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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.
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Objective:To investigate the relationship of etiology and complications of rhabdomyolysis with its prognosis in the elderly.Methods:Patients with rhabdomyolysis at the emergency department of our hospital from January 1, 2018 to December 31, 2019 were retrospectively analyzed.Based on age, patients were divided into the non-elderly group(<65 years old)and the elderly group(≥65 years old). The frequency distribution of etiological factors, concurrent acute kidney injury, and their association with prognosis were analyzed.Results:The number of patients with rhabdomyolysis caused by 2 or more etiologies was higher in the elderly group than in the non-elderly group(40.3% or 48/119 vs.17.0% or 16/94, χ2=13.582, P=0.000). The frequency distribution of etiological factors was different between the two groups.The top-five etiologies were infection, muscle ischemia/hypoxia, endocrine metabolic abnormalities, trauma and muscle fatigue in the elderly group and muscle fatigue, infection, endocrine metabolic abnormalities, drugs/toxicants and trauma in the non-elderly group.Compared with the non-elderly group, the elderly group had fewer patients with typical clinical manifestations(32.8% or 39/119 vs.48.9% or 46/94, χ2=5.067, P=0.024). In contrast, patients who newly presented with disturbance of consciousness were more likely to be found in the elderly group than in the non-elderly group(40.3% or 48/119 vs.21.3% or 20/94)( χ2=7.923, P=0.005). There were 37 patients with AKI(38.9% or 37/95)in the elderly group and 13 of them died(35.1%), and there were 17 patients with AKI in the non-elderly group(19.3% or 17/88)and 4 died(23.5%), indicating the elderly were prone to AKI( χ2=7.545, P=0.006). There was a significant correlation between AKI and prognosis in the non-elderly group( χ2=7.196, P=0.007). Conclusions:Rhabdomyolysis caused by multiple etiologies is more common in elderly patients than in non-elderly patients.The etiological classification of rhabdomyolysis in the elderly is different from that in the non-elderly.Elderly patients are less likely to have typical clinical manifestations and are more prone to AKI.Elderly patients with rhabdomyolysis combined with AKI have a poor prognosis.
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Objective:To investigate the clinical diagnostic value of soluble leukocyte differentiation antigen 14 subtype (sCD14-ST, presepsin) in elderly patients with acute left heart failure (AHF) complicated with bacterial pneumonia.Methods:The data of 111 elderly patients with acute left heart failure complicated with bacterial pneumonia or acute left heart failure (the control group) who were admitted into emergency department from August 2017 to August 2018 were retrospectively analyzed. Chemilluminescence immunoassay was performed to detect presepsin in all patients. And meanwhile, fever or not, presepsin, procalcitonin (PCT), C-reaction protein (CRP) and other clinical data were compared between the two groups. Univariate and multivariate logistic regression analysis were adopted to screen the risk factor influencing the diagnosis. The receiver operating characteristic (ROC) curve was used to analyze the clinical value of presepsin on diagnosing acute left heart failure complicated with bacterial pneumonia in elderly patients.Results:Presepsin of the group complicated with bacterial pneumonia was significantly higher than that of the control group [(500.9±283.5) ng/L vs. (167.7±102.3) ng/L, t=-7.902, P=0.000]. The logistic regression analysis, showed that fever, presepsin and procalcitonin were independent risk factors for AHF combined with bacterial pneumonia diagnosis. The area under ROC curve (AUC) of presepsin, PCT and WBC was 0.887 (95% CI: 0.825-0.949, P<0.001), 0.794(95% CI: 0.704-0.885, P<0.001), and 0.566 (95% CI: 0.455-0.678, P=0.231), respectively. The optimal threshold value of presepsin was 227 ng/L, the sensitivity was 82.0%, specificity was 83.6%, the positive likelihood ratio was 5, the negative likelihood ratio was 0.22, the positive predictive value) was 80.4%, and the negative predictive value was 85%. Conclusions:Presepsin has an important diagnostic value for the identification of AHF combined with bacterial pneumonia in elderly patients.
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Objective:At present, the postgraduate education of emergency medicine in China mainly relies on the internal medicine system and lacks specialty pertinence. The purpose of this study is to establish a compulsory curriculum system for professional postgraduates of emergency medicine.Methods:Modified Delphi method was used to subscribe questionnaires to experts, and the contents were mainly about medical education management and research of emergency in the affiliated teaching hospitals of Peking University. Microsoft Excel 2016 was used for double entry of questionnaire contents, and SPSS 22.0 software was used for statistics.Results:The panel was consisted of 14 experts in total and two rounds of Delphi questionnaires were completed. The response rate of the two rounds were both 100%. The authority coefficient of experts was > 0.9 and the average score of each evaluation index was 4.07-5.00 points. The coefficient of variation of each index was 0-0.22 and the Kendall coefficient of concordance was 0.07-0.10.Conclusion:As a result, a comprehensive emergency professional postgraduate curriculum system has been established.
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Objective To analyze the clinical characteristics of elderly patients with disulfiramlike reaction,in order to raise awareness of this disease.Methods Clinical data of 19 elderly patients diagnosed as disulfiram-like reaction in the emergency department of Beijing Hospital from January 2012 to March 2017 were retrospectively analyzed.Disulfiram-like reaction was diagnosed by comprehensive data of the drugs-induced disulfiram-like reaction,related clinical manifestations,auxiliary examination,treatment response,and by differential diagnosis.Results All of 19 patients were male,with one or more chronic disease,mean ± SD age were 75.6±5.1 years.Of 19 patients,16 patients were taking antibiotics,including ceftriaxone,cefoperazone sodium sulbactam,cefpropene,cefuroxime and moxifloxacin,and other patients received warfarin sodium,glimepiride and metformin before the onset of disulfiram-like reaction.Clinical manifestations of disulfiram like reaction mainly involved the cardiovascular system such as palpitation,chest distress,angina,hypotension,etc.,and might be accompanied by dizziness,facial flushing,awareness disorder,gastrointestinal hemorrhage,renal dysfunction,etc.The myocardial ischemia in ECG was observed in 13 patients,the elevated serum troponin in 3 patients,and a continuing organ dysfunction in 1 patient.Conclusions The elderly patients with disulfiram-like reaction are mainly male,with various pathogenic factors and dangerous prognosis.The symptoms of cardiovascular system are obvious,including arrhythmia,myocardial injury,heart failure,shock and other serious cardiovascular complications.
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Objective To investigate clinical significance of soluble CD14 subtype presepsin for diagnosing,evaluating severity and predicting prognosis of acute infections in elderly patients.Methods Sixty elderly emergency patients without acute infections as control and 117 elderly emergency patients with acute infections were enrolled.Patients with infections were divided into the systemicinflamatory response syndrome(SIRS) (infection+ SIRS group,n =59),sepsis group (n =41)and septic shock group(n=17),and were further divided into survival group(n=90)and death group (n=27)according to 30-day mortality.Serum levels of presepsin and procalcitonin (PCT)were measured by using enzyme-linked immunosorbent assay(ELISA)within 24 hours after doctors' office visiting.The mortality in emergency department sepsis(MEDS) scores was evaluated.Clinical value and correlations of presepsin and PCT in diagnosis,disease evaluation and prognosis evaluation were compared and analyzed Results Presepsin level was higher in acute infection group than in no-infection group[734.0(422.5,1120.0) ng/L vs.159.50 (119.0,234.3) ng/L,P ＜0.05].Presepsin level was 423.0(266.3,554.0)ng/L in infection+SIRS group,1042.0(854.0,1213.0)ng/L in sepsis group,and 2188.0(1599.5,2946.0) ng/L in septic shock group,with statistically significant differences among infection+SIRS group,sepsis group and septic shock group(P ＜0.05).No significant differences in PCT levels were found between sepsis group and septic shock group[4.4(1.4,16.9)ng/L,vs.8.8 (0.7,51.1)ng/L,P＞0.05].MEDS had no difference between sepsis group and septic shock group [(13.0(11.0,17.5) vs.15.0 (11.5,19.5),P ＞ 0.05].There were significant differences in serum levels of presepsin(554.0ng/L vs.1232.5 ng/L),PCT(1.18 μg/L vs.10.07 μg/L) and MEDS(9.0 vs.18.0)between the survival group and the death group(P＜0.05),and their area under a receiver operating characteristic(ROC) curve was (0.853 ± 0.037),(0.732 ± 0.057) and (0.900 ± 0.034)respectively.Serum level of presepsin was moderately correlated with MEDS(r =0.609,P =0.00)and lowly correlated with PCT(r =0.477,P =0.00).Conclusions Presepsin is a good biomarker for acute infection,which has better clinical value for diagnosis,severity evaluation and prognostic prediction of acute infections in elderly patients.
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Objective To investigate the effectiveness and safety of carbapenem antimicrobial management programs (ASP). Methods 671 patients who were discharged from the emergency department of the hospital from January 2017 to April 2018 were enrolled. These patients were subject to before-and-after self-control studies, using such intervention measures as MDT proactive management-feedback-training. January-September of 2017 was set as the pre-intervention stage, and September 2017-April 2018 as the post-intervention stage. The two stages were compared in such indicators as the monthly antibacterial use, quality of care and hospital acquired infection. Results Thanks to the ASP measure against antibiotics like carbapenems, the use rate of carbapenems at the emergency department ward fell from 36.7% to 18.6% , the defined drug doses (DDDs) of carbapenems fell from 211.92 to 82.22, and the antibiotics use density (AUD) of carbapenems fell from 29. 18 DDDs/100 day/patient to 11. 56. The pathogen detected rate increased significantly (0.61 ± 0.08 versus 0.78 ± 0.16), with a difference of statistical significance (P=0.020). On the other hand, the mean days of stay, average cost per hospitalization, proportion of antibiotics use, incidence of hospital acquired infections, and the infection/colonization rate of carbapenem-resistant organisms ( CROs ) present no significant changes. There was a moderate positive correlation between carbapenem DDDs and mean days of stay ( P=0.034), and also a moderate positive correlation between hospital acquired infection incidence and CROs infection/colonization rate ( r = 0.545, P = 0.029 ). Conclusions The carbapenem ASP at the hospital proves safe and effective. CROs infection/colonization may be the cause of hospital acquired infection. Prevention and control against multi-drug resistant bacteria on the basis of ASP may add to the effect of ASP.
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Objective To summarize the epidemiological characteristics of ankle fractures and clinical outcome of open reduction and fixation for the treatment of posterior Pilon fracture with supporting plate. Methods From January 1st,2013 to December 31st,2016,the data of three hundred and twelve patients with ankle fracture in Jinshan Hospital of Fudan University were collected, and 21 cases of posterior Pilon fracture were treated with open reduction and fixation using supporting plate and were followed up,the ankle function was assessed by American Orthopaedic Foot and Ankle Society ankle hindfoot scale. Results There were 312 patients with ankle fractures,180 males,132 females. The age distribution of patients was as follows:1. 28%,12. 82%,14. 42%,24. 04%,28. 53%,11. 54%,6. 09% and 1. 28% in the following age group:≥18 and≤20 years of age,>20 and ≤30 years of age,>30 and ≤40 years of age,40> and ≤50 years of age,>50 and≤60 years of age,>60 and ≤70 years of age,>70 and ≤80 years of age and >80years of age. Traffic accidents (49%),sprains(31%),falling injury (11%),heavy pound(6%) were the main causes of ankle fractures. In terms of fracture types,238 (76. 2%) cases with lateral malleolus,235 (75. 3%) cases with medial malleolus fractures,161 (51. 6%) cases with posterior malleolus,and 105 (33. 7%) cases with trimalleolar fracture,21 (6. 8%)cases with posterior Pilon fracture. 21 patients with posterior Pilon fracture were followed up for 13. 0 to 56. 0 months,with an average of (31. 7±12. 6) months. Postoperative incision infection occurred in 3 patients,of which 1 cases had mild external leakage,and all wounds healed after dressing change. No fracture and screw prolapse occurred in all follow-up patients. The average score of AOFAS was (87. 2± 7. 1) points,of which 9 cases were excellent,10 cases were good,and 2 cases were fair. Conclusion Patients with ankle fractures were more common in males aged 60 and below,while in patients above 60 years old,the majority patients were females. In addition,patients aged 40 to 60 years old accounts for more than half of the population and the most common age group were between 50 and 60 years old. Traffic accidents and sprains are the common causes. The incidence of different fracture types in descending order were as follows: lateral malleolus fractures, medial malleolus fractures,posterior malleolus fractures and trimalleolar fractures. Pilon fracture was a common type of ankle fracture. Clinical outcome of open reduction and fixation for the treatment of posterior Pilon fracture with supporting plate was satisfied.
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Objective To explore the impact factors of liver uptake of 18F-FDG in PET/CT imaging,and to preliminary analyze the application of maximum standardized uptake values corrected by conventional body mass,lean body mass and body surface area (SUVmax-B,SUVmax-L,SUVmax-S).Methods A retrospective analysis was performed on 67 healthy subjects who underwent 18F-FDG PET/CT.SUVmax-B,SUVmax-L and SUVmax-S were measured,and the impact of age,levels of fasting blood glucose,body mass index (BMI),CT value of liver,gender and the fatty liver on SUVmax-B,SUVmax-L and SUVmax-S were analyzed.Results The liver SUVmax-B,SUVmax-L,SUVmax-S were positively correlated with the levels of fasting blood glucose (r=0.329,0.336,0.353,P =0.012,0.010,0.007).There was a positive correlation between BMI and SUVmax-B (r=0.543,P＜0.01),SUV-L (r=0.328,P=0.007),while BMI value had no correlation with SUVmax-S (r=0.026,P=0.833).There was no correlation between age,CT value of the liver nor SUVmax-B,SUVmax-L and SUVmax-S (all P＞0.05).The liver SUVmax-B (t=2.608,P=0.011) and SUVmax-L (t=5.272,P=0.001) of male were significantly higher than those of female,while there was no difference between male's and female's liver SUVmax-S and liver SUVmax-S (t=0.759,P=0.450).There was no difference in SUVmax-B,SUVmax-L nor SUVmax-S between fatty liver subjects and non-fatty liver subjects (P=0.646,0.775,0.068).Conclusion The fasting blood glucose level,BMI and sex are the impact factors of liver uptake of 18F-FDG in PET/CT imaging.SUVmax-B can be replaced by SUVmax-L or SUVmax-S for larger BMI subjects,while SUVmax-S can make up differences between different genders.However,correction techniques can not weaken the impact of blood glucose level on SUVmax value of liver.
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Objective To study the predictive value of serum soluble ST2 (sST2) in patients with sepsis.Methods A total of 63 patientswith sepsis and 30 healthy subjects as a control group in the emergency Department,Beijing Hospital,National Center of Gerontology,were enrolled in the study.Serum sST2 concentrations were measured by ELISA method.Patients were divided into sepsis group (n=44) and septic shock group (n=19).According to 28-day mortality after the diagnosis of sepsis,patients were divided into death group (n=18) and survival group (n=45).Respiratory rate,oxygenation index,white blood cell count,procalcitonin (PCT),C reactive protein (CRP),serum creatinine (CRE),total bilirubin (TBIL) of patients and control subjects were measured.SPSS 23.0 software was used for the statistical analyses.The measurement data was analyzed by t test and the enumeration data was analyzed by Chi square test.The survival status was analyzed by Logistic binary regression analysis and ROC curve analysis.Results The serum sST2 level (1 382.12±384.07) pg/mL in sepsis group was significantly higher than that in control group (569.28±163.46) pg/mL (P＜0.05).in septic shock group,28-day mortality rate (63.16％) and serum sST2 level (1 675.49±457.59) pg/mL was higher than those in sepsis group (13.64％) (1255.44 ± 265.70) pg/ml (P＜0.05).The PCT (16.37±16.36) ng/mL and serum sST2 level (1794.47±335.18)pg/mL in death group were higher than those in survival group (P＜0.05).The ROC curve showed that the AUC of sST2 was larger than that of PCT (0.917 vs.0.884),the sensitivity was higher than that of PCT (88.9％ vs.72.2％),and the specificity was lower than that of PCT (82.2％ vs.93.3％).The combination AUC of sST2 and PCT was 0.944.Conclusions Serum sST2 has a certain value in the diagnosis of sepsis,and can be used to predict the prognosis of patients with sepsis.The higher the sST2 value,the worse the prognosis.Compared with PCT,sST2 is more sensitive in the prognosis of sepsis,but the specificity is not high enouph.The measurement of sST2 level coupled with PCT level may be more useful.
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Objective To investigate the current status and features of the use of medical resources for emergency patients with medical insurance in China clarified by analysis of large numbers of data.Methods Using the database from China Medical Insurance Research Association's research group,the total amount and the average cost of emergency medicines for patients with medical insurance,as well as the proportion of emergency medicines in total medical resources used in the emergency department were statistically analyzed.Additional analyses were made based on cities and medical institutions of different levels.Results The data were collected from more than 63 million pieces of medication information,from which 260 thousand pieces of information involved in emergency medicine used within 100 sorts of emergency medicines.The use of emergency medicines for emergency cases accounted for a low proportion of over all medicine used in emergency department in our country,and the specifications of emergency medicine were limited in a few kinds of medicine such as tetanus antitoxin injectio (1500 U),50％ glucose solution in 20 ml water,and 50 g mannitol in 250 ml water frequently used as the leading essential agents.The sum of consumption of emergency medicines in tertiary hospitals was the highest among all levels of medical institutions,and the proportion of which in all medicine used in the emergency department also in the first place of the list.In the third-tier cities,although the sum of consumption of emergency medicines accounted for a small proportion of the whole country,the proportion of which in all kinds of medicine used in the emergency department was highest,while the situation of first-tier cities was just on the contrary.Except for only a few medicines,the ranking of the use of any emergency medicine else varied little in different cities and in various medical institutions.Conclusions On one hand,the current status and characteristics of the use of emergency medicines for emergency patients with medical insurance in China may be related to the characteristics of emergency departments and emergency cases,and on the other hand,they could also be influenced by medicines in clinical needs,clinical compliance,and shortages.This study showed the clinical application of emergency medicines in China in the past three years,which can provide some clinical data for the revision of emergency drug list in the future.
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Fast track surgery(FTS) is a novel surgery concept in recent years.Through using a series of perioperative optimization measures,to reduce the postoperative complications,the length of stay,and to achieve the goal of patients' rapidly rehabilitation.Nowadays,FTS protocols is widely used in general surgery,cardio-thoracic surgery,ophthalmology and orthopedics etc.This article reviewed the application of FTS in the perioperative patients which taking hip and knee arthroplasty.
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Specific to the existing problems of uneven distribution of resources in the medical industry,especially the shortage of grass-root high-quality medical resources,the paper introduces the construction objective,overall architecture and construction contents of regional medical collaboration,and normalizes the medical service process through informationalized technological means,in order to promote standardized construction of the regional medical information system and information interconnection and intercommunication.
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Objective To investigate the prognostic value of National Early Warning Scores (NEWS) combined with arterial lactate level in elderly patients with critical illness in emergency department.Methods A total of 413 elderly patients with critical illness randomly (random number) selected from resuscitation room in emergency department from September 2013 to July 2015 were enrolled in this study.NEWS system was employed to determine the patients' condition.Arterial lactate level was detected.The patients were followed for the 30-day death by telephone calls and patients were divided into survival group and death group.Multivariate logistic regression analysis and receiver operating characteristic curve (ROC) were used to evaluate the prognostic values of NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level in patients without survival.Results There were significant differences in NEWS score and arterial lactate level between the death group and the survival group.The results of multiple factor regression showed that NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were all independent predictors of 30-day death (P ＜ 0.05,OR ＞ 1).The AUCs of the three evaluation modalities were 0.721,0.746 and 0.762,respectively.There was a significant difference in the area under the ROC curve between NEWS score and NEWS score combined with arterial lactate level.The optimal cut-off point of NEWS score was 7,and arterial lactate level was 2.7 mmol/L.Conclusions NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were independent predictors of 30-day death in elderly patients with critical illness in emergency department.They all had some predictive value,and NEWS score combined with arterial lactate level had higher capability to predict 30-day death in elderly patients with critical illness in emergency department than NEWS score alone.
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Two cases of ectopic varices(EV) admitted in our hospital were reported.According to literature search from Wanfang Data and China National Knowledge Infrastructure 127 cases of ectopic varices were reported in mainland China.Among 129 cases there were 93 males and 36 females,with a mean age of (54.4 ± 7.2) years.The most common cause of EV was portal hypertension with cirrhosis (n =104,80.6％).The common manifestations of EV were melena (35.7％) and hematemesis (18.6％).The diagnosis was confirmed by endoscopy in 100 cases(77.5％),by surgery in 16 cases(12.4％),and by angiography in 13 cases(10.1％).The sites of EV lesions included duodenum (n =52,40.3％),rectum (n =34,26.4％),and jejunum or ileum (n =13,10.1％).Among 129 EV patients,4(3.1％)died and 125(96.9％)survived.Analysis indicates that most ectopic varices are secondary to portal hypertension of cirrhosis,and ectopic varices account for a certain percentage of all gastrointestinal hemorrhage.
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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.
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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.
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The paper elaborates on the construction concept ofHealthy Henan Health Service Cloud and introduces the project goals and system architecture.This platform effectively promotes the application and popularization of achievements in health informatization in Henan,enables the basic mass to experience the efficiency and convenience brought about by health informatization,and facilitates the monitoring and management by health administrative departments.
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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.
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Objective To evaluate the value of gelsolin for the prognosis of patients with severe sepsis.Methods 50 patients in the emergency intensive care unit of Beijing hospital from January 2015 to July 2015,were determined white blood cell count (WBC),C-reactive protein (CRP),procalcitonin (PCT),gelsolin at admission,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were estimated within 24 hours.According to the 28 days of survival outcome,50 patients were divided into two groups:survival group and death group.The significant difference of these factors was compared.Binary logistic regression analysis was applied for screening independent risk factors for the prediction of death.The receiver operating characteristic (ROC) curve was applied for the evaluation and comparison about prognosis ability.Results 31 patients were in the survival group,19 patients in the death group.The gelsolin [(21.43±10.54) vs.(13.31±8.54),P=0.007] andAPACHE Ⅱ score [(19.2±6.86) vs.(24.6 ± 8.9),P =0.021] in two groups had significance difference.Binary logistic regression analysis indicated that the gelsolin and APACHE Ⅱ score were independent risk factors of predicting death.The area under of ROC curve (AUC) of the gelsolin was 0.745 (95％ CI:0.599-0.851,P =0.004) and the APACHE Ⅱ score was 0.699 (95％ CI:0.537-0.862,P =0.019).Both prognosis ability were equivalent.To combine the tow factors,the accuracy of predition was 90％ and has better complementarity.Conclusions the gelsolin could assess the severity of patients with severe sepsis and predict the prognosis more accurately.