Sepsis-associated encephalopathy (SAE) is a diffuse dysfunction of the nervous system resulting from sepsis originating outside the central nervous system. The elderly (≥65 years of age) are a particularly vulnerable population, and the emergency department is typically the first point of contact after onset. Clinical symptoms in elderly patients with SAE are often atypical, compounded by a high burden of underlying diseases and complications, which frequently leads to underdiagnosis or misdiagnosis. These patients are at an increased risk of long-term or permanent central nervous system impairment, making rapid and accurate diagnosis and treatment especially critical. Currently, there are no standardized diagnostic or treatment guidelines tailored specifically to geriatric SAE. This expert consensus, grounded in evidence-based medicine and clinical experience, offers recommendations on the risk factors, clinical characteristics, diagnosis, and treatment of geriatric SAE. The goal is to standardize care, improve diagnostic accuracy, reduce mortality, and enhance patient outcomes.
Background: Electrolyte imbalance is closely related to the occurrence and prognosis of cardiac arrest. However, current research mainly focuses on the three ions—sodium, potassium, and calcium—while lacking attention to magnesium ions, chloride ions, bicarbonate ions, and phosphate ions. Therefore, we plan to explore the effects of electrolytes on the 30-day in-hospital mortality rate of patients with cardiac arrest based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database.
Method: Data were collected from the MIMIC IV database version 3.0 (v3.0) on electrolyte levels and 30-day in-hospital mortality rates of hospitalized patients with “cardiac arrest” from 2008 to 2022. Cox regression analysis was used to identify variables that affect the 30-day mortality rate of patients. Finally, the Kaplan-Meier curve was used in this study to further explore the effects of electrolytes on the 30-day mortality rate of patients.
Result: A total of 1491 patients who experienced cardiac arrest were included in this study. Cox regression analysis showed a correlation between age, calcium ions, bicarbonate ions, chloride ions, phosphate, and the 30-day in-hospital mortality rate in patients. The Kaplan-Meier curve further revealed that patients with advanced age, low calcium ion concentration, low chloride ion concentration, low bicarbonate concentration, and high phosphate concentration had poor prognoses.
Conclusion: Levels of bicarbonate ions, chloride ions, and inorganic phosphate at admission were associated with mortality on day 30 of admission.
Background: Systemic inflammatory markers are associated with cardiovascular disease. This study aimed to assess the relationship between systemic inflammatory markers and abdominal aortic calcification (AAC).
Methods: Data were collected from the 2013 to 2014 cycle of the National Health and Nutrition Examination Survey (NHANES). AAC was quantified using the Kauppila scoring system, which is based on dual-energy X-ray absorptiometry. Severe abdominal aortic calcification (sAAC) was defined as a total AAC score ≥6. Multivariate regression models were used to determine the relationships between systemic inflammation indicators, AAC scores, and sAAC.
Results: Data from 3047 participants were analyzed. After adjusting for multiple covariates, AAC scores increased slightly for every one-unit increase in standardized systemic immune-inflammation index (SII; β = 0.13; 95% confidence interval [CI]: 0.01-0.25, P=0.030). Neutrophil-to-lymphocyte ratio (NLR) was positively correlated with higher AAC scores (β = 0.15; 95% CI: 0.06-0.24, P=0.001) and sAAC (odds ratio [OR]: 1.10; 95% CI: 1.01-1.19, P=0.025). There was no significant correlation between platelet-to-lymphocyte ratio (PLR) and AAC scores (β = −0.0006; 95% CI: −0.0018 to 0.0030). Conversely, lymphocyte-to-monocyte ratio (LMR) was positively associated with lower AAC scores (β = −0.14; 95% CI: −0.22 to −0.05, P=0.001), with a 12% decrease in the odds of sAAC for every one-unit increase in LMR (OR: 0.88; 95% CI: 0.79-0.97, P=0.013).
Conclusion: Correlations between different systemic inflammation markers and AAC varied among the adult population of the United States. NLR was associated with higher AAC scores and an increased incidence of sAAC, whereas LMR had the opposite effect. NLR and LMR have emerged as potential biomarkers for AAC risk, highlighting their importance in understanding the inflammatory processes associated with AAC.
Background: Elevated soluble growth stimulation-expressed gene 2 (sST2) protein levels are associated with poor prognosis in patients with myocardial infarction or heart failure. However, few studies have investigated the association between sST2 expression and plaque stability. This study aimed to investigate the expression of sST2 in patients with acute myocardial infarction and its predictive value for vulnerable plaque characteristics in culprit lesions.
Methods: From October 2022 to December 2024, 230 patients with acute myocardial infarction who underwent coronary angiography and optical coherence tomography (OCT) in (emergency) outpatient and inpatient departments of Jining No.1 People’s Hospital were selected as subjects of this prospective study. Based on the inclusion and exclusion criteria, 203 patients were included in this study. Clinical data were analyzed. Based on the characteristics of criminal plaques detected by OCT, 123 cases were divided into a thin-cap fibroatheroma (TCFA) group (60.6%) and a non-thin-cap fibroatheroma (NTCFA) group (80 cases). Serum sST2 levels were measured before surgery. Optical coherence tomography was used to observe the nature of the criminal lesions before interventional therapy. The relationship between serum sST2 levels and criminal plaque vulnerability was analyzed using a multivariable logistic regression model.
Results: Serum cardiac troponin, C-reactive protein, and sST2 levels were higher in the TCFA group than those in the NTCFA group. OCT observations showed that patients in the TCFA group had many characteristics of vulnerable plaques, including macrophage aggregation, larger lipid radians, and thinner minimum fibrous caps. sST2 independently predicted the presence of TCFA in patients with acute myocardial infarction, with enhanced predictive accuracy when combined with C-reactive protein (area under the curve 0.837 vs. 0.782 for sST2 alone, P = 0.043).Conclusion sST2 can independently predict the presence of thin cap atherosclerosis in patients with acute myocardial infarction, and when combined with C-reactive protein, its prediction accuracy is higher.
Ketamine, a dissociative anesthetic with distinct sedative and analgesic properties, is receiving renewed attention in critical care owing to its unique pharmacological profile. Although historically limited by concerns over psychoactive side effects, its ability to maintain hemodynamic stability has prompted growing interest in its use in intensive care settings. This narrative review synthesizes emerging evidence on 10 potential applications of ketamine in the intensive care unit (ICU), including opioid-sparing analgesia, sedation during mechanical ventilation, rapid sequence intubation, and management of sepsis, postcardiac surgery states, acute brain injury, super-refractory status epilepticus, acute severe asthma, delirium, and psychiatric disorders. Although ketamine shows promising advantages—such as reduced opioid use and improved cardiovascular stability—the quality of supporting evidence remains low, with limitations including small sample sizes, study heterogeneity, and methodological concerns. Evidence regarding its impact on long-term outcomes, such as mortality, cognitive function, and length of ICU stay remains inconclusive. Some data suggest that ketamine may reduce the incidence of ICU delirium and aid in managing refractory psychiatric conditions; however, concerns about adverse effects—including cardiovascular strain, emergence reactions, and potential neurotoxicity—require cautious application. Despite these challenges, the utility of ketamine in patients with hemodynamic instability, particularly in sepsis and during tracheal intubation, highlights its potential as a versatile agent in critical care pharmacotherapy. Current guidelines recommend restrained, adjunctive use pending further high-quality evidence. This review emphasizes the need for large-scale, multicenter randomized controlled trials to define the role of ketamine, refine dosing strategies, and assess safety across diverse ICU populations. As clinical interest expands, the integration of ketamine into ICU practice must be guided by both innovation and vigilant safety monitoring.