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Objective:To investigate the clinical significance of the acute physiology and chronic health evaluationⅡ (APACHEⅡ) combined with different systematic inflammation markers (SIMs) including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)-in adult patients with venous-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:A total of 89 adult patients with VA-ECMO ( ≥ 3 d) in the Emergency Department of Jiangsu Provincial People's Hospital from January 2017 to June 2020 were retrospectively analyzed. Patients were divided into two groups: survivors ( n=39) and non-survivors ( n=50). The baseline APACHE Ⅱscore and PLR, NLR, LMR before ECMO implantation and at 1, 2, 3 day after ECMO were recorded. Binary logistic regression was used to analyze the risk factors of 28-day mortality in patients with VA-ECMO. The utility of APACHEⅡ score and SIMs alone or combination for predicting clinical prognosis was evaluated using receiver operating characteristic (ROC) curve analysis. The patients were divided into the high risk group and the low risk group according to the best cut-off value, and the difference of ECMO-related complications between the two groups was compared. Results:When combined APACHEⅡ score with SIMs, APACHEⅡ + PLR 48 h + LMR 24 h + LMR 72 h demonstrated the greatest predictive ability with an AUC of 0.833. Compared with the high-risk group, the low-risk group has a lower incidence of acute renal injury, infection, bleeding complications, the use of continuous renal replacement therapy, mechanical ventilation, and a higher hospital survival rate.Conclusions:The combination of APACHEⅡ score and SIMs-PLR, LMR- is better than a single one for death prediction, and it is expected to be a new predictive model for early identification of the risk of death or poor prognosis in patients with VA-ECMO.
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Objective:To explore the relationship between hematocrit, early fluid therapy, and clinical outcomes in patients with septic shock, and to provide evidence for fluid resuscitation therapy and prognosis assessment in these patients.Methods:The clinical information of patients with septic shock who were diagnosed and treated in the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University from January 1, 2018 to December 31, 2020 were collected. Taking the survival or death of patients 28 days after admission as the end point of clinical research, the patients were divided into the survival and death groups. After analyzing the basic data of the two groups, the univariate and multivariate COX regression analyses were used to analyze the evaluation value of Δ Hematocrit (HCT) d2-d1 and ΔHCT d3-d1 on the prognosis of patients with septic shock. At the same time, the Kaplan-Meier survival curve was used to analyze the overall survival rate of patients with septic shock, and the smooth curve fitting graph was used to verify its relationship with net fluid intake and death. Results:There were 241 cases in the survival group and 67 cases in the death group. Univariate COX analysis showed statistically significant differences between the survival and death groups in acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) ( P=0.0006), red cell volume distribution width (RDW) ( P=0.0043), age ( P=0.0184), ΔHCT d2-d1 ( P=0.0136), ΔHCT d3-d1 ( P=0.0204), and white blood cell (WBC) ( P=0.0444). Multivariate COX analysis showed that ΔHCT d2-d1 ( P=0.0115) and ΔHCT d3-d1 ( P=0.0029) were independent risk factors for death in EICU patients with septic shock. ΔHCT d2-d1 and ΔHCT d3-d1 were divided into three groups according to the three-digit method. The Kaplan-Meier survival curve showed no significant difference among the three groups in the overall survival rate related to ΔHCT d2-d1 ( P=0.16), but there was a statistically significant difference in the overall survival rate among the three groups related to ΔHCT d3-d1 ( P=0.025). The smooth fitting curve of ΔHCT d3-d1, net fluid intake, and prognosis showed that ΔHCT d3-d1 was negatively correlated with net fluid intake, and the middle ΔHCT d3-d1 group had the best prognosis. Conclusions:The value of ΔHCT d3-d1 is related to the net fluid intake of patients with septic shock. An appropriate decrease in HCT on the third day can improve the prognosis of patients with septic shock. The dynamic changes of hematocrit can provide a certain basis for fluid resuscitation and prognosis evaluation in patients with septic shock.
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Objective:To explore the predictive value of the serum C-reactive protein (CRP)/albumin (ALB) ratio (CAR) for organ damage in tsutsugamushi disease.Methods:The clinical data of 166 patients with tsutsugamushi disease admitted to the First Affiliated Hospital of Wenzhou Medical University from January 1, 2010 to December 31, 2020 were retrospectively analyzed. The patients were divided into the organ damage group (72 cases) and non-organ damage group (94 cases) according to the organ damage criteria. The general data and laboratory test results of the two groups of patients were compared. The significant indicators of univariate analysis were analyzed by multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to analyze the predictive value of CAR for organ damage in patients with tsutsugamushi disease.Results:There were no significant differences in age, sex, days of fever, and admission body temperature between the organ damage group and non-organ damage group ( P>0.05). However, the body mass index, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA), length of hospital stay, hospitalization expense, percentage of neutrophils (NEUT), lymphocyte count, procalcitonin, CRP, and CAR in the organ damage group were significantly higher than those in the non-organ damage group ( P<0.05), and ALB was significantly lower than that in the non-organ damage group ( P<0.05). Multivariate logistic regression analysis showed that APACHEⅡ( P=0.039), NEUT ( P=0.003), and CAR ( P=0.011) were independent risk factors for tsutsugamushi disease complicated by organ damage. The ROC curve showed that the AUCs of APACHEⅡ, NEUT, and CAR were 0.655, 0.716, and 0.727, respectively. When the cut-off value of CAR was 2.86, the sensitivity was 55.6%, and the specificity was 79.8%. Conclusions:Elevated CAR is an independent risk factor for tsutsugamushi disease complicated with organ damage and can be used as an important indicator to evaluate the presence or absence of organ damage in patients with tsutsugamushi disease.
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Objective To investigate the significance of using procalcitonin (PCT) combined with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores to estimate the prognosis of elderly patients with sepsis. Methods One hundred and fourteen elderly patients with sepsis admitted into the Department of Intensive Care Unit (ICU) of 13th Division Xinjiang Production and Construction Corps Red Star Hospital from January 2011 to December 2017 were enrolled, general information of all patients [sex, age, body mass index (BMI), smoking, drinking alcohol, site of infection, underlying disease or complication, education level and marital status], vital signs (pulse, respiration frequency, pH value, body temperature, oxygenation index, diastolic blood pressure, systolic blood pressure), blood and biochemical indicators [blood sugar, high-density lipoprotein (HDL) and low-density lipoprotein (LDL)], D-dimer, PCT, C-reactive protein (CRP), APACHE Ⅱ, chronic health score (CHS) were recorded and survival situation of all patients after entering the study for 28 days. Univariate and multivariate analyses were used to analyze the prognostic factors of elderly patients with sepsis, and the receiver operating characteristic curve (ROC) was drawn to evaluate the diagnostic efficacy of the factors in sepsis. Results Within 28 days from admission to hospital, 64 patients (44.44%) died, 80 patients (55.56%) survived, and there were no significant differences in the sex, age, BMI, infected site, underlying disease or complication, education level, marital status, smoking, drinking alcohol, pulse, respiration frequency, pH, body temperature, oxygenation index, blood pressure, blood glucose, HDL, LDL and infection type in the comparisons between the survival and death groups (all P > 0.05). Compared with the survival group, the D-dimer, PCT, CRP, APACHE Ⅱ, mechanical ventilation ratio were higher in the death group [D-dimer (mg/L):3.6±1.1 vs. 3.2±1.2, PCT (mg/L): 15.4±3.5 vs. 4.1±1.4, CRP (ng/L): 637.0±8.9 vs. 596.0±9.6, APACHEⅡ:31.4±5.5 vs. 16.4±4.5, proportion of mechanical ventilation: 87.5% (56/64) vs. 56.2% (45/80), all P < 0.05];multivariate analyses showed that PCT, APACHEⅡ and proportion of mechanical ventilation were independent risk factors of the prognosis of sepsis [PCT: odds ratio (OR) = 4.126, 95% confidence interval (95%CI) = 2.045-6.115, P = 0.000; APACHEⅡ: OR = 2.935, 95%CI = 1.237-4.118, P = 0.001; mechanical ventilation: OR = 2.012, 95%CI =1.068-3.048, P = 0.034, all P < 0.05]. The PCT, APACHE Ⅱ and PCT combined with APACHEⅡ all can be used to diagnose the prognosis of senile sepsis, and the diagnostic value of PCT combined with APACHEⅡ was the largest [area under the ROC curve (AUC) = 0.946, 95%CI = 0.894-0.971, sensitivity = 86.7%, specificity = 90.8%, P = 0.000]. Conclusion PCT combined with APACHE Ⅱscore can be used to estimate the prognosis of elderly patients with sepsis.