Annals of Intensive Care最新文献

{"title":"Efficacy and safety of ilaprazole for stress ulcer - associated upper gastrointestinal bleeding prophylaxis in critically ill patients: a randomized, double-blind, non-inferiority phase 3 trial.","authors":"Jiao Liu, Xiaojun Pan, Sisi Huang, Shouzhi Fu, Yannan Cui, Jingwen Yang, Xuemei Hou, Ying Xia, Sheng Zhang, Zhenliang Wen, Hong Sun, Yi Xiao, Hui Li, Weifeng Shang, Xiangyou Yu, Dechang Chen","doi":"10.1016/j.aicoj.2026.100044","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100044","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the efficacy and safety of Ilaprazole in preventing stress ulcer-associated upper gastrointestinal bleeding in critically ill patients.</p><p><strong>Design: </strong>A Randomized, Double-Blind, non-inferiority Phase 3 Trial.</p><p><strong>Setting: </strong>70 hospitals across China from July 16, 2021, to April 28, 2022.</p><p><strong>Patients: </strong>441 Patients (mean age 59 years; 150 female) at high risk for stress ulcer bleeding requiring invasive mechanical ventilation were enrolled.</p><p><strong>Interventions: </strong>Patients were randomly assigned to receive either Ilaprazole (10 mg once daily, first dose doubled; 220 patients) or esomeprazole (40 mg twice daily; 221 patients).</p><p><strong>Measurements and main results: </strong>441 patients (mean age 59 years; 150 female) were enrolled: 220 received Ilaprazole and 221 received esomeprazole. In FAS set, the primary endpoint occurred in 213 (96.80%) patients in the Ilaprazole and 215 (97.30%) in esomeprazole arms (Absolute Risk Difference: -0.47, 95% CI: -4.02, 3.03, p = 0.772). Secondary outcomes showed comparable incidences of clinically insignificant UGI bleeding, any gastrointestinal bleeding, 28-day mortality, ICU mortality, and pneumonitis. Adverse events were similar between groups, but Ilaprazole had a significantly lower incidence of hepatobiliary disorders (0.9% vs. 5%, p = 0.012).</p><p><strong>Conclusions: </strong>Ilaprazole demonstrated non-inferiority to esomeprazole in preventing UGI bleeding in critically ill patients at high risk of stress ulcer.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100044"},"PeriodicalIF":5.5,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: physiology-guided subphenotyping of hypotension in early sepsis.","authors":"Tanmoy Ghatak","doi":"10.1016/j.aicoj.2026.100043","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100043","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100043"},"PeriodicalIF":5.5,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarifying physiology-guided subphenotyping of hypotension in early sepsis.","authors":"Carlos Sanchez-Escalante, Jean-Louis Teboul","doi":"10.1016/j.aicoj.2026.100042","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100042","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100042"},"PeriodicalIF":5.5,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfusion-associated capillary leak in cardiac surgery is linked to adverse postoperative outcomes: a prospective observational study.","authors":"Babak Saravi, Ulrich Goebel, Jan O Friess, Leonard Simeth, Melina Heine, Paul Philipp Heinisch, Zhide Meng, Lukas Wessendorf, Andrea U Steinbicker, Felix Ulbrich, Jochen D Muehlschlegel, Julian Hubrich, Jakob Wollborn","doi":"10.1016/j.aicoj.2026.100040","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100040","url":null,"abstract":"<p><strong>Background: </strong>Cardiac surgery patients are prone to complex inflammatory reactions associated with increased microvascular permeability, edema formation, and Capillary Leak Syndrome. Perioperative transfusions have been independently associated with higher risks of complications. This study aimed to investigate the association between transfusion, Capillary Leak Syndrome, and adverse postoperative outcomes in cardiac surgery patients.</p><p><strong>Methods: </strong>A prospective observational cohort of 405 adults undergoing cardiac surgery was enrolled at a tertiary academic center from May 2019 to October 2020. Body impedance electrical analysis and serial serum biomarker measurements were conducted throughout the patients' peri- and postoperative course. Main outcome measures included inflammatory and endothelial biomarkers (IL-6, IL-8, angiopoietin-2, syndecan-1), body fluid composition assessed by bioelectrical impedance, and clinical outcomes, including acute kidney injury (AKI), ICU length of stay (LOS), and ICU mortality. To study the impact of transfusion on outcomes, statistical analyses including logistic regression, case-matching, and exploratory clustering were performed.</p><p><strong>Results: </strong>Transfusions of red blood cells, fresh frozen plasma, or platelets were associated with elevated postoperative IL-6 (p < 0.001) and IL-8 (p < 0.001) levels, along with complications in a dose-dependent manner. Higher mortality was observed among patients receiving ≥5 units of each individual component. Transfusions were associated with modest increases in extracellular water and elevated serum levels of angiopoietin-2 and syndecan-1, consistent with Capillary Leak Syndrome, although absolute ECW differences were small. Cluster generation of transfusion-associated capillary leak (TAC) revealed that TAC patients were more frequently prone to death during their ICU stay (p = 0.006), had higher odds of developing AKI (p < 0.001), and a longer ICU LOS (p < 0.001).</p><p><strong>Conclusions: </strong>Among 405 patients undergoing cardiac surgery, perioperative transfusion was associated with higher inflammatory markers, an increase in extracellular water, and higher risks of AKI and ICU mortality in dose-response analyses, consistent with a transfusion-associated capillary leak phenotype that co-occurs with adverse postoperative outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100040"},"PeriodicalIF":5.5,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of persistent sepsis-associated acute kidney injury in septic shock: a post-hoc analysis of a multicenter prospective cohort study.","authors":"Michihito Kyo, Yu Kawazoe, Takeshi Morimoto, Hitoshi Yamamura, Kyohei Miyamoto, Noriko Miyagawa, Yoshinori Ohta, Kazuya Kikutani, Shinichiro Ohshimo, Nobuyuki Hirohashi, Nobuaki Shime","doi":"10.1016/j.aicoj.2026.100041","DOIUrl":"10.1016/j.aicoj.2026.100041","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-associated acute kidney injury (SA-AKI) contributes to a large morbidity and mortality burden. While emerging evidence suggests that the trajectory of SA-AKI, such as persistent SA-AKI, is associated with clinical outcomes, their association in septic shock remains unclear.</p><p><strong>Methods: </strong>In this multicenter prospective study in 20 ICUs, we investigated the incidence, clinical impact, and risk factors of persistent SA-AK in patients with septic shock requiring high-dose norepinephrine. Persistent SA-AKI was defined as an episode of AKI by KDIGO criteria lasting for at least 48 h in sepsis defined by sepsis-3 criteria. We assessed the association of persistent SA-AKI with clinical outcomes using multivariable Cox proportional hazards and logistic regression models. We also investigated risk factors for persistent SA-AKI.</p><p><strong>Results: </strong>In 257 patients with septic shock, 215 (84%) developed SA-AKI within 48 h of ICU admission, and 111 (43%) progressed to persistent SA-AKI. Patients with persistent SA-AKI had a significantly higher risk of 90-day mortality (adjusted HR, 2.75; 95% CI, 1.39-5.42; <i>P</i> = 0.004) and hospital mortality (adjusted OR, 4.29; 95% CI, 1.87-10.70; <i>P</i> < 0.001) than those with transient SA-AKI. Greater time-weighted average vasoactive-inotropic score was independently associated with the development of persistent SA-AKI (adjusted OR, 1.03; 95% CI, 1.01-1.06; <i>P</i> = 0.03).</p><p><strong>Conclusions: </strong>In patients with septic shock requiring high-dose norepinephrine, persistent SA-AKI is associated with worse clinical outcomes. These findings support the need for further research on risk stratification and targeted interventions based on the trajectory of SA-AKI.</p><p><strong>Trial registration: </strong>The study was registered on UMIN Clinical Trial Registry (UMIN000038302) on November 1, 2019.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100041"},"PeriodicalIF":5.5,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The time course of fluid responsiveness.","authors":"Ricardo Castro, Eduardo Kattan, Paulo Melo, Macarena Amthauer, Glenn Hernandez","doi":"10.1016/j.aicoj.2026.100036","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100036","url":null,"abstract":"<p><p>Fluid responsiveness (FR) is a cornerstone concept in the hemodynamic management of critically ill patients, referring to the heart's ability to increase output in response to fluid administration. This review explores the time course of FR, emphasizing its dynamic and transient nature influenced by various patient-specific factors and treatments. We highlight that FR is not a stable, binary state but rather a continuum that requires repeated evaluations using appropriate tools. We examine into factors affecting the temporal profile of FR, including the stage of resuscitation, fluid infusion rate, norepinephrine use, mechanical ventilation settings, systolic function, spontaneous breathing, and the patient's health condition. Understanding the duration and decay of the hemodynamic response is crucial for individualizing fluid therapy, potentially reducing the risks of both fluid overload and under-resuscitation. This review underscores the necessity of frequent reassessment of FR in critically ill patients and integrating this knowledge into personalized resuscitation protocols to improve clinical outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100036"},"PeriodicalIF":5.5,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and outcomes in women and men weaning from invasive mechanical ventilation: insights from the WEAN SAFE study.","authors":"Reginald Caldecott, Kate Laffey, Omid Khazaei, Yueyun Zhu, Bairbre A McNicholas, Emanuele Rezoagli, Tài Pham, Leo Heunks, Giacomo Bellani, Laurent Brochard, Andrew J Simpkin, Martin Dres, Paolo Navalesi, John G Laffey","doi":"10.1016/j.aicoj.2026.100037","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100037","url":null,"abstract":"<p><strong>Objective: </strong>To understand the differences in the weaning process and outcomes in men and women enrolled in the WorldwidE AssessmeNt of Separation of pAtients From ventilatory assistancE (WEAN SAFE) study.</p><p><strong>Methods: </strong>We analysed patients in the WEAN SAFE cohort who commenced weaning from invasive ventilation, stratified by biological sex. The primary outcome was the effect of sex on delayed weaning and failed weaning from invasive mechanical ventilation. Secondary outcomes included the influence of sex on ventilatory management, ICU/hospital survival and decisions to limit life-sustaining interventions.</p><p><strong>Results: </strong>Of 4,523 patients who entered the weaning process, 1,754 (38.8%) were women and 2,769 (61.2%) were men. Women were shorter, had higher P/F ratios, and received higher tidal volumes and lower PEEP than men. Women on controlled ventilation received higher driving pressures, while women on assisted ventilation received higher inspiratory pressures than men. Both female sex and shorter stature were independently associated with higher tidal volume ventilation, with shorter females at particular risk. In univariate analyses, women were less likely to successfully wean from invasive ventilation. When adjusted for factors such as height, age, and frailty profile, there was no independent association between sex and weaning success. In patients with more severe respiratory failure (P/F ratios <200), there were no sex differences in ventilatory support, weaning management and outcomes.</p><p><strong>Conclusions: </strong>Women weaning from ventilation were shorter and had less severe respiratory failure but received less protective lung ventilation and more frequent ventilatory over-assistance. When adjusted for height and age, female sex was not independently associated with failed weaning from invasive ventilation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT03255109.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100037"},"PeriodicalIF":5.5,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early mobilization with or without cycloergometry in patients with septic shock in Intensive Care Unit: a randomized controlled trial.","authors":"B Michaux, V Harter, E Occhiali, A Astier, A Freynet, G Fossat, R Galliot, G Mourrisoux, J Charpentier, B Rozec, F Tamion, G Béduneau","doi":"10.1016/j.aicoj.2026.100034","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100034","url":null,"abstract":"<p><strong>Purpose: </strong>Acquired weakness in intensive care unit (ICU) contributes to increased mechanical ventilation (MV) and morbi-mortality. Cycloergometry could be added to standard physiotherapy (SP). The objective of the study was to determine the effect of early mobilization with cycloergometry and SP on ICU length of stay (LOS).</p><p><strong>Methods: </strong>This prospective, randomized, multicenter study included sedated-ventilated patients admitted to ICU for septic shock. ICU LOS was assessed in two phases. Phase I: from hemodynamic stability to first awakening, and phase II: from first awakening to ICU discharge. In each phase, patients were randomized to an intervention group: cycloergometry and SP (C+SP), or a control group (SP), generating four groups in total. In the intervention group, patients received a daily session of 20 min of cycloergometry in addition to SP.</p><p><strong>Results: </strong>From December 2016 to March 2020, 119 patients were included (instead of 234 planned). Mean SAPSII score at ICU admission was 59.5. Characteristics at baseline were similar. When phase I and phase II were analyzed separately, no statistical difference was observed between groups in time to first awakening or time to ICU discharge (phase I: C+SP 4 [IQR 2-7] days vs SP 4 [IQR 2-8] days, p = 0.6, and phase II: C+SP 9 [IQR 6-15] days vs SP 12 [IQR 6-28] days, p = 0.3).In post-hoc analysis when phase I and phase II were considered together, the median duration of MV was significantly longer in patients who received no cycloergometry (14 [IQR 8-60] days vs 9 [IQR 6-17] days, p = 0.04). Moreover, a trend was observed for a shorter time from hemodynamic stability to ICU discharge in patients who received cycloergometry in at least one phase: C+SP in phase I and/or phase II (13 [IQR 8-33] days) vs SP only (20 [IQR 11-66] days), p = 0.052.</p><p><strong>Conclusion: </strong>Although the planned number of patients could not be included, a non-significant signal for decreased ICU LOS was observed in patients who received cycloergometry in at least one phase, in post-hoc analysis. Furthermore, cycloergometry was associated with a significantly lower duration of artificial ventilation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100034"},"PeriodicalIF":5.5,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of distinct immune subtypes in sepsis through dual immunomarker trajectory.","authors":"Fei Pei, Ning Liu, Jun Yuan, Yin Liu, Rui Shi, Xiang Si, Zihuai Liao, Qiaohan Liu, Jingyi Wen, Qing Fu, Yawen Zhu, Guangzhen Li, Sivasubramanium V Bhavani, Min Shao, Bin Gu, Luhao Wang, Jianfeng Wu, Xiangdong Guan","doi":"10.1016/j.aicoj.2026.100039","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100039","url":null,"abstract":"<p><strong>Background: </strong>While endotyping approaches have enhanced precision immunotherapy in sepsis, their temporal instability limits consistent clinical application. To overcome this challenge, the current study utilizes longitudinal immune markers to derive clinically relevant classifications.</p><p><strong>Methods: </strong>This study included three cohorts of 3,223 adult septic patients with at least three measurements of two readily available longitudinal immune markers, C-reactive protein (CRP) and absolute lymphocyte count (ALC), within four days following ICU admission. Group-based multi-trajectory modeling was used to cluster sepsis patients based on the dynamic changes of CRP and ALC to identify potential immune subgroups. Comparisons of clinical characteristics, hospital mortality, and persistent inflammation immunosuppression catabolism syndrome (PICS) incidence were made across the derived subgroups. We further characterized the immune-specific properties of each subgroup using 28 immune markers.</p><p><strong>Results: </strong>Based on the optimal classification, 471 sepsis patients in the derivation cohort were categorized into three subgroups: immune homeostasis subgroup (n = 39, 8.3%), immunosuppression subgroup (n = 180, 38.2%), and immune imbalance subgroup (n = 252, 53.5%). This classification remained robust upon validation in both internal (n = 2,527) and external (n = 225) cohorts. Differences in clinical profiles were observed in these subgroups: the immune homeostasis subgroup had the mildest disease severity with the lowest rates of PICS and mortality; the immunosuppression subgroup featured more chronic comorbidities, longer hospital stays, and higher mortality; while the immune imbalance subgroup exhibited the most critical condition, with more complications, longer ICU stays, and the highest incidence of PICS and mortality. Immune features revealed distinct subtype properties: the immune homeostasis subgroup exhibited inflammatory resolution and near-normal immunity; the immunosuppression subgroup characterized by a general reduction in lymphocyte subsets, persistent early T-cell activation, and the highest degree of T cell inhibition; and the immune imbalance subgroup showed a cytokine storm alongside the most severely impaired innate and adaptive immunity, as indicated by markedly low monocyte human leukocyte antigen-DR (mHLA-DR) expression and deficient late T cell activation.</p><p><strong>Conclusions: </strong>This study presents a practical immunological classification for sepsis based on the longitudinal dynamics of two immune markers. These immune subtypes complement existing consensus endotypes and provide a simple, clinically actionable approach particularly applicable in resource-limited settings.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100039"},"PeriodicalIF":5.5,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe hypotension but not systemic inflammation or endothelial activation predicts encephalopathy in circulatory shock.","authors":"Duc Nam Nguyen, Luc Huyghens, Truc Mai Nguyen, Johan Schiettecatte, Marc Diltoer, Wilfried Cools, Helene De Cuyper, David Rhapsorski, Johan Smitz, Haibo Zhang","doi":"10.1016/j.aicoj.2026.100033","DOIUrl":"10.1016/j.aicoj.2026.100033","url":null,"abstract":"<p><strong>Background: </strong>Encephalopathy is a frequent complication of circulatory shock and is associated with adverse outcomes. Whether encephalopathy is driven primarily by systemic inflammation, endothelial activation or cerebral hypoperfusion remains uncertain.</p><p><strong>Methods: </strong>We retrospectively studied 198 intensive care unit (ICU) patients with circulatory shock (95 septic shock, 103 non-septic shock). Encephalopathy (coma and delirium) was assessed using the Glasgow Coma Scale, Richmond Agitation-Sedation Scale, and Confusion Assessment Method for the ICU. Neuroinflammation or blood-brain barrier (BBB) dysfunction was evaluated using serum S100B protein. Systemic inflammation and endothelial activation were assessed using serum C-reactive protein (CRP), Matrix metalloproteinase-9 (MMP-9), Intercellular Adhesion Molecule -1 (ICAM-1) and Vascular Endothelial Growth Factor (VEGF). Severe hypotension was defined a priori as mean arterial pressure (MAP) <50 mmHg sustained ≥1 min; we also quantified the number of episodes and cumulative duration of MAP <60 and <50 mmHg across the first 72 h. Multivariable logistic regression and mixed-effect models examined associations with encephalopathy and ICU outcomes.</p><p><strong>Results: </strong>Encephalopathy developed in 140 patients (71%): 31 (23%) with coma and 99 (71%) with delirium. Severe hypotension (OR: 2.56 (1.18, 4.75), p = 0.022), longer sedation duration (OR: 1.09 (1.02, 1.18), p = 0.017), ICU-acquired infections (OR: 1.61(0.73, 3.54), p = 0.021), and elevated S100B (OR: 1.72 (0.66, 3.65), p = 0.03) were associated with encephalopathy. In contrast, systemic inflammation (CRP, MMP-9) and endothelial activation (ICAM-1, VEGF) were not associated with encephalopathy. Despite higher systemic inflammation in septic shock, the prevalence of encephalopathy and structural brain injury was similar to non-septic shock.</p><p><strong>Conclusions: </strong>In circulatory shock, encephalopathy is most strongly associated with recurrent/severe hypotension (MAP <50 mmHg) and markers of neuroinflammation, not systemic inflammation or endothelial activation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100033"},"PeriodicalIF":5.5,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}