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Objective To determine a combination of biomarkers that assure the diagnosis of sepsis and severe sepsis in patients in emergency department (ED).Methods A total of 652 patients with systemic inflammatory response syndrome (SIRS) were enrolled for this prospective study in the ED of Beijing Chaoyang Hospital of the Capital Medical University between March 2010 and March 2013.Eight biomarkers were determined,including levels of procalcitonin (PCT),interleukin-6 (IL-6),D-dimer,C-reactive protein (CRP),brain natriuretic peptide (BNP),white blood cell count (WBC),percentage of immature neutrophil,and platelet count (PLT).Patients were divided into the sepsis group (452 cases) and non-sepsis group (200 cases) according to the diagnostic criteria of sepsis.Then all these patients were stratified into severe sepsis group (190 cases,including septic shock) and non-severe sepsis group (462 cases) according to the diagnosis of severe sepsis.Logistic regression was performed to identify the independent factors for the diagnosis of sepsis and severe sepsis,and the optimal combination of biomarkers was established.Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic ability of the combination and the biomarkers.Results PCT,IL-6 and D-dimer were independent factors for diagnosis of sepsis and severe sepsis.The area under the ROC curve (AUC) of the combination of three biomarkers was 0.866 for diagnosis of sepsis,and it was higher than the AUC of PCT (0.803),IL-6 (0.770) and D-dimer (0.737) alone,and this new combination showed better sensitivity,specificity,positive predictive (PPV),and negative predictive (NPV) values than that when the three biomarkers was used individually (the results of combination were 81.2％,8 1.0％,90.6％,56.5％ ; that of PCT were 75.2％,80.0％,89.5％,58.8％; that ofIL-6 were 81.0％,61.0％,82.4％,58.7％; and that of D-dimer were 79.9％,59.0％,81.5％,56.5％,respectively).The AUC of the combination was 0.815 for the diagnosis of severe sepsis and was better than the three biomarkers used alone,which was 0.758 for PCT,0.740 for IL-6,and 0.704 for D-dimer respectively.Moreover,the sensitivity,specificity,PPV and NPV of the combination were higher than that of the three biomarkers used singularly (the results of combination were 81.6％,73.6％,56.0％,90.6％; that of PCT were 79.5％,65.0％,48.2％,88.5％; that of IL-6 were 65.8％,70.6％,47.9％,83.4％; and that of D-dimer were 60.5％,73.2％,48.1％,81.8％,respectively).Conclusion The combination of PCT,IL-6 and D-dimer enhances the diagnostic ability for sepsis and severe sepsis.
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Objective To investigate the type 2 diabetic patients with glomerular filtration rate and urinary albumin value as renal finction evaluation.Methods A total of 1217 patients with type 2 diabetic nephropathy from August 1,2010 to June 31,2012 were selected.Evaluated glomerular filtration rate (eGFR) was calculated according to the currently recommended simplified modification of diet in renal disease study (MDRD) formula.According to the K/DOQI guidelines for chronic kidney disease,patients were divided into three groups:group A [eGFR ≥90 ml/ (min ·1.73 m2)] of 891 cases,group B [60 ml/(min· 1.73 m2) ≤eGFR ＜ 90 ml/(min· 1.73 m2)] of 256 cases,group C[eGFR ＜ 60 ml/(min· 1.73 m2)]of 70 cases,respectively.Eight-hour urinary albumin excretion rate (UAER) was compared between and among the groups; according to 8-hour UAER,patients were divided into three groups:group a (8-hour UAER ＜20 μg/min) of 946 cases,group b (20 μg/min≤8-hour UAER ＜200 μg/min) of 193 cases,group c(8-hour UAER ≥ 200 μ g/min) of 78 cases.eGFR was calculated and compared between and among the groups.Results Eight-hour UAER was (32.71 + 79.62),(57.56 + 130.59),(107.50 + 222.64) μ g/min in group A,B,C,and the difference among three groups was statistically significant (P＜0.05).eGFR was (110.78 ±32.75),(108.26 ±45.78),(94.96 ±32.30) ml/ (min ·1.73 m2) in group a,b,c,and the difference between group a and group c,or between group b and group c was statistically significant (P ＜0.05),but the difference between group a and group b was not statistically significant (P ＞0.05).Conclusion When evaluating the function of type 2 diabetic nephropathy,two indicators should be considered:glomerular filtration rate and urinary albumin.
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ObjectiveTo assess the sepsis score used for detecting the mortality of patients with sepsis in emergency department, and to compare with APACHE Ⅱ score, simplified acute physiology Ⅱ score ( SAPS Ⅱ ) and modified early warning score (MEWS) in terms of 28-day mortality of patients. Methods A total of 613 patients with sepsis were enrolled from the emergency department for a prospective study from September 2009 to September 2010. The sepsis score, APACHE Ⅱ score, SAPS Ⅱ score and MEWS score all were recorded and compared. The patients with sepsis were followed up for 28 days. Based on the sepsis score, patients with sepsis were stratified into 5 mortality risk groups, namely very low risk group (0～4 points), low risk group (5 ～7 paints), moderate risk group (8 ～ 12 points), high risk group ( 13 ～ 15points) and very high risk group (more than 15 points). The actual mortality rates were compared among all 5 groups by using Chi square test. Then, comparison between survivors and non-survivors carried out with logistic regression analysis to determine the independent risk factors of mortality.Receiver operating characteristic curve (ROC curve) was used to compare the sepsis score with APACHE Ⅱ score, SAPS Ⅱscore and MEWS in respect of the prognosis validity. ResultsTen patients were out of the follow-up and the data of 603 patients followed up were completely documented. The actual mortality rates of 5 risk groups were 0％, 7.7％, 18.5％, 46. 7％ and 63％, respectively. There were significant differences in age and four scoring systems between survivors ( n = 440) and non-survivors ( n = 163 ) ( P ＜ 0. 01 ). Sepsis score,APACHE Ⅱ score, SAPS Ⅱ and MEWS all were valid and eligible for detecting the risk of mortality in patients with sepsis. The ROC areas under the curve (AUC) of these 4 scoring systems were 0. 767, 0. 743,0. 741 and 0. 636, respectively. ConclusionsThe sepsis score can be used to stratify patients with sepsis according to mortality risk with better sensitivity to predict 28-day mortality. It is rational for evaluation in prediction of patients with sepsis in Emergency Department.
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Objective To investigate the relationship between the severity of diabetic retinopathy and serum bilirubin level. Methods From August 1 2008 to December 31 2009, hospitalized patients of 1062 cases with type 2 diabetes were divided into three groups according to fundus examination: no diabetic retinopathy (NDR) group (457 cases), non-proliferative diabetic retinopathy (NPDR) group (484 cases)and proliferative diabetic retinopathy (PDR) group ( 121 cases). The difference in serum bilirubin level was compared. Results Total bilirubin in PDR, NPDR and NDR group were (9.96 ± 3.84), ( 11.41 ± 3.82),( 13.38 ± 3.98) μ mol/L respectively. There was significant difference among three groups (P ＜ 0.01 ). Logistic multivariate regression analysis showed that a drop in serum total bilirubin level was an independent risk factor of diabetic retinopathy. Conclusions Bilirubin level and the severity of diabetic retinopathy have some relationship. The antioxidant bilirubin and anti-inflammatory effect should be paid attention to.