Search Results (14)

Background: This study aimed to investigate the association between serum potassium levels and the risk of cardiac arrest in patients admitted to the emergency resuscitation room and to identify the optimal potassium range associated with the lowest risk. Methods: We conducted a retrospective cohort study of 784 adults (384 with cardiac arrest and 400 controls) admitted to the emergency resuscitation room of a tertiary academic medical center between January 2020 and July 2021. Using multivariable logistic regression and restricted cubic spline analysis with four knots, we examined the nonlinear relationship between serum potassium levels and cardiac arrest risk after adjusting for critical confounders including lactate levels and MEWS scores. Results: A robust J-shaped association was observed between serum potassium levels and cardiac arrest risk. The lowest risk occurred within the range of 3.1–4.0 mmol/L, with significantly increased risk both below and above this range. The association remained significant after adjustment for lactate alone (p-nonlinear < 0.001) and after simultaneous adjustment for the MEWS score and lactate (p-nonlinear < 0.05). Serum potassium demonstrated fair predictive accuracy for cardiac arrest with an AUC of 0.709 (95% CI: 0.672–0.747). At the optimal cut-off value of 4.45 mmol/L, specificity reached 87.5% and positive predictive value was 80.4%. Conclusions: This study reveals a consistent J-shaped distribution between serum potassium levels and cardiac arrest risk in emergency resuscitation room patients, with the safest range identified at 3.1–4.0 mmol/L. These findings suggest that maintaining potassium levels in the lower physiological range may be beneficial for preventing cardiac arrest in critically ill emergency patients. Serum potassium assessment provides a valuable tool for risk stratification in resuscitation settings. Full article

Purpose: Accurate assessment of nursing workload is essential for staffing allocation and operational management in emergency infusion rooms. However, workload generation is influenced by complex and potentially nonlinear interactions among patient volume, treatment duration, and care activities, which may not be adequately captured by conventional statistical approaches. This study aimed to identify key predictors associated with nursing workload intensity and develop an interpretable workload stratification framework using a Classification and Regression Tree (CRT) model. Methods: Daily operational data were collected from an emergency infusion room between July 2023 and August 2025. Daily chair utilization rate was used as a proxy indicator of workload intensity. Candidate predictors included total infusion duration, direct care encounters, number of patients receiving infusions, medication dispensing time, severe dependency, fall-risk patients, and triage-level patient volume. A CRT model was developed to identify hierarchical predictor relationships and threshold-based workload classification rules. Model robustness was evaluated using 10-fold cross-validation, comparative analyses with multiple linear regression, random forest, and gradient boosting models, and sensitivity analyses excluding total infusion duration. Results: The analysis included 761 valid observation days. Total infusion duration emerged as the most influential predictor, followed by direct care encounters and the number of patients receiving infusions. The CRT model identified clinically interpretable workload thresholds and generated a parsimonious decision structure for workload stratification. Re-substitution and cross-validation risk estimates were 0.045 (SE = 0.005) and 0.046 (SE = 0.005), respectively, indicating stable model performance. Although random forest and gradient boosting achieved higher predictive accuracy, the CRT model provided greater interpretability through transparent decision rules. Sensitivity analyses demonstrated that the overall workload stratification pattern remained largely unchanged after excluding total infusion duration. Conclusions: The CRT model identified total infusion duration, direct care encounters, and patient volume as key predictors associated with workload intensity in emergency infusion rooms. Although alternative models achieved higher predictive performance, the CRT approach provided interpretable workload stratification rules that may support staffing allocation and operational decision-making. The findings offer a practical data-driven framework for workload assessment in infusion care settings. Full article

Background and Objectives: Depression has emerged in recent years as a significant global health issue, drawing considerable research interest and attention. The development of depression could be impacted by a range of environmental factors. Aim: To investigate the relationship between depressive symptoms and various indoor environmental factors, such as microclimate, odors, mold, and room ventilation, in association with some sociodemographic and lifestyle factors. Materials and Methods: This epidemiological health survey of the study “Chronic diseases and their risk factors in the adult population” was performed during 2023–2024 in Kaunas city (Lithuania) following the methodology of the WHO MONICA study. A random sample of Kaunas inhabitants aged 25–69 years, stratified by sex and age, was randomly selected from the Lithuanian population register. The 3426 individuals were screened. The associations of various indoor environmental factors with depressive symptoms were investigated using binary logistic regression analysis. Results: Depressive symptoms were associated with sociodemographic, lifestyle, and indoor environmental factors. Poor microclimate conditions, unpleasant household odors, mold exposure, and insufficient room ventilation were associated with increased odds of depressive symptoms. The significance of these associations varied across sex, age, marital status, socioeconomic status, and physical activity of responders. Additional multivariable logistic regression analyses, including interaction terms between each indoor environmental factor and the stratification variables (sex, age groups, marital status, family economic situation, and physical activity), were performed. Significant interaction was found only between family status and room ventilation (p = 0.007). This indicates that the association between ventilation and depressive symptoms differed by family status. Conclusions: This study contributes to the cross-disciplinary understanding of the role of indoor environmental quality, sociodemographic, and lifestyle factors in the development of depression, adding to the evidence on the role of other factors in depression inequalities. Full article

Ambient air pollution, particularly fine particulate matter (PM_2.5), poses significant health risks, especially concerning cardiovascular diseases (CVDs). This study assesses the association between PM_2.5 exposure and CVD hospital admissions (HAs) and emergency room (ER) visits in Karachi, Pakistan. Daily PM_2.5 samples were collected from four Karachi sites (Makro, Karachi University, Keamari, and Malir) between October 2009 and June 2011. CVD morbidity data, including HAs and ER visits, were gathered from major hospitals. A single-pollutant model was employed to evaluate associations between PM_2.5 levels and CVD outcomes, adjusting for meteorological variables and other potential confounders. PM_2.5 concentrations and CVD morbidity were significantly associated across all sites Stratification by age and gender revealed stronger associations among males and individuals aged 40 and above. Exposure to elevated levels of PM_2.5 in Karachi was significantly associated with increased CVD HAs and ER visits, with the highest association found between PM_2.5 exposure and arrhythmias. The study underscores the need for effective air quality management policies and interventions to reduce PM_2.5 levels. Karachi’s high PM_2.5 levels demand urgent attention from regulatory agencies and public health professionals to implement interventions that mitigate air pollution and protect vulnerable populations. Full article

Chronic kidney disease (CKD) represents a major and widespread global health challenge. It affects over 800 million people worldwide, which is approximately 13% of the world’s population. Over the past 20 years, it has consistently ranked among the leading causes of death. As a result of its typically painless and asymptomatic presentation in the early stages of the disease, CKD is frequently diagnosed late, when the patient is already suffering from serious complications. In recent years, studies have identified novel biomarkers associated with the pathophysiology of CKD, including chronic inflammation, tubular injury, and CKD-related outcomes such as bone and mineral metabolism disorders, cardiovascular events, and all-cause mortality. Identifying and using these emerging biomarkers—like kidney injury molecule, N-acetyl–D-glucosaminidase, ficolins, the NLRP3 (nucleotide-binding domain, leucine-rich–containing family, pyrin domain–containing-3) inflammasome, soluble suppression of tumorigenicity-2, galectin-3, growth differentiation factor-15, soluble urokinase-type plasminogen activator receptor, sclerostin, the Dick-kopf proteins, and indexes such as the systemic inflammation response index—may lead to a significant advancement in early diagnosis, risk stratification, and personalized treatment strategies for CKD patients. Despite their potential, the routine clinical use of these novel biomarkers remains limited due to challenges such as high costs and the lack of standardized testing methods. There is still considerable room for advancement in both the diagnosis and management of CKD. Hopefully, increasingly more new biomarkers will become usable in clinical practice, ultimately improving care quality and outcomes for patients with CKD. Full article

Background: to date, there are no specific markers available for diagnosing sepsis. Diagnosis is, indeed, mainly determined by clinical suspicion and the evaluation of the patient’s overall condition. This evaluation involves assessing various inflammatory markers, such as C-reactive protein (CRP) and procalcitonin (PCT), along with markers of tissue hypoxia, such as serum lactate. Additionally, it includes scores that account for complete blood count (CBC), organ function markers, and the patient’s vital parameters, including SOFA, qSOFA, SIRS, and NEWS. Over the years, various potential biomarkers have been studied; among these presepsin appears to offer some significant advantages. Objective: Presepsin, which is the N-terminal fragment of the soluble component of CD14, is primarily elevated in infectious conditions. Its levels rise much earlier in the context of infection compared to currently used biomarkers. As a result, Presepsin shows promise for the early identification of septic patients and could aid in prognostic assessment, allowing clinicians to prioritize care for critically ill individuals. Methods: this study aims to evaluate the role of serum presepsin in the early diagnosis of sepsis in patients who present to the emergency room with a clinical suspicion of sepsis. The secondary objectives include comparing the diagnostic performance of presepsin with traditional biomarkers currently used for sepsis diagnosis and assessing its utility as a prognostic biomarker for mortality risk stratification, in comparison with validated severity prediction scores. Result: Presepsin had valuable diagnostic utility for sepsis (AUC 0.946, p < 0.001) comparable to PCT (AUC 0.905, p < 0.001). Conclusions: the combination of Presepsin, PCT, and EWS yielded the highest diagnostic accuracy for sepsis. Full article

Mortality rates from pulmonary embolism (PE) remain significant, highlighting the need for alternative treatment strategies beyond traditional anticoagulation. Percutaneous interventions, including mechanical thrombectomy and catheter-directed thrombolysis, are emerging as promising options. Given the complex pathophysiology and unique risk profiles of these patients, meticulous multidisciplinary planning is essential. Anesthesiologists play a central role in coordinating care and managing perioperative risks to improve outcomes. This article provides insights into best safety practices and shares experiences from a leading quaternary center. It offers guidance for anesthesia providers to proactively engage in comprehensive risk stratification, participate in multidisciplinary discussions, and support robust contingency planning for managing PE patients undergoing percutaneous interventions in non-operating room anesthesia settings. Full article

Background: Mediastinal mass syndrome represents a major threat to respiratory and cardiovascular integrity, with difficult evidence-based risk stratification for interdisciplinary management. Methods: We conducted a narrative review concerning risk stratification and difficult airway management of patients presenting with a large mediastinal mass. This is supplemented by a case report illustrating our individual approach for a patient presenting with a subtotal tracheal stenosis due to a large cyst of the thyroid gland. Results: We identified numerous risk stratification grading systems and only a few case reports of regional anesthesia techniques for extracorporeal membrane oxygenation patients. Clinical Case: After consultation with his general physician because of exertional dyspnea and stridor, a 78-year-old patient with no history of heart failure was advised to present to a cardiology department under the suspicion of decompensated heart failure. Computed tomography imaging showed a large mediastinal mass that most likely originated from the left thyroid lobe, with subtotal obstruction of the trachea. Prior medical history included the implantation of a dual-chamber pacemaker because of a complete heart block in 2022, non-insulin-dependent diabetes mellitus type II, preterminal chronic renal failure with normal diuresis, arterial hypertension, and low-grade aortic insufficiency. After referral to our hospital, an interdisciplinary consultation including experienced cardiac anesthesiologists, thoracic surgeons, general surgeons, and cardiac surgeons decided on completing the resection via median sternotomy after awake cannulation for veno-venous extracorporeal membrane oxygenation via the right internal jugular and the femoral vein under regional anesthesia. An intermediate cervical plexus block and a suprainguinal fascia iliaca compartment block were performed, followed by anesthesia induction with bronchoscopy-guided placement of the endotracheal tube over the stenosed part of the trachea. The resection was performed with minimal blood loss. After the resection, an exit blockade of the dual chamber pacemaker prompted emergency surgical revision. The veno-venous extracorporeal membrane oxygenation was explanted after the operation in the operating room. The postoperative course was uneventful, and the patient was released home in stable condition. Conclusions: Awake veno-venous extracorporeal membrane oxygenation placed under local anesthetic infiltration with regional anesthesia techniques is a feasible individualized approach for patients with high risk of airway collapse, especially if the mediastinal mass critically alters tracheal anatomy. Compressible cysts may represent a subgroup with easy passage of an endotracheal tube. Interdisciplinary collaboration during the planning stage is essential for maximum patient safety. Prospective data regarding risk stratification for veno-venous extracorporeal membrane oxygenation cannulation and effectiveness of regional anesthesia is needed. Full article

Background & Aims: Several risk scores have been proposed for risk-stratification of patients with upper gastrointestinal bleeding. ABC score was found more accurate predicting mortality than AIMS65. MAP(ASH) is a simple, pre-endoscopy score with a great ability to predict intervention and mortality. The aim of this study was to compare ABC and MAP(ASH) discriminative ability for the prediction of mortality and intervention in UGIB. As a secondary aim we compared both scores with Glasgow-Blatchford score and AIMS65. Methods: Our study included patients admitted to the emergency room of Virgen de las Nieves University Hospital with UGIB (2017–2020). Information regarding clinical, biochemical tests and procedures was collected. Main outcomes were in-hospital mortality and a composite endpoint for intervention. Results: MAP(ASH) and ABC had similar AUROCs for mortality (0.79 vs. 0.80). For intervention, MAP(ASH) (AUROC = 0.75) and ABC (AUROC = 0.72) were also similar. Regarding rebleeding, AUROCs of MAP(ASH) and ABC were 0.67 and 0.61 respectively. No statistically differences were found in these outcomes. With a low threshold for MAP(ASH) ≤ 2, ABC and MAP(ASH) classified a similar proportion of patients as being at low risk of death (42% vs. 45.2%), with virtually no mortality under these thresholds. Conclusions: MAP(ASH) and ABC were similar for the prediction of relevant outcomes for UGIB, such as intervention, rebleeding and in-hospital mortality, with an accurate selection of low-risk patients. MAP(ASH) has the advantage of being easier to calculate even without the aid of electronic tools. Full article

Predictors of mortality in illicit drug users involving Novel Psychoactive Substances (NPS) and multiple substances have not been elucidated. We aimed to define predictors of mortality in the NPS endemic era’s illicit drug users to strengthen patient care in emergency treatment. This was a retrospective study. LC-MS/MS-confirmed positive illicit drug users who visited the emergency departments (ED) of six medical systems were enrolled. Demographic information, physical examinations, and laboratory data were abstracted for mortality analysis. There were 16 fatalities in 355 enrolled patients. The most frequently used illicit drugs were amphetamines, followed by opioids, cathinones, and ketamine. The most frequently detected cathinones among the 16 synthetic cathinones were eutylone, followed by mephedrone. The combined use of cathinones and ketamine was most commonly observed in our results. Univariate analysis revealed that the mortality patients were older, with deep coma, faster heart rate and respiratory rate, lower blood pressures and O₂ room air saturation, more seizures, abnormal breath sounds, and had urine incontinence compared to the survivor patients. The mortality patients also had acute kidney injury, higher potassium, blood sugar, liver function test, and lactate level. The results of multiple logistic regression demonstrated that SBP < 90 mmHg, dyspnea, blood sugar > 140 mg/dl, and HCO₃ < 20.6 mmHg were independent predictors of in-hospital mortality. Regardless of the pattern of the use of illicit drugs, the predictors allow for risk stratification and determining the optimal treatment. Full article

The Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has rapidly spread to become a global pandemic, putting a strain on health care systems. SARS-CoV-2 infection may be associated with mild symptoms or, in severe cases, lead patients to the intensive care unit (ICU) or death. The critically ill patients suffer from acute respiratory distress syndrome (ARDS), sepsis, thrombotic complications and multiple organ failure. For optimization of hospital resources, several molecular markers and algorithms have been evaluated in order to stratify COVID-19 patients, based on the risk of developing a mild, moderate, or severe disease. Here, we propose the soluble urokinase receptor (suPAR) as a serum biomarker of clinical severity and outcome in patients who are hospitalized with COVID-19. In patients with mild disease course, suPAR levels were increased as compared to healthy controls, but they were dramatically higher in severely ill patients. Since early identification of disease progression may facilitate the individual management of COVID-19 symptomatic patients and the time of admission to the ICU, we suggest paying more clinical attention on patients with high suPAR levels. Full article

An early analysis of circulating monocytes may be critical for predicting COVID-19 course and its sequelae. In 131 untreated, acute COVID-19 patients at emergency room arrival, monocytes showed decreased surface molecule expression, including low HLA-DR, in association with an inflammatory cytokine status and limited anti-SARS-CoV-2-specific T cell response. Most of these alterations had normalized in post-COVID-19 patients 6 months after discharge. Acute COVID-19 monocytes transcriptome showed upregulation of anti-inflammatory tissue repair genes such as BCL6, AREG and IL-10 and increased accessibility of chromatin. Some of these transcriptomic and epigenetic features still remained in post-COVID-19 monocytes. Importantly, a poorer expression of surface molecules and low IRF1 gene transcription in circulating monocytes at admission defined a COVID-19 patient group with impaired SARS-CoV-2-specific T cell response and increased risk of requiring intensive care or dying. An early analysis of monocytes may be useful for COVID-19 patient stratification and for designing innate immunity-focused therapies. Full article

We present the case of a 35-year-old woman who had a high-risk pulmonary embolism (according to ESC risk stratification for pulmonary embolism) after she had undergone a Caesarion section. Postoperatively, she presented with acute left lower limb pain, swelling and erythema. A diagnosis was made of deep vein thrombosis (DVT) of the ilio-femoral and popliteal veins. She was started on anticoagulant therapy, which proved to be inefficient, the patient developing a left calf and thigh oedema and shortness of breath. A CT scan revealed high-risk embolus located in the right atrium and through the tricuspid valve. The decision was made to refer her to a cardiovascular surgeon. During her preoperative evaluation, the patient became hemodynamically unstable and was rushed into the operating room, severely desaturated, bradycardic, without consciousness, with severe hypotension. On the basis of the severe state of the patient and the CT scan findings we performed an emergency pulmonary embolectomy, with the patient on cardio-pulmonary by-pass, without cross-clamping the aorta, using a modified Trendelenburg procedure. This case supports using open pulmonary embolectomy for patients with hemodynamic instability on the basis of clinical diagnosis. Full article

Cholangiocarcinomas (CCAs) are a heterogeneous group of tumors that arise from the biliary tract. Jaundice is a common clinical presentation; however, the prognostic impact of this symptom is poorly understood, and current management recommendations lack solid evidence. We aim to assess the clinical outcomes and predictive factors of CCA patients presenting with jaundice in the Emergency Room (ER). We retrospectively analyzed all consecutive ER cases presenting with jaundice between January 2010 and December 2017. During the study period, 403,766 patients were admitted to the ER, 1217 (0.3%) presented with jaundice, and in 200 (0.049%), the diagnosis was CCA. CCA cases increased during the study period (p for trend 0.026). Most of them presented with advance disease (stage III 46.5%, stage IV 43.5%) and median survival was 4.5 months (95% CI 3.4–6.0). Factors associated with better survival were age, stage of disease, presence of jaundice at the moment of diagnosis, and lack of concomitant viral hepatitis. A nomogram was constructed that significantly predicts 1-month, 6-month, and 1-year survival after patients’ admission. In conclusion, the majority of CCA patients presenting with jaundice to the ER have advanced disease and poor prognosis. Risk stratification of these patients can allow tailored management. Full article