An early scoring system to predict mechanical ventilation for botulism: a single-center-based study

BACKGROUND: Early identification of patients requiring ventilator support will be beneficial for the outcomes of botulism. The present study aimed to establish a new scoring system to predict mechanical ventilation(MV) for botulism patients.METHODS: A single-center retrospective study was conducted to identify risk factors associated with MV in botulism patients from 2007 to 2022. Univariate analysis and multivariate logistic regression analysis were used to screen out risk factors for constructing a prognostic scoring system. The area under the receiver operating characteristic(ROC) curve was calculated.RESULTS: A total of 153 patients with botulism(66 males and 87 females, with an average age of 43 years) were included. Of these, 49 patients(32.0%) required MV, including 21(13.7%) with invasive ventilation and 28(18.3%) with non-invasive ventilation. Multivariate analysis revealed that botulinum toxin type, pneumonia, incubation period, degree of hypoxia, and severity of muscle involvement were independent risk factors for MV. These risk factors were incorporated into a multivariate logistic regression analysis to establish a prognostic scoring system. Each risk factor was scored by allocating a weight based on its regression coefficient and rounded to whole numbers for practical utilization([botulinum toxin type A: 1], [pneumonia: 2], [incubation period ≤1 day: 2], [hypoxia <90%: 2], [severity of muscle involvement: grade Ⅱ, 3;gradeⅢ, 7;grade IV, 11]). The scoring system achieved an area under the ROC curve of 0.82(95% CI 0.75–0.89, P<0.001). At the optimal threshold of 9, the scoring system achieved a sensitivity of 83.7% and a specificity of 70.2%.CONCLUSION: Our study identified botulinum toxin type, pneumonia, incubation period, degree of hypoxia, and severity of muscle involvement as independent risk factors for MV in botulism patients. A score ≥9 in our scoring system is associated with a higher likelihood of requiring MV in botulism patients. This scoring system needs to be validated externally before it can be applied in clinical settings.

急性心肌梗死合并心源性休克患者预后因素分析97例

目的分析影响急性心肌梗死(AMI)合并心源性休克(CS)患者预后的因素,为判断预后提供参考并提出可能改善预后的措施。方法回顾性分析2018年12月至2021年12月于河北医科大学第二医院急诊医学科就诊的AMI合并CS患者的临床资料,包括性别、年龄、身体质量指数(BMI);既往史(吸烟、冠心病、心律失常、糖尿病、高血压、高脂血症、脑血管病);APACHEⅡ评分、入院后24 h内最高血管活性药物评分(VIS)、入院后24 h内最快HR;入院后24 h内最差辅助检查值:血乳酸、白细胞计数(WBC)、心肌肌钙蛋白I(cTnI)、丙氨酸转氨酶(ALT)、总胆红素(TBil)、肌酐(Cr)、血清钾、左室舒张末期内径(LVEDD)、左室射血分数(LVEF);是否应用持续性肾脏替代治疗(CRRT)、是否应用主动脉内球囊反搏(IABP)、是否应用体外膜肺氧合(ECMO)等。根据发病30 d的预后情况将患者分为存活组和死亡组,单因素分析比较2组上述指标的差异,采用Logistic回归分析影响AMI合并CS患者预后的独立危险因素,并绘制ROC曲线评价危险因素对患者预后的预测价值。根据患者是否应用ECMO、IABP,分别分为非ECMO组与ECMO组、非IABP组与IABP组,比较APACHE-Ⅱ评分、VIS评分的差异。结果97例患者中30d存活62例(63.9%),死亡35例(36.1%);与存活组比较,死亡组APACHE-Ⅱ评分、VIS评分、WBC、血乳酸均明显升高,死亡组应用IABP比例均明显升高;Logistic回归分析显示WBC、血乳酸是影响AMI合并CS患者30 d预后的独立危险因素,优势比(OR)和95%可信区间(95%CI)分别为1.137(1.012~1.278)、1.166(1.025~1.326),P<0.05;ROC曲线分析显示WBC对应的AUC为0.710,截断值为15.35×10^(9)/L时,敏感度为60.0%,特异度为77.4%,血乳酸对应的AUC为0.756,截断值为6.05 mmol/L时,敏感度为85.7%,特异度为67.7%;与非ECMO组比较,ECMO组APACHE-Ⅱ评分、VIS评分均明显升高;与非IABP组比较,IABP组VIS评分明显升高(均P<0.05)。结论WBC、血乳酸是影响AMI合并CS患者预后的独立危险因素,当入院24小时内WBC最高值>15.35×10^(9)/L、血乳酸最高值>6.05 mmol/L时均提示不良预后。IABP、ECMO等支持手段不能改善AMI合并CS患者预后,与IABP、ECMO支持的患者更为危重有关。