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Background With the widespread use of corticosteroids and immunosuppressants, the incidence of pneumocystis pneumonia in non-human immunodeficiency virus patients (non-HIV PCP) has continued to rise and has led to a high mortality rate. This study analyzed the clinical characteristics of severe HIV-negative PCP patients to explore the risk factors that can predict the risk of death. Methods A retrospective analysis was conducted on the clinical data of 165 adult patients with severe HIV-negative PCP patients who were hospitalized at Peking Union Medical College Hospital from January 2019 to October 2024. Univariate analysis of variance and chi-square test were used to compare the differences between the death group and the survival group. Multivariate logistic regression analysis was employed to identify the risk factors for mortality; To further explore the efficacy of different treatment strategies, the study subjects were divided into three groups: group1 [Trimethoprim/sulfamethoxazole (TMP/SMZ) monotherapy)], group2 (TMP/SMZ combined with caspofungin), and group3 (TMP/SMZ combined with clindamycin). Chi-square test was used to analyze the differences among the groups. Results Compared with the survivor group, the death group had lower platelet counts and albumin levels, and higher rates of shock, mediastinal emphysema and tracheal intubation with mechanical ventilation ( p  < 0.05). Multivariate logistic regression analysis showed that albumin was negatively correlated with the outcome of death (OR 0.9; 95% CI 0.83–0.97; p  = 0.005), while advanced age, cytomegalovirus (CMV) infection, and aspergillus infection might be positively correlated with the outcome of death, but the correlations were not statistically significant(OR 1.02; 95%, CI 1.00–1.05; p  = 0.064)、(OR 1.62; 95%, CI 0.81–3.28; p  = 0.178)、(OR 1.50; 95%, CI 0.71–2.21; p  = 0.292). For patients receiving invasive mechanical ventilation treatment, multivariate logistic regression analysis showed that connective tissue disease was positively correlated with death (OR 2.88; 95% CI 1.02–8.15; p  = 0.046), while albumin was negatively correlated with death (OR 0.88; 95% CI 0.79–0.96; p  = 0.016). The number of patients in the three groups according to the treatment plan was 79 (48.5%) in group 1, 35 (21.5%) in group 2, and 45 (27.6%) in group 3. The rates of receiving invasive mechanical ventilation were (54.4% vs 77.1%, 79.6%, p  = 0.013), and the mortality rates were (39.2% vs 51.4%, 65.3%, p  = 0.041), with statistically significant differences ( p  < 0.05). This suggests that among severe HIV-negative PCP patients, the group using TMP/SMZ had the largest number of patients, the lowest rate of invasive mechanical ventilation, and the lowest mortality rate. Further analysis of the patients who received invasive mechanical ventilation showed that the mortality rates in group 1, group 2, and group 3 were (69.8% vs. 66.7%, 82.1%, p  = 0.491), suggesting that the mortality rate in the group TMP/SMZ combined with caspofungin was lower than the groups TMP/SMZ monotherapy and TMP/SMZ combined with clindamycin, but the difference was not statistically significant ( p  > 0.05). Conclusions Hypoalbuminemia is a risk factor for death in severe HIV-negative PCP patients, while connective tissue diseases are another risk factor for death who receive invasive mechanical ventilation treatment. TMP/SMZ is the main treatment method for severe HIV-negative PCP patients. However, for patients who received invasive mechanical ventilation, TMP/SMZ combined with caspofungin may have a better therapeutic effect than using TMP/SMZ monotherapy and TMP/SMZ combined with clindamycin. Further research with a larger sample size is needed in the future.

Background There is growing evidence that patients recovering after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have a variety of acute sequelae including newly diagnosed diabetes. However, the risk of diabetes in the post-acute phase is unclear. To solve this question, we aimed to determine if there was any association between status post-coronavirus disease (COVID-19) infection and a new diagnosis of diabetes. Methods We performed a systematic review and meta-analysis of cohort studies assessing new-onset diabetes after COVID-19. PubMed, Embase, Web of Science, and Cochrane databases were all searched from inception to June 10, 2022. Three evaluators independently extracted individual study data and assessed the risk of bias. Random-effects models estimated the pooled incidence and relative risk (RR) of diabetes compared to non-COVID-19 after COVID-19. Results Nine studies with nearly 40 million participants were included. Overall, the incidence of diabetes after COVID-19 was 15.53 (7.91–25.64) per 1000 person-years, and the relative risk of diabetes after COVID-19 infection was elevated (RR 1.62 [1.45–1.80]). The relative risk of type 1 diabetes was RR=1.48 (1.26–1.75) and type 2 diabetes was RR=1.70 (1.32–2.19), compared to non-COVID-19 patients. At all ages, there was a statistically significant positive association between infection with COVID-19 and the risk of diabetes: <18 years: RR=1.72 (1.19–2.49), ≥18 years: RR=1.63 (1.26–2.11), and >65 years: RR=1.68 (1.22–2.30). The relative risk of diabetes in different gender groups was about 2 (males: RR=2.08 [1.27–3.40]; females: RR=1.99 [1.47–2.80]). The risk of diabetes increased 1.17-fold (1.02–1.34) after COVID-19 infection compared to patients with general upper respiratory tract infections. Patients with severe COVID-19 were at higher risk (RR=1.67 [1.25–2.23]) of diabetes after COVID-19. The risk (RR=1.95 [1.85–2.06]) of diabetes was highest in the first 3 months after COVID-19. These results remained after taking confounding factors into account. Conclusions After COVID-19, patients of all ages and genders had an elevated incidence and relative risk for a new diagnosis of diabetes. Particular attention should be paid during the first 3 months of follow-up after COVID-19 for new-onset diabetes.

Variation in the incidence, survival rate and factors associated with survival after cardiac arrest in China is reported. Some studies have tried to fill the knowledge gap regarding the epidemiology of cardiac arrest in China but were unable to identify reasons for the reported differences. Therefore, the purpose of this study was to describe Chinese management of cardiac arrest, particularly from the perspective of compression, ventilation, monitoring, treatment, and extracorporeal cardiopulmonary resuscitation. An online questionnaire with 56 questions was designed about demographic characteristics, management of cardiac arrest, compression, ventilation, treatment and medicine, as well as advanced life support and resuscitation skill training. A total of 814 copies of questionnaire were received from 23 provinces, 4 autonomous regions and 4 municipalities of China. Results were combined with official information on population density. Throughout China, hospitals resuscitate according to the guideline, however, there are still differences varies in implement with regard to chest compression, ventilation, medicine, monitoring, as well as advanced life support and resuscitation skills training because of economical and developmental level from different regions. All the startup of chest compression is manual, whereas mechanical compression instruments are increasingly involved in sequential resuscitation. Most of clinicians rotate during resuscitation every five cycles other than the guideline recommends every 2 min or when they are tired. About half of the participants don’t build the advanced airway rather than use bag valve mask to ventilate, and 75% of the rest use mechanical ventilation whether they succeed to ROSC. Most of rescuers choose endotracheal intubation which is consistent with many other clinical trials results. Various compression feedback devices play increasingly significant roles in assessment of ROSC. More and more regional hospitals have access to ECPR and implement TTM, but still lead to various divergences. Thus, more elaborate clinical trials need to be designed to verify and explore every procedure in the CPR life cycle.

Identifying critically ill patients is a key challenge in emergency department (ED) triage. Mis-triage errors are still widespread in triage systems around the world. Here, we present a machine learning system (MLS) to assist ED triage officers better recognize critically ill patients and provide a text-based explanation of the MLS recommendation. To derive the MLS, an existing dataset of 22,272 patient encounters from 2012 to 2019 from our institution’s electronic emergency triage system (EETS) was used for algorithm training and validation. The area under the receiver operating characteristic curve (AUC) was 0.875 ± 0.006 (CI:95%) in retrospective dataset using fivefold cross validation, higher than that of reference model (0.843 ± 0.005 (CI:95%)). In the prospective cohort study, compared to the traditional triage system’s 1.2% mis-triage rate, the mis-triage rate in the MLS-assisted group was 0.9%. This MLS method with a real-time explanation for triage officers was able to lower the mis-triage rate of critically ill ED patients.

We evaluated the serum levels of (1–3)-beta- d -glucan (BG) and lactate dehydrogenase (LDH) as a tool to support pneumocystis pneumonia (PCP) diagnostic procedures in non-HIV patients. We retrospectively collected non-HIV (human immunodeficiency virus) patients presenting clinical features of PCP between April 1st, 2013, and December 31st, 2018. A total of 225 included patients were tested for Pneumocystis jirovecii by polymerase chain reaction (PCR) and methenamine silver staining. Based on different exclusion criteria, 179 cases were included in the BG group, and 196 cases were included in the LDH group. In each group, cases with positive immunofluorescence (IF) microscopy and PCR were considered proven PCP, while cases with only positive PCR were considered probable PCP. Fifty patients with negative IF and PCR results and proven to be non-PCP infection were chosen randomly as the control group. The cut-off levels of BG and LDH to distinguish non-PCP from probable PCP were 110 pg/mL and 296 U/L with 88% sensitivity and 86% specificity, and 66% sensitivity and 88% specificity, respectively. The cut-off levels of BG and LDH to distinguish non-PCP from proven PCP were 285.8 pg/mL and 379 U/L with 92% sensitivity and 96% specificity, and 85% sensitivity and 77% specificity, respectively. The cut-off levels of BG and LDH to distinguish non-PCP from proven/probable PCP were 144.1 pg/mL and 363 U/L with 90% sensitivity, 86% specificity and 80% sensitivity, 76% specificity respectively. BG and LDH are reliable indicators for detecting P. jirovecii infection in HIV-uninfected immunocompromised patients.

Fat embolism syndrome (FES) is a clinical syndrome in which the obstruction of small blood vessels by fat emboli triggers a systemic inflammatory response, leading to organ dysfunction. Due to a lack of specific laboratory tests and physical examination, FES is clinically underdiagnosed. We report a case of a 39-year-old woman who presented with dyspnea that had developed after augmentation mammaplasty and vaginal tightening with autologous fat. Bedside transthoracic echocardiography (TTE) carried out in our emergency department evidently revealed right heart embolic material presumed to be fat. Based on echocardiography findings, combined with medical history and computed tomography pulmonary angiography images, a diagnosis of pulmonary fat embolism was made. This case presents valuable echocardiographic images and emphasizes the availability of bedside TTE in the diagnosis of fat embolism in a patient with dyspnea after plastic surgery, highlighting the value of bedside TTE in rapidly identifying pulmonary fat embolism.

Background Cardiac arrest is currently one of the leading causes of mortality in clinical practice, and the Charlson Comorbidity Index (CCI) is widely utilized to assess the severity of comorbidities. We aimed to evaluate the relationship between the age-adjusted CCI score and in-hospital mortality in intensive care unit (ICU) patients with the diagnosis of cardiac arrest, which is important but less explored previously. Methods This was a retrospective study including patients aged over 18 years from the MIMIC-IV database. We calculated the age-adjusted CCI using age information and ICD codes. The univariate analysis for varied predictors’ differences between the survival and the non-survival groups was performed. In addition, a multiple factor analysis was conducted based on logistic regression analysis with the primary result set as hospitalization death. An additional multivariate regression analysis was conducted to estimate the influence of hospital and ICU stay. Results A total of 1772 patients were included in our study, with median age of 66, among which 705 (39.8%) were female. Amongst these patients, 963 (54.3%) died during the hospitalization period. Patients with higher age-adjusted CCI scores had a higher likelihood of dying during hospitalization ( P  < 0.001; OR: 1.109; 95% CI: 1.068–1.151). With the age-adjusted CCI incorporated into the predictive model, the area under the receiver operating characteristic curve was 0.794 (CI: 0.773–0.814), showing that the prediction model is effective. Additionally, patients with higher age-adjusted CCI scores stayed longer in the hospital ( P  = 0.026, 95% CI: 0.056–0.896), but there was no significant difference between patients with varied age-adjusted CCI scores on the days of ICU stay. Conclusion The age-adjusted CCI is a valid indicator to predict death in ICU patients with cardiac arrest, which can offer enlightenment for both theory literatures and clinical practice.

Background Systemic amyloidosis is a kind of clinical syndrome in which amyloid is deposited between the cells of various organs in the body, resulting in gradual failure of the function of the affected organs. Depending on the site of amyloid deposition, it may show various clinical symptoms of multiple system involvement. Patient concerns A 44-years-old female with spontaneous giant retroperitoneal hematoma was admitted to the emergency department of Peking Union Medical College Hospital in Mar 2023. Diagnoses She was found with a extremely X-factor deficiency and diagnosed with AL amyloidosis according to pathological findings finally. Interventions and outcomes She received a variety of treatments to improve her coagulation function and underwent chemotherapy for AL in the hematology department which improved her coagulation function and was discharged to her local hospital for follow-up treatment. Conclusion This case provides a new reference for emergency doctors in the diagnosis and treatment of acute severe hemorrhagic diseases.

Background The inflammatory immune response is involved in the pathophysiology of the post-cardiac arrest syndrome and leads to high mortality. The admission (neutrophil + monocyte) to lymphocyte ratio (NMLR) can help us to assess the immune inflammatory status of patients. We aimed to identify factors that affect the prognosis and explore the association between NMLR and the prognosis of patients after cardiopulmonary resuscitation (CPR). Methods This is a retrospective study based on the MIMIC-IV database. We assessed patients admitted to the ICU after cardiopulmonary resuscitation, included demographic characteristics, peripheral blood cell count and blood gas indicators for the first time after admission to the ICU, developed a multivariate COX proportional-hazards model to explore prognostic factors, and divided patients into High NMLR and Low NMLR groups by cutoff values of NMLR. Propensity score matching (PSM) was used to adjust confounding factors. Results A total of 955 patients were included in the analysis, with 497 surviving and 458 dying during the follow-up period. In a multivariate Cox proportional-hazards model, age (RR 1.007, p  = 0.0411), NMLR levels (RR 1.003, p  = 0.0381), lactate (RR 1.097, p  < 0.001) and hematocrit (RR 1.101, p  < 0.001) were independent risk factors for patient death following CPR. Patients were divided into a high NMLR group (> 14.2) and a low NMLR group (≤ 14.2) based on the optimal threshold for NMLR. Compared to low NMLR group, high NMLR group had higher total vasoactive drugs and lower 28-day survival. After PSM, there were no differences in baseline characteristics. The high NMLR group still had a higher mortality rate ( p  = 0.001), lower 28-day survival ( p  = 0.001) and shorter length of stay ( p  = 0.005) compared to the low NMLR group. Conclusions Age, NMLR levels, lactate levels and hematocrit were independent risk factors for death in patients after CPR. NMLR > 14.2 was associated with higher mortality and was a potential predictor of clinical outcome in patients after CPR.