ABSTRACT
Objective:To investigate the relationship between previous bleeding history and poor prognosis of patients with acute upper gastrointestinal bleeding.Methods:This study was a prospective multicentre real-world study (Acute Upper Gastrointestinal Real-word study, AUGUR study). The data of patients with UGIB who were admitted to the emergency department of 20 tertiary hospitals in China from June 30, 2020 to February 10, 2021 were collected. According to the number of previous bleeding history, the patients were divided into three groups (0 time, 1-3 times, and≥4 times). Based on the patient’s demographic data, clinical characteristics, laboratory data, treatment, and outcomes, univariate and logistic regression analysis were performed to investigate the correlation between the number of previous bleeding and the 90-day mortality and rebleeding of patients with gastrointestinal bleeding.Results:A total of 1 072 patients with acute UGIB were included in this study. The all-cause mortality and rebleeding rate of all patients were 10.9% (117/1 072) and 11.8% (129/1 072), respectively. Among them, 712 patients (66.42%) had no previous bleeding, 297 patients (27.71%) had previous bleeding 1-3 times, and 63 patients (5.88%) had previous bleeding≥4 times. In univariate analysis, age, vital signs and consciousness on admission, history of liver cirrhosis, onset with hematemesis, admission hemoglobin, varicose veins bleeding, peptic ulcer bleeding, red blood cell infusion, tracheal intubation and the use of vasopressors after admission were risk factors for the 90-day mortality and rebleeding rate. Multivariate logistic regression analysis showed that patients with previous bleeding≥4 times had a higher risk of the 90-day mortality ( OR=2.17, 95% CI: 1.04-4.57, P=0.040) and rebleeding ( OR=2.32, 95% CI: 1.19-4.53, P=0.013). Conclusions:The history of previous bleeding≥ 4 times can be used as an independent risk factor for the 90-day mortality and rebleeding in patients with acute UGIB.
ABSTRACT
Objective:To evaluate the value of mechanical ventilation combined with ultrasound in evaluating the volume reactivity of patients with septic shock.Methods:A prospective study was performed, and 59 patients with septic shock who were admitted to the Emergency Intensive Care Unit of the First Affiliated Hospital of Xinjiang Medical University from October 2016 to February 2018 were included according to the established inclusion and exclusion criteria. First, end-expiratory block test (EEO) and end-inhalation block test (EIO) were performed, followed by volume expansion test (VE) (intravenous infusion of 250 mL saline for 10 min), with cardiac index (CI) change value after VE (ΔCI)≥15% for volume-responsive group (37 cases), ΔCI<15% for volume-free group (22 cases), Vigileo-FloTrac system was used to continuously monitor EEO, EIO, and VE before and after changes in hemodynamic parameters, such as central venous pressure (CVP), mean arterial pressure (MAP), stroke volume variation (SVV), CI, and improved inferior vena cava diameter (IVCD) and respiratory variability index (RVI). The values of predicted capacity reactivity such as changes in CVP, MAP, SVV, CI, and RVI before and after EIO were evaluated, and the relationship between EEO, EIO, and capacity reactivity was analyzed by ROC curve.Results:There was no significant difference between MAP and CI in the response group and non-response group after EEO, EIO and VE intervention ( P>0.05). EEO-ΔSVV, EEO-ΔRVI, EEO-ΔCVP, EIO-ΔSVV and EIO-ΔRVI were compared between the reaction group and the non-reaction group, and the difference was statistically significant ( P<0.05); In the correlation analysis, EEO-ΔRVI and EIO-ΔRVI were correlated with VE-ΔRVI ( r=0.695, P<0.01; r=-0.489, P<0.01); EEO-ΔCVP and VE-ΔCVP were correlated ( r=0.566, P<0.01); EEO-ΔSVV, EIO-ΔSVV are related to VE-ΔSVV ( r=0.842, P<0.01; r= -0.727, P<0.01), and the ROC curve showed ( AUCEEO-ΔSVV=0.890, 95% CI: 0.792-0.988), showed AUCEEO-ΔSVV> AUCEEO-ΔRVI> AUCEIO-ΔSVV> AUCEIO-ΔRVI> AUCEEO-ΔCVP. Conclusions:EEO and EIO combined with ultrasound have certain clinical value in the evaluation of volume responsiveness in patients with septic shock, and the evaluation value of SVV and RVI is superior to CVP, MAP, and CI.
ABSTRACT
Objective To investigate the predictive value of IL-9 cytokines in the patients with acute respiratory distress syndrome (ARDS).Methods According to Berlin definition of ARDS published in 2012,data of 28 patients with ARDS and another 22 healthy subjects as control were collected for prospective study from June,2013 to July,2014.Of them,there were 23 patients with severe pneumonia,1 patient with acute mercury poisoning,2 patients with severe acute pancreatitis,2 patients with acute paraquat poisoning.The survivors of ARDS patients were followed up.The ARDS patients were divided into moderate group (n =18) and severe group (n =10) as per the severity of the disease diagnosed at the first day after admission.And the ARDS patients were also divided into non-survival group (n =15) and survival group (n =13) according to the ARDS patients survived for 28 days.Three mLs of peripheral venous blood were collected in the early morning from fasted ARDS patients on the first and the third day after diagnosis of ARDS confirmed,and those of healthy subjects were collected on the first day after admission.The IL-9 cytokine level of peripheral venous blood detected by using enzyme linked immunosorbent assay (ELISA).The comparisons of levels of IL-9 cytokine were carried out between ARDS group and control group on the first day after diagnosis of ARDS established,between moderate group and severe group on the first day and the third day,and between survival group and non-survival group.The receiver operating characteristic (ROC) curve was used to evaluate the performance of IL-9 as a prognostic indicator in the early stage of ARDS.Data were analyzed by using SPSS 19.0 software.Results On the first day after diagnosis of ARDS,there were no statistically significant differences in age,APACHE Ⅱ score,procalcitonin (PCT),C-reactive protein (CRP),white blood cell count,lactate,and albumin between survival group and non-survival group (P ＞ 0.05).PH value in non-survival group was significantly lower than that in survival group (P＜0.05).IL-9 cytokine level of peripheral venous serum in ARDS group was significantly higher than that in healthy control group (P ＜ 0.05).There were no statistically significant differences in IL-9 level of peripheral venous serum both between moderate group and severe group and between survival group and non-survival group (P ＞ 0.05).On the third day,IL-9 level in severe group was significantly higher than that in moderate group (P ＜ 0.05),and that in survival group was significantly lower than that in non-survival group (P ＜ 0.05).The ROC of IL-9 at the first day for predicting mortality had all area under curve (AUC) to be 0.579 (95％ CI 0.361-0.798,P ＞ 0.05).The ROC of IL-9 on the third day for predicting mortality had AUC of 0.769 (95％ CI 0.592-0.947,P ＜ 0.05).When the cut-off value of IL-9 for the death followed up for 28 day' s was 2.88 pg/mL,the sensitivity was 86.7％,and the specificity was 61.5％.Conclusions IL-9 levels of in patients with ARDS were significantly higher,and IL-9 level can be helpful for the assessment of ARDS severity in the early stage,and for prognosis as well.