RESUMO
Background: Effective body temperature management is crucial for the favorable prognosis of patients undergoing surgery. The purpose of this study is to explore the risk factors of intraoperative hypothermia and to develop a risk prediction model to provide basis for clinical treatment. Methods: Patients who underwent laparoscopic surgery in a tertiary hospital in China from February 1, 2023 to January 31, 2024 were included. The body temperature characteristics of patients in hypothermia group and non-hypothermia group were collected and evaluated. Univariate and Logistic regression analysis were used to evaluate the influencing factors. Based on the regression coefficients of risk factors, a risk prediction model of hypothermia was established. The model was assessed by Hosmer's Lemeshow (H- L) test and receiver working characteristic (ROC) curve. Results: In 216 patients undergoing laparoscopic surgery, the incidence of hypothermia was 52.78 %. BMI≤23 kg/m2(OR = 2.061, 95%CI: 1.413-3.263), basal body temperature≤36.1 °C (OR = 3.715, 95%CI: 3.011-4.335), operating room temperature≤22 °C (OR = 2.481, 95%CI: 1.906-3.014), length of surgery≥120 min (OR = 2.228, 95%CI: 1.925-2.981) were the risk factors of hypothermia in patients undergoing laparoscopic surgery (all P < 0.05). The P value of H-L test was 0.098, the area under ROC curve and 95%CI were 0.806 (0.746-0.869). The sensitivity and specificity of the model in this study were good. Conclusions: Patients undergoing laparoscopic surgery are at a high risk of developing hypothermia, a condition influenced by a multitude of factors. This model is designed to be integrated into clinical practice, enabling healthcare providers to identify patients with a higher risk and to implement targeted preventive measures.
RESUMO
Objective: Ischemic stroke is a common complication in patients with tubercular meningitis (TBM). However, the risk factors for Ischemic stroke in TBM patients are not fully understood, especially in those patients without conventional vascular risk factors. The aim of the present study was to explore the clinical features and independent risk factors for tubercular meningitis-related Ischemic stroke (TBMRIS). Methods: Tubercular meningitis patients with acute Ischemic stroke without conventional vascular risk factors were recruited between July 2010 and July 2020 as the TBMRIS group. Patients who solely had tubercular meningitis were recruited as the control group (TMB group). Demographic characteristics, clinical presentations, and cerebrospinal fluid (CSF) examinations were collected, and multiple logistic regression analysis was applied to analyse the independent risk factors for TBMRIS. Results: A total of 70 TBMRIS patients and 70 TMB patients were enrolled. Most (82.86%) of the TBMRIS patients experienced Ischemic stroke events within 3 months after the diagnosis of tubercular meningitis. The multiple logistic regression analysis revealed that variation in red blood cell distribution width (RDW-CV), mean platelet volume (MVP), C-reactive protein (CRP), CSF glucose and Modified Research Council Grade II (MRC Grade II) were independent risk factors for TBRIS. The AUC of the identification model was 0.808, with a sensitivity of 68.60% and a specificity of 84.30%. Conclusion: This study revealed that RDW-CV, MVP, CRP, CSF glucose and MRC Grade II are potential independent risk factors for TBMRIS. The identification model established in this study may help monitor TBM patients who are at high risk of developing TBMRIS.
RESUMO
Objective: There have been only a few studies of ischemic stroke in patients with pulmonary tuberculosis (pTB). This study aimed to explore the clinical features and the underlying pathogenesis of pulmonary tuberculosis-related ischemic stroke (TBRIS). Methods: Active pulmonary tuberculosis patients with acute ischemic stroke (without conventional vascular risk factors) were recruited as the TBRIS group. Patients who solely had active pulmonary tuberculosis were recruited as the control group (pTB group). Clinical data were collected, and multiple logistic regression analysis was applied to analyze the independent risk factors for TBRIS. Results: A total of 179 TBRIS patients and 179 pTB patients were enrolled. Most (56.42%) of the TBRIS patients experienced the ischemic stroke events within 3 months after the diagnosis of tuberculosis. The multiple logistic regression analysis revealed that an increased mean platelet volume; elevated plasma D-dimer, C-reactive protein, and serum ferritin levels; and an increased monocyte percentage were independent risk factors for TBRIS. The AUC of the identification model was 0.778, with a sensitivity of 70.30% and a specificity of 78.90%. Conclusion: The findings in the present study suggested that most of the TBRIS patients experienced ischemic stroke within 3 months after the diagnosis of tuberculosis. And the more intensive immune response to the tuberculosis infection in the TBRIS group contributed to the initiation of platelet activation and to the development of a hypercoagulable state, which were attributed to the pathogenesis of TBRIS. Index of TBRIS equaling to 0.3234 facilitates clinicians to identify the pTB patients who were at higher risk for TBRIS, and allow physicians to take further effective measures to prevent ischemic stroke in patients with pTB. However, our findings will need to be confirmed by further studies.
