Purpose
Fournier gangrene (FG) is a life-threatening condition characterized by rapid tissue necrosis in the perineal and genital regions. Early identification of risk factors is essential for improving prognosis and reducing mortality rates. This study aimed to identify predictive factors associated with mortality in patients with FG.
Methods
A multi-institutional retrospective study was conducted across four tertiary care centers in Korea, including patients diagnosed with FG between January 2014 and December 2023. Data on demographic characteristics, laboratory findings, and clinical outcomes were collected. Independent risk factors for mortality were identified using multivariate logistic regression analysis, and optimal cutoff values for these predictors were determined.
Results
A total of 133 patients were included. The findings showed that age, initial lactate level, hemoglobin level, platelet count, and albumin level were significant predictors of mortality. Age was associated with an odds ratio of 1.105 (95% confidence interval [CI], 1.038–1.177; P=0.0018), while initial lactate level exhibited an odds ratio of 1.820 (95% CI, 1.335–2.480; P=0.0002). The optimal cutoff values identified were 64.5 years for age, 3.15 mmol/L for lactate, 8.65 g/dL for hemoglobin, 208×109/L for platelet count, and 3.05 g/dL for albumin, with varying sensitivity and specificity.
Conclusion
The study concluded that age, and initial levels of lactate, hemoglobin, albumin, and platelet count are independently predictive of mortality in patients with FG. These findings underscore the importance of aggressive management for patients presenting with abnormal serum values at admission to improve clinical outcomes. Further research is warranted to validate these results and to refine management strategies for FG.

Purpose
Despite guidelines on the prevention of central venous line-associated bloodstream infection, it is left to the clinical judgment of the attending physician to determine the risk of infection and how long a central line should remain in place. This study aimed to identify risk factors for peripherally inserted central venous catheter (PICC)-associated infection.
Methods
This retrospective study included 1,136 patients with a PICC who were hospitalized at the National Health Insurance Service Ilsan Hospital (January 2015 to January 2022). Electronic medical records were reviewed for patients with positive blood cultures. Patients with suspicion of infection at the PICC insertion site or with unclear infection at other sites were defined as having a PICC-associated infection.
Results
Thirty-five patients (3.08%) had a PICC-associated infection. There were significant differences in hypertension (p = 0.026), lung disease (p = 0.001), PICC duration > 14 days, and antibiotic use before PICC insertion (p = 0.016) between no PICC-associated infection, and infection in the bloodstream. Total parenteral nutrition with PICC was not significantly different between groups. Logistic regression analysis identified hypertension, lung disease, PICC duration > 14 days (OR 2.088, 95% CI 1.032-4.224, p = 0.041), and antibiotic use before PICC insertion (OR 0.159, 95% CI 0.049-0.515, p = 0.002) as independent risk factors for PICC-associated infection.
Conclusion
The study suggested that PICCs maintained longer than 14 days is a risk factor for PICC-associated infection. Antibiotic use prior to PICC insertion was observed as a negative factor for PICC-associated infection.

Purpose
This study aimed to investigate the incidence rate, types and risk factors for delirium in patients admitted to the surgical Step-Down Unit (SDU).
Methods
This study was a retrospective study of the electronic medical records of patients admitted to a surgical SDU from February 2020 to July 2020. The delirium assessment was conducted using the short Confusion Assessment Method (a tool that allows quick and easy screening of delirium) and the incidence and risk factors for delirium were determined.
Results
Among a total of 227 patients in the study, the incidence rate of delirium was 35 cases (16.7%). It predominantly occurred on the first day (n = 16, 45.7%) and the second day of admission (n = 15, 42.8%). The peak occurrence of delirium was between 14:00 and 22:00 (n = 30, 85.7%). The most common type of delirium was hypoactive (n = 19, 54.3%). The results of multiple logistic regression analysis indicated that the factors influencing the occurrence of delirium in the surgical step down unit (SDU) were age, hypertension, stroke, white blood cell count, and the use of restraints.
Conclusion
Considering the characteristics of high-risk groups for delirium in the surgical SDU, it is necessary to establish nursing practice guidelines to minimize delirium.

Citations

• A Systems Biology Approach to Understanding Delirium Pathophysiology and Identifying Natural Compounds for Potential Therapeutic Purposes
  Babak Sokouti
  OBM Neurobiology.2025; 09(01): 1.     CrossRef

In August, 2011, the Korean Public Health Surveillance declared an outbreak of pulmonary disease due to the inhalation of humidifier disinfectants (HDs), which led to approximately 20,000 deaths. In March, 2020, the World Health Organization declared coronavirus disease-2019 (COVID-19) a pandemic. In this Case Report, we present a rare case of a patient who inhaled toxic HDs and developed COVID-19. He was young and had a low risk of severe COVID-19, however, he had a critical course to recovery. He was admitted to the intensive care unit and administered high-flow oxygen via a nasal cannula. He received dexamethasone injections each day for 10 days and his condition began to improve on hospital Day 6, although radiographical findings revealed no improvement. He was discharged on hospital Day 26. Despite the patient’s chronic lung disease becoming asymptomatic, HDs could be an important risk factor affecting the clinical course of COVID-19.

Purpose
Pelvis fractures are associated with bladder and urethral injury (BUI). The purpose of this study was to identify risk factors associated with BUI in patients with pelvic fracture.
Methods
Patients (> 18 years) with pelvic injury (N = 314) at our hospital between January 2015 and June 2020 were retrospectively analyzed for age, sex, cause of injury, initial vital signs, urine red blood cell (RBC) count, Glasgow Coma Scale and Abbreviated Injury Scale score, Injury Severity Score, preperitoneal pelvic packing, and femur, lumbar spine, and pelvic fractures.
Results
Compared with the BUI-absent group, the BUI-present group had a greater percentage of patients who were male (79.2% vs. 55.9%; p = 0.026), had a urine RBC count/high power field (HPF) ≥ 30 (94.4% vs. 38.8%; p < 0.001), underwent preperitoneal pelvic packing (37.5% vs. 18.6%; p = 0.035), had symphysis pubis diastasis (33.3% vs. 11.7%; p = 0.008), and had sacroiliac joint dislocation (54.2% vs. 23.4%; p = 0.001). Independent risk factors associated with BUI were symphysis pubis diastasis [odds ratio (OR) was 3.958 (95% confidence interval: 1.191–13.154); p = 0.025] and a urine RBC count/HPF ≥ 30 [OR = 25.415 (95% confidence interval: 3.252–198.637); p = 0.006]. Of those with BUI, 15 patients were diagnosed at the trauma bay, and 9 had a delayed diagnosis.
Conclusion
Patients with pelvic injury who display symphysis pubis diastasis or have a urine RBC count/ HPF ≥ 30 are at higher risk of BUI, therefore, further BUI investigations should be considered.

Citations

• Hematuria as a Screening Tool for Bladder and Urethral Injuries in Pelvic Trauma: A Sensitivity and Specificity Analysis
  Md Habibur Rahman, Muktadir Tamim, Goutom Mukharzi
  TAJ: Journal of Teachers Association.2024; 37(2): 802.     CrossRef

Purpose
The prognosis of an emergent laparotomy in hypotensive patients is poor. This study aimed to review the outcomes of hypotensive patients who had emergent laparotomies and elucidate the risk factors of mortality.
Methods
Patients who underwent an emergent laparotomy from January 2011 to December 2019 were retrospectively reviewed. The exclusion criteria included initial systolic blood pressure > 90 mmHg, aged < 19 years, and cardiac arrest before the laparotomy. Patients were categorized into survival groups (survived or deceased). Univariate and multivariate analyses were conducted to determine the risk factors of mortality. The time from the laparotomy to death was also reviewed and the effect of organ injury.
Results
There were 151 patient records, analyzed 106 survivors, and 45 deceased. The overall mortality was 29.8%. Liver injury was the main organ-related event leading to an emergent laparotomy, and most patients died in the early phase following the laparotomy. Following multivariate analysis, the Glasgow Coma Scale score [odds ratio (95% confidential interval) 0.733 (0.586-0.917), p = 0.007], total red blood cell transfusion volume in 24 hours[1.111 (1.049-1.176), p < 0.001], major bleed from the liver [3.931 (1.203-12.850), p = 0.023], and blood lactate [1.173 (1.009-1.362), p = 0.037] were identified as risk factors for mortality.
Conclusion
Glasgow Coma Scale score, total red blood cell transfusion volume in 24 hours, major bleed from the liver, and lactate were identified as risk factors for mortality. Initial resuscitation and management of liver injuries have major importance following trauma.

Citations

• Effects of prior antiplatelet and/or nonsteroidal anti-inflammatory drug use on mortality in patients undergoing abdominal surgery for abdominal sepsis
  Se Hun Kim, Ki Hoon Kim
  Surgery.2023; 174(3): 611.     CrossRef

Purpose:

The aim of this study is to evaluate treatment outcomes and mortality risks associated with hemodynamic instability caused by severe pelvic fracture in a regional trauma center.

Methods:

The medical charts of 44 patients with hemodynamic instability due to pelvic fractures who were admitted to a regional trauma center from January 2014 to May 2017 were analyzed retrospectively.

Results:

The mean age was 61.8 years, and the mean injury severity score was 39.1. Twenty-six patients (59.1%) were transferred from other hospitals, and the median time from injury to emergency room arrival was 115.5 minutes. Preperitoneal pelvic packing, pelvic angiography, and external pelvic fixation were performed in 38 patients (86.4%) for hemostasis. The mortality rate was 52.3%, and 15 patients (34.1%) died from hemorrhage. Logistic regression analysis showed that initial low systolic blood pressure and packed red blood cell (PRBC) requirement were independent risk factors associated with mortality. PRBC requirement for four hours and application of emergent hemostatic procedures were independent factors associated with hemorrhage-induced mortality.

Conclusion:

Emergency procedures for hemostasis should be performed immediately for patients with hemodynamic instability due to pelvic fracture, and they should be transferred to a regional trauma center as soon as possible.