Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis. To provide clinical practice recommendations on the immune function in sepsis, an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed. Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed, Web of Science, and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire. Then, the Delphi method was used to form consensus opinions, and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions. This consensus achieved satisfactory results through two rounds of questionnaire survey, with 2 statements rated as perfect consistency, 13 as very good consistency, and 9 as good consistency. After summarizing the results, a total of 14 strong recommended opinions, 8 weak recommended opinions and 2 non-recommended opinions were produced. Finally, a face-to-face discussion of the consensus opinions was performed through an online meeting, and all judges unanimously agreed on the content of this consensus. In summary, this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.

The research was performed to explore the diagnosis value of dynamic serum calprotectin (SC) expression for sepsis in postoperative intensive care unit patients. One hundred sixty-three patients who met the inclusion criteria served as the study group. All cases in the study group were further divided into the sepsis subgroup (51 cases) and the nonsepsis subgroup (112 cases). Fifty healthy volunteers served as the control group. The levels of SC and other laboratory indexes including complete blood counts, leukocytes, the immature-to-total-neutrophil ratio, procalcitonin (PCT), C-reactive protein, and blood lactate were detected, cytokines [interleukin (IL)-2, IL-6, and interferon-γ] released by neutrophils were also determined. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the Sequential Organ Failure Assessment score were calculated. The factors related to prognosis were analyzed with multivariate logistic regression analysis. The diagnostic accuracies of ΔSC [the differences of SC levels between postoperative day (POD) 1 and POD 2, 3, 5, 7] and ΔPCT (the differences of PCT levels between POD 1 and POD 2, 3, 5, 7) on sepsis were compared with other markers for sepsis. The levels of SC and cytokines were markedly increased on POD 1, 2, 3, 5, and 7 in the study group compared with the control group (P < 0.05 or P < 0.01). The same results were found in the sepsis subgroup compared with the nonsepsis subgroup (P < 0.05 or P < 0.01). Significant positive correlations between SC and cytokines were confirmed in patients of the study group (P < 0.05 or P < 0.01). APACHE II scores and the levels of SC and PCT on POD 1 were the variables significantly associated with sepsis. The diagnostic accuracies of ΔSC_1–3 (sensitivity 87%, specificity 89%) and ΔPCT_1–3 (sensitivity 89%, specificity 90%) for sepsis were greater than other ΔSCs and ΔPCTs. It appears that the dynamic changes in SC are of the predictive values for septic patients after major surgeries.

Ultrasound is a convenient tool to evaluate cardiac and diaphragm function. The ratio (E/Ea) of mitral Doppler inflow velocity to annular tissue Doppler wave velocity by transthoracic echocardiography (TTE) and diaphragmatic excursion (DE) by diaphragm ultrasound have been confirmed in predicting extubation outcomes independently, however their different roles in the weaning process have not been determined until now. We designed a cohort study to preform diaphragm ultrasound and TTE before and after the spontaneous breathing trial (SBT) in difficult-to-wean patients. Patients considered for enrollment should succeed on a SBT and have been extubated. They were followed up with the events of respiratory failure within 48 h, and divided into the respiratory failure and extubation success subgroups. Relevant risk factors predicting respiratory failure were analysed by a multivariate logistic regression model. Then, each subgroup was assessed with respect to re-intubation within 1 week, and divided into the re-intubation and non-intubation subgroups. Furthermore, relevant risk factors predicting re-intubation were also analysed in each subgroup. The area under the curve (AUC) and optimum cut-off value were identified by the receiver operating characteristic curve. Among 60 patients, 29 cases developed respiratory failure within 48 h, and 14 cases were re-intubated or died within 1 week, respectively. Multivariate logistic regression analysis showed that E/Ea (average) after SBT [odds ratio (OR) 1.450, 95% confidence intervals (CI) 1.092-1.926, P = 0.01] and left ventricular ejection fraction were associated with respiratory failure. The AUC of E/Ea (average) after SBT was 0.789, and a cut-off value ≥ 12.5 showed the highest diagnostic accuracy with a sensitivity and specificity of 72.4% and 77.4%, respectively. Furthermore, in the respiratory failure subgroup only DE (average) after SBT was associated with re-intubation (OR 0.690, CI 0.499-0.953, P = 0.024). The AUC of DE (average) after SBT was 0.805, and a cut-off value ≤ 12.6 mm showed the highest diagnostic accuracy with a sensitivity and specificity of 80% and 68.4%, respectively. E/Ea (average) after SBT could help predict respiratory failure within 48 h. However, DE (average) after SBT could help predict re-intubation within 1 week in the respiratory failure subgroup.

Background: Early allograft dysfunction (EAD) is a common postliver transplant complication that has been associated with graft failure and risk for poor prognosis. There are many risk factors for the incidence of EAD after liver transplantation (LT). This study investigated whether elevated postoperative myoglobin (Mb) increases the incidence of EAD in liver transplanted recipients.Methods: A total of 150 adult recipients who measured Mb within 3 days after liver transplantation between June 2019 and June 2021 were evaluated. Then, all patients were divided into two groups: the EAD group and the non-EAD group. Univariate and multivariate logistic regression analyses were performed, and receiver operating characteristic curves (ROCs) were constructed.Results: The incidence of EAD was 53 out of 150 patients (35.3%) in our study. Based on the multivariate logistic analysis, the risk of EAD increased with elevated postoperative Mb (OR = 1.001, 95% CI 1.000–1.001, P = 0.002). The Mb AUC was 0.657, and it was 0.695 when combined with PCT. When the subgroup analysis was conducted, the AUC of serum Mb prediction was better in patients whose preoperative model for end-stage liver disease score ≤ 15 or operative time ≥ 10 h (AUC = 0.751, 0.758, respectively, or 0.760, 0.800 when combined with PCT).Conclusion: Elevated Mb significantly increased the risk of postoperative EAD, suggesting that postoperative Mb may be a novel predictor of EAD after liver transplantation.The study was registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2100044257, URL: http://www.chictr.org.cn).

Background: Acute kidney injury (AKI) is a common and multifactorial complication after liver transplantation (LT). Myoglobin (Mb) which can be served as O₂ storage and delivery depot is present in muscles and cardiac myocytes. Previous studies had shown the close relationship between Mb and AKI. But there is a lack of clinical studies for Mb with the risk of AKI due to LT. This study was performed to determine the association between the serum level of Mb and incidence of AKI in patients underwent LT. Methods: The clinical data of 140 consecutive adult patients who underwent LT at our center from June 2018 to August 2020 were analyzed in this study. One hundred and fifteen patients met the inclusion criteria. The performances of postoperative laboratory variables (including serum Mb) were evaluated. The outcomes after LT, including the duration of intensive care unit (ICU) stay, hospital stay and 28-day mortality, were also measured. Results: We divided 115 patients into AKI group (n=44) and non-AKI group (n=71). Serum Mb on post-operative day 0 (POD0) was significantly higher in AKI group than those in non-AKI group (P<0.001). According to univariate and multivariable logistic regression analysis, the levels of serum albumin (P=0.024), alanine transaminase (P=0.007) and Mb (P=0.006) on POD0 were independently associated with development of new AKI. The area under curve (AUC) of serum Mb after LT immediately had the best value for predicting AKI [AUC: 0.755, sensitivity: 63.6%, specificity: 77.3%, 95% confidence interval (CI): 0.661–0.849], its cut-off value was 957 ng/mL. Conclusions: Postoperative serum Mb was an independent risk factor for new AKI and could increase the accuracy of predicting the occurrence of post-LT AKI. Trial Registration: The study was registered in Chinese Clinical Trial Registry (registration number: ChiCTR2100044257).