Baseline left ventricular (LV) dysfunction is associated with subsequent risks of acute kidney injury (AKI) and mortality in patients with sepsis. This study investigated the therapeutic effects of continuous renal replacement therapy (CRRT) in hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction. In this multicenter retrospective study, severe sepsis and septic shock patients with LV dysfunction were classified into one of two groups according to the timing of CRRT: the early group (before AKI was detected) or the control group (patients with AKI). Patients from the control group received an accelerated strategy or a standard strategy of CRRT. The primary outcome was all-cause intensive care unit (ICU) mortality. Patients were weighted by stabilized inverse probability of treatment weights (sIPTW) to overcome differences in baseline characteristics. After sIPTW analysis, the ICU mortality was significantly lower in the early group than the control group (27.7% vs. 63.5%, p < 0.001). Weighted multivariable analysis showed that early CRRT initiation was a protective factor for the risk of ICU mortality (OR 0.149; 95% CI 0.051–0.434; p < 0.001). The ICU mortality was not different between the accelerated- and standard-strategy group (52.5% vs. 52.9%, p = 0.970). Early CRRT in the absence of AKI is suggested for hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction since it benefits survival outcomes.

Background: Low birth weight (LBW) is one of the risk factors for coronary heart disease (CHD). The association of LBW and other risk factors with male patients with premature CHD has not been fully determined. This study aims to assess the association of LBW and other risk factors with the incidence of male patients with premature CHD.Methods We identified hospitalized male patients with premature CHD (CHD group) and healthy male subjects (control group) from January 2013 to December 2018. The differences of demographics, birth weight (BW) and other traditional risk factors were compared between the CHD group and the control group and logistic regression was used to estimate their effects on the risk of premature CHD.Results A total of 384 male subjects were enrolled in the study (183 in the CHD group vs 201 in the control group). There were significant differences in BW, smoking, diabetes and hyperlipidemia between the two groups (2.98±0.35 vs 3.37±0.39kg, P<0.001, 73.22% vs 27.36%, P<0.001, 8.74% vs 3.48%, P=0.033, 53.55% vs 37.31%, P=0.001) respectively. The risk of premature CHD increased significantly with the LBW (OR=4.530, 95% CI：1.331-15.412，P=0.016) and smoking (OR=6.748, 95% CI：4.258-10.693，P<0.001) respectively according to the multivariate logistic regression model. Conclusion LBW and smoking are independently and positively correlated with male patients with premature CHD. A history of LBW should be paid particularly attention in younger men for primordial prevention of premature CHD, especially away from tobacco.

Sepsis, a life-threatening syndrome with especially high incidence and mortality in older adults, imposes a major global health burden. Although the gut ba

Background : Baseline left ventricular (LV) dysfunction is associated with subsequent risks of acute kidney injury (AKI) and mortality in patients with sepsis. This study investigated the therapeutic effects of continuous renal replacement therapy (CRRT) in hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction.Methods : In this multicenter retrospective study, severe sepsis and septic shock patients with LV dysfunction were classified into one of two groups according to the timing of CRRT: the early group (before AKI was detected) or the control group (patients with AKI). All-cause intensive care unit (ICU) mortality and ICU stay were compared between the groups. Patients were weighted by stabilized inverse probability of treatment weights (sIPTW) to overcome differences in baseline characteristics.Results : After sIPTW analysis, the ICU mortality was significantly lower in the early group than the control group (25.9% vs 59.0%, p < 0.001). Weighted multivariable analysis showed that early CRRT initiation was a protective factor for the risk of ICU mortality. Early CRRT initiation significantly improved the ICU mortality compared to the control group (OR, 0.322; 95% CI, 0.125-0.834; p = 0.020).Conclusions : Early CRRT in the absence of AKI is suggested for hemodynamically unstable patients with severe sepsis and septic shock combined with LV dysfunction since it benefits survival outcomes.Trial registration: The study was preregistered in the Chinese Clinical Trial Registry (number, ChiCTR2000033083).

Background: Sepsis-induced cardiomyopathy (SICM) is a frequent and under-recognized complication of sepsis. Early diagnosis remains challenging. We evaluated the diagnostic value of admission myoglobin (MYO), alone and combined with NT-proBNP and the SOFA score, for SICM in patients with sepsis. Methods: In this single-center prospective cohort study (April 2022 to May 2024), we enrolled 158 patients with sepsis diagnosed according to Sepsis-3 criteria. Blood samples for MYO and NT-proBNP were collected within 24 h of admission; admission echocardiography was performed as soon as feasible (within 24 h whenever possible, and within 72 h in all enrolled patients); follow-up echocardiography was performed between day 7 and day 14. SICM was defined as left ventricular ejection fraction (LVEF) below 50% with documented reversibility. Univariate and multivariate logistic regression analyses were performed to identify factors associated with SICM, adjusting for age, sex, body mass index, and renal function. Receiver operating characteristic (ROC) curve analysis, internal validation by 1,000 bootstrap resamples, and decision curve analysis (DCA) were performed. Model calibration was assessed by a calibration plot, the calibration intercept and slope, and the Brier score, with bootstrap optimism-corrected estimates. Results: Of 158 patients, 63 (39.9%) were diagnosed with SICM. MYO levels were significantly higher in the SICM group than in the non-SICM group (median 395.7 vs. 97.3 ng/mL, P < 0.001). In multivariate analysis adjusting for age, sex, BMI, and renal function, MYO (OR 1.061 per 100 ng/mL, 95% CI 1.008–1.115; P = 0.023) and NT-proBNP (OR 1.087 per 1,000 pg/mL, 95% CI 1.025–1.153; P = 0.005) were independently associated with SICM. The combined model (MYO + NT-proBNP + SOFA) achieved an area under the ROC curve (AUC) of 0.821 (95% CI: 0.750–0.892), outperforming SOFA alone (AUC 0.743; likelihood ratio test P < 0.001); the optimism-corrected AUC after bootstrap validation was 0.812. The model was well calibrated (calibration intercept 0.00, slope 1.00; Brier score 0.173). DCA suggested potential net benefit across threshold probabilities of 0.1–0.7. Conclusion: Admission MYO, particularly in combination with NT-proBNP and SOFA, may assist in the early identification and diagnosis of SICM.