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.

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.

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.