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Background We investigated the diagnostic and prognostic value of presepsin among patients with organ failure, including sepsis, in accordance with the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Methods This prospective observational study included 420 patients divided into three groups: non-infectious organ failure (n = 142), sepsis (n = 141), and septic shock (n = 137). Optimal cut-off values of presepsin to discriminate between the three groups were evaluated using receiver operating characteristic curve analysis. We determined the optimal cut-off value of presepsin levels to predict mortality associated with sepsis and performed Kaplan–Meier survival curve analysis according to the cut-off value. Cox proportional hazards model was performed to determine the risk factors for 30-day mortality. Results Presepsin levels were significantly higher in sepsis than in non-infectious organ failure cases ( p  < 0.001) and significantly higher in patients with septic shock than in those with sepsis ( p  = 0.002). The optimal cut-off value of the presepsin level to discriminate between sepsis and non-infectious organ failure was 582 pg/mL (p < 0.001) and between sepsis and septic shock was 1285 pg/mL ( p  < 0.001). The optimal cut-off value of the presepsin level for predicting the 30-day mortality was 821 pg/mL ( p  = 0.005) for patients with sepsis. Patients with higher presepsin levels (≥ 821 pg/mL) had significantly higher mortality rates than those with lower presepsin levels (< 821 pg/mL) (log-rank test; p  = 0.004). In the multivariate Cox proportional hazards model, presepsin could predict the 30-day mortality in sepsis cases (hazard ratio, 1.003; 95% confidence interval 1.001–1.005; p  = 0.042). Conclusions Presepsin levels could effectively differentiate sepsis from non-infectious organ failure and could help clinicians identify patients with sepsis with poor prognosis. Presepsin was an independent risk factor for 30-day mortality among patients with sepsis and septic shock.

Muscle mass depletion is associated with mortality and morbidity in various conditions including sepsis. However, few studies have evaluated muscle mass using point-of-care ultrasound in patients with sepsis. This study aimed to evaluate the association between thigh muscle mass, evaluated using point-of-care ultrasound with panoramic view in patients with sepsis in the emergency department, and mortality. From March 2021 to October 2022, this prospective observational study used sepsis registry. Adult patients who were diagnosed with sepsis at the emergency department and who underwent point-of-care ultrasounds for lower extremities were included. The thigh muscle mass was evaluated by the cross-sectional area of the quadriceps femoris (CSA-QF) on point-of-care ultrasound using panoramic view. The primary outcome was 28 day mortality. Multivariable Cox proportional hazard model was performed. Of 112 included patients with sepsis, mean CSA-QF was significantly lower in the non-surviving group than surviving group (49.6 [34.3–56.5] vs. 63.2 [46.9–79.6] cm 2 , p = 0.002). Each cm 2 increase of mean CSA-QF was independently associated with decreased 28 day mortality (adjusted hazard ratio 0.961, 95% CI 0.928–0.995, p = 0.026) after adjustment for potential confounders. The result of other measurements of CSA-QF were similar. The muscle mass of the quadriceps femoris evaluated using point-of-care ultrasound with panoramic view was associated with mortality in patients with sepsis. It might be a promising tool for determining risk factors for mortality in sepsis patients in the early stages of emergency department.

Background Timely and accurate triage is crucial for the emergency department (ED) care. Recently, there has been growing interest in applying large language models (LLMs) to support triage decision-making. However, most existing studies have evaluated these models using simulated scenarios rather than real-world clinical cases. Therefore, we evaluated the performance of multiple commercial LLMs for non-critical triage support in ED using real-world clinical conversations. Methods We retrospectively analyzed real-world triage conversations prospectively collected from three tertiary hospitals in South Korea. Multiple commercial LLMs—including OpenAI GPT-4o, GPT-4.1, O3, Google Gemini 2.0 flash, Gemini 2.5 flash, Gemini 2.5 pro, DeepSeek V3, and DeepSeek R1—were evaluated for the accuracy in triaging patient urgency based solely on unsummarized dialogue. The Korean Triage and Acuity Scale (KTAS) assigned by triage nurses was used as the gold standard for evaluating the LLM classifications. Model performance was assessed under both a zero-shot prompting condition and a few-shot prompting condition that included representative examples. Results A total of 1,057 triage cases were included in the analysis. Among the models, Gemini 2.5 flash achieved the highest accuracy (73.8%), specificity (88.9%), and PPV (94.0%). Gemini 2.5 pro demonstrated the highest sensitivity (90.9%) and F1-score (82.4%), though with lower specificity (23.3%). GPT-4.1 also showed balanced high accuracy (70.6%) and sensitivity (81.3%) with practical response times (1.79s). Performance varied widely between models and even between different versions from the same vendor. With few-shot prompting, most models showed further improvements in accuracy and F1-score. Conclusions LLMs can accurately triage ED patient urgency using real-world clinical conversations. Several models demonstrated both high sensitivity and acceptable response times, supporting the feasibility of LLM in non-critical triage support tools in diverse clinical environments. These findings apply to non-critical patients (KTAS 3–5), and further research should address integration with objective clinical data and real-time workflow.

AbstractIntroductionIdentifying patients with at a high risk of progressing to septic shock is essential. Due to systemic vasodilation in the pathophysiology of septic shock, the use of diastolic blood pressure (DBP) has emerged. We hypothesized that the initial shock index (SI) and diastolic SI (DSI) at the emergency department (ED) triage can predict septic shock. MethodThis observational study used the prospectively collected sepsis registry. The primary outcome was progression to septic shock. Secondary outcomes were the time to vasopressor requirement, vasopressor dose, and severity according to SI and DSI. Patients were classified by tertiles according to the first principal component of shock index and diastolic shock index. ResultsA total of 1267 patients were included in the analysis. The area under the receiver operating characteristic curve (AUC) for predicting progression to septic shock for DSI was 0.717, while that for SI was 0.707. The AUC for predicting progression to septic shock for DSI and SI were significantly higher than those for conventional early warning scores. Middle tertile showed adjusted Odd ratio (aOR) of 1.448 (95% CI 1.074–1.953), and that of upper tertile showed 3.704 (95% CI 2.299–4.111). ConclusionThe SI and DSI were significant predictors of progression to septic shock. Our findings suggest an association between DSI and vasopressor requirement. We propose stratifying lower tertile as being at low risk, middle tertile as being at intermediate risk, and upper tertile as being at high risk of progression to septic shock. This system can be applied simply at the ED triage.

Although rib fractures are a risk factor, not all rib fracture patients will develop delayed hemothorax. This study aimed to evaluate risk factors which can identify rib fracture patients in the emergency department who may develop delayed hemothorax. Adult patients seen in the emergency room between January 2016 and February 2021 with rib fractures caused by blunt chest trauma were included in this retrospective observational study. Patients who underwent chest tube insertion within 2 days and those without follow-up chest radiographs within 2–30 days were excluded. We used a stepwise backward-elimination multivariable logistic regression model for analysis. A total of 202 patients were included in this study. The number of total (P < 0.001), lateral (P = 0.019), and displaced (P < 0.001) rib fractures were significantly associated with delayed hemothorax. Lung contusions (P = 0.002), and initial minimal hemothorax (P < 0.001) and pneumothorax (P < 0.001) were more frequently associated with delayed hemothorax. Age (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.00–1.06, P = 0.022), mechanical ventilator use (aOR 9.67, 95% CI 1.01–92.75, P = 0.049), initial hemothorax (aOR 2.21, 95% CI 1.05–4.65, P = 0.037) and pneumothorax (aOR 2.99, 95% CI 1.36–6.54, P = 0.006), and displaced rib fractures (aOR 3.51, 95% CI 1.64–7.53, P = 0.001) were independently associated with delayed hemothorax. Age, mechanical ventilation, initial hemo- or pneumothorax, and displaced rib fractures were risk factors for delayed hemothorax. Patients with these risk factors, and especially those with ≥2 displaced rib fractures, require close chest radiography follow-up of 2–30 days after the initial trauma.

Sex differences in the in-hospital management of sepsis exist. Previous studies either included patients with sepsis that was defined using previous definitions of sepsis or evaluated the 3-h bundle therapy. Therefore, this study sought to assess sex differences in 1-h bundle therapy and in-hospital management among patients with sepsis and septic shock, defined according to the Sepsis-3 definitions. This observational study used data from Korean Shock Society (KoSS) registry, a prospective multicenter sepsis registry. Adult patients with sepsis between June 2018 and December 2021 were included in this study. The primary outcome was adherence to 1-h bundle therapy. Propensity score matching (PSM) and multivariable logistic regression analyses were performed. Among 3264 patients with sepsis, 3129 were analyzed. PSM yielded 2380 matched patients (1190 men and 1190 women). After PSM, 1-h bundle therapy was performed less frequently in women than in men (13.0% vs. 19.2%; p  < 0.001). Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently in women than in men (25.4% vs. 31.6%, p  < 0.001), whereas adequate fluid resuscitation was performed more frequently in women than in men (96.8% vs. 95.0%, p  = 0.029). In multivariable logistic regression analysis, 1-h bundle therapy was performed less frequently in women than in men [adjusted odds ratio (aOR) 1.559; 95% confidence interval (CI) 1.245–1.951; p  < 0.001] after adjustment. Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently to women than men (aOR 1.339, 95% CI 1.118–1.605; p  = 0.002), whereas adequate fluid resuscitation was performed more frequently for women than for men (aOR 0.629, 95% CI 0.413–0.959; p  = 0.031). Invasive arterial blood pressure monitoring was performed less frequently in women than in men. Resuscitation fluid, vasopressor, steroid, central-line insertion, ICU admission, length of stay in the emergency department, mechanical ventilator use, and renal replacement therapy use were comparable for both the sexes. Among patients with sepsis and septic shock, 1-h bundle therapy was performed less frequently in women than in men. Continuous efforts are required to increase adherence to the 1-h bundle therapy and to decrease sex differences in the in-hospital management of patients with sepsis and septic shock.

Ischemia-modified albumin (IMA) is produced during ischemia and reactive oxygen species production. This study aimed to evaluate the association between IMA and mortality in a larger population and the prognostic value of the combination of IMA and lactate for predicting mortality in septic shock patients in the emergency department. This retrospective observational study included adult septic shock patients between October 2019 and December 2021. A multivariable Cox proportional hazards model was performed. IMA was significantly higher in the non-surviving group than in the surviving group (89.1 ± 7.2 vs. 83.8 ± 6.2 U/mL, p < 0.001). IMA was independently associated with 28-day mortality after adjustments (adjusted hazard ratio [aHR]: 1.075, 95% confidence interval [CI]: 1.016–1.138, p = 0.012). The area under the ROC curve (AUROC) of IMA was 0.712 (95% CI: 0.648–0.775, p < 0.001) and was comparable to that of lactate. The AUROC of the combination of IMA and lactate was 0.838 (95% CI: 0.786–0.889, p < 0.001). The group with both high lactate and high IMA levels showed an extremely high risk of mortality than other groups (86.1%; aHR 8.956, 95% CI 4.071–19.70, p < 0.001). The elevation of IMA was associated with mortality in septic shock patients. The combination of IMA and lactate can be a helpful tool for early risk stratification of septic shock patients.

Influenza is a seasonal epidemic that poses significant health risks. Early antiviral treatment is recommended, making rapid and accurate diagnostic testing essential. Although rapid antigen tests (RATs) are widely used, they have limited sensitivity. In contrast, rapid nucleic acid amplification tests (NAATs) may offer improved diagnostic accuracy. This study compares the performance of a rapid NAAT and RAT for influenza in the emergency department. This prospective comparative study evaluated the rapid NAAT (ID NOW Influenza A&B, Abbott) and the RAT (BD Veritor System for Rapid Detection of Flu A + B, BD). Paired nasopharyngeal swabs were tested as point-of-care tests. Discordant results and agreement between the two tests were evaluated. A total of 453 patients were analyzed from December 2023 to February 2025. Mean age was 50.6 ± 20.6 years; 239 (52.8 %) were male. Influenza was detected in 166 (36.6 %) patients. Mean time from symptom onset to testing was 32.4 ± 62.1 h. Rapid NAAT-positive but RAT-negative cases were significantly more frequent (P < 0.001), supporting the higher sensitivity of the rapid NAAT. Cohen's kappa coefficient between tests was 0.750 (95 % CI 0.685–0.815, P < 0.001). This suggests systematic differences in sensitivity rather than random disagreement. Among patients tested within 48 h of symptom onset, discordance remained significant (P < 0.001). In patients with suspected influenza in the emergency department, although rapid NAAT and RAT demonstrated good agreement, the cases that tested positive by the rapid NAAT but negative by the RAT were significantly more frequent. This suggests that rapid NAAT may be a more suitable diagnostic tool in the emergency department, as rapid NAAT can help avoid false negatives, enable timely antiviral treatment, and improve clinical decision-making within the critical treatment window.