Annals of Intensive Care最新文献

{"title":"Beyond chronological age: physiological reserve and myocardial recovery potential in a european registry of microaxial flow pump in cardiogenic shock.","authors":"Connor O'Brien, Antoine Kimmoun, Bertrand Rozec","doi":"10.1016/j.aicoj.2026.100110","DOIUrl":"10.1016/j.aicoj.2026.100110","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100110"},"PeriodicalIF":6.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497023","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 circuit temperature gradient and hemodynamic instability during continuous renal replacement therapy: an observational study.","authors":"Lorna Fraire, Téo Keraron, Matthieu Chivot, Hodane Yonis, Guillaume Chazot, Mehdi Mezidi, Louis Chauvelot, Guillaume Deniel, Jean-Christophe Richard, Laurent Bitker","doi":"10.1016/j.aicoj.2026.100108","DOIUrl":"10.1016/j.aicoj.2026.100108","url":null,"abstract":"<p><strong>Introduction: </strong>Lowering extracorporeal circuit temperature (T°_CRRT) below core temperature (T°_CORE) during continuous renal replacement therapy (CRRT) may modify hemodynamic instability (HIRRT) risk by affecting cardiac output (CO) and vasomotor tone. This study aimed to identify the mediators involved in the relationship between CRRT-to-core temperature gradient and HIRRT risk.</p><p><strong>Methods: </strong>This ancillary analysis of a prospective, single-center center study (NCT03139123) included patients with stage 3 acute kidney injury, receiving CRRT for <24 h and with continuous cardiac index monitoring. T°_CRRT, T°_CORE and hemodynamics parameters were collected 4-hly between inclusion and day 7 (or end of follow-up). Temperature gradient (ΔT°) corresponded to T°_CRRT minus T°_CORE. HIRRT (defined as a mean arterial pressure [MAP] <65 mmHg requiring therapeutic intervention) were reported hourly. An exploratory mediation analysis evaluated the effect of ΔT° on HIRRT risk during follow-up, mediated through CO and MAP.</p><p><strong>Results: </strong>42 patients were enrolled in this ancillary analysis (age 68 [58-76], SOFA 12 [8-15], 79% with sepsis), and were followed over 119 [57-143] hours (N = 1012 observations). Decreasing ΔT° (extracorporeal cooling) was significantly associated with higher heart rate, CO and MAP, lower norepinephrine dose, and was associated with a reduction in HIRRT risk in univariate analysis (<i>P</i> < 0.01). In mediation analysis, ΔT° ≤0°C decreased the probability of HIRRT by 7% (95% confidence interval: 1%-14%, <i>total effect</i>). A significant indirect effect was observed (average causal mediation effect [ACME]), operating through MAP and CO mediators (MAP: 5% [2%-7%]; CO: 4% [1%-5%]).</p><p><strong>Conclusions: </strong>During CRRT, setting the circuit temperature below body temperature was associated with a reduced HIRRT risk, an effect potentially mediated through improvements in MAP and CO.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100108"},"PeriodicalIF":6.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497076","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":"External validation of SOFA 2 score: a retrospective Chinese cohort study.","authors":"Rong Liufu, Maomao Cao, Xian-Qing Shi, Xiao-Yun Fu, Feng Shen, Yan Chen, Jin-Min Peng, Wen-Ying Han, Chun-Yao Wang, Li Weng, Xiang Zhou, Bin Du","doi":"10.1016/j.aicoj.2026.100107","DOIUrl":"10.1016/j.aicoj.2026.100107","url":null,"abstract":"<p><strong>Background: </strong>The revised Sequential Organ Failure Assessment (SOFA) 2 score was developed to improve early identification of acute organ dysfunction, which restricted from incomplete data in resource-limited settings. To compare the performance of original (SOFA-1) and updated SOFA-2 scores in these settings.</p><p><strong>Methods: </strong>The retrospective multicenter analysis included 118,542 adult patients admitted to intensive care units (ICUs) between 2014 and 2024. SOFA scores were calculated using clinical data from the first seven ICU days. The primary outcome was ICU mortality. Multiple approaches were applied to address missing data. We assessed the discriminative performance of total SOFA and organ-specific scores using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>A total of 5,286 patients (4.45%) died in the ICU, and 6,173 patients (5.2%) died during hospitalization. Across all cohorts, higher SOFA-2 subscores (0-4) and total scores were associated with lower frequency and higher ICU mortality. SOFA-2 demonstrated significantly better discrimination for ICU mortality than SOFA-1 [AUROC of 80.9% (95% CI, 80.3%-81.5%) vs. 76.7% (95% CI, 76.0%-77.4%)]. Each 1-point increase in SOFA-2 was associated with increasing odds of ICU mortality (OR 1.33, 95% CI 1.33-1.35). Between-cohort variance was lower for SOFA-2 (0.07) than for SOFA-1 (0.23), indicating greater robustness across these cohorts. Longitudinal analyses showed widening divergence in SOFA-2 trajectories between survivors and non-survivors over the first 7 days.</p><p><strong>Conclusion: </strong>In this external validation, SOFA-2 demonstrated improved discrimination for ICU mortality and more consistent score distribution than SOFA-1. These findings support the broader applicability of SOFA-2 across diverse healthcare settings, including those with substantial resource constraints.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100107"},"PeriodicalIF":6.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417948","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 effectiveness of tissue-perfusion-guided resuscitation in shock: A systematic review and meta-analysis.","authors":"Tamás Tóth, Patricia Schneidereit, Julia Hollosi, Dávid Lackó, Bence Szabó, Daniel Louis Albert, Caner Turan, László Zubek, Péter Hegyi, Zsolt Molnar","doi":"10.1016/j.aicoj.2026.100106","DOIUrl":"10.1016/j.aicoj.2026.100106","url":null,"abstract":"<p><p>Resuscitation from shock generally targets macrohemodynamic parameters. However, this approach may not be followed by improved microcirculation and carries a risk of fluid overload. We aimed to evaluate the efficacy of tissue-perfusion-guided therapy (TP-GT) compared with standard care in adult patients with shock. Following the PRISMA 2020 guidelines, we searched MEDLINE, Embase, and CENTRAL on October 26, 2025, for randomized controlled trials (RCTs) comparing TP-GT to standard therapy. The protocol was prospectively registered on PROSPERO (CRD420251163043). The primary outcomes were 30-day and 90-day mortality. Secondary outcomes included intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), fluid administration volumes, fluid balances and organ support requirements. The meta-analyses were performed using the random-effect model, and the risk of bias was assessed using the RoB2 tool. Eight RCTs were analyzed, comprising 2,394 patients. TP-GT did not significantly reduce either 30-day mortality (Risk Ratio [RR] 0.96; 95% CI 0.83-1.10; <i>P</i> = 0.49) or 90-day mortality (RR 0.94; 95% CI 0.82-1.07; <i>P</i> = 0.17) compared to standard care. However, patients managed with TP-GT were associated with a shorter ICU LOS (Mean Difference [MD] -0.72 day; 95% CI -1.42 to -0.01; P = 0.048), although this finding proved fragile in sensitivity analyses. Furthermore, TP-GT significantly reduced the volume of fluid administered through the first 6-8 h of resuscitation (MD -466.95 mL; 95% CI -917.17 to -16.72; P = 0.046). It promotes personalized fluid stewardship by significantly reducing early fluid administration and may be associated with shorter ICU LOS.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100106"},"PeriodicalIF":6.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417903","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":"Age-associated outcomes in cardiogenic shock supported with microaxial flow pumps.","authors":"Aurore Ughetto, Clement Delmas, Monika Fürholz, Laurent Bonello, Guillaume Leurent, Wiktor Kuliczkowski, Ana Hurtado, Philippe Gaudard, Chloé Tassain, François Xavier Herion, Agnieszka Tycinska, Benedikt Schrage, Marta Zaleska Kociecka, Frederic Bouisset, Matias Jacomet, Mikolaj Blaziak, Aneta Klotzka, Antoine Beurton, Miloud Cherbi","doi":"10.1016/j.aicoj.2026.100104","DOIUrl":"10.1016/j.aicoj.2026.100104","url":null,"abstract":"<p><strong>Background: </strong>Age represents a critical prognostic factor in cardiogenic shock (CS), yet older patients are underrepresented in randomized trials evaluating temporary mechanical circulatory support (tMCS). We aimed to assess the impact of age on outcomes in CS patients supported with micro-Axial Flow Pump (mAFP) across the age spectrum.</p><p><strong>Methods: </strong>We analyzed patients with CS treated with mAFP (Impella CP, 5.0 and 5.5) across 11 European centers between 2010 and 2023. Patients were stratified into quartiles by age: Q1 ≤ 52.0 years, Q2 > 52.0-60.0 years, Q3 > 60.0-69.0 years, and Q4 ≥ 69.0 years. The association between age and mortality was assessed using a Fine-Gray competing risks model and restricted cubic spline analysis. The primary endpoint was all-cause mortality at 30 days.</p><p><strong>Results: </strong>Among 1,043 patients supported with mAFP, the oldest quartile (Q4) was more frequently female, had higher comorbidity burden, and received less intensive support compared to Q1. In the Fine-Gray competing risks model, Q3 and Q4 patients had significantly higher 30-day and 1-year mortality risks (30-day: adjusted sHR 1.66 [95% CI: 1.19-2.34] and 1.87 [1.34-2.62]; 1-year: sHR 1.78 [1.31-2.41] and 2.08 [1.54-2.80]; Ptrend < 0.01 for all), with each additional year of age conferring a 3.2% increase in 30-day mortality risk (adjusted sHR 1.032 [1.017-1.047]). Major left ventricular ejection fraction (LVEF) recovery (≥10 percentage points) declined progressively with age, from 74.5% in Q1 to 41.9% in Q4 (p < 0.01), with each year associated with a 0.40 percentage-point reduction in LVEF improvement.</p><p><strong>Conclusions: </strong>In this European registry, increasing age was associated with higher mortality and lower observed myocardial recovery among patients with cardiogenic shock supported with mAFP.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100104"},"PeriodicalIF":6.9,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148389903","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":"Capillary refill time changes are associated with Vascular Waterfall response in post-cardiac surgery patients.","authors":"Stefan Andrei, Stéphane Bar, Maxime Nguyen, Bélaid Bouhemad, Dan Longrois, Pierre-Grégoire Guinot","doi":"10.1016/j.aicoj.2026.100105","DOIUrl":"10.1016/j.aicoj.2026.100105","url":null,"abstract":"<p><strong>Background: </strong>Capillary refill time (CRT) has emerged as a validated resuscitation target in acute circulatory failure following the ANDROMEDA-SHOCK trials and the 2025 ESICM guidelines, yet the physiological mechanisms underlying its clinical utility remain incompletely understood. The vascular waterfall (VW), defined as the difference between critical closing pressure (Pcc) and mean systemic filling pressure (Pmsf), represents the pressure gradient driving microcirculatory flow. We hypothesized that CRT changes reflect VW changes during hemodynamic treatment in post-cardiac surgery patients.</p><p><strong>Methods: </strong>This was a secondary analysis of a prospective observational study conducted in post-cardiac surgery patients with acute circulatory failure (n = 74). Patients were classified into vasoplegic (n = 30), preload-dependent (n = 33), or cardiogenic (n = 11) phenotypes and treated with norepinephrine, fluid expansion, or dobutamine, respectively. Hemodynamic parameters that comprise mean arterial pressure (MAP), indexed systemic arterial resistances (SARi), indexed venous resistances (VRi) were measured before and after treatment. VW was measured using the inspiratory hold technique before and after treatment. CRT was assessed using standardized methodology. Associations between CRT and VW changes were evaluated using Spearman correlations and multivariable logistic regression.</p><p><strong>Results: </strong>Patients with prolonged baseline CRT (>3 seconds, n = 55) had significantly lower VW compared to those with normal CRT (2.8 vs 18.3 mmHg, p = 0.014). Changes in CRT correlated significantly with changes in VW across the entire cohort (ρ = -0.40, p < 0.001). Subgroup analysis showed a significant correlation in preload-dependent patients (ρ = -0.37, p = 0.032), with similar trends in vasoplegic (ρ = -0.34, p = 0.065) and cardiogenic groups (ρ = -0.20, p = 0.555). Notably, ΔCRT correlated with ΔPcc (ρ = -0.42, p < 0.001) but not with ΔPmsf (ρ = -0.03, p = 0.81), indicating that CRT changes were more closely associated with the arterial component of vascular waterfall. In multivariable logistic regression, ΔCRT independently predicted VW response (OR 0.31 per second, 95% CI 0.12-0.84, p = 0.021), alongside ΔMAP, ΔSARi, and ΔVRi. Hemodynamic phenotype did not modify this association (p = 0.90).</p><p><strong>Conclusions: </strong>CRT changes are associated with vascular waterfall changes in post-cardiac surgery patients, primarily through the relationship with critical closing pressure rather than mean systemic filling pressure. These findings may provide a physiological framework for CRT-guided resuscitation and support its potential role as a bedside marker for assessing microcirculatory perfusion pressure.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100105"},"PeriodicalIF":6.9,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148389880","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":"Impact of Respiratory Effort Parameters on Clinical Outcomes in Respiratory Failure Patients (Effort-I): A Prospective Observational Study.","authors":"Phruet Soipetkasem, Touchapong Taksinwarajarn, Detajin Junhasavasdikul, Yuda Sutherasan, Pongdhep Theerawit","doi":"10.1016/j.aicoj.2026.100103","DOIUrl":"10.1016/j.aicoj.2026.100103","url":null,"abstract":"<p><strong>Background: </strong>Excessive or insufficient respiratory drive and inspiratory effort during mechanical ventilation may worsen outcomes through patient self-inflicted lung injury or diaphragm disuse. We evaluated whether bedside measures of respiratory drive and effort during the first 48 h of ventilation were associated with outcomes in critically ill adults with acute respiratory failure.</p><p><strong>Methods: </strong>In this single-center, prospective, observational study, adults aged 18-75 years with acute respiratory failure requiring invasive mechanical ventilation and a PaO₂/FiO₂ ratio >150 mmHg were enrolled within 24 h of ICU admission. Airway occlusion pressure at 100 ms (P_0.1) and occlusion pressure (P_occ) were measured at baseline and at 12, 24, 36, and 48 h. Calculated respiratory muscle pressure (P_mus) and calculated transpulmonary driving pressure (ΔP_L) were calculated from P_occ. Median values over the first 48 h represented exposure. The primary outcome was 28-day ventilator-free days (VFDs). Secondary outcomes included 28-day mortality, oxygenation changes, and correlations with Richmond Agitation-Sedation Scale scores. Multivariable Poisson and Cox regression analyses were performed.</p><p><strong>Results: </strong>A total of 206 patients were included. Patients within prespecified preferred ranges (P_0.1 1.5-3.5 cmH₂O, calculated P_mus 5-10 cmH₂2O, and calculated ΔP_L ≤20 cmH₂O) had more 28-day VFDs than those with low or high values. In multivariable Poisson regression, low and high P_0.1, low calculated P_mus, and high calculated ΔP_L were independently associated with fewer VFDs. In multivariable Cox regression adjusted for age, immunocompromised status, peak airway pressure, and APACHE II score, calculated ΔP_L >20 cmH₂O was independently associated with increased 28-day mortality (hazard ratio 6.57, 95% confidence interval 2.29-18.86; <i>P</i> < 0.001). Both low and high P_0.1 were also independently associated with mortality (hazard ratios 3.75 and 4.81, respectively). Oxygenation improved in patients with preferred effort levels, whereas ΔP_L >20 cmH₂O was associated with new-onset hypoxemia. Richmond Agitation-Sedation Scale scores correlated most strongly with calculated P_mus (r = 0.76), followed by P0.1 (r = 0.50) and ΔPL (r = 0.43).</p><p><strong>Conclusions: </strong>Early respiratory drive and inspiratory effort within preferred physiological ranges were associated with more VFDs and lower mortality. Calculated ΔP_L showed the strongest association with adverse outcomes, supporting bedside monitoring of drive and effort during assisted ventilation.</p><p><strong>Trial registration: </strong>NCT06433076. Registered 29 May 2024, retrospectively registered.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100103"},"PeriodicalIF":6.9,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366625","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":"Response letter to \"Venovenous extracorporeal membrane oxygenation initiation and reduction in vasopressor requirements\".","authors":"Bernhard Nagler, Thomas Staudinger","doi":"10.1016/j.aicoj.2026.100102","DOIUrl":"10.1016/j.aicoj.2026.100102","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100102"},"PeriodicalIF":6.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366648","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":"Human Development Index and outcomes in older critically ill patients: A European multicentre study.","authors":"Daniel Dankl, Raphael Romano Bruno, Michael Beil, Hans Flaatten, Malte Kelm, Sviri Sigal, Wojciech Szczeklik, Muhammed Elhadi, Michael Joannidis, Andreas Koköfer, Barbara Schreiber, Franz Singhartinger, Sandra Oeyen, Brian Marsh, Rui Moreno, Susannah Leaver, Dylan W De Lange, Bertrand Guidet, Ariane Boumendil, Christian Jung, Bernhard Wernly","doi":"10.1016/j.aicoj.2026.100101","DOIUrl":"10.1016/j.aicoj.2026.100101","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Older adults represent an increasing proportion of intensive care unit admissions, but the relationship between country-level human development and outcomes after critical illness remains incompletely understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a secondary analysis of three prospective multicentre registries, VIP1, VIP2, and COVIP, including acutely admitted older ICU patients with available Clinical Frailty Scale assessment, country-level Human Development Index (HDI), and 30-day vital status. VIP1 and VIP2 enrolled patients aged ≥80 years, whereas COVIP enrolled patients aged ≥70 years. The primary exposure was exceptionally high human development, defined as HDI ≥ 0.90 versus &lt;0.90. The primary outcome was 30-day mortality. Associations were assessed using logistic regression with robust standard errors clustered by country, adjusting for age, sex, SOFA score, frailty, admission diagnosis, organ support modalities, and treatment-limitation decisions. Exploratory mediation analyses examined selected ICU management variables as potential pathways linking HDI to mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 9920 patients included in the primary analysis, 8324 (83.9%) were treated in countries with HDI ≥ 0.90 and 1596 (16.1%) in countries with HDI &lt; 0.90. Thirty-day mortality was lower in high-HDI countries than in lower-HDI countries (40.0% vs. 53.3%). In unadjusted analysis, HDI ≥ 0.90 was associated with lower 30-day mortality (OR 0.58; 95% CI 0.38-0.90; &lt;i&gt;P&lt;/i&gt; = 0.016). This association persisted after multivariable adjustment (adjusted OR 0.49; 95% CI 0.31-0.80; &lt;i&gt;P&lt;/i&gt; = 0.004) and was similar after additional adjustment for study cohort (aOR 0.49; 95% CI 0.31-0.77; &lt;i&gt;P&lt;/i&gt; = 0.002) and ICU bed capacity (aOR 0.50; 95% CI 0.29-0.86; &lt;i&gt;P&lt;/i&gt; = 0.013). When modelled continuously, higher HDI was associated with lower mortality after full adjustment (OR 0.33 per 0.10-unit increase; 95% CI 0.19-0.56; &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Exploratory mediation analyses suggested that lower use of invasive mechanical ventilation in high-HDI countries may partially contribute to the observed association (NIE OR 0.86; 95% CI 0.83-0.89). Mediation analyses involving treatment-limitation decisions were more difficult to interpret because these decisions are closely linked to prognosis, clinical trajectory, and end-of-life practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this large European cohort of older critically ill patients, treatment in countries with exceptionally high human development was associated with lower 30-day mortality. The association persisted after adjustment for patient-level severity, frailty, treatment limitation, organ support, study cohort, and ICU bed capacity. These findings suggest that country-level development and ICU management patterns, particularly invasive ventilation practices, may contribute to outcome differences. Because this was an observational secondary analysis using country-lev","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100101"},"PeriodicalIF":6.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366560","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":"Improved survival in patients admitted to ICU with multiple myeloma: a retrospective cohort analysis.","authors":"Sabrine Nakaa, Leo Caillot, Akli Chermak, Helene Kemp, Stéphanie Harel, Michael Darmon, Elie Azoulay, Virginie Lemiale","doi":"10.1016/j.aicoj.2026.100100","DOIUrl":"10.1016/j.aicoj.2026.100100","url":null,"abstract":"<p><strong>Background: </strong>In the recent years, multiple myeloma (MM) has been associated with long-term survival. Life-threatening complications may occur in those patients leading to high risk of ICU admission. Within the same period, survival of critically ill patients with malignancy improved. The aim of this study was to evaluate severity and outcome in patients with MM admitted to ICU within the last 16 years.</p><p><strong>Methods: </strong>In this monocentric retrospective study, patients with MM admitted to ICU within two periods (2007-2015) and (2016-2023) around major therapeutic changes, were included. Patients from two periods were compared in terms of short and long terms outcomes. In the recent period, factors associated with mortality were assessed by multivariate analysis.</p><p><strong>Results: </strong>During the first period (2007-2015), 199 patients were included and compared to 229 patients admitted within the second period (2016-2023). Median delay from MM diagnosis to ICU was 25.9 (2.2-70.6) months and 82 (19.2%) patients were newly diagnosed patients. MM classified as high risk concerned 119 (52%) or Stade III Salmon-Durie for 142 (71.4 %) patients. SOFA score on Day 1 was 5 (2-7). During ICU stay, 115 (26.9%) patients needed invasive mechanical ventilation, 105 (24.5%) patients received vasopressors and 97 (22.7%) had renal replacement therapy. Median length of ICU stay was 3 (2-6) days. Reason for ICU admission was different between the two periods: Shock was more frequent in the second period (29.7% vs 13.7%) whereas acute respiratory failure was more frequent in the first period (35.2% vs 46.7%) (p < 0.001). ICU and one-year mortality rates were respectively 12.1% (n = 50) and 40.6% (n = 170). Mortality rates, adjusted on age, comorbidities, more than 2 lines treatment, time between hospital and ICU admission >1 day, kidney amyloidosis, SOFA score at ICU admission and reason for ICU admission, were lower in the recent period compared to the first period (0.68 (0.49-0.95), p = 0.02).</p><p><strong>Conclusions: </strong>Survival in MM patients admitted to ICU improved in the recent years. Particularly, patients who were not previously heavily treated had better outcome and should be admitted to ICU.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"16 ","pages":"100100"},"PeriodicalIF":6.9,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148389915","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}