ABSTRACT
Objective To investigate the predictive value of intracerebral hemorrhage (ICH) score for stroke-associated pneumonia (SAP) in patients with primary intracerebral hemorrhage. Methods From January 2014 to July 2015,209 consecutive patients with ICH at the Emergency Department,Shanghai Jiading District Central Hospital were enrolled retrospectively.The general information of the patients were analyzed. They were divided into either a SAP group (n=73) or a non-SAP group (n=136) according to whether they had SAP or not.Based on the ICH score,the incidence and mortality of SAP were analyzed;the occurrence of SAP was prejudged by ICH score.The ROC curve was plotted,and the sensitivity,specificity and the best cut-off value were calculated. Results (1) The incidence of SAP was 34.9% (73/209) and the mortality was 21.1% (44/209) in patients with ICH.(2) There were significant differences in age (73 ± 12 and 63 ± 14),hematoma volume (23.4 [9.6,51.1] and 6.2 [3.1,16.0],and ICH score (2[1,3] and 1 [0,2]) between the SAP group and the non-SAP group (all P<0.01).Compared with non-SAP group,Glasgow coma scale(GCS) score of the SAP group was significantly decreased(8 [4,11] and 15 [13,15],P<0.01).The area under the ROC curve of the ICH score predicting the occurrence of SAP was 0.775 (95% CI 0.709-0.842,P<0.01).When the maximum Youden index was 0.453,the best cut-off value of the corresponding ICH score was 2,its sensitivity was 74%,specificity was 71%,the positive predictive value was 0.58,and the negative predictive value was 0.84. Conclusions The incidence of SAP in patients with ICH is higher.The ICH score may predict the clinical value of the occurrence of SAP. Clinical attention should be paid to the risk of occurring SAP in patients with ICH whose ICH score≥2.
ABSTRACT
Objective Toinvestigatethecorrelationbetweentheredbloodcelldistributionwidth (RDW)and in-hospital prognosis in elderly patients with cerebral infarction and severe hemiplegia. Methods Atotalof209consecutiveelderlypatientswithcerebralinfarctionandhemiplegiadiagnosedat the Emergency Department,Central Hospital of Jiading District in Shanghai from January 2012 to December 2013 were enrolled retrospectively. All patients were divided into an L-RDW group (n=73 ),an M-RDW group (n=56),and an H-RDW group (n=80)according to the RDW trisection level. A single factor analysis of variance was used to compare the differences of clinical data,laboratory indexes,and mortality during hospitalization among the three groups. The patients were redivided into either a survival group (n=170)or a death group (n=39)according to their clinical outcomes. Its differences of RDW levels in the acute phase were compared. Logistic regression analysis was used to analyze the independence risk factors for the death of patients,and the risk ratio (OR)was calculated. Spearman correlation analysis was used to analyzeRDWandtheNationalInstitutesofHealthStrokeScale(NIHSS)scores.Results Themortality of the M-RDW group was significantly lower than that of the L-RDW and the H-RDW groups (1. 8%[n=1] vs. 12. 3%[n=9]and 36. 2%[n=29],all P<0. 01). the RDW level of the death group was significantly higher than that of the survival group (14.2 [13.3,15.1]vs.12.5 [11. 9,13. 5];P =0. 002). The H-RDW level (OR,12. 164,95%CI 2.544-58.181,P=0.002)and the NIHSS score (OR,1. 136, 95%CI 1. 056-1. 221,P=0. 001)were the independence risk factors for the death of the elderly patients with severe hemiplegia cerebral infarction;the RDW level was positively correlated with the NIHSSscore(r=0.167,P=0.016).Conclusion ThemortalityofdifferentRDWlevelsinelderly patients with cerebral infarction and severe hemiplegia showed aU shape. The mortality of the H-RDW is the highest. The RDW level has an important reference value for identifying the prognosis in elderly patients with cerebral infarction and severe hemiplegia.
ABSTRACT
Objective To investigate the correlation between red cell distribution width RDW) and prognosis in patients with severe traumatic brain injury.Methods A total of 264 consecutive patients with severe traumatic brain injury admitted from May 2012 to November 2014 were enrolled.The patients were divided into low-RDW group (RDW ＜ 15％,n =198) and high-RDW group (RDW ≥ 15％,n =66) based on their RDW levels.Between-group differences were evaluated on general conditions,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),inflammatory markers [high sensitivity C-reactive proteins(hs-CRP) and arterial lactate],liver/renal dysfunction,and 28-day mortality.Spearman correlation analysis of RDW with mortality was conducted.Independent factors of 28-day mortality were identified using multivariate Logistic regression.Kaplan-Meier 28-day survival curve was analyzed and survival probability of the two groups was compared using Log-Rank test.Results The 28-day mortality was significantly enhanced in high-RDW group compared to that in lowRDW group (43.9％ vs 26.8％,P ＜ 0.01).RDW ≥ 15％ related positively to APACHE Ⅱ and mortality(r =0.172 and 0.253 respectively,P ＜ 0.01),but negatively to Glagow coma score (GCS) (r =-0.169,P ＜0.01).RDW≥ 15％ was the independent risk factor for predicting the 28-day mortality (OR =2.144,95％ CI 1.202-3.826,P ＜0.01).After adjusted gender,age,and other relative factors,RDW≥15％ was still strongly correlated with the 28-day mortality(OR =2.244,95％ CI 1.076-4.678,P ＜ 0.05).Significantly lower 28-day survival rate was found in high-RDW group than in low-RDW group (P ＜ 0.01).Conclusions RDW level rises beyond the normal range on admission in patients with severe traumatic brain injury,which is closely correlated with the 28-day poor outcome.RDW≥ 15％ has significant predictive value in the prognosis.