Purpose: Acute respiratory distress syndrome (ARDS) is a prevalent respiratory condition associated with significant mortality. Current literature on ARDS epidemiology reports a wide range of incidence (7.2–78.9/100,000 population/year), hospital mortality (32–51%), and associated costs ($8476–$547,974). We have analyzed epidemiological trends of mechanically ventilated ARDS (MV-ARDS) in Spain from 2000 to 2022 using the Minimum Basic Data Set (MBDS), focusing on MV-ARDS incidence, associated mortality, and economic impact. Methods: We conducted a nationwide, population-based retrospective study of all hospitalizations for MV-ARDS in Spanish hospitals—from January 1, 2000 to December 31, 2022—using MBDS records, with an estimated coverage of 99.5%. The study reports MV-ARDS incidence per 100,000 population/year, hospital mortality rate, and mean cost per patient. We also considered the effect of COVID-19 on MV-ARDS epidemiology. Results: We analyzed 93,192 records of patients with a new diagnosis of MV-ARDS during the study period. MV-ARDS incidence ranged from 2.96 to 20.14/100,000 population-years, peaking in 2021. Mortality ranged between 38.0 and 55.0%, showing a declining trend, while the cost per patient increased, stabilizing ~€30,000–€40,000 after reaching a peak of €42,812 in 2011. During the COVID-19 pandemic, hospital stay lengthened (p < 0.001), while hospital mortality decreased (p < 0.001). There was an increased proportion of patients with obesity and diabetes mellitus, with fungal or viral etiologies. Conclusion: This is the largest epidemiological study on ARDS in Europe. MV-ARDS incidence has stabilized in recent years, with mortality showing a declining trend. ARDS-related costs have increased nearly fourfold. MBDS data could enhance ARDS understanding and guide future studies.

Introduction: Prevalence and mortality of the acute respiratory distress syndrome (ARDS) in intensive care units (ICU) are unacceptably high. There is scarce literature on post-operative sepsis-induced ARDS despite that sepsis and major surgery are conditions associated with ARDS. We aimed to examine the impact of post-operative sepsis-induced ARDS on 60-day mortality.Methods: We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups depending on whether they met criteria for ARDS. Primary outcome was 60-day mortality of post-operative sepsis-induced ARDS. Secondary outcome measures were potential risk factors for post-operative sepsis-induced ARDS, and for 60-day mortality.Results: Higher SOFA score (OR 1.1, 95% CI 1.0–1.3, p = 0.020) and higher lactate (OR 1.9, 95% CI 1.2–2.7, p = 0.004) at study inclusion were independently associated with ARDS. ARDS patients (n = 45) had higher ICU stay [14 (18) vs. 5 (11) days, p < 0.001] and longer need for mechanical ventilation [6 (14) vs. 1 (5) days, p < 0.001] than non-ARDS patients (n = 409). Sixty-day mortality was higher in ARDS patients (OR 2.7, 95% CI 1.1–6.3, p = 0.024). Chronic renal failure (OR 4.0, 95% CI 1.2–13.7, p = 0.026), elevated lactate dehydrogenase (OR 1.7, 95% CI 1.1–2.7, p = 0.015) and higher APACHE II score (OR 2.7, 95% CI 1.3–5.4, p = 0.006) were independently associated with 60-day mortality.Conclusion: Post-operative sepsis-induced ARDS is associated with higher 60-day mortality compared to non-ARDS post-operative septic patients. Post-operative septic patients with higher severity of illness have a greater risk of ARDS and worse outcomes. Further investigation is needed in post-operative sepsis-induced ARDS to prevent ARDS.

Nowadays, mortality rates in intensive care units are the highest of all hospital units. However, there is not a reliable prognostic system to predict the likelihood of death in patients with postsurgical shock. Thus, the aim of the present work is to obtain a gene expression signature to distinguish the low and high risk of death in postsurgical shock patients. In this sense, mRNA levels were evaluated by microarray on a discovery cohort to select the most differentially expressed genes between surviving and non-surviving groups 30 days after the operation. Selected genes were evaluated by quantitative real-time polymerase chain reaction (qPCR) in a validation cohort to validate the reliability of data. A receiver-operating characteristic analysis with the area under the curve was performed to quantify the sensitivity and specificity for gene expression levels, which were compared with predictions by established risk scales, such as acute physiology and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA). IL1R2, CD177, RETN, and OLFM4 genes were upregulated in the non-surviving group of the discovery cohort, and their predictive power was confirmed in the validation cohort. This work offers new biomarkers based on transcriptional patterns to classify the postsurgical shock patients according to low and high risk of death. The results present more accuracy than other mortality risk scores.

Postoperative delirium increases morbidity, mortality, hospital stays, and costs, though 30-40 % of cases are preventable. This study assessed early delirium incidence in 2442 surgical patients across 43 Spanish hospitals, analyzing it by surgery type and related factors. Conducted from November 14 and 21, 2023, with follow-ups on days 2 and 60, it provides insights into factors influencing postoperative delirium and outcomes. The study included three phases: (1) recruitment and assessment of surgical patients on November 14 and 21, 2023, across all centers; (2) monitoring for delirium by postoperative day 2; and (3) a follow-up at 60 days. Delirium was diagnosed using the CAM, CAM-ICU, and 4AT scales. The sample size was estimated and multivariable logistic regression and Cox regression analysis were performed to identify independent risk factors and assess the impact of delirium on mortality. A total of 2442 surgical patients were recruited, mainly male (51.9 %), with a mean age of 76 ± 16 years. The delirium incidence was 3.93 %, with four preoperative independent risk factors identified through multivariate analysis.: Patient age (odds ratio (OR) 1.05, 95 % CI 1.04 to 1.08, p > 0.001), cognitive impairment (SBT > 6 points) (OR 1.12, 95 % CI 1.08 to 1.15, p < 0.001), substance use disorder (SUD) (OR 3.97, 95 % CI 1.05 to 14.93, p = 0.042) and alcoholism (OR 1.92, 95 % CI 1.20 to 3.07, p = 0.006), with a model AUROC of 0.81 (95 % CI 0.76 to 0.85). Postoperative delirium was associated with longer hospital stays and significantly higher mortality at 60 days (8.3 % vs 0.6 %). This Spanish study found that postoperative delirium, linked to longer hospital stays and higher mortality, requires early detection and prevention to improve outcomes.

Background: procalcitonin is a valuable marker in the diagnosis of bacterial infections; however, the impairment of renal function can influence its diagnostic precision. The objective of this study is to evaluate the differential behaviour of procalcitonin, as well as its usefulness in the diagnosis of postoperative pulmonary infection after cardiac surgery, depending on the presence or absence of impaired renal function. Materials and methods: A total of 805 adult patients undergoing cardiac surgery with extracorporeal circulation (CBP) were prospectively recruited, comparing the behaviour of biomarkers between the groups with and without postoperative pneumonia and according to the presence or absence of renal dysfunction. Results: Pulmonary infection was diagnosed in 42 patients (5.21%). In total, 228 patients (28.32%) presented postoperative renal dysfunction. Procalcitonin was significantly higher in infected patients, even in the presence of renal dysfunction. The optimal procalcitonin threshold differed markedly in patients with renal dysfunction compared to patients without renal dysfunction (1 vs. 0.78 ng/mL p < 0.05). The diagnostic accuracy of procalcitonin increased significantly when the procalcitonin threshold was adapted to renal function. Conclusions: Procalcitonin is an accurate marker of postoperative infection in cardiac surgery, even in the presence of renal dysfunction. Renal function is an important determinant of procalcitonin levels and, therefore, its diagnostic thresholds must be adapted in the presence of renal dysfunction.