Prevalence and risk factors of organ failure in patients with severe acute pancreatitis

BACKGROUND： This study was undertaken to determine the prevalence of organ failure and its risk factors in patients with severe acute pancreatitis （SAP） .METHODS： A retrospective analysis was made of 186 patients with SAP who were had been hospitalized in the intensive care unit of Jinzhong First People’s Hospital between March 2000 and October 2009. The patients met the diagnostic criteria of SAP set by the Surgical Society of the Chinese Medical Association in 2006. The variables collected included age, gender, etiology of SAP, the number of comorbidit, APACHEII score, contrast-enhanced CT （CECT） pancreatic necrosis, CT severity index （CTSI） , abdominal compartment syndrome （ACS） , the number of organ failure, and the number of death. The prevalence and mortality of organ failure were calculated. The variables were analyzed by unconditional multivariate logistic regression to determine the independent risk factors for organ failure in SAP.RESULTS： Of 186 patients, 96 had organ failure. In the 96 patients, 47 died. There was a significant association among the prevalence of organ failure and age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI, and ACS. An increase in age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis were correlated with increased number of organ failure. Age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI and ACS were assessed by unconditional multivariate logistic regression.CONCLUSIONS： Organ failure occurred in 51.6% of the 186 patients with SAP. The mortality of SAP with organ failure was 49.0%. Age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI and ACS are independent risk factors of organ failure.

Risk factors of infected pancreatic necrosis secondary to severe acute pancreatitis

BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.

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.

Risk Factors and Distribution of Pathogens for Pulmonary Infection in Patients with Severe Acute Pancreatitis

Objective:To investigate risk factors and distribution of pathogens for pulmonary infection in patients with severe acute pancreatitis.Methods:The clinical data of 285 patients with severe acute pancreatitis were retrospectively analyzed.Sputum specimens of patients with lung infections were studied.Univariate analysis and logistic regression were performed to screening the factors correlating to lung infections.Results:Gram-negative bacilli were the principal microorganisms isolated from those lung infections,and these bacterial pathogens demonstrated a marked pattern of antibiotic resistance.It was identified that age(OR 1.05,95%CI 1.01-1.09,p=0.01),Ranson scores(OR 3.01,95%CI 1.13-8.03,p=0.03)and surgical treatment(OR4.27,95%CI 1.03-17.65,p=0.04)were independent risk factors of lung infections in patients with severe acute pancreatitis.Conclusion:Analysis of pathogen spectrum and drug sensitivity will contribute to choosing antibiotics empirically.And preventive measures aimed at risk factors could help reduce the incidence of lung infections in patients with severe acute pancreatitis.

Analysis of the risk factors for severity in post endoscopic retrograde cholangiopancreatography pancreatitis: The indication of prophylactic treatments

To determine the risk factors of severe post endoscopic retrograde cholangiopancreatography pancreatitis (sPEP) and clarify the indication of prophylactic treatments. METHODSAt our hospital, endoscopic retrograde cholangiopancreatography (ERCP) was performed on 1507 patients from May 2012 to December 2015. Of these patients, we enrolled all 121 patients that were diagnosed with post endoscopic retrograde PEP. Fourteen of 121 patients diagnosed as sPEP were analyzed. RESULTSForty-one patients had contrast media remaining in the pancreatic duct after completion of ERCP. Seventy-one patients had abdominal pain within three hours after ERCP. These were significant differences for sPEP (P < 0.05). The median of Body mass index, the median time for ERCP, the median serum amylase level of the next day, past histories including drinking and smoking, past history of pancreatitis, sphincter of Oddi dysfunction, whether emergency or not, expertise of ERCP procedure, diverticulum nearby Vater papilla, whether there was sphincterotomy or papillary balloon dilation, pancreatic duct cannulation, use of intra-ductal ultrasonography enforcement, and transpapillary biopsies had no significant differences with sPEP. CONCLUSIONContrast media remaining in the pancreatic duct and the appearance of abdominal pain within three hours after ERCP were risk factors of sPEP.

Advances in prognostic factors in acute pancreatitis:a mini-review

BACKGROUND:Early assessment of the severity of acute pancreatitis is essential to the proper management of the disease.It is dependent on the criteria of the Atlanta classification system.DATA SOURCES:PubMed search of recent relevant articles was performed to identify information about the severity and prognosis of acute pancreatitis.RESULTS:The scoring systems included the Ranson’s or Glasgow’s criteria ≥3,the APACHE II classification system ≥8,and the Balthazar’s criteria ≥4 according to the computed tomography enhanced scanning findings.The single factors on admission included age >65 years,obesity,hemoconcentration(>44%),abnormal chest X-ray,creatinine >2 mg/dl,C-reactive protein>150 mg/dl,procalcitonin >1.8 ng/ml,albumin <2.5 mg/dl,calcium <8.5 mg/dl,early hyperglycemia,increased intra-abdominal pressure,macrophage migration inhibitory factor,or a combination of IL-10 >50 pg/ml with calcium <6.6 mg/dl.CONCLUSION:The prediction of the severity of acute pancreatitis is largely based on well defined multiple factor scoring systems as well as several single risk factors.

Portosplenomesenteric vein thrombosis in patients with early-stage severe acute pancreatitis

AIM To investigate the incidence and risk factors of portosplenomesenteric vein thrombosis(PSMVT) in the early stage of severe acute pancreatitis(SAP).METHODS Patients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography(CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic(ROC) curve was generated for the qualifying independent risk factors.RESULTS Twenty-five of the one hundred and forty(17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis(AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar's CT severity index(CTSI) scores [odds ratio(OR): 2.742; 95% confidence interval(CI): 1.664-4.519; P = 0.000], hypoalbuminemia(serum albumin level < 25 g/L)(OR: 32.573; 95%CI: 2.711-391.353; P = 0.006) and gastrointestinal wall thickening(OR: 4.367, 95%CI: 1.218-15.658; P = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar's CTSI scores was 0.777(P = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.CONCLUSION High Balthazar's CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP.

Development and validation of a nomogram for predicting survival in patients with acute pancreatitis

BACKGROUND:Acute pancreatitis(AP)is a complex and heterogeneous disease.We aimed to design and validate a prognostic nomogram for improving the prediction of short-term survival in patients with AP.METHODS:The clinical data of 632 patients with AP were obtained from the Medical Information Mart for Intensive Care(MIMIC)-IV database.The nomogram for the prediction of 30-day,60-day and 90-day survival was developed by incorporating the risk factors identified by multivariate Cox analyses.RESULTS:Multivariate Cox proportional hazard model analysis showed that age(hazard ratio[HR]=1.06,95%confidence interval[95%CI]1.03-1.08,P<0.001),white blood cell count(HR=1.03,95%CI 1.00-1.06,P=0.046),systolic blood pressure(HR=0.99,95%CI 0.97-1.00,P=0.015),serum lactate level(HR=1.10,95%CI 1.01-1.20,P=0.023),and Simplified Acute Physiology Score II(HR=1.04,95%CI 1.02-1.06,P<0.001)were independent predictors of 90-day mortality in patients with AP.A prognostic nomogram model for 30-day,60-day,and 90-day survival based on these variables was built.Receiver operating characteristic(ROC)curve analysis demonstrated that the nomogram had good accuracy for predicting 30-day,60-day,and 90-day survival(area under the ROC curve:0.796,0.812,and 0.854,respectively;bootstrap-corrected C-index value:0.782,0.799,and 0.846,respectively).CONCLUSION:The nomogram-based prognostic model was able to accurately predict 30-day,60-day,and 90-day survival outcomes and thus may be of value for risk stratification and clinical decision-making for critically ill patients with AP.

Effects of acute kidney injury on acute pancreatitis patients’ survival rate in intensive care unit: A retrospective study

BACKGROUND Acute kidney injury(AKI)is one of the most common acute pancreatitis(AP)-associated complications that has a significant effect on AP,but the factors affecting the AP patients’survival rate remains unclear.AIM To assess the influences of AKI on the survival rate in AP patients.METHODS A total of 139 AP patients were included in this retrospective study.Patients were divided into AKI group(n=72)and non-AKI group(n=67)according to the occurrence of AKI.Data were collected from medical records of hospitalized patients.Then,these data were compared between the two groups and further analysis was performed.RESULTS AKI is more likely to occur in male AP patients(P=0.009).AP patients in AKI group exhibited a significantly higher acute physiologic assessment and chronic health evaluation II score,higher Sequential Organ Failure Assessment score,lower Glasgow Coma Scale score,and higher demand for mechanical ventilation,infusion of vasopressors,and renal replacement therapy than AP patients in non-AKI group(P<0.01,P<0.01,P=0.01,P=0.001,P<0.01,P<0.01,respectively).Significant differences were noted in dose of norepinephrine and adrenaline,duration of mechanical ventilation,maximum and mean values of intra-peritoneal pressure(IPP),maximum and mean values of procalcitonin,maximum and mean serum levels of creatinine,minimum platelet count,and length of hospitalization.Among AP patients with AKI,the survival rate of surgical intensive care unit and in-hospital were only 23%and 21%of the corresponding rates in AP patients without AKI,respectively.The factors that influenced the AP patients’survival rate included body mass index(BMI),mean values of IPP,minimum platelet count,and hospital day,of which mean values of IPP showed the greatest impact.CONCLUSION AP patients with AKI had a lower survival rate and worse relevant clinical outcomes than AP patients without AKI,which necessitates further attention to AP patients with AKI in surgical intensive care unit.

Oral allopurinol to prevent hyperamylasemia and acute pancreatitis after endoscopic retrograde cholangiopancreatography

AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to two groups:a study group(n=85)who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography(ERCP)and a control group(n=85)receiving an oral placebo at the same times.Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis.Serum amylase levels were classified as normal(<150 IU/L)or hyperamylasemia(>151 IU/L).Episodes of PEP were classified following Ranson's criteria and CT severity index.RESULTS:Gender distribution was similar between groups.Mean age was 53.5±18.9 years for study group and 52.8±19.8 years for controls.Also,the distribution of benign pathology was similar between groups.Hyperamylasemia was more common in the control group(P=0.003).Mild PEP developed in two patients from the study group(2.3%)and eight(9.4%) from control group(P=0.04),seven episodes were observed in high-risk patients of the control group(25%) and one in the allopurinol group(3.3%,P=0.02).Risk factors for PEP were precut sphincterotomy(P=0.02),pancreatic duct manipulation(P=0.002)and multiple procedures(P=0.000).There were no deaths or side effects.CONCLUSION:Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures.

Seasonal variation in the onset of acute pancreatitis

AIM:A drcannual variation in the onset of several acute diseases, mostly dealing with cardiovascular system,has been reported. The present study was to verify the possible existence of a seasonal variability in the onset of acute pancreatitis. METHODS:All patients consecutively admitted to the Hospital of Ferrara,Italy,between January 1998 to December 2002, whose discharge diagnosis was acute pancreatitis,were considered.According to the time of admission,cases were categorized into twelve 1-mo intervals and in four periods by season.x^2 test for goodness of fit and partial Fourier series were used for statistical analysis. RESULTS:During the study period,549 cases of acute pancreatitis were observed.A significant peak of higher incidence was found in March-May,both for total population, males and subgroups with and without cholelithiasis or alcoholism.Fourier analysis showed the existence of a circannual rhythmic pattern with its main peak in March(95% CL.:February-April,P=0.005),and a secondary one in September.Death occurred more frequently in December- February,compared to the other periods(P=0.029),and chronobiologic analysis yielded a seasonal peak in November- December(P<0.001). CONCLUSION:This study shows the existence of a circannual variation in the onset of acute pancreatitis,with a significantly higher frequency of events in the spring,especially for patients with cholelithiasis or alcoholism.Moreover,events occurring during the colder months seem to be characterized by a higher mortality rate.

Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency

BACKGROUND:This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.METHODS:The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed.The data of 321 patients with no acute respiratory insufficiency as controls were also collected.Clinical variables of the first 24 hours after admission to intensive care unit were collected,including age,sex,comorbid disease,type of surgery,admission type,presence of shock,presence of acute kidney injury,presence of acute lung injury/acute respiratory distress syndrome,acute physiologic and chronic health evaluation(APACHE Ⅱ) score,sepsis-related organ failure assessment(SOFA),and PaO_2/FiO_2 ratio.Duration of mechanical ventilation,length of intensive care unit stay,intensive care unit death,length of hospitalization,hospital death and one-year survival were calculated.RESULTS:The incidence of acute respiratory insufficiency was 37.2%(190/321).Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases(P=0.001),surgeryrelated infection(P=0.004),hypo-volemic shock(P<0.001),and emergency surgery(P=0.018),were independent risk factors of postoperative acute respiratory insufficiency.Compared with the patients without acute respiratory insufficiency,the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay(P<0.001),a prolonged length of hospitalization(P=0.006),increased intensive care unit mortality(P=0.001),and hospital mortality(P<0.001).Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency(P=0.029,RR:8.522,95%CI:1.243-58.437,B=2.143,SE=0.982,Wald=4.758).Compared with the patients without acute respiratory insufficiency,those with acute respiratory insufficiency had a shortened one-year survival rate(78.7%vs.97.1%,P<0.001).CONCLUSION:A history of chronic obstructive pulmonary diseases,surgery-related infection,hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency.Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency.Compared with patients without acute respiratory insufficiency,those with acute respiratory insufficiency had adverse shortterm outcome and a decreased one-year survival rate.

Risk factors analysis of prognosis of adult acute severe myocarditis

BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.AIM To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis(ASM).METHODS Adult patients with ASM(ASM group,n=218)and acute nonsevere myocarditis(ANSM group,n=80)who came to our department from January 2014 to January 2020 were enrolled in this study.Patients with ASM were divided into the ASM survival group(n=185)and ASM nonsurvival group(n=33)according to the treatment results during hospitalization.The clinical symptoms,laboratory examinations,treatment methods,complications,and the relationship between the treatment results of the two groups were retrospectively compared and discussed.The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression.A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge,and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.RESULTS Compared with the ASM survival group,the ASM nonsurvival group had longer QRS complex,higher incidence of cardiogenic shock,higher serum creatinine(SCr,235μmol/L vs 89μmol/L,P<0.05),higher sensitive cardiac troponin I(cTnI,4.45μg/L vs 1.66μg/L,P<0.05)and brain natriuretic peptide(BNP,1756 pg/mL vs 401 pg/mL,P<0.05).The binary logistic regression revealed that there were statistical differences between the two groups in SCr,cTnI,and BNP values(all P<0.05).After discharging from the hospital,patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidencerate of dilated cardiomyopathy.CONCLUSION Elevated SCr,cTnI,and BNP are independent predictors for poor prognosis in patients with ASM.The long-term prognosis of patients in the ASM survival group is good.

Soluble mannose receptor as a predictor of prognosis of hepatitis B virus-related acute-on-chronic liver failure

BACKGROUND Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)is a syndrome with a high short-term mortality rate,and it is crucial to identify those patients at a high mortality risk clinically.AIM To investigate the clinical value of soluble mannose receptor(sMR)in predicting the 90-day mortality of HBV-ACLF patients.METHODS A total of 43 patients were diagnosed with HBV-ACLF between October 2017 and October 2018 at the Second Hospital of Anhui Medical University,and all of them were enrolled in this retrospective study.Their serum sMR levels were determined using an enzyme-linked immunosorbent assay.Demographic and clinical data,including gender,age,albumin level,total bilirubin(TBIL)level,international normalized ratio,HBV-DNA level,HBV serological markers,procalcitonin level,interleukin-6 level,and model for end-stage liver disease(MELD)score were accessed at the time of diagnosis of HBV-ACLF.A multivariate logistic regression analysis was used to analyze the independent risk factors for mortality.RESULTS Serum sMR level was significantly increased in HBV-ACLF patients compared with chronic hepatitis B patients and healthy controls(P<0.01).When compared with surviving patients,it was higher in those patients who succumbed to HBVACLF(P<0.05).Serum sMR level was positively correlated with MELD score(rs=0.533,P=0.001),HBV-DNA level(rs=0.497,P=0.022),and TBIL level(rs=0.894,P<0.001).Serum sMR level(odds ratio=1.007,95%confidence interval:1.004–1.012,P=0.001)was an independent risk factor for the 90-day mortality in the HBV-ACLF cases.The patients with HBV-ACLF were stratified into two groups in accordance with their serum sMR levels at the baseline(low risk:<99.84 pg/mL and high risk:≥99.84 pg/mL).The 90-day mortality rates were 27.3%in the low-risk group and 87.5%in the high-risk group.Furthermore,sMR level apparently improved the performance of MELD score for predicting the prognosis of patients with HBV-ACLF.CONCLUSION Serum sMR level may be a predictor of the prognosis of HBV-ACLF patients.

Correlation of neutrophil to lymphocyte ratio to severity of coronary artery disease and in-hospital clinical outcomes in patients with acute coronary syndrome: A prospective observational study

Objective:To explore correlation of neutrophil-to-lymphocyte ratio(NLR)to severity of coronary artery disease(CAD)and in-hospital clinical outcomes in patients with acute coronary syndrome(ACS).Methods:In this prospective and observational study,we recruited 500 patients with ACS.For all the eligible patients,demographic details were collected,and laboratory parameters were evaluated.The CAD severity was evaluated in terms of the number of involved vessels.The NLR was calculated based on neutrophils and lymphocytes and the correlation of various risk factors and severity and outcome of CAD was performed.Results:77.2%of Patients was male,and 52%of the patients aged between 55-70 years.Based on the type of ACS,396 out of 500 patients had ST-elevation myocardial infarction.An ascending trend in the white blood cell levels and NLR value was noted as the severity of the ACS increased and the highest white blood cell levels and NLR was noted among classⅣpatients.The mean NLR value among the non-survivors were higher compared to the survivors(9.52±5.72 vs.4.76±2.36;P<0.01).Receiver operating curve showed that the cut-off NLR value was 5.76 with a sensitivity of 75.0%and a specificity of 77.3%.Conclusions:The NLR can be used as an independent prognostic marker in ACS.An elevated NLR value serves as a reliable predictor for short-term complications,notably in-hospital mortality.

An effective model for predicting acute kidney injury after liver transplantation

BACKGROUND: Acute kidney injury (AKI) is a common complication in the early period after liver transplantation (LT), posing an enormous obstacle to treatment efficiency and patient survival. However, the exact influencing factors of AKI are still unclear and a predictive model is desperately required in the clinic. METHODS: Data of 102 consecutive LTs were reviewed. A model for predicting AKI was established and further validated in a prospective study of 44-patients receiving LT. RESULTS: The incidence of AKI was 32.4%. AKI patients showed a significantly lower survival rate than non-AKI patients. Multivariate analysis demonstrated the independent influencing factors of AKI were preoperative serum creatinine >1.2 mg/dl, intraoperative urine output <= 60 ml/h, intraoperative hypotension status, and intraoperative use of noradrenaline. A model was then established and showed a sensitivity of 75.0%, a specificity of 93.8%, and an accuracy of 88.6% in predicting AKI. CONCLUSIONS: High preoperative serum creatinine, low intraoperative urine output, and intraoperative hypotension contribute to the development of AKI, and intraoperative use of noradrenaline serves as a protective factor. The predictive model could potentially facilitate early prediction and surveillance of AKI. (Hepatobilinty Pancreat Dis Int 2010; 9:259-263)

Risk factors of prognosis after acute kidney injury in hospitalized patients

The risk factors, especially laboratory indicators, of prognosis after acute kidney injury （AK1） remain unclear. We conducted a retrospective survey of Chinese People＇s Liberation Army General Hospital from January 1, 2012 to December 31, 2012 according to the AKI diagnosis standard issued by Kidney Disease Improving Global Outcomes. The epidemiological features and factors influencing hospital mortality and renal function recovery were evaluated through logistic regression analysis. Among 77 662 cases of hospitalized patients, 1387 suffered from AKI. The incidence rate and mortality of AKI were 1.79~ and 14.56%, respectively. Multivariate logistic regression analysis revealed that high AKI stage, age greater than 80 years, neoplastic disease, low cardiac output, increased white blood cell count, and decreased platelet count and serum albumin levels were the risk factors affecting the mortality of AKI patients. Conversely, body mass index between 28 and 34.9 was a protective factor. Increased AKI stage, tumor disease, post-cardiopulmonary resuscitation, and RRT were the risk factors of renal function recovery upon discharge. In addition to traditional risk factors, white blood cell count, platelet count, albumin, and BMI were the predictors of the mortality of AKI patients. No laboratory indicators were found to be the risk factors of renal function recovery in AKI patients.

A Nomogram Model for Predicting Type-2 Myocardial Infarction Induced by Acute Upper Gastrointestinal Bleeding

Objective To examine the independent risk factors of type-2 myocardial infarction(T2MI)elicited by acute upper gastrointestinal bleeding(AUGIB),and to establish a nomogram model for the prediction of AUGIB-induced T2MI.Methods A nomogram model was established on the basis of a retrospective study that involved 533 patients who suffered from AUGIB in the Department of Critical Care Medicine(CCM)or Emergency Intensive Care Unit(EICU)of Renmin Hospital of Wuhan University,Wuhan,China,from January 2017 to December 2020.The predictive accuracy and discriminative power of the nomogram were initially evaluated by internal validation,which involved drawing the receiver operating characteristic(ROC)curve,calculating the area under the curve(AUC),plotting the calibration curve derived from 1000 resampled bootstrap data sets,and computing the root mean square error(RMSE).The predictive ability of the nomogram was further validated through the prospective and multicenter study conducted by the investigators,which enrolled 240 AUGIB patients[including 88 cases from Renmin Hospital of Wuhan University,73 cases from Qilu Hospital of Shandong University(Qingdao),and 79 cases from Northern Jiangsu People’s Hospital)],who were admitted to the Department of CCM or EICU,from February 2021 to July 2021.Results Among the 533 patients in the training cohort,78(14.6%)patients were assigned to the T2MI group and 455(85.4%)patients were assigned to the non-T2MI group.The multivariate analysis revealed that age>65,hemorrhagic shock,cerebral stroke,heart failure,chronic kidney disease,increased blood urea nitrogen,decreased hematocrit,and elevated D-Dimer were independent risk factors for AUGIB-induced T2MI.All these factors were incorporated into the nomogram model.The AUC for the nomogram for predicting T2MI was 0.829(95%CI,0.783-0.875)in the internal validation cohort and 0.848(95%CI,0.794-0.902)in the external validation cohort.The calibration curve for the risk of T2MI exhibited good consistency between the prediction by the nomogram and the actual clinical observation in both the internal validation(RMSE=0.016)and external validation(RMSE=0.020).Conclusion The nomogram was proven to be a useful tool for the risk stratification of T2MI in AUGIB patients,and is helpful for the early identification of AUGIB patients who are prone to T2MI for early intervention,especially in emergency departments and intensive care units.

A Nomogram Model for Prediction of Mortality Risk of Patients with Dangerous Upper Gastrointestinal Bleeding:A Two-center Retrospective Study

Objective:This study aimed to establish a nomogram model to predict the mortality risk of patients with dangerous upper gastrointestinal bleeding(DUGIB),and identify high-risk patients who require emergent therapy.Methods:From January 2020 to April 2022,the clinical data of 256 DUGIB patients who received treatments in the intensive care unit(ICU)were retrospectively collected from Renmin Hospital of Wuhan University(n=179)and the Eastern Campus of Renmin Hospital of Wuhan University(n=77).The 179 patients were treated as the training cohort,and 77 patients as the validation cohort.Logistic regression analysis was used to calculate the independent risk factors,and R packages were used to construct the nomogram model.The prediction accuracy and identification ability were evaluated by the receiver operating characteristic(ROC)curve,C index and calibration curve.The nomogram model was also simultaneously externally validated.Decision curve analysis(DCA)was then used to demonstrate the clinical value of the model.Results:Logistic regression analysis showed that hematemesis,urea nitrogen level,emergency endoscopy,AIMS65,Glasgow Blatchford score and Rockall score were all independent risk factors for DUGIB.The ROC curve analysis indicated the area under curve(AUC)of the training cohort was 0.980(95%CI:0.962-0.997),while the AUC of the validation cohort was 0.790(95%CI:0.685-0.895).The calibration curves were tested for Hosmer-Lemeshow goodness of fit for both training and validation cohorts(P=0.778,P=0.516).Conclusion:The developed nomogram is an effective tool for risk stratification,early identification and intervention for DUGIB patients.

老年急性脑梗死患者血清Del-1和IL-17水平变化及与梗死面积和预后的关系

目的 探究老年急性脑梗死(ACI)患者血清内皮发育调节基因-1(Del-1)、白细胞介素-17(IL-17)水平与脑梗死面积、病情严重程度及预后的关系。方法 回顾性收集2019-01-2021-12厦门大学附属东南医院收治的126例老年ACI患者(病例组)及105名健康体检者(对照组)的临床资料,根据脑梗死面积将病例组患者分为大面积梗死组(梗死最大直径>5 cm,n=14)、中面积梗死组(梗死最大直径3~5 cm,n=53)和小面积梗死组(梗死最大直径<3 cm,n=59);根据NIHSS评分分为重症组(NIHSS评分≥16分,n=13)、中症组(5分<NIHSS评分<15分,n=58)和轻症组(NIHSS评分≤5分,n=55);根据m RS评分分为预后良好组(mRS评分≤2分,n=81)和预后不良组(mRS评分>2分,n=45)。采用荧光免疫法检测血清Del-1、IL-17水平,受试者工作特征(ROC)曲线评估血清Del-1、IL-17水平预测老年ACI患者预后的价值。结果 病例组吸烟史比例、收缩压、舒张压、糖化血红蛋白、血清IL-17水平均高于对照组,血清Del-1水平低于对照组(P<0.05)。不同脑梗死面积患者血清Del-1水平比较,小面积梗死组>中面积梗死组>大面积梗死组;血清IL-17水平比较,小面积梗死组<中面积梗死组<大面积梗死组(P<0.05)。轻症组血清Del-1水平高于中症组、重症组(P<0.05),不同病情严重程度患者血清IL-17水平比较,重症组>中症组>轻症组(P<0.05)。预后良好组患者血清Del-1水平高于预后不良组,血清IL-17水平低于预后不良组(P<0.05)。ROC曲线分析显示,血清Del-1、IL-17预测ACI患者预后的AUC值分别为0.763、0.747(P<0.05)。结论 老年ACI患者血清Del-1水平较低,IL-17水平较高,二者与患者脑梗死面积、病情严重程度和预后关系密切,可作为预测老年ACI患者预后的可靠指标。