Infections are serious postoperative complications, and strongly affects the mortality and prognosis of patients. Body mass index (BMI) and lipids are factors in postoperative infection, but a causal relationship has not been know. In this Mendelian randomization (MR) study, we utilized genome-wide association study (GWAS) data from the Global Lipids Genetics Consortium and FinnGen database, treating lipids and BMI as exposures. Postoperative infection GWAS data from the UK Biobank served as the outcome. We utilized linkage disequilibrium score regression (LDSC) analysis to evaluate the genetic correlations between lipids, BMI, and postoperative infections. We employed univariate and reverse MR analyses to explore the causal relationships between exposure and outcome factors. The analysis primarily utilized the inverse variance weighted method, supplemented by MR-Egger and weighted median methods. The MR-PRESSO method was used to detect horizontal pleiotropy and potential outliers. Additionally, stepwise mediation MR analysis was employed to investigate indirect factors potentially influencing the relationships between lipids, BMI, and postoperative infections. The genetic covariance analysis indicates that there is no sample overlap among all the GWAS conducted. In the LDSC analysis, genetic correlations (GC) were found between BMI(GC = 0.430, P < 0.05), HDL-C(GC = − 0.414, P < 0.05), nonHDL-C(GC = 0.137, P < 0.05), TG(GC = 0.417, P < 0.05), and postoperative infection. HDL-C showing a negative genetic association with postoperative infection, while other phenotypes showed positive associations. In MR analysis, causal relationships were identified between BMI and postoperative infection (OR = 1.36, 95% CI = 1.16–1.60, P < 0.05) and HDL-C and postoperative infection (OR = 0.87, 95% CI = 0.78–0.96, P < 0.05), with BMI showing a positive causal association and HDL-C showing a negative causal association with postoperative infection. These findings are consistent with the LDSC results. In the reverse MR analysis, there was no significant causal relationship identified between postoperative infection and both BMI and lipids. Stepwise mediation MR analysis excluded the impact of potential mediating factors between exposure and outcomes. In this study, through LDSC and MR analyses, we identified genetic correlations and causal links between BMI, HDL, and postoperative infection. It was found that BMI might increase the risk of postoperative infection, whereas HDL could potentially lower the risk of developing postoperative infection.

Background: Transesophageal lung ultrasound (TELUS) has emerged as a novel modality that utilizes the esophageal acoustic window to obtain high-resolution images of posterior lung regions. However, its quantitative assessment and clinical relevance remain poorly explored. This study aimed to evaluate the feasibility and prognostic value of TELUS in critically ill patients, focusing on its association with arterial oxygenation and 28-day mortality. Methods: In this prospective observational study, TELUS was performed in 69 mechanically ventilated ICU patients. TELUS imaging was acquired at three esophageal levels corresponding to posterior apical, mid, and basal lung regions. A semi-quantitative TELUS score was derived and its correlation with clinical variables was analyzed. Univariate and multivariate logistic regression analyses were employed to identify predictors of 28-day mortality. Receiver operating characteristic (ROC) analysis was used to assess the predictive performance of TELUS for mortality and severe hypoxemia (PaO₂/FiO₂ ≤ 100). Results: Non-survivors had significantly higher TELUS scores compared to survivors (median 5 [IQR 4–6] vs. 4 [3–5], P = 0.001). Regional TELUS scores at the upper-aortic arch level and mid-esophageal level were elevated in non-survivors ( P = 0.018 and P = 0.004, respectively). TELUS scores showed a significantly negative correlation with the PaO₂/FiO₂ ratio ( r = −0.51, P < 0.0001), and positive correlations with PEEP ( r = 0.32, P = 0.007) and SOFA scores ( r = 0.26, P = 0.032). Multivariate analysis identified both SOFA (OR 1.31, 95% CI 1.08–1.63, P = 0.009) and TELUS scores (OR 1.72, 95% CI 1.08–2.96, P = 0.030) as independent predictors of 28-day mortality. ROC analysis showed that a TELUS score ≥ 4 predicted 28-day mortality and severe hypoxemia (PaO₂/FiO₂ ≤ 100), yielding areas under the ROC (AUCs) of 0.74 and 0.72, with high sensitivity (89% and 100%, respectively) and negative predictive values (92% and 100%, respectively.) Conclusion: TELUS is a feasible novel technique that provides a reliable assessment of posterior lung aeration in critically ill patients. TELUS scoring correlates with impaired oxygenation and is independently associated with 28-day mortality. These findings highlight the prognostic value of TELUS and support its potential integration into transesophageal cardiopulmonary ultrasound protocols.

Intra-abdominal hypertension (IAH) may reduce the diagnostic accuracy of the passive leg raising (PLR) test for predicting fluid responsiveness, with uncle

Background The performance of muscular ultrasound in diagnosing intensive care unit (ICU)-acquired weakness (ICUAW) is debated. We conducted this systematic review and meta-analysis to assess the diagnostic efficacy of muscular ultrasound in ICUAW. Methods Three researchers independently searched PubMed, Web of Science, Embase, Cochrane library, CNKI, VIP and Wanfang databases for articles published before May 2023. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was employed to evaluate the methodological quality of the studies. A random-effects model was utilized to drive the summary estimates of sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval (CI), and summary receiver operating characteristic (SROC) curve was estimated. Additionally, a Fagan nomogram was constructed to calculate the post-test probabilities. Sources of heterogeneity were explored by subgroup analysis and meta-regression. Results This meta-analysis comprised nine prospective studies involving 485 participants, of whom 207 (42.68%) were diagnosed as ICUAW. Overall, the muscular ultrasound exhibited good performance for diagnosing ICUAW, with the area of SROC curve of 0.84 (95%CI 0.81–0.87), sensitivity of 0.76 (95%CI 0.70–0.82), specificity of 0.79 (95%CI 0.73–0.83), and DOR of 11.61 (95%CI 7.43–18.13). The included studies exhibited heterogeneity. Upon subgroup analysis, rectus femoris exhibited significantly superior discriminatory ability in identifying ICUAW when compared to the non-rectus femoris, with higher specificity (0.84 [95%CI 0.76–0.90] versus 0.71 [95%CI 0.64–0.77], p = 0.04) and SROC (0.89 [95%CI 0.86–0.91] versus 0.76 [95%CI 0.72–0.79], p < 0.01). Moreover, cross-sectional area was more effective than thickness, with higher specificity (0.84 [95%CI 0.77–0.89] versus 0.74 [95%CI 0.68–0.79], p = 0.02) and SROC (0.85 [95%CI 0.82–0.88] versus 0.76 [95%CI 0.72–0.80], p < 0.01). Furthermore, the integrated analysis of these two indicators revealed that the cross-sectional area of rectus femoris was statistically superior to the thickness of rectus femoris, with higher SROC (0.87 [95%CI 0.83–0.89] versus 0.80 [95%CI 0.76–0.83], p < 0.01). Conclusion Muscular ultrasound has potential to be a reliable tool for ICUAW diagnosis. Comparing to alternative indices, the cross-sectional area of the rectus femoris exhibits superior diagnostic efficacy and may be considered as a valuable parameter for clinical application.