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Objective:To explore the impact of completion rates of 3-hour and 6-hour sepsis bundle therapy on prognosis of patients with septic shock in Prefecture-level grade A hospitals, and analyze the risk factors for prognosis.Methods:A retrospective analysis was conducted to patients with septic shock in the intensive care unit (ICU) of Liaocheng People's Hospital, Shandong Province from January 1, 2020 to December 31, 2021. The data of gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA), sites of infection, pathogenic microorganisms, completion rates of 3-hour and 6-hour sepsis bundle therapy, 28-day prognosis were collected. Logistic regression analysis was used to identify risk factors for patients' mortality at 28-day.Results:① Among 159 patients with septic shock, 93 survived and 66 died with 28-day. There were no significant differences in gender and age between the survival group and death group. Compared with the survival group, APACHE Ⅱ score and SOFA score were significantly higher in the death group [APACHE Ⅱ score: 26.85±5.04 vs. 20.67±4.29, SOFA score: 12.86±3.02 vs. 9.37±2.51, both P < 0.05]. ② Sites of infection in the 159 patients: 47 cases were abdominal infection (29.6%), 36 case were bloodstream infection (22.6%), 31 cases were pulmonary infection (19.5%), 16 cases were soft tissue infection (10.1%), 13 cases were urinary tract infection (8.2%), 12 cases were biliary tract infection (7.5%), and 4 cases were other sites infection (2.5%). Pathogens were found in 128 cases and the positive rate was 80.5%, including 90 cases of Gram-negative (G -) bacilli (56.6%), 27 cases of Gram-positive (G +) cocci (17.0%) and 11 cases of fungi (6.9%). The top three pathogenic bacteria were Escherichia coli (49 cases, 30.8%), Klebsiella pneumoniae (21 cases, 13.2%) and Staphylococcus aureus (15 cases, 9.4%). The differences were not statistically significant. ③ Among the 159 patients, 101 cases completed 3-hour sepsis bundle therapy (63.5%), including 67 cases (72.0%) in survival group and 34 cases (51.5%) in death group; 106 cases completed 6-hour sepsis bundle therapy (66.7%), including 70 cases (75.3%) in survival group and 36 cases (54.5%) in death group. The differences between the two groups were statistically significant (all P < 0.05). ④ The factors (APACHE Ⅱ score, SOFA score and completion rate of 3-hour and 6-hour sepsis bundle therapy) affecting the prognosis in the univariate analysis were included in the binary Logistic regression analysis, and the results showed that the APACHE Ⅱ score, SOFA score, completion rate of 3-hour sepsis bundle therapy were independent risk factors affecting mortality within 28-day [odds ratio ( OR) was 1.216, 1.303, 0.402, all P < 0.05]. Conclusions:The higher APACHE Ⅱ score and SOFA score in septic shock, the worse the prognosis. Improving the completion rates of 3-hour and 6-hour bundle therapy especially the completion rate of 3-hour bundle therapy can reduce the mortality of patients and improve the prognosis.
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<p><b>INTRODUCTION</b>Acute fatty liver of pregnancy (AFLP) frequently causes liver failure in pregnant women. A better understanding of the clinical characteristics, management, outcomes and risk factors of AFLP is required, given its relatively high mortality rate. We aimed to describe the characteristics of AFLP, and further assess its outcomes and potential risk factors from the perspectives of the mother and fetus.</p><p><b>METHODS</b>This was a retrospective cohort study of 133 patients with AFLP hospitalised at four tertiary hospitals in China between January 2009 and April 2014.</p><p><b>RESULTS</b>Among 133 patients, AFLP was diagnosed in the postpartum period for 13 (9.8%) patients. Potential factors influencing adverse maternal outcome were male fetus (p = 0.04), postpartum diagnosis of AFLP (p < 0.01), intrauterine fetal death (p = 0.04), disseminated intravascular coagulation (p < 0.01), prothrombin time (p < 0.01) and activated partial thromboplastin time (p = 0.04). The frequency of fetal distress (p = 0.03) and activated partial thromboplastin time (p < 0.05) were significantly higher in pregnancies with dead fetuses than in those where the fetuses survived. Independent risk factors for perinatal maternal mortality were history of legal termination of pregnancy (odds ratio [OR] 1.958, 95% confidence interval [CI] 1.133-3.385), total bilirubin (OR 1.009, 95% CI 1.003-1.014) and serum creatinine (OR 1.010, 95% CI 1.003-1.017).</p><p><b>CONCLUSION</b>Compared with total bilirubin and serum creatinine, history of legal termination of pregnancy appeared to be a greater risk factor for maternal mortality among patients with AFLP.</p>
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Objective To investigate the diagnostic values of procalcitonin (PCT),high sensitive C-reactive protein (hs-CRP),white blood cell (WBC)and percentage of neutrocyte (NEU％)in Gramnegative and Gram-positive bacterial blood stream infection in early stage of sepsis in order to investigate the correlation between PCT and APACHE lⅡ score as well as between PCT and SOFA score,and the prognostic value in assessment of Gram-negative and Gram-positive bacterial blood stream infection.Methods Clinical data of patients admitted to ICU from January 2012 through December 2014 were retrospectively analyzed.A total of 124 sepsis patients with blood stream infection were checked with PCT,hs-CRP,WBC and NEU％ tests,and APACHE Ⅱ score and SOFA score were calculated.The differences in APACHE Ⅱ score and SOFA score were compared between Gram-negative group (n =41) and Gram-positive group (n =83).The correlation between PCT and APACHE Ⅱ score as well as between PCT and SOFA score was analyzed.The differences in diagnostic values of PCT,hs-CRP,WBC and NEU％ between Gram-negative group and Grampositive group were analyzed by using receiver operating characteristic (ROC) curve and it was plotted to assess the prognostic values of PCT,hs-CRP,WBC and NEU％ for septic patients with blood stream infection.Results Compared with Gram-positive group,the levels of PCT [.55.32 (22.01,97.11) vs.2.13 (0.27,5.27)] (P ＜0.01),hs-CRP [105.09 (69.97,186.12) vs.70.54 (42.37,138.63)] (P=0.508),NEU％ [88.30 (75.79,93.52) vs.55.32 (22.01,97.11)] (P=0.302) were higher but WBC was lower [13.59 (10.74,17.58) vs.13.73 (11.32,20.90)] (P=0.058) in Gram-negative group.The ROC curve analysis of PCT showed the area under the curve (AUC) was 0.867 (95％ CI:0.789-0.946).When the optimal cutoff point of PCT was 17.48 ng/mL,the largest Youden's index was found to be 0.661 with 76.9％ sensitivity and 89.2％ specificity.Between two groups,there were significant differences in APACHE Ⅱ score and SOFA score (27.46 ± 9.60 vs.23.67 ± 7.74,P =0.020;8.05 ±3.38 vs.6.59-±3.45,P =0.028).There was significant difference in diagnostic value between PCT and SOFA (r =0.536,P =0.036) in Gram-negative group but no significant difference in Gram-positive group.Conclusions Higher PCT levels are found in Gram-negative group and it can play a role in differntiation between the Gram-negative group and Gram-positive group rather than hs-CRP,WBC and NEU％.PCT can be a better indicator for evaluation of severity of sepsis as well as for prognosis of sepsis patients with Gram-negative bacterium infection.
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Objectives:To study the clinical features of multiple organ dysfunction syndrome(MODS) complicated with hypoalbuminemia. Methods:80 cases of MODS whose APACHE Ⅱ was from 17 to 18 were selected and devided into two groups according to existance of peritoneal infection or not. Results:The occurrence rate of hypoalbuminemia was 73.8% in the 80 cases. The rate was 97.0% in the group complicated with peritoneal infection,with the lowest level occurring on the second day and being (24? 3.5 )g/L, and 57.4% in the group without peritoneal infection,with the lowest level occurring on the seventh day and being (35?2.9)g/L.There were very marked differences between the two groups( P