Data mining: Seasonal and temperature fluctuations in thyroid-stimulating hormone

BackgroundThyroid-stimulating hormone (TSH) plays a key role in maintaining normal thyroid function. Here, we used “big data” to analyze the effects of seasonality and temperature on TSH concentrations to understand factors affecting the reference interval.MethodsInformation from 339,985 patients at Peking Union Medical College Hospital was collected from September 1st, 2013, to August 31st, 2016, and retrospectively analyzed. A statistical method was used to exclude outliers, with data from 206,486 patients included in the final analysis. The research period was divided into four seasons according to the National Weather Service. Correlations between TSH concentrations and season and temperature were determined.ResultsMedian TSH levels during spring, summer, autumn, and winter were 1.88, 1.86, 1.87, and 1.96 μIU/L, respectively. TSH fluctuation was larger in winter (±0.128) than in summer (±0.125). After normalizing the data from each year to the lowest TSH median value (summer), TSH appeared to peak in winter and trough in summer, showing a negative correlation with temperature. Pearson correlation analysis indicated that the monthly median TSH values were negatively correlated with temperature (r = −0.663, p < .001).ConclusionsThis study showed significant seasonal- and temperature-dependent variation in TSH concentrations. Thus, these might be important factors to consider when diagnosing thyroid function disorders.     

Sex Specific Seasonal Variation in Hematological and Serum Biochemical Indices of <Emphasis Type="Italic">Barilius bendelisis</Emphasis> from Central Himalaya,India

The study aimed to assess the effects of sex and season on hematological and serum biochemical indices of Barilius bendelisis. Hematological and biochemical results showed significant differences (p < 0.05) among seasons as well as between sexes. In summer, hemoglobin, hematocrit, erythrocyte and WBC number were highest and significantly (p < 0.05) different between sexes. Differential WBC count also showed marked seasonal variation but do not show any significant difference (p < 0.05) between male and female. Mean corpuscular volume and mean corpuscular hemoglobin was high in winter and low in summer. For males and females, mean corpuscular hemoglobin concentration was high in summer, rainy, and low in winter season. Cholesterol level and low-density lipids were high in autumn and low in spring. High-density lipids (HDL) and very low-density lipids (VLDL) also fluctuated in different seasons with maximum HDL in both sexes in autumn. Maximum VLDL for male was observed in summer and in spring for female. Triglycerides were high in autumn and summer and low in spring. Throughout winter the total protein, albumin and globulin levels were highest. Glucose level was higher in summer and autumn whereas, lower in winter in both male and female respectively. This study revealed that the variation in seasonal environmental parameters have direct effect on the health status of B. bendelisis. The baseline data generated in this study will serve as a tool for fish physiologists and pathologists in monitoring the stress, health and nutritional status of B. bendelisis under aquaculture production.     

Differences of 25-hydroxyvitamin D3 concentrations in children and adults with neurofibromatosis type 1

ObjectivesNeurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder, frequently associated with reduced bone mineral density. Serum 25-hydroxyvitamin D3 concentrations in NF1 adults are lower than in healthy controls in autumn respectively winter and are inversely correlated with the number of dermal neurofibromas. We investigated 25-hydroxyvitamin D3 levels in children and adults with neurofibromatosis type 1 in winter and summer and compared them to healthy controls to get more pathogenic insights in vitamin D3 metabolism in NF1 patients.Design and methodsNF1 patients were clinically examined and serum 25-hydroxyvitamin D3 concentrations were measured in 58 NF1 adults and 46 children in winter as well as in summer and compared to sex-, age- and month-matched controls.Results52 adults suffered from 10 to 5000 dermal neurofibromas, whereas none of the children presented neurofibromas. 25-Hydroxyvitamin D3 increased from winter to summer (mean: 21.0 to 46.5 nmol/l) in NF1 adults. This increase was even larger (p = 0.0001) than in healthy controls (mean: 50.5 to 60.5 nmol/l). However, there were no differences of 25-hydroxyvitamin D3 concentrations in NF1 children and healthy controls both in winter and in summer.ConclusionsOnly adults with NF1 showed lower 25-hydroxyvitamin D3 levels in winter and summer, which are unlikely due to impaired UV-dependent dermal synthesis, but rather might be caused by an accelerated catabolism.     

全髋及全膝关节置换后下肢深静脉血栓形成的季节因素

背景：有研究确认大宗人群中下肢深静脉血栓及肺栓塞与季节有明确相关性,但没有关于全髋及全膝关节置换后下肢深静脉血栓形成的季节因素的相关研究。 目的：分析全髋及全膝关节置换后患者下肢深静脉血栓发生率与季节的相关性。 方法：对866例行全髋及全膝人工关节置换的1114个关节进行回顾性分析,共506个髋关节,608个膝关节。其中,男313例420个关节,287髋、133膝;女553例694个关节,219髋、475膝。平均年龄（60.98±0.87）岁。关节置换后3,7,10 d复查彩超检测下肢和盆腔深静脉行下肢多普勒彩超检查,分析下肢下肢深静脉血栓发生率与季节的相关性。 结果与结论：人工关节置换后下肢深静脉血栓发生率,夏冬季差异最明显（χ2=7.190,P=0.007）,春夏（χ2=6.995,P=0.008）、秋夏季（χ2=5.663,P=0.017）比较差异有显著性意义（P 0.05）。表明季节与关节置换后血栓发生率有明显的相关性,冬季发生率最高。     

Seasonal factitious increase in serum potassium: Still a problem and should be recognised

AimSpurious serum elevation of potassium concentration can occur in the presence of cold ambient temperatures and the aim of this study was to assess the effect of changes in temperature on the average serum potassium concentration in our population.MethodWe conducted a retrospective review of all serum potassium samples received to the laboratory between January 2009 and September 2012 from accident & emergency (AE), general practice (GP), in-patient (IP) and out-patient (OP) departments and compared these with the mean ambient temperatures for these months supplied by the Met Office for South East and Central England.ResultsWe have identified that in a relatively condensed south London region seasonal factitious serum potassium elevation occurs in primary care samples but also somewhat surprisingly also in hospital in-patient and out-patient samples although apparently less so in AE samples. We found an inverse correlation between ambient temperature and serum potassium in GP blood samples (Pearson correlation coefficient = − 0.83, P < 0.001), there were weaker correlations with inpatient (− 0.41, P = 0.005) and outpatient samples (− 0.28, P = 0.06) but not in AE samples.ConclusionFactitious seasonal potassium increase can occur in patient blood samples particularly those from primary health care.     

Meteorological parameters and seasonal variations in pulmonary thromboembolism

Background and objectives

In recent years, circannual variations in incidence and mortality for venous thromboembolic disease have been demonstrated, with a peak in winter. However, several investigators have observed no seasonal variation in these diseases. The aim of our study was to investigate whether a seasonal variation, in terms of atmospheric pressure, humidity, and temperature, exists for pulmonary thromboembolism.

Method

We retrospectively included 206 patients with a diagnosis of pulmonary embolism (PE) between 1 June 2001 and 31 May 2006.

Results

The highest number of cases in the 5 years concerned occurred in May (29 cases). Although PE occurred most commonly in the spring (72 cases) and autumn (51 cases), the difference was statistically significant (P = .003). There were no case correlations with months and pressure, temperature, or humidity. However, there was a statistically significant positive correlation between case incidence and atmospheric pressure (r = 0.53, P < .0005) and humidity (r = 0.57, P < .0005). In terms of risk factors, seasonal distribution was not statistically significant as regards cases of embolism occurring for surgical or nonsurgical reasons (r = 0.588).

Conclusion

In terms of the relationship between seasons and embolism cases, despite the determination of an insignificant positive correlation, a statistically significant positive correlation was determined between air pressure and humidity and case incidence. There is now a need for further wide-ranging prospective studies including various hematological parameters to clarify the correlation between PE and air pressure.     

Seasonal vitamin D changes and the impact on health risk assessment

ObjectiveTo investigate seasonal variation of vitamin D levels in 148,821 serum samples during a 2 year time period in a northern-latitude city in the United States.MethodsTotal vitamin D assay testing by chemiluminescence was performed on the DiaSorin Liaison. Vitamin D results were extracted from the laboratory information system without patient identification during 2011 and 2012 and separated by season and vitamin D results: less than 10 ng/mL (deficient), 10–20.0 ng/mL (insufficient), 20.1–30 ng/mL (borderline), 30.1–40 ng/mL (sufficient), 40.1–100 ng/mL, and greater than 100 ng/mL.ResultsThe seasonal winter period constituted the months of January through March; spring, April through June; summer, July through September; and fall, October through December. The data set analyzed included 36,643 samples during the winter, 38,299 in spring, 36,141 in summer, and 37,738 in fall and demonstrated an expected rise and fall in vitamin D levels.ConclusionThis retrospective epidemiological study demonstrates seasonal variation of vitamin D levels at clinical decision points. Although not unexpected, this variation has an impact on studies relating low vitamin D levels to higher rates of cancer, cardiovascular disease, multiple sclerosis, diabetes, autoimmune disease, and a host of other health risk assessments.     

中心静脉置管局部换药敷料的比较研究

目的探讨中心静脉置管患者局部不同季节换药的最佳敷料,减少局部感染并发症,使患者舒适,降低医疗费用。方法将中心静脉置管的患者随机分为2组,每组各100例,透明敷料组以一次性透明敷料覆盖固定。无菌纱布组以传统的无菌纱布覆盖固定。对两组局部感染情况、与冬春季与夏秋季感染的关系及敷料留置的时间进行分析、比较。结果透明敷料组局部感染9例,无菌纱布组局部感染2例,两组均无严重感染病例,差异有显著意义(P<0.05),透明敷料组夏秋季局部感染率明显高于春冬季;两组敷料在使用时间上无菌纱布组明显长于透明敷料组(P<0.05);两组敷料在消耗费用上,透明敷料的换药费用明显高于无菌纱布的换药费用,尤其在夏秋季。结论两组方法对比表明,中心静脉置管局部换药应根据患者的具体情况和季节的不同选择敷料,作者推荐春冬季可选择透明膜敷料,夏秋季使用无菌纱布(棉质)敷料。     

Epidemiological investigation and antimicrobial susceptibility analysis of Ureaplasma and Mycoplasma hominis in a teaching hospital in Shenyang,China

ObjectivesThe aim of this study was to estimate the prevalence and antimicrobial susceptibility of Ureaplasma urealyticum and Mycoplasma hominis in a comprehensive teaching hospital Shenyang, China over the past 4 years.MethodsA total of 1448 individuals with urogenital symptoms underwent mycoplasma testing between April 2016 and March 2020. Detection, identification and antimicrobial susceptibility testing were carried out using Mycoplasma ID/AST kits.ResultsThe total infection rate of genital mycoplasmas was 37.5% (543/1448 cases) with an observed increase over the past 4 years. The positive rates of all three detected infections, as well as overall infection rate, were significantly higher in females than in males (P < 0.05). A higher positive rate of infection was observed in females aged 25–29 (60.5%), and in the 15–19 years age group (57.7%). The changes observed among all age groups of females were statistically significantly different (P < 0.001). The positive rates of U. urealyticum and M. hominis co-infection among the four seasons during which the survey was carried out were also observed to be statistically different (P = 0.01). More than 70% of U. urealyticum isolates were found to be resistant to ciprofloxacin, and more than 80% of M. hominis isolates were resistant to erythromycin, roxithromycin, azithromycin and clarithromycin. Josamycin, doxycycline and minocycline were most effective against U. urealyticum and M. hominis.ConclusionsResults of this study found increasing rates of U. urealyticum and M. hominis infection over the past 4 years, particularly among younger age groups. U. urealyticum/Mycoplasma hominis screening among younger age cohorts are therefore strongly recommend to preventing the spread of pathogens. Monitoring antimicrobial resistance is important for preventing transmission of resistant strains of infection and for the management of antibiotics.     

Seasonal variability and influence of outdoor temperature on body temperature of cardiac arrest victims

Aim of the study

Mild therapeutic hypothermia is a major advance in post-resuscitation-care. Some questions remain unclear regarding the time to initiate cooling and the time to achieve target temperature below 34 °C. We examined whether seasonal variability of outside temperature influences the body temperature of cardiac arrest victims, and if this might have an effect on outcome.

Methods

Patients with witnessed out-of-hospital cardiac arrests were enrolled retrospectively. Temperature variables from 4 climatic stations in Vienna were provided from the Central Institute for Meteorology and Geodynamics. Depending on the outside temperature at the scene the study participants were assigned to a seasonal group. To compare the seasonal groups a Student's t-test or Mann–Whitney U test was performed as appropriate.

Results

Of 134 patients, 61 suffered their cardiac arrest during winter, with an outside temperature below 10 °C; in 39 patients the event occurred during summer, with an outside temperature above 20 °C. Comparing the tympanic temperature recorded at hospital admission, the median of 36 °C (IQR 35.3–36.3) during summer differed significantly to winter with a median of 34.9 °C (IQR 34–35.6) (p < 0.05). This seasonal alterations in core body temperature had no impact on the time-to-target-temperature, survival rate or neurologic recovery.

Conclusion

The seasonal variability of outside temperature influences body temperature of out-of-hospital cardiac arrest victims.     

Prognostication Based on the Change in the Palliative Prognostic Index for Patients With Terminal Cancer

ContextThe use of the Palliative Prognostic Index (PPI) in relation to the clinical time course has not yet been established.ObjectivesTo investigate the association between the changes in the PPI over time and the survival of terminal cancer patients in a palliative care unit (PCU).MethodsThis retrospective cohort study analyzed data from 374 terminal cancer patients who were admitted to the PCU of a university hospital in Japan. Clinical data, such as age, gender, body mass index, vital signs, initial PPI, and subsequent PPI, were collected from the medical records. The PPI change per day (ΔPPI) was calculated using the initial PPI at admission and the one after five to seven days. The factors associated with death within three weeks were identified using Cox proportional hazards model analysis.ResultsAfter their admission to the PCU, 147 (39.3%) patients were deceased within three weeks. The multivariate-adjusted analysis showed that body temperature (hazard ratio [HR] 0.7; 95% CI 0.5, 1.0), initial PPI (HR 1.3; 95% CI 1.2, 1.4), and ΔPPI (HR 6.6; 95% CI 4.9, 9.0) were significantly and independently associated with death within three weeks. In the subanalysis, the ΔPPI was significantly associated with death within three weeks in the group with initial PPI ≤ 4 (HR 9.3; 95% CI 5.8, 15.0), 4 < initial PPI ≤ 6 (HR 14.4; 95% CI 5.7, 36.2), and initial PPI > 6 (HR 9.0; 95% CI 4.1, 20.0).ConclusionOur data suggest that the ΔPPI may be useful for predicting the survival of terminally ill cancer patients.     

Clinical and environmental influences on metabolic biomarkers collected for newborn screening

ObjectivesIdentifying common clinical and environmental factors that influence newborn metabolic biomarkers will improve the utilization of metabolite panels for clinical diagnostic medicine.Design and methodsEnvironmental effects including gender, season of birth, gestational age, birth weight, feeding method and age at time of collection were evaluated for over 50 metabolites collected by the Iowa Neonatal Metabolic Screening Program on 221,788 newborns over a six year period.ResultsWe replicated well known observations that low birth weight and preterm infants have higher essential amino acids and lower medium and long chain acylcarnitine levels than their term counterparts. Smaller, but still significant, differences were observed for gender and timing of sample collection, specifically the season in which the infant was born. Most intriguing were our findings of higher thyroid stimulating hormone in the winter months (P < 1 × 10^? 40) which correlated with an increased false positive rate of congenital hypothyroidism in the winter (0.9%) compared to summer (0.6%). Previous studies, conducted globally, have identified an increased prevalence of suspected and confirmed cases of congenital hypothyroidism in the winter months. We found that the percentage of unresolved suspected cases were slightly higher in the winter (0.3% vs. 0.2%).ConclusionsWe identified differences in metabolites by gestational age, birth weight, gender and season. Some are widely reported such as gestational age and birth weight, while others such as the effect of seasonality are not as well studied.     

成年人肠套叠49例CT分析

目的探讨成年人肠套叠CT表现及CT检查的意义。方法回顾性分析经CT检查并手术病理证实的成年人肠套叠49例的CT表现,并分析CT检查的意义。结果小肠套叠型12例,回-回-结肠型13例,回-结肠型9例,回-结-结肠型9例,结-结肠型6例。CT判断肠套叠正确45例,提示性诊断4例,套叠部位判断正确39例(79.6%);特发性肠套叠9例,继发性肠套叠40例,对原发病变判断正确14例;47例套叠头体部发现肿块状改变,分别呈“靶征“37例,“肾征“38例,不规则肿块改变9例,同时可见“靶征“及“肾征“29例,套叠体尾部双肠管征39例;套叠部远端肠腔内见造影剂30例;增强扫描41例,肿块状影与正常肠壁同步强化35例,肿块状影无强化或轻微强化6例,胃次全手术史8例。结论CT对成人肠套叠诊断准确,套叠部位判断有一定价值,但对病因判断意义不大,同时可提示套叠肠管坏死的可能性以及估计是否为完全性肠梗阻。     

S100B and the influence of seasonal variation

Background A blood test for S100B can be used to rule out intracranial complications after minor head injury and thereby reduce the need for computed tomography (CT) examinations. The aim of this study was to investigate the clinical importance of a possible influence of seasonal variation on S100B. Methods The individual seasonal variation of S100B in 69 healthy volunteers living at latitudes with extremely variable seasonal exposure to sunlight was investigated. Results The mean serum concentration of S100B was 13% higher in August than in February, but however, not statistically significant (p?=?0.068). A good agreement between summer and winter S100B values was confirmed by Bland-Altman analysis and a significant correlation (r?=?0.317, p?=?0.008) was shown between summer and winter S100B values. Conclusion This study did not show any clinical importance of seasonal variation of S100B that may influence the decision of CT scanning patients with head injuries.     

Treatment Patterns Among Patients With Mantle Cell Lymphoma and Comparison of Healthcare Resource Utilization and Costs Among Relapsed/Refractory Patients Treated With Ibrutinib or Chemoimmunotherapy: A Real-world Retrospective Study

PurposeThis study assessed treatment patterns in patients with mantle cell lymphoma (MCL) and compared health care resource utilization (HRU) and costs of ibrutinib with or without rituximab (I ± R) versus chemoimmunotherapy (CIT) in patients with relapsed/refractory MCL.MethodsFor this retrospective cohort study, adults with MCL observed between May 13, 2013, and June 30, 2019, were identified using Optum’s de-identified Clinformatics Data Mart Database. Treatment patterns were described among patients who received ≥1 line of therapy (LOT). HRU and costs (payer's perspective) were compared between patients treated with I ± R and CIT in the second or later line (2L+) of therapy. To account for differences in baseline characteristics between the 2 cohorts, inverse probability of treatment weighting was used. Monthly HRU and costs starting from I ± R or CIT treatment initiation (index date) were compared during the first Oncology Care Model (OCM) episode (ie, first 6 months) postindex and during the observed duration of I ± R or CIT LOT (index LOT) using rate ratios (RRs) and mean monthly cost differences (MMCDs), respectively.FindingsAmong 1346 patients with ≥1 LOT (median follow-up, 15.3 months), 870 (64.6%) were treated with CIT in the first line. Only 348 (25.9%) had a 2L of therapy, of whom 110 (31.6%) were treated with CIT and 98 (28.2%) with an ibrutinib-based therapy. A total of 300 patients were included for the comparison of HRU and costs between 2L+ I ± R and 2L+ CIT. The weighted cohorts (after inverse probability of treatment weighting) included 149 patients treated with I ± R (mean age, 71.6 years; 73.7% men) and 151 treated with CIT (mean age, 71.5 years; 76.2% men). During the first OCM episode and during the index LOT, the I ± R cohort had significantly fewer monthly days with outpatient services compared to the CIT cohort (OCM, RR = 0.63 [P < 0.001]; index LOT, RR = 0.73 [P = 0.004]). Compared to the CIT cohort, the I ± R cohort incurred significantly higher monthly pharmacy costs (MMCDs: OCM, 9938 US dollars [USD] [P < 0.001]; index LOT, 8920 USD [P < 0.001]) that were fully offset by lower monthly medical costs (MMCDs: OCM, –19,373 USD [P < 0.001]; index LOT, –13,548 USD [P < 0.001]), resulting in monthly total health care cost savings (MMCDs, OCM, –9435 USD [P < 0.001]; index LOT , –4628 USD [P = 0.01]).ImplicationsOver a median follow-up of 15.3 months, most patients with MCL were treated with CIT in the first line, and only one fourth had a 2L therapy. Patients with relapsed/refractory MCL treated with I ± R had significantly fewer days with outpatient services and lower monthly total health care costs versus those treated with CIT during the first OCM episode and the index LOT.     

Serotonin level and serotonin uptake in human platelets: a variable interrelation under marked physiological influences

BackgroundAlthough it is known that platelet serotonin level (PSL) depends directly on platelet serotonin uptake (PSU) through the plasma membrane, reports on their interrelation are inconsistent. The aim of this study was to systematically explore the relationship between these two platelet serotonin parameters in large human population.MethodsPSL and full-kinetics of PSU were determined on 318 blood donors (276 males, 42 females; 20–67 years).ResultsThe overall correlation coefficient between PSL and maximal velocity of PSU was highly significant but unexpectedly low (r = 0.269). Further analyses revealed lack of correlation among females, and variable association among males, depending on the subject age and season of measurements. Highly significant correlations were observed in spring–winter, while association was absent during summer–autumn. Lowering of PSL–PSU correlation with increased age was also demonstrated, showing modest interrelation among younger men and no interrelation in older population. By multiple regression analyses season was identified as the only independent predictor of PSL–PSU relationship.ConclusionsThe results show prominent influence of biological (sex, age) and, especially, environmental (seasons) physiology on the intraindividual relationship between PSL and PSU. Although serotonin transporter activity plays an important role in determining PSL, the observed correlations indicate that other factors may predominate.     

Comparing Forced-Air to Resistive-Polymer Warming for Perioperative Temperature Management: A Retrospective Study

PurposeCompare perioperative temperature management between forced-air warming (FAW) and resistive-polymer heating blankets (RHBs).DesignA retrospective, quasi-experimental study.MethodsRetrospective data analysis of nonspine orthopedic cases (N = 426) over a one-year period including FAW (n = 119) and RHBs (n = 307).FindingsFAW was associated with a significantly higher final intraoperative temperature (P = .001, d = 0.46) than the RHB. The incidence of hypothermia was not found to be significantly different at the end (P = .102) or anytime throughout surgery (P = .270). Of all patients who started hypothermic, the FAW group had a lower incidence of hypothermia at the end of surgery (P = .023).ConclusionsFAW was associated with higher final temperatures and a greater number of normothermic patients than RHBs. However, no causal relationship between a warming device and hypothermia incidence should be assumed.     

Domicile-related carbon monoxide poisoning in cold months and its relation with climatic factors

Background

Many studies have identified strong correlations between winter months and acute, unintentional carbon monoxide (CO) poisoning. In this study, we aimed to investigate the incidence pattern of acute domicile-related CO poisoning in Beijing and its relation with climatic factors.

Methods

Data on CO poisoning were collected from the emergency medical service system during August 1, 2005, to July 31, 2007, in Beijing. Variations of the monthly and seasonal distribution of CO poisoning occurrences were examined with χ² testing. Climatic data including temperature, barometric pressure, humidity, wind speed, and visibility were obtained from the Beijing Meteorological Bureau. Correlations between the occurrence of CO poisoning and mean of each meteorological parameter spanning 3 days were analyzed with partial correlation test, with related parameters controlled.

Results

Significant differences were found among the cases occurring each month of the year (P < .001). The monthly caseload reached the peak and the nadir in January and in September, respectively. During the cold period, 3331 patients were recorded, accounting for 88.4% of the total cases of the 2-year study period. Among the 5 climatic parameters, only temperature had a significant inverse correlation with the occurrence of CO poisoning (P < .001, r = –0.467).

Conclusions

The incidences of CO poisoning were highest during winter, particularly during the time period when charcoal or coal use for indoor heating would be most prevalent in Beijing.     

High respiratory effort decreases splanchnic and peripheral perfusion in patients with respiratory failure during mechanical ventilation

PurposeThis study aimed to evaluate the effects of high respiratory effort(HRE) on spleen, kidney, intestine, and peripheral perfusion in patients with respiratory failure during mechanical ventilation.MethodsHRE was defined as a pressure muscle index (PMI) > 6 cmH₂O and airway pressure swing during occlusion (ΔPOCC) > 10 cmH₂O. Capillary refill time(CRT) and peripheral perfusion index (PPI) were determined when HRE occurred. The resistance indices of the snuffbox, intestine, spleen, and kidney were measured using Doppler ultrasonography simultaneously. These parameters were re-measured when the patients had normal respiratory effort (NRE) following sedation and analgesia.ResultsA total of 33 critically ill patients were enrolled in this prospective observational study. There was a significant increase in CRT (p = 0.0345) and PPI (p < 0.0001) from HRE to NRE; meanwhile, the resistance index of the snuffbox artery decreased (p < 0.0001). Regarding splanchnic perfusion indicators, all resistance indices of the superior mesenteric artery (p = 0.0002), spleen (p < 0.0001), and kidney (p < 0.0001) decreased significantly when the patient changed from HRE status to NRE.ConclusionsHRE could decrease perfusion of peripheral tissues and splanchnic organs. The status of HRE should be avoided to protect splanchnic and peripheral organs in mechanically ventilated patients.