blood gas measurements. We assessed the quality of data using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.</p><p><strong>Results: </strong>Twenty-five trials, including 4260 patients met the inclusion criteria. Thirteen investigated reintubation and the pooled result was not significant [odds ratio (OR); 0.93; 95% confidence interval (CI): 0.36-2.38; <i>I</i> ² = 47.1%; <i>P</i> = 0.86]. However, HFNC reduced the incidence of atelectasis (OR 0.33; 95%CI: 0.18-0.59; <i>I</i> ² = 10.8%; <i>P</i> = 0.0046) and hypoxemia (OR 0.42; 95%CI: 0.21-0.83; <i>I</i> ² = 78.3%; <i>P</i> = 0.017). There were no clinical differences detected in other outcomes. GRADE for certainty of evidence was low to moderate.</p><p><strong>Conclusion: </strong>HFNC does not reduce reintubation risk in our analysis with moderate certainty. Use of HFNC should not delay escalation of therapy to noninvasive ventilation or a definitive airway.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 2","pages":"118285"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221228","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":"Noise quantification in the intensive care unit of a tertiary care hospital.","authors":"Ruchi Gupta, Arshdeep S Chadha, Himanshi Lakra, Rimsha Rehan, Raminder Kalra, Sumit Ray","doi":"10.5492/wjccm.v15.i2.114240","DOIUrl":"10.5492/wjccm.v15.i2.114240","url":null,"abstract":"<p><strong>Background: </strong>Noise in intensive care units (ICUs) frequently exceeds recommended levels [the World Health Organization (WHO) recommends equivalent continuous noise level (Leq) < 35 dB], arising from alarms, equipment, and staff activity. Elevated sound can disrupt patients' sleep, increase stress, and impair recovery.</p><p><strong>Aim: </strong>To identify the extent of noise exposure in the ICU.</p><p><strong>Methods: </strong>This observational study was conducted in the adult ICU of a tertiary care hospital. Noise was measured using the SERRAX SLM1090 sound level meter, which was placed in the center of the 10-bed ICU at a height of 6 feet above ground level. A 30-minute time window was set to obtain half-hourly Leq, L10, L50, L90 (representing sound levels exceeding 10%, 50%, and 90% of the time, respectively), and maximum sound level (Lmax).</p><p><strong>Results: </strong>Data were collected over 4 months (December 2024 to March 2025), yielding 5443 half-hourly recordings. The average Leq, Lmax, L10, L50, L90 and sound exposure level were 64.8 ± 2.8 dB, 82.5 ± 4.4 dB, 67.5 ± 2.9 dB, 61.4 ± 3.2 dB, 56.4 ± 2.8 dB and 97.7 ± 2.8 dB, respectively. Nurses' handover, visitation and twilight hours were the noisiest. Nighttime (1:00 hours to 3:00 hours) was the quietest in the ICU. Lmax in the ICU exceeded the WHO cut-offs for industrial sounds and public addresses of 75 dB and 85 dB in 96.7% and 25.5% of readings, respectively. Twenty-four-hour cumulative sound exposure to the patient for night and evening-night penalties were 68 dB and 70 dB, respectively.</p><p><strong>Conclusion: </strong>The noise exposure in the ICU persistently exceeded WHO-recommended thresholds. Maximum noise occurred during handovers, visitation and twilight activities, indicating that these times would be the most effective for intervention.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 2","pages":"114240"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221209","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":"Paroxysmal supraventricular tachycardia associated with dexmedetomidine withdrawal in an adult liver transplant recipient: A case report.","authors":"Karen Kimura, Shinichi Kai, Moritoki Egi","doi":"10.5492/wjccm.v15.i2.120336","DOIUrl":"10.5492/wjccm.v15.i2.120336","url":null,"abstract":"<p><strong>Background: </strong>Dexmedetomidine is a selective α₂-adrenergic receptor agonist widely used for sedation and anxiolysis in intensive care units (ICUs). Abrupt discontinuation after prolonged infusion may induce withdrawal symptoms because of sympathetic rebound. Although sinus tachycardia and hypertension are common manifestations, clinically significant tachyarrhythmias have rarely been reported in adults.</p><p><strong>Case summary: </strong>A woman in her 60 years was readmitted to the ICU for septic shock following liver transplantation. Prolonged high-dose dexmedetomidine infusion was required to manage sleep disturbance and anxiety. Two hours after abrupt discontinuation of dexmedetomidine, the patient developed paroxysmal supraventricular tachycardia that was refractory to adenosine triphosphate and landiolol. Reinitiation of dexmedetomidine promptly restored sinus rhythm, suggesting withdrawal-related sympathetic overactivity as the precipitating mechanism. Gradual tapering prevented recurrence.</p><p><strong>Conclusion: </strong>Dexmedetomidine withdrawal should be considered in adult ICU patients presenting with unexplained tachyarrhythmia. Careful tapering and multimodal sedation strategies are essential when prolonged dexmedetomidine administration is anticipated.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 2","pages":"120336"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220678","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":"Clinical profile and outcomes of critically ill obstetric patients in the intensive care unit of a tertiary care center.","authors":"Tanvi M Meshram, Ankur Sharma, Nikhil Kothari, Akshaya Kumar Das, Garima Choudhary, Darshana Rathod, Kamlesh Kumari, Pradeep K Bhatia","doi":"10.5492/wjccm.v15.i2.118246","DOIUrl":"10.5492/wjccm.v15.i2.118246","url":null,"abstract":"<p><strong>Background: </strong>Although obstetric patients account for only 1%-2% of general intensive care unit (ICU) admissions, they constitute a distinct population with unique physiological characteristics and risk profiles. Therefore, understanding the clinical profile of these patients is essential for their appropriate management.</p><p><strong>Aim: </strong>To evaluate clinical characteristics, outcomes, and mortality predictors among obstetric patients admitted to a multidisciplinary ICU, and to assess the performance of established severity scoring systems in this unique population.</p><p><strong>Methods: </strong>We conducted a retrospective study of all obstetric patients (pregnant or ≤ 6 weeks postpartum) admitted to the ICU of a tertiary care teaching hospital from January 2020 to April 2022. Primary outcomes included mortality rates and length of stay. Secondary outcomes included evaluation of Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, Simplified Acute Physiology Score II, and Modified Early Obstetric Warning Score systems for mortality prediction.</p><p><strong>Results: </strong>During the research period, 101 patients were admitted to the ICU. The documented mortality rate was 27.7% among these patients admitted to the ICU. The predominant reason for ICU hospitalization was hypertensive disorders of pregnancy (20.7%), followed by postpartum hemorrhage (19.8%). Mechanical ventilation was necessitated in 67.3% of parturient. Cesarean delivery was the most common mode of delivery (58.4%). Fetal outcomes included 81.1% live births, 12.8% intrauterine deaths, and 2.9% stillbirths. Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Modified Early Obstetric Warning Score, and Sequential Organ Failure Assessment scores of 21 (14-26.5), 36 (28.7-43), 6 (4-7), and 5 (4-6) significantly predicted mortality (<i>P</i> < 0.05) in non-survivors.</p><p><strong>Conclusion: </strong>Parturient may present to the critical care unit with hypertensive disorders, hemorrhage, morbidly adherent placenta, and other non-obstetric causes demanding obstetric and critical care. The availability of a dedicated obstetric critical care unit with specialized personnel would help decrease the mortality in this subset of patients.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 2","pages":"118246"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221175","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":"Outcomes of acute kidney injury in critically ill adults with tropical acute febrile illness: Prospective observational study.","authors":"Sankalp Ranjan, Srishti Jain, Puneet Panwar, Ashish Jain, Ravi Jain","doi":"10.5492/wjccm.v15.i2.118803","DOIUrl":"10.5492/wjccm.v15.i2.118803","url":null,"abstract":"<p><strong>Background: </strong>Tropical acute febrile illness (TAFI) is a major illness with a large number of intensive care unit (ICU) admissions in tropical regions. It is frequently complicated by acute kidney injury (AKI) and associated poor outcomes. The data on the predictors of outcomes, in terms of in-hospital mortality and renal outcomes, amongst critically-ill TAFI patients from our region remain limited.</p><p><strong>Aim: </strong>To evaluate the clinical profile and outcomes of AKI amongst critically-ill TAFI patients and to identify the factors associated with in-hospital mortality.</p><p><strong>Methods: </strong>This prospective observational cohort study was conducted amongst the patients admitted in ICU at a tertiary care teaching hospital in the state of Rajasthan (India) between June and September 2025. Adult patients (aged ≥ 18 years), with laboratory-confirmed TAFI and AKI diagnosed using AKI network criteria, were included in the study. Demographic, clinical, laboratory, and organ-support variables were recorded. The primary outcome was all-cause in-hospital mortality while the secondary outcomes included renal recovery at the time of discharge and a composite net negative outcome (NNO) (defined as in-hospital mortality or persistent renal dysfunction during discharge). Univariate and exploratory multivariable logistic regression analyses were conducted to identify the predictors of the outcomes.</p><p><strong>Results: </strong>The data collected from a total of 68 critically-ill TAFI patients with AKI was analyzed. Their median age was 52 years while 37 (54.4%) were females. Scrub typhus 43 (63.24%) was found to be the most common etiology, followed by dengue 9 (13.24%). AKI stage I was found to be the most frequent (37; 54.4%) at ICU admission, while 19 (27.94%) required renal replacement therapy. Overall, the in-hospital mortality was 8 (11.8%) while NNO was observed in 23 (33.8%) patients. In terms of multivariable analysis, higher APACHE II scores and lower arterial oxygen tension at admission independently predicted the mortality. Dialysis requirement was found to be a strong predictor of NNO (odds ratio 21.95), along with hypoxemia and greater illness severity.</p><p><strong>Conclusion: </strong>AKI in critically-ill TAFI patients has the modest mortality yet it results in substantial morbidity and incomplete renal recovery outcomes. Early hypoxemia, illness severity, and the need for dialysis are the key predictors of adverse outcomes. The study findings emphasize the importance of a comprehensive severity assessment beyond the existing creatinine-based AKI staging method.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 2","pages":"118803"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220727","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}