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Objective:To study the influence of time-dependent acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on 14-day death risk in patients with severe stroke, and to provide reference for clinical diagnosis and treatment.Methods:Data of 3 229 patients with severe stroke were enrolled from Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ). According to the main types of stroke, the patients were divided into subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic stroke (IS) and other groups. According to age, patients were divided into > 60 years old and ≤ 60 years old subgroups. According to the baseline of sequential organ failure assessment (SOFA) score, they were divided into subgroups of > 3 and ≤ 3. The daily measured values of APACHE Ⅱ scores in each patient were recorded. And all-cause death within 14 days after admission to intensive care unit (ICU) was used as the outcome index to obtain the survival status and survival time of patients. Joint models for longitudinal and time-to-event data were established to evaluate the effect of APACHE Ⅱ score measured at multiple time points on the death risk of patients, and a subgroup analysis was performed.Results:Among the joint models, the one which include APACHE Ⅱ score, and the interaction items between APACHE Ⅱ and age showed the better fitting. Further analysis showed that APACHE Ⅱ score was affected by age, gender, hospital admission, baseline SOFA score and smoking history. After controlling for these confounding factors, APACHE Ⅱ score was significantly associated with 14-day all-cause death in patients with severe stroke [hazard ratio ( HR) = 1.48, 95% confidence interval (95% CI) was 1.31-1.66, P < 0.001], which indicated that the risk of death increased by 48% (95% CI was 31%-66%) for each 1-point increase in APACHE Ⅱ score. Subgroup analysis showed that for different types of severe stroke patients, APACHE Ⅱ score had a greater impact on the risk of 14-day death in SAH patients ( HR = 1.43, 95% CI was 1.10-1.85), but had a smaller impact on ICH and IS groups [HR (95% CI) was 1.37 (1.15-1.64) and 1.35 (1.06-1.71), respectively]. There was no significant difference in APACHE Ⅱ score on the risk of 14-day death between the patients aged > 60 years old and those aged ≤ 60 years old [ HR (95% CI): 1.37 (1.08-1.72) vs. 1.35 (1.07-1.70), respectively]. Compared with patients with SOFA score > 3, APACHE Ⅱ score had a greater impact on the risk of 14-day death in patients with SOFA score ≤ 3 [ HR (95% CI): 1.40 (1.16-1.70) vs. 1.34 (1.16-1.55)]. Conclusion:Time-dependent APACHE Ⅱ score is an important indicator to evaluate the risk of death in patients with severe stroke.
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Objective:To explore the effect of nutritional status on pulmonary infection in patients with severe stroke, and to identify the nutrition-related risk factors of pulmonary infection, so as to provide reference for the prevention and treatment of pulmonary infection from the perspective of nutrition.Methods:The clinical data of 122 patients admitted to the neuro-intensive care unit (NICU) of the First Affiliated Hospital of Chongqing Medical University from August 2019 to February 2020 were retrospectively analyzed. Patients with severe stroke were divided into two groups according to whether they had pulmonary infection during hospitalization in NICU, and there were 25 patients in case group and 97 patients in control group. Nutritional Risk Screening (NRS2002), Nutrition Risk in the Critically ill (NUTRIC) score and malnutrition criteria, combined with anthropometry, clinical comprehensively history and laboratory data were used to evaluate the nutritional status of patients. Logistic regression was used to identify nutrition-related risk factors for pulmonary infection in patients with severe stroke.Results:The incidence of pulmonary infection in severe stroke patients was 20.5% (25/122). Univariate analysis showed that the difference of chronic obstructive pulmonary disease, endotracheal intubation, nasogastric tube use, NUTRIC ≥ 5, the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Sequential Organ Failure Assessment (SOFA), Glasgow Coma Scale (GCS), and creatinine levels, duration of enteral nutrition, length NICU stay, and length of hospital stay between the two groups were statistically significant ( χ2 value was 7.542-34.403, t value was 2.207, Z value was -3.511, 3.083 and 3.115, P<0.05 or 0.01). Multivariate Logistic regression analysis showed that NUTRIC≥5 ( OR= 12.202, 95% CI 2.342-63.568) and nasogastric tube use ( OR=16.990, 95% CI5.343-54.024) were independent risk factors of pulmonary infection in patients with severe stroke ( P<0.01). Conclusions:NUTRIC score≥ 5, high nutritional risk and nasogastric tube use were independent risk factors of pulmonary infection in patients with severe stroke, which should be given early nutritional assessment and individualized care.
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To investigate and analyze the clinical characteristics and prognosis of brain-heart interaction (BHI) in patients with acute severe stroke. Methods The patients with acute severe stroke admitted to Neurointensive Care Unit of Xuanwu Hospital, Capital Medical University from January 1st, 2015 to December 31st, 2017 were enrolled. The clinical data, indicators related to BHI and prognosis were collected. Patients were divided into BHI group and non-BHI group according to the presence or absence of BHI. The differences of each index were compared between two groups. The independent risk factors of BHI were analyzed using multivariate Logistic regression analysis. In addition, subgroup analysis was performed for patients in the BHI group based on the presence or absence of Takotsubo syndrome (TTS), and multivariate Logistic regression was used to analyze independent risk factors for TTS. Results 119 patients with acute severe stroke were analyzed, BHI occurred in 91 cases (76.5%), and 17 cases (14.3%) TTS were included in the BHI group. Compared with non-BHI group, BHI group had lower rates of cerebrovascular disease history (20.9% vs. 42.9%, P = 0.020), lower smoking history (25.3% vs. 50.0%, P = 0.013), lower statin use (16.5% vs. 50.0%, P = 0.000), lower total cholesterol [TC (mmol/L): 3.97±1.05 vs. 4.43±0.88, P =0.039], and lower low density lipoprotein [LDL (mmol/L): 2.30±0.76 vs. 3.00±0.84, P = 0.000]. Multivariate Logistic regression showed that the use of statins [odds ratio (OR) = 0.222, 95% confidence interval (95%CI) = 0.075-0.658, P =0.007] and the history of cerebrovascular diseases (OR = 0.321, 95%CI = 0.113-0.912, P = 0.033) were protective factors of BHI. Compared with non-TTS subgroup, TTS subgroup had a lower percentage of diabetes history (0% vs. 37.8%, P = 0.002), lower glycated hemoglobin [HbA1c: 0.055 (0.050, 0.056) vs. 0.064 (0.056, 0.075), P = 0.000], higher TC (mmol/L: 4.70±1.16 vs. 3.80±0.95, P = 0.001), first day mean arterial pressure [MAP (mmHg, 1 mmHg = 0.133 kPa):114 (98, 122) vs. 103 (94, 108), P = 0.042], third day diastolic blood pressure [DBP (mmHg): 82 (77, 94) vs. 67 (59, 86), P = 0.002], and third day MAP [mmHg: 106 (95, 114) vs. 94 (80, 106), P = 0.015]. Multivariate Logistic regression analysis showed that increased MAP on the third day of admission was an independent risk factor for TTS (OR = 11.833, 95%CI = 1.113-125.779, P = 0.040), increased HbA1c was protective factor of TTS (OR = 0.022, 95%CI = 0.001-0.345, P = 0.006). The rate of poor outcome at discharge of all the BHI patients were higher than those of the non-BHI patients (34.1% vs. 14.3%, P = 0.045). Conclusions Acute severe stroke patients with high incidence of acquiring BHI and having BHI is associated with poor outcome after discharge. Using statins, ischemic preconditioning and control blood pressure, the occurrence of BHI can be reduced and might be beneficial to patients.
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Objective: To evaluate the clinical effect of individualized enteral nutritional (EN) support in severe stroke patients.Methods: Totally 120 severe stroke patients with nutritional risk were divided into two groups according to single or double admission number.The 60 patients in the intervention group received an individualized EN with different formula and concentrations according to the clinical status,and supplemented trace elements as occasion required.In the routine group, the patients received EN with standard formula.The energy supply was 83-125 kJ· kg-1·d-1 in both groups.Blood albumin(Alb), pre-albumin(PA), hemoglobin(Hb) and vitamin C(VC) were examined before and after the 21-day nutritional support.The lung infection and gastrointestinal (GI) complications were observed, and the hospital stay and cost were recorded as well.Results: After 21 day''s nutrition support, the serum levels of Alb, PA and VC in the intervention group were not statisticly significant than before (P＞0.05), and the serum levels of Alb, PA and VC were significantly higher than those in the routine group(P＜0.05).The incidence of complications in the in the intervention group was lower than that in the routine group (P＜0.05), and the length of hospital stay and hospitalization was shorter than that in the routine group (P＜0.05).Conclusion: Individualized enteral nutritional support can significantly improve nutritional status, reduce inflammation reactions and GI complications in severe stroke patients, which is worthy of clinical use.
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Objective To observe the effect of early enteral nutrition combined with probiotics for acute severe stroke patients. Methods EiGhty-seven patients with acute severe stroke were randomly divided into control Group(47cases)and research Group(40 cases). Within 48 -72 h,both Groups were Given enternal nutrition,and research Group added probiotics on the basis of enternal nutrition. HemoGlobin( Hb ),serum albumin(ALB)and prealbumin(PLB)were detected on the lst,7th,2lth day after hospitalization. Infection incidence and the incidence of the Gastrointestinal adverse reaction were observed on the 7th,2lth day. GlasGow coma scale( GTS)and NeuroloGic impairment sccore( NIHSS)were assessed on the lst,2lth day. Results There were no satistical siGnificant differences between two Groups in terms of ALB,PLB and Hb on the first day after hospitalization(P>0. 05). The indicators of the two Groups occurred downward trend on the 7th day and control Group declined siGnificantly( The two Groups respectively:ALB:( 3l. 27 ±2. 42 ) G/L and( 27. 2l ±2. 69)G/L,P0. 05). Conclusion Enteral nutrition add probiotics is superior to enteral nutrition on the aspects of enhancinG body nutrition situation,relievinG the infection and the Gastrointestinal adverse reaction.