Critical care explorations最新文献

{"title":"Health-Related Quality of Life of Adult Sepsis Survivors Following Critical Illness: A Systematic Review.","authors":"Sheraya De Silva, Anna Urwin, Chantal Grimwood, Ethan K E Goh, Alisa M Higgins, Carol L Hodgson","doi":"10.1097/CCE.0000000000001238","DOIUrl":"10.1097/CCE.0000000000001238","url":null,"abstract":"<p><strong>Objective: </strong>As survival following sepsis improves, there is increased attention on the health-related quality of life (HRQoL) of survivors following critical illness. The aim of this study is to systematically review the literature on the HRQoL of adult sepsis survivors following critical illness.</p><p><strong>Data sources: </strong>OVID MEDLINE, Embase, and CINAHL were searched using a combination of MeSH subject headings and keywords.</p><p><strong>Study selection: </strong>English-language studies published between January 2009 and June 2024, which investigated the HRQoL of adult sepsis survivors at 90 days or more following critical illness.</p><p><strong>Data extraction: </strong>Extracted data from included studies comprised HRQoL findings, the instruments administered, and representation of adult survivors following critical illness. Risk-of-bias quality assessment was assessed using the Cochrane Risk of Bias In Non-Randomised Studies - of Exposure tool. Selection of studies, data extraction, and quality assessment were conducted independently by two reviewers.</p><p><strong>Data synthesis: </strong>Thrity-three eligible studies were yielded from 25,611 records, with the sample size among included studies ranging from 55 to 2,151 participants. Included studies were mostly conducted in Europe. The EuroQol 5-dimension three-level instrument was most commonly administered (19 [58%] studies). Our review found that adult sepsis survivors following critical illness have lower HRQoL than population norms, regardless of follow-up timepoint. No significant difference was found in the HRQoL of adult survivors following critical illness with or without sepsis. High risk of bias in included studies was mostly due to missing data and confounding.</p><p><strong>Conclusions: </strong>As survival following critical illness improves, future research on improving long-term HRQoL following sepsis is crucial.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1238"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733111","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":"Outcome Predictions at Two Time Points among Surrogates and Physicians of Mechanically Ventilated Patients.","authors":"Benjamin Dufour, Hannah M Duehren, Ashley Eaton England, Kevin Keuper, Thomas V Quinn, Raj C Shah, Quyen M Diep, James Gerhart, Jared A Greenberg","doi":"10.1097/CCE.0000000000001235","DOIUrl":"10.1097/CCE.0000000000001235","url":null,"abstract":"<p><strong>Objectives: </strong>The decisions surrogates and physicians make for incapacitated critically ill patients depend in part on their expectations for patient recovery. We sought to determine whether the accuracy of surrogate and physician outcome predictions made during the ICU stay improves over time.</p><p><strong>Design: </strong>Survey study.</p><p><strong>Setting: </strong>Academic Medical Center.</p><p><strong>Subjects: </strong>Surrogates and physicians of 100 mechanically ventilated patients from March 2018 to April 2019.</p><p><strong>Interventions: </strong>At the end of the first week of mechanical ventilation and 1 week later, participants indicated on visual analog scales (0-100%) expectations that the patient would require mechanical ventilation in 1 month, require artificial nutrition in 1 month, be alive in 3 months, and be living at home in 3 months. Patient status was determined at 1 and 3 months.</p><p><strong>Measurements and main results: </strong>Area under the receiver operating characteristic curves (AUROCs) were determined for each outcome, at each time point. Patients who died within the first month were considered to require mechanical ventilation and artificial nutrition in the primary analysis. AUROCs for initial surrogate predictions were 0.61 (95% CI, 0.50-0.72) for mechanical ventilation, 0.67 (95% CI, 0.56-0.78) for artificial nutrition, 0.66 (95% CI, 0.55-0.7) for survival, and 0.61 (95% CI, 0.50-0.73) for living at home. AUROCs for initial physician predictions were 0.60 (95% CI, 0.49-0.71) for mechanical ventilation, 0.72 (95% CI, 0.61-0.0.83) for artificial nutrition, 0.69 (95% CI, 0.59-0.80) for survival, and 0.76 (95% CI, 0.66-0.85) for living at home. Average expectations among surrogates and physicians were highly stable over time; adjustments made to expectations did not result in more accurate predictions for the measured outcomes (p > 0.05).</p><p><strong>Conclusions: </strong>Among surrogates and physicians of patients who were mechanically ventilated for 1 week, outcome predictions were better than would be expected by chance and not significantly improved 1 week later.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1235"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733557","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":"The Impact of Extended-Hours Patient Recruitment on Critical Care Clinical Trial Enrollment.","authors":"John H Lee, Jacob Vine, Max Meier, Alan Berkovitz, Lakshman Balaji, Anne V Grossestreuer, Ari Moskowitz, Katherine M Berg, Michael W Donnino","doi":"10.1097/CCE.0000000000001239","DOIUrl":"10.1097/CCE.0000000000001239","url":null,"abstract":"<p><strong>Importance: </strong>Patient recruitment is a critical factor in running successful and timely clinical trials in the critical care field where the timing of presentation of patients is difficult to predict and the study interventions are often time sensitive.</p><p><strong>Objectives: </strong>The goal of this study was to analyze the timing of patient enrollments from previous clinical trials to identify patterns and assess the impact of providing extended-hours coverage on patient enrollment.</p><p><strong>Design, setting, and participants: </strong>This was a retrospective cohort study at a tertiary academic hospital in the United States between 2016 and 2024 on patients who were enrolled in five recent critical care clinical trials.</p><p><strong>Main outcomes and measures: </strong>We reviewed the patient enrollment data. We quantified the number of enrollments during business hours (9 am-5 pm) compared with outside of business hours and analyzed the frequency of enrollment by day of the week and time of day.</p><p><strong>Results: </strong>There were 352 patients enrolled between 2016 and 2024 across five clinical trials. A total of 242 patients (68.8%) were enrolled outside of business hours. 72.4% of patients were enrolled during weekdays and 27.6% during weekends. The enrollment pattern did not differ significantly across days of the week, ranging from 45 (12.8%) on Friday to 56 (15.9%) on Thursday. Enrollment from 2 pm to 10 pm accounted for more than 50% of the total enrollments. Recruiting only during business hours would have resulted in an additional 15 years to complete one of the trials.</p><p><strong>Conclusions and relevance: </strong>A review of our five recent critical care trials showed that nearly 70% of enrollment occurred outside of business hours. Limiting recruitment to only business hours would have resulted in a prohibitively longer time to complete the trials. This analysis provides a strong motivation and rationale for extending research staffing coverage beyond business hours.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1239"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733559","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":"Exploring Peripheral and Respiratory Muscle Weakness and Functional Impairments in ICU Patients: Insights From a Resource-Constrained Setting.","authors":"Shanita Chhiba, Susan D Hanekom, Alison R Lupton-Smith","doi":"10.1097/CCE.0000000000001245","DOIUrl":"10.1097/CCE.0000000000001245","url":null,"abstract":"<p><strong>Importance and objectives: </strong>The aim of this study was to explore peripheral and respiratory muscle structure and strength from unit admission to hospital discharge among ICU patients in a resource-constrained setting.</p><p><strong>Design: </strong>Prospective, observational study.</p><p><strong>Setting: </strong>Tertiary academic hospital.</p><p><strong>Participants: </strong>Newly intubated critically ill adults admitted to the medical and surgical ICUs and expected to be mechanically ventilated for more than 48 hours were included in the study.</p><p><strong>Main outcomes and measures: </strong>Ultrasonography of the right hemi-diaphragm and quadriceps muscles were taken at admission for 3 consecutive days. Respiratory and peripheral muscle strength were evaluated using the Medical Research Council-Sum Score, dynamometry and maximal inspiratory pressure (MIP) at awakening, ICU discharge and hospital discharge.</p><p><strong>Results: </strong>Forty-five participants were included, with a median (interquartile range) age of 34.5 (24.3-47.4) years and 73% were male. Most of the change in diaphragm thickness was observed on day 3, with 5 (22%) participants showing a decrease of more than 10% from baseline. Minimal changes in rectus femoris cross-sectional area were noted during the first 3 days. Eleven participants (44%) presented with ICU-acquired weakness at awakening, which decreased to 7 (29%) participants at ICU discharge and 5 (24%) participants at hospital discharge. The mean ± sd percentage of predicted quadriceps force was 22.2 ± 5.1 N at hospital discharge. The mean ± sd percentage of predicted MIP scores was 29.6% ± 10.5% at ICU discharge and 29.1% ± 8.6% at hospital discharge.</p><p><strong>Conclusions and relevance: </strong>Patients discharged from the ICU in a resource-constrained setting presented with peripheral and respiratory muscle weakness, with minimal change in muscle structure shown by ultrasonography, despite short ICU stays, low Acute Physiology and Chronic Health Evaluation II scores, and a relatively young age. Future research should explore whether these findings indicate a distinct phenotype of critical illness in such environments.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1245"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732625","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":"Multicenter Development and Prospective Validation of eCARTv5: A Gradient-Boosted Machine-Learning Early Warning Score.","authors":"Matthew M Churpek, Kyle A Carey, Ashley Snyder, Christopher J Winslow, Emily Gilbert, Nirav S Shah, Brian W Patterson, Majid Afshar, Alan Weiss, Devendra N Amin, Deborah J Rhodes, Dana P Edelson","doi":"10.1097/CCE.0000000000001232","DOIUrl":"10.1097/CCE.0000000000001232","url":null,"abstract":"<p><strong>Background: </strong>Early detection of clinical deterioration using machine-learning early warning scores may improve outcomes. However, most implemented scores were developed using logistic regression, only underwent retrospective validation, and were not tested in important subgroups.</p><p><strong>Objective: </strong>The objective of our multicenter retrospective and prospective observational study was to develop and prospectively validate a gradient-boosted machine model (eCARTv5) for identifying clinical deterioration on the wards.</p><p><strong>Derivation cohort: </strong>All adult patients admitted to the inpatient medical-surgical wards at seven hospitals in three health systems for model development (2006-2022).</p><p><strong>Validation cohort: </strong>All adult patients admitted to the inpatient medical-surgical wards and at 21 hospitals from three health systems for retrospective (2009-2023) and prospective (2023-2024) external validation.</p><p><strong>Prediction model: </strong>Predictor variables (demographics, vital signs, documentation, and laboratory values) were used in a gradient-boosted trees algorithm to predict ICU transfer or death in the next 24 hours. The developed model (eCARTv5) was compared with the Modified Early Warning Score (MEWS), the National Early Warning Score (NEWS), and eCARTv2 using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>The development cohort included 901,491 admissions, the retrospective validation cohort included 1,769,461 admissions, and the prospective validation cohort included 205,946 admissions. In retrospective validation, eCARTv5 had the highest AUROC (0.834; 95% CI, 0.834-0.835), followed by eCARTv2 (0.775 [95% CI, 0.775-0.776]), NEWS (0.766 [95% CI, 0.766-0.767]), and MEWS (0.704 [95% CI, 0.703-0.704]). eCARTv5's performance remained high (AUROC ≥0.80) across a range of patient demographics, clinical conditions, and during prospective validation.</p><p><strong>Conclusion: </strong>We developed eCARTv5, which performed better than eCARTv2, NEWS, and MEWS retrospectively, prospectively, and across a range of subgroups. These results served as the foundation for Food and Drug Administration clearance for its use in identifying deterioration in hospitalized ward patients.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1232"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733149","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":"Visual-Guided Transillumination Method for Accurate Percutaneous Tracheal Tube Placement.","authors":"Diane C McLaughlin, Michael P Schaller, Julian Bösel, Mohamad Chmayssani","doi":"10.1097/CCE.0000000000001227","DOIUrl":"10.1097/CCE.0000000000001227","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous tracheostomy (PT) is generally considered a safe procedure, but complications such as malpositioning, bleeding, and tracheal ring rupture remain concerns, particularly during initial needle insertion. This study investigates the feasibility, ease of use, and safety of a novel device and technique for bedside PT, named the Illuminated Tracheal Alignment Guide (iTAG).</p><p><strong>Methods: </strong>An interventional pilot study evaluated the feasibility and safety of the iTAG device and method. The study was approved by our local institutional review board and a Food and Drug Administration waiver was granted for use of our device. Patients in a neurocritical care unit requiring tracheostomy were screened and consented for inclusion. Exclusion criteria included significant vascular overlap and specific ventilator settings. The iTAG method involves a laser light source and a needle guide with a hard stop, used in conjunction with standard PT equipment. Data on demographics, procedure details, and early complications were collected and compared with historical control data from patients who underwent standard tracheostomy (ST).</p><p><strong>Results: </strong>From January 2023 to July 2024, 30 patients underwent PT using the iTAG device. The mean time from intubation to tracheostomy was 15.53 days, with a mean ICU length of stay of 31.14 days. The iTAG group experienced significantly fewer early complications compared with the historical ST control group, including reduced hemorrhage, and there were no instances of tracheal ring fracture, posterior wall injury, or pneumothorax. The iTAG method allowed for safe PT in all patients.</p><p><strong>Conclusions: </strong>The iTAG device enhances the safety and efficacy of PT by providing precise visualization and limiting needle penetration, reducing early complications. Its use expands patient candidacy for PT and offers a valuable tool for training less-experienced practitioners. Further research with larger cohorts and randomized controlled trials is needed to confirm these findings and establish the iTAG method as a standard of care for PT.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1227"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722765","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":"Practice Pattern Variation in Management of Severe Acute Asthma Among Mechanically Ventilated Patients in Pediatric Versus Adult ICUs.","authors":"Aaron Dobie, Burton Shen, Collin Homer-Bouthiette, Divya Shankar, Brandon Pang, Anica Law, Nicholas A Bosch","doi":"10.1097/CCE.0000000000001233","DOIUrl":"10.1097/CCE.0000000000001233","url":null,"abstract":"<p><p>A large multicenter retrospective study was conducted to examine practice patterns in the care of severe acute asthma in PICUs compared with adult ICUs. Eligible patients were 12-26 y old, admitted to a PICU or an adult ICU with severe acute asthma, and received noninvasive ventilation or mechanical ventilation. Multiple medication prescribing practice patterns were examined. 3,361 total patients were included: 583 (17.3%) were admitted to PICUs and 2,778 (82.7%) were admitted to adult ICUs. Significantly more patients admitted to PICUs received parenteral terbutaline (25.7% vs. 10.2%, standard mean differences = 0.412) than those admitted to adult ICUs. Admission to PICUs for asthma was associated with a trend toward increased mortality, cardiac arrhythmias and duration of mechanical ventilation compared with adult ICUs. Further studies are needed to assess the safety and efficacy of parenteral terbutaline in adolescents and young adults; guidelines for the management of severe acute asthma in the ICU are needed.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1233"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702211","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":"Airway Safety During Mechanical Ventilation: Survey of ICU Clinicians Practices and Perceptions.","authors":"Maged A Tanios, Jaqueline C Stocking, Jean G Charchaflieh, Andrew G Miller, Jay V Patel, Antonia L Vilella, Huan Mark Nguyen, Scott K Epstein, Antonio Beltran, John W Devlin","doi":"10.1097/CCE.0000000000001234","DOIUrl":"10.1097/CCE.0000000000001234","url":null,"abstract":"<p><p>We report results from a survey of members of the Society of Critical Care Medicine to assess ICU clinicians' perceptions of artificial airway safety practices and unplanned extubation (UE) prevention. The survey was distributed between January and February 2024 and received 518 responses (68.5% response rate), with 87.5% from adult ICUs and 12.5% from Pediatric ICUs. Only 48% of adult ICU respondents tracked UE, compared with 73% tracking pressure injuries. Most respondents did not consider UE a \"never event,\" with over half viewing it as unavoidable. In adult ICUs, delirium was ranked as the highest UE risk factor, and commercial securement devices were the primary endotracheal tube securement method (75.2%). Significant variations were observed in artificial airway management practices and responsibility assignments across ICU settings. The results highlight substantial disparities in airway safety management beliefs and practices, underscoring the need for standardized, evidence-based guidelines.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1234"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701525","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":"The Association Between Dysglycemia and Endotheliopathy in ICU Patients With and Without Diabetes: A Cohort Study.","authors":"Christian Gantzel Nielsen, Mikkel Thor Olsen, Peter Lommer Kristensen, Martin Schønemann-Lund, Pär Ingemar Johansson, Ulrik Pedersen-Bjergaard, Morten Heiberg Bestle","doi":"10.1097/CCE.0000000000001229","DOIUrl":"10.1097/CCE.0000000000001229","url":null,"abstract":"<p><strong>Importance: </strong>Dysglycemia in critically ill patients is associated with endotheliopathy. This relationship may be altered in patients with diabetes.</p><p><strong>Objectives: </strong>Dysglycemia is common in critically ill patients and associated with increased mortality. Endotheliopathy is thought to play a role in this relationship; however, evidence is scarce. The aim of this study was to investigate the associations between dysglycemia and endotheliopathy to inform future glycemic management.</p><p><strong>Design, setting, and participants: </strong>This prospective observational study included 577 acutely admitted adult ICU patients at Copenhagen University Hospital-North Zealand, Denmark.</p><p><strong>Main outcomes and measures: </strong>Up to twenty-four hours of patient glycemia was paired with same-day levels of endothelial biomarkers measured after each 24-hour period for three consecutive days. Endotheliopathy was assessed by measurement of Syndecan-1, Platelet Endothelial Cell Adhesion Molecule-1 (PECAM-1), and soluble thrombomodulin (sTM).</p><p><strong>Results: </strong>Of the included patients, a total 57.5% were males, median age was 71 yr (interquartile range [IQR], 63-79), and 24.6% had diabetes prior to admission. Median admission time was 5 d (IQR, 3-10). Time above range (TAR) greater than 13.9 mmol/L, but not TAR 10.0-13.9 mmol/L, was associated with increase in sTM (0.01 ng/mL per %-point increase in TAR, p = 0.049) and PECAM-1 (0.01 ng/mL per %-point increase, p = 0.007). Glycemic variability was associated with increases in sTM (0.24 ng/mL per mmol/L increase in sd, p = 0.001 and 0.03 ng/mL per %-point increase in coefficient of variation, p < 0.001). Hypoglycemia 3.0-3.9 mmol/L was associated with increases in sTM (3.0 ng/mL, p < 0.001) and PECAM-1 (1.54 ng/mL, p < 0.001).</p><p><strong>Conclusions and relevance: </strong>In acutely admitted adult ICU patients, hypoglycemia was associated with endotheliopathy regardless of preadmission diabetes status. Hyperglycemia and high glycemic variability were associated with endotheliopathy in patients without diabetes. This suggests different responses to acute dysglycemia in patients with and without diabetes and warrants further investigation in clinical trials.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1229"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702238","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":"Glucagon-Like Peptide-1 Is Prognostic of Mortality in Acute Respiratory Failure.","authors":"Cole E Hansell, Hamam A Aneis, Georgios D Kitsios, William G Bain, Yanwu Zhao, Tomeka L Suber, John W Evankovich, Lokesh Sharma, Sadeesh K Ramakrishnan, Niall T Prendergast, Matthew K Hensley, Shehryar Malik, Nancy Petro, Jayshil J Patel, Seyed Mehdi Nouraie, Charles S Dela Cruz, Yingze Zhang, Bryan J McVerry, Faraaz A Shah","doi":"10.1097/CCE.0000000000001247","DOIUrl":"10.1097/CCE.0000000000001247","url":null,"abstract":"<p><strong>Objectives: </strong>The incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) have therapeutic effects in diabetes mellitus. Prior clinical studies suggest incretins are prognostic of adverse outcomes in critical illness. We investigated whether incretin levels indicate disease severity and clinical outcomes in patients with acute respiratory failure, a common cause of critical illness.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>ICUs in UPMC Health Systems hospitals within Western Pennsylvania.</p><p><strong>Patients: </strong>Two hundred ninety-seven critically ill adults with acute respiratory failure.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We measured GLP-1 and GIP levels in baseline samples collected at the time of study enrollment. We compared incretin levels across subgroups differing by severity of illness and investigated associations between incretins and markers of systemic host responses and intestinal permeability. In our primary analysis, we tested the association of each incretin level with 90-day mortality by logistic regression in unadjusted analyses and in analyses adjusted for age, Sequential Organ Failure Assessment score, and circulating interleukin-6 levels. GLP-1 levels were higher in nonsurvivors and patients with or at-risk for acute respiratory distress syndrome compared to those intubated for airway protection. GLP-1 levels also positively correlated with systemic immune response biomarkers but not with markers of intestinal permeability. GLP-1 levels positively correlated with mortality in unadjusted (odds ratio, 1.99 [1.55-2.56]; p < 0.01) and adjusted (2.02 [1.23-3.31]; p < 0.01) analyses. GIP levels were not associated with mortality or with host response biomarkers.</p><p><strong>Conclusions: </strong>GLP-1 but not GIP levels were positively associated with systemic inflammation and mortality in critically ill patients with acute respiratory failure. Increased circulating GLP-1 levels may serve as prognostic biomarkers to identify patients who are likely to have worse outcomes.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1247"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701536","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}