Predictive value of hemoglobin to serum creatinine ratio combined with serum uric acid for in-hospital mortality after emergency percutaneous coronary intervention in patients with acute myocardial infarction / 中华危重病急救医学

OBJECTIVE@#To investigate the clinical value of hemoglobin to serum creatinine ratio (Hb/SCr) combined with blood uric acid (SUA) in predicting in-hospital mortality after emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).@*METHODS@#The clinical data of AMI patients who underwent emergency PCI in the First Affiliated Hospital of Kangda College of Nanjing Medical University from January 2017 to December 2021 were retrospectively analyzed. The general information, underlying medical history, blood routine, liver and kidney function, blood coagulation routine, SUA and other indicators were collected from patients. The primary composite endpoint was defined as in-hospital death, including in-hospital all-cause death during PCI and 15-day post-procedure hospitalization. Multivariate Logistic regression was used to analyze factors associated with in-hospital death after emergency PCI in patients with AMI. Multivariate Logistic regression was used to analyze the independent related factors and construct a risk prediction model. The Hosmer-Lemeshow method and receiver operator characteristic curve (ROC curve) were used to test the goodness of fit and predictive effect of the model and correlates, respectively.@*RESULTS@#A total of 1 976 patients were enrolled, 92 died in hospital and 1 884 survived. SUA was higher in the death group than that in the survival group (μmol/L: 476.88±132.04 vs. 354.87±105.31, P < 0.01), and the Hb/SCr ratio was significantly lower than that in the survival group (13.84±5.48 vs.19.20±5.74, P < 0.01). Pearson analysis showed a linear negative correlation between SUA and Hb/SCr ratio (r = -0.502, P < 0.01). Logistic regression risk model analysis finally included age [odds ratio (OR) = 0.916], Hb/SCr ratio (OR = 0.182), white blood cell count (WBC, OR = 2.733), C-reactive protein (CRP, OR = 3.611), SUA (OR = 4.667), blood glucose (Glu, OR = 2.726), homocysteine (Hcy, OR = 2.688) 7 factors to construct a risk prediction model, which were independent correlation factors for in-hospital death in AMI patients after emergency PCI (all P < 0.05). Hosmer-Lemeshow test verified the fitting effect of the model, and the result showed P = 0.447. The area under the ROC curve (AUC) of the model for predicting in-hospital death in AMI patients after emergency PCI was 0.764 [95% confidence interval (95%CI) was 0.712-0.816, P = 0.001]. When the cut-off value was 0.565 8, the sensitivity was 70.7%, the specificity was 70.2%, and the Yoden index was 0.410. When Hb/SCr ratio+SUA, SUA, Hb/SCr ratio, Hb and SCr were used to predict in-hospital death in AMI patients after emergency PCI, the AUC of Hb/SCr ratio+SUA was the largest, which was 0.810. When the optimal cut-off value was -0.847, the sensitivity was 77.7%, the specificity was 74.5%, and the Youden index was 0.522.@*CONCLUSIONS@#Age, SUA, Hb/SCr ratio, WBC, CRP, Glu, and Hcy are independent risk factors for in-hospital death after emergency PCI in AMI patients. The lower the Hb/SCr ratio and the higher the SUA at admission, the higher the risk of in-hospital death after emergency PCI in AMI patients. Hb/SCr ratio combined with SUA has a higher predictive value for in-hospital death after emergency PCI in AMI patients than single index, which is helpful for early identification of high-risk patients.

Changes of Ventilatory Function of the Young Soldiers Coming from Different Regions During Cold-tolerance Training / 医学研究杂志

Objective To study the changes of ventilatory function of young soldiers coming from different regions during cold - tol-erance training. Methods The recruited young soldiers were divided into 2 groups:Group Ⅰ (50 coming from the northern region)and group Ⅱ (50 coming from the southern region) . According to the new training outline of cold -tolerance in winter,their ventilatory func-tions were tested before training and 60 days after training. Ventilatory functions were compared between smoking and non - smoking sub-jects. Results 25% forced expiratory flow (FEF25%) , 50% forced expiratory flow (FEF50%) and 75% forced expiratory flow (FEF75 %) were significant different between two groups before the course of training (P < 0.05). After 60 days, ventilatory functions of two groups were improved significantly as compared with that before training (P <0.01 ,P <0.05). There was no significant difference in ventilatory between two groups after 60 days of training (P > 0.05). There was significant difference in partial small airway function be-tween smoking and non - smoking subjects. Conclusion Cold air could decline the small airway function of soldiers coming from south-ern region before training. Cold -tolerance training has significant influence on soldiers' ventilatory function. Long- term and heavy smok-ing could decline the small airway function.