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Objective:To explore the value of peripheral blood ionized calcium on the prognosis of elderly patients with sepsis.Methods:The clinical data of 73 elderly patients with sepsis from January 2018 to June 2019 in Shanghai Minhang Hospital, Fudan University, were retrospectively analyzed. Among them, 19 patients died within 28 days (death group), and 54 patients survived (survival group). The peripheral blood ionized calcium, procalcitonin (PCT), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and arterial lactic acid were compared between 2 groups. The risk factors affecting prognosis in elderly patients with sepsis was analyzed by multivariate Logistic regression. The receiver operating characteristic (ROC) curve was used to analyze the ability of each indicator in evaluating the prognosis.Results:The peripheral blood ionized calcium in death group was significantly lower than that in survival group: (0.93 ± 0.07) mmol/L vs. (1.05 ± 0.16) mmol/L, the PCT and APACHE Ⅱ were significantly higher than those in survival group: 2.43 (1.89, 3.76) μg/L vs. 1.34 (1.05, 2.72) μg/L and (20.20 ± 2.86) scores vs. (17.40 ± 3.95) scores, and there were statistical differences ( P<0.01); there was no statistical difference in arterial lactic acid between 2 groups ( P>0.05). Multivariate Logistic regression analysis result showed that the peripheral blood ionized calcium and PCT were independent risk factors affecting the prognosis in elderly patients with sepsis ( OR = 1.634 and 1.876, P<0.05). The ROC curve analysis result showed that the area under curve (AUC) of peripheral blood ionized calcium for the prognosis in elderly patients with sepsis was 0.844 (95% CI 0.740 to 0.918), the optimal cut -off value was 0.89 mmol/L, with a sensitivity of 83.3% and a specificity of 79.0%; the AUC of PCT for the prognosis in elderly patients with sepsis was 0.880 (95% CI 0.783 to 0.944), the optimal cut -off value was 2.79 μg/L, with a sensitivity of 81.4% and a specificity of 89.5%. Conclusions:The level of peripheral blood ionized calcium can predict the clinical outcome of elderly patients with sepsis.
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Objective To investigate the diagnostic value of serum proadrenomedullin( pro-ADM)in catheter related blood stream infection( CRBSI). Methods Prospective diagnostic test was performed with 76 cases patients with clinically suspected diagnosis of CRBSI,and the patients were divided into CRBSI group( n=25)and non-CRBSI group. Serum pro-ADM,procalcitonin( PCT),C-reactive protein( CRP)and white blood cell( WBC)levels were measured at the study entry and on the day of CRBSI suspicion. Results On the day of CRBSI suspicion,the levels of pro-ADM,PCT,CRP and WBC in the CRBSI group were(5. 17 ± 1. 28)nmol/L, 2. 29(1. 47-4. 28)μg/L,(102. 04 ± 51. 00)μg/L and(14. 66 ± 5. 09)× 109/L respectively,significantly higher than those in the non-CRBSI group((2. 83 ± 1. 25)nmol/L,2. 29(1. 4-4. 28)μg/L,(61. 43 ± 53. 52) mg/L and(11. 78 ± 3. 52)× 109/L respectively;t or Z=7. 636,-4. 777,3. 156,2. 882;P﹤0. 05). For the diagnosis of CRBSI,the area under the curve(AUC)of pro-ADM,PCT,CRP and WBC were 0. 89(95%CI 0. 82-0. 97),0. 84(95%CI 0. 75-0. 93),76(95%CI 0. 65-0. 86)and 0. 68(0. 54-0. 81)respectively. Taking pro-ADM with 4. 31 nmol/L as the cutoff value,the sensitivity,specificity,positive predictive value and negative predictive value were 76. 0%,84. 3%,70. 4% and 87. 8% respectively. Simultaneously,taking procalcitonin with 1. 52 μg/L as the cutoff value, the sensitivity and specificity was 81. 8% and 87. 0%respectively. Conclusion Serum level of pro-ADM in the diagnosis of CRBSI has good specificity. Simultaneous surveillance of serum pro-ADM and PCT may be helpful for the diagnosis of CRBSI in the early stage.
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Objective To investigate the risk factors for death within 30 days of stroke associated pneumonia(SAP) in elderly patients of the intensive care unit (ICU).Methods Clinical data of 116 patients with SAP who were admitted to ICU were reviewed.The predicting factors of death within 30 days were analyzed through variable analysis method.Results The hospitalization periods of the SAP group and control group were (27±8) d and (12±5) d,the difference was statistically significant(t =1 1.30,P =0.002).The most common pathogenic bacteria in SAP were Klebsiella pneumoniae,Bauman Acinetobacter,Escherichia coli,and gram negative bacteria.There was significant difference between the two groups in term of mortality rate(37.9％(44/ 116) of SAP group,22.0％ (22/100) of control group,x2 =6.423,P =0.011).Logistic regression analysis showed that basic diseases(OR =2.778,95％ CI:1.205-6.401),high CRUB-65 score (OR =1.978,95％ CI:0.871-11.098),lower Glasgow coma score(GCS) (OR=3.601,95％CI:0.244-9.477),bucking(OR=3.020,95％CI:1.305-10.603),mechanical ventilation(OR=2.654,95％CI:1.176-5.990),shock(OR=2.636,95％ CI:1.164-5.969) and high plasma CRP level(OR=2.333,95％CI:1.046-5.206) were risk factors for SAP (all P＜0.05).In Cox regression analysis,a GCS score of ＜ 9 was an independent risk factor for 30 d mortality of patientswithSAP(HR=7.23,95％Cl:2.24-20.11,P=0.001).Conclusion SAP is one of the serious complications of the elderly hospitalized for the acute stroke in the ICU,which may affect the prognosis of the patients.
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ObjectiveTo investigate the risk factors and pathogenic characteristics of catheterrelated infection (CRI) in intensive care unit (ICU),so as to find a better way for its treatment.Methods Retrospective analysis was performed on 247 deep-venous catheter (DVC) from January 2007 to December 2010.ResultsAmong 247 patients,positive results of 41 patients diagnosed CRI,negative results of 206 patients undiagnosed CRI.Compared with undiagnosed CRI patients,found the correlation of the underlying infectious diseases,indwelling time of catheter and puncture sites associated with CRI occurred(P ＜ 0.05 ).CRI major pathogen was gram-positive bacteria (58.5％,24/41 ),in which Staphylococcus epidermis was the major pathogenic bacteria(22.0％,9/41).The drug resistance occurred in most pathogen.Conclusions The occurrence of CRI is related with multiple clinical factors.The gram-positive bacteria is the major pathogen.The etiological monitor should be enforced in patients with DVC.
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The major pathogenic bacterium of catheter-related bloodstream infection is gram-positive bacteria.The occurrence of catheter-related bloodstream infection is related with exogenous factors and endogenous factors.It is suggested that catheter-related bloodstream infection should be diagnosed without removing the catheter.It is shown that the catheter should be removed and the patient should use antibiotics as soon as possible if catheter-related bloodstream infection occurred.Buliding a detection system,using antimicrobial dressings and antimicrobial central catheters,and improving patient's nutritional status can decrease the morbidity of catheter-related bloodstream infection.The authors summarize the epidemiology,diagnosis,treatment and prevention strategies of catheter-related bloodstream infection.