Journal of intensive medicine最新文献_第2页

Influence of hydrocortisone infusion method on the clinical outcome of patients with septic shock: A systematic review and meta-analysis

Journal of intensive medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.jointm.2024.05.001

Yuting Li, Youquan Wang, Jianxing Guo, Dong Zhang

Background

The effect of the modality of hydrocortisone administration on clinical outcomes in patients with septic shock remains uncertain. This systematic review and meta-analysis evaluate the impact of intermittent bolus and continuous infusion of hydrocortisone on these outcomes.

Methods

We searched the PubMed, Embase databases, and Cochrane Library for randomized controlled trials (RCTs) and cohort studies published from inception to January 1, 2023. We included studies involving adult patients with septic shock. All authors reported our primary outcome of short-term mortality and clearly compared the clinically relevant secondary outcomes (ICU length of stay, hospital length of stay, vasopressor-free days, hyperglycemia, hypernatremia, and ICU-acquired weakness [ICUAW]) of intermittent bolus and continuous infusion of hydrocortisone. Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). The PROSPERO registration number is CRD42023392160.

Results

Seven studies, including 554 patients, were included. The primary outcome of this meta-analysis showed no statistically significant difference in the short-term mortality between intermittent bolus and continuous infusion groups (OR=1.21, 95% CI: 0.84 to 1.73; P=0.31; Chi²=9.06; I²=34%). Secondary outcomes showed no statistically significant difference in the ICU length of stay (MD=−0.15, 95% CI: −2.31 to 2.02; P=0.89; Chi²=0.95; I²=0%), hospital length of stay (MD=0.63, 95% CI: −4.24 to 5.50; P=0.80; Chi²=0.61; I²=0%), vasopressor-free days (MD=−1.18, 95% CI: −2.43 to 0.06; P=0.06; Chi²=2.48; I²=60%), hyperglycemia (OR=1.27, 95% CI: 0.80 to 2.02; P=0.31; Chi²=5.23; I²=43%), hypernatremia (OR=0.93, 95% CI: 0.44 to 1.96; P=0.85; Chi²=0.37; I²=0%), or ICUAW (OR=0.83, 95% CI: 0.36 to 1.94; P=0.67; Chi²=0.90; I²=0%) between the two groups.

Conclusions

This meta-analysis indicated no significant difference in short-term mortality between intermittent bolus or continuous hydrocortisone infusion in patients with septic shock. Additionally, the hydrocortisone infusion method was not associated with ICU length of stay, hospital length of stay, vasopressor-free days, hyperglycemia, hypernatremia, or ICUAW.

{"title":"Influence of hydrocortisone infusion method on the clinical outcome of patients with septic shock: A systematic review and meta-analysis","authors":"Yuting Li, Youquan Wang, Jianxing Guo, Dong Zhang","doi":"10.1016/j.jointm.2024.05.001","DOIUrl":"10.1016/j.jointm.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><div>The effect of the modality of hydrocortisone administration on clinical outcomes in patients with septic shock remains uncertain. This systematic review and meta-analysis evaluate the impact of intermittent bolus and continuous infusion of hydrocortisone on these outcomes.</div></div><div><h3>Methods</h3><div>We searched the PubMed, Embase databases, and Cochrane Library for randomized controlled trials (RCTs) and cohort studies published from inception to January 1, 2023. We included studies involving adult patients with septic shock. All authors reported our primary outcome of short-term mortality and clearly compared the clinically relevant secondary outcomes (ICU length of stay, hospital length of stay, vasopressor-free days, hyperglycemia, hypernatremia, and ICU-acquired weakness [ICUAW]) of intermittent bolus and continuous infusion of hydrocortisone. Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). The PROSPERO registration number is CRD42023392160.</div></div><div><h3>Results</h3><div>Seven studies, including 554 patients, were included. The primary outcome of this meta-analysis showed no statistically significant difference in the short-term mortality between intermittent bolus and continuous infusion groups (OR=1.21, 95% CI: 0.84 to 1.73; <em>P</em>=0.31; <em>Chi<sup>2</sup></em>=9.06; <em>I</em><sup>2</sup>=34%). Secondary outcomes showed no statistically significant difference in the ICU length of stay (MD=−0.15, 95% CI: −2.31 to 2.02; <em>P</em>=0.89; <em>Chi<sup>2</sup></em>=0.95; <em>I</em><sup>2</sup>=0%), hospital length of stay (MD=0.63, 95% CI: −4.24 to 5.50; <em>P</em>=0.80; <em>Chi<sup>2</sup></em>=0.61; <em>I</em><sup>2</sup>=0%), vasopressor-free days (MD=−1.18, 95% CI: −2.43 to 0.06; <em>P</em>=0.06; <em>Chi<sup>2</sup></em>=2.48; <em>I</em><sup>2</sup>=60%), hyperglycemia (OR=1.27, 95% CI: 0.80 to 2.02; <em>P</em>=0.31; <em>Chi<sup>2</sup></em>=5.23; <em>I</em><sup>2</sup>=43%), hypernatremia (OR=0.93, 95% CI: 0.44 to 1.96; <em>P</em>=0.85; <em>Chi<sup>2</sup></em>=0.37; <em>I</em><sup>2</sup>=0%), or ICUAW (OR=0.83, 95% CI: 0.36 to 1.94; <em>P</em>=0.67; <em>Chi<sup>2</sup></em>=0.90; <em>I</em><sup>2</sup>=0%) between the two groups.</div></div><div><h3>Conclusions</h3><div>This meta-analysis indicated no significant difference in short-term mortality between intermittent bolus or continuous hydrocortisone infusion in patients with septic shock. Additionally, the hydrocortisone infusion method was not associated with ICU length of stay, hospital length of stay, vasopressor-free days, hyperglycemia, hypernatremia, or ICUAW.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 100-107"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Previous treatment with anthracycline does not affect the course of sepsis in cancer patients: Retrospective cohort study

Journal of intensive medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.jointm.2024.07.005

Windsor Camille , Joseph Adrien , Pons Stephanie , Mokart Djamel , Pène Frederic , Kouatchet Achille , Demoule Alexandre , Bruneel Fabrice , Nyunga Martine , Borcoman Edith , Legrand Matthieu , Darmon Michael , Zafrani Lara , Azoulay Elie , Lemiale Virginie

Background

Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity. The aim of this study was to evaluate the effect of anthracycline treatment on the outcome of cancer patients with sepsis.

Methods

Data from cancer patients admitted to intensive care units (ICUs) for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994–2015). Comparison between patients who received anthracycline and those who did not was performed using a propensity score, including confounding variables (age and underlying diseases). A competing risk adjusted for severity of illness (Sequential Organ Failure Assessment [SOFA] score) was used to analyze the duration of vasopressor requirement.

Results

Among 2046 patients, 1070 (52.3%) patients who received anthracycline were compared with 976 (47.7%) who did not. The underlying disease was mostly acute hematological malignancy (49.2%). Sepsis, mostly pneumonia (47.7%), had developed 2 days (interquartile range [IQR]:1–4 days) prior to ICU admission. Most patients (n=1156/1980,58.4%) required vasopressors for 3 days (IQR: 2–6 days). Factors associated with the need for vasopressors were aplasia (hazard ratio [HR]=1.72, 95% confidence interval [CI]: 1.21 to 2.47, P=0.002) and day 1 respiratory SOFA score (HR=7.07, 95% CI: 2.75 to 22.1, P <0.001). Previous anthracycline treatment was not associated with an increased risk of vasopressor use. The duration of vasopressors was not different between patients who received anthracycline and those who did not (P=0.79). Anthracycline was not associated with ICU mortality.

Conclusion

Previous anthracycline treatment did not alter the course of sepsis in a cohort of cancer patients admitted to intensive care with sepsis.

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引用次数: 0

Critical Care Almanac: Annual Innovations and Achievements

Journal of intensive medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.jointm.2024.10.001

Changsong Wang , Dechang Chen

引用次数: 0

Overexpression of Parkin promotes the protective effect of mitochondrial autophagy on the lung of rats with exertional heatstroke

Journal of intensive medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.jointm.2024.07.004

Ran Meng , Zhengzhong Sun , Ruxue Chi , Yan Gu , Yuxiang Zhang , Jiaxing Wang

Background

The roles of the Pink1/Parkin pathway and mitophagy in lung injury during heat stroke remain unclear. In this study, we investigated the role of Pink1/Parkin-mediated mitophagy in acute lung injury (ALI) in rats with exertional heat stroke (EHS).

Methods

Sixty Sprague Dawley rats were randomly divided into control (CON), control + Parkin overexpression (CON + Parkin), EHS, and EHS + Parkin overexpression (EHS + Parkin) groups. Parkin was overexpressed by injecting an adeno-associated virus carrying the Parkin gene into the tail vein, and a rat model of EHS was established. Pathological changes in the lung tissue were analyzed using microcomputed tomography (micro-CT), and the lung coefficient and pulmonary capillary permeability were measured. Enzyme-linked immunosorbent assay were used to determine the levels of interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α, and reactive oxygen species. The morphology of mitochondria in type Ⅱ epithelial cells of lung tissue was observed using transmission electron microscopy; and the apoptosis of lung tissue, the level of mitophagy, and the co-localization of Pink1 and Parkin were determined using immunofluorescence. The expression of Pink1, Parkin, mitofusin-2 (MFN2), phosphatase and tensin homolog (PTEN), PTEN-L, p62, and the autophagy marker microtubule-associated protein 1 light chain 3 (LC3) in rat lung tissue was measured by Western blotting, and the ratio of LC3II/LC3I was calculated.

Results

Compared with the EHS group, the survival rate of rats in the EHS + Parkin group was significantly higher. Their lung coefficient and pulmonary vascular permeability decreased and the pathological changes were significantly alleviated (P <0.05). Their levels of inflammatory factors and reactive oxygen species were significantly decreased (P <0.05), and the degree of mitochondrial swelling in pulmonary type II epithelial cells was alleviated. The apoptosis of lung tissue was alleviated, the colocalization of Pink1 and Parkin, LC3 and Tom20 was enhanced, and the ratio of LC3-II/LC3-I increased. The expression of Pink1, MFN2, PTEN-L, and p62 decreased, whereas the expression of PTEN was not significantly different from that in the EHS group (P >0.05).

Conclusion

Pink1/Parkin-mediated mitophagy dysfunction is one of the mechanisms underlying ALI in rats with EHS, and activation of Parkin overexpression-mediated mitophagy can alleviate ALI caused by EHS.

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引用次数: 0

Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients 微循环病灶深度测量显示白蛋白复苏可减轻烧伤患者的组织水肿

Journal of intensive medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.jointm.2024.05.002

Olcay Dilken , Annemieke Dijkstra , Göksel Güven , Bülent Ergin , Nicole Trommel , Margriet E. van Baar , Helma WC Hofland , Can Ince , Cornelis H. van der Vlies

Background

Severe burns induce volume shifts via capillary leaks, eventually requiring massive fluid resuscitation and promoting tissue edema. Albumin may help to mitigate the edema, thereby improving perfusion. This study shows that sublingual microcirculation measurements can quantify both tissue perfusion and edema.

Methods

This prospective observational study was conducted between November 2018 and December 2019 in the intensive care unit of Maasstad Hospital Burn Center, Rotterdam, The Netherlands. Patients with severe burns affecting >15% of the total body surface area were included. Fluid management was conducted in accordance with the Parkland formula. Albumin (20%) was administered at a rate of 0.5 mL/(kg·h), starting 12 h after the burn incident. Alterations in the sublingual microcirculation, including capillary perfusion and density, were measured at admission (T0) and 4 h (T4) and 12 h (T12) after admission. Sublingual depth of focus (DOF) of the microcirculation was used to quantify the tissue edema.

Results

Nine patients were recruited with a mean total body surface area of 36% ± 23%. By T12, a median of 4085 mL (interquartile range [IQR]: 3714–6756 mL) of crystalloids and 446 mL (IQR: 176–700 mL) of 20% albumin were administered. The DOF increased significantly after crystalloid administration (T4 vs. T0, mean difference [MD]=27.4 µm, 95% confidence interval [CI]: 3.4 to 50.9, P=0.040). Following albumin administration, DOF significantly decreased (T12 vs. T4, MD=−76.4 µm, 95% CI: −116.6 to −36.1, P=0.002). Total vessel density decreased significantly with crystalloid administration (T4 vs. T0, MD=−3.5 mm/mm², 95% CI: −5.7 to −1.4, P=0.004) but increased after albumin administration (T12 vs. T4, MD=6.2 mm/mm², 95% CI: 3.2 to 9.3, P=0.001).

Conclusion

Sublingual microcirculation measurement of DOF and other parameters provide a valuable tool for the assessment of tissue perfusion and edema in patients with severe burns. Further investigation is required to evaluate the role of albumin in increasing microcirculatory convection and reducing tissue edema.

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引用次数: 0

Nebulized aminoglycosides for ventilator-associated pneumonia: Methodological considerations and lessons from experimental studies

Journal of intensive medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.jointm.2024.07.006

Jean-Jacques Rouby , Jing Xia , Jayesh Dhanani , Gianluigi Li Bassi , Antoine Monsel , Antoni Torres

Aminoglycosides are concentration-dependent antibiotics exerting a bactericidal effect when concentrations at the site of infection are equal to or greater than 5 times the minimum inhibitory concentrations (MIC). When administered intravenously, they exhibit poor lung penetration and high systemic renal and ototoxicity, imposing to restrict their administration to 5 days. Experimental studies conducted in anesthetized and mechanically ventilated sheep and pigs provide evidence that high doses of nebulized aminoglycosides induce a rapid and potent bacterial killing in the infected lung parenchyma. They also confirm that the alveolar-capillary membrane, either normal or injured by the infectious process, restricts the penetration of intravenous aminoglycosides in the infected lung parenchyma, precluding a bactericidal effect at the site of infection. However, injury of the alveolar-capillary membrane promotes the systemic diffusion of nebulized aminoglycosides. Based on experimental data obtained in animals with inoculation pneumonia, it challenges the classical belief that nebulization protects against systemic toxicity. Loss of lung aeration decreases the lung penetration of nebulized aminoglycosides. Nevertheless, lung tissue concentrations measured in non-aerated lung regions with severe and extended pneumonia are most often greater than 5 times the MICs, resulting in a bactericidal effect followed by a progressive pulmonary reaeration. It is likely that the penetration into the consolidated lung, results from the bronchial diffusion of nebulized aminoglycosides toward adjacent non-aerated infected alveolar spaces and their penetration into mechanical ventilation-induced intraparenchymal pseudocysts and distended bronchioles. In animals receiving nebulized aminoglycosides, epithelial lining fluid concentrations grossly overestimate lung interstitial fluid concentrations because of the bronchial contamination of the distal tip of the bronchoscope during the bronchoalveolar procedures. Lung microdialysis is the only technique able to accurately assess lung pharmacokinetics in animals with inoculation pneumonia treated by nebulized aminoglycosides. In 2024, the European Investigators Network for Nebulized Antibiotics in Ventilator-associated Pneumonia (ENAVAP) called for the creation of an international research network for Lung Microdialysis applied to Nebulized Antibiotics (LUMINA) to promote multicentered, experimental, randomized, and controlled studies addressing lung pharmacokinetics of intravenous vs. nebulized antibiotics, using different dosing and ventilator settings.

{"title":"Nebulized aminoglycosides for ventilator-associated pneumonia: Methodological considerations and lessons from experimental studies","authors":"Jean-Jacques Rouby , Jing Xia , Jayesh Dhanani , Gianluigi Li Bassi , Antoine Monsel , Antoni Torres","doi":"10.1016/j.jointm.2024.07.006","DOIUrl":"10.1016/j.jointm.2024.07.006","url":null,"abstract":"<div><div>Aminoglycosides are concentration-dependent antibiotics exerting a bactericidal effect when concentrations at the site of infection are equal to or greater than 5 times the minimum inhibitory concentrations (MIC). When administered intravenously, they exhibit poor lung penetration and high systemic renal and ototoxicity, imposing to restrict their administration to 5 days. Experimental studies conducted in anesthetized and mechanically ventilated sheep and pigs provide evidence that high doses of nebulized aminoglycosides induce a rapid and potent bacterial killing in the infected lung parenchyma. They also confirm that the alveolar-capillary membrane, either normal or injured by the infectious process, restricts the penetration of intravenous aminoglycosides in the infected lung parenchyma, precluding a bactericidal effect at the site of infection. However, injury of the alveolar-capillary membrane promotes the systemic diffusion of nebulized aminoglycosides. Based on experimental data obtained in animals with inoculation pneumonia, it challenges the classical belief that nebulization protects against systemic toxicity. Loss of lung aeration decreases the lung penetration of nebulized aminoglycosides. Nevertheless, lung tissue concentrations measured in non-aerated lung regions with severe and extended pneumonia are most often greater than 5 times the MICs, resulting in a bactericidal effect followed by a progressive pulmonary reaeration. It is likely that the penetration into the consolidated lung, results from the bronchial diffusion of nebulized aminoglycosides toward adjacent non-aerated infected alveolar spaces and their penetration into mechanical ventilation-induced intraparenchymal pseudocysts and distended bronchioles. In animals receiving nebulized aminoglycosides, epithelial lining fluid concentrations grossly overestimate lung interstitial fluid concentrations because of the bronchial contamination of the distal tip of the bronchoscope during the bronchoalveolar procedures. Lung microdialysis is the only technique able to accurately assess lung pharmacokinetics in animals with inoculation pneumonia treated by nebulized aminoglycosides. In 2024, the European Investigators Network for Nebulized Antibiotics in Ventilator-associated Pneumonia (ENAVAP) called for the creation of an international research network for Lung Microdialysis applied to Nebulized Antibiotics (LUMINA) to promote multicentered, experimental, randomized, and controlled studies addressing lung pharmacokinetics of intravenous vs. nebulized antibiotics, using different dosing and ventilator settings.</div></div>","PeriodicalId":73799,"journal":{"name":"Journal of intensive medicine","volume":"5 1","pages":"Pages 12-22"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intestine-derived fibroblast growth factor 19 alleviates lipopolysaccharide-induced liver injury by regulating bile acid homeostasis and directly improving oxidative stress

Journal of intensive medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.jointm.2024.06.003

Xiaomeng Tang , Jingjing Ning , Yilin Zhao , Shuyun Feng , Lujing Shao , Tiantian Liu , Huijie Miao , Yucai Zhang , Chunxia Wang

Background

Cholestasis plays a critical role in sepsis-associated liver injury (SALI). Intestine-derived fibroblast growth factor 19 (FGF19) is a key regulator for bile acid homeostasis. However, the roles and underlying mechanisms of FGF19 in SALI are still unclear.

Methods

We conducted a case–control study that included 58 pediatric patients aged from 1 month to 14-years-old diagnosed with sepsis at Shanghai Children's Hospital from January to December 2018 and 30 healthy individuals. The serum FGF19 levels of these patients with sepsis were analyzed and compared with those of healthy controls. Recombinant human FGF19 was intravenously injected in mice once a day for 7 days at a dose of 0.1 mg/kg body weight before lipopolysaccharide (LPS) treatment. Liver bile acid profiles and the gene expression involved in bile acid homeostasis were investigated in the mice groups. Metabolomic data were further integrated and analyzed using Ingenuity Pathways Analysis (IPA) software. In the in vitro analysis using HepG2 cells, the influence of FGF19 pretreatment on reactive oxygen species (ROS) production and mitochondrial dysfunction was analyzed. Compound C (CC), an inhibitor of AMP-activated protein kinase (AMPK) activation, was used to confirm the roles of AMPK activation in FGF19-mediated hepatoprotective effects.

Results

Serum FGF19 levels were significantly lower in children with sepsis than in healthy controls (115 pg/mL vs. 79 pg/mL, P=0.03). Pre-administration of recombinant human FGF19 alleviated LPS-induced acute liver injury (ALI) and improved LPS-induced cholestasis in mice. Moreover, FGF19 directly reversed LPS-induced intracellular ROS generation and LPS-decreased mitochondrial membrane potential in vitro and in vivo, resulting in hepatoprotection against LPS-induced apoptosis. More importantly, the inhibition of AMPK activity partially blocked the protective effects of FGF19 against LPS-induced oxidative stress and mitochondrial dysfunction.

Conclusions

Intestine-derived FGF19 alleviates LPS-induced ALI via improving bile acid homeostasis and directly suppressing ROS production via activating the AMPK signaling pathway.

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引用次数: 0

Advancing understanding and management of invasive fungal diseases in the intensive care unit: Insights from FUNDICU consensus definitions 促进对重症监护病房侵袭性真菌疾病的了解和管理：从 FUNDICU 共识定义中获得的启示

Journal of intensive medicine

Pub Date : 2024-07-12 DOI: 10.1016/j.jointm.2024.06.001

Ignacio Martin-Loeches

引用次数: 0

Investigating computational models for diagnosis and prognosis of sepsis based on clinical parameters: Opportunities, challenges, and future research directions 研究基于临床参数的败血症诊断和预后计算模型：机遇、挑战和未来研究方向

Journal of intensive medicine

Pub Date : 2024-07-10 DOI: 10.1016/j.jointm.2024.04.006

Jyotirmoy Gupta , Amit Kumar Majumder , Diganta Sengupta , Mahamuda Sultana , Suman Bhattacharya

This study investigates the use of computational frameworks for sepsis. We consider two dimensions for investigation – early diagnosis of sepsis (EDS) and mortality prediction rate for sepsis patients (MPS). We concentrate on the clinical parameters on which sepsis diagnosis and prognosis are currently done, including customized treatment plans based on historical data of the patient. We identify the most notable literature that uses computational models to address EDS and MPS based on those clinical parameters. In addition to the review of the computational models built upon the clinical parameters, we also provide details regarding the popular publicly available data sources. We provide brief reviews for each model in terms of prior art and present an analysis of their results, as claimed by the respective authors. With respect to the use of machine learning models, we have provided avenues for model analysis in terms of model selection, model validation, model interpretation, and model comparison. We further present the challenges and limitations of the use of computational models, providing future research directions. This study intends to serve as a benchmark for first-hand impressions on the use of computational models for EDS and MPS of sepsis, along with the details regarding which model has been the most promising to date. We have provided details regarding all the ML models that have been used to date for EDS and MPS of sepsis.

本研究调查了败血症计算框架的使用情况。我们从两个方面进行研究--败血症的早期诊断（EDS）和败血症患者的死亡率预测（MPS）。我们将重点放在目前脓毒症诊断和预后所依据的临床参数上，包括基于患者历史数据的定制治疗方案。我们根据这些临床参数确定了使用计算模型来处理 EDS 和 MPS 的最著名文献。除了对建立在临床参数基础上的计算模型进行综述外，我们还提供了有关常用公开数据源的详细信息。我们对每种模型的现有技术进行了简要评述，并对各自作者声称的结果进行了分析。关于机器学习模型的使用，我们从模型选择、模型验证、模型解释和模型比较等方面提供了模型分析的途径。我们进一步介绍了使用计算模型所面临的挑战和局限性，并提供了未来的研究方向。本研究旨在为脓毒症 EDS 和 MPS 计算模型的使用提供第一手资料，并详细介绍迄今为止最有前途的模型。我们提供了迄今为止用于 EDS 和 MPS 败血症的所有 ML 模型的详细信息。

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引用次数: 0

Association between hyperglycemia at ICU admission and postoperative acute kidney injury in patients undergoing cardiac surgery: Analysis of the MIMIC-IV database 心脏手术患者入住重症监护室时的高血糖与术后急性肾损伤之间的关系：MIMIC-IV 数据库分析

Journal of intensive medicine

Pub Date : 2024-06-25 DOI: 10.1016/j.jointm.2024.04.004

Juan Ruan , Weipeng Huang , Jun Jiang , Chang Hu , Yiming Li , Zhiyong Peng , Shuhan Cai

Background

This study aimed to explore the correlation between hyperglycemia at intensive care unit (ICU) admission and the incidence of acute kidney injury (AKI) in patients after cardiac surgery.

Methods

We conducted a retrospective cohort study, in which clinical data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Adults (≥18 years) in the database who were admitted to the cardiovascular intensive care unit after cardiac surgery were enrolled. The primary outcome was the incidence of AKI within 7 days following ICU admission. Secondary outcomes included ICU mortality, hospital mortality, ICU length of stay, and the 28-day and 90-day mortality. Multivariable Cox regression analysis was used to assess the association between ICU-admission hyperglycemia and AKI incidence within 7 days of ICU admission. Different adjustment strategies were used to adjust for potential confounders. Patients were divided into three groups according to their highest blood glucose levels recorded within 24 h of ICU admission: no hyperglycemia (<140 mg/dL), mild hyperglycemia (140–200 mg/dL), and severe hyperglycemia (≥200 mg/dL).

Results

Of the 6905 included patients, 2201 (31.9%) were female, and the median (IQR) age was 68.2 (60.1–75.9) years. In all, 1836 (26.6%) patients had severe hyperglycemia. The incidence of AKI within 7 days of ICU admission, ICU mortality, and hospital mortality was significantly higher in patients with severe admission hyperglycemia than those with mild hyperglycemia or no hyperglycemia (80.3% vs. 73.6% and 61.2%, respectively; 2.8% vs. 0.9% and 1.9%, respectively; and 3.4% vs. 1.2% and 2.5%, respectively; all P <0.001). Severe hyperglycemia was a risk factor for 7-day AKI (Model 1: hazard ratio [HR]=1.4809, 95% confidence interval [CI]: 1.3126 to 1.6707; Model 2: HR=1.1639, 95% CI: 1.0176 to 1.3313; Model 3: HR=1.2014, 95% CI: 1.0490 to 1.3760; all P <0.050). Patients with normal glucose levels (glucose levels <140 mg/dL) had a higher 28-day mortality rate than those with severe hyperglycemia (glucose levels ≥200 mg/dL) (4.0% vs. 3.8%, P <0.001).

Conclusions

In post-cardiac surgery patients, severe hyperglycemia within 24 h of ICU admission increases the risk of 7-day AKI, ICU mortality, and hospital mortality. Clinicians should be extra cautious regarding AKI among patients with hyperglycemia at ICU admission after cardiac surgery.

背景本研究旨在探讨重症监护病房（ICU）入院时的高血糖与心脏手术后患者急性肾损伤（AKI）发生率之间的相关性。方法我们进行了一项回顾性队列研究，从重症监护医学信息中心（MIMIC）-IV 数据库中提取临床数据。研究对象为数据库中心脏手术后入住心血管重症监护室的成人（≥18 岁）。主要结果是入住重症监护室后 7 天内的 AKI 发生率。次要结果包括重症监护室死亡率、住院死亡率、重症监护室住院时间以及 28 天和 90 天死亡率。多变量 Cox 回归分析用于评估 ICU 入院高血糖与 ICU 入院 7 天内 AKI 发生率之间的关系。采用不同的调整策略来调整潜在的混杂因素。根据患者入住 ICU 24 小时内记录的最高血糖水平将其分为三组：无高血糖（140 毫克/分升）、轻度高血糖（140-200 毫克/分升）和重度高血糖（≥200 毫克/分升）。结果在纳入的 6905 例患者中，2201 例（31.9%）为女性，中位（IQR）年龄为 68.2（60.1-75.9）岁。共有1836名（26.6%）患者患有严重高血糖。与轻度高血糖或无高血糖患者相比，重度高血糖患者入院后 7 天内发生 AKI 的发生率、ICU 死亡率和住院死亡率明显更高（分别为 80.3% 对 73.6% 和 61.2%；分别为 2.8% 对 0.9% 和 1.9%；分别为 3.4% 对 1.2% 和 2.5%；均为 P <0.001）。严重高血糖是7天AKI的风险因素（模型1：危险比[HR]=1.4809，95%置信区间[CI]：1.3126至1.6）：模型 2：HR=1.1639，95% 置信区间[CI]：1.0176 至 1.3313；模型 3：HR=1.2014，95% 置信区间[CI]：1.0490 至 1.3760；所有 P <0.050）。结论在心脏手术后患者中，ICU 入院 24 小时内的严重高血糖会增加 7 天 AKI、ICU 死亡率和住院死亡率的风险。临床医生应对心脏手术后入住 ICU 时出现高血糖的 AKI 患者格外谨慎。

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引用次数: 0