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Objective:To analyze the clinical characteristics and risk stratification of 182 patients with acute pulmonary embolism (APE), and to investigate the correlation of neutrophil (N)/lymphocyte (L) ratio (NLR) and risk stratification/prognosis.Methods:The clinical data of 182 APE patients admitted to Peking University People’s Hospital from January 2015 to March 2021 were retrospectively collected, including age, sex, symptoms and signs, blood pressure, blood gas analysis, blood routine parameters, cardiac biomarkers, coagulation parameters, and right ventricular imaging parameters. The patients were divided into groups according to the risk stratification at admission and prognosis in hospital. χ2 test, t test or nonparametric test were used to analyze the differences in clinical characteristics, blood routine parameters, blood gas analysis, coagulation parameters and other parameters between the groups. Multivariate logistic regression analysis was used to study the independent risk factors for the prognosis of APE. Results:Among the 182 patients, 79 were male and 103 were female, 23 were in the high-risk group, 51 were in the intermediate-high-risk group, 46 were in the intermediate-low risk group, and 62 were in the low-risk group. There were 27 deaths and 155 survivors. The respiratory rate of the high/intermediate-high-risk group was significantly higher than that of the low/intermediate-low-risk group. Compared with the other three groups, pH, oxygen partial pressure (PO 2) and blood oxygen saturation (SO 2) in the high-risk group were significantly lower ( both P<0.05). There were statistically significant differences in WBC, N, and NLR levels between the high/intermediate-high-risk group and low/intermediate-low-risk group ( both P<0.05). However there were no significant differences in PLT, PLT/MPV, PLT/PDW, and coagulation related parameters PT, FIB, APTT and D-D between groups (all P > 0.05). MPV and PDW were only significantly different between the low-risk group, intermediate-low-risk group and high-risk group ( both P<0.05). Multivariate logistic regression analysis showed that NLR ( OR=1.179,95% CI:1.029-1.410, P=0.039) and PH ( OR=1.156,95% CI:1.031-1.522, P=0.041) were independent predictors of in-hospital mortality. The ROC curve was used to analyze the predictive value of NLR for in-hospital mortality. When the cutoff value of NLR was 8.38, the AUC of NLR was 0.824 (95% CI: 0.829-0.913), the corresponding sensitivity was 0.831, and the specificity was 0.887. Conclusions:NLR is correlated with risk stratification and prognosis of APE, and is an independent risk factor for poor prognosis.
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Objective:To explore the value of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) combined with bedside index for severity in acute pancreatitis (BISAP) score in predicting severe acute pancreatitis (SAP) in patients with hypertriglyceridemia pancreatitis (HTGP).Methods:Patients who met the diagnostic criteria of HTGP were retrospectively collected in the Emergency Department of Peking University People's Hospital from January to December in 2019. Patients were assigned to two groups according to the severity of acute pancreatitis: the mild acute pancreatitis group and severe acute pancreatitis (SAP) group. Blood samples were taken within 24 h after the onset of HTGP for analysis. White blood cell count, neutrophil count, lymphocyte count, and other laboratory indicators were detected. BISAP score was performed, and NLR and PLR were calculated in all patients within 24 h of the onset of HTGP. Comparison of various indicators was performed in the two groups. The risk factors of SAP patients with HTGP were analyzed by Logistic regression. The correlation of risk factors was analyzed by correlation. The receiver operating characteristic (ROC) curve was drawn, and the optimal thresholds of NLR and PLR were calculated respectively. The BISAP score, NLR combined with BISAP score (BN score), PLR combined with BISAP score (BP score), and NLR, PLR combined with BISAP score (BNP score) were compared respectively to predict SAP in patients with HTGP.Results:A total of 82 patients were collected. There were significant differences in the proportion of patients with fever, NLR, PLR, lactate dehydrogenase, urea nitrogen, Ranson score, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score and BISAP score between the two groups (all P<0.05). Logistic regression analysis showed that NLR ( OR=1.859, 95% CI: 1.385-2.497, P<0.001), PLR ( OR=1.074, 95% CI: 1.036-1.112, P<0.001) and BISAP score ( OR=2.880, 95% CI: 1.578-5.258, P=0.001) were risk factors for severe HTGP. Correlation analysis confirmed that NLR and PLR were positively correlated with BISAP, APACHE Ⅱand Ranson score. The AUC of BISAP score, BN score, BP score and BNP score for predicting SAP in HTGP were 0.865 (95% CI: 0.787-0.943), 0.925 (95% CI: 0.869-0.981),0.930 (95% CI: 0.885-0.987), and 0.936 (95% CI: 0.874-0.986). Conclusions:NLR and PLR combined with BISAP score has a higher sensitivity to predict the severity of HTGP, which can predict severe pancreatitis within 24 h of the onset of HTGP, so that providing better guidance for treatment.
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Objective:To investigate the diagnostic value of synthetic MRI methods in the differentiation of benign and malignant breast lesions.Methods:Clinical and imaging data of 93 breast patients confirmed by pathology in the Second Affifiliated Hospital of Xi′an Jiaotong University from May 2019 to April 2020 were analyzed retrospectively. All patients underwent synthetic MRI technique, and the quantitative parameters of T 1, T 2, and proton density (PD) values were measured. Independent samples t-test and Wilcoxon test were used to compare the differences in clinical and imaging characteristics between the benign and malignant breast lesions. ROC curve was used for the comparison of the diagnostic efficacy of the quantitative parameters in differentiating malignant from benign breast lesions. Results:Of the 93 patients with breast lesions, 62 cases were malignant and 31 cases were benign. The quantitative T 2 values for benign and malignant lesions were 103 (93, 126)ms and 83 (77, 90)ms respectively, and the quantitative PD values were 87.7 (72.7, 96.7)pu and 73.5(63.3, 79.4)pu respectively. There were statistically significant differences between benign and malignant lesion( P<0.05). Taking quantitative T 2 values of 90.5 ms and PD values of 84.8 pu as the cut-off value, the area under the ROC curve in differentiating benign from malignant breast lesions were 0.87 and 0.75, accuracy values were 80.6% and 78.5%, specificity values were 87.1% and 54.8%, sensitivity values were 77.4% and 90.3% respectively. Conclusion:Synthetic MRI methods can be applied in the examination of breast lesions and has the potential to be an effective diagnostic method for the differential diagnosis between benign and malignant lesions of breast.
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Objective:To explore the early prediction value of neutrophil to lymphocyte ratio (NLR) combined with platelet to lymphocyte ratio (PLR) for severe acute pancreatitis (SAP).Methods:A total of 216 patients were collected in the Emergency Department of Peking University People's Hospital who met the diagnostic criteria of acute pancreatitis (AP) from January to December in 2019. Patients were assigned to 3 groups according to the severity of AP: the mild acute pancreatitis group (MAP, n=86), moderately severe acute pancreatitis group (MSAP, n=40), and severe acute pancreatitis group (SAP, n=90). The peripheral blood was taken immediately. White blood cell count (WBC), neutrophil count (NEUT), lymphocyte count (LYM), hemoglobin (HGB), platelet count (PLT), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low density lipoprotein (LDL), serum creatinine (CR), and glucose (GLU) were detected. At the same time, CT imaging and other examinations were completed. NLR and PLR were calculated and compared among the three groups. The correlation between NLR, PLR, APACHE II score and Ranson score were compared. The receiver operating characteristic (ROC) curve was drawn to calculate the optimal thresholds of NLR and PLR. NLR-PLR was calculated according to the optimal thresholds of NLR and PLR, and the ROC curve was drawn to study the predictive value of NLR-PLR for SAP. Results:NLR [ OR=1.071, 95% CI (1.025, 1.120), P=0.002] and PLR [ OR=1.003, 95% CI (1.000, 1.244), P=0.044] were risk factors for SAP. NLR was positively correlated with Ranson score ( r=0.0342). NLR was positively correlated with APACHE II score ( r=0.0210). PLR was positively correlated with Ranson score ( r=0.0218, P=0.002). There was no correlation between PLR and APACHE II score ( P=0.157). The areas under the ROC curve (AUC) of NLR and PLR were 0.894 and 0.728. The optimal threshold, sensitivity and specificity of NLR were 6.105, 92.9% and 76.1%, and the optimal threshold, sensitivity and specificity of PLR were 154.358, 78.2% and 73.2%. The AUC of NLR-PLR (0.864) was the largest. Conclusions:NLR and PLR have predictive value for SAP patients within 48 h of the onset of AP. NLR-PLR combined detection have early predictive value for SAP within 48 h of onset.
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Objective:To investigate the prognostic value of platelet volume indices (PVIs), neutrophil/lymphocyte ratio (NLR) and the combination of these parameters for the neurological function of acute ischemic stroke (AIS) patients after intravenous thrombolysis.Methods:From January 2016 to January 2019, the data of 147 AIS patients with intravenous thrombolysis in the Emergency Department of Peking University People's Hospital who met the diagnostic criteria of AIS were retrospectively analyzed. The patients were divided into two groups according to modified rank in scale (MRS) score: MRS≤2 and MRS≥3. The general information, past medical history and laboratory examination results of each group were compared. Logistic regression analysis was used to analyze the risk factors of poor prognosis of neurological function in AIS patients with thrombolysis.Results:NLR ( OR=1.045, 95% CI: 1.032-2.350, P=0.032), mean platelet volume (MPV) ( OR=4.212, 95% CI:1.074-16.513, P=0.039), MPV×NLR/PLT ( OR=5.711, 95% CI: 1.342-24.298, P=0.018), platelet distribution width (PDW) ( OR=1.015, 95% CI: 1.001-2.372, P=0.032), and NIHSS score ( OR=1.266, 95% CI: 1.111-1.443, P<0.01) were related with poor prognosis neurological function of AIS patients with intravenous thrombolysis. Conclusions:MPV, NLR, MPV×NLR/PLT PDW and NIHSS scores are the risk factors for poor prognosis of neurological function in AIS patients with thrombolysis. MPV×NLR/PLT can predict the neurological severity of AIS after 3 months.
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Objective:To investigate the relationship between neutrophil to lymphocyte ratio (NLR) and the severity of acute ischemic stroke (AIS) and the prognosis of patients undergoing intravenous thrombolysis (IVT).Methods:From January 2016 to January 2019, 147 AIS patients with intravenous thrombolysis in the Emergency Department of Peking University People's Hospital who met the diagnostic criteria of AIS were studied retrospectively. According to the NLR value, 147 patients were divided into the NLR 2 or less group ( n=37) or less, 2 < NLR < 3 group ( n=31), and the NLR≥3 group ( n=79). General data, medical history, laboratory examination results, NIHSS score and mRS score of patients in each group were compared. Logistic regression analysis was used to analyze the relationship between NLR and severity of acute ischemic stroke patients and clinical prognosis with thrombolysis. Results:NLR was associated with AIS stroke severity ( OR=2.044, 95% CI: 1.011-8.566, P=0.006). NLR was associated with poor prognosis of AIS neurological function with thrombolysis ( OR=3.744, 95% CI: 0.997-4.713, P=0.003). However, NLR was not associated with AIS death after thrombolysis ( OR=0.591, 95% CI: 0.750-1.933, P=0.442). Conclusions:NLR was associated with the severity of stroke in AIS patients and the prognosis of poor neurological function with thrombolysis.
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Objective:To investigate the clinical characteristics, risk stratification, thrombolytic effects and prognosis of 110 patients with acute pulmonary embolism (PE) treated with thrombolysis.Methods:The clinical data of 110 patients with PE admitted to Beijing University People's Hospital from May 2009 to March 2019 were retrospective analyzed. The clinical data including general information, symptoms and signs, blood pressure, artery blood gas, coaglulation, and radiography were collected. Inclusion criteria: high-risk and intermediate high-risk group. Exclusion criteria: intermediate low-risk and low-risk group. According to the prognosis and risk stratification, the patients were divided into survival group and non-survival group, high-risk group and intermediate high-risk group. The indicators above were compared between with χ 2 test, t test or nonparametric test where appropriate. Results:Of the 110 patients with PE, 49 patients were male and 61 female with an average age of 65±16 years old; and 12 patients were in the high-risk group and 98 in the intermediate high-risk group. The respiratory rate of the high-risk group was higher, and blood pressure, PO 2, SaO 2 before thrombolysis were more lower than the intermediate high-risk group ( P<0.05). One hundred and nine patients were treated with systemic recombinant tissue plasminogen activator (rtPA), 70 patients with 50 mg, and 39 patients with 100 mg. One patient, who was contraindicated to systemic thrombolysis (with active vagina bleeding), was treated with interventional local thrombolysis; another 5 patients treated with interventional local thrombolysis because the clinical symptom were not improved markedly. One hundred and two patients survived and 8 patients died, among which, 3 patients were in the high-risk group and 5 in the intermediate high-risk group. The age, heart rate, respiration rate of the non-survival group were higher than those in the survival group, and the PO 2 before thrombolysis, PCO 2 after thrombolysis were lower ( P<0.05). Bleeding complication were occurred in 22 patients: 18 patients with minor bleeding, such as bleeding gums, skin ecchymosis, and 4 patients with moderate-severe bleeding, such as cerebral hemorrhage, abdominal bleeding, gastrointestinal bleeding, and vagina bleeding. Thirteen of 70 patients in the 50 mg group and 9 of 39 patients in the 100 mg group occurred bleeding complication. The bleeding complication of the low dose group was lower than that of the standard dose group ( P<0.05). Conclusions:Thrombolysis is first-line therapy to high-risk PE. Thrombolysis is safe and effective in the intermediate high-risk group with a lower incidence rate of bleeding complication.
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Objective To investigate the clinical features,diagnosis,treatment and prognosis of 59 patients with thrombotic thrombocytopenic purpura (TTP),therefore to improve the ability of diagnosis and treatment.Methods The clinical data of 59 patients with TTP admitted to Peking University People's Hospital from January 2004 to October 2018 were retrospectively analyzed.All the patients were clinically diagnosed,fulfilled the triad syndrome,or quinary syndrome.Laboratory data included complete blood count,blood biochemistry,immtmology,hemolysis;some patients tested the activity of ADAMTS13.The differences between groups were compared according to the prognosis.Results Among the 59 patients with TTP,21 were male and 38 were female,with an average age of 46.8 years.Fifty-five patients had the triad syndrome and 46 patients had the quinary syndrome.The platelet count and hemoglobin decreased,the percentage of erythrocyte fragmented increased,and the value or the activity of ADAMTS13 was decreased significantly.PLASMIC scores of 57 patients were between 6 and 7.All 59 patients were treated with glucocorticoid,41 patients received plasma exchange (PEX),and 28 patients survived;18 patients did not received PEX,and only 6 patients survived.There was a significant difference of the survival between the two groups (P＜0.05).Six patients were treated with rituximab and four patients survived.Conclusion The PLASMIC score can predict the activity of ADAMTS 13 well.PEX can significantly improve the survival rate of patients with TTP.
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Objective@#To investigate the clinical characteristics, coagulation function and associated prognostic factors of acute aortic dissection.@*Methods@#The clinical data of 119 patients with acute aortic dissection (AAD) admitted to Beijing University People's Hospital from November 2008 to January 2016 were analyzed. All the participants were confirmed by computed tomography angiography, and the onset time was less than 14 days. Data of blood routine test, coagulation function at the first admission were collected, and surgical intervention and prognosis were recorded. All the patients, according to the prognosis, or whether disseminated intravascular coagulation (DIC) occurred, were divided into two groups, and the differences between the two groups were compared. Logistic regression analysis was applied to analyze independent risk factors related to in-hospital death in AAD patients.@*Results@#In 119 patients with AAD, the average age was (52.9±14.2) years, with a male/female ratio of 5.3:1. Pain was the most common clinical manifestation in patients with AAD, accounting for more than 90.0%. The nature of pain was mostly expansible and/or transitive pain. Dominant DIC occurred in 13 cases (10.9%), and 7 patients died (53.8%). There were significant differences between the DIC group and non-DIC group in neutrophil/lymphocyte ratio (NLR), platelet count, fibrinogen, D-dimer, FDP, PT, APTT and mortality rate (P<0.05). All the 16 patients in the death group were type A AAD, among which, 7 patients (43.8%) developed with DIC. There were significant differences between the death group and survival group in NLR, platelet count, fibrinogen, D-dimer, FDP, PT, APTT, DIC proportion and surgical operation rate (P<0.05).Logistic regression analysis showed that NLR and platelet count were independent risk factors of in-hospital death (P<0.05).@*Conclusions@#D-dimer has a high diagnostic and prognosis value for AAD. The mortality increased with the activation and depletion of platelet. Once DIC occurs, the prognosis is extremely poor. NLR and platelet count are independent risk factors for in-hospital death in patients with AAD.
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Objective To investigate the clinical characteristics and prognosis of patients with acute aortic dissection (AAD) and hypertension,and explore other related prognostic factors in AAD.Methods The present study enrolled consecutive patients diagnosed with AAD who were admitted to Peking University People's Hospital between January 2000 to December 2015.Patients diagnosed with AAD by CT angiography,aortography or magnetic resonance imaging within 14 days of onset were included.Patients with infectious diseases,haematological diseases,malignancies,autoimmune diseases and patients without clearly clinical diagnosis or incomplete data were excluded.The patients were initially divided into two groups based on their history of hypertension,and their clinical characteristics were compared and analyzed.We further divided AAD patients into survival group and death group according to their in-patient outcomes,and factors related to their prognoses were analyzed.Logistic regression analysis was applied to analyze the independent risk factors related to hospital death in AAD patients with P＜0.05 as the significant value.Results The hypertensive group contained 237/346 cases included (68.45％),patients in this group were generally older than their non-hypertensive counterparts,accompanied by increased prevalence of comorbidities (coronary heart diseases or diabetes) and a statistical significant elevated admission blood pressures (systolic and diastolic,P＜0.05).No significant difference were found between the groups in terms of white blood cell and platelet count,D-dimer,neutrophil to lymphocyte ratio(NLR),fibrinogen,serum creatinine and serum lipid profiles (P＞0.05).Hypertensive patients were less likely to receive surgical treatment compared with those without hypertension(P＜0.05),with increased risk of in-hospital mortality (P＞0.05).Further logistic regression analysis revealed the presence of hypertension did not independently predict in-hospital mortality of AAD patients.Factors such as age,Stanford classification of the AAD,NLR and platelet counts were found to have independent predictive values for in-hospital mortality (P＜0.05).Conclusion AAD patients with hypertension are generally older,have more comorbidities such as coronary heart diseases and diabetes.The presence of hypertension itself is not directly associated with in-hospital mortality in AAD patients,while the Stanford classification,age,NLR and platelet counts are independent risk predictors.
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Objective To investigate the clinical characteristics,coagulation function and associated prognostic factors of acute aortic dissection.Methods The clinical data of 119 patients with acute aortic dissection (AAD) admitted to Beijing University People's Hospital from November 2008 to January 2016 were analyzed.All the participants were confirmed by computed tomography angiography,and the onset time was less than 14 days.Data of blood routine test,coagulation function at the first admission were collected,and surgical intervention and prognosis were recorded.All the patients,according to the prognosis,or whether disseminated intravascular coagulation (DIC) occurred,were divided into two groups,and the differences between the two groups were compared.Logistic regression analysis was applied to analyze independent risk factors related to in-hospital death in AAD patients.Results In 119 patients with AAD,the average age was (52.9±14.2) years,with a male/female ratio of 5.3:1.Pain was the most common clinical manifestation in patients with AAD,accounting for more than 90.0％.The nature of pain was mostly expansible and/or transitive pain.Dominant DIC occurred in 13 cases (10.9％),and 7 patients died (53.8％).There were significant differences between the DIC group and non-DIC group in neutrophil/lymphocyte ratio (NLR),platelet count,fibrinogen,D-dimer,FDP,PT,APTT and mortality rate (P＜0.05).All the 16 patients in the death group were type AAAD,among which,7 patients (43.8％) developed with DIC.There were significant differences between the death group and survival group in NLR,platelet count,fibrinogen,D-dimer,FDP,PT,APTT,DIC proportion and surgical operation rate (P＜0.05).Logistic regression analysis showed that NLR and platelet count were independent risk factors of in-hospital death (P＜0.05).Conclusions D-dimer has a high diagnostic and prognosis value for AAD.The mortality increased with the activation and depletion of platelet.Once DIC occurs,the prognosis is extremely poor.NLR and platelet count are independent risk factors for in-hospital death in patients with AAD.
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Objective To investigate the clinical characteristics and associated prognostic factors of the acute aortic syndrome. Methods The clinical data of 391 patients with acute aortic syndrome (AAS) admitted to Beijing University People's Hospital from January 2000 to December 2015 were analyzed. Results In 391 patients with AAS, the average age was (52.7 ±13.3) with a male/female ratio of 4.3:1, and 73.4％ patients had hypertension. The most common clinical manifestation of patients with AAS was pain accounting for more than 90.0％, and the nature of pain was expansible and/or transitive pain. The level of D-dimer was elevated in 91.1％ of patients with AAS (ELISA), and significantly higher in type A patients than type B patients. Ultrasound/echocardiography was used to diagnose AAS with a sensitivity of 88.4％, of which the sensitivity of type A patients was 99.1％; the mortality of type A patients was significantly higher than type B patients (34.3％ vs. 0.9％, P <0.01). The mortality was declined obviously (11.7％ vs. 28.0％, P <0.01) when patients were treated with stent. Compared with the in-hospital surviving group, the in-hospital mortality group had decreased platelet counts and FIB, higher level of D-dimer, FDP and NLR (neutrophil to lymphocyte ratio). Conclusions Transitive and(or) expansible pains were the characteristic clinical manifestations of acute aortic syndrome,which usually happened suddenly or tearing;D - dimer and ultrasound were valueble and simple methods in AAS patients; Compared with In-hospital surviving group,the In-hospital mortality group had decreased platelet counts and FIB,higher level of D-dimer, FDP and NLR.The mortality of type A was significantly higher than type B,operation can lower the mortality of AAS patients obviously.
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Objective To investigate the prognostic significance of serum lactate level and lactate clearance rate for critical illness patients.Methods Two hundred and eighty-six patients with hyperlactacidemia were investigated by analyzing the clinical data,laboratory data and outcomes.Comparison of mortality rate and APACHE Ⅱ score between different stratified levels of serum lactate was carried out.The blood pH,HCO3-,BE,and Lac were compared between survivors and non-survivors in terms of in-hospital death in seven days after admission.The above variables of blood gas analysis were studied in patients with severe hyperlactacidemia as well as the different lactate clearance rates and APACHE Ⅱ scores were compared between survivors and non-survivors.The mortality rates and APACHE Ⅱ scores were compared between high and low lactate-clearance rate groups.Results The mortality rates of different stratified levels of serum lactate (≥2,＜4 mmol/L; ≥4,＜ 10mmol/L; ≥ 10 mmoL/L) were 14.04％,46.67％,78.79％,respectively.As the serum level of lactate increased,the decompensation rate of pH,APACHE Ⅱ score and mortality rate increased consequently.Compared with non-survivors,survivors had a higher lactate clearance rate (P ＜ 0.01),and lower APACHE Ⅱ score (P ＜ 0.01).The high-clearance group had lower mortality rate and 6-hour APACHE Ⅱ score compared with the low-clearance group (P ＜ 0.01),but the initiate levels of serum lactate and APACHE Ⅱ scores were not noticeably different between the two groups (P ＞ 0.05).Serum lactate level had a significant positive relationship with APACHE Ⅱ score (r =0.868,P ＜ 0.01),but lactate clearance rate had a significant reverse relationship with APACHE Ⅱ score (r =-0.823,P ＜ 0.01).Conclusions Both serum lactate levels and early lactate clearance rate had high prognostic value for critical illness patients,and in combination with changes in APACHE Ⅱ score,they could guide clinical treatment and give precise evaluation of the prognosis.
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Drug resistance is the most important obstacle in the treatment of cancer.People can know more about the mechanisms of drug resistance by study of cancer stem cells,and then identify new therapeutic targets and to develope better anticancer strategies.If we regard cancer stem cells as the therapeutic targets we can selectively kill cancer stem cells without harming normal ones,so overcome the drug resistance and avoid cancer relapse or metastasis.