Objective To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome(PICS)in ICU.Methods A total of 126 patients admitted to ICU(ICU stay of ...Objective To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome(PICS)in ICU.Methods A total of 126 patients admitted to ICU(ICU stay of more than 10 days,age≥18 years)between January 2014 and December 2014 were retrospectively studied.Data were collected from electronic medical records including demographics,underlying disease。展开更多
目的:探讨3-脱氧葡萄糖醛酮(3-deoxyglucosone,3-DG)在持续炎症、免疫抑制和分解代谢综合征(persistent inflammation,immunosuppression,and catabolism syndrome,PICS)诊断及其与脓毒症病情和预后判断中的价值。方法:采用观察性队列...目的:探讨3-脱氧葡萄糖醛酮(3-deoxyglucosone,3-DG)在持续炎症、免疫抑制和分解代谢综合征(persistent inflammation,immunosuppression,and catabolism syndrome,PICS)诊断及其与脓毒症病情和预后判断中的价值。方法:采用观察性队列研究方法,选择2017年1月1日—2019年12月31日收住南通市第三人民医院重症医学科的脓毒症患者240例作为研究对象,按照是否合并PICS分为PICS组和非PICS组,检测两组患者血浆中3-DG的水平,对比两组患者临床检验指标,分析PICS的影响因素及3-DG预测PICS的价值,评估3-DG与脓毒症患者病情严重程度以及临床预后价值。结果:PICS组淋巴细胞计数、血清白蛋白、格拉斯哥昏迷评分(Glasgow coma scale,GCS)低于非PICS组,而PICS组在血浆3-DG、C-反应蛋白、急性生理与慢性健康Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、序贯器官衰竭(sequential organ failure assessment,SOFA)评分高于非PICS组(P<0.05)。多项Logistic回归分析结果显示,淋巴细胞计数、血浆3-DG、C-反应蛋白、APACHEⅡ评分、SOFA评分是PICS的影响因素(P<0.05)。3-DG预测脓毒症致PICS的ROC曲线下结果为0.720,敏感度为81.3%,特异度为56.6%。相关性分析显示3-DG与APACHEⅡ评分(r=0.237,P=0.004)、SOFA评分(r=0.308,P<0.001)、GCS评分(r=0.125,P=0.041)具有相关性。生存分析显示3-DG不同表达水平与脓毒症患者预后具有相关性(P<0.05)。结论:淋巴细胞计数、血浆3-DG、C-反应蛋白、APACHEⅡ评分、SOFA评分是PICS的影响因素,3-DG预测PICS具有较高价值。3-DG表达水平与脓毒症患者的病情及预后具有相关性。展开更多
目的分析重症患者持续性炎症-免疫抑制-分解代谢综合征(persistent inflammation immunosuppression catabolism syndrome,PICS)的临床特征。方法以2014年1月—2020年12月延安市人民医院重症医学科(intensive care unit,ICU)收治的患者...目的分析重症患者持续性炎症-免疫抑制-分解代谢综合征(persistent inflammation immunosuppression catabolism syndrome,PICS)的临床特征。方法以2014年1月—2020年12月延安市人民医院重症医学科(intensive care unit,ICU)收治的患者200例为研究对象,回顾性收集其临床资料,根据是否并发PICS分为PICS组(n=108)、非PICS组(n=92)。比较两组临床一般资料、T淋巴细胞亚群、血液指标及预后情况。结果PICS组年龄、急性生理学及慢性健康状况评分系统(acute physiology andchronic health evaluation scoring systemⅡ,APACHEⅡ)评分、序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分、消化道穿孔比例高于非PICS组,体质量指数(body mass index,BMI)低于非PICS组(P<0.05)。PICS组CD8^(+)高于非PICS组(P<0.05),PICS组CD3^(+)、CD4^(+)/CD8^(+)、CD4^(+)低于非PICS组(P<0.05)。PICS组前白蛋白(proalbumin,PAB)、淋巴细胞计数低于非PICS组,降钙素原(procalcitonin,PCT)水平高于非PICS组(P<0.05)。PICS组ICU内获得性感染的发生率、死亡率高于死亡,住ICU时间长于非PICS组(P<0.05)。结论ICU内重症患者并发PICS较为常见,患者存在T淋巴细胞亚群及血液指标异常,继发感染风险高,预后较差,临床可针对性采取干预措施。展开更多
With improvements in personnel and vehicular body armor,robust casualty evacuation capabilities,and damage control resuscitation strategies,more combat casualties are surviving to reach higher levels of care throughou...With improvements in personnel and vehicular body armor,robust casualty evacuation capabilities,and damage control resuscitation strategies,more combat casualties are surviving to reach higher levels of care throughout the casualty evacuation system.As such,medical centers are becoming more accustomed to managing the deleterious late consequences of combat trauma related to the dysregulation of the immune system.In this review,we aim to highlight these late consequences and identify areas for future research and therapeutic strategies.Trauma leads to the dysregulation of both the innate and adaptive immune responses,which places the injured at risk for several late consequences,including delayed wound healing,late onset sepsis and infection,multi-organ dysfunction syndrome,and acute respiratory distress syndrome,which are significant for their association with the increased morbidity and mortality of wounded personnel.The mechanisms by which these consequences develop are complex but include an imbalance of the immune system leading to robust inflammatory responses,triggered by the presence of damage associated molecules and other immune-modifying agents following trauma.Treatment strategies to improve outcomes have been difficult to develop as the immunophenotype of injured personnel following trauma is variable,fluid and difficult to determine.As more information regarding the triggers that lead to immune dysfunction following trauma is elucidated,it may be possible to identify the immunophenotype of injured personnel and provide targeted treatments to reduce the late consequences of trauma,which are known to lead to significant morbidity and mortality.展开更多
文摘Objective To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome(PICS)in ICU.Methods A total of 126 patients admitted to ICU(ICU stay of more than 10 days,age≥18 years)between January 2014 and December 2014 were retrospectively studied.Data were collected from electronic medical records including demographics,underlying disease。
文摘目的:探讨3-脱氧葡萄糖醛酮(3-deoxyglucosone,3-DG)在持续炎症、免疫抑制和分解代谢综合征(persistent inflammation,immunosuppression,and catabolism syndrome,PICS)诊断及其与脓毒症病情和预后判断中的价值。方法:采用观察性队列研究方法,选择2017年1月1日—2019年12月31日收住南通市第三人民医院重症医学科的脓毒症患者240例作为研究对象,按照是否合并PICS分为PICS组和非PICS组,检测两组患者血浆中3-DG的水平,对比两组患者临床检验指标,分析PICS的影响因素及3-DG预测PICS的价值,评估3-DG与脓毒症患者病情严重程度以及临床预后价值。结果:PICS组淋巴细胞计数、血清白蛋白、格拉斯哥昏迷评分(Glasgow coma scale,GCS)低于非PICS组,而PICS组在血浆3-DG、C-反应蛋白、急性生理与慢性健康Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、序贯器官衰竭(sequential organ failure assessment,SOFA)评分高于非PICS组(P<0.05)。多项Logistic回归分析结果显示,淋巴细胞计数、血浆3-DG、C-反应蛋白、APACHEⅡ评分、SOFA评分是PICS的影响因素(P<0.05)。3-DG预测脓毒症致PICS的ROC曲线下结果为0.720,敏感度为81.3%,特异度为56.6%。相关性分析显示3-DG与APACHEⅡ评分(r=0.237,P=0.004)、SOFA评分(r=0.308,P<0.001)、GCS评分(r=0.125,P=0.041)具有相关性。生存分析显示3-DG不同表达水平与脓毒症患者预后具有相关性(P<0.05)。结论:淋巴细胞计数、血浆3-DG、C-反应蛋白、APACHEⅡ评分、SOFA评分是PICS的影响因素,3-DG预测PICS具有较高价值。3-DG表达水平与脓毒症患者的病情及预后具有相关性。
文摘目的分析重症患者持续性炎症-免疫抑制-分解代谢综合征(persistent inflammation immunosuppression catabolism syndrome,PICS)的临床特征。方法以2014年1月—2020年12月延安市人民医院重症医学科(intensive care unit,ICU)收治的患者200例为研究对象,回顾性收集其临床资料,根据是否并发PICS分为PICS组(n=108)、非PICS组(n=92)。比较两组临床一般资料、T淋巴细胞亚群、血液指标及预后情况。结果PICS组年龄、急性生理学及慢性健康状况评分系统(acute physiology andchronic health evaluation scoring systemⅡ,APACHEⅡ)评分、序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分、消化道穿孔比例高于非PICS组,体质量指数(body mass index,BMI)低于非PICS组(P<0.05)。PICS组CD8^(+)高于非PICS组(P<0.05),PICS组CD3^(+)、CD4^(+)/CD8^(+)、CD4^(+)低于非PICS组(P<0.05)。PICS组前白蛋白(proalbumin,PAB)、淋巴细胞计数低于非PICS组,降钙素原(procalcitonin,PCT)水平高于非PICS组(P<0.05)。PICS组ICU内获得性感染的发生率、死亡率高于死亡,住ICU时间长于非PICS组(P<0.05)。结论ICU内重症患者并发PICS较为常见,患者存在T淋巴细胞亚群及血液指标异常,继发感染风险高,预后较差,临床可针对性采取干预措施。
基金RJS was supported by National Institutes of Health grants,K08-GM117367.
文摘With improvements in personnel and vehicular body armor,robust casualty evacuation capabilities,and damage control resuscitation strategies,more combat casualties are surviving to reach higher levels of care throughout the casualty evacuation system.As such,medical centers are becoming more accustomed to managing the deleterious late consequences of combat trauma related to the dysregulation of the immune system.In this review,we aim to highlight these late consequences and identify areas for future research and therapeutic strategies.Trauma leads to the dysregulation of both the innate and adaptive immune responses,which places the injured at risk for several late consequences,including delayed wound healing,late onset sepsis and infection,multi-organ dysfunction syndrome,and acute respiratory distress syndrome,which are significant for their association with the increased morbidity and mortality of wounded personnel.The mechanisms by which these consequences develop are complex but include an imbalance of the immune system leading to robust inflammatory responses,triggered by the presence of damage associated molecules and other immune-modifying agents following trauma.Treatment strategies to improve outcomes have been difficult to develop as the immunophenotype of injured personnel following trauma is variable,fluid and difficult to determine.As more information regarding the triggers that lead to immune dysfunction following trauma is elucidated,it may be possible to identify the immunophenotype of injured personnel and provide targeted treatments to reduce the late consequences of trauma,which are known to lead to significant morbidity and mortality.
