Annals of Intensive Care最新文献

{"title":"Proenkephalin A for assessing kidney integrity and guiding KRT liberation decisions in critically ill patients.","authors":"David C Gabriel, Philipp Sauer, Rebecca Happel, Julia Grenz, Louise Benning, Florian Kälble, Florian Uhle, Felix C F Schmitt, Uta Merle, David Czock, Markus Verch, Matthias Karck, Mascha O Fiedler, Martin Zeier, Christian Morath, Markus A Weigand, Christian Nusshag","doi":"10.1016/j.aicoj.2026.100113","DOIUrl":"10.1016/j.aicoj.2026.100113","url":null,"abstract":"<p><strong>Background: </strong>Utility of serum creatinine (SCr) and urine output (UO) is limited for real-time assessments of functional integrity and guiding kidney replacement therapy (KRT) decisions in acute kidney injury (AKI). Proenkephalin A 119-159 (PENK) may overcome these limitations. We evaluate PENK's use for AKI staging, assessment of residual kidney function during KRT, and assessment of liberation failure.</p><p><strong>Methods: </strong>Prospective, real-world study in 1,436 critically ill patients at Heidelberg University Hospital, including a subgroup of 138 patients receiving KRT for liberation analyses. Plasma PENK was measured from admission to discharge. AKI was defined by KDIGO criteria; biomarker kinetic, ROC analyses and binary logistic regression models were performed. KRT liberation was considered successful if no re-initiation occurred within >5 days.</p><p><strong>Results: </strong>Of 1,436 patients, 621 (43.2%) developed AKI. Acute KRT was required in 12.6%, 40.9% of whom were successfully liberated, 24.3% failed, and 31.5% underwent no liberation attempt (3.3% lost to follow up). PENK rose with AKI stages and, unlike SCr/UO, distinguished stage 3 AKI with versus without acute KRT requirements, and differentiated acute from chronic KRT patients even under ongoing KRT. From KRT start, mean PENK levels increased progressively whereas SCr decreased under treatment. Later, PENK declined around successful liberation, with lower values compared to cases with liberation failure. PENK was the strongest, independent predictor of KRT liberation failure, outperforming SCr. A PENK cut-off of ≥250 pmol/L provided >90% specificity for liberation failure. Combining PENK and UO, further improved risk stratification.</p><p><strong>Conclusions: </strong>PENK may reflect kidney integrity independent of KRT, enhance residual kidney function assessment, and may aid prediction of KRT liberation failure, warranting multicenter validation.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100113"},"PeriodicalIF":6.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148696969","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":"Use of [TIMP-2] • [IGFBP7] to identify sepsis-related acute kidney injury in the emergency department.","authors":"B Cisteró, V Monforte, A Navas, T M Tomasa-Irriguible, M Camprubí-Rimblas, A Areny-Balagueró, E Campaña-Duel, I Martin, A Tomas, I Miñarro, M Vila, M Cuevas, T Teles, M Savone, C Stable, P Salom, C Guijarro, J Tajan, G Goma, E Diaz, Ll Blanch, E Gene, M Ostermann, J A Kellum, P M Honore, A Artigas, A Ceccato","doi":"10.1016/j.aicoj.2026.100119","DOIUrl":"10.1016/j.aicoj.2026.100119","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a common and harmful syndrome associated with sepsis. It is difficult to predict and has an adverse impact on both short- and long-term prognosis. Two urinary biomarkers, tissue inhibitor of metalloproteinases-2 (TIMP-2), and insulin-like growth factor-binding protein 7 (IGFBP7) have been validated for predicting moderate and severe AKI and improving the recognition of organ failure in critically ill patients with sepsis. We aimed to evaluate the performance of these markers for predicting sepsis-related AKI and its evolution in a cohort of patients admitted to the Emergency Department with infectious disease and high risk of sepsis. This single-centre, prospective, observational study included adult patients presenting to the Emergency Department (ED) with suspected infection. Patients were included in the study if they had a National Early Warning Score 2 (NEWS 2) of 3 or higher. Three blood samples were drawn during the first 24 h, and we defined AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) definition. The first urine sample during ED stay was collected for urinary [TIMP-2]•[ IGFBP7] determination. Higher admission levels of urinary [TIMP-2]•[IGFBP7] were associated with the development of AKI moderate-severe within 24 h (adjusted Odds Ratio 1.24; 95% Confidence Interval 1.07-1.43; p < 0.01). The biomarker showed only modest overall discrimination (AUC 0.67). Still, predefined cut-offs revealed complementary diagnostic roles: low values (<0.3) may help exclude AKI with a negative predictive value of 0.86, whereas the highest values (>2.0) increase its likelihood. Creatinine trajectories and inflammatory profiles were largely similar across groups, except for elevations in IL-10 and IL-1RN in high-risk patients. In conclusion, urinary [TIMP-2]•[IGFBP7] measured on presentation to the ED had only moderate discrimination for sepsis-associated AKI. However, values (<0.3 units) could help to rule out the risk of developing AKI, while values >2.0 indicated high risk.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100119"},"PeriodicalIF":6.9,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683467","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":"Long-term frailty trajectory in older ICU survivors requiring mechanical ventilation: a prospective cohort study in Norway.","authors":"B A Kroken, D Bergum, K S Berg, M Espinasse, O K Fossum, M Hoff, P Klepstad, B Å Sjøbø, R Kvåle, H Flaatten, S K Frisvold","doi":"10.1016/j.aicoj.2026.100115","DOIUrl":"10.1016/j.aicoj.2026.100115","url":null,"abstract":"<p><strong>Background: </strong>While intensive care unit (ICU) capacity remains constrained, the number of older patients receiving resource-demanding ICU treatment continues to rise. Yet, long-term outcomes and post-critical illness frailty trajectories remain poorly characterized. We examined long-term mortality and frailty trajectories, and their associations with clinical characteristics and ICU treatment intensity.</p><p><strong>Methods: </strong>In this prospective, observational study across five Norwegian hospitals representing all health regions, we included patients aged ≥65 years who required invasive mechanical ventilation for ≥24 h. Frailty was assessed using the Clinical Frailty Scale (CFS) at baseline and at 3 and 12 months, categorized as robust (CFS 1-3), prefrail (CFS 4) and frail (CFS ≥ 5). Multiple regression models were used to examine associations between frailty trajectories and mortality, with baseline frailty, clinical characteristics and potentially modifiable aspects of ICU treatment.</p><p><strong>Results: </strong>346 patients were included. Mean age was 74 years (± 6), and 98 % lived at home before admission. The median ICU length of stay was 8 (IQR 9) days. Total mortality was 52 %, with most deaths occurring before hospital discharge. In the survivors, the prevalence of frailty increased from 23 % (79/346) at baseline, to 47 % (81/174) at three months. Between the three- and 12- month follow-up, CFS scores remained unchanged in 71 % (108/153), improved in 19 % (29/153) and deteriorated in 10 % (15/153). By 12 months 86 % (132/153) had returned home, though 32 % (49/153) required home care compared to 10 % pre-admission. Baseline CFS showed the strongest association with 12-month mortality (Risk Ratio 1.46, <i>p <</i> 0.001). Age (Risk Ratio 1.22, <i>p <</i> 0.001) and SOFA score on the first day after intubation (Risk Ratio 1.14, <i>p <</i> 0.01) were also significant predictors, whereas comorbidity was not.</p><p><strong>Conclusions: </strong>In elderly ICU-patients long-term frailty is deranged, and baseline CFS is closely associated with mortality. However, a small group of patients had a transitory decline in frailty at three months follow-up and then improved. Intervention studies targeting modifiable factors associated with long-term functional decline and mortality are warranted.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT06012942).</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100115"},"PeriodicalIF":6.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683533","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":"Volatile sedation using isoflurane versus intravenous sedation in intensive care unit: a propensity matched case control study.","authors":"Romain Tymen, Kahaia De Longeaux, Pierre Bailly, Erwan L'Her","doi":"10.1016/j.aicoj.2026.100118","DOIUrl":"10.1016/j.aicoj.2026.100118","url":null,"abstract":"<p><strong>Background: </strong>Sedation in the ICU relies on the use of a combination of intravenous hypnotics and opioids. Volatile anesthetics such as isoflurane or sevoflurane have been explored for sedation in ICU for a few years, based on their pharmacological properties. Even if early studies were promising, recent evidence raised concerns about higher mortality while using sevoflurane in ICU. This study aims to evaluate the impact of volatile sedation with Isoflurane within a real-world ICU setting.</p><p><strong>Methods: </strong>Within a prospective data warehouse system (ReaSTOC), we screened patients receiving mechanical ventilation for more than 24 hours while being sedated for more than 12 hours. A cohort of 216 patients receiving volatile sedation (isoflurane) was matched with 432 patients sedated using intravenous drugs (midazolam and propofol).</p><p><strong>Results: </strong>ICU and hospital mortality rates were 40.6% and 43.5% in the volatile sedation group vs. 42.3% and 50.0% in intravenous sedation group (p-value 0.73 and 0.14, respectively). Major adverse events including acute kidney injury and dialysis were similar across both groups. Interestingly, ventilation duration and ICU length of stay were higher in volatile sedation group.</p><p><strong>Conclusion: </strong>No difference in terms of mortality and adverse events occurrence was observed between intravenous and volatile sedation. These findings support the continued use of volatile sedation (isoflurane) in ICU settings.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100118"},"PeriodicalIF":6.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148652916","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":"Prevalence and prognosis impact of right ventricular injury in patients with acute respiratory distress syndrome: a systematic review and meta-analysis.","authors":"Mathieu Jozwiak, Adrien Joseph, Alan Mourougayen, Matthieu Petit, Antoine Vieillard-Baron, Philippe Vignon, Bruno Evrard","doi":"10.1016/j.aicoj.2026.100117","DOIUrl":"10.1016/j.aicoj.2026.100117","url":null,"abstract":"<p><strong>Background: </strong>Right ventricular (RV) injury is a frequent complication in patients with acute respiratory distress syndrome (ARDS), yet its prevalence and prognostic significance remain uncertain. The main objective of this systematic review and meta-analysis was to evaluate the association between RV injury and mortality in patients with ARDS. The secondary objectives were to determine the prevalence of RV injury and to assess the impact of both COVID-19 status and the definition of RV injury on mortality.</p><p><strong>Methods: </strong>From January 2013 to December 2024, we searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials for all studies including adult patients with ARDS according to the Berlin definition, which reported mortality according to the presence or absence of RV injury.</p><p><strong>Results: </strong>Twenty-three studies including 3,977 patients with ARDS were analyzed. The pooled prevalence of RV injury was 30% (95% confidence intervals (CI) 23-38%), ranging from 6% to 56% across studies depending on the definition used, and did not differ between COVID-19 (33%, 95%CI 22-47%) and non-COVID-19 (25%, 95%CI 21-29 %) patients. RV injury was associated with increased ICU mortality in unadjusted analyses (random-effects odds ratio (OR) 2.49, 95%CI 1.81-3.42; I² = 56%) and in adjusted analyses (aOR 2.37, 95%CI 1.24-4.51, I² = 42%; adjusted hazard ratio (aHR) 2.64, 95%CI 1.60-4.37, I² = 24%). This association remained consistent across subgroups based on COVID-19 status and RV injury definition, and across sensitivity analyses excluding patients receiving venovenous extracorporeal membrane oxygenation and low to moderate quality studies.</p><p><strong>Conclusions: </strong>RV injury is common in patients with ARDS and is consistently associated with increased mortality, irrespective of the definition used. Further studies enrolling consecutive patients, with standardized and repeated echocardiographic assessment of RV function, are needed to establish causal inference.</p><p><strong>Trial registration: </strong>CRD42024568063 and date of registration: 22/07/2024.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100117"},"PeriodicalIF":6.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148696974","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":"Pre-ICU hospital length of stay and 30-day mortality in the very old: a national cohort of 315 042 ICU admissions.","authors":"Björn Ahlström, Miklos Lipcsey","doi":"10.1016/j.aicoj.2026.100116","DOIUrl":"10.1016/j.aicoj.2026.100116","url":null,"abstract":"<p><strong>Background: </strong>The number of very old (≥80 years) patients (VIPs) admitted to intensive care units (ICUs) is rising. Hospital length of stay before ICU admission (pre-ICU LOS) is associated with short-term mortality, but whether this association is uniform across adult age is unclear. We examined how age modifies the association between pre-ICU LOS and 30-day mortality.</p><p><strong>Methods: </strong>We included all adult first ICU admissions in the Swedish Intensive Care Registry 2005-2016, with comorbidity and vital status from national registers. We fit a logistic regression on 30-day mortality with restricted cubic splines for age, pre-ICU LOS, and Charlson comorbidity index, with interactions. Marginal predicted risks and within- and between-age risk differences (RDs) were from the model. Two sensitivity analyses included Simplified Acute Physiology Score (SAPS3) functional form of pre-ICU LOS and age, and adjustment for acute physiology at admission (SAPS3 Box III) with multiple imputation.</p><p><strong>Results: </strong>Among 315 042 patients, 30-day mortality rose with pre-ICU LOS in every age decile, but the magnitude of this gradient varied with age. In VIPs, the within-age RD from day 0 to day 60 was 12.8 percentage points (95% CI 10.0-15.6) against a day-0 baseline of 34.6 %, compared with 17.5 (16.0-18.9) in 60-69-year-olds. Findings were consistent across sensitivity analyses.</p><p><strong>Conclusions: </strong>Pre-ICU hospital length of stay is a weaker prognostic marker in VIPs than in the majority of ICU patients, although the extent to which this reflects biology versus age-dependent ICU triage remains unresolved.ClinicalTrials.gov identifier NCT07571213 (retrospectively registered).</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100116"},"PeriodicalIF":6.9,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583351","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":"Extracorporeal CO₂ removal integrated with continuous renal replacement therapy in patients with acute respiratory distress syndrome and acute kidney injury: a systematic review and meta-analysis.","authors":"Yuri de Albuquerque Pessoa Dos Santos, Paulo Ricardo Gessolo Lins, Bruno Martins Tomazini, Eduardo Lyra de Queiroz, Laerte Pastore Júnior, Fernando José da Silva Ramos, Maristela Carvalho de Costa, Eduardo Leite Vieira Costa, Marcelo Brito Passos Amato, Alain Combes","doi":"10.1016/j.aicoj.2026.100114","DOIUrl":"10.1016/j.aicoj.2026.100114","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) represent a complex clinical scenario. Permissive hypercapnia during lung-protective ventilation may cause severe acidemia and limit further reductions in ventilatory intensity. Extracorporeal carbon dioxide removal integrated into the CRRT circuit may enhance carbon dioxide clearance while providing renal support, but its physiological effects and safety in this population remain uncertain.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of adult studies evaluating ECCO₂R integrated with continuous RRT in patients with ARDS and AKI. Literature searches were performed in PubMed, Embase (Ovid), and Cochrane CENTRAL from inception to May 15, 2026, without language or date restrictions, and were supplemented by reference screening, forward citation tracking, and trial registry searches. The primary outcomes were changes in PaCO₂ and arterial pH after treatment initiation. Secondary outcomes included changes in ventilatory parameters, clinical outcomes, and safety events. Pre-post changes were pooled using random-effects models with restricted maximum likelihood estimation.</p><p><strong>Results: </strong>Seven observational studies comprising 105 patients were included. ECCO₂R integrated with RRT was associated with sustained reductions in PaCO₂ at 2 h (mean difference [MD] -8.22 mmHg; 95% CI -12.00 to -4.44), 6 h (MD -9.02 mmHg; 95% CI -15.69 to -2.34), and 24 h (MD -9.10 mmHg; 95% CI -13.59 to -4.61). These changes were accompanied by increases in arterial pH at 2 h (MD + 0.05; 95% CI 0.02 to 0.08) and 24 h (MD + 0.06; 95% CI 0.02 to 0.11). Ventilatory variables also improved, with reductions in tidal volume normalized to predicted body weight (MD -1.14 mL/kg PBW; 95% CI -1.74 to -0.54), driving pressure (MD -3.61 cmH₂O; 95% CI -4.87 to -2.35), and mechanical power (MD -6.82 J/min; 95% CI -9.12 to -4.51). Safety and patient-centered outcomes were limited and heterogeneously reported.</p><p><strong>Conclusion: </strong>ECCO₂R integrated with CRRT was associated with early PaCO₂ reduction, pH improvement, and lower ventilatory intensity in patients with ARDS and AKI. These findings support the physiological feasibility of this combined approach, although prospective comparative studies are needed to define its clinical role, safety, and impact on patient-centered outcomes.</p><p><strong>Trial registration: </strong>PROSPERO CRD420251234033.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100114"},"PeriodicalIF":6.9,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583411","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":"Corrigendum to \"Acute hYpErcapnic respiratory failure in The ICU: A multicenter prospective observational study - The YETI study\" [Ann Intensive Care (2026) 100016].","authors":"Dupuis Claire, Kamel Toufik, Beyls Christophe, Le Moal Charlène, Garcon Pierre, Goursaud Suzanne, Bodet-Contentin Laetitia, Ferré Alexis, Guillot Max, Gachet Alexandre, Noel Thibaut, Garin Aude, Argaud Laurent, Bachoumas Konstantinoss, Persichini Romain, Jonas Maud, Nay Mai-Anh, Cadoz Cyril, Schortgen Frédérique, Guinard Solène, Foucault Camille, Labro Guylaine, Jean-François Llitjos, Rouze Anahita, Pham Tài, Hermann Bertrand","doi":"10.1016/j.aicoj.2026.100109","DOIUrl":"https://doi.org/10.1016/j.aicoj.2026.100109","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1016/j.aicoj.2025.100016.].</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100109"},"PeriodicalIF":6.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497021","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":"A contemporary overview of severe community-acquired bacterial infections in pediatric intensive care units.","authors":"Michael Levy, Annelise Mary, Fleur Cour Andlauer, Jeremie Rousseaux, Lionel Berthomieu, Camille Brehin, Stephane Bechet, Montserrat Sierra-Colomina, Camille Aupiais, Francois Angoulvant, Elise Launay, Damien Dubois, Robert Cohen, Stephane Leteurtre, Corinne Levy, Etienne Javouhey","doi":"10.1016/j.aicoj.2026.100112","DOIUrl":"10.1016/j.aicoj.2026.100112","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired bacterial infections (CABIs) remain a leading cause of pediatric morbidity and mortality. This study aimed to provide a contemporary description of pediatric CABIs requiring admission to pediatric intensive care units (PICUs) in France.</p><p><strong>Methods: </strong>The CAPRICE study is a prospective, multicenter cohort including all children with suspected CABIs who were admitted to 28 French PICUs from January to December 2024. Demographic, clinical, microbiologic, and outcome data were prospectively collected. The primary outcome was mortality at day 28 and secondary outcomes included sequelae at day 28, PICU length of stay, and total hospital stay. Independent predictors of mortality were identified by multivariable logistic regression.</p><p><strong>Results: </strong>Among 897 children, the median age was 1.9 years (IQR 0.2-8.8); 55% were male, and 30% had a chronic condition. The leading infections were lower respiratory tract infection (43%), meningitis (20%), and ear-nose-throat infections (13%). Septic shock occurred in 17% of cases. A pathogen was identified in 89% of cases: <i>Bordetella pertussis</i> (22%) and <i>Mycoplasma pneumoniae</i> (15%) were predominant, followed by <i>Streptococcus pneumoniae</i> (13%), and <i>Staphylococcus aureus</i> (11%). In all, 34% patients had viral co-infection and 70% required organ support. Overall mortality was 7%, increasing to 19% with septic shock. Independent predictors of death included multiple organ failure, meningitis, and <i>B. pertussis</i> infection. Sequelae occurred in 15% of survivors.</p><p><strong>Conclusions: </strong>Severe CABIs in French PICUs in 2024 were mainly caused by <i>B. pertussis</i> and <i>M. pneumoniae</i>, followed by <i>S. pneumoniae</i> and <i>S. aureus</i>. Mortality and morbidity of these infections remain substantial.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100112"},"PeriodicalIF":6.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583418","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":"Urinary biomarkers IGFBP7 and TIMP-2 in the ICU: a multicenter prospective study on acute kidney injury outcomes.","authors":"Diego Ángeles-Sistac, Jaume Baldirà-Martínez de Irujo, Antoni Jordi Betbesé-Roig, José Alberto Santos-Rodríguez, Xosé Luis Pérez-Fernández, Joan Sabater-Riera, Javiera Puentes-Yáñez, Teresa María Tomasa-Irriguible, Ana Campos-Gómez, Ricard Ferrer, Marcos Pérez-Carrasco, Yolanda Díaz-Buendía, Rosana Muñoz-Bermúdez, Mireia Cuartero-Sala","doi":"10.1016/j.aicoj.2026.100111","DOIUrl":"10.1016/j.aicoj.2026.100111","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is prevalent in critically ill patients, contributing to high morbidity, mortality, and healthcare costs. Early detection and differentiation between transient and persistent AKI are critical for guiding timely interventions. This study evaluates the NephroCheck® score, based on Tissue inhibitor of metalloproteinases-2 (TIMP-2) and Insulin-like growth factor-binding protein 7 (IGFBP7) biomarkers. The primary objective was to assess its ability to predict AKI risk and AKI subtype within the first seven days of Intensive Care Unit (ICU) admission. Secondary objectives included evaluating its association with the need for renal replacement therapy (RRT) and overall ICU outcomes in a heterogeneous critical care population.</p><p><strong>Methods: </strong>This prospective, multicenter observational study included 455 ICU patients from five hospitals in Barcelona, Spain. Biomarker analysis was conducted on urine samples collected at admission, and AKI was classified according to the kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients were grouped by TIMP-2·IGFBP7 values and AKI subtypes. Data was analyzed using Stata version 18.0 (StataCorp, College Station, TX).</p><p><strong>Results: </strong>AKI occurred in 51% of patients; with 29% transient and 71% persistent. High TIMP-2·IGFBP7 (TIMP-2·IGFBP7 > 2.0) levels were significantly associated with AKI (OR 19.44; 95% CI [2.57-146.5], p = 0.004), persistent AKI (OR 4.3; 95% CI [1.61-11.41], p = 0.003), and RRT requirements (OR 3.93; 95% CI [1.34-11.47], p = 0.012). Patients with high TIMP-2·IGFBP7 had longer ICU stays, more severe AKI, increased RRT duration, and higher mortality rates. TIMP-2·IGFBP7 values correlated positively with ICU and in-hospital mortality and reduced 90-day survival.</p><p><strong>Conclusion: </strong>TIMP-2·IGFBP7 showed modest performance for early AKI detection, identifying RRT requirements and risk stratification in critically ill patients. While moderately effective for predicting outcomes, its role in differentiating transient from persistent AKI remains inconsistent. Further research is warranted to optimize TIMP-2·IGFBP7 guided interventions and explore its application in diverse AKI etiologies.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100111"},"PeriodicalIF":6.9,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13382416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597961","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}