ABSTRACT
Objective:To explore the incidence of secondary hemophagocytic lymphohistiocytosis (sHLH) in elderly patients with severe SARS-CoV-2 infection, and to analyze and summarize its clinical features and risk factors for early identification of high-risk groups.Methods:A retrospective cohort study was conducted. From January to May 2020, No. 960 Hospital of People's Liberation Army, the Second Hospital Affiliated to Cheeloo College of Medicine of Shandong Province, the First Rehabilitation Hospital of Shandong Province, the Public Health Clinical Center Affiliated to Shandong University, and Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine received 248 patients over 60 years old who were diagnosed with severe SARS-CoV-2 infection during their assistance to Hubei or support for diagnosis and treatment of SARS-CoV-2 infection in Shandong Province. The clinical data of patients were collected. According to the hemophagocytic lymphohistiocytosis diagnosis scoring (HScore) criteria, the patients were divided into sHLH group (HScore > 169) and non-sHLH group (HScore < 98). The demographic data, clinical features, laboratory results, the proportion of organ failure and 60-day mortality of patients were collected and compared between the two groups. The risk factors of sHLH and 60-day death were evaluated through binary multivariate Logistic regression analysis in elderly patients with severe SARS-CoV-2 infection. The receiver operator characteristic curve (ROC curve) was plotted to analyze the diagnostic value of indicators only or combined for sHLH.Results:Among 248 elderly patients with severe SARS-CoV-2 infection, 82 patients with incomplete data and untraceable clinical outcomes, and 35 patients with HScore of 98-169 were excluded. Finally, 131 patients were enrolled in the final follow-up and statistics, including 25 patients in the sHLH group and 106 patients in the non-sHLH group. Compared with the non-sHLH group, plasma albumin (ALB), hemoglobin (Hb), lymphocyte count (LYM), platelet count (PLT), fibrinogen (Fib) and prealbumin (PAB) in the sHLH group were significantly reduced, while alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), MB isoenzyme of creatine kinase (CK-MB), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ferritin (Fer), lactate dehydrogenase (LDH), procalcitonin (PCT), cardiac troponin I (cTnI), triglycerides (TG), interleukin-6 (IL-6), total bilirubin (TBil) were significantly higher. The fever and fatigue in the sHLH group were more severe than those in the non-sHLH group, and the patients in the sHLH group had higher rates of shock, acute kidney injury, liver dysfunction, and cardiac injury than the non-sHLH group. The 60-day mortality of patient in the sHLH group was significantly higher than that in the non-sHLH group [84.0% (21/25) vs. 40.6% (43/106), P < 0.01]. Binary multivariate Logistic regression analysis showed that high Fer [odds ratio ( OR) = 0.997, 95% confidence interval (95% CI) was 0.996-0.998], D-dimer ( OR = 0.960, 95% CI was 0.944-0.977), LDH ( OR = 0.998, 95% CI was 0.997-0.999) and TG ( OR = 0.706, 95% CI was 0.579-0.860) were independent risk factors for sHLH in elderly patients with severe SARS-CoV-2 infection (all P < 0.01), while elevated Fer ( OR = 1.001, 95% CI was 1.001-1.002), LDH ( OR = 1.004, 95% CI was 1.002-1.005) and D-dimer ( OR = 1.036, 95% CI was 1.018-1.055) were independent risk factors for 60-day death of patients (all P < 0.01). The death risk of the sHLH patients was 7.692 times higher than that of the non-sHLH patients ( OR = 7.692, 95% CI was 2.466-23.987, P = 0.000). ROC curve analysis showed that a three-composite-index composed of LDH, D-dimer and TG had good diagnostic value for sHLH in elderly patients with severe SARS-CoV-2 infection [area under the ROC curve (AUC) = 0.920, 95% CI was 0.866-0.973, P = 0.000]. Conclusions:Elderly patients with severe SARS-CoV-2 infection complicated by sHLH tend to be critically ill and have refractory status and worse prognosis. High Fer, LDH, D-dimer and TG are independent risk factors for sHLH, and are highly suggestive of poor outcome. The comprehensive index composed of LDH, D-dimer and TG has good diagnostic value, and can be used as an early screening tool for sHLH in elderly patients with severe SARS-CoV-2 infection.
ABSTRACT
OBJECTIVE:To observe the efficacy of Shenmai injection combined with insulin in the intensive treatment of stress hyperglycemia in the septicopyemia patients. METHODS:The data of 156 septicopyemia patients with stress hyperglycemia was collected Retrospectively,according to the different medication divided into control group (78 cases) and observation group (78 cases).All patients determined the pathogenic bacteria and received related anti-infection treatment,improving ventilation state, adequate fluid resuscitation support,immune therapy,nutritional support and other conventional treatment;based on it,control group received different dosages of insulin [1 U/ml,intravenous micro pump,with speed of 0.1 U/(kg·h)] based on different blood glucose levels;observation group additionally received 40 ml Shenmai injection,adding into insulin mixed solution,intrave-nous micro pump. Endpoint events(mortality),recovering time of blood glucose,total dosage of insulin,basic indicators [Acute physiology and chronic health(24 APACHE-Ⅱ)score,mechanical ventilation time,hospitalization days in ICU and frequency of hypoglycaemia] and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total mortality rate in observa-tion group was significantly lower than control group,recovering time of blood glucose was significantly shorter than control group,the total dosage of insulin was significnatly less than control group,mechanical ventilation time was significantly shorter than control group,hospitalization days in ICU was significantly less than control group,the differences were statistically significant (P0.05);after treat-ment,the 24 APACHE-Ⅱ score in 2 groups were significantly reduced,and observation group was lower than control group,the differences were statistically significant(P<0.05). And there were no obvious adverse reactions in 2 groups during treatment. CON-CLUSIONS:Based on conventional treatment,Shenmai injection combined with insulin shows good efficacy in the intensive treat-ment of stress hyperglycemia in the septicopyemia patients,it can decrease total dosage of insulin,reduce mortality rate and 24 APACHE-Ⅱscore,shorten mechanical ventilation time and decrease hospitalization days in ICU,with good safety.
ABSTRACT
BACKGROUND:Acelular matrix which is decelularized but retains the matrix components in the nature materials can reduce the immunogenicity of natural materials effectively and keep the material mechanical strength. OBJECTIVE:To prepare the natural biological scaffold material by using elution method to remove the cels in the rabbit costicartilage matrix. METHODS:After removal of the surrounding tissues, the costicartilage samples from New Zealand white rabbits were randomly divided them into three groups: costicartilages untreated as normal control group, detergent-enzyme digestion for 48 hours as 48-hour treatment group, detergent-enzyme digestion for 96 hours as 96-hour treatment group. Hematoxylin-eosin staining and electron microscope were used to observe decelularized effects. At 7 days of induction, bone marrow mesenchymal stem cels, 3×109/L, were colected and co-cultured with alogeneic acelular costicartilage matrixin vitro. At 3 and 7 days of co-culture, the composite was taken for observation of cel growth on the cel-free substrate surface under electron microscope. RESULTS AND CONCLUSION:Two or three cartilage cels were closely packed in each cartilage pit, began to depigment using the detergent-nuclease digestion method, and then completely depigmented at 96 hours after treatment. At 3 days of co-culture, there were a large amount of polygon-shaped adherent cels with pseudopodiasobserved on the acelular matrix surfacein vitro, and cels could proliferate and divide in partial regions. At 7 days of co-culture, adherent cels spread mostly throughout the acelular matrix surface, these cels were flat-shaped and extended with multiple interconnected processes. Mass of secreted excelular matrixes were deposited on the matrix surface and showed frost-like changes, indicating the prepared acelular matrix has favorable cytocompatibility.