目的探讨成年无肝病重症患者入重症监护室(ICU)首次血氨水平与患者ICU死亡及医院死亡发生风险间的关系。方法采用回顾性队列研究,纳入eICU合作研究数据库(eICU Collaborative Research Database,eICU-CRD)中单次入院,首次入住ICU初始48 ...目的探讨成年无肝病重症患者入重症监护室(ICU)首次血氨水平与患者ICU死亡及医院死亡发生风险间的关系。方法采用回顾性队列研究,纳入eICU合作研究数据库(eICU Collaborative Research Database,eICU-CRD)中单次入院,首次入住ICU初始48 h内有血氨检测记录且入ICU未患有肝脏疾病的患者。提取患者的年龄、性别、种族、急性生理和慢性健康评分Ⅳ(APACHEⅣ评分)、肾脏替代治疗等治疗措施、基础患病情况及结局。采用单因素及多因素Logistic回归分析血氨水平与患者死亡风险之间的关系。采用交互作用分析初始血氨水平与患者死亡风险间的关系在不同APACHEⅣ评分、年龄、性别和种族患者中是否存在差异,同时进行亚组分析。结果共纳入1674名患者,多因素Logistic回归显示,初始血氨每增加10μg/dL,患者ICU死亡风险增高6.9%(OR=1.069,95%CI:1.036~1.104),患者医院死亡风险增高4.6%(OR=1.046,95%CI:1.017~1.076);初始血氨在49~82μg/dL组、≥82μg/dL组的患者ICU死亡风险和≥82μg/dL组患者医院死亡风险分别是<49μg/dL组患者的1.7倍(OR=1.700,95%CI:1.165~2.482)、2.862倍(OR=2.862,95%CI:1.792~4.570)、1.844倍(OR=1.844,95%CI:1.213~2.804)。初始血氨水平与ICU及医院死亡发生风险间的关系在不同APACHEⅣ评分、年龄、性别及种族患者中差异无统计学意义。结论在未患有肝脏疾病的重症患者中,入ICU后初始血氨水平升高与患者ICU及医院高死亡风险相关。展开更多
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 commu...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.展开更多
BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive ca...BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.展开更多
目的观察不同时间点神经元特异性烯醇化酶(NSE)水平对重症社区获得性肺炎(SCAP)患者ICU死亡的预测价值。方法选取2021年6月至2023年6月在河北省人民医院急诊重症监护病房(EICU)住院的74例SCAP患者。患者于入院后12小时内检测血中性粒细...目的观察不同时间点神经元特异性烯醇化酶(NSE)水平对重症社区获得性肺炎(SCAP)患者ICU死亡的预测价值。方法选取2021年6月至2023年6月在河北省人民医院急诊重症监护病房(EICU)住院的74例SCAP患者。患者于入院后12小时内检测血中性粒细胞计数、血肌酐(Scr)、白蛋白(Alb)、降钙素原(PCT)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)和白细胞介素6(IL-6)水平。于患者入院后第1天[NSE(day1)]和第4天[NSE(day4)]早晨采集NSE血样进行检验。并根据患者ICU内是否死亡分为生存组(n=57)和死亡组(n=17)。采用多因素logistic回归分析、受试者工作特征(ROC)曲线及曲线下面积(AUC)评价上述参数的预测效果。结果死亡组患者急性生理和慢性健康II评分(APACHE II score)、IL-6水平、中性粒细胞计数、NSE(day1)和NSE(day4)水平高于生存组(P<0.05),氧合指数(PaO_(2)/FiO_(2))明显低于生存组(P<0.05)。APACHE IIscore、IL-6水平、中性粒细胞计数、NSE(day1)和NSE(day4)水平与SCAP患者ICU死亡呈弱的正相关(P<0.05),PaO_(2)/FiO_(2)与患者ICU死亡呈弱的负相关(P<0.05)。多因素logistic回归分析结果显示,APACHE IIscore和NSE(day4)与SCAP患者ICU死亡相关(P<0.05)。APACHE II score和NSE(day4)预测SCAP患者ICU死亡的AUC分别为0.729(95%CI 0.613~0.826)和0.787(95%CI0.676~0.874),两者的AUC差异无统计学意义(P=0.561)。NSE(day4)预测患者ICU死亡的敏感性和特异性分别为57.89%和88.24%(临界值为14.83μg/L)。结论NSE(day4)是SCAP患者ICU死亡的独立预测指标,是评估SCAP患者预后的一个很好的替代选择。展开更多
目的探讨急诊重症监护室(emergency intensive care unit,EICU)血流感染患者临床结局的风险因子,为临床决策提供依据。方法回顾性收集2019年1月至2023年4月我院就诊的141例EICU血流感染患者的病历资料及血培养记录,采用Logistic回归分...目的探讨急诊重症监护室(emergency intensive care unit,EICU)血流感染患者临床结局的风险因子,为临床决策提供依据。方法回顾性收集2019年1月至2023年4月我院就诊的141例EICU血流感染患者的病历资料及血培养记录,采用Logistic回归分析患者死亡的危险因素,运用Cox回归分析上述因素与患者生存时间和临床结局的关系。结果在141例EICU血流感染患者中,两种及以上细菌混合血流感染[比值比(OR)=5.68,95%置信区间(CI):1.20~26.98,P<0.05]及多重耐药菌血流感染(OR=6.39,95%CI:2.78~14.67,P<0.01)与患者死亡具有显著相关性;是否根据药敏结果及时调整用药[风险比(HR)=0.47,95%CI:0.30~0.74]和多重耐药菌血流感染(HR=2.02,95%CI:1.28~3.20)是EICU血流感染患者死亡的风险因子(P<0.01)。结论尽早采集血培养,明确感染病原菌,精准用药控制感染,可以有效降低患者的死亡率。展开更多
文摘目的探讨成年无肝病重症患者入重症监护室(ICU)首次血氨水平与患者ICU死亡及医院死亡发生风险间的关系。方法采用回顾性队列研究,纳入eICU合作研究数据库(eICU Collaborative Research Database,eICU-CRD)中单次入院,首次入住ICU初始48 h内有血氨检测记录且入ICU未患有肝脏疾病的患者。提取患者的年龄、性别、种族、急性生理和慢性健康评分Ⅳ(APACHEⅣ评分)、肾脏替代治疗等治疗措施、基础患病情况及结局。采用单因素及多因素Logistic回归分析血氨水平与患者死亡风险之间的关系。采用交互作用分析初始血氨水平与患者死亡风险间的关系在不同APACHEⅣ评分、年龄、性别和种族患者中是否存在差异,同时进行亚组分析。结果共纳入1674名患者,多因素Logistic回归显示,初始血氨每增加10μg/dL,患者ICU死亡风险增高6.9%(OR=1.069,95%CI:1.036~1.104),患者医院死亡风险增高4.6%(OR=1.046,95%CI:1.017~1.076);初始血氨在49~82μg/dL组、≥82μg/dL组的患者ICU死亡风险和≥82μg/dL组患者医院死亡风险分别是<49μg/dL组患者的1.7倍(OR=1.700,95%CI:1.165~2.482)、2.862倍(OR=2.862,95%CI:1.792~4.570)、1.844倍(OR=1.844,95%CI:1.213~2.804)。初始血氨水平与ICU及医院死亡发生风险间的关系在不同APACHEⅣ评分、年龄、性别及种族患者中差异无统计学意义。结论在未患有肝脏疾病的重症患者中,入ICU后初始血氨水平升高与患者ICU及医院高死亡风险相关。
基金Capital Clinical Characteristic Application Research of Beijing Municipal Science & Technology Commission (Z171100001017057).
文摘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.
文摘BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.
文摘目的观察不同时间点神经元特异性烯醇化酶(NSE)水平对重症社区获得性肺炎(SCAP)患者ICU死亡的预测价值。方法选取2021年6月至2023年6月在河北省人民医院急诊重症监护病房(EICU)住院的74例SCAP患者。患者于入院后12小时内检测血中性粒细胞计数、血肌酐(Scr)、白蛋白(Alb)、降钙素原(PCT)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)和白细胞介素6(IL-6)水平。于患者入院后第1天[NSE(day1)]和第4天[NSE(day4)]早晨采集NSE血样进行检验。并根据患者ICU内是否死亡分为生存组(n=57)和死亡组(n=17)。采用多因素logistic回归分析、受试者工作特征(ROC)曲线及曲线下面积(AUC)评价上述参数的预测效果。结果死亡组患者急性生理和慢性健康II评分(APACHE II score)、IL-6水平、中性粒细胞计数、NSE(day1)和NSE(day4)水平高于生存组(P<0.05),氧合指数(PaO_(2)/FiO_(2))明显低于生存组(P<0.05)。APACHE IIscore、IL-6水平、中性粒细胞计数、NSE(day1)和NSE(day4)水平与SCAP患者ICU死亡呈弱的正相关(P<0.05),PaO_(2)/FiO_(2)与患者ICU死亡呈弱的负相关(P<0.05)。多因素logistic回归分析结果显示,APACHE IIscore和NSE(day4)与SCAP患者ICU死亡相关(P<0.05)。APACHE II score和NSE(day4)预测SCAP患者ICU死亡的AUC分别为0.729(95%CI 0.613~0.826)和0.787(95%CI0.676~0.874),两者的AUC差异无统计学意义(P=0.561)。NSE(day4)预测患者ICU死亡的敏感性和特异性分别为57.89%和88.24%(临界值为14.83μg/L)。结论NSE(day4)是SCAP患者ICU死亡的独立预测指标,是评估SCAP患者预后的一个很好的替代选择。
文摘目的探讨急诊重症监护室(emergency intensive care unit,EICU)血流感染患者临床结局的风险因子,为临床决策提供依据。方法回顾性收集2019年1月至2023年4月我院就诊的141例EICU血流感染患者的病历资料及血培养记录,采用Logistic回归分析患者死亡的危险因素,运用Cox回归分析上述因素与患者生存时间和临床结局的关系。结果在141例EICU血流感染患者中,两种及以上细菌混合血流感染[比值比(OR)=5.68,95%置信区间(CI):1.20~26.98,P<0.05]及多重耐药菌血流感染(OR=6.39,95%CI:2.78~14.67,P<0.01)与患者死亡具有显著相关性;是否根据药敏结果及时调整用药[风险比(HR)=0.47,95%CI:0.30~0.74]和多重耐药菌血流感染(HR=2.02,95%CI:1.28~3.20)是EICU血流感染患者死亡的风险因子(P<0.01)。结论尽早采集血培养,明确感染病原菌,精准用药控制感染,可以有效降低患者的死亡率。
