Comparing the demographic data and outcomes of septic shock patients presenting to teaching or non-teaching metropolitan hospitals in the United States

doi:10.5847/wjem.j.1920-8642.2022.101

Abstract

Abstract:

BACKGROUND: Studies looking at the effect of hospital teaching status on septic shock related in-hospital mortality are lacking. The aim of this study was to examine the effect of hospital teaching status on mortality in septic shock patients in the United States.

METHODS: This was a retrospective observational study, using the Nationwide Emergency Department Sample Database (released in 2018). All patients with septic shock were included. Complex sample logistic regression was performed to assess the impact of hospital teaching status on patient mortality.

RESULTS: A total of 388,552 septic shock patients were included in the study. The average age was 66.93 years and 51.7% were males. Most of the patients presented to metropolitan teaching hospitals (68.2%) and 31.8% presented to metropolitan non-teaching hospitals. Septic shock patients presenting to teaching hospitals were found to have a higher percentage of medical comorbidities, were more likely to be intubated and placed on mechanical ventilation (50.5% vs. 46.9%) and had a longer average length of hospital stay (12.47 d vs. 10.20 d). Septic shock patients presenting to teaching hospitals had greater odds of in-hospital mortality compared to those presenting to metropolitan non-teaching hospitals (adjusted odd ratio [OR]=1.295, 95% confidence interval [CI]: 1.256-1.335).

CONCLUSION: Septic shock patients presenting to metropolitan teaching hospitals had significantly higher risks of mortality than those presenting to metropolitan non-teaching hospitals. They also had higher rates of intubation and mechanical ventilation as well as longer lengths of hospital stay than those in non-teaching hospitals.

Key words: Sepsis, Septic shock, In-hospital mortality, Hospital teaching status, United States, Epidemiology, Outcome

Ralph Bou Chebl, Nadim Kattouf, Mohamad Assaf, Saadeddine Haidar, Gilbert Abou Dagher, Sarah Abdul Nabi, Rana Bachir, Mazen El Sayed. Comparing the demographic data and outcomes of septic shock patients presenting to teaching or non-teaching metropolitan hospitals in the United States[J]. World Journal of Emergency Medicine, 2022, 13(6): 433-440.

Figures/Tables 5

Figure 1.

Table 1.

The characteristics and disposition of the septic shock patients presenting to the emergency department

Variables	Frequency/mean (n=388,552)	Percentage (95%CI)/ 95%CI alone
Gender Male Female Missing = 144 (0.01%)	200,662 187,746	51.7 (51.4-52.0) 48.3 (48.0-48.6)
Average age of patients, years	66.93	66.84-67.03
Past medical history History of infectious and parasitic disease Malignancy Endocrine, nutritional, metabolic diseases and immunity disorders Diseases of blood and blood-forming organs Psychiatric disorders Diseases of the nervous system Diseases of the circulatory system Diseases of the respiratory system Diseases of the digestive system Diseases of the genitourinary system Diseases of the skin and subcutaneous tissue Diseases of the musculoskeletal system	380,129 70,087 360,963 245,795 183,053 224,667 339,981 310,263 224,493 326,819 93,019 118,864	97.8 (97.7-97.9) 18.0 (17.8-18.3) 92.9 (92.7-93.0) 63.3 (63.0-63.5) 47.1 (46.8-47.4) 57.8 (57.5-58.1) 87.5 (87.3-87.7) 79.9 (79.6-80.1) 57.8 (57.5-58.1) 84.1 (83.9-84.3) 23.9 (23.7-24.2) 30.6 (30.3-30.9)
Region of the hospital Northeast Midwest South West	76,219 74,802 148,958 88,573	19.6 (19.6-19.6) 19.3 (19.3-19.3) 38.3 (38.3-38.3) 22.8 (22.8-22.8)
Teaching status of hospital Metropolitan non-teaching Metropolitan teaching	123,731 264,821	31.8 (31.8-31.8) 68.2 (68.2-68.2)
Disposition of patient from emergency department Transfer to another short-term hospital Other transfers (including skilled nursing facility, intermediate care, and another type of facility) Admitted as an inpatient to this hospital Died in emergency department	2,414 635 383,372 2,131	0.6 (0.6-0.7) 0.2 (0.1-0.2) 98.7 (98.6-98.7) 0.5 (0.5-0.6)
Disposition of patient from hospital Discharged home Transfer to short-term hospital Other transfers (including skilled nursing facility, intermediate care, and another type of facility) Home health care Against medical advice Deceased Discharged alive with unknown destination Missing= 5,304 (1.4%)	64,363 15,557 133,917 47,893 2,988 118,471 59	16.8 (16.6-17.0) 4.1 (3.9-4.2) 34.9 (34.7-35.2) 12.5 (12.3-12.7) 0.8 (0.7-0.8) 30.9 (30.6-31.2) 0 (0-0)
In-hospital mortality No Yes	267,950 120,602	69.0 (68.7-69.2) 31.0 (30.8-31.3)
Average length of stay, d	11.76	11.67-11.84

Table 1.

Table 2.

Table 3.

The characteristics, disposition and hospital procedures of the septic shock patients presenting to the emergency department based on hospital teaching status

Variables	Metropolitan non-teaching hospital		Metropolitan teaching hospital		P-value
Variables	Frequency (n=123,730)	Percentage (95%CI) or mean (95%CI)	Frequency (n=264,822)	Percentage (95%CI) or mean (95%CI)	P-value
Gender Male Female	63,547 60,141	51.4 (50.9-51.9) 48.6 (48.1-49.1)	137,115 127,605	51.8 (51.4-52.2) 48.2 (47.8-48.6)	0.190
Average age, years	123,730	68.01 (67.86-68.17)	264,822	66.43 (66.32-66.54)	<0.001
Past medical history History infectious or parasitic disease Malignancy Endocrine, nutritional, metabolic diseases and immunity disorders Diseases of blood and blood-forming organs Psychiatric disorders Diseases of the nervous system Diseases of the circulatory system Diseases of the respiratory system Diseases of the digestive system Diseases of the genitourinary system Diseases of the skin and subcutaneous tissue Diseases of the musculoskeletal system	120,664 20,564 114,645 76,852 58,635 71,340 108,627 98,163 69,771 103,844 27,182 37,871	97.5 (97.4-97.7) 16.6 (16.2-17.0) 92.7 (92.4-92.9) 62.1 (61.6-62.6) 47.4 (46.9-47.9) 57.7 (57.1-58.2) 87.8 (87.5-88.1) 79.3 (78.9-79.8) 56.4 (55.9-56.9) 83.9 (83.5-84.3) 22.0 (21.5-22.4) 30.6 (30.1-31.1)	259,465 49,523 246,317 168,943 124,418 153,327 231,354 212,100 154,721 222,976 65,837 80,993	98.0 (97.9-98.1) 18.7 (18.4-19.0) 93.0 (92.8-93.2) 63.8 (63.5-64.1) 47.0 (46.6-47.3) 57.9 (57.5-58.2) 87.4 (87.1-87.6) 80.1 (79.8-80.4) 58.4 (58.1-58.8) 84.2 (83.9-84.5) 24.9 (24.6-25.2) 30.6 (30.3-30.9)	<0.001 <0.001 0.029 <0.001 0.201 0.444 0.042 0.003 <0.001 0.249 <0.001 0.936
Region of hospital Northeast Midwest South West	15,654 21,961 49,771 36,344	12.7 (12.7-12.7) 17.7 (17.7-17.7) 40.2 (40.2-40.2) 29.4 (29.4-29.4)	60,565 52,841 99,186 52,229	22.9 (22.9-22.9) 20.0 (20.0-20.0) 37.5 (37.5-37.5) 19.7 (19.7-19.7)	<0.001
Disposition of patient from emergency department Transfer to short-term hospital Other transfers (including skilled nursing facility, intermediate care, and another type of facility) Admitted as an inpatient to this hospital Died in emergency department	1,584 275 121,153 718	1.3 (1.2-1.4) 0.2 (0.2-0.3) 97.9 (97.8-98.1) 0.6 (0.5-0.7)	831 359 262,218 1,413	0.3 (0.3-0.4) 0.1 (0.1-0.2) 99.0 (98.9-99.1) 0.5 (0.5-0.6)	<0.001
Disposition of patient from hospital Discharged home or home health care Transfer to short-term hospital or other transfers (including skilled nursing facility, intermediate care, and another type of facility) Deceased Against medical advice or discharged alive with unknown destination	36,604 49,238 34,014 1,222	30.2 (29.8-30.7) 40.7 (40.2-41.2) 28.1 (27.6-28.6) 1.0 (0.9-1.1)	75,653 100,236 84,457 1,824	28.9 (28.5-29.2) 38.2 (37.9-38.6) 32.2 (31.9-32.5) 0.7 (0.6-0.8)	<0.001
In-hospital mortality No Yes	88,999 34,731	71.9 (71.5-72.4) 28.1 (27.6-28.5)	178,950 85,871	67.6 (67.2-67.9) 32.4 (32.1-32.8)	<0.001
Average length of stay, d	121,135	10.20 (10.09-10.31)	262,177	12.47 (12.37-12.58)	<0.001
Hospital procedures (for patients admitted to the same hospital of the emergency department) Small bowel resection Colorectal resection Appendectomy Fluoroscopy of the biliary and pancreatic ducts (ERCP, ERC and ERP) Cholecystectomy and common duct exploration Laparoscopy (GI only) Exploratory laparotomy Other non-operative upper GI therapeutic procedures Other operative upper GI therapeutic procedures Other non-operative lower GI therapeutic procedures Other operative lower GI therapeutic procedures Other gastrointestinal diagnostic procedures Other non-operative gastrointestinal therapeutic procedures Other operative gastrointestinal therapeutic procedures Respiratory intubation and mechanical ventilation	n=121,154 479 2,615 756 478 1,561 493 383 3,324 1,647 690 2,812 1,913 3,207 2,643 56,761	0.4 (0.3-0.5) 2.2 (2.0-2.3) 0.6 (0.5-0.7) 0.4 (0.3-0.5) 1.3 (1.2-1.4) 0.4 (0.3-0.5) 0.3 (0.3-0.4) 2.7 (2.6-2.9) 1.4 (1.2-1.5) 0.6 (0.5-0.7) 2.3 (2.2-2.5) 1.6 (1.5-1.7) 2.6 (2.5-2.8) 2.2 (2.0-2.3) 46.9 (46.3-47.4)	n=262,218 675 5,264 1,173 1,161 2,376 1,045 1,276 9,163 4,297 1,832 6,823 6,807 8,636 6,750 132,550	0.3 (0.2-0.3) 2.0 (1.9-2.1) 0.4 (0.4-0.5) 0.4 (0.4-0.5) 0.9 (0.8-1.0) 0.4 (0.4-0.4) 0.5 (0.4-0.5) 3.5 (3.4- 3.6) 1.6 (1.6-1.7) 0.7 (0.6-0.8) 2.6 (2.5-2.7) 2.6 (2.5-2.7) 3.3 (3.2-3.4) 2.6 (2.5-2.7) 50.5 (50.2-50.9)	<0.001 0.104 <0.001 0.260 <0.001 0.834 <0.001 <0.001 0.001 0.013 0.006 <0.001 <0.001 <0.001 <0.001

Table 3.

Table 4.

References 31

1	Genga KR, Russell JA. Update of sepsis in the intensive care unit. J Innate Immun. 2017; 9(5):441-5. doi: 10.1159/000477419 pmid: 28697503
2	Torio CM, Andrews RM. National inpatient hospital costs: the most expensive conditions by payer, 2011. Agency for Healthcare Research and Quality (US) 2013. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.pdf.
3	Paoli CJ, Reynolds MA, Sinha M, Gitlin M, Crouser E. Epidemiology and costs of sepsis in the United States-an analysis based on timing of diagnosis and severity level. Crit Care Med. 2018; 46(12): 1889-97. doi: 10.1097/CCM.0000000000003342 pmid: 30048332
4	Rockville MD. HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Available at: https://www.ncbi.nlm.nih.gov/books/NBK52651/
5	Vincent JL, Jones G, David S, Olariu E, Cadwell KK. Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis. Crit Care. 2019; 23(1): 196. doi: 10.1186/s13054-019-2478-6
6	Mohamed AKS, Mehta AA, James P. Predictors of mortality of severe sepsis among adult patients in the medical Intensive Care Unit. Lung India. 2017; 34(4): 330-5. doi: 10.4103/lungindia.lungindia_54_16 pmid: 28671163
7	Khwannimit B, Bhurayanontachai R. The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting. Epidemiol Infect. 2009; 137(9): 1333-41. doi: 10.1017/S0950268809002027 pmid: 19192320
8	Artero A, Zaragoza R, Camarena JJ, Sancho S, González R, Nogueira JM. Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock. J Crit Care. 2010; 25(2): 276-81. doi: 10.1016/j.jcrc.2009.12.004 pmid: 20149587
9	López-Mestanza C, Andaluz-Ojeda D, Gómez-López JR, Bermejo-Martín JF. Clinical factors influencing mortality risk in hospital-acquired sepsis. J Hosp Infect. 2018; 25(2): 194-201.
10	Investigators ARISE, Group ANZISSCT, Peake SL, Delaney A, Bailey M, Bellomo R, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014; 371(16): 1496-506. doi: 10.1056/NEJMoa1404380
11	Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015; 372(14): 1301-11. doi: 10.1056/NEJMoa1500896
12	Investigators P, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014; 370(18): 1683-93. doi: 10.1056/NEJMoa1401602
13	Burke LG, Frakt AB, Khullar D, Orav EJ, Jha AK. Association between teaching status and mortality in US hospitals. JAMA. 2017; 317(20): 2105-13.
14	Shahian DM, Nordberg P, Meyer GS, Blanchfield BB, Mort EA, Torchiana DF, et al. Contemporary performance of US teaching and nonteaching hospitals. Acad Med. 2012; 87(6): 701-8.
15	Shahian DM, Liu X, Meyer GS, Normand SLT. Comparing teaching versus nonteaching hospitals: the association of patient characteristics with teaching intensity for three common medical conditions. Acad Med. 2014; 89(1): 94-106. doi: 10.1097/ACM.0000000000000050 pmid: 24280849
16	Shahian DM, Liu X, Meyer GS, Torchiana DF, Normand SLT. Hospital teaching intensity and mortality for acute myocardial infarction, heart failure, and pneumonia. Med Care. 2014; 52(1): 38-46. doi: 10.1097/MLR.0000000000000005 pmid: 24322988
17	Mueller SK, Lipsitz S, Hicks LS. Impact of hospital teaching intensity on quality of care and patient outcomes. Med Care. 2013; 51(7): 567-74. doi: 10.1097/MLR.0b013e3182902151 pmid: 23604017
18	Nationwide Emergency Department Sample (NEDS). Overview of the Nationwide Emergency Department Sample (NEDS). Available at: www.hcup-us.ahrq.gov/nedsoverview.jsp
19	Healthcare Cost and Utilization Project. Introduction to the HCUP nationwide emergency department sample (NEDS). Available at:
20	Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315(8): 801-10. doi: 10.1001/jama.2016.0287 pmid: 26903338
21	Rivers E, Nguyen B, Havstad S, Ressler J. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001; 345(19):1368-77. doi: 10.1056/NEJMoa010307
22	Investigators PRISM, Rowan KM, Angus DC, Bailey M, Barnato AE, Bellomo R, et al. Early, goal-directed therapy for septic shock - a patient-level meta-analysis. N Engl J Med. 2017; 376(23): 2223-34. doi: 10.1056/NEJMoa1701380
23	Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017; 43(3): 304-77. doi: 10.1007/s00134-017-4683-6 pmid: 28101605
24	Tian D, Smyth C, Keijzers G, Macdonald SP, Peake S, Udy A, et al. Safety of peripheral administration of vasopressor medications: a systematic review. Emerg Med Australas. 2020; 32(2):220-7. doi: 10.1111/1742-6723.13406 pmid: 31698544
25	Lewis T, Merchan C, Altshuler D, Papadopoulos J. Safety of the peripheral administration of vasopressor agents. J Intensive Care Med. 2019; 34(1): 26-33. doi: 10.1177/0885066616686035 pmid: 28073314
26	Medlej K, Kazzi AA, El Hajj Chehade A, Saad Eldine M, Chami AL, Bachir R, et al. Complications from administration of vasopressors through peripheral venous catheters: an observational study. J Emerg Med. 2018; 54(1): 47-53. doi: S0736-4679(17)30863-6 pmid: 29110979
27	Noronha S, Sangli S, Kim B, Ochieng P, Jean R. Outcomes for septic shock: a comparison between teaching and non-teaching hospitals. Chest. 2016; 150(4): 364A.
28	Whiles B, Deis A, Miller P, Simpson S. Comorbid conditions predict outcomes in patients with severe sepsis. Chest. 2016; 149(4): A170. doi: 10.1016/j.chest.2016.02.176
29	Delbove A, Darreau C, Hamel JF, Asfar P, Lerolle N. Impact of endotracheal intubation on septic shock outcome: a post hoc analysis of the SEPSISPAM trial. J Crit Care. 2015; 30(6): 1174-8. doi: 10.1016/j.jcrc.2015.08.018 pmid: 26410680
30	Fuller BM, Mohr NM, Dettmer M, Kennedy S, Cullison K, Bavolek R, et al. Mechanical ventilation and acute lung injury in emergency department patients with severe sepsis and septic shock: an observational study. Acad Emerg Med. 2013; 20(7): 659-69. doi: 10.1111/acem.12167 pmid: 23859579
31	Klompas M, Khan Y, Kleinman K, Evans RS, Lloyd JF, Stevenson K, et al. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. PLoS One. 2011; 6(3): e18062. doi: 10.1371/journal.pone.0018062

Procedures	Frequency (n=383,372)	Percentage (95%CI)
Procedure class for inpatient procedure Minor diagnostic Minor therapeutic Major diagnostic Major therapeutic	167,559 318,419 11,771 73,161	43.7 (43.4-44.0) 83.1 (82.8-83.3) 3.1 (3.0-3.2) 19.1 (18.9-19.3)
Hospital procedures Small bowel resection Colorectal resection Appendectomy Fluoroscopy of the biliary and pancreatic ducts (ERCP, ERC and ERP) Cholecystectomy and common duct exploration Laparoscopy (GI only) Exploratory laparotomy Other non-operative upper GI therapeutic procedures Other operative upper GI therapeutic procedures Other non-operative lower GI therapeutic procedures Other operative lower GI therapeutic procedures Other gastrointestinal diagnostic procedures Other non-operative gastrointestinal therapeutic procedures Other operative gastrointestinal therapeutic procedures Respiratory intubation and mechanical ventilation	1,153 7,879 1,929 1,640 3,937 1,538 1,660 12,487 5,944 2,522 9,635 8,720 11,843 9,393 189,311	0.3 (0.3-0.3) 2.1 (2.0-2.1) 0.5 (0.5-0.5) 0.4 (0.4-0.5) 1.0 (1.0-1.1) 0.4 (0.4-0.4) 0.4 (0.4-0.5) 3.3 (3.2-3.4) 1.6 (1.5-1.6) 0.7 (0.6-0.7) 2.5 (2.4-2.6) 2.3 (2.2-2.4) 3.1 (3.0-3.2) 2.5 (2.4-2.5) 49.4 (49.1-49.7)

Teaching status of hospital	Crude				Adjusted*
Teaching status of hospital	OR	95% CI	P-value		OR	95% CI	P-value
Metropolitan non-teaching Metropolitan teaching	- 1.230	- 1.196-1.264	- <0.001		- 1.295	- 1.256-1.335	- <0.001

[1]	Hui Chen, Yuanhua Lu, Songjie Bai, Yang Li, Tao Wang, Long Cai, Xinyi Yang, Yang Fang, Jianguo Wan, Yaqun Tang, Wenqiang Tao, Meiling Huang, Wei Zhong, Fen Liu, Kejian Qian. Stress-hyperglycemia ratio and glycemic variability predict severity and mortality in sepsis-associated acute respiratory distress syndrome [J]. World Journal of Emergency Medicine, 2026, 17(3): 250-257.
[2]	Zengzheng Ge, Xin Lu, Shiyuan Yu, Mubing Qin, Chao Gong, Qun Xu, Yanxia Gao, Joseph Harold Walline, Huadong Zhu, Yi Li. Diagnostic value of mismatch-negativity and P3a event-related potentials for sepsis-associated encephalopathy in non-sedated patients: a pilot study [J]. World Journal of Emergency Medicine, 2026, 17(2): 172-178.
[3]	Jinlan Ma, Li Peng, Hongming Yu, Jianfeng Xie, Ying Tang, Shenglin Su, Libing Ma, Xiaojun Yang. Single-cell transcriptomics reveals pathogen-specific monocyte heterogeneity and potential biomarkers in gram-positive versus gram-negative bloodstream infections [J]. World Journal of Emergency Medicine, 2026, 17(2): 162-171.
[4]	Paulo Henrique Reis Negreiros, Mariana Rebello Hilgert, Bruno Guerra, Maurício de Carvalho, Hugo Manuel Paz Morale, Gustavo Lenci Marques. The Brazilian risk assessment severity index score: a novel tool for predicting in-hospital mortality in emergency departments [J]. World Journal of Emergency Medicine, 2026, 17(2): 154-161.
[5]	Yi Yao, Wenjin Li, Dejiang Hong, Ze Chen, Kai Peng, Guangju Zhao. Prediction model for quality of life in sepsis survivors one year after discharge [J]. World Journal of Emergency Medicine, 2026, 17(2): 105-112.
[6]	Xin Lu, Mubing Qin, Zengrui Song, Ying Chen, Huadong Zhu, Yanxia Gao, Yi Li. Normal initial lactate level in sepsis patients: is lactate still useful for prognosis prediction? [J]. World Journal of Emergency Medicine, 2026, 17(1): 57-64.
[7]	Yuhui Pan, Yanyan Ma, Ke Wan, Yizhou Xu, Guoxing Wang, Miaorong Xie. Endothelial cell injury: a crucial link in microcirculatory dysfunction associated with sepsis [J]. World Journal of Emergency Medicine, 2026, 17(1): 28-35.
[8]	Yi Jiang, Jianyong Wu, Ying Liu, Xianfei Ji, Ping Gong. The association of the plasma iron and neuron-specific enolase combination and the 28-day neurological outcome after cardiopulmonary resuscitation: a prospective study of iron metabolism disturbances [J]. World Journal of Emergency Medicine, 2025, 16(6): 559-566.
[9]	Wei Gu, Jie Zhong, Chuanzhu Lyu, Guoqiang Zhang, Miaorong Xie, Yuefeng Ma, Wei Guo. An approach for the emergency diagnosis and treatment of sepsis-associated encephalopathy in elderly individuals: a literature review [J]. World Journal of Emergency Medicine, 2025, 16(5): 415-422.
[10]	Zesheng Wu, Fanghui Chen, Chen Xiao, Xue Zhao, Yuansheng Xu, Jinyan Fang, Yinyan Shao. Long-term cardiovascular outcomes and risk factors in adult sepsis survivors: a systematic review and meta-analysis [J]. World Journal of Emergency Medicine, 2025, 16(5): 423-430.
[11]	Qiaosheng Wang, Qiong Luo, Zhiwei Su, Yan Xu, Liangshan Peng, Yin Wen, Hongke Zeng, Hongguang Ding. Activation of the α7 nicotinic acetylcholine receptor mitigates cognitive deficits in mice with sepsis-associated encephalopathy by inhibiting microglial pyroptosis [J]. World Journal of Emergency Medicine, 2025, 16(5): 438-446.
[12]	Sen Jiang, Xiandong Liu, Tong Liu, Yi Gu, Bo An, Chunxue Wang, Dongyang Zhao, Haitao Zhang, Lunxian Tang. Performance of a novel medical artificial intelligence large language model on supporting decision-making for emergency patients with suspected sepsis [J]. World Journal of Emergency Medicine, 2025, 16(5): 447-455.
[13]	Xiaodong Huang, Zhihong Xu, Siyao Liu, Xiong Liu, Long Lin, Mandong Pan, Xianwei Huang, Jiyan Lin. Association of fluid balance index with in-hospital mortality in critically ill patients with acute pancreatitis: a multicenter retrospective cohort study [J]. World Journal of Emergency Medicine, 2025, 16(5): 462-468.
[14]	Quan Li, Yun Qu, Jinfang Xue, Hai Kang, Chuanzhu Lyu. Exploring lipid-modifying therapies for sepsis through the modulation of circulating inflammatory cytokines: a Mendelian randomization study [J]. World Journal of Emergency Medicine, 2025, 16(3): 256-261.
[15]	Peili Chen, Yan Ge, Huiqiu Sheng, Wenwu Sun, Jiahui Wang, Li Ma, Enqiang Mao. The role of early changes in routine coagulation tests in predicting the occurrence and prognosis of sepsis [J]. World Journal of Emergency Medicine, 2025, 16(2): 136-143.