Predictive value of the maximum aggregation rate of platelet for septic shock and septic shock with disseminated intravascular coagulation / 中华危重病急救医学

Objective:To investigate the predictive value of the maximum aggregation rate (MAR) of platelet for septic shock and septic shock with disseminated intravascular coagulation (DIC).Methods:A retrospective case-control study enrolled patients with sepsis admitted to department of critical care medicine of the First Affiliated Hospital of Zhengzhou University from January 2021 to November 2022. The basic data, dynamic platelet aggregation rate, blood routine, inflammation indicators, sequential organ failure assessment (SOFA) and other clinical indicators within 24 hours after admission were collected. Septic patients were divided into the shock group and the non-shock group according to the presence of septic shock; then refer to the International Society on Thrombosis and Hemostasis (ISTH) standard, patients with septic shock were divided into the shock DIC group and the shock non-DIC group according to the presence of dominant DIC. Compared the differences in platelet aggregation function between these groups, and the receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of the MAR for septic shock and septic shock with DIC. Spearman correlation analysis was used to analyze the correlation of MAR with inflammation indicators and the severity of illness in patients with sepsis.Results:A total of 153 sepsis patients were included and 61 with septic shock (including 17 with dominant DIC and 44 without dominant DIC). Compared with the non-shock group, the level of procalcitonin (PCT), C-reactive protein (CRP), and SOFA score were significantly higher in the shock group [PCT (mg/L): 6.90 (2.50, 23.50) vs. 0.87 (0.26, 5.75), CRP (mg/L): 156.48 (67.11, 230.84) vs. 90.39 (46.43, 182.76), SOFA score: 11.00 (8.00, 14.00) vs. 5.00 (3.00, 8.00), all P < 0.05]. The platelet count (PLT) and the MAR induced by adenosine diphosphate (ADP), adrenaline (A), collagen (COL), and arachidonic acid (AA; ADP-MAR, A-MAR, COL-MAR, AA-MAR) in the shock group were significantly decreased [PLT (×10 9/L): 101.00 (49.00, 163.50) vs. 175.50 (108.25, 254.50), ADP-MAR: 28.50% (22.00%, 38.05%) vs. 45.90% (33.98%, 60.28%), A-MAR: 38.90% (30.00%, 55.40%) vs. 65.15% (54.38%, 72.53%), COL-MAR: 27.90% (20.85%, 36.55%) vs. 42.95% (33.73%, 54.08%), AA-MAR: 24.70% (16.40%, 34.20%) vs. 46.55% (28.33%, 59.20%), all P < 0.05]. Subgroup analysis revealed that, compared with the shock non-DIC group, the SOFA scores were significantly higher in patients in the shock DIC group (13.29±5.23 vs. 10.39±3.58, P < 0.05), the PLT and COL-MAR in the shock DIC group were significantly reduced [PLT (×10 9/L): 36.00 (22.00, 67.50) vs. 115.50 (84.25, 203.75), COL-MAR: 21.50% (17.85%, 32.60%) vs. 30.95% (22.98%, 38.53%), all P < 0.05]. ROC curve analysis showed that A-MAR had a higher predictive value for septic shock, and the area under the ROC curve (AUC) was 0.814 [95% confidence interval (95% CI) was 0.742-0.886, P = 0.000]. When the optimal cut-off value was 51.35%, the sensitivity was 68.9%, the specificity was 82.6%, the positive predictive value was 0.724 and the negative predictive value was 0.800. COL-MAR had some predictive value for septic shock with DIC, and the AUC was 0.668 (95% CI was 0.513-0.823, P = 0.044). When the optimal cut-off value was 21.90%, the sensitivity was 52.9%, the specificity was 79.5%, the positive predictive value was 0.500, and the negative predictive value was 0.813. Spearman correlation analysis showed that the MAR induced by each inducer was negatively correlated with inflammatory indicators and SOFA scores in sepsis patients, with A-MAR showing the strongest correlation with SOFA score ( r = -0.327, P = 0.000). Conclusions:MAR, an indicator of platelet aggregation function, shows predictive value for septic shock and septic shock with DIC, and it could be used to for evaluating the severity of patients with sepsis. In addition, tt alsocan be used as a monitoring index to predict the changes of sepsis patients and to guide the treatment.

Expression level of cytokines in patients with sepsis and its effect on prognosis / 中华危重病急救医学

OBJECTIVE@#To observe the expression level of cytokines in patients with sepsis and its effect on prognosis.@*METHODS@#The clinical data of sepsis patients admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were analyzed retrospectively, including gender, age, and acute physiology and chronic health evaluation II (APACHE II), blood routine, procalcitonin (PCT), C-reactive protein (CRP), and cytokines levels [interleukins (IL-2, IL-4, IL-6, IL-10, IL-17), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ)] within 24 hours of admission to ICU. The 28-day prognosis of the patients was followed up. The patients were divided into survival group and death group according to the prognosis. The clinical data between the two groups of sepsis patients with different prognosis were compared. Binary Logistic regression analysis was used to analyze the independent risk factors affecting the prognosis of patients with sepsis, and the receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of each risk factor for the prognosis of patients with sepsis.@*RESULTS@#(1) A total of 227 patients with sepsis were enrolled, including 168 patients in the survival group (survival rate 74.0%) and 59 patients in the death group (mortality 26.0%). There were no significant differences in age (years old: 55.97±2.13 vs. 54.67±1.11) and gender (male: 71.2% vs. 57.1%) between the death group and the survival group (both P > 0.05), indicating that the baseline data of the two groups were comparable. (2) The APACHE II (19.37±0.99 vs. 14.88±0.61, P < 0.001) and PCT (μg/L: 12.39±2.94 vs. 4.14±0.90, P < 0.001) in the death group were significantly higher than those in the survival group, while the platelet count [PLT (×109/L): 144.75±12.50 vs. 215.99±11.26, P = 0.001] and thrombocytocrit [(0.14±0.01)% vs. (0.19±0.01)%, P = 0.001] were significantly lower than those in the survival group. (3) The level of IL-6 in the death group was significantly higher than that in the survival group (ng/L: 577.66±143.16 vs. 99.74±33.84, P < 0.001). There were no statistically significant differences in other cytokines, IL-2, IL-4, IL-10, TNF-α, IFN-γ and IL-17 between the death group and the survival group [IL-2 (ng/L): 2.44±0.38 vs. 2.63±0.27, P = 0.708; IL-4 (ng/L): 3.26±0.67 vs. 3.18±0.34, P = 0.913; IL-10 (ng/L): 33.22±5.13 vs. 39.43±2.85, P = 0.262; TNF-α (ng/L): 59.33±19.21 vs. 48.79±29.87, P = 0.839; IFN-γ (ng/L): 6.69±5.18 vs. 1.81±0.16, P = 0.100; IL-17 (ng/L): 2.05±0.29 vs. 2.58±0.33, P = 0.369]. (4) Binary Logistic regression analysis showed that APACHE II and IL-6 were independent risk factors affecting the prognosis of patients with sepsis [odds ratio (OR) and 95% confidence interval (95%CI) were 1.050 (1.008-1.093) and 1.001 (1.000-1.002), P values were 0.019 and 0.026, respectively]. (5) ROC curve analysis showed that APACHE II and IL-6 had certain predictive value for the prognosis of patients with sepsis, the area under the ROC curve (AUC) was 0.754 (95%CI was 0.681-0.827) and 0.592 (95%CI was 0.511-0.673), P values were < 0.001 and 0.035, respectively. When the optimal cut-off value of APACHE II was 16.50 score, the sensitivity was 72.6% and the specificity was 69.9%. When the optimal cut-off value of IL-6 was 27.87 ng/L, the sensitivity was 67.2% and the specificity was 52.8%.@*CONCLUSIONS@#APACHE II score and IL-6 level have certain predictive value for the prognosis of patients with sepsis, the higher APACHE II score and IL-6 level, the greater the probability of death in patients with sepsis.

Analysis of lymphocyte subsets in patients with sepsis and its impact on prognosis / 中华危重病急救医学

OBJECTIVE@#To explore the characteristics of changes in peripheral blood lymphocyte subsets in patients with sepsis in intensive care unit (ICU) and analyze their predictive value for prognosis.@*METHODS@#The clinical data of sepsis patients admitted to the surgical intensive care unit (SICU) of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021 were analyzed retrospectively. The patients met the diagnostic criteria of Sepsis-3 and were ≥ 18 years old. Peripheral venous blood samples were collected from all patients on the next morning after admission to SICU for routine blood test and peripheral blood lymphocyte subsets. According to the 28-day survival, the patients were divided into two groups, and the differences in immune indexes between the two groups were compared. Logistic regression analysis was used to analyze the risk factors of immune indexes that affect prognosis.@*RESULTS@#(1) A total of 279 patients with sepsis were enrolled in the experiment, of which 198 patients survived at 28 days (28-day survival rate 71.0%), and 81 patients died (28-day mortality 29.0%). There were no significant differences in age (years old: 57.81±1.71 vs. 54.99±1.05) and gender (male: 60.5% vs. 63.6%) between the death group and the survival group (both P > 0.05), and the baseline data was comparable.(2) Acute physiology and chronic health evalution II (APACHE II: 22.06±0.08 vs. 14.08±0.52, P < 0.001), neutrophil percentage [NEU%: (88.90±1.09)% vs. (84.12±0.77)%, P = 0.001], procalcitonin [PCT (μg/L): 11.97±2.73 vs. 5.76±1.08, P = 0.011], platelet distribution width (fL: 16.81±0.10 vs. 16.57±0.06, P = 0.029) were higher than those in the survival group, while lymphocyte percentage [LYM%: (6.98±0.78)% vs. (10.59±0.86)%, P = 0.012], lymphocyte count [LYM (×109/L): 0.70±0.06 vs. 0.98±0.49, P = 0.002], and platelet count [PLT (×109/L): 151.38±13.96 vs. 205.80±9.38, P = 0.002], and thrombocytocrit [(0.15±0.01)% vs. (0.19±0.07)%, P = 0.012] were lower than those in the survival group. (3) There was no statistically significant difference in the percentage of lymphocyte subsets between the death group and the survival group, but the absolute value of LYM (pieces/μL: 650.24±84.67 vs. 876.64±38.02, P = 0.005), CD3+ absolute value (pieces/μL: 445.30±57.33 vs. 606.84±29.25, P = 0.006), CD3+CD4+ absolute value (pieces/μL: 239.97±26.96 vs. 353.49±18.59, P = 0.001), CD19+ absolute value (pieces/μL: 111.10±18.66 vs. 150.30±10.15, P = 0.049) in the death group was lower than those in the survival group. Other lymphocyte subsets in the death group, such as CD3+CD8+ absolute value (pieces/μL: 172.40±24.34 vs. 211.22±11.95, P = 0.112), absolute value of natural killer cell [NK (pieces/μL): 101.26±18.15 vs. 114.72±7.64, P = 0.420], absolute value of natural killer T cell [NKT (pieces/μL): 33.22±5.13 vs. 39.43±2.85, P = 0.262], CD4-CD8- absolute value (pieces/μL: 41.07±11.07 vs. 48.84±3.31, P = 0.510), CD4+CD8+ absolute value (pieces/μL: 3.39±1.45 vs. 3.47±0.36, P = 0.943) were not significantly different from those in the survival group. (4)Logistic regression analysis showed that lymphocyte subsets were not selected as immune markers with statistical significance for the prognosis of sepsis.@*CONCLUSIONS@#The changes of immune indexes in sepsis patients are closely related to their prognosis. Early monitoring of the above indexes can accurately evaluate the condition and prognosis of sepsis patients.

Expressions of PBK and MMP-9 and their effect on concurrent chemoradiotherapy in cervical cancer / 中华放射医学与防护杂志

Objective@#To investigate the expression of DNA damage repair factor PDZ binding kinase (PBK) and matrix metalloproteinase 9 (MMP-9) in cervical cancer and the effect on clinical outcomes of concurrent chemoradiotherapy.@*Methods@#A total of 65 cervical cancer pathological specimens were collected from January 2014 to July 2016. Immunohistochemistry was used to detect PBK and MMP-9 expression in the specimens.External irrsdeation was treated with intensity-modulated radiation therapy at a dose of 50 Gy/25 F. After 18 times of external irradiation, high-dose rate postoperative treatment was giver at a dose of 30-36 Gy/5-6 F which lasts 3-4 weeks. Weekly chemotherapy with Cisplatin(DDP) begins simultaneously at the beginning of external irradiation. DDP was administered intravenously at a dosage of 40 mg/m2 for 2 to 6 week. All patients were followed-up as routine. The relationship between clinical characteristics and prognosis of patients and the expression of PBK and MMP-9 were analyzed.@*Results@#PBK was expressed in 92.3% of tissues and MMP-9 was expressed in 69.2% of tissues. The expression of PBK was positively associated with overall survival (OS) and disease progression-free survival (PFS) of cervical cancer patients (χ2=4.324, 8.068, P<0.05). The expression of MMP-9 was related with PFS (χ2=5.134, P<0.05). Patients with PBK and MMP-9 expression suffered poor OS and PFS (χ2=5.382, 9.364, P<0.05).@*Conclusions@#PBK and MMP-9 could be a biomarker to predict the prognosis of cervical cancer.

Retrospective analysis of serum C-reactive protein/albumin ratio for the prognosis of the adult patients with sepsis / 中华危重病急救医学

Objective To explore the prognostic value of serum C-reactive protein/albumin (CRP/ALB) ratio in the adult patients with sepsis.Methods A retrospective study was conducted.Clinical data were collected from septic patients who were at least 18 years old and whose intensive care unit (ICU) lengths of stay were at least 3 days,and who were admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University in Henan Province from September 2013 to September 2015.These patients were divided into survival group and death group according to 28-day outcome.The serum CRP,ALB,and CRP/ALB ratio levels at the start of treatment (0 hour),24 hours and 72 hours after treatment in ICU were analyzed.And the receiver-operating characteristic (ROC) curve was plotted to assess the value of CRP,ALB and CRP/ALB ratio at different time points for predicting the outcome.Results Sixty-nine patients with sepsis were selected,among whom 28 cases were in the death group and the mortality was 40.6％.The characteristic of the baseline data in the two groups was balanced.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score at the first 24 hours of ICU admission in the death group were significantly higher than those in the survival group (APACHE Ⅱ score:25.18 ± 3.18 vs.17.88±3.20,SOFA score:11.71± 1.78 vs.9.17 ± 2.38,both P ＜ 0.05).And the ICU length of stay in the death group was significantly longer than that in the survival group [days:9.0 (2.5) vs.8.0 (3.0),P ＜ 0.05].The ALB level increased gradually as the treatment was extended in both groups while the levels of CRP and CRP/ALB declined gradually.The ALB levels at 0,24,72 hours after treatment in the death group were significantly lower,and the CRP and CRP/ALB levels were significantly higher than those in survival group [ALB (g/L):23.40 (4.20) vs.25.20 (8.20) at 0 hour,24.18±4.33 vs.28.54±4.88 at 24 hours,25.50±4.88 vs.34.88±7.23 at 72 hours;CRP (mg/L):179.32±34.04 vs.159.55±36.82 at 0 hour,160.08±22.91 vs.146.23±30.31 at 24 hours,159.36±25.81vs.142.53±36.30 at 72 hours;CRP/ALB:7.52±1.32 vs.6.04±1.46 at 0 hour,6.77±1.42 vs.5.23±1.24 at 24 hours,6.40± 1.34 vs.4.19± 1.21 at 72 hours;all P ＜ 0.05].ROC curves analysis showed that the area under ROC curves (AUC) of CRP/ALB at all time points were larger than those of CRP and ALB,with higher sensitivity and specificity;the AUC of ARP/ALB at 0,24,72 hours were 0.767,0.807,0.895,respectively;the cut-off values were 6.96,5.44,4.91,the sensitivity were 71.4％,85.7％ and 89.3％,and the specificity were 73.2％,63.4％ and 82.9％,respectively.Conclusions High serum CRP,CRP/ALB and low ALB in adult patients with sepsis indicate a poor prognosis,while the prognostic value of CRP/ALB is obviously better than the single value of CRP or ALB.CRP/ALB at 72 hours may be one of the best indicators for the assessment of clinical therapy and prognosis of patients with sepsis.

Expression and clinical significan ce of miR-326 on regulatory T cells of patients with systemic lupus erythematosus / 中华风湿病学杂志

Objective To analyze the association of miR-326 mRNA expression level on regulatory T cells between clinical manifestations of patients with systemic lupus erythematosus (SLE), in order to inves-tigate the role of miR-326 on Treg cells and pathogenesis as well as its association with disease activity of SLE. Methods Twenty milimeter anti-coagulated peripheral blood was obtained from 52 SLE patients and 20 healthy controls. Treg were purified by MACS from peripheral blood, in which the quantity of miR-326 and Ets-1 mRNA were assessed by real-time polymerase chain reaction (PCR). Data were analyzed by using Mann-Whitney U test and Spearman correlation analysis. Results Compared with healthy controls [0.921(0.345, 1.879)], the expression of miR-326 mRNA level was significantly higher in Treg from SLE patients [2.927 (0.518, 8.662) (Z=-3.756, P<0.05). The difference between new-onset SLE patients [8.878(5.922, 12.466)] and recurrence group [3.512(0.582, 11.223)] with healthy controls was significant (Z=-2.135, Z=-4.928, P<0.05). The expression level of miR-326 in new-onset SLE patients was higher than inactive SLE patients (Z=-4.928, P<0.05). Significant difference of the expression level of miR-326 mRNA was found between new-onset SLE patients with serous cavity effusion [7.606(0.656, 16.795)] and new-onset SLE patients without it [1.840(0.576, 13.025)](Z=4.263, P<0.05). Our analysis showed that significant positive correlation was found between the expression of miR-326 mRNA in Treg with CRP (rs=0.481, P<0.05) and anti-C1q antibody (rs=0.729, P<0.05) from new-onset SLE patients. Conclusion The expression level of miR-326 is upregulated in Treg from SLE patients and is associated with disease active index, which suggests that miR-326 in Treg may participate the pathological process and disease activity in SLE.

Value of detection of pentraxins 3 value combined with measurement of vascular lung water index in prognosis of patients with sepsis / 中华危重病急救医学

Objective To evaluate prognostic value of pentraxin3 (PTX3) content combining with extravascular lung water index (EVLWI) in patients with sepsis.Methods A retrospective analysis of complete clinical data of septic patients admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University from February 2013 to February 2014 was conducted.These patients were divided into two groups,survival group and death group,according to the outcome on the 28th day.Pulse index continuous cardiac output (PiCCO) was used to record the levels of EVLWI on the 1st,2nd and 3rd day of intensive care unit (ICU) admission.The plasma level of PTX3 was measured simultaneously by enzyme-linked immunosorbent assay (ELISA).At the same time,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) were calculated.Correlation analysis between plasma PTX3 and EVLWI values was performed,receiver operating characteristic curve (ROC) was drawn,and the prognostic value of each parameter was assessed finally.Results A total of 74 septic patients were enrolled,with 41 cases in the survival group and 33 cases in the non-survival group.Blood lactate,APACHE Ⅱ,SOFA scores in the non-survival group were significantly higher than those of the survival group at ICU admission,and the length of ICU stay was significantly shorter than that of the survival group,while differences of the other clinical characteristics between two groups were not statistically significant.The plasma PTX3 level gradually declined with time in both groups,and plasma PTX3 at 1,2,3 days after ICU admission in non-survival group were significantly higher than those in survival group [PTX3 (μg/L) at 1 day:46.3± 10.5 vs.19.4±6.5,t =-13.486,P =0.000; 2 days:34.8± 10.7 vs.17.7±8.4,t =-8.284,P =0.000; 3 days:23.9± 11.2 vs.15.6 ± 7.9,t =-5.036,P =0.000].EVLWI gradually declined in survival group,but increased in death group.EVLWI at 1,2,3 days after ICU admission in non-survival group were significantly higher than those in survival group [EVLWI (mL/kg) at 1 day:12.12 ± 4.31 vs.10.02 ± 2.87,t =-2.502,P =0.023; 2 days:13.67 ± 4.95 vs.9.08 ± 2.89,t =-5.188,P =0.000; 3 days:14.51±5.06 vs.8.09±2.50,t =-7.126,P =0.000].PTX3 at 1,2,3 days after ICU admission showed a significant positive correlation with EVLWI (r1 =0.747,r2 =0.719,r3 =0.705,all P =0.000).ROC curve analysis showed that the area under the ROC (AUC) of PTX3 at 1 day was 0.845 ± 0.045,at the cut-off point of 23.0 μg/L,PTX3 showed a sensitivity of 84.8％,a specificity of 74.1％,a negative predictive value of 85.81％,and a positive predictive value of 72.42％.AUC of EVLWI at 3 days was 0.838 ± 0.048,at the cut-off point of 10.5 mL/kg,EVLWI showed a sensitivity of 83.9％,a specificity of 82.9％,a negative predictive value of 86.45％,and a positive predictive value of 79.79％.Their sensitivities and specificities were found to be better than APACHE Ⅱ,SOFA score.AUC of PTX3 combined with EVLWI at 1 day was 0.886 ± 0.038.On the 1st day after ICU admission,with combination of the two indicators,cut-off point was found to be 0.312,a sensitivity of 86.8％,a specificity of 85.4％,a negative predictive value of 88.93％,and a positive predictive value of 82.72％.On the 3rd day after ICU admission,AUC of PTX3 combined with EVLWI was 0.856 ± 0.046,and showed a cut-off of 0.471 for the prognosis of sepsis,a sensitivity of 85.8％,a specificity of 85.4％,a negative predictive value of 87.97％,and a positive predictive value of 82.50％.Compared with other single index,a combination of above mentioned two indexes showed a better sensitivity and specificity.Conclusions PTX3 can serve as a novel prognostic indicator at early stage in septic patients.Combined with EVLWI,it shows important value in predicting prognosis of septic patients,and it also provides guidance in treatment of high-risk patients.