SHOCK最新文献

Background: Fluid resuscitation in septic shock lacks bedside tools that simultaneously evaluate fluid distribution and cellular function, often leading to fluid overload and increased mortality. Bioelectrical Impedance Vector Analysis (BIVA) is a non-invasive bedside technique for comprehensive assessment of body composition and hydration status, but its prognostic value and application criteria in septic shock remain undefined.

Methods: A prospective observational study was conducted in an intensive care unit (ICU) of a university-affiliated hospital. Consecutive adult patients meeting Sepsis-3.0 criteria for septic shock were enrolled. BIVA parameters (whole-body and segmental PhA, ECW/ICW ratio, tolerance ellipses), hemodynamic indices, and serum lactate were dynamically monitored at ICU admission (within 24h of diagnosis), 6 hours post-resuscitation (T1), 24 hours (T2), and then daily until ICU discharge or death. Receiver operating characteristic (ROC) curve analysis determined prognostic cutoffs. Spearman's correlation and linear mixed models analyzed BIVA-lactate relationships. Passive leg raising (PLR) test served as the reference for fluid responsiveness, with predictive performance analyzed for mean arterial pressure (MAP) gradient (ΔMAP) between bilateral upper arms at different lateral decubitus positions combined with BIVA parameters.

Results: Among 128 enrolled patients, multivariate Cox regression identified initial PhA ≤ 3.10° (Hazard Ratio [HR] = 3.85, 95% Confidence Interval [CI]: 2.12-6.99) and BIVA-derived hydration fraction >74% (HR = 2.41, 95% CI: 1.32-4.39) as independent predictors of 30-day mortality. The Extracellular Water/Intracellular Water ECW/ICW ratio strongly correlated with lactate levels (r = 0.71, p < 0.001), and their combination predicted acute kidney injury more effectively (Area Under the Curve [AUC] = 0.92) than either parameter alone. In 95 patients undergoing positional testing, ΔMAP≥8.00 mmHg at 40°lateral decubitus position predicted fluid responsiveness with 85.7% sensitivity and 84.2% specificity; combining this with upper-arm BIVA parameters further enhanced predictive value (AUC = 0.93).

Conclusion: BIVA provides an effective individualized assessment tool for metabolic and fluid management in septic shock. PhA and hydration status are robust prognostic indicators; the ECW/ICW-lactate correlation reveals the pathophysiological link between tissue edema and hypoperfusion; and positional BIVA testing with upper-arm pressure gradient offers an innovative method for non-invasive assessment of fluid responsiveness.

Background: Heat stroke (HS) is a life-threatening condition marked by hyperthermia, central nervous system dysfunction, and multi-organ injury. Exertional heatstroke (EHS), which commonly affects healthy young people, typically follows intensity training or heavy physical labor in high temperature and high humidity environment. However, the molecular events driving the progression from mild to severe EHS remain poorly understood. This study integrated clinical data with serum proteomics to identify key pathways and biomarkers involved in EHS progression.

Methods: From June 2022 to October 2023, serum samples were collected from heat stroke, including 7 mild and 7 severe cases, with the remaining as controls. Demographic data, laboratory results, and Sequential Organ Failure Assessment (SOFA) scores were recorded. Serum proteins were analyzed using label-free mass spectrometry. Differentially expressed proteins (DEPs) were identified and analyzed using protein-protein interaction (PPI) networks, Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Comparisons between mild vs. control, severe vs. control, and severe vs. mild groups were performed with Benjamini-Hochberg correction. Receiver operating characteristic analysis was used to evaluate discriminative ability; proteins with area under the curve (AUC) ≥0.85 and a lower bound of the 95% confidence interval ≥0.50 were selected. ELISA was used for further validation.

Results: Compared with patients with mild EHS, patients with severe EHS exhibited significantly higher markers of inflammation (WBC), coagulation abnormalities (PT, APTT, fibrinogen, D-dimer), organ injury (CK-MB, AST, LD, Creatinine, Uric Acid), and higher SOFA scores (P < 0.05). Proteomic profiling identified 51 shared DEPs across comparisons. PPI analysis highlighted proteins in the complement and coagulation cascades. Enrichment results indicated significant activation of complement-coagulation pathways, nuclear factor kappa-B (NF-κB) signaling, metabolic dysregulation, and immune responses. Key biomarkers-such as von Willebrand factor (vWF), mannose-binding lectin serine protease 1 (MASP1), coagulation factor VIII (F8), and protein C (PROC)-demonstrated strong discriminative performance and were associated with disease severity. Meanwhile, serum levels of HSPA13 (HSP70) and HSP90AA1/HSP90B1 (HSP90) were elevated in both mild and severe EHS relative to controls, with no significant differences between severity groups.

Conclusions: Complement-coagulation activation and metabolic dysregulation appear to drive the transition from mild to severe EHS. The proteins MASP-1, F8, PROC, and vWF represent promising biomarkers and potential therapeutic targets. These findings offer mechanistic insights for early risk stratification and targeted intervention in EHS.

Background: Pediatric hemophagocytic lymphohistiocytosis (HLH) patients who develop disseminated intravascular coagulation (DIC) experience rapid disease progression and substantially elevated mortality. Currently, no validated early identification strategies exist for this life-threatening complication. We aimed to develop a prediction model for early DIC detection in pediatric HLH patients.

Methods: This retrospective cohort study included patients from the Hunan Children's Hospital HLH database (January 2018-August 2024). Data imbalance was addressed through combined oversampling and undersampling techniques, including Synthetic Minority Over-sampling Technique (SMOTE). The cohort was divided into training and validation sets (7:3 ratio). A LASSO-logistic regression model was developed and validated internally, with external validation using prospectively collected cases (January-August 2025). Model performance was evaluated using receiver operating characteristic curves, calibration plots, and decision curve analysis.

Results: Of 265 included patients, 217 cases were analyzed after SMOTE application. DIC incidence was 42.1% (64/152) and 44.6% (29/65) in training and validation cohorts, respectively. LASSO regression (lambda.1se=0.08) identified six potential predictors: C-reactive protein (CRP), globulin, cholesterol, high-density lipoprotein cholesterol, prothrombin time (PT), and interferon-γ (IFN-γ). Multivariable logistic regression confirmed three independent predictors: CRP, PT, and IFN-γ (all P<0.05). The model demonstrated robust discriminative performance with area under the receiver operating characteristic curve (AUROC) of 0.865 (95% CI: 0.809-0.922) in the training cohort and bootstrap-corrected C-index of 0.857 (95% CI: 0.828-0.886). Internal validation yielded AUROC of 0.797 (95% CI: 0.686-0.908), whereas external validation achieved an AUROC of 0.950. Decision curve analysis showed positive net benefit across threshold probabilities of 0%-99% in training and 0%-88% in validation sets.

Conclusion: The LASSO-logistic prediction model, incorporating three readily available biomarkers, demonstrated promising discriminative ability for predicting DIC risk in pediatric HLH. This tool may facilitate early risk stratification and timely therapeutic interventions to improve clinical outcomes.

Background: Postextubation airway obstruction represents a significant complication in critical care, potentially necessitating reintubation and prolonging intensive care unit (ICU) stay. The cuff leak test (CLT) is commonly used to predict postextubation stridor and reintubation risk, but its clinical utility remains controversial. This study evaluated the relationship between CLT results and reintubation risk in a large cohort of critically ill patients.

Methods: This single-center, retrospective, descriptive study analyzed 742 adult patients admitted to the medical and surgical ICUs who underwent mechanical ventilation for ≥24 h between January 2020 and December 2024. The primary outcome was reintubation within 48 h of planned extubation. Quantitative cuff leak volume measurements were performed preextubation, with leak volume expressed as absolute values and percentage of tidal volume. Multivariable logistic regression was used to identify independent predictors of reintubation, including CLT results and patient characteristics.

Results: Of the 742 patients studied, 68 (9.2%) required reintubation within 48 h. Patients with a cuff leak volume <110 mL or <15% of tidal volume had significantly higher reintubation rates (18.7% vs. 7.1%, P  < 0.001). After adjusting for confounding variables, a positive CLT (defined as cuff leak volume <110 mL) remained independently associated with reintubation (adjusted odds ratio, 2.86; 95% confidence interval [CI], 1.65-4.97; P  < 0.001). Other significant independent predictors included prolonged intubation (>7 days), female sex, body mass index >30 kg/m 2 , and traumatic or difficult intubation. Combining CLT results with these clinical risk factors improved prediction accuracy (area under the curve, 0.82; 95% CI, 0.76-0.87).

Conclusion: A positive CLT is independently associated with increased reintubation risk in critically ill patients. The predictive accuracy is enhanced when CLT results are combined with clinical risk factors. These findings suggest that CLT should be incorporated into extubation decision-making, particularly for patients with additional risk factors for postextubation airway complications.

Background: Liver ischemia-reperfusion injury (LIRI) is a main cause of complication development regarding the liver. This study examines how Oridonin mitigates oxidative stress and pyroptosis in macrophages during LIRI by inhibiting the mitochondrial reactive oxygen species (ROS)/thioredoxin-interacting protein (TXNIP)/NOD-like receptor protein 3 (NLRP3) signaling pathway.

Methods: LIRI mouse models were treated with Oridonin at doses of 1, 5, and 10 mg/kg. Liver damage was evaluated through serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels enzyme linked immunosorbent assay (ELISA), histological analysis (HE staining and Suzuki scoring), and immunofluorescence for NLRP3 and macrophage markers (F4/80, inducible nitric oxide synthase [iNOS]). Inflammatory cytokines (Tumor necrosis factor alpha, interleukin-1beta [IL-1β], IL-18, and IL-6) and oxidative stress markers (malondialdehyde [MDA], total superoxide dismutase [T-SOD], and glutathione peroxidase [GSH-Px]) were measured using ELISA. M1 macrophage markers (iNOS, CD86, and CD80) were assessed via quantitative real-time polymerase chain reaction (qRT-PCR). Primary hepatic macrophages were isolated for flow cytometry, cell-counting kit (CCK)-8 assays, and ROS detection. Protein expression was analyzed using Western Blot and immunohistochemistry.

Results: Oridonin dose-dependently reduced liver damage, lowering ALT/AST levels and improving histological scores. Depletion of Kupffer cells with clodronate liposomes abolished Oridonin's protective effects, indicating macrophage mediation. LIRI increased M1 macrophages, F4/80⁺/iNOS⁺ cells, and inflammatory cytokines, all of which were partially reversed by Oridonin. In vitro, Oridonin reduced oxidative stress and pyroptosis in hypoxia-reoxygenation-exposed hepatic macrophages, evidenced by decreased ROS and lower levels of pyroptosis-related proteins (gasdermin D, Cleaved-Caspase-1, and IL-1β). Mechanistically, Oridonin may ameliorate oxidative stress and pyroptosis in hepatic macrophages of LIRI mice by inhibiting the ROS/TXNIP/NLRP3 pathway.

Conclusions: Oridonin effectively protects against LIRI by decreasing macrophage M1 polarization, oxidative stress, and pyroptosis through inhibition of the mitochondrial ROS/TXNIP/NLRP3 pathway.

Objective: Sepsis remains a major cause of morbidity and mortality in children, necessitating an early risk assessment to prevent delayed treatment and achieve optimal outcomes. This study investigated the association between systemic immune-inflammatory indices and clinical outcomes in children with sepsis.

Design: Single-center, retrospective cohort study.

Setting: Pediatric intensive care unit of a tertiary care children's hospital from 2015 to 2023.

Patients: Children aged 0-18 years admitted with sepsis. Patients were excluded if they lacked a complete blood count with differential on admission.

Results: In total, 420 patients were included. The platelet-to-lymphocyte ratio (PLR) was associated with higher mortality [hazard ratio 1.001 (1.000-1.002), P  = 0.032]. Incorporating PLR into the Pediatric Index of Mortality score improved the model discrimination for mortality (area under the receiver operator characteristic curves 0.705 vs. 0.774; area under the precision-recall curve 0.202 vs. 0.257). Similarly, adding PLR to the Pediatric Risk of Mortality-III improved the area under the receiver operator characteristic curves from 0.648 to 0.697. High PLR was also associated with higher odds of requiring intubation (OR 2.42, P  = 0.005) and extracorporeal membrane oxygenation (OR 4.74, P  = 0.002) and with decreased subdistribution hazard ratio of extubation, intensive care unit discharge, and hospital discharge alive at 28 days (subdistribution hazard ratio 0.89, 0.72, and 0.76, respectively; all P  < 0.005).

Conclusions: High PLR at admission was independently associated with worse clinical outcomes in pediatric patients with sepsis. Adding PLR to the Pediatric Index of Mortality and Pediatric Risk of Mortality-III enhanced the predictive performance. PLR is a simple and readily available index that may improve early risk stratification in this high-risk population.