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Table of Content

    01 September 2025, Volume 16 Issue 5
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    Review Articles
    An approach for the emergency diagnosis and treatment of sepsis-associated encephalopathy in elderly individuals: a literature review Open Access
    Wei Gu, Jie Zhong, Chuanzhu Lyu, Guoqiang Zhang, Miaorong Xie, Yuefeng Ma, Wei Guo
    2025, 16(5):  415-422.  doi:10.5847/wjem.j.1920-8642.2025.0101
    Abstract    HTML    PDF (241KB)   

    BACKGROUND: Sepsis-associated encephalopathy (SAE) is a diffuse dysfunction of the nervous system resulting from sepsis originating outside the central nervous system. Elderly individuals (≥65 years of age) constitute a particularly vulnerable population comprised by a high burden of underlying diseases and complications, which frequently leads to underdiagnosis or misdiagnosis. These patients are at increased risk of long-term or permanent central nervous system impairment, making rapid and accurate diagnosis and treatment especially critical. The review is expected to promote improvements in the diagnosis and treatment of SAE in elderly patients, ultimately achieving more standardized and efficient SAE management.

    METHODS: We performed a literature search in four databases—PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang—from inception to April 2025 using bilinguals (Chinese and English).

    RESULTS: The diagnostic criteria for SAE in elderly individuals include the following: (1) sepsis; (2) new-onset neurological dysfunction; and (3) exclusion of other causes of neurological dysfunction. Physicians should develop tailored empiric anti-infective plans for elderly SAE patients, considering comorbidities, organ function, infection site, local bacterial spectrum, and resistance. The treatment protocol can be adjusted once the pathogen is identified. Stabilizing hemodynamics and ensuring cerebral perfusion are two fluid resuscitation strategies used in elderly SAE patients. An individualized approach to fluid resuscitation using restrictive fluid volumes should be employed. Supportive treatment for elderly SAE patients focuses on improving tissue perfusion/oxygenation, controlling blood glucose levels, and correcting internal imbalances. Early rehabilitation, nutritional support, cognitive training, and family-based emotional support are important components of comprehensive care.

    CONCLUSION: The diagnosis and management of SAE in elderly patients support early recognition and timely intervention.

    Long-term cardiovascular outcomes and risk factors in adult sepsis survivors: a systematic review and meta-analysis Open Access
    Zesheng Wu, Fanghui Chen, Chen Xiao, Xue Zhao, Yuansheng Xu, Jinyan Fang, Yinyan Shao
    2025, 16(5):  423-430.  doi:10.5847/wjem.j.1920-8642.2025.098
    Abstract    HTML    PDF (245KB)   

    BACKGROUND: Sepsis may increase the risk of long-term cardiovascular outcomes. This study aims to investigate association between sepsis survivorship and cardiovascular outcomes and to identify risk factors.

    METHODS: We conducted a comprehensive systematic search of MEDLINE, EMBASE, the Cochrane Library, Wanfang, and CNKI from database inception through May 2025, without language restrictions. The primary outcome was a composite of myocardial infarction, stroke, congestive heart failure, or cardiovascular death. To evaluate the association between sepsis survivors and cardiovascular outcomes, we calculated cumulative incidence rates and hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs).

    RESULTS: Twenty-five observational studies comprising 7,525,271 participants were included. The pooled cumulative incidence of major cardiovascular events was 9.0% (95% CI: 6.1%-11.9%), myocardial infarction 2.4% (95% CI: 1.6%-3.1%), stroke 4.9% (95% CI: 3.8%-6.1%), and congestive heart failure 8.6% (95% CI: 4.6%-12.6%). Compared with non-sepsis controls, sepsis survivors had a significantly higher risk of major cardiovascular events (HR: 1.54; 95% CI: 1.32-1.79), myocardial infarction (HR: 1.41; 95% CI: 1.29-1.54), stroke (HR: 1.45; 95% CI: 1.32-1.60), and congestive heart failure (HR: 1.51; 95% CI: 1.46-1.56). Risk factors associated with increased cardiovascular events in sepsis survivors included age ≤ 45 years, male, hyperlipidemia, and multiple comorbidities.

    CONCLUSION: Adult sepsis survivors may face significantly increased risks of long-term cardiovascular outcomes. Both common cardiovascular risk factors and sepsis-related pathophysiological changes contribute to this association.

    Original Articles
    Defining optimal volume of inflation for partial resuscitative endovascular balloon occlusion of the aorta in swine hemorrhagic shock model Open Access
    Shin Ae Lee, Jongwon Ha, Ye Rim Chang
    2025, 16(5):  431-437.  doi:10.5847/wjem.j.1920-8642.2025.096
    Abstract    HTML    PDF (741KB)   

    BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive technique used to control non-compressible torso hemorrhage. However, the optimal degree of partial occlusion that offers maximum therapeutic benefit remains unclear. This study aimed to identify the optimal partial inflation volume for REBOA.

    METHODS: In a swine model of hemorrhagic shock, nine healthy female pigs were randomly assigned to three groups based on balloon inflation volume: 30% (R30), 60% (R60), and 100% (R100) of the volume required to eliminate the contralateral femoral arterial waveform. Hemodynamic variables, fluid and vasopressor requirements, and biochemical markers were evaluated during balloon occlusion and resuscitation following 40% blood volume-controlled hemorrhage.

    RESULTS: The R30 group showed higher mean arterial pressure during resuscitation and required less fluid and norepinephrine than those of the R100 group. The mean heart rate significantly differed over time among the groups, with more gradual changes in the R30 group. Markers of ischemia-reperfusion injury (lactate, pH, blood urea nitrogen, and creatinine) similarly exhibited significant temporal differences. Post hoc analysis revealed significant pH differences between the groups. The plasma lactate and creatinine levels were significantly lower in the R30 group than those in the other two groups.

    CONCLUSION: In this swine hemorrhagic shock model, partial REBOA with 30% balloon inflation maintained hemodynamic stability while reducing metabolic derangement compared with higher ballon volumes of 60% and 100% inflation. A strategy involving partial inflation targeting approximately 30%, followed by monitoring the blood pressure trend while using a vasoconstrictor, if necessary, may have potential clinical utility.

    Activation of the α7 nicotinic acetylcholine receptor mitigates cognitive deficits in mice with sepsis-associated encephalopathy by inhibiting microglial pyroptosis Open Access
    Qiaosheng Wang, Qiong Luo, Zhiwei Su, Yan Xu, Liangshan Peng, Yin Wen, Hongke Zeng, Hongguang Ding
    2025, 16(5):  438-446.  doi:10.5847/wjem.j.1920-8642.2025.099
    Abstract    HTML    PDF (3329KB)   

    BACKGROUND: While the α7 nicotinic acetylcholine receptor (α7 nAChR) is implicated in sepsis-associated encephalopathy (SAE), its pathophysiological contributions require further investigation.

    METHODS: SAE was induced in mice via cecal ligation and puncture (CLP), and microglia were treated with lipopolysaccharide (LPS). PHA-543613 (an α7 nAChR agonist) was used to activate α7 nAChR. To study the role of α7 nAChR in mitophagy and pyroptosis, caspase-1-deficient mice and PTEN-induced kinase 1 (PINK1) small interfering RNA (siRNA) were used. Cognitive function, cerebral oxygen extraction ratio (CERO2), and brain tissue oxygen pressure (PbtO2) were measured. Blood-brain barrier (BBB) integrity was evaluated via Evan’s blue staining. Mitophagy, pyroptosis, and cytokine levels were analyzed via Western blotting and immunofluorescence.

    RESULTS: CLP or LPS treatment significantly down-regulated α7 nAChR protein expression in microglia. The administration of PHA-543613 to activate α7 nAChR not only restored its expression post-sepsis, but also notably decreased BBB permeability and mitigated cognitive deficits. Both α7 nAChR activation and caspase-1 knockout effectively suppressed microglial pyroptosis. The activation of α7 nAChR also promoted mitophagy in microglia. This led to an amelioration of brain tissue hypoxia, as shown by elevated PbtO2 and reduced CERO2 levels. The suppression of microglial pyroptosis by α7 nAChR was counteracted when mitophagy was inhibited through the siRNA-mediated silencing of PINK1.

    CONCLUSION: The activation of α7 nAChR reduces pyroptosis by enhancing microglial mitophagy, thereby mitigating SAE.

    Performance of a novel medical artificial intelligence large language model on supporting decision-making for emergency patients with suspected sepsis Open Access
    Sen Jiang, Xiandong Liu, Tong Liu, Yi Gu, Bo An, Chunxue Wang, Dongyang Zhao, Haitao Zhang, Lunxian Tang
    2025, 16(5):  447-455.  doi:10.5847/wjem.j.1920-8642.2025.095
    Abstract    HTML    PDF (801KB)   

    BACKGROUND: Large language models (LLMs) are being explored for disease prediction and diagnosis; however, their efficacy for early sepsis identification in emergency departments (EDs) remains unexplored. This study aims to evaluate MedGo, a novel medical LLM, as a decision-support tool for clinicians managing patients with suspected sepsis.

    METHODS: This retrospective study included anonymized medical records of 203 patients (mean age 79.9±10.2 years) with confirmed sepsis from a tertiary hospital ED between January 2023 and January 2024. MedGo performance across nine sepsis-related assessment tasks was compared with that of two junior (<3 years of experience) and two senior (>10 years of experience) ED physicians. Assessments were scored on a 5-point Likert scale for accuracy, comprehensiveness, readability, and case-analysis skills.

    RESULTS: MedGo demonstrated diagnostic performance comparable to that of senior physicians across most metrics, achieving a median Likert score of 4 in accuracy, comprehensiveness, and readability. MedGo significantly outperformed junior physicians (P<0.001 for accuracy and case-analysis skills). MedGo assistance significantly enhanced both junior (P<0.001) and senior (P<0.05) physicians' diagnostic accuracy. Notably, MedGo-assisted junior physicians achieved accuracy levels comparable to those of unassisted senior physicians. MedGo maintained consistent performance across varying sepsis severities.

    CONCLUSION: MedGo shows significant diagnostic efficacy for sepsis and effectively supports clinicians in the ED, particularly enhancing junior physicians’ performance. Our study highlights the potential of MedGo as a valuable decision-support tool for sepsis management, paving the way for specialized sepsis AI models.

    Development and validation of a nomogram for predicting prolonged ICU stays after pediatric cardiac surgery Open Access
    Jungang Zheng, Wenyuan Zhang, Yuqian Guo, Huiyi Hu, Yue Jin, Xiangming Fang
    2025, 16(5):  456-461.  doi:10.5847/wjem.j.1920-8642.2025.039
    Abstract    HTML    PDF (474KB)   

    BACKGROUND: This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit (ICU) stays.

    METHODS: Pediatric patients who underwent cardiac surgery were included, with data collected from the pediatric intensive care database. The datasets were randomly divided into a training set (75%) and a testing set (25%). A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.

    RESULTS: A total of 795 patients and 266 patients were assigned to the training and testing sets, respectively, with consistent variables. The nomogram developed from the training set included eight characteristics: age, systolic blood pressure, respiratory rate, bicarbonate, direct bilirubin, high-sensitivity C-reactive protein, international normalized ratio, and operation time. The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736, respectively. The nomogram demonstrated excellent discrimination and calibration. Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.

    CONCLUSION: This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.

    Association of fluid balance index with in-hospital mortality in critically ill patients with acute pancreatitis: a multicenter retrospective cohort study Open Access
    Xiaodong Huang, Zhihong Xu, Siyao Liu, Xiong Liu, Long Lin, Mandong Pan, Xianwei Huang, Jiyan Lin
    2025, 16(5):  462-468.  doi:10.5847/wjem.j.1920-8642.2025.102
    Abstract    HTML    PDF (786KB)   

    BACKGROUND: Fluid resuscitation in acute pancreatitis (AP) patients requires precise titration because both excess and insufficient volumes may worsen outcomes. This study aimed to develop a weight-normalized fluid balance index (FBI) and assess its association with in-hospital mortality in critically ill AP patients.

    METHODS: This retrospective cohort study utilized data from the MIMIC-IV 3.0 database and the emergency intensive care unit (EICU) of our hospital (validation cohort) and was based on inclusion and exclusion criteria. Using the R package cutoff, an FBI of 145 mL/kg was identified as the optimal risk stratification threshold. The primary outcome was in-hospital all-cause mortality. Machine learning was used to screen covariates for inclusion in multivariable Cox models. Cox regression and restricted cubic spline (RCS) models were used to evaluate the relationship between FBI and mortality. Propensity score matching (PSM) was applied to minimize baseline confounding. After PSM, Kaplan-Meier survival curves were generated, and the results were validated via data from our center.

    RESULTS: In this study, 547 AP patients from the MIMIC-IV database and 156 from the EICU of our hospital were included. In the MIMIC-IV cohort, the overall in-hospital mortality rate was 8.96%. Patients with FBI ≥145 mL/kg had significantly higher in-hospital mortality than did those with FBI <145 mL/kg (P<0.05). High-risk classification remained an independent predictor of death after full adjustment (hazard ratio [HR] 1.99, 95% confidence interval [95% CI]: 1.08-3.69). Post-PSM Kaplan-Meier analysis confirmed significantly higher in-hospital mortality in the high-risk group (P<0.05). This result was corroborated by our validation cohort. RCS analysis further demonstrated a non-linear increase in in-hospital mortality with increasing FBI values.

    CONCLUSION: An FBI ≥145 mL/kg may be associated with increased in-hospital mortality in critically ill AP patients.

    Effects of pulse indicated continuous cardiac output monitoring on outcomes of intensive care unit patients with shock: a propensity score matching analysis Open Access
    Danyang Li, Yi Xia, Yangmin Hu, Linlin Du, Tiancha Huang, Chengyang Chen, Yufei Xiao, Leiqing Li, Yang Yu, Shujun Dai, Wei Cui, Huahao Shen
    2025, 16(5):  469-474.  doi:10.5847/wjem.j.1920-8642.2025.0100
    Abstract    HTML    PDF (261KB)   

    BACKGROUND: Pulse indicated continuous cardiac output (PiCCO) has largely replaced Swan-Ganz catheterization in shock patients. However, whether PiCCO monitoring can improve outcomes of shock patients, such as mortality, length of hospital stay, duration of mechanical ventilation, or laboratory parameters, remains unknown.

    METHODS: This retrospective cohort study included patients with shock in the intensive care unit (ICU) from January 2013 to January 2020. Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not. Demographic characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, quick Sequential Organ Failure Assessment (qSOFA) scores, 14-day mortality, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 0, 1, 3 and 7 days after onset of shock, duration of mechanical ventilation, length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching (PSM).

    RESULTS: Real-world analysis of 1,583 ICU patients suffering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups (36.2% vs. 32.6%, P=0.343). Duration of mechanical ventilation, hospital stay, and hospitalization costs were also similar between the two groups (P>0.05). No differences in changes of NT-proBNP levels on days 0, 1, 3, and 7 as compared to baseline were noted between the two groups (P>0.05).

    CONCLUSIONS: The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation, length of hospital stay, or reduce hospitalization costs, nor will it bring survival benefits to ICU patients suffering shock.

    Genetic liability to atrial fibrillation, aortic valve disease, and mitral valve disease: a two-sample Mendelian randomization study Open Access
    Yun Zhang, Chengui Zhuo, Ting Chen, Xiaosheng Hu
    2025, 16(5):  475-480.  doi:10.5847/wjem.j.1920-8642.2025.086
    Abstract    HTML    PDF (535KB)   

    BACKGROUND: Research has revealed a relationship between atrial fibrillation (AF) and valvular heart disease; however, the causality remains largely unknown. This study explored whether a causal association between AF and non-rheumatic aortic valve disease (AVD) and mitral valve disease (MVD) could be found.

    METHODS: A two-sample Mendelian randomization (TSMR) method was applied to determine the causal effect of AF on AVD, mitral regurgitation, and MVD. The inverse variance weighted (IVW) method was used as the primary analytical approach, and several complementary analyses were conducted. Outliers were detected using the Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) and radial Mendelian randomization (MR) methods.

    RESULTS: Genetically predicted AF was found to be causally associated with the risk of MVD (odds ratio [OR]=1.001; 95% confidence interval [CI]: 1.000-1.001; P=1.33×10-6) and mitral regurgitation (OR=1.001; 95% CI: 1.000-1.002; P=0.009). However, no significant causal associations between AF and AVD were detected (OR=1.000; 95% CI: 0.999-1.000; P=0.804). Causal effects were still detected, even after adjusting for potential risk factors or removing the identified outliers. Reverse MR analyses revealed no significant causal effect of valvular heart disease on AF.

    CONCLUSION: Our findings demonstrate a positive causal association between AF, MVD, and mitral regurgitation, but not AVD. Further research and an aggressive AF management strategy should be explored as potential measures for preventing MVD.

    Clinical characteristics of acute adrenal insufficiency in emergency patients: an analysis of data in Lhasa, Xizang Autonomous Region of China Open Access
    Guiying Dong, Jianbo Yu, Lobsang Chodron, Tenzin Chodron, Peiliang Gao, Xueying Fu, Jihong Zhu, Zhenzhong Yang, Lobsang Cering
    2025, 16(5):  481-485.  doi:10.5847/wjem.j.1920-8642.2025.085
    Abstract    HTML    PDF (586KB)   

    BACKGROUND: The nonspecific clinical presentation of adrenal insufficiency (AI) frequently leads to misdiagnosis, often as psychiatric or gastrointestinal disorders. AI is classified anatomically as primary AI (PAI), secondary AI (SAI), or tertiary AI (TAI). Without timely recognition, progression to adrenal crisis (AC) can result in life-threatening outcomes. This study aimed to systematically analyze the clinical features, etiologies, and outcomes of AI in Lhasa’s emergency population to improve diagnostic accuracy and optimize clinical management.

    METHODS: A retrospective analysis of emergency department admissions from January 2020 to August 2024 at People’s Hospital of Xizang Autonomous Region was conducted. AI diagnoses were identified via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes from electronic health records (EHR). Patients were grouped into incipient AC (IAC) or AC cohorts based on hemodynamic status. Demographic profiles, etiologies, clinical presentations, and laboratory results were analyzed.

    RESULTS: Forty-three AI patients were identified. The population-standardized admission rate for AI increased from 9 to 16 per million person-years, with PAI cases doubling during this period. Adrenal tuberculosis (58.1%) and adrenal hematoma (18.6%) were the leading etiologies. Compared to the IAC group, the AC group demonstrated lower systolic blood pressure (SBP) (P=0.001) and diastolic blood pressure (DBP) (P<0.001); higher neutrophil count (P=0.048), eosinophil count (P=0.044), CRP (P=0.004), blood urea nitrogen (BUN) (P=0.007); lower sodium (P<0.001) and glucose levels (P=0.001). The hospital stay was longer in the AC group (20 d vs. 14 d; P<0.001).

    CONCLUSION: AI incidence is rising in high-altitude regions, with adrenal tuberculosis remaining the most common cause. AC is associated with increased inflammatory responses, hemodynamic instability, and metabolic disturbances. Targeted interventions are required to improve outcomes.

    Research Letters
    Accuracy of machine electrocardiogram interpretation and implementation of a de-prioritization protocol in the emergency department Open Access
    Adam K Stanley, Isobel Sonksen, Henry Morgan, Nicola Hilton, Sukhbir Bhullar
    2025, 16(5):  486-487.  doi:10.5847/wjem.j.1920-8642.2025.087
    Abstract    HTML    PDF (386KB)   
    Clinical characteristics of botulinum toxin poisoning following cosmetic injections Open Access
    Jiujiu Gui, Zhi Li, Shuhao Ye, Yuheng Shi, Yahui Tang, Zhongqiu Lu, Aifang Sun
    2025, 16(5):  491-493.  doi:10.5847/wjem.j.1920-8642.2025.091
    Abstract    HTML    PDF (386KB)   
    No genetic causal relationship between smoking and acute respiratory distress syndrome: insights from Mendelian randomization and transcriptomics Open Access
    Yan Zhang, Xiaotong Han, Maiying Fan, Siyu Lu, Yuteng Zeng, Zhitong Zhou, Xueyu Xu, Yimin Zhu, Xiquan Yan
    2025, 16(5):  494-496.  doi:10.5847/wjem.j.1920-8642.2025.076
    Abstract    HTML    PDF (381KB)   
    Viewpoint
    Electrical impedance tomography: from technical innovations to bedside clinical solutions Open Access
    Nanxia Xuan, Baoping Tian, Lan Ying, Xiajing Cao, Danqiong Wang, Gensheng Zhang
    2025, 16(5):  497-502.  doi:10.5847/wjem.j.1920-8642.2025.097
    Abstract    HTML    PDF (957KB)   
    Case Letters
    Transverse colon volvulus: a case report of a 19-year-old patient with bowel obstruction Open Access
    Lindelani Neo Mukhuba, Mirza Mohamod Zahir Uddin Bhuiyan
    2025, 16(5):  503-504.  doi:10.5847/wjem.j.1920-8642.2025.074
    Abstract    HTML    PDF (544KB)   
    Disseminated mucormycosis originating from the stomach Open Access
    Yongli Han, Mengting Liu, Weiping Huang, Hongke Zeng
    2025, 16(5):  508-510.  doi:10.5847/wjem.j.1920-8642.2025.088
    Abstract    HTML    PDF (788KB)   
    Ventricular aneurysm formation after successful intensive hemoperfusion in chlorfenapyr poisoning: a case report Open Access
    Ruiqiao Zhao, Cuifei Luo, Ping Wang, Yuanqiang Lu
    2025, 16(5):  511-513.  doi:10.5847/wjem.j.1920-8642.2025.092
    Abstract    HTML    PDF (662KB)   
    A case of colorectal cancer with urinary tract infection induced by bayberry pits Open Access
    Simin Yang, Haoran Li, Yan Xiao
    2025, 16(5):  514-515.  doi:10.5847/wjem.j.1920-8642.2025.075
    Abstract    HTML    PDF (510KB)   
    Pneumonia with parapneumonic effusion due to Fusobacterium necrophorum: a case report Open Access
    Xiaojun Dong, Qian Li, Anquan Zhu, Xiaocui Wu, Xuejie Wu
    2025, 16(5):  516-518.  doi:10.5847/wjem.j.1920-8642.2025.077
    Abstract    HTML    PDF (334KB)