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Objective:To establish a predictive model of acute physiological and chronic health status score (APACHEⅡ) and the British Thoracic Society modified pneumonia score (CURB-65) score on the prognosis of patients with emergency severe pneumonia complicated with acute respiratory distress syndrome (ARDS) and to evaluate the predictive effect.Methods:The relevant clinical data of patients with severe pneumonia combined with ARDS admitted to the Emergency Intensive Care Unit (EICU) of General Hospital of Ningxia Medical University from January 2017 to December 2021 were retrospectively collected, and different logistic regression models were established. On this basis, three prediction models (model 1: APACHE Ⅱ score, model 2: CURB-65 score, Model 3: APACHE Ⅱ score combined with CURB-65 score) were established and the accuracy of the prediction model was evaluated by repeating 50 times of 10-fold cross-validations. The efficacy of the prediction model was evaluated by C statistics, Kendall's tau-a rank correlation coefficient, R2, Brier score, calibration curve, net reclassification index (NRI), composite discriminant improvement index (IDI) and decision curve (DCA).Results:The study eventually included 108 patients, including 81 males and 27 females, with mean age (57.92 ± 16.56) years. Forty-eight patients survived and 60 patients died. The age of the death group was older, and APACHEⅡ score and CURB-65 score of the death group were all greater than those in the survival group, and the differences were statistically significant ( P<0.05). Different logistic regression models showed that the OR value of model 1 was 1.12 (95% CI: 1.06 -1.20), that of model 2 was 2.21 (95% CI: 1.43 - 3.40), and that of model 3 was 1.10 (95% CI: 1.03 - 1.18) and 1.95 (95% CI: 1.24 - 3.07). The average accuracy of model 1, model 2, and model 3 were 0.68±0.14, 0.66±0.11, and 0.72±0.13, respectively. The C statistic, Kendall's Tau-a rank correlation coefficient, R2 and Bril score of model 3 were better than those of model 1 and model 2, and the different models fit well ( P<0.05). The calibration curve results of 500 resampling showed that the calibration degree of model 2 was better than that of model 1 and model 3, and the predictive ability of model 3 was improved compared with model 1, and the IDI was increased by 0.08 ( P<0.01). Compared with model 2, the reclassification ability of cases and the comprehensive discrimination ability of model 3 were improved ( P<0.01). The decision curves of different models showed that the net benefit of model 3 was higher than that of single model 1 and model 2 when the prediction probability was about 25% to 55%, while the benefits of model 1, model 2 and model 3 in other probability prediction intervals were basically equal. Conclusions:Both APACHE Ⅱ score and CURB-65 score have certain predictive power for prognosis of patients with emergency severe pneumonia and ARDS, and their combination has the best prediction effect. CURB-65 score has fewer parameters, and its prognostic benefit in emergency patients with severe pneumonia complicated with ARDS is basically equivalent to APACHE Ⅱ score, which may be more suitable for the prognosis evaluation of emergency patients with severe pneumonia complicated with ARDS.
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Objective:To evaluate the predictive value of serum amyloid A (SAA) and neutrophil-lymphocyte ratio (NLR) for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team.Methods:A total of 105 patients with severe preeclampsia admitted to the ICU of Hangzhou First People's Hospital from October 2014 to July 2022 were retrospectively enrolled. They were divided into the adverse pregnancy outcome group ( n = 62) and the non-adverse pregnancy outcome group ( n = 43) according to the pregnancy outcome. SAA, NLR and other laboratory indicators and related clinical data of all patients were collected within 24 h after admission. The general clinical data of the two groups were compared, and multivariate Logistic regression analysis was used to find the risk factors affecting adverse pregnancy outcome of patients with severe preeclampsia. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SAA and NLR for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team. Results:The ICU length of stay [4.00 (3.00, 5.00) vs. 3.00 (3.00, 4.00), P=0.022], acute physiology and chronic health evaluationⅡ (APACHEⅡ) score [9.00 (7.00, 11.25) vs. 7.00 (5.00, 9.00), P=0.002], white blood cell count [(12.29±4.25) vs. (10.41±4.00), P=0.025], SAA [37.85 (11.00, 72.83) vs. 9.00 (8.00, 20.70), P<0.001] and NLR [7.95 (5.22, 12.37) vs. 5.20 (3.25, 8.77), P=0.002] in the adverse pregnancy outcome group were higher than those in the non-adverse pregnancy outcome group. The gestational weeks [30.00 (26.75, 31.00) vs. 33.00 (32.00, 35.00), P<0.001], direct bilirubin [2.10 (1.50, 2.50) vs. 2.20 (1.90, 4.60), P=0.019] and alkaline phosphatase (99.00 (74.00, 124.25) vs. 133.00 (95.00, 188.00), P<0.001] levels in the adverse pregnancy outcome group were significantly lower than those in the non-adverse pregnancy outcome group ( P<0.05). Multivariate Logistic regression analysis showed that earlier gestational weeks ( OR=0.564, 95% CI: 0.408-0.780, P<0.001), higher SAA ( OR=1.028, 95% CI: 1.002-1.055, P=0.036) and APACHE Ⅱ score ( OR=1.282, 95%CI: 1.048-1.569, P=0.016) were the risk factors affecting adverse pregnancy outcomes in patients with severe preeclampsia. The area under the curve of SAA, NLR and SAA, NLR combined with APACHE Ⅱ score were 0.770, 0.678, and 0.844, respectively. The combined prediction efficiency of SAA, NLR and APACHE Ⅱ score was higher than that of single prediction ( P<0.05). Conclusions:SAA and NLR have good predictive efficacy for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team. The predictive efficacy of SAA and NLR combined with APACHE Ⅱ score is higher than that of single index.
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Objective:To explore the value of neutrophil to lymphocyte rate (NLR) combined with red blood cell distribution width to platelet count ratio (RPR) in evaluating the condition and prognosis of emergency elderly sepsis patients.Methods:A prospective research method was conducted to select 169 elderly patients with sepsis who visited the emergency department of Xuanwu Hospital of Capital Medical University from January 2020 to February 2022.After admission, blood routine examination, chest computerized tomography, biochemical examination, procalcitonin, and pathogenic examination were given, and the scores of acute physiology and chronic health evaluation (APACHE Ⅱ) were scored according to worst value of 24 hours. After 28 days of follow-up, the patients were divided into the survival group(125 cases) and the death group(44 cases) according to the prognosis. The differences of white blood cell count(WBC), NLR, PCT, RPR and APACHE Ⅱ scores were compared between the two groups. The correlation between NLR,RPR and APACHE Ⅱ scores were analyzed. The difference of area under receiver operating characteristic curve (ROC) of RPR, NLR, their combination and PCT in predicting mortality were compared in elderly patients with sepsis. The independent sample t test was used to compare the measurement data with normal distribution, and the χ 2 test was used to compare the enumeration data. The risk factors were analyzed by multiple logistic regression analysis. Results:There was no significant difference in WBC between the survival group and the death group ( P=0.361). The APACHE Ⅱ scores ((18.52±2.41) points), RPR (0.17±0.03), NLR (10.64±3.48), PCT ((2.55±1.14) μg/L) in the death group were higher than those in the survival group ((14.17±2.71) points, (0.14±0.03), NLR (7.67±3.33), (1.19±0.81) μg/L), the difference was statistically significant ( t values were 9.44,7.32,4.92, and 7.32, respectively; all P<0.001). RPR and NLR were positively correlated with APACHE Ⅱ scores ( r=0.393,0.368;both P<0.001). Multivariate logistic regression analysis showed that increased NLR ( OR=1.174,95% CI 1.041-1.325), procalcitonin ( OR=4.353,95% CI 2.382-7.954), RPR ( OR=14.247,95% CI 2.635-77.025) were independent risk factors for the prognosis of sepsis patients ( P values were 0.009,<0.001, and 0.002, respectively).The area under receiver operating characteristic curve (AUC) of PCT in predicting mortality was 0.859 (95% CI:0.801-0.917), the AUC of RPR was 0.755 (95% CI:0.665-0.845), and the AUC of NLR was 0.727 (95% CI: 0.643-0.812). The AUC of RPR and NLR was smaller than that of PCT ( P=0.033, 0.015), but the AUC of RPR combined with NLR was 0.799, which had no significant difference compared with PCT ( P=0.195). Conclusion:Both NLR and RPR had a certain predictive value for the condition and prognosis of elderly sepsis patients in emergency, and their combined evaluation value was similar to that of PCT.
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Drug-induced liver injury (DILI) is a type of necrotizing and inflammatory liver disease caused by certain commonly-used drugs, Chinese herbal medicines or dietary supplements. In severe cases, it may lead to acute liver failure. Without liver transplantation, the fatality could reach up to 80%. It is of significance to master the indications of liver transplantation. Several prognostic scoring systems have been developed to help clinicians to decide which patients need urgent liver transplantation, such as King's College criteria (KCC) and model for end-stage liver disease (MELD) scoring systems. However, these scoring methods have been developed for a long period of time and lack of modifications. Therefore, scholars have proposed several new scoring systems, such as acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scoring systems, which provide novel ideas for the evaluation of liver transplantation. As an important treatment measure for drug-induced acute liver failure, urgent liver transplantation has greatly improved the survival rate of patients. In this article, the classification, clinical diagnosis, liver transplantation evaluation and prognosis of DILI were summarized, aiming to provide reference for the treatment of DILI by liver transplantation.
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Objective:To evaluate the effect of the timing of peripancreatic drainage on the survival outcome of patients with severe acute pancreatitis (SAP).Methods:This retrospective study included 271 patients with SAP admitted to two tertiary hospitals from January 2015 to December 2019. The Acute Physiology and Chronic Health EvaluationⅡ score (APACHEⅡ), Sequential Organ Failure Assessment score (SOFA), computed tomography (CT) grade, peripancreatic drainage situations, and survival outcome of patients were recorded. Patients were divided into the early and non-early peripancreatic catheter drainage groups (EPCD and non-EPCD). The data were analyzed using the Cox proportional hazard model for propensity score matching (PSM) and stratification.Results:After PSM, the 30-day and 90-day risk of death between the EPCD and non-EPCD groups were significantly different (0.134, 95% CI: 0.029-0.576, P=0.007; 0.166, 95% CI: 0.044-0.631, P=0.008, respectively). Furthermore, stratified analysis revealed significant differences in 30-day and 90-day risk of death between the EPCD and non-EPCD groups when the SOFA score was≥4 or the APACHEⅡ score was ≥8. Conclusions:For patients with SAP with SOFA score ≥4 or APACHEⅡ score≥8, early peripancreatic drainage can reduce the risk of death, but CT grading is not helpful for the decision-making of drainage timing in patients with SAP.
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Objective:To investigate the clinical characteristics of the severe trauma patients with Acute kidney injury (AKI) ,and analyze the risk factors and clinical prognosis.Methods:Clinical data of severe trauma patients admitted to ICU of Xiaolan Hospital of Southern Medical University, from July 2018 to December 2020 were retrospectively analyzed. Demographic data, basic diseases, critical disease score, serum creatinine, hemoglobin, treatment options, blood transfusion volume, and clinical outcomes were collected to establish a clinical database. AKI was diagnosed and graded according to the Kidney Disease Improving Global Outcomes (KDIGO) criterion, and trauma type was classified according to the main injury part. The clinical data and laboratory examination of different groups were compared to analyze the clinical characteristics and prognosis in severe trauma patients. The risk factors of AKI in severe trauma patients were analyzed by Logistic regression.Results:(1) A total of 175 patients with severe trauma were eligible for inclusion, and the incidence of AKI was 30.9%(54/175), including 29 patients with AKI stage 1(16.6%), 15 patients with AKI stage 2 (8.6%), and 10 patients with AKI stage 3 (5.7%). In the cohort, the rate of in-hospital renal replacement therapy was 4%, in-hospital mortality was 5.7%, and 28-day mortality was 16.6%. (2) The age, shock patients, ICU admission serum creatinine, APACHEⅡscore and ISS score of AKI group were significantly higher than those of non-AKI group ( P<0.05). There were no significant differences between the two groups in gender, underlying diseases (hypertension and diabetes), ICU admission hemoglobin level and contrast agent utilization rate( P>0.05). Compared with the non-AKI group, AKI group had higher rates of surgical treatment (63% vs. 44.6%), more blood transfusion [875(720,1110)mL & 670(610,750)mL], longer ICU stay [6(4,11)d & 4(2.5,7.5)d], and higher rates of mechanical ventilation (96.3% vs. 81%), renal replacement therapy rate (13% vs. 0), in-hospital mortality (13% vs. 2.5%) and 28-day mortality (25.9% vs. 12.4%), the differences were statistically significant ( P<0.05). (3) The incidence of AKI was different in patients with different types of severe trauma, and the abdominal trauma group with a highest rate (50%). The serum creatinine at ICU admission and the peak value during hospitalization in abdominal trauma group were significantly higher than those in other injury types ( P<0.05). (4) Logistic regression analysis showed Age [ OR=1.020, 95% CI(1.003,1.038), P=0.024], APACHEⅡscore [ OR=1.137, 95% CI(1.053,1.228), P=0.001], shock [ OR=1.102, 95% CI(0.906,1.208), P=0.034], ICU admission serum creatinine [ OR=1.068, 95% CI(1.036,1.102), P=0.000], surgical treatment [ OR=4.205, 95% CI(1.446,12.233), P=0.008], blood transfusion volume [ OR=1.006, 95% CI(1.002,1.009), P=0.001] were independent risk factors for AKI in severe trauma patients. Conclusions:Severe trauma patients yield a high incidence of AKI influencing clinical prognosis. The incidence of AKI varies with different types of severe trauma. Age, APACHEⅡscore, shock, ICU admission serum creatinine, surgical treatment, and blood transfusion volume are independent risk factors for AKI in severe trauma patients.
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Objective:To explore the predictive value of Red Blood Cell Distribution Width (RDW) in predicting the prognosis of patients with Extracorporeal Membrane Oxygenation (ECMO).Methods:The clinical data of patients undergoing ECMO admitted to Intensive Care Unit of Sichuan Provincial People’s Hospital from January 2015 to January 2020 were retrospectively analyzed. Patients were divided into the survival group and death group according to the prognosis during ICU hospitalization. The patients' basic data , acute physiology and chronic health score system Ⅱ (APACHE Ⅱ), RDW and activated partial thromboplastin time (APTT) at 72 hours after treatment with ECMO were compared between the two groups. Univariate and Logistic regression multivariate analyses were used to analyze the prognostic factors of patients with ECMO, predictive models and death warning scores were established. The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of RDW and death warning scores for the prognosis of patients with ECMO.Results:A total of 71 patients with ECMO who met the inclusion criteria were included, including 38 patients in the death group and 33 patients in the survival group. The age, APACHE-Ⅱscore, 72 h RDW and 72 h APTT in the death group were higher than those in the survival group. Respectively, the hospitalization time of ICU in the death group was significantly lower than that in the survival group ( P< 0.05). Logistic regression analysis showed that APACHE-Ⅱscore ( OR=1.117, P=0.047)、72 h RDW( OR=1.102, P=0.029) and 72 h APTT ( OR=1.049, P=0.029) were independent risk factors for death in patients with ECMO. ROC curve analysis showed that the area under ROC curve (AUC) of the APACHE-Ⅱ, score 、72 h RDW and 72 h APTT were 0.691, 0.691 and 0.632( P<0.05), Respectively, the combined AUC was 0.764, the sensitivity was 0.526, and the specificity was 0.909. The death warning score of patients with ECMO was established according to the Predictive model , which is less than 2 points with low risk of death and more than 2 points with high risk of death. The area under the ROC curve of death warning score is 0.8, the sensitivity is 0.607 and the specificity is 0.923. Conclusions:The RDW at 72 hours after treatment with ECMO has a good value in predicting the prognosis of patients with ECMO. Besides, a greater predictive value for the prognosis of patients with ECMO by combining 72 hours RDW, 72 hours APTT with APACHE-Ⅱscore than that of any separate indicator.
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Objective:To investigate the incidence and risk factors of acute kidney injury in patients admitted to the resuscitation room of the Emergency Department.Methods:Patients were enrolled from the resuscitation room of our hospital from September to December 2018 by a retrospective cohort study. Patients were divided into AKI group and non-AKI group according to whether AKI occurred within seven days after admission. Demographic characteristics, APACHEⅡ score, whether to use nephrotoxic drugs,24-hour fluid volume, and patients survival time were collected. Multivariate regression analysis was used to explore the risk factors for AKI. Cox regression was used to study the effect of the occurrence of AKI on survival and to analyze the influence of AKI severity on the death risk of patients in the resuscitation room.Results:Among 238 critical patients who were finally included, 108 patients developed AKI(45.4%), 83 patients were in AKI stage 1 (34.9%), and 25 patients were in AKI stage 2-3 ( 10.5%).APACHEⅡ score>13( OR=1.11, 95% CI (1.08-1.16), P <0.01), vasoactive drugs ( OR=2.20, c95% CI (1.08-4.49), P=0.03), diabetes mellitus ( OR=2.33, 95% CI (1.23-4.42), P=0.01), and fluid load> 3 L( OR=3.10, 95% CI (1.17-8.25). P=0.02) were independent risk factors for AKI. After adjustment for APACHEⅡ score and age by multivariate COX regression, AKI remained an independent risk factor for death in emergency patients, and the severity of AKI significantly increased the risk of death in these patients(AKI 1: HR=1.45, 95% CI (1.08-2.03), P =0.04; AKI 2~3: HR=3.15, 95% CI (1.49-4.81), P=0.03). Conclusions:AKI occurred commonly in the resuscitation room of the emergency department. APACHE Ⅱ score>13, vasoactive drugs, diabetes, and fluid load>3 L were independent risk factors for AKI. The risk of death increased with the aggravation of AKI severity.
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Objective:To investigate the value of serum trimethylamine N-oxide (TMAO) level in evaluating the severity and short-term clinical prognosis of patients with sepsis.Methods:A prospective case-control study was conducted. Patients in the case group were admitted to the emergency intensive care unit of Shanghai Putuo District People′s Hospital Affiliated to Tongji University from March 2018 to December 2019. According to the diagnosis criteria of sepsis 3.0 in 2016, the patients in the case group were divided into sepsis non shock group (33 cases) and septic shock group (12 cases). They were divided into survival group and death group according to 28 day outcome; Healthy volunteers were selected as control group (30 cases). The levels of C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), Acute Physiology And Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and the sequential organ failure assessment (SOFA), serum TMAO were compared. The relationship between serum TMAO, sepsis severity and short-term clinical prognosis were analyzed.Results:The serum IL-6, CRP, PCT, scores of SOFA and APACHE Ⅱ in septic shock group were significantly higher than those in normal sepsis group ( P<0.01). The serum IL-6, PCT, scores of SOFA and APACHE Ⅱ in the death group of sepsis patients were significantly higher than those in the survival group ( P<0.01). The serum TMAO level of the sepsis group on 1st day was significantly higher than that of the healthy control group ( P<0.01). The serum TMAO level in the septic shock group on the 1st, 3rd and 7 th day was higher than that in the normal sepsis group, with statistically significant difference ( P<0.01). The serum TMAO level in the septic shock group and normal sepsis group on the third day were significant different with the first day ( P<0.01). The serum TMAO level in the death group on the 1st, 3rd and 7th day was higher than that in the survival group, with statistically significant difference ( P<0.05). And the serum TMAO level in the death group and survival group on the third day were significant different with the first day ( P<0.01). The serum TMAO level of sepsis patients was positively correlated with APACHE Ⅱ score ( r=0.848, P<0.01). The level of TMAO was positively correlated with serum IL-6 ( r=0.956, P<0.01). Conclusions:Serum TMAO is closely related to the severity and recent clinical prognosis of patients with sepsis, and is a risk factor for the death of patients with sepsis.
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【Objective】 To explore the prognosis of critically ill patients with coagulation dysfunction using thrombelastogram(TEG) and coagulation four items combined with APACHEⅡ score. 【Methods】 From March 2017 to March 2020, 287 critically ill patients with coagulation dysfunction in our hospital were selected as the study group, and 303 patients with normal coagulation function during the same period were set as the control. The study group was divided into low-risk group(group A), intermediate-risk group(group B) and high-risk group (group C) based on the APACHEⅡ score, and into survival group and death group according to the prognosis. The difference of TEG, coagulation four items, and APACHEⅡ scores between the two groups were analyzed. The correlation and difference between TEG, coagulation four items and APACHE II score in the study group were analyzed. The ROC curve was drawn to analyze the prognostic predictive value of research indicators. 【Results】 Blood coagulation function related indicators in the study group fluctuated significantly: in comparison to the control, the CI value, MA value, and α angle were smaller, while the K time and R time were longer; among the coagulation four items, PT, APTT and TT were higher; Fg level was lower, and the APACHE Ⅱ score was higher(P0.05). There were significant differences between the TEG and coagulation function related index levels in patients with different prognosis. Compared with the survivals, the CI value, MA value and α angle of the dead group were smaller, while the K time and R time were longer; and among the coagulation four items, PT, APTT, and TT were higher, the Fg level was lower, and the APACHEⅡ score was higher (PP4\\P5>APACHE Ⅱ score>P1>P2. 【Conclusion】 TEG, coagulation four items, and APACHE Ⅱ score can be used to assess the severity of patients with severe coagulation dysfunction. and the combined application of the 3 indicators are of high value in predicting the prognosis of such patients, and can provide reference for clinical formulation or adjustment of intervention programs to correct coagulation dysfunction.
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Objective To explore the predictive values of procalcitonin (PCT) and lactate combined with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score for disseminated intravascular coagulation (DIC) in patients with septic shock. Methods The clinical data of 164 patients with septic shock admitted to the Department of Critical Care Medicine of Shenzhen Second People's Hospital from January 1, 2015 to December 30, 2018 were analyzed retrospectively. According to International Society on Thrombosis and Haemostasis (ISTH) scoring criteria, the patients were divided into DIC group (n=58, 35.4%) and non-DIC group (n=106, 64.6%). Comparing the differences in clinical data of patients, we can establish a ROC curve to determine the sensitivity and specificity of DIC patients with septic shock for PCT, lactate and APACHE Ⅱ score, and calculate the best cut-off point. Results The AUC of PCT in predicting septic shock with DIC was 0.701(95% CI 0.619-0.784, P<0.001), the cut-off was 41.18 ng/ml, the sensitivity and specificity were 60.34% and 72.64%, respectively. The AUC of lactate was 0.669(95% CI 0.579-0.759, P<0.001), the cut-off was 4.2 mmol/L, the sensitivity and specificity were 51.70% and 77.40%, respectively. The AUC of APACHE Ⅱ was 0.643(95% CI 0.550-0.736, P=0.002), the cut-off of APACHE Ⅱ score was 28.5, the sensitivity and specificity were 53.45% and 74.53%, respectively. The AUC of the three parameters combined was 0.772(95% CI 0.697-0.848, P<0.001), the sensitivity and specificity were 65.50% and 80.20% respectively. Conclusions PCT, lactate and APACHE Ⅱ score can be used to predict the early diagnosis of disseminated intravascular coagulation induced by septic shock, and the combination of the three parameters can improve the accuracy of early prediction.
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OBJECTIVE: To evaluate the prognostic value of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment(SOFA) score and the blood lactic acid in heat stroke patients combined with multiple organ dysfunction syndrome(MODS). METHODS: A judge sampling method was used to select 42 cases of heat stroke patients combined with MODS as study subjects. They were divided into survival group(23 cases) and death group(19 cases) according to prognosis. The APACHEⅡ, SOFA score and blood lactate level after admission to intensive care unit(ICU) were detected. The prognostic value of each index was analyzed according to receiver operating characteristic curve(ROC) curve. RESULTS: At the 48 th hour after admission to ICU, the APACHEⅡ and SOFA scores of the patients in the death group were higher than those in the survival group(P<0.05). At the 6 th hour after admission to ICU, the blood lactate level in the death group increased compare with that in the survival group(P<0.05). APACHEⅡ or SOFA scores at 48 hours, and the blood lactate levels at the 1 st, 2 nd, and 6 th hours after admission to ICU were all positively correlated with prognosis(P<0.05). ROC curve analysis showed that APACHEⅡ and SOFA scores at 48 hours, and the blood lactate levels at the 1 st, 2 nd, and 3 rd hours after admission to ICU could be used to evaluate the prognosis(P<0.01). CONCLUSION: The dynamic monitoring of APACHEⅡ, SOFA score and the blood lactic acid have important clinical significance on the prognosis of heat stroke patients with MODS.
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Objective@#To explore the correlation of apolipoprotein levels with the severity of hyperlipidemic acute pancreatitis.@*Methods@#Clinical date of 169 patients with hyperlipidemic acute pancreatitis (AP) admitted in our hospital from September 2012 to December 2018 were retrospectively analyzed. Apolipoprotein (Apo) AⅠ, Apo B, Apo B/Apo AⅠ ratio were compared among hyperlipidemic AP patients with different severity. Pearson correlation analysis was conducted to explore the correlation of Apo AⅠ, Apo B, Apo B/Apo AⅠ with Atlanta classification, CTSI score, APACHE-Ⅱscore, RANSON score and C-reaction protein level. The optimal cut-off point of apolipoproteins for predict the severe hyperlipidemic AP was determined by ROC curve. The local and systemic complications of pancreatitis patients with different Apo levels were compared with chi-square test.@*Results@#There were no significant differences in general conditions among patients with severe AP (SAP), median-severe AP (MSAP) and mild AP (MAP). The Apo AⅠ levels of SAP [ (0.89±0.36) g/L] were lower than those of MSAP [(1.07±0.40)g/L, t=2.07, P=0.04] and MAP [(1.14±0.70) g/L, t=2.55, P=0.01]. Apo AⅠ was negatively correlated with Atlanta classification (r=-0.24, P<0.01). The optimal cut-off point of Apo A Ⅰ to predict SAP was 0.8 g/L, with the sensitivity of 0.877, specificity of 0.674 and Youden index of 0.55. The area under curve (AUC) was 0.623 (P<0.01). The proportions of SAP patients [52.94% (27/51) vs. 30.51%(36/118), χ2=7.66, P<0.01] and the patients of APACHE-Ⅱscore>8 [70.59%(36/51) vs. 55.08%(65/118), χ2=3.56, P=0.04] in patients with Apo AⅠ≤0.8 g/L were higher than those in patients with Apo AⅠ>0.8 g/L.@*Conclusion@#Apolipoprotein AⅠ level is negatively correlated with Atlanta classification and Apo AⅠ level can be used to predict severity of hyperlipidemic acute pancreatitis.
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Objective To investigate the risk factors for multiple organ dysfunction syndrome (MODS) in patients with type 2 diabetes mellitus (T2DM) complicated with infection.Methods The clinical data of 115 patients with T2DM complicated with infection in our hospital from Jan.2016 to Jan.2018 were retrospectively reviewed,including 60 patients with MODS(study group) and 55 patients without MODS(the control group).The related risk factors were analyzed by single factor and multi-factor logistic regression analysis.Results Single factor analysis showed that HbAlc[(5.47±0.86) vs (8.67±1.34)],hs-CRP[(8.31±2.18) vs (19.03±2.13)],PCT [(4.59±1.46) vs (13.42±2.67)],lac[(3.69±0.99) vs (6.58±1.18)],APACHE Ⅱ [(14.94±1.83) vs (24.98±3.19)],MBG[(9.81±0.62) vs (8.72±0.44)],SDBG[(3.43±0.20) vs (2.65±0.22)],MACE [(4.31±0.36) vs (2.93±0.19)],LAGE[(10.55±0.89) vs (6.49±0.19)],and MODD [(3.28±0.34) vs (2.05±0.25)] had statistical difference between the control group and the study group (P＜0.05).There was no significantly difference of blood glucose between the study group and the control group.Multi-factor logistic regression analysis showed that HbAlc,CRP,PCT,lac,APACHE Ⅱ],SDBG,LAGE,course of the disease were the main risk factors for MODS in patients with T2DM complicated with infection (P＜0.05).Conclusion HbAlc,CRP,PCT,lac,APACHE Ⅱ,SDBG,LAGE,and course of the disease were the main risk factors for MODS in patients with T2DM complicated with infection.
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Objective To explore the predictive value of serum hypoxia-inducible factor-1α (HIF-1α) and interleukin-6 (IL-6) at admission on short-time 6-month prognosis of patients with severe traumatic brain injury (sTBI). Methods Seventy-two sTBI patients with Glasgow coma score (GCS) 3-8 points in our hospital were selected from September 2016 to January 2018 and divided into the group with good prognosis and group with poor prognosis according to Glasgow outcome score (GOS) after injury 6 months. Serum HIF-1α and IL-6 at admission were detected by using ELISA. The levels of plasma biochemistry indexes, acute physiology and chronic health evaluationⅡ(APACHEⅡ) scores and GCS scores were evaluated. Univariable and Multivariable COX proportional hazards models were performed to analyze the risk factors for short-time prognosis of patients with sTBI. Receiver operating characteristic (ROC) curve was built to analyze the predictive value of APACHEⅡ scores, HIF-1α and IL-6 on short-time prognosis of patients with sTBI. Results After 6-month followed up, there were 33 patients with good prognosis and 39 patients with poor prognosis. There was statistical difference of the baseline values of ages, serum HIF-1α and IL-6 at admission, APACHEⅡscores and GCS scores, the interval from injury to admission, the size of traumatic brain injury between two groups (t=2.312,14.132,16.628,3.172,3.644,3.073,4.284, P＜0.05). The serum HIF-1α [HR (95%CI)=2.645 (1.710-4.679), P＜0.05] and IL-6 [HR(95%CI)=1.821(1.674-2.957), P＜0.05] at admission, APACHEⅡscores [HR(95%CI)=1.789(1.105-2.928), P＜0.05] and the size of traumatic brain injury [HR (95%CI)=6.256 (1.727-10.834), P＜0.05] were the independent influence factors of short-time 6m prognosis of sTBI patients. The area under ROC curve and Youden＇s index of HIF-1α, IL-6 and APACHEⅡscores at admission on prediction of prognosis of sTBI patients were 0.94 (95% CI: 0.81-0.99) and 0.85, which was higher than separate predictive value of HIF-1α, IL-6 and APACHEⅡ scores. Conclusion The present study demontrated that serum HIF-1α and IL-6 at admission may be the early sensitive predictors of short-time prognosis in sTBI patients.
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Objective To evaluate the value of procalcitonin (PCT) combined with CURB-65 score in the elderly patients with community acquired pneumonia(CAP). Methods Seventy-eight elderly patients with CAP were selected in the Emergency Department of Xuanwu Hospital Capital Medical University,After admission,blood routine, PCT, blood gas analysis and biochemical examination were given, and Acute Physiology and Chronic Health Evaluation(APACHEⅡ) and CURB-65 score were carried out. According to the prognosis,the patients were divided into death group (16 cases) and survival group (62 cases),The difference of PCT,white blood cell(WBC),CURB-65 score and APACHE Ⅱ score in the two groups were compared. The differences of area under ROC curve of APACHE II score,procalcitonin (PCT),CURB-65 score,PCT and CURB-65 score were compared. Results The PCT,CURB-65 and APACHEE Ⅱ scores of the death group and the survival group were (3. 35±1. 79) μg/L vs. (2. 05±1. 89) μg/L,(2. 06±0. 85) points vs. (1. 40±0. 99) points,(20. 50±4. 06) points vs. (14. 13+5. 63) points,respectively. There were significant differences between the two groups ( P＜0. 05) . The number of WBCs in survival group and survival group were ( 9. 90 ± 3. 04)×109/L and ( 8. 77 ± 3. 70)×109/L, respectively, with no significant difference between the two groups (P＝0. 263); the area under the ROC curve of PCT predicting death was 0. 716 (P＝0. 001),the area under the ROC curve of CURB-65 predicting death was 0. 679 ( P＝0. 005), and the area under the ROC curve of APACHE II score was 0. 836 (P＝0. 001) ,which was larger than PCT and CRUB-65 (P＜0. 05). The area under ROC curve of death predicted by PCT and CRUB-65 was 0. 775 (P＝0. 001). There was no significant difference between PCT and CRUB-65 and APACHE II (P＝0. 345) . Conclusion PCT combined with CURB-65 score can accurately and rapidly assess the condition of elderly patients with community-acquired pneumonia,and has important application value.
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Objective To study the clinical value of brain natriuretic peptide (BNP) and soluble urokinase plasminogen activator receptor (suPAR) in the diagnosis and prognosis of bloodstream infection.Methods Totally 165 patients suspected of bloodstream infection admitted in intensive care unit (ICU) of the Second Hospital Affiliated to Suzhou University were enrolled in this study.According to the diagnosis standard of bloodstream inflection,patients were divided into the bloodstream infection group and non-bloodstream infection group.According to the prognosis of the patients,the bloodstream infection group was further divided into the survival group and the death group.Serum levels of suPAR,BNP,CRP,PCT,and chronic health evaluation Ⅱ acute physiology score (APACHE Ⅱ),and mortality of the patients were analyzed,and the possible relation of the above indexes between the two groups were compared.Based on the receiver operating characteristic curve (ROC) and the area under the curve (AUC),the early diagnostic value of suPAR,BNP,CRP,PCT,and APACHE Ⅱ score in the bloodstream infection patients was determined.Results Serum levels of suPAR,BNP,CRP,PCT and APACHE Ⅱ score in the bloodstream infection group were higher than those in the non-bloodstream infection group (P＜0.05);Serum levels of suPAR,BNP,CRP,PCT and APACHE Ⅱ score in the death group were higher than those in the survival group (P＜0.05).There was a positive correlation between serum suPAR,BNP,PCT and APHCHE Ⅱ] score in patients of bloodstream infection(r=0.503,0.548,0.781,all P＜0.05).The levels of suPAR,BNP,PCT and APACHE Ⅱ in the patients of blood stream infection were related to significant the prognosis (P＜0.05).And these indexes can provide good evaluation on the prognosis of the patients.Conclusion Detection of serum suPAR,BNP can evaluate the severity of bloodstream infection and preliminarily determine the prognosis of patients with bloodstream infection.Therefore,the method is worth applying in the clinical field.
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Objective To observe the effect of heated humidified high flow nasal cannula oxygen therapy (HFNC) on patients with post-stroke systemic inflammatory response syndrome (SIRS). Methods Totally 78 patients with post-stroke SIRS were selected in the department of neurology of Wuxi People's Hospital and were randomly divided into HFNC group (n=40) and conventional therapy group (n = 38). The neurological impairment score (NIHSS) , APACHE-Ⅱ, clinical pulmonary infection score (CPIS) , C-reactive protein (CRP) of the 2 groups were recorded before and after the treatment. At the same time, modified Rankin score (mRS) of the two groups were also recorded. Results There was no significant difference in terms of morality and the number of patients with mechanical ventilation in the 2 groups. The 7-day APACHE Ⅱ, 7-day CPIS, 7-day SIRS cure rate, 14-day NIHSS and mRS of 3 months in HFNC group were higher than those in the conventional therapy group (P < 0.05).There was no significant difference in 7-day CRP, 14-day CRP and 14-day CPIS between HFNC group and conventional oxygen therapy group (P> 0.05). Conclusions HFNC can improve lung infection of patients with SIRS thus improve the recovery rate of SIRS. At the same time, it can improve the recovery of the neurological deficit and prognosis in acute stroke.
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Objective To investigate the clinical value of serum cystatin C (sCysC) and APACHE Ⅱ score in predicting diagosis and prognosis of acute kidney injury(AKI) in patients with sepsis. Methods In this study, we prospectively enrolled 138 adult patients with sepsis who had been admitted to the mixed ICU of Xiaolan Hospital of Southern Medical University during March 2015 to January 2016. According to the Kidney Disease Improving Global Outcomes (KDIGO) criterion, the patients were divided into non-AKI group and AKI group (including mild AKI and severe AKI). The receiver operating characteristic(ROC) curve and the area under curve(AUC) were used to evaluate these indexes' capability of detecting septic AKI and its prognosis. Results In this study,72 patients (52.2％) developed AKI. The levels of sCysC and APACHE Ⅱ score were significantly higher in AKI than in non-AKI (P<0.05). In total, 33 patients (23.9％) developed severe AKI. The levels of sCysC and APACHE Ⅱscore were significantly higher in severe AKI than in non-AKI and mild AKI (P<0.05) . Combination of sCysC and APACHE Ⅱ score predicted AKI and severe AKI after ICU admission with a higherAUC value (0.880&0.930) than each biomarker alone. In this cohort, in-hospital mortality was 19.6％and renal replacement therapy rate was 9.4％,which were strikingly higher in AKI group than non AKI group (P<0.05). Conclusions sCysC is a novel indexes for predicting AKI and its prognosis in patients with sepsis. Combinating with APACHE Ⅱ score can further improve its predictive performance of AKI detection and short-term prognosis.
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Objective To determine the prognostic indicators of severe acute respiratory distress syndrome (ARDS) by comprehensive analysis.Methods The clinical data of 71 patients with ARDS admitted from Feb.2012 to Apr.2017 were retrospectively collected and analyzed.The acute pathophysiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,occurrence of extrapulmonary organ dysfunction and mortality within 28d after final diagnosis were calculated.The risk factors were screened using the logistic regression analysis to construct the risk prediction model by dynamic recording and comparing the variation of each baseline index within 7 days,and ROC curve was used to evaluate the prediction efficiency of the model.Results Of the 71 cases analyzed,the overall mortality within 28d after final diagnosis was 57.7％(41/71).Single factor logistic regression analysis showed that the APACHE Ⅱ score,the occurrence of extrapulmonary organ dysfunction,the changing rate within 7 days of APACHE Ⅱ score,pH,CO2 partial pressure and oxygenation index were significantly related to mortality.Multiple logistic regression showed that the occurrence of extrapulmonary organ dysfunction and the changing rate within 7 days of APACHE Ⅱ score were the independent risk factors for the death of patients 28 days after admission.The prediction model of 28d mortality in ARDS patients was constructed using the single factor-and multiple logistic regression as covariant,the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of the model were 93.9％,91.7％,93.3％ and 91.7％,respectively.Conclusions Occurrence of extrapulmonary organ dysfunction and changing rate within 7 days of APACHE Ⅱ score can be used as an indicator to evaluate the prognosis of patients with severe ARDS.