Search Results (2,015)

Background: In catheter-related candidemia, a true catheter-source infection is often difficult to distinguish from a catheter that merely marks critical illness. Our primary aim was to identify predictors of 30-day mortality; secondary aims were to characterize species-specific patterns of persistent candidemia, its prognostic meaning within the host immune–inflammatory context, and the relationship between echinocandin therapy and secondary bacterial bloodstream infection (BSI). Methods: We retrospectively reviewed 89 consecutive episodes of catheter-related candidemia at Bursa City Hospital (2021–2025). Catheter association required Candida spp. growth in concurrent catheter and peripheral blood cultures. The primary endpoint was 30-day mortality; persistent candidemia (≥72 h) and secondary bacterial BSI on days 3–30 were evaluated as exploratory endpoints. Raw MIC values were retrospectively reinterpreted according to EUCAST v12.1 breakpoints (effective 10 April 2026). Results: Thirty-day mortality was 53.9% (48/89). The multivariable model was significant (LR χ² = 12.12, df = 4, p = 0.017; Nagelkerke R² = 0.170); NLR was not significantly associated with mortality (OR = 1.061, 95% CI 1.00–1.13, p = 0.064). Catheter removal, initial echinocandin therapy, and persistent candidemia were not independent predictors, though catheter retention was associated with higher mortality on univariable analysis (83.3%; p = 0.033). Persistent candidemia occurred in 51.7% of episodes, most notably with C. parapsilosis and C. auris. The NLR-persistence interaction was not formally significant, but mortality was higher when both co-occurred (66.7% vs. 36.4%; OR = 3.50, p = 0.075). Secondary BSI occurred in 28.4% of episodes and was more frequent in the echinocandin group (39% vs. 20%; p = 0.062); sensitivity analyses did not change the main findings. Conclusions: Mortality could not be explained by antifungal choice alone; these findings are exploratory. Host response, source control, species distribution, survival time, and device exposure are possible contributing factors warranting evaluation in prospective studies. Full article

Bloodstream infections (BSIs) represent a major clinical challenge, particularly in patients with suspected sepsis, where rapid pathogen identification is critical for timely and appropriate antimicrobial therapy. Blood culture (BC) remains the reference diagnostic method but is limited by a long turnaround time and reduced sensitivity, especially in patients receiving prior antibiotics. This pilot study aimed to evaluate the diagnostic performance and clinical added value of culture-independent digital PCR (dPCR) performed directly on whole blood compared with paired BC. A total of 37 samples from 27 patients with suspected BSI admitted to a tertiary-care hospital were analyzed. dPCR demonstrated the ability to detect a broader spectrum of pathogens compared with BC (34 vs. 28 species), with improved identification of fastidious organisms and fungi, particularly Candida spp. Diagnostic performance analysis showed a sensitivity of 75.0% and a specificity of 53.8%, with a positive predictive value of 75.0% and a negative predictive value of 53.8%. Likelihood ratios indicated moderate rule-in capability (Likelihood ration positive 1.62) but limited rule-out performance (Likelihood ratio negative 0.46). Importantly, concordance analysis integrating microbiological and clinical data revealed that a substantial proportion of discordant dPCR-positive results were clinically plausible, suggesting detection of infections not captured by BC, particularly in polymicrobial settings, under antibiotic pressure, or in fungal infections. Longitudinal observations further highlighted the potential of dPCR for monitoring pathogen dynamics and treatment response. Overall, dPCR provides rapid and complementary diagnostic information, enabling earlier pathogen detection, identification of antimicrobial resistance markers, and improved characterization of complex infections. While not suitable as a standalone test due to limited negative predictive value, its integration with conventional microbiology may enhance diagnostic accuracy and support antimicrobial stewardship in the management of BSIs. Full article

Background/Objectives: We evaluated the diagnostic performance of the Alifax Molecular Mouse (MM) sepsis panel for rapidly directly detecting pathogens and resistance genes in positive blood culture broths. Methods: In this prospective single-center study, 40 positive blood culture specimens were analyzed using four MM cartridges targeting Gram-positive and -negative bacteria and major antimicrobial resistance genes. The results were compared with those obtained using the routine microbiological protocol, including organism identification using the MALDI Biotyper system and antimicrobial susceptibility testing using the VITEK 2 and MicroScan WalkAway systems. Additionally, the MM panel results were compared with those obtained using the FilmArray BCID2. Results: Compared with the routine protocol, the MM panel achieved a positive percent agreement (PPA) of 89.5% (34/38; 95% confidence interval [CI], 75.9–95.8%) for bacterial identification, indicating moderate-to-good diagnostic performance. For antimicrobial resistance gene detection, the PPA was 92.1% (35/38; 95% CI, 79.2–97.3%). Compared with the FilmArray BCID2, the overall agreement of the MM panel was 89.4% (34/38) for bacterial identification and 84.2% (32/38) for antimicrobial resistance gene detection. The MM panel generated clinically actionable results within 1 h (mean turnaround time, 55.5 min; 95% CI, 55.1–55.9 min), substantially reducing the turnaround time compared with the conventional microbiological workflow, which requires 1.5–2 days for subculture and automated antimicrobial susceptibility testing. Conclusions: The MM sepsis panel enabled rapid, direct identification of bloodstream pathogens and key antimicrobial resistance markers from positive blood cultures, substantially reducing turnaround time and exhibiting its potential as an adjunct to routine microbiological workflows. Full article

Virus-based cancer therapy (virotherapy) is currently being researched as a novel form of immunotherapy and has already entered the clinical application phase. Among various types of virotherapy, oncolytic virotherapy involves infecting tumors with tumor-selective viruses, such as herpes simplex virus, adenoviruses, and vaccinia virus, and utilizing their replicative capacity to induce cell destruction within tumors. In addition, this therapy aims to enhance tumor immunity by changing the tumor microenvironment through viral infection. Genetic deletion in viruses is used to reduce their virulence and confer tumor selectivity, while the expression of foreign genes is utilized to enhance antitumor effects. Oncolytic viruses for head and neck cancer (HNC) are administered locally or systemically and are sometimes used as adjuvant therapy or in combination with immune checkpoint inhibitors. Another form of virotherapy involves non-replicating viruses, which are used to produce antitumor cytokines or as cancer vaccines expressing tumor antigens. Research on the efficacy of cancer vaccines in preventing postoperative recurrence is currently underway. A number of challenges have yet to be overcome for further advances in virotherapy, including the efficient delivery of viruses to tumor cells, avoiding viral inactivation in the bloodstream, ensuring efficient replication of the virus, and enhancing antitumor immunity. The development of effective strategies based on the findings of clinical studies will lead to improvements in virotherapy for HNC. Full article

Background/Objectives: Traumatic spinal injury (TSI) is associated with substantial morbidity, but factors contributing to in-hospital complications remain insufficiently defined. This study evaluated factors associated with in-hospital complications after TSI. Methods: We conducted a retrospective cohort study at a tertiary center (January 2018–May 2025). Among 5380 trauma patients screened by computed tomography, 413 admitted patients with TSI were included. The primary outcome was any documented in-hospital complication. Factors were assessed using multivariable logistic regression and reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: The median age was 28.0 years, 337 were male (81.6%), and four-wheel motorized vehicle accidents were the most common injury mechanism (57.1%). In-hospital complications occurred in 99 patients (24.0%). Pulmonary infection was most common (9.9%), followed by bloodstream infection (4.4%), urinary tract infection (3.9%), and surgical site infection (3.9%). Compared with patients without complications, those with complications had longer hospital stays, higher ICU admissions, longer ICU stays, and lower discharge home. In multivariate logistic regression, complications were associated with worse AIS grade (OR 1.690, 95% CI 1.241–2.302), inpatient physical therapy requirement (OR 4.385, 95% CI 2.494–7.711), greater number of associated non-spinal injuries (OR 1.729, 95% CI 1.463–2.042), and greater cervical vertebral injury burden (OR 1.479, 95% CI 1.061–2.062). Conclusions: Neurological severity, polytrauma burden, and cervical injury were independently associated with complications, supporting early risk stratification and multidisciplinary prevention in high-risk patients. Findings should be interpreted considering the retrospective single-center design, predominantly young male cohort, low spinal cord injury proportion, and limited post-discharge data. Full article

Colorectal cancer (CRC) kills approximately 850,000 people annually and is the second leading cause of cancer mortality worldwide. After curative-intent surgical resection, recurrence rates of 15–20% in stage II and 30–40% in stage III diseases highlight the fundamental limitations of pathological staging as the sole basis for adjuvant treatment decision-making. Circulating tumor DNA (ctDNA), which comprises tumor-derived cell-free DNA fragments shed into the bloodstream by dying cancer cells, offers a direct and dynamic readout of molecular residual disease (MRD) in the postoperative period. Because ctDNA clears within hours of macroscopically complete surgery, any persistently detectable postoperative signal reflects viable microscopic disease rather than surgical contamination. Over the past decade, evidence has matured rapidly from proof-of-concept observational studies to completed randomized clinical trials, culminating in the recent publication of DYNAMIC-III and ALTAIR in 2025–2026. The DYNAMIC trial established that ctDNA-guided management reduced adjuvant chemotherapy use from 27.9% to 15.3% in stage II colon cancer while maintaining an equivalent five-year recurrence-free survival (88% vs. 87%; difference 1.1%, 95% CI 5.8% to 8.0%). The GALAXY study confirmed ctDNA as the most powerful prognostic biomarker in resected CRC, with a disease-free survival hazard ratio of 11.99. Critically, DYNAMIC-III demonstrated that escalating chemotherapy intensity in ctDNA-positive stage III patients did not improve recurrence-free survival (HR 1.11, p = 0.6), and the phase III ALTAIR trial showed that trifluridine/tipiracil failed to significantly improve disease-free survival at the point of molecular recurrence (HR 0.79, p = 0.107). This review critically synthesizes the current evidence for ctDNA-guided treatment decisions in resected CRC across three therapeutic strategies: de-escalation in ctDNA-negative patients, escalation in ctDNA-positive patients, and post-adjuvant therapy at the point of molecular recurrence. Future progress requires biomarker-matched escalation strategies, adaptive trial designs, and formal validation of ctDNA clearance as a surrogate endpoint for predicting patient outcomes. Full article

Historical microbiological collections linked to epidemiological and clinical metadata represent a valuable resource for retrospective investigation of long-term changes in pathogen populations. In this retrospective study, we analyzed the epidemiological, clinical, and microbiological information recorded in the datasheets accompanying Salmonella enterica isolates archived in a historical collection assembled in Lombardy, Italy, between 2001 and 2016. Overall, metadata associated with 6624 salmonellosis cases with confirmed serovar identification were included to describe serovar distribution, bloodstream infections, and antimicrobial resistance (AMR) patterns within the collection. Four serovars (S. Typhimurium, S. Enteritidis, S. 1,4,[5],12:i:-, S. Napoli) accounted for approximately 80% of all cases. The relative representation of S. Napoli increased over the study period, whereas S. Choleraesuis showed the highest proportion of bloodstream isolates and predominantly affected adults. Overall, resistance to penicillins (46.9%) and tetracyclines (48.0%) was common, whereas resistance to fluoroquinolones (2.9%) and third-generation cephalosporins (<2%) remained low. Among invasive non-typhoidal Salmonella (iNTS) infections, 69.3% of isolates were resistant to at least one antimicrobial class, and 34.7% exhibited multidrug resistance (MDR), with fluoroquinolone resistance increasing to 13.9%. These findings highlight the value of historical microbiological collections and their associated metadata for documenting long-term changes in serovar distribution, invasive infections, and AMR, while emphasizing their importance as a resource for future molecular epidemiology and One Health surveillance. Full article

Background and Objectives: Sepsis is a life-threatening condition characterized by organ dysfunction due to a dysregulated host response to infection. Blood cultures (BCs) remain the gold standard for diagnosing bloodstream infections, yet their positivity rate is limited and culture-negative sepsis remains poorly characterized. This study aimed to identify clinical and laboratory predictors of BC positivity in patients with suspected sepsis and to evaluate the prognostic implications of BC results on 28-, 90-, and 365-day survival. Materials and Methods: We retrospectively analyzed adult patients admitted to the Emergency Department of Policlinico di Bari (March 2023–December 2025) with sepsis or septic shock (Sepsis-3 criteria). After excluding contaminated cultures, 912 patients were included (602 culture-positive; 310 culture-negative) with a 1-year follow up. Predictors of BC positivity were assessed using logistic regression and ROC analysis; survival was evaluated with Kaplan–Meier curves and Cox models adjusted for age and Sequential Organ Failure Assessment (SOFA) score. We also evaluated time-to-positivity (TTP) for all blood culture isolates. Results: Culture-positive patients presented with greater initial severity, including higher rates of septic shock, elevated procalcitonin, CRP, lactate, and SOFA scores, and more frequent thrombocytopenia. Procalcitonin showed good discriminatory ability (AUC (area under the ROC curve) 0.785; cutoff 0.85 ng/mL; sensitivity 59.8%; specificity 83.8%). Key laboratory thresholds included a procalcitonin cutoff of 0.85 ng/mL, while CRP and platelet count did not show meaningful discriminatory cutoffs beyond their significant differences between culture-positive and culture-negative patients. Survival was consistently lower in culture-positive patients at 28 days (72.9% vs. 85.9%), 90 days (57.5% vs. 71.8%), and 365 days (44.3% vs. 61.2%). However, in adjusted Cox regression, BC positivity was not independently associated with 1-year mortality (HR 1.46; p = 0.092), whereas age and SOFA score remained significant predictors. Conclusions: Blood culture positivity identifies patients with greater initial severity, explaining their poorer unadjusted survival. However, culture positivity itself is not an independent predictor of long-term mortality, as age and organ dysfunction remain the main determinants of outcome. Procalcitonin showed solid discriminatory ability for true bacteremia. Full article

Background/Objectives: Bloodstream infections (BSIs) carry high mortality, and any delay in initiating optimal antimicrobial therapy worsens outcomes. Syndromic multiplex-PCR panels applied to signal-positive blood cultures markedly shorten time-to-identification but are expensive and report results in a strictly qualitative format. We describe twenty-two months of real-world BioFire FilmArray Blood Culture Identification 2 (BCID2) testing in a southern Italian hospital, focusing on pathogen epidemiology, resistance-gene detection, and the economic and interpretive trade-offs of the assay. Methods: We retrospectively reviewed all BCID2 runs performed on signal-positive blood-culture bottles at P.O. “Vito Fazzi” (ASL Lecce) from July 2024 to April 2026. Each run was classified as single-pathogen-positive, polymicrobial (co-infection)-positive, or negative (no on-panel target). Resistance determinants were tabulated by year and by presumptive carrier. A direct-cost analysis was performed at a reagent cost of €250 per test. Results: Of 498 runs, 401 (80.5%) yielded at least one on-panel target (330 single-pathogen, 71 polymicrobial), whereas 97 (19.5%) were negative. Among 526 organism detections, Gram-positive (48.9%) and Gram-negative (45.8%) bacteria predominated; Staphylococcus spp., Escherichia coli and the Klebsiella pneumoniae group were most frequent. Resistance determinants (n = 244) were dominated by mecA/C, CTX-M and KPC. Co-infections (17.7% of positives) frequently prevented unambiguous attribution of a resistance gene to a specific co-detected organism. Total reagent expenditure was €124,500, of which €24,250 (19.5%) was spent on negative results. Conclusions: BCID2 delivered rapid, broad pathogen and resistance-gene detection in a high-resistance setting. Its qualitative-only output, the difficulty of attributing a resistance gene to a specific organism in polymicrobial samples, and the cost of negative results nonetheless argue for diagnostic-stewardship gating, semiquantitative reporting, and local validation of complementary and lower-cost assays. Full article

Spinal cord injury (SCI) is a devastating neurological disorder. The development of effective therapies to ameliorate the consequences of SCI represents a major challenge and a central priority of international biomedical research. The stromal vascular fraction (SVF) derived from adipose tissue possesses considerable functional potential. SVF is a heterogeneous mixture of cells that act synergistically. However, after local transplantation, SVF is rapidly cleared via the bloodstream, and its poor survival severely compromises therapeutic efficacy. To overcome this limitation, we employed a self-assembling peptide nanohydrogel HGF-RADA16-IKVAV (where HGF denotes the tripeptide histidine–glycine–phenylalanine) as a scaffold to enhance SVF retention and efficacy in a rat model of SCI. Implantation of SVF and HGF into the injured spinal cord demonstrated that this combined therapy significantly modulated the inflammatory response, increased neuronal survival, and promoted a denser network of axon tracts. Consequently, the SVF-encapsulated HGF hydrogel resulted in superior restoration of limb movement and reduced neuropathic pain. Proteomic analysis confirmed that the combined treatment shifted the injury-induced molecular landscape, particularly in immune and inflammatory pathways. Collectively, these findings demonstrate that this combinatorial strategy represents an effective therapeutic paradigm for SCI. Full article

Background: Staphylococcus aureus bloodstream infection remains a major clinical challenge because of its association with invasive disease, antimicrobial resistance, biofilm formation, and substantial mortality. Local susceptibility surveillance is essential for guiding empirical therapy and antimicrobial stewardship. This study evaluated the epidemiology, resistance patterns, turnaround time, and clinical correlates of S. aureus bacteremia in a Romanian tertiary-care hospital. Methods: We conducted a retrospective, single-center observational study including all consecutive adults with positive blood cultures for S. aureus admitted to Sibiu County Clinical Emergency Hospital between 1 January 2024 and 31 December 2025. Demographic, clinical, microbiological, antimicrobial susceptibility, and outcome data were extracted from electronic medical records. MRSA was defined phenotypically, while MDR and XDR phenotypes were classified according to standard resistance definitions. Between-year comparisons and regression analyses were performed to explore factors associated with mortality, MRSA, and MDR status. Results: During the study period, 11,578 blood culture sets were processed, of which 2472 (21.3%) were positive; S. aureus accounted for 314 isolates (12.7% of positive cultures). After one isolate per patient was retained, the final analysis included 142 patients with S. aureus bacteremia. Median age was 70 years, 55.6% were male, and 67.6% lived in urban areas. Overall mortality was 33.1% (47/142). MRSA was identified in 39.4% of cases and MDR in 49.3%, while no XDR isolates were detected. The most frequent resistances were observed for penicillin (75.9%), erythromycin (66.2%), clindamycin (46.5%), tetracycline (45.1%), and oxacillin (38.0%). Full susceptibility was preserved for vancomycin, linezolid, ceftaroline, daptomycin, and mupirocin. Turnaround time significantly improved in 2025 compared with 2024 (median 71.4 h vs. 66.3 h; p = 0.004). In adjusted analysis, acute or chronic kidney disease was independently associated with mortality, whereas MRSA and MDR status were not independent predictors of death. Conclusions: In this single-center cohort, S. aureus bacteremia was associated with high mortality and a substantial burden of MRSA and MDR phenotypes, although preserved activity of key anti-staphylococcal agents was observed. These findings support the need for continuous local resistance surveillance, rapid microbiological diagnosis, and stewardship-guided treatment strategies. Full article

Background: Antimicrobial resistance (AMR) threatens empirical therapy for invasive pediatric infections, but contemporary data from Serbia and the Western Balkans remain limited for blood and cerebrospinal fluid isolates. Methods: We performed a retrospective CAESAR-linked multicenter microbiological surveillance analysis of first eligible invasive bacterial isolates from hospitalized children in Serbia from 1 January 2020 to 31 December 2024. Organism distribution, ESBL production, carbapenemase marker results, and selected resistance outcomes were analyzed descriptively and with temporal trend and multivariable models. Results: Among 907 isolates, 879 (96.9%) were recovered from blood and 28 (3.1%) from cerebrospinal fluid; neonates and infants accounted for 57.9% of isolates. K. pneumoniae was the predominant organism (318/907, 35.1%), followed by E. coli (172/907, 19.0%), S. aureus (137/907, 15.1%), and Acinetobacter spp. (96/907, 10.6%). Among K. pneumoniae and E. coli isolates with available ESBL results, ESBL production was frequent, whereas carbapenemase testing was restricted to a selected subset and the carbapenemase type was not recorded in the national surveillance extract. In K. pneumoniae, meropenem resistance increased from 19.7% in 2020 to 48.6% in 2024, and later study years remained independently associated with meropenem resistance after adjustment. Conclusions: This microbiological surveillance study identifies K. pneumoniae predominance, neonatal concentration, frequent ESBL production, and a rising carbapenem-resistance signal as the principal findings among invasive pediatric isolates in Serbia. Resistance estimates, particularly carbapenemase production, should be interpreted as surveillance indicators rather than clinical prevalence estimates. These data support strengthened pediatric invasive-isolate surveillance, center- and age-specific antibiograms, molecular characterization, and coordinated antimicrobial stewardship and infection prevention and control efforts within the wider European AMR context. Full article

Candida auris (C. auris) is a multidrug-resistant pathogen that spreads clonally in healthcare settings and was designated an urgent threat by the Centers for Disease Control and Prevention in 2019. We conducted a multicenter study to identify mortality risk factors in C. auris bloodstream infection (BSI) in South Korea. In this retrospective cohort study across three tertiary centers, 50 adults with first-episode C. auris BSI were analyzed. Primary and secondary outcomes were 30- and 90-day mortality. 30-day mortality was 24%, and 90-day mortality was 46%. Older age and higher Sequential Organ Failure Assessment score were independently associated with 30-day mortality. Microbiologic clearance within 30 days was protective. For 90-day mortality, older age was the only independent risk factor, and microbiologic clearance within 90 days was also protective. In conclusion, C. auris BSI causes substantial 30-day mortality, underscoring the need for risk-stratified, clearance-focused management. Full article

Introduction: Candidemia is the most significant invasive fungal disease in critically ill patients. As a shift towards non-albicans Candida (NAC) species has been observed in recent years, differentiation among Candida species is essential for appropriate therapeutic management and improved prognosis. This study evaluated trends in the epidemiology of candidemia, species-specific characteristics, treatment practices, and mortality in a multidisciplinary Greek intensive care unit (ICU). Materials and Methods: In this single-center retrospective observational study, 90 ICU patients with candidemia were evaluated. Clinical characteristics, infection-related factors, treatment practices, and outcomes were compared according to isolated Candida species and patient survival. Results: C. parapsilosis accounted for the majority of isolates (33.7%; 41.9% fluconazole-resistant), followed by C. albicans (31.5%) and Candidozyma auris (23.9%). No significant differences in co-morbidities, origin of candidemia, or treatment-related factors were identified. However, NAC bloodstream infections occurred significantly later during ICU hospitalization, were associated with lower disease severity, and were preceded by nearly five-fold higher exposure to antifungal agents before candidemia onset. Overall, the ICU mortality rate was 53.3%. No significant differences were observed among species-specific mortality rates. Neither prompt initiation of antifungal therapy nor the antifungal class administered was associated with improved survival. Conclusions: NAC species predominated among candidemia episodes in critically ill patients, with C. parapsilosis emerging as the most frequent isolate and exhibiting substantial fluconazole resistance. Mortality remained high and did not differ significantly according to species. Treatment timing and antifungal class were not associated with outcome, highlighting the need for continued surveillance and optimized management strategies in the ICU. Full article

Background/Objectives: Intensive care unit (ICU) mortality reflects interactions between baseline vulnerability, acute physiological derangement, ICU-acquired infection, and the intensity of organ-support therapy. Methods: This single-center retrospective cohort study included 3323 adult first ICU hospitalizations at the University Clinical Hospital in Bialystok, Poland, between 1 January 2017 and 1 June 2023. Secondary ICU admissions/readmissions, patients aged <18 years, and one pregnancy admission were excluded. Patients were classified as ICU survivors (n = 1778) or ICU non-survivors (n = 1545). Variables were compared using t-tests, chi-square tests, or Fisher exact tests, and an adjusted logistic regression model was fitted as an exploratory prognostic model. Results: ICU mortality was 46.5%, and 28-day ICU mortality was 40.2%. Non-survivors were older than survivors (66.7 ± 15.1 vs. 60.9 ± 17.2 years; p < 0.001) and more frequently had arterial hypertension, diabetes mellitus, COVID-19, ischemic heart disease, atrial fibrillation, renal failure, and acute myocardial infarction or ischemic stroke. In the adjusted model, ICU mortality was associated with age per 10 years (OR 1.32, 95% CI 1.18–1.47), COVID-19 (OR 3.15, 95% CI 2.07–4.79), ventilator-associated pneumonia (OR 1.68, 95% CI 1.22–2.30), lactate per 1 mmol/L (OR 1.29, 95% CI 1.16–1.43), pH per 0.1-unit decrease (OR 1.79, 95% CI 1.41–2.29), mechanical ventilation (OR 14.74, 95% CI 3.40–63.87), cardiopulmonary resuscitation (OR 9.45, 95% CI 4.67–19.13), renal replacement therapy (OR 2.01, 95% CI 1.39–2.91), and treatment of acidosis or alkalosis (OR 1.95, 95% CI 1.29–2.94). Conclusions: ICU non-survival was associated with older age, COVID-19, cardiovascular and renal vulnerability, ICU-acquired infection, inflammatory and metabolic dysfunction, and early requirement for rescue organ-support interventions. These findings should be interpreted as adjusted associations, not causal effects. Full article