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Objective:To investigate the predictive value of serum thyroid hormone in the short-term prognosis of patients with septic shock..Methods:The 133 patients with septic shock admitted to Intensive Care Unit (ICU) of Nanjing Hospital of Nanjing Medical University were enrolled. Data of patient’s general clinical information, acute physiology and chronic health evaluationⅡ (APACHE Ⅱ), serum triiodothyronine ( T3 ), thyroxine (T4), free triiodothyronine (FT3) , free thyroxine (FT4) and thyroid stimulating hormone(TSH) in 24 h were collected, and the ratio of T3 to FT3 (T3/FT3) was calculated. The patients were divided into the survival group and death group according to the prognosis during ICU hospitalization. Univariate and multivariate analyses were used to analyze the prognostic factors of patients with septic shock. The receiver operating characteristic (ROC) curve and Kaplan-Meier analysis were plotted to evaluate the diagnostic efficacy of serum thyroid hormone for the short-term prognosis of patients with septic shock.Results:Compared to the survival group, FT3, T3 and T3/FT3 were significantly lower in the death group [1.73 (1.54, 2.52) vs. 1.32 (0.94, 1.54) pmol/L, 0.70 (0.56, 0.79) vs. 0.33 (0.25, 0.43) nmol/L, 318.18(299.44, 448.05) vs. 250.00 (192.31, 313.92), respectively; all P < 0.05 ]. The levels of serum T3 and FT3 were significantly correlated with the APACHEⅡ score in patients with septic shock (FT3: r = -0.25, P= 0.004; T3: r = - 0.24, P= 0.006). Binary Logistic regression analysis showed that FT3, T3 and T3/FT3 were independent risk factors of the short-term prognosis of patients with septic shock [FT3: OR = 6.533, 95% CI: 0.687 - 62.157, P = 0.012; T3: OR = 0.529, 95% CI: 0.372 - 0.975, P= 0.000; T3/FT3: OR = 1.719, 95% CI: 1.007 - 1.931, P= 0.002]. ROC curve analysis showed that FT3, T3 and T3/FT3 all had certain predictive value for the short-term prognosis of patients with septic shock, and the diagnostic value of T3 was the largest [AUC = 0.874, 95% CI: 0.794-0.954, P= 0.000]. The Kaplan-Meier curve showed a significantly higher survival rate in patients with T3 greater than 0.535 nmol/L than patients with T3 less than 0.535 nmol/L. Conclusions:The serum levels of thyroid hormone T3 and FT3 are closely related to the severity of septic shock. T3 is an effective ICU mortality during hospitalization prognostic indicator for patients with septic shock, which is better than FT3 and T3/FT3.
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Objective:To investigate the predictive value of different glycemic variability indexes within 6 hours on the short-term prognosis of septic shock patients.Methods:A retrospective study was conducted. The 133 patients with septic shock admitted to intensive care unit (ICU) of Nanjing Hospital Affiliated to Nanjing Medical University from December 2014 to December 2019 were enrolled. Patients with septic shock admitted to ICU died during hospitalization were enrolled in the death group and others in the survival group. General data of the patients including gender, age, underlying disease, site of infection, duration of mechanical ventilation, length of ICU stay, whether to use continuous renal replacement therapy (CRRT) and acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores within 24 hours were collected. The blood glucose (GLUadm), mean arterial pressure (MAP), serum creatinine (SCr) and procalcitonin (PCT) were recorded at ICU admission. The patients admitted to ICU received bundle therapy within 6 hours and blood glucose was observed every 2 hours. The blood glucose difference (GLUdif), average blood glucose (GLUave), blood glucose standard deviation (GLUsd) and blood glucose variation coefficient (GLUcv) within 6 hours were calculated. Multivariate Logistic regression analysis was used to analyze the prognostic factors of short-term prognosis of patients with septic shock, and receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of glycemic parameters for short-term prognosis of septic shock patients.Results:A total of 133 patients with septic shock were admitted to ICU, among them 87 patients survived and 46 patients died during the ICU hospitalization. Compared with the survival group, the SCr at ICU admission and APACHEⅡ score within 24 hours were significantly higher in the death group [SCr (μmol/L): 208.5 (143.0, 286.5) vs. 172.0 (91.0, 234.0), APACHEⅡ score: 30.28±6.67 vs. 24.03±5.90, both P < 0.05], the length of ICU stay was shorter [days: 4.00 (2.00, 10.25) vs. 9.00 (4.00, 13.00), P < 0.01]. However, there were no significant differences in the baseline data of gender, age, underlying disease, infection site, CRRT ratio, MAP or PCT at ICU admission between the two groups. Compared with the survival group, the GLUsd and GLUcv within 6 hours in the death group were higher [GLUsd (mmol/L): 2.33 (1.95, 3.14) vs. 2.02 (1.66, 2.52), GLUcv: (31.00±7.06)% vs. (23.31±10.51)%, both P < 0.05]. There were no statistically significant differences in the levels of GLUadm, GLUdif or GLUave within 6 hours between the two groups. Multivariate Logistic regression analysis showed that APACHEⅡ score within 24 hours and GLUsd and GLUcv within 6 hours were independent risk factors of the short-term prognosis of septic shock patients [APACHEⅡ score: odds ratio ( OR) = 1.173, 95% confidence interval (95% CI) was 1.095-1.256, P = 0.000; GLUsd: OR = 1.465, 95% CI was 1.038-2.067, P = 0.030; GLUcv: OR = 1.089, 95% CI was 1.043-1.138, P = 0.000]. ROC curve analysis showed that GLUsd and GLUcv within 6 hours both had certain predictive value for the short-term prognosis of septic shock patients, the area under ROC curve (AUC) of GLUcv within 6 hours was higher than that of APACHEⅡ score (0.765 vs. 0.753), and AUC of GLUsd within 6 hours was close to APACHEⅡ score (0.629 vs. 0.753); and the diagnostic value of GLUsd combined with GLUcv within 6 hours was higher than the two respectively (AUC: 0.809 vs. 0.629, 0.765), the sensitivity was 97.8%, and the specificity was 66.7%. Conclusion:GLUsd combined with GLUcv within 6 hours can be used to estimate the short-term prognosis of septic shock patients.
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Objectives:To explore the value of heparin-binding protein (HBP) in the diagnosis and prognosis of patients with respiratory viral infections.Methods:The patients who were admitted to Emergency Department of Nanjing Hospital Affiliated to Nanjing Medical University from November 2018 to November 2020 were selected as the viral infection group, and the non-infected patients admitted in the same period as the non-viral infection group. Data of all patients’ general clinical information, peripheral white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), and HBP in 24 h were collected. The differences in various indicators were compared between the two groups of patients, the receiver operating characteristic (ROC) curves were drawn, and the diagnostic value of each indicator for patients with respiratory virus infection were evaluated. The prognostic indicators such as sequential organ failure assessment (SOFA) score, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score within 24 h were recorded, and duration of ICU stay, antiviral treatment, ventilator and vasoactive agents to total length of hospital stay of patients in the viral infection group were calculated. The Spearman correlation analysis of HBP and the above indicators was performed to determine the prognostic value of HBP in patients with respiratory virus infections.Results:A total of 106 patients were included in the viral infection group, and 107 in the non-viral infection group. There were no significant differences in sex, age, and body mass index (BMI) between the two groups of patients (P>0.05). Compared with the non-viral infection group, the serum CRP and HBP of the viral infection group were significantly higher (P<0.05), while the WBC and NLR levels were significantly lower (P<0.05). There was no statistical difference in PCT between the two groups (P>0.05). HBP had the best diagnosis efficiency for respiratory viral infections, the areas under the ROC was 0.895, the optimal cut-off point was 13.625 μg/L, the sensitivity was 92.50% and the specificity was 76.60%. Correlation analysis showed that serum HBP levels within 24 h in the viral infection group were positively correlated with SOFA score and APACHEⅡ score in 24 h after admission (r = 0.756, P<0.05; r = 0.747, P<0.05). In the viral infection group, duration of ICU stay, antiviral treatment, and ventilator and vasoactive agents to total length of hospital stay were also positively correlated with serum HBP level (r = 0.873, 0.748, 0.830, and 0.794, P<0.05).Conclusions:HBP can be used as a favorable diagnostic indicator for patients with respiratory virus infections and has a good evaluation value for the prognosis.
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Objective To explore the effect of different doses of dobutamine on acute lung injury (ALI) in rabbits with septic shock and to clarify the possible mechanism.Methods The rabbits model of septic shock was made by cecal ligation and puncture combined with intravenous injection of endotoxin,70 male New Zealand white rabbits were randomly divided into five groups (14 rabbits in each groups):shamc operation group (group A),ALI group (group B),dobutamine low-dose group (group C),dobutamine medium-dose group (group D) and dobutamine high-dose group (group E),7 rabbits from each group were sacrificed 3 h and 6 h after septic shock.The level of cyclic adenosine monophosphate (cAMP) in lung tissue was detected by ELISA.The expression of aquaporin 5 (AQP5) protein was determined by western blotting.The wet to dry weight (W/D) ratio was measured.The pathological and ultrastructural changes of lung tissue were evaluated by optical microscopy and electron microscope,and lung injury score was assessed.The differences among the different groups were analyzed by one-way ANOVA (LSD test).Results The level of cAMP and expression of AQP5 protein in lung tissue at 3 h and 6 h were dramatically lower in group B than those in group A (3.53 ±0.43) pmol/mLvs.(21.18 ±0.62) pmol/mL; (0.44 ± 0.04) pmol/mLvs.(0.99±0.06)pmol/mL; (2.71±0.56)pmol/mLvs.(21.78±0.62)pmol/mL; (0.29 ±0.05) pmol/mLvs.(0.91 ±0.06) pmol/mL; all P ＜0.001,while the W/D ratio was obviously higher in group B than those in group A (all P ＜0.001).Compared with group B,the level of cAMP and AQP5 protein expression in lung tissue were significantly increased at 6 h in group C (8.48 ±0.61) pmol./ mLvs.(2.71±0.56) pmol/mL,P＜0.01; (0.49 ±0.04) pmol/mLvs.(0.29 ±0.05) pmol/mL,P=0.001 and at3 hand6 hin groupDandE (10.86±0.66) pmol/mLvs.(3.53±0.43) pmol/mL; (0.60±0.05) pmol/mLvs.(0.44±0.04) pmol/mL; (13.80±0.49) pmol/mLvs.(2.71±0.56) pmol/mL; (0.64 ± 0.03) pmol/mLvs.(0.29 ± 0.05) pmol/mL; (15.57 ± 0.60) pmol/mL vs.(3.53±0.43) pmol/mL; (0.91 ±0.05) pmol/mLvs.(0.44 ±0.04) pmol/mL; (19.30±0.42) pmol/mL vs.(2.71 ±0.56) pmol/mL; (0.89 ±0.08) pmol/mL vs.(0.29 ±0.05) pmol/mL; all P ＜ 0.01,while the W/D ratio in group E was decreased obviously (P =0.002; P =0.001).Compared with group C and D,the level of cAMP and the expression of AQP5 protein at 3 h and 6 h in group E increased significantly (all P ＜0.01.The pathological and ultrastructural changes of lung tissue were more intensive in group B than those in group A and the lung injury scores were obviously higher (P ＜0.01).The degree of lung pathological and ultrastructural lesion was ameliorated after administration of dobutanmine.Additionally,histological scores decreased significantly (P ＜ 0.01).Conclusions Our study demonstrated that dobutamine could improve ALI induced by endotoxin,the mechanism of protective effect may involve in increasing the level of cAMP and up-regulating the AQP5 protein expression,and high-dose dobutamine had better effects.