Indian Journal of Critical Care Medicine最新文献

How to cite this article: Nimavat BD, Zirpe KG. Old Wine in a New Bottle: Vasograde Scale and Biomarkers, Composite Model in Subarachnoid Hemorrhage. Indian J Crit Care Med 2025;29(12):979-982.

Background and aims: Existing clinical prediction tools for delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH) patients do not integrate systemic inflammatory status, which is increasingly recognized as a contributor to DCI. We evaluated whether adding inflammatory indices, Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI), to existing tools improves DCI prediction.

Patients and methods: This retrospective observational study included 624 adult patients with aSAH who underwent clipping or coiling over a 2-year period. Patients were stratified into DCI and non-DCI groups. Multivariable logistic regression identified independent predictors of DCI, which were used to construct a bedside score (VASS-DCI) based on adjusted odds ratios. Receiver operating characteristic (ROC) analysis, DeLong's test, and decision curve analysis (DCA) were used to assess model performance and clinical utility.

Results: A total of 179 patients (28.7%) developed DCI. Increasing age, VASOGRADE (yellow/red), SII ≥ 2,056,309, and SIRI ≥ 5,568 were independent predictors of DCI. A multivariable model developed using these variables significantly outperformed the VASOGRADE score (AUC 0.774 vs 0.637; p < 0.0001). DCA demonstrated a higher net clinical benefit of the full model across a threshold probability range of 10-55% compared to VASOGRADE. A clinical risk score, the VASS-DCI (range 0-6), was developed using these predictors. The score stratified patients into low (0-2), moderate (3-4), and high-risk (5-6) groups, with corresponding DCI incidences of 11.8, 48.8, and 64.3%, respectively.

Conclusion: The VASS-DCI score integrates inflammatory, clinical, and radiological parameters into a practical bedside tool for early prediction of DCI in aSAH patients.

How to cite this article: Sharma P, Muthuchellappan R, Francis T, Sharma P, Mallesha HS, Nagaraja S. A Composite Model - "VASS-DCI" - for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage: Role of VASOGRADE and Inflammatory Biomarkers. Indian J Crit Care Med 2025;29(12):988-995.

How to cite this article: Bhattacharjee A, Datta PK, Ravikumar RH, Sathe P, Kumar V, Kundu R. Author Response: Timing Matters: Caution and Opportunity in Early Vasopressin for Septic Shock. Indian J Crit Care Med 2025;29(12):1059-1060.

Background and aims: Personalized parenteral nutrition (PPN) is a customized strategy to address the individual metabolic and nutritional requirements of the critically ill patients, especially in cases where enteral nutrition (EN) is not possible. However, available evidence regarding its effectiveness and safety is still inconclusive. This systematic review and meta-analysis aim to evaluate the impact of PPN on the clinical outcome of critically ill patients, including its effect on their length of stay in the intensive care unit (ICU), morbidity, and mortality.

Methodology: A systematic literature search was conducted in PubMed, EMBASE, and Cochrane databases. Information pertinent to the question was retrieved from the selected studies by using a structured data extraction form. Included studies were those that had assessed the impact on clinical outcomes of PPN in critically ill patients. Data were synthesized using a random-effects meta-analysis model. An odds ratio (OR) with 95% confidence intervals (CIs) was used as the pooled effect size.

Results: The meta-analysis included seven studies. The clinical risk was significantly higher in PPN with an OR of 1.24 (95% CI: 1.10-1.39; p < 0.01). Although there were some studies that showed an improvement in nutritional markers and decreased inflammation, the overall impact on mortality and the length of stay in the ICU was inconsistent with considerable clinical and methodological heterogeneity (I² = 81%).

Conclusion: Personalized parenteral nutrition has demonstrated improved benefits in tailored nutritional support for critically ill patients. The evidence, however, has shown mixed clinical outcomes, and its effect on mortality and morbidity has been inconclusive. Future research is needed to optimize the composition of PPN formulations and evaluate the long-term effects of this intervention.

How to cite this article: Gatar O, Arishi AA, Sultan MA, Gatar MM. Impact of Personalized Parenteral Nutrition on Inflammatory Markers and Clinical Outcomes in Critically Ill Patients: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(12):1040-1049.

Background: In emergency department (ED) settings, accurate and timely measurement of biochemical parameters like sodium, potassium, hemoglobin (Hb), and glucose is critical for initiating appropriate interventions. These parameters can be measured by a hospital laboratory autoanalyzer (HLA) or a blood gas analyzer (BGA). Although BGAs, as compared to HLAs, are able to deliver rapid results at the point of care, their accuracy has been a subject of debate. Therefore, this study was designed to compare them and determine their interchangeability.

Patients and methods: A prospective, cross-sectional study was conducted in 1,000 adult patients in the Emergency Medicine Department. Both arterial sampling for blood gas analysis and venous sampling for laboratory analysis were taken simultaneously. The reliability between two measurements was evaluated using the intraclass correlation coefficient (ICC), and agreement was assessed using Bland-Altman analysis with 95% limits of agreement (LOA).

Results: The intraclass correlation coefficient indicated good to excellent reliability for all parameters: Sodium (ICC = 0.946, 95% CI: 0.790-0.976), potassium (ICC = 0.907, 95% CI: 0.769-0.951), Hb (ICC = 0.947, 95% CI: 0.938-0.953), and glucose (ICC = 0.967, 95% CI: 0.962-0.971). The Bland-Altman plot showed moderate to high agreement for sodium, potassium, and Hb levels, and the mean bias was within acceptable limits. Despite the excellent ICC and high correlation for glucose, the Bland-Altman analysis revealed a substantial bias (+6.19 mg/dL) and very wide LOA (-67.69 to +80.07 mg/dL), indicating poor agreement.

Conclusion: We advocate the use of BGA for sodium, potassium, and Hb measurement in emergency settings for quick decision-making. However, glucose measurements from BGA require careful interpretation and should be supplemented with laboratory testing.

How to cite this article: Mittal G, Gupta K, Kaushal A, Chauhan R, Sharma N, Singh K, et al. Comparison of Sodium, Potassium, Hemoglobin, and Glucose Levels by Blood Gas Analyzer and Hospital Laboratory Autoanalyzer in Emergency Department Settings: A Cross-sectional Study. Indian J Crit Care Med 2025;29(12):1020-1025.

How to cite this article: Chanchalani G. Aviptadil in Aviptadil in Acute Respiratory Distress Syndrome-Promise or Mirage? Indian J Crit Care Med 2025;29(11):895-896.

How to cite this article: Prakash J, Choudhuri B. Mechanical Power and Driving Pressure in ARDS: Clarifying Overlap Context and Clinical Meaning. Indian J Crit Care Med 2025;29(11):974-975.

How to cite this article: Chaudhuri S, Rao S, Parampalli V. Author Response: Mechanical Power and Driving Pressure in Acute Respiratory Distress Syndrome: Clarifying Overlap Context and Clinical Meaning. Indian J Crit Care Med 2025;29(11):976-977.

Aims and background: Sepsis-associated liver dysfunction (SALD) represents a prevalent and critical complication frequently observed in patients with sepsis. The association between the initial aspartate aminotransferase (AST)-to-platelet (PLT) ratio index (APRI) and SALD is unclear in adult patients diagnosed with sepsis.

Patients and methods: We retrospectively analyzed data from the Medical Information Mart for Intensive Care-IV database. Sepsis-associated liver dysfunction was defined as an elevated serum aminotransaminase (>800 IU/L) or total bilirubin (>2 mg/dL) level. Multivariate and smoothing curve analyses were performed to investigate the relationship between the APRI [APRI = (AST (IU/L)/upper limits of normal)/PLT (k/uL)×100] and SALD. Subgroup analysis was additionally conducted to assess the robustness of the finding. Receiver operating characteristic (ROC) curve was performed to evaluate the discriminatory ability of SALD. External validation was performed using our own dataset.

Results: Overall, 6,334 sepsis patients (SALD, n = 985; no-SALD, n = 5,349) were included. Initial APRI was positively associated with SALD occurrence after controlling for potential confounding variables [odds ratio (OR) = 1.17; 95% confidence interval (CI): 1.15-1.20; p < 0.001]. A nonlinear dose-dependent relationship was found between initial APRI and SALD (p < 0.001). Subgroup analysis revealed no significant interaction between initial APRI and each subgroup divided by age, sex, albumin level, and Sequential Organ Failure Assessment score (p > 0.05). The area under the curve (AUC) for APRI was 0.769 (95% CI: 0.752-0.786), and the optimal cutoff was 0.95. External validation also exhibited good consistency (AUC: 0.761; 95% CI: 0.680-0.842).

Conclusion: A high initial APRI was linked to an elevated risk of developing SALD in adult patients with sepsis, as shown by the non-linear dose-dependent relationship.

Clinical significance: Initial APRI is an easy and accessible tool that can be adopted for timely detection of the risk of SALD and prompt initiation of interventions for adult patients with sepsis.

How to cite this article: Zhang B, Li X, Qin Z, Dong D, Yu W. Initial Aspartate Aminotransferase-to-platelet Ratio Index is Associated with Sepsis-associated Liver Dysfunction in Adult Patients with Sepsis: A Retrospective Cohort Study. Indian J Crit Care Med 2025;29(11):916-924.

Background and aims: It is unclear if maternal and fetal outcomes of pregnant women admitted to the intensive care unit (ICU) with A/H1N1pdm and SARS-CoV-2 infection are different.

Patients and methods: This retrospective study (2007-2022) included pregnant women admitted to the ICU with real-time reverse transcription polymerase chain reaction-confirmed A/H1N1pdm or SARS-CoV-2 pneumonia; non-viral pneumonia and incomplete records were excluded. The primary outcome was maternal mortality. Secondary outcomes included need for organ support, duration of ventilation, hospital stay, and fetal outcome. Predictors of maternal mortality were explored using multivariate logistic regression.

Results: Fifty-six women (A/H1N1pdm = 42, SARS-CoV-2 = 14) were admitted to the ICU at a median (interquartile) gestational age of 32.3 (27.3-36) weeks. Gestational diabetes (p = 0.02), hypothyroidism (p = 0.04), hypertension (p = 0.09), and infertility treatment (p = 0.09) were more frequent among SARS-CoV-2 infected women. Time from symptom onset to ICU admission was 4 (3-5) days. Although APACHE-II scores were similar in both groups, a higher proportion of patients with A/H1N1pdm had tachycardia (87.8% vs 21.4%, p = 0.001), and their median oxygen saturation at admission was lower (89% vs 94%, p = 0.02). Ventilatory support (non-invasive and/or invasive support) was required in all A/H1N1pdm patients and 78.6% with SARS-CoV-2 (p = 0.013). Ventilation duration was 12 days (4-18) for SARS-CoV-2 and 4 days (2-7) for A/H1N1pdm (p < 0.001). The frequency of cardiac and renal dysfunction was similar in both groups. Maternal mortality was 21.4% in A/H1N1pdm and 28.6% in SARS-CoV-2; fetal loss was 16.7% and 26.3%, respectively. Four neonatal deaths occurred. Delayed hospital presentation independently predicted maternal mortality (OR: 1.8; 95% CI: 1.07-3.06).

Conclusion: Respiratory failure due to A/H1N1pdm and SARS-CoV-2 infections in pregnancy is associated with high maternal mortality and fetal loss. Delayed presentation is independently associated with maternal death.

How to cite this article: Thomas VV, Nakkeeran G, Jacob KR, Chacko B, Moorthy M, Gowri M, et al. Maternal and Fetal Outcomes in Pregnant Women Admitted to the Intensive Care Unit with A/H1N1pdm or SARS-CoV-2 Infection: A Retrospective Study. Indian J Crit Care Med 2025;29(11):907-915.