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Effect of premorbid beta-blockers on cardiac function and clinical outcomes in septic patients: a retrospective study

Siyu Yang, Rongyao Feng, Xiangzhou Fang, Chaojie Wei

Zhongnan Hospital of Wuhan University, Wuhan Hubei, China

DOI: 10.2478/jccm-2026-0030

Background: Beta-blockers have been reported to exert potential beneficial effects in sepsis in recent years. However, their clinical application in sepsis remains limited due to concerns regarding hemodynamic impacts. This study aims to explore whether premorbid use of beta-blockers is associated with improvements in cardiac function and favorable clinical outcomes among patients with sepsis.
Methods: This single-center, retrospective cohort study was conducted in the Intensive Care Unit (ICU) of a university-affiliated hospital. All patients diagnosed with sepsis admitted between August 2022 and March 2024 were enrolled. Exclusion criteria included age < 18 years, hospitalization duration < 48 hours, a history of severe underlying cardiac conditions, and incomplete clinical records. Primary outcomes included myocardial injury markers, echocardiographic parameters, and electrocardiographic indices to assess cardiac function. Secondary outcome was mortality.
Results: Among 1005 septic patients, 228 had received premorbid beta-blockers. No significant difference in baseline disease severity was observed between the two groups. Patients with premorbid beta-blocker exposure had lower levels of cardiac troponin I (TnI, 87.9 [IQR, 23.4-306.0] vs 142.0 [IQR, 37.8-481.2]), lactic dehydrogenase (LDH, 274.0 [IQR, 175.0-496.0] vs 319.0 [IQR, 229.0-456.8]), and B-type natriuretic peptide (BNP, 267.9 [IQR, 118.1-1065.1] vs 509.3 [IQR, 184.8-1203.0]). Echocardiographic assessments revealed that premorbid beta-blockers were associated with a higher left ventricular ejection fraction (LVEF, 58% [IQR 52-60] vs 55% [IQR 50-60]). Additionally, premorbid beta-blockers were linked to lower 14-day (13.6% [IQR 9.1-18.1] vs 21.5% [IQR 18.6-24.4]), 28-day (17.5% [IQR 12.6-22.5] vs 27.4% [IQR 24.3-30.6]), and in-hospital (18.9% [IQR 13.7-24.0] vs 28.8% [IQR 25.6-32.0]) mortality rates.
Conclusions: Among septic patients, premorbid beta-blockers are associated with preserved cardiac function and improved clinical outcomes. These findings highlight the need for prospective or randomized controlled trials to further explore the potential cardioprotective role of beta-blockers in sepsis.

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Evaluation of muscle strength and renal function in survivors of severe COVID-19: A 12-month follow-up study

Roberto Marco1, Sayane Marlla Silva Leite Montenegro2, Daniela Cassula1, Tayline Gabriel1, Alessandra Lima da Silva Martins1, Rosani Teresa de Siqueira e Silva1, Rosilene Motta Elias1, Maria Aparecida Dalboni1

1 Universidade Nove de Julho – Campus Vergueiro, São Paulo, Brazil
2 Instituto Federal de Pernambuco: Instituto Federal de Educacao Ciencia e Tecnologia de Pernambuco

DOI: 10.2478/jccm-2026-0022

Introduction: Severe COVID-19 is known to cause kidney injury via ACE2-mediated mechanisms, inflammation, and microvascular damage potentially leading to long-term renal impairment. Critically ill patients are particularly vulnerable to muscle loss and sarcopenia due to immobility, poor nutrition, and cytokine storm–induced catabolism. Post-COVID-19 syndrome often includes fatigue, muscle weakness, and reduced quality of life, yet evidence on long-term outcomes remains limited. This study evaluated kidney function, sarcopenia risk, and quality of life 12 months after intensive care unit (ICU) discharge in patients without pre-existing chronic kidney disease (CKD).
Methods: This retrospective observational cohort included 82 patients without CKD admitted to the ICU between February 2020 and April 2022 who recovered from severe COVID-19. Data collected included serum creatinine, estimated glomerular filtration rate (eGFR), and sarcopenia risk assessed via the SARC-CalF (SARC-F combined with calf circumference). Functional outcomes were assessed by SF-36, pain by a Visual Analog Scale (VAS), and lower limb strength by the 30-second sit-to-stand test.
Results: The mean age was 52 ± 12 years; 90% were male, 46% had hypertension, and 31% diabetes. At 12 months, patients showed low functional scores (SF-36: 47 ± 21), high pain prevalence (VAS: 57%), reduced lower limb strength (sit-to-stand: 8 ± 5 repetitions), and high sarcopenia risk (SARC-F: 46%). Higher sarcopenia scores correlated with poorer physical functioning (r = -0.60; p < 0.001) and greater pain (r = -0.44; p < 0.001). In 49 patients without hypertension, diabetes, or prior acute kidney injury (AKI), creatinine significantly increased (0.95 ± 0.2 to 1.10 ± 0.2 mg/dL; p = 0.007) and eGFR significantly declined (87 ± 22 to 77 ± 18 mL/min; p = 0.001), representing a mean reduction of 10 mL/min.
Conclusion: Critically ill COVID-19 survivors experienced significant declines in kidney function, muscle strength, and functional capacity, alongside increased pain 12 months post-ICU discharge. These results underscore the need for multidisciplinary follow-up, incorporating nephrology, physiotherapy, and nutritional support.

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Predictive value of NLMR, PLR, and ferritin in relation to SOFA, APACHE II, and SAPS II in sepsis patients

Oana Coman1, Bianca-Liana Grigorescu2 Adina Hutanu3,4, Stefania Raluca Fodor2, Marius Petrisor1, Leonard Azamfirei1

1 Department of Simulation Applied in Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2 Department of Anaesthesiology and Intensive Therapy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3 Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4 Centre for Advanced Medical and Pharmaceutical Research, Immunology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/jccm-2026-0029

Introduction: Sepsis, a critical topic in the medical field, remains one of the deadliest pathologies in intensive care units. It involves an overzealous immune system, with a hyperinflammatory phase that overlaps with a subsequent hypoinflammatory phase.
Aim of the study: To ease the burden on medical systems, this study aimed to assess the predictive value of clinical severity scores (Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the Simplified Acute Physiology Score II (SAPS II)) and inflammatory biomarkers (neutrophile-to-lymphocyte-to-monocyte ratio (NLMR), and platelet-to-lymphocyte ratio (PLR), carboxyhemoglobin (COHb) and ferritin) in predicting outcomes of critically ill intensive care unit (ICU) patients.
Material and methods: This prospective, observational study included 101critically ill patients, for whom we assessed the parameters on the first and fifth days after confirmation of either sepsis or septic shock in ICU, according to the Sepsis-3 Consensus.
Results: Severity scores showed significant correlations on both day 1 and day 5 across all groups. APACHE II and SAPS II correlated with ferritin on day 5 in sepsis, septic shock, and non-survivors. The severity scores correlated with COHb on day 5 in survivors, and on day 1 in non-survivors. NLMR and PLR correlated consistently across groups, with additional associations between these ratios, ferritin, and COHb, particularly in non-survivors. Regarding mortality, NLMR on day 1 showed only modest predictive value, which declined to non-significant by day 5. In contrast, the SOFA, APACHE II, and SAPS II scores demonstrated good discriminatory ability on both days, confirming their strong and reliable performance in predicting mortality.
Conclusions: The study shows that simple cellular ratios and severity scores correlate with ferritin, COHb, and each other, reflecting inflammation, oxidative stress, and organ dysfunction in sepsis. Because these markers are inexpensive and easy to monitor, they may enhance bedside risk stratification, though broader prospective studies are still required.

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The effect of oral protein and carbohydrate solution administration on NLR, IL-6 and CRP levels in patients undergoing surgery

Mahendratama P. Adhi1, Oscar Febriano1, Alfi Yasmina2, Iwan Nuryawan1, Agung Ary Wibowo3, Kenanga Marwan Sikumbang1

1 Department of Anesthesiology, Faculty of Medicine and Health Sciences, Lambung Mangkurat University, Banjarmasin, Indonesia
2 Department of Pharmacology, Faculty of Medicine and Health Sciences, Lambung Mangkurat University, Indonesia
3 Department of Surgery, Digestive Division, Faculty of Medicine and Health Sciences, Lambung Mangkurat University, Indonesia

DOI: 10.2478/jccm-2026-0028

Aims: To determine the effect of administering oral protein and carbohydrate solutions the C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Neutrophil-Lymphocyte Ratio (NLR) in patients planned any surgery
Methods: a double-blind, randomized clinical study, at Ulin Regional Hospital, Banjarmasin with patients planned any surgery. This research had 80 patients in total (40 subjects in the control group and 40 subjects in the intervention group). Before surgery, 200 mL of a protein and carbohydrate solution per oral was given to the intervention group, while a placebo was given to the control group. Twenty-four hours after surgery, each subject’s levels of CRP, IL-6 and NLR were measured. Statistical Package for the Social Sciences Version 29 was used to analyze the data.
Results: NLR at 24 hours postoperatively in the intervention group was lower than in the control group, but not statistically different (8.65±4.33 vs. 7.86±4.65, p=0.308). The IL-6 level at 24 hours postoperatively in the intervention group was significantly lower than in the control group (9.49 (6.03-22.65) vs. 20.08 (11.64-50.11), p=0.011). Although not statistically different, the CRP level at 24 hours postoperatively in the intervention group was lower than in the control group (15.10 (7.20-41.60) vs. 34.70 (11.87-71.55), p=0.056). There was no difference in postoperative nausea or vomiting between the two groups.
Conclusion: Postoperative interleukin-6 levels have been demonstrated to decrease when oral protein and carbohydrate solutions are given to patients undergoing surgery; however, NLR and CRP levels have not been seen to decrease.

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Early clinical outcomes and quality of life assessment after HeartMate 3 implantation: A single-centre descriptive study

Samuel Michelini1, Marius Mihai Harpa1,2, Dan Nistor2, David-Emanuel Anitei3, Alexandru Stan3, Paul Calburean4, Emil Marian Arbanasi5, Dragos-Florin Baba6, Sabrina Mancino1, Horatiu Suciu2,7

1 George Emil Palade University of Medicine Pharmacy Science and Technology of Targu Mures, Targu Mures, Romania
2 Department of Cardiovascular Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, Romania
3 Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and, Technology of Targu Mures, Targu Mures, Romania
4 Department of Biostatistics and Medical Informatics, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
5 Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
6 Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
7 Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/jccm-2026-0025

Background: Advanced heart failure remains a leading cause of morbidity and mortality worldwide, with limited access to transplantation, particularly in Eastern Europe. Left ventricular assist device therapy offers improved survival and quality of life for end-stage disease. HeartMate 3, a modern form of mechanical circulatory support, is used as bridge-to-transplant or destination therapy. Despite increasing global experience with the HeartMate 3, clinical data from Romanian centers remain scarce. This study aimed to assess early clinical outcomes, postoperative complications, and quality of life after HeartMate 3 implantation at a single cardiovascular surgery center in Romania.
Materials and methods: We conducted a retrospective observational cohort study including 13 patients with Advanced heart failure who underwent HeartMate 3 implantation between September 2023 and March 2025. Preoperative variables (demographics, comorbidities, INTERMACS profile, EuroSCORE II, echocardiographic findings) and postoperative outcomes were analyzed. Quality of life was assessed in 10 surviving patients using a 16-item structured telephone questionnaire addressing physical function, autonomy, social reintegration, and psychological well-being.
Results: The cohort was predominantly male (84.6%); mean age 47.2 ± 12.3 years. Implant strategy: bridge-to-transplant 76.9%, destination therapy 23.1%. Early mortality was 23.1% (n = 3), occurring primarily in patients with EuroSCORE II >8% and INTERMACS I–II. The most frequent postoperative complications were significant perioperative bleeding (61.5%) and right ventricular failure (23.1%). Among survivors, all reported improved mobility, greater independence in activities of daily living, and better social reintegration; 7/10 rated overall quality of life as good or excellent. Psychological distress was frequent early after surgery but showed progressive improvement over time.
Conclusions: HeartMate 3 implantation resulted in favorable early clinical outcomes and significant improvements in quality of life, aligning with international data. Optimizing outcomes with left ventricular assist device therapy relies on timely referral, rigorous patient selection, and comprehensive postoperative management, including psychological and social support.

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Impact of creatinine measurement methods on eGFR and GFR category assignment

Elena-Cristina Preda, Oana Oprea, Zsolt Albert Barabas, Ioana Paula Simion, Ana-Maria Fotache, Minodora Dobreanu

George Emil Palade University of Medicine Pharmacy Science and Technology of Targu Mures, Romania

DOI: 10.2478/jccm-2026-0023

Background: Accurate measurement of serum creatinine (SCr) is critical in estimating glomerular filtration rate (eGFR) and classifying kidney function. This study evaluated the analytical differences between the enzymatic and Jaffe methods for SCr measurement and their impact on eGFR estimation using two widely applied equations: CKD-EPI and EKFC.
Methods: The study included 427 patients over 40 years old. SCr was measured using both enzymatic and Jaffe methods on the Alinity c platform. eGFR was calculated with the CKD-EPI (2009) and EKFC equations. Agreement between methods was assessed using Bland-Altman and Passing-Bablok regression. eGFR differences were analyzed using the Wilcoxon signed-rank test and multiple linear regression. Agreement in GFR category classification was evaluated using weighted kappa and Kendall’s tau.
Results: While the mean difference between methods was small, both systematic and proportional biases were statistically significant. eGFR values differed significantly between methods in both sexes (p < 0.01), regardless of the equation used. ΔeGFR was significantly associated with SCr values, but not with age. Although overall agreement in GFR categories was high (kappa > 0.91), method-dependent reclassification of patients was observed, which may influence CKD diagnosis and clinical decision-making.
Conclusions: Even minor analytical differences between enzymatic and Jaffe SCr measurements can lead to clinically relevant discrepancies in GFR categorization. These findings highlight the need for harmonization in laboratory methods to ensure consistent reporting and patient management.

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Prognosis prediction by urinary liver-type fatty acid-binding protein in patients in the intensive care unit admitted from the emergency department: A single-center, historical cohort study

Hirozumi Okuda1, Hideki Asai1, Koji Yamamoto1, Keita Miyazaki1, Hidetada Fukushima1, Keigo Saeki2

1 Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Japan
2 Department of Epidemiology, Nara Medical University, Kashihara City, Japan

DOI: 10.2478/jccm-2026-0026

Introduction: Early risk stratification of critically ill patients is essential for optimizing intensive care unit (ICU) resource allocation and treatment decisions. Urinary liver-type fatty acid-binding protein (L-FABP) is a simple, noninvasive biomarker that may provide real-time information on organ dysfunction. However, its prognostic utility in patients admitted to the ICU from the emergency department remains unclear.
Aim of the study: The aim of this study was to evaluate the prognostic value of L-FABP levels measured shortly after ICU admission in predicting 28-day mortality among patients admitted from the emergency department.
Methods: This single-center retrospective observational study included patients admitted to the ICU between December 2020 and August 2022. Urinary L-FABP concentrations were measured at ICU admission (T0) and 3 hours later (T3). The primary outcome was 28-day in-hospital mortality. Prognostic performance was assessed using receiver operating characteristic curves and Cox proportional hazards models with inverse probability of treatment weighting. Results were compared with Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) scores, and lactate levels.
Results: Data of 118 patients were included in the final analysis. Urinary L-FABP levels at T3 showed the highest AUC for predicting 28-day mortality (area under the curve [AUC] = 0.873), compared with APACHE II (AUC = 0.801), SOFA (AUC = 0.753), and the lactate level (AUC = 0.734). An elevated L-FABP (T3) level was independently associated with increased mortality (hazard ratio [HR] = 8.60, 95% confidence interval [CI]: 1.02–72.64, P = 0.047). The T3/T0 ratio showed only modest predictive value (AUC = 0.623).
Conclusions: Urinary L-FABP levels measured 3 hours after ICU admission were an independent predictor of short-term mortality. The marker’s simplicity and bedside applicability suggest its potential utility not only in ICUs but also in emergency departments and triage decision-making.

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Venoarterial extracorporeal membrane oxygenation as bridge support for refractory catecholamine-resistant shock and severe lactic acidosis in a patient with metformin exposure and multifactorial contributors: A case report

Ans Alamami, Rabee Tawel, Saleh Mahmoud, Shameel Ahammed, Abdurrahmaan Elbuzidi, Nadir Kharma

Department of Critical Care Medicine, Hamad General Hospital, Doha, Qatar

DOI: 10.2478/jccm-2026-0024

A 47-year-old male with type 2 diabetes on metformin and hypertension presented with profound hypoxemia, severe metabolic acidosis (pH unrecordable, lactate 17 mmol/L), and progressive cardiac dysfunction in the setting of presumed sepsis. Despite maximal conventional therapy—including mechanical ventilation, broad-spectrum antimicrobials, and high-dose vasopressors—the patient developed refractory shock and multi-organ dysfunction. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated on hospital day 2 as hemodynamic bridge support, combined with continuous renal replacement therapy (CRRT). This intervention facilitated stabilization of hemodynamics, correction of acidosis, and improvement in organ function. The patient was successfully decannulated and survived to discharge, though with residual cardiomyopathy. Lactic acidosis in this case was likely multifactorial, with metformin exposure as one potential contributor amid acute kidney injury, hypoperfusion, and possible septic elements. This report describes the use of VA-ECMO as supportive therapy in a complex, refractory critical illness scenario, highlighting the importance of timely multidisciplinary escalation while emphasizing diagnostic challenges in attributing causality and the need for cautious patient selection in such high-risk interventions.

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Predictive ability of malnutrition screening tools in enterally fed, mechanically ventilated patients with phase angle inference:A prospective observational study

Mahmoud Al-Kalaldeh1, Mohammad Abu Sabra1, Omar Al-Kalaldeh2

1 Faculty of Nursing, The University of Jordan-Aqaba Campus, Aqaba, Jordan
2 Ministry of Health, Jordan

DOI: 10.2478/jccm-2026-0027

Background: The prognostic abilities of malnutrition assessment tools for the critically ill are still controversial. This study aimed to assess the predictive ability of MUST, NRS-2002, and NUTRIC tools to predict malnutrition risk for enterally fed, mechanically ventilated patients in intensive care.
Methods: In a multicenter, prospective, observational study, patients from five ICU units in Jordan were observed at two stages. During the first 24 hours of admission, MUST, NUTRIC, and NRS-2002 scores were obtained in addition to the demographic and admission characteristics. In the assessment stage, on day 6th of admission forward, the Bioelectrical Impedance Analysis (BIA), including body compositions and Phase Angle (PhA) were assessed. Machine Learning (ML), structural equation modeling (SEM), and area under the curve (AUC) were used for measuring malnutrition estimates.
Results: A total of 709 patients were observed. At admission, NUTRIC, MUST, and NRS-2002 were congruent in identifying high malnutrition risk (45.1%, 46.4%, and 53.6%, respectively). In reference to PhA, MUST and NRS-2002 scored higher for sensitivity (77.6%, and 76.8%, respectively) and specificity (93.3%, and 90.7%, respectively). They reported acceptable correlation estimates by SEM (0.65, and 0.70, respectively), and ML (0.90, and 0.91, respectively). Further, MUST was the best to discriminate malnutrition, followed by NRS-2002 and NUTRIC (AUC= 0.76, 0.64, and 0.53, respectively).
Conclusions: Alongside validated BIA technology, MUST and NRS-2002 functioned as reliable prognostic indicators of malnutrition risk in the ICU.

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High-fidelity simulation programs in ICU-related ethical non-technical skills training: A narrative review

Alexandra-Maria Boldis, Cristina Petrisor, Darius Turcas, George-Calin Dindelegan

Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

DOI: 10.2478/jccm-2026-0021

Objective: Is there a place for non-technical skills training in the ICU? And what teaching strategy should we implement in this process? This narrative review analyzes the benefits of teaching ethics in the ICU environment by applying high-fidelity simulation scenarios to real-life situations, thereby improving communication, moral reasoning, self-reliance, cooperation, and perceptual skills.
Methods: In the literature, there are few publications on the training of ICU residents in non-technical skills and ethical dilemmas using high-fidelity simulations. After searching and scoping the database, we have identified 8 publications relevant to this narrative review.
Results: In the reviewed studies, the main topics discussed and rehearsed using simulations were as follows: communicating an adverse event during anesthesia in one study [5], delivering bad news in two studies [14,18], the ethics of end-of-life care, and the do-not-resuscitate order in three studies [5,18,19], and ethical non-technical skills such as communications, teamwork and confidence in emergent real-life situations in four studies [15,16,17,20].
Conclusions: Developing a more structured approach to teaching ethics-related events is important, particularly in critical care settings. All reviewed studies reached the same conclusion: high-fidelity simulation training is an educational strategy for ICU residents to develop a foundation in ethical considerations and moral reasoning by improving ethical non-technical skills, such as confidence, communication, teamwork, delivering bad news, and end-of-life care.

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