ABSTRACT
Objective:To investigate the prognostic value of copeptin(COP)and troponin I(cTnI)for elderly patients with acute myocardial infarction(AMI).Methods:81 elderly AMI patients admitted to the Department of Emergency of Beijing Hospital from August 2016 to August 2018 were included as study subjects.COP and cTnI were measured and other relevant examinations were conducted.The correlation between each factor and the risk of death was evaluated in a 6-month follow-up, and the prognostic value of each indicator was assessed.Results:There were statistically significant differences in COP, cTnI, arterial lactic acid(LAC), the acute physiology and chronic health evaluation(APACHE)Ⅱ score, D-Dimer and N-terminal brain natriuretic peptide precursor(NT-pro-BNP)between the survival group and the death group(all P<0.05).COP and cTnI levels in the death group were significantly higher than those in the survival group[COP: 29.08(13.73, 43.19)ng/L vs.13.76(4.81, 20.82)ng/L; cTnI: 0.78(0.35, 2.23)μg/L vs.0.33(0.19, 0.57)μg/L].Binary Logistic regression analysis showed that COP( OR=1.071, 95% CI: 1.016-1.130, P=0.040)and cTnI( OR=3.261, 95% CI: 1.058-10.045, P=0.011)were independent risk factors for death within 6 months in elderly AMI patients.The ROC curves were constructed for cTnI, COP and their combination, and the AUCs(95% CI)were 0.742(0.593-0.892), 0.752(0.655-0.910)and 0.790(0.648-0.932), respectively. Conclusions:COP and cTnI may be used to assess the prognosis for elderly patients with AMI, and their combination can further increase the predictive value for short-term death risk.
ABSTRACT
Objective To investigate the predicting value of serial serum human stromelysin-2 (ST2)testing on prognosis in elderly patients with acute heart failure(AHF).Methods 75 AHF patients aged 60 to 90 were selected in our study who were in Beijing Hospital during 2013.1 ～ 2014.8,blood sampling of serum ST2 took place at admission and 72-96 h later.Moreover,38 healthy people aged 70 to 80 were chosen as control group.Follow-up was performed 1 year after acute attack.We defined the end of observation as recurrence of heart failure or any cause of death.The data was analyzed by SPSS19.0.Results Among 55 AHF patients,sST2 level was higher in patients with endpoint events than those without it on the two moment(P=0.000).And we found that the change in sST2 was higher in patients with endpoint events than those without it(P=0.023);and the percentage change in sST2 was also significantly different(P=0.033).Receiver operator curve analysis of the change in sST2 from baseline to 72-96 h later was strongly reflective of prognosis with area under the curve(AUC) of 0.696(P=0.013).And the change in sST2 Combined with the sST2 level at admission to predict the prognosis of AHF,the result would be more exciting,the area under the receiver operating characteristic (ROC) curve is 0.861 (P ＜ 0.001).The endpoint event rate of the patients whose level of sST2 at admission was below 1408 ng/L and the change level in sST2 below 101 ng/L was 21.4％(3/14),while the data in patients whose level of sST2 at admission is above 1 408 ng/L and the change level in sST2 above 100 ng/L was 85.7％(12/14).Conclusions in elderly patients of AHF,sST2 elevate markedly.The result shows that the level of sST2 may be used to evaluate AHF prognosis.And the change in sST2 are able to predict the prognosis of AHF.Compared with NT-proBNP,serial sST2 testing appears to be a promising candidate for monitoring these patients.
ABSTRACT
Objective To investigate the value of serum soluble leukocyte differentiation antigen 14 subtype (sCD14-ST,presepsin) combined with national early warning score (NEWS) for predicting the prognosis of emergency patients with sepsis.Methods To select 119 patients who came to the emergency department of Beijing Hospital with sepsis from September 2009 to July 2015 as the objects of the study.The serum samples were collected immediately as they came,the presepsin was measured,and the NEWS scorescalculated.Patients were divided into survival group (81 cases) and death group (38 cases) according to the 30-day prognosis,and the value of the presepsin,NEWS score and presepsin + NEWS score in the assessment of prognosis were compared.Results Presepsin and NEWS scores both were higher in the death group than the survival group.Presepsin and NEWS were the independent risk factors of the 30-day mortality of patients with sepsis.Under the ROC curve area (AUC) of presepsin and NEWS were 0.842 and 0.823;the combination of Presepsin and NEWS was 0.906.When presepsin ＞ 927.5 pg / mL and NEWS ＞ 6.5 points,it can significantly improve the efficacy of predicting prognosis.Conclusions Serum presepsin is a good indicator to judge the prognosis of patients with sepsis,and the combination with NEWS can improve the ability to predict the risk of septic death.
ABSTRACT
Objective To investigate the mechanisms and clinical characteristics of fatal asthma attack induced by amiodarone in the elderly,and to discuss its serious potent risks.Methods We reported two cases of fatal asthma attack in the elderly with fast atrial fibrillation induced by amiodarone,and discussed the clinical manifestation and emergency treatment,with literatures review.Results The two patients presented with respiratory arrest.After targeted therapies,including artificial ventilation and hormone injection,the patients were capable of spontaneously breathing,while still in severe asthma attack.And further anti-asthma treatment led to a complete remission.Conclusions Amiodarone may cause extremely severe asthma attack in elder patients with tachyarrhythmia complicated with bronchial hyper-responsiveness diseases such as asthma or chronic obstructive pulmonary diseases.Clinicians should pay great attention to this situation and be prepared to cope with serious adverse reactions.
ABSTRACT
Objective To investigate the predicting value of serum sST2 on risk stratification and prognosis in elderly patients with acute heart failure (AHF).Methods Total of 75 AHF patients aged 60 to 93 were selected in our study who were in Beijing Hospital during 2013.1-2014.8,including 40 cases of male and 35 cases of female.Moreover,38 healthy people aged 70 to 80 were chosen as control group,which contains 18 cases of male and 20 cases of female.Follow-up was performed 1 year after acute attack.We defined the end of observation as recurrence of heart failure or any causes of death.The data was analyzed by SPSS19.0.Results Compared with control group,sST2 level (pg/mL) was significantly elevated in AHF group [(596.9 ±181.2) vs.(1 698.9 ±797.0),P ＜0.001].No significant difference was found between male and female (1 713.1 ± 1 322.2 vs.1 727.5 ±867.1,P =0.956).sST2 level was significantly different between patients with different clinical heart function grade [1 439.5 ±694.5 (mild-Ⅰ and Ⅱ grade) vs.2 057.8 ± 1428.6 (severeⅢ and Ⅳ grade),P =0.026].Among the 75 AHF patients,sST2 level was higher in patients with endpoint events than those without endpoint events [(2 234.4 ± 1 308.5) vs.(1 162.3 ±452.6),P=0.000].According to the independent risk factors of unconditioned logistic bivariate regression model analysis,the levels of sST2,NT-proBNP and the clinical heart function Grade had independent predicting value of AHF (OR value were 1.003,1.001 and 7.46 respectively).We found that the cutoff value of sST2 (1 760 pg/mL) may be an valuable evaluation marker of prognosis,the sensitivity and specificity was 64％ and 92％,and the positive and negtive predictive rate were 89％ and 70％.The accuracy rate was 77％.Combined with NT-proBNP to predict the prognosis of AHF,the result would be more exciting.The area under the ROC curve is 0.889.The endpoint event rate of the patients whose level of sST2 was below 1400pg/mL and NT-proBNP level below 4000pg/mL was 7％,while the data in patients whose level of sST2 is above 1400 pg/mL and NT-proBNP above 4000pg/mL was 95％.Conclusions Early at admission of AHF in elderly patients,sST2 began to elevate markedly related with the extent of heart failure.The result shows that the level of sST2 may be used to evaluate patient.The elevation of sST2 has independent predictive value to the prognosis of AHF.It will be better to predict the prognosis combining ST2 with other biomarkers such as NT-proBNP.
ABSTRACT
Objective To investigate the clinical value of the plasma N-terminal pro-brain natriuretic peptide levels in patients with acute cardiac dyspnea or noncardiac dyspnea.Methods 93 patients with acute dyspnea were divided into two groups:cardiac dyspnea group(61 cases)and noncardiac dyspnea group(32 cases).In cardiac dyspnea group,according to the results of echocardiography,the cases were divided into three groups:pure diastolic heart failure(25 cases),pure systolic heart failure(21 cases)as well as diastolic and systolic heart failure(15 cases).At the same time,heart function was classified according to NYHA.The plasma NT-proBNP level was measured by ELISA.The data was analyzed by SPSS12.0.Results The plasma NT-proBNP level of the cases with cardiac dyspnea and noncardiac dyspnea was(3.591 ?2.943)ng/L and(0.429 ?0.119)ng/L respectively.There was a significant difference between cardiac dyspnea cases and noncardiac dyspnea cases(P