World journal of emergency medicine最新文献

Background: Sepsis, a common acute and critical disease, leads to 11 million deaths annually worldwide. Probiotics are living microorganisms that are beneficial to the host and may benefit sepsis outcomes, but their effects are still inconclusive. This study aimed to evaluate the overall effect of probiotics on the prognosis of patients with sepsis.

Data resources: We searched several sources for published/presented studies, including PubMed, EMBASE, Web of Science, the Cochrane Library and the US National Library of Medicine Clinical Trials Register (www.clinicaltrials.gov) updated through July 30, 2023, to identify all relevant randomized controlled trials (RCTs) or observational studies that assessed the effectiveness of probiotics or synbiotics in patients with sepsis and reported mortality. We focused primarily on mortality during the study period and analyzed secondary outcomes, including 28-day mortality, in-intensive care unit (ICU) mortality and other outcomes.

Results: Data from 405 patients in five RCTs and 108 patients in one cohort study were included in the analysis. The overall quality of the studies was satisfactory, but clinical heterogeneity existed. All adult studies reported a tendency for probiotics to reduce the mortality of patients with sepsis, and most studies reported a decreasing trend in the incidence of infectious complications, length of ICU stay and duration of antibiotic use. There was only one RCT involving children.

Conclusion: Probiotics show promise for improving the prognosis of patients with sepsis, including reducing mortality and the incidence of infectious complications, particularly in adult patients. Despite the limited number of studies, especially in children, these findings will be encouraging for clinical practice in the treatment of sepsis and suggest that gut microbiota-targeted therapy may improve the prognosis of patients with sepsis.

Background: Intracranial hemorrhage (ICH), a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO), is often related to poor outcomes. This study aimed to establish a predictive model for ICH in adults receiving ECMO treatment.

Methods: Adults who received ECMO between January 2017 and June 2022 were the subjects of a single-center retrospective study. Patients under the age of 18 years old, with acute ICH before ECMO, with less than 24 h of ECMO support, and with incomplete data were excluded. ICH was diagnosed by a head computed tomography scan. The outcomes included the incidence of ICH, in-hosptial mortality and 28-day mortality. Multivariate logistic regression analysis was used to identify relevant risk factors of ICH, and a predictive model of ICH with a nomogram was constructed.

Results: Among the 227 patients included, 22 developed ICH during ECMO. Patients with ICH had higher in-hospital mortality (90.9% vs. 47.8%, P=0.001) and higher 28-day mortality (81.8% vs. 47.3%, P=0.001) than patients with non-ICH. ICH was associated with decreased grey-white-matter ratio (GWR) (OR=0.894, 95%CI: 0.841-0.951, P<0.001), stroke history (OR=4.265, 95%CI: 1.052-17.291, P=0.042), fresh frozen plasma (FFP) transfusion (OR=1.208, 95%CI: 1.037-1.408, P=0.015) and minimum platelet (PLT) count during ECMO support (OR=0.977, 95%CI: 0.958-0.996, P=0.019). The area under the receiver operating characteristic curve of the ICH predictive model was 0.843 (95%CI: 0.762-0.924, P<0.001).

Conclusion: ECMO-treated patients with ICH had a higher risk of death. GWR, stroke history, FFP transfusion, and the minimum PLT count were independently associated with ICH, and the ICH predictive model showed that these parameters performed well as diagnostic tools.