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Objective:To investigate the correlation and predictive value of thromboelastography (TEG) in the severity and prognosis of patients with sepsis.Methods:Clinical data of 147 patients with sepsis admitted to Intensive Care Unit (ICU) of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2013 to December 2019 were retrospectively analyzed. Inflammation indicators and TEGt were performed within 24 h after admission, and APACHE Ⅱ score was evaluated. According to APACHE Ⅱ score, the patients were divided into the mild group and severe group. TEG indicators were compared between the two groups. Patients with sepsis were divided into the death group and survival group to assess the value of TEG for prognosis of patients with sepsis.Results:Compared with patients with mild sepsis, patients with severe sepsis had lower α angle ( P=0.015), longer K time ( P=0.015), and higher maximum amplitude ( P=0.045). The K time of the death group was significantly longer than that of the survival group. When K time ≥2.2 min (sensitivity 77.27% and specificity 95.2%), the risk of sepsis death was the highest ( P<0.001). Conclusions:Patients with severe sepsis show marked hypocoagulability, and K time has predictive value for the prognosis of patients with sepsis.
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Objective@#To investigate the clinical and prognosis value of left ventricular diastolic function(LVDF)in predicting the short-term prognosis of sepsis-associated acute lung injury/acute respiratory distress syndrome(ALI/ARDS)in the elderly.@*Methods@#This was a prospective case-control study.A total of 93 elderly patients with sepsis-associated ALI/ARDS, who admitted to our hospital between February 2015 and February 2018, were selected as the study subjects.And they were divided into ALI group(n=52)and ARDS group(n=41). Meanwhile 50 elderly sepsis patients without ALI/ARDS were selected as the control group.Based on the prognosis at the 28th days of admission, patients with ALI/ARDS were divided into a death group and a survival group.General clinical data and left ventricular diastolic function index at different time points after admission were compared between groups.@*Results@#There were statistically significant differences among the ALI group, ARDS group and control group(P<0.05)on admission and at 3 and 7 days after admission in the parameters as the following: heart rate, mean arterial pressure(MAP), acute physiology and chronic health evaluation system Ⅱ(APACHEⅡ)score, acute lung injury score(LIS), oxygenation index(PaO2/FiO2), arterial blood lactic acid, blood glucose, serum creatinine, troponin I, B-type brain natriuretic peptide(BNP), procalcitonin(PCT), C-reactive protein(CRP)and early diastolic transmitral velocity to early mitral anulus diastolic velocity ratio(E/Em). APACHEⅡscore, LIS score, blood glucose, troponin I, BNP, PCT, CRP and E/Em were higher in the death group than in the survival group on admission and at 3 and 7 days after admission(all P<0.05). Multivariate logistic regression analysis showed that E/Em on admission and at 3 and 7 days after admission were the independent predictors for mortality in patients with sepsis-associated ALI/ARDS(OR=1.346, 2.150 and 1.954, respectively, P<0.05). ROC curve analysis showed that the area under curve(AUC)of E/Em for predicting death on admission and at 3 and 7 days after admission were 0.687, 0.840 and 0.771, respectively, with the optimal threshold value of 13.26, 14.90 and 14.62, respectively, and the sensitivity and specificity were 74.2% and 67.1%, 81.5% and 84.2%, 79.1% and 87.8%, respectively, .The mortality rate was higher in patients with E/Em above the optimal threshold value than below the optimal threshold value at each time point(all P<0.05).@*Conclusions@#The impairment of LVDF is serious in elderly patients with sepsis-associated ALI/ARDS, may be an independent predictor for recent death in such patients, and has a good predictive value for the prognosis of elderly patients with sepsis-associated ALI/ARDS.
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Objective To investigate the clinical and prognosis value of left ventricular diastolic function(LVDF) in predicting the short-term prognosis of sepsis-associated acute lung injury/acute respiratory distress syndrome(ALI/ARDS) in the elderly.Methods This was a prospective casecontrol study.A total of 93 elderly patients with sepsis-associated ALI/ARDS,who admitted to our hospital between February 2015 and February 2018,were selected as the study subjects.And they were divided into ALI group(n=52)and ARDS group(n=41).Meanwhile 50 elderly sepsis patients without ALI/ARDS were selected as the control group.Based on the prognosis at the 28th days of admission,patients with ALI/ARDS were divided into a death group and a survival group.General clinical data and left ventricular diastolic function index at different time points after admission were compared between groups.Results There were statistically significant differences among the ALI group,ARDS group and control group (P ＜0.05)on admission and at 3 and 7 days after admission in the parameters as the following:heart rate,mean arterial pressure(MAP),acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score,acute lung injury score (LIS),oxygenation index (PaO2/FiO2),arterial blood lactic acid,blood glucose,serum creatinine,troponin Ⅰ,B-type brain natriuretic peptide(BNP),procalcitonin(PCT),C-reactive protein(CRP) and early diastolic transmitral velocity to early mitral anulus diastolic velocity ratio (E/Em).APACHE Ⅱ score,LIS score,blood glucose,troponin I,BNP,PCT,CRP and E/Em were higher in the death group than in the survival group on admission and at 3 and 7 days after admission(all P＜0.05).Multivariate logistic regression analysis showed that E/Em on admission and at 3 and 7 days after admission were the independent predictors for mortality in patients with sepsis-associated ALI/ARDS(OR =1.346,2.150 and 1.954,respectively,P＜0.05).ROC curve analysis showed that the area under curve(AUC)of E/Em for predicting death on admission and at 3 and 7 days after admission were 0.687,0.840 and 0.771,respectively,with the optimal threshold value of 13.26,14.90 and 14.62,respectively,and the sensitivity and specificity were 74.2％ and 67.1％,81.5％ and 84.2％,79.1％ and 87.8％,respectively,.The mortality rate was higher in patients with E/Em above the optimal threshold value than below the optimal threshold value at each time point (all P ＜ 0.05).Conclusions The impairment of LVDF is serious in elderly patients with sepsis-associated ALI/ARDS,may be an independent predictor for recent death in such patients,and has a good predictive value for the prognosis of elderly patients with sepsis-associated ALI/ARDS.
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Objective To explore the clinical significance of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) during intraoperative period in children with congenital heart disease (CHD).Methods Ninety-two CHD patients (CHD group) and 92 healthy controls (control group) were enrolled.For CHD patients,the level of plasma NT-proBNP was assayed preoperative and 1st,3rd and 5th day postoperation.The relationship between NT-proBNP and recovery of cardiac function after operation was analyzed.The relationship between complications and days for hospitalization was also determined.Results Before operation,the level of NT-proBNP in CHD group was significantly higher than that in control group (median:231.26 ng/L vs.62.18 ng/L)(P＜0.05).After operation,the level of NT-proBNP in CHD group was significantly increased at 1st day (median:357.26 ng/L) (P＜0.05),3rd day(median:310.66 ng/L)(P＜0.05 ),and decreased at 5th day (median:139.37 ng/L)(P＜0.05 ).The difference of LVEF preoperative and postoperative was significantly lower in high level of NT-proBNP patients(46 cases) than that in low level of NT-proBNP patients (46 cases)[ (4.61 ± 1.69)％ vs.(6.31 ± 1.27)％](P＜0.05).The rate of congestive heart failure and the third atrioventricular block,the days for hospitalization were higher in high level of NT-proBNP patients than those in low level of NT-proBNP patients [ 17.39％ (8/46) vs.2.17％ (1/46),15.22％(7/46) vs.0,(9.36 ± 1.27) d vs.(7.21 ± 1.39) d](P＜0.05).Conclusion Plasma NT-proBNP is a useful marker during intraoperative period in CHD patients.
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ObjectiveTo observe the effect of atorvastatin on heart function of patients with chronic congestive heart failure(CCHF) and the changes of brain natriuretic peptide(BNP),C-reactive protein (CRP).MethodsSeventy-eight patients with CCHF were divided into control group and atorvastatin group by random number table with 39 cases each.Patients in control group were treated with routine treatment such as diuretic,inotropic agents,beta receptor blockers,and atorvastatin group were treated with atorvastatin calcium 20 mg once a day at the base of routine treatment.After treatment for 6 months,the levels of left ventricular ejection fraction (LVEF),left ventricular end-diastolic dimension (LVEDd),left ventricular end-systolic dimension (LVESd) and CRP,BNP were detected and compared between two groups.ResultsAfter treatment,the level of LVEF was significantly increased and the levels of LVEDd,LVESd were significantly decreased in two groups (P ＜0.05).Moreover,the level of LVEF in atorvastatin group was significantly higher than that in control group [ (46.75 ± 5.82)％ vs.(40.58 ± 4.92 )％ ] (t = 4.016,P ＜0.05),and the levels of LVEDd,LVESd in atorvastatin group were significantly lower than those in control group [ (49.13 ± 4.02) mm vs.(57.62 ± 4.77) mm,(37.76 ± 3.02) mm vs.(41.89 ± 3.53 ) mm] ( t =4.135,4.253,P ＜ 0.05 ).The levels of CRP,BNP after treatment in atorvastatin group [ ( 11.86 ± 4.11 ) mg/L and (247.92 ± 32.78) ng/L] were significantly decreased compared with those before treatment [( 19.62 ±7.93) mg/L and(496.61 ± 78.87) ng/L] (t = 4.668,4.821,P ＜ 0.05 ),and the levels of CRP,BNP were significantly lower than those in control group [ (16.79 ± 6.52) mg/L and(475.41 ± 65.62) ng/L] (t =3.889,4.011,P ＜ 0.05).ConclusionAtorvastatin can significantly improve heart function in patients with CCHF and reduce the plasma levels of CRP and BNP,which is good for CCHF patients to improve conditions.
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Objective The relationship between DNA methylation and the overexpression of cell cycle negative regulator p16MTS1/INK4a in senescent cells was studied. Methods PCR amplification of p16 exon I following digestion with Sma I , a methylation sensitive DNA endonuclease, was adapted to determine the methylation status at specific site. Results T-he increased expression of p16 in the aging process of human fetal lung diploid fibroblasts (2BS) was observed. In middle-aged and old cells, the p16 level was about 3 folds and 10 folds respectively as that in young cells. The methylation level of the Sma I site in p16 exon I tended to decline with aging, being about 64% and 41% in young and middle-aged cells respectively, but still maintain relatively as high as about 24% in senescent cells. Conclusions The overexpression of p16 in senescent human fibroblasts might be related to the alteration of methylation level of exon I, its mechanisms need to be defined further.