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Comparison of prognosis in emergency department elderly septic shock patients with initial hypotension versus delayed hypotension

2026-06-10T02:11:21Z

Title: Comparison of prognosis in emergency department elderly septic shock patients with initial hypotension versus delayed hypotension Authors: Lee, Chaeeun; Suh, Gil Joon; Choi, Sung-Hyuk; Chung, Sung Phil; Kim, Won Young; Lim, Tae Ho; Choi, Sangchun; Shin, Tae Gun; Nah, Sangun; Han, Sangsoo Abstract: Background and importanceHypotension and advanced-age are significant risk factors for increased sepsis-related mortality. However, the relationship between the timing of hypotension in the emergency department (ED) and the prognosis of elderly patients with septic shock is little understood.ObjectiveTo determine the effect of hypotension on arrival at the ED with the prognosis of elderly patients with septic shock.Design, settings, and participantsA retrospective analysis of a multicenter registry that was prospectively collected from 12 EDs. Patients aged older than 65 years who were diagnosed with septic shock requiring vasopressor support from October 2015 to December 2022 were included. Hypotension was defined as a systolic blood pressure less than 90 mmHg or a mean arterial pressure less than 65 mmHg. Based on the timing of the first hypotension episode, patients were divided into two groups: the initial hypotension group (hypotension on arrival at the ED) and the delayed hypotension group (developed hypotension while staying in the ED).Outcome measures and analysisThe primary outcome was 28-day mortality of elderly patients with septic shock, and the secondary outcomes were ICU admission, mechanical ventilation within 24 h, and renal replacement therapy (RRT) within 24 h. A multivariable Cox proportional hazards model was used to analyze the association between initial hypotension and the outcomes. A Kaplan-Meier curve was constructed to investigate the survival probabilities of the patients.Main resultsThis study included 1444 patients [868 (60.1%) with initial hypotension and 576 (39.9%) with delayed hypotension]. Initial hypotension was significantly associated with 28-day mortality [hazard ratio: 1.20, 95% confidence interval (CI): 1.00-1.45, P = 0.049]. However, initial hypotension was not associated with ICU admission (hazard ratio: 1.13, 95% CI: 0.96-1.33, P = 0.154), mechanical ventilation within 24 h (hazard ratio: 0.85, 95% CI: 0.69-1.06, P = 0.147), or RRT within 24 h (hazard ratio: 1.05, 95% CI: 0.76-1.46, P = 0.775).ConclusionThis study highlights the prognostic value of initial hypotension in elderly patients with septic shock, showing its association with a high risk of 28-day mortality.

Optimizing smartwatch emergency sirens for high-quality CPR: a call for multimodal guidance integration

2026-04-29T07:42:17Z

Title: Optimizing smartwatch emergency sirens for high-quality CPR: a call for multimodal guidance integration Authors: You, Jeesang; You, Je Sung

Targeted temperature management at 33 and 36°C mitigates contrast-induced acute kidney injury

2026-07-03T05:58:41Z

Title: Targeted temperature management at 33 and 36°C mitigates contrast-induced acute kidney injury Authors: Oh, Hyewon; Beom, Jinho; Park, June; Park, Ga Bin; You, Je Sung; Chung, Yong Eun Abstract: Iodinated contrast agents are essential for accurate diagnostics but pose a risk of contrast-induced acute kidney injury (CIAKI), primarily through oxidative stress. Current guidelines recommend intravenous hydration as the main preventive strategy. Targeted temperature management (TTM), which lowers core body temperature, has shown protective effects in ischemic conditions. However, its role in CIAKI remains unclear. This study investigated whether TTM at 33 and 36 °C can mitigate CIAKI. Forty-two Sprague-Dawley rats were assigned to six groups (n = 7 per group): Control, TTM 33 °C, TTM 36 °C, CIAKI, CIAKI with TTM 33 °C, and CIAKI with TTM 36 °C. Body temperature was regulated using external cooling, and blood and tissue samples were collected after 24 h. Serum creatinine, blood urea nitrogen, and markers of oxidative stress, apoptosis, inflammation, and renal injury were evaluated. Oxidative stress increased in the CIAKI group but decreased in both TTM groups. Superoxide dismutase levels declined in the CIAKI group but were restored with TTM. Apoptotic and inflammatory markers were elevated in the CIAKI group but reduced with TTM. Renal function was better preserved in the TTM at 36 °C group than in the TTM at 33 °C group. These findings suggest that TTM at 33 and 36 ℃ groups attenuates CIAKI by reducing oxidative stress, apoptosis, and inflammation. While TTM at 33 and 36℃ demonstrated protective effects, TTM at 36 °C may provide a more pronounced functional benefit. © 2026. The Author(s).

Age-Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort Study

2026-04-14T00:10:29Z

Title: Age-Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort Study Authors: Maeng, Seung Jin; Park, Jong Eun; Lee, Gun Tak; Hwang, Sung Yeon; Kim, Minha; Heo, Sejin; Lim, Tae Ho; Chung, Sung Phil; Choi, Sung-Hyuk; Shin, Tae Gun Abstract: Background: Sepsis remains a leading cause of mortality worldwide. This study evaluated the independent and combined effects of age and chronic comorbidities on clinical outcomes in patients with septic shock. Methods: We conducted a multicenter retrospective observational study to evaluate the factors associated with 28-day mortality in the Korean Shock Society registry between 2015 and 2023. Adults with suspected infection and refractory hypotension or hypoperfusion within 6 h of emergency department (ED) arrival were included. Patients were grouped by age (<50, 50-74, and >= 75 years) and comorbidity status. Comorbidities encompass major chronic conditions including hypertension, diabetes mellitus, malignancy, history of organ transplant, dementia, nursing home residence, chronic disease of cardiac, lung, liver, and kidney. The primary outcome was 28-day mortality. Multivariable logistic regression analysis was used. Results: Among 8787 patients (median age 70.2 years), the 28-day mortality rate was 22.9% (n = 2018). Elderly patients with comorbidities had the highest mortality (27.5%). Additionally, patients aged over 50 with at least one comorbidity accounted for 18% of the total cohort (n = 1605) but accounted for nearly 80% of all 28-day deaths. Although younger patients without comorbidities represented a small subgroup, their mortality was not negligible (7.3%) and was substantially higher with comorbidities (22.2%). Compared with patients <50 years, adjusted odds ratios (aORs) of 28-day mortality were 1.81 (95% CI, 1.08-3.03) for 50-74 years and 3.21 (95% CI, 1.92-5.37) for >= 75. The presence of any comorbidities was independently associated with higher odds of 28-day mortality compared with no comorbidity (aOR 2.67; 95% CI, 1.57-4.54). A significant interaction between age and comorbidity status (p for interaction = 0.008) suggested that the age-related gradient in mortality differed depending on comorbidity burden. Conclusions: Age and comorbidities were both significantly associated with septic shock mortality, and their significant interaction demonstrates effect modification, indicating that the prognostic impact of comorbidities differs by age group and that age-related mortality gradients are influenced by comorbidity burden.