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Objective:To study the prognostic risk factors of Enterobacteriaceae bloodstream infection in patients with sepsis.Methods:The medical records of patients with sepsis caused by Enterobacteriaceae bloodstream infection in our hospital from June 2017 to May 2019 were screened. The gender, age, admission department, basic disease, infection site, etiology examination and treatment plan were recorded in detail. The survival and death groups were divided according to the patient's survival status. The ratio of C-reactive protein (CRP) to serum prealbumin (PA) was recorded within 24 h after admission. The acute physiological and chronic health scores (APACHEⅡ score) and Pitt bacteremia score (PBS score) were calculated within 24 h, and based on the results of blood culture drug sensitivity test to analyze whether the initial experience treatment was appropriate. Logistic regression analysis was used to analyze the risk factors affecting the prognosis of patients, and the receiver operating characteristic curve (ROC curve) was drawn to predict the occurrence of poor prognosis in patients with sepsis.Results:Logistic regression analysis showed that CRP ( OR=1.021, P<0.01), CRP/PA ( OR=34.638, P<0.01), extended-spectrum β-lactamase production ( OR=0.244, P<0.01), inappropriate empirical antibacterial treatment ( OR=0.156, P<0.01), APACHE Ⅱ score ( OR=1.436, P<0.01), and PBS score ( OR=8.622, P<0.01) were risk factors affecting patient's prognosis. Multivariate regression analysis showed that CRP/PA ( OR=25.420, P<0.05), inappropriate empirical treatment ( OR=0.077, P<0.05), APACHEⅡ score ( OR=1.476, P<0.01), PBS score ( OR=12.042, P<0.01) were independent risk factors for death in patients with sepsis ( P<0.05). The higher the CRP/PA level, PBS score and APACHEⅡ score, the worse the prognosis. When CRP/PA ≥0.89, PBS score ≥3.5, APACHEⅡ score ≥17.5, the patient's risk of death increased significantly. In addition, inappropriate empirical treatment was also a key factor in patients with poor prognosis. Conclusions:CRP/PA, PBS score, APACHE Ⅱ score, and inappropriate empiricaltreatment are independent risk factors affecting the prognosis of patients with enterobacter hemorrhagic infection with sepsis. The PBS score and APACHEⅡ score can better predict the poor prognosis and risk of death. Compared with APACHEⅡscore, the former is simpler and practical and can be widely used.
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Objective To verify the validity and feasibility of national early warning score (NEWS) in evaluation of death risk in elderly patients with critical illness,in order to find out which scoring method is more suitable for elderly critical illness patients.Methods A prospective case-control study was conducted.The critical illness patients aged over 60 years old with the length of hospital stay over 24 hours,and admitted to Department of Emergency of Qingdao Municipal Hospital from January to December 2015 were enrolled.The clinical data including in emergency and the actual outcome of patients were collected,and the patients were divided into death group and survival group according to 30-day outcome.Patients in the two groups were assessed by using NEWS and risk classification according to the first results of vital signs monitoring.Multivariate logistic regression model was used to analyze the relationship between the NEWS classification and the risk of death in elderly critical ill patients.Results 1 950 emergency elderly patients with critical illness were enrolled,with 78 cases (4.0％) dead within 30 days and 1 872 survived (96.0％).Compared with the survival group,patients in death group were older (years:79.8 ± 10.8 vs.75.3 ± 8.9,t =4.335,P ＜0.001),and had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (22.9± 4.6 vs.18.2 ± 4.8,t =8.487,P ＜ 0.001),lower Glasgow coma scale (GCS) score (12.2 ± 4.5 vs.13.4 ± 5.2,t =-2.007,P =0.045),higher incidence of respiratory system diseases (29.5％ vs.17.9％,x 2 =12.742,P =0.013),higher NEWS score (11.2 ± 5.5 vs.3.9 ± 2.7,t =22.063,P ＜ 0.001),as well as higher proportion of patients with NEWS classification of high risk and very high risk (65.4％ vs.15.8％,x 2 =263.125,P ＜ 0.001).With the increase of NEWS risk classification,mortality rate was also increased,and the mortality rate in the patients with low,medium,high and very high risk were 0.81％ (9/1 108),3.63％ (18/496),5.83％ (13/223),30.89％ (38/123),respectively,with statistically significant difference (x 2 =179.741,P ＜ 0.001).It was showed by logistic regression analysis that the NEWS score of elderly patients with critical illness were positively correlated with 30-day death.The 30-day death risk of patients with middle risk,high risk and very high risk was 4.600,9.052 and 54.598 folds of the patients with low risk respectively.Conclusion NEWS score can be used to assess the risk of death in emergency elderly patients with critical illness.NEWS risk classification can quantify and classify the risk of death in the elderly patients with critical illness.
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Objective To evaluate the efficacy of modified quadruple therapy for patients who were failed in previous Helicobacter pylori ( Hp) eradication treatment .Methods A total of 86 patients with confirmed Hp infection and failed in previous Hp eradication treatment were collected from Qingdao Municipal Hospital during January 2012 and January 2014.Patients were randomly assigned into two group:43 patients in control group were given conventional quadruple therapy ( rabeprazole +colloidal bismuth pectin +amoxicillin +clarithromycin for 14 d ) , and 43 patients in test group were given modified quadruple therapy ( rabeprazole +colloidal bismuth pectin +amoxicillin +clarithromycin for 7 d, and lansoprazole +colloidal bismuth pectin +levofloxacin +metronidazole for 7 d).Chi square test was performed to analyze per-protocol (PP) eradication rates, intent-to-treat (ITT) eradication rates, and Hp recurrence rates between two groups .Results Among 43 patients in test group , 42 completed treatments with PP eradication rate of 100.00% and ITT eradication rate of 97.67%.All patients in control group completed treatments , and Hp eradication was observed in 24 patients , and both PP and ITT eradication rates were 55.81%.The differences in PP and ITT eradication rates between two groups were of statistical significance (χ2 =23.90 and 21.11, P0.05).Conclusion The efficacy of modified quadruple therapy for patients who were failed in the previous Hp eradication treatment is satisfactory.