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Objective:To observe the dynamic changes of platelet counts in septic shock patients within first week, and to explore their predictive value for prognosis.Methods:Retrospective analysis of clinical data of patients with septic shock admitted to the department of intensive care unit (ICU) of the First Affiliated Hospital of University of Science and Technology of China from January 2020 to December 2021 was conducted. The baseline data on gender, age and primary diseases, clinical indicators on infection site, pathogenic microbial type, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA), laboratory indicators and the trend of platelet count (PLT) on day 1, 3, 5 and 7 admitting ICU and patients prognosis of in-hospital were collected. Binary Logistic regression was used to assess the independent risk factors of in-hospital death in septic shock patients. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive power of each index for in-hospital mortality.Results:A total of 193 patients with sepsis were enrolled. Among them, 73 patients died and 120 patients survived. Univariate analysis showed that the age, proportion of hypertension and respiratory system infection, APACHE Ⅱ score, SOFA score and blood lactic acid (Lac) in the death group were significantly higher than those in the survival group, while the proportion of urinary system infection, white blood cell (WBC) and neutrophil (NEU) were significantly lower in the death group. Within 7 days after admitting ICU, the platelet (PLT) firstly decreased and then rebounded in the survival group, whereas it's showed a continuous downward trend in the death group. And the PLT count in both day 5 and 7 were significantly higher in the survival group compared with the dead group [×10 9/L: 94.5 (54.0, 182.0) vs. 50.0 (30.5, 87.5), 135.0 (86.8, 205.8) vs. 46.0 (23.5, 71.5), all P < 0.05]. Multivariate binary Logistic regression analysis showed that age [odds ratio ( OR) = 1.059, 95% confidence interval (95% CI) was 1.002-1.118], hypertension ( OR = 6.108, 95% CI was 1.340-27.851), respiratory system infection ( OR = 5.300, 95% CI was 1.116-25.118), APACHE Ⅱ score ( OR = 1.158, 95% CI was 1.054-1.273), SOFA score ( OR = 1.494, 95% CI was 1.060-2.107) and PLT on day 7 after admitting ICU ( OR = 0.926, 95% CI was 0.894-0.958) were independent risk factors for in-hospital prognosis in septic shock patients (all P < 0.05). ROC analysis showed that APACHE Ⅱ score, SOFA score and PLT on day 7 after admitting ICU all had good predictive value for in-hospital prognosis in septic shock patients, and the area under the ROC curve (AUC) of PLT on day 7 (AUC = 0.899, 95% CI was 0.857-0.941) was significantly higher than that of APACHE Ⅱ score (AUC = 0.748, 95% CI was 0.680-0.816), SOFA score (AUC = 0.767, 95% CI was 0.702-0.833). Conclusions:Clinicians should pay close attention to the dynamic changes of platelet counts in septic shock patients, especially the platelet counts on day 7 after admitting ICU. And active intervention should be provided to improve the prognosis.
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Objective:To investigate the influence of hypomagnesemia on the prognosis of patients with severe sepsis.Methods:A retrospective study was conducted. The clinical data of 207 septic patients admitted to the department of critical care medicine of the First Affiliated Hospital of University of Science and Technology of China from January 1, 2016 to December 21, 2020 were analyzed, including gender, age and laboratory indicators within 24 hours after sepsis diagnosis [procalcitonin (PCT), C-reactive protein (CRP), blood lactic acid (Lac), pH value and blood magnesium, calcium, chlorine and phosphorus levels]. The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score and 28-day prognosis were collected. The patients were divided into survival group and non-survival group according to the prognosis, and the clinical data and laboratory indexes were compared between the two groups. Pearson correlation test was used to analyze the correlation between clinical indicators. Multivariate Logistic regression analysis was used to screen the risk factors affecting the prognosis. The receiver operator characteristic curve (ROC curve) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the potential prognostic indicators.Results:Among the 207 septic patients, 102 survived and 105 died on the 28th day, and the 28-day mortality was 50.72%. There were no significant differences in gender, age, CRP, pH value, blood chlorine or blood phosphorus levels between the two groups. The blood magnesium and blood calcium levels in the non-survival group were significantly lower than those in the survival group [blood magnesium (mmol/L): 0.68±0.14 vs. 0.80±0.12, blood calcium (mmol/L): 1.93±0.21 vs. 2.01±0.20, both P < 0.01], and PCT, Lac, APACHE Ⅱ score and SOFA score were significantly higher than those in the survival group [PCT (mg/L): 8.32 (1.64, 55.01) vs. 3.55 (0.97, 12.31), Lac (mmol/L): 2.90 (1.70, 4.30) vs. 2.10 (1.03, 3.89), APACHE Ⅱ score: 21.24±6.40 vs. 17.42±7.02, SOFA score: 9.14±3.55 vs. 6.91±3.31, all P < 0.01]. Among the 207 patients, 96 patients had normal blood magnesium level (0.75-1.25 mmol/L) and 111 patients had hypomagnesemia (< 0.75 mmol/L). The 28-day mortality of septic patients in the hypomagnesemia group was significantly higher than that in the normal magnesium group [61.26% (68/111) vs. 38.54% (37/96), P < 0.01]. Pearson correlation analysis showed that the blood magnesium level of sepsis patients was negatively correlated with PCT ( r = -0.173, P < 0.05), and it was positively correlated with APACHE Ⅱ score ( r = 0.159, P < 0.05), but it had no correlation with CRP or SOFA score ( r values were -0.029 and 0.091, both P > 0.05). Logistic regression analysis showed that serum magnesium, APACHE Ⅱ score and SOFA score were independent risk factors for 28-day death in patients with sepsis [serum magnesium: odds ratio ( OR) < 0.001, 95% confidence interval (95% CI) was 0.000-0.002, P < 0.001; APACHE Ⅱ score: OR = 1.092, 95% CI was 1.022-1.168, P = 0.010; SOFA score: OR = 1.168, 95% CI was 1.026-1.330, P = 0.019]. ROC curve analysis showed that blood magnesium and APACHE Ⅱ score had a certain predictive value for 28-day mortality in patients with severe sepsis [AUC (95% CI) was 0.723 (0.655-0.791) and 0.680 (0.607-0.754), respectively]. When the blood magnesium threshold was 0.64 mmol/L, the sensitivity was 41.0% and the specificity was 93.1%. When APACHE Ⅱ score threshold was 16.50, the sensitivity was 78.1% and the specificity was 55.9% indicating that the specificity of serum magnesium was higher than that of APACHE Ⅱ score. Conclusions:Severe septic patients complicated with hypomagnesemia have a poor prognosis. Serum magnesium level can be used as a prognostic indicator for severe septic patients.
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Tocilizumab has been reported to attenuate the "cytokine storm" in COVID-19 patients. We attempted to verify the effectiveness and safety of tocilizumab therapy in COVID-19 and identify patients most likely to benefit from this treatment. We conducted a randomized, controlled, open-label multicenter trial among COVID-19 patients. The patients were randomly assigned in a 1:1 ratio to receive either tocilizumab in addition to standard care or standard care alone. The cure rate, changes of oxygen saturation and interference, and inflammation biomarkers were observed. Thirty-three patients were randomized to the tocilizumab group, and 32 patients to the control group. The cure rate in the tocilizumab group was higher than that in the control group, but the difference was not statistically significant (94.12% vs. 87.10%, rate difference 95% CI-7.19%-21.23%, P = 0.4133). The improvement in hypoxia for the tocilizumab group was higher from day 4 onward and statistically significant from day 12 (P = 0.0359). In moderate disease patients with bilateral pulmonary lesions, the hypoxia ameliorated earlier after tocilizumab treatment, and less patients (1/12, 8.33%) needed an increase of inhaled oxygen concentration compared with the controls (4/6, 66.67%; rate difference 95% CI-99.17% to-17.50%, P = 0.0217). No severe adverse events occurred. More mild temporary adverse events were recorded in tocilizumab recipients (20/34, 58.82%) than the controls (4/31, 12.90%). Tocilizumab can improve hypoxia without unacceptable side effect profile and significant influences on the time virus load becomes negative. For patients with bilateral pulmonary lesions and elevated IL-6 levels, tocilizumab could be recommended to improve outcome.
Subject(s)
Humans , Antibodies, Monoclonal, Humanized , COVID-19/drug therapy , SARS-CoV-2 , Treatment OutcomeABSTRACT
Objective:To evaluate the diagnostic value of metagenomics next-generation sequencing (mNGS) in detecting pathogens in bronchoalveolar lavage fluid (BALF) for pulmonary infection in solid organ transplant patients in intensive care unit (ICU).Methods:A retrospective study was conducted, the BALF samples from 46 patients with post organ transplant pneumonia/suspected pneumonia admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of University of Science and Technology of China from August 2018 to August 2021 were collected, all tested by simultaneous mNGS and conventional comprehensive microbial test (CMT), and the results of CMT were used as the reference standard to compare the differences in the diagnostic value of mNGS and CMT for pulmonary infections in solid organ transplant patients, and to analyze the diagnostic value of mNGS for mixed infections.Results:① Pneumonia pathogens: a total of 31 pathogens were detected in 35 patients, including bacteria (16 species), fungi (9 species) and viruses (6 species). Among them, 25 pathogens were detected by mNGS and CMT, and only 19 pathogens were detected by mNGS. Among the microorganisms isolated by mNGS method, the detection rates of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae were higher [51.4%(18/35), 42.9% (15/35), 31.4% (11/35), respectively]; Candida albicans, Aspergillus and Pneumocystis carinii were the most commonly detected fungi [31.4% (11/35), 22.9% (8/35), 22.9% (8/35), respectively]; 20 patients were positive for the virus, and the most commonly detected viruses were cytomegalovirus, herpesvirus and EB virus [28.6% (10/35), 20.0% (7/35), 17.1% (6/35), respectively]. In addition, one case of Brucella was detected by mNGS.② Diagnostic efficiency: as far as bacterial detection is concerned, 20 cases of negative results were obtained by CMT detection of 35 samples included in the study, and a total of 10 cases of positive results were obtained by mNGS detection of negative samples; the percentage of mNGS positive samples was significantly higher than that of CMT positive samples [odds ratio ( OR) = 5.5, 95% confidence interval (95% CI) = 1.2-24.8, P = 0.02]. When compared with CMT, the sensitivity and specificity of mNGS were 93.3% and 50.0%, and the positive predictive value (PPV) and negative predictive value (NPV) were 58.3%, 91.1%. As far as fungal detection was concerned, there was no significant difference in the percentage of positive samples between the two methods ( OR = 1.5, 95% CI = 0.5-4.2, P = 0.60); the sensitivity and specificity of mNGS were 72.2% and 64.7%, and the PPV and NPV were 68.4%, 68.8%; CMT test of the 35 included samples produced 17 negative results, and mNGS test of the negative samples produced 6 positive results. A total of 20 patients tested positive for the virus by mNGS. In addition, 23 patients (65.7%) were diagnosed with pulmonary mixed infection. Conclusion:The use of mNGS to detect pathogens in BALF can improve the sensitivity and specificity of bacterial identification of pulmonary infection in critically ill organ transplant patients, and mNGS has obvious advantages in detecting virus and identifying mixed infections.
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Organ transplantation is an effective treatment for end-stage organ failure. However, organ shortage has always been a common problem faced by countries around the world. The recognition and active participation of intensive care unit (ICU) medical staff in organ donation contributes to promoting the development of organ donation, thereby alleviating the shortage of donor organ. In this article, the key strategies of ICU donor management to promote organ donation and the key strategies of ICU medical staff management to promote organ donation were summarized, aiming to provide reference for organ donation practitioners (especially ICU medical staff) and jointly facilitate the professional development of organ donation.
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Objective:To investigate the clinical characteristics of gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19) during the whole disease process, and provide reference for etiological diagnosis and treatment.Methods:The clinical data of patients with COVID-19 admitted in the Infectious Diseases Branch of the First Affiliated Hospital of University of Science and Technology of China from January 22nd, 2020 to March 8th, 2020 were analyzed retrospectively. According to whether there were gastrointestinal symptoms (poor appetite, nausea/vomiting and diarrhea), all patients were divided into gastrointestinal symptom group and asymptomatic group. The characteristics of gastrointestinal symptoms, such as poor appetite, nausea, vomiting and diarrhea were counted and analyzed, and the correlation between gastrointestinal symptoms and gender, age, basic diseases, disease severity, laboratory examination and drug treatment were analyzed.Results:A total of 80 COVID-19 patients were involved, 43 cases (53.8%) presented with poor appetite, 17 cases (21.3%) had nausea and vomiting, and 33 cases (41.3%) had diarrhea. Among them, 5 cases, 1 case and 4 cases respectively preformed poor appetite, nausea/vomiting and diarrhea before admission, while the others experienced gastrointestinal symptoms within 48 hours after admission. Duration of poor appetite, nausea/vomiting and diarrhea (days) of all patients were 5.3±2.1, 2.2±1.0 and 1.4±0.9, respectively. The patients with poor appetite were older than those without symptoms (years old: 48.2±17.6 vs. 39.3±15.1), albumin (Alb) level and the lymphocytes ratio were lower than those in asymptomatic group [Alb (g/L): 39.8 (35.7, 45.1) vs. 46.1 (42.6, 49.4), lymphocytes ratio: 0.19 (0.09, 0.28) vs. 0.28 (0.17, 0.35)], while the neutrophil ratio, the levels of C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) were higher than those in asymptomatic group [the neutrophil ratio: 0.74 (0.61, 0.85) vs. 0.64 (0.52, 0.76), CRP (mg/L): 21.4 (3.9, 52.9) vs. 5.6 (2.4, 14.0), D-dimer (mg/L): 0.2 (0.2, 0.5) vs. 0.2 (0.1, 0.3), LDH (μmol·s -1·L -1): 4.49 (3.59, 5.19) vs. 3.12 (2.77, 4.90)]; at the same time, more traditional Chinese medicine was used in the patients with gastrointestinal symptoms [65.1% (28/43) vs. 40.5% (15/37), all P < 0.05]. In addition, 14 cases of 18 patients with cardiovascular diseases presented with poor appetite, 7 patients had nausea and vomiting symptoms. All of the 3 patients with chronic kidney disease presented with poor appetite, nausea and vomiting, and 2 of them had diarrhea. Conclusions:The gastrointestinal symptoms in patients with COVID-19 are common. Whether it is caused by the virus or related drugs, diet and mental conditions, clinicians should analyze the causes of these symptoms timely, and then provide a better treatment for patients with COVID-19.
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Objective@#To evaluate the in vitro activity of ceftazidime-avibactam (CAZ-AVI) alone or in combination with colistin (COL) against clinically isolated extensively drug-resistant Pseudomonas aeruginosa (XDR-PA).@*Methods@#Minimum inhibitory concentration (MIC) of 16 clinical XDR-PA isolates was determined by broth dilution method and chessboard design when CAZ-AVI and COL were used alone or in combination, then the combined inhibitory concentration index (FICI) was calculated. Class A [Klebsiella pneumoniae carbapenemase β-lactamase (blaKPC), Guiana extended-spectrum β-lactamase (blaGES)], Class B [imipenemase β-lactamase (blaIMP), Verona-Integronmetallo β-lactamase (blaVIM), New Delhi metallo β-lactamase (blaNDM), German imipenemase β-lactamase (blaGIM), Sao Paulo metallo -β- lactamase (blaSPM)], Class C [AmpC β-lactamase (blaAmpC)], Class D [oxacillinase β-lactamase (blaOXA)] β- lactamase-related resistance genes were detected by polymerase chain reaction. Drug-resistant mutation frequencies of each strain were determined on a drug-containing plate. The time kill curves of three XDR-PA were plotted by colony counting method. A biofilm model was established in vitro, and the synergistic effect of CAZ-AVI and COL on biofilm inhibition was detected by methythiazolyl tetrazolium assay (MTT).@*Results@#The MICs of 16 XDR-PA for CAZ-AVI ranged from 1 mg/L to 128 mg/L, and three of the isolates showed resistance (MIC > 8 mg/L). The FICI range of CAZ-AVI combined with COL was 0.312-1.000. Four isolates were synergistic, while the other 12 isolates were additive. Three isolates resistant to CAZ-AVI contained Class B resistance genes such as blaIMP and blaVIM, while 13 susceptible isolates carried resistance genes belonging to Class A, C or D. The logarithm values of mutation frequencies of drug resistance in CAZ-AVI group, COL group and combination group were -4.81±0.88, -7.06±0.69 and -9.70 (-9.78, -9.53), respectively. There were significant differences among the three groups (H = 33.601, P < 0.001), and between every two groups (adjusted P < 0.05). In time kill curves, the phytoplankton load of three XDR-PA decreased more than 6 log CFU/L when these two drugs were used together, and number of PA1819 planktonic bacteria decreased more than 5.1 log CFU/L compared with monotherapy group. Viable quantity in biofilm (A490) of normal saline group, CAZ-AVI group, COL group and CAZ-AVI-COL group were 0.665±0.068, 0.540±0.072, 0.494±0.642 and 0.317±0.080, respectively. There was significant difference between the other two groups (all P < 0.001), except for that between CAZ-AVI group and COL group (P = 0.109).@*Conclusions@#CAZ-AVI combined with COL can effectively improve the bactericidal effect of each drug alone on XDR-PA. The regimen can also reduce the production of drug-resistant bacteria and inhibit the formation of biofilm. Therefore, it is a potential treatment for XDR-PA infection.
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Objective To evaluate the in vitro activity of ceftazidime-avibactam (CAZ-AVI) alone or in combination with colistin (COL) against clinically isolated extensively drug-resistant Pseudomonas aeruginosa (XDR-PA). Methods Minimum inhibitory concentration (MIC) of 16 clinical XDR-PA isolates was determined by broth dilution method and chessboard design when CAZ-AVI and COL were used alone or in combination, then the combined inhibitory concentration index (FICI) was calculated. Class A [Klebsiella pneumoniae carbapenemase β-lactamase (blaKPC), Guiana extended-spectrum β-lactamase (blaGES)], Class B [imipenemase β-lactamase (blaIMP), Verona-Integronmetallo β-lactamase (blaVIM), New Delhi metallo β-lactamase (blaNDM), German imipenemase β-lactamase (blaGIM), Sao Paulo metallo -β- lactamase (blaSPM)], Class C [AmpC β-lactamase (blaAmpC)], Class D [oxacillinase β-lactamase (blaOXA)] β- lactamase-related resistance genes were detected by polymerase chain reaction. Drug-resistant mutation frequencies of each strain were determined on a drug-containing plate. The time kill curves of three XDR-PA were plotted by colony counting method. A biofilm model was established in vitro, and the synergistic effect of CAZ-AVI and COL on biofilm inhibition was detected by methythiazolyl tetrazolium assay (MTT). Results The MICs of 16 XDR-PA for CAZ-AVI ranged from 1 mg/L to 128 mg/L, and three of the isolates showed resistance (MIC > 8 mg/L). The FICI range of CAZ-AVI combined with COL was 0.312-1.000. Four isolates were synergistic, while the other 12 isolates were additive. Three isolates resistant to CAZ-AVI contained Class B resistance genes such as blaIMP and blaVIM, while 13 susceptible isolates carried resistance genes belonging to Class A, C or D. The logarithm values of mutation frequencies of drug resistance in CAZ-AVI group, COL group and combination group were -4.81±0.88, -7.06±0.69 and -9.70 (-9.78, -9.53), respectively. There were significant differences among the three groups (H = 33.601, P < 0.001), and between every two groups (adjusted P < 0.05). In time kill curves, the phytoplankton load of three XDR-PA decreased more than 6 log CFU/L when these two drugs were used together, and number of PA1819 planktonic bacteria decreased more than 5.1 log CFU/L compared with monotherapy group. Viable quantity in biofilm (A490) of normal saline group, CAZ-AVI group, COL group and CAZ-AVI-COL group were 0.665±0.068, 0.540±0.072, 0.494±0.642 and 0.317±0.080, respectively. There was significant difference between the other two groups (all P < 0.001), except for that between CAZ-AVI group and COL group (P = 0.109). Conclusions CAZ-AVI combined with COL can effectively improve the bactericidal effect of each drug alone on XDR-PA. The regimen can also reduce the production of drug-resistant bacteria and inhibit the formation of biofilm. Therefore, it is a potential treatment for XDR-PA infection.
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Objective To evaluate the in vitro activity of ceftazidime-avibactam (CAZ-AVI) alone or in combination with colistin (COL) against clinically isolated extensively drug-resistant Pseudomonas aeruginosa (XDR-PA). Methods Minimum inhibitory concentration (MIC) of 16 clinical XDR-PA isolates was determined by broth dilution method and chessboard design when CAZ-AVI and COL were used alone or in combination, then the combined inhibitory concentration index (FICI) was calculated. Class A [Klebsiella pneumoniae carbapenemase β-lactamase (blaKPC), Guiana extended-spectrum β-lactamase (blaGES)], Class B [imipenemase β-lactamase (blaIMP), Verona-Integronmetallo β-lactamase (blaVIM), New Delhi metallo β-lactamase (blaNDM), German imipenemase β-lactamase (blaGIM), Sao Paulo metallo -β- lactamase (blaSPM)], Class C [AmpC β-lactamase (blaAmpC)], Class D [oxacillinase β-lactamase (blaOXA)] β- lactamase-related resistance genes were detected by polymerase chain reaction. Drug-resistant mutation frequencies of each strain were determined on a drug-containing plate. The time kill curves of three XDR-PA were plotted by colony counting method. A biofilm model was established in vitro, and the synergistic effect of CAZ-AVI and COL on biofilm inhibition was detected by methythiazolyl tetrazolium assay (MTT). Results The MICs of 16 XDR-PA for CAZ-AVI ranged from 1 mg/L to 128 mg/L, and three of the isolates showed resistance (MIC > 8 mg/L). The FICI range of CAZ-AVI combined with COL was 0.312-1.000. Four isolates were synergistic, while the other 12 isolates were additive. Three isolates resistant to CAZ-AVI contained Class B resistance genes such as blaIMP and blaVIM, while 13 susceptible isolates carried resistance genes belonging to Class A, C or D. The logarithm values of mutation frequencies of drug resistance in CAZ-AVI group, COL group and combination group were -4.81±0.88, -7.06±0.69 and -9.70 (-9.78, -9.53), respectively. There were significant differences among the three groups (H = 33.601, P < 0.001), and between every two groups (adjusted P < 0.05). In time kill curves, the phytoplankton load of three XDR-PA decreased more than 6 log CFU/L when these two drugs were used together, and number of PA1819 planktonic bacteria decreased more than 5.1 log CFU/L compared with monotherapy group. Viable quantity in biofilm (A490) of normal saline group, CAZ-AVI group, COL group and CAZ-AVI-COL group were 0.665±0.068, 0.540±0.072, 0.494±0.642 and 0.317±0.080, respectively. There was significant difference between the other two groups (all P < 0.001), except for that between CAZ-AVI group and COL group (P = 0.109). Conclusions CAZ-AVI combined with COL can effectively improve the bactericidal effect of each drug alone on XDR-PA. The regimen can also reduce the production of drug-resistant bacteria and inhibit the formation of biofilm. Therefore, it is a potential treatment for XDR-PA infection.
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Objective? To?estimate?the?incidence?and?risk?factors?for?deep?venous?thrombosis?(DVT)?in?patients?with?severe?traumatic?brain?injury?(TBI)?treated?in?the?intensive?care?unit?(ICU).? Methods? 105?patients?with?TBI?admitted?to?the?First?Affiliated?Hospital?of?University?of?Science?and?Technology?of?China?from?January?2016?to??June?2018?were?enrolled?[Glasgow?coma?scale?(GCS)?3-8;?concise?injury?score?for?other?parts≤3].?All?patients?did?not?receive?any?medication?or?physical?measures?to?prevent?DVT?during?hospitalization.?Bilateral?compression?Doppler?ultrasounds?of?the?double?lower?limbs?and?upper?limbs?were?performed?to?clarify?the?occurrence?of?DVT?on?the?first?day?of?admission?and?twice?a?week?until?ICU?discharge?or?the?death?of?patient.?The?examination?was?performed?by?a?senior?ultrasound?doctor.?It?was?defined?as?DVT?as?long?as?any?deep?vein?had?thrombosis.?Patients?were?divided?into?two?groups?according?to?whether?DVT?occurred?or?not?during?hospitalization.?Clinical?data?such?as?body?mass?index?(BMI),?coagulation?index,?platelet?count?(PLT)?and?deep?venous?catheterization?were?obtained?from?the?clinical?chemistry?laboratory?database?and?patient?files.?Logistic?regression?was?used?to?analyze?the?risk?factors?of?DVT.?Binary?Logistic?regression?was?used?to?calculate?the?predictive?probability?of?risk?factors.?The?predictive?value?of?risk?factors?and?predictive?probability?to?the?occurrence?of?DVT?was?analyzed?by?receiver?operating?characteristic?(ROC)?curve.? Results? In?105?patients?with?simple?TBI,?42?patients?developed?DVT?during?hospitalization,?and? the?incidence?of?DVT?was?40%.?Univariate?Logistic?regression?showed?that?high?BMI?[odds?ratio?(OR)?=?1.490,?95%?confidence?interval?(95%CI)?=?1.174-1.891,?P?=?0.001],?high?PLT?(OR?=?1.023,?95%CI =?1.006-1.040,?P =?0.007),?shorten?activated?partial?thromboplastin?time?(APTT;?OR?=?0.913,?95%CI?=?0.853-0.978,?P?=?0.010)?and?catheterization?in?deep?vein?(OR?=?0.114,?95%CI =?0.026-0.493,?P?=?0.004)?were?risk?factors?for?DVT.?It?was?shown?by?multivariate?regression?analysis?that?high?BMI?(OR?=?1.378,?95%CI =?1.411-1.665,?P?=?0.001),?high?PLT?(OR?=?1.017,?95%CI =?1.003-1.032,?P?=?0.020),?low?APTT?(OR =?0.920,?95%CI =?0.860-0.982,?P?=?0.012)?and?catheterization?in?deep?vein??(OR?=?0.113,?95%CI =?0.029-0.443,?P?=?0.002)?were?independent?risk?factors?for?DVT.?The?predictive?probability?formula:?Logit?P?=?-4.673+0.321×BMI－0.083×APTT+0.017×PLT－2.181×catheterization?in?deep?vein.?It?was?shown?by?ROC?curve?analysis?that?high?BMI,?high?PLT,?low?APTT?and?catheterization?in?deep?vein?could?predict?the?occurrence?of?DVT?in?severe?TBI?patients,?and?the?area?under?ROC?curve?(AUC)?was?0.775,?0.709,?0.709?and?0.680,?respectively.?The?AUC?of?prediction?probability?was?0.890,?and?its?sensitivity?and?specificity?were?respectively?increased?to?88.10%?and?85.71%.? Conclusions? The?incidence?of?DVT?was?higher?in?patients?with?simple?severe?TBI.?High?coagulation,?high?BMI,?high?PLT?and?catheterization?in?deep?vein?are?the?independent?risk?factors?for?DVT.
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Objective To investigate the effect of serum calcium level on the prognosis of patients with sepsis. Methods Clinical data of 119 patients with sepsis admitted to intensive care medicine (ICU) of the First Affiliated Hospital of the University of Science and Technology of China from January 2017 to October 2018 were retrospectively analyzed. Gender, age, and C-reactive protein (CRP), procalcitonin (PCT), serum calcium levels, acute physiology and chronic health evaluationⅡ(APACHEⅡ), sequential organ failure score (SOFA) within 24 hours of diagnosis, and 28-day mortality were collected. The patients were divided into the normal serum calcium group (serum calcium 2.00-2.67 mmol/L) and the hypocalcemia group (serum calcium < 2.00 mmol/L) according to their serum calcium level. The patients were divided into survival group and death group according to 28-day prognosis. Pearson correlation test was used to analyze the correlation between serum calcium level and clinical indicators. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum calcium level on prognosis. Results A total of 119 patients with sepsis were included, including 50 patients with normal serum calcium, with serum calcium level of (2.14±0.10) mmol/L; and 69 patients of hypocalcemia, and the incidence of hypocalcemia was 57.98%, with serum calcium level of (1.81±0.14) mmol/L. In the hypocalcemia group, except that the APACHEⅡ score was significantly higher than that of the normal serum calcium group (25.59±5.52 vs. 22.28±4.89, P < 0.01), there was no significant difference in gender, age, CRP, PCT and SOFA score between the two groups. The 28-day mortality rate of the hypocalcemia group was significantly higher than that of the normal serum calcium group [78.26% (54/69) vs. 48.00% (24/50), χ2 = 10.45, P < 0.01]. The level of serum calcium in the death group was significantly lower than that in the survival group (mmol/L: 1.90±0.20 vs. 2.04±0.19), while the APACHEⅡ score was significantly higher than the survival group (25.78±5.25 vs. 21.20±4.68), with statistically significant differences (both P < 0.01). There was a negative correlation between serum calcium level and PCT, APACHEⅡ scores in patients with sepsis (r1 = -2.10, P1 = 0.04;r2 = -3.91, P2 < 0.01), but no correlation with CRP and SOFA score (r1 = 0.75, P1 = 0.46; r2 = -1.21, P2 = 0.23). The ROC curve analysis showed that the area under the ROC curve (AUC) for predicting the prognosis of sepsis patients with serum calcium level was 0.70 [95% confidence interval (95%CI) = 0.602-0.798], and the best cut-off value was 1.92 mmol/L, with the sensitivity was 52.56%, and the specificity was 82.93%. Conclusions The prognosis of sepsis patients with hypocalcemia is poor. Serum calcium level can be used as a predictor of prognosis in patients with sepsis.
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Objective To investigate the effect of early rehabilitation physiotherapy on muscle quality and function in critical patients. Methods A prospective randomized controlled study was performed. Adult critically ill patients admitted to intensive care unit (ICU) of Anhui Provincial Hospital from October 1st, 2016 to August 31st, 2017 who had been hospitalized for more than 7 days and had acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ ) > 8 were enrolled, and they were divided into treatment group and control group according to random number table method. All patients were given routine treatment, and on this basis, the treatment group was given rehabilitation therapy within 24 hours after admission, including limb active / passive activities, respiratory muscle function training and transcutaneous electrical nerve stimulation, etc. Bedside ultrasound was used to measure the area and cross sectional thickness of left rectus femoris muscle and the cross sectional thickness of middle thigh muscle of patients at 1, 4 and 7 days after treatment; at the same time, the muscle strength of sober patients was evaluated by medical research council (MRC) muscle strength evaluation method, and the mechanical ventilation time, ICU hospitalization time and ICU expenses were recorded. Results Forty patients were enrolled in this study, with 20 in each group. Compared with the control group, the difference of left rectus femoris muscle area between 1 day and 4 days, 4 days and 7 days, 1 day and 7 days (cm2: 0.19±0.02 vs. 0.31±0.19, 0.02±0.01 vs. 0.08±0.05, 0.04±0.02 vs. 0.38±0.23), and the difference in left rectus femoris thickness (cm: 0.01±0.01 vs. 0.14±0.13, 0.03±0.03 vs. 0.16±0.14) and the difference in middle thigh muscle thickness (cm: 0.02±0.02 vs. 0.11±0.09, 0.03±0.02 vs. 0.16±0.12) between 1 day and 4 days, 1 day and 7 days in the treatment group were significantly reduced (all P <0.01). The MRC strength score in the treatment group was significantly higher than that of the control group at 7 days (52.06±3.52 vs. 47.94±3.96, P < 0.05). The mechanical ventilation time in the treatment group (n = 15) and the control group (n = 13) were (138.5±34.5) hours and (185.0±40.9) hours, respectively, and the difference between two groups were statistical significance (P < 0.05). Compared with the control group, the incidence rate of ICU acquired muscle weakness (ICUAW) in the treatment group was significantly decreased [5.0% (1/20) vs. 40.0% (8/20), P < 0.05], the length of ICU stay was significantly shortened (days: 17.67±4.91 vs. 22.06±5.94, P < 0.05), and the ICU expenses were significantly reduced (ten thousand yuan: 7.53±2.09 vs. 9.55±1.73, P < 0.05). Conclusion Early rehabilitation physiotherapy can improve the muscle quality and function in critical patients, and decrease the length of ICU stay.
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Objective To observe the variation tendency of laboratory indexes after delivery in pregnant women with acute fatty liver of pregnancy (AFLP) and the effects of plasma exchange (PE) on the patients prognoses and those parameters. Methods The data of 37 patients with AFLP admitted to the Department of Intensive Care Unit (ICU) of Anhui Provincial Hospital from January 2009 to June 2017 were retrospectively analyzed and the authors tried to clarify the natural course of AFLP; all the selected patients met the Swansea criteria of the AFLP diagnosis. The patients were divided into a PE group (9 cases) and a non-PE group (28 cases) according to whether they were treated with PE or not. At the same time, the effects of PE on liver function and coagulation parameters in the patients were analyzed. Results The most common clinical symptoms of 37 AFLP patients were as follows: nausea and vomiting (21 cases, incidence 56.8%), jaundice (21 cases, 56.8%), upper abdominal pain (14 cases, 37.8%), and more than 90% of patients had more than one symptom. All 37 patients with AFLP had abnormal liver function, their differences in the severity degrees were great, and the level of aspartate aminotransferase (AST) was (271.65±265.90) U/L;the levels of creatinine (SCr) of 72.9% patients (27 cases) were more than 140 mmol/L; the prothrombin times (PT) of 72.97% patients (27 cases) were more than 15 seconds; all patients had received blood product transfusion. Liver function and blood coagulation parameters mostly returned to normal within 1 week after delivery: AST rapidly decreased on the 1 - 2 days after delivery and then continued to decrease; all the cholesterol levels in the two groups decreased to the lowest levels within 3 - 4 days after delivery and then began to rise; the total bilirubin (TBil) levels kept on basically unchanging after delivery; in the patients with levels of platelet counts (PLT) on admission ≥ 150×109/L, on the second day after delivery, their counts returned to approximately 100×109/L, while in patients with PLT < 150×109/L on admission, on the sixth day after delivery, the counts began to slowly increase to about 100×109/L; the patients with fibrinogen (Fib) levels > 1.5 g/L on admission, the levels slightly decreased 2 days before delivery, then gradually recovered and stabilized after delivery, while the patients with Fib < 1.5 g/L, the levels began to rise slowly on the second day after delivery; prothrombin time (PT) and activated partial thromboplastin time (APTT) were basically return to the normal reference ranges on the fifth day after delivery. The PE therapy could significantly improve the patients' laboratory indexes: the levels of AST, TBil, PLT, PT were significant lower immediately and on the second day after PE compared with those levels before the PE [AST (U/L): 197 (114, 383), 116 (65, 311) vs. 239 (125, 430), TBil (μmol/L):109 (67, 126), 125 (103, 178) vs. 164 (99, 198), PLT (×109/L): 96.44±33.10, 89.89±33.03 vs. 126.22±40.83, PT (s): 17.82±5.93, 18.36±3.19 vs. 22.67±8.44, all P < 0.05]. Conclusion After terminating the delivery in time for about one week, the AFLP patients' various indexes may basically return to normal; PE therapy can improve the patients' liver function and coagulation indexes.
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Objective To evaluate the efficacy and safety of colistimethate sodium (CMS) for the treatment of critical patients infected by pan-drug resistantAcinetobacter baumannii (PDR-AB) or pan-drug resistant Pseudomonas aeruginosa (PDR-PA).Methods 321 isolates of PDR-AB and 204 isolates of PDR-PA from critical patients admitted to 35 intensive care units (ICUs) of grade two or above were collected from the Anhui Antimicrobial Resistance Investigation Net (AHARIN) program from September 2012 to September 2015, while the minimal inhibitory concentrations (MIC) of colistin were determined by the E-test. A series of Monte Carlo simulations was performed for CMS regimens (1 MU q8h, 2 MU q8h, and 3 MU q8h, and MU meant a million of unit), and the probability of achieving a 24-hour area under the drug concentration time curve (AUC24)/MIC ratio > 60 and risk of nephrotoxicity for each dosing regimen was calculated. Each simulation was run over three CLCr ranges: 32.51%). Moreover, low value of PTA ( 89.24%) even in patients with CLCr ≥ 90-120 mL/min, and PTA was 33.68%).Conclusion Measurement of MIC, individualized CMS therapy and therapeutic drug-level monitoring should be considered to achieve the optimal drug exposure and ensure the safety of CMS.
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Objective To investigate the possible mechanism of natural killer cells(NK cells)in immune dysfunction in sepsis by monitoring the phenotype and function of periphery NK cells in patients with sepsis. Methods A retrospective study was conducted. The patients with systemic inflammatory response syndrome(SIRS,n=59)or sepsis(n=65)admitted to Department of Critical Care Medicine of Anhui Provincial Hospital from August 2011 to August 2013 were enrolled. Blood samples were collected within 48 hours after intensive care unit(ICU)admission,the phenotype and function of periphery NK cells were determined by flow cytometry. Twenty-eight healthy people served as controls. Results The proportion and number of peripheral blood CD3-CD56+NK cells in SIRS and sepsis groups were normal,and no statistical difference was found when compared with those of the healthy control group〔cell proportion:0.102±0.019,0.102±0.108 vs. 0.106±0.018,F=0.018,P=0.982;cell number(×106/L):182.46±65.98, 172.97±63.51 vs. 179.25±60.44,F=0.349,P=0.706〕. It was shown by NK cell degranulation detection that there was no significant difference in the expression of CD107 and interferon-γ(IFN-γ)secretion〔CD107:0.135±0.050,0.140±0.058,0.128±0.070,F=0.583,P=0.560;IFN-γ(kU/L):14.36±4.74,12.49±4.21, 13.45±5.04,F=1.616,P=0.202〕among healthy control group,SIRS group,and sepsis group. It was shown by antibody dependent cytotoxic effect(ADCC)test that there was no difference in the expression of CD107 among healthy control group,SIRS group,and sepsis group(0.574±0.166,0.643±0.165,0.581±0.157,F=0.808,P=0.448). When compared with healthy controls,the secretion of IFN-γwas increased in SIRS patients(kU/L:40.5±13.2 vs. 28.4±9.6,P=0.001),while reduced in sepsis patients(kU/L:19.8±6.7 vs. 28.4±9.6,P<0.01). Compared with SIRS group,only NK cell surface inhibitory receptors CD158e(KIR 3DL1)expression in sepsis group was significantly increased(0.203±0.057 vs. 0.079±0.021,t=15.762,P<0.001),and there were no significant differences in the other phenotype between the two groups. Compared with SIRS group,the IFN-γproduction of the sepsis group was significantly lowered(kU/L:0.280±0.040 vs. 0.310±0.038,t=3.390,P=0.009),and the level of IL-12 was also significantly decreased(ng/L:0.15±0.03 vs. 0.30±0.08,t=32.832,P<0.001). Conclusion It was showed by NK cell phenotype and function assay that the function of NK cells in patients with sepsis was impaired and led to a poor production of IFN-γ. The IFN-γmediated immune dysfunction may be a main reason for the disorder of NK cell function,which laid the foundation of the clinical immune intervention practice to improve to NK cell function.
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Objective To investigate the effects of positive end-expiratory pressure (PEEP) on hemodynamics and intra-abdominal pressure in patients with acute respiratory distress syndrome (ARDS) with normal intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) during mechanical ventilation under a incremental PEEP.Methods Eighteen ARDS patients with normal IAP or IAH treated in intensive care unit of Anhui Provincial Hospital were enrolled for study.At different PEEP levels (5,10,15,20 cmH2O),hemodynamic parameters including extravascular lung water index (EVLWI),intrathoracic blood volume index (ITBVI),stroke volume variation (SVV) and IAP were measured with PICCO technology.Results Compared with ARDS patients with normal IAP,the ARDS patients with IAH were characterized by:(1) EVLWI was decreasing under the increment of PEEP,but there was no significant difference between 15 cmH2O and 20 cmH2O (t =0.593,P =0.572).As PEEP was gradually escalated,EWLVI had no significant changes in patients with normal IAP.(2) SVV increased as PEEP was being titrated to higher level in both groups but in normal IAP group such effect was observed till PEEP above 10cmH2O (PEEP5 vs.PEEP10,t=0.326,P=0.752; PEEP,10 vs.PEEP 15,t=-20.032,P＜ 0.01).(3) There was no statistical difference in ITBVI between two groups at varied levels of PEEP.(4) PEEP could increase IAP levels and had much more profound effects on patients with IAH.Conclusions PEEP is a contributing factor changing IAP.It is necessary to take the level of PEEP into account as IAP variation is interpreted in patients under mechanical ventilation.Different PEEP levels can significantly affect the EVLWI in patients with IAH but not do not in ones with nomal IAP.
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Objective To study the risk factors of severe acute pancreatitis(SAP) complicated with MODS at the early stage.Methods One hundred and seven SAP patients served as A group,who admitted from Janurary 1995 to December 1999.One hundred and thirty patients served as B group who admilted from Janurary 2000 to 2005.Age,sex,Ranson' score,APACHEⅡ ,CT score,biliary tract obstruction,hypoxia,lung infection,shock,abdomen compartment syndrome,hyperlipemia,pleural effusion,and mortality were analyzed.Results Twenty-five in the A group and 28 in B group two were complicated with MODS at the early stage.There existed difference in Ranson's score,APACHEⅡ,CT score between patients with and without MODS(P