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Objective:To investigate the association between early central venous pressure (CVP) measurement and mortality in patients with sepsis.Methods:The adult patients with sepsis were identified from the health data of Medical Information Mart for Intensive Care-Ⅲ v1.4 (MIMIC-Ⅲ v1.4). Data of all adult patients with sepsis were collected, including gender, age, comorbidities, length of survival, total length of hospital stay and intensive care unit (ICU) stay, sequential organ failure assessment (SOFA) score, vital signs, laboratory test results on the first day, vasoactive agents usage, fluid input, urine output and fluid balance on the first day, need for renal replacement therapy and mechanical ventilation, diagnosis of sepsis, and the time and value of the first CVP measurement in the ICU. Patients were divided into early measurement and control groups based on whether or not they had a CVP measurement within the first 6 hours of ICU stay. According to the time of the first CVP measurement, the patients were subdivided into four subgroups: ≤ 3 hours, 4-6 hours, 7-12 hours and no measurement within 12 hours. The primary endpoint was 28-day mortality. The relationship between initial CVP and mortality was analyzed by Lowess smoothing method. Kaplan-Meier survival analysis and Log-Rank test were performed for univariate analysis. Cox regression analysis was performed for multivariate analysis to estimate the relationship between timeliness of CVP measurement and mortality.Results:A total of 4 733 sepsis patients were enrolled, 1 673 of whom had CVP measured within 6 hours of admission to the ICU, and the other 3 060 patients served as the control group. There were no differences in demographic characteristics and underlying diseases between the two groups, except that the early CVP measurement group had less underlying renal failure compared with control group. The early CVP measurement group had higher lactic acid (Lac) levels and SOFA scores, indicating worse severity of disease as compared with control group. The 28-day mortality in the early CVP measurement group was significantly lower than that in the control group (34.2% vs. 40.7%, P < 0.01). The early CVP measurement group had shorter length of total hospitalization and longer length of ICU stay, higher rate of mechanical ventilation and vasoactive agents dependent, and more fluid input and fluid balanced in the first day of ICU stay compared with control group. Lowess smoothing analysis showed that a "U"-shaped relationship between initial CVP and mortality was identified, suggesting that too high or too low initial CVP was associated with worse survival. Kaplan-Meier survival analysis showed that compared with the patients without early CVP measurement within 12 hours, the cumulative survival rate of patients with CVP measured within 3 hours was significantly higher (66.7% vs. 59.1%; Log-Rank test: χ2 = 15.810, adjusted P < 0.001); while no significant difference was found in patients with CVP measured between 4 hours and 6 hours and between 7 hours and 12 hours compared with the patients without early CVP measurement within 12 hours (64.4%, 60.3% vs. 59.1%; Log-Rank test: χ2 values were 5.630 and 0.100, and adjusted P values were 0.053 and > 0.999, respectively). Cox multivariate analysis showed that the Cox proportional risk model was established by taking patients without CVP measurement within 12 hours as reference, timely CVP measurement after ICU admission was associated with reduced 28-day mortality of patients with sepsis [≤3 hours: hazard ratio ( HR) = 0.65, 95% confidence interval (95% CI) was 0.55-0.77, P < 0.001; 4-6 hours: HR = 0.72, 95% CI was 0.60-0.87, P = 0.001; 7-12 hours: HR = 0.80, 95% CI was 0.66-0.98, P = 0.032] after the confounding variables (gender, age, SOFA score, initial Lac, renal failure, maximal blood glucose and white blood cell count, and minimal platelet count within 24 hours) were adjusted. Conclusions:Early CVP measurement is associated with decreased 28-day mortality in patients with sepsis. CVP should be considered as a valuable and easily accessible safety parameter during early fluid resuscitation.
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Objective To analyze the distribution and antimicrobial resistance of bloodstream pathogens in surgical intensive care unit (SICU) and medical intensive care unit (MICU) of Fujian Provincial Hospital in the past four and half years for better use of antimicrobial drugs.Methods A retrospective analysis was carried out for the bloodstream pathogens isolated from SICU and MICU patients from January 2012 to June 2016.The clinical data and outcomes of patients were also reviewed.Results A total of 329 strains of isolates were recovered from blood samples in SICU,including gram-negative bacteria (53.5％),gram-positive bacteria (39.2％),and fungi (7.3％);258 strains were collected from MICU,including gram-negative bacteria (57.8％),gram-positive bacteria (36.0％),and fungi (6.2％).A.baumannii,K.pneumonia and E.coli were the top three gram-negative species in both SICU and MICU.The main gram-positive species were coagulase-negative Staphylococcus and Enterococcusfaecium.Overall,386 cases of bloodstream infections were diagnosed,including 226 cases in SICU (202 cases of single bacterial infection and 24 cases of multiple bacterial infection),and 160 cases in MICU (138 cases of single bacterial infection and 22 cases of multiple bacterial infection).A.baumannii isolates showed significantly higher rate of resistance to antibiotics in SICU than in MICU,while the K.pneumoniae and E.coli isolates in MICU showed higher resistance rates to cephalosporins,quinolones,penicillins and carbapenems than the corresponding isolates in SICU.The coagulase negative Staphylococcus and E.faecium isolates in MICU were associated with significantly higher resistance rates to quinolones and tigecycline than those strain in SICU.The bloodstream infections due to K.pneumoniae,E.coli and E.faecium were associated with higher mortality in MICU than in SICU,while the bloodstream infections due to A.baumannii were associated with higher mortality in SICU than in MICU.The total mortality rate of bloodstream infections was higher in MICU than in SICU.Conclusions SICU and MICU share similar profile of main bloodstream pathogens even though the disease spectrum was different between SICU and MICU.All the bloodstream pathogens isolated from MICU patients except A.baumannii showed significantly higher antimicrobial resistance rates than the isolates from SICU.The mortality rate associated with bloodstream infection was also higher in MICU patients than in SICU.
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Objective To report the diagnosis and treatment of a case of renal inflammatory myofibroblastoma. Methods A 30-year-old man presented with space-occupying lesion of the kidney with no symptoms in physical examination.No abnormality was found in the laboratory tests.B-ultrasound showed a clear-edged,solid mass which was 4.5 cm?3.7 cm in size and had heterogeneous echo in the upper,middle part of the left kidney.CT showed a similar value of the mass to that of the normal tissue.Enhanced MRI showed heterogeneous intensification of the mass whose signal was slightly lower than that of the normal tissue.Preliminary diagnosis of renal cancer was made. Results Nephrectomy was performed.On pathological examination the tumor was mainly composed of spindle-shaped,fibrous cells, and positive staining for Vimentin,SMA and HHF35 were observed immunohistochemically.Inflammatory myofibroblastoma of the kidney was diagnosed.Follow-up of 54 months showed no recurrence and metastasis of the tumor. Conclusions Inflammatory myofibroblastoma is a kind of rare,benign or low-grade malignant tumor of the kidney, and the clinical diagnosis is often difficult.Definite diagnosis relies on pathology.For the sake of avoidance of resecting the kidney by mistake, pathological examination is the preferred choice during operation.