A new in-hospital mortality prediction nomogram for intensive care unit patients with acute pancreatitis.

Introduction: Acute pancreatitis (AP) is a prevalent inflammatory disease that can lead to severe abdominal pain and multiple organ failure, potentially resulting in pancreatic necrosis and persistent dysfunction. A nomogram prediction model was developed to accurately evaluate the prognosis and provide therapy guidance to AP patients. Material and methods: Retrospective data extraction was performed using MIMIC-IV, an open-source clinical database, to obtain 1344 AP patient records, of which the primary dataset included 1030 patients after the removal of repeated hospitalizations. The prediction of in-hospital mortality (IHM) used the least absolute shrinkage and selection operator (LASSO) regression model to optimize feature selection. A multivariate logistic regression analysis was used to build a prediction model incorporating the selected features, and the C-index, calibration plot, and decision curve analysis (DCA) were utilized to evaluate the discrimination, calibration, and clinical applicability of the prediction model. Results: The nomogram utilized a combination of indicators, including the SAPS II score, RDW, MBP, RR, PTT, and fluid-electrolyte disorders. Impressively, the model exhibited a satisfactory diagnostic performance, with area under the curve values of 0.892 and 0.856 for the training cohort and internal validation, respectively. Moreover, the calibration plots and the Hosmer-Lemeshow goodness-of-fit (HL) test revealed a strong correlation between the predicted and actual outcomes (p = 0.73), further confirming the reliability of our model. Notably, the results of the decision curve analysis (DCA) highlighted the superiority of our model over previously described scoring methods in terms of net clinical benefit, solidifying its value in clinical applications. Conclusions: Our novel nomogram is a simple tool for accurately predicting IHM in ICU patients with AP. Treatment methods that enhance the factors involved in the model may contribute to increased in-hospital survival for these ICU patients.

Risk factors for acute kidney injury after intracranial hemorrhage.

OBJECTIVE: This study investigated the risk factors for acute kidney injury (AKI) occurrence in patients with spontaneous intracerebral hemorrhage. METHODS: The clinical data of patients with spontaneous intracerebral hemorrhage who were hospitalized in the Department of Intensive Care Medicine of Mingguang People's Hospital from January 2016 to August 2020 were retrospectively analyzed. The patients were divided into AKI group and non-AKI group according to whether the patient had secondary AKI, and the clinical data of the two groups were compared. Logistic regression analysis was used to screen out the risk factors for secondary AKI in patients with spontaneous intracerebral hemorrhage. RESULTS: Three hundred thirty-seven patients were included in this study, whereby 186 males (55.2%) and 151 females (44.8%). A total of 65 patients developed AKI, of whom 44 patients were (67.69%) in stage 1, 12 patients (18.46%) in stage 2, and 9 patients (13.85%) in stage 3. Univariate logistic regression analysis showed that Acute Physiology, Age and Chronic Health Evaluation (APACHE II score), diabetes, chronic kidney disease, fasting blood glucose level and amount of mannitol used were risk factors for AKI in patients with intracerebral hemorrhage. Multivariate logistic regression analysis showed APACHE II score (OR: 1.846, 95% CI: 1.319 to 2.585, p < 0.001), diabetes (OR: 3.609, 95% CI: 1.596 to 8.163, p=0.002) and amount of mannitol use (OR: 3.495, 95% CI: 1.910~3.395, p < 0.001) are the independent risk factors for AKI after intracranial hemorrhage. CONCLUSION: In summary, APACHE II score, diabetes, and total mannitol use are independent risk factors for AKI in patients with spontaneous intracerebral hemorrhage. It is necessary to monitor renal function frequently in patients with high APACHE II scores and control the amount of mannitol administrated in the prevention of AKI after intracranial hemorrhage. The intervention of the above factors is expected to reduce the risk of secondary AKI.

Early decrease of ventilatory ratio after prone position ventilation may predict successful weaning in patients with acute respiratory distress syndrome: A retrospective cohort study.

Background: Previous studies usually identified patients who benefit the most from prone positioning by oxygenation improvement. However, inconsistent results have been reported. Physiologically, pulmonary dead space fraction may be more appropriate in evaluating the prone response. As an easily calculated bedside index, ventilatory ratio (VR) correlates well with pulmonary dead space fraction. Hence, we investigated whether the change in VR after prone positioning is associated with weaning outcomes at day 28 and to identify patients who will benefit the most from prone positioning. Materials and methods: This retrospective cohort study was performed in a group of mechanically ventilated, non-COVID ARDS patients who received prone positioning in the ICU at Zhongda hospital, Southeast University. The primary outcome was the rate of successful weaning patients at day 28. Arterial blood gas results and corresponding ventilatory parameters on five different time points around the first prone positioning were collected, retrospectively. VR responders were identified by Youden's index. Competing-risk regression models were used to identify the association between the VR change and liberation from mechanical ventilation at day 28. Results: One hundred and three ARDS patients receiving prone positioning were included, of whom 53 (51%) successfully weaned from the ventilator at day 28. VR responders were defined as patients showing a decrease in VR of greater than or equal to 0.037 from the baseline to within 4 h after prone. VR responders have significant longer ventilator-free days, higher successful weaning rates and lower mortality compared with non-responders at day 28. And a significant between-group difference exists in the respiratory mechanics improvement after prone (P < 0.05). A linear relationship was also found between VR change and compliance of the respiratory system (Crs) change after prone (r = 0.32, P = 0.025). In the multivariable competing-risk analysis, VR change (sHR 0.57; 95% CI, 0.35-0.92) was independently associated with liberation from mechanical ventilation at day 28. Conclusion: Ventilatory ratio decreased more significantly within 4 h after prone positioning in patients with successful weaning at day 28. VR change was independently associated with liberation from mechanical ventilation at day 28.