Analysis of clinical characteristics and risk factors of early heat stroke-related acute liver injury / 中华危重病急救医学

OBJECTIVE@#To analyze the clinical characteristics and risk factors of early acute liver injury in patients with heat stroke (HS), and to provide basis for early identification of HS-related liver injury and its pathogenesis in clinical practice.@*METHODS@#The clinical data of patients with HS admitted to the department of critical care medicine of Haian People's Hospital from June 2015 to August 2022 were retrospectively analyzed. The patients with HS were divided into early liver injury group and early non-liver injury group according to the occurrence of acute liver injury within 24 hours of admission. The differences of basic data, clinical data, laboratory indexes and clinical outcomes of the two groups were analyzed. Logistic regression was used to analyze the risk factors for early HS-related acute liver injury, and receiver operator characteristic (ROC) curves were drawn to evaluate their value in predicting the occurrence of early HS-related acute liver injury.@*RESULTS@#A total of 76 patients with HS were enrolled, and 46 patients with acute liver injury, accounting for 60.53%. In the early liver injury group, 14 patients (30.43%) had elevated aminotransferase alone, 9 patients (19.57%) had elevated total bilirubin (TBil) alone, and 23 patients (50.00%) had elevated both aminotransferase and TBil. Among the patients with elevated aminotransferases, 24 patients (64.87%) had mild elevation, 5 patients (13.51%) had moderate elevation, 8 patients (21.62%) had severe elevation. Compared with the early non-liver injury group, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), arterial blood lactate (Lac), interleukin-6 (IL-6), procalcitonin (PCT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), TBil, γ-gamma glutamyl transferase (γ-GGT), lactate dehydrogenase (LDH), creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB), cardiac troponin I (cTnI), myoglobin (MYO), N-terminal B-type pro-brain natriuretic peptide (NT-proBNP), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer in the early liver injury group were significantly increased, while platelet count (PLT) were significantly decreased within 24 hours after admission, the 28-day mortality was significantly increased [28.26% (13/46) vs. 6.67% (2/30)], and the differences were statistically significant (all P < 0.05). Univariate Logistic regression analysis showed that APACHE II score, SOFA score, PLT, Lac, IL-6, PCT, γ-GGT, LDH, CK, CK-MB, cTnI, MYO, PT, APTT, D-dimer were risk factors of early HS-related acute liver injury (all P < 0.05). Multivariate Logistic regression analysis showed that PLT, IL-6, and LDH were independent risk factors of early HS-related acute liver injury [odds ratio (OR) and 95% confidence interval (95%CI) were 0.986 (0.974-0.998), 1.027 (1.012-1.041), and 1.002 (1.000-1.004), all P < 0.05]. The ROC curve analysis showed that the area under the ROC curve (AUC) of PLT, IL-6 and LDH for predicting the occurrence of early HS-related acute liver injury was 0.672 (95%CI was 0.548-0.797), 0.897 (95%CI was 0.824-0.971) and 0.833 (95%CI was 0.739-0.927), respectively. IL-6 had the highest predictive value for early HS-related liver injury. When the optimal diagnostic threshold of IL-6 was 48.25 ng/L, the sensitivity was 95.7%, the specificity was 73.3%, and the predictive value of PLT was the lowest.@*CONCLUSIONS@#The early HS-related liver injury is mainly manifested as the simultaneous elevation of aminotransferase and TBil, and most of cases are mild liver injury. PLT, IL-6 and LDH are independent risk factors of early HS-related acute liver injury.

Effect of different blood glucose levels on the new carotid plaque / 中国综合临床

Objective To explore the relationship between different blood glucose levels and new carotid artery plaques.Methods A total of 5 440 participants met the inclusion criteria were selected stratified randomly from the 101,510 serving and retired workers of Tangshan Kailuan Company who participated the health examination from 2006 to 2007.The follow-up health examination were respectively preformed from 2010 to 2011 and from 2012 to 2013 which included carotid ultrasound for these 5 440 participants.The 5 440 participants were divided into three groups (ideal blood glucose group,impaired fasting glucose group and diabetic group) according to their fasting glucose levels in 2010-2011 examination.Multivariate Logistic regression analysis was used to analyze the risk factors of new carotid artery plaques.Results Among 5 440 subjects,participants whose FPG,ultrasound data incomplete and ultrasound detection of carotid plaques during the 2010-2011 health examination were excluded,then 3 084 participants were included in this study,among them,175 participants who did not participate the 2012-2013 health examination and 561 participants whose carotid plaque ultrasound data incomplete were excluded.Thus,a total of 2 348 participants were included in the present analysis.The total detection of new carotid artery plaque rate was 15.0％ (352/2 348) after 2 years of follow-up.The detection of new carotid artery plaque rate in normal glucose group(n =1724),impaired fasting glucose group(n=464) and diabetic group(n=160) were 14.2％(245/1 724),14.9％(69/464) and 23.8％(38/160),respectively.The diabetic group was higher than that of the ideal blood glucose group and the impaired fasting glucose group,the difference was statistically significant(P＜0.05).Impaired fasting glucose group and diabetic group had an increased risk of new carotid artery plaque compared with those in ideal glucose group(OR =0.924,95％CI 0.691-1.235 and OR =1.733,95％CI 1.107-2.713,respectively),the difference was statistically significant(P＜0.05).After adjusted for the other risk factors,with the risk-adjusted ratio (OR =1.117,95％CI 0.824-1.513 and OR =1.393,95％CI 0.872-2.226).Conclusion The detection of new carotid artery plaque increase in the diabetic group.However,after adjustment for other risk factors associate with emerging danger of new carotid artery plaque is no significant difference.This requires more long-term follow-up study of a large sample to be further confirmed.