Background & Aims: Digital pathology image analysis can phenotype liver fibrosis using histological traits that reflect collagen content, morphometry and architecture. Here, we aimed to calculate fibrosis severity scores to quantify these traits.Methods: Liver biopsy slides were categorised by Ishak stage and aetiology. We used a digital pathology technique to calculate four fibrosis severity scores: Architecture Composite Score (ACS), Collagen Composite Score (CCS), Morphometric Composite Score (MCS) and Phenotypic Fibrosis Composite Score (PH‐FCS). We compared how these scores varied according to disease stage and aetiology.Results: We included 80 patients (40% female, mean age 59.0 years, mean collagen proportionate area 17.1%) with mild (F0‐2, n = 28), moderate (F3‐4, n = 17) or severe (F5‐6, n = 35) fibrosis. All four aetiology independent scores corelated with collagen proportionate area (ACS: r_p = .512, CCS: r_p = .727, MCS: r_p = .777, PFCS: r = .772, p < .01 for all) with significant differences between moderate and severe fibrosis (p < .05). ACS increased primarily between moderate and severe fibrosis (by 95% to 226% depending on underlying aetiology), whereas MCS and CCS accumulation was more varied. We used 28 qFTs that distinguished between autoimmune‐ and alcohol‐related liver disease to generate an MCS that significantly differed between mild and severe fibrosis for these aetiologies (p < .05).Conclusions: We describe four aetiology‐dependent and ‐independent severity scores that quantify fibrosis architecture, collagen content and fibre morphometry. This approach provides additional insight into how progression of architectural changes and accumulation of collagen may differ depending on underlying disease aetiology.

Background and Objectives: The use of non-invasive ventilation (NIV) for community-acquired pneumonia (CAP) remains controversial. NIV failure in the setting of acute hypoxemic respiratory failure is associated with increased mortality, highlighting the need for careful patient selection. Methods and Methods: This is a retrospective observational cohort study. We included 140 patients with severe CAP, treated with either NIV or invasive mechanical ventilation (IMV) as their primary oxygenation strategy. Results: The median PaO₂/FiO₂ ratio and SOFA score upon ICU admission were 151 mmHg and 6, respectively. We managed 76% of patients with NIV initially and report an NIV success rate of 59%. Overall, the 28-day mortality was 25%, whilst for patients with NIV success, the mortality was significantly lower at 13%. In the univariate analysis, NIV failure was associated with the SOFA score (OR 1.33), the HACOR score (OR 1.14) and the presence of septic shock (OR 3.99). The SOFA score has an AUC of 0.75 for NIV failure upon ICU admission, whilst HACOR has an AUC of 0.76 after 2 h of NIV. Conclusions: Our results suggest that a SOFA ≤ 4 and an HACOR ≤ 5 are reasonable thresholds to identify patients with severe CAP likely to benefit from NIV.

Background and Subject: Hyponatraemia is a common electrolyte disorder. For patients with severe hyponatraemia, intensive care unit (ICU) admission may be required. This will enable close monitoring and allow safe management of sodium levels effectively. While severe hyponatraemia may be associated with significant symptoms, rapid overcorrection of hyponatraemia can lead to complications. We aimed to describe the management and outcomes of severe hyponatraemia in our ICU and identify risk factors for overcorrection. Materials and Methods: This was a retrospective single-centre cohort that included consecutive adults admitted to the ICU with serum sodium < 120 mmol/L between 1 January 2017 and 8 March 2023. Anonymised data were collected from electronic records. We included 181 patients (median age 67 years, 51% male). Results: Median admission serum sodium was 113 mmol/L (IQR: 108–117), with an average rate of improvement over the first 48 h of 10 mmol/L/day (IQR: 5–15 mmol/L). A total of 62 patients (34%) met the criteria for overcorrection at 48 h, and they were younger, presented with severe symptoms (seizures/arrythmias), and had lower admission sodium concentration. They were more likely to be treated with hypertonic saline infusions. Lower admission sodium was an independent risk factor for overcorrection within 48 h, whereas the presence of liver cirrhosis and fluid restriction was associated with normal correction. No difference was identified between the normal and overcorrected cohorts for ICU/hospital length of stay or mortality. Conclusions: In some patients with severe hyponatraemia, overcorrection is inevitable to avoid symptoms such as seizures and arrhythmias, and consequently, we highlight the key factors associated with overcorrection. Overall, we identified that overcorrection was common and concordant with the current literature.

There is little known about parainfluenza virus (PIV) infection in adult intensive care unit (ICU) patients. Here, we aim to describe the characteristics, clinical course and outcomes of PIV infection in adults requiring intensive care. In this retrospective study of consecutive patients admitted to our ICU with confirmed PIV infection over a 7-year period, we report the patient characteristics, laboratory tests and prognostic scores on ICU admission. The main outcomes reported are 30-day mortality and organ support required. We included 50 patients (52% male, mean age 67.6 years). The mean PaO₂/FiO₂ and neutrophil/lymphocyte ratios on ICU admission were 198 ± 82 mmHg and 15.7 ± 12.5. Overall, 98% of patients required respiratory support and 24% required cardiovascular support. The median length of ICU stay was 5.9 days (IQR 3.7–9.1) with a 30-day mortality of 40%. In conclusion, PIV infection in adult ICU patients is associated with significant mortality and morbidity. There were significant differences between patients who presented with primary hypoxemic respiratory failure and hypercapnic respiratory failure.

Background/Objectives: Out-of-hospital cardiac arrests (OHCAs) are common, with return of spontaneous circulation (ROSC) achieved in approximately 25% of patients. However, it remains unknown whether post-ROSC care delivered by a pre-hospital critical care team (CCT) improves patient outcomes. We therefore aimed to investigate this in OHCA patients admitted to our intensive care unit (ICU). Methods: In this retrospective observational study, consecutive adults with ROSC after non-traumatic OHCA admitted to our ICU between 1 September 2019 and 31 August 2022 were included. We compared patients who received post-ROSC care from a CCT to those who received standard care. The primary outcome was a good neurological outcome on hospital discharge (defined as Cerebral Performance Category 1–2). Descriptive statistics, Area Under the Receiver Operating Characteristic Curve (AUC) values, and adjusted Odds Ratios (ORs) are reported. We constructed multivariable logistic regression models that adjusted for the component variables of the MIRACLE2 score. Results: We included 126 OHCAs (median age 63 years, 69% male), which were largely witnessed (82%), involved bystander cardiopulmonary resuscitation (87%), and had an initial shockable rhythm (61%). The prevalence of good neurological outcomes was higher in patients who received post-ROSC care from a pre-hospital CCT (37% vs. 17%, p = 0.012). The MIRACLE2 score was a strong predictor of good neurological outcomes (AUC 0.932), and in our multivariable analysis, good neurological outcome was associated with both CCT presence post-ROSC (aOR 3.77, 95% CI 1.02–13.89) and the delivery of PHEA (aOR 4.10, 95% CI 1.10–15.27, p = 0.035). Furthermore, in patients meeting the Utstein criteria (n = 69), good neurological outcomes were also more prevalent with CCT presence post-ROSC (62% vs. 29%, p < 0.001). Conclusions: We found that post-ROSC care delivered by a pre-hospital CCT was associated with good neurological outcomes on hospital discharge.