Search Results (39)

Background and Objectives: Postspinal hypotension (PSH) remains a common complication of cesarean delivery under spinal anesthesia. Simple prespinal predictors may assist in identifying patients at increased risk. This study evaluated the associations of shock index (SI), modified shock index (MSI), diastolic shock index (DSI), and right internal jugular vein collapsibility index (RJV-CI) with postspinal hypotension (PSH). Materials and Methods: This prospective observational study included term parturients undergoing elective cesarean delivery under spinal anesthesia. Prespinal SI, MSI, DSI, and RJV-CI were measured before intrathecal injection. PSH was defined as systolic arterial pressure <90 mmHg or a reduction of ≥30% from baseline within 15 min after intrathecal injection. Receiver operating characteristic (ROC) analyses were performed for individual predictors. Three logistic regression models combining RJV-CI with SI, MSI, or DSI were evaluated using bootstrap internal validation. Results: Of 80 enrolled patients, 76 were included in the final analysis; 36 (47.4%) developed PSH. SI, MSI, DSI, and RJV-CI were significantly higher in the PSH group than in the non-PSH group. The areas under the ROC curve (AUCs) were 0.757 for SI, 0.747 for MSI, 0.693 for DSI, and 0.709 for RJV-CI. In multivariable models, RJV-CI remained significantly associated with PSH after adjustment for the respective shock index. The model combining RJV-CI and SI showed the highest apparent AUC (0.790; 95% confidence interval, 0.688–0.886) and an optimism-corrected AUC of 0.775. The RJV-CI plus MSI model showed an optimism-corrected AUC of 0.774. Conclusions: Prespinal SI, MSI, DSI, and RJV-CI were associated with PSH in this cohort. Models combining RJV-CI with SI or MSI showed numerically higher discrimination than the individual predictors. The derived cutoff values should be considered exploratory and require external validation before routine clinical use. Full article

Background: This study aimed to investigate the association of contrast extravasation (EV) detected on contrast-enhanced computed tomography (CE-CT) with the clinical characteristics, management, and outcomes of patients with postpartum hemorrhage (PPH). Methods: We retrospectively analyzed 51 patients with PPH who underwent CE-CT between August 2013 and July 2024. Patients were classified into EV (−) group (n = 28) and EV (+) group (n = 23). Baseline characteristics, management strategies, and clinical outcomes were compared. Results: The proportion of patients with a shock index (SI) ≥ 1.0 was significantly higher in the EV (+) group (10.7% vs. 39.1%, p = 0.017). Surgical intervention was more frequently required in the EV (+) group (10.7% vs. 56.5%, p = 0.001), whereas conservative management alone was more frequently successful in the EV (−) group (89.3% vs. 43.5%, p = 0.001). The EV (+) group showed higher rates of massive blood loss (> 2000 mL, 3.6% vs. 34.8%, p = 0.009), longer hospital stays (4.61 ± 2.61 vs. 6.88 ± 3.78 days, p = 0.034), and more frequent intensive care unit (ICU) admission (10.7% vs. 34.8%, p = 0.039). Patients in the EV (+) group had higher transfusion requirements (p < 0.005) and increased rates of disseminated intravascular coagulation (7.1% vs. 30.4%, p = 0.032). Conclusions: The presence of EV on CE-CT in PPH was associated with more severe clinical features, including greater transfusion requirements, increased rates of surgical intervention, ICU admission, and disseminated intravascular coagulation (DIC). Additionally, a higher proportion of patients with EV had a shock index ≥ 1.0, indicating early hemodynamic compromise. Full article

Background: This study aimed to compare the prognostic value of three surrogate insulin resistance (IR) markers for predicting 360-day mortality in critically ill patients with ischemic stroke (IS): the triglyceride–glucose (TyG) index, TyG–shock index (TyG-SI), and TyG–lactate (TyG-Lac). Methods: The study population comprised critically ill IS patients identified from the Medical Information Mart for Intensive Care (MIMIC) IV database. The main outcome was 360-day mortality. We employed multiple analytical approaches to examine relationships between the three biomarkers and mortality outcomes, including multivariable Cox proportional hazards models (Cox models), Kaplan–Meier survival analysis, and restricted cubic spline (RCS). Furthermore, receiver operating characteristic (ROC) curve analyses were conducted to assess the predictive capacity of these three indices. We performed ROC analyses to evaluate whether the IR index improved the discriminatory ability of a base model that included baseline variables significantly different between survivors and non-survivors. Results: Altogether, 812 patients with IS were included in the analysis. In Cox proportional hazards models, the TyG index was independently associated with higher 360-day mortality (HR, 1.68; 95% CI, 1.52–1.76). Similarly, both TyG-SI and TyG-Lac indices showed significant associations with 360-day mortality, with the HR (95% CI) of 1.24 (1.05–1.38) and 1.11 (1.08–1.23), respectively. Kaplan–Meier survival curves showed a progressive elevation in cumulative 360-day mortality across ascending quartiles of each index (TyG, TyG-SI, and TyG-Lac). ROC curve analysis revealed relatively better discriminatory ability of the TyG-SI compared to TyG and TyG-Lac for all-cause 360-day mortality prediction (area under the curve: 0.605 [0.578–0.623] vs. 0.566 [0.532–0.592] vs. 0.587 [0.532–0.614]). Furthermore, incorporation of either the TyG-SI or TyG index modestly improved the 360-day mortality prognostic accuracy of the base model (area under the curve [AUC], 0.701 for the base model vs. 0.723 for the base model + TyG-SI vs. 0.716 for base model + TyG index). Conclusions: When analyzed as continuous variables, each of the three indices demonstrated significant associations with 360-day mortality risk of critically ill IS populations. Moreover, both TyG-SI and TyG can improve the 360-day mortality predictive accuracy of the base model. Among the three indices, TyG-SI showed comparatively better discriminatory performance; however, the magnitude of AUC improvement was modest, and its clinical utility should be interpreted cautiously pending external validation. Full article

Introduction: Currently, REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is an emerging technique for resuscitation in patients presenting severe pathology in hemodynamic shock refractory to conventional treatments. The REBOA technique consists of inserting a balloon through the femoral artery to temporarily occlude the aorta and thus control massive bleeding and improve perfusion of vital organs in critical situations such as hemorrhagic shock. Although it is not a definitive technique, its use buys time before the implementation of a definitive treatment when possible. This makes REBOA an ideal technique for the philosophy of out-of-hospital emergency services and more particularly in the HEMS (Helicopter Emergency Medical Service) environment. On the other hand, REBOA has been postulated as one of the basic pillars in the resuscitation of severe trauma patients with hemorrhagic shock and of the doctrine of damage-control resuscitation in non-compressible torso and lower limb hemorrhage. Objective: To evaluate the potential feasibility of REBOA implementation in patients attended by HEMS teams in Castilla-La Mancha, Spain. Method: A retrospective observational study was conducted analyzing medical and nursing reports from HEMS units between 1 January and 31 December 2023. A statistical study of the variables collected was carried out using statistical techniques appropriate to the pre-specified study variables. A descriptive analysis of the population was performed. Frequency results are expressed in absolute terms, as percentages and confidence intervals. Continuous variables are expressed as mean (SD) and median (range) according to normality test (Kolmogorov–Smirnov test). For the study of the relationship between the different variables, Chi-square or Analysis of Variance is used if they are parametric. Descriptive and inferential statistics were performed using SPSS v24. Results: A total of 103 patients (72.81% men, mean age 57.7 years) were identified as potential REBOA candidates. On arrival of the emergency services the mean SI (shock index) of the patients was 1.36 (SD +/− 0.380). On arrival at the hospital, the mean SI was 1.25 (SD +/− 0.601). Of the series, 57 (55.33%) patients suffered cardiorespiratory arrest (CRA) at some point during pre-hospital care. Of the total number of patients, 38 were patients presenting severe trauma criteria (characterized by life-threatening injuries, with RTS score ≤ 11, shock index > 0.9, or ISS ≥ 16, indicating severe physiological or anatomical alterations), of which 26 (68.4%) did not go into CRA, while 12 (31.6%) did. Of the total number of patients, 65 (63.1%) did not meet severe trauma criteria, but did present medical criteria for REBOA placement, of which 55 (53.4%) were patients who at some point during attendance presented CRA. Although the shock index showed a slight decrease after healthcare without statistical significance or relevant correlation, a highly significant association was observed between severe trauma and cardiorespiratory arrest (p < 0.001). Conclusions: It could be affirmed that it may have been feasible to implement REBOA in 4.47% (103) of the patients attended by the HEMS healthcare team of Castilla-La Mancha. This could help to reduce the morbimortality and mortality of critical patients in medical helicopters. More studies are needed to corroborate this assertion. Full article

Background and Objectives: Older adults with ST-segment elevation myocardial infarction (STEMI) experience disproportionately high mortality despite advances in reperfusion therapy. The Shock Index (SI) and Age–Shock Index (ASI) offer rapid hemodynamic assessment but do not address hypoxia. The Hypoxia–Age–Shock Index (HASI), which incorporates oxygen saturation (SpO₂), may improve early mortality prediction in geriatric STEMI. Materials and Methods: This retrospective cohort study included adult STEMI patients receiving primary percutaneous coronary intervention (PCI) at a tertiary center from 2019 to 2023. A total of 711 patients were analyzed, including 254 aged ≥65 years. SI, ASI, and HASI were calculated using triage vital signs prior to intervention. The primary outcome was in-hospital mortality. Thirty-day mortality was analyzed as a pre-specified secondary endpoint using Kaplan–Meier survival analysis and multivariable Cox regression. Discrimination was assessed using ROC curves with pairwise AUC comparison by DeLong’s test. Results: Elderly patients showed higher creatinine and troponin T levels, lower hemoglobin, and elevated ASI and HASI values (all p < 0.001). They had increased rates of cardiogenic shock (26.8% vs. 14.0%), major adverse events (26.0% vs. 10.1%), and in-hospital mortality (9.4% vs. 3.7%, p = 0.003). Age ≥ 65 years independently predicted 30-day mortality (adjusted HR 2.59, 95% CI 1.34–5.04). Among indices, HASI demonstrated the highest discriminative performance (AUC 0.703 in elderly; 0.743 in younger patients). Conclusions: In geriatric STEMI, HASI demonstrated numerically higher discriminative performance for in-hospital mortality compared with SI and ASI, supporting its use as a simple and rapid triage tool. Full article

Background and Objectives: The study aimed to evaluate the predictive significance of Shock Indices and induction agents in predicting the risk of Peri-Intubation Cardiovascular Collapse (PIC) during intubation in the ICU. Materials and Methods: A total of 130 patients were analyzed in the study after dividing them into 2 groups based on the definition of PIC as Patients with PIC and Non-PIC Patients. PIC was defined as the detection of at least SBP < 65 mmHg measured at least once within 30 min after the intubation, SBP < 90 mmHg for 30 min, initiation of norepinephrine treatment, increasing the norepinephrine dose taken before the intubation, increasing SBP to >90 mmHg with >15 mL/kg crystalloid fluid infusion, or development of cardiac arrest. The relationship between Shock Index (SI), Diastolic Shock Index (DSI), Modified Shock Index (MSI), Age Shock Index (Age-SI), and induction agents (ketamine, propofol) and PIC was evaluated. Results: The PIC was detected in 62 patients (47.7%). Age-SI showed the highest predictive performance (AUC = 0.686, p < 0.001). Ketamine provided a protective effect (OR = 0.161, p = 0.003). Propofol (OR = 2.962, p = 0.048), age (OR = 1.065, p = 0.002), lactate (OR = 1.265, p = 0.047), and DSI (OR = 2.300, p = 0.037) were identified as independent risk factors. ICU mortality was significantly higher in the PIC group (74.2% vs. 20.6%, p < 0.001). Conclusions: Age, lactate, DSI, and Age-SI are valuable predictive parameters for PIC. Ketamine reduces the risk of PIC, while propofol increases it. These results support evidence-based risk assessment and induction agent selection in ICU intubation protocols. Full article

Background and Objective: Acute kidney injury (AKI) is a serious condition requiring prompt fluid resuscitation, yet both under- and over-treatment carry risks. Accurate volume assessment is essential, especially in emergency settings. The Inferior Vena Cava Collapsibility Index (IVCCI) is commonly used but has limitations. The Pleth Variability Index (PVI) offers a non-invasive alternative, though its role in AKI remains unclear. To compare the efficacy of the Pleth Variability Index (PVI) and Inferior Vena Cava Collapsibility Index (IVCCI) in assessing fluid responsiveness and predicting in-hospital mortality in patients with acute kidney injury. Materials and Methods: This prospective observational study enrolled 50 adult AKI patients presenting to a tertiary emergency department. All patients received sequential fluid resuscitation with 1000 mL and 2000 mL of isotonic saline. PVI, IVCCI, mean arterial pressure (MAP), peripheral oxygen saturation (SpO₂, perfusion index (PI), and shock index (SI) were recorded at baseline and after each fluid bolus. Changes in these parameters were analyzed to assess their utility in fluid responsiveness. Additionally, the prognostic value of baseline PVI for in-hospital mortality was investigated. Results: PVI demonstrated a significant and dose-responsive decrease following fluid administration, outperforming IVCCI, MAP, PI, SpO₂, and SI in sensitivity (p < 0.001). Baseline PVI values were significantly associated with mortality (AUC: 0.821, p < 0.001), whereas post-resuscitation PVI values showed no prognostic significance. IVCCI and PI showed comparable reliability but were less sensitive to incremental volume changes. Conclusions: PVI is a sensitive, non-invasive marker of fluid responsiveness in non-intubated AKI patients and may also serve as an early prognostic indicator. Its use in emergency departments could support fluid management decisions, but further large-scale, multicenter studies are needed to validate these findings. Full article

Background: Shock index (SI) is calculated by dividing heart rate (HR) by systolic blood pressure (sBP) and is a useful tool for predicting the prognosis of trauma patients. This study aimed to determine whether SI is useful in predicting mortality in patients undergoing emergency surgery for trauma. Methods: We analyzed 1657 patients who underwent emergency surgery for trauma. Patients were divided into SI < 1 and SI ≥ 1 groups and the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), revised trauma score (RTS), Korean Triage and Acuity Scale (KTAS), transfusion amount, and mortality were compared. Binary logistic regression analysis was performed to identify factors associated with mortality. Results: There were significant differences in GCS, ISS, RTS, and KTAS in the SI ≥ 1 group compared to the SI < 1 group (all p-values < 0.001). In the SI < 1 cohort, the mortality rate was 11% (144/1283), and in the SI ≥ 1 group the mortality rate was 33% (125/374) (p < 0.001). Age, GCS, ISS, SI ≥ 1, and KTAS were determined to be predictors of mortality by logistic regression analysis. In particular, SI ≥ 1 group members exhibited a high association with elevated mortality (OR, 2.498; 95% CI, 1.708–3.652; p < 0.01). Conclusions: Although SI alone has limitations in predicting the patient’s prognosis, patients with SI ≥ 1 upon arrival at the emergency room are associated with mortality of patients undergoing emergency surgery for trauma, along with already known trauma assessment systems such as GCS, ISS, and KTAS. Full article

Norepinephrine (NE) and dopamine (DA) are vasopressors used to treat vasodilatory shock for decades, and norepinephrine is considered the preferred first-line vasopressor in human patients. However, there is a dearth of evidence to support specific treatment recommendations for the management of hypotensive, non-anesthetized, fluid-replete dogs. The objective of this study was to compare the effects of NE and DA on systolic blood pressure (SBP), heart rate, and shock index (SI) when used as first-line vasopressors for the treatment of vasodilatory shock in dogs. Twenty-four client-owned canine patients of similar age, sex, and weight with hypotension necessitating vasopressor therapy were randomized to receive NE or DA; attending clinicians were blinded. Twenty-two dogs were included in the final analysis (10 in the NE group and 12 in the DA group). Seventy-seven percent of all dogs achieved normotension. In both groups, SBP increased significantly compared to baseline (p = 0.0004 in the NE group and p = 0.006 in the DA group). The SI also decreased in both groups compared to baseline values (p = 0.01 in the NE group and p = 0.01 in the DA group). The heart rate in the NE group was higher than in the DA group at timepoints 6–10 (p = 0.023). Both NE and DA cause an increase in blood pressure and a decrease in SI in dogs with vasodilatory hypotension. Further investigation is warranted to determine if there are differences between NE and DA or the requirement for a second vasopressor, occurrence of arrhythmias, length of stay, and survival. Full article

Background: In trauma, the shock index (SI) is commonly used to assess the presence of significant blood loss. Prior studies have shown that the SI has a fair predictive ability for clinical outcomes such as massive transfusion (MT) or mortality in adult trauma patients. We hypothesized that the relatively lower predictive power of the SI in older adult patients compared to that of younger adult patients results in the overall fair predictive ability of the SI for clinical outcomes in adult trauma patients. Methods: This retrospective observational study analyzed adult trauma patients who presented to a single regional trauma center between 2019 and 2023, categorizing them into younger (18–64 years) and older (≥65 years) cohorts. The association between SI and MT was evaluated using simple logistic regression, while the modifying effect of age on this association was evaluated through an interaction model. The predictive performance was compared between the groups using the area under the receiver operating characteristic curve (AUC). Age-stratified AUC trends were visualized using cubic spline analysis. Results: A total of 2404 trauma patients met the inclusion criteria, including 1531 younger adults and 873 older adults. The SI was identified as an independent predictor of MT, with a stronger association in younger adults. The AUC for predicting MT was significantly higher in younger adults compared to older adults (0.801 vs. 0.666; p < 0.001), with optimal SI cut-off values of 1.18 and 0.88, respectively. Age-stratified analysis showed the highest AUC in the 41–50 age group (AUC 0.880; 95% CI, 0.836–0.916) and the lowest in the 71–80 age group (AUC 0.624; 95% CI, 0.573–0.674). Conclusions: The predictive performance of the SI for MT was influenced by age, demonstrating a lower predictive ability in older adult patients compared to younger adults. Full article

Background: The identification of the optimal management for blunt splenic trauma—angioembolization (AE), splenectomy, or observation—remains a challenge. This study applies Optimal Policy Trees (OPT), an artificial intelligence (AI) model, to prescribe appropriate management and improve in-hospital mortality. Methods: OPTs were trained on patients with blunt splenic injuries in the ACS-TQIP 2013–2019 to prescribe one of the three interventions: splenectomy, angioembolization (AE), or observation. Prescriptive trees were derived in two separate patient cohorts: those who presented with a systolic blood pressure (SBP) < 70 mmHg and those with an SBP ≥ 70 mmHg. Splenic injury severity was graded using the American Association of Surgical Trauma (AAST) grading scale. Counterfactual estimation was used to predict the effects of interventions on overall in-hospital mortality. Results: Among 54,345 patients, 3.1% underwent splenic AE, 13.1% splenectomy, and 83.8% were managed with observation. In patients with SBP < 70 mmHg, AE was recommended for shock index (SI) < 1.5 or without transfusion, while splenectomy was indicated for SI ≥ 1.5 with transfusion. For patients with SBP ≥ 70 mmHg, AE was recommended for AAST grades 4–5, or grades 1–3 with SI ≥ 1.2; observation was recommended for grades 1–3 with SI < 1.2. Predicted mortality using OPT-prescribed treatments was 18.4% for SBP < 70 mmHg and 4.97% for SBP ≥ 70 mmHg, compared to observed rates of 36.46% and 7.60%, respectively. Conclusions: Interpretable AI models may serve as a decision aid to improve mortality in patients presenting with a blunt splenic injury. Our data-driven prescriptive OPT models may aid in prescribing the appropriate management in this patient cohort based on their characteristics. Full article

In recent years, industrial explosion accidents are frequent, causing serious negative influences on society. Mechanical shock waves, as a typical destructive factor in explosion accidents, can cause serious personal injury and building damage. In addition, actual explosion accidents usually involve heat sources, harming protective materials and personnel. In this study, we designed SiO₂-aerogel-modified polyurea and studied the effects of manufacturing pressure process and the concentration of SiO₂ aerogel on the mechanical shock wave mitigation and thermodynamic properties of the modified polyurea. The results show that the addition of SiO₂ aerogel can improve the mechanical shock wave mitigation performance of polyurea. The maximum peak overpressure and acceleration mitigation rate of the material has reached 17.84% and 62.21%, respectively. The addition of SiO₂ aerogel helps to reduce the thermal conductivity of materials and improve the thermal insulation performance, and the atmospheric pressure process is more conducive to improving the thermal insulation performance of materials. The minimum thermal conductivity of the material has reached 0.14174 W/m·K, which is 45.65% lower than that of pure polyurea. The addition of SiO₂ aerogel has different effects on the limiting oxygen index (LOI) of polyurea. Using a vacuum process, the LOI value increased with the increase in the SiO₂ aerogel concentration, while using atmospheric pressure, the LOI value increased but is always lower than 21% and lower than pure polyurea. Thermogravimetric analysis showed that the addition of SiO₂ aerogel under the vacuum process was helpful to improve the thermal stability of materials. However, atmospheric pressure would disrupt the thermal stability, manifested in a decrease in peak degradation temperature, an increase in peak degradation rate, and a decrease in residual mass. Full article

Background and Objectives: Acute heart failure (AHF) is a life-threatening condition frequently encountered in the emergency department (ED). Identifying reliable prognostic indicators for in-hospital mortality is crucial for risk stratification and the appropriate management of AHF patients. This study aimed to assess the most effective method for predicting in-hospital mortality among various physiological parameters in patients with AHF presenting to the ED. Additionally, the study evaluated the effectiveness of the RAM index—respiratory rate (RR), age, and mean arterial pressure (MAP)—derived from the shock index (SI) by replacing heart rate with RR, as a novel prognostic tool. This was compared with the SI and its other derivatives to predict in-hospital mortality in adult patients with AHF presenting to the ED. Materials and Methods: This is a retrospective study conducted in the ED of an urban medical center, enrolling adult patients with signs and symptoms of AHF, who met the epidemiological diagnosis criteria, between January 2017 and December 2021. Baseline physiological parameters, including the RR, heart rate, systolic blood pressure, and diastolic blood pressure, were recorded upon ED admission. The RAM index was calculated as the RR multiplied by the age divided by the MAP. Statistical analysis was performed, including univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: A total of 2333 patients were included in the study. A RAM index > 18.6 (area under ROC curve (AUROC): 0.81; 95% confidence interval (CI): 0.79–0.83) had a superior mortality discrimination ability compared to an SI > 0.77 (AUROC: 0.75; 95% CI: 0.72–0.77), modified shock index > 1.11 (AUROC: 0.75; 95% CI: 0.73–0.77), age shock index > 62.7 (AUROC: 0.74; 95% CI: 0.72–0.76), and age-modified shock index > 79.9 (AUROC: 0.75; 95% CI: 0.73–0.77). A RAM index > 18.6 demonstrated a 7.36-fold higher risk of in-hospital mortality with a sensitivity of 0.80, specificity of 0.68, and negative predictive value of 0.97. Conclusions: The RAM index is an effective tool to predict mortality in AHF patients presenting to the ED. Its superior performance compared to traditional SI-based parameters suggests that the RAM index can aid in risk stratification and the early identification of high-risk patients, facilitating timely and aggressive treatment strategies. Full article

Background: The respiratory adjusted shock index (RASI) is a risk score whose usefulness in patients with sepsis and trauma has previously been reported. However, its relevance in elderly emergency patients with medical diseases is yet to be clarified. This study assessed the usefulness of the RASI, which can be evaluated without requiring special equipment, to provide objective and rapid emergency responses. Methods: In this retrospective study, we recruited patients with medical diseases, aged 65 years or older, who were transported to the emergency room from Tokushima Prefectural Kaifu Hospital and underwent arterial blood gas testing from 1 January 2022 to 31 December 2023. We investigated the association of the RASI with other indices, including the lactate level, National Early Warning Score 2 (NEWS2), Shock Index (SI), Sequential Organ Failure Assessment (SOFA) score, quick SOFA (qSOFA) score, and systemic inflammatory response syndrome (SIRS). Results: In this study, we included 260 patients (mean age, 86 years), of whom 234 were admitted to the hospital; 27 and 49 patients died within 7 and 30 days of admission, respectively. The RASI was positively correlated with the lactate level, NEWS2, SI, and increase in the SOFA score (p < 0.001). The RASI was higher in patients with a SIRS or qSOFA score ≥ 2 than in those without (p < 0.001). It predicted death within 7 and 30 days of admission with an area under the curve (AUC) of 0.80 (95% confidence interval [CI]: 0.73–0.87), sensitivity of 96.3%, and specificity of 53.6% when the cutoff value was set to 1.58 and with an AUC of 0.73 (95% CI: 0.66–0.81), sensitivity of 69.4%, and specificity of 70.6% when the cutoff value was set to 1.83, respectively. Conclusions: The RASI is a simple indicator that can be used for predicting in-hospital outcomes in elderly emergency patients with medical diseases. Larger prospective studies based on this study are needed. Full article

Background and Objectives: In patients with urolithiasis-related obstructive pyelonephritis (UROP), sepsis represents a critical and concerning complication that can substantially increase the mortality rate. This study aimed to identify the risk factors for sepsis in UROP patients and to develop a predictive nomogram model. Materials and Methods: We analyzed data from 148 patients who met the UROP criteria and were admitted to Chang Gung Memorial Hospital between 1 January 2016 and 31 December 2021. The primary outcome evaluated was the incidence of sepsis, as defined by the most recent Sepsis-3 guidelines. To identify potential risk factors for sepsis, we employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression technique. Subsequently, we utilized multivariable logistic regression to construct the predictive model. Results: There was a total of 102 non-sepsis cases and 46 sepsis cases. Risk factors for sepsis in multivariable analysis were a history of diabetes mellitus (DM) (OR = 4.24, p = 0.007), shock index (SI) (×10⁻¹) (OR = 1.55, p < 0.001), C-reactive protein (CRP) (mg/dL) (OR = 1.08, p = 0.005), and neutrophil to lymphocyte ratio (NLR) (×10) (OR = 1.58, p = 0.007). The nomogram exhibited an area under the receiver operating characteristic curve of 0.890 (95% CI 0.830–0.949). Conclusions: Our study demonstrated that patients with UROP who have DM, higher SI, higher NLR, and elevated CRP levels are significantly more likely to develop sepsis. These insights may aid in risk stratification, and it is imperative that clinicians promptly initiate treatment for those identified as high risk. Full article