Shihwan Chang

Candida auris has emerged as a multidrug-resistant, healthcare-associated pathogen worldwide; however, outcome data on C. auris candidaemia in East Asia remain limited. We conducted a retrospective cohort study of adult patients with candidaemia who received antifungal therapy at a tertiary hospital in Seoul, Republic of Korea, from January 2023 to December 2024, comparing C. auris with other Candida species. Confounding was addressed by inverse probability of treatment weighting (IPTW) using a five-covariate propensity score (age, Charlson Comorbidity Index, septic shock, ICU admission at antifungal initiation, and concomitant Gram-negative infection). Among 423 patients, C. auris accounted for 6.9% of cases and was uniformly fluconazole non-susceptible, with frequent high-level caspofungin resistance but preserved micafungin and anidulafungin susceptibility. Patients with C. auris were older, with greater comorbidity and more frequent ICU admission at antifungal initiation. After IPTW adjustment, C. auris was not associated with higher 30-day mortality, the primary outcome (adjusted hazard ratio 0.59, 95% CI 0.26–1.32); the wide confidence interval indicates limited precision rather than equivalence, and results were directionally consistent for 90-day and in-hospital mortality and across sensitivity analyses that varied both the comparison cohort and the analytic method. Residual confounding by unmeasured illness severity and limited precision preclude concluding equivalence. Continued surveillance, molecular characterisation, and infection control remain essential.

Background: Body mass index (BMI) is a common nutritional marker, but admission-only measurements present limitations. Early dynamic BMI changes may better reflect metabolic stress and fluid balance. However, the clinical significance of early BMI trajectory during critical illness remains poorly understood. This study evaluated the impact of early BMI trajectory on mortality and ventilator weaning in critically ill patients. Methods: This retrospective cohort study included 1355 adult patients (ICU stay ≥ 7 days) admitted to the medical ICU between 2019 and 2025. BMI trajectory was defined as the percentage change from admission to day 7 and was categorized into three groups: decrease (>5% reduction), stable (±5%), and increase (>5% gain). Multivariable Cox proportional hazard and logistic regression analyses were performed to evaluate the association between BMI trajectory and clinical outcomes. Results: Of the 1355 patients, 15.9%, 57.7%, and 26.4% were in the decrease, stable, and increase groups, respectively. The increase group demonstrated significantly higher hospital mortality (52.5%) than the decrease (41.9%) and stable (40.0%) groups (p = 0.001). Multivariable analysis revealed that an increasing BMI trajectory was independently associated with higher hospital mortality (HR 1.25, 95% CI 1.05–1.48). A decreasing BMI trajectory strongly predicted successful ventilator weaning (OR 2.76, 95% CI 1.81–4.21). Conclusions: Early BMI trajectory significantly predicted ICU outcomes. Increasing and decreasing BMI were associated with higher mortality and improved ventilator weaning, respectively. These findings suggest that BMI trajectory may be a simple surrogate marker of metabolic stress, nutritional status, and fluid balance during early critical illness.

Background/Objectives: Ventilator weaning imposes profound hemodynamic stress, unmasking cardiopulmonary vulnerability. Since conventional predictors of post-tracheostomy weaning failure remain elusive, biomarker-driven risk stratification offers a translational approach. We evaluated the prognostic utility of admission N-terminal pro-B-type natriuretic peptide (NT-proBNP) as an early triaging tool for weaning failure and explored its therapeutic implications alongside optimal tracheostomy timing. Methods: In this large-scale retrospective cohort study, we analyzed 707 critically ill patients who underwent tracheostomy in a medical intensive care unit. We investigated the association between baseline NT-proBNP levels—measured as a molecular surrogate of cardiovascular stress at ICU admission; echocardiographic parameters; and weaning outcomes. Multivariable logistic regression analysis was utilized to identify independent pathophysiological predictors associated with weaning failure. Results: Patients experiencing weaning failure exhibited significantly elevated admission NT-proBNP levels compared to those successfully weaned (3077.0 vs. 1410.0 pg/mL, p < 0.001). High admission NT-proBNP (>3271 pg/mL) was independently associated with an increased risk of weaning failure (adjusted odds ratio [aOR] 2.86, 95% confidence interval [CI] 1.81–4.53, p < 0.001). Conversely, an early clinical intervention—tracheostomy performed within 10 days of mechanical ventilation initiation—was associated with a significantly lower risk of weaning failure (aOR 0.55, 95% CI 0.35–0.87, p = 0.010). Furthermore, elevated biomarker levels strongly correlated with prolonged intensive care unit stays and higher 90-day mortality. Conclusions: Admission NT-proBNP serves as a powerful biomarker associated with cardiopulmonary vulnerability from the earliest stages of critical illness. Integrating this diagnostic biomarker with interventional strategies like optimal tracheostomy timing has significant prognostic implications. This biomarker-guided approach facilitates personalized risk stratification from ICU admission, potentially optimizing weaning pathways for mechanically ventilated patients.

Background/Objectives: Neutrophil-to-lymphocyte ratio (NLR) may predict outcomes after organ transplantation. This study evaluated the peri-transplant prognostic value of NLR in lung transplantation (LTx). Methods: This retrospective study included 282 LTx recipients (2012–2020). NLR measured on PODs 1, 3, 7, and 28 predicted 6-month mortality. Generalized estimating equations analyzed serial trends. Multivariable regression and ROC analysis identified predictors for a composite model, assessing discrimination and calibration. Results: Among 282 recipients (mean age, 54.2 years; male, 65.2%; idiopathic pulmonary fibrosis, 54.3%), 24.1% died within 6 months, most commonly from infection. Median NLR increased sharply after LTx (pre-LTx, 5.4; POD 1, 23.1; POD 3, 31.2), then decreased (POD 7, 18.8; POD 28, 8.7). Non-survivors had significantly higher preoperative and postoperative NLRs, particularly on POD 28. POD 28 NLR independently predicted 6-month mortality (multivariable analysis: OR, 1.05 per unit; 95% CI, 1.02–1.07; p < 0.001), alongside age and donor lung PaO₂/FiO₂ (P/F) ratio. Notably, a composite model combining these variables demonstrated significantly superior discrimination (area under the curve [AUC], 0.742; p = 0.001) compared to the NLR-only model (AUC, 0.698; p < 0.05). GEE demonstrated significantly steeper post-transplant NLR decline among survivors than non-survivors after adjusting for age (p = 0.02). Patients with NLR > 9.20 at POD 28 (area under the curve, 0.698; 95% CI, 0.615–0.782; sensitivity, 71.4%; specificity, 59.8%)—showed significantly lower survival on Kaplan–Meier analysis (p < 0.001, log-rank). Conclusions: Persistent NLR elevation on POD 28 independently predicts early mortality post-LTx and may support routine post-transplant risk stratification.

Leem AY, et al. Yonsei Med J. 2026 Oct;67(10):724-735. https://doi.org/10.3349/ymj.2025.0533

Background/Objectives: Sepsis is basically an inflammatory disease that involves the host’s immune response. Granzyme B, a cytotoxic protease, has garnered attention for its involvement in modulating immune responses. This study aimed to elucidate the clinical implications of granzyme B in critically ill patients with sepsis, focusing on plasma granzyme B levels as a potential prognostic marker. Methods: We conducted a retrospective analysis of sequentially collected blood samples from 57 sepsis patients admitted to the medical intensive care unit at Severance Hospital, a tertiary hospital in Seoul, South Korea. Clinical and laboratory data were comparatively analyzed between 28-day survivors and nonsurvivors. Results: The number of patients in the survivor and nonsurvivor groups was 32 (56.1%) and 25 (43.9%), respectively. Compared to survivors, nonsurvivors had higher APACHE II (23.5 vs. 34, p = 0.007) and SOFA (10 vs. 15, p = 0.001) scores, as well as increased levels of serum lactate (1.8 vs. 9.2 mmol/L, p < 0.001) and plasma granzyme B (28.2 vs. 71 pg/mL, p < 0.001). Granzyme B exhibited a robust area under the receiving operating characteristic (AUROC) for predicting 28-day mortality (AUROC = 0.794), comparable to lactate (0.804), SOFA (0.764), and APACHE II (0.709). The combined index of lactate and granzyme B demonstrated the highest AUROC (0.838) among all investigated predictors. Significant positive correlations were observed between log granzyme B and various inflammatory cytokines, including log IFN-γ (r = 0.780), IL-4 (r = 0.540), IL-10 (r = 0.534), and IL-6 (r = 0.520). Conclusions: Plasma granzyme B demonstrated fair short-term mortality prediction among patients admitted to the ICU, suggesting its potential utility for risk stratification and managing patients with sepsis.

Despite advancements in artificial intelligence-based decision-making, transitioning patients from intensive care units (ICUs) to low-acuity wards is challenging, especially in resource-limited settings. This study aimed to develop a simple scoring system to predict ICU discharge safety. We retrospectively analyzed patients admitted to a tertiary hospital’s medical ICU (MICU) between July 2016 and December 2021. This period was divided into two phases for model development and validation. We identified risk factors associated with unexpected death within 14 days of MICU discharge and developed a predictive scoring system that incorporated these factors. We verified the system’s performance using validation data. In the development cohort, 522 patients were discharged from the MICU, and 42 (8.04%) died unexpectedly. In multivariate analysis, the Sequential Organ Failure Assessment (SOFA) score (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.13–1.41), red blood cell distribution width (RDW) (OR 1.20, 95% CI 1.07–1.36), and albumin (OR 0.37, 95% CI 0.16–0.84) were predictors of unexpected death. Each variable was assigned a weighted point in the scoring system, and the area under the curve (AUC) was 0.788 (95% CI 0.714–0.855). The scoring system was performed using an AUC of 0.738 (95% CI 0.653–0.822) in the validation cohort of 343 patients with 9.62% of unexpected deaths. When a cut-off of 0.032 was applied, a sensitivity and a specificity of 81.8% and 55.2%, respectively, were achieved. This simple bedside predictive score for ICU discharge uses the SOFA score, albumin level, and RDW to aid in timely decision-making and optimize critical care facility allocation in resource-limited settings.