BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factor...BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factors for SAP complicated with AGI and their interactive effects.METHODS We selected 168 SAP patients admitted to our hospital between December 2019 and June 2022.They were divided into AGI group and non-AGI group according to whether AGI was present.Demographic data and laboratory test data were compared between the two groups.The risk factors for SAP with concomitant AGI were analyzed using multifactorial logistic regression,and an analysis of the interaction of the risk factors was performed.RESULTS The percentage of patients with multiple organ dysfunction syndrome,acute physiological and chronic health scoring system II(APACHE II)score,white blood cell count and creatinine(CRE)level was higher in the AGI group than in the non-AGI group.There was a statistically significant difference between the two groups(P<0.05).Logistic regression analysis indicated that an APACHE II score>15 and CRE>100μmol/L were risk factors for SAP complicating AGI.The interaction index of APACHE II score and CRE level was 3.123.CONCLUSION An APACHE II score>15 and CRE level>100μmol/L are independent risk factors for SAP complicated with AGI,and there is a positive interaction between them.展开更多
AIM:To identify the risk factors in predicting the outcome of acute-on-chronic hepatitis B liver failure patients.METHODS:We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus(A...AIM:To identify the risk factors in predicting the outcome of acute-on-chronic hepatitis B liver failure patients.METHODS:We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus(ACLF-HBV) and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy.Their demographic,clinical,and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test,Fisher's exact test,and a multiple logistic regression analysis.RESULTS:The study included 113 patients(87 men and 26 women) with a mean age of 49.84 years.Fiftytwo patients survived,and 61 patients died.Liver failure(85.2%),sepsis(34.4%),and multiple organ failure(39.3%) were the main causes of death.Multivariate analyses showed that Acute Physiology and Chronic Health Evaluation(APACHE) Ⅱ scores ≥ 12 [odds ratio(OR) = 7.160,95% CI:2.834-18.092,P < 0.001] and positive blood culture(OR = 13.520,95% CI:2.740-66.721,P = 0.001) on the day of diagnosis and model for end-stage liver disease(MELD) scores ≥ 28(OR = 8.182,95% CI:1.884-35.527,P = 0.005) after the first week of treatment were independent predictors of mortality.CONCLUSION:APACHE Ⅱ scores on the day of diagnosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLFHBV patients.展开更多
AIM:To evaluate the relationship between peptic ulcer disease(PUD) and acute pancreatitis.METHODS:A cohort of 78 patients with acute pancreatitis were included in this study.The presence of PUD and the Helicobacter py...AIM:To evaluate the relationship between peptic ulcer disease(PUD) and acute pancreatitis.METHODS:A cohort of 78 patients with acute pancreatitis were included in this study.The presence of PUD and the Helicobacter pylori(H.pylori) status were assessed by an endoscopic method.The severity of acute pancreatitis was assessed using Ranson's score,the Acute Physiology and Chronic Health Evaluation(APACHE) □ score,computed tomography severity indexand the clinical data during hospitalization,all of which were compared between the patients with and without PUD.The risk factors for PUD were also evaluated.RESULTS:Among 78 patients,41 patients(52.6%) with acute pancreatitis suffered from PUD,but only 13(31.7%) patients with PUD were infected by H.pylori.On univariate analysis,male gender,an etiology of alcohol-induced pancreatitis,a history of smoking or alcohol consumption,elevated triglyceride and C-reactive protein levels,and high APACHE □ score were signif icantly associated with PUD.However,on multivariate logistic regressionanalysis,the APACHE □ score(odds ratio:7.69;95% conf idence interval:1.78-33.33;P < 0.01) was found to be the only independent risk factor for PUD.CONCLUSION:Patients with acute pancreatitis are liable to suffer from PUD.PUD is associated with severeacute pancreatitis according to the APACHE □ score,and treatment for PUD should be considered for patients with severe acute pancreatitis.展开更多
目的探讨感染性休克患者血清肽酰基精氨酸脱亚胺酶2(peptidylarginine deiminase type 2,PAD2)表达水平与急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分的相关性。方法选取内江市第...目的探讨感染性休克患者血清肽酰基精氨酸脱亚胺酶2(peptidylarginine deiminase type 2,PAD2)表达水平与急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分的相关性。方法选取内江市第一人民医院2020年6月~2022年6月收治的103例感染性休克患者作为研究组,采用APACHEⅡ评分根据患者病情严重程度将其分为轻度组(n=9)、中度组(n=51)和重度组(n=13),另外选取103例同期在该院体检且一般资料与研究组患者相匹配的健康者作为对照组。采用酶联免疫吸附法测定感染性休克患者血清PAD2表达水平;采用Spearman法分析感染性休克患者血清PAD2表达水平与APACHEⅡ评分的相关性;采用Logistic回归分析影响感染性休克患者病情严重程度的相关因素;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析血清PAD2对中重度感染性休克的诊断价值。结果研究组与对照组血肌酐(137.52±9.01μmol/L vs 112.22±8.67μmol/L)水平及血小板计数(74.58±5.19 vs 86.02±5.34)×109/L比较,差异具有统计学意义(t=20.535,15.591,均P<0.05);研究组患者血清PAD2表达水平(42.47±6.22 ng/ml)高于对照组(38.59±5.31 ng/ml),差异具有统计学意义(t=4.815,P<0.05);感染性休克患者血清PAD2表达水平和APACHEⅡ评分均随病情严重程度的增加而逐渐升高(F=3.777,176.582,均P<0.05);感染性休克患者血清PAD2表达水平与APACHEⅡ评分呈正相关(r=0.859,P<0.05);血肌酐(OR=1.927)、PAD2(OR=1.803)及APACHEⅡ评分(OR=1.657)均为发生中重度感染性休克的危险因素(均P<0.05),血小板计数(OR=0.781)则是发生中重度感染性休克的保护因素(P<0.05)。血清PAD2诊断中重度感染性休克的曲线下面积(area under the curve,AUC)为0.880,敏感度、特异度分别为75.73%(95%CI:0.701~0.826)和90.29%(95%CI:0.851~0.935),对中重度感染性休克具有较高的诊断价值。结论血清PAD2表达水平与APACHEⅡ评分呈正相关,且对中重度感染性休克具有较好诊断价值。展开更多
目的探讨肺损伤预测评分(lung injury prediction score,LIPS)联合急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分对重症创伤性脑损伤(severe traumatic brain injury,sTBI)患者合并...目的探讨肺损伤预测评分(lung injury prediction score,LIPS)联合急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分对重症创伤性脑损伤(severe traumatic brain injury,sTBI)患者合并急性肺损伤(acute lung injury,ALI)的预测价值。方法回顾性选取2019年1月至2021年12月安徽医科大学附属省立医院收治的75例sTBI患者,根据是否合并ALI,将其分为ALI组(n=24)和非ALI组(n=51)。收集患者入院时的基本资料、实验室指标、APACHEⅡ评分、LIPS评分、格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分;采用Logistic回归分析sTBI患者合并ALI的危险因素,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价指标对sTBI合并ALI的预测价值。结果ALI组患者的APACHEⅡ评分、LIPS评分均显著高于非ALI组,GCS评分、红细胞体积分布宽度显著低于非ALI组(P<0.05)。Logistic回归分析显示,APACHEⅡ评分和LIPS评分升高及GCS评分降低均是sTBI合并ALI的独立危险因素(P<0.05)。ROC曲线分析显示,LIPS评分、APACHEⅡ评分诊断sTBI合并ALI的曲线下面积(area under the curve,AUC)分别为0.869和0.754;二者联合检测的AUC为0.916(95%CI:0.855~0.976),敏感度和特异性分别为83.4%和84.3%。结论LIPS评分联合APACHEⅡ评分可有效预测sTBI合并ALI的风险。展开更多
BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red bloo...BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of prognosis.Similarly,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.AIM To investigate the prognostic value of RDW for SAP patients.METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival group.RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between the two groups.The receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.RESULTS In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two groups.The coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,respectively.The areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the greatest.The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients.When the RDW-SD was greater than 45.5,the sensitivity for predicting prognosis was 77.8%and the specificity was 70.8%.Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis,similar to the APACHE II and SOFA scores.CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients.RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.展开更多
基金This study was approved by the Medical Ethics Committee of Longyan First Affiliated Hospital of Fujian Medical University(Approved No.LYREC2023-k016-01).
文摘BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factors for SAP complicated with AGI and their interactive effects.METHODS We selected 168 SAP patients admitted to our hospital between December 2019 and June 2022.They were divided into AGI group and non-AGI group according to whether AGI was present.Demographic data and laboratory test data were compared between the two groups.The risk factors for SAP with concomitant AGI were analyzed using multifactorial logistic regression,and an analysis of the interaction of the risk factors was performed.RESULTS The percentage of patients with multiple organ dysfunction syndrome,acute physiological and chronic health scoring system II(APACHE II)score,white blood cell count and creatinine(CRE)level was higher in the AGI group than in the non-AGI group.There was a statistically significant difference between the two groups(P<0.05).Logistic regression analysis indicated that an APACHE II score>15 and CRE>100μmol/L were risk factors for SAP complicating AGI.The interaction index of APACHE II score and CRE level was 3.123.CONCLUSION An APACHE II score>15 and CRE level>100μmol/L are independent risk factors for SAP complicated with AGI,and there is a positive interaction between them.
基金Supported by Tri-Service General Hospital,No.TSGH-C101-137
文摘AIM:To identify the risk factors in predicting the outcome of acute-on-chronic hepatitis B liver failure patients.METHODS:We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus(ACLF-HBV) and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy.Their demographic,clinical,and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test,Fisher's exact test,and a multiple logistic regression analysis.RESULTS:The study included 113 patients(87 men and 26 women) with a mean age of 49.84 years.Fiftytwo patients survived,and 61 patients died.Liver failure(85.2%),sepsis(34.4%),and multiple organ failure(39.3%) were the main causes of death.Multivariate analyses showed that Acute Physiology and Chronic Health Evaluation(APACHE) Ⅱ scores ≥ 12 [odds ratio(OR) = 7.160,95% CI:2.834-18.092,P < 0.001] and positive blood culture(OR = 13.520,95% CI:2.740-66.721,P = 0.001) on the day of diagnosis and model for end-stage liver disease(MELD) scores ≥ 28(OR = 8.182,95% CI:1.884-35.527,P = 0.005) after the first week of treatment were independent predictors of mortality.CONCLUSION:APACHE Ⅱ scores on the day of diagnosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLFHBV patients.
文摘AIM:To evaluate the relationship between peptic ulcer disease(PUD) and acute pancreatitis.METHODS:A cohort of 78 patients with acute pancreatitis were included in this study.The presence of PUD and the Helicobacter pylori(H.pylori) status were assessed by an endoscopic method.The severity of acute pancreatitis was assessed using Ranson's score,the Acute Physiology and Chronic Health Evaluation(APACHE) □ score,computed tomography severity indexand the clinical data during hospitalization,all of which were compared between the patients with and without PUD.The risk factors for PUD were also evaluated.RESULTS:Among 78 patients,41 patients(52.6%) with acute pancreatitis suffered from PUD,but only 13(31.7%) patients with PUD were infected by H.pylori.On univariate analysis,male gender,an etiology of alcohol-induced pancreatitis,a history of smoking or alcohol consumption,elevated triglyceride and C-reactive protein levels,and high APACHE □ score were signif icantly associated with PUD.However,on multivariate logistic regressionanalysis,the APACHE □ score(odds ratio:7.69;95% conf idence interval:1.78-33.33;P < 0.01) was found to be the only independent risk factor for PUD.CONCLUSION:Patients with acute pancreatitis are liable to suffer from PUD.PUD is associated with severeacute pancreatitis according to the APACHE □ score,and treatment for PUD should be considered for patients with severe acute pancreatitis.
文摘目的探讨感染性休克患者血清肽酰基精氨酸脱亚胺酶2(peptidylarginine deiminase type 2,PAD2)表达水平与急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分的相关性。方法选取内江市第一人民医院2020年6月~2022年6月收治的103例感染性休克患者作为研究组,采用APACHEⅡ评分根据患者病情严重程度将其分为轻度组(n=9)、中度组(n=51)和重度组(n=13),另外选取103例同期在该院体检且一般资料与研究组患者相匹配的健康者作为对照组。采用酶联免疫吸附法测定感染性休克患者血清PAD2表达水平;采用Spearman法分析感染性休克患者血清PAD2表达水平与APACHEⅡ评分的相关性;采用Logistic回归分析影响感染性休克患者病情严重程度的相关因素;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析血清PAD2对中重度感染性休克的诊断价值。结果研究组与对照组血肌酐(137.52±9.01μmol/L vs 112.22±8.67μmol/L)水平及血小板计数(74.58±5.19 vs 86.02±5.34)×109/L比较,差异具有统计学意义(t=20.535,15.591,均P<0.05);研究组患者血清PAD2表达水平(42.47±6.22 ng/ml)高于对照组(38.59±5.31 ng/ml),差异具有统计学意义(t=4.815,P<0.05);感染性休克患者血清PAD2表达水平和APACHEⅡ评分均随病情严重程度的增加而逐渐升高(F=3.777,176.582,均P<0.05);感染性休克患者血清PAD2表达水平与APACHEⅡ评分呈正相关(r=0.859,P<0.05);血肌酐(OR=1.927)、PAD2(OR=1.803)及APACHEⅡ评分(OR=1.657)均为发生中重度感染性休克的危险因素(均P<0.05),血小板计数(OR=0.781)则是发生中重度感染性休克的保护因素(P<0.05)。血清PAD2诊断中重度感染性休克的曲线下面积(area under the curve,AUC)为0.880,敏感度、特异度分别为75.73%(95%CI:0.701~0.826)和90.29%(95%CI:0.851~0.935),对中重度感染性休克具有较高的诊断价值。结论血清PAD2表达水平与APACHEⅡ评分呈正相关,且对中重度感染性休克具有较好诊断价值。
文摘目的:观察西维来司他钠治疗脓毒症伴急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的效果。方法:将阳江市人民医院2023年6—12月收治的脓毒症伴ARDS患者总计60例,以随机数字表法分成两组,各30例,其中一组以常规治疗为对照组,另一组以常规治疗配合西维来司他钠治疗为研究组,均治疗7 d。比较两组血清学指标(炎症指标、血小板计数、血气指标),急性生理和慢性健康状况Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、肺损伤评分,序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分,机械通气时间及病死率。结果:治疗前,两组炎症指标、血气指标、血小板计数、APACHEⅡ评分、肺损伤评分、SOFA评分相比,差异均无统计学意义(P>0.05);治疗后,两组血清炎症指标、动脉血二氧化碳分压、APACHEⅡ评分、肺损伤评分、SOFA评分均较治疗前显著下降,且研究组均低于对照组,动脉血氧饱和度及血小板计数均较治疗前提升,研究组均高于对照组,差异均有统计学意义(P<0.05)。研究组机械通气时间短于对照组,差异有统计学意义(P<0.05)。两组的14 d病死率相比,差异无统计学意义(P>0.05)。结论:脓毒症伴急性呼吸窘迫综合征患者在接受西维来司他钠治疗,可显著减轻患者的血清炎症指标水平,改善血气指标,减轻肺损伤,缩短患者的机械通气时间,效果理想。
文摘目的探讨肺损伤预测评分(lung injury prediction score,LIPS)联合急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分对重症创伤性脑损伤(severe traumatic brain injury,sTBI)患者合并急性肺损伤(acute lung injury,ALI)的预测价值。方法回顾性选取2019年1月至2021年12月安徽医科大学附属省立医院收治的75例sTBI患者,根据是否合并ALI,将其分为ALI组(n=24)和非ALI组(n=51)。收集患者入院时的基本资料、实验室指标、APACHEⅡ评分、LIPS评分、格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分;采用Logistic回归分析sTBI患者合并ALI的危险因素,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价指标对sTBI合并ALI的预测价值。结果ALI组患者的APACHEⅡ评分、LIPS评分均显著高于非ALI组,GCS评分、红细胞体积分布宽度显著低于非ALI组(P<0.05)。Logistic回归分析显示,APACHEⅡ评分和LIPS评分升高及GCS评分降低均是sTBI合并ALI的独立危险因素(P<0.05)。ROC曲线分析显示,LIPS评分、APACHEⅡ评分诊断sTBI合并ALI的曲线下面积(area under the curve,AUC)分别为0.869和0.754;二者联合检测的AUC为0.916(95%CI:0.855~0.976),敏感度和特异性分别为83.4%和84.3%。结论LIPS评分联合APACHEⅡ评分可有效预测sTBI合并ALI的风险。
基金Supported by Health and Birth Control Committee of Liaoning Province,China
文摘BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of prognosis.Similarly,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.AIM To investigate the prognostic value of RDW for SAP patients.METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival group.RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between the two groups.The receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.RESULTS In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two groups.The coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,respectively.The areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the greatest.The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients.When the RDW-SD was greater than 45.5,the sensitivity for predicting prognosis was 77.8%and the specificity was 70.8%.Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis,similar to the APACHE II and SOFA scores.CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients.RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.