Acute and Critical Care

Original Articles

Neurosurgery
Comparison of intracranial pressure prediction in hydrocephalus patients among linear, non-linear, and machine learning regression models in Thailand: Avika Trakulpanitkit, Thara Tunthanathip; Acute Crit Care. 2023;38(3):362-370. Published online August 18, 2023; DOI: https://doi.org/10.4266/acc.2023.00094

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Background
Hydrocephalus (HCP) is one of the most significant concerns in neurosurgical patients because it can cause increased intracranial pressure (ICP), resulting in mortality and morbidity. To date, machine learning (ML) has been helpful in predicting continuous outcomes. The primary objective of the present study was to identify the factors correlated with ICP, while the secondary objective was to compare the predictive performances among linear, non-linear, and ML regression models for ICP prediction.
Methods
A total of 412 patients with various types of HCP who had undergone ventriculostomy was retrospectively included in the present study, and intraoperative ICP was recorded following ventricular catheter insertion. Several clinical factors and imaging parameters were analyzed for the relationship with ICP by linear correlation. The predictive performance of ICP was compared among linear, non-linear, and ML regression models.
Results
Optic nerve sheath diameter (ONSD) had a moderately positive correlation with ICP (r=0.530, P<0.001), while several ventricular indexes were not statistically significant in correlation with ICP. For prediction of ICP, random forest (RF) and extreme gradient boosting (XGBoost) algorithms had low mean absolute error and root mean square error values and high R2 values compared to linear and non-linear regression when the predictive model included ONSD and ventricular indexes.
Conclusions
The XGBoost and RF algorithms are advantageous for predicting preoperative ICP and establishing prognoses for HCP patients. Furthermore, ML-based prediction could be used as a non-invasive method.

Citations

Citations to this article as recorded by

Cost-effectiveness of intracranial pressure monitoring in severe traumatic brain injury in Southern Thailand
Jidapa Jitchanvichai, Thara Tunthanathip
Acute and Critical Care.2025; 40(1): 69. CrossRef
Imaging biomarkers for detection and longitudinal monitoring of ventricular abnormalities from birth to childhood
Antonio Navarro-Ballester, Rosa Álvaro-Ballester, Miguel Á Lara-Martínez
World Journal of Radiology.2025;[Epub] CrossRef
Impact of Preoperative Hair Removal on Self-Esteem after Brain Tumor Surgery
Thara Tunthanathip, Natthanee Pisitthaworakul
Asian Journal of Neurosurgery.2025;[Epub] CrossRef
Deep learning-based model for detection of intracranial waveforms with poor brain compliance in southern Thailand
Thara Tunthanathip, Avika Trakulpanitkit
Acute and Critical Care.2025; 40(3): 473. CrossRef
A nomogram for the prediction of traumatic intracranial abnormalities in the elderly: Development and validation
Apisorn Jongjit, Thara Tunthanathip
Chinese Journal of Traumatology.2025;[Epub] CrossRef
Feasibility comparison of deep learning image regressions to estimate intracranial pressure from cranial computed tomography in hydrocephalus
Thara Tunthanathip, Rakkrit Duangsoithong, Sakchai Sae-Heng
Journal of Neurosciences in Rural Practice.2025; 16: 606. CrossRef
Risk factors and dose-response relationship of catheter-associated urinary tract infection in neurosurgical patients
Thara Tunthanathip, Natthanee Pisitthaworakul
International Journal of Nutrition, Pharmacology, Neurological Diseases.2025; 15(4): 451. CrossRef
Prognosis of subarachnoid hemorrhage determined by intracranial pressure thresholds
Thara Tunthanathip, Rakkrit Duangsoithong, Sakchai Sae-Heng
Journal of Cerebrovascular and Endovascular Neurosurgery.2025; 27(4): 309. CrossRef
Assessing interpretability of data‐driven fuzzy models: Application in industrial regression problems
Jorge S. S. Júnior, Carlos Gaspar, Jérôme Mendes, Cristiano Premebida
Expert Systems.2024;[Epub] CrossRef
Progressive Optic Neuropathy in Hydrocephalic Ccdc13 Mutant Mice Caused by Impaired Axoplasmic Transport at the Optic Nerve Head
Mingjuan Wu, Xinyi Zhao, Shanzhen Peng, Xiaoyu Zhang, Jiali Ru, Lijing Xie, Tao Wen, Yingchun Su, Shujuan Xu, Dianlei Guo, Jianmin Hu, Haotian Lin, Tiansen Li, Chunqiao Liu
Investigative Ophthalmology & Visual Science.2024; 65(13): 5. CrossRef

Pulmonary
An algorithm to predict the need for invasive mechanical ventilation in hospitalized COVID-19 patients: the experience in Sao Paulo: Eduardo Atsushi Osawa, Alexandre Toledo Maciel; Acute Crit Care. 2022;37(4):580-591. Published online September 8, 2022; DOI: https://doi.org/10.4266/acc.2022.00283

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Abstract PDF

Background
We aimed to characterize patients hospitalized for coronavirus disease 2019 (COVID-19) and identify predictors of invasive mechanical ventilation (IMV).
Methods
We performed a retrospective cohort study in patients with COVID-19 admitted to a private network in Sao Paulo, Brazil from March to October 2020. Patients were compared in three subgroups: non-intensive care unit (ICU) admission (group A), ICU admission without receiving IMV (group B) and IMV requirement (group C). We developed logistic regression algorithm to identify predictors of IMV.
Results
We analyzed 1,650 patients, the median age was 53 years (42–65) and 986 patients (59.8%) were male. The median duration from symptom onset to hospital admission was 7 days (5–9) and the main comorbidities were hypertension (42.4%), diabetes (24.2%) and obesity (15.8%). We found differences among subgroups in laboratory values obtained at hospital admission. The predictors of IMV (odds ratio and 95% confidence interval [CI]) were male (1.81 [1.11– 2.94], P=0.018), age (1.03 [1.02–1.05], P<0.001), obesity (2.56 [1.57–4.15], P<0.001), duration from symptom onset to admission (0.91 [0.85–0.98], P=0.011), arterial oxygen saturation (0.95 [0.92– 0.99], P=0.012), C-reactive protein (1.005 [1.002–1.008], P<0.001), neutrophil-to-lymphocyte ratio (1.046 [1.005–1.089], P=0.029) and lactate dehydrogenase (1.005 [1.003–1.007], P<0.001). The area under the curve values were 0.860 (95% CI, 0.829–0.892) in the development cohort and 0.801 (95% CI, 0.733–0.870) in the validation cohort.
Conclusions
Patients had distinct clinical and laboratory parameters early in hospital admission. Our prediction model may enable focused care in patients at high risk of IMV.

Citations

Citations to this article as recorded by

Predictive Models of Patient Severity in Intensive Care Units Based on Serum Cytokine Profiles: Advancing Rapid Analysis
Cristiana P. Von Rekowski, Tiago A. H. Fonseca, Rúben Araújo, Ana Martins, Iola Pinto, M. Conceição Oliveira, Gonçalo C. Justino, Luís Bento, Cecília R. C. Calado
Applied Sciences.2025; 15(9): 4823. CrossRef
Intelligent alert system for predicting invasive mechanical ventilation needs via noninvasive parameters: employing an integrated machine learning method with integration of multicenter databases
Guang Zhang, Qingyan Xie, Chengyi Wang, Jiameng Xu, Guanjun Liu, Chen Su
Medical & Biological Engineering & Computing.2024; 62(11): 3445. CrossRef

Infection
Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock: Surat Tongyoo, Kamonlawat Sutthipool, Tanuwong Viarasilpa, Chairat Permpikul; Acute Crit Care. 2022;37(1):108-117. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00332

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Abstract PDF Supplementary Material

Background
In septic shock patients with cirrhosis, impaired liver function might decrease lactate elimination and produce a higher lactate level. This study investigated differences in initial lactate, lactate clearance, and lactate utility between cirrhotic and non-cirrhotic septic shock patients.
Methods
This is a retrospective cohort study conducted at a referral, university-affiliated medical center. We enrolled adults admitted during 2012–2018 who satisfied the septic shock diagnostic criteria of the Surviving Sepsis Campaign: 2012. Patients previously diagnosed with cirrhosis by an imaging modality were classified into the cirrhosis group. The initial lactate levels and levels 6 hours after resuscitation were measured and used to calculate lactate clearance. We compared initial lactate, lactate at 6 hours, and lactate clearance between the cirrhosis and non-cirrhosis groups. The primary outcome was in-hospital mortality.
Results
Overall 777 patients were enrolled, of whom 91 had previously been diagnosed with cirrhosis. Initial lactate and lactate at 6 hours were both significantly higher in cirrhosis patients, but there was no difference between the groups in lactate clearance. A receiver operating characteristic curve analysis for predictors of in-hospital mortality revealed cut-off values for initial lactate, lactate at 6 hours, and lactate clearance of >4 mmol/L, >2 mmol/L, and <10%, respectively, among non-cirrhosis patients. Among patients with cirrhosis, the cut-off values predicting in-hospital mortality were >5 mmol/L, >5 mmol/L, and <20%, respectively. Neither lactate level nor lactate clearance was an independent risk factor for in-hospital mortality among cirrhotic and non-cirrhotic septic shock patients.
Conclusions
The initial lactate level and lactate at 6 hours were significantly higher in cirrhosis patients than in non-cirrhosis patients.

Citations

Citations to this article as recorded by

Comparison between traditional logistic regression and machine learning for predicting mortality in adult sepsis patients
Hongsheng Wu, Biling Liao, Tengfei Ji, Keqiang Ma, Yumei Luo, Shengmin Zhang
Frontiers in Medicine.2025;[Epub] CrossRef
Development and external validation of an artificial intelligence model for predicting mortality and prolonged ICU stay in postoperative critically ill patients: a retrospective study
Dong Jin Park, Seung Min Baik, Kyung Sook Hong, Heejung Yi, Jae Gil Lee, Jae-Myeong Lee
World Journal of Emergency Surgery.2025;[Epub] CrossRef
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
A Rare Case of Drug-Induced Liver Injury Due to Metformin and Literature Review
清正刘
Advances in Clinical Medicine.2025; 15(09): 472. CrossRef
Comparison of the accuracy of predictive models in early detection of clinically relevant posthepatectomy liver failure
Ying Li, Yu-Meng Liu, Yu-Lin Gao, Zun-Qiang Xiao, Lei Jin, Jun-Wei Liu, Xiao-Dong Sun, Yi Lu
BMC Cancer.2025;[Epub] CrossRef
Serum lactate and mean arterial pressure thresholds in patients with cirrhosis and septic shock
Thomas N. Smith, Chansong Choi, Puru Rattan, Laura Piccolo Serafim, Blake A. Kassmeyer, Ryan J. Lennon, Ognjen Gajic, Jody C. Olson, Patrick S. Kamath, Alice Gallo De Moraes, Douglas A. Simonetto
Hepatology Communications.2024;[Epub] CrossRef
Review article: Evaluation and care of the critically ill patient with cirrhosis
Iva Kosuta, Madhumita Premkumar, K. Rajender Reddy
Alimentary Pharmacology & Therapeutics.2024; 59(12): 1489. CrossRef
Diagnostic Value of Endotoxin Activity for Acute Postoperative Complications: A Study in Major Abdominal Surgery Patients
Hye Sung Kim, Gyeo Ra Lee, Eun Young Kim
Biomedicines.2024; 12(12): 2701. CrossRef
Norepinephrine dose, lactate or heart rate: what impacts prognosis in sepsis and septic shock? Results from a prospective, monocentric registry
Tobias Schupp, Kathrin Weidner, Jonas Rusnak, Schanas Jawhar, Jan Forner, Floriana Dulatahu, Lea Marie Brück, Ursula Hoffmann, Thomas Bertsch, Ibrahim Akin, Michael Behnes
Current Medical Research and Opinion.2023; 39(5): 647. CrossRef
Intensive care management of acute-on-chronic liver failure
Giovanni Perricone, Thierry Artzner, Eleonora De Martin, Rajiv Jalan, Julia Wendon, Marco Carbone
Intensive Care Medicine.2023; 49(8): 903. CrossRef

Review Article

Basic science and research
The Role of Oliguria and the Absence of Fluid Administration and Balance Information in Illness Severity Scores: Neil J. Glassford, Rinaldo Bellomo; Korean J Crit Care Med. 2017;32(2):106-123. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00192

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Abstract PDF

Urinary examination has formed part of patient assessment since the earliest days of medicine. Current definitions of oliguria are essentially arbitrary, but duration and intensity of oliguria have been associated with an increased risk of mortality, and this risk is not completely attributable to the development of concomitant acute kidney injury (AKI) as defined by changes in serum creatinine concentration. The increased risk of death associated with the development of AKI itself may be modified by directly or indirectly by progressive fluid accumulation, due to reduced elimination and increased fluid administration. None of the currently extant major illness severity scoring systems or outcome prediction models use modern definitions of AKI or oliguria, or any values representative of fluid volumes variables. Even if a direct relationship with mortality is not observed, then it is possible that fluid balance or fluid volume variables mediate the relationship between illness severity and mortality in the renal and respiratory physiological domains. Fluid administration and fluid balance may then be an important, easily modifiable therapeutic target for future investigation. These relationships require exploration in large datasets before being prospectively validated in groups of critically ill patients from differing jurisdictions to improve prognostication and mortality prediction.

Citations

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Impact of CRRT Timing on Mortality in Oliguric Sepsis-Associated Acute Kidney Injury: A Propensity Score Matching Cohort Study
Jing Li, Caiyun Xu, Zhe Huang, Lan Yao, Huayun Liu, Fuxing Deng, Can Zhu, Qinjuan Jiang
Clinical Therapeutics.2026; 48(1): 65. CrossRef
Short-Term Reactions to Oliguria in Critically Ill Patients: A Retrospective Cohort Study
Dekel Stavi, Amir Gal Oz, Nimrod Adi, Asaph Nini, Yoel Angel, Andrey Nevo, Daniel Aviram, Itay Moshkovits, Yael Lichter, Ron Wald, Noam Goder
Journal of Clinical Medicine.2025; 14(9): 3107. CrossRef
Comparison of methods to normalize urine output in critically ill patients: a multicenter cohort study
Céline Monard, Nicolas Tebib, Bastien Trächsel, Tatiana Kelevina, Antoine Guillaume Schneider
Critical Care.2024;[Epub] CrossRef
Management of oliguria
Marlies Ostermann, Andrew D. Shaw, Michael Joannidis
Intensive Care Medicine.2023; 49(1): 103. CrossRef
Nomenclature and diagnostic criteria for acute kidney injury – 2020 consensus of the Taiwan AKI-task force
Shao-Yu Yang, Terry Ting-Yu Chiou, Chih-Chung Shiao, Hugo You-Hsien Lin, Ming-Jen Chan, Che-Hsiung Wu, Chiao-Yin Sun, Wei-Jie Wang, Yen-Ta Huang, Vin-Cent Wu, Yung-Chang Chen, Ji-Tsung Fang, Shang-Jyh Hwang, Heng-Chih Pan
Journal of the Formosan Medical Association.2022; 121(4): 749. CrossRef
Haemodynamic frailty – A risk factor for acute kidney injury in the elderly
Neil G. Docherty, Christian Delles, Patrick D’Haese, Anita T. Layton, Carlos Martínez-Salgado, Benjamin A. Vervaet, Francisco J. López-Hernández
Ageing Research Reviews.2021; 70: 101408. CrossRef
Does Fluid Type and Amount Affect Kidney Function in Critical Illness?
Neil J. Glassford, Rinaldo Bellomo
Critical Care Clinics.2018; 34(2): 279. CrossRef

Original Article

Comparing the Usefulness of the Initial Acute Physiologic and Chronic Health Evaluation (APACHE) II Score in the Emergency Department (ED) and the Mortality in Emergency Department Sepsis (MEDS) Score for Predicting the Prognosis of Septic Patients Admitt: Chan Young Koh, Young Sik Kim, Tae Yong Shin, Young Rock Ha; Korean J Crit Care Med. 2008;23(2):90-95.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.90

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Abstract PDF

BACKGROUND
To determine the prognostic value of the initial APACHE II score in the ED compared with the classic APACHE II score in the ICU and to check the usefulness of the MEDS score together for more rapid risk stratification of septic patients admitted to the ICU via the ED.
METHODS
We prospectively checked the initial APACHE II and MEDS scores of all the patients who had systemic inflammatory response syndrome in the ED and the classic APACHE II scores after admission to the ICU, as well 6 months later. We enrolled the only sepsis cases in the final diagnosis after reviewing the medical records. We evaluated the predictive abilities of the initial APACHE II and MEDS scores compared with the classic APACHE II score.
RESULTS
During 6 months, 58 patients diagnosed with sepsis were enrolled. Twenty-four (41.4%) patients died within 28 days of admission and 34 patients survived. The mortality group had a significantly higher mean classic APACHE II score (19 +/- 6.7 vs. 15 +/- 5.0, p < 0.01) and a higher mean MEDS score (16.67 +/- 2.70 vs. 8.91 +/- 3.11, p < 0.01) than the survivor group. The initial APACHE II score at the ED was not significantly different between the two groups. ROC analysis showed the discriminative power of the MEDS score in predicting mortality was much better than the APACHE II score (areas under the curves of the APACHE II score in the ED and ICU, and the MEDS scores were 0.668, 0.807, and 0.967, respectively; p < 0.01).
CONCLUSIONS
The initial APACHE II score in the ED did not predict mortality better than the classic APACHE II score. However, the MEDS score predicted the poor prognosis of septic patients more rapidly and accurately in the ED than the APACHE II model.

Citations

Citations to this article as recorded by

Thrombomodulin is a Strong Predictor of Multiorgan Dysfunction Syndrome in Patients With Sepsis
Dunja M. Mihajlovic, Dajana F. Lendak, Biljana G. Draskovic, Aleksandra S. Novakov Mikic, Gorana P. Mitic, Tatjana N. Cebovic, Snezana V. Brkic
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Endocan is useful biomarker of survival and severity in sepsis
Dunja M. Mihajlovic, Dajana F. Lendak, Snezana V. Brkic, Biljana G. Draskovic, Gorana P. Mitic, Aleksandra S. Novakov Mikic, Tatjana N. Cebovic
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Soo-Min Lee, Seong-Heon Choi, An-Na Song, Ji-Young Lee, Jin Chae, Eu-Hong Jung, Soo-Kyung Lee
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