Indian Journal of Critical Care Medicine最新文献

Background and aim: Nicotinamide phosphoribosyl transferase (NAMPT) is an upstream cytozyme (cytokine plus enzyme) with unique features, having intracellular NAMPT (iNAMPT) and extracellular NAMPT (eNAMPT) components. Genetic associations and therapeutic inhibition highlight its potential as both a biomarker and therapeutic target. We aimed to study the utility of eNAMPT as a predictor of severe organ dysfunction and its association with mortality in acute respiratory distress syndrome (ARDS).

Patients and methods: This is a single-center, prospective observational study involving 90 patients with ARDS. We noted plasma eNAMPT levels, oxygenation levels, inflammatory markers, lung ultrasound scores, driving pressures, and echocardiography parameters. Severity of organ dysfunction and ICU mortality were the outcomes.

Results: Plasma eNAMPT was found to be a predictor of severe organ dysfunction in ARDS [adjusted OR: 1.343, 95% CI (1.105-1.634), p-value 0.003]. The cut-off eNAMPT level of ≥ 4.38 ng/mL was used to predict early severe organ dysfunction, with an AUC of 0.752, 95% CI (0.647-0.857), p-value < 0.001, sensitivity of 71.4%, and specificity of 79.2%. Plasma eNAMPT was significantly higher in non-survivors [4.53 (4-9.98) ng/mL] as compared to survivors [3.76 (3.40-4.29) ng/mL] (p-value < 0.001). eNAMPT level ≥4.175 ng/mL was associated with higher mortality (hazard ratio: 3.82; 95% CI: 2.010-7.276, p-value < 0.001) and a shorter median survival time [5 days vs. 16 days (Log-rank (Mantel-Cox) p-value < 0.001].

Conclusion: Plasma eNAMPT (≥4.38 ng/mL) predicts early severe organ dysfunction in ARDS patients. It is also associated with mortality and a shorter median survival time.

How to cite this article: Rao S, Srinivas T, Parampalli V, Todur P, Udupa AA, Rao S, et al. Utility of Extracellular Nicotinamide Phosphoribosyl Transferase as a Novel Biomarker in Predicting Early Severe Organ Dysfunction and Mortality in Acute Respiratory Distress Syndrome: A Prospective Observational Study. Indian J Crit Care Med 2025;29(12):1010-1019.

How to cite this article: Shanmugam H, Airen L, Rawat S. Author Response: From Narrative to Navigation: A Translational Roadmap for AI-enabled Early Sepsis Prediction-Comment on Shanmugam et al. Indian J Crit Care Med 2025;29(12):1052-1053.

How to cite this article: Ghatak T, Mani UA. The Sci-Hub Ban in India: When Copyright Collides with Clinical Reality. Indian J Crit Care Med 2025;29(12):986-987.

Background: NETosis is a unique form of cell death leading to the formation of neutrophil extracellular traps (NETs), which may be responsible for many of the serious complications of COVID-19, such as acute respiratory distress syndrome (ARDS), cytokine storm, thromboembolic complications, acute organ dysfunction, and multiorgan failure.

Aims: The aim was to assess the relationship between markers of NETosis [citrullinated histones (Cit-H3), myeloperoxidase (MPO), and elastase] and COVID-19, as well as its severity.

Patients and methods: Ninety-nine hospitalized adult patients aged 18 years or older with COVID-19 and 30 controls were prospectively enrolled. Serum levels of Cit-H3, MPO, and elastase were measured at the time of admission, and their levels were compared between the clinical categories of COVID-19 (non-severe, severe, and critical). The correlation between markers of NETosis and the PO₂/FiO₂ ratio was also determined.

Results: Among the NETs markers, Cit-H3 and elastase levels significantly increased in the COVID-19 patients compared to the control. In the comparison of COVID-19 categories, only Cit-H3 significantly increased in severe categories compared to the non-severe group. Citrullinated histones showed fair diagnostic ability for the prediction of the severity, with a sensitivity and specificity of approximately 74 and 64%, respectively, at a cut-off of 34 ng/mL. Elastase was found to have a weak negative correlation, while Cit-H3 had a moderate negative correlation with the PO₂/FiO₂ ratio.

Conclusions: Citrullinated histones, along with C-reactive protein (CRP), are independently associated with COVID-19 severity. These findings support the relevance of NETosis-related biomarkers in disease progression and may inform future research on targeted monitoring strategies.

Clinical trial registration no: Clinical trial registry of India (CTRI/2020/10/028488).

How to cite this article: Kumar A, Kumar N, Banerjee A, Kumar A, Kumar A, Sinha C. Relationship of Circulatory Markers of NETosis with COVID-19 Severity: A Prospective Cohort Study. Indian J Crit Care Med 2025;29(12):1032-1039.

How to cite this article: Scorza CA, Scorza FA, Finsterer J. Diagnose Pediatric Delirium Preferentially by Psychiatric Examination, as CAPD Has Low Specificity. Indian J Crit Care Med 2025;29(12):1061-1062.

Point‑of‑care ultrasound (PoCUS) has transformed bedside diagnostics in critical care, yet its educational framework remains fragmented. Despite decades of use, training often relies on short workshops or ad hoc mentorship, leaving many trainees with suboptimal image-acquisition skills and/or interpretive competence. This commentary highlights barriers to effective PoCUS education, illustrated through clinical cases where misinterpretation posed significant risks. We identify systemic challenges including inconsistent curricula, poorly defined competencies, reliance on arbitrary scan numbers, and limited supervision. Accreditation processes remain variable, with guidelines offering aspirational statements but little implementation detail. Medicolegal concerns further underscore the need for structured training. We propose a way forward through longitudinal, competency‑based programs anchored in educational milestones, validated assessment tools, and quality assurance mechanisms. Global collaboration and standardized frameworks are essential to harmonize training and ensure safe practice. Addressing these gaps will strengthen PoCUS education and safeguard patient outcomes.

How to cite this article: Rajamani A, McLean A, Pichamuthu K, Huang S. Point-of-care, Point-of-concern? A Commentary on What Ails Point-of-care Ultrasound Education. Indian J Crit Care Med 2025;29(12):983-985.

How to cite this article: Karim HMR, Khandelwal A, Atlapure B, Aspari A. Timing Matters: Caution and Opportunity in Early Vasopressin for Septic Shock. Indian J Crit Care Med 2025;29(12):1058.

How to cite this article: Mehta KN, Otiya DM. Lung Ultrasound in the ICU: Strengths, Limitations, and the Continued Role of Computed Tomography. Indian J Crit Care Med 2025;29(12):1054-1055.

How to cite this article: Al Tayar AS, Salem HA, Nasa P. Author Response: Lung Ultrasound in the Intensive Care Unit: Strengths, Limitations, and the Continued Role of Computed Tomography. Indian J Crit Care Med 2025;29(12):1056-1057.

Background and aims: Trauma continues to represent a major global contributor to morbidity and mortality, with individuals sustaining polytrauma particularly vulnerable to developing systemic inflammatory response syndrome (SIRS) and sepsis. This study aims to evaluate the C-reactive protein (CRP) to albumin ratio (CAR) in predicting the postoperative SIRS and sepsis occurrence among polytrauma cases admitted to intensive care units (ICUs).

Patients and methods: This prospective observational study involved 100 polytrauma cases admitted to Ain Shams University Hospital ICUs. C-reactive protein and albumin levels were measured upon ICU admission and on postoperative days 1, 3, and 5. The CAR was calculated, and its association with SIRS and sepsis was assessed.

Results: Systemic inflammatory response syndrome developed in 35% and sepsis in 28% of patients. C-reactive protein/albumin ratio (CAR) was significantly higher in SIRS-positive patients at Day-1 (median 9.7 vs 8.0, p < 0.001), Day-3 (17.5 vs 11.9, p < 0.001), and Day-5 (28.9 vs 13.8, p < 0.001). C-reactive protein/albumin ratio (CAR) also differentiated sepsis-positive patients at Day-3 (17.7 vs 12.1, p < 0.001) and Day-5 (29.0 vs 14.0, p < 0.001). Receiver-operating characteristic (ROC) analysis showed that CAR at Day-5 had an area under the curve (AUC) of 0.989 for SIRS (sensitivity: 91.4%, specificity: 98.5%) and 0.934 for sepsis (sensitivity: 89.3%, specificity: 88.9%).

Conclusion: Progressive elevation of CAR is a reliable early predictor of postoperative SIRS and sepsis in polytrauma patients, peaking on Day-5.

Clinical significance: Early detection of postoperative sepsis in polytrauma patients by a simple, inexpensive screening tool allows risk stratification and timely intervention of this high-risk group, improving clinical outcomes.

How to cite this article: Salem AS, Zaghloul MA, Boctor AM, Abd Elfattah MM, Shehata OM. C-reactive Protein/Albumin Ratio as a Predictive Inflammatory Marker for Postoperative Systemic Inflammatory Response Syndrome and/or Sepsis in Polytraumatized Patients in ICU. Indian J Crit Care Med 2025;29(12):1002-1009.