ABSTRACT
Objective:To understand the vancomycin dose, therapeutic drug monitoring(TDM) situation and therapeutic effect of children after liver transplantation.Methods:A retrospective analysis of the data of 98 children who received intravenous vancomycin treatment after liver transplantation were conducted in the Department of Critical Care Medicine of Beijing Friendship Hospital from January 2017 to June 2019, including demographic data, vancomycin dose, serum trough concentration, drug-related adverse reactions and clinical outcome data.Results:A total of 98 children received intravenous vancomycin treatment and at least one steady-state TDM blood sample was collected.Among them, 53 cases (54.1%) were male, and the median age was 9 months(5 months to 14 years old). The median first daily dose of vancomycin treatment was 50(30-60)mg/(kg·d), and the median duration of treatment was 14(3-54)days.Only 27.5%(27/98)of the children′s initial trough concentration reached the target concentration (10-20 mg/L), while 26 cases(26.5%) did not reach the target after adjusting the treatment.Six children(6.1%)had renal toxicity caused by vancomycin, and two children had skin rash.The effective treatment rate accounted for 51.7%(15/29). The initial trough concentrations of vancomycin in the effective and ineffective groups were(5.92±3.82)mg/L and(10.43±5.37)mg/L, respectively.The difference was statistically significant ( P=0.041). Conclusion:The rate of intravenous vancomycin in children after liver transplantation is low, and the dose needs to be adjusted individually.
ABSTRACT
Objective To analyze the characteristics of change in plasma cholesterol level in patients with sepsis, and to explore its relationship with prognosis and its clinical significance. Methods A retrospective analysis was conducted. 568 patients with sepsis admitted to Department of Critical Care Medicine of Beijing Friendship Hospital Affiliated to Capital Medical University from August 2013 to August 2015 were enrolled, and 475 patients without sepsis hospitalized in the same period served as the control. The basic clinical data of the two groups were collected, and the results of blood fat and biochemical parameters were compared. The patients with sepsis were divided into death group and survival group, and risk factors influencing the prognosis of patients with sepsis were analyzed with multivariate logistic model regression analysis. Results Compared with non-sepsis patients, the levels of plasma total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C) in the patients with sepsis were significantly lower [TC (mmol/L): 2.5±1.2 vs. 3.4±1.4, t = 4.274, P = 0.021; HDL-C (mmol/L): 1.6±0.9 vs. 2.5±0.8, t = 3.413, P = 0.018], and that of low density lipoprotein cholesterol (LDL-C) showed no statistically significant difference (mmol/L: 1.9±0.9 vs. 2.1±0.9, t = 0.749, P = 0.614). In the patients with sepsis, the patients in death group (n = 227) were older than those of the survival group (n = 341, years: 74.3±15.5 vs. 65.5±17.5, t = 4.037, P = 0.012), serum creatinine (SCr) was higher than that of survival group (μmol/L: 251.0±115.6 vs. 167.4±108.7, t = 3.254, P = 0.023), the levels of plasma TC, HDL-C and LDL-C were significantly lower than those of survival group [TC (mmol/L): 2.2±1.6 vs. 2.9±1.1, t = 3.057, P = 0.023; HDL-C (mmol/L): 1.4±0.8 vs. 1.9±0.8, t = 4.692, P = 0.016; LDL-C (mmol/L): 1.7±0.7 vs. 2.0±0.8, t = 2.541, P = 0.038]; there was no significant difference in the proportion of male, body mass index (BMI), based disease, intensive care unit (ICU) hospitalization time, the severity of the disease and other biochemical indexes between two groups. With single factor analysis with indicators of statistical significance as a covariate into binary logistic regression equation, the results show that age was the risk factor of death in patients with sepsis [odds ratio (OR) = 1.024, 95% confidence interval (95%CI) = 1.010-1.048, P = 0.009], and TC was the protective factor on the prognosis of patients with sepsis (OR = 0.747, 95%CI = 0.682-0.811, P = 0.013). Conclusions Plasma cholesterol levels in patients with sepsis were significantly lowered, and the levels in death group was significantly lower than that in the survival group. TC may be used as a clinical indicator to assess the outcome of patients with sepsis.
ABSTRACT
Objective To investigate the epidemiological characteristics and mortality risk factors of severe sepsis patients admitted into intensive care unit (ICU).Methods The clinical data of 419 severe sepsis patients admitted to an adult ICU of Beijing Friendship Hospital from January 2009 to December 2012 were retrospectively analyzed and evaluated.Logistic regression analysis was employed to identify independent risk factors for the death of patients with severe sepsis during ICU stay.Results Overall ICU mortality was 43.9％ (184/419),and the respiratory tract was the most common site of infection (50.8％),followed by infection of the gastrointestinal tract and abdominal cavity (27.8％),and hematogenous infection (4.3％).Gram-negative bacteria were the most common pathogens [46.0％ (214/465)].Iatrogenic infections accounted for 53.7％ (225/419) of the enrolled patients.Logistic regression analysis showed that age [odds ratio (OR)=0.003,95％ confidence interval (95％CI) 1.015-1.056,P=0.O00],vasoactive drug application (OR=3.251,95％CI 1.562-6.768,P=0.002),failure of 3 or more organs (OR=2.452,95％ CI 1.015-5.924,P=0.046),and iatrogenic infection (OR =1.775,95％ CI 0.981-3.221,P=0.046) were independent risk factors for ICU mortality.Conclusions Severe sepsis is a common cause of ICU admission.Patients with risk factors for high mortality should be carefully monitored,and aggressive treatment should be administered.