BACKGROUND:Secondary screw perforation of the articular surface is one of the major complications after locking plate internal fixation of proximal humerus fracture,and cut-out screws can damage shoulder function by abrading the glenoid and causing impingement of the acromion.Therefore,accurate risk prediction has positive clinical significance.OBJECTIVE:To screen risk factors for secondary screw perforation after proximal humerus fracture plating by machine learning methods,and to develop and validate a risk prediction model that facilitates clinicians to identify and intervene in high-risk patients at an early stage.METHODS:Clinical data of 214 patients with proximal humerus fractures who underwent locking plate internal fixation from June 2013 to June 2022 were collected as a training group to establish the model,and 61 similar patients from another hospital in the same period were included in the external validation group.The patients were divided into secondary screw perforation and screw maintenance groups according to whether they developed secondary screw perforation after surgery.The training group used three machine learning algorithms,namely,random forest,support vector machine,and logistic regression,to construct the prediction model.The recursive feature elimination method was used,and 10-fold cross-validation resampling was used as the screening method for the variables,and the intersection of the variables that were included when the accuracy of the three models was the highest was taken as the highly correlated with the secondary screw perforation reliable risk variables.The dynamic predictive model was constructed by R language software and presented as a web calculator,and the model was internally and externally validated.The internal test of the model was conducted by the Bootstrap method with 1 000 resamples,and the area under the receiver operating characteristic curve,the calibration curve,and the clinical decision curve were used to evaluate the differentiation,calibration ability,and clinical application value of the model.The Youden index was used to determine the optimal risk threshold of the prediction model,according to which the patients in the external validation group were divided into high-and low-risk groups,and the stability and extensibility of the model were evaluated according to the accuracy of its risk prediction ability.RESULTS AND CONCLUSION:(1)The machine learning algorithm identified four risk variables that were highly correlated with secondary screw perforation,namely cortical support of the proximal medial humeral column,deltoid tuberosity index,fracture type,and postoperative reduction.(2)The constructed risk prediction model showed good discrimination and accuracy[area under the curve=0.874,95％confidence interval(0.827,0.922)],and the calibration curve showed good agreement between the model predicted risk and the actual occurrence risk.(3)The clinical decision curve suggested that the model had good clinical applicability when the probability of the risk threshold was in the 0.1-0.75 range.(4)A risk probability of 26％was the optimal threshold for model risk stratification,and the external validation group used model risk stratification to predict secondary screw perforation with an overall accuracy rate of 84％.(5)The risk prediction model has good accuracy and extrapolation,and may provide a basis for guiding clinical treatment.

BACKGROUND:Secondary screw perforation of the articular surface is one of the major complications after locking plate internal fixation of proximal humerus fracture,and cut-out screws can damage shoulder function by abrading the glenoid and causing impingement of the acromion.Therefore,accurate risk prediction has positive clinical significance.OBJECTIVE:To screen risk factors for secondary screw perforation after proximal humerus fracture plating by machine learning methods,and to develop and validate a risk prediction model that facilitates clinicians to identify and intervene in high-risk patients at an early stage.METHODS:Clinical data of 214 patients with proximal humerus fractures who underwent locking plate internal fixation from June 2013 to June 2022 were collected as a training group to establish the model,and 61 similar patients from another hospital in the same period were included in the external validation group.The patients were divided into secondary screw perforation and screw maintenance groups according to whether they developed secondary screw perforation after surgery.The training group used three machine learning algorithms,namely,random forest,support vector machine,and logistic regression,to construct the prediction model.The recursive feature elimination method was used,and 10-fold cross-validation resampling was used as the screening method for the variables,and the intersection of the variables that were included when the accuracy of the three models was the highest was taken as the highly correlated with the secondary screw perforation reliable risk variables.The dynamic predictive model was constructed by R language software and presented as a web calculator,and the model was internally and externally validated.The internal test of the model was conducted by the Bootstrap method with 1 000 resamples,and the area under the receiver operating characteristic curve,the calibration curve,and the clinical decision curve were used to evaluate the differentiation,calibration ability,and clinical application value of the model.The Youden index was used to determine the optimal risk threshold of the prediction model,according to which the patients in the external validation group were divided into high-and low-risk groups,and the stability and extensibility of the model were evaluated according to the accuracy of its risk prediction ability.RESULTS AND CONCLUSION:(1)The machine learning algorithm identified four risk variables that were highly correlated with secondary screw perforation,namely cortical support of the proximal medial humeral column,deltoid tuberosity index,fracture type,and postoperative reduction.(2)The constructed risk prediction model showed good discrimination and accuracy[area under the curve=0.874,95％confidence interval(0.827,0.922)],and the calibration curve showed good agreement between the model predicted risk and the actual occurrence risk.(3)The clinical decision curve suggested that the model had good clinical applicability when the probability of the risk threshold was in the 0.1-0.75 range.(4)A risk probability of 26％was the optimal threshold for model risk stratification,and the external validation group used model risk stratification to predict secondary screw perforation with an overall accuracy rate of 84％.(5)The risk prediction model has good accuracy and extrapolation,and may provide a basis for guiding clinical treatment.

Objective:To analyze the clinical characteristics of patients with Vibrio vulnificus infection, share diagnosis and treatment experience, and establish a rapid diagnosis procedure for this disease. Methods:This study was a retrospective case series study. From January 2009 to November 2022, 11 patients with Vibrio vulnificus infection who met the inclusion criteria were admitted to the Department of Burns and Wound Repair of Guangdong Provincial People's Hospital Affiliated to Southern Medical University. The gender, age, time of onset of illness, time of admission, time of diagnosis, route of infection, underlying diseases, affected limbs, clinical manifestations and signs on admission, white blood cell count, hemoglobin, platelet count, C-reactive protein (CRP), alanine transaminase (ALT), aspartate transaminase (AST), creatinine, procalcitonin, albumin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and blood sodium levels on admission, culture results and metagenomic next-generation sequencing (mNGS) results of pathogenic bacteria and the Vibrio vulnificus drug susceptibility test results during hospitalization, treatment methods, length of hospital stay, and outcomes of all patients were recorded. Comparative analysis was conducted on the admission time and diagnosis time of patients with and without a history of exposure to seawater/marine products, as well as the fatality ratio and amputation of limbs/digits ratio of patients with and without early adequate antibiotic treatment. For the survived patients with hand involvement, the hand function was assessed using Brunnstrom staging at the last follow-up. Based on patients' clinical characteristics and treatment conditions, a rapid diagnosis procedure for Vibrio vulnificus infection was established. Results:There were 7 males and 4 females among the patients, aged (56±17) years. Most of the patients developed symptoms in summer and autumn. The admission time was 3.00 (1.00, 4.00) d after the onset of illness, and the diagnosis time was 4.00 (2.00, 8.00) d after the onset of illness. There were 7 and 4 patients with and without a history of contact with seawater/marine products, respectively, and the admission time of these two types of patients was similar ( P>0.05). The diagnosis time of patients with a history of contact with seawater/marine products was 2.00 (2.00, 5.00) d after the onset of illness, which was significantly shorter than 9.00 (4.25, 13.00) d after the onset of illness for patients without a history of contact with seawater/marine products ( Z=-2.01, P<0.05). Totally 10 patients had underlying diseases. The affected limbs were right-hand in 8 cases, left-hand in 1 case, and lower limb in 2 cases. On admission, a total of 9 patients had fever; 11 patients had pain at the infected site, and redness and swelling of the affected limb, and 9 patients each had ecchymosis/necrosis and blisters/blood blisters; 6 patients suffered from shock, and 2 patients developed multiple organ dysfunction syndrome. On admission, there were 8 patients with abnormal white blood cell count, hemoglobin, and albumin levels, 10 patients with abnormal CRP, procalcitonin, and NT-proBNP levels, 5 patients with abnormal creatinine and blood sodium levels, and fewer patients with abnormal platelet count, ALT, and AST levels. During hospitalization, 4 of the 11 wound tissue/exudation samples had positive pathogenic bacterial culture results, and the result reporting time was 5.00 (5.00, 5.00) d; 4 of the 9 blood specimens had positive pathogenic bacterial culture results, and the result reporting time was 3.50 (1.25, 5.00) d; the mNGS results of 7 wound tissue/exudation or blood samples were all positive, and the result reporting time was 1.00 (1.00, 2.00) d. The three strains of Vibrio vulnificus detected were sensitive to 10 commonly used clinical antibiotics, including ciprofloxacin, levofloxacin, and amikacin, etc. A total of 10 patients received surgical treatment, 4 of whom had amputation of limbs/digits; all patients received anti-infection treatment. The length of hospital stay of 11 patients was (26±11) d, of whom 9 patients were cured and 2 patients died. Compared with that of the 6 patients who did not receive early adequate antibiotic treatment, the 5 patients who received early adequate antibiotic treatment had no significant changes in the fatality ratio or amputation of limbs/digits ratio ( P>0.05). In 3 months to 2 years after surgery, the hand function of 8 patients was assessed, with results showing 4 cases of disabled hands, 2 cases of incompletely disabled hands, and 2 cases of recovered hands. When a patient had clinical symptoms of limb redness and swelling and a history of contact with seawater/marine products or a pre-examination triage RiCH score of Vibrio vulnificus sepsis ≥1, the etiological testing should be initiated immediately to quickly diagnose Vibrio vulnificus infection. Conclusions:Vibrio vulnificus infection occurs most frequently in summer and autumn, with clinical manifestations and laboratory test results showing obvious infection characteristics, and may be accompanied by damage to multiple organ functions. Both the fatality and disability ratios are high and have a great impact on the function of the affected limbs. Early diagnosis is difficult and treatment is easily delayed, but mNGS could facilitate rapid detection. For patients with red and swollen limbs accompanied by a history of contact with seawater/marine products or with a pre-examination triage RiCH score of Vibrio vulnificus sepsis ≥1, the etiological testing should be initiated immediately to quickly diagnose Vibrio vulnificus infection.

BACKGROUND:Proximal humeral fracture in older adults is one of the three major osteoporotic fractures.Anatomic locking plate fixation is the first choice for most scholars to treat difficult-to-reduce and complex fracture types.However,the probability of reduction failure after the operation is high,which seriously affects patients'quality of life. OBJECTIVE:To investigate the correlation between deltoid tuberosity index and postoperative reduction failure of proximal humeral fractures in the elderly,analyze and filter preoperative independent risk factors for reduction failure of proximal humeral fractures in the elderly,and construct and verify the effectiveness of a clinical prediction model. METHODS:The clinical data of 153 elderly patients with proximal humeral fractures who met the diagnosis and inclusion criteria and received open reduction and locking plate surgery in Foshan Hospital of TCM from June 2012 to June 2021 were collected.The patients were divided into the reduction failure subgroup and the reduction maintenance subgroup.The independent risk factors were selected by multivariate Logistic regression analysis,and the nomogram was constructed by R language.After 1000 times of resampling by Bootstrap method,the Hosmer-Lemeshow goodness of fit correlation test,receiver operating characteristic curve,calibration curve,clinical decision,and influence curve were plotted to evaluate its goodness of fit,discrimination,calibration ability,and clinical application value.Fifty-five elderly patients with proximal humeral fractures from June 2013 to August 2021 were selected as the model's external validation group to evaluate the prediction model's stability and accuracy. RESULTS AND CONCLUSION:(1)Of the 153 patients in the training group,44 patients met reduction failure after internal plate fixation.The prevalence of postoperative reduction failure was 28.8%.Multivariate Logistic regression analysis identified that deltoid tuberosity index[OR=9.782,95%CI(3.798,25.194)],varus displacement[OR=4.209,95%CI(1.472,12.031)],and medial metaphyseal comminution[OR=4.278,95%CI(1.670,10.959)]were independent risk factors for postoperative reduction failure of proximal humeral fractures in older adults(P<0.05).(2)A nomogram based on independent risk factors was then constructed.The Hosmer-Lemeshow test results for the model of the training group showed that χ2=0.812(P=0.976)and area under curve=0.830[95%CI(0.762,0.898)].The calibration plot results showed that the model's predicted risk was in good agreement with the actual risk.The decision and clinical influence curves showed good clinical applicability.(3)In the validation group,the accuracy rate in practical applications was 86%,area under curve=0.902[95%CI(0.819,0.985)].(4)It is concluded that deltoid tuberosity index<1.44,medial metaphyseal comminution,and varus displacement were independent risk factors for reduction failure.(5)The internal and external validation of the risk prediction model demonstrated high discrimination,accuracy,and clinical applicability could be used to individually predict and screen the high-risk population of postoperative reduction failure of proximal humeral fractures in the elderly.The predicted number of patients at high risk is highly matched to the actual number of patients who occur when the model's threshold risk probability is above 65%,and clinicians should use targeted treatment.

BACKGROUND:Internal fixation and open reduction with locking plate is the main treatment for proximal humeral fractures with medial column instability.However,reduction failure is one of the main postoperative complications,and accurate risk factor assessment is beneficial for screening high-risk patients and clinical decision selection. OBJECTIVE:To construct four types of prediction models by different machine learning algorithms,compare the optimal model to analyze and sort the risk variables according to their weight scores on the impact of outcome,and explore their significance in guiding clinical diagnosis and treatment. METHODS:262 patients with proximal humeral fractures with medial column instability,aged(60.6±10.2)years,admitted to Foshan Hospital of Traditional Chinese Medicine between June 2012 and June 2022 were included.All patients underwent open reduction with locking plate surgery.According to the occurrence of reduction failure at 5-month follow-up,the patients were divided into a reduction failure group(n=64)and a reduction maintenance group(n=198).Clinical data of patients were collected,and model variables and their classification were determined.The data set was randomly divided into a training set and a test set according to a 7:3 ratio,and the optimal hyperparameters were obtained in the training set according to a 5-fold cross-over test.Four machine learning prediction models of logistic regression,random forest,support vector machine,and XGBoost were constructed,and the performance of different algorithms was observed in the test set using AUC,correctness,sensitivity,specificity,and F1 scores,so as to comprehensively evaluate the prediction performance of the models.The best-performing model was evaluated using SHAP to assess important risk variables and to evaluate its clinical guidance implications. RESULTS AND CONCLUSION:(1)There were significant differences between the two groups in deltoid tuberosity index,fracture type,fracture end with varus deformity before operation,fragment length of inferior metaphyseal of humerus,postoperative reduction,cortical support of medial column of proximal humerus,and insertion of calcar screw(P<0.05).(2)The best-combined performance of the four machine models was XGBoost.The AUC,accuracy,and F1 scores were 0.885,0.885,and 0.743,respectively;followed by random forest and support vector machine,with both models performing at approximately equal levels.Logistic regression had the worst combined performance.The SHAP interpretation tool was used in the optimal model and results showed that deltoid tuberosity index,medial humeral column cortical support,fracture type,fracture reduction quality,and the status of the calcar screw were important influencing fators for postoperative fracture reduction failure.(3)The accuracy of using machine learning to analyze clinical problems is superior to that of traditional logistic regression analysis methods.When dealing with high-dimensional data,the machine learning approach can solve multivariate interaction and covariance problems well.The SHAP interpretation tool can not only clarify the importance of individual variables but also obtain detailed information on the impact of dummy variables in each variable on the outcome.

A semi-supervised learning method based on multi-scale consistency and regional reliability perception is proposed to combine unlabeled data with a small amount of labeled data to achieve high-performance lung tumor segmentation tasks.A multi-scale consistency mean teacher framework is used to construct a multi-scale consistency loss and constrain the outputs in the mean teacher network to be consistent across multiple scales,so that the model learns richer consistency knowledge.In addition,a regional reliability perception scheme is adopted to make the knowledge exchange between consistency learning more efficient,enabling the model to learn more valid and reliable knowledge from unlabeled data.The evaluation on the lung tumor dataset in the Medical Segmentation Decathlon shows superior performance of the proposed method over current state-of-the-art semi-supervised learning methods,validating its effectiveness.

Objective To compare the clinical efficacy of emergency and elective laparoscopic common bile duct exploration(LCBDE)in the treatment of choledocholithiasis with acute cholangitis based on propensity score matching(PSM).Methods Retro-spective cohort study was used.The clinical data of 162 patients with choledocholithiasis complicated with acute cholangitis who underwent LCBDE in Wuhu Hospital,East China Normal University from January 2021 to October 2023 were retrospectively analyzed.Among them,59 patients underwent emergency LCBDE(emergency group),and 103 patients underwent elective LCBDE after conservative treatment(elective group).The PSM method was used to match the two groups of patients by 1∶1,and the relevant clinical data of the two groups were compared.Results The two groups successfully matched 44 pairs of patients.The intraoperative blood loss in the emergency group was more than that in the elective group(65.00±19.88ml vs 54.89±17.90ml,P=0.014).The use time of antibiotics was lower than that in the elective group(3.68±1.46days vs 5.95±1.46days,P＜0.001).The total hospitalization time was lower than that in the e-lective group[7.0(6.0,8.0)days vs 8.0(7.0,9.0)days,P＜0.001].The hospitalization cost was lower than that in the elective group[1.19(1.10,1.45)ten thousand yuan vs 1.43(1.22,1.67)ten thousand yuan,P=0.001].There was no significant difference in operation time,conversion rate,operation method,peritoneal drainage tube removal time,postoperative hospital stay,and postoperative complication rate between the two groups(P＞0.05).Conclusion Both emergency and elective LCBDE are safe and effective in the treatment of choledocholithiasis with mild to moderate acute cholangitis,but emergency LCBDE has significant advantages in the use of an-tibiotics,total hospitalization time and hospitalization costs.

Objective:To investigate the clinical value of open abdomen therapy in non-traumatic critically patients.Methods:The retrospective cohort study was conducted. The clinical data of 23 non-traumatic critically patients who underwent open abdomen therapy in 5 hospitals in China from July 2015 to July 2024 were collected. There were 17 males and 6 females, aged 70(range, 24-84)years. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Repeated measurement data were analyzed using the repeated ANOVA, and pairwise comparison within groups was conducted using the least significant difference method. The Boruta algorithm was applied for analyzing variables related to survival outcomes. Results:(1) Treatment of patients undergoing open abdomen therapy. ① The intra-abdominal pressure, lactate, heart rate, central venous pressure, mean arterial pressure, sequential organ failure assessment score of 23 patients from preoperation to postoperative day 3 were changed from (19.7±5.4)mmHg (1 mmHg=0.133 kPa), (6.1±1.9)mmol/L, (120±14)beats/minutes, (13.1±4.3)cmH 2O (1 cmH 2O=0.098 kPa), (58.8±6.8)mmHg, 13.2±1.8 to (10.6±1.3)mmHg, (2.3±0.6)mmol/L, (95±10)beats/minutes, (8.8±2.0)cmH 2O, (75.2±8.5)mmHg, 10.1±1.6, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=46.40, 29.19, 24.91, 11.84, 27.81, 11.71, P<0.05). ② The oxygenation index, total intake, total output of 23 patients from preoperation to postoperative day 3 were changed from (255.0±54.2)mmHg, (5388±1562)mL, (2 520±630)mL to (291.7±25.0)mmHg, (2 886±866)mL, (3 221±923)mL, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=7.61, 13.83, 2.97, P<0.05). ③The daily caloric intake, daily protein supplementation of 23 patients from preoperation to postoperative day 3 were changed from (465±116)kcal, (18±5)g to (1 628±472)kcal, (60±18)g, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=40.31, 41.23, P<0.05). (2) Patients outcomes after open abdomen therapy. Of 23 patients, 18 cases survived and 5 cases died. The duration of intensive care unit stay and duration of hospital stay of 23 patients were 26(range, 5-82)days and 40(range, 5-98)days. Twelve of 23 patients received renal replacement therapy for 12 (range, 5-32)days. Time of pain and sedation management, mechanical ventilation, antimicrobial therapy, vasopressor therapy of 23 patients were 13(range, 5-74)days, 12(range, 5-74)days,20(range, 5-50)days, 6(range, 2-35)days. (3) Analysis of variables related to survival outcomes for patients after open abdomen therapy. Results of Boruta analysis showed that postoperative high-output enteric fistula, postoperative bile fistula, postoperative intra-abdominal hemorrhage, postoperative enteric air fistula, and preoperative mean arterial pressure were significantly associated with survival outcomes. Conclusions:Open abdomen therapy is effective in the treatment of non-traumatic critically patients. Postoperative high-output enteric fistula, postoperative bile fistula, postoperative intra-abdominal hemorrhage, postoperative enteric air fistula, and preoperative mean arterial pressure reduction are significantly associated with survival outcomes.

Objective To compare the clinical efficacy of emergency and elective laparoscopic common bile duct exploration(LCBDE)in the treatment of choledocholithiasis with acute cholangitis based on propensity score matching(PSM).Methods Retro-spective cohort study was used.The clinical data of 162 patients with choledocholithiasis complicated with acute cholangitis who underwent LCBDE in Wuhu Hospital,East China Normal University from January 2021 to October 2023 were retrospectively analyzed.Among them,59 patients underwent emergency LCBDE(emergency group),and 103 patients underwent elective LCBDE after conservative treatment(elective group).The PSM method was used to match the two groups of patients by 1∶1,and the relevant clinical data of the two groups were compared.Results The two groups successfully matched 44 pairs of patients.The intraoperative blood loss in the emergency group was more than that in the elective group(65.00±19.88ml vs 54.89±17.90ml,P=0.014).The use time of antibiotics was lower than that in the elective group(3.68±1.46days vs 5.95±1.46days,P＜0.001).The total hospitalization time was lower than that in the e-lective group[7.0(6.0,8.0)days vs 8.0(7.0,9.0)days,P＜0.001].The hospitalization cost was lower than that in the elective group[1.19(1.10,1.45)ten thousand yuan vs 1.43(1.22,1.67)ten thousand yuan,P=0.001].There was no significant difference in operation time,conversion rate,operation method,peritoneal drainage tube removal time,postoperative hospital stay,and postoperative complication rate between the two groups(P＞0.05).Conclusion Both emergency and elective LCBDE are safe and effective in the treatment of choledocholithiasis with mild to moderate acute cholangitis,but emergency LCBDE has significant advantages in the use of an-tibiotics,total hospitalization time and hospitalization costs.

Objective:To investigate the clinical value of open abdomen therapy in non-traumatic critically patients.Methods:The retrospective cohort study was conducted. The clinical data of 23 non-traumatic critically patients who underwent open abdomen therapy in 5 hospitals in China from July 2015 to July 2024 were collected. There were 17 males and 6 females, aged 70(range, 24-84)years. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Repeated measurement data were analyzed using the repeated ANOVA, and pairwise comparison within groups was conducted using the least significant difference method. The Boruta algorithm was applied for analyzing variables related to survival outcomes. Results:(1) Treatment of patients undergoing open abdomen therapy. ① The intra-abdominal pressure, lactate, heart rate, central venous pressure, mean arterial pressure, sequential organ failure assessment score of 23 patients from preoperation to postoperative day 3 were changed from (19.7±5.4)mmHg (1 mmHg=0.133 kPa), (6.1±1.9)mmol/L, (120±14)beats/minutes, (13.1±4.3)cmH 2O (1 cmH 2O=0.098 kPa), (58.8±6.8)mmHg, 13.2±1.8 to (10.6±1.3)mmHg, (2.3±0.6)mmol/L, (95±10)beats/minutes, (8.8±2.0)cmH 2O, (75.2±8.5)mmHg, 10.1±1.6, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=46.40, 29.19, 24.91, 11.84, 27.81, 11.71, P<0.05). ② The oxygenation index, total intake, total output of 23 patients from preoperation to postoperative day 3 were changed from (255.0±54.2)mmHg, (5388±1562)mL, (2 520±630)mL to (291.7±25.0)mmHg, (2 886±866)mL, (3 221±923)mL, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=7.61, 13.83, 2.97, P<0.05). ③The daily caloric intake, daily protein supplementation of 23 patients from preoperation to postoperative day 3 were changed from (465±116)kcal, (18±5)g to (1 628±472)kcal, (60±18)g, respectively, showing significant differences in the time effect of changes in the above indicators ( Ftime=40.31, 41.23, P<0.05). (2) Patients outcomes after open abdomen therapy. Of 23 patients, 18 cases survived and 5 cases died. The duration of intensive care unit stay and duration of hospital stay of 23 patients were 26(range, 5-82)days and 40(range, 5-98)days. Twelve of 23 patients received renal replacement therapy for 12 (range, 5-32)days. Time of pain and sedation management, mechanical ventilation, antimicrobial therapy, vasopressor therapy of 23 patients were 13(range, 5-74)days, 12(range, 5-74)days,20(range, 5-50)days, 6(range, 2-35)days. (3) Analysis of variables related to survival outcomes for patients after open abdomen therapy. Results of Boruta analysis showed that postoperative high-output enteric fistula, postoperative bile fistula, postoperative intra-abdominal hemorrhage, postoperative enteric air fistula, and preoperative mean arterial pressure were significantly associated with survival outcomes. Conclusions:Open abdomen therapy is effective in the treatment of non-traumatic critically patients. Postoperative high-output enteric fistula, postoperative bile fistula, postoperative intra-abdominal hemorrhage, postoperative enteric air fistula, and preoperative mean arterial pressure reduction are significantly associated with survival outcomes.