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Keywords = sepsis scoring systems

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15 pages, 633 KiB  
Article
Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital
by Wisanu Wanlumkhao, Duangduan Rattanamongkolgul and Chatchai Ekpanyaskul
Antibiotics 2025, 14(7), 708; https://doi.org/10.3390/antibiotics14070708 - 15 Jul 2025
Viewed by 582
Abstract
Background: Early identification of sepsis is critical for improving outcomes, particularly in low-resource emergency settings. In Thai community hospitals, where physicians may not always be available, triage is often nurse-led. Selecting accurate and practical sepsis screening tools is essential not only for timely [...] Read more.
Background: Early identification of sepsis is critical for improving outcomes, particularly in low-resource emergency settings. In Thai community hospitals, where physicians may not always be available, triage is often nurse-led. Selecting accurate and practical sepsis screening tools is essential not only for timely clinical decision-making but also for timely diagnosis and promoting appropriate antibiotic use. Methods: This cross-sectional study analyzed 475 adult patients with suspected sepsis who presented to the emergency department of a Thai community hospital, using retrospective data from January 2021 to December 2022. Six screening tools were evaluated: Systemic Inflammatory Response Syndrome (SIRS), Quick Sequential Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), National Early Warning Score version 2 (NEWS2), and Search Out Severity (SOS). Diagnostic accuracy was assessed using International Classification of Diseases, Tenth Revision (ICD-10) codes as the reference standard. Performance metrics included sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic (AUROC) curve, all reported with 95% confidence intervals. Results: SIRS had the highest sensitivity (84%), while qSOFA demonstrated the highest specificity (91%). NEWS2, NEWS, and MEWS showed moderate and balanced diagnostic accuracy. SOS also demonstrated moderate accuracy. Conclusions: A two-step screening approach—using SIRS for initial triage followed by NEWS2 for confirmation—is recommended. This strategy enhances nurse-led screening and optimizes limited resources in emergency care. Early sepsis detection through accurate screening tools constitutes a feasible public health intervention to support appropriate antibiotic use and mitigate antimicrobial resistance, especially in resource-limited community hospital settings. Full article
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17 pages, 706 KiB  
Article
Hematological Parameter-Derived Inflammatory Scores in Non-Pancreatic Hyperlipasemia (NPHL)—The Prognosis Lies in the Blood
by Krisztina Eszter Feher, David Tornai and Maria Papp
Biomedicines 2025, 13(7), 1719; https://doi.org/10.3390/biomedicines13071719 - 14 Jul 2025
Viewed by 293
Abstract
Background/Objectives: Non-pancreatic hyperlipasemia (NPHL) is associated with high in-hospital mortality, with sepsis being one of the most common etiologies. The prognostic value of hematological parameter-derived inflammatory scores has not been extensively studied in NPHL to date. Methods: The prognostic value of eight inflammatory [...] Read more.
Background/Objectives: Non-pancreatic hyperlipasemia (NPHL) is associated with high in-hospital mortality, with sepsis being one of the most common etiologies. The prognostic value of hematological parameter-derived inflammatory scores has not been extensively studied in NPHL to date. Methods: The prognostic value of eight inflammatory scores for in-hospital mortality was assessed in a total of 545 NPHL patients from two hospitalized patient cohorts (COVID-19 [n = 144] and non-COVID-19 [n = 401], the latter stratified as bacterial sepsis [n = 111] and absence of systemic infection [n = 290]). We assessed the neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), neutrophil-to-lymphocyte and platelet ratio (N/(LP)), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), aggregate index of systemic inflammation (AISI), systemic inflammation index (SII), and systemic inflammation response index (SIRI), comparing their prognostic value among etiological groups. Results: Patients with bacterial sepsis were older, had more comorbidities, and experienced worse outcomes, including longer hospitalization (median: 15, 7, and 11 days; p < 0.001), higher ICU admission rates (75.7%, 33.8%, and 47.9%, p < 0.001), and increased mortality (45.0%, 13.8%, and 38.2%, p < 0.001), compared to those without systemic infection or with COVID-19-induced NPHL. Overall, NLR, dNLR, and N/(LP) were the most accurate predictors of in-hospital mortality at admission (AUROC: non-infection: 0.747; 0.737; 0.772; COVID-19: 0.810; 0.789; 0.773, respectively). The accuracy of NLR decreased in bacterial sepsis, and only N/(LP) and PLR remained associated with in-hospital mortality (AUROC: 0.653 and 0.616, respectively). Conclusions: The prognostic performance of hematological parameter-derived inflammatory scores in NPHL is etiology-dependent. NLR is the most accurate prognostic tool for mortality in the absence of bacterial sepsis, while N/(LP) is the best score in sepsis-induced NPHL. Full article
(This article belongs to the Section Molecular and Translational Medicine)
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12 pages, 827 KiB  
Article
Evaluating Sepsis Mortality Predictions from the Emergency Department: A Retrospective Cohort Study Comparing qSOFA, the National Early Warning Score, and the International Early Warning Score
by German Alberto Devia-Jaramillo, Lilia Erazo-Guerrero, Vivian Laguado-Castro and Juan Manuel Alfonso-Parada
J. Clin. Med. 2025, 14(14), 4869; https://doi.org/10.3390/jcm14144869 - 9 Jul 2025
Viewed by 410
Abstract
Introduction: Sepsis has a high mortality rate, especially in low-income countries. Improving outcomes depends on the early recognition of patients at risk of death. Therefore, rapid and applicable prediction scores are needed in emergency triage. Objective: This study assessed the effectiveness [...] Read more.
Introduction: Sepsis has a high mortality rate, especially in low-income countries. Improving outcomes depends on the early recognition of patients at risk of death. Therefore, rapid and applicable prediction scores are needed in emergency triage. Objective: This study assessed the effectiveness of the qSOFA, NEWS, and IEWS scales in predicting in-hospital mortality during emergency triage. Additionally, we analyzed the efficacy of the IEWS_L, which integrates the IEWS with arterial lactate levels measured upon admission to the emergency department. Method: This retrospective study included patients who consulted the emergency department with suspected sepsis, where various scoring systems were evaluated for their effectiveness. We evaluated the diagnostic capacity of the tests by measuring the specificity, sensitivity, positive and negative predictive values, as well as the areas under the curve (AUC) of each score to predict mortality. Results: The study included 383 patients who had visited the emergency department. The overall mortality rate was 20.6%, and the mortality rate, precisely due to septic shock, was 35.2%. The AUC values for predicting in-hospital deaths due to sepsis were as follows: qSOFA: 0.68 (95% CI: 0.62–0.74); NEWS: 0.71 (95% CI: 0.64–0.77); IEWS: 0.74 (95% CI: 0.68–0.80); IEWS_L: 0.81 (95% CI: 0.76–0.86). Conclusions: In the emergency department, the IEWS scale demonstrated the best ability to accurately predict in-hospital mortality from sepsis when compared to the qSOFA and NEWS scale. Additionally, incorporating the serum lactate level into the IEWS scale significantly enhances its capacity to predict mortality. Full article
(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)
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18 pages, 1416 KiB  
Article
Herpes Zoster Reactivation Following COVID-19 and the Risk of Renal, Infectious, and Autoimmune Complications: A Global Propensity-Matched Cohort Study
by Ming-Hung Chien, Joshua Wang, Kuo-Cheng Lu and Chien-Lin Lu
Biomedicines 2025, 13(7), 1628; https://doi.org/10.3390/biomedicines13071628 - 2 Jul 2025
Viewed by 568
Abstract
Background: Herpes zoster (HZ), resulting from the reactivation of latent varicella-zoster virus, has been increasingly observed in individuals following COVID-19. Given the shared immunological disturbances between the two conditions, this study aimed to investigate whether HZ following COVID-19 is associated with an elevated [...] Read more.
Background: Herpes zoster (HZ), resulting from the reactivation of latent varicella-zoster virus, has been increasingly observed in individuals following COVID-19. Given the shared immunological disturbances between the two conditions, this study aimed to investigate whether HZ following COVID-19 is associated with an elevated risk of renal, infectious, and autoimmune complications. Methods: This retrospective cohort study utilized data from the TriNetX global federated health network, encompassing over 9 million adults diagnosed with COVID-19 between January 2020 and January 2022. Patients who developed HZ within one year following COVID-19 diagnosis were compared to 1:1 propensity score-matched controls without HZ. Time-to-event analyses over a three-year follow-up period were conducted to estimate the risks of major adverse kidney events (MAKE; defined as acute kidney injury, dialysis dependence, or severely reduced kidney function with eGFR <30 mL/min/1.73 m2), sepsis, systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA), using Kaplan–Meier survival curves and Cox proportional hazards models. Results: HZ following COVID-19 was significantly associated with increased risks of all four outcomes: MAKE (HR 1.940, 95% CI: 1.866–2.017), sepsis (HR 2.362, 95% CI: 2.250–2.479), SLE (HR 2.667, 95% CI: 2.254–3.156), and RA (HR 2.484, 95% CI: 2.267–2.730). Subgroup analyses identified older age, diabetes, impaired renal function, and elevated inflammatory markers as key risk-enhancing factors. Conclusions: HZ following COVID-19 may serve as a clinical indicator of systemic immune dysregulation and is independently associated with increased long-term risks of renal, infectious, and autoimmune sequelae. Enhanced monitoring of this high-risk population is warranted. Full article
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13 pages, 1352 KiB  
Article
Time Matters: Methane Inhalation Mitigates Mitochondrial and Organ Dysfunction in Advanced Experimental Sepsis
by Levente Frigyes Gulácsi, Attila Rutai, László Juhász, Bálint László Czakó, Andrea Szabó, Mihály Boros, József Kaszaki, Marietta Zita Poles and Szabolcs Péter Tallósy
Antioxidants 2025, 14(7), 814; https://doi.org/10.3390/antiox14070814 - 1 Jul 2025
Viewed by 346
Abstract
This study aimed to characterize the time-dependent effects of methane (CH4) inhalation, initiated at defined intervals following sepsis onset, on organ function, systemic oxygen utilization, and mitochondrial respiration in a rodent model. Adult rats were subjected to abdominal sepsis or sham [...] Read more.
This study aimed to characterize the time-dependent effects of methane (CH4) inhalation, initiated at defined intervals following sepsis onset, on organ function, systemic oxygen utilization, and mitochondrial respiration in a rodent model. Adult rats were subjected to abdominal sepsis or sham operation. Septic animals were assigned to groups receiving 2.2% CH4 in normoxic air at specific post-insult phases (early: 3–6 h; intermediate: 16–19 h; late: 19–22 h), while a control group remained untreated. At 24 h, organ function was evaluated using a Rat-Specific Organ Failure Assessment (ROFA) score, along with measurements of plasma myeloperoxidase (MPO) activity, Complex I–II-linked oxidative phosphorylation in renal and cerebellar tissues, systemic oxygen extraction, and global tissue perfusion (pCO2-gap). Sepsis induced significant organ dysfunction, impaired hemodynamics, reduced oxygen utilization, and decreased mitochondrial respiration. CH4 inhalation improved survival when administered early, restored cerebellar mitochondrial respiration during the intermediate phase, and in the late phase reduced ROFA scores and MPO levels, while attenuating mitochondrial dysfunction in renal and cerebellar tissues. All CH4-treated groups demonstrated improved renal function and enhanced tissue oxygenation. Targeted CH4 inhalation during sepsis confers protective effects by preserving mitochondrial function, reducing inflammation, and improving oxygen dynamics, suggesting promising therapeutic potential. Full article
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12 pages, 415 KiB  
Article
Comparison of Intensive Care Scoring Systems in Predicting Overall Mortality of Sepsis
by Mustafa Ozgur Cirik, Guler Eraslan Doganay, Melek Doganci, Tarkan Ozdemir, Murat Yildiz, Abdullah Kahraman, Seray Hazer, Mehtap Tunc, Kerem Ensarioglu, Azra Ozanbarci and Oral Mentes
Diagnostics 2025, 15(13), 1660; https://doi.org/10.3390/diagnostics15131660 - 29 Jun 2025
Viewed by 540
Abstract
Background: Prognostic scoring systems are applied in intensive care units (ICUs) to monitor patients’ responses to treatment and guide treatment modalities. These scoring systems are also used as predictors in sepsis, where mortality rates are high. This study aims to compare the scores [...] Read more.
Background: Prognostic scoring systems are applied in intensive care units (ICUs) to monitor patients’ responses to treatment and guide treatment modalities. These scoring systems are also used as predictors in sepsis, where mortality rates are high. This study aims to compare the scores (APACHE II, SOFA, SAPS II, OASIS) in terms of their role in predicting overall mortality in patients admitted to ICUs with a diagnosis of sepsis or septic shock. Methods: Among 740 patients admitted to the tertiary intensive care unit within a 2-year period, 165 patients diagnosed with sepsis and septic shock were included in the study. Demographic data, comorbidities, SOFA, SAPSII, OASIS, and APACHE II scores, invasive or noninvasive mechanical ventilation requirements and durations, ICU admissions, hospital stays, and 28-day mortalities were retrospectively evaluated. Results: All scoring systems were positively correlated with mortality and CCI score. SAPS II and OASIS showed a higher correlation with mortality compared to other scoring systems, correlated with ICU admission and mechanical ventilation, unlike other scoring systems. The AUC values for the APACHE II, SOFA, SAPS II, and OASIS were 0.803, 0.873, 0.902, and 0.879, respectively. No statistically significant difference was found between the scores (p > 0.05). Conclusions: Compared to commonly used scoring systems, OASIS is a practical tool and serves as a robust scoring system for assessing mortality in ICU patients diagnosed with sepsis. Full article
(This article belongs to the Section Clinical Diagnosis and Prognosis)
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12 pages, 356 KiB  
Article
Pleural Empyema in Spain (2016–2022): A Nationwide Study on Trends in Hospitalizations, Mortality, and Impact of Comorbidities
by Begoña Perez-de-Paz, Maria-Jose Fernandez-Cotarelo, Lydia Rodriguez-Romero, Carolina Ribeiro-Neves-Pinto, Natividad Quilez-Ruiz-Rico, Dolores Álvaro-Álvarez, Victor Moreno-Cuerda and Cesar Henriquez-Camacho
J. Pers. Med. 2025, 15(7), 263; https://doi.org/10.3390/jpm15070263 - 20 Jun 2025
Viewed by 403
Abstract
Background: Pleural empyema (PE) is a major cause of morbidity and mortality worldwide. This study aimed to analyze the epidemiological characteristics of patients hospitalized for PE in Spain between 2016 and 2022. Methods: This retrospective observational study of PE cases was [...] Read more.
Background: Pleural empyema (PE) is a major cause of morbidity and mortality worldwide. This study aimed to analyze the epidemiological characteristics of patients hospitalized for PE in Spain between 2016 and 2022. Methods: This retrospective observational study of PE cases was based on the hospital discharge records from the National Health System between 2016 and 2022. The variables analyzed were sex, age, comorbidities, discharge diagnoses and procedures, overall severity, whether empyema was a primary or secondary diagnosis, admission to the intensive care unit (ICU), length of stay (LOS), in-hospital mortality, and healthcare costs. Results: Between 2016 and 2022, 19864 PE cases were diagnosed in Spain, revealing an overall rate of 0.64 per 1000 hospitalizations, with the exception of a slight decline in 2021. The mean age of the patients with PE was 61 years, and 73.85% were men. Most patients had low comorbidities, with a median Charlson comorbidity index (CCI) of 1.7. Most cases (63%) involved secondary diagnoses (pneumonia, pneumococcal pneumonia, sepsis, COVID, or lung cancer). The in-hospital mortality rate was higher in the secondary diagnosis group than in the primary diagnosis group (13.4% vs. 6.2%, respectively, p < 0.001). The factors associated with increased mortality included older age (≥66 years), higher CCI scores, ICU admission, and shorter LOS (<10 days). Conversely, pleural drainage and pneumonia as secondary diagnoses were protective factors. Conclusions: PE is an increasingly common pathology in clinical practice, especially in older and frail patients. It is associated with high morbidity and mortality, and its prognosis worsens with age and comorbidities. Therefore, early and appropriate diagnosis and standardized management strategies are required to mitigate the mortality and healthcare costs. Full article
(This article belongs to the Special Issue Advances in Infectious Disease Epidemiology)
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10 pages, 396 KiB  
Article
The Effect of Systemic Inflammation on Newborns: The Prognostic Value of the Aggregate Systemic Inflammation Index (AISI) and Systemic Inflammatory Response Index (SIRI)
by Samet Kırat
Diagnostics 2025, 15(12), 1544; https://doi.org/10.3390/diagnostics15121544 - 17 Jun 2025
Viewed by 418
Abstract
Objective: This study aimed to investigate the prognostic value of two novel systemic inflammatory indices—the Aggregate Systemic Inflammation Index (AISI) and the Systemic Inflammatory Response Index (SIRI)—in predicting preterm delivery and associated neonatal outcomes. Methods: A retrospective, descriptive, cross-sectional study was conducted using [...] Read more.
Objective: This study aimed to investigate the prognostic value of two novel systemic inflammatory indices—the Aggregate Systemic Inflammation Index (AISI) and the Systemic Inflammatory Response Index (SIRI)—in predicting preterm delivery and associated neonatal outcomes. Methods: A retrospective, descriptive, cross-sectional study was conducted using the electronic health records of 1056 pregnant women admitted to a tertiary university hospital between 2020 and 2025. Pregnancies were classified into preterm (n = 528) and term (n = 528) groups. Demographic, obstetric, neonatal, and laboratory data were analyzed. Results: The AISI and SIRI values in the first trimester and at admission were significantly higher in the preterm delivery group than in the term delivery group (p < 0.001). Elevated AISI and SIRI levels correlated with lower 1st- and 5th-minute APGAR scores (p < 0.001) and higher neonatal intensive care unit (NICU) admission rates (35.8% vs. 4.5%; p < 0.001). The AISI cut-offs were 399.2 for preterm delivery (59.7% sensitivity, 59.8% specificity), 558.8 for NICU admission (79.3% sensitivity, 79.2% specificity), 694.0 for RDS (87.8% sensitivity, 87.8% specificity), 602.1 for sepsis (79.6% sensitivity, 79.2% specificity), and 753.8 for congenital pneumonia (81.6% sensitivity, 81.9% specificity). The SIRI cut-offs were 1.7 for preterm delivery (59.1% sensitivity, 58.9% specificity), 2.4 for NICU admission (81.7% sensitivity, 81.6% specificity), 3.1 for RDS (89.0% sensitivity, 89.5% specificity), 3.0 for sepsis (85.8% sensitivity, 85.7% specificity), and 3.4 for congenital pneumonia (85.7% sensitivity, 83.8% specificity). Conclusions: The AISI and SIRI showed significant predictive utility for neonatal morbidity in preterm delivery. The use of these markers in clinical practice may improve neonatal outcomes by enhancing the early diagnosis and management of high-risk pregnancies. Full article
(This article belongs to the Special Issue Advancements in Maternal–Fetal Medicine)
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15 pages, 748 KiB  
Protocol
Incidence of Sepsis-Induced Coagulopathy (INSIC) Trial: Study Protocol of a Combined Retrospective and Prospective, Multicenter, International, Cross-Sectional, Longitudinal, and Epidemiological Observational Trial
by Thomas Schmoch, Patrick Möhnle, Markus A. Weigand, Maximilian Dietrich, Jonas Gregorius, Sandra Frank, Josef Briegel, David I. Radke, Michael Bauer, Frank Bloos, Patrick Meybohm, Holger Bogatsch and Thorsten Brenner
J. Clin. Med. 2025, 14(12), 4222; https://doi.org/10.3390/jcm14124222 - 13 Jun 2025
Viewed by 913
Abstract
Background/Objectives: Sepsis and septic shock are the most severe forms of infection. Due to the intensive cross-talk of the coagulation and immune system, coagulopathies regularly occur in sepsis. The International Society on Thrombosis and Hemostasis refers to these coagulation abnormalities as sepsis-induced coagulopathies [...] Read more.
Background/Objectives: Sepsis and septic shock are the most severe forms of infection. Due to the intensive cross-talk of the coagulation and immune system, coagulopathies regularly occur in sepsis. The International Society on Thrombosis and Hemostasis refers to these coagulation abnormalities as sepsis-induced coagulopathies (SICs). The presence of SICs can be assessed using the SIC score. In parallel, a score for “sepsis-associated coagulopathy” (SAC) was introduced that, in contrast to the SIC score, allows coagulopathy to be classified according to its severity. In the past, multicenter, randomized controlled trials have repeatedly failed to prove the efficacy of specific therapeutic measures targeting SICs or SACs. This could potentially be explained by insufficient knowledge about the prevalence and incidence of SIC and the rate of spontaneous recovery. The Incidence of Sepsis-Induced Coagulopathy (INSIC) trial is intended to address this problem. Methods: The aim of the INSIC trial is to measure the incidence and prevalence of SIC—in addition to the rate of spontaneous SIC recoveries—during the first days of sepsis treatment to provide a solid base of data for future interventional trials. We aim to include all patients with sepsis treated in any one of 150 participating intensive care units in 100 hospitals located in Austria, Luxembourg, and Germany to determine the prevalence of SIC (on day 1 of the study period as well as on three selected days in the fourth quarter of each year from 2019 to 2024). SIC incidence will be assessed over a 14-day period starting on 10 March 2025. Secondary endpoints are 28-day survival and the occurrence of severe thromboembolic events and bleeding. In addition, each of the aforementioned outcome parameters will be assessed for correlation with the severity classification of the SAC score. Conclusions: The INSIC trial is the first study to determine the prevalence as well as the incidence of SIC, to prospectively examine the course of SIC longitudinally over a 14-day period, and to determine the rate of spontaneous recoveries within 72 h under standard treatment in a large cohort of patients. This information will provide a sound basis for future studies. Full article
(This article belongs to the Section Intensive Care)
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27 pages, 2815 KiB  
Article
Machine Learning-Augmented Triage for Sepsis: Real-Time ICU Mortality Prediction Using SHAP-Explained Meta-Ensemble Models
by Hülya Yilmaz Başer, Turan Evran and Mehmet Akif Cifci
Biomedicines 2025, 13(6), 1449; https://doi.org/10.3390/biomedicines13061449 - 12 Jun 2025
Viewed by 862
Abstract
Background/Objectives: Optimization algorithms are acknowledged to be critical in various fields and dynamical systems since they provide facilitation in identifying and retrieving the most possible solutions concerning complex problems besides improving efficiency, cutting down on costs, and boosting performance. Metaheuristic optimization algorithms, on [...] Read more.
Background/Objectives: Optimization algorithms are acknowledged to be critical in various fields and dynamical systems since they provide facilitation in identifying and retrieving the most possible solutions concerning complex problems besides improving efficiency, cutting down on costs, and boosting performance. Metaheuristic optimization algorithms, on the other hand, are inspired by natural phenomena, providing significant benefits related to the applicable solutions for complex optimization problems. Considering that complex optimization problems emerge across various disciplines, their successful applications are possible to be observed in tasks of classification and feature selection tasks, including diagnostic processes of certain health problems based on bio-inspiration. Sepsis continues to pose a significant threat to patient survival, particularly among individuals admitted to intensive care units from emergency departments. Traditional scoring systems, including qSOFA, SIRS, and NEWS, often fall short of delivering the precision necessary for timely and effective clinical decision-making. Methods: In this study, we introduce a novel, interpretable machine learning framework designed to predict in-hospital mortality in sepsis patients upon intensive care unit admission. Utilizing a retrospective dataset from a tertiary university hospital encompassing patient records from January 2019 to June 2024, we extracted comprehensive clinical and laboratory features. To address class imbalance and missing data, we employed the Synthetic Minority Oversampling Technique and systematic imputation methods, respectively. Our hybrid modeling approach integrates ensemble-based ML algorithms with deep learning architectures, optimized through the Red Piranha Optimization algorithm for feature selection and hyperparameter tuning. The proposed model was validated through internal cross-validation and external testing on the MIMIC-III dataset as well. Results: The proposed model demonstrates superior predictive performance over conventional scoring systems, achieving an area under the receiver operating characteristic curve of 0.96, a Brier score of 0.118, and a recall of 81. Conclusions: These results underscore the potential of AI-driven tools to enhance clinical decision-making processes in sepsis management, enabling early interventions and potentially reducing mortality rates. Full article
(This article belongs to the Section Molecular and Translational Medicine)
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15 pages, 445 KiB  
Review
Literature Review of Prognostic Factors in Secondary Generalized Peritonitis
by Valerii Luțenco, Adrian Beznea, Raul Mihailov, George Țocu, Verginia Luțenco, Oana Mariana Mihailov, Mihaela Patriciu, Grigore Pascaru and Liliana Baroiu
Life 2025, 15(6), 880; https://doi.org/10.3390/life15060880 - 29 May 2025
Viewed by 992
Abstract
Generalized secondary peritonitis is a life-threatening intra-abdominal infection requiring urgent surgical intervention. Despite advances in surgical and antimicrobial therapy, morbidity and mortality remain high. Identifying key prognostic factors is crucial for improving patient outcomes. This review examines significant prognostic indicators and explores the [...] Read more.
Generalized secondary peritonitis is a life-threatening intra-abdominal infection requiring urgent surgical intervention. Despite advances in surgical and antimicrobial therapy, morbidity and mortality remain high. Identifying key prognostic factors is crucial for improving patient outcomes. This review examines significant prognostic indicators and explores the potential role of scoring systems and artificial intelligence in risk stratification. A review was conducted using PubMed, Web of Science, Scopus, and Medline databases. Studies published from 2000 to 2024 focusing on prognostic factors in secondary peritonitis were included. A total of 145 studies were identified, with 40 selected based on relevance and methodological quality. Data extraction included patient demographics, comorbidities, severity scores, microbiological profiles, and artificial intelligence applications in peritonitis management. Poor prognosis was associated with advanced age, severe sepsis, organ failure, chronic kidney disease, cardiovascular comorbidities, and diabetes mellitus. The Mannheim Peritonitis Index (MPI) remains a widely validated prognostic tool, while APACHE II and SOFA scores also provide valuable risk estimates. Increasing multidrug-resistant infections further complicate management and impact outcomes. Emerging evidence suggests that machine learning algorithms may improve early risk stratification and individualized outcome prediction when integrated with conventional scoring systems. Identifying prognostic factors remains essential for optimizing outcomes in secondary peritonitis, and future research should prioritize the clinical validation and integration of AI-based models into perioperative management protocols. Full article
(This article belongs to the Section Medical Research)
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12 pages, 1777 KiB  
Article
Impact of a Sepsis Quality Improvement Initiative on Clinical and Operational Outcomes
by Christopher B. Thomas, Benjamin Wyler, Claude M. D’Antonio, Mark Laperouse, Shannon Alwood, Kristen Richard, Alyse Grantham, Roya Sheybani, Matt G. Sorrells, Wei-Jien Tan, James W. Teague, Hollis O’Neal and Tonya Jagneaux
Healthcare 2025, 13(11), 1273; https://doi.org/10.3390/healthcare13111273 - 28 May 2025
Viewed by 1257
Abstract
Background/Objectives: Sepsis is a costly and life-threatening condition caused by a dysregulated host response to infection. Lack of a reliable, timely diagnostic for sepsis leads to under- and overdiagnosis, suboptimal outcomes, and strained hospital resources. Our Lady of the Lake Regional Medical Center [...] Read more.
Background/Objectives: Sepsis is a costly and life-threatening condition caused by a dysregulated host response to infection. Lack of a reliable, timely diagnostic for sepsis leads to under- and overdiagnosis, suboptimal outcomes, and strained hospital resources. Our Lady of the Lake Regional Medical Center (OLOLRMC) implemented a sepsis learning health program to evaluate and improve outcomes through standardized ED workflows and the incorporation of a novel sepsis diagnostic test. Methods: We report the results of the first year of experience following the implementation of the learning health initiative and sepsis testing. Data from the Epic EHR were analyzed across two groups: pre-implementation (April 2023–July 2023) vs. post-implementation (August 2023–July 2024), and temporally matched cohorts (April–July 2023 vs. April–July 2024). We assessed clinical outcomes (sepsis-associated mortality, hospital length of stay, or HLOS), and resource utilization (antibiotic use, blood cultures). Results: Post-implementation, sepsis-associated mortality dropped from 10.9% to 6.6% in the temporally matched group (p < 0.001). There was also a 0.76-day reduction in mean HLOS among sepsis DRG patients (p < 0.05). Blood culture utilization fell from 50.8% to 45.7%, driven by reductions in blood culture utilization among patients receiving a Band 1 IntelliSep score. Conclusions: The FMOLHS experience demonstrated significant benefits to patient outcomes and resource utilization after implementing a sepsis QI initiative including protocolized and standardized ED workflows via a nurse-driven triage system with sepsis testing for the early risk stratification of patients who present to the ED with signs and symptoms of infection. Full article
(This article belongs to the Section Critical Care)
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14 pages, 867 KiB  
Article
Neutrophil Percentage-to-Albumin Ratio as a Prognostic Marker in Pneumonia Patients Aged 80 and Above in Intensive Care
by Maside Ari, Aslı Haykir Solay, Tarkan Ozdemir, Murat Yildiz, Oral Mentes, Omer Faruk Tuten, Husra Tetik Manav, Deniz Celik, Melek Doganci, Guler Eraslan Doganay, Emrah Ari and Eren Usul
J. Clin. Med. 2025, 14(9), 3033; https://doi.org/10.3390/jcm14093033 - 28 Apr 2025
Cited by 2 | Viewed by 574
Abstract
Background/Objectives: In recent years, inflammatory markers have been increasingly utilized to predict disease prognosis. The neutrophil percentage-to-albumin ratio (NPAR) has emerged as a novel biomarker reflecting inflammation and systemic response. This study was conducted to evaluate the prognostic value of NPAR in pneumonia [...] Read more.
Background/Objectives: In recent years, inflammatory markers have been increasingly utilized to predict disease prognosis. The neutrophil percentage-to-albumin ratio (NPAR) has emerged as a novel biomarker reflecting inflammation and systemic response. This study was conducted to evaluate the prognostic value of NPAR in pneumonia patients aged 80 years and older hospitalized in intensive care. Methods: Patients aged 80 years and older who were followed up in the intensive care unit with a diagnosis of pneumonia between 1 October 2022, and 31 May 2024, were retrospectively reviewed. Demographic characteristics, laboratory data, disease severity scores (APACHE II, SOFA), intensive care interventions, and variables associated with mortality were analyzed. NPAR was calculated by dividing the neutrophil percentage by the serum albumin level. The prognostic value of NPAR was assessed using Kaplan–Meier survival analysis, receiver operating characteristic (ROC) curve analysis, and Cox regression analysis. Results: A total of 135 patients were included in the study. Patients with NPAR > 0.286 had significantly higher SOFA (p = 0.002) and APACHE II (p = 0.007) scores. The high NPAR group was at significantly greater risk for requiring invasive mechanical ventilation (p = 0.003), vasopressor support (p = 0.042), and developing sepsis (p = 0.035). Elevated NPAR was strongly associated with mortality (p < 0.001) and was identified as an independent predictor of mortality in the Cox regression analysis (HR = 2.488, 95% CI: 1.167–5.302, p = 0.018). Conclusions: NPAR may serve as an effective biomarker for predicting disease severity and mortality risk in pneumonia patients aged 80 years and older. Due to its simplicity and accessibility, it can be considered a practical parameter for integration into clinical practice. However, large-scale, multicenter, and prospective studies are needed to validate these findings. Full article
(This article belongs to the Special Issue Update on Acute Severe Respiratory Infections)
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23 pages, 2966 KiB  
Article
Critical Management of Septic Orthopedic Patients: The Impact of Intensive Care on Survival and Recovery
by Angelica Bratu, Catalin Cirstoiu, Mihnea Ioan Gabriel Popa, Mihai Popescu, Oana Clementina Dumitrascu, Mihaela Agapie and Carmen Orban
Life 2025, 15(4), 674; https://doi.org/10.3390/life15040674 - 21 Apr 2025
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Abstract
The management of septic orthopedic patients, particularly those with periprosthetic joint infections (PJIs) and trauma-related sepsis, remains a significant clinical challenge. This retrospective cohort study evaluated 27 patients admitted to the Intensive Care Unit (ICU) at the Emergency University Hospital in Bucharest between [...] Read more.
The management of septic orthopedic patients, particularly those with periprosthetic joint infections (PJIs) and trauma-related sepsis, remains a significant clinical challenge. This retrospective cohort study evaluated 27 patients admitted to the Intensive Care Unit (ICU) at the Emergency University Hospital in Bucharest between 2021 and 2024. Patients presented with either PJIs or polytrauma-related infections requiring critical care interventions. The PJI-TNM classification system was employed to assess infection complexity, comorbidities, and implant stability. Therapeutic strategies included one- or two-stage revision surgeries and targeted antimicrobial therapy, including the use of antibiotic-impregnated calcium sulfate beads. Infection resolution was achieved in 85.2% of patients, with a mean ICU stay of 13 days. The overall ICU mortality rate was 11%, with two deaths occurring within the first 30 days of admission. Elevated SOFA scores (≥10) and poor glycemic control (HbA1c > 8.5%) were significantly associated with prolonged ICU stays and higher complication rates. Statistical analysis revealed significant differences in CRP normalization and bone healing times across glycemic control groups (p < 0.001). Patients requiring mechanical ventilation exhibited longer ICU stays and increased mortality (25%). The PJI-TNM classification showed potential utility for risk stratification and guiding personalized treatment strategies. These findings underscore the importance of multidisciplinary ICU-level care and metabolic control in improving outcomes for septic orthopedic patients. Future multicenter studies are needed to validate these preliminary observations and refine prognostic models for this high-risk population. Full article
(This article belongs to the Section Medical Research)
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Article
Assessment of Culture-Negative Neonatal Early-Onset Sepsis: Risk Factors and Utility of Currently Used Serum Biomarkers
by Diana Iulia Vasilescu, Adriana Mihaela Dan, Laura Andreea Stefan, Sorin Liviu Vasilescu, Vlad Dima and Monica Mihaela Cîrstoiu
Children 2025, 12(3), 355; https://doi.org/10.3390/children12030355 - 13 Mar 2025
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Abstract
Introduction: Neonatal sepsis is a severe and life-threatening condition caused by pathogens in the systemic circulation within the first 28 days of life. The classical definition of neonatal sepsis implies positive central cultures, but recent findings discuss culture-negative sepsis (clinical sepsis associated with [...] Read more.
Introduction: Neonatal sepsis is a severe and life-threatening condition caused by pathogens in the systemic circulation within the first 28 days of life. The classical definition of neonatal sepsis implies positive central cultures, but recent findings discuss culture-negative sepsis (clinical sepsis associated with laboratory findings). Since infected neonates initially express few non-specific clinical signs and there are unreliable biochemical markers to identify sepsis in the early stages, it is essential to improve the accuracy of diagnosis and reduce unnecessary antibiotic exposure. Objective: Our study aims to assess the influence of risk factors and the utility of currently used biomarkers in culture-negative neonatal early-onset sepsis (CN-EOS). Materials and methods: We performed a retrospective study at Bucharest University Hospital, which included 131 preterm and term newborns at risk for EOS admitted in the Neonatal Intensive Care Unit (NICU) over 12 months. The neonates included were classified into two groups: confirmed negative-culture early-onset sepsis (CN-EOS) and suspected early-onset sepsis (S-EOS). Patients from both groups received antibiotic therapy from the first day of life; the type and duration of antibiotic therapy were different in the two groups. For all the patients, we measured C-reactive protein (CRP), procalcitonin (PCT) and white blood count (WBC) at birth and after 72 h, tested blood culture in the first 24 h of life and correlated the results with clinical signs and prenatal risk factors. Categorical variables were presented as frequencies and percentages, while the continuous variables were the mean and the standard deviation. The differences between the continuous variable groups were determined by Student’s t-test or the Mann–Whitney U test, whereas for the categorical variables, the Chi-square test (X2) was employed. The performance of laboratory biomarkers (CRP and PCT) in diagnosing confirmed EOS was calculated. All the tests were statistically significant at a p-value < 0.05. Results: The findings support the significance of low birth weight and gestational age and low Apgar scores as potential indicators for EOS; PROM diagnosed with chorioamnionitis and smoking during the pregnancy were also important predictive risk factors. Respiratory signs, such as apnea and respiratory distress syndrome, were most encountered in the clinical evaluation of infants with CN-EOS. Inflammatory markers were inconsistent in CN-EOS cases, proving that they are not reliable enough for initiating, continuing or stopping antibiotic therapy. Conclusions: Culture-negative neonatal sepsis remains a significant challenge for the neonatologist, since the time elapsed between the moment sepsis is suspected and the initiation of empirical therapy can make the difference between survival and death. Continued efforts are needed to develop more reliable and effective diagnostic tools for timely and appropriate intervention. Full article
(This article belongs to the Section Pediatric Infectious Diseases)
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