Background Comorbidity is one of the most important determinants ot short-term and long-term outcomes in septic patients. Charlson＇s weighted index of comorbidities （WIC） and the chronic health score （CHS）, which...Background Comorbidity is one of the most important determinants ot short-term and long-term outcomes in septic patients. Charlson＇s weighted index of comorbidities （WIC） and the chronic health score （CHS）, which is a component of the acute physiology and chronic health evaluation （APACHE） II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit （ICU） patients with sepsis. Methods A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of- sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score （APS）, sequential organ failure assessment （SOFA） and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WlC and CHS. The area under the receiver operating characteristic curve （AUC） was used to predict hospital mortality over classes of risk. Results Of all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WlC, CHS, APACHE II, and SOFA scores than the non-surviving patients （P 〈0.05）. Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WlC, CHS and APS scores （P 〈0.05）. The AUC for the hospital mortality were 0.564 （95% confidence interval （CO 0.496-0.631） of CHS, 0.663 （95% CI 0.599-0.727） of WIC, 0.770 （95% CI 0.718-0.822） of APACHE II, 0.856 （95% Cl 0.815-0.897） of the CHS combined with other administrative data, and 0.857 （95% CI 0.817-0.897） of the WlC combined with other administrative data. The diagnostic value of WIC was better than that of CHS （P=0.0015）. Conclusions The WlC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis. WlC might be an even better predictor of the mortality of septic patients with comorbidities than CHS. Chin Med J 2014;127 （14）： 2623-2627展开更多
目的探讨基础疾病评分系统查尔森基础疾病权重指数(Charlson’s weighted index of comorbidities,WIC)评估脓毒症患者预后的价值。方法回顾性分析3年收治的234例脓毒症患者的临床资料,计算WIC评分及急性病理生理和慢性健康状况评分Ⅱ(A...目的探讨基础疾病评分系统查尔森基础疾病权重指数(Charlson’s weighted index of comorbidities,WIC)评估脓毒症患者预后的价值。方法回顾性分析3年收治的234例脓毒症患者的临床资料,计算WIC评分及急性病理生理和慢性健康状况评分Ⅱ(APACHEⅡ),根据28d预后情况分为存活组和死亡组,分析WIC评分对患者预后的评估价值。结果共有234例脓毒症患者纳入研究,死亡77例(32.9%)。WIC评分越高,患者的死亡风险越大;多因素logistic回归分析提示WIC评分是决定脓毒症患者预后的危险因素(OR=1.434,95%CI:1.097～1.875,P=0.008);WIC评分、APACHEⅡ评分以及两者联合预测死亡概率的ROC曲线下面积(95%CI)分别0.670(0.591～0.748)、0.770(0.703～0.837)和0.821(0.757～0.885)。结论 WIC评分可以较好地评估基础疾病对于危重病患者预后的影响。展开更多
目的:研究查尔森合并症指数(Charlson's weighted index of comorbidities,WIC)评分系统在急诊病人留院观察时间预测中的应用。方法:回顾性分析3 353例急诊留院观察病人的相关资料。按照留院观察时间对3 353例病人(不包括死亡病人)...目的:研究查尔森合并症指数(Charlson's weighted index of comorbidities,WIC)评分系统在急诊病人留院观察时间预测中的应用。方法:回顾性分析3 353例急诊留院观察病人的相关资料。按照留院观察时间对3 353例病人(不包括死亡病人)进行分组,留院观察时间≥72 h为A组(2 239例),留院观察时间<72 h为B组(1 114例)。对影响病人留院观察的因素进行logistic回归分析,包括病人的年龄、性别、基础疾病、居住条件(是否居住养老院)、留院观察疾病诊断,以及急性生理与慢性健康状况(APACHE)Ⅱ评分和留院观察的WIC评分。同时,根据受试者工作特征曲线(ROC),评定WIC评分在病人留院观察时间中的预测作用。结果:3 353例急诊留院观察病人中,因泌尿和内分泌系统疾病留院病人299例(8.9%),消化系统疾病522例(15.6%),循环和神经系统疾病838例(25.0%),呼吸系统疾病1 356例(40.4%),其他原因疾病338例(10.1%)。A组急诊病人的APACHEⅡ评分和WIC评分均高于B组(P<0.01)。年龄、居住养老院、WIC评分和APACHEⅡ评分均可影响病人留院观察时间(P<0.01)。多因素logistic回归分析显示,年龄、居住养老院、APACHEⅡ评分、WIC评分无共线性关系,均为影响病人留院观察时间的独立相关因素(P<0.01),APACHEⅡ评分的ROC曲线下面积为0.796,WIC评分的为0.691,两者结合的ROC曲线下面积为0.892。结论:基于基础疾病评价的WIC评分系统能够较好地预测急诊病人留院观察时间。展开更多
Background:Hypertension is one of the most common comorbid conditions of epilepsy.Hypertension and epilepsy may be related to each other.Qigong Bigu practice induces a similar effect as fasting in the first week.As ke...Background:Hypertension is one of the most common comorbid conditions of epilepsy.Hypertension and epilepsy may be related to each other.Qigong Bigu practice induces a similar effect as fasting in the first week.As ketogenesis is induced during ketogenic diet therapy,we hypothesize that ketogenesis is detectable and related body weight loss would occur during the first week of Qigong Bigu practice.Methods:During the prospective observational study,34 healthy adult participants attended the Qigong Bigu practice for one week.The blood pressure,body weight,calorie consumption,blood glucose and beta-hydroxybutyrate level were measured.Results:The body weight and body mass index decreased by 2.39±1.34 kg(95%CI 1.92–2.85)and 0.94±0.57(95%CI 0.73–1.15),respectively,after five days of practice(P<0.001).The systolic and diastolic blood pressure decreased by 17.86±14.17 mmHg(95%CI 12.36–23.35)and 9.75±7.45 mmHg(95%CI 6.86–12.64),respectively(P<0.001).The average five-day calorie consumption was 1197.47±569.97 kcal(95%CI 998.60–1396.35).Meanwhile,no symptomatic hypoglycemia or other significant side effects were observed.The blood beta-hydroxybutyrate level increased to a nutritional level of 1.15±1.12 mmol/L(95%CI 0.76–1.62).The calorie consumption negatively correlated to the beta-hydroxybutyrate level in the blood.The loss of body weight and the decrease of body mass index were positively correlated to the blood beta-hydroxybutyrate level.Conclusions:Qigong Bigu can decrease the blood pressure,the body weight and the body mass index in healthy adult participants.The fasting stage of Qigong Bigu is accompanied by ketogenesis.Clinical trial of Qigong Bigu in hypertension and epilepsy patients might be worthwhile.The blood beta-hydroxybutyrate might be used as a biomarker to evaluate the effect of Qigong Bigu practice during fasting.展开更多
Background:Hypertension is one of the most common comorbid conditions of epilepsy.Hypertension and epilepsy may be related to each other.Qigong Bigu practice induces a similar effect as fasting in the first week.As ke...Background:Hypertension is one of the most common comorbid conditions of epilepsy.Hypertension and epilepsy may be related to each other.Qigong Bigu practice induces a similar effect as fasting in the first week.As ketogenesis is induced during ketogenic diet therapy,we hypothesize that ketogenesis is detectable and related body weight loss would occur during the first week of Qigong Bigu practice.Methods:During the prospective observational study,34 healthy adult participants attended the Qigong Bigu practice for one week.The blood pressure,body weight,calorie consumption,blood glucose and beta-hydroxy butyrate level were measured.Results:The body weight and body mass index decreased by 2.39±1.34 kg(95%CI1.92-2.85)and 0.94±0.57(95%CI 0.73-1.15),respectively,after five days of practice(P<0.001).The systolic and diastolic blood pressure decreased by 17.86±14.17 mmHg(95%Ci 12.36-23.35)and 9.75±7.45 mmHg(95%CI 6.86-12.64),respectively(P<0.001).The average five-day calorie consumption was 1197.47±569.97 kcal(95%CI 998.60-1396.35).Meanwhile,no symptomatic hypoglycemia or other significant side effects were observed.The blood beta-hydroxy butyrate level increased to a nutritional level of 1.15±1.12 mmol/L(95%CI 0.76-1.62).The calorie consumption negatively correlated to the beta-hydroxy butyrate level in the blood.The loss of body weight and the decrease of body mass index were positively correlated to the blood beta-hydroxy butyrate level.Conclusions:Qigong Bigu can decrease the blood pressure,the body weight and the body mass index in healthy adult participants.The fasting stage of Qigong Bigu is accompanied by ketogenesis.Clinical trial of Qigong Bigu in hypertension and epilepsy patients might be worthwhile.The blood beta-hydroxy butyrate might be used as a biomarker to evaluate the effect of Qigong Bigu practice during fasting.展开更多
文摘Background Comorbidity is one of the most important determinants ot short-term and long-term outcomes in septic patients. Charlson＇s weighted index of comorbidities （WIC） and the chronic health score （CHS）, which is a component of the acute physiology and chronic health evaluation （APACHE） II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit （ICU） patients with sepsis. Methods A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of- sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score （APS）, sequential organ failure assessment （SOFA） and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WlC and CHS. The area under the receiver operating characteristic curve （AUC） was used to predict hospital mortality over classes of risk. Results Of all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WlC, CHS, APACHE II, and SOFA scores than the non-surviving patients （P 〈0.05）. Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WlC, CHS and APS scores （P 〈0.05）. The AUC for the hospital mortality were 0.564 （95% confidence interval （CO 0.496-0.631） of CHS, 0.663 （95% CI 0.599-0.727） of WIC, 0.770 （95% CI 0.718-0.822） of APACHE II, 0.856 （95% Cl 0.815-0.897） of the CHS combined with other administrative data, and 0.857 （95% CI 0.817-0.897） of the WlC combined with other administrative data. The diagnostic value of WIC was better than that of CHS （P=0.0015）. Conclusions The WlC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis. WlC might be an even better predictor of the mortality of septic patients with comorbidities than CHS. Chin Med J 2014;127 （14）： 2623-2627
文摘目的探讨基础疾病评分系统查尔森基础疾病权重指数(Charlson’s weighted index of comorbidities,WIC)评估脓毒症患者预后的价值。方法回顾性分析3年收治的234例脓毒症患者的临床资料,计算WIC评分及急性病理生理和慢性健康状况评分Ⅱ(APACHEⅡ),根据28d预后情况分为存活组和死亡组,分析WIC评分对患者预后的评估价值。结果共有234例脓毒症患者纳入研究,死亡77例(32.9%)。WIC评分越高,患者的死亡风险越大;多因素logistic回归分析提示WIC评分是决定脓毒症患者预后的危险因素(OR=1.434,95%CI:1.097～1.875,P=0.008);WIC评分、APACHEⅡ评分以及两者联合预测死亡概率的ROC曲线下面积(95%CI)分别0.670(0.591～0.748)、0.770(0.703～0.837)和0.821(0.757～0.885)。结论 WIC评分可以较好地评估基础疾病对于危重病患者预后的影响。
基金supported by Sanming Project of Medicine in Shenzhen(SZSM201812005)Shenzhen Key Medical Discipline Construction Fund(No.SZXK033)Shenzhen Fund for Guangdong Provincial High Level Clinical Key Specialties(No.SZGSP012).
文摘Background:Hypertension is one of the most common comorbid conditions of epilepsy.Hypertension and epilepsy may be related to each other.Qigong Bigu practice induces a similar effect as fasting in the first week.As ketogenesis is induced during ketogenic diet therapy,we hypothesize that ketogenesis is detectable and related body weight loss would occur during the first week of Qigong Bigu practice.Methods:During the prospective observational study,34 healthy adult participants attended the Qigong Bigu practice for one week.The blood pressure,body weight,calorie consumption,blood glucose and beta-hydroxybutyrate level were measured.Results:The body weight and body mass index decreased by 2.39±1.34 kg(95%CI 1.92–2.85)and 0.94±0.57(95%CI 0.73–1.15),respectively,after five days of practice(P<0.001).The systolic and diastolic blood pressure decreased by 17.86±14.17 mmHg(95%CI 12.36–23.35)and 9.75±7.45 mmHg(95%CI 6.86–12.64),respectively(P<0.001).The average five-day calorie consumption was 1197.47±569.97 kcal(95%CI 998.60–1396.35).Meanwhile,no symptomatic hypoglycemia or other significant side effects were observed.The blood beta-hydroxybutyrate level increased to a nutritional level of 1.15±1.12 mmol/L(95%CI 0.76–1.62).The calorie consumption negatively correlated to the beta-hydroxybutyrate level in the blood.The loss of body weight and the decrease of body mass index were positively correlated to the blood beta-hydroxybutyrate level.Conclusions:Qigong Bigu can decrease the blood pressure,the body weight and the body mass index in healthy adult participants.The fasting stage of Qigong Bigu is accompanied by ketogenesis.Clinical trial of Qigong Bigu in hypertension and epilepsy patients might be worthwhile.The blood beta-hydroxybutyrate might be used as a biomarker to evaluate the effect of Qigong Bigu practice during fasting.
基金This work was supported by Sanming Project of Medicine in Shenzhen(SZSM201812005)Shenzhen Key Medical Discipline Construction Fund(No.SZXK033)Shenzhen Fund for Guangdong Provincial High Level Clinical Key Specialties(No.SZGSP012).
文摘Background:Hypertension is one of the most common comorbid conditions of epilepsy.Hypertension and epilepsy may be related to each other.Qigong Bigu practice induces a similar effect as fasting in the first week.As ketogenesis is induced during ketogenic diet therapy,we hypothesize that ketogenesis is detectable and related body weight loss would occur during the first week of Qigong Bigu practice.Methods:During the prospective observational study,34 healthy adult participants attended the Qigong Bigu practice for one week.The blood pressure,body weight,calorie consumption,blood glucose and beta-hydroxy butyrate level were measured.Results:The body weight and body mass index decreased by 2.39±1.34 kg(95%CI1.92-2.85)and 0.94±0.57(95%CI 0.73-1.15),respectively,after five days of practice(P<0.001).The systolic and diastolic blood pressure decreased by 17.86±14.17 mmHg(95%Ci 12.36-23.35)and 9.75±7.45 mmHg(95%CI 6.86-12.64),respectively(P<0.001).The average five-day calorie consumption was 1197.47±569.97 kcal(95%CI 998.60-1396.35).Meanwhile,no symptomatic hypoglycemia or other significant side effects were observed.The blood beta-hydroxy butyrate level increased to a nutritional level of 1.15±1.12 mmol/L(95%CI 0.76-1.62).The calorie consumption negatively correlated to the beta-hydroxy butyrate level in the blood.The loss of body weight and the decrease of body mass index were positively correlated to the blood beta-hydroxy butyrate level.Conclusions:Qigong Bigu can decrease the blood pressure,the body weight and the body mass index in healthy adult participants.The fasting stage of Qigong Bigu is accompanied by ketogenesis.Clinical trial of Qigong Bigu in hypertension and epilepsy patients might be worthwhile.The blood beta-hydroxy butyrate might be used as a biomarker to evaluate the effect of Qigong Bigu practice during fasting.
