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The impact of infections on ICU stay and mortality was studied by comparing the characteristics of study population with demographically matched patients without infections. Patients admitted to the Surgical ICU were included in the study and their demographic characteristics and clinical features (diagnosis, acute physiology and chronic health evaluation (APACHE II score, comorbidities, device use, etc.) were noted in a structured proforma. Comparison of the two groups of patients by univariate analysis showed statistically significant difference in the history of diabetes mellitus, alcoholism, sepsis, immunocompromised state, immobilisation, admission due to roadside accident/ polytrauma, gastrointestinal perforation, diabetic foot/ gangrene and abscess/cellulitis. Majority of patients were males (73.6%), similar to the study by Baviskar et al (M = 76%; Е = 24%) but in contrast with the findings of Markogiannakis et al (М = 48.8%; Е = 51.2%).1121 Similar to the study by Alexiou et al HI diabetes was observed as the predominantcomorbidity in 33.4% patients whereas hypertension was most common in a study by Banan et al.!#! The majority of isolates were Gram-negative (83.8%) similar to data reported from other parts of the world.!°!

Background Post-intensive care syndrome (PICS) is a term coined by the Society of Critical Care Medicine to describe the psychological, cognitive, and physical dysfunction that ICU survivors may experience. Although surgical patients represent a substantial proportion of ICU survivors, studies describing PICS in this specific population remain limited. This study aims to determine the incidence and independent risk factors associated with PICS among surgical ICU survivors in a Chinese cohort. Methods The study was a prospective cohort study of critically ill surgical patients who were discharged from the ICU at the First Affiliated Hospital of Sun Yat-sen University between August 2021 and June 2022. Demographic characteristics, disease-related information, and ICU treatment were collected, and enrolled participants were followed up within six months after ICU discharge. The Chinese version of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and the Short Memory Questionnaire (SMQ) were used to assess PICS. The physical component summary (PCS) and the mental component summary (MCS) were averaged from the corresponding four-dimension scores in the SF-36. PICS diagnosis was determined based on the presence of at least one of the following: physiological dysfunction (defined as PCS reductions greater than 10), psychological dysfunction (defined as MCS reductions greater than 10), or cognitive dysfunction (defined as SMQ reductions and scores less than 40 at six months). PICS diagnosis was based on the presence of at least one of the following: physiological, psychological, or cognitive dysfunction. Results A total of 565 patients were screened in this study, and 83 were enrolled after applying the inclusion and exclusion criteria. Overall, 65 surgical ICU survivors developed PICS within six months, with an incidence rate of 78.3%. The prevalences were 55.4% and 27.7% at the end of 3 and 6 months after ICU discharge, respectively. Univariate analysis showed that there was a correlation between the occurrence of PICS and the total bilirubin and creatinine levels at ICU admission, APACHE II score, ICU length of stay, and the presence of dialysis ( P  < 0.05). ICU length of stay was identified as an independent risk factor for the occurrence of PICS in surgical ICU survivors after adjusting for confounders. Conclusion The overall PICS incidence in surgical ICU survivors was 78.3%, with prevalence gradually decreasing over time to 27.7% within 6 months. For surgical survivors requiring ICU care, the longer the ICU stay, the more likely to develop PICS. Implications for clinical practice The findings offer valuable insights into the incidence and risk factors of PICS in surgical ICU survivors, which can help healthcare professionals identify surgical cases at high risk of developing PICS and tailor the treatment effectively.

Purpose Our aim was to investigate the prevalence, risk factors, and impact on outcome of nonconvulsive seizures (NCSz), nonconvulsive status epilepticus (NCSE), and periodic epileptiform discharges (PEDs) in surgical intensive care unit (SICU) patients with continuous electroencephalography (cEEG) monitoring. Methods This was a retrospective study of SICU patients who underwent cEEG monitoring for altered mental status over a 6-year period. We report the frequency of NCSz (including NCSE) and PEDs on cEEG. The primary outcome was death or severe disability at hospital discharge. Multivariable logistic regression was used to identify whether NCSz (including NCSE) and PEDs were independently associated with poor outcome (death, vegetative state or severe disability). Results Of 154 patients, the mean age was 64 ± 14 years old, and 40 % were women. The majority of patients were admitted following abdominal surgery (36 %) and liver transplantation (24 %). Sepsis developed in 100 (65 %) patients. Sixteen percent ( n  = 24) had NCSz [including 5 % ( N  = 8) with NCSE], and 29 % ( N  = 45) had PEDs. All eight patients with NCSE were septic. Clinical seizures prior to cEEG and coma were more common among patients who developed NCSz or NCSE compared to patients without NCSz or NCSE (70 vs. 27 %; p  < 0.01; 75 vs. 52 %; p  = 0.046 and 63 vs. 34 %; p  = 0.09, respectively). NCSzs (including NCSE) were independently associated with poor outcome (20 vs. 3 %, OR 10.4, 95 % CI 1.0–53.7; p  = 0.039). Conclusion In this retrospective study of SICU patients with cEEG monitoring for altered mental status, NCSz and periodic discharges were frequent and NCSz were independently associated with poor outcome. NCSz were more common when clinical seizures occurred before cEEG.

Background Despite of massive development in health sciences, maternal mortality in Pakistan is still highest in Southeast Asia. Derailment of widespread physiological changes or evolution of any highrisk pregnancy induced condition may necessitate admission to an intensive care unit (ICU) during the course of pregnancy or postpartum. The purpose of this study is to identify the factors leading to ICU admissions and outcomes of obstetric patients in surgical ICU of a tertiary care hospital. Methods A descriptive study was conducted in Department of Anaesthesiology, the Surgical ICU and Pain Management, Civil Hospital Karachi for 6 months from June to December 2022.A Total 138 patients with antepartum and postpartum conditions requiring ICU admission were recruited in this study. All demographic details were recorded in a predesigned proforma. The patient’s parturient status as antepartum or postpartum and the comorbidities with which they presented were recorded. Results Patients’ mean age was 26.68 ± 5.67 years. Hypertensive disorder was the commonest factor (51.45%) leading to ICU admission followed by obstetric hemorrhage 37.86% and sepsis was observed in 10.87%. There were 15.94% (22 of 138) women who were expired and 81.06% (116 of 18) were discharged from surgical ICU. Mortality rate was significantly high in those women whose causes were obstetric hemorrhage and sepsis. (p=0.0005). Conclusion The most frequent cause of ICU admission was the hypertensive condition of pregnancy, which was followed by obstetric hemorrhage and infection. It is essential to approach these patients meticulously and embark on rapid management protocol with a team approach to save these precious lives. BJMS, Vol. 24 No. 03 July’25 Page : 807-814

Major reconstructive free-flap surgery often requires ICU admission, yet early signals associated with postoperative antibiotic escalation remain poorly characterized. We conducted a single-center retrospective cohort study of 119 consecutive postoperative ICU admissions after major free-flap reconstruction. Exposures were postoperative day-1 procalcitonin (PCT) and documented postoperative shock; the primary endpoint was clinician-initiated antibiotic escalation (“upgrade”), and secondary endpoints were documented microbiological positivity and ICU mechanical ventilation duration. Escalation occurred in 85/119 admissions (71.4%). Day-1 PCT was higher with escalation (median 0.25 vs. 0.135 ng/mL; p = 0.033), and shock was more frequent (59/85 [69.4%] vs. 13/34 [38.2%]; p = 0.003). Escalation was associated with longer ventilation (median 3515 vs. 2170 min; p < 0.001) and higher rates of any positive culture (54/85 [63.5%] vs. 8/34 [23.5%]; p < 0.001). In multivariable logistic regression adjusting for operative time and intraoperative IV volume, shock remained independently associated with escalation (adjusted OR 3.52, 95% CI 1.48–8.36; p = 0.004), whereas log-transformed PCT was not (p = 0.224). PCT showed modest apparent discrimination for escalation (AUC 0.63), improving to 0.71 when combined with shock. These findings should be interpreted as observational associations with escalation behavior, supporting prospective evaluation of physiology-plus-biomarker stewardship approaches.

The prognostic value of dynamic body mass index (BMI) changes during hospitalization in surgical intensive care unit (ICU) patients admitted emergently remains unclear. This study aimed to investigate the association between in-hospital BMI change and 28-day mortality in this high-risk population. This retrospective cohort study utilized data from the eICU Collaborative Research Database (2014-2015). A total of 20,543 adult surgical ICU patients admitted via the emergency department (ED) were included. BMI change was calculated as discharge BMI minus admission BMI. Multivariable Cox regression, restricted cubic splines, and subgroup analyses were employed to evaluate the association between BMI change and mortality. The 28-day ICU mortality was 4.70%. BMI change exhibited a U-shaped, non-linear association with death: risk declined modestly as BMI rose toward the nadir of -1.75 kg/m , then increased sharply thereafter. Each additional kg/m above this threshold raised mortality by 9% (HR 1.09, 95% CI 1.05-1.12,  < 0.0001). Patients in the highest BMI-gain quartile faced a 52% higher risk than those in the lowest quartile (HR 1.52, 95% CI 1.27-1.82, p < 0.0001). Dynamic BMI change outperformed static BMI or weight measures (AUC 57.9). In-hospital BMI change is a significant predictor of 28-day mortality in surgical ICU patients admitted via the ED. A moderate reduction in BMI (-1.75 kg/m ) was associated with the lowest mortality risk. Dynamic BMI monitoring may enhance risk stratification and guide personalized fluid management in this population.

Background Sepsis is a syndrome characterized by a constellation of clinical manifestations and a significantly high mortality rate in the surgical intensive care unit (ICU). It is frequently complicated by acute kidney injury (AKI), which, in turn, increases the risk of mortality. Therefore, it is of paramount importance to identify those septic patients at risk for the development of AKI and mortality. The objective of this pilot study was to evaluate several different biomarkers, including NGAL, calprotectin, KIM-1, cystatin C, and GDF-15, along with SOFA scores, in predicting the development of septic AKI and associated in-hospital mortality in critically ill surgical patients. Methods Patients admitted to the surgical ICU were prospectively enrolled, having given signed informed consent. Their blood and urine samples were obtained and subjected to enzyme-linked immunosorbent assay (ELISA) to determine the levels of various novel biomarkers. The clinical data and survival outcome were recorded and analyzed. Results A total of 33 patients were enrolled in the study. Most patients received surgery prior to ICU admission, with abdominal surgery being the most common type of procedure (27 patients (81.8%)). In the study, 22 patients had a diagnosis of sepsis with varying degrees of AKI, while the remaining 11 were free of sepsis. Statistical analysis demonstrated that in patients with septic AKI versus those without, the following were significantly higher: serum NGAL (447.5 ± 35.7 ng/mL vs. 256.5 ± 31.8 ng/mL, P value 0.001), calprotectin (1030.3 ± 298.6 pg/mL vs. 248.1 ± 210.7 pg/mL, P value 0.049), urinary NGAL (434.2 ± 31.5 ng/mL vs. 208.3 ± 39.5 ng/mL, P value < 0.001), and SOFA score (11.5 ± 1.2 vs. 4.4 ± 0.5, P value < 0.001). On the other hand, serum NGAL (428.2 ± 32.3 ng/mL vs. 300.4 ± 44.3 ng/mL, P value 0.029) and urinary NGAL (422.3 ± 33.7 ng/mL vs. 230.8 ± 42.2 ng/mL, P value 0.001), together with SOFA scores (10.6 ± 1.4 vs. 5.6 ± 0.8, P value 0.003), were statistically higher in cases of in-hospital mortality. A combination of serum NGAL, urinary NGAL, and SOFA scores could predict in-hospital mortality with an AUROC of 0.911. Conclusions This pilot study demonstrated a promising panel that allows an early diagnosis, high sensitivity, and specificity and a prognostic value for septic AKI and in-hospital mortality in surgical ICU. Further study is warranted to validate our findings.

Background Acute kidney injury requiring renal replacement therapy (RRT) is a critical complication in elderly surgical patients in the intensive care unit (ICU) and is associated with high mortality and healthcare costs. The prognostic nutritional index (PNI), calculated as 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (per mm 3 ), integrates both the serum albumin level and lymphocyte count to reflect a patient's nutritional and immunological status, however, its association with the need for RRT remains underexplored. This study aimed to evaluate the association between the PNI and need for RRT in critically ill surgical patients aged ≥ 65 years. Methods A secondary analysis of 3,406 elderly surgical patients in the ICU (2015–2020) from a single-center cohort was conducted. The PNI was calculated serum albumin levels and lymphocyte counts obtained at ICU admission. Patients were stratified into PNI tertiles (low: 26.50–41.00; middle: 41.50–48.50; high: 49.00–73.00). Multivariate logistic regression and subgroup analyses were applied to explore the association of the PNI with the need for RRT. Furthermore, we also examined the association between the PNI and the need for RRT by employing restricted cubic splines. The discriminative ability of the PNI was assessed using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Results According to the multivariate regression models, the PNI demonstrated a significant inverse association with the need for RRT after comprehensive covariate adjustment. The adjusted odds ratio (OR) for the need for RRT was 0.95 (95% CI 0.93–0.97; P  < 0.0001) per 10-unit increase in the PNI. When the PNI was analyzed by tertile, patients in the middle (OR = 0.72, 95% CI: 0.54–0.97,  P  = 0.0285) and high tertiles (OR = 0.42, 95% CI: 0.29–0.60, P  < 0.0001) presented a progressively lower risk of RRT than did those in the low tertile, with a significant dose‒response trend ( P  for trend < 0.0001). We further performed exploratory subgroup analyses and confirmed that higher PNI levels were independently associated with a lower risk of RRT ( P for interaction > 0.05). The RCS analysis suggested a linear relationship between the PNI and the need for RRT ( P for nonlinearity = 0.2848). The E-value of 2.59 demonstrates the robustness of the results against unmeasured confounding. Conclusion In geriatric surgical patients (≥ 65 years) presenting with critical illness, an elevated PNI demonstrated an inverse correlation with the need for RRT.

: Unplanned readmission to the surgical intensive care unit (UR-SICU) is a serious adverse event linked to higher morbidity, prolonged stay, and increased mortality. Most evidence derives from mixed ICUs, limiting applicability to surgical cohorts. We aimed to identify risk factors for UR-SICU and assess their impact on outcomes. : We performed a retrospective cohort study of adults admitted to a 20-bed SICU in a tertiary hospital between June 2021 and December 2022 after non-cardiac surgery (elective, urgent, trauma, or liver transplantation). Patients dying during the first SICU stay or transferred to another ICU were excluded. Demographics, comorbidities, severity scores, treatments, and complications were recorded. Logistic regression identified predictors. Kaplan-Meier curves analyzed survival. : Among 1361 patients, 82 (6.4%) required UR-SICU. Half were surgical (mainly hemorrhage and sepsis), while respiratory and infectious complications predominated among medical readmissions. Independent predictors for UR-SICU were age (OR 1.03/year; = 0.002), active malignancy (OR 1.79; = 0.012), and delirium during the first SICU stay (OR 1.86; = 0.030). UR-SICU patients had longer hospital stays [46 vs. 13 days; < 0.001] and higher hospital mortality (27.1% vs. 1.48%; OR 24.68; < 0.001). Mortality remained higher at 6 months (33.3% vs. 7.1%) and 1 year (42.3% vs. 11.1%). : UR-SICU occurred in 6.4% of patients and was independently associated with age, malignancy, and delirium. Readmission was strongly linked to prolonged hospitalization and increased short- and long-term mortality. Early recognition of high-risk patients and targeted, personalized preventive strategies may help reduce avoidable readmissions.

Background Sepsis, a complex condition characterized by dysregulated immune response and organ dysfunction, is a leading cause of mortality in ICU patients. Current diagnostic and prognostic approaches primarily rely on non-specific biomarkers and illness severity scores, despite early endothelial activation being a key feature of sepsis. This study aimed to evaluate the levels of soluble thrombomodulin and soluble endoglin in seriously ill surgical septic patients and explore their association with organ dysfunction and disease severity. Methodology A case control study was conducted from March 2022 to November 2022, involving seriously ill septic surgical patients. Baseline clinical and laboratory data were collected within 24 h of admission to the Surgical Intensive Care Unit. This included information such as age, sex, hemodynamic parameters, blood chemistry, SOFA score, qSOFA score, and APACHE-II score. A proforma was filled out to record these details. The outcome of each patient was noted at the time of discharge. Results The study found significantly elevated levels of soluble thrombomodulin and soluble endoglin in seriously ill surgical septic patients. The RTqPCR analysis revealed a positive correlation between soluble thrombomodulin and soluble endoglin levels with the qSOFA score, as well as, there was a positive association between RTqPCR soluble thrombomodulin and the SOFA score. These findings indicate a correlation between these biomarkers and organ dysfunction and disease severity. Conclusion The study concludes that elevated levels of soluble thrombomodulin and soluble endoglin can serve as endothelial biomarkers for early diagnosis and prognostication in seriously ill surgical septic patients.