Sentiment Analysis for Necessary Preview of 30-Day Mortality in Sepsis Patients and the Control Strategies.

This study was to preview the risk of 30-day mortality in sepsis patients using sentiment analysis. The clinical data of patients and nursing notes were collected from the Medical Information Mart for Intensive Care (MIMIC-III) database. The factors influencing 30-day mortality were analyzed using the Cox regression model. And, the prognostic index (PI) was estimated. The receiver operating characteristic (ROC) curve was used to determine the PI cut-off point and assess the prediction ability of the model. In total, 1844 of 3560 patients were eligible for the study, with a 30-day mortality of 37.58%. Multivariate Cox analysis showed that sentiment polarity scores, sentiment subjectivity scores, simplified acute physiology score (SAPS)-II, age, and intensive care unit (ICU) types were all associated with the risk of 30-day mortality (P < 0.05). In the preview of 30-day mortality, the area under the curve (AUC) of ROC was 0.78 (95%CI: 0.74-0.81,P < 0.001) when the cut-off point of PI was 0.467. The documented notes from nurses were described for the first time. Sentiment scores measured in nursing notes are associated with the risk of 30-day mortality in sepsis patients and may improve the preview of 30-day mortality.

[A 1-hour Bundle compliance survey of the "Surviving Sepsis Campaign" and its impact on the prognosis of sepsis patients: a multicenter, prospective observational cohort study].

OBJECTIVE: To investigate clinicians' compliance with the 2018 Surviving Sepsis Campaign (SSC) update "1-hour sepsis Bundle therapy" (1-hour Bundle) when treating patients with Sepsis 3 in the intensive care unit (ICU), and to analyze its impact on patient outcomes. METHODS: A multicenter, prospective observational cohort study was conducted. A total of 153 ICU patients in Ziyang First People's Hospital, Ziyang People's Hospital and Yanjiang District People's Hospital who were diagnosed of sepsis by the definition and diagnostic criteria of Sepsis 3 from January 2019 to December 2020 were selected. Among them, 95 patients who had completed 1-hour Bundle were divided into the Bundle compliance group. 58 patients who did not complete the Bundle within 1 hours were classified as the Bundle non-compliance group. The distribution of pathogenic bacteria and infected sites, 1-hour Bundle compliance and 28-day survival in the 3 hospitals were analyzed. Univariate analysis was used to analyze the risk factors affecting the prognostic between the two groups of sepsis patients. Cox regression model was used to draw a 28-day survival curve to evaluate the survival of the patients in the two groups. RESULTS: Among 153 sepsis patients in 3 hospitals, the detection rate of pathogenic bacteria was 61.44% (94/153), and Gram-negative bacteria accounted for 79.79% (75/94). The top 3 infection sites were respiratory system, gastrointestinal tract and urinary system, accounted for 32.0%, 28.1% and 18.3%, respectively. In the 3 hospitals, 62.09% (95/153) of patients fully implemented the 1-hour Bundle. The poorly implemented indicators in the 1-hour Bundle were 1-hour blood microbial culture [77.78% (119/153)] and 1-hour antimicrobial application [79.74% (122/153)]. There was no significant difference in the baseline indicators between Bundle compliance and non-compliance groups. Univariate analysis showed that the main prognostic indicators: 28-day survival rate in the Bundle compliance group was significantly higher than that in the Bundle non-compliance group [80.00% (76/95) vs. 62.06% (36/58), χ2 = 6.447, P = 0.014]. Secondary evaluation indicators: mean arterial pressure (MAP) at 6 hours and 24 hours in the Bundle compliance group were significantly higher than those in the Bundle non-compliance group [mmHg (1 mmHg = 0.133 kPa): 78.22±11.25 vs. 69.86±14.04, 79.78±11.45 vs. 75.35±12.90]. However, the median length of in hospital stay in the Bundle compliance group was significantly longer than that in the Bundle non-compliance group [days: 13 (17) vs. 6 (11)], with statistically significant differences (all P < 0.05). Bivariate Logistic regression analysis showed that 6 hours and 24 hours MAP were risk factors affecting the prognosis of patients with sepsis [odds ratio (OR), 95% confidence interval (95%CI): 1.064 (0.994-1.102), 1.032 (1.003-1.063), both P < 0.05]. CONCLUSIONS: The 1-hour Bundle compliance rate of ICU patients with sepsis in 3 hospitals of Ziyang City was 62.09%, and the compliance is still to be improved, especially for the 2 aspects of empirical antimicrobial use and microbial culture retention before antimicrobial use. The 28-day survival rate in the Bundle compliance group was significantly higher than that in the Bundle non-compliance group, suggesting that the 1-hour Bundle regimen can improve the prognosis of patients with sepsis.

[Expression of cation-chloride cotransporters KCC2 and NKCC1 in brainstem of para- chlorophenylalanine-induced acute insomnia rats].

OBJECTIVE: To explore the possible roles of KCC2 and NKCC1 in the pathological mechanism of acute insomnia in rats. METHODS: A total of 18 Sprague-Dawley rats were randomly selected into model, interference and normal control groups.The expressions of KCC2 and NKCC1 in brainstem were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.The concentration of intracellular Cl(-) ([Cl(-)]i) in brainstem was detected by fluorescence probe MQAE with laser confocal microscopy. RESULTS: (1) Comparing with the control group, both KCC2 mRNA and protein expression were down-regulated in the model and interference groups (mRNA:0.196 ± 0.021 vs 0.939 ± 0.109, P < 0.05; 0.485 ± 0.026 vs 0.939 ± 0.109, P < 0.05; protein expression:0.363 ± 0.058 vs 0.967 ± 0.155, P < 0.05; 0.663 ± 0.106 vs 0.967 ± 0.155, P < 0.05).However they became up-regulated in the interference group versus the model group (mRNA: 0.485 ± 0.026 vs 0.196 ± 0.021, P < 0.05; protein expression:0.663 ± 0.106 vs 0.363 ± 0.058, P < 0.05). (2) Comparing with the control group, both NKCC1 mRNA and protein expression in the model group were slightly up-regulated.But statistical difference was insignificant (mRNA: 0.344 ± 0.026 vs 0.320 ± 0.019, P > 0.05; protein expression:0.244 ± 0.010 vs 0.230 ± 0.021, P > 0.05).There was down-regulation in the interference group versus the model and control groups (mRNA: 0.066 ± 0.031 vs 0.320 ± 0.019, P < 0.05; 0.066 ± 0.031 vs 0.344 ± 0.026, P < 0.05; protein expression:0.131 ± 0.012 vs 0.230 ± 0.021, P < 0.05; 0.131 ± 0.012 vs 0.244 ± 0.010, P < 0.05). (3) Comparing with the control group, [Cl(-)]i became up-regulated in the model group (0.0315 ± 0.0039 vs 0.0164 ± 0.0019, P < 0.05).It was down-regulated in the interference group versus the model group (0.0182 ± 0.0013 vs 0.0315 ± 0.0039, P < 0.05), but higher than control group without statistical difference (0.0182 ± 0.0013 vs 0.0164 ± 0.0019, P > 0.05). CONCLUSION: The down-regulation of KCC2 and rise of [Cl(-)]i in brainstem may participate in the pathological mechanism of acute insomnia in rats. And the mechanism of sedative-hypnotic diazepam may be operate through an up-regulation of KCC2, a down-regulation of NKCC1 and decreased [Cl(-)]i.