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OBJECTIVE@#To investigate the correlation of hemoglobin (Hb) level with prognosis of elderly patients diagnosed as sepsis.@*METHODS@#A retrospective cohort study was conducted. Information on the cases of elderly patients with sepsis in the Medical Information Mart for Intensive Care-IV (MIMIC-IV), including basic information, blood pressure, routine blood test results [the Hb level of a patient was defined as his/her maximum Hb level from 6 hours before admission to intensive care unit (ICU) and 24 hours after admission to ICU], blood biochemical indexes, coagulation function, vital signs, severity score and outcome indicators were extracted. The curves of Hb level vs. 28-day mortality risk were developed by using the restricted cubic spline model based on the Cox regression analysis. The patients were divided into four groups (Hb < 100 g/L, 100 g/L ≤ Hb < 130 g/L, 130 g/L ≤ Hb < 150 g/L, Hb ≥ 150 g/L groups) based on these curves. The outcome indicators of patients in each group were analyzed, and the 28-day Kaplan-Meier survival curve was drawn. Logistic regression model and Cox regression model were used to analyze the relationship between Hb level and 28-day mortality risk in different groups.@*RESULTS@#A total of 7 473 elderly patients with sepsis were included. There was a "U" curve relationship between Hb levels within 24 hours after ICU admission and the risk of 28-day mortality in patients with sepsis. The patients with 100 g/L ≤ Hb < 130 g/L had a lower risk of 28-day mortality. When Hb level was less than 100 g/L, the risk of death decreased gradually with the increase of Hb level. When Hb level was ≥ 130 g/L, the risk of death gradually increased with the increase of Hb level. Multivariate Logistic regression analysis revealed that the mortality risks of patients with Hb < 100 g/L [odds ratio (OR) = 1.44, 95% confidence interval (95%CI) was 1.23-1.70, P < 0.001] and Hb ≥ 150 g/L (OR = 1.77, 95%CI was 1.26-2.49, P = 0.001) increased significantly in the model involving all confounding factors; the mortality risks of patients with 130 g/L ≤ Hb < 150 g/L increased, while the difference was not statistically significant (OR = 1.21, 95%CI was 0.99-1.48, P = 0.057). The multivariate Cox regression analysis suggested that the mortality risks of patients with Hb < 100 g/L [hazard ratio (HR) = 1.27, 95%CI was 1.12-1.44, P < 0.001] and Hb ≥ 150 g/L (HR = 1.49, 95%CI was 1.16-1.93, P = 0.002) increased significantly in the model involving all confounding factors; the mortality risks of patients with 130 g/L ≤ Hb < 150 g/L increased, while the difference was not statistically significant (HR = 1.17, 95%CI was 0.99-1.37, P = 0.053). Kaplan-Meier survival curve showed that the 28-day survival rate of elderly septic patients in 100 g/L ≤ Hb < 130 g/L group was significantly higher than that in Hb < 100 g/L, 130 g/L ≤ Hb < 150 g/L and Hb ≥ 150 g/L groups (85.26% vs. 77.33%, 79.81%, 74.33%; Log-Rank test: χ2 = 71.850, P < 0.001).@*CONCLUSIONS@#Elderly patients with sepsis exhibited low mortality risk if their 100 g/L ≤ Hb < 130 g/L within 24 hours after admission to ICU, and both higher and lower Hb levels led to increased mortality risks.
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Humans , Male , Female , Aged , Retrospective Studies , Sepsis/diagnosis , Critical Care , Intensive Care Units , Prognosis , Hemoglobins , ROC CurveABSTRACT
Sepsis is a systemic disease with severe health consequences, and it was redefined in 2016 as a life-threatening organ dysfunction caused by an abnormal host response to infection and is a global public health priority. In recent years, there has been increasing recognition of the role of dysregulated micronutrient iron metabolism in the pathogenesis of sepsis. The concept of ferroptosis, an iron-dependent, non-apoptotic mode of cell death characterized by the accumulation of lipid reactive oxygen species (ROS), was first proposed by Dixon et al. in 2012. As a novel mode of programmed cell death, ferroptosis differs in morphological and biochemical characteristics from various forms of cell death, such as apoptosis, autophagy, necrosis and lysis. Recent studies have shown that ferroptosis plays an important regulatory role in the development of sepsis and has become a research focus and highlight for the diagnosis and prognosis of related diseases. Therefore, this paper reviews the latest developments in ferroptosis in sepsis, in order to further understanding its pathogenesis and providing new therapeutic targets for sepsis-related organ dysfunction.
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Objective:To evaluate the effect of 2019 novel coronavirus inactivated vaccine on the disease severity of patients with Delta variant of coronavirus disease 2019.Methods:A retrospective analysis was performed on 704 patients with coronavirus disease 2019 infected with Delta variant who were older than 18 years old and admitted in the coronavirus disease 2019 designated hospital of Yangzhou (Subei Hospital New Area Branch) from July 2021 to September 2021. They were divided into severe (severe, critical) group and non-severe (light, ordinary) group according to the clinical characteristics of patients. According to the vaccination status, they were divided into 0-dose group, 1-dose group and 2-dose group. We evaluated the effects of vaccination on the severity of the disease and the production of antibodies, and analyzed the influencing factors leading to the severe group of coronavirus disease 2019.Results:The proportion of severe group in the 2-dose vaccinated group was significantly lower than that in the 1-dose vaccinated group and 0-dose vaccinated group [3.02% (7/232) vs. 9.48% (22/232), 15.83% (38/240), P < 0.05]. The time from onset to admission (day: 1.97±1.66 vs. 2.66±2.70), age (years: 45.3±12.2 vs. 63.6±17.0), direct bilirubin [DBil (μmol/L): 3.70±1.83 vs. 5.30±5.13], lactate dehydrogenase [LDH (U/L): 240.69±74.29 vs. 256.30±85.18], creatinine [SCr (μmol/L): 63.38±19.86 vs. 70.23±25.43], interleukin-6 [IL-6 (ng/L): 7.32 (1.54, 17.40) vs. 18.38 (8.83, 33.43)], creatine kinase [CK (U/L): 66.00 (43.00, 99.75) vs. 78.00 (54.50, 144.00)] and D-dimer [mg/L: 0.30 (0.08, 0.49) vs. 0.41 (0.23, 0.69)] of patients in the 2-dose group were significantly lower than those in the 0-dose group (all P < 0.05), while platelet [PLT (×10 9/L): 176.69±60.25 vs. 149.25±59.07], white blood cell count [WBC (×10 9/L): 5.43±1.77 vs. 5.03±1.88] and lymphocyte [LYM (×10 9/L): 1.34±0.88 vs. 1.17±0.50] were significantly higher than those in the 0-dose group (all P < 0.05). The titer of immunoglobulin G (IgG) in the 2-dose group was significantly higher than those in the 1-dose group and 0-dose group on the 10th day after admission [U/L: 130.94 (92.23, 326.31), 113.18 (17.62, 136.20), 117.85 (33.52, 156.73), both P < 0.05], and higher than 0-dose group on the 16th day [U/L: 156.12 (120.32, 167.76) vs. 126.52 (61.34, 149.57), P < 0.05]. The proportion of complete 2-dose vaccination [10.45% (7/67) vs. 35.32% (225/637)], LYM (×10 9/L: 1.09±0.32 vs. 1.25±0.56) and PLT (×10 9/L: 138.55±68.03 vs. 166.93±59.70) in the severe group were significantly lower than those in the non-severe group ( P < 0.05), while the time from onset to admission (day: 3.01±2.99 vs. 2.25±2.09), the length of hospital stay (day: 28±18 vs. 16±6), male proportion [77.61% (52/67) vs. 34.54% (220/637)], age (years: 69.13±12.63 vs. 52.28±16.53), DBil [μmol/L: 4.20 (3.18, 6.65) vs. 3.60 (2.80, 4.90], LDH (U/L: 310.61±98.33 vs. 238.19±72.14), SCr (μmol/L: 85.67±38.25 vs. 65.98±18.57), C-reactive protein [CRP (μmol/L): 28.12 (11.32, 42.23) vs. 8.49 (2.61, 17.58)], IL-6 [ng/L: 38.38 (24.67, 81.50) vs. 11.40 (4.60, 22.07)], CK [U/L: 140.00 (66.00, 274.00) vs. 72.80 (53.00, 11.00)] and the D-dimer [mg/L: 0.46 (0.29, 0.67) vs. 0.35 (0.19, 0.57)] in the severe group were significantly higher than those in the non-severe group (all P < 0.05). Multivariate regression analysis showed that the odds ratio ( OR) of severe group was 0.430 ( P = 0.010) in the 1-dose group and the 2-dose group compared with the 0-dose group. However, the risk of severe group was 0.381-fold in the 2-dose group compared with the 0-dose group [ OR = 0.381, 95% confidence interval (95% CI) was 0.121-1.199] which was not statistically significant, when the age was included in the regression analysis ( P > 0.05). PLT ( OR = 0.992, 95% CI was 0.986-0.998) were protective factors, but older than 60 years old ( OR = 3.681, 95% CI was 1.637-8.278), CK ( OR = 1.001, 95% CI was 1.000-1.001), IL-6 ( OR = 1.006, 95% CI was 1.002-1.010), SCr ( OR = 1.020, 95% CI was 1.007-1.033) were risk factors for severe group (all P < 0.05). Conclusions:Compared with the 0-dose vaccinated patients, the coronavirus disease 2019 patients infected with delta variant and fully vaccinated with 2-dose 2019 novel coronavirus inactivated vaccine had lower level of IL-6, SCr, CK and D-dimer, and higher PLT, LYM and IgG titer, who were not easy to develop into the severe condition.
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Objective:To investigate the epidemiological characteristics of septic cardiomyopathy and explore the relationship between the relevant indexes measured by echocardiography and the prognosis of patients with sepsis.Methods:A case-control study was conducted. The data of patients with sepsis admitted to the department of critical care medicine of Jiangsu Subei People's Hospital Affiliated to Yangzhou University and the department of critical care medicine of Beijing Electric Power Hospital of State Grid Corporation of China from June 2018 to June 2021 were enrolled. The general information and 28-day prognosis were recorded. At the same time, ultrasonic parameters obtained by transthoracic echocardiography within 24 hours after intensive care unit (ICU) admission were recorded. The differences in ultrasound indexes between the death group and the survival group on 28 days were compared. Parameters with significant statistical differences between the death group and the survival group were included in the Logistic regression analysis to find the independent risk factors for the prognosis of patients with sepsis, the predictive value of each index for the prognosis of patients with sepsis was evaluated by receiver operator characteristic curve (ROC curve).Results:A total of 145 patients with sepsis were enrolled, including 106 patients with septic shock. Among the 145 patients, septic cardiomyopathy was found in 73 patients, with the incidence of 50.3%. The incidence of left ventricular diastolic dysfunction cardiomyopathy was 41.4% ( n = 60), the incidence of left ventricular systolic dysfunction cardiomyopathy was 24.8% ( n = 36), and the incidence of right ventricular systolic dysfunction cardiomyopathy was 12.4% ( n = 18). At 28 days, 98 patients survived and 47 died, with the mortality of 32.4%. The peak e' velocity by tissue Doppler imaging (e') and right ventricular myocardial systolic tricuspid annulus velocity (RV-Sm) of the death group were significantly lower than those of the survival group [e' (cm/s): 7.81±1.12 vs. 8.61±1.02, RV-Sm (cm/s): 12.12±2.04 vs. 13.73±1.74, both P < 0.05], left ventricular ejection fraction (LVEF) and left ventricular systolic mitral annulus velocity (LV-Sm) in the death group were slightly higher than those in the survival group [LVEF: 0.550±0.042 vs. 0.548±0.060, LV-Sm (cm/s): 8.92±2.11 vs. 8.23±1.71], without significant differences (both P > 0.05). Parameters with significant statistical differences between the two groups were included in the Logistic regression analysis and showed that e' and RV-Sm were independent risk factors for the 28-day prognosis of patients with sepsis [e': odds ratio ( OR) = 0.623, 95% confidence interval (95% CI) was 0.410-0.947, P = 0.027; RV-Sm: OR = 0.693, 95% CI was 0.525-0.914, P = 0.010]. ROC curve analysis showed that the area under the ROC curve (AUC) of e' for predicting the 28-day prognosis of patients with sepsis was 0.657, 95% CI was 0.532-0.781, P = 0.016, the best cut-off value was 8.65 cm/s, the sensitivity was 62.1%, and the specificity was 73.4%. The AUC of RV-Sm for predicting the 28-day prognosis of patients with sepsis was 0.641, 95% CI was 0.522-0.759, P = 0.030, the best cut-off value was 14.80 cm/s, the sensitivity was 96.6%, and the specificity was 26.6%. Conclusions:The incidence of septic cardiomyopathy is high. The LVEF measured by early echocardiography has no predictive value for 28-day prognosis in septic patients, while RV-Sm and e' are important predictors for 28-day prognosis.
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Objective:Sepsis patients usually have a fever, but it is still controversial about whether sepsis patients with fever need cooling treatment. This study aimed to evaluate the effect of external physical cooling on the prognosis of sepsis patients.Methods:This study was a single-center, open-label, randomized clinical trial. Adult sepsis patients with body temperature above 38.3 °C admitted to the Critical Care Medicine of Northern Jiangsu People's Hospital from June 2020 to December 2020 were selected, and randomly assigned in a 1∶1 ratio to the cooling group and control group. Patients in the cooling group used external physical cooling methods to reduce their core body temperature to the normal range (36.5-37.5°C) within 4 h of enrollment and maintained for 48 h. Standard care was implemented in the control group at all times, and all antipyretic treatments were prohibited. The 28-day mortality, 72 h-Δ sequential organ failure assessment (SOFA) score (SOFA score at enrollment–SOFA score after 72 h), length of hospital stay and length of ICU stay were compared between the two groups.Results:A total of 53 patients (32 males and 21 females) were enrolled in the study, including 26 patients in the cooling group and 27 patients in the control group. There were no statistical differences in age, sex, source of infection, SOFA score and body temperature between the two groups (all P>0.05). There was no significant difference in the 28-day mortality between the cooling group and the control group ( RR=1.38, 95% CI: 0.62-3.07, P=0.430). The 72 h-ΔSOFA score of the cooling group was significantly higher than that of the control group, the mean difference between the two groups was 1.90 (95% CI: 0.09-3.71, P=0.040), and there was no significant difference in length of hospital stay, length of ICU stay and 28-day mortality between the two groups. Conclusions:External physical cooling management can not significantly reduce the 28-day mortality of sepsis patients. However, external physical cooling can reduce the 72-h SOFA score in sepsis patients, and improve the organ function of patients.
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Objective:To investigate the risk factors and prognosis of early septic shock-related thrombocytopenia.Methods:Retrospective analysis of clinical data of patients with septic shock admitted to the department of intensive care unit (ICU) of Northern Jiangsu People's Hospital from June 2016 to November 2020 was conducted. According to the lowest platelet count (PLT) in the early stage of septic shock (within 24 hours of using vasoactive drugs), the patients were divided into mild thrombocytopenia group [PLT (50-100)×10 9/L], severe thrombocytopenia group (PLT < 50×10 9/L) and normal platelet group (PLT > 100×10 9/L). The differences in general information, laboratory indicators, mechanical ventilation time, length of ICU stay, in-hospital stay, and 28-day mortality among the three groups were analyzed. Multivariate Logistic regression was used to analyze the influencing factors of thrombocytopenia, and the 28-day Kaplan-Meier survival curve of patients with different PLT levels was drawn. Results:A total of 486 patients with septic shock were enrolled, including 123 patients with mild thrombocytopenia, 75 patients with severe thrombocytopenia and 288 patients with normal platelets. Patients with diabetes ( χ2 = 30.460, P < 0.001), abdominal infection ( χ2 = 15.024, P = 0.001), urinary tract infection ( χ2 = 36.633, P < 0.001), bloodstream infection ( χ2 = 7.755, P = 0.022), Gram negative (G -) bacilli infection ( χ2 = 19.569, P < 0.001), hyperlactic acidemia ( H = 23.404, P < 0.001), elevated procalcitonin (PCT, H = 43.368, P < 0.001), high acute physiology and chronic health evaluation Ⅱ (APACHEⅡ, F = 11.122, P < 0.001) and high sequential organ failure assessment (SOFA, F = 84.328, P < 0.001) were more likely to have thrombocytopenia within 24 hours of septic shock. Multivariate Logistic regression analysis of early septic shock-related thrombocytopenia showed that, diabetes [odds ratio ( OR) = 0.19, 95% confidence interval (95% CI) was 0.08-0.42, P < 0.001], urinary tract infection ( OR = 0.33, 95% CI was 0.13-0.83, P = 0.018), G - bacilli infection ( OR = 0.20, 95% CI was 0.07-0.58, P = 0.003), hyperlactic acidemia ( OR = 1.25, 95% CI was 1.07-1.46, P = 0.005) and high APACHEⅡ score ( OR = 0.85, 95% CI was 0.78-0.92, P < 0.001) were independent risk factors for platelets < 50×10 9/L. Abdominal infection was an independent risk factor for PLT (50-100)×10 9/L ( OR = 0.56, 95% CI was 0.34-0.95, P = 0.03). High SOFA score was an independent risk factor for PLT ≤ 100×10 9/L [PLT < 50×10 9/L: OR = 2.03, 95% CI was 1.65-2.52, P < 0.001; PLT (50-100)×10 9/L: OR = 1.31, 95% CI was 1.16-1.48, P < 0.001]. There were no significant differences in mechanical ventilation time, length of ICU stay, and in-hospital stay among the three groups ( H values were 0.142, 2.134, and 3.990, respectively, all P > 0.05). The 28-day mortality of septic shock patients increased with the severity of thrombocytopenia ( χ2 = 40.406, P < 0.001), and the 28-day mortality of severe thrombocytopenia group and mild thrombocytopenia group was significantly higher than those of the normal platelet group [66.7% (50/75), 43.1% (53/123) vs. 27.8% (80/288), both P < 0.05]. Kaplan-Meier survival curve analysis showed that the 28-day survival rate gradually decreased with the decrease of PLT, and the 28-day survival rate was higher in the normal platelet group (Log-Rank test: χ2 = 80.667, P < 0.001). Conclusions:Diabetes, abdominal infection, urinary tract infection, G - bacilli infection, hyperlactic acidemia, high APACHEⅡ score, and high SOFA score are independent risk factors for early septic shock-related thrombocytopenia. Early thrombocytopenia in patients with septic shock indicates a high risk of 28-day death.
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Objective:To explore the value of Sepsis-3 standard in diagnosis of patients with sepsis.Methods:Patients who were infected or suspected of infection in intensive care unit (ICU) of six hospitals in Jiangsu Province from September 2017 to August 2018 were enrolled. They were divided into four groups: group A was in accordance with Sepsis-1 and Sepsis-3, group B only met the Sepsis-1 standard, group C only met the Sepsis-3 standard, and both Sepsis-1 and Sepsis-3 standard did not match in group D. The age, gender, underlying disease, diagnosis and source of infection, vital signs within 24 hours of ICU, systemic inflammatory response syndrome (SIRS) score, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, quick sequential organ failure assessment (qSOFA) score, the length of ICU stay, total hospitalization time, 28-day mortality rate, etc. were recorded. The above collected data were compared and analyzed in groups, and the receiver operating characteristic (ROC) curves of each scoring standard were drawn and calculated. The area under the ROC curve (AUC), and the Youden index of each score was calculated to predict the optimal cut-off value of 28-day mortality in patients with sepsis and its corresponding sensitivity and specificity. Results:A total of 527 patients with infection or suspected infection were enrolled in the study, including 324 patients in group A, 113 patients in group B, 22 patients in group C, 68 patients in group D, and 28-day mortality were 38.9%, 17.7%, 31.8%, and 11.8%, respectively, and there was statistically significant difference among four groups ( P < 0.05). The SIRS scores of the A, B, C, D groups were 3 (1), 2 (1), 1 (0), 1 (0), APACHEⅡ scores were 17 (10), 11 (10), 15 (8), 12 (8), qSOFA score were 2 (1), 1 (1), 1 (1), 1 (2), SOFA scores were 8 (6), 1 (0), 7 (4), 1 (0), respectively, there were statistically significant differences among four group (all P < 0.05). Values of SOFA, qSOFA and SIRS scores were evaluated by ROC to predict the value of 28-day mortality. The results showed that AUC and 95% confidence interval of SOFA score was superior to qSOFA score and SIRS score [0.71 (0.66-0.76) vs. 0.59 (0.55-0.64), 0.57 (0.51-0.62), both P < 0.01]. According to the Youden index, the best cut-off values for the 28-day mortality of SOFA, qSOFA and SIRS scores for sepsis were 7, 2 and 2, respectively, and the sensitivity was 69.4%, 60.1%, 53.6%, the specificity was 61.8%, 76.2%, 51.1%, respectively. Conclusions:The Sepsis-3 standard is superior to the Sepsis-1 standard in the diagnosis and prediction of 28-day mortality in patients with sepsis. qSOFA can be used as an early tool for rapid screening of patients with high-risk sepsis in the ICU bedside.
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Objective To evaluate microcirculatory changes after bundle therapy and prognostic values of the ratio of transcutaneous oxygen pressure and transcutaneous carbon dioxide pressure (PtcO2/PtcCO2) in the treatment of septic shock. Methods A retrospective analysis was conducted. Patients with septic shock admitted to department of intensive care unit (ICU) of Northern Jiangsu People's Hospital from July 2017 to February 2019 were enrolled. The gender, age, infection site, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), the length of ICU stay and 28-day prognosis were collected; PtcCO2, PtcO2, PtcO2/PtcCO2 ratio, arterial lactate (Lac), central venous oxygen saturation (ScvO2), mean arterial pressure (MAP) were measured before treatment (at admission) and 6 hours after bundle treatment. According to the 28-day prognosis, the patients were divided into survival group and death group, and the differences of each index between the two groups were compared. The risk factors of prognosis were analyzed by binaryLogistic regression analysis. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the related indicators for the 28-day mortality of septic shock patients. Results A total of 78 patients with septic shock were enrolled, with 47 cases in survival group and 31 cases in death group. Compared with survival group, APACHEⅡ score and PtcCO2 were higher and PtcO2/PtcCO2 ratio was lower in death group [APACHEⅡ:28.33±6.35 vs. 21.61±6.64, PtcCO2 (mmHg, 1 mmHg = 0.133 kPa): 51.80±19.05 vs. 38.17±6.79, PtcO2/PtcCO2 ratio: 1.20±0.72 vs. 1.80±0.81, all P < 0.05]. Compared with before treatment, the PtcO2/PtcCO2 ratio, Lac, MAP were substantially improved at 6 hours of bundle therapy [PtcO2/PtcCO2 ratio: 1.76±0.81 vs. 1.56±0.82, Lac (mmol/L):3.74±2.40 vs. 4.42±2.60, MAP (mmHg): 83.34±7.58 vs. 71.00±5.36, all P < 0.05], and there was no changes in PtcCO2 and ScvO2. The PtcO2/PtcCO2 ratio at 6 hours of bundle therapy in the survival group was significantly higher than before treatment and was higher than that in death group (2.13±0.75 vs. 1.80±0.81, 1.19±0.53, both P < 0.05). There was no significant difference in PtcO2/PtcCO2 ratio of death group before and after treatment (1.19±0.53 vs. 1.20±0.72, P > 0.05). The binary Logistic regression showed that PtcO2/PtcCO2 ratio at 6 hours of bundle therapy and APACHEⅡ score were risk factors of prognosis [PtcO2/PtcCO2 ratio: odds ratio (OR) = 7.876, P = 0.026; APACHEⅡscore: OR = 0.846, P = 0.035]. ROC curve analysis showed that 6-hour of PtcO2/PtcCO2 ratio, APACHEⅡscore and 6-hour Lac level could predict 28-day mortality in septic shock patients, and the area under curve (AUC) was 0.864, 0.784, and 0.752 respectively. The cut-off value of 6-hour PtcO2/PtcCO2 ratio for predicting mortality in septic shock patients was 1.42, the sensitivity was 87.0％, and the specificity was 73.3％. In addition, the patients were divided into two groups according to whether the 6-hour PtcO2/PtcCO2 ratio was greater than 1.42. The results showed that: compared with the PtcO2/PtcCO2 < 1.42 group, the APACHEⅡ score in PtcO2/PtcCO2 ≥ 1.42 group was lower, the 6-hour Lac level was lower, 24-hour Lac reaching standard rate was higher and the 28-day mortality was lower. Conclusions Compared with the traditional metabolic parameters, the improvement of early microcirculatory perfusion in patients with septic shock can reflect the effect of bundle therapy. The PtcO2/PtcCO2 ratio at 6 hours of bundle therapy can be used as a new index to predict the prognosis of patients with septic shock which supports the monitoring and evaluation of microcirculation in the early stage of treatment in septic shock.
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Objective@#To evaluate microcirculatory changes after bundle therapy and prognostic values of the ratio of transcutaneous oxygen pressure and transcutaneous carbon dioxide pressure (PtcO2/PtcCO2) in the treatment of septic shock.@*Methods@#A retrospective analysis was conducted. Patients with septic shock admitted to department of intensive care unit (ICU) of Northern Jiangsu People's Hospital from July 2017 to February 2019 were enrolled. The gender, age, infection site, acute physiology and chronic health evaluationⅡ (APACHEⅡ), the length of ICU stay and 28-day prognosis were collected; PtcCO2, PtcO2, PtcO2/PtcCO2 ratio, arterial lactate (Lac), central venous oxygen saturation (ScvO2), mean arterial pressure (MAP) were measured before treatment (at admission) and 6 hours after bundle treatment. According to the 28-day prognosis, the patients were divided into survival group and death group, and the differences of each index between the two groups were compared. The risk factors of prognosis were analyzed by binary Logistic regression analysis. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the related indicators for the 28-day mortality of septic shock patients.@*Results@#A total of 78 patients with septic shock were enrolled, with 47 cases in survival group and 31 cases in death group. Compared with survival group, APACHEⅡ score and PtcCO2 were higher and PtcO2/PtcCO2 ratio was lower in death group [APACHEⅡ: 28.33±6.35 vs. 21.61±6.64, PtcCO2 (mmHg, 1 mmHg = 0.133 kPa): 51.80±19.05 vs. 38.17±6.79, PtcO2/PtcCO2 ratio: 1.20±0.72 vs. 1.80±0.81, all P < 0.05]. Compared with before treatment, the PtcO2/PtcCO2 ratio, Lac, MAP were substantially improved at 6 hours of bundle therapy [PtcO2/PtcCO2 ratio: 1.76±0.81 vs. 1.56±0.82, Lac (mmol/L): 3.74±2.40 vs. 4.42±2.60, MAP (mmHg): 83.34±7.58 vs. 71.00±5.36, all P < 0.05], and there was no changes in PtcCO2 and ScvO2. The PtcO2/PtcCO2 ratio at 6 hours of bundle therapy in the survival group was significantly higher than before treatment and was higher than that in death group (2.13±0.75 vs. 1.80±0.81, 1.19±0.53, both P < 0.05). There was no significant difference in PtcO2/PtcCO2 ratio of death group before and after treatment (1.19±0.53 vs. 1.20±0.72, P > 0.05). The binary Logistic regression showed that PtcO2/PtcCO2 ratio at 6 hours of bundle therapy and APACHEⅡ score were risk factors of prognosis [PtcO2/PtcCO2 ratio: odds ratio (OR) = 7.876, P = 0.026; APACHEⅡ score: OR = 0.846, P = 0.035]. ROC curve analysis showed that 6-hour of PtcO2/PtcCO2 ratio, APACHEⅡscore and 6-hour Lac level could predict 28-day mortality in septic shock patients, and the area under curve (AUC) was 0.864, 0.784, and 0.752 respectively. The cut-off value of 6-hour PtcO2/PtcCO2 ratio for predicting mortality in septic shock patients was 1.42, the sensitivity was 87.0%, and the specificity was 73.3%. In addition, the patients were divided into two groups according to whether the 6-hour PtcO2/PtcCO2 ratio was greater than 1.42. The results showed that: compared with the PtcO2/PtcCO2 < 1.42 group, the APACHEⅡ score in PtcO2/PtcCO2 ≥ 1.42 group was lower, the 6-hour Lac level was lower, 24-hour Lac reaching standard rate was higher and the 28-day mortality was lower.@*Conclusions@#Compared with the traditional metabolic parameters, the improvement of early microcirculatory perfusion in patients with septic shock can reflect the effect of bundle therapy. The PtcO2/PtcCO2 ratio at 6 hours of bundle therapy can be used as a new index to predict the prognosis of patients with septic shock which supports the monitoring and evaluation of microcirculation in the early stage of treatment in septic shock.
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Objective To compare the effect of 0.9％ NaCl solution, Ringer solution, and acetate sodium potassium magnesium calcium glucose solution (ASPMCG solution) on internal environment in patients with septic shock receiving early fluid resuscitation.Methods A prospective randomized controlled trial was conducted. From June 2016 to January 2018, a total of 280 patients with septic shock admitted to intensive care unit (ICU) of Northern Jiangsu People's Hospital were enrolled. All eligible patients were randomly divided into 0.9％ NaCl solution group (group N), Ringer solution group (group L) and ASPMCG solution group (group P) with random number table. In all patients, catheters were placed in the right internal jugular vein or subclavian vein and were infused with 30 mL/kg of corresponding crystalloid within 3 hours after admission. According to fluid responsiveness, the rehydration rate and fluid volume were determined by the researcher within 6 hours. Other treatments were based on the 2012 Surviving Sepsis Campaign (SSC) guidelines during the study. In this study, 6-hour or 24-hour fluid volume and 7-day exogenous insulin use were recorded. The changes in arterial blood pH, base excess (BE), blood glucose (Glu), lactic acid (Lac), and serum Na+, K+, Cl-, Ca2+ were observed at 0, 3, 6, 24 hours, and 3 days and 7 days of resuscitation.Results In this study, a total of 1082 patients were admitted to the ICU, and patients who did not meet the diagnostic criteria for septic shock, death or discharge within 24 hours of ICU admission were excluded. Finally, 280 patients with septic shock were enrolled in the analysis, with 94 patients in group N, 94 patients in group L and 92 patients in group P. There was [Abstract] Objective To compare the effect of 0.9％ NaCl solution, Ringer solution, and acetate sodium potassium magnesium calcium glucose solution (ASPMCG solution) on internal environment in patients with septic shock receiving early fluid resuscitation.Methods A prospective randomized controlled trial was conducted. From June 2016 to January 2018, a total of 280 patients with septic shock admitted to intensive care unit (ICU) of Northern Jiangsu People's Hospital were enrolled. All eligible patients were randomly divided into 0.9％ NaCl solution group (group N), Ringer solution group (group L) and ASPMCG solution group (group P) with random number table. In all patients, catheters were placed in the right internal jugular vein or subclavian vein and were infused with 30 mL/kg of corresponding crystalloid within 3 hours after admission. According to fluid responsiveness, the rehydration rate and fluid volume were determined by the researcher within 6 hours. Other treatments were based on the 2012 Surviving Sepsis Campaign (SSC) guidelines during the study. In this study, 6-hour or 24-hour fluid volume and 7-day exogenous insulin use were recorded. The changes in arterial blood pH, base excess (BE), blood glucose (Glu), lactic acid (Lac), and serum Na+, K+, Cl-, Ca2+ were observed at 0, 3, 6, 24 hours, and 3 days and 7 days of resuscitation.Results In this study, a total of 1082 patients were admitted to the ICU, and patients who did not meet the diagnostic criteria for septic shock, death or discharge within 24 hours of ICU admission were excluded. Finally, 280 patients with septic shock were enrolled in the analysis, with 94 patients in group N, 94 patients in group L and 92 patients in group P. There was no significant difference in the amount of crystalloid, colloidal fluid, total fluid within 6 hours or 24 hours or exogenous insulin dose within 7 days among the three groups. After fluid resuscitation, blood Cl- concentration in the three groups was increased in different degrees, peaked at 24 hours, but it in group N was significantly higher than that in group L and group P (mmol/L: 107.5±5.6 vs. 106.1±4.8, 105.1±4.2, bothP ﹤ 0.05). Moreover, blood Ca2+concentration also showed an increased tendency, it was significantly lower at 3 hours and 6 hours in group N than that in group L and group P (mmol/L: 1.10±0.08 vs. 1.15±0.09, 1.12±0.10 at 3 hours, 1.12±0.10 vs. 1.16±0.08, 1.15±0.09 at 6 hours, all P < 0.05). There was no significant difference in blood Cl- or Ca2+between groups L and P (bothP > 0.05). Arterial blood pH, BE, Glu, Lac, Na+, or K+at each time point during fluid resuscitation also showed no difference among the three groups.Conclusion Among patients with septic shock receiving early fluid resuscitation, compared with Ringer solution and ASPMCG solution, 0.9％ NaCl solution may cause hyperchloremia and hypocalcemia, but has no significant effect on acid-base balance.Clinical Trial Registration Chinese Clinical Trial Registry, ChiCTR-IOR-16009176.
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Objective To explore the correlations of extravascular lung water index (ELWI),oxygenation index and intrathoracic blood volume index (ITBI) in patients with acute exacerbation chronicobstructive pulmonary disease (AECOPD) and examine the significance of ELWI in fluid management.Methods A total of 63 hospitalized AECOPD patients with respiratory failure were recruited from our hospital from October 2010 to April 2013.Pulse indicator continuous cardiac output (PiCCO) technology was employed to monitor ITBI and ELWI.We compared the relationship of ELWI,ITBI and oxygenation index.And simple correlation analysis was used for statistical processing.Results Significant negative correlation existed in ELWI and oxygenation index (r =-0.741,P ＜ 0.01).ELWI 14 ml/kg was defined as a cutoff value for subgroup analysis.A negative correlation existed between ELWI and oxygenation index in the subgroup with ELWI ＜ 14 ml/kg,but there was no significant difference (r =-0.524,P =0.080) ; in the subgroup with ELWI ≥ 14 ml/kg,there was significant negative correlation (r =-0.952,P ＜ 0.01).No significant correlation existed between ELWI and ITBI (r =0.477,P =0.072).ITBI 1 000 ml/m2 was defined as a cutoff value for subgroup analysis.No significant difference existed in the subgroup with ITBI ＜ 1 000 ml/m2 (r =0.332,P =0.117).However,significant positive correlation existed in the subgroup with ITBI≥ 1 000 ml/m2 (r =0.677,P ＜ 0.01).Conclusion Excessive extravascular lung water is an important factor for acute exacerbation of COPD leading to respiratory failure.
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Objective To investigate the clinical effects of the pulse indicator continuous cardiac output (PiCCO) in goal-optimized fluid management on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure.Methods A total of 71 AECOPD patients with respiratory failure who were hospitalized in department of Critical Care Medicine in our hospital were selected from October 2010 to September 2013.The PiCCOtechnology was applied to monitor intrathoracic blood volume index (ITBI) and extravascular lung water index (ELWI).We compared the relationship of ELWI with ITBI and oxygenation index,and a simple correlation analysis was used for statistical analysis.Results A significantly negative correlation was found between ELWl and oxygenation index (r=-0.743,P＜0.01).ELWI =14 ml/kg was defined as the cutoff value for the subgroup analysis.A negative correlation still was found between ELWI and oxygenation index in the subgroup with ELWI ＜ 14 ml/kg,but it had no significant difference (r=-0.533,P=0.080),while a significantly negative correlation was found in the subgroup with ELWI≥14 ml/kg (r=-0.961,P＜0.01).There was no significant correlation between ELWI and ITBI (r=0.477,P=0.072).ITBI=1 000 ml/m2 was defined as the cutoff value for the subgroup analysis.There is no significant correlation between ELWI and ITBI in the subgroup with ITBI＜1 000 ml/m2(r=0.338,P=0.116),but in the subgroup with ITBI≥1 000 ml/m2,a significantly positive correlation between ELWI and ITBI was found (r=0.677,P＜ 0.01).Conclusions The results suggest that when ELWI is higher than 14 ml/kg,ELWI becomes an important influencing factor for oxygenation,which can be decreased to improve oxygenation in patients with AECOPD,and when ITBI≥ 1 000 ml/m2,ITBI can be reduced by decreasing ELWI.PiCCO has an important clinical significance on a goal-optimized fluid management in AECOPD patients with respiratory failure.
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Objective To evaluate the role ofpleth variability index (PVI) by passive leg raising (PLR) test in volume responsiveness and volume status prediction in patients with septic shock.Methods A prospective randomized controlled trial (RCT) was conducted.Eighty-seven patients suffering from septic shock undergoing mechanical ventilation in Department of Critical Care Medicine of Subei People's Hospital from June 2012 to September 2014 were enrolled.The hemodynamic changes before and after PLR were monitored by pulse indicated continuous cardiac output (PiCCO) and PVI monitoring.Responsive group:positive fluid response was defined as an increase in cardiac index (CI) ≥ 10％ after PLR.Unresponsive group:negative fluid response was defined as an increase in CI ＜ 10％ after PLR.The hemodynamic parameters,including heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),stroke volume variation (SVV),CI and PVI,and the changes in cardiac parameters (△ HR,△ MAP,△ CVP,△ SVV,△ CI,and △ PVI) before and after PLR were determined.The relations between hemodynamic parameters and their changes with △ CI were analyzed by the Pearson analysis.The role of the parameters for volume responsiveness prediction was evaluated by receiver operating characteristic (ROC) curves.Results 145 PLRs in 87 patients with septic shock were conducted,with 67 in responsive group and 78 in unresponsive group.There were no statistically significant differences in HR,MAP,CVP and CI before PLR between the responsive and unresponsive groups.SVV and PVI in responsive group were significantly higher than those in the unresponsive group [SVV:(16.9± 3.1)％ vs.(8.4±2.2) ％,t =9.078,P =0.031; PVI:(20.6±4.3)％ vs.(11.1 ±3.2)％,t =19.189,P =0.022].There were no statistically significant differences in HR,MAP,CVP,SVV,and PVI after PLR between the responsive group and unresponsive group.CI in the responsive group was significantly higher than that in the unresponsive group (mL·s-1·m-2:78.3±6.7 vs.60.0±8.3,t =2.902,P =0.025).There were no statistically significant differences in △HR,△MAP,△ CVP between responsive group and unresponsive group.△ SVV,△ CI and △ PVI in responsive group were significantly higher than those in the unresponsive group [△ SVV:(4.6 ± 1.5)％ vs.(1.8 ± 0.9)％,t =11.187,P =0.022;△ CI (mL·s-1·m-2):18.3 ± 1.7 vs.1.7 ± 0.5,t =3.696,P =0.014; △ PVI:(6.4 ± 1.1)％ vs.(1.3 ± 0.2)％,t =19.563,P =0.013].No significant correlation between HR,MAP or CVP before PLR and △ CI was found.SVV (r =0.850,P =0.015) and PVI (r =0.867,P =0.001) before PLR were correlated with △ CI.It was shown by ROC curve that the area under ROC curve (AUC) for SVV fluid responsiveness prediction was 0.948,and cut-off of SVV was 12.4％,the sensitivity was 85.4％,and specificity was 86.6％.The AUC for PVI fluid responsiveness prediction was 0.957,and cut-off was 14.8％,the sensitivity was 87.5％,and specificity was 84.8％.It was higher than other hemodynamic parameters (HR,MAP,CVP).Conclusions PVI and SVV can better predict fluid responsiveness in mechanically ventilating patients with septic shock after PLR.PVI as a new continuous,noninvasive and functional hemodynamic parameter has the same accuracy as SVV.
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Objective To explore the effect of early goal-directed therapy (EGDT) according to pulse indicated continuous cardiac output (PiCCO) on septic shock patients.Methods Eighty-two septic shock patients in Subei People's Hospital of Jiangsu Province from January 2009 to December 2012 were enrolled and randomly divided into two groups using a random number table,standard surviving sepsis bundle group (n=40) and modified surviving sepsis bundles group (n =42).The patients received the standard EGDT bundles in standard surviving sepsis bundle group.PiCCO catheter was placed in modified surviving sepsis bundles group.Fluid resuscitation was guided by intrathoracic blood volume index (ITBVI) with the aim of 850-1 000 mL/m2.Dobutamine was used to improve the heart function according to left ventricular contractile index (dPmax) and stroke volume index (SVI).The mean arterial blood pressure (MAP) was maintained 65 mmHg (1 mmHg=0.133 kPa) or above with norepinephrine.Extra-vascular lung water was monitored for the titration of liquid and diuretics.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,the number of patients needed vasopressor,serum procalcitonin (PCT),lactic acid and lactate extraction ratio,the amount of fluid resuscitation,duration of mechanical ventilation,duration of intensive care unit (ICU) stay,hospital mortality were recorded in both groups.Results After treatment,the APACHE Ⅱ score,SOFA score and the number of patients needed vasopressor were gradually reduced in both groups,and those in modified surviving sepsis bundle group were significantly lower than those of standard sepsis bundle group at 72 hours (APACHE Ⅱ score:13.1 ± 6.5 vs.20.9 ± 7.5,SOFA score:8.8 ± 4.3 vs.14.6 ± 4.9,the number of patients needed vasopressor:8 vs.17,all P＜0.05).Arterial blood lactate clearance rate was gradually increased after treatment in both groups.Lactate clearance rate in modified surviving sepsis bundle group was significantly higher than that of standard surviving sepsis bundle group [6 hours:(18.2 ± 8.3)％ vs.(10.8 ± 7.5)％,t=-6.036,P=0.001 ; 12 hours:(22.6 ± 7.3)％ vs.(12.4 ± 8.1)％,t=-4.536,P=0.001 ; 24 hours:(27.8 ± 5.6)％ vs.(16.4 ± 9.5)％,t=-5.882,P=0.000].The amount of fluid resuscitation within 6 hours in modified surviving sepsis bundle group increased significantly compared with standard surviving sepsis bundle group (mL:3 608 ± 715 vs.2 809 ± 795,t=-3.865,P=0.033).The amount of fluid resuscitation within 24,48 and 72 hours in modified surviving sepsis bundle group was significantly less than that of standard modified surviving sepsis bundle group with the nadir at 72 hours (mL:918 ± 351 vs.1 805 ± 420,t=5.907,P=0.037).Duration of mechanical ventilation (hours:98.4 ± 20.3 vs.143.3 ± 29.6,t=9.766,P=0.001) and ICU stay (days:7.1 ± 3.1 vs.9.5 ± 2.5,t=2.993,P=0.004) were significantly reduced in modified surviving sepsis bundle group compared with standard surviving sepsis bundle group.The hospital mortality in modified surviving sepsis bundle group was slightly lower than that in standard surviving sepsis bundle group [16.7％(7/42)比 17.5％(7/40),x2=0.010,P=0.920].Conclusions Modified surviving sepsis bundle treatment according PiCCO can reduce the severity of disease in patients with septic shock,can make more accurately guide fluid resuscitation,and can reduce lung water and duration of mechanical ventilation and ICU stay.It has great clinical significance.
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Objective To evaluate the value of the RIFLE criteria of acute kidney injury (AKI) for predicting the incidence and prognosis in critically ill patients and to identify the risk factors associated with the outcomes of those patients.Methods All ICU patients admitted over three years and 6-month period were retrospectively studied at Subei People's Hospital.Based on RIFLE criteria,AKI patients were diagnosed and classified into four groups:NAKI (non-AKI),R (risk),I (injury),F (failure)groups.Results (1) AKI occurred in 404 of the 2472 patients (16.3％) during their ICU stay.The mean age of the patients was (61.4 ± 17.4) years.Infectious disease,pulmonary disease,neurological disease and trauma were the major cause of AKI.(2) Mortality in the ICU was much higher in patients with AKI than in patients without AKI (47.3％ vs.23.0％,P ＜ 0.05).The mortality rate was 35.6％ in R group,48.9％ in I group and 60.6％ in F group.(3) The logistic regression suggested that MODS and septic shock were the independent risk factors of AKI,but continuous renal replacement therapy (CRRT) are the independent protective factor of AKI.Conclusions In these ICU patients,AKI is associated with increased hospital mortality.The RIFLE classification is a simple and useful diagnosis tool to detect and stratify the severity of AKI and aid in predicting outcome of patients.
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Objective To evaluate the clinical effects of PiCCO in the treatment of COPD patients with sepsis shock.Methods 43 COPD patients with sepsis shock were randomly divided into two groups.The control group (n =23) were guided fluid resuscitation according to CVP.The study group (n =20) were placed PiCCO,and according to the PiCCO for fluid resuscitation.The average amount of fluid resuscitation,the amount of norepinephrine and the blood lactate level in 24 hours were observed.The average duration of mechanical ventilation and ICU mortality were also observed.Results After 24 hours,the average amount of fluid resuscitation was (3 986.2 ± 542.1) ml of control group and (4 927.9 ± 761.8)ml of study group,the difference between the two groups was statistically significant (t =-4.71,P ＜ 0.05).The average norepinephrine dosage was (0.38 ± 0.21) μg · min-1 · kg-1 of control group and (0.14 ±0.08)μg · min-1 · kg-1 of study group,the difference between the two groups was statistically significant (t =2.45,P ＜ 0.05).The blood lactate level was (4.79 ± 1.95) mmol/L of control group and (3.44 ±1.45) mmol/L of study group,the difference between the two groups was statistically significant(t =2.59,P ＜ 0.05).Five patients died in control group(mortality 21.7％),and three patients died in study group(mortality 15.0％).Mortality between the two groups was not statistically different (x2 =0,03,P ＞ 0.05).The duration of mechanical ventilation in the control group was (101.22 ± 44.77) h,that in the study group was (74.71 ± 20.25) h,the difference between the two groups was statistically significant (t =2.234,P ＜ 0.05).Conclusion Long-term COPD patients maybe have right ventricular dysfunction,and CVP is difficult to truly reflect the volume status of patients,PiCCO can make up for deficiencies in CVP.PiCCO used to guide these patients with fluid resuscitation,which could guide fluid management of patients,reduce the amount of vasoactive drugs,improve tissue hypoxia,and could reduce the duration of mechanical ventilation.
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Objective To evaluate the effects of prone position ventilation (PPV) combined with inhalation of NO on oxygenation of acute respiratory distress syndrome (ARDS) patients.Methods A total of 21 patients with ARDS composed of 15 male and 6 female aged ranging from 2 to 74 years with mean age of 39 ± 17.4 years were hospitalized from September 2008 through January 2011.After application of mechanical ventilation with optimal PEEP,patients still needed the high concentration oxygen inhalation (FiO2 ≥ 60％).They were randomly (random number) divided into three groups for controlled study.Patients of group A were given NO in addition to oxygen inhalation for 4 hours,patients of group B were put in prone position ventilation with oxygen inhalation for 2 hours,then they were returned to the supine position ventilation,and patients of group C were put into prone position ventilation with inhalation of oxygen plus NO for 2 hours,and then they were returned to the supine position ventilation,but they were continued to inhaled NO.The oxygenation indexes of three groups of patients were measured before the intervention,2 hours and 4 hours after the procedure of experiment.Results The oxygenation indexes of three groups of patients were improved in terms of comparison between pre-intervention and 2 hours after intervention,but there was no statistically significant difference found in group A (P ＞ 0.05),the differences in group B and group C were statistically significant (P ＜ 0.05).Compared the oxygen index between pre-intervention and 4 hours after intervention,the differences in group A and group B were not statistically significant (P ＞0.05),but the difference in group C was statistically significant (P ＜ 0.05).Conclusions PPV could improve oxygenation in acute respiratory distress syndrome (ARDS) patients.PPV with NO inhalation could improve oxygenation in acute respiratory distress syndrome (ARDS) patients as well as effectively maintain the oxygenation after patients were returned to the supine position ventilation.Therefore prone position ventilation combined with inhalation of NO improved oxygenation and at the same time reduced the prone position time.
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Objective To evaluate the compliance of sepsis bundles and its impact on the mortality rate in patients with sepsis shock.Methods Fifty-eight adult patients with sepsis shock admitted in the intensive care units from January to December 2007 were enrolled in the study,and the compliance with the 6-h bundle was analyzed.Age,gender,sites of infection,acute physiology and chronic health evaluation II (APACHE II)score,duration of mechanical ventilation,ICU stay and the mortality rate were compared between patients completed 6-h bundles and those not completed 6-h bundles.Results Compliance with the 6-h bundle was obtained in 22 out of 58 patients(37.9%).Patients receiving bundle care had shorter duration of mechanical ventilation and shorter length of ICU stay than non-bundle patients(t=-2.225 and -3.702,P=0.037 and 0.001,respectively),and the mortality rate in 6-h bundle patients was also lower (X2=10.236,P=0.000).Conclusion The application of 6-h bundle care can reduce the mortality rate of the patients with sepsis shock.and the compliance should be improved.
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Objective To find out some possible risk factors of death postcardiac surgery undergoing cardiopulmonary bypass.Method Totally 36 patients,who underwent postcardiotomy undergoing cardiopulmonary bypass in Subei Hospital of Jiangsu Provience from March 2005 to June 2006,were retrospectively analyzed.The criteria for the selection of patients were as follow:(1)patients underwent on-pump cardiopulmonary bypass;(2)patients with heart function in Ⅰ-Ⅲ degree; (3)all patients didn't have organ dysfunction before operation;(4)patients died within 28 days postcardiotomy.Therefore,6 patients who died were admitted as death group,the other 30 patients were admitted as control group.The analysis included: (1)preoperative factors,including gender,age,diagnosis preoperative,NYHA grade,APACHEⅡscore,left ventricular end-diastolic diameter.(2)operative factors:operation time,block aorta time. (3)postoperation factors:hemorrhage volume,mechanical ventilation time,and factors of hemodynamics and oxygen metabolism 6 hour postoperative:heart rate(HR),central venous pressure(CVP),pulmonary arteria wedged pressure(PAWP),cardiac output index(CI),arterial blood lactic acid,partial pressure of oxygen(PaO2),mixed venous oxygen saturation(SvO2),oxygen delivery index(DO2I),oxygen comsume index(VO2I),oxygen extraction ratio (O2ext).Comparisons between two group was made with SPSSl0.0 for windows.Firstly,the data were analyzed with process of single variable analysis and Some parameters,which showed the significant difference,were sorted out from two groups.Then these parameters were put to the IDGISTIC regression analysis.Consequently,the independent risk factors of death of postcardiac surgery could be found.Results The single variable analysis showed that the parameters of APACHE Ⅱ score,left ventricular end-diastolic diameter,block aorta time,mechanical ventilation time,arterial blood lactic acid,SvO2 had significant difference betwen groups(P＜0.05).The LOGISTIC regression showed that left ventricular end-diastolic diameter and arterial blood lactic acid ale the two independent risk factors of death(P＜0.05).Conclusions Arterial lactatemia and left ventricular end-diastolic diameter can be used to predict the prognosis of postcardiotomy undergoing cardiopulmonary bypass.