BACKGROUND Sepsis is a life-threatening inflammatory condition in which the invading pathogen avoids the host's defense mechanisms and continuously stimulates and damages host cells. Consequently, many immune responses initially triggered for protection become harmful because of the failure to restore homeostasis, resulting in ongoing hyperinflammation and immunosuppression. METHODS: A literature review was conducted to address bacterial sepsis, describe advances in understanding complex immunological reactions, critically assess diagnostic approaches, and emphasize the importance of studying bacterial bottlenecks in the detection and treatment of sepsis. RESULTS: Diagnosing sepsis via a single laboratory test is not feasible; therefore, multiple key biomarkers are typically monitored, with a focus on trends rather than absolute values. The immediate interpretation of sepsis-associated clinical signs and symptoms, along with the use of specific and sensitive laboratory tests, is crucial for the survival of patients in the early stages. However, long-term mortality associated with sepsis is now recognized, and alongside the progression of this condition, there is an in vivo selection of adapted pathogens. CONCLUSION: Bacterial sepsis remains a significant cause of mortality across all ages and societies. While substantial progress has been made in understanding the immunological mechanisms underlying the inflammatory response, there is growing recognition that the ongoing host-pathogen interactions, including the emergence of adapted virulent strains, shape both the acute and long-term outcomes in sepsis. This underscores the urgent need for novel high-throughput diagnostic methods and a shift toward more pre-emptive, rather than reactive, treatment strategies in sepsis care.

BACKGROUND Sepsis, a common acute and critical disease, leads to 11 million deaths annually worldwide. Probiotics are living microorganisms that are beneficial to the host and may benefit sepsis outcomes, but their effects are still inconclusive. This study aimed to evaluate the overall effect of probiotics on the prognosis of patients with sepsis. DATA RESOURCES: We searched several sources for published/presented studies, including PubMed, EMBASE, Web of Science, the Cochrane Library and the US National Library of Medicine Clinical Trials Register (www.clinicaltrials.gov) updated through July 30, 2023, to identify all relevant randomized controlled trials (RCTs) or observational studies that assessed the effectiveness of probiotics or synbiotics in patients with sepsis and reported mortality. We focused primarily on mortality during the study period and analyzed secondary outcomes, including 28-day mortality, in-intensive care unit (ICU) mortality and other outcomes. RESULTS: Data from 405 patients in five RCTs and 108 patients in one cohort study were included in the analysis. The overall quality of the studies was satisfactory, but clinical heterogeneity existed. All adult studies reported a tendency for probiotics to reduce the mortality of patients with sepsis, and most studies reported a decreasing trend in the incidence of infectious complications, length of ICU stay and duration of antibiotic use. There was only one RCT involving children. CONCLUSION: Probiotics show promise for improving the prognosis of patients with sepsis, including reducing mortality and the incidence of infectious complications, particularly in adult patients. Despite the limited number of studies, especially in children, these findings will be encouraging for clinical practice in the treatment of sepsis and suggest that gut microbiota-targeted therapy may improve the prognosis of patients with sepsis.

BACKGROUND Targeted temperature management (TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest (OHCA) survivors using clinical patient-level data. METHODS: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios (ICERs) were calculated and compared with various decision makers’ willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ellipse. RESULTS: Among 925 non-traumatic OHCA survivors, only 30 (3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost (delta cost -$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065, P=0.79) and higher survival to hospital discharge (delta effect 6%, 95% CI: -11% to 23%, P=0.41). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane. CONCLUSION: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.

BACKGROUND Inappropriate antibiotic treatment for patients with viral infections has led to a surge in antimicrobial resistance, increasing mortality and healthcare costs. Viral and bacterial infections are often difficult to distinguish. Myxovirus resistance protein A (MxA), an essential antiviral factor induced by interferon after viral infection, holds promise for distinguishing between viral and bacterial infections. This study aimed to determine the ability of MxA to distinguish viral from bacterial infections. METHODS: We quantified MxA in 121 infected patients via dry immunofluorescence chromatography. The Kruskal-Wallis test and receiver operating characteristic (ROC) curve analysis were used to determine the diagnostic value of MxA, either alone or in combination with C-reactive protein (CRP) or procalcitonin (PCT), in patients with viral, bacterial, or co-infections. RESULTS: The value of MxA (ng/mL) was significantly higher in patients with viral infections than in those with bacterial and co-infections (82.3 [24.5-182.9] vs. 16.4 [10.8-26.5], P<0.0001) (82.3 [24.5-182.9] vs. 28.5 [10.2-106.8], P=0.0237). The area under the curve (AUC) of the ROC curve for distinguishing between viral and bacterial infections was 0.799 (95% confidence interval [95% CI] 0.696-0.903), with a sensitivity of 68.9% (95% CI54.3%-80.5%) and specificity of 90.0% (95% CI 74.4%-96.5%) at the threshold of 50.3 ng/mL. Combining the MxA level with the CRP or PCT level improved its ability. MxA expression was low in cytomegalovirus (15.8 [9.6-47.6] ng/mL) and Epstein-Barr virus (12.9 [8.5-21.0] ng/mL) infections. CONCLUSION: Our study showed the diagnostic efficacy of MxA in distinguishing between viral and bacterial infections, with further enhancement when it was combined with CRP or PCT. Moreover, Epstein-Barr virus and human cytomegalovirus infections did not elicit elevated MxA expression.

BACKGROUND Prehospital medication is a reality, and the role of these therapies must be explored to assess their validity, especially for acute respiratory diseases, which are usually associated with increased morbidity. The aim of this study was to examine the association of prehospital medication use with mortality in patients with acute respiratory disease. METHODS: A prospective, multicenter, emergency medical service (EMS) delivery cohort study was carried out in adults with unselected respiratory diseases managed by EMS who were transferred to the emergency department. From January 1, 2019, to October 31, 2023, six advanced life support units, thirty-eight basic life support units, and four hospitals in Spain participated in the study. Demographic data, vital signs, use of mechanical ventilation, prehospital respiratory diagnosis, and prehospital medication were collected. The primary outcome was 30-day in-hospital mortality. RESULTS: A total of 961 patients were included, with a mortality rate of 17.5% (168 patients). Age, an increasing number of comorbidities, the use of invasive mechanical ventilation (IMV), the use of major analgesics, hypnotics, and bicarbonate were risk factors. In contrast, elevated systolic blood pressure and Glasgow Coma Scale scores were found to be protective factors against mortality. The predictive capacity of the model reached an area under the curve (AUC) of 0.857 (95% confidence interval [95% CI] 0.827-0.888). CONCLUSION: Our data revealed that IMV, major analgesics, hypnotics and bicarbonate administration were associated with elevated mortality. Adding prehospital drug therapy information to demographic variables and vital signs could improve EMS decision-making, allowing a better characterization of patients at risk of clinical worsening.

BACKGROUND This study aimed to explore the risk factors associated with intensive care unit-acquired weakness (ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition (EEN) and the role of biomarkers in managing ICU-AW. METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition (PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW. RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation (MV), body mass index (BMI), blood urea nitrogen (BUN), and creatinine (Cr) levels (P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed (log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin (PAB)/C-reactive protein (CRP) ratio had the highest diagnostic accuracy (area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892-0.946), surpassing the mean Cr/BUN ratio (AUC 0.740, 95% CI 0.663-0.819) and mean transferrin levels (AUC 0.653, 95% CI 0.574-0.733). CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.

BACKGROUND The increasing morbidity of liver cancer has led to a growing demand for transplantation. Split liver transplantation (SLT) is a promising way to ameliorate organ shortages. However, the safety and efficacy of SLT are still controversial. The aim of this study was to assess the clinical outcome of SLT in liver cancer patients at our center. METHODS: A total of 74 patients who received liver transplantation at a tertiary hospital from March 2019 to July 2023 were retrospectively studied, of whom 37 recipients underwent SLT and 37 recipients underwent whole-graft liver transplantation (WGLT). Clinical data were analyzed and compared between patients who underwent SLT and WGLT. RESULTS: SLT and WGLT were successfully performed, with no intraoperative transplant-related mortality. Postoperatively, no significant differences in total bilirubin (TB, P=0.266), alanine transaminase (ALT, P=0.403) and aspartate transaminase (AST, P=0.160) levels within 30 d were detected between the two groups. The transplant-related mortality rates were 8.1% in the SLT group and 5.4% in the WGLT group within 30 d of surgery (P=1.000), and 10.8% and 8.1%, respectively, at 90 d after surgery (P=1.000). There were no significant differences in overall survival (OS) and progress-free survival (PFS) between the SLT and WGLT groups (P=0.910, P=0.190). CONCLUSION: Our results show that SLT does not imply additional risks in treating liver cancer compared with WGLT.

Despite efforts to develop treatment technology for cardiac arrest (CA), CA incidence and mortality rates are still high.[1,2] A recent study of CA patients in emergency departments revealed that the incidence of CA is increasing annually, and the in-hospital survival rate of CA patients is only approximately 28.7%.[3] Echocardiography has been widely used as an important monitoring tool in critical care and helps to identify the cause of shock, monitor hemodynamics, and guide fluid therapy utilization.[4] One study reported that approximately one-third of patients underwent formal echocardiography during hospitalization in the intensive care unit (ICU).[5]

The incidence of in-hospital cardiac arrest (IHCA) has increased over the past decade, with more than half occurring in intensive care units (ICUs).[1] ICU cardiac arrest (ICU-CA) presents unique challenges, with worse outcomes than those in monitored wards, highlighting the need for early detection and intervention.[2] Up to 80% of patients exhibit signs of deterioration hours before IHCA.[3] Although early warning scores based on vital signs are useful, their effectiveness in ICUs is limited due to abnormal physiological parameters.[4] Laboratory markers, such as sodium, potassium, and lactate, are predictive of poor outcomes,[5] but static measurements may not capture the patient’s trajectory. Trends in laboratory indicators, such as variability and extremes, may offer better predictive value.[6] This study aimed to evaluate ICU-CA predictive factors, with a focus on vital signs and trends of laboratory indicators.