Ulinastatin for acute lung injury and acute respiratory distress syndrome: A systematic review and meta-analysis.

AIM: To investigate the efficacy and safety of ulinastatin for patients with acute lung injury (ALI) and those with acute respiratory distress syndrome (ARDS). METHODS: A systematic review of randomized controlled trials (RCTs) of ulinastatin for ALI/ARDS was conducted. Oxygenation index, mortality rate [intensive care unit (ICU) mortality rate, 28-d mortality rate] and length of ICU stay were compared between ulinastatin group and conventional therapy group. Meta-analysis was performed by using Rev Man 5.1. RESULTS: Twenty-nine RCTs with 1726 participants were totally included, the basic conditions of which were similar. No studies discussed adverse effect. Oxygenation index was reported in twenty-six studies (1552 patients). Ulinastatin had a significant effect in improving oxygenation [standard mean difference (SMD) = 1.85, 95%CI: 1.42-2.29, P < 0.00001, I(2) = 92%]. ICU mortality and 28-d mortality were respectively reported in eighteen studies (987 patients) and three studies (196 patients). We found that ulinastatin significantly decreased the ICU mortality [I(2) = 0%, RR = 0.48, 95%CI: 0.38-0.59, number needed to treat (NNT) = 5.06, P < 0.00001], while the 28-d mortality was not significantly affected (I(2) = 0%, RR = 0.78, 95%CI: 0.51-1.19, NNT = 12.66, P = 0.24). The length of ICU stay (six studies, 364 patients) in the ulinastatin group was significantly lower than that in the control group (SMD = -0.97, 95%CI: -1.20--0.75, P < 0.00001, I(2) = 86%). CONCLUSION: Ulinastatin seems to be effective for ALI and ARDS though most trials included were of poor quality and no information on safety was provided.

[Clinical analysis of acute hyperlipidemic pancreatitis during pregnancy and postpartum period].

OBJECTIVE: To describe the characteristics of acute pancreatitis during pregnancy and postpartum. METHODS: From 1994 to 2012, 18 cases of gravida and postpartum women complicated with acute pancreatitis were treated at Peking University Third Hospital and retrospective analysis was performed. RESULTS: The admission rate due to acute pancreatitis was 41.24 per 100 000 admission. The median age was 32.0 (28.0, 34.7) years, with the onset of acute pancreatitis on 35.0 (23.5, 37.0) weeks'gestation. Of all the cases, 13 (72.2%) were interstitial edematous acute pancreatitis, and 5 (27.8%) were necrotizing. Nine (50.0%) were caused by hyperlipidemia, of which 7 (38.9%) were caused by gallstones, and 2 (1.1%) were idiopathic. Stratified by severity, 6 (33.3%) were mild, 7 (38.9%) were moderately severe and 5 (27.8%) were severe, of which 8 were transferred to Intensive Care Unit. Compared with non-hyperlipidemic acute pancreatitis, cases caused by hyperlipidemia were more severe, however, the prognoses of mothers and infants were good. CONCLUSION: The incidence of acute pancreatitis during pregnancy and postpartum was similar to that of the regular population, and mostly caused by gallstones and hyperlipidemia. Although acute hyperlipidemic pancreatitis is more severe, the morbidity and mortality of maternal and perinatal could be decreased by aggressive therapy.

[Pharmacokinetics of meropenem administered with prolonged infusion time in patients receiving continuous veno-venous hemofiltration].

OBJECTIVE: To demonstrate the pharmacokinetic profile of meropenem when administered by 3-hour infusion in patients undergoing continuous veno-venous hemofiltration (CVVH). METHODS: The study was conducted in 10 patients, who were treated with CVVH. Each subject received meropenem in 3-hour infusion of 500 mg every 6 hours. Blood samples were collected before infusion (0 hour) and 0.25, 0.5, 1, 1.5, 2, 3, 4, 5, 6 hours (just before the infusion of the next dose) after the beginning of the fourth infusion. The concentrations of meropenem in plasma were measured by high-performance liquid chromatography method, and mean serum meropenem concentration-time curve was plotted. RESULTS: Peak plasma drug concentrations measured 3 hours post-infusion were (25.05 ± 5.64) mg/L, and trough levels after 6 hours of infusion were (13.03 ± 3.01) mg/L. The area under the plasma concentration-time curve (AUC) was (118.42 ± 26.78) mg x h⁻¹ x L⁻². The elimination half-life (T1/2) was (3.74 ± 0.55) hours. The mean residence time (MRT) was (4.99 ± 0.84) hours. The volume of distribution (Vb) was (22.85 ± 9.85) L and clearance of meropenem (CL) was (4.49 ± 1.32) L/h. The percentage of time that the serum drug concentration was above the minimum inhibitory concentration (MIC) accounting for the interval time of infusion (%T>MIC) was 100% (MIC 8 mg/L) in all the 10 patients. CONCLUSION: Based on these data, we concluded that satisfactory pharmacodynamic parameters could be attained in CVVH patients treated with meropenem by a prolonged infusion time of 3 hours with a dosage of 500 mg for every 6 hours.

[The effect of an optimized resuscitation strategy on prognosis of patients with septic shock: a systematic review].

OBJECTIVE: To determine the treatment effect of an optimized resuscitation strategy on prognosis of patients with septic shock. METHODS: A systematic review of MEDLINE, the Cochrane Library, EMBASE, CBM, CNKI and other sources using a comprehensive strategy was conducted. All randomized controlled trials (RCTs) of treatment of severe sepsis and septic shock were included. The patients were randomized into treatment group and control group. Preplanned subgroup analysis required studies to be categorized based on early (goal-directed therapy accomplished within 6-24 hours) vs. late (initiated after 24 hours or unknown time of resuscitation implementation). Two authors independently extracted data and assessed study quality using standardized methods. Consensus was reached by conference. The Cochrance Collaboration's software RevMan 5.0 was used for data analysis. RESULTS: Eleven studies were included in the final analysis, providing a sample of 2066 patients. The combined results demonstrated a decrease in mortality [odds ratio (OR) = 0.63, 95% confidence interval (95%CI) 0.48-0.84, P = 0.002]; however, there was statistically significant heterogeneity [P = 0.01, I(2) = 55%]. Among the early optimal resuscitation studies (n = 8) there was minimal heterogeneity [P = 0.44, I(2) = 0%] and a significant decrease in mortality (OR = 0.53, 95%CI 0.42-0.66, P < 0.00001) and incidence of multiple organ dysfunction syndrome (MODS, OR = 0.61, 95%CI 0.43-0.85, P = 0.004). For the late resuscitation studies (n = 3), there was statistically significant difference [P = 0.05, I (2)=66%], and there was no significant effect on mortality (OR = 0.89, 95%CI 0.52-1.54, P = 0.68) and incidence of MODS (OR = 0.43, 95%CI 0.17-1.08, P = 0.07). CONCLUSION: This meta-analysis found that the application of an early optimal resuscitation strategy to patients with septic shock imparts a significant reduction in mortality and incidence of MODS.

[Influence of albumin as a resuscitation fluid on the prognosis of patients with sepsis: a Meta-analysis].

OBJECTIVE: To compare the effect of albumin as a resuscitation fluid with other fluids in lowering the mortality of patients with sepsis. METHODS: By searching MEDLINE, Embase, Cochrane Central Registration of Controlled Trials databases, the metaRegister of Controlled Trials, the Medical Editors Trial Amnesty Register, and retrieval of the randomized controlled trial (RCT) literature to compare the result of resuscitation using albumin-containing fluid and other fluids. The study population included adult patients who were diagnosed to have sepsis, and the patients with sepsis who were studied as subgroup. The RevMan 5.0 software was used for Meta-analysis, and the main outcome was the mortality of the hospitalized patients. RESULTS: In the 14 RCTs, 1729 patients received the albumin-containing fluid resuscitation or resuscitation with other fluids. It was found that the patients with sepsis were the only research objects in five studies, and in other nine studies patients with sepsis were studied as subgroup. P = 0.98, I (2)=0%, i.e. no heterogenicity, and the fixed effect model was used for combining results. There was no evident difference between the group of patients with sepsis resuscitated by albumin-containing fluids and other fluids [odds ratio (OR) was 0.87, 95% confidence interval (95%CI) 0.71-1.07, P = 0.18]. The pooled OR of resuscitation using high concentration albumin solution (20%) was 1.11, 95%CI 0.71-1.73, P = 0.65, the pooled OR of resuscitation using low concentration albumin solution (4%, 5%) was 0.82, 95%CI 0.65-1.03, P = 0.09. Resuscitation with different concentration of albumin-containing fluids was identical with the whole research results. After rejecting six articles of Boldt and other authors, and also saline versus albumin fluid evaluation (SAFE) study, the sensitivity analysis of the study was performed in order to check whether the data produced decisive significance to the whole research results or not. The whole results did not change after their rejection(Boldt studies were rejected:OR 0.82, 95%CI 0.65-1.02, P = 0.08; SAFE study was rejected: OR 1.05, 95%CI 0.71-1.55, P = 0.82). Therefore the analysis results were satisfactory. CONCLUSION: The Meta-analysis shows that by using albumin-containing fluids for resuscitation can not lower the mortality of sepsis as compared with other fluids.

Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial*.

OBJECTIVES: To evaluate the efficacy and safety of short-term low-dose intravenous haloperidol for delirium prevention in critically ill elderly patients after noncardiac surgery. DESIGN: Prospective, randomized, double-blind, and placebo-controlled trial in two centers. SETTING: Intensive care units of two large tertiary teaching hospitals. PATIENTS: Four hundred fifty-seven patients 65 yrs or older who were admitted to the intensive care unit after noncardiac surgery. INTERVENTION: Haloperidol (0.5 mg intravenous bolus injection followed by continuous infusion at a rate of 0.1 mg/h for 12 hrs; n = 229) or placebo (n = 228) was randomly administered from intensive care unit admission. MEASURES: The primary end point was the incidence of delirium within the first 7 days after surgery. Secondary end points included time to onset of delirium, number of delirium-free days, length of intensive care unit stay, all-cause 28-day mortality, and adverse events. Delirium was assessed using the confusion assessment method for the intensive care unit. RESULTS: The incidence of delirium during the first 7 days after surgery was 15.3% (35/229) in the haloperidol group and 23.2% (53/228) in the control group (p = .031). The mean time to onset of delirium and the mean number of delirium-free days were significantly longer (6.2 days [95% confidence interval 5.9-6.4] vs. 5.7 days [95% confidence interval 5.4-6.0]; p = .021; and 6.8 ± 0.5 days vs. 6.7 ± 0.8 days; p = .027, respectively), whereas the median length of intensive care unit stay was significantly shorter (21.3 hrs [95% confidence interval 20.3-22.2] vs. 23.0 hrs [95% confidence interval 20.9-25.1]; p = .024) in the haloperidol group than in the control group. There was no significant difference with regard to all-cause 28-day mortality between the two groups (0.9% [2/229] vs. 2.6% [6/228]; p = .175). No drug-related side effects were documented. CONCLUSIONS: For elderly patients admitted to intensive care unit after noncardiac surgery, short-term prophylactic administration of low-dose intravenous haloperidol significantly decreased the incidence of postoperative delirium. The therapy was well-tolerated.

[Analysis of risk factors of prolonged intensive care unit stay of critically ill obstetric patients: a 5-year retrospective review in 3 hospitals in Beijing].

OBJECTIVE: To identify the risk factors of prolonged intensive care unit (ICU) stay of critically ill obstetric patients. METHODS: A retrospective analysis of cases of critically ill obstetric patients admitted to the ICUs of Peking University Third Hospital, Capital Medical University Affiliated Beijing Chaoyang Hospital, and PLA 306 Hospital from January 1st 2006 to December 31st 2010 was made. Data included demographics, causes of critical illness or complications that prompted ICU admission, the acute physiology and chronic health evaluation II (APACHEII) scores, the time intervals between onset of acute symptoms and ICU admission, laboratory test results, treatment measures, length of ICU stay and the final maternal mortality. Data were used to identify univariate and multivariate predictors for prolonged ICU stay. RESULTS: During the 5-year period there were 207 obstetric patients [mean age (31.74±2.32) years old, mean gestational age (34.86±4.72) weeks] were transferred to the ICU for critical care (42 ICU admissions per 10 000 deliveries), and among them 4 women died (mortality rate 1.93%). The pathogenesis of the cases could be divided into direct obstetric pathologies (n=138) and indirect or coincidental pathologies (n=69). The most common obstetric causes of admission were massive postpartum haemorrhage (n=42, 20.29%) and pregnancy associated hypertension (n=36, 17.39%), followed by acute fatty liver of pregnancy (AFLP, n=27, 13.04%), obstetric disseminated intravascular coagulation (DIC, n=23, 11.11%). The most common non obstetric causes of admission were acute heart failure (n=26, 12.56%) and acute respiratory failure (n=22, 10.63%), followed by severe acute pancreatitis (SAP, n=11, 5.31%). The incidence of prolonged ICU stay (ICU stay >3 days) was 52.66% (n=109). Univariate predictors of prolonged ICU stay included inadvertent antenatal care, high serum creatinine, abnormal international normalized ratio of prothrombin time (INR), abnormal oxygenation index (PaO(2)/FiO(2)), AFLP, obstetric DIC, SAP, use of mechanical ventilation, indications for inotropic support, and blood purification, and >24 hour interval between onset of acute symptoms and ICU admission. Multivariate modeling identified that inadvertent and irregular antenatal care [odds ratio (OR) 1.68, 95% confidence interval (95%CI) 1.14-2.69, P=0.011], PaO(2)/FiO(2) (OR 4.73, 95%CI 1.46-11.37, P=0.013), AFLP (OR3.21, 95%CI 1.13-4.76, P=0.026), DIC (OR 2.73, 95%CI 1.28-4.02, P=0.018), SAP (OR 4.78, 95%CI 1.83-7.42, P=0.021 ), indications for inotropic support (OR 1.96, 95%CI 1.24-3.15, P=0.001), blood purification (OR 11.02, 95%CI 3.04-58.02, P=0.015) and >24 hour interval between onset of acute symptoms and ICU admission (OR 2.04, 95%CI 1.21-4.25, P<0.001) were the independent predictors for prolonged ICU stay. CONCLUSION: The incidence of prolonged ICU stay is high for critically ill obstetric patients. Patients with identified multivariate predictors carry a high risk of prolonged ICU stay, they may benefit from enhanced regular antenatal care, prevention of critical obstetric and medical complications, shortening the interval between onset of acute symptoms and ICU admission and strengthening the support of organ function.

Relationship between time to positivity of blood culture with clinical characteristics and hospital mortality in patients with Escherichia coli bacteremia.

BACKGROUND: Previous studies indicated that the time to positivity (TTP) of blood culture is a parameter correlating with degree of the bacteremia and outcome in patients with bloodstream infections caused by Escherichia coli (E. coli). The objective of this study was to further investigate the diagnostic and prognostic power of using TTP to predict E. coli bacteremia. METHODS: A retrospective cohort study at two university hospitals was conducted. We retrieved all the medical records of those with E. coli bloodstream infection according to the records generated by their microbiology departments. Univariate and multivariate analyses were applied to identify clinical factors correlating with fast bacterial growth and significant prognostic factors for hospital mortality. RESULTS: Medical records of 353 episodes of E. coli bacteremia diagnosed between January 1, 2007 and December 31, 2009 were retrieved in the investigation. Univariate analysis demonstrated that the TTP ≤ 7 hours group is associated with higher incidence of active malignancies (41.7% vs. 27.2%, P = 0.010), neutropenia (30% vs.14.3%, P = 0.007), primary bacteremia (55.0% vs. 33.4%, P = 0.002), and poorer outcome (hospital mortality 43.3% vs.11.9%, P = 0.000) than the TTP > 7 hours group. Multivariate analysis revealed that the significant predictors of hospital mortality, in rank order from high to low, were TTP (for TTP ≤ 7 hours, odds ratio (OR): 4.886; 95% confidence interval (CI): 2.572 - 9.283; P = 0.000), neutropenia (OR: 2.800; 95%CI: 1.428 - 5.490; P = 0.003), comedication of steroids or immunosuppressive agents (OR: 2.670; 95%CI: 0.971 - 7.342; P = 0.057). CONCLUSIONS: Incidence of malignancies, neutropenia and primary bacteremia correlates with fast bacterial growth in patients with E. coli bacteremia. The parameter of TTP has been identified as a variable of highest correlation to hospital mortality and therefore can be potentially utilized as a mortality prognostic marker.

[Correlation between in vitro bacterial growth velocity of blood of patients with clinical parameters and prognosis in patients with Escherichia coli bacteremia].

OBJECTIVE: To identify the clinical and laboratory parameters correlating with speed of bacterial growth in culture and independent risk factors of in-hospital mortality in patients with Escherichia coli bacteremia. METHODS: This retrospective study was conducted at Beijing University Third Hospital. The medical records and microbiological database of the patients diagnosed as Escherichia coli bacteremia between January 2007 and December 2009 were collected. The parameter of time to positivity (TTP) was used to be a surrogate marker of bacterial growth. Univariate analysis was used to identify relationship between clinical parameters and the speed of bacterial growth. Logistic multivariate analysis was used to identify risk factors of in-hospital mortality. RESULTS: The medical records of 112 patients during the study period were collected, 25 patients died during hospital stay, the overall in-hospital mortality rate was 22.3%. Univariate analysis indicated the rapid-growth (TTP≤7 hours) group (n=20) had higher incidence of neutropenia (40.0% vs. 15.2%), higher incidence of primary bacteremia (40.0% vs. 18.5%) and higher in-hospital mortality rate (45.0% vs. 17.4%) than those with slow bacterial growth (TTP>7 hours) group (n =92, all P<0.05). The death group (n=25) was found to have a higher incidence of TTP≤7 hours (36.0% vs. 12.6%), higher incidence of active malignancies (44.0% vs. 24.1%), higher incidence of neutropenia (36.0% vs. 14.9%), higher rate of isolation of extended spectrum ß lactamases (ESBL)-producing strains (48.0% vs. 24.1%) than the survival group (n=87, all P<0.05). Logistic multivariate analysis suggested the significant predictors of in-hospital mortality included TTP≤7 hours [odds ratio (OR)=3.412, 95% confidence interval (95% CI)=1.1819.856, P=0.023], ESBL-producing strains (OR=2.545, 95% CI=0.9776.625, P=0.056). CONCLUSION: In vitro Escherichia coli growth speed in the blood culture correlates with the incidence of neutropenia and primary bacteremia, and TTP≤7 hours and ESBL-producing strains may be the strong, independent risk factors of a worse prognosis in patients with Escherichia coli bacteremia.

[Prognostic value of assay of brain natriuretic peptide in patients with acute respiratory distress syndrome].

OBJECTIVE: To explore the prognostic value of brain natriuretic peptide (BNP) level in patients with acute respiratory distress syndrome (ARDS). METHODS: Eighty-six patients with ARDS who had normal left ventricular ejection fraction (LVEF), from January 2004 to May 2009, were studied retrospectively. The baseline characteristics of the patients were recorded. The plasma concentration of BNP and Murray lung injury score (LIS) of the patients with their outcomes, and the relationship between the BNP concentration and LIS were analyzed. The prediction results of death and survival of patients using the cut off points of concentration of BNP and LIS were also analyzed. RESULTS: Eighty-six patients were diagnosed as ARDS.Among those patients with ARDS, 55 patients were dead and 31 patients were survival in 14 days. The proportion of pulmonary hypertension (25.8% vs. 72.7%) and that of using large dose of intravenous norepinephrine (38.7% vs. 94.5%), the time without using mechanical ventilation in 14 days [(8.63+/-3.26) days vs. (0.38+/-0.02) days], BNP concentration [(179.5+/-84.5) ng/L vs. (550.8+/-337.1) ng/L] and LIS (1.37+/-0.65 vs. 2.29+/-0.46) differed significantly between the survivors and the nonsurvivors (P<0.05 or P<0.01). The plasma concentration of BNP had a significant correlation with LIS (r=0.786, P<0.001). By using the threshold value of 329.5 ng/L for BNP, the specificity for the prediction of mortality was 96.8%. The threshold value for LIS of 1.875 showed sensitivity of 80.0%. CONCLUSION: BNP concentration and LIS were significantly elevated in nonsurvivors than survivors in patients with ARDS who have normal LVEF. High BNP level can predict mortality.

[A case report of left ventricular apical systolic dysfunction syndrome].

The left ventricular apical systolic dysfunction syndrome was a rare acute cardiac syndrome. Its clinical presentation and electrocardiography were similar to acute myocardial infarction. The syndrome was characterized by transient ventricular wall-motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of obstructive epicardial coronary disease. Cardiac enzyme was normal or minor elevation. At present, the cause of the syndrome is unknown. In this paper, we describe a 56-year-old female patient. She was admitted in hospital for acute appendititis and the transient left ventricular apical ballooning syndrome. She developed acute heart failure and septic shock in the hospital. The drainage of the appendiceal abscess was done and the heart failure and septic shock recovered completely in a few days.

[A study on the effect of recruitment maneuver imposed on extravascular lung water in patients with acute respiratory distress syndrome].

OBJECTIVE: To investigate the possible effects of recruitment maneuver (RM) imposing on extravascular lung water (EVLW) in patients with acute respiratory distress syndrome (ARDS). METHODS: Twenty patients with ARDS who were eligible for the study were randomized to two groups, one group of which received regular therapy+RM (RM group), and to the other group only regular therapy was given (control group). Mechanical ventilation of all the patients was performed on the principles of lung protective ventilation. RM was carried out in bi-level positive airway passage (BIPAP) mode, and repeated every 8 hours per day until on the 7th day or before weaning of mechanical ventilation. The treatment was same between the two groups except RM. Baseline data and the influencing factors of EVLW were all recorded, which included everyday EVLW, extravascular lung water index (EVLWI) after RM, respiratory mechanics, oxygenation parameters, central venous pressure (CVP), plasma colloid osmotic pressure (COP), dosage of corticosteroid and adrenergic drugs, 24-hour net fluid balance. RESULTS: EVLW and EVLWI in RM and control group showed a tendency of decrease with passage of time, but the difference between both groups had no statistical significance (all P>0.05). The comparisons between the influencing factors of the groups, consisting of CVP, COP, noradrenaline and hydrocortisone, had no significant difference either (all P>0.05). Dopamine dosage in RM group on the 4th day was smaller than that of control group (P<0.05). Net fluid balance in RM group on the 7th day was negative, whereas it was positive in control group (P<0.05). Mean airway pressure [Pmean, RM group (18.8+/-3.2) cm H(2)O (1 cm H(2)O=0.098 kPa) vs. control group (16.6+/-3.9) cm H(2)O] and lung quasi-static compliance [Cstat, RM group (36.5+/-14.5) ml/cm H(2)O vs. control group (29.3+/-12.0) ml/cm H(2)O] in RM group were higher than those in control group (both P<0.05). Cstat on the 5th day was higher than that on the 2nd and 3rd day in RM group (both P<0.05). But oxygenation index (PaO(2)/FiO(2)) showed no distinct difference between the groups (all P>0.05). CONCLUSION: RM for the patients with ARDS can merely improve lung mechanics without obvious effect on EVLW. Neither of the influencing factors involved in the study has impact on emergence and clearance of EVLW.

[Assessment of severity of acute pancreatitis in early stage].

OBJECTIVE: To assess the accuracy of indexes for predicting severe acute pancreatitis (SAP). METHODS: Thirty-nine patients suffering from acute pancreatitis (AP) were randomly selected, including 20 SAP cases and 19 mild acute pancreatitis (MAP) cases. The levels of polymorphonuclear leucocyte-elastase (PMN-E), serum phospholipase A2 (PLA2), pancreatic PLA2 (Pan-PLA2), PLA2 catalytic activity (CA-PLA2), amylase, as well as C-reactive protein (CRP) were determined Acute Physiology and chronic health evaluation II (APACHE II) was scored in every patient. Sensitivity and specificity of all the parameters were assessed, and receiver operator characteristic curve (ROC) was plotted. Positive predictive value, negative predictive value, and overall accuracy were then analyzed. RESULTS: PMN-E, CRP and CA-PLA2 were obviously higher in SAP than in MAP, and were indicative of the severity of the disease (all P < 0.01). Pan-PLA2 and amylase of AP patients raised at the onset of the disease, and they showed no difference between the SAP groups and MAP groups. When SAP was predicted by PMN-E, sensitivity was 94.5%, specificity was 99.4%, positive predictive value was 97.8%, negative predictive value was 99.4%, overall accuracy was 98.7%, higher than other indexes. When SAP was Predicted by CRP, the overall accuracy was also high and reached 84.0%. CONCLUSION: PMN-E, CA-PLA2, CRP, and APACHE II are all indexes for the diagnosis of SAP. PMN-E is found to be the best index in predicting SAP.

[Epidemiological investigation on acute respiratory distress syndrome occurring in intensive care units in Beijing from 1998 to 2003].

OBJECTIVE: To investigate incidence, causes and mortality of acute respiratory distress syndrome (ARDS) in intensive care units (ICU) in Beijing. METHODS: Patients in ICU of eight general hospitals in Beijing from May 1998 to April 2003 were retrospectively studied. ARDS was diagnosed according to the 1994 American-European consensus conference criteria. Results Of 8 482 patients admitted to ICUs in the same period, there were 383 patients (4.5%) diagnosed as having ARDS. Major primary diseases for ARDS were sepsis (21.7%), pneumonia (16.2%), surgical operation (13.1%), acute pancreatitis (12.8%) and multiple severe trauma (10.7%). The mean interval between onset of the primary disease and onset of ARDS was (61.8 +/- 43.7) hours. The overall mortality of ARDS was 52.0%, the mortality adjusted for age (< or =39, 40-64, > or =65 years old) and gender (male) showed significant changes in each year (all P<0.05), but acute physiology and chronic health evaluation II (APACHE II, < or =12, 13-19, > or =20 scores) score showed no significant changes during the 5 years. Septic shock (36.2%) and heart failure (20.6%) were major lethal causes, while only 14.6% died of respiratory failure. CONCLUSION: ARDS was frequent in ICU in Beijing, the mortality remains high, and there is no tendency to decline in recent years.