Objectives: To investigate the association between the severities of left ventricular (LV) systolic dysfunction and clinical outcomes in patients with sepsis, with a particular focus on in-hospital mortality. Design: Multicenter cohort study. Setting: Nineteen tertiary or university-affiliated hospitals in South Korea. Patients: A total of 2274 adult patients with sepsis or septic shock underwent echocardiographic examination within 24 hours of sepsis recognition. Interventions: None. Measurements and Main Results: Patients were stratified by left ventricular ejection fraction (LVEF) into three groups: normal (> 50%, n = 1803), mild-to-moderate dysfunction (30–50%, n = 356), and severe dysfunction (< 30%, n = 115). In-hospital mortality is significantly associated with LV dysfunction severity (normal: 25.73%, mild-to-moderate: 29.49%, severe: 40.00%; p = 0.023). After propensity score matching using three different methodologies, severe LV dysfunction remained independently associated with increased in-hospital mortality (adjusted odds ratio [OR] 1.81; 95% CI, 1.09–3.03). This effect was more pronounced in patients without preexisting cardiovascular disease (CVD) (OR 1.84; 95% CI, 1.08–3.13) and those with bacteremia (OR 2.20; 95% CI, 1.5–3.22). Cardiopulmonary arrest rates increased significantly with dysfunction severity (normal: 2.11%, mild-to-moderate: 3.93%, severe: 10.43%; p < 0.001), while other ICU complications showed no significant differences. Conclusions: Severe LV systolic dysfunction (LVEF < 30%) is associated with significantly increased in-hospital mortality in sepsis patients, particularly in those with bacteremia and without preexisting CVD. These findings highlight the importance of early cardiac function assessment in sepsis and suggest that infection status and underlying cardiovascular health modify the relationship between LV dysfunction and clinical outcome.

It remains uncertain how long pure ground-glass nodules (pGGNs) detected on low dose computed tomography (LDCT) should be followed. Further studies with longer follow-up periods are needed to determine the optimal follow-up duration for pGGNs. What is the percentage of enlarging nodules among pGGNs that have remained stable for 10 years? This was a retrospective cohort study originating from subjects with pGGNs detected on LDCT scans between 1997 and 2006, whose natural courses were reported in 2013. We re-analyzed all the follow-up data until July 2022. The study subjects were followed by our institutional guidelines until they were no longer a candidate for definitive treatment. The growth of the pGGNs was defined as an increase in the diameter of the entire nodule by 2 mm or more or the appearance of new solid portions within the nodules. A total of 89 patients with 135 pGGNs were followed for a median of 193 months. Of 135 pGGNs, 23 (17.0%) increased in size, and the median time to the first detection of a size change was 71 months. Of the 23 growing pGGNs, 122 were detected on the first LDCT, and 13 were newly detected on the follow-up CT scan. An increase in size was observed within 5 years in 8 nodules (34.8%), between 5 and 10 years in 12 nodules (52.2%) and after 10 years in 3 nodules (13.0%). Fifteen nodules were histologically confirmed as adenocarcinoma by surgery. Among the 76 pGGNs stable for 10 years, 3 (3.9%) increased in size. Among pGGNs that remained stable for 10 years, 3.9% eventually grew, indicating that some pGGNs can grow even after a long period of stability. We suggest that pGGNs may need to be followed for more than 10 years to confirm growth.

Background: Sepsis‐induced cardiac dysfunction, known as septic cardiomyopathy, is a common complication associated with increased mortality. Cardiac troponins serve as markers for myocardial injury and are frequently elevated in patients with sepsis. However, the role of troponin elevation at sepsis recognition in risk stratification remains controversial. Methods and Results: This nationwide multicenter prospective cohort study analyzed 2141 adult patients with sepsis without prior cardiovascular disease from the Korean Sepsis Alliance registry. These patients were classified as having either elevated troponin levels or troponin levels in the normal range at the time of sepsis recognition, according to the reference ranges specific to each participating institution. The primary outcome was hospital mortality, and propensity score matching was used to control for confounding factors. In the propensity score‐matched cohort (523 pairs), there were no significant differences in hospital mortality (35.2% versus 32.7%, odds ratio [OR], 1.12 [95% CI, 0.86–1.44], P =0.396), hospital length of stay (13.0 versus 15.0 days, OR, 1.00 [95% CI, 0.99–1.00], P =0.128), intensive care unit mortality (24.7% versus 25.0%, OR, 0.98 [95% CI, 0.74–1.30], P =0.886), or intensive care unit length of stay between the elevated troponin and control groups. However, landmark analysis revealed that the elevated troponin group had a lower survival probability after 1 week (log‐rank P =0.033) and significantly higher kidney Sequential Organ Failure Assessment scores from intensive care unit admission to day 7 ( P =0.003). Conclusions: Troponin elevation at sepsis recognition was not significantly associated with increased hospital mortality or worse clinical outcomes in patients with sepsis.

Background: Data on noninvasive ventilation (NIV) use in intensive care units (ICUs) are very limited in South Korea. Methods: A prospective observational study was performed in 20 ICUs of university-affiliated hospitals from June 2017 to February 2018. Adult patients (age>18 years) who were admitted to the ICU and received NIV treatment for acute respiratory failure were included. Results: A total of 156 patients treated with NIV were enrolled (mean age, 71.9 +/- 11.6 years). The most common indications for NIV were acute hypercapnic respiratory failure (AHRF, n=89) and post-extubation respiratory failure (n=44). The main device for NIV was an invasive mechanical ventilator with an NIV module (61.5%), and the majority of patients (87.2%) used an oronasal mask. After the exclusion of 32 do-not-resuscitate patients, NIV success rate was 68.5% (85/124); ICU and hospital mortality rates were 8.9% and 15.3%, respectively. However, the success rate was lower in patients with de novo respiratory failure (27.3%) compared to that of patients with AHRF (72.8%) or post-extubation respiratory failure (75.0%). In multivariate analysis, immunocompromised state, de novo respiratory failure, post-NIV (2 hours) respiratory rate, NIV mode (i.e., non. pressure support ventilation mode), and the change of NIV device were significantly associated with a lower success rate of NIV. Conclusion: AHRF and post-extubation respiratory failure were the most common indications for NIV in Korean ICUs. Overall NIV success was achieved in 68.5% of patients, with the lowest rate in patients with de novo respiratory failure.

Nam H, et al. J Korean Med Sci. 2026 Nov;41:e284. https://doi.org/10.3346/jkms.2026.41.e284

Background: Dedicated pulmonary embolism (PE) thrombectomy devices are not universally available. We evaluated the early outcomes and safety of catheter-directed bolus thrombolysis plus manual aspiration thrombectomy (BT-MAT) using conventional catheters for intermediate-high- or high-risk acute PE. Methods: This retrospective, single-center, historical control study included adults with acute intermediate-high- or high-risk PE involving the main pulmonary artery. Patients who underwent BT-MAT from November 2023 to October 2025 were compared with historical controls who received conventional management such as anticoagulation or systemic thrombolysis before BT-MAT implementation (November 2022 to October 2023). BT-MAT comprised catheter-directed bolus alteplase injection followed by manual aspiration using conventional 7- to 8-Fr catheters or sheaths. Results: Twenty-three patients were included (BT-MAT, n = 11; historical control, n = 12). BT-MAT patients were younger (65.3 ± 16.5 vs. 78.2 ± 11.4 years; p = 0.040) and more frequently had bilateral main pulmonary artery involvement (82% vs. 33%; p = 0.036). Technical success was achieved in all BT-MAT procedures. Clinical success occurred in 11/11 BT-MAT patients and 10/12 conventional-treatment patients (100.0% vs. 83.3%; p = 0.478). No treatment-related complications occurred in the BT- MAT group, whereas two patients in the historical control group developed blood-tinged sputum and hematuria. Estimated right ventricular systolic pressure decreased from 47.1 ± 8.6 to 36.2 ± 10.1 mmHg after BT-MAT. Hospital stay did not differ significantly between groups. Conclusions: BT-MAT was technically feasible and showed favorable early clinical outcomes in this small series. Further prospective studies are warranted to evaluate its efficacy and safety.