Predictors of the outcomes of acute-on-chronic hepatitis B liver failure

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.

Risk factors and their interactive effects on severe acute pancreatitis complicated with acute gastrointestinal injury

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.

Prognostic value of red blood cell distribution width for severe acute pancreatitis

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.

Prediction of the severity of acute pancreatitis on admission by urinary trypsinogen activation peptide: A meta-analysis

AIM: To undertake a meta-analysis on the value of urinary trypsinogen activation peptide (uTAP) in predicting severity of acute pancreatitis on admission. METHODS: Major databases including Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in the Cochrane Library were searched to identify all relevant studies from January 1990 to January 2013. Pooled sensitivity, specificity and the diagnostic odds ratios (DORs) with 95%CI were calculated for each study and were compared to other systems/biomarkers if mentioned within the same study. Summary receiver-operating curves were conducted and the area under the curve (AUC) was evaluated. RESULTS: In total, six studies of uTAP with a cut-off value of 35 nmol/L were included in this meta-analysis. Overall, the pooled sensitivity and specificity of uTAP for predicting severity of acute pancreatitis, at time of admission, was 71% and 75%, respectively (AUC = 0.83, DOR = 8.67, 95%CI: 3.70-20.33). When uTAP was compared with plasma C-reactive protein, the pooled sensitivity, specificity, AUC and DOR were 0.64 vs 0.67, 0.77 vs 0.75, 0.82 vs 0.79 and 6.27 vs 6.32, respectively. Similarly, the pooled sensitivity, specificity, AUC and DOR of uTAPvs Acute Physiology and Chronic Health Evaluation Ⅱ within the first 48 h of admission were found to be 0.64 vs 0.69, 0.77 vs 0.61, 0.82 vs 0.73 and 6.27vs 4.61, respectively. CONCLUSION: uTAP has the potential to act as a stratification marker on admission for differentiating disease severity of acute pancreatitis.

Clinical significance of melatonin concentrations in predicting the severity of acute pancreatitis

AIM: To assess the value of plasma melatonin in pre-dicting acute pancreatitis when combined with the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and bedside index for severity in acute pancreatitis (BISAP) scoring systems. METHODS: APACHEⅡ and BISAP scores were calculated for 55 patients with acute physiology (AP) in the first 24 h of admission to the hospital. Additionally, morning (6:00 AM) serum melatonin concentrations were measured on the first day after admission. According to the diagnosis and treatment guidelines for acute pancreatitis in China, 42 patients suffered mild AP (MAP). The other 13 patients developed severe AP (SAP). A total of 45 healthy volunteers were used in this study as controls. The ability of melatonin and the APACHEⅡ and BISAP scoring systems to predict SAP was evaluated using a receiver operating characteristic (ROC) curve. The optimal melatonin cutoff concentration for SAP patients, based on the ROC curve, was used to classify the patients into either a high concen-tration group (34 cases) or a low concentration group (21 cases). Differences in the incidence of high scores, according to the APACHEⅡ and BISAP scoring sys- tems, were compared between the two groups. RESULTS: The MAP patients had increased melatonin levels compared to the SAP (38.34 ng/L vs 26.77 ng/L) (P = 0.021) and control patients (38.34 ng/L vs 30.73 ng/L) (P = 0.003). There was no significant difference inmelatoninconcentrations between the SAP group and the control group. The accuracy of determining SAP based on the melatonin level, the APACHEⅡ score and the BISAP score was 0.758, 0.872, and 0.906, respectively, according to the ROC curve. A melatonin concentration ≤ 28.74 ng/L was associated with an increased risk of developing SAP. The incidence of high scores (≥ 3) using the BISAP system was significantly higher in patients with low melatonin concentration (≤ 28.74 ng/L) compared to patients with high melatonin concentration (> 28.74 ng/L) (42.9% vs 14.7%, P = 0.02). The incidence of high APACHEⅡ scores (≥ 10) between the two groups was not significantly different. CONCLUSION: The melatonin concentration is closely related to the severity of AP and the BISAP score. Therefore, we can evaluate the severity of disease by measuring the levels of serum melatonin.

Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis

BACKGROUND Acute mesenteric venous thrombosis(AMVT)can cause a poor prognosis.Prompt transcatheter thrombolysis(TT)can achieve early mesenteric revascularization.However,irreversible intestinal ischemia still occurs and the mechanism is still unclear.AIM To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT.METHODS The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed.We compared patients who required resection of irreversible intestinal ischemia to patients who did not require.RESULTS Among 58 patients,prompt TT was carried out 28.5 h after admission.A total of 42(72.4%)patients underwent arteriovenous combined thrombolysis,and 16(27.6%)underwent arterial thrombolysis alone.The overall 30-d mortality rate was 8.6%.Irreversible intestinal ischemia was indicated in 32(55.2%)patients,who had a higher 30-d mortality and a longer in-hospital stay than patients without resection.The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation(APACHE)II score(odds ratio=2.368,95% confidence interval:1.047-5.357,P=0.038)and leukocytosis(odds ratio=2.058,95% confidence interval:1.085-3.903,P=0.027).Using the receiver operating characteristic curve,the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12×10^9/L,respectively.CONCLUSION Prompt TT could achieve a favorable outcome in AMVT patients.High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia.Therefore,close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia,in whom ultimately surgical resection is required,before the initiation of TT.

Association between acute pancreatitis and peptic ulcer disease

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.

Different phenotypes of monocytes in patients with newonset mild acute pancreatitis

AIM To evaluate the numbers of different subsets of monocytes and their associations with the values of clinical measures in mild acute pancreatitis(MAP) patients.METHODS The study included one group of 13 healthy controls and another group of 24 patients with new-onset MAP. The numbers of different subsets of monocytes were examined in these two groups of subjects by flow cytometry. The concentrations of plasma interleukin(IL)-10 and IL-12 were determined by cytometric bead array. The acute physiology and chronic health evaluation(APACHE) II scores of individual patients were evaluated, and the levels of plasma C-reactive protein(CRP) as well as the activities of amylase and lipase were measured. RESULTS In comparison with that in the controls, significantly increased numbers of CD14+CD163-, CD14+CD163-MAC387+ M1 monocytes, but significantly reduced numbers of CD14+CD163+IL-10+ M2 monocytes were detected in the MAP patients(P < 0.01 or P < 0.05). Furthermore, significantly higher levels of plasma IL-10 and IL-12 were observed in the MAP patients(P < 0.01 for all). More importantly, the levels of plasma CRP were positively correlated with the numbers of CD14+CD163-(R = 0.5009, P = 0.0127) and CD14+CD163-MAC387+(R = 0.5079, P = 0.0113) M1 monocytes and CD14+CD163+CD115+ M2 monocytes(R = 0.4565, P = 0.0249) in the patients. The APACHE II scores correlated with the numbers of CD14+CD163+CD115+(R = 0.4581, P = 0.0244) monocytes and the levels of plasma IL-10(R = 0.4178, P = 0.0422) in the MAP patients. However, there was no significant association among other measures tested in this population. CONCLUSION Increased numbers of CD14+CD163- and CD14+ CD163-MAC387+ monocytes may contribute to the pathogenesis of MAP, and increased numbers of CD14+CD163+CD115+ monocytes may be a biomarker for evaluating the severity of MAP.

乳酸/白蛋白比值对肝硬化并发脓毒症患者预后的影响研究:基于MIMIC-Ⅳ数据库

目的 探讨乳酸/白蛋白比值(LAR)对肝硬化并发脓毒症患者预后的评估价值。方法 回顾性纳入MIMIC-Ⅳ数据库中2012~2018年期间贝斯以色列女执事医疗中心(美国马萨诸塞州波士顿)肝硬化并发脓毒症的重症监护病房(ICU)患者,根据是否死亡分为存活组(550例)和死亡组(249例)。应用t检验及χ~2检验分析死亡组和存活组的临床特征差异,采用单因素及多因素Logistic回归分析患者预后不良的危险因素,通过Pearson分析探究LAR和序贯器官衰竭评分(SOFA)、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分的相关性,绘制受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),并根据ROC曲线的敏感度和特异度确定最佳临界值。收集2017年1月1日至2022年12月31日入住福建医科大学附属第一医院ICU的肝硬化并发脓毒症患者的临床数据,对LAR的诊断效能进行进一步验证。结果 与死亡组比较,存活组年龄、心率、平均动脉压、血红蛋白、白蛋白、血小板、白细胞、乳酸、LAR、SOFA评分和APACHEⅡ评分等差异均有统计学意义(均为P<0.001)。单因素及多因素Logistic回归分析显示,LAR(OR=1.285,P<0.001)、SOFA评分(OR=1.016,P=0.001)和APACHEⅡ评分(OR=1.024,P=0.003)是肝硬化并发脓毒症患者预后不良的独立危险因素。LAR与SOFA评分的相关性良好(r=0.726,P=0.001)。ROC曲线分析显示,LAR预测患者预后的曲线下面积是0.804,以2.7为截断值时,敏感度(67.1%)和特异度(83.6%)最好。加以验证的ROC分析结果显示,LAR的曲线下面积是0.790,以1.3为截断值的敏感度和特异度分别是73.7%和74.5%。结论 LAR对肝硬化并发脓毒症患者的预后具有良好的预测价值。

APACHE Ⅳ评分对严重出血性脑卒中患者机械通气治疗的影响——一项来自eICU数据库的回顾性观察性研究

目的通过急性生理学与慢性健康状况评分IV(APACHE Ⅳ)评估机械通气(MV)治疗对严重出血性脑卒中(SHS)患者总病死率的影响,并分析SHS患者MV的时机。方法选取美国急诊重症监护病房数据库(eICU数据库)的个体患者数据(200859例),最终确定首要诊断为SHS患者(997例)进行统计分析,根据是否接受MV,采用1∶1倾向性评分匹配(PSM),接受MV和非MV(NMV)两组分别纳入236例,比较并分析匹配前后患者的独立预测因素,使用独立预测因素检验整个队列预测的病死率和观察到的病死率与MV之间的相互作用。结果276例(27.7%)的患者接受了MV治疗。在整个队列的多变量Logistic回归中,MV、APACHE Ⅳ评分是影响SHS患者死亡的独立危险因素〔优势比(OR)及其95%可信区间(95%CI)分别为5.616(3.785~8.334)和1.036(1.028~1.044),均P<0.001〕。在NMV组多变量Logistic回归中,APACHE Ⅳ评分〔OR(95%CI)为1.050(1.039~1.062)〕是总病死率的独立预测因素,并被用于预测整个队列的住院死亡风险。APACHE Ⅳ用于预测整个队列住院死亡风险的受试者工作特征(ROC)曲线下面积(AUC)=0.784,95%CI为0.746~0.821,P<0.001。Hosmer-Lemeshow拟合优度检验结果显示,预测值与实际观测值之间差异无统计学意义(χ^(2)=3.893,P=0.867),拟合度良好。广义线性模型的二元Logistic回归分析显示,预测的总病死率与MV之间的交互作用显著,MV和NMV的交叉率为73%,表明预测总病死率风险>73%的患者可从MV中获益。PSM后,多变量Logistic回归分析显示,MV、APACHE Ⅳ评分仍是影响SHS患者死亡的独立危险因素〔OR(95%CI)分别为4.242(2.575~6.991)和1.030(1.019~1.040)〕。APACHE Ⅳ评分预测SHS患者死亡风险的AUC=0.702,95%CI为0.649~0.754,P<0.001;Hosmer-Lemeshow拟合优度检验结果显示,预测值与实际观测值差异无统计学意义(χ^(2)=10.390,P=0.239),拟合度良好。结论APACHE Ⅳ评分对SHS具有较好的预测能力。具体来说,当APACHE Ⅳ评分预测病死率低于73%时,NMV的SHS患者预后更好,预测病死率高于73%时,MV的SHS患者预后更好。

血清脂联素、成纤维生长因子-23在心脏瓣膜置换术患者预后中的评估价值

目的探讨血清脂联素、成纤维生长因子-23(FGF23)水平在心脏瓣膜置换术患者预后中的评估价值。方法选取行心脏瓣膜置换术的患者98例为研究组。根据研究组患者的预后情况分为预后良好组(n=67)和预后不良组(n=31)。选取同期健康体检者90例为对照组。采用Spearman法分析血清脂联素、FGF23水平分别与血浆N末端B型利钠肽前体(NT-proBNP)水平和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分的相关性。采用多因素Logistic回归分析法分析心脏瓣膜置换术患者预后的影响因素。绘制受试者工作特征(ROC)曲线分析血清脂联素、FGF23水平对心脏瓣膜置换术患者预后的预测价值。结果研究组血清FGF23、NT-proBNP水平、APACHEⅡ评分高于对照组,血清脂联素水平低于对照组,差异有统计学意义(P<0.05)。预后不良组血清FGF23、NT-proBNP水平和APACHEⅡ评分高于预后良好组,血清脂联素水平低于预后良好组,差异有统计学意义(P<0.05)。患者的血清FGF23水平与NT-proBNP水平、APACHEⅡ评分呈正相关(P<0.05)。血清脂联素水平与NT-proBNP水平、APACHEⅡ评分呈负相关(P<0.05)。血清脂联素、FGF23、NT-proBNP水平和APACHEⅡ评分为心脏瓣膜置换术患者预后的影响因素(P<0.05)。血清脂联素、FGF23单独预测和联合预测心脏瓣膜置换术患者预后的曲线下面积(AUC)分别为0.862、0.807、0.911。脂联素、FGF23联合预测的AUC大于单独预测,差异有统计学意义(P<0.05)。结论血清脂联素、FGF23联合预测心脏瓣膜置换术患者预后的效果较好。血清脂联素、FGF23有望成为评估心脏瓣膜置换术患者预后效果的有效指标。

血清sTWEAK、Netrin-1联合APACHEⅡ评分对重型颅脑损伤患者术后预后不良的预测价值

目的探讨血清可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)、神经轴突导向因子-1(Netrin-1)联合急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对重型颅脑损伤患者术后预后不良的预测价值。方法选取2020年6月至2022年6月该院收治的120例重型颅脑损伤患者,根据术后30 d预后情况分为预后良好组和预后不良组。对比两组血清sTWEAK、Netrin-1水平及APACHEⅡ评分。采用单因素和多因素Logistic回归分析重型颅脑损伤患者术后预后不良的影响因素,并据以构建血清sTWEAK、Netrin-1及APACHEⅡ评分联合应用的预测模型,受试者工作特征(ROC)曲线分析血清sTWEAK、Netrin-1水平及APACHEⅡ评分对重型颅脑损伤患者术后预后不良的预测价值。结果预后不良组的重症监护室居住时间长于预后良好组,白蛋白水平、入院时格拉斯哥昏迷评分法评分和血清Netrin-1水平低于预后良好组,多发脑挫裂伤占比、机械通气占比、入院时APACHEⅡ评分和血清sTWEAK、血清肌酐、血尿素氮水平均高于预后良好组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,多发脑挫裂伤、Netrin-1水平降低、入院时APACHEⅡ评分升高、sTWEAK水平升高为重型颅脑损伤患者术后预后不良的危险因素(P<0.05)。ROC曲线分析结果显示,血清sTWEAK、Netrin-1及APACHEⅡ评分3个指标单独及联合应用时曲线下面积及其95%CI分别为0.742(0.552~0.925)、0.731(0.488~0.963)、0.714(0.502~0.911)、0.882(0.795~0.947)。结论血清sTWEAK、Netrin-1联合APACHEⅡ评分对重型颅脑损伤患者术后预后不良具有较好的预测价值,可为临床治疗方案的制订提供参考。

联合检测外周血TIRAP、FOXO3a、HBP预测脓毒症患者近期预后的价值及意义

目的探讨联合检测外周血TOLL/白介素-1受体相关蛋白(TIRAP)、叉头蛋白转录因子3a(FOXO3a)、肝素结合蛋白(HBP)对脓毒症患者近期预后的预测价值。方法回顾性收集2020年1月—2022年12月本院205例脓毒症患者的临床资料,根据28 d生存情况分为生存组157例、死亡组48例。统计两组外周血TIRAP、FOXO3a、HBP及急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分。分析TIRAP、FOXO3a、HBP与APACHEⅡ、SOFA评分的相关性。采用Logistic回归方程分析TIRAP、FOXO3a、HBP交互作用对脓毒症近期预后的影响。评价TIRAP、FOXO3a、HBP联合预测脓毒症近期预后的价值。结果死亡组入院第1、3、7天外周血TIRAP、HBP水平及APACHEⅡ、SOFA评分高于生存组,FOXO3a水平低于生存组(P<0.05);入院第1天,脓毒症死亡患者TIRAP、HBP水平与APACHEⅡ、SOFA评分呈正相关,FOXO3a与APACHEⅡ、SOFA评分呈负相关(P<0.05);TIRAP×FOXO3a×HBP在脓毒症近期预后中存在交互作用(P<0.05);入院第1天外周血TIRAP+FOXO3a+HBP联合预测预后的曲线下面积(AUC)大于TIRAP+FOXO3a、TIRAP+HBP、FOXO3a+HBP,预测效能更佳(P<0.05)。结论脓毒症预后不良患者外周血TIRAP、HBP水平升高,FOXO3a水平降低,其水平变化与病情严重程度、近期预后有关,联合检测其水平可提高近期预后的预测效能。

两种评分系统评估急性脑梗死患者卧床期间压疮发生的研究

目的对比Braden量表、急性生理与慢性健康评分-Ⅱ(APACHE-Ⅱ)评估急性脑梗死患者卧床期间压疮风险的价值。方法选取70例急性脑梗死患者,患者清醒时,采用Braden量表、APACHE-Ⅱ量表评估患者卧床期间压疮发生风险,统计患者的一般资料和压疮发生情况,对比上述两种量表评估急性脑梗死患者压疮发生价值。结果70例急性脑梗死卧床期间发生压疮13例,占比18.57%,未发生压疮57例,占比81.43%;发生组Braden评分低于未发生组,APACHE-Ⅱ评分高于未发生组(P<0.05);绘制ROC曲线图结果显示,Braden量表和APACHE-Ⅱ量表评估急性脑梗死患者卧床期间压疮发生风险的AUC分别为0.814、0.832,评估价值较理想,且APACHE-Ⅱ量表的AUC大于Braden量表。结论相较于Braden量表,在急性脑梗死患者中应用APACHE-Ⅱ评估卧床期间压疮风险的价值更高。

国家早期预警评分联合急性生理学与慢性健康状况评分Ⅱ对急诊科敌草快中毒患者预后的评估价值

目的:探讨国家早期预警评分(NEWS)联合急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)对急诊科敌草快中毒患者预后的评估价值。方法:回顾性分析2020年1月—2022年6月广州市第十二人民医院急诊科收治的急性敌草快中毒患者93例的临床资料,根据患者入院后30 d内预后情况分为痊愈组(n=68)和死亡组(n=25)。比较两组一般资料、NEWS分级、APACHEⅡ评分。绘制受试者工作特征(ROC)曲线获取NEWS和APACHEⅡ评分的曲线下面积(AUC),分析二者对敌草快中毒患者预后的评估价值。结果:两组性别、年龄、病程比较,差异无统计学意义(P>0.05);痊愈组中毒剂量、NEWS分级和APACHEⅡ评分均低于死亡组,差异有统计学意义(P<0.001)。NEWS、APACHEⅡ评分对急性敌草快中毒患者预后均具有显著的预测价值(AUC>0.7,P<0.001),且二者联合的AUC最大。结论:NEWS和APACHEⅡ评分对敌草快中毒患者预后均具有良好的评估价值,联合两种评分系统有助于提高评估准确度。

中性粒细胞与淋巴细胞比值联合红细胞分布宽度在急诊老年脓毒症病人中的应用价值

目的 探讨中性粒细胞与淋巴细胞比值(NLR)结合红细胞分布宽度(RDW)对急诊老年脓毒症病人疾病严重程度和预后的评估意义。方法 收集2019年1月到2022年2月在首都医科大学宣武医院急诊科就诊及住院治疗的老年脓毒症病人169例。病人入急诊后给予生化全项、血气分析、全血细胞计数、降钙素原(PCT)、胸部计算机体层摄影(CT)、病原学检查等。依据以上检查结果进行急性生理与慢性健康状况评估(APACHEⅡ)。根据病人入急诊时合并脓毒性休克情况分为脓毒症组114例和脓毒性休克组55例。随访28 d,依据病人死亡情况分成生存组125例和死亡组44例。分别比较脓毒性休克组和脓毒症组、生存组和死亡组病人NLR、白细胞计数(WBC)、PCT、RDW和APACHEⅡ评分的区别,进行NLR、RDW与PCT及APACHEⅡ评分的相关性分析;分析RDW、NLR及2个指标相互结合评估老年脓毒症病人死亡风险的受试者工作特征曲线下面积(AUC)和PCT曲线下面积的区别。结果 脓毒症休克组病人PCT、NLR、RDW和APACHEⅡ评分分别为(1.86±1.04)μg/L、9.63±3.92、(14.95±3.49)%和(16.75±3.53)分,均明显高于脓毒症组的(1.38±1.06)μg/L、7.87±3.94、(12.74±3.83)%、(14.61±2.87)分(P<0.01);WBC在脓毒症死亡组与生存组比较差异无统计学意义(P=0.361),死亡组APACHEⅡ评分、NLR、PCT和RDW分别为(18.52±2.41)分、(10.64±3.74)、(2.55±1.14)μg/L和(15.98±3.69)%,均大于生存组的(14.17±2.71)分、7.67±3.82、(1.19±0.81)μg/L、(12.57±3.43)%(P<0.01),RDW和NLR均与APACHEⅡ评分和PCT具有相关性(均P<0.01);PCT的AUC 95%CI为0.86(0.80,0.92),APACHEⅡ评分的AUC 95%CI为0.88(0.83,0.93),RDW的AUC 95%CI为0.75(0.66,0.83),NLR的AUC95%CI为0.73(0.64,0.81),RDW和NLR的AUC均小于PCT(P=0.048,0.024),但RDW与NLR联合的AUC为0.80,与PCT比较差异无统计学意义(P=0.363)。结论 NLR及RDW两个指标都能够在急诊老年脓毒症病人的病情和预后评估中有较好的应用价值,二者联合的应用价值与PCT相近。

急性生理和慢性健康状况Ⅳ评分模型在老年重症医学科中的验证

目的研究急性生理和慢性健康状况(APACHE)Ⅳ评分模型的精确度以及是否适用于老年重症患者。方法前瞻性观察2011年7月至2015年7月广州军区广州总医院老年重症医学科收治的421例重症老年患者,计算入住ICU 24 h内的APACHEⅣ评分,通过受试者工作曲线下面积(ROC AUC)和Hosmer-Lemeshow(HL)检验分别检验模型的辨别力和校准,标准化死亡比值(SMR)检验模型预测群体死亡率的准确性,并计算模型的Brier评分(BS)。结果 421例老年重症患者,住院死亡率为33.3%(140/421)。APACHEⅣ模型辨别力为良好到优秀(AUC=0.82,95%CI:0.78~0.86),模型的HL检验显示校准不适(χ~2=20.49,P=0.009)。BS显示模型良好的精确度(BS=0.18),但APACHEⅣ模型可能低估老年重症患者住院死亡率(SMR=1.50,95%CI:1.30~1.70)。结论在老年重症患者中,APACHEⅣ模型显示优秀的辨别力,但模型校准不良同时低估住院死亡率。老年专科患者使用危险预测模型前应验证模型并使用定制化模型拟合预测群体。

重症急性胰腺炎患者并发急性肾损伤的影响因素分析

目的探讨重症急性胰腺炎(SAP)患者并发急性肾损伤(AKI)的影响因素。方法采用回顾性研究的方法,收集66例SAP患者的临床资料,根据是否并发AKI分为AKI组和非AKI组,分别采用Logistic回归和受试者操作特征(ROC)曲线分析SAP患者并发AKI的危险因素。结果SAP合并AKI患者的总体年龄和急性生理学和慢性健康状况评价(APACHEⅡ)评分高于未合并者,但糖尿病多见于未合并者(P<0.05)。与非AKI组相比,AKI组患者入院时的CRP、全身炎症反应指数(SIRI)、血清肌酐、CRP/白蛋白比值、D-二聚体升高,但三酰甘油-葡萄糖(TyG)指数、白蛋白、总胆固醇、HDL-C、血钙水平下降(P<0.05)。逐步回归分析结果显示,APACHEⅡ评分升高、SIRI升高、血小板/淋巴细胞比值(PLR)升高、全身免疫炎症指数(SII)降低、血钙水平下降是SAP患者并发AKI的独立危险因素(P<0.05)。ROC曲线结果显示,除血清肌酐外,APACHEⅡ评分、SIRI指数、血钙水平对SAP患者并发AKI有一定的诊断价值,其中APACHEⅡ评分的AUC为0.880(95%CI 0.787~0.974,截断值11.50分),SIRI指数的AUC为0.662(95%CI 0.521~0.804,截断值10.89),血钙水平的AUC为0.754(95%CI 0.627~0.881,截断值2.07 mmol/L),P均<0.05;当上述三种指标联合血清肌酐时可进一步提高对于SAP患者并发AKI的诊断效能,其中血清肌酐+血钙的AUC最大,达0.969(95%CI 0.929~1.000,P<0.05)。结论APACHEⅡ评分、SIRI指数、PLR指数、SII指数、血钙水平是SAP并发AKI的影响因素,APACHEⅡ评分、SIRI指数和血钙水平对SAP患者并发AKI具有诊断价值,三者联合血清肌酐可提高对AKI的诊断效能,为临床识别SAP患者并发AKI提供新的手段。

T淋巴细胞、免疫球蛋白水平联合预测重症肺炎患者院内死亡的价值

目的分析T淋巴细胞、免疫球蛋白水平联合预测重症肺炎患者院内死亡的价值。方法回顾性分析2021年5月—2022年5月在成都中医药大学附属医院接受治疗的80例重症肺炎患者的临床资料,依据患者入院后1个月的存活情况分为死亡组(26例)和存活组(54例)。比较两组基线资料,以及T淋巴细胞[白细胞分化抗原3(CD3^(+))、白细胞分化抗原4(CD4^(+))、白细胞分化抗原8(CD8^(+))]、免疫球蛋白[免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)]水平。绘制受试者工作特征(ROC)曲线分析入院时急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分,以及T淋巴细胞、免疫球蛋白水平联合预测重症肺炎患者院内死亡的价值。采用多因素逐步Logistic回归分析重症肺炎患者院内死亡的危险因素。结果两组年龄、性别、体质量指数、合并症及呼吸频率比较,差异均无统计学意义(P>0.05)。死亡组APACHEⅡ评分高于存活组(P<0.05),CD3^(+)、CD4^(+)、CD8^(+)、IgA、IgM及IgG水平低于存活组(P<0.05)。ROC曲线分析结果显示,T淋巴细胞、免疫球蛋白水平联合检测重症肺炎患者院内死亡的敏感性为90.3%(95%CI:0.757,0.954),特异性为78.8%(95%CI:0.654,0.819),曲线下面积(AUC)为0.854(95%CI:0.678,0.912)。入院时APACHEⅡ评分检测重症肺炎患者院内死亡的敏感性为71.1%(95%CI:0.657,0.873),特异性为96.2%(95%CI:0.751,0.984),AUC为0.801(95%CI:0.707,0.894)。多因素逐步Logistic回归分析结果显示,入院时APACHEⅡ评分高[OR=1.536(95%CI:1.118,2.110)]、CD3^(+)[OR=1.797(95%CI:1.122,2.878)]、CD4^(+)[OR=1.751(95%CI:1.121,2.735)]、CD8^(+)[OR=1.886(95%CI:1.075,3.309)]、IgA[OR=1.967(95%CI:1.142,3.388)]、IgM[OR=1.945(95%CI:1.145,3.304)]及IgG[OR=2.132(95%CI:1.176,3.865)]均为重症肺炎患者院内死亡的影响因素(P<0.05)。结论入院时APACHEⅡ评分、T淋巴细胞及免疫球蛋白水平预测重症肺炎患者院内死亡的价值较高,且T淋巴细胞、免疫球蛋白水平联合预测时具有更高的敏感性,可有效提高检测效率,另入院时APACHEⅡ评分高、CD3^(+)、CD4^(+)、CD8^(+)、IgA、IgM及IgG均为重症肺炎患者院内死亡的影响因素,临床应结合以上指标对重症肺炎患者进行重点筛查,及时采取干预措施,降低病死率。

感染性休克患者血清PAD2表达水平与APACHEⅡ评分的相关性分析

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。