Search Results (3,473)

Background/Objectives: We identified the factors related to post-intensive care syndrome in a sample of patients from northern Colombia. Methods: This study employed a quantitative, observational, descriptive, and correlational approach. A sample of 277 adults was obtained through non-probabilistic convenience sampling, and a characterization form comprising sociodemographic and clinical variables was applied. The Healthy Aging Brain Care Monitor (HABC-M) instrument was also used, which is a clinical tool with a high capacity to detect post-intensive care syndrome (PICS) in surviving intensive care unit (ICU) patients. Results: The final sample consisted of 277 adults, 67.5% male, with university degrees, cohabiting in a marital union, working, from urban areas, and of the Catholic religion. Seventy percent of the sample presented both cardiovascular and neurological alterations and was admitted to the ICU, and 66% had a personal history of arterial hypertension (AHT) and type 2 diabetes mellitus (DM2). Patients had a mean ICU stay of 10.7 days, with a standard deviation of 4 days, and displayed a moderate risk of morbidity and mortality according to Acute Physiology and Chronic Health Evaluation II (APACHE II). A total of 38.6% of the sample received mechanical ventilation, with a mean duration of 8.3 days, and 7.5% underwent tracheostomy. As for sedation, 38.6% were administered fentanyl. In total, 83.4% of the sample presented the syndromes under study, with a predominance of the severe category. The global score of the scale was taken as the dependent variable, and statistical significance (p < 0.05) was found with sociodemographic variables, including origin and religion, and with clinical variables such as receiving pharmacological treatment. Conclusions: The sample presented PICS globally and showed how it affects the different dimensions, showing associations with the sociodemographic and clinical variables of interest. Full article

Mucormycosis is a rare invasive fungal disease in pediatric patients with hematological malignancies and is associated with poor outcomes. We present a fulminant and ultimately fatal case of rhino-orbito-cerebral mucormycosis, addressing important issues including clinical signs and symptoms, diagnostic approaches and the challenges of timely diagnosis. The patient was an 11-year old girl undergoing re-induction chemotherapy for Central Nervous System relapse of B-cell precursor acute lymphoblastic leukemia. She presented six days into the second course of chemotherapy in profound neutropenia with aggravating headaches, painful abducens nerve palsy and anisocoria. At first (day −3), no significant radiological or ophthalmological correlations were found, and methyl–prednisolone was started due to suspected vasculitis following ICU admission. After further clinical deterioration, a second MRI scan (day 0) revealed a prolonged occlusion of the left carotid artery, which was successfully stented in a neuroradiological intervention (day +1). However, during the next day the child developed clinical signs indicating severe cerebral dysfunction. An emergency CT scan showed complete infarction of the left hemisphere including a progredient perfusion deficit and beginning brain edema. Based on the unfavorable prognosis, best supportive care was initiated, and the patient deceased on day +2. Pathological and microbiological workup identified thrombotic infarction in all major cerebral arteries. While microscopy was suspicious for mucormycosis, nested PCR from retained blood specimens confirmed the genus Lichtheimia. Final NGS on brain tissue led to the identification of Lichtheimia ramosa. This case illustrates the rapidity and severity of Mucorales infection. It shows the importance of early clinical suspicion and the need for an aggressive laboratory testing algorithms. The stratification of risk factors and definition of red flags may be a future task fighting these infections. Full article

Background: Pan-drug-resistant (PDR) Acinetobacterinfections are an escalating ICU threat, demanding both patient-level triage and facility-wide forecasting. Objective: The aim of this study was to build a dual-scale AI framework that (i) predicts PDR status at infection onset and (ii) forecasts hospital-level PDR burden through 2027. Methods: We retrospectively analyzed 270 Acinetobacter infection episodes (2020–2024) with 65 predictors spanning demographics, timelines, infection type, resistance-class flags, and a 25-drug antibiogram. TabTransformer and XGBoost were trained on 2020–2023 episodes (n = 210), evaluated by stratified 5-fold CV, and externally tested on 2024 episodes (n = 60). Metrics included AUROC, AUPRC, accuracy, and recall at 90% specificity; AUROC was optimism-corrected via 0.632 + bootstrap and DeLong-tested for drift. SHAP values quantified feature impact. Weekly PDR incidence was forecast with an attention–LSTM model retrained monthly (200 weekly origins, 4-week horizon) and benchmarked against seasonal-naïve, Prophet, and SARIMA models (MAPE and RMSE). Quarterly projections (TFT-lite) extended forecasts to 2027. Results: The CV AUROC was 0.924 (optimism-corrected 0.874); an ensemble of TabTransformer + XGBoost reached 0.958. The 2024 AUROC fell to 0.586 (p < 0.001), coinciding with a PDR prevalence drop (75→38%) and three covariates with PSIs > 1.0. Isotonic recalibration improved the Brier score from 0.326 to 0.207 and yielded a net benefit equivalent to 26 unnecessary isolation-days averted per 100 ICU admissions at a 0.20 threshold. SHAP highlighted Ampicillin/Sulbactam resistance, unknown acquisition mode, and device-related infection as dominant drivers. The attention–LSTM achieved a median weekly MAE of 0.10 (IQR: 0.028–0.985) vs. 1.00 for the seasonal-naïve rule, outperforming it on 48.5% of weeks and surpassing Prophet and SARIMA (MAPE = 6.2%, RMSE = 0.032). TFT-lite projected a ≥ 25% PDR tipping point in 2025 Q1 with a sustained rise in 2027. Conclusions: The proposed framework delivers explainable patient-level PDR risk scores and competitive 4-week and multi-year incidence forecasts despite temporal drift, supporting antimicrobial stewardship and ICU capacity planning. Shrinkage and bootstrap correction were applied to address the small sample size (EPV = 2.1), which poses an overfitting risk. Continuous recalibration and multi-center validation remain priorities. Full article

Background/Objectives: The optimal protein dose for critically ill cancer patients, especially for muscle mass preservation and survival, remains unclear. This study evaluated whether a higher protein intake, compared to usual intake, was associated with improved clinical outcomes in this population. Methods: This was a prospective analysis of critically ill adult cancer patients admitted to an oncological intensive care unit (ICU). Patients were initially assigned to receive protein prescriptions of either 1.5 or 2.0 g per kilogram per day (g/kg/day), but due to common limitations in achieving prescribed targets in this setting, a prespecified per-protocol analysis was conducted. After three days of exclusive nutritional therapy, patients were reclassified into two groups based on actual protein intake: >1.5 g/kg/day (higher intake group, IG) and ≤1.5 g/kg/day (usual intake group, CG). The primary outcome was muscle mass preservation, measured by quadriceps muscle thickness (QMT) via ultrasound on days 1, 7, and 14. Secondary outcomes included ICU survival, hospital and ICU length of stay, mechanical ventilation duration, dialysis requirement, and 60-day survival. Results: From June 2019 to September 2023, 117 patients were included. Following the planned interim analysis, the study was stopped after meeting the Pocock criterion for ICU survival (p = 0.0013). After reclassification, 68.4% (n = 80) were in the IG and 31.6% (n = 37) in the CG. ICU stay was similar (both medians 13 days), but the IG had shorter hospital stays [21.0 vs. 27.5 days, p = 0.020], less QMT loss, and improved ICU (HR = 0.31, 95% CI 0.15–0.64), hospital (HR = 0.43, CI 0.23–0.80), and 60-day survival (HR = 0.43, CI 0.23–0.80), along with shorter ventilation duration (HR = 0.54, CI 0.30–0.99). Conclusions: Higher protein intake (>1.5 g/kg/day) was associated with better muscle mass preservation and improved clinical outcomes in critically ill cancer patients. Full article

Pulmonary coinfection involving both viral and opportunistic pathogens is an emerging challenge in immunosuppressed patients. We report the case of a 59-year-old man with rheumatoid arthritis on long-term immunosuppressive therapy who developed necrotizing pneumonia and acute respiratory failure and was ultimately diagnosed with triple pulmonary coinfection by SARS-CoV-2, Nocardia cyriacigeorgica, and Aspergillus fumigatus. Diagnosis required comprehensive imaging, bronchoscopy with BAL, and microbiological work-up. The case was complicated by septic shock, multiple organ failure, and family-driven end-of-life decisions. This report highlights the diagnostic and therapeutic complexity of triple coinfection in the ICU, emphasizing the importance of systematic microbiology, imaging, and interdisciplinary care in critically ill immunocompromised hosts. Full article

Background/Objectives: The use of intravenous immunoglobulins enriched with IgA and IgM (eIg) in patients with septic shock remains controversial due to a lack of robust, standardized criteria for patient selection and the timing of treatment. This study introduces the SORRISO Score, which is a novel, evidence-informed scoring system designed to guide clinical decision-making for the administration of eIg. Methods: Based on data from the Italian multicentric SORRISO registry, involving 248 patients across seven ICUs from 2015 to 2022, the score integrates patient-related and therapy-related variables. These were derived through an enhanced version of the TO-PIRO Score and include factors such as immunosuppressive status, infection type, timing of treatment, and adequacy of antibiotic therapy. Results: Statistical analyses, including Kaplan–Meier curves and regression models, identified the key predictors of survival and validated the score’s ability to stratify patients by outcome. A cutoff of 13.7 showed a significant prognostic value (AUC = 0.731), with lower scores correlating with increased mortality. Conclusions: The SORRISO Score thus offers a practical bedside tool for improving patient selection for eIg therapy, potentially optimizing outcomes in septic shock; however, it should be validated in a larger cohort of patients. Full article

Purpose: This study aimed to develop and validate a new machine learning (ML)-based screening tool for a two-step prediction of the need for and type of nutritional therapy (enteral, parenteral, or combined) using Nutrition Risk Screening 2002 (NRS-2002) and other demographic parameters from the Optimal Nutrition Care for All (ONCA) national cohort data. Methods: This multicenter retrospective cohort study included 191,028 patients, with data on age, gender, body mass index (BMI), NRS-2002 score, presence of cancer, and hospital unit type. In the first step, classification models estimated whether patients required nutritional therapy, while the second step predicted the type of therapy. The dataset was divided into 60% training, 20% validation, and 20% test sets. Random Forest (RF), Artificial Neural Network (ANN), deep learning (DL), Elastic Net (EN), and Naive Bayes (NB) algorithms were used for classification. Performance was evaluated using AUC, accuracy, balanced accuracy, MCC, sensitivity, specificity, PPV, NPV, and F₁-score. Results: Of the patients, 54.6% were male, 9.2% had cancer, and 49.9% were hospitalized in internal medicine units. According to NRS-2002, 11.6% were at risk of malnutrition (≥3 points). The DL algorithm performed best in both classification steps. The top three variables for determining the need for nutritional therapy were severe illness, reduced dietary intake in the last week, and mild impaired nutritional status (AUC = 0.933). For determining the type of nutritional therapy, the most important variables were severe illness, severely impaired nutritional status, and ICU admission (AUC = 0.741). Adding gender, cancer status, and ward type to NRS-2002 improved AUC by 0.6% and 3.27% for steps 1 and 2, respectively. Conclusions: Incorporating gender, cancer status, and ward type into the widely used and validated NRS-2002 led to the development of a new scale that accurately classifies nutritional therapy type. This ML-enhanced model has the potential to be integrated into clinical workflows as a decision support system to guide nutritional therapy, although further external validation with larger multinational cohorts is needed. Full article

Background: Post-Intensive Care Syndrome (PICS), which includes Intensive Care Unit-Acquired Weakness (ICU-AW), can lead to lasting functional impairments even after patients are discharged from the hospital. Early mobilization is a key strategy for preventing ICU-AW, a major contributor to PICS. The primary objective of this study is to assess the impact of early mobilization on ICU-AW in critically ill sepsis patients, while also evaluating the feasibility of a larger, multicenter study through comparison with previous data. Methods: This multicenter observational study, conducted in four hospitals in Nagano Prefecture, Japan, from April 2020 to March 2023, included sepsis patients admitted to the ICU or emergency departments. Patients were classified into ICU-AW and non-ICU-AW groups based on admission data. Background factors and discharge outcomes (complications, ADL, physical function) were assessed. Logistic regression analysis was performed to evaluate the relationship between early mobilization and ICU-AW incidence, with a subgroup analysis on the impact of a dedicated team or physiotherapist. Results: A total of 154 sepsis patients were enrolled, with 76 (49.4%) diagnosed with ICU-AW at discharge. The most common infection source in ICU-AW patients was the urinary tract (31%). Early mobilization (≥3 days) significantly reduced ICU-AW incidence, with adjusted odds ratios of 3.73 (95% CI = 1.79–7.77) for treatment details and 2.93 (95% CI = 1.22–7.08) for patient factors. However, the presence of a dedicated team or physiotherapist did not significantly affect ICU-AW incidence, with adjusted odds ratios of 0.50 (95% CI = 0.24–10.6) and 0.99 (95% CI = 0.40–2.47), respectively. Conclusions: Early mobilization effectively reduced ICU-AW incidence in sepsis patients, though a dedicated team or physiotherapist had no significant impact. Urinary tract infections were the most common infection source in ICU-AW patients. Early mobilization during dialysis for acute kidney injury shows promising potential and warrants further promotion. Full article

Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most prevalent clinically significant complication in adult patients undergoing open heart surgery, closely linked to increased mortality and morbidity. Among intensive care unit (ICU) patients, CSA-AKI is the second most common type of acute kidney injury, surpassed only by sepsis-induced AKI. The Doppler-based Renal Resistive Index (RRI) measurement is a rapid and non-invasive diagnostic tool with potential for the early detection of acute kidney injury in intensive care unit patients and could also be useful as an early predictor of acute kidney injury (AKI) in the context of cardiac surgery, particularly when used in conjunction with novel biomarkers. Full article

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, spread rapidly across the globe in 2020, with most countries experiencing two distinct waves of infection. In Brazil, the second wave was marked by the emergence of the P.1 (Gamma) variant, which disproportionately affected younger individuals and was associated with increased mortality. This study aimed to evaluate the epidemiological profile and post mortem histopathological lung findings, correlate them with laboratory results, and compare the first and second waves of COVID-19. To investigate neutrophil extracellular traps (NETs), we performed immunohistochemistry for citrullinated histone H3 (cit-H3) and myeloperoxidase (MPO). Our cohort included patients who died in the intensive care unit (ICU) of a single center in southern Brazil. The study included 42 patients, 24 from the first wave and 18 from the second, who died between March 2020 and August 2021. Laboratory data included complete blood counts and D-dimer levels. Histopathological analyses were conducted using H&E-stained slides and reviewed independently by two blinded pathologists. MPO and cit-H3 immunohistochemistry were performed to evaluate NETs markers. All cases exhibited varying degrees of inflammation and diffuse alveolar damage (DAD), with frequent microvascular thrombi. Neutrophilic infiltration was significantly higher in the second wave. Additionally, cases with intense neutrophilic infiltration showed a stronger association with thrombosis. NETs were identified in 10 cases. No significant correlation was found between histopathological findings, NETs, and laboratory blood count results. The histopathological findings were consistent with those reported globally. The second wave of COVID-19 showed higher neutrophilic infiltrate in the lung tissue. Neutrophils play a key role in the inflammatory response and NET formation might indicate an increased risk of mortality. Further studies can consider NET-targeted therapies as potential strategies. Full article

Background/Objectives: Community-acquired pneumonia (CAP) remains a major cause of hospitalisation and death, particularly among older and frail adults. Although treatment guidelines exist, adherence to empiric antibiotic recommendations is variable. This study examined whether receiving guideline-concordant antibiotics for CAP was associated with better short- and long-term clinical outcomes. Methods: We conducted a retrospective cohort study of adults admitted with radiologically confirmed CAP to a tertiary hospital in Australia from 1 January to 31 December 2023. Patients with hospital-acquired pneumonia or COVID-19 were excluded. Antibiotic concordance was assessed against local guidelines. Propensity score matching (PSM) accounted for 16 covariates including age, comorbidities (Charlson Index), frailty (Hospital Frailty Risk Score), and pneumonia severity (SMART-COP). Primary outcomes were in-hospital, 30-day, and one-year mortality. Secondary outcomes included ICU admission, invasive ventilation, vasopressor use, hospital length of stay, and 30-day readmissions. Results: Of 241 patients, 51.4% received guideline-concordant antibiotics. Mean age was 73.5 years; 50.2% were male; 42.2% had severe pneumonia (SMART-COP ≥ 5); 36.5% were frail. In unadjusted analysis, in-hospital mortality was higher in the concordant group (5.6% vs. 0.9%, p = 0.038). After PSM (n = 105 matched pairs), concordant treatment was associated with significantly lower 30-day mortality (coefficient = –0.12; 95% CI: –0.23 to –0.02; p = 0.018) and there was a non-significant trend towards reduced 1-year mortality (p = 0.058). Other outcomes, including in-hospital mortality, were not significantly different. Conclusions: Guideline-concordant antibiotics were associated with reduced 30-day mortality in CAP. These results support adherence to evidence-based treatment guidelines to improve patient outcomes. Full article

Background/Objectives: Acute liver failure (ALF) is a life-threatening condition with high mortality in nontransplant candidates. Therapeutic plasma exchange (TPE) has emerged as a promising intervention for removing inflammatory mediators and toxic metabolites. In Latin America, data on the efficacy of TPE in ALF patients are limited. This real-world study aimed to compare 30-day survival outcomes between patients receiving standard medical treatment (SMT) and those receiving SMT plus TPE. Methods: We analyzed 25 ALF patients admitted to the tertiary intensive care unit (ICU) of Hospital Juárez of Mexico City, Mexico, from 2018 to 2024. Patients received either standard medical treatment (SMT group, n = 12) or SMT with TPE (TPE group, n = 13), including high-volume TPE (n = 8) and standard-volume TPE (n = 5). Survival analysis was performed via Kaplan–Meier estimates, and binomial regression analysis was run to estimate the mortality probability stratified by the hepatic encephalopathy grade. Results: At 30 days, survival was significantly greater in the TPE group (92%) than in the SMT group (50%) (p = 0.02). The greatest survival benefit was observed in patients with Grade 4 encephalopathy. The ICU stay was longer in the TPE group, reflecting the complexity of ALF management. Conclusions: TPE significantly improves 30-day survival in ALF patients compared with SMT alone, supporting its role as an adjunct therapy. Further studies are needed to refine patient selection and optimize treatment protocols. Full article

Background and Objectives: The treatment of choice for aortic valve stenosis in patients with low and intermediate risk is still debated. In this study, we compared the outcomes of low-to-intermediate surgical risk patients who underwent surgical versus transcatheter aortic valve replacement for severe aortic valve stenosis (AS). Methods: Between 2015 and 2019, 326 consecutive patients with severe AS underwent transcatheter aortic valve implantation (TAVI), while 341 patients underwent surgical aortic valve replacement (SAVR). The two populations were propensity score matched by age, gender and Euroscore II. The survival rate of patients during median 5-year follow-up between SAVR and TAVI patients was evaluated. Results: After propensity score matching, 94 pairs of patients were compared and the mean standard deviation age of patients, sex (female) and Euroscore II were 77.5 (6.6) versus 76.6 (6.5) years, 51.1% versus 51.1% and 3.3 (1.88)% versus 3.0 (1,84)%, respectively. Permanent pacemaker implantation was higher in transcatheter group (21.3% versus 1.1%, p < 0.001). No difference in length of ICU and in-hospital stay was observed, p = 0.08 and p = 0.12, respectively. During follow-up the presence of more than moderate insufficiency of the prosthetic valve postoperatively was significantly less frequent in the surgical versus transcatheter (0% versus 14.3%). Survival rates over 1, 3 and 5 years did not differ in surgical versus transcatheter group (93.6%, 81.9% and 62.8% versus 86.2%, 69.1% and 59.6%, respectively (p = 0.16)). Conclusions: Short- and long-term survival rates were similar in patients who underwent transcatheter versus surgical aortic valve replacement, whereas SAVR showed superior results concerning the postoperative detection of residual regurgitation and need for PPM. It is extremely important to personalize the choice of treatment according to patients’ age, clinical status and life expectancy. Full article

Introduction: Human metapneumovirus (HMPV), though commonly perceived as a pediatric pathogen, significantly impacts adults, yet its role in acute respiratory tract infections (ARTIs) remains underappreciated. The COVID-19 pandemic has reshaped respiratory virus epidemiology and amplified the need for comprehensive differential diagnosis. This study aimed to comprehensively investigate the prevalence, clinical characteristics, and post-COVID-19 trends of HMPV infection in adults and to elucidate its critical role in the differential diagnosis of ARTIs by distinguishing it from other common viral pathogens. Methods: This was a retrospective, multicenter study conducted across six hospitals within the Acibadem Hospitals Group in Istanbul, Turkey. Data were collected from two periods: January 2016 to January 2020 (pre-COVID-19) and January 2021 to September 2023 (post-COVID-19), excluding the peak pandemic phase (March 2020 to May 2021). Respiratory samples (sputum, BAL, nasopharyngeal/nasal/throat swabs) were analyzed using multiplex PCR (Seegene RV12-ACE), with an expanded panel including SARS-CoV-2 in the post-COVID-19 era. Demographic data, comorbidities, symptoms, hospitalization, and ICU admission rates were collected. Results: In the post-COVID-19 period, 2197 positive viral panels were recorded, an increase from 1357 in the pre-COVID period, reflecting enhanced testing. HMPV prevalence reached 9.7% post-COVID-19, making it the fourth most common respiratory virus in adults (8.7% of 644 positive adult tests), following SARS-CoV-2 (26.4%), influenza A (21.3%), and rhinovirus (17.5%). The average age of HMPV-infected adults was 52.14 years (18–90 years); 64% were female. While 52% had no comorbidities, common underlying conditions included hypertension (24%), cancer (12%), and diabetes (10%). Weakness (34%), lower respiratory symptoms (16%), and fever (12%) were frequent. A significant proportion of HMPV patients required hospitalization (34%) and ICU admission (18%), with 40% receiving antibiotics. Despite potential severity, the mortality rate was low (2.8%). No significant difference in severity was observed between HMPV monoinfection and co-infected groups (e.g., with influenza A, rhinovirus, SARS-CoV-2, parainfluenza virus 2). Conclusion: Our findings establish HMPV as a significant and increasingly prevalent respiratory pathogen among adults in Istanbul in the post-COVID-19 era. Its non-specific clinical presentation underscores the critical importance of multiplex PCR for accurate differential diagnosis, enabling appropriate patient management and antimicrobial stewardship. While HMPV can lead to severe outcomes requiring hospitalization and ICU admission, particularly in patients with comorbidities, the overall mortality rate remains low. Given the lack of specific antiviral treatments and vaccines, sustained surveillance and continued research into targeted interventions are crucial. Full article

Background/Objectives: We compared short- and long-term outcomes of patients with native left-sided infective endocarditis (IE) confined to the valve leaflet (“simple”) versus those with perivalvular extension (“complex”) over two decades. Methods: From 2005 to 2024, 177 patients (mean age 59.6 ± 13.8 years, 71.8% male) underwent surgery for IE. Patients were classified as having simple (n = 129) or complex IE (n = 48) based on imaging and intraoperative findings. Mean follow-up was 86.5 ± 63.3 months (range: 2–232 months). Outcomes included operative and late mortality, recurrent infection, and reoperation. Results: Complex IE was associated with worse preoperative status, longer ICU stays, and mechanical ventilation times. Predictors of early mortality included critical preoperative state (OR 6.35, p = 0.001), chronic renal failure/dialysis (OR 3.01, p = 0.05), and staphylococcal IE (OR 5.62, p = 0.002) but not perivalvular extension. Overall survival at 1, 5, 10, 15, and 20 years was 83%, 74.2%, 59.9%, 51.3%, and 40.7%, with no significant difference between groups (p = 0.18). Female gender (HR 1.93, p = 0.04) and chronic renal failure (HR 3.5, p < 0.01) predicted late mortality. Freedom from re-endocarditis and reoperation d/t relapse of endocarditis was 94.2% and 97.3%, respectively. Freedom from re-intervention d/t structural valve degeneration was 92.1% at 10 years. Repair was performed in 28.2% of cases involving the mitral valve, with 93.1% freedom from reoperation. Conclusions: Surgery for complex IE is not an independent risk factor for long-term mortality. Rates of recurrent endocarditis and reoperation are remarkably low. Excellent durability of bioprostheses and mitral repair was demonstrated. Full article