ABSTRACT
Objective:To retrospectively assess early risk factor of persistent inflammation, immunosuppression and catabolism syndrome (PICS) in patients with severe polytrauma, in order to deepen the understanding of the pathological changes of chronic critical illness (CCI) after severe polytrauma.Methods:A total of 276 patients with severe polytrauma admitted to Department of Trauma Surgery of Tongji Hospital from March 2019 to December 2020 were enrolled. Inclusion criteria included patients who suffered severe polytrauma, and injury severity score (ISS) ≥27, age ≥18 years old, and had length of hospital stay >15 days. Exclusion criteria included previous medical history of malignancy, or immunological, consumptive, and metabolic diseases. The patient’s clinical characteristics, ISS scores, Glasgow coma scale (GCS), sequential organ failure assessment, APACHEⅡ scores, and nutrition and immune indexes on day 3 after injury were collected. The difference between the PICS group and N-PICS group were performed by Student’s t test, χ2 test or Mann-Whitney U test. The early risk factors were assessed in patients with PICS after severe polytrauma by logistic regression analysis. Results:According to the diagnostic criteria of PICS, all enrolled patients were divided into two groups: PICS group ( n=102) and N-PICS group (without PICS, n=174). Compared with the N-PICS group, patients in the PICS group were older and associated with more brain and chest injuries. On the third day after injury, serum levels of IL-6 and IL-10, and the ratio of Treg cells were significantly higher, the number and ratio of NK cells subset, and the ratio of activated T lymphocyte were significantly lower in the PICS group than in the N-PICS group ( P<0.05). Logistic regression analysis showed that the age>65 years old ( OR=2.375, 95% CI: 1.442-4.531), GCS ≤8 scores ( OR=3.431, 95% CI: 1.843-8.512), IL-10 >10 pg/mL ( OR=2.173, 95% CI: 1.751-5.614), the ratio of Treg cells >7% ( OR=3.871, 95% CI: 1.723-6.312), and the occurrence of traumatic brain and chest injuries ( OR=2.846, 95% CI: 1.522-5.361) were the early risk factors in patients with PICS after severe polytrauma. Conclusions:Age>65 years old, GCS score, IL-10, the ratio of Treg cells, and the occurrence of traumatic brain and chest injuries could be used as the early risk factors in patients with PICS after severe polytrauma. The discovery of early risk factors will help identify patients at high risk of PICS after severe polytrauma, and create the possibility for early intervention.
ABSTRACT
INTRODUCCIÓN: La evidencia de las últimas décadas ha demostrado que el apego temprano es un proceso vital para la comprensión, prevención e intervención de la salud mental y física de las personas. Sin embar go, es escasa la información sobre el comportamiento del sistema de apego en la realidad chilena. OBJETIVO: Describir la distribución de los estilos de apego en poblaciones de niños bajo diferentes tipos de cuidado. SUJETOS Y MÉTODO: A través de un método descriptivo retrospectivo, se evaluaron 714 díadas madre-bebé (de 1 a 36 meses) seleccionadas al azar y de modo intencionado, a través de los procedimientos de la Situación Extraña, Escala de Apego durante Stress (ADS), y la Escala de Relación Profesor-Alumno. Las muestras provinieron de familias normativas seleccionadas al azar, infantes de salas de cuna y jardines infantiles JUNJI, e infantes de los centros CONIN y en condiciones de privación de libertad junto a sus madres. RESULTADOS: Las 6 muestras provenien tes de 6 estudios demuestran el espectro del comportamiento de los estilos de apego en diversas condiciones: un 70% seguro y 30% inseguro, y un 51,1% seguro y 48.9% inseguro en muestras normativas; un 48,5% de seguridad y un 51,5% de inseguridad en cuidado alternativo y; un 39,6% de seguridad y 60,4% inseguridad, y 25% de estilos seguros y 75% inseguros en muestras de alto riesgo. CONCLUSIÓN: El estudio presenta interesantes evidencias sobre las distribuciones de apego en la infancia, que permiten reflexionar sobre la dispar realidad de la situación chilena en lo que a desarrollo socio-afectivo temprano.
INTRODUCTION: Scientific evidence gathered over the last decades has demonstrated that early attachment is a vital process for the understanding, prevention, and intervention of people's mental and physical health. However, information about the attachment system functioning in Chile is scarce. OBJECTIVE: To des cribe attachment styles distribution in populations of children under different types of care. SUBJECTS AND METHOD: Through a retrospective descriptive method, 714 mother-child pairs (1 to 36 months- old) selected at random and purposefully, were assessed using the Strange Situation Procedure, Atta chment during Stress Scale (ADS), and Student-Teacher Relationship Scale. The samples were collec ted from randomly selected normative families, infants attending JUNJI nurseries and kindergartens, and infants from CONIN centers and who live in prison with their mothers. RESULTS: The samples from six studies show the spectrum of the attachment system functioning in diverse conditions: 70% secure and 30% insecure, and 51.1% secure and 48.9% insecure in normative samples; 48.5% secure and 51.5% in secure in alternative care; 39.6% secure and 60.4% insecure, and 25% secure and 75% in secure styles in high-risk samples. CONCLUSION: the study presents interesting evidence on the atta chment distributions in childhood, which allow reflecting on the uneven Chilean reality with regard to early social and emotional development.