Search Results (431)

Background: This study aimed to determine the incidence of refeeding hypophosphatemia (RH) in critically ill surgical patients admitted to the surgical intensive care unit, to identify associated risk factors, and to evaluate its impact on clinical outcomes. Methods: This prospective observational study included 135 patients admitted to the general surgery ICU for ≥48 h, with 109 included in the final analysis. Clinical, nutritional, and laboratory data from the first five ICU days were collected and evaluated. According to the baseline phosphorus level, a 10–20% decrease was classified as mild RH, a 20–30% decrease as moderate RH, and a decrease of more than 30% as severe RH. Results: Serum phosphorus levels over the first five days were 3.89 ± 1.5, 3.44 ± 1.6, 3.20 ± 1.6, 3.13 ± 1.7, and 3.35 ± 1.8 mg/dL, respectively, with the lowest level on Day 4. The overall RH incidence was 76% (11% mild, 11% moderate, 54% severe). In multivariable analysis, lower albumin, decreased HCO₃ and higher WBC were associated with RH. Reoperation (18%) and shock (14%) were the most common complications. Mechanical ventilation was required in 62% of patients. Median ICU stay was 8 days, and ICU mortality was 22%. Conclusion: Refeeding hypophosphatemia is highly prevalent among critically ill surgical patients, with more than half of affected patients developing severe hypophosphatemia. Higher disease severity, hypoalbuminemia, and vasopressor use were identified as significant risk factors for RH. Full article

Background/Objectives: Frailty is a validated predictor of waitlist mortality and perioperative risk in liver transplant candidates, but its association with early post-transplant outcomes in large real-world cohorts remains incompletely characterized. This study evaluated the association between administratively defined pre-transplant frailty and early clinical outcomes following liver transplantation. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Research Network. Adults undergoing first-time isolated liver transplantation through February 2026 were included. Frailty was identified using ICD-10-CM codes for frailty, sarcopenia, cachexia, weakness, abnormal gait/mobility, or reduced mobility documented within 12 months before transplantation; patients coded only for nonspecific weakness were excluded from the frailty cohort. Patients underwent 1:1 propensity score matching using 18 baseline covariates, including demographics, comorbidities, laboratory values, albumin, and MELD-Na. The primary outcome was all-cause mortality at 7, 30, and 90 days. Secondary outcomes included acute kidney injury, prolonged mechanical ventilation, vasopressor requirement/hemodynamic instability, renal replacement therapy, ICU and hospital length of stay, and 90-day readmission. Sensitivity analyses used a restrictive ≥ 2-code frailty definition and substituted MELD 3.0 for MELD-Na in the propensity model. Results: Among 4860 eligible recipients, 742 had administratively defined frailty and 4118 did not. After matching, 730 patients remained in each group with well-balanced covariates. Administratively defined frailty was associated with higher mortality at 7, 30, and 90 days, with numerically smaller relative risks at later time points. It was also associated with higher risks of acute kidney injury, prolonged mechanical ventilation, vasopressor requirement/hemodynamic instability, renal replacement therapy, longer ICU and hospital stays, and 90-day readmission. Findings were directionally consistent in both sensitivity analyses. Etiology-stratified analyses were exploratory and showed no statistically significant heterogeneity across liver disease etiologies. Conclusions: In this large propensity-matched multicenter cohort, administratively defined pre-transplant frailty was associated with worse early outcomes after liver transplantation. Because frailty and several outcomes were identified using structured EHR and administrative data, findings should be interpreted as associative and hypothesis-generating. Prospective studies using validated frailty instruments and granular donor, intraoperative, and center-level variables are needed to confirm these findings. Full article

Background: The pan-immune–inflammation (PIV) score is a hematological index derived from neutrophil, platelet, monocyte and lymphocyte counts. It has been demonstrated that it has high prognostic value in oncological patients. The aim of this study was to evaluate the association between PIV and 28-day mortality in elderly (≥65 years) critically ill patients admitted to the intensive care unit (ICU) with a diagnosis of sepsis. Methods: This single-centre retrospective study included 96 patients aged ≥65 years who were admitted to the ICU with a diagnosis of sepsis according to the Sepsis-3 criteria between 15 July 2024 and 15 July 2025. Patients were divided into low- and high-PIV groups based on the median PIV. Cox proportional hazards regression analysis and Kaplan–Meier survival analysis were performed. Results: The overall 28-day mortality rate was found to be 55.2% (n = 53). The median PIV was 866.58 (IQR: 497.34–1978.43). The PIV was shown not to be a significant predictor of 28-day mortality (AUC: 0.550; p = 0.400). No difference in survival was observed between the low- and high-PIV groups in the Kaplan–Meier analysis (log-rank p = 0.662). In multivariate Cox regression, high creatinine (HR: 2.683; p < 0.001), high calcium (HR: 2.312; p = 0.004), a low partial thromboplastin time (HR: 0.396; p = 0.005) and a requirement for vasopressors (HR: 2.225; p = 0.025) were identified as independent predictors of mortality. In the Kaplan–Meier analysis for 28-day survival, chronic obstructive pulmonary disease (p = 0.023) and chronic renal disease (p = 0.034) were found to be significantly associated with poorer survival. Conclusions: The PIV is unable to predict 28-day mortality in elderly critically ill patients diagnosed with sepsis. This finding suggests that immunosenescence and inflammaging reduce the predictive power of composite hematological indices. Markers of organ dysfunction, coagulopathy and hemodynamic instability remain more reliable prognostic indicators in geriatric patients with sepsis. Full article

Background/Objectives: Sepsis is a dynamic clinical syndrome characterized by a rapidly evolving inflammatory response, where early identification of patients at risk for adverse outcomes remains a major challenge. While inflammatory biomarkers are widely used, their prognostic value at baseline is limited. This study aimed to evaluate whether early changes in inflammatory biomarkers, particularly the neutrophil-to-lymphocyte ratio (ΔNLR), provide additional prognostic value in predicting short-term outcomes in patients with sepsis. Methods: A retrospective longitudinal observational study was conducted, including 168 adult patients admitted with sepsis at a tertiary infectious diseases hospital. Inflammatory biomarkers (CRP, procalcitonin, leukocyte subpopulations, and NLR) were assessed at admission and at 48–72 h. Early changes (Δ values) were calculated and analyzed in relation to a composite adverse outcome, including ICU admission, vasopressor requirement, mechanical ventilation, or in-hospital mortality. Logistic regression and ROC curve analyses were used to evaluate predictive performance. Results: Patients with adverse outcomes had significantly higher baseline inflammatory markers and severity scores. Early reductions in CRP and NLR were more pronounced in survivors, whereas non-survivors showed persistently elevated or minimally decreasing values. In multivariate analysis, ΔNLR remained independently associated with in-hospital mortality (OR 0.91, 95% CI 0.84–0.98, p = 0.015), alongside Sequential Organ Failure Assessment (SOFA) score and septic shock. ΔNLR demonstrated better discriminative performance (AUC 0.74) compared to baseline markers and improved predictive accuracy when combined with SOFA score (AUC 0.81). Higher baseline NLR quartiles were associated with a stepwise increase in adverse outcomes. Conclusions: Early changes in inflammatory biomarkers, particularly ΔNLR, provide clinically relevant prognostic information beyond baseline measurements and severity scores in sepsis. Dynamic assessment of immune response may improve early risk stratification and support more individualized clinical decision-making. Full article

Background/Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) requires deep sedation, which is increasingly provided by anaesthetists using propofol-based regimens. However, real-world data on the incidence and predictors of anaesthesia-related adverse events (AEs) in this setting remain limited. The objective of this study was to assess the frequency, predictors, and clinical significance of adverse events during anaesthetist-delivered sedation for ERCP, based on a propofol regimen. Methods: We conducted a retrospective single-centre cohort study including 388 consecutive adult patients who underwent ERCP with propofol-based sedation administered by an anaesthetist. Adverse events were classified into three tiers: Tier 1 (any adverse physiological events, including haemodynamic and respiratory threshold crossings), Tier 2 (clinically significant events requiring pharmacological intervention—the primary regression outcome), and Tier 3 (high-severity outcomes, reported descriptively). Independent predictors of Tier 2 events were identified using multivariable logistic regression. Results: Adverse physiological events occurred in 220 patients (56.7%), the majority of which were minor and self-limiting. Clinically significant events requiring active pharmacological intervention occurred in 108 patients (27.8%), with vasopressor-treated hypotension as the predominant component (88 patients, 22.7%). All bradycardia episodes required atropine administration (34 patients, 8.8%), while desaturation was largely self-limiting, with advanced airway management required in only three patients (0.8%). High-severity outcomes were rare (9 patients, 2.3%). In multivariable logistic regression predicting clinically significant adverse events, propofol dose (OR 1.20 per 10 mg, 95% CI 1.14–1.25, p < 0.001), ASA physical status (OR 1.63, 95% CI 1.07–2.49, p = 0.024), age (OR 1.04 per year, 95% CI 1.01–1.07, p = 0.007), and ketamine use, confounded by indication (OR 2.18, 95% CI 1.14–4.14, p = 0.018) were independent predictors. Model fit was good (Nagelkerke R² = 0.43). Conclusions: Adverse events are frequent when defined using inclusive criteria, but are predominantly minor in severity. Propofol dose is the principal modifiable risk factor, demonstrating a consistent dose–response relationship across multiple adverse outcomes. ASA physical status and age further identify patients at increased risk of clinically significant events requiring intervention. Ketamine use was associated with increased odds of adverse events; however, this association is likely confounded by indication and should not be interpreted as a direct causal effect. These findings support stepwise propofol titration guided by clinical sedation assessment, with avoidance of anticipatory dosing particularly in older patients and those with higher ASA scores, and highlight the safety of anaesthetist-led sedation in this setting. Full article

Patients with left ventricular dysfunction undergoing cardiac surgery face a heightened risk of perioperative complications, including postcardiotomy shock (PCS). Conventional management with inotropes and vasopressors can exacerbate end-organ dysfunction, underscoring the need for alternative strategies. The planned use of mechanical circulatory support (MCS) devices, such as the Impella, offers a proactive approach to mitigating PCS in high-risk patients. This study presents our early experience at Johns Hopkins with planned Impella utilization in high-risk cardiac surgery. We detail our risk stratification methodology, patient selection criteria, and perioperative management strategies. Our proposed risk stratification scoring system incorporates surgical intent, preoperative myocardial function, anticipated postoperative course, and exit strategy to identify optimal candidates for perioperative MCS. We describe the intraoperative central placement technique for the Impella 5.5, perioperative management protocols—including anticoagulation strategies and weaning protocols—and postoperative device extraction. A retrospective review of our first 11 consecutive patients with severely reduced left ventricular ejection fraction (<30%) who underwent Impella-assisted cardiac surgery demonstrated favorable outcomes, with no postoperative mortality and a two-year follow-up. Our findings suggest that planned Impella use in high-risk cardiac surgery is both feasible and beneficial. However, further studies are necessary to validate these results, assess long-term outcomes, and evaluate cost-effectiveness. Full article

Background: The Endothelial Activation and Stress Index (EASIX) is a biomarker initially developed to predict survival in patients with acute graft-versus-host disease after allogeneic haemato-poietic stem cell transplantation and is regarded as a surrogate of endothelial dysfunction. This study aimed to evaluate whether EASIX reflects early hemodynamic instability and vasopressor requirement in critically ill patients. Methods: We retrospectively analysed 447 patients admitted to the intensive care unit (ICU) at the University Clinical Centre in Gdańsk. Illness severity scores—including the Simplified Acute Physiology Score II (SAPS II), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA)—and laboratory parameters, were collected at admission. EASIX, simplified EASIX (sEASIX), and modified EASIX (mEASIX) were calculated using established formulas. Vasopressor requirements, ex-pressed as norepinephrine equivalents (NEE), were recorded during the first 72 h. Statistical analyses included Spearman’s correlation, logistic regression, and receiver operating characteristic curve analysis. Results: In univariate analysis, EASIX was associated with ICU mortality (OR 1.333; 95% CI 1.135–1.576), but this association was not significant after adjustment. EASIX positively correlated with vasopressor requirements, severity scores (SOFA, SAPS II, APACHE II), and inflammatory and metabolic markers (PCT, CRP, lactate). It correlated with norepinephrine-equivalent doses within the first 48 h and moderately discriminated high-dose vaso-pressor use (>0.1 µg/kg/min). A weak negative correlation with ICU length of stay was observed. No association with age was found. Conclusions: EASIX is an age-independent marker associated with disease severity and early vaso-pressor burden in ICU patients. Rather than providing a direct measurement of endothelial function, it reflects a global signal of systemic stress and microvascular derangement and should be interpreted accordingly. Full article

Objectives: The aim of this study is to investigate the relationship between the lactate/albumin ratio (LAR) and 28-day mortality in gastric cancer patients undergoing monitoring in a postoperative intensive care unit due to reasons such as haemodynamic instability, need for vasopressor support, or intraoperative bleeding. Methods: This retrospective study included patients followed up at the tertiary surgical intensive care unit of Kastamonu University Faculty of Medicine between January 2020 and October 2025 who were diagnosed with histologically confirmed gastric adenocarcinoma and underwent total open surgery or subtotal gastrectomy + D2 lymphadenectomy. The patients were categorized into two groups: non-survivors within 28 days (n: 45) and survivors within 28 days (n: 139). Results: A total of 184 critically ill patients (110 males, 74 females) who underwent gastric adenocarcinoma surgery and were followed up in the surgical intensive care unit were included in this study. The mean age of the patients was 72.2 ± 11.3 years. Of these patients, 139 (75.5%) were survivors, and 45 (24.5%) were non-survivors. Albumin, the C-reactive protein (CRP)/albumin ratio, lactate, and the lactate/albumin ratio were associated with 28-day mortality. Receiver operating characteristic (ROC) analysis showed that the LAR (area under the curve (AUC): 0.839) was superior to the serum albumin (AUC: 0.736) and lactate levels (AUC: 0.796) for predicting 28-day mortality. The optimal cut-off value of the LAR was 0.82, and an LAR of ≥ 0.82 was shown to be a significant and independent prognostic factor for 28-day mortality in patients with stomach cancer in a critical postoperative condition (odds ratio (OR): 4.78, confidence interval (CI): 1.09–21.08, p = 0.0386). Conclusions: The lactate/albumin ratio is a prognostic parameter for 28-day mortality in critically ill postoperative gastric cancer patients. The optimal cut-off value for the lactate/albumin ratio is 0.82. Full article

Background/Objectives: Despite high recanalization rates associated with mechanical thrombectomy (MT), disability and death remain possible for many patients. Baseline stroke severity and reperfusion status predict outcomes; however, the influence of modifiable perioperative factors during general anesthesia (GA) remains unclear. We investigated actionable perioperative determinants of functional outcomes and 90-day mortality following MT under GA. Methods: We retrospectively analyzed 166 patients with acute ischemic stroke who underwent emergency MT with GA over 10 years (2014–2024). Poor functional outcomes were defined as a 90-day modified Rankin Scale score of 3–6, with all-cause 90-day mortality as the secondary endpoint. Independent predictors were identified using multivariable logistic regression, and discrimination was assessed using receiver operating characteristic analysis. Results: At 90 days, 56.6% of patients had poor functional outcomes, and mortality was 24.1%. Independent predictors of poor outcomes included preoperative hyperglycemia ≥ 140 mg/dL, vasopressor requirement, incomplete reperfusion, prolonged ventilator duration, and severe post-procedural neurological deficit. Optimal anesthetic induction dosing was strongly protective. Shorter groin puncture-to-recanalization time predicted better functional recovery. Mortality was associated with hyperglycemia, National Institutes of Health Stroke Scale ≥ 16, poor reperfusion, and prolonged ventilation. The models demonstrated excellent discrimination (area under the curve, 0.879 for poor outcomes; 0.923 for mortality). Perioperative physiological factors remained associated with outcomes independent of procedural success. Conclusions: Beyond technical success, perioperative physiological stability strongly influenced outcomes following MT under GA. Optimization of metabolic control, hemodynamic stability, procedural efficiency, and early ventilator liberation represents a clinically actionable strategy for improving neurological recovery and survival. Full article

Background/Objectives: Infective endocarditis (IE) carries substantial mortality, particularly in middle-income settings where patient profiles and microbial ecology differ from those of cohorts used to derive international prognostic scores. Syndrome-specific, locally grounded decision aids for empirical therapy are also scarce. We aimed to identify predictors of in-hospital mortality, externally evaluate the RiskE and ICE scores, and construct a Bayesian weighted-incidence syndromic combination antibiogram (WISCA) for IE. Methods: We conducted a retrospective cohort study of consecutive adults with definite or possible IE admitted between January 2019 and January 2026. Candidate predictors were screened in two phases, and a clinically specified model was estimated with maximum-likelihood and Firth penalization, with 1000-replicate bootstrap optimism correction. Calibration was assessed with bootstrap calibration plots and the Hosmer–Lemeshow test. Discrimination was compared against RiskE and ICE using DeLong’s test and reclassification metrics. For empirical coverage, we built a WISCA using identified pathogens, reporting both non-Bayesian bootstrap estimates and Bayesian hierarchical partial-pooling estimates with species- and antibiotic-level random intercepts; analyses were also stratified by IE type. Results: In-hospital mortality was 22.9% in a young cohort (median 37 years) characterized by high hemodialysis prevalence (47.4%), substantial right-sided IE (46.4%), and Staphylococcus aureus predominance (32%) with no methicillin-resistant isolates. Vasopressor-requiring shock (Firth OR 9.23, 95% CI 2.40–40.61) and acute heart failure (OR 10.01, 95% CI 2.78–41.07) were the strongest predictors; the final model achieved an AUC of 0.922 (optimism-corrected 0.908), significantly outperforming RiskE (0.598) and ICE (0.632). The Bayesian WISCA identified multiple carbapenem-sparing and anti-MRSA–sparing regimens with adequate coverage (≥80%), particularly for community-acquired IE, supporting stewardship-oriented empirical selection. Coverage was consistently lower in healthcare-associated IE. Conclusions: A parsimonious three-variable model provided strong, locally valid mortality prediction in this hemodialysis-predominant, MRSA-free cohort, substantially outperforming European-derived scores. External validation in independent cohorts is required before clinical adoption. The Bayesian WISCA demonstrated that adequate empirical coverage is achievable without routine broad-spectrum agents, offering institution-specific guidance for stewardship-compatible regimen selection; multicenter validation is warranted. Full article

Objective: This study evaluated the relationships between the development and clinical course of pressure injuries (PIs) and neurological status, nutritional risk, and laboratory parameters among patients admitted to a tertiary intensive care unit. Materials and Methods: The single-center, retrospective, observational study included 220 patients hospitalized in the intensive care unit for at least 5 days. On the day of admission, Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II), Braden, and Nutritional Risk Screening 2002 (NRS-2002) scores were assessed. Demographic characteristics, comorbidities, need for sedation and vasopressors, and laboratory parameters during the first 24 h (albumin, C-reactive protein, lactate, D-dimer) were analyzed. Factors independently associated with new PI development and clinical improvement were identified using binary logistic regression. Results: New PIs developed in 25% of patients. Patients with PI progression were older and had lower GCS and Braden scores, higher NRS-2002 scores, lower albumin levels, and higher D-dimer levels (p < 0.05). In multivariable analysis, low GCS (OR = 0.824), presence of comorbidity (OR = 2.327), and a high NRS-2002 risk level were independent predictors of new PI development. The model’s discriminative ability was acceptable (AUC = 0.756). Among patients with existing PIs, NRS-2002 score (OR = 0.450) and age (OR = 1.058) were independently associated with clinical improvement in an exploratory multivariable model. Conclusions: NRS-2002 was the only variable independently associated with both new PI development and the clinical improvement of existing lesions, underscoring the central role of nutritional risk assessment in ICU-based PI prevention and prognosis. Full article

Background/Objectives: Hypoalbuminaemia is a consistent predictor of mortality in sepsis; however, the temporal dynamics of albumin decline and its relationship with fluid exposure and early norepinephrine therapy remain incompletely characterised. Determining whether early norepinephrine use is associated with attenuation of albumin loss could inform fluid management strategies and identify therapeutic windows for combined vasopressor–albumin interventions. The study aimed to assess whether serum albumin trajectories in sepsis are associated with fluid exposure, modulated by early norepinephrine therapy, and related to 30-day mortality. Methods: We conducted a prospective longitudinal study of patients admitted to an intermediate care unit (IMCU) with community-acquired sepsis. Serum albumin concentrations, cumulative fluid balance (CFB), and vasopressor use were recorded during the first 5 days of hospitalisation. Longitudinal mixed-effects and segmented linear models assessed the association of CFB and vasopressor therapy with albumin trajectories. Lagged mediation modelling explored the potential mediating role of albumin in the association between fluid exposure and 30-day mortality. Results: A total of 389 patients with community-acquired sepsis were included. Thirty-day mortality was 18%. Mean serum albumin at baseline was 2.58 g/dL and declined early to 2.24 g/dL at 72 h. Serum albumin was inversely correlated with cumulative fluid balance over time (r ranging from −0.235 to −0.348; p < 0.001). In longitudinal models, each 1% increase in ΔCFB was associated with a −0.029 g/dL decrease in serum albumin (p < 0.001), supporting an independent effect of fluid exposure. Before norepinephrine initiation, the albumin slope was −0.043 g/dL per interval and was −0.008 g/dL after vasopressor initiation (interaction p = 0.012). Lower albumin concentrations at 72 h predicted 30-day mortality (OR 1.49 per 0.5 g/dL decrease), and serum albumin mediated 18.6% of the association between fluid exposure and mortality. Conclusions: Cumulative fluid exposure was associated with a progressive decline in serum albumin in patients with community-acquired sepsis. Early norepinephrine initiation was associated with attenuation of this trajectory, consistent with the hypothesis that vasopressor-guided haemodynamic stabilisation may limit fluid-associated albumin loss. Full article

Background/Objectives: Patients with adrenal insufficiency (AI) are at an increased risk of adverse events (AEs) during cardiovascular hospitalization. However, the association between AI and takotsubo cardiomyopathy (TCM) remains unclear. We investigated the association between AI and cardiovascular outcomes in patients with TCM. Methods: We analyzed data on patients with TCM included in the 2019 Nationwide Readmissions Database to compare in-hospital outcomes between patients with and without AI. The primary outcome measure was inpatient mortality. Secondary outcomes included the odds of all-cause 90-day readmission, acute kidney injury (AKI), mechanical ventilation use, vasopressor use, cardiogenic shock, length of stay (LOS), and total hospitalization charges (THC). Multivariate regression models were used to adjust for confounding variables. Results: Among 30,987 cases, 0.59% (n = 183) had concomitant AI. AI was associated with higher odds of in-hospital mortality (adjusted odds ratio [aOR] 3.32, 95% confidence interval [CI] 1.43–7.74, p = 0.005), cardiogenic shock (aOR 5.28, 95% CI 3.16–8.82, p < 0.001), mechanical ventilation use (aOR 3.20, 95% CI 1.78–5.74, p < 0.001), AKI (aOR 1.96, 95% CI 1.11–3.48, p = 0.021), vasopressor use (aOR 4.59, 95% CI 1.56–13.47, p = 0.006), longer LOS (6.84 vs. 3.67 days, p < 0.001), and higher THC ($97,419 vs. $54,574, p < 0.001). Additionally, AI was associated with lower odds of all-cause 90-day readmissions (aOR 0.44, 95% CI 0.25–0.79, p = 0.006). Conclusions: Among patients with TCM, AI was associated with higher odds of fatal and non-fatal adverse events. Further studies are required to confirm these findings and better understand how to improve outcomes in this high-risk population. Full article

Background/Objectives: Central line-associated bloodstream infections (CLABSIs) remain a leading healthcare-associated infection in intensive care units (ICUs), yet independent risk factors and evidence-based catheter duration thresholds have not been defined through analytical study designs in settings with endemic multidrug-resistant organisms (MDROs). Methods: A retrospective case–control study was conducted in the ICU of a tertiary teaching university hospital in western Türkiye (January 2019–December 2024). Cases (n = 74) were patients with confirmed CLABSIs per CDC/NHSN criteria; controls (n = 148) were randomly selected central venous catheter (CVC)-bearing patients without CLABSIs. A reduced multivariate logistic regression model (seven variables; events-per-variable ratio 10.6) identified independent risk factors. Results: In multivariate analysis, catheter duration (adjusted OR: 1.19 per day; 95% CI: 1.13–1.24; p < 0.001), renal replacement therapy (aOR: 3.66; 95% CI: 1.68–7.95; p = 0.001), vasopressor support (aOR: 3.04; 95% CI: 1.50–6.17; p = 0.002), APACHE-II score (aOR: 1.07 per point; 95% CI: 1.02–1.11; p = 0.002), lower Glasgow Coma Scale (aOR: 0.86 per point; 95% CI: 0.78–0.94; p = 0.002), mechanical ventilation (aOR: 2.48; 95% CI: 1.24–4.95; p = 0.010), and total parenteral nutrition (aOR: 2.33; 95% CI: 1.12–4.86; p = 0.024) were independently associated with CLABSI. The model demonstrated good discrimination (C-statistic: 0.864) and calibration (Hosmer–Lemeshow p = 0.425). Kaplan–Meier analysis showed CLABSI-free survival declining from 98.9% at day 7 to 42.9% at day 21 (log-rank p < 0.001); these within-study estimates reflect relative risk patterns given the artificial 1:2 case-to-control ratio. Receiver operating characteristic (ROC) analysis identified day 13 as an exploratory optimal cutoff (AUC: 0.818; 95% CI: 0.762–0.874; sensitivity: 77.0%; specificity: 74.3%). CLABSI-attributable ICU mortality was 20.3% (47.3% vs. 27.0%; p = 0.004). Late-onset CLABSIs (>10 days) were dominated by Gram-negative pathogens (68.3%) versus 35.7% in early-onset infections (Fisher’s exact p = 0.012), with Acinetobacter baumannii as the predominant organism (27.0%; 83.3% carbapenem-resistant). Conclusions: Each additional catheter-day is independently associated with a 19% increment in CLABSI odds, with an exploratory critical threshold at day 13 beyond which enhanced surveillance measures should be considered, pending external validation. Full article

Hemorrhagic shock remains one of the leading causes of preventable death for both civilian and military trauma. Fluid resuscitation is the primary treatment but requires constant monitoring, particularly for volume non-responsive patients susceptible to fluid overload, pulmonary edema, and other life-threatening conditions. To overcome fluid non-responsiveness, vasoactive drugs or vasopressors can be necessary adjuvants to fluid therapy but require tedious titrations that can be difficult to manage during mass-casualty situations. This study developed and evaluated automated closed-loop vasopressor controllers for hemorrhage scenarios. Ten physiological closed-loop controller (PCLC) configurations with different underlying functionalities were tuned to be either more aggressive or conservative to reach the target mean arterial pressure. A hardware-in-loop test platform with fluid-pressure responsiveness, derived from animal data, tested each controller across three different starting pressure scenarios. The platform successfully differentiated controller designs based on performance metrics. While some configurations overshot the target and others could not reach the target pressure, strong-performing PCLCs consistently reached and maintained the target quickly. Three candidate PCLCs outperformed the rest and will be evaluated across wider scenarios to develop a robust controller design. This work accelerates PCLC-driven vasopressor administration development, providing a necessary fluid resuscitation adjuvant for precise hemodynamic management in hemorrhagic trauma. Full article