Acute and Critical Care

Original Articles

CPR/Resuscitation
Prognostic value of initial hemoglobin levels for neurological outcomes in patients with out-of-hospital cardiac arrest in South Korea: Jihun Keum, Kyung Hun Yoo, Yongil Cho, Tae Ho Lim, Hyunggoo Kang, Jaehoon Oh, Byuk Sung Ko, Juncheol Lee; Received October 21, 2025 Accepted March 2, 2026 Published online May 19, 2026; DOI: https://doi.org/10.4266/acc.005075 [Epub ahead of print]

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Abstract PDF Supplementary Material: Background
Previous studies suggest that lower hemoglobin (Hb) levels are associated with adverse outcomes after out-of-hospital cardiac arrest (OHCA). However, most of these were limited by small sample sizes and single-center designs. We aimed to evaluate the association between initial Hb levels and clinical outcomes after OHCA using a large multicenter registry.
Methods
This retrospective observational study analyzed prospectively collected multicenter registry data. Hb levels measured at emergency department arrival were analyzed as continuous variables with restricted cubic spline (RCS) models, which flexibly characterize dose–response relationships with unfavorable neurological outcomes and in-hospital mortality. Generalized estimating equations with a logit link were used to account for within-hospital clustering and to adjust for clinically relevant covariates.
Results
Lower Hb levels were independently associated with higher adjusted odds of unfavorable neurological outcomes and in-hospital mortality. RCS analyses showed a statistically significant overall association between Hb levels and both outcomes after multivariable adjustment (overall P<0.001). The adjusted odds of adverse outcomes increased progressively with decreasing Hb levels. Cluster-adjusted analyses using generalized estimating equations yielded consistent results.
Conclusions
Initial Hb levels were independently associated with neurological outcomes and in-hospital mortality after OHCA. Modeling Hb as a continuous variable showed a graded association across the Hb spectrum. These findings highlight the prognostic relevance of baseline Hb levels.

Epidemiology
Long-term mortality of adult patients with carbon monoxide poisoning presenting to the emergency department in Korea: a population-based cohort study: Sang Hwan Lee, Soo Rack Ryu, Kyung Hun Yoo, Juncheol Lee, Yongil Cho, Tae Ho Lim, Hyunggoo Kang, Jaehoon Oh, Byuk Sung Ko; Acute Crit Care. 2024;39(4):526-534. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.00199

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Background
Carbon monoxide (CO) poisoning can lead to significant morbidity and mortality. However, relatively few studies have investigated its long-term mortality impact. This nationwide population-based cohort study examined the association between CO poisoning and long-term mortality.
Methods
This retrospective study utilized data from the National Health Insurance Service database in South Korea. We compared the patients with CO poisoning to those without CO poisoning. Inverse probability treatment weights were applied to both groups to control for potential confounding factors. Subsequently, mortality was assessed using the incidence rate and Cox proportional hazard ratios.
Results
This study included 23,387 patients with CO poisoning and 359,851 without it. Over a median follow-up period of 7.6 years after CO poisoning diagnosis, the mortality risk was 2.6 times higher in patients with CO poisoning compared to that in the control group. In a long-term follow-up of patients surviving beyond 30 days, mortality remained 2.18 times higher. Additionally, a higher mortality risk was observed in the relatively younger age group (18–39 years) and the group with fewer underlying diseases, as indicated by a Charlson Comorbidity Index score of 0.
Conclusions
CO poisoning is associated with an elevated long-term mortality rate particularly in a relatively young and healthy population.

Citations

Citations to this article as recorded by

Optimizing hyperbaric oxygen initiation time in carbon monoxide poisoning: a 3-hour window enhances neurological recovery via lactate clearance
Dongjun Xu, Xiaoqin Xu, Hui Sun, Jun Xu, Danting Fei, Yaye Shen
Open Medicine.2026;[Epub] CrossRef

Infection/Hematology
The Prevalence and Significance of Overt Disseminated Intravascular Coagulation in Patients with Septic Shock in the Emergency Department According to the Third International Consensus Definition: Byuk Sung Ko, Hyun Young Cho, Seung Mok Ryoo, Myung Chun Kim, Woong Jung, Sung Hyuk Park, Chang Min Lee, Won Young Kim; Korean J Crit Care Med. 2016;31(4):334-341. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00339

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Background
The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock.
Methods
We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality.
Results
Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]).
Conclusions
Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.

Citations

Citations to this article as recorded by

A comparison of disseminated intravascular coagulation scoring systems and their performance to predict mortality in sepsis patients: A systematic review and meta-analysis
Girum Tesfaye Kiya, Gemeda Abebe, Zeleke Mekonnen, Edosa Tadasa, Gedion Milkias, Elsah Tegene Asefa, Mehmet Baysal
PLOS ONE.2025; 20(1): e0315797. CrossRef
Disseminated intravascular coagulation, associated factors and clinical outcomes among critically Ill septic adults admitted to a tertiary hospital in Ethiopia: A prospective longitudinal study
Girum Tesfaye Kiya, Zeleke Mekonnen, Elsah Tegene Asefa, Gedion Milkias, Edosa Tadasa, Edosa Kejela, Iyasu Demeke, Aragaw Fiseha, Gemeda Abebe, Kovuri Umadevi
PLOS One.2025; 20(8): e0330842. CrossRef
Which Septic Shock Patients With Non-Overt DIC Progress to DIC After Admission? Point-of-Care Thromboelastography Testing
Sang-Min Kim, Sang-Il Kim, Gina Yu, Youn-Jung Kim, Won Young Kim
Shock.2022; 57(2): 168. CrossRef
Dysregulated haemostasis in thrombo-inflammatory disease
Paula A. Klavina, Gemma Leon, Annie M. Curtis, Roger J.S. Preston
Clinical Science.2022; 136(24): 1809. CrossRef
Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman, Jordan
Eman Mahmoud Qasim Emleek, Amani Anwar Khalil
Biological Research For Nursing.2021; 23(4): 689. CrossRef
Features of Development and Course of Disseminated Intravascular Coagulation Syndrome During Surgical Interventions in Children with Oncological Diseases
N. P. Leonov, V. V. Schukin, G. A. Novichkova, M. A. Maschan, F. I. Ataullakhanov, S. S. Yashin, A. M. Zeynalov, Е. A. Spiridonova
General Reanimatology.2020; 16(3): 54. CrossRef
Relationship between low hemoglobin levels and mortality in patients with septic shock
Sung Min Jung, Youn-Jung Kim, Seung Mok Ryoo, Won Young Kim
Acute and Critical Care.2019; 34(2): 141. CrossRef

Does Adding Somatostatin to Proton Pump Inhibitor Improve the Outcome of Peptic Ulcer Bleeding?: Insung Kim, Yoon Seon Lee, Byuk Sung Koh, Won Kim, Kyoung Soo Lim; Korean J Crit Care Med. 2008;23(2):75-78.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.75

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Abstract PDF

BACKGROUND
Somatostatin has been shown to offer a distinct advantage over antisecretory drugs in the management of peptic ulcer bleeding (PUB). However, rebleeding rates are still high in spite of endoscopic and medical treatment. In this study, we intended to determine whether combined therapy of a proton pump inhibitor (PPI) plus somatostatin is more beneficial than a PPI alone in patients with PUB.
METHODS
We enrolled 90 consecutive patients who presented with PUB between January 2006 and October 2007. All the patients were managed with endoscopic hemostasis and divided into two treatment groups: 1) PPI alone (group A) and 2) PPI plus somatostatin (group B). The primary outcome was rebleeding within 72 hours. The secondary outcomes were rebleeding in 30 days, packed red blood cells (pRBC) transfused, length of hospital stay, need for surgery, and in-hospital mortality.
RESULTS
Forty-five patients in the PPI group (A) and 45 patients in the PPI plus somatostatin group (B) were studied. There was no difference between the two groups with respect to clinical and endoscopic features at admission. After medical treatment, there was no difference between groups A and B in rebleeding at 72 hours (11% vs. 13%, p = NS), rebleeding in 30 days (13% vs. 16%, p = NS), pRBC transfused (mean, 3.2 vs. 4.5 units, p = NS), length of hospital stay (mean, 7.4 vs. 8.4 days, p = NS), and in-hospital mortality (2% vs. 7%, p = NS).
CONCLUSIONS
Combined therapy with PPI and somatostatin did not result in better outcomes than PPI alone.

Citations

Citations to this article as recorded by

The effect of octreotide in acute nonvariceal upper gastrointestinal bleeding: A randomized, double-blind, placebo-controlled trial
Masoud Abrishami, Payam Peymani, Marziyeh Zare, KamranB Lankarani
Journal of Research in Pharmacy Practice.2020; 9(2): 94. CrossRef
Octreotide Added to a Proton Pump Inhibitor Versus a Proton Pump Inhibitor Alone in Nonvariceal Upper-Gastrointestinal Bleeds
Heidi M. Riha, Rachel Wilkinson, Jennifer Twilla, L. Jeff Harris, Lauren A. Kimmons, Mehmet Kocak, Megan A. Van Berkel
Annals of Pharmacotherapy.2019; 53(8): 794. CrossRef

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