Acute and Critical Care

Original Articles

Infection
Early prognostication of septic shock in Korean adults aged 80 years and over: serum albumin combined with Sequential Organ Failure Assessment score: Sang-Min Kim, Seung Mok Ryoo, Woon Yong Kwon, Kyuseok Kim, Tae Ho Lim, Sung Pil Chung, Sung-Hyuk Choi, Won Young Kim; Acute Crit Care. 2026;41(2):304-314. Published online May 11, 2026; DOI: https://doi.org/10.4266/acc.005625

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Abstract PDF Supplementary Material: Background
Septic shock requires careful risk stratification in patients aged 80 and over. Serum albumin levels reflect host status and, when combined with the severity of organ dysfunction, may enhance early prognostication. Here, we evaluated whether combining albumin levels with the Sequential Organ Failure Assessment (SOFA) score upon emergency department (ED) arrival can improve risk classification. Methods: We conducted an observational study from October 2015 to May 2022 using a prospective multicenter registry of septic shock from 12 EDs in the Korean Shock Society. We included 1,300 (18.8%) patients with septic shock aged ≥80 years. The SOFA score was calculated in the ED at the time of septic shock recognition. Patients were divided into three groups according to albumin levels (cutoff, 3.5 g/dl) and the initial SOFA score (cutoff, 7): A, normal albumin with low SOFA score; B, high SOFA with normal albumin or low SOFA with low albumin; and C, low albumin with high SOFA score. The primary outcome was 28-day mortality. Results: Groups A, B, and C included 175, 592, and 533 patients, with 28-day mortality rates of 12.0%, 26.9%, and 49.3%, respectively. Adjusted odds ratios (95% CI) for mortality were 3.02 (1.76–5.18) for group B and 5.80 (3.38–9.97) for group C vs. group A. Conclusions: Combining the SOFA score with the albumin level allows early classification of patients aged ≥80 years with septic shock in the ED, facilitating treatment discussions, particularly decision-making with patients and their families.

Pediatrics
Refining mortality risk stratification in pediatric sepsis: the roles of PELOD-2, vasoactive-inotropic scores, and procalcitonin in a tertiary hospital in Eastern Indonesia: Arya Krisna Manggala, Dyah Kanya Wati, Ida Bagus Gede Suparyatha, I Nyoman Budi Hartawan; Acute Crit Care. 2026;41(2):387-398. Published online April 17, 2026; DOI: https://doi.org/10.4266/acc.002450

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Abstract PDF: Background
Sepsis is a leading cause of mortality and morbidity in children. While the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score is a common predictor of mortality, it does not account for the use of inotropic drugs or sepsis markers, which are addressed by the vasoactive-inotropic score (VIS) and measurements of procalcitonin levels. Combining these components enables faster and more accurate predictions of mortality risks. Therefore, this study aimed to develop a new stratification model of mortality risks by integrating PELOD-2, VIS, and procalcitonin among children with septic shock. Methods: A single-center, three-year, retrospective cohort study was conducted in the pediatric intensive care unit of a tertiary hospital. Children aged 1 month to 18 years and diagnosed with septic shock between 2022 and 2024 received vasoactive and/or inotropic support within 24 hours of diagnosis. PELOD-2 scores and procalcitonin levels were recorded at diagnosis. The cutoff values for PELOD-2, VIS, and procalcitonin were determined using receiver operating characteristic curves. Multivariate analysis was used to generate a final equation and validated with the Hosmer-Lemeshow goodness-of-fit test. Results: A total of 101 children were included, with a mortality rate of 78.2%. The optimal cutoff values were a PELOD-2 score ≥8 (sensitivity, 88.6%; specificity, 72.7%), a VIS score ≥11.5 (sensitivity, 78.5%; specificity, 72.7%), and a procalcitonin level ≥5 ng/ml (sensitivity, 74.7%; specificity, 68.2%). Multivariate analysis revealed significant associations with outcomes: PELOD-2 (adjusted odds ratio [aOR], 12.75; P<0.001), VIS (aOR, 4.686; P=0.02), and procalcitonin (aOR, 4.245; P=0.029). The new mortality risk prediction model achieved a range of 12.8% to 97.39% and exhibited excellent discriminator power (area under the curve, 0.911). The Hosmer–Lemeshow test confirmed good calibration. Conclusions: The new scoring approach that refines stratification of mortality risks by incorporating PELOD-2, VIS, and procalcitonin is a more comprehensive predictor.

Infection
Application of Sepsis-3 Criteria to Korean Patients with Critical Illnesses: Jae Yeol Kim, Hwan Il Kim, Gee Young Suh, Sang Won Yoon, Tae-Yop Kim, Sang Haak Lee, Jae Young Moon, Jae-Young Kwon, Sungwon Na, Ho Geol Ryu, Jisook Park, Younsuck Koh; Acute Crit Care. 2019;34(1):30-37. Published online January 29, 2019; DOI: https://doi.org/10.4266/acc.2018.00318; Correction in: Acute Crit Care 2019;34(2):172

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Abstract PDF

Background
The 2016 Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM) task force for Sepsis-3 devised new definitions for sepsis, sepsis with organ dysfunction and septic shock. Although Sepsis-3 was data-driven, evidence-based approach, East Asian descents comprised minor portions of the project population. Methods: We selected Korean participants from the fever and antipyretics in critically ill patients evaluation (FACE) study, a joint study between Korea and Japan. We calculated the concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria and evaluated mortality rates of sepsis, sepsis with organ dysfunction, and septic shock by Sepsis-3 criteria using the selected data. Results: Korean participants of the FACE study were 913 (383 with sepsis and 530 without sepsis by Sepsis-2 criteria). The concordance rate for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria was 55.4%. The intensive care unit (ICU) and 28-day mortality rates of sepsis, sepsis with organ dysfunction, and septic shock patients according to Sepsis-3 criteria were 26.2% and 31.0%, 27.5% and 32.5%, and 40.8% and 43.4%, respectively. The quick Sequential Organ Failure Assessment (qSOFA) was inferior not only to SOFA but also to systemic inflammatory response syndrome (SIRS) for predicting ICU and 28-day mortality. Conclusions: The concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria were low. Mortality rate for septic shock in Koreans was consistent with estimates made by the 2016 SCCM/ESICM task force. SOFA and SIRS were better than qSOFA for predicting ICU and 28-day mortality in Korean ICU patients.

Citations

Citations to this article as recorded by

Evaluating the diagnostic performance of adult sepsis event criteria in the emergency department: impact of including isolated serum lactate elevations
Hyojun Park, Ryoung-Eun Ko, Hyo-Seok Oh, Jae Young Moon, Youjin Chang, Gee Young Suh
Journal of Intensive Care.2025;[Epub] CrossRef
HYPOTENSION AT THE TIME OF SEPSIS RECOGNITION IS NOT ASSOCIATED WITH INCREASED MORTALITY IN SEPSIS PATIENTS WITH NORMAL LACTATE LEVELS
Ji Hwan Kim, Yong Kyun Kim, Dong Kyu Oh, Kyeongman Jeon, Ryoung-Eun Ko, Gee Young Suh, Sung Yun Lim, Yeon Joo Lee, Young-Jae Cho, Mi-Hyeon Park, Sang-Bum Hong, Chae-Man Lim, Sunghoon Park
Shock.2023; 59(3): 360. CrossRef
The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis
Mark E. Nunnally, Ricard Ferrer, Greg S. Martin, Ignacio Martin-Loeches, Flavia R. Machado, Daniel De Backer, Craig M. Coopersmith, Clifford S. Deutschman, Massimo Antonelli, Judith Hellman, Sameer Jog, Jozef Kesecioglu, Ishaq Lat, Mitchell M. Levy
Intensive Care Medicine Experimental.2021;[Epub] CrossRef

Hematology
Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage: Soon Chang Park, Seok Ran Yeom, Sang Kyoon Han, Young Mo Jo, Hyung Bin Kim; Korean J Crit Care Med. 2017;32(4):333-339. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00787

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Abstract PDF

Background
Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients.
Methods
A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher.
Results
Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients’ mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016).
Conclusions
This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.

Citations

Citations to this article as recorded by

Evolving perspectives on blood transfusion in obstetric hemorrhage: a narrative review
Yoon Ji Choi, Sang Hun Kim
Korean Journal of Anesthesiology.2026; 79(1): 13. CrossRef
Clinical practice guidelines for management of disseminated intravascular coagulation in Japan 2024: part 4—trauma, burn, obstetrics, acute pancreatitis/liver failure, and others
Mineji Hayakawa, Yoshinobu Seki, Takayuki Ikezoe, Kazuma Yamakawa, Kohji Okamoto, Shigeki Kushimoto, Yuichiro Sakamoto, Yuki Itagaki, Yuki Takahashi, Hiroyasu Ishikura, Toshihiko Mayumi, Toshihisa Tamura, Kenji Nishio, Yu Kawazoe, Ayami Shigeno, Yudai Tak
International Journal of Hematology.2025; 121(5): 633. CrossRef
Role of recombinant factor VIIa in the clinical management of severe postpartum hemorrhage: consensus among European experts
D. Surbek, J. Blatný, M. Wielgos, N. Acs, H. Edwards, O. Erez, J. L. Bartha, H. Madar, F. J. Mercier, D. Schlembach, G. C. Di Renzo
The Journal of Maternal-Fetal & Neonatal Medicine.2024;[Epub] CrossRef
Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage
Camila Caram-Deelder, Hellen McKinnon Edwards, Jarmila A. Zdanowicz, Thomas van den Akker, Camilla Birkegård, Jan Blatný, Johanna G. van der Bom, Giuseppe Colucci, Derek van Duuren, Nan van Geloven, Dacia D. C. A. Henriquez, Marian Knight, Lars Korsholm,
Journal of Clinical Medicine.2024; 13(9): 2656. CrossRef
Thromboembolic events in severe postpartum hemorrhage treated with recombinant activated factor VII: a systematic literature review and meta-analysis
Johanna G. van der Bom, Frédéric J. Mercier, Damaris Bausch-Fluck, Mads Nordentoft, Morten Medici, Rezan Abdul-Kadir
Research and Practice in Thrombosis and Haemostasis.2024; 8(5): 102533. CrossRef
GUIDELINES FOR APPROPRIATE TRANSFUSION IN PATIENTS WITH MASSIVE BLEEDING (SECOND EDITION)
Masanori Matsumoto, Tomohiko Sato, Makoto Aoki, Yosuke Inoue, Tatsuki Uemura, Kenji Okada, Satoru Ogawa, Nobuyuki Katori, Shigeki Kushimoto, Nobuyuki Saito, Keita Shibahashi, Hideyuki Shimizu, Sho Takakura, Jun Takeda, Takahiro Tamura, Kimitoshi Nishiwaki
Japanese Journal of Transfusion and Cell Therapy.2024; 71(6): 750. CrossRef
Coagulation management and transfusion in massive postpartum hemorrhage
Christina Massoth, Manuel Wenk, Patrick Meybohm, Peter Kranke
Current Opinion in Anaesthesiology.2023; 36(3): 281. CrossRef
Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care
Sibylle Kietaibl, Aamer Ahmed, Arash Afshari, Pierre Albaladejo, Cesar Aldecoa, Giedrius Barauskas, Edoardo De Robertis, David Faraoni, Daniela C. Filipescu, Dietmar Fries, Anne Godier, Thorsten Haas, Matthias Jacob, Marcus D. Lancé, Juan V. Llau, Jens Me
European Journal of Anaesthesiology.2023; 40(4): 226. CrossRef

Neurology/Emergency
Acute Physiologic and Chronic Health Examination II and Sequential Organ Failure Assessment Scores for Predicting Outcomes of Out-of-Hospital Cardiac Arrest Patients Treated with Therapeutic Hypothermia: Sung Joon Kim, Yong Su Lim, Jin Seong Cho, Jin Joo Kim, Won Bin Park, Hyuk Jun Yang; Korean J Crit Care Med. 2014;29(4):288-296. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.288

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Abstract PDF

BACKGROUND
The aim of this study was to assess the relationship between acute physiologic and chronic health examination (APACHE) II and sequential organ failure assessment (SOFA) scores and outcomes of post-cardiac arrest patients treated with therapeutic hypothermia (TH).
METHODS
Out-of-hospital cardiac arrest (OHCA) survivors treated with TH between January 2010 and December 2012 were retrospectively evaluated. We captured all components of the APACHE II and SOFA scores over the first 48 hours after intensive care unit (ICU) admission (0 h). The primary outcome measure was in-hospital mortality and the secondary outcome measure was neurologic outcomes at the time of hospital discharge. Receiver-operating characteristic and logistic regression analysis were used to determine the predictability of outcomes with serial APACHE II and SOFA scores.
RESULTS
A total of 138 patients were enrolled in this study. The area under the curve (AUC) for APACHE II scores at 0 h for predicting in-hospital mortality and poor neurologic outcomes (cerebral performance category: 3-5) was more than 0.7, and for SOFA scores from 0 h to 48 h the AUC was less than 0.7. Odds ratios used to determine associations between APACHE II scores from 0 h to 48 h and in-hospital mortality were 1.12 (95% confidence interval [CI], 1.03-1.23), 1.13 (95% CI, 1.04-1.23), and 1.18 (95% CI, 1.07-1.30).
CONCLUSIONS
APACHE II, but not SOFA score, at the time of ICU admission is a modest predictor of in-hospital mortality and poor neurologic outcomes at the time of hospital discharge for patients who have undergone TH after return of spontaneous circulation following OHCA.

Citations

Citations to this article as recorded by

Multiorgan failure in patients after out of hospital resuscitation: a retrospective single center study
Yaacov Hasin, Yigal Helviz, Sharon Einav
Internal and Emergency Medicine.2024; 19(1): 159. CrossRef

Case Report

Multiple Organ Dysfunction Syndrome and Quadriplegia due to Acute Methamphetamine Intoxication: A Case Report: Oh Young Kwon, Jong Seok Lee, Han Sung Choi, Hoon Pyo Hong, Young Gwan Ko; Korean J Crit Care Med. 2010;25(1):33-36.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.33

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Abstract PDF: Methamphetamine (MA) is an extremely addictive central nervous system stimulant. MA abuse has increased during the past three decades in Korea because it is cheap relatively and easily produced. Acute toxicity can occur via nasal insufflation, intravenous administration and ingestion of liquid formulations. The clinical manifestations include hypertension, tachycardia, hyperthermia, an altered mentality and seizure. Severe complications can occur such as pulmonary edema, rhabdomyolysis, disseminated intravascular coagulation and multiple organ dysfunction syndrome. This case report describes a previously healthy 40-year-old woman who presented to an emergency department with complaints of hyperthermia, an altered mentality and vomiting. This patient was diagnosed as acute MA intoxication by urine toxicology screening, and she showed a variety of clinical manifestations and complications. Physicians should suspect MA intoxication if a patient shows an unknown fever, an altered mentality and hypertension, and they should carefully manage these patients in the ICU.

Review Article

Inflammation and Sepsis: Ji Young Yoon, Jae Young Kwon; Korean J Crit Care Med. 2010;25(1):1-8.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.1

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Abstract PDF

Despite the development of modern intensive care and new antimicrobial agents, the mortality of the patients with severe sepsis and septic shock remains high. The poor outcome is considered to be a consequence of an overactive systemic inflammatory response. Sepsis is now defined as systemic inflammatory response syndrome (SIRS) in which there is an identifiable focus of infection. As a consequence of the overactive SIRS response, the function of various organ systems may be compromised, resulting in multiple organ dysfunction syndrome (MODS) and death. Systemic inflammation is a consequence of activation of the innate immune system. It is characterized by intravascular release of pro-inflammatory cytokines and other vasoactive mediators, and the concurrent activation of the innate immune cells. In addition to the pro-inflammatory reactions, the host's anti-inflammatory mechanisms are also activated and aimed at counteracting the inflammatory response. The balance between pro- and anti-inflammatory reactions is critical for the outcome of the patient. Understanding the mechanisms of acute inflammatory responses in critical ill patients is necessary for the development of urgently needed therapeutics. The aim of this review is to provide a description of the key components and mechanisms involved in the inflammatory response in patients with SIRS and sepsis.

Citations

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A Study on the Relationship Between Sayeok-tang and Systemic Inflammatory Response Syndrome
Ju-Hyun Lee, Sang-Bae Lee, Eun-Heui Jo, Min-Cheol Park
Journal of Korean Medicine.2024; 45(2): 1. CrossRef
Enhancing acute inflammatory and sepsis treatment: superiority of membrane receptor blockade
Seok-Jun Mun, Euni Cho, Hyo Keun Kim, Woo Jin Gil, Chul-Su Yang
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Journal of Korean Medicine.2023; 44(3): 39. CrossRef
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Journal of Korean Academy of Community Health Nursing.2018; 29(3): 290. CrossRef
The Anti-Inflammatory Effect of Arginine-Vasopressin on Lipopolysaccharide-Induced IκBα/Nuclear Factor-κB Cascade
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The Korean Journal of Critical Care Medicine.2015; 30(3): 151. CrossRef
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Korean Journal of Critical Care Medicine.2013; 28(4): 336. CrossRef
A Case of Systemic Inflammatory Response Syndrome Secondary to an Acute Polyarticular Gout
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Journal of the Korean Geriatrics Society.2012; 16(3): 158. CrossRef

Original Article

The Effect of Discharge Decision-Making of the Intensivist on Readmission to the Intensive Care Unit: Dong Woo Han, One Chul Kang, So Young Ban, Shin Ok Koh; Korean J Crit Care Med. 2003;18(2):74-79.

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Abstract PDF: BACKGROUND
Patients readmitted to intensive care unit (ICU) have significantly higher mortality. The role of intensivists to judge when to discharge from ICU may be important. We performed this study to assess the effect of intensivist's discharge decision-making on readmission to ICU. METHODS: Data were collected prospectively from patients admitted to ICUs (group 1). Another data were collected retrospectively from the patients' record (group 2). Discharge of the patients in group 1 were based on intensivist's discharge decision-making but not in group 2. We encouraged deep breathing and expectoration to patients of group 1 at risk of pulmonary complication during ICU stay and used a guideline for making discharge decisions. Readmission cause, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and multiple organ dysfunction syndrome (MODS) score of readmitted patients were evaluated. RESULTS: Readmission rate of group 1 was lower than that of group 2 (p<0.05). The mortality of readmitted patients in each group was higher than that of non-readmitted patients (p<0.05). Respiratory disease was the major cause of readmission. In non-survivors of readmitted patients, APACHE III score on initial discharge and readmission, MODS score on initial admission, discharge and readmission were higher than those of survivors (p<0.05). CONCLUSIONS: Readmission rate was lower when intensivists participated in discharge decision- making. ICU readmission was associated with higher hospital mortality and longer ICU stay. MODS and APACHE III score at first discharge and readmission were significant prognostic factors of the outcome in readmitted patients.

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