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Objective:To investigate the correlation between strong ion gap (SIG) and prognosis of adult hospitalized patients who experienced cardiac arrest (CA).Methods:A retrospective cohort study was conducted on adult CA patients (≥18 years old) who were admitted to the intensive care unit (ICU) for the first time from the Medical Information Mart for Intensive Care Ⅲ (MIMIC-Ⅲ) database from 2001 to 2012. The patients were divided into 3 groups based on the tertiles of serum SIG value. The clinical baseline characteristics and related data of CA patients were compared. Kaplan-Meier method was used to draw the 28- and 90-day cumulative survival curves of CA patients. Meanwhile, the log-rank test was used to compare the differences in the survival curves among different groups, and Cox proportional hazard regression model was established to analyze whether SIG was an independent predictor of all-cause mortality in CA patients.Results:Six hundred and six adult CA patients were eligible for final analysis. The patients were divided into 3 groups based on the tertiles of serum SIG value [<3.91 mmol/L ( n=202), 3.91~7.32 mmol/L ( n=202) and >7.32 mmol/L ( n=202)]. The mean age was (66.91±15.95) years and 382 patients (63.04%) were male. The all-cause mortality rates of ICU, 28 days and 90 days were 36.47%, 49.17% and 56.93%, respectively. There were significant differences in SOFA score, SIG, anion gap, pH, lactic acid, white blood cells, prothrombin time, creatinine, blood potassium, blood phosphorus, hypertension, coronary heart disease, cardiogenic shock, and ICU, 28-day and 90-day all-cause mortality among the 3 groups (all P<0.05). The Kaplan-Meier survival curves showed that the 28- and 90-day cumulative survival rates of CA patients decreased gradually with the increase of SIG level, and the differences were statistically significant among the 3 groups (all P<0.001). Multivariate Cox proportional hazard models showed that the increase of SIG level (>7.32 mmol/L) was an independent risk factor for 28-day ( HR=1.610, 95% CI: 1.177-2.203, P=0.003) and 90-day all-cause mortality ( HR=1.506, 95% CI: 1.123-2.019, P=0.006) among CA patients, after adjusting for the related confounders. Conclusions:The elevated SIG level (>7.32 mmol/L) is an independent predictor of 28- and 90-day all-cause mortality in CA patients. The calculation of SIG level in these patients is helpful for early identification of patients with poor prognosis.
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Objective To investigate the effect of daptomycin on the serum levels of proclacitonin (PCT) and copeptin in septicopyemia patients induced by methicillin-resistant Staphylococcus aureus (MRSA). Methods 54 cases septicopyemia patients induced by MRSA were selected and divided into two groups, 27 cases in each group. The two groups received fluid replacement therapy and nutrition support, the control group received vancomycin (0.5g per times, three times daily) with intravenous drip, and the study group received daptomycin (6mg/kg, once daily) with intravenous drip. The serum PCT, proclacitonin levels pre-and post-treatment in two groups were detected, the acute physiology and chronic health evaluationⅡ (APACHEⅡ) and sepsis-related organ failure assessment (SOFA) were used to evaluate the patients' condition, the clearance time of pathogenic bacteria was recorded and the clinical efficacy was compared between two groups. Results Compared with before treatment, serum PCT, C-reactive protein (CRP), interleukin-1β(IL-1β) and IL-6 in two groups decreased(P<0.01), the count of WBC, NE% and copeptin decreased (P<0.01), the APACHEⅡ and SOFA score were lower(P<0.05); compared with the control group, the PCT, CRP, IL-1 beta and IL-6 in study group were lower(P<0.05), the count of WBC, NE% and copeptin level were lower(P<0.05), APACHEⅡ and SOFA score were lower(P<0.05), the pathogen clearance rate was higher(P<0.05), clearance time was shorter(P<0.05), the total efficiency was higher(P<0.05). Conclusion Daptomycin can reduce serum PCT and copeptin in patients with septicopyemia induced by MRSA, and remove pathogenic bacteria rapidly, inhibit the inflammatory reaction, safe and reliable.