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Objectives: Frailty is a multidimensional syndrome or state of increased vulnerability to poor resolution of homoeostasis following a stressor event. Frailty is common in patients with sepsis. Sepsis and frailty are both associated with older age and chronic medical conditions. However, there is limited evidence about the direct association between frailty and sepsis. The aim of this study is to determine the association between preexisting clinical frailty and clinical outcomes in patients with sepsis.Design: A nationwide propensity score-matched cohort study analyzing data prospectively collected between September 2019 and February 2020.Setting: Nineteen tertiary or university-affiliated hospitals in South Korea.Patients: Adult patients who were diagnosed with sepsis.Interventions: None.Measurements and Main Results: Frailty status was assessed using the Clinical Frailty Scale. All patients were classified as "frail" (Clinical Frailty Scale score, 5-9) or "nonfrail" (Clinical Frailty Scale score, 1-4). Propensity score matching identified comparable nonfrail patients. The primary outcome was inhospital mortality. Multivariable logistic regression analysis was used to evaluate the association between frailty and inhospital mortality. The propensity score-matched cohort comprised 468 nonfrail patients and 468 frail patients; all covariate imbalances were alleviated. In the matched cohort (mean age, 69 ± 14 yr), 27.2% had septic shock at presentation. Inhospital mortality was 34.2% in the frail group and 26.9% in the nonfrail group (p = 0.019). The adjusted odds ratio for inhospital mortality in the frail group compared with the nonfrail group was 2.00 (95% CI, 1.39-2.89; p < 0.001). Among the patients who survived to discharge, the frail group was less likely to be discharged home compared with the nonfrail group, 64.0% versus 81.3%, respectively (p < 0.001).Conclusions: In patients with sepsis, preexisting clinical frailty is associated with worse clinical outcomes than that in nonfrail patients, including inhospital mortality and discharge to home. [ABSTRACT FROM AUTHOR]

This study revealed that patients with IPF have a higher cancer incidence risk than matched controls without IPF. Physicians should be aware of this risk when treating patients with IPF. Background and objective: IPF shares common risk factors and has pathogenic similarities with cancer. However, limited population‐based data are available on cancer risk among patients with IPF. Herein, we investigated whether IPF is associated with an increased risk for cancer incidence from a nationwide database in South Korea. Methods: In this population‐based cohort study, patients with IPF were enrolled from 2009 to 2014, and matched controls were randomly selected at a control‐to‐case ratio of 3:1. In both groups, individuals diagnosed with any malignancy before the index date were excluded. The incidence rates of cancer were measured as the number of events per 1000 person‐years. Multivariable Cox regression models were used to assess the cancer incidence risk. Results: This study included 25 241 patients with IPF and 75 723 matched controls. The overall cancer incidence in patients with IPF was 29.0 cases per 1000 person‐years, and it was significantly higher in the IPF group than in the non‐IPF group (HR, 2.09; 95% CI, 1.96–2.16). Lung cancer showed the highest HR (5.89; 95% CI, 5.40–6.42), followed by lymphoma, skin, uterine cervical, multiple myeloma, thyroid, leukaemia, pancreatic, liver and prostate cancer. Moreover, adjustment for the effects of smoking and other cancer‐associated covariates had little effect on the HR of overall and specific cancers. Conclusion: The cancer incidence risk was higher in the IPF group than in the non‐IPF group. Therefore, healthcare providers should be aware of this risk when treating patients with IPF. [ABSTRACT FROM AUTHOR]

Purpose: Estimating tidal volume (V T ) from electrocardiography (ECG) can be quite useful during deep sedation or spinal anesthesia since it eliminates the need for additional monitoring of ventilation. This study aims to validate and compare V T estimation methodologies based on ECG-derived respiration (EDR) using real-world clinical data., Materials and Methods: We analyzed data from 90 critically ill patients for general analysis and two critically ill patients for constrained analysis. EDR signals were generated from ECG data, and V T was estimated using impedance-based respiration waveforms. Linear regression and deep learning models, both subject-independent and subject-specific, were evaluated using mean absolute error and Pearson correlation., Results: There was a strong short-term correlation between V T and the respiration waveform (r = 0.78 and 0.96), which weakened over longer periods (r = 0.23 and - 0.16). V T prediction models performed poorly in the general population (R 2  = 0.17) but showed satisfactory performance in two constrained patient records using measured respiration waveforms (R 2  = 0.84 to 0.94)., Conclusion: Although EDR-based V T estimation is promising, current methodologies are limited by noisy ICU ECG signals, but controlled environment data showed significant short-term correlations with measured respiration waveforms. Future studies should develop reliable EDR extraction procedures and improve predictive models to broaden clinical applications., Competing Interests: Declaration of competing interest All authors declared no competing interests., (Copyright © 2024. Published by Elsevier Inc.)

Background/aims: Risk factors for progression to critical illness in hospital-acquired coronavirus disease 2019 (COVID-19) remain unknown. Here, we assessed the incidence and risk factors for progression to critical illness and determined their effects on clinical outcomes in patients with hospital-acquired COVID-19., Methods: This retrospective cohort study analyzed patients admitted to the tertiary hospital between January 2020 and June 2022 with confirmed hospital-acquired COVID-19. The primary outcome was the progression to critical illness of hospital- acquired COVID-19. Patients were stratified into high-, intermediate-, or low-risk groups by the number of risk factors for progression to critical illness., Results: In total, 204 patients were included and 37 (18.1%) progressed to critical illness. In the multivariable logistic analysis, patients with preexisting respiratory disease (OR, 3.90; 95% CI, 1.04-15.18), preexisting cardiovascular disease (OR, 3.49; 95% CI, 1.11-11.27), immunocompromised status (OR, 3.18; 95% CI, 1.11-9.16), higher sequential organ failure assessment (SOFA) score (OR, 1.56; 95% CI, 1.28-1.96), and higher clinical frailty scale (OR, 2.49; 95% CI, 1.62-4.13) showed significantly increased risk of progression to critical illness. As the risk of the groups increased, patients were significantly more likely to progress to critical illness and had higher 28-day mortality., Conclusion: Among patients with hospital-acquired COVID-19, preexisting respiratory disease, preexisting cardiovascular disease, immunocompromised status, and higher clinical frailty scale and SOFA scores at baseline were risk factors for progression to critical illness. Patients with these risk factors must be prioritized and appropriately isolated or treated in a timely manner, especially in pandemic settings.

Background: Prolonged length of hospital stay (LOS) is associated with an increased risk of hospital-acquired conditions and worse outcomes. We conducted a nationwide, multicenter, retrospective cohort study to determine whether prolonged hospitalization before developing sepsis has a negative impact on its prognosis., Methods: We analyzed data from 19 tertiary referral or university-affiliated hospitals between September 2019 and December 2020. Adult patients with confirmed sepsis during hospitalization were included. In-hospital mortality was the primary outcome. The patients were divided into two groups according to their LOS before the diagnosis of sepsis: early- (< 5 days) and late-onset groups (≥ 5 days). Conditional multivariable logistic regression for propensity score matched-pair analysis was employed to assess the association between late-onset sepsis and the primary outcome., Results: A total of 1,395 patients were included (median age, 68.0 years; women, 36.3%). The early- and late-onset sepsis groups comprised 668 (47.9%) and 727 (52.1%) patients. Propensity score-matched analysis showed an increased risk of in-hospital mortality in the late-onset group (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.69-5.34). The same trend was observed in the entire study population (aOR, 1.85; 95% CI, 1.37-2.50). When patients were divided into LOS quartile groups, an increasing trend of mortality risk was observed in the higher quartiles ( P for trend < 0.001)., Conclusion: Extended LOS before developing sepsis is associated with higher in-hospital mortality. More careful management is required when sepsis occurs in patients hospitalized for ≥ 5 days., Competing Interests: Dr. Lim received financial support for research from the Korea Disease Control and Prevention Agency. The remaining authors have disclosed that they do not have any potential competing interests., (© 2024 The Korean Academy of Medical Sciences.)