ABSTRACT
Objective:To evaluate the value of shock index and platelet count in early identification of grade 3 acute cholangitis.Methods:This study is a retrospective case-control study. A total of 750 patients who met the diagnostic criteria of acute cholangitis were treated in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2018 to December 2020. They were divided into grade 1, grade 2 and grade 3 groups according to the 2018 Tokyo Guidelines. The age, gender, etiology, complications, Charlson comorbidity index (CCI), vital signs, blood routine indexes, C-reactive protein, lactic acid and consciousness of patients in each group were compared, and the effective indexes for differentiating grade 3 cholangitis were selected. Logistic regression and receiver operating characteristic curve (ROC) analysis were used to screen the indexes with high specificity and sensitivity for early identification of acute cholangitis.Results:There were significant differences in age, CCI score, incidence of acute cholecystitis, all-cause mortality, shock index, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiration, lactic acid, white blood cell count, neutrophil count, lymphocyte count, granulocyte ratio, C-reactive protein, hematocrit, platelet count, thrombocytocrit and platelet distribution width among the three groups ( P<0.05). ROC curve analysis showed that platelet count and thrombocytocrit were more effective in predicting grade 3 cholangitis ( P<0.05). Logistic regression analysis showed that shock index and platelet were significantly correlated with grade 3 cholangitis ( P<0.05). For patients without unconsciousness, the area under curve (AUC) value of shock index alone was 0.621 for differentiating grade 3 cholangitis; The sensitivity was 47.6%, and the specificity was 71.3%. The AUC value of combined shock index and platelet for differentiating grade 3 cholangitis was 0.861, with a specificity of 95.6% and sensitivity of 71%. Conclusions:Shock index combined with platelet can be used as a good indicator for early differentiation of severe acute cholangitis without conscious disorder.
ABSTRACT
Acute cholangitis (AC) is a morbid condition with acute inflammation and infection in the bile duct, which meets the diagnostic criteria of sepsis 3.0. AC mortality rate is high without treatment in time, and it is a main disease in emergency department. The occurrence and development of sepsis depend on the regulation of nerve and immunity system, and cholinergic anti-inflammatory pathway plays an important role in connecting nerve and immune function. The biliary tract is innervated by vagus nerves, which can be excited when the pressure increases in the biliary tract. The research on the role of vagus nerves and cholinergic anti-inflammatory pathway (CAIP) in sepsis caused by acute cholangitis is more advantageous than other infectious diseases.
ABSTRACT
Acute cholangitis (AC) is a morbid condition with acute inflammation and infection in the bile duct,which meets the diagnostic criteria of sepsis 3.0.AC mortality rate is high without treatment in time,and it is a main disease in emergency department.The occurrence and development of sepsis depend on the regulation of nerve and immunity system,and cholinergic anti-inflammatory pathway plays an important role in connecting nerve and immune function.The biliary tract is innervated by vagus nerves,which can be excited when the pressure increases in the biliary tract.The research on the role of vagus nerves and cholinergic anti-inflammatory pathway (CAIP) in sepsis caused by acute cholangitis is more advantageous than other infectious diseases.
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Objective To investigate the ultrasound measured inferior vena cava (IVC) caliber used as an objective indicator to assess water retention of patients with acute heart failure (AHF).Methods A total of 72 consecutive patients with acute heart failure admitted in the emergency department between December 2013 and April 2014 were enrolled.Acute heart failure was defined by the presence of symptoms such as asthmatic embarrassment and nocturnal paroxysmal dyspnea with or without signs of tracheobronchchial rale and edema of lower limbs,and by objective evidence of cardiac dysfunction as well,either a left ventricular ejection fraction (LVEF) ≤ 45％ or the combination of both left atrium dilation (≥ 4 cm diameter in the parasternal long axis) and a plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) ＞ 450 pg/mL (patients under 50 years old) or ＞ 900 pg/mL (patients over 50 years old and under 75 years old) or ＞ 1800 pg/mL (patients over 75 years old) or ＞ 1200 pg/mL (patients with renal dysfunction,glomerular filtration rate ＜ 60 mL/min).Exclusion criteria were chronic hepatic disease and acute myocardial infarction.Another 22 patients were enrolled as control.Independent t tests were used to compare normally distributed continuous variables between two groups,while nonparametric tests were used to compare non-normally distributed continuous ones,and chi-squared tests were used for categorical variables.The relations between IVC inner diameter and other normally distributed variables were assessed by Pearson correlation coefficients.A 2-sided P value ＜ 0.05 was considered statistically significant.Results The congestion score and IVC inner diameter were significantly higher in patients with AHF (P ＜ 0.05 ; P ＜ 0.01).The IVC inner diameter was correlated with NT-proBNP concentration (r =0.339,P =0.01 3) and congestion score (r =0.431,P =0.002).There was no relation between IVC inner diameter and LVEF (r =-0.241,P =0.102).IVC inner diameter had significantly positive correlations with pulmonary artery pressure and tricuspid regurgitation (r =0.414,P =0.004 ; r =0.359,P =0.015).Creatinine,blood urea nitrogen,and bilirubin were independently associated with increasing IVC inner diameter (r =0.313,P =0.032 ; r =0.379,P =0.009 ; r =0.385,P =0.007),while IVC inner diameter had negative relation with glomerular filtration rate (r =-0.337,P =0.021).Conclusions The IVC inner diameter can be used as a measurable and objective indicator to estimate the magnitude of access water retention in patients with AHF.
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Objective To investigate the high mobility group box chromosomal protein-1 (HMGB1) levels in patients with acute pancreatitis (AP); and to study the relationship between the serum level of HMGB1 and the severity of AP. Methods The patients' serum HMGB1 concentrations were determined right after admission, 24, 48 hour after admission. The levels of HMGB1 were measured by ELASA kit and its relationship with the severity of AP was analyzed. 20 healthy adults were treated as the control group. Results At the time of admission, and 24, 48 hours after admission, the serum HMGB1 levels in AP patients were (8.05 + 1.60 ), ( 8.04 ± 1.39 ), ( 8.25 ± 1.56) ng/ml, respectively, which were significantly higher than that in the healthy control [ ( 2.20 + 0.57 ) ng/ml, P ＜ 0. 01]. There were 35 patients with severe acute pancreatitis (SAP) and 27 patients with mild acute pancreatitis (MAP). The HMBG1 levels in patients with SAP were (7.99 + 1.69) ,(8.12 ± 1.40), (8.13 ± 1.34) ng/ml, and they were (8.12 + 1.52), (7.92 +1.40), (8.39 ± 1.81 )ng/ml in patients with MAP, and the difference between the two groups was not statistically significant. Conclusions The serum HMGB1 level in AP patients was significantly higher than that in healthy controls, but it was not related with the severity of AP.