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Objective@#To evaluate the accuracy of the new non-invasive liver disease model platelet-albumin-bilirubin index (PALBI) in the diagnosis of patients with acute upper gastrointestinal hemorrhage (AUGIB) due to cirrhosis.@*Methods@#277 patients with AUGIB due to cirrhosis were analyzed retrospectively. The data of platelet, total bilirubin, albumin, creatinine, international standardized ratio and etiology of cirrhosis were collected. Univariate and multivariate logistic regression analysis was used to identify independent risk factors for death in patients with cirrhosis complicated by AUGIB. Analysis of variance was used to compare the differences between the model for end-stage liver disease (MELD) and PALBI grades. Pearson correlation analysis was used to assess the association between MELD and PALBI. The operating characteristic curve (ROC) was used to compare the predictive power of both for short-term and long-term mortality in patients with cirrhosis complicated by AUGIB.@*Results@#The short-term and long-term mortality rates of patients with cirrhosis complicated by AUGIB were 13.7% and 23.5%, respectively. The average hospital stay was (9.1±3.9)days. The high MELD score and high PALBI index were confirmed as independent risk factors of death by single factor and multiple factors [odds ratio (OR)=1.17, 4.43; P<0.05]; the Pearson correlation analysis showed there was a positive correlation between MELD score and PALBI index (r=0.735, P<0.05). The PALBI score was scored in MELD-a patients, further subdivided into PALBI-1a and PALBI-1b. There were statistical difference in the 1-year mortality rate between the two groups (7.0% vs 17.8%, χ2=4.033, P<0.05). The ROC curve was used to compare the predictive power of MELD and PALBI for short-term mortality. The area under curve (AUC) of PALBI was 0.767 (95% CI: 0.712-0.815), while the AUC of the MELD score was 0.651 (95% CI: 0.591-0.707), with statistically significant difference (Z=2.328, P<0.05). The predictive power of PALBI and MELD for long-term mortality were 0.731(95% CI: 0.674-0.782), 0.754 (95% CI: 0.699-0.804), but the difference was not statistically significant (Z=0.828, P>0.05).@*Conclusions@#PALBI has a better predictive effect on patients with cirrhosis complicated by AUGIB than MELD scores. PALBI can achieve a more precise prognosis classification for patients with MELD-a, and maintain a good prediction ability on the short-term (within 30 days of hospitalization and discharge) and long-term (within 1 year after discharge) mortality of patients. As a new liver disease model, PALBI can be used as an effective non-invasive means to judge the prognosis of patients with liver cirrhosis complicated by AUGIB .
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Objective To evaluate the accuracy of the new non-invasive liver disease model platelet-albumin-bilirubin index (PALBI) in the diagnosis of patients with acute upper gastrointestinal hemorrhage (AUGIB) due to cirrhosis.Methods 277 patients with AUGIB due to cirrhosis were analyzed retrospectively.The data of platelet,total bilirubin,albumin,creatinine,international standardized ratio and etiology of cirrhosis were collected.Univariate and multivariate logistic regression analysis was used to identify independent risk factors for death in patients with cirrhosis complicated by AUGIB.Analysis of variance was used to compare the differences between the model for end-stage liver disease (MELD) and PALBI grades.Pearson correlation analysis was used to assess the association between MELD and PALBI.The operating characteristic curve (ROC) was used to compare the predictive power of both for short-term and long-term mortality in patients with cirrhosis complicated by AUGIB.Results The short-term and long-term mortality rates of patients with cirrhosis complicated by AUGIB were 13.7％ and 23.5％,respectively.The average hospital stay was (9.1 ± 3.9) days.The high MELD score and high PALBI index were confirmed as independent risk factors of death by single factor and multiple factors [odds ratio (OR) =1.17,4.43;P ＜0.05];the Pearson correlation analysis showed there was a positive correlation between MELD score and PALBI index (r =0.735,P ＜ 0.05).The PALBI score was scored in MELD-a patients,further subdivided into PALBI-1a and PALBI-1b.There were statistical difference in the 1-year mortality rate between the two groups (7.0％ vs 17.8％,x2 =4.033,P ＜ 0.05).The ROC curve was used to compare the predictive power of MELD and PALBI for short-term mortality.The area under curve (AUC) of PALBI was 0.767 (95％ CI:0.712-0.815),while the AUC of the MELD score was 0.651 (95％ CI:0.591-0.707),with statistically significant difference (Z =2.328,P ＜ 0.05).The predictive power of PALBI and MELD for long-term mortality were 0.731 (95％ CI:0.674-0.782),0.754 (95％ CI:0.699-0.804),but the difference was not statistically significant (Z =0.828,P ＞ 0.05).Conclusions PALBI has a better predictive effect on patients with cirrhosis complicated by AUGIB than MELD scores.PALBI can achieve a more precise prognosis classification for patients with MELD-a,and maintain a good prediction ability on the short-term (within 30 days of hospitalization and discharge) and long-term (within 1 year after discharge) mortality of patients.As a new liver disease model,PALBI can be used as an effective non-invasive means to judge the prognosis of patients with liver cirrhosis complicated by AUGIB.
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Objective To evaluate the effects on nutritional intakes and clinical outcomes of severe brain injury patients receiving percutaneous gastrojejunostomy (PEG-J) feedings. Methods The severe brain injury patients treated in ICU of Changshu No.1 Hospital from Jan 2013 to Dec 2016 were enrolled in the study. Patients were randomized into: control group, patients received nasoduodenal feedings and treatment group, patients received PEG-J feedings. The feeding speed was adjusted according to the amount of gastric residual or reflux vomiting. The daily dose of enteral nutrition in the first week, endocrine function, immune function, nutritional states and clinical outcomes were recorded. Results Totally 87 patients were enrolled in this study, 45 patients in the control group and 42 patients in the treatment group. The daily dose of enteral nutrition of the treatment group were significantly more than the control group from the fourth to the seventh days (P= 0.001, <0.01, 0.024), the CD4+T-lymphocyte percentage and CD4+/CD8+ ratio were significantly higher in the treatment group on day 7 (P=0.03, 0.01), levels of thyroidstimulating hormone, free triiodothyronine and free thyroxine of the treatment group were higher (P=0.036, 0.013, 0.025), and the level of hormonal was lower in the treatment group (P=0.004).The levels of albumin, prealbumin and insulin dosage were not significantly different between the two groups, neither did mortality, rates of organ failures. But the treatment group has a higher Barthel index scores (P=0.049), shorter length of mechanical ventilation and stay ICU (P=0.044, 0.048), and the lower incidence of vomiting and ventilator associated pneumonia (P=0.013, 0.037). Conclusions PEG-J could increase energy intake, improve immunity and endocrine function, promote the recovery of life ability, reduce the incidence of VAP, shorten mechanical ventilation time and ICU stay in severe brain injury patients.
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Objective To explore the influence of percutaneous gastrostomy-jejunostomy ( PEG-J) on the nutritional status and prognosis of critically ill patients in ICU .Methods Totally 58 patients who received me-chanical ventilation in the ICU of Changshu No .1 People's Hospital from January 2013 to December 2015 were di-vided into two groups according to random number table:treatment group ( n=28, enteral nutrition by establis-hing PEG-J tube in 120 hours after excluding contraindications );and control group ( n=30, nasogastric tube as the way of giving enteral nutrition and if delayed gastric emptying happened , nasogastric tube would be replaced by nasointestinal tube).The incidence of ventilation-associated pneumonia (VAP) within 28 days, duration of ICU stay, and duration of mechanical ventilation were compared between these two groups .Results The inci-dence of 28-day VAP (7.14%vs.26.67%, P=0.049), duration of ICU stay [ (13.6 ±5.9) d vs.(16.8 ± 4.4) d, P=0.024], duration of mechanical ventilation [ (8.1 ±5.0) d vs.(10.7 ±4.5) d, P=0.041] were significantly lower or shorter in treatment group than in control group .Conclusions The use of PEG-J tube for enteral nutrition in critically ill patients is reliable and safe .It also helps to reduce VAP .
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Background:Conventional gastrointestinal endoscopy is incapable of determining the deriving layers,size and nature of submucosal lesions,however,mini probe ultrasonography(MPS)is effective for mural stratification and determining the deriving layers and nature of lesions within gastrointestinal wall,and is considered to be an optimal examination for suspected submucosal tumors before endoscopic or surgical operation. Aims:To assess the diagnostic value of MPS for gastrointestinal submucosal lesions and the significance of MPS-assisted endoscopic therapy. Methods:A total of 69 patients with presumed gastrointestinal submucosal protruded lesions were retrospectively enrolled. All of them underwent MPS and then endoscopic therapy,such as cyst incision,high frequency electric snare resection,endoscopic mucosal resection and endoscopic submucosal dissection were performed according to the deriving layers,size and nature determined by MPS. The ultimate diagnosis was confirmed by histopathological examination. Results:In the 69 cases of lesions,MPS showed that 15 were derived from muscularis mucosa,40 from submucosa,and 14 from muscularis propria;10 of them were considered as cyst,18 were stromal tumor,8 were leiomyoma,6 were ectopic pancreas,15 were neuroendocrine tumor,and 12 were lipoma. Compared with pathological diagnosis,an overall coincidence rate of 91. 3%(63 / 69)was achieved by MPS. Conclusions:The accuracy rate of MPS is high for determining the deriving layers and nature of gastrointestinal submucosal protruded lesions prior to the attempting of endoscopic removal. It might be helpful for selecting treatment modalities for this kind of lesions.
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Objectives To evaluate the efficacy of rectally administered indomethacin for the prevention of post-ERCP pancreatitis(PEP).Methods All eligible patients without high risk factors such as heart,lung,liver and kidney,coagulation dysfunction,without malignant disease and contraindication for NSAIDs,and pre-operative imaging study and lab test suggesting no pancreatitis,aged from 18 ～ 75 who underwent ERCP and EST were enrolled.In a randomized prospective trial,patients were randomized to receive a suppository containing indomethacin,100 mg,or an identical placebo 30 minutes after ERCP.PEP was diagnosed when there was pancreatitis related clinical symptoms,and serum amylase was higher than 3 times of the normal values,and when the patient needed more than 1 day hospitalization.Patients with PEP were evaluated with APACHE Ⅱ score 72 hours after ERCP.Results During 2004 ～ 2010,a total of 348 patients were enrolled,of which 182 received indomethacin and 166 received placebo.Six patients developed pancreatitis in the indomethacin group and 14 in the placebo group (3.3％ vs.8.4％,P ＜0.05),and the difference between the two group was statistically significant ( P ＜ 0.05 ).In those patients with PEP,the APACHE Ⅱ scores in indomethacin group (4.3 ± 1.3 ) were lower than that in the placebo group (7.4 ±1.7),and the difference between the two groups was statistically significant ( P ＜ 0.05 ).The incidence of hyperamylasemia in both groups was not statistically significant (9.3％ vs.10.8％,P ＞ 0.05 ).Conclusions This trial shows that rectally administered indomethacin after ERCP and EST can effectively reduce the incidence and severity of PEP.