Category Archives: AoP

Quality of life and patient safety: The impact of the work environment on the well-being of medical staff in ICU settings

Sebastian Isac1, Elisabeta Nita1, Victor Cristian Toma1, Andrada-Georgiana Badea1, Mihaela Camelia Popa2, Teodora Isac3, Mara Madalina Mihai4, Cristina Veronica Andreescu5, Cristina Martac1, Gabriela Droc1

1 Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, Bucharest, Romania
2 Institute of Philosophy and Psychology ˝Constantin Radulescu- Motru˝, Romanian Academy, Bucharest, Romania
3 Department of Internal Medicine II, The Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
4 Department of Oncologic Dermatology and Allergology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
5 Department of Foreign Languages, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

DOI: 10.2478/jccm-2026-0036

Background and aim: Professional Quality of Life (ProQoL) is essential for understanding the well-being of the healthcare professionals working in high-stress environments, such as the intensive care units (ICUs). – This study aimed to assess the influence of age, gender, hospital affiliation, and professional role on the ProQoL dimensions (Compassion Satisfaction – CS, Burnout – BO, Secondary Traumatic Stress – STS) and to analyze the relationship between the perceptions of patient safety (measured via the Safety Attitudes Questionnaire – SAQ) and the professional quality of life.
Method: This cross-sectional observational study included 247 healthcare professionals (April-November 2024) from 20 different hospitals, working in ICUs (nurses, attending physicians, medical residents -, and other staff). Participants filled out the ProQoL and SAQ questionnaires out of which only 10 SAQ items were used. Statistical analyses were performed using ANOVA, t-tests, and Pearson correlation coefficients.
Results: Medical residents and participants in the 20–30 age group reported having the highest burnout scores (28.37 ± 0.37), and the lowest level of compassion satisfaction score (36.65±0.61), while attending physicians had elevated levels of secondary traumatic stress (25.69±0.57). Positive perceptions of the work environment (safety, conflict resolution, workplace satisfaction) were negatively correlated with the burnout (r = –0.5888, p < 0.0001). Finally, the perception of a pleasant job and workplace positively correlates with the CS score (r=0.53 p˂0.0001).
Conclusions: Professional well-being varies significantly in terms of age, and position. These findings suggest that workplace strategies focusing on safety, teamwork, and workload balance may play a role in supporting the ICU staff well-being.

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Efficacy of prehospital amiodarone on survival in adult out-of-hospital cardiac arrest: A retrospective observational study

Yuki Kishihara1, Shunsuke Amagasa2, Yosuke Homma3, Takashi Tagami4, Hideto Yasuda1,5-7, Masahiro Kashiura1, Yutaro Shinzato1, Takashi Moriya1, SOS-KANTO 2017 Study Group8

1 Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
2 Department of Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan
3 Department of Emergency and Critical Care Medicine, Chiba Kaihin Municipal Hospital, Chiba, Japan
4 Department of Emergency and Disaster Medicine, The Jikei University School of Medicine, Tokyo, Japan
5 Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
6 School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Australia
7 School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Australia
8 Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan

DOI: 10.2478/jccm-2026-0035

Aim of the study: This study sought to determine whether prehospital administration of amiodarone improves outcomes among adult patients with out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The analysis accounted for time-dependent confounding and resuscitation time bias using real-world registry data.
Material and methods: We conducted a multicenter, retrospective cohort study using a nationwide Japanese OHCA database, including adult nontraumatic shockable rhythms. The exposure was prehospital amiodarone administration at a given time, and the comparator was no amiodarone at the same time point. The comparison reflects amiodarone administration at that time versus no amiodarone, not ‘amiodarone versus never-amiodarone‘. The primary and secondary endpoints were favorable neurological status and survival at 30 days. Patients were matched 1:3 using time-dependent propensity score matching, followed by generalized estimating equations to address intrahospital clustering. Sensitivity analyses included covariates with standardized mean differences greater than 0.25 after matching. Associations were expressed as risk ratios (RRs) with 95% confidence intervals (CIs).
Results: Among 9,909 eligible patients, 56 (0.6%) remained after matching, including 19 (0.2%) who received amiodarone at the index time point. Median (IQR) age was 65 (52–76) years, and 81.8% were male. The median interval from first medical contact to drug administration was 27 (22–32) minutes. In models adjusted for timing variables and hospital clustering, amiodarone was not significantly related to favorable neurological recovery (RR, 0.45 [95% CI, 0.14–1.47]) or survival (RR, 0.74 [95% CI, 0.31–1.73]). Sensitivity analyses yielded consistent findings, though survival model convergence was limited. 
Conclusions: Prehospital administration of amiodarone in adult OHCA patients with shockable rhythms was not associated with improved neurological or survival outcomes. However, these findings should be interpreted with caution, and further studies are warranted to confirm and extend these observations.

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Emergency anticancer therapy in intensive care medicine: A mainland China survey

Hao Zhang1, DongHao Wang2, ChangSong Wang3, Xue-Zhong Xing1

1 National Cancer Center/National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2 Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
3 First Affiliated Hospital of Harbin Medical University, Harbin, China

DOI: 10.2478/jccm-2026-0017

Objective: To identify intensivists‘ attitudes toward emergency anticancer therapy (EAT) in patients with cancer in intensive care units (ICUs).
Material and methods: A 11-question survey was performed among intensivists in the Cancer Critical Care Medicine Committee of the Chinese Anti-Cancer Association and Critical Care Medicine Committee of Beijing Association of Oncology between November 11 and December 11, 2024. Response were compared between mixed and oncologic ICU physicians.
Results: In total, 120 intensivists completed the survey. For 9 of 11 questions, the agreement rate exceeded 85%. There were 61.5% mixed ICU physicican and 35.5% oncologic ICU physicians in favor of compostion of the composition of a multidisciplinary team (MDT) composing of an intensivist, an oncologis and a pharmacist, respectively. However this difference was not significant (P=0.281).
Conclusions: Intensivists in China generally hold positive attitudes toward emergency anticancer therapy in ICUs for critically ill patients with cancer-related organ dysfunction. However, opinions differ regarding the MDT composition between mixed and oncologic ICU physicicans.

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Early outcomes of pediatric heart transplantation: Impact of mechanical circulatory support and perioperative challenges. A single-center retrospective study

Muhammad Shahzad, Reem Beheri, Bushra Algethami, Yasser Alheraish, Dimpna Albert, Felix W Tsai, Zohair Alhalees, Khaled Alarwan

King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia

DOI: 10.2478/jccm-2026-0033

Background: Pediatric heart transplantation stays the gold standard treatment for end-stage heart failure, but outcomes are influenced by pre-transplant status and bridging strategies, particularly mechanical circulatory support (MCS).
Objectives: To evaluate early outcomes following pediatric heart transplantation and assess the impact of pre-transplant MCS on survival and complications.
Methods: We retrospectively analyzed all pediatric patients (<14 years) who underwent orthotopic heart transplantation at a single tertiary center between January 2020 and January 2025. Demographics, pre-transplant support, intraoperative data, and early outcomes were collected. Primary outcome was 30-day survival; secondary outcomes included acute rejection, infection, acute kidney injury (AKI), neurologic complications, and ICU/hospital length of stay (LOS). Comparative analyses were performed between patients having ECMO- and ventricular assist devises (VAD) using Fisher’s exact and Wilcoxon rank-sum tests. Kaplan–Meier survival estimates were generated.
Results: Thirty patients were transplanted (median age 9 years, 63.3% female). Most (96.7%) needed MCS, including 11 ECMO and 18 VAD. Thirty-day survival was 28/30 (93.5%, 95% CI 78–99). Acute rejection occurred in 3 (10%), infections in 4 (13.3%), AKI in 8 (26.7%), with two requiring CRRT, and neurologic complications in 3 (10.3%). Median ICU and hospital LOS were 20 and 37 days, respectively. ECMO patients had longer post-transplant ventilation (12 vs 6 days, p = 0.04) and ICU length of stay (LOS) compared to VAD patients. Total Ischemic time, and CPB times were associated with increased morbidity.
Conclusions: Early outcomes after pediatric heart transplantation prove high short-term survival but substantial morbidity. ECMO bridging was associated with greater resource use than VAD. Improving donor heart ischemic time, donor-recipient matching, perioperative management, and early initiation of durable MCS may further improve outcomes.

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Case report: Necrotizing enterocolitis with gastric perforation in a 24-day old preterm neonate

Tamas Toth1, Reka Borka-Balas2, Manuela Cucerea3, Radu-Alexandru Prisca4

1 Institution Organizing University Doctoral Studies (IOSUD) George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures; Pediatric Surgery and Orthopedics Department, Targu Mures Emergency Clinical County Hospital, Targu Mures, Romania
2 Pediatric Clinic I, Targu Mures Emergency Clinical County Hospital; George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
3 Neonatology Department, Targu Mures Emergency Clinical County Hospital; George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
4 Pediatric Surgery and Orthopedics Department, Targu Mures Emergency Clinical County Hospital, Targu Mures, Romania

DOI: 10.2478/jccm-2026-0034

Introduction: Neonatal gastric perforation (NGP) is a rare, life-threatening surgical emergency that predominantly affects premature and extremely low birth weight (ELBW) infants and remains associated with high mortality.
Case presentation: A 600 g female infant born at 25/26 weeks of gestational age developed necrotizing enterocolitis (NEC) during the third postnatal week and deteriorated with abdominal distension and pneumoperitoneum. Emergency laparotomy on day 24 revealed a single posterior gastric wall perforation with circumferential necrotic margins; the nasogastric tube tip was located at the defect. After minimal debridement and primary two-layer closure, the infant survived a prolonged intensive care course complicated by recurrent sepsis, cholestasis, bronchopulmonary dysplasia, and later adhesive obstruction requiring adhesiolysis.
Conclusions: Gastric perforation may represent an uncommon manifestation of severe NEC in ELBW infants. Delayed onset, necrotic margins, and systemic inflammatory deterioration may favor ischemic NEC-related injury over iatrogenic trauma. Early radiographic evaluation and prompt surgical exploration are crucial for survival.

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Balanced crystalloids versus normal saline for initial fluid resuscitation in diabetic ketoacidosis: A systematic review and meta-analysis of randomized controlled trials

Khaled Ahmed Reda Soliman1, Ahmed Osman Hassan Ali2, Farrukh Ameer3, Bashaer Alharbi4, Mohamed Hany Elmasry5, Rawabi Mohammed Alwashmi6, Bandar Saad Alshreef7, Mohammad Saleh H Almabouth8, Kinda Ahmed Hardan9, Aymen Ali Alqurain10

1 Department of Emergency Medicine, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
2 Department of Critical Care Medicine, Dr. Soliman Fakeeh Hospital, Riyadh, Saudi Arabia
3 Department of Adult Cardiology, Dr. Soliman Fakeeh Hospital, Fakeeh Care Group, Riyadh, Saudi Arabia
4 Department of Clinical Pharmacy, Ministry of Health, Jeddah, Saudi Arabia
5 Department of ICU and Anesthesia, Care Medical Hospital Almalaz, Riyadh, Saudi Arabia
6 Burydah College, Qassim, Saudi Arabia
7 Healthcare Management, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
8 Department of Internal Medicine, NSH, Medina, Saudi Arabia
9 Senior House Officer of General Medicine, International University of Africa, Riyadh, Saudi Arabia
10 Department of Clinical Practice, Faculty of Pharmacy, Northern Border University, Saudi Arabia

DOI: 10.2478/jccm-2026-0031

Objective: To systematically synthesize evidence from RCTs that evaluate the efficacy and safety of balanced crystalloids compared with normal saline for initial fluid resuscitation of patients with DKA.
Methods: This systematic review and meta-analysis were performed considering PRISMA guidelines and was registered in PROSPERO. A comprehensive search was performed to identify RCTs comparing balanced crystalloids with normal saline in adults and children with DKA. The risk of bias was assessed by using Cochrane RoB 2 tool. A random-effects meta-analysis was performed using R software to calculate pooled Mean Differences for continuous outcomes and Odds Ratios for dichotomous outcomes with 95% Confidence Intervals.
Results: Eleven RCTs were included. In the quantitative synthesis of six RCTs (n = 491) using continuous time-to-event data, balanced crystalloids were not associated with a statistically significant reduction in time to DKA resolution compared with normal saline (Mean Difference [MD] = -1.50 hours; 95% CI: -3.79 to 0.79; p=0.15), with moderate heterogeneity (I2 = 36.2%). The 95% prediction interval ranged from -5.44 to 2.44 hours. However, balanced crystalloids resulted in a significantly greater increase in serum bicarbonate at 12 hours (MD = +2.50 mmol/L; 95% CI: 1.51 to 3.48; p=0.004; I2 = 0.0%). Subgroup analyses by fluid type, DKA severity, and age group showed no significant subgroup differences.
Conclusion: Initial fluid resuscitation with balanced crystalloids was not associated with a shorter time to DKA resolution compared with normal saline, and they were associated with a rapid increase in serum bicarbonate levels; however, this biochemical improvement did not translate into a shorter time to DKA resolution or other clinical benefits. The choice of crystalloids for initial DKA resuscitation remains an area of clinical equipoise because of the substantial heterogeneity and methodological limitations of the available evidence, emphasizing the need for further high-quality research.

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Echocardiographic factors associated with prolonged duration of inotrope therapy and ICU length of stay in a retrospective study of cardiac surgery patients

Kelly Tankard1, William Vasquez McTeigue2, Matthew Smith2, Ariel Mueller2, Timothy Houle2, Eriberto Michel2, Judy Hung2, Adam Dalia2, Jerome Crowley2, Kenneth Shelton2

1 Department of Anesthesiology, University of Kansas Medical Center, Kansas City, USA
2 Department of Anesthesiology, Massachusetts General Hospital, Boston, USA

DOI: 10.2478/jccm-2026-0032

Introduction: Post-operative heart failure following cardiac surgery carries risk and can impact patient outcomes. Preoperative echocardiography can be useful for stratifying risk. Although there has been a historical focus on left ventricular ejection fraction (LVEF), the importance of left ventricular (LV) size, as measured by left ventricle end-diastolic diameter (LVEDD), may be an underappreciated echocardiographic factor which can help predict risk in patients undergoing cardiac surgery.
Aim of the study: To investigate the association between LVEF and LVEDD with inotrope use, inotrope duration, and intensive care unit (ICU) length of stay (LOS) in patients undergoing cardiac surgery.
Materials and methods: Retrospective cohort study including 2,965 adult patients undergoing non-emergent cardiac surgery at a single academic institution between February 2017 and October 2021. Primary outcomes were the use of inotropes and duration of inotrope therapy. The secondary outcome was ICU LOS.
Results: In adjusted analyses, a one standard deviation increase in LVEF was associated with decreased odds of inotrope initiation (OR 0.45, 95% CI: 0.41 to 0.50; P < 0.001), while a one standard deviation increase in LVEDD was associated with increased odds of receiving inotropes (OR 1.18, 95% CI: 1.07 to 1.31; P = 0.001). Among those receiving inotropes, a one standard deviation increase in LVEF was associated with a 25% decrease in inotrope hours in adjusted analyses (0.75, 95% CI: 0.68 to 0.82; P < 0.001). An interaction was observed such that LVEDD modified the association between LVEF and ICU LOS (0.98, 95% CI: 0.95 to 0.99; P = 0.03).
Conclusions: Preoperative LVEDD, particularly when combined with LVEF, can predict risk after cardiac surgery.

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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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