World journal of emergency medicine最新文献

Background: Pulse indicated continuous cardiac output (PiCCO) has largely replaced Swan-Ganz catheterization in shock patients. However, whether PiCCO monitoring can improve outcomes of shock patients, such as mortality, length of hospital stay, duration of mechanical ventilation, or laboratory parameters, remains unknown.

Methods: This retrospective cohort study included patients with shock in the intensive care unit (ICU) from January 2013 to January 2020. Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not. Demographic characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, quick Sequential Organ Failure Assessment (qSOFA) scores, 14-day mortality, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 0, 1, 3 and 7 days after onset of shock, duration of mechanical ventilation, length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching (PSM).

Results: Real-world analysis of 1,583 ICU patients suffering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups (36.2% vs. 32.6%, P=0.343). Duration of mechanical ventilation, hospital stay, and hospitalization costs were also similar between the two groups (P>0.05). No differences in changes of NT-proBNP levels on days 0, 1, 3, and 7 as compared to baseline were noted between the two groups (P>0.05).

Conclusions: The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation, length of hospital stay, or reduce hospitalization costs, nor will it bring survival benefits to ICU patients suffering shock.

Background: The nonspecific clinical presentation of adrenal insufficiency (AI) frequently leads to misdiagnosis, often as psychiatric or gastrointestinal disorders. AI is classified anatomically as primary AI (PAI), secondary AI (SAI), or tertiary AI (TAI). Without timely recognition, progression to adrenal crisis (AC) can result in life-threatening outcomes. This study aimed to systematically analyze the clinical features, etiologies, and outcomes of AI in Lhasa's emergency population to improve diagnostic accuracy and optimize clinical management.

Methods: A retrospective analysis of emergency department admissions from January 2020 to August 2024 at People's Hospital of Xizang Autonomous Region was conducted. AI diagnoses were identified via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes from electronic health records (EHR). Patients were grouped into incipient AC (IAC) or AC cohorts based on hemodynamic status. Demographic profiles, etiologies, clinical presentations, and laboratory results were analyzed.

Results: Forty-three AI patients were identified. The population-standardized admission rate for AI increased from 9 to 16 per million person-years, with PAI cases doubling during this period. Adrenal tuberculosis (58.1%) and adrenal hematoma (18.6%) were the leading etiologies. Compared to the IAC group, the AC group demonstrated lower systolic blood pressure (SBP) (P=0.001) and diastolic blood pressure (DBP) (P<0.001); higher neutrophil count (P=0.048), eosinophil count (P=0.044), CRP (P=0.004), blood urea nitrogen (BUN) (P=0.007); lower sodium (P<0.001) and glucose levels (P=0.001). The hospital stay was longer in the AC group (20 d vs. 14 d; P<0.001).

Conclusion: AI incidence is rising in high-altitude regions, with adrenal tuberculosis remaining the most common cause. AC is associated with increased inflammatory responses, hemodynamic instability, and metabolic disturbances. Targeted interventions are required to improve outcomes.

Background: Research has revealed a relationship between atrial fibrillation (AF) and valvular heart disease; however, the causality remains largely unknown. This study explored whether a causal association between AF and non-rheumatic aortic valve disease (AVD) and mitral valve disease (MVD) could be found.

Methods: A two-sample Mendelian randomization (TSMR) method was applied to determine the causal effect of AF on AVD, mitral regurgitation, and MVD. The inverse variance weighted (IVW) method was used as the primary analytical approach, and several complementary analyses were conducted. Outliers were detected using the Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) and radial Mendelian randomization (MR) methods.

Results: Genetically predicted AF was found to be causally associated with the risk of MVD (odds ratio [OR]=1.001; 95% confidence interval [CI]: 1.000-1.001; P=1.33×10^-6) and mitral regurgitation (OR=1.001; 95% CI: 1.000-1.002; P=0.009). However, no significant causal associations between AF and AVD were detected (OR=1.000; 95% CI: 0.999-1.000; P=0.804). Causal effects were still detected, even after adjusting for potential risk factors or removing the identified outliers. Reverse MR analyses revealed no significant causal effect of valvular heart disease on AF.

Conclusion: Our findings demonstrate a positive causal association between AF, MVD, and mitral regurgitation, but not AVD. Further research and an aggressive AF management strategy should be explored as potential measures for preventing MVD.

Background: This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit (ICU) stays.

Methods: Pediatric patients who underwent cardiac surgery were included, with data collected from the pediatric intensive care database. The datasets were randomly divided into a training set (75%) and a testing set (25%). A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.

Results: A total of 795 patients and 266 patients were assigned to the training and testing sets, respectively, with consistent variables. The nomogram developed from the training set included eight characteristics: age, systolic blood pressure, respiratory rate, bicarbonate, direct bilirubin, high-sensitivity C-reactive protein, international normalized ratio, and operation time. The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736, respectively. The nomogram demonstrated excellent discrimination and calibration. Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.

Conclusion: This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.