Persistent critical illness in acute hypoxic respiratory failure: A retrospective cohort study

by Michael Kalinoski, Leah Bolden, Qi Wang, R. Adams Dudley, Nathan Mesfin, Nicholas E. Ingraham

Introduction

Persistent critical illness (PerCI) describes patients with prolonged intensive care unit (ICU) dependence after their acute phase of illness and affects 5–20% of the general ICU population. PerCI has been studied in the general ICU cohort, but prevalence and outcomes remain unclear among mechanically ventilated patients with acute hypoxic respiratory failure (AHRF), a high-risk cohort that is more prone to ICU-associated complications. The objective of this study is to quantify PerCI prevalence, identify risk factors for PerCI development, and describe one-year mortality in this population.

Methods

We conducted a retrospective study of patients with AHRF (PaO2/FiO2 ratio < 300) requiring mechanical ventilation within 72 hours of ICU admission across a 12-hospital health system (2011–2022). PerCI was defined as ICU length of stay ≥ 10 days. The primary outcome was one-year mortality, modeled using a Cox proportional hazards model with PerCI as a time-varying exposure. To identify risk factors for PerCI while accounting for competing early mortality, we used a dual-model approach: logistic regression comparing PerCI to early death (≤ 10-day mortality) and PerCI to early ICU discharge, with factors associated with both models considered robust predictors.

Results

Among 10,626 eligible patients, 3,107 (29.2%) met criteria for PerCI. One-year survival was 64.2% in the PerCI group compared to 73.8% in the non-PerCI group. After PerCI onset, mortality risk increased threefold (hazard ratio 3.01; 95% CI 2.72–3.33). Factors consistently associated with PerCI across both models included ARDS, pneumonia, aspiration pneumonitis, heart failure, septic shock, weight loss, surgical admission, and postprocedural respiratory and circulatory failure.

Conclusion

Nearly one in three mechanically ventilated AHRF patients developed PerCI, far exceeding rates in the general ICU populations and was associated with worse one-year survival. Identifiable clinical risk factors may support earlier goals-of-care conversations and post-ICU care planning in this high-risk population.

Workplace Incivility and Suicidal Ideation in Nurses: A Cross‐Sectional Study Assessing Independent, Cumulative, and Latent Risk Profiles

ABSTRACT

Introduction

Nurses face significantly higher rates of workplace incivility and suicide risk than the general population. However, the magnitude of this association remains unquantified empirically. This study aims to determine the association between nurses' experiences of workplace incivility and suicidal ideation, and to explore the independent, cumulative, and pattern-specific associations between incivility from various sources and suicidal ideation.

Design

Cross-sectional study.

Methods

This cross-sectional study employed convenience sampling to enroll 2337 eligible nurses, who provided valid responses during July–August 2024. Suicidal ideation was assessed using two items from the National Comorbidity Survey, and the workplace incivility was assessed by the Nursing Incivility Scale. Logistic regression analysis was used to examine overall, independent, cumulative, and latent-profile-analysis-derived associations between workplace incivility experiences and suicidal ideation.

Results

Workplace incivility experience significantly elevated risk of suicidal ideation after adjustment for confounders. Nurse-initiated workplace incivility demonstrated the strongest association with elevated suicidal ideation risk, surpassing workplace incivility from other sources including physicians and patients. A dose–response relationship was also observed between cumulative workplace incivility experience among nurses and increased risk of suicidal ideation. Nurses in the “high incivility” pattern and “patient and physician incivility” pattern exhibited a higher risk of suicidal ideation compared to nurses in the “low incivility” pattern.

Conclusion

Nurses experiencing workplace incivility demonstrate a heightened risk of suicidal ideation.

Clinical Relevance

Workplace incivility experienced by nurses was associated with an increased risk of suicidal ideation. Medical institutions and nursing managers are encouraged to consider workplace incivility in routine screening and intervention efforts for suicide prevention.

The METTL3 inhibitor STM2457 suppresses gastric cancer progression by modulating m⁶A RNA modification

by Hang Sun, Haozhi Xu, Junying Li, Xiaoman Xie, Junmei Zhang, Hongjie Dong, Huanhuan Xie, Qi Wang, Guihua Zhao, Kun Yin, Jingyu Yang, Jianwei Zhou, Ruili Wu, Chao Xu

Gastric cancer (GC) is one of the most common and lethal cancers globally. methyltransferase-like 3 (METTL3)-mediated N6-methyladenosine (m⁶A) RNA methylation plays a crucial role in tumor initiation and progression by regulating RNA function. STM2457, a highly efficient METTL3 inhibitor, can inhibit METTL3 activity and may serve as a potential therapeutic strategy in cancers. However, the role of STM2457 for GC cells is still unknown. In this study, we analyzed the expression profile data of GC in TCGA and GEO databases, and further explored the expression involvement of METTL3 in GC cell line, investigated the therapeutic effect of STM2457 targeted inhibition of METTL3 in GC both in vitro and in vivo experiments. The results indicated that STM2457 could suppress GC cell proliferation and migration by inhibiting METTL3, and also promoted cell apoptosis and arrest the cell cycle in S phase. In addition, STM2457 could inhibit tumor growth in subcutaneous xenotransplantation mouse model. Our findings suggested that STM2457 had great potential for the treatment of GC and could serve as a foundation for future clinical applications.