Nutritional status and prognostic factors for mortality in patients admitted to emergency department observation units:a national multi-center study in China

BACKGROUND:Nutritional risk is common among patients admitted to the emergency department and is associated with adverse clinical outcomes.Despite its large population,few comprehensive studies have been conducted in China concerning the nutritional status of patients admitted to emergency department observation units(EDOUs).METHODS:Patients admitted to EDOUs of 90 tertiary hospitals in China between June 2020 and December 2020 were enrolled.Demographic information,laboratory parameters,nutritional support therapies,and 28-day mortality were recorded.Risk factors for mortality were examined using multi-variateadjusted logistic regression analysis.Receiver operating characteristic(ROC)curves for each predictor of mortality were plotted,and the area under the ROC(AUROC)curves was compared.RESULTS:A total of 2,005 eligible patients were finally enrolled.At the 28-day follow-up,1,911 patients survived,and 94 died.The group with a Nutritional Risk Screening 2002(NRS 2002)score of 3-4 points was the largest(52.01%).The number of patients receiving oral nutritional supplements,enteral nutrition(EN),parenteral nutrition(PN),and the combination of EN and PN was 425,314,853,and 413,respectively.Among the total,77.55%of patients had nutritional risk(NRS 2002≥3).The proportion of patients with high nutritional risk(NRS2002≥5)in the age group>80 years was significantly higher than that in the age group 66-80 years(29.00%vs.23.93%,P=0.032),but not significantly higher than that in the age group 18-65 years(29.00%vs.26.54%,P=0.449).Logistic regression analysis revealed that heart failure(odds ratio[OR]1.856,95%confidence interval[CI]1.087-3.167,P=0.023),consciousness(OR 2.967,95%CI 1.894-4.648,P<0.001),Acute Physiology and Chronic Health Evaluation II(APACHE II)score(OR 1.037,95%CI 1.017-1.058,P<0.001),NRS 2002 score(OR 1.286,95%CI 1.115-1.483,P=0.001),and Mini Nutritional Assessment-Short Form score(OR 0.946,95%CI 0.898-0.997,P=0.039)were all independent risk factors for 28-day mortality.APACHE II and NRS 2002 scores were superior to other predictors according to the comparison of AUROC.CONCLUSIONS:Nutritional risk is prevalent among older patients in EDOUs in China.APACHE II and NRS 2002 scores are important risk factors for mortality in patients admitted to the EDOU.Timely and appropriate nutritional screening and support measures are critical to reduce patients’length of hospital stay and mortality.

Outcome prediction value of National Early Warning Score in septic patients with community-acquired pneumonia in emergency department: A single-center retrospective cohort study

BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with community-acquired pneumonia(CAP)compared with other commonly used severity scores(CURB65,Pneumonia Severity Index[PSI],Sequential Organ Failure Assessment[SOFA],quick SOFA[qSOFA],and Mortality in Emergency Department Sepsis[MEDS])and admission lactate level.METHODS:Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA≥2 from baseline were enrolled.Demographic characteristics were collected.The primary outcome was the 28-day mortality after admission,and the secondary outcome included ICU admission and mechanical ventilation use.Outcome prediction value of parameters above was compared using receiver operating characteristics(ROC)curves.Cox regression analyses were carried out to determine the risk factors for the 28-day mortality.Kaplan-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and NEWS.RESULTS:Among the 340 enrolled patients,90 patients were dead after a 28-day follow-up,62 patients were admitted to ICU,and 84 patients underwent mechanical ventilation.Among single predictors,NEWS achieved the largest area under the receiver operating characteristic(AUROC)curve in predicting the 28-day mortality(0.861),ICU admission(0.895),and use of mechanical ventilation(0.873).NEWS+lactate,similar to MEDS+lactate,outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality(AUROC 0.866)and ICU admission(AUROC 0.905),while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation(AUROC 0.886).Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU admission.CONCLUSIONS:NEWS could be a valuable predictor in septic patients with CAP in emergency departments.Admission lactate did not predict well the outcomes or improve the severity scores.A qSOFA≥2 and a NEWS≥9 were strongly associated with the 28-day mortality,ICU admission,and mechanical ventilation of septic patients with CAP in the emergency departments.

Clinical characteristics of patients with Haff disease after eating crayfish

BACKGROUND: The study aimed to explore the clinical presentations, laboratory findings, treatments and prognosis of patients with Haff disease after eating crayfi sh. METHODS: Sixteen patients with Haff disease after eating crayfish were admitted to the Emergency Department of Beijing Chao-yang Hospital between June 2013 and August 2017. Clinical data was retrospectively analyzed. RESULTS: Alcohol consumption and exercise were found to be most commonly associated with the onset of rhabdomyolysis after consuming crayfi sh. Most patients were young adults and the symptoms mostly occurred within 24 hours of consumption of crayfi sh. Clinical symptoms included myalgia (100%), fatigue (87.5%), nausea (43.8%), dizziness (62.5%), chest distress (37.5%) and fever (18.8%). Also found after laboratory testing was elevations in the levels of creatine kinase (11,376±5,535 U/L), myoglobin (350±158 ng/mL), lactate dehydrogenase (6,539±3,180 U/L), alanine transaminase (174±71 U/L) and aspartate aminase (348±100 U/L). The incidence of renal dysfunction was low (6.25%), and all 16 patients had a good prognosis. CONCLUSION: Patients with Haff disease exhibited typical symptoms after consuming crayfish, and laboratory findings gave highly accurate diagnostic results. The development of rhabdomyolysis was considered to be associated with alcohol consumption and exercise, but further studies are needed to demonstrate its relationship with crayfi sh consumption. Compared with other causes of rhabdomyolysis, rhabdomyolysis after crayfi sh consumption has fewer complications and better prognosis.

Empyema and mediastinal abscess in pyriform sinus f istula: A case report

Dear editor,Though notorious for its tendency to induce recurrent neck abscess,pyriform sinus fistula is of importance despite its rarity.It usually presents diagnostic and therapeutic challenges.Because of post-infectious fi brosis,the embryologic origin of pyriform sinus fi stula is diffi cult to appreciate in certain cases.Here we present a case with empyema and mediastinal abscess caused by pyriform sinus fi stula and share our experience in the treatment of this patient.

Clinical characteristics of patients with black widow spider bites: A report of 59 patients and single-center experience

Dear editor,The black widow spider species, also known as the Latrodectus species by its biological nomenclature, is one of more than 40,000 different spider species and one of the most common poisonous species to humans.[1] It is reported to be responsible for most of the clinically significant envenomation among all species of spiders in the USA.

Retroperitoneal Fibrosis： A Retrospective Clinical Data Analysis of 30 Patients in a 10-year Period

Background:Retroperitoneal fibrosis (RPF) is an uncommon disease that is characterized by development of fibrosclerotic tissues involving retroperitoneal structures.This study aimed to investigate the clinical features of 30 patients with RPF in a single center in Beijing in a 10-year period.Methods:We retrospectively analyzed clinical data on demographic characteristics,clinical manifestations,laboratory findings,radiological findings,modalities of treatments,outcomes and prognosis of 30 patients with RPF.Patients were treated in Beijing Chao-Yang Hospital between January 2003 and December 2013.Results:The mean age of patients with RPF was 56.7 ± 14.4 years.Twenty-three patients were men and seven patients were women.Acute phase reactants were elevated in most patients.Rheumatic factor was positive in 4/25 (16.0％) patients,and antinuclear antibody was positive in 6/22 (27.3％) patients.Elevation of IgG4 was observed in 9/22 (40.9％) patients.The most common type was I + Ⅲ (n =13),followed by Ⅰ + Ⅱ +Ⅲ (n =12).Five patients undertook an 18F-fluoro-deoxy-D-glucose positron emission tomography examination and increased uptake was detected in four patients.Eight patients received combination therapy with glucocorticoids and tamoxifen.Surgical intervention treatments included intraureteral double-J stent implantation (n =26),percutaneous nephrostomy (n =2),open ureterolysis and intraperitonealization of the ureters (n =5) and Iaparoscopic ureterolysis and intraperitonealization of the ureters (n =5).Three patients underwent hemodialysis because of renal failure.Conclusions:Clinical characteristics of RPF patients in our study are similar to those previously reported.Steroids and immunosuppressive therapy combined with ureterolysis could be a viable choice of treatment for RPF.More prospective,multi-center studies with a longer follow-up are warranted.

Role of R.E.N.A.L.Nephrometry Score in Laparoscopic Partial Nephrectomy

Background：Preoperative anatomical scoring system is conducive to comparison between treatment options and evaluation of postoperative outcomes in patients with small renal tumors.This study aimed to evaluate the clinical application efficacy of the R.E.N.A.L.nephrometry score （RNS） in predicting perioperative outcomes in patients with renal tumor who underwent laparoscopic partial nephrectomy （LPN）.Methods：The clinical data of 139 patients with renal tumors who underwent LPN between 2009 and 2015 were collected and analyzed.Patients were divided into three groups according to their RNS （low,moderate,and high）.Clinical characteristics including perioperative variables,complications,and RNS were compared to evaluate the differences between the three groups.Multivariable logistic regression analysis was used to analyze the risk factors of postoperative complications.Results：According to the RNS,there were 74,50,and 15 patients in the low,moderate,and high RNS groups,respectively.There were significant differences in estimated blood loss （EBL;χ^2 =7.285,P =0.026）,warm ischemia time （WIT;χ^2 =13.718,P =0.001）,operation time （OT;χ^2 =6.882,P =0.032）,perioperative creatinine clearance change （PCCC;χ^2 =6.206,P =0.045）,and number of patients with complications （NPC;P =0.002） among the three groups.The values for EBL,WIT,OT,PCCC,and NPC for patients in the high RNS group were higher than those for patients in the low RNS group.After adjustment for OT,WIT,and EBL,RNS was statistically significantly associated with the risk of postoperative complications in a multivariable logistic regression model （odds ratio =1.541,95% confidence interval：1.0592.242,P =0.024）.Conclusions：The RNS is a valuable tool for evaluating the complexity of renal tumor anatomy.It can aid surgeons in preoperative decision-making concerning management therapy.Future multicenter,large sample size studies are warranted for evaluating its predicting performance of perioperative outcomes.