The American journal of the medical sciences最新文献

{"title":"Glucose concentration predicting mortality in patients with COVID-19: A propensity score-matched study.","authors":"Xing Wang, Yue Li, Qiao Wang, Fan Xia, Wuqian Chen, Chao You, Lu Ma","doi":"10.1016/j.amjms.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.05.003","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronavirus disease-19 (COVID-19) often develop systemic inflammation, which is associated with increased mortality. Elevated blood glucose levels can exacerbate the cytokine storm, further worsening disease severity and accelerating patient death. Therefore, this study aims to investigate the association between glucose levels and mortality in hospitalized patients, providing insights into the importance of optimizing glucose management in hospitalized COVID-19 patients.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, involving adult COVID-19 patients in a university hospital. The primary outcome was in-hospital mortality. Propensity score matching (PSM) was utilized to match patients' baseline characteristics. Discrimination capacity of different models was assessed using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Trends in blood glucose over time were detected using the ordinary least squares model.</p><p><strong>Results: </strong>Among the 4583 COVID-19 patients during the study period, 2147 (46.8%) exhibited normal glycemia, while 2436 (53.2%) had admission hyperglycemia. After adjusting for confounding factors through multivariate regression analysis, patients with hyperglycemia showed significantly higher odds of in-hospital mortality (adjusted odds ratio [aOR]: 3.10, 95% CI: 2.25 to 4.28; P < 0.001). PSM analysis yielded similar results (aOR: 2.66, 95% CI: 2.09 to 3.41; P < 0.001). The incorporation of admission glucose significantly improved C-statistics (P < 0.001), IDI (P < 0.001), and NRI (P < 0.001) for predicting mortality.</p><p><strong>Conclusion: </strong>This study concludes that blood glucose levels ≥ 6.1 mmol/L can independently predict all-cause mortality and clinical sequelae in COVID-19 patients. Furthermore, even a mild increase in blood glucose was associated with a significantly higher risk of mortality in these patients. These findings underscore the importance of managing hyperglycemia and monitoring blood glucose in individuals with COVID-19.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory muscle ultrasound echo characteristics and weaning outcomes in mechanically ventilated patients with sepsis: a prospective observational study.","authors":"Chenliang Sun, Mengjie Zhan, Lei Yu, Tingting Li, Hongsheng Zhao, Qin Gu, Guangquan Zhou, Fengmei Guo","doi":"10.1016/j.amjms.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.05.002","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to determine the relationship between changes in the ultrasound echo intensity of respiratory muscles and weaning outcomes in mechanically ventilated patients with sepsis.</p><p><strong>Methods: </strong>We prospectively observed patients with sepsis receiving mechanical ventilation admitted to the Department of Critical Care Medicine at our hospital, and categorized them into weaning success (n = 75) and weaning failure (n = 35) groups according to their weaning outcomes. The baseline respiratory muscle echo intensity of the patients was observed, and the relationship between the respiratory muscle ultrasonographic echo characteristics and weaning outcomes was evaluated.</p><p><strong>Results: </strong>Baseline respiratory muscle echo intensity was significantly higher in the weaning failure group than in the weaning success group. The incidence of respiratory muscle echoes during mechanical ventilation was significantly higher in the weaning failure group than in the weaning success group. The respiratory muscle echo characteristics changed after ICU admission. Increased respiratory muscle echo intensity was detected earlier and more readily in patients with weaning failure than in those with respiratory muscle atrophy, and enhanced respiratory muscle echo was associated with a decrease in the incidence of cumulative weaning success.</p><p><strong>Conclusion: </strong>Mechanically ventilated patients with sepsis with failed weaning had higher respiratory muscle echo intensities than those in the weaning success group. Futhermore, there was an association between the respiratory muscle echo intensity and weaning outcomes.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of early dexmedetomidine administration with the risk of ARDS in sepsis patients during ICU stay: results from MIMIC-IV.","authors":"Fei Pang, Wei Xu, Lingjun Guo, Hua Ling","doi":"10.1016/j.amjms.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.05.001","url":null,"abstract":"<p><strong>Background: </strong>This study sought to investigate the relationship between early administration of dexmedetomidine (DEX) and the risk of acute respiratory distress syndrome (ARDS) in sepsis patients in the intensive care unit (ICU).</p><p><strong>Method: </strong>The study was a retrospective cohort study. We extracted and obtained data on sepsis patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The primary exposure of interest was the administration of DEX, and the primary outcome was the occurrence of ARDS. Univariable and multivariable Logistic regression analyses were conducted to adjust for confounding factors.</p><p><strong>Results: </strong>A total of 6,220 sepsis patients were included in the study, of which 1,071 (17.22%) developed ARDS. Multivariable logistic regression analysis revealed that early administration of DEX was associated with a lower risk of ARDS [odds ratio (OR) = 0.74, 95% confidence interval (CI): 0.55-0.99]. Additionally, compared to sepsis patients who did not receive DEX, those with shorter durations of DEX treatment had a lower risk of developing ARDS (OR = 0.54, 95% CI: 0.34-0.85). Subgroup analysis indicated that among sepsis patients younger than 65 years old, males, and those without comorbidities (hypertension, diabetes, chronic kidney disease), a shorter duration of DEX use was associated with a lower risk of ARDS in sepsis patients.</p><p><strong>Conclusion: </strong>The early administration of DEX was associated with the risk of ARDS in sepsis patients within 24 hours of ICU admission, suggesting that DEX may play a significant role in the health management of sepsis patients.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of radiometabolic properties on bronchoscopic cytopathology results in lung cancers: A multicenter retrospective study.","authors":"Coşkun Doğan, Samet Samancı, Azat Kapan, Elif Torun Parmaksız, Ferhan Karataş, Ayşe Nur Toksöz Yıldırım, Sacit İçten, Onur İncealtın","doi":"10.1016/j.amjms.2025.04.019","DOIUrl":"10.1016/j.amjms.2025.04.019","url":null,"abstract":"<p><strong>Background: </strong>Cytologic examination of bronchial washing fluid (BWF) in lung cancers (LC) has a low diagnostic rate. This study investigated the relationship between the cytologic diagnostic success of bronchial washing performed with fiberoptic bronchoscopy (FOB) in lung cancer cases and the radiometabolic (PET-CT) characteristics of the tumor.</p><p><strong>Materials and methods: </strong>FOB reports of cases with a final diagnosis of lung cancer (LC) in our hospital bronchoscopy unit were scanned and the files of cases sent for BWF cytology were retrospectively reviewed. The clinical, demographic, radiologic, and PET-CT characteristics of the cases, and other diagnostic procedures performed during the FOB procedure were recorded. BWF cytologic examinations were divided into two groups as diagnostic and non-diagnostic. The characteristics of both groups were compared with each other.</p><p><strong>Results: </strong>A total of 163 patients were included in the study, 118 (72.4 %) were male, 45 (27.6 %) were female, and the mean age was 65.4 years. In 75 (46 %) cases, BWF cytologic examinations were diagnostic and in 88 (54 %) cases they were non-diagnostic. The mean SUVmax value in the BWF diagnostic group was 15.8 ± 8.6 and in the non-diagnostic group it was 12.6 ± 7 (p = 0.015). In the ROC analysis, the optimal SUVmax cut-off value for predicting BWF diagnostic success was 12 (AUC: 0.617). At SUVmax 12 and above, the sensitivity was 70 % and specificity was 51 %. In the regression analysis performed for the independent factors affecting the diagnostic success of BWF cytologic examination, the SUVmax value was one of the independent factors (p = 0.026).</p><p><strong>Conclusions: </strong>In LCs with relatively high SUV max values, the chance of diagnosis may be high in BWF cytologic examinations performed with FOB.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognostic nutritional index as a risk factor for severe COVID-19 infection among hospitalized patients: A multicenter historical cohort study.","authors":"Ashish Bhargava, Susan Szpunar, Louis Saravolatz","doi":"10.1016/j.amjms.2025.04.018","DOIUrl":"10.1016/j.amjms.2025.04.018","url":null,"abstract":"<p><strong>Introduction: </strong>Malnutrition is a critical prognostic factor in COVID-19, affecting up to 50 % of hospitalized patients and increasing their mortality risk tenfold compared to well-nourished patients. The prognostic nutritional index (PNI) assesses nutritional and immune status and can help gauge the severity of COVID-19.</p><p><strong>Objective: </strong>To evaluate whether PNI was independently associated with the severity of COVID-19 infection among hospitalized patients in the United States.</p><p><strong>Methods: </strong>This study was a historical cohort study of adult patients with COVID-19 hospitalized in five hospitals in southeast Michigan. Data collected from the electronic medical record were analyzed using SPSS v. 29.0, and a p-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Data were included on 286 patients, with a mean age of 58.7 ± 17.5 years, 53.5 % (153/286) female, and 48.3 % (138/286) black/African American. The most common comorbidities were hypertension (62.9 %), obesity (54.2 %) and type 2 diabetes mellitus (32.1 %). Of the 286 patients, 144 (50.3) had severe/ critical disease. Patients with severe COVID-19 had significantly lower mean PNI levels than those with mild to moderate disease (35.1 ± 5.2 vs 37.7 ± 6.4, p < 0.001). After controlling for smoking status, vaccination status, race, and home steroid use, PNI remained an independent predictor for severe/ critical COVID-19 (OR=0.92, p < 0.001).</p><p><strong>Conclusions: </strong>This study demonstrated that PNI is an independent predictor of severe COVID-19. The PNI score can be easily calculated from routine blood tests for every patient and helps risk stratify hospitalized COVID-19 patients. Additional research is needed to confirm these results.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of sodium-glucose co-transporter 2 inhibitors on cardiovascular outcomes in patients with acute myocardial infarction: Systematic review and meta-analysis.","authors":"Mohammad Akkawi, Prakash Upreti, Ahmad Damlakhy, George G Kidess, Mohammad Hamza, Kripa Rajak, Mustafa Turkmani, Khaled M Harmouch, Yasemin Bahar, M Chadi Alraies","doi":"10.1016/j.amjms.2025.04.013","DOIUrl":"10.1016/j.amjms.2025.04.013","url":null,"abstract":"<p><strong>Background: </strong>The role of sodium-glucose co-transporter inhibitors (SGLT2i) in heart failure is well-established. However, evidence supporting their use in acute myocardial infarction remains limited.</p><p><strong>Methods: </strong>Two independent researchers conducted a comprehensive literature review on PubMed and Embase until April 2024. They identified 14 articles, consisting of randomized controlled trials and observational studies, investigating the use of SGLT2i in acute myocardial infarction. The analysis focused on cardiovascular outcomes, including all-cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), heart failure exacerbation, strokes, and recurrence of acute coronary syndrome.</p><p><strong>Results: </strong>Our pooled analysis of 19,319 participants revealed a significant reduction in MACE [OR 0.50, 95 % CI [0.36; 0.70], p-value = 0.0001] and hospitalization due to heart failure [OR 0.59 (0.43-0.79), P < 0.0004] in the SGLT2i group compared to the control group. In contrast, there were no statistically significant differences between the SGLT2i and control groups regarding all-cause mortality, cardiovascular mortality, recurrence of acute coronary syndrome, or new-onset arrhythmia.</p><p><strong>Conclusions: </strong>Our study highlights that among patients with acute myocardial infarction, the use of SGLT2i reduces MACE and hospitalizations due to heart failure. However, there was no significant reduction in mortality, recurrence of acute coronary syndrome, or arrhythmia in the SGLT2i group.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of the conicity index as an indicator of abdominal obesity in predicting cardiovascular disease and all-cause mortality risk in patients with diabetes based on NHANES data from 1999-2018.","authors":"Peng Ning, Jiali Huang, Hong Ouyang, Qiu Feng, Hongyi Cao, Fan Yang, Jie Hou","doi":"10.1016/j.amjms.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.014","url":null,"abstract":"<p><strong>Objective: </strong>The mortality risk among patients with diabetes is increasingly severe, yet the relationship between obesity and mortality risk in these patients remains controversial. This study evaluated the Conicity index (C-index), an indicator of abdominal obesity, to determine its value in predicting cardiovascular disease (CVD) and all-cause mortality in patients with diabetes.</p><p><strong>Methods: </strong>This cross-sectional study utilized NHANES 1999-2018 data. Patients were grouped into quartiles based on the C-index. The relationship between the C-index and mortality risk was assessed using Cox proportional hazards regression models and restricted cubic spline (RCS) analysis.</p><p><strong>Results: </strong>A total of 7694 patients with diabetes were included in the study. The obesity rate was 55.7 %, with an average follow-up duration of 88 months. During this period, 588 CVD deaths and 2094 all-cause deaths occurred. Higher C-index quartiles were associated with increased mortality risks, with hazard ratios for all-cause mortality ranging from 1.00 to 2.29 and for CVD mortality from 1.00 to 2.23. Unadjusted RCS analysis showed a linear positive correlation between the C-index and mortality risks. After adjusting for confounding factors, a non-linear positive correlation was observed between the C-index and all-cause mortality risk, particularly when the C-index exceeded 1.40. Subgroup analysis revealed that the relationship between the C-index and all-cause mortality was more significant in men and nonobese patients.</p><p><strong>Conclusions: </strong>The C-index is a valuable predictor of mortality in patients with diabetes. A C-index above 1.40, being male, and being nonobese are associated with a more significant risk of all-cause mortality.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inappropriate prescription of loop diuretics for calcium channel blocker-related peripheral edema: Lessons from physiology.","authors":"Jesús Daniel Meléndez-Flores, Mónica Sánchez-Cárdenas","doi":"10.1016/j.amjms.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.015","url":null,"abstract":"<p><p>Calcium Channel Blockers (CCB) are commonly used antihypertensive agents, with peripheral edema being a common side effect, reported in up to 70 % of cases. A common pitfall among physicians is that they consider this fluid overload, with some prescribing loop diuretics. Nonetheless, this might lead to several complications, such as electrolyte abnormalities and acute kidney injury, among others. In this article, we describe the main mechanisms of the vasodilatory and diuretic-resistant edema of CCB and suggest several strategies that might aid physicians in reducing this side effect.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in coronary angiography through radial artery access due to anatomic variations: A single-center experience.","authors":"Wissam Harmouch, Alan Villarreal Rizzo, Ravi Thakker, Selma Abdurrahman, Vishal Patel, Neha Kumar, Salman Farooqi, Danielle El Haddad, Syed Gilani, Wissam Khalife","doi":"10.1016/j.amjms.2025.04.016","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.016","url":null,"abstract":"<p><strong>Background: </strong>Radial artery (RA) access has become common in cardiac catheterization due to fewer vascular complications and MACE compared to transfemoral approach (TFA). However, anatomic variations are more common in the upper-extremity.</p><p><strong>Methods: </strong>We performed a single-center retrospective analysis of 926 patients from January 2010 to January 2023 who underwent coronary angiography through transradial approach (TRA) via the right upper-extremity where RA angiogram was performed. Outcomes included anatomic variations, sociodemographic and health characteristics, adverse outcomes, and procedural challenges. Multivariate logistic regression was utilized to estimate the odds ratio of the association between anatomic variations and adverse outcomes and procedural challenges.</p><p><strong>Results: </strong>Our analysis included 926 patients with a mean age of 59.9 years. Approximately 32.3 % of patients had at least one anatomic variation. Individual variations included 14.4 % radial tortuosity, 12 % high bifurcation, 11.9 % M-sign, and 1 % RA loops. These patients were older (P < 0.001) and more likely to have hyperlipidemia (P = 0.049). They had high odds of high contrast dose (>73.7 mL) (OR = 1.73, P < 0.001), long fluoroscopy time (>10.7 mins) (OR = 2.02, P < 0.001), high radiation exposure (>1120 mGy) (OR = 2.47, P < 0.001), difficulty engaging coronary arteries (OR = 2.70, P < 0.001), and transfer to TFA (OR = 4.89, P < 0.001). Females (OR = 2.89, P < 0.001) and smaller RA size (OR = 2.61, P < 0.001) were associated with spasm. Major complications were not significant.</p><p><strong>Conclusions: </strong>We found a high prevalence of anatomic variations in the upper-extremity vasculature. They were associated with high odds of high contrast dose, long fluoroscopy time, high radiation exposure, and procedural challenges during TRA coronary angiography. The rate of major complications was not significant in these patients.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between body mass index and ICU 28-day mortality rate in patients with sepsis: A retrospective observational study.","authors":"Danxuan Cai, Bo Zou, Yizhen Zhang, Xinglin Chen, Bin Wang, Yanling Tao","doi":"10.1016/j.amjms.2025.04.017","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.017","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis remains the major cause of mortality among critically ill patients worldwide, indicating the importance of better understanding of its influencing factors for fast recognition and management. Although greater concerns have been raised about the \"obesity paradox\" and sepsis related mortality, the evidence regarding on overweight or obese septic patients is still controversial. To provide more clinical evidence for the exploration of body mass index (BMI) on sepsis prognostic prediction, we assessed the association of BMI with 28-day mortality of septic patients in intensive care unit (ICU).</p><p><strong>Methods: </strong>This was a retrospective observational study with patient data extracted from the eICU Collaborative Research Database. We employed a logistic regression to assess the effect of admission BMI levels on sepsis related mortality risk. Furthermore, the two-piecewise linear model was used to identify BMI mortality thresholds, and BMI-outcome associations were evaluated by interaction tests and subgroup analyses.</p><p><strong>Results: </strong>Our cohort included a total of 17,454 patients, of whom 1,555 (8.91%) died within 28 days after being admitted to the ICU. The connection between BMI and 28-day mortality in the ICU displayed a U-shaped curve. The threshold effect analysis results in two inflection points of BMI were 23.62kg/m² and 45.53kg/m². When the BMI was <23.62kg/m², the mortality rate decreased by 7% (95%CI 0.91, 0.96, P<0.0001) for every 1 increment in the BMI. When the BMI was ≥45.53kg/m², the mortality rate increased by 8% (95%CI 1.01,1.15, P=0.0322) for every 1 increment in the BMI. Subgroup analysis showed that neither age nor sex covariates affected the stability of these results (all P for interaction≥0.05).</p><p><strong>Conclusions: </strong>In septic ICU patients, the correlation between BMI and 28-day mortality exhibited a U-shaped pattern, indicating that both low and extremely high BMIs were linked to a heightened risk of mortality within 28 days.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}