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Ethnopharmacological relevanceOphiocordyceps sinensis (O. sinensis), a genus of ascomycete fungi, has been widedly used in China as a dietary supplement or natural remedy and intensively studied in various disease models with its immunomodulatory potentials. It is a rich source of various bioactive compounds and used for treating end-stage renal disease. This systematic review with clinical evidence aimed to highlight the efficacy and safety of O. Sinensis as an adjuvant treatment for patients undergoing dialysis.Materials and methodsA systematic search through nine electronic databases up to 31 April 2024, was conducted for related studies. The Cochrane risk-of-bias tool was used to evaluate the quality of studies. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the certainty of evidence. Two researchers independently searched the literature and evaluated the risk of bias.ResultsAfter the screening, 35 randomized controlled trials (RCTs) involving 2,914 patients were eventually included. The meta-analysis showed that using O. sinensis effectively reduced the following outcomes in patients undergoing dialysis: C-reactive protein (15RCTs, MD = −2.22, 95% CI −3.24 to −1.20; very low certainty evidence); creatinine (22RCTs, MD =1.33, 95% CI −1.79 to −0.87; very low certainty evidence); blood urea nitrogen (21RCTs, MD = −1.57, 95% CI −2.07 to −1.07; low certainty evidence);. It could also effectively improve the following outcomes in patients undergoing dialysis: albumin (20RCTs, MD = −0.81, 95% CI −1.21 to −0.41; low certainty evidence); hemoglobin (19RCTs, MD = −1.00, 95% CI −1.43 to −0.57; low certainty evidence). The rate of adverse drug reactions was higher in the control group than in the experimental group (4RCTs, MD = 1.81, 95% CI 0.88–3.74).ConclusionThe current evidence indicates that patients with dialysis receiving O. sinensis in the adjuvant treatment may improve nutritional and micro-inflammatory status and renal function for both hemodialysis and peritoneal dialysis patients. However, some limitation affected the generalizability of our findings. High-quality studies evaluating mortality outcomes of patients with different dialytic modalities in CKD are warranted in future.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022324508, registration number CRD42022324508.

BackgroundSepsis-associated encephalopathy (SAE) occurs as a result of systemic inflammation caused by sepsis. It has been observed that the majority of sepsis patients experience SAE while being treated in the intensive care unit (ICU), and a significant number of survivors continue suffering from cognitive impairment even after recovering from the illness. The objective of this study was to create a predictive nomogram that could be used to identify SAE risk factors in patients with ICU sepsis.MethodsWe conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We defined SAE as a Glasgow Coma Scale (GCS) score of 15 or less, or delirium. The patients were randomly divided into training and validation cohorts. We used least absolute shrinkage and selection operator (LASSO) regression modeling to optimize feature selection. Independent risk factors were determined through a multivariable logistic regression analysis, and a prediction model was built. The performance of the nomogram was evaluated using various metrics including the area under the receiver operating characteristic curve (AUC), calibration plots, Hosmer-Lemeshow test, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).ResultsAmong the 4,476 sepsis patients screened, 2,781 (62.1%) developed SAE. In-hospital mortality was higher in the SAE group compared to the non-SAE group (9.5% vs. 3.7%, p