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ObjectiveTo investigate the value of gamma-glutamyl transpeptidase (GGT)/albumin (Alb) ratio in the noninvasive diagnosis of liver fibrosis degree in patients with chronic hepatitis B virus (HBV) infection. MethodsA retrospective analysis was performed for the clinical data of 322 patients with chronic HBV infection who underwent liver biopsy in Chaohu Hospital of Anhui Medical University from January 2018 to March 2020, and according to liver fibrosis degree based on liver biopsy, the 322 patients were divided into S0-S1 group with 183 patients, S2 group with 68 patients, S3 group with 35 patients, and S4 group with 36 patients. The clinical indices of routine blood test, virology, and blood biochemistry were collected. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data. A Spearman rank correlation analysis was used to investigate the correlation of the three noninvasive models GGT/Alb ratio, aspartate aminotransferase-to-platelet ratio index (APRI) score, and fibrosis-4 (FIB-4) index with liver fibrosis degree. A receiver operating characteristic (ROC) curve was plotted for GGT/Alb ratio to evaluate its diagnostic value. ResultsWith the aggravation of liver fibrosis degree, there were gradual reductions in Alb (F=7351, P＜0.05), HBV DNA (χ2=2.820, P＜0.05), and platelet count (F=6.182, P＜0.05) and gradual increases in age (χ2=3145, P＜0.05), GGT (χ2=6.149, P＜0.05), GGT/Alb ratio (χ2=7.064, P＜0.05), APRI score (χ2=9.022, P＜0.05), and FIB-4 index (χ2=8.254, P＜0.05). The Spearman rank correlation analysis showed that GGT/Alb ratio was positively correlated with liver fibrosis stage (r=0.396, P＜0.01), with a significantly higher correlation coefficient than APRI score (r=0.327, P＜0.001) and FIB-4 index (r=0.370, P＜0.001). The ROC curve analysis showed that in the patients with significant liver fibrosis, severe liver fibrosis, and liver cirrhosis, GGT/Alb ratio had similar areas under the ROC curve to APRI score and FIB-4 index (0.680/0.676/0.695 vs 0692/0.698/0.728 and 0.659/0.661/0.684, all P＞0.05). At the optimal cut-off values of 0.435, 0.465, 0.465, respectively, GGT/Alb ratio had sensitivities of 69.1%, 66.2%, and 69.0%, respectively, and specificities of 65.4%, 65.9%, and 67.0%, respectively, in the diagnosis of significant liver fibrosis, severe liver fibrosis, and liver cirrhosis. ConclusionLike APRI score and FIB-4 index, GGT/Alb ratio is a simple and practical noninvasive model for the diagnosis of liver fibrosis and can provide a reference for the diagnosis of liver fibrosis degree in patients with chronic HBV infection.
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Objective To compare the clinical characteristics and prognosis of bacterial liver abscess in patients with or without type 2 diabetes mellitus, in order to guide clinical diagnosis and treatment.Methods The clinical data of 110 patients with bacterial liver abscess at the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed.Among them, 45 cases with type 2 diabetes mellitus and 65 cases without type 2 diabetes mellitus were included in the study.The demographic data, clinical signs and symptoms, laboratory findings, pathogenic results, imaging findings, treatment and prognosis were compared between the two groups.Differences among the quantitative data with normal distribution were compared using t test, while count data were compared with χ2 test or Fisher exact test.Multivariate Logistic regression was used to determine the prognostic risk factors of two groups.Results Fever as initial symptom in diabetic group and non-diabetic group were 37 cases and 40 cases, respectively, while abdominal pain presented in 7 cases and 22 cases of the two groups, respectively, both with statistically significant difference (χ2=5.417 and 4.582, respectively, both P<0.05).As for laboratory examination, neutrophil counts in the two groups were (12.87±8.83)×109/L and (10.24±4.86)×109/L, respectively, the percentages of neutrophils were 0.841±0.077 and 0.799±0.103, respectively, albumin levels were (28.36±4.65) g/L and (30.67±6.16) g/L, respectively, with statistically significant difference (t=2.010, 2.317 and-2.265, respectively, all P<0.05).Patients with elevated blood urea nitrogen in the two groups were 13 cases and 8 cases, respectively, patients with elevated creatinine were 9 cases and 4 cases, respectively, with statistically significant difference (χ2=4.733 and 4.892, respectively, both P<0.05).In diabetic group, pus culture was positive in 13 out of 19 cases, and blood culture was positive in 7 out of 21 cases.In non-diabetic group, pus culture was positive in 9 out of 13 cases, and blood culture was positive in 6 out of 25 cases.The positive rates of Klebsiella pneumoniae in the two groups were 37.5% (15/40) and 15.8% (6/38) , respectively, with statistically significant difference (χ2=4.669, P=0.031).The effective rates of the two groups with glycemic control were 84.4% (38/45) and 84.6% (55/65), respectively, and the mortality rates of the two groups were 2.2% (1/45) and 1.5% (1/65), respectively.Multivariate Logistic regression showed that multiple abscess (OR=34.61, 95% CI: 1.601-748.457, P=0.024) was prognostic risk factor and invasive intervention (OR=0.028, 95%CI: 0.001-0.984, P=0.049) was protective factor in the diabetes mellitus group.Hypoalbuminemia (OR=14.793, 95% CI: 1.605-136.322, P=0.017) and the history of abdominal surgery within two years (OR=7.624, 95% CI: 1.294-44.913, P=0.025) were prognostic risk factors in the non-diabetic group.Conclusions Patients with bacterial liver abscess showing symptoms of severe infection in diabetic group are more frequently than patients in non-diabetic group.Klebsiella pneumoniae infection rate is also higher in diabetic group.Patients with bacterial liver abscess and diabetes mellitus should receive antibiotic treatment combined with invasive therapy in time.
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Objective To investigate the profile and antibiotic resistance of bacteria in patients with ascites infection in intensive care unit (ICU) patients in order to provide a reference for rational clinical use of antibiotics. Methods A retrospective analysis was conducted. The bacteria isolated from ascetic fluid patients admitted from January 1st, 2004 to October 31st, 2015 to ICU of the First Affiliated Hospital of Anhui Medical University were identified, and their susceptibility to antibiotics was analyzed. Patients, who were admitted from January 1st, 2004 to December 31st, 2009 were assigned to group A, and patients admitted afterwards were assigned to group B. Results A total of 637 specimens of ascetic fluid were examined, with 185 positive culture (29.0%) during the 12 years, and 203 strains of bacteria were found. Among them 126 strains (62.1%) of gram-negative bacteria (G-), 54 (26.6%) of gram-positive bacteria (G+) and 23 (11.3%) strains of fungi were found. Compared the result of group B with that of group A, the proportion of G- bacteria was increased [71.2% (99/139) vs. 44.2% (27/64)], and that of G+ decreased [17.3% (24/139) vs. 46.9% (30/64)] in group B. The difference was statistically significant (χ2 = 20.34, P = 0.001). The main pathogenic bacteria were G-, and Enterobacteriaceae was the most common pathogenic bacteria in intra-abdominal infection of ICU patients. The isolation rate of Escherichia coli and Klebsiella pneumoniae(35.7%, 10.3%) ranked in the first and third in G- bacteria, respectively. The resistant rate of Escherichia coli against penicillin and third generation cephalosporin were > 95.0% and > 73.3%, and it showed a sensitive rate of 70% to β-lactam/inhibitor, amikacin and minocycline, and a higher sensitivity to carbapenems and tigecycline (11.1%, 0). Forty-eight strains of non-fermentation bacteria were found with a rate of 23.7%. The positive rates of Acinetobacter baumannii in groups A and B were 7.8% (5/64) and 23.7% (33/139), respectively, and they ranked first among non-fermentation bacteria. Twenty strains (62.5%) multidrug-resistant Acinetobacter baumannii were found. Acinetobacter baumannii showed a resistance rate of 84.6% to cefoperazone/sulbactam, 35.3% to minocycline, and 53.3% to tigecycline. Candida albicans was the most commonly isolated fungus in intra-abdominal infections (87.5%). No strains resistant to common antifungal drugs were isolated. Conclusions G- bacteria was the main pathogen in intra-abdominal infection in patients with ascites. Non-fermenters showed an increasing trend of producing infection, and the proportion of multidrug-resistant Acinetobacter baumannii infection increased year by year, and more attention should be taken by attending doctors.