While C-reactive protein (CRP) is a well-studied marker for predicting treatment response and mortality in sepsis, it was aimed to assess the efficacy of the neutrophil lymphocyte ratio (NLR) as a predictor of mortality and treatment response in sepsis patients in the intensive care unit (ICU). In this retrospective cross-sectional study, sepsis patients were divided according to the presence of septic shock on the 1st day of ICU stay, and then subgrouped according to mortality. Patient demographics, acute physiologic and chronic health evaluation II and sequential organ failure assessment scores, NLR and CRP (on the 1st, 3rd, and last day in the ICU), microbiology data, antibiotic responses, ICU data, and mortality were recorded. Receiver operating characteristic (ROC) curves for the area under curve (AUC) were calculated for the inflammatory markers and ICU severity scores for mortality. Of the 591 (65% male) enrolled patients, 111 (18.8%) were nonsurvivors with shock, 117 (19.8%) were survivors with shock, 330 (55.8%) were survivors without shock, and 33 (5.6%) were nonsurvivors without shock. On the 1st day of ICU stay, the NLR and CRP were similar in all of the groups. On the 3rd day of antibiotic response, the NLR was increased (11.8) in the nonresponsive patients when compared with the partially responsive (11.0) and responsive (8.5) patients. If the NLR was ≥15 on the 3rd day, the mortality odds ratio was 6.96 (CI: 1.4–34.1, P < 0.017). The NLR and CRP on the 1st, 3rd, and last day of ICU stay (0.52, 0.58, 0.78 and 0.56, 0.70, 0.78, respectively) showed a similar increasing trend for mortality. The NLR can predict mortality and antibiotic responsiveness in ICU patients with sepsis and septic shock. If the NLR is >15 on the 3rd day of postantibiotic initiation, the risk of mortality is high and treatment should be reviewed carefully.

Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear.Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19.Study Design: Multicenter prospective observational clinical study.Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged >= 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated.Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 +/- 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004).Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

Background: Sepsis and septic shock are associated with high mortality in intensive care units (ICUs), with a substantial risk persisting after ICU discharge. However, it remains unclear whether inflammatory biomarkers retain their prognostic value at the time of ICU discharge. This study aimed to evaluate whether discharge inflammatory biomarkers—including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-mean platelet volume ratio (PLT/MPV), and C-reactive protein-to-albumin ratio (CAR)—remain predictive of short- and long-term mortality in patients with sepsis and septic shock. Methods: In this single-center, retrospective cohort study, adult patients with sepsis or septic shock discharged from a tertiary ICU specializing in chest diseases between January 2013 and January 2015 were included. Sepsis and septic shock were retrospectively re-classified according to Sepsis-3 criteria. Inflammatory biomarkers measured at ICU admission and discharge, along with clinical variables and disease severity scores (APACHE II and SOFA), were recorded. Patients were followed for 28-day, 6-month, and 2-year mortality. The prognostic performance of biomarkers was assessed using receiver operating characteristic (ROC) analysis, and optimal cut-off values were determined. Independent predictors of mortality were evaluated using Cox proportional hazards regression analysis. Results: A total of 461 patients were included. In total, 291 (63.1%) had sepsis without shock and 170 (36.9%) had septic shock. The overall male proportion was 62%, with a median age of 65 (IQR 54–74) years in the sepsis group and 70 (63–79) years in the septic shock group. Mortality rates were significantly higher in patients with septic shock compared to those with sepsis at 28 days (24% vs. 10%, p < 0.001), 6 months (44% vs. 27%, p < 0.001), and 2 years (71% vs. 57%, p = 0.003). In unadjusted survivor/non-survivor comparisons, elevated discharge NLR and CAR were associated with early post-ICU mortality. However, in multivariable Cox regression, discharge NLR, but not discharge CAR, remained independently associated with 28-day and 6-month mortality. On ROC analysis, discharge NLR showed moderate discriminative performance for 28-day mortality (AUC 0.67, 95% CI 0.60–0.74), as did discharge CAR (AUC 0.68, 95% CI 0.60–0.76), although CAR did not retain independent prognostic significance after adjustment. An NLR value ≥ 5 was identified as an independent predictor of 28-day mortality (HR 2.44; 95% CI 1.24–4.80; p = 0.010) and was also significantly associated with 6-month mortality (HR 2.02; 95% CI 1.18–3.45; p = 0.011), although its predictive value decreased over longer follow-up periods (HR 1.37; 95% CI 0.93–2.01; p = 0.11 at 2 years). Conclusions: Inflammatory biomarkers measured at ICU discharge, particularly NLR, remain predictive of short-term mortality in patients with sepsis and septic shock, but their prognostic value diminishes over time. Assessment of inflammatory status at ICU discharge may provide a practical tool for early post-ICU risk stratification and may support clinical decisions regarding intensified outpatient surveillance and follow-up scheduling in this vulnerable population.

Background and Objectives: Delayed cerebral ischemia (DCI) is a major determinant of poor outcome after aneurysmal subarachnoid hemorrhage (aSAH), yet early risk prediction remains difficult, particularly in sedated or ventilated intensive care patients. We evaluated whether a large language model (LLM) could predict DCI from phase-based dynamic clinical data, compared with intensive care specialists. Materials and Methods: In this single-center, retrospective study, 216 consecutive patients with aSAH were assessed at three predefined phases of accumulating clinical data (day 1; days 1 + 3; days 1 + 3 + 5). For each patient–phase, an LLM (ChatGPT, GPT-5.5 Thinking) and two blinded intensive care specialists predicted DCI risk using only the data available up to that time point. DCI was adjudicated by a blinded three-member panel. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC), with non-inferiority defined a priori as Δ = 0.10. Calibration, decision-curve analysis, and reproducibility were also assessed. Results: Of 216 patients, 60 (27.8%) were DCI-positive and 15 were indeterminate; the primary sample comprised 201 patients. In the prespecified primary analysis, the LLM met the non-inferiority criterion relative to both specialists across all three phases (LLM AUC 0.703–0.747; specialists 0.712–0.764); however, in an equal-granularity sensitivity analysis, non-inferiority remained supported only in Phases 2 and 3 and was not demonstrated in Phase 1. Discrimination increased numerically as data accumulated (Phase 1 vs. 3, p = 0.072), an increase that was attenuated in a landmark-restricted analysis accounting for DCI-onset timing. The LLM showed the lowest false-reassurance rate (3.3–11.7%), reflecting a more cautious threshold rather than better discrimination. Confidence did not reliably indicate accuracy (~25% of high-confidence predictions were wrong); outputs were highly reproducible (Fleiss κ 0.887; intraclass correlation coefficient (ICC) 0.968). Conclusions: An LLM achieved DCI discrimination that was non-inferior to—but not better than—that of experienced specialists; its unreliable confidence scores support clinician-supervised rather than autonomous use.

Background: Weaning from mechanical ventilation remains a complex and failure-prone process, with extubation failure rates reaching up to 30%. Conventional indices inadequately capture the multifactorial physiology underlying weaning failure. This study aimed to evaluate whether a multimodal ultrasound approach could improve the identification of mechanisms and prediction of extubation outcomes. Methods: In this prospective pilot observational study, adult mechanically ventilated patients with preserved left ventricular ejection fraction (LVEF ≥ 50%) undergoing spontaneous breathing trials (SBT) were included. Multimodal ultrasound assessment—including transthoracic echocardiography (TTE), lung ultrasound (LUS), diaphragmatic ultrasound (DUS), and venous excess ultrasound (VExUS)—was performed at two predefined time points. Conventional respiratory mechanics parameters were recorded concurrently. The primary outcome was a composite of SBT failure (permanent weaning failure) or reintubation within 48 h. Results: A total of 27 patients were included, of whom 8 (29.6%) experienced extubation failure (5 permanent SBT failure, 3 post-extubation reintubation). Respiratory system compliance showed consistent associations with extubation failure across both ROC and regression analyses (AUC 0.806, 95% CI 0.611–1.000; cutoff ≤ 45 mL/cmH₂O; sensitivity 88%; specificity 74%; NPV 93%). Diaphragm excursion was significantly lower in the failure group (p = 0.042) and showed useful predictive performance (AUC 0.750, 95% CI 0.565–0.935; cutoff ≤ 24 mm; sensitivity 100%; specificity 58%; NPV 100%). Lung ultrasound, VExUS, and echocardiographic parameters did not demonstrate significant predictive value. Given the limited number of outcome events (n = 8) and events-per-variable ratio of 4.0 (EPV = 4.0), all multivariable findings are hypothesis-generating. Conclusions: In this prospective pilot study, respiratory system compliance and diaphragm excursion were associated with extubation failure in patients with preserved left ventricular function, while echocardiographic indices, LUS, and VExUS grading did not demonstrate significant predictive value. These hypothesis-generating findings suggest that impaired diaphragmatic function and reduced compliance may be more closely associated with weaning failure than cardiopulmonary congestion parameters. However, given the small sample size, low EPV, and single-centre design, all findings require validation in larger multicentre studies including patients with impaired systolic function.

Background/Objectives: Postoperative intensive care unit (ICU) disposition after anatomical lung resection is usually planned preoperatively, but the final care pathway may be substantially influenced by intraoperative events. We evaluated actual postoperative ICU admission among patients with a documented preoperative ICU monitoring recommendation and compared preoperative-only and perioperative triage approaches. Methods: In this retrospective single-centre cohort study, 1060 adults undergoing elective anatomical lung resection for non-small cell lung cancer (NSCLC) between January 2019 and December 2025 were screened; 159 patients with a documented preoperative ICU monitoring recommendation constituted the analytical cohort. A clinically pre-specified primary perioperative model incorporating operative duration, intraoperative complication, chronic obstructive pulmonary disease (COPD), and pre-existing arrhythmia was compared with a preoperative-only model and with an exploratory perioperative ICU triage score. Results: Actual postoperative ICU admission occurred in 45 patients (28.3%). Operative duration (adjusted odds ratio [OR] 1.012 per minute; 95% confidence interval [CI], 1.005–1.018; p < 0.001) and intraoperative complication (adjusted OR 15.002; 95% CI, 3.738–60.210; p < 0.001) were significantly associated with actual postoperative ICU admission. The primary perioperative model achieved an AUC of 0.802 (95% CI, 0.717–0.876), compared with 0.759 for the exploratory perioperative triage score and 0.665 for the preoperative-only model. Conclusions: Fewer than one-third of patients with a documented preoperative ICU monitoring recommendation underwent actual postoperative ICU admission. In this selected cohort, perioperative reassessment incorporating intraoperative information showed higher apparent discriminative performance than the preoperative-only approach while the exploratory score showed intermediate, hypothesis-generating performance. Because the outcome reflected observed institutional ICU disposition rather than independently adjudicated ICU-level care requirement, prospective multicentre validation using predefined ICU admission criteria is required before clinical implementation.