Background: Sepsis-3 definitions have been published recently;however, their diagnostic value remains controversial. This study was to assess the accuracy of Sepsis-3 definitions compared to Sepsis-1 definitions by st...Background: Sepsis-3 definitions have been published recently;however, their diagnostic value remains controversial. This study was to assess the accuracy of Sepsis-3 definitions compared to Sepsis-1 definitions by stratifying mortality among adult critically ill patients with suspected infection. Methods: A multicenter, prospective cohort study was conducted from November 10, 2017 to October 10, 2018, in five Intensive Care Units (ICUs) at four teaching hospitals. Thirty-day mortality was compared across categories for both Sepsis-3 definitions and Sepsis-1 definitions, which were evaluated by logistic regression analysis followed by measurement of the area under the receiver operating characteristic curve (AUROC) for predicting 30-day mortality rates. Results: Of the 749 enrolled patients, 644 (85.9%) were diagnosed with sepsis according to the Sepsis-1 definitions. Among those patients, 362 were diagnosed with septic shock (362/749, 48.3%). However, according to the Sepsis-3 definitions, there were 483 patients with a diagnosis of sepsis (483/749, 64.5%), among whom 299 patients were diagnosed with septic shock (299/749, 39.9%). According to the Sepsis-3 definitions, sepsis (sepsis and septic shock) patients had higher 30-day mortality (41.8%) than sepsis patients according to the Sepsis-1 definitions (31.8%,χ^2 = 5.552, P = 0.020). The AUROC of systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) scores with regard to 30-day mortality rates were 0.609 (0.566-0.652) and 0.694 (0.654-0.733), respectively. However, the AUROC of SOFA scores (0.828 [0.795-0.862]) were significantly higher than that of SIRS or qSOFA scores (P < 0.001). Conclusion: In adult critically ill patients with suspected infection, the Sepsis-3 definitions were relatively accurate in stratifying mortality and were superior to the Sepsis-1 definitions.展开更多
To the Editor： The symptoms of cerebral fat embolism （CFE） are often a triad of acute respiratory failure, unconsciousness, and petechial rash after a symptom-free interval of 12-24 h following trauma. Although cas...To the Editor： The symptoms of cerebral fat embolism （CFE） are often a triad of acute respiratory failure, unconsciousness, and petechial rash after a symptom-free interval of 12-24 h following trauma. Although cases of CFE have been reported since the 1960s, to our knowledge, a few reports have discussed the beneficial effects of corticosteroids for CFE treatment though corticosteroids are generally believed to have preventative effects. Here, we report a case of CFE in a 63-year-old woman who had fractures of the right tibia and fibula without cranial trauma. We gave her intravenous injections of dexamethasone lbr 11 days starting from the 1th day of trauma, and the patient experienced good recovery.展开更多
基金Funding： This study was funded by the National Natural Science Foundation of China （81260488 and 81560669）, KeyLab Construction Project of the Educational Department of Guizhou Province （Project No. Guizhou EducationCooperation KY[2014]212） , Science Inovative Talent Team for Medicinal Insect Research and Development in Zunyi（Zunyi shi ke he 2015-40） and Modernization of Traditional Chinese Medicine in Guizhou Province high-tech researchand development projects （Qian ke he ZY 2012-2009）.
基金grants from Social Development Funds of Jiangsu Province (No. BE2017691)National Natural Science Foundations of China (No. 81670065)Social Development Funds of Yangzhou City (No. YZ2017086).
文摘Background: Sepsis-3 definitions have been published recently;however, their diagnostic value remains controversial. This study was to assess the accuracy of Sepsis-3 definitions compared to Sepsis-1 definitions by stratifying mortality among adult critically ill patients with suspected infection. Methods: A multicenter, prospective cohort study was conducted from November 10, 2017 to October 10, 2018, in five Intensive Care Units (ICUs) at four teaching hospitals. Thirty-day mortality was compared across categories for both Sepsis-3 definitions and Sepsis-1 definitions, which were evaluated by logistic regression analysis followed by measurement of the area under the receiver operating characteristic curve (AUROC) for predicting 30-day mortality rates. Results: Of the 749 enrolled patients, 644 (85.9%) were diagnosed with sepsis according to the Sepsis-1 definitions. Among those patients, 362 were diagnosed with septic shock (362/749, 48.3%). However, according to the Sepsis-3 definitions, there were 483 patients with a diagnosis of sepsis (483/749, 64.5%), among whom 299 patients were diagnosed with septic shock (299/749, 39.9%). According to the Sepsis-3 definitions, sepsis (sepsis and septic shock) patients had higher 30-day mortality (41.8%) than sepsis patients according to the Sepsis-1 definitions (31.8%,χ^2 = 5.552, P = 0.020). The AUROC of systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) scores with regard to 30-day mortality rates were 0.609 (0.566-0.652) and 0.694 (0.654-0.733), respectively. However, the AUROC of SOFA scores (0.828 [0.795-0.862]) were significantly higher than that of SIRS or qSOFA scores (P < 0.001). Conclusion: In adult critically ill patients with suspected infection, the Sepsis-3 definitions were relatively accurate in stratifying mortality and were superior to the Sepsis-1 definitions.
文摘To the Editor： The symptoms of cerebral fat embolism （CFE） are often a triad of acute respiratory failure, unconsciousness, and petechial rash after a symptom-free interval of 12-24 h following trauma. Although cases of CFE have been reported since the 1960s, to our knowledge, a few reports have discussed the beneficial effects of corticosteroids for CFE treatment though corticosteroids are generally believed to have preventative effects. Here, we report a case of CFE in a 63-year-old woman who had fractures of the right tibia and fibula without cranial trauma. We gave her intravenous injections of dexamethasone lbr 11 days starting from the 1th day of trauma, and the patient experienced good recovery.
