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BACKGROUND: Mechanically ventilated Intensive Care Unit (ICU) patients often require wrist restraints, contributing to immobility and agitation, over-sedation, and delirium. The Exersides® Refraint® (Healthy Design, LLC), a novel restraint alternative, may be safe and facilitate greater mobility than traditional restraints. OBJECTIVE: This National Institutes of Health Small Business Technology Transfer (STTR) Program Grant-funded single-site Phase I feasibility study evaluated Exersides® safety and feasibility in anticipation of a multi-site Phase II randomized controlled trial (RCT). METHODS: In two academic ICUs, mechanically ventilated adults ⩾25 years old who were non-comatose, required restraints and had an expected stay of ⩾2 days were enrolled to wear Exersides® and traditional wrist restraints for 4 h on day 1, in a randomized order, and in the reverse order on day 2. Main outcomes were Exersides® safety (i.e., patient/clinician lacerations/injuries), feasibility (i.e., ⩾90% of required data collected), and patient/family/clinician feedback. RESULTS: Eight patients were enrolled; one no longer required restraints at initiation, yielding seven subjects (median [interquartile range (IQR)] age 65 [55, 70] years, 86% men). All seven wore Exersides®, averaging (SD) 2.5 (1.0) hours per session, with no safety events reported. Across restraint time periods, 92% and 100% of Richmond Agitation-Sedation Scale (RASS) and wrist actigraphy data, respectively, were collected. Feedback was positive (more movement and comfortable than traditional restraints) and constructive (bulky, intimidating to apply). CONCLUSIONS: This pilot study provided key safety and feasibility data for a Phase II RCT evaluating Exersides® versus traditional wrist restraints. Feedback motivated minor device modifications before RCT initiation.

This study explores the association between serum chloride concentrations and all-cause mortality among patients in the Surgical Intensive Care Unit (SICU). Employing a retrospective cohort design, the study utilized data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, specifically focusing on individuals admitted to the surgical/trauma ICUs. This dataset encompassed demographic profiles, laboratory findings, historical medical data, vital statistics, and variables pertinent to prognosis. Participants were divided into four groups based on their serum chloride concentrations. The primary outcomes assessed were mortality rates at 30, 90, and 180 days post-admission to the ICU. Analytical methods included Kaplan–Meier survival curves, Cox proportional hazards regression models, and Restricted Cubic Spline (RCS) analyses to delineate the relationship between serum chloride concentrations and patient outcomes. The study cohort comprised 10,996 patients, with observed mortality rates of 12.78% at 30 days, 17.14% at 90 days, and 20.32% at 180 days. Kaplan–Meier analyses revealed significant disparities in survival rates across the quartiles of serum chloride during the follow-up intervals (p < 0.001). The results from the multivariable Cox regression suggested a substantial inverse association between high serum chloride levels and decreased mortality at 30 days (hazard ratio [HR]: 0.96; 95%confidence interval [CI]: 0.95–0.97; P < 0.001), 90 days (HR: 0.97; 95% CI: 0.96–0.98; P < 0.001), and 180 days (HR: 0.97; 95% CI: 0.96–0.98; P < 0.001). Particularly, patients in the highest quartile of serum chloride faced significantly lower mortality risks compared to those in the lowest quartile (30 days HR = 0.65, 90 days HR = 0.71, 180 days HR = 0.69, P < 0.001). RCS analysis depicted an L-shaped curve demonstrating the dynamics between serum chloride concentrations and the risk of all-cause mortality across the 30-day, 90-day, and 180-day periods.Starting at a concentration of 104 mmol/L, a decrease in serum chloride levels was associated with an increased risk of mortality.These findings elucidate a marked nonlinear association between serum chloride levels and all-cause mortality in SICU patients, enhancing our comprehension of serum chloride's impact on clinical outcomes in this setting. [ABSTRACT FROM AUTHOR]

Cholecystectomy is the preferred treatment for acute cholecystitis in average surgical-risk patients. For those with high perioperative risk, percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) are alternatives. However, PT-GBD is limited by contraindications such as large hepatic masses, significant ascites, and coagulopathy, and some critically ill patients cannot be transferred for PT-GBD or EUS-GBD. This case series demonstrates that bedside EUS-GBD in the ICU is technically feasible and safe for critically ill patients who are unsuitable for other interventions. Three cases involving severely ill patients successfully underwent bedside EUS-GBD with initial post-procedure improvement. Unfortunately, all patients eventually required comfort care due to their severe underlying conditions. These cases highlight EUS-GBD as an effective bedside option for gallbladder drainage in ICU patients when supported by multidisciplinary teams. Further research could confirm its expanded role in managing high-risk patients in intensive care. [ABSTRACT FROM AUTHOR]

Background: Arterial blood gas (ABG) values are important in the assessment of critically ill patients. However, arterial puncture may be challenging to perform in these patients. The venous‐to‐arterial conversion method (v‐TAC) is used to convert venous blood gas values to calculated values meant to resemble arterial values. Calculated pH and partial pressure of carbon dioxide (PCO2) values have shown good agreement with arterial values in stable patients, but performance of the method in patients with severe acid–base disturbances is unknown. We aim to evaluate venous and calculated blood gas value congruency with arterial values in critically ill patients. Methods: Critically ill adult patients with abnormal arterial pH (<7.35 or >7.45) admitted to an intensive care unit were included in this study. Patients were divided in groups based on arterial pH (alkalemia, moderate acidaemia and severe acidaemia). ABG samples were obtained from arterial catheters and venous samples simultaneously from peripheral or central venous catheters. Venous blood gas values were converted to calculated values using the v‐TAC software. Both venous and calculated values of pH, PCO2 and partial pressure of oxygen (PO2) were compared to arterial values in scatterplots and using the Spearman's Rank Correlation. Results: Arterial and venous sample pairs were obtained from 28 patients, and 24 venous values were converted using the v‐TAC method. Scatterplots showed similar congruency of venous and calculated pH and PCO2 values to arterial values. However, one patient in the severe acidaemia group had arterial pH 7.07 and venous pH 7.04, but calculated pH 7.42. Spearman's Rank Correlation rho showed no correlation of venous and calculated PO2 values compared to arterial values (p =.989 and p =.361). Conclusion: Venous and calculated pH and PCO2 values showed similar congruency with arterial values in patients with alkalemia and moderate acidaemia, while the method was unreliable in a patient suspected of severe metabolic acidaemia. [ABSTRACT FROM AUTHOR]

Aims: To assess the level of mental workload (MWL) of intensive care unit (ICU) nurses in performing different human‐machine tasks and examine the predictors of the MWL. Design: A cross‐sectional questionnaire study. Methods: Between January and February 2021, data were collected from ICU nurses (n = 427) at nine tertiary hospitals selected from five (east, west, south, north, central) regions in China through an electronic questionnaire, including sociodemographic questions, the National Aeronautics and Space Administration Task Load Index, General Self‐Efficacy Scale, Difficulty‐assessing Index System of Nursing Operation Technique, and System Usability Scale. Descriptive statistics, t‐tests, one‐way ANOVA and multiple linear regression models were used. Results: ICU nurses experienced a medium level of MWL (score 52.04 on a scale of 0–100) while performing human‐machine tasks. ICU nurses' MWL was notably higher in conducting first aid and life support tasks (using defibrillators or ventilators). Predictors of MWL were task difficulty, system usability, professional title, age, self‐efficacy, ICU category, and willingness to study emerging technology actively. Task difficulty and system usability were the strongest predictors of nearly all typical tasks. Conclusion: ICU nurses experience a medium MWL while performing human‐machine tasks, but higher mental, temporal, and effort are perceived compared to physical demands. The MWL varied significantly across different human‐machine tasks, among which are significantly higher: first aid and life support and information‐based human‐machine tasks. Task difficulty and system availability are decisive predictors of MWL. Impact: This is the first study to investigate the level of MWL of ICU nurses performing different representative human‐machine tasks and to explore its predictors, which provides a reference for future research. These findings suggest that healthcare organizations should pay attention to the MWL of ICU nurses and develop customized management strategies based on task characteristics to maintain a moderate level of MWL, thus enabling ICU nurses to perform human‐machine tasks better. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Hospitalization represents a major access point for prescription opioids, yet little is known regarding patterns and outcomes of opioid exposures before and after hospitalization for critical illness. Methods: This is an observational, population-based cohort study of adults (≥18 years) hospitalized for critical illness from 2010 to 2019. Multivariable models assess associations between opioid exposures prior to hospitalization, classified according to the Consortium to Study Opioid Risks and Trends, and posthospitalization opioid exposures and clinical outcomes through 1-year posthospitalization. Results: Of 11 496 patients, 6318 (55%) were men with a median age of 66 (51, 79) years and 40% (n = 4623) surgical admissions. Prehospitalization opioid availability included 8449 (73%) none, 2117 (18%) short-term, 471 (4%) episodic, and 459 (4%) long-term. Thirty-nine percent (4144/10 708) of hospital survivors were discharged with opioids, with higher prescribing rates for surgical admissions (55%). Greater preadmission opioid exposures were associated with higher prevalent opioid availability at 1 year (odds ratio [95% confidence interval] 24.1 [18.3-31.8], 9.42 [7.18-12.3], and 2.55 [2.08-3.12] for long-term, episodic, and short-term exposures, respectively, vs none, P <.001). Greater preadmission opioid exposures were associated with longer hospitalizations (1.13 [1.04-1.23], 1.15 [1.06-1.25], and 1.08 [1.04-1.13] multiplicative increase in geometric mean, P <.001), more readmissions (hazard ratio [HR] 2.08 [1.74-2.49], 1.88 [1.56-2.26], and 1.48 [1.33-1.64], P <.001), and higher 1-year mortality (HR 1.59 [1.28-1.98], 1.75 [1.41-2.18], and 1.49 [1.32-1.69], P <.001). Similar associations were observed across surgical and nonsurgical admissions. Conclusions: Prehospitalization opioid exposures in survivors of critical illness are associated with clinical outcomes through 1 year and may serve as important prognostic markers. [ABSTRACT FROM AUTHOR]

Background: Patients in the intensive care unit (ICU) often experience poor sleep quality. Pharmacologic sleep aids are frequently used as primary or adjunctive therapy to improve sleep, although their benefits in the ICU remain uncertain. This review aims to provide a comprehensive assessment of the objective and subjective effects of medications used for sleep in the ICU, as well as their adverse effects. Methods: PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials were systematically searched from their inception until June 2023 for comparative studies assessing the effects of pharmacologic sleep aids on objective and subjective metrics of sleep. Results: Thirty-four studies with 3498 participants were included. Medications evaluated were melatonin, ramelteon, suvorexant, propofol, and dexmedetomidine. The majority of studies were randomized controlled trials. Melatonin and dexmedetomidine were the best studied agents. Objective sleep metrics included polysomnography (PSG), electroencephalography (EEG), bispectral index, and actigraphy. Subjective outcome measures included patient questionnaires and nursing observations. Evidence for melatonin as a sleep aid in the ICU was mixed but largely not supportive for improving sleep. Evidence for ramelteon, suvorexant, and propofol was too limited to offer definitive recommendations. Both objective and subjective data supported dexmedetomidine as an effective sleep aid in the ICU, with PSG/EEG in 303 ICU patients demonstrating increased sleep duration and efficiency, decreased arousal index, decreased percentage of stage N1 sleep, and increased absolute and percentage of stage N2 sleep. Mild bradycardia and hypotension were reported as side effects of dexmedetomidine, whereas the other medications were reported to be safe. Several ongoing studies have not yet been published, mostly on melatonin and dexmedetomidine. Conclusions: While definitive conclusions cannot be made for most medications, dexmedetomidine improved sleep quantity and quality in the ICU. These benefits need to be balanced with possible hemodynamic side effects. [ABSTRACT FROM AUTHOR]

Background: An intensive care unit (ICU) diary provides a powerful and moving account of a patient's journey through critical care. Aim: The primary goal of this research was to explore the qualitative perceptions of general ICU survivors toward the ICU diary, which was completed during their hospital stay and reintroduced to them during a follow-up visit 6 months after ICU discharge. Setting: An Italian general ICU with structured follow-up and an ICU diary program. Design: A qualitative descriptive method was used using semistructured telephone interviews involving 10 ICU survivors admitted between December 1, 2019, and April 30, 2021. Findings: The main findings showed that the ICU diary is considered a very useful tool by ICU survivors to gain a better understanding of what happened during their ICU stay. Two main themes and 5 subthemes emerged from the analysis: (1) to fill the gap (clinical events in the ICU, family members' experience, care provided by nurses and physicians) and (2) personal feelings (positive and negative). Reading the diary enabled participants, and hence unaware of their surroundings, to bridge a "time gap" and gain a clearer understanding of events that occurred during the ICU stay. The participants emphasized the significance of reading the ICU diary in understanding what their family members went through. The ICU diary has allowed individuals to become aware of the extensive efforts of health care professionals to meet their needs. Several emotions emerged from reading the ICU diary: amazement, contentment, gratitude, joy, love, affection, happiness, pain, and anguish. Conclusions: ICU diaries are highly valued by ICU survivors because they allow them to gain a deeper understanding of ICU stay. Increased comprehension and processing of events can help reduce the symptoms of post–intensive care syndrome and empower patients to regain control of their lives with renewed motivation. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Background Design Methods Results Conclusion Relevance to Clinical Practice Patient or Public Contribution To investigate the correlation between intensive care unit (ICU) nurses' demographic characteristics, teamwork, moral sensitivity and missed nursing care.Teamwork, moral sensitivity and missed nursing care are important health challenges among ICU nurses. Clarifying the relationship between variables is benefit to improve the quality of patients care. Nevertheless, a comprehensive conceptualisation of the relationship between teamwork, moral sensitivity and missed nursing care remains lacking.A cross‐sectional design.This study follows the STROBE checklist. ICU nurses were recruited by two hospitals between November 2023 and January 2024, in Shandong Province, China. The demographic characteristic questionnaire, teamwork perceptions questionnaire, moral sensitivity questionnaire–revised version into Chinese and the Chinese version of the missed nursing care questionnaire were used for investigation. Multiple linear regression was used to clarify the factors affecting missed nursing care. Pearson correlation was used to test the correlation between teamwork, moral sensitivity and missed nursing care.The level of missed nursing care for ICU nurses was low, with overall mean score of 37.49. Missed nursing care for ICU nurses in the labour dispatch were much higher than nurses with the contract system and personnel agency (p < 0.05). The 12‐h shifts of ICU nurses also influenced missed nursing care. Furthermore, teamwork has a positive relationship with moral sensitivity (r = 0.653, p < 0.001).Hospital and nursing managers should pay attention to the clinical sense of belonging of ICU nurses, reasonably set the working shifts, which will help to reduce the occurrence of missed nursing care.It is recommended that nursing managers should invest in strategies to enhance nurse teamwork and implement a 12‐h shift pattern, which can alleviate moral distress and improve quality of care.No patient or public contribution. (The data of this were collected from nurses and not related to patients. They were informed of the research process and precautions, signed informed consent.) [ABSTRACT FROM AUTHOR]

Obesity is a significant public health challenge, yet the link between BMI and mortality in critical illness remains unclear. This study analyzed 19,311 patients from the MIMIC-III database, categorized into underweight, normal weight, overweight, and obese groups. Using Cox models and restricted cubic splines, we explored the complex association between BMI and mortality. Finally, multiple sensitivity analyses were performed to test the robustness of the results. The proportion of underweight patients (2.3%) was the lowest, while overweight (34.8%) and obese (34.5%) patients constituted a large proportion. Being underweight portended a greater risk, while being overweight or obese was associated with a lower risk of mortality, which is consistent with the sensitivity analysis. Moreover, we observed a typical L-shaped association between BMI and the risk of mortality with and without adjustment, with the lowest mortality occurring at approximately 32 kg/m2. The overall pattern of the nonlinear association between BMI and mortality was similar for most subgroup analyses. Underweight was associated with a greater risk of mortality, while obesity and overweight were both associated with a lower risk of mortality in critically ill patients. BMI had a typical L-shaped association with the risk of mortality. [ABSTRACT FROM AUTHOR]

Background: Vancomycin, an antibiotic with activity against methicillin-resistant Staphylococcus aureus (MRSA), is frequently included in empiric treatment for community-acquired pneumonia (CAP) despite the fact that MRSA is rarely implicated in CAP. Conducting polymerase chain reaction (PCR) testing on nasal swabs to identify the presence of MRSA colonization has been proposed as an antimicrobial stewardship intervention to reduce the use of vancomycin. Observational studies have shown reductions in vancomycin use after implementation of MRSA colonization testing, and this approach has been adopted by CAP guidelines. However, the ability of this intervention to safely reduce vancomycin use has yet to be tested in a randomized controlled trial. Methods: STOP-Vanc is a pragmatic, prospective, single center, non-blinded randomized trial. The objective of this study is to test whether the use of MRSA PCR testing can safely reduce inappropriate vancomycin use in an intensive care setting. Adult patients with suspicion for CAP who are receiving vancomycin and admitted to the Medical Intensive Care Unit at Vanderbilt University Medical Center will be screened for eligibility. Eligible patients will be enrolled and randomized in a 1:1 ratio to either receive MRSA nasal swab PCR testing in addition to usual care (intervention group), or usual care alone (control group). PCR testing results will be transmitted through the electronic health record to the treating clinicians. Primary providers of intervention group patients with negative swab results will also receive a page providing clinical guidance recommending discontinuation of vancomycin. The primary outcome will be vancomycin-free hours alive, defined as the expected number of hours alive and free of the use of vancomycin within the first 7 days following trial enrollment estimated using a proportional odds ratio model. Secondary outcomes include 30-day all-cause mortality and time alive off vancomycin. Discussion: STOP-Vanc will provide the first randomized controlled trial data regarding the use of MRSA nasal swab PCR testing to guide antibiotic de-escalation. This study will provide important information regarding the effect of MRSA PCR testing and antimicrobial stewardship guidance on clinical outcomes in an intensive care unit setting. Trial registration: ClinicalTrials.gov NCT06272994. Registered on February 22, 2024. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the association between serum calcium level and the risk of acute kidney injury (AKI) in patients with subarachnoid hemorrhage (SAH). Methods: In this retrospective cohort study, data on adults from the Medical Information Mart for Intensive Care (MIMIC-III and MIMIC-IV) databases, spanning from 2008 to 2019, were extracted. In the logistic regression models, confounding variables, including age, white blood cell (WBC), systolic blood pressure (SBP), heart rate, blood urea nitrogen (BUN), glucose, international normalized ratio (INR), and the Charlson Comorbidity Index (CCI), were finally adjusted by stepwise regression. The outcome event was the occurrence of AKI after intensive care unit (ICU) admission. The univariate and multivariate logistic regression models were utilized to assess the association between serum calcium level and the risk of AKI in SAH patients, with odds ratios (ORs) and 95% confidence intervals (CIs). To further explore the association, subgroup analyses were performed, stratified by age, Glasgow Coma Scale (GCS) scores, drugs, and surgical methods. Results: A total of 1,128 patients with SAH were included in the study, of which 457 patients developed AKI. Low levels of serum calcium were significantly associated with a high risk of AKI in patients with SAH, with an OR (95%CI) of 1.38 (1.01–1.89). Further subgroup analyses showed that low levels of calcium were significantly associated with a high risk of AKI in SAH patients aged ≥60 years (OR = 0.27, 95%CI: 0.09–0.83), who had GCS score ≥13 (OR = 1.57, 95%CI: 1.08–2.30), who did not use calcium channel blockers (CCB) (OR = 2.22, 95%CI: 1.16–4.25) and angiotensin-converting enzyme (ACE) inhibitors (OR = 1.51, 95%CI: 1.06–2.14), and who did not undergo aneurysm embolization (OR = 1.48, 95%CI: 1.01–2.17) and aneurysm clipping (OR = 1.45, 95%CI: 1.04–2.01). Conclusion: The results of our study indicated that low levels of serum calcium were significantly associated with the risk of AKI in patients with SAH. [ABSTRACT FROM AUTHOR]

Background and aim: Critically ill cirrhotic patients exhibit high in-hospital mortality and require substantial healthcare resources, including multiorgan support. Egypt has the highest age-standardized death rate from cirrhosis worldwide. This study aimed to compare the performance and accuracy of different prognostic scores for mortality prediction, including Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD), MELD with serum sodium incorporation (MELD-Na), Royal Free Hospital (RFH), as well as general intensive care unit (ICU) prognostic models, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Chronic liver failure -sequential organ failure assessment (CLIF-SOFA), in cirrhotic patients admitted to an ICU in an Egyptian tertiary facility. Patients and methods: This prospective observational study included ninety patients admitted to the ICU between July 2021 and June 2022. All patients underwent clinical assessment with the estimation of all included scores within the first 24 h of admission, alongside basic laboratory and radiological investigations. Results: Mortality occurred in 56.7% (n = 51) of the patients. Non-survivors exhibited statistically significantly higher APACHE II, CLIF-SOFA, RFH, and CTP scores but lower Glasgow Coma Scale (GCS) than survivors. However, no statistically significant difference was found regarding the performance of the scoring systems. At cut-off levels > 20 for APACHE II and > 46 for CLIF-SOFA, these scores were the most independent predictors of in-hospital mortality. Conclusions: While CTP, MELD, and MELD-Na scores demonstrated satisfactory performance in critically ill cirrhotic patients, APACHE II and CLIF-SOFA scores were superior in predicting short-term mortality in this patient population. [ABSTRACT FROM AUTHOR]

Background: The effect of ramelteon, a melatonin receptor agonist, on survival in septic patients remains unknown. The purpose of this retrospective cohort study was to explore the relationship between ramelteon exposure and survival outcomes in septic patients. Methods: Data from septic patients admitted to the intensive care unit (ICU) were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, with patients categorized into ramelteon exposure and non-exposure groups based on the use of ramelteon. The primary outcome was 30-day mortality, and secondary outcomes included 90-day mortality, in-hospital mortality, length of ICU stay, and hospital stay. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to address confounding variables. Kaplan–Meier (K-M) analysis and Cox proportional hazards regression models for stepwise regression were utilized to assess the impact of ramelteon exposure on survival. Results: This study included 22,152 unexposed patients and 2,708 exposed patients, resulting in 2,607 matched pairs after PSM. Following PSM, ramelteon exposure was associated with significantly lower in-hospital mortality (11.6% vs.19.7%, p < 0.001), 30-day mortality (13.4% vs. 23.2%, p < 0.001), and 90-day mortality (22.1% vs. 30%, p < 0.001).K-M curves demonstrated a significant difference in 30-day and 90-day mortality between the two groups (P < 0.001), irrespective of PSM application. Both PSM (hazard ratio [HR] = 0.53, 95% confidence intervals [CIs] 0.47–0.61, p < 0.001) and IPTW models (HR = 0.59, 95% CI 0.50–0.70, p < 0.001) indicated a significant positive effect of ramelteon usage on 30-day mortality among septic patients compared to the non-exposure group. Conclusions: This exploratory, retrospective study suggests an association between ramelteon exposure and reduced 30-day and 90-day mortality in septic patients compared with the non-exposure group. Considering the limitations of the retrospective design and the potential for unmeasured confounding, well-designed prospective studies and randomized controlled trials will be needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background Study Design and Methods Results Discussion Current guidelines discourage prophylactic plasma use in non‐bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.This was a sub‐study of an international, prospective, observational cohort. Primary outcomes were in‐ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non‐bleeding indications.Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non‐MTP events included active bleeding (54%), prophylactic (25%), and pre‐procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre‐transfusion INR/PT or visco‐elastic hemostatic assays (VHA) were reported for 73%. Thirty‐seven percent of events were administered for non‐bleeding indications, 54% with a pre‐transfusion INR < 3.0 and 30% with an INR < 1.5.Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non‐bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre‐transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion. [ABSTRACT FROM AUTHOR]

A novel time-dependent deterministic SEIRS model, extended with vaccination, hospitalization, and vital dynamics, is introduced. Time-varying basic and effective reproduction numbers associated with this model are defined, which are crucial metrics in understanding epidemic dynamics. Furthermore, a parameter identification approach has been used to develop a numerical method to compute these numbers for long-term epidemics. We analyze the actual COVID-19 data from the USA, Italy, and Bulgaria to solve appropriate inverse problems and gain an understanding of the time evolution behavior of the basic and effective reproduction numbers. Moreover, an insightful comparison of key coronavirus data and epidemiological parameters across these countries has been conducted. For this purpose, while the basic and effective reproduction numbers provide insights into the virus transmission potential, we propose data-driven criteria for assessing the actual realization of the transmission potential of the SARS-CoV-2 virus and the effectiveness of the applied restrictive measures. To obtain these results, we conduct a mathematical analysis to demonstrate various biological properties of the new differential model, including non-negativity, boundedness, existence, and uniqueness of the solution. The new model and the associated numerical simulation tools proposed herein could be applied to COVID-19 data in any country worldwide and hold a promising potential for the transmission capacity and impact of the virus. [ABSTRACT FROM AUTHOR]

Developing interfaces for seizure diagnosis, often challenging to detect visually, is rising. However, their effectiveness is constrained by the need for diverse and extensive databases. This study aimed to create a seizure detection methodology incorporating detailed information from each EEG channel and accounts for frequency band variations linked to the primary brain pathology leading to ICU admission, enhancing our ability to identify epilepsy onset. This study involved 460 video-electroencephalography recordings from 71 patients under monitoring. We applied signal preprocessing and conducted a numerical quantitative analysis in the frequency domain. Various machine learning algorithms were assessed for their efficacy. The k-nearest neighbours (KNN) model was the most effective in our overall sample, achieving an average F1 score of 0.76. For specific subgroups, different models showed superior performance: Decision Tree for 'Epilepsy' (average F1 score of 0.80) and 'Craniencephalic Trauma' (average F1 score of 0.84), Random Forest for 'Cardiorespiratory Arrest' (average F1 score of 0.89) and 'Brain Haemorrhage' (average F1 score of 0.84). In the categorisation of seizure types, Linear Discriminant Analysis was most effective for focal seizures (average F1 score of 0.87), KNN for generalised (average F1 score of 0.84) and convulsive seizures (average F1 score of 0.88), and logistic regression for non-convulsive seizures (average F1 score of 0.83). Our study demonstrates the potential of using classifier models based on quantified EEG data for diagnosing seizures in ICU patients. The performance of these models varies significantly depending on the underlying cause of the seizure, highlighting the importance of tailored approaches. The automation of these diagnostic tools could facilitate early seizure detection. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aims Methods Results Conclusions Acute kidney injury (AKI) represents a commonly seen condition in the natural course of cirrhosis associated with unfavourable outcomes.To evaluate and compare the pooled mortality rates of patients with cirrhosis, with versus without AKI, across different clinical settings and diagnostic criteria.A systematic search of several databases was performed up to Oct 2023. Meta‐analysis was performed using a generalised linear mixed model with a random effects model for all calculations.A total of 59 studies comparing patients with cirrhosis, with and without AKI, were included in the meta‐analysis, encompassing 1,153,193 individuals with AKI and 4,630,814 without AKI. AKI development predisposed to significantly higher short (in‐hospital and 30‐days)‐, intermediate (90‐days)‐ and long (1‐year)‐term mortality rates in both inpatients and outpatients. Remarkably, patients with AKI admitted to intensive care unit (ICU) or diagnosed with acute‐on‐chronic liver failure (ACLF) experienced the higher short‐term mortality rates, reaching 76% [95% confidence interval (CI): 73%–79%] and 54% (95%CI: 33%–73%), respectively. AKI staging correlated with mortality risk, with higher stages indicating higher mortality rates, while the timing of AKI development, whether community‐acquired or hospital‐acquired, plays a crucial role in patient prognosis, with distinct mortality patterns observed in each group. The selection of diagnostic criteria for AKI may also impact its association with the short‐term mortality risk.AKI substantially affects the prognosis of patients with cirrhosis, especially those in ICU and/or with ACLF. Prognosis is also greatly influenced by the AKI stage, timing of onset and diagnostic criteria. [ABSTRACT FROM AUTHOR]

Critical illness myopathy (CIM) detrimentally affects muscle function in ICU patients, with a dramatic loss of muscle mass and function where the loss in specific force exceeds the loss in muscle mass (maximum force normalized to muscle cross-sectional area). The preferential loss of the molecular motor protein myosin, representing the hallmark of CIM, exhibiting a significant negative impact on the specific force generation by the muscle. Interestingly however, the preferential myosin loss is a relatively late event, and a specific loss in force generation capacity, is observed prior to the myosin loss. In the current study, employing an optimized cadmium telluride quantum dots (QD) mediated-thermometry approach to assess the efficiency of the myosin, we were able to determine the loss in specific force generated by the muscle, prior to the preferential loss of myosin. Reduction in QD fluorescent intensity correlates with greater heat loss, reflecting inefficient myosin function (less mechanical work performed and more heat loss on ATP hydrolysis by myosin). A significant decrease in myosin efficiency was observed in rats subjected to the ICU condition (immobilization and mechanical ventilation) for 5 days using an established experimental ICU model not limited by early mortality. Thus, qualitative myosin changes preceding quantitative myosin loss offer a mechanism underlying the early loss in specific force generation capacity associated with CIM and opens a venue for future CIM intervention strategies. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of bedside swallowing therapy on swallowing function and conscious status of stroke patients with disturbance of consciousness in ICU. Method: From June 2021 to September 2023, 60 patients with stroke and disturbance of consciousness in ICU were randomly divided into control group (n=30) and observation group (n=30). The control group received clinical treatment in ICU, and the observation group was treated with bedside swallowing therapy on the basis of clinical treatment in ICU for a total of 4 weeks. Swallowing function and state of consciousness were evaluated before and after treatment. Result: After treatment, the 2-minute frequency of spontaneous swallowing in the observation group was (1.17± 0.99) times, which was higher than that in the control group (0.67±0.84) times, and the difference was statistically significant (P<0.05). After treatment, the positive rate of the first and second steps of simple swallowing provocation test in the observation group was 66.7% and 43.3%, respectively, both lower than that of the control group 80% and 56.7%, and the positive rate of the second step of simple swallowing provocation test in the observation group was significantly lower after treatment than before treatment, with statistical significance (P<0.05). After treatment, standardized swallowing assessment score of the observation group was significantly lower than that of the control group, and the difference was statistically significant (P<0.05). After treatment, the score of glasgow coma scale in the observation group was significantly higher than that in the control group, and the difference was statistically significant (P<0.05). Conclusion: Bedside swallowing therapy can improve the swallowing function and conscious state of stroke patients with disturbance of consciousness in ICU. [ABSTRACT FROM AUTHOR]

Among hospitalized patients worldwide, infections caused by multidrug-resistant (MDR) bacteria are a major cause of morbidity and mortality. This study aimed to isolate MDR bacteria from five intensive care units (ICUs) at Tripoli University Hospital (TUH). A prospective cross-sectional study was conducted over a seven-month period (September 2022 to March 2023) across five ICUs at TUH. A total of 197 swabs were collected from Patients', healthcare workers' and ICUs equipment. Samples collected from patients were nasal swabs, oral cavity swabs, hand swabs, sputum specimens, skin swabs, umbilical venous catheter swabs, and around cannula. Swabs collected from health care workers were nasal swabs, whereas ICUs equipment's samples were from endotracheal tubes, oxygen masks, and neonatal incubators. Identification and antimicrobial susceptibility test was confirmed by using MicroScan auto SCAN 4 (Beckman Coulter). The most frequent strains were Gram negative bacilli 113 (57.4%) with the predominance of Acinetobacter baumannii 50/113 (44%) followed by Klebsiella pneumoniae 44/113 (40%) and Pseudomonas aeruginosa 6/113 (5.3%). The total Gram positive bacterial strains isolated were 84 (42.6%), coagulase negative Staphylococci 55 (66%) with MDRs (89%) were the most common isolates followed by Staphylococcus aureus 15 (17.8%). Different antibiotics were used against these isolates; Gram- negative isolates showed high resistance rates to ceftazidime, gentamicin, amikacin and ertapenem. A. baumannii were the most frequent MDROs (94%), and the highest resistance rates in Gram-positive strains were observed toward ampicillin, oxacillin, ampicillin/sulbactam and Cefoxitin, representing 90% of total MDR Gram-positive isolates. ESBL and MRS were identified in most of strains. The prevalence of antibiotic resistance was high for both Gram negative and Gram positive isolates. This prevalence requires strict infection prevention and control intervention, continuous monitoring, implementation of effective antibiotic stewardship, immediate, concerted and collaborative action to monitor its prevalence and spread in the hospital. [ABSTRACT FROM AUTHOR]

This review explores the current landscape and evolving understanding of sepsis, highlighting both challenges and future directions. Sepsis remains a major global health burden, with diverse clinical presentations complicating timely diagnosis and management. Existing definitions, including the Sepsis-3 criteria, emphasize the importance of organ dysfunction, yet early sepsis detection remains limited by available tools. The Sequential Organ Failure Assessment (SOFA) score, though widely used, may not fully capture early stages of infection or account for complex presentations like noncatecholamine-resistant shock. Additionally, the review underscores the pressing need for standardized terminology across sepsis and shock characterization to ensure consistency in diagnosis and treatment strategies. Accessible, resource-adapted solutions are particularly crucial in low- and middle-income countries where sepsis-related mortality rates are higher due to limited resources. Future research should focus on developing and validating integrated, multi-parameter tools that combine clinical, biochemical, and microbiological data to improve sepsis outcomes globally. Advancing sepsis care will require both technological innovation and collaborative, globally consistent guidelines to bridge disparities in healthcare delivery. [ABSTRACT FROM AUTHOR]

Purpose: Glycemic control poses a challenge in intensive care unit (ICU) patients and dysglycemia is associated with poor outcomes. Continuous glucose monitoring (CGM) has been successfully implemented in the type 1 diabetes out-patient setting and renewed interest has been directed into the transition of CGM into the ICU. This scoping review aimed to provide an overview of CGM accuracy in ICU patients to inform future research and CGM implementation. Methods: We systematically searched PubMed and EMBASE between 5th of December 2023 and 21st of May 2024 and reported findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for scoping reviews (PRISMA-ScR). We assessed studies reporting the accuracy of CGM in the ICU and report study characteristics and accuracy outcomes. Results: We identified 2133 studies, of which 96 were included. Most studies were observational (91.7%), conducted in adult patients (74%), in mixed ICUs (47.9%), from 2014 and onward, and assessed subcutaneous CGM systems (80%) using arterial blood samples as reference test (40.6%). Half of the studies (56.3%) mention the use of a prespecified reference test protocol. The mean absolute relative difference (MARD) ranged from 6.6 to 30.5% for all subcutaneous CGM studies. For newer factory calibrated CGM, MARD ranged from 9.7 to 20.6%. MARD for intravenous CGM was 5–14.2% and 6.4–13% for intraarterial CGM. Conclusions: In this scoping review of CGM accuracy in the ICU, we found great diversity in accuracy reporting. Accuracy varied depending on CGM and comparator, and may be better for intravascular CGM and potentially lower during hypoglycemia. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess whether there is a discrepancy between clinical and autopsy-based diagnoses in adult intensive care unit (ICU) patients. Methods: We conducted a systematic review of cohort studies reporting on conventional autopsy-confirmed missed diagnoses. The discrepancy rate was per study calculated by dividing the number of patients with a missed diagnosis by the number of autopsies. Missed diagnoses were classified according to the Goldman classification as 'major' and 'minor' with major missed diagnoses further differentiated into Class I missed diagnoses (i.e., diagnoses that may have altered therapy or survival) and Class II missed diagnoses (i.e., diagnoses that would not have altered therapy or survival). Class I missed diagnoses constitute the primary outcome of interest. Pooled estimates for discrepancy rates (95% confidence intervals) were calculated using a mixed-effects logistic regression model with 'study' as random effect. Meta-regression was used to assess relationships between major discrepancy rates and autopsy rates, start year of study, and ICU type. Results: Forty-two studies were identified totaling 6305 analyzed autopsies and 1759 patients with missed diagnoses. The pooled discrepancy rates for Class I and major missed diagnoses were 6.5% (5–8.5) and 19.3% (15.3–24), respectively. Meta-regression analysis revealed that autopsy rate was inversely associated with discrepancy rate. Class I discrepancy rates did not change over time. Burn and trauma ICUs had lower discrepancy rates as compared to medical ICUs, possibly because of higher autopsy rates. Conclusions: Missed diagnoses remain common in ICUs. A higher autopsy rate does not reveal more major diagnostic errors. These data support a clinically driven autopsy policy rather than a systematic autopsy policy. [ABSTRACT FROM AUTHOR]

Older adults surviving critical illness often experience new or worsening functional impairments. Modifiable positive psychological constructs such as resilience may mitigate post-intensive care morbidity. Is pre-ICU resilience associated with: (1) post-ICU survival; (2) the drop in functional independence during the ICU stay; or (3) the trend in predicted independence before vs after the ICU stay? This retrospective cohort study was performed by using Medicare-linked Health and Retirement Study surveys from 2006 to 2018. Older adults aged ≥ 65 years admitted to an ICU were included. Resilience was calculated prior to ICU admission. The resilience measure was defined from the Simplified Resilience Score, which was previously adapted and validated for the Health and Retirement Study. Resilience was scored by using the Leave-Behind survey normalized to a scale from 0 (lowest resilience) to 12 (highest resilience). Outcomes were survival and probability of functional independence. Survival was modeled by using Gompertz models and independence using joint survival models adjusting for sociodemographic and clinical variables. Average marginal effects were estimated to determine independence probabilities. Across 3,409 patients aged ≥ 65 years old admitted to ICUs, preexisting frailty (30.5%) and cognitive impairment (24.3%) were common. Most patients were previously independent (82.7%). Mechanical ventilation occurred in 14.8% and sepsis in 43.2%. Those in the highest resilience group (vs lowest resilience) had a lower risk of post-ICU mortality (adjusted hazard ratio, 0.81; 95% CI, 0.70-0.94). Higher resilience was associated with greater likelihood of post-ICU functional independence (estimated probability of functional independence 5 years after ICU discharge in highest-to-lowest resilience groups (adjusted hazard ratio [95% CI]): 0.53 (0.33-0.74), 0.47 (0.26-0.68), 0.49 (0.28-0.70), and 0.36 (0.17-0.55); P <.01. Resilience was not associated with a difference in the drop in independence during the ICU stay or a difference in the pre-ICU vs post-ICU trend in predicted independence. ICU survivors with higher resilience had increased rates of survival and functional independence, although the slope of functional decline before vs after the ICU stay did not differ according to resilience group. [ABSTRACT FROM AUTHOR]

Background: Pressure injuries (PIs) impose a significant burden on patients in the intensive care unit (ICU) and the healthcare system. Assessing the risk of developing PIs is crucial for prevention. However, it is unclear whether all subscales of the Waterlow scale can be used to assess PIs risk in ICU. Objectives: To assess whether all subscales of the Waterlow scale can predict PIs risk in ICU. Design: Multicentre prospective study. Methods: A total of 18,503 patients from ICUs in 40 tertiary‐level hospitals in Gansu province of China were enrolled from April 2021 to August 2023. The incidence and characteristics of PIs were recorded. Univariate Cox regression analyses were performed for each subscale as a predictor of PIs development, followed by multivariate Cox regression with covariates for each subscale separately. Results: Out of 17,720 patients included, the incidence of PIs was 1.1%. Multivariate analysis revealed skin type (HR: 1.468, 95% CI: 1.229, 1.758), sex (HR: 0.655, 95% CI: 0.472, 0.908), advanced age (HR: 1.263, 95% CI: 1.106, 1.442), continence (HR: 1.245, 95% CI: 1.052, 1.473), tissue malnutrition (HR: 1.070, 95% CI: 1.007, 1.136) and neurological deficit (HR: 1.153, 95% CI: 1.062, 1.251) were independently predictive of PIs development for all participants. Skin type (HR: 2.326, 95% CI: 1.153, 3.010) (HR: 2.217, 95% CI: 1.804, 2.573) independently predicted PIs occurrence for high‐risk and very high‐risk group, respectively, while sex (HR: 0.634, 95% CI: 0.431, 0.931) and age (HR: 1.269, 95% CI: 1.083, 1.487) predicted PIs development for very high‐risk group. Conclusions: This study found that not all subscales of the Waterlow scale are associated with the PIs development in patients in ICU, highlighting the importance of the skin type subscale in predicting PI risk across all patient groups. Implications for Clinical Practice: Nurses need to focus on patient's skin and related (moisture, pain and pressure) conditions and take measures to promote skin health and avoid the occurrence of PI. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Background: Despite high negative predictive values (NPVs) seen with methicillin-resistant Staphylococcus aureus (MRSA) nares polymerase chain reaction (PCR) assays, utilization of both respiratory sample Gram stain and MRSA nares PCR in patients with pneumonia may contribute to overuse of laboratory resources. The purpose of this study was to evaluate if a Gram stain demonstrating no Gram-positive organisms from a respiratory sample is sufficient to allow for de-escalation of vancomycin therapy. Methods: This single center study retrospectively identified intensive care unit (ICU) patients started on vancomycin for presumed pneumonia at University of Wisconsin (UW) Health in Madison, WI between August 2022 and March 2023. Patients with respiratory sample demonstrating no Gram-positives on Gram stain met inclusion criteria if the sample was ordered within 24 h of vancomycin initiation. The primary outcome was NPV of respiratory sample Gram stain demonstrating no Gram-positive organisms with respect to MRSA detection of the respiratory culture. Secondary outcomes included the NPV of combined MRSA nares PCR plus respiratory sample Gram stain, and difference in time to event in patients that had both a respiratory sample and MRSA nares PCR ordered. Results: A total of 370 patients were screened for study eligibility; of which 99 patients met inclusion criteria. NPV of respiratory sample Gram stain was 99% for MRSA culture. The combined NPV of respiratory sample Gram stain plus MRSA nares PCR was 98.9% for MRSA culture (n = 88). Respiratory sample was ordered 2.3 h faster compared to MRSA nares PCR (4.3 vs 6.6 h, P =.036). Respiratory sample Gram stain resulted 4.5 h faster compared to MRSA nares PCR (10.7 vs 15.2 h, P =.002). Conclusion: Respiratory sample Gram stains demonstrating no Gram-positive organisms may be used to de-escalate vancomycin and deprioritize the use of MRSA nares PCR. [ABSTRACT FROM AUTHOR]

Introduction: Early noninvasive respiratory support (NIRS) is correlated with a success rate of 60-75% in patients experiencing SARS-CoV-2 ARDS. We conducted a prospective case–control study to assess differences in outcomes between Helmet c-PAP (H-c-PAP) and noninvasive positive pressure ventilation (NIPPV). Methods: All patients with SARS-CoV-2 ARDS, treated with H-c-PAP or NIPPV between October 2021 and April 2022 were sampled. We recorded: demographics, comorbidities, clinical, respiratory, sepsis, NIRS parameters, and outcomes. A "NIRS team" followed the patients in respiratory support supplying them with early and timely intensive physiotherapy i-PKT as well. The Cox's proportional hazard model was applied for multivariate analyses. Results: 368 patients were admitted to our hospital medical ward. 85 patients were treated with H-c-PAP and 145 underwent NIPPV. 138 patients needing oxygen supplementation alone were excluded. The two groups were homogeneously distributed and ICU admission rates were lower in the H-c-PAP one (9.4 vs 11% P =.001) while mortality was higher in the NIPPV group (22.7 vs 9.4%, P =.001). The two multivariate models, that had overall mortality as primary outcome, identified age, H-c-PAP daily, i-PKT and ICU admission as independent variables impacting on the outcome. Age was no longer a significant independent predictor after the inclusion of elderly patients (age >80). The third model showed daily i-PKT could prevent ICU admission whereas the length of NIRS was inversely proportional to outcome. Conclusions: A "NIRS multidisciplinary team" made it possible to adopt an early and timely combination of NIRS and i-PKT resulting in the saving of both patient lives and ICU resources. [ABSTRACT FROM AUTHOR]

Introduction: Critically ill patients often endure pain, a distressing experience that can trigger diverse pathophysiological consequences. While remifentanil, with its rapid kinetics, is commonly used for analgesia in intensive care units (ICU), it frequently leads to opioid-related adverse effects. A promising alternative has emerged in oliceridine, a novel G protein-biased μ-opioid receptor agonist. This new drug offers the potential for effective pain relief with fewer side effects. However, its efficacy and safety profile in mechanically ventilated ICU patients remain to be fully elucidated. Methods: This is a multicenter, prospective, randomized, single-blind, active-controlled trial conducted across 24 ICUs in China. A total of 292 mechanically ventilated patients requiring analgesia and sedation will be randomly assigned in a 1:1 ratio to either the oliceridine or remifentanil group. The oliceridine group will receive oliceridine (2–20 μg/kg/h), while the remifentanil group will receive remifentanil (1.5–12 μg/kg/h). Both groups will receive propofol for sedation if necessary. The target for analgesia is Critical-Care Pain Observation Tool (CPOT) < 3, and for sedation is Richmond Agitation-Sedation Scale (RASS) − 2 to 0. Planned Outcomes: The primary outcome will be the percentage of time within target analgesia during study drug administration. Secondary outcomes will include gastrointestinal dysfunction, respiratory depression, sedative usage, mechanical ventilation duration, ICU stay length, extubation failure rate, etc. Trial Registration: NCT06454292. Registered on June 11, 2024. [ABSTRACT FROM AUTHOR]

Summary: In the backdrop of the global obesity pandemic, recognized as a notable risk factor for coronavirus disease 2019 (COVID‐19) complications, the study aims to explore clinical and epidemiological attributes of hospitalized COVID‐19 patients throughout 2021 in Brazil. Focused on four distinct age cohorts, the investigation scrutinizes parameters such as intensive care unit (ICU) admission frequency, invasive mechanical ventilation (IMV) usage, and in‐hospital mortality among individuals with and without obesity. Using a comprehensive cross‐sectional study methodology, encompassing adult COVID‐19 cases, data sourced from the Influenza Epidemiological Surveillance Information System comprises 329 206 hospitalized patients. Of these individuals, 26.3% were affected by obesity. Analysis reveals elevated rates of ICU admissions, increased dependence on IMV, and heightened in‐hospital mortality among the individuals with obesity across all age groups (p <.001). Logistic regression, adjusting for confounding variables, underscores a progressively rising odds ratio for mortality in younger age brackets: 1.2 (95%CI 1.1–1.3) for those under 50 years, 1.1 (95%CI 1.0–1.2) for the 50–59 age group, and 1.1 (95%CI 1.0–1.2) for the 60–69 age group. Conversely, no significant mortality difference is observed for patients over 70 years (OR: 0.972, 95%CI 0.9–1.1). In summary, hospitalized COVID‐19 patients with obesity, particularly in younger age groups, exhibit elevated rates of ICU admission, IMV requirement, and in‐hospital mortality compared with the control group. Notably, the 'obesity paradox' is not evident among hospitalized COVID‐19 patients in 2021. [ABSTRACT FROM AUTHOR]

Sepsis-associated acute kidney injury (S-AKI) is a critical illness and is often associated with high morbidity and mortality rates. The soluble urokinase-type plasminogen activator receptor (suPAR) is an important immune mediator and is involved in kidney injury. However, its diagnostic value in S-AKI patients remains unclear. Therefore, we assessed the early predictive value of suPAR for S-AKI patients. We prospectively enrolled adult patients, immediately after fulfilling the sepsis-3 criteria. Plasma suPAR levels at 0-, 12-, 24-, and 48-h post-sepsis diagnosis were measured. S-AKI development was the primary outcome. S-AKI risk factors were analyzed using logistic regression, and the value of plasma suPAR for early S-AKI diagnosis was assessed using receiver operating characteristic (ROC) curves. Of 179 sepsis patients, 63 (35.2%) developed AKI during hospitalization. At 12-, 24-, and 48-h post-sepsis diagnosis, plasma suPAR levels were significantly higher in patients with S-AKI than in patients without S-AKI (p < 0.05). The plasma suPAR had the highest area under the ROC curve of 0.700 (95% confidence interval (CI), 0.621–0.779) at 24-h post-sepsis diagnosis, at which the best discrimination ability for S-AKI was achieved with suPAR of ≥6.31 ng/mL (sensitivity 61.9% and specificity 71.6%). Logistic regression analysis showed that suPAR at 24-h post-sepsis diagnosis remained an independent S-AKI risk factor after adjusting for mechanical ventilation, blood urea nitrogen, and pH. The findings suggest that plasma suPAR may be a potential biomarker for early S-AKI diagnosis. [ABSTRACT FROM AUTHOR]