BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality predictio...BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality prediction.To enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,2019.Receiver operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various scores.RESULTS:Among the 936 enrolled cases,there were 835 survivors and 101 deaths.The AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,respectively.The sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,respectively.The specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,respectively.The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSIONS:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA.As the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.展开更多
BACKGROUND Acute pancreatitis(AP)is a common surgical condition,with severe AP(SAP)potentially lethal.Many prognostic indices,including;acute physiology and chronic health evaluation II score(APACHE II),bedside index ...BACKGROUND Acute pancreatitis(AP)is a common surgical condition,with severe AP(SAP)potentially lethal.Many prognostic indices,including;acute physiology and chronic health evaluation II score(APACHE II),bedside index of severity in acute pancreatitis(BISAP),Glasgow score,harmless acute pancreatitis score(HAPS),Ranson’s score,and sequential organ failure assessment(SOFA)evaluate AP severity and predict mortality.AIM To evaluate these indices'utility in predicting severity,intensive care unit(ICU)admission,and mortality.METHODS A retrospective analysis of 653 patients with AP from July 2009 to September 2016 was performed.The demographic,clinical profile,and patient outcomes were collected.SAP was defined as per the revised Atlanta classification.Values for APACHE II score,BISAP,HAPS,and SOFA within 24 h of admission were retrospectively obtained based on laboratory results and patient evaluation recorded on a secure hospital-based online electronic platform.Data with<10%missing data was imputed via mean substitution.Other patient information such as demographics,disease etiology,and patient outcomes were also derived from electronic medical records.RESULTS The mean age was 58.7±17.5 years,with 58.7%males.Gallstones(n=404,61.9%),alcohol(n=38,5.8%),and hypertriglyceridemia(n=19,2.9%)were more common aetiologies.81(12.4%)patients developed SAP,20(3.1%)required ICU admission,and 12(1.8%)deaths were attributed to SAP.Ranson’s score and APACHE-II demonstrated the highest sensitivity in predicting SAP(92.6%,80.2%respectively),ICU admission(100%),and mortality(100%).While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP(13.6%,24.7%respectively),ICU admission(40.0%,25.0%respectively)and mortality(50.0%,25.5%respectively).However,SOFA demonstrated the highest specificity in predicting SAP(99.7%),ICU admission(99.2%),and mortality(98.9%).SOFA demonstrated the highest positive predictive value,positive likelihood ratio,diagnostic odds ratio,and overall accuracy in predicting SAP,ICU admission,and mortality.SOFA and Ranson’s score demonstrated the highest area under receiver-operator curves at 48 h in predicting SAP(0.966,0.857 respectively),ICU admission(0.943,0.946 respectively),and mortality(0.968,0.917 respectively).CONCLUSION The SOFA and 48-h Ranson’s scores accurately predict severity,ICU admission,and mortality in AP,with more favorable statistics for the SOFA score.展开更多
目的探讨电子序贯器官衰竭评分(simplified organ dysfunction criteria optimized for electronic health records,eSOFA)对急诊脓毒症患者28、90 d及1年预后的预测价值,并与序贯器官衰竭评分(sequential organ failure assessment,SO...目的探讨电子序贯器官衰竭评分(simplified organ dysfunction criteria optimized for electronic health records,eSOFA)对急诊脓毒症患者28、90 d及1年预后的预测价值,并与序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理学与慢性健康状况Ⅱ评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)进行比较。方法连续纳入2018年12月1日至2021年1月31日中国康复研究中心急诊重症监护室收治的脓毒症患者。分别绘制eSOFA、SOFA和APACHEⅡ评分对患者28、90 d及1年预后的受试者工作特征(receiver operating characteristic,ROC)曲线,计算相应的曲线下面积(area under curve,AUC),并进行比较。根据eSOFA评分的截断值将患者分为eSOFA评分≤2分和eSOFA评分>2分两组,比较两组的一般临床特点。结果本研究最终纳入197例脓毒症患者,年龄为84(74~88)岁,其中男119例。纳入患者28、90 d及1年的病死率分别为38.6%(76/197)、51.8%(102/197)及58.9%(116/197)。eSOFA、SOFA和APACHEⅡ评分对脓毒症患者28、90 d及1年预后均具有预测能力,但三者差异无统计学意义(P>0.05),eSOFA评分对脓毒症患者1年死亡预测模型的拟和优度差,对1年预后预测效果不佳(P=0.01)。与eSOFA评分≤2分组相比,eSOFA评分>2分组患者死亡风险高(P<0.05),SOFA评分[分:5(4,7)vs.9(7,12)]和APACHEⅡ评分[分:23(18,27)vs.28(23,35)]更差,且更多患者发生急性肾损伤(acute kidney injury,AKI)(61.8%vs.83.6%)及接受血管活性药物(10.3%vs.59.1%)和机械通气(19.1%vs.50.8%)治疗。结论eSOFA、SOFA和APACHEⅡ评分均能有效评估脓毒症患者的中短期预后,优化患者早期治疗策略,但eSOFA评分简便易计算,更适合应用于急诊科。展开更多
Background The prognostic power of n-terminal pro-brain natriuretic peptide （NT-proBNP） in sepsis is disputable and unstable among different models. We attempt to evaluate the prognostic potential of NT-proBNP in co...Background The prognostic power of n-terminal pro-brain natriuretic peptide （NT-proBNP） in sepsis is disputable and unstable among different models. We attempt to evaluate the prognostic potential of NT-proBNP in combination with the sequential organ failure assessment （SOFA） score in sepsis. Methods In this retrospective study, 100 consecutive sepsis patients were enrolled. Clinical data such as admission SOFA, the Acute Physiologic and Chronic Health Evaluation score, shock prevalence, use of lung protective ventilation, vasopressors, and glucocorticoids were recorded. Additionally, serum creatinine （Scrl and Scr3） and NT-proBNP （NT-proBNP1 and NT-proBNP3） were assayed and evaluated at admission and on day 3 respectively. Results ANT-proBNP （NT-proBNP3 minus NT-proBNP1） （P 〈0.001, Hazard ratio （HR）=1.245, 95% confidence interval （CI）, 1.137-1.362） and admission SOFA （P 〈0.001, HR=1.197, 95% CI, 1.106-1.295） were independently related to in-hospital mortality. Their combination was a more robust predictor for in-hospital mortality than either of them individually. Patients with high ANT-proBNP and SOFA had the poorest prognosis. Conclusions In our study, both ANT-proBNP and SOFA were independent predictors of septic patients＇ prognosis. Moreover, the combination of ,~NT-proBNP and admission SOFA provided a novel strategy that contained information regarding both the response to treatment and sepsis severity.展开更多
Background： The quick Sequential Organ Failure Assessment （qSOFA） score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism （PE） by combining with electrocardiogr...Background： The quick Sequential Organ Failure Assessment （qSOFA） score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism （PE） by combining with electrocardiography （ECG）. Methods： Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low-risk groups by imaging and biomarkers. The ECG scores consisted oftachycardia, McGinn-White sign （S1Q3T3）, right bundle branch block, and T-wave inversion of leads V1-V3. A new combination of qSOFA scores and ECG scores by logistic regression for predicting high-risk stratification patients with acute PE was evaluated by a receiver operating characteristic curve. Results： Totally 1318 patients were enrolled, including 271 in the high-risk group and 1047 in the low-risk group. A combination predictive scoring system named qSOFA-ECG = qSOFA score ＋ ECG score was created. The optimal cutoffvalue for qSOFA-ECG was 2, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.5%, 72.3%, 43.2%, and 93.8%, respectively. For predicting high-risk stratification and reperfusion therapy, the qSOFA-ECG is superior to PE Severity Index （PESI） and simplified PESI. Conclusions： The qSOFA score contributes to identify acute PE patients with potentially hemodynamic decompensation that need monitoring and possible reperfusion therapy at the emergency department arrival when used in combination with ECG score.展开更多
目的:探究外周血高迁移率族蛋白-1(high mobility group box protein 1,HMGB1)、糖基化终产物受体(receptor for advanced glycation endproducts,RAGE)和快速顺序器官功能衰竭评估(quick sequential organ failure assessment,qSOFA)...目的:探究外周血高迁移率族蛋白-1(high mobility group box protein 1,HMGB1)、糖基化终产物受体(receptor for advanced glycation endproducts,RAGE)和快速顺序器官功能衰竭评估(quick sequential organ failure assessment,qSOFA)评分在急性呼吸衰竭并发心肌损伤评估中的应用价值。方法:选择2020年1月-2022年12月就诊于兴山县人民医院的129例急性呼吸衰竭患者作为观察对象,根据患者是否并发心肌损伤将其分为心肌损伤组(n=43)和非心肌损伤组(n=86)。收集所有研究对象入组时的年龄、性别、体重指数等一般资料;评估受试者qSOFA评分,检测受试者外周血HMGB1和RAGE水平;logistic回归分析急性呼吸衰竭并发心肌损伤的影响因素;受试者工作特性曲线(receiver operator characteristic curve,ROC)分析HMGB1、RAGE联合qSOFA评分对急性呼吸衰竭并发心肌损伤的评估价值。结果:心肌损伤组一秒率[第1秒用力呼气容积(forced expiratory volume in one second,FEV1)/用力肺活量(forced vital capacity,FVC)%]和动脉血氧分压(arterial partial pressure of oxygen,PaO2)显著低于非心肌损伤组,动脉血二氧化碳分压(arterial carbon dioxide partial pressure,PaCO_(2))显著高于非心肌损伤组,差异有统计学意义(P<0.05);心肌损伤组外周血HMGB1、RAGE水平和q SOFA评分均显著高于非心肌损伤组,差异有统计学意义(P<0.05);logistic回归分析显示,HMGB1、RAGE水平和qSOFA评分升高均为急性呼吸衰竭患者并发心肌损伤的独立危险因素(P<0.05);ROC分析显示,HMGB1、RAGE水平、qSOFA评分联合检测ROC曲线下面积(AUC)明显高于各指标单独检测,差异有统计学意义(P<0.05)。结论:HMGB1、RAGE水平和qSOFA评分升高均为急性呼吸衰竭患者并发心肌损伤的独立危险因素;HMGB1、RAGE水平和qSOFA评分均可对急性呼吸衰竭患者心肌损伤的发生进行评估,且联合评估的价值更高。展开更多
BACKGROUND Sepsis is a severe medical condition that occurs when the body's immune system overreacts to an infection,leading to life-threatening organ dysfunction.The"Third international consensus definitions...BACKGROUND Sepsis is a severe medical condition that occurs when the body's immune system overreacts to an infection,leading to life-threatening organ dysfunction.The"Third international consensus definitions for sepsis and septic shock(Sepsis-3)"defines sepsis as an increase in sequential organ failure assessment score of 2 points or more,with a mortality rate above 10%.Sepsis is a leading cause of intensive care unit(ICU)admissions,and patients with underlying conditions such as cirrhosis have a higher risk of poor outcomes.Therefore,it is critical to recognize and manage sepsis promptly by administering fluids,vasopressors,steroids,and antibiotics,and identifying and treating the source of infection.AIM To conduct a systematic review and meta-analysis of existing literature on the management of sepsis in cirrhotic patients admitted to the ICU and compare the management of sepsis between cirrhotic and non-cirrhotic patients in the ICU.METHODS This study is a systematic literature review that followed the PRISMA statement's standardized search method.The search for relevant studies was conducted across multiple databases,including PubMed,Embase,Base,and Cochrane,using predefined search terms.One reviewer conducted the initial search,and the eligibility criteria were applied to the titles and abstracts of the retrieved articles.The selected articles were then evaluated based on the research objectives to ensure relevance to the study's aims.RESULTS The study findings indicate that cirrhotic patients are more susceptible to infections,resulting in higher mortality rates ranging from 18%to 60%.Early identification of the infection source followed by timely administration of antibiotics,vasopressors,and corticosteroids has been shown to improve patient outcomes.Procalcitonin is a useful biomarker for diagnosing infections in cirrhotic patients.Moreover,presepsin and resistin have been found to be reliable markers of bacterial infection in patients with decompensated liver cirrhosis,with similar diagnostic performance compared to procalcitonin.CONCLUSION This review highlights the importance of early detection and management of infections in cirrhosis patients to reduce mortality.Therefore,early detection of infection using procalcitonin test and other biomarker as presepsin and resistin,associated with early management with antibiotics,fluids,vasopressors and low dose corticosteroids might reduce the mortality associated with sepsis in cirrhotic patients.展开更多
文摘BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality prediction.To enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,2019.Receiver operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various scores.RESULTS:Among the 936 enrolled cases,there were 835 survivors and 101 deaths.The AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,respectively.The sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,respectively.The specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,respectively.The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSIONS:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA.As the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.
文摘BACKGROUND Acute pancreatitis(AP)is a common surgical condition,with severe AP(SAP)potentially lethal.Many prognostic indices,including;acute physiology and chronic health evaluation II score(APACHE II),bedside index of severity in acute pancreatitis(BISAP),Glasgow score,harmless acute pancreatitis score(HAPS),Ranson’s score,and sequential organ failure assessment(SOFA)evaluate AP severity and predict mortality.AIM To evaluate these indices'utility in predicting severity,intensive care unit(ICU)admission,and mortality.METHODS A retrospective analysis of 653 patients with AP from July 2009 to September 2016 was performed.The demographic,clinical profile,and patient outcomes were collected.SAP was defined as per the revised Atlanta classification.Values for APACHE II score,BISAP,HAPS,and SOFA within 24 h of admission were retrospectively obtained based on laboratory results and patient evaluation recorded on a secure hospital-based online electronic platform.Data with<10%missing data was imputed via mean substitution.Other patient information such as demographics,disease etiology,and patient outcomes were also derived from electronic medical records.RESULTS The mean age was 58.7±17.5 years,with 58.7%males.Gallstones(n=404,61.9%),alcohol(n=38,5.8%),and hypertriglyceridemia(n=19,2.9%)were more common aetiologies.81(12.4%)patients developed SAP,20(3.1%)required ICU admission,and 12(1.8%)deaths were attributed to SAP.Ranson’s score and APACHE-II demonstrated the highest sensitivity in predicting SAP(92.6%,80.2%respectively),ICU admission(100%),and mortality(100%).While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP(13.6%,24.7%respectively),ICU admission(40.0%,25.0%respectively)and mortality(50.0%,25.5%respectively).However,SOFA demonstrated the highest specificity in predicting SAP(99.7%),ICU admission(99.2%),and mortality(98.9%).SOFA demonstrated the highest positive predictive value,positive likelihood ratio,diagnostic odds ratio,and overall accuracy in predicting SAP,ICU admission,and mortality.SOFA and Ranson’s score demonstrated the highest area under receiver-operator curves at 48 h in predicting SAP(0.966,0.857 respectively),ICU admission(0.943,0.946 respectively),and mortality(0.968,0.917 respectively).CONCLUSION The SOFA and 48-h Ranson’s scores accurately predict severity,ICU admission,and mortality in AP,with more favorable statistics for the SOFA score.
文摘目的探讨电子序贯器官衰竭评分(simplified organ dysfunction criteria optimized for electronic health records,eSOFA)对急诊脓毒症患者28、90 d及1年预后的预测价值,并与序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理学与慢性健康状况Ⅱ评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)进行比较。方法连续纳入2018年12月1日至2021年1月31日中国康复研究中心急诊重症监护室收治的脓毒症患者。分别绘制eSOFA、SOFA和APACHEⅡ评分对患者28、90 d及1年预后的受试者工作特征(receiver operating characteristic,ROC)曲线,计算相应的曲线下面积(area under curve,AUC),并进行比较。根据eSOFA评分的截断值将患者分为eSOFA评分≤2分和eSOFA评分>2分两组,比较两组的一般临床特点。结果本研究最终纳入197例脓毒症患者,年龄为84(74~88)岁,其中男119例。纳入患者28、90 d及1年的病死率分别为38.6%(76/197)、51.8%(102/197)及58.9%(116/197)。eSOFA、SOFA和APACHEⅡ评分对脓毒症患者28、90 d及1年预后均具有预测能力,但三者差异无统计学意义(P>0.05),eSOFA评分对脓毒症患者1年死亡预测模型的拟和优度差,对1年预后预测效果不佳(P=0.01)。与eSOFA评分≤2分组相比,eSOFA评分>2分组患者死亡风险高(P<0.05),SOFA评分[分:5(4,7)vs.9(7,12)]和APACHEⅡ评分[分:23(18,27)vs.28(23,35)]更差,且更多患者发生急性肾损伤(acute kidney injury,AKI)(61.8%vs.83.6%)及接受血管活性药物(10.3%vs.59.1%)和机械通气(19.1%vs.50.8%)治疗。结论eSOFA、SOFA和APACHEⅡ评分均能有效评估脓毒症患者的中短期预后,优化患者早期治疗策略,但eSOFA评分简便易计算,更适合应用于急诊科。
文摘Background The prognostic power of n-terminal pro-brain natriuretic peptide （NT-proBNP） in sepsis is disputable and unstable among different models. We attempt to evaluate the prognostic potential of NT-proBNP in combination with the sequential organ failure assessment （SOFA） score in sepsis. Methods In this retrospective study, 100 consecutive sepsis patients were enrolled. Clinical data such as admission SOFA, the Acute Physiologic and Chronic Health Evaluation score, shock prevalence, use of lung protective ventilation, vasopressors, and glucocorticoids were recorded. Additionally, serum creatinine （Scrl and Scr3） and NT-proBNP （NT-proBNP1 and NT-proBNP3） were assayed and evaluated at admission and on day 3 respectively. Results ANT-proBNP （NT-proBNP3 minus NT-proBNP1） （P 〈0.001, Hazard ratio （HR）=1.245, 95% confidence interval （CI）, 1.137-1.362） and admission SOFA （P 〈0.001, HR=1.197, 95% CI, 1.106-1.295） were independently related to in-hospital mortality. Their combination was a more robust predictor for in-hospital mortality than either of them individually. Patients with high ANT-proBNP and SOFA had the poorest prognosis. Conclusions In our study, both ANT-proBNP and SOFA were independent predictors of septic patients＇ prognosis. Moreover, the combination of ,~NT-proBNP and admission SOFA provided a novel strategy that contained information regarding both the response to treatment and sepsis severity.
文摘Background： The quick Sequential Organ Failure Assessment （qSOFA） score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism （PE） by combining with electrocardiography （ECG）. Methods： Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low-risk groups by imaging and biomarkers. The ECG scores consisted oftachycardia, McGinn-White sign （S1Q3T3）, right bundle branch block, and T-wave inversion of leads V1-V3. A new combination of qSOFA scores and ECG scores by logistic regression for predicting high-risk stratification patients with acute PE was evaluated by a receiver operating characteristic curve. Results： Totally 1318 patients were enrolled, including 271 in the high-risk group and 1047 in the low-risk group. A combination predictive scoring system named qSOFA-ECG = qSOFA score ＋ ECG score was created. The optimal cutoffvalue for qSOFA-ECG was 2, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.5%, 72.3%, 43.2%, and 93.8%, respectively. For predicting high-risk stratification and reperfusion therapy, the qSOFA-ECG is superior to PE Severity Index （PESI） and simplified PESI. Conclusions： The qSOFA score contributes to identify acute PE patients with potentially hemodynamic decompensation that need monitoring and possible reperfusion therapy at the emergency department arrival when used in combination with ECG score.
文摘目的:探究外周血高迁移率族蛋白-1(high mobility group box protein 1,HMGB1)、糖基化终产物受体(receptor for advanced glycation endproducts,RAGE)和快速顺序器官功能衰竭评估(quick sequential organ failure assessment,qSOFA)评分在急性呼吸衰竭并发心肌损伤评估中的应用价值。方法:选择2020年1月-2022年12月就诊于兴山县人民医院的129例急性呼吸衰竭患者作为观察对象,根据患者是否并发心肌损伤将其分为心肌损伤组(n=43)和非心肌损伤组(n=86)。收集所有研究对象入组时的年龄、性别、体重指数等一般资料;评估受试者qSOFA评分,检测受试者外周血HMGB1和RAGE水平;logistic回归分析急性呼吸衰竭并发心肌损伤的影响因素;受试者工作特性曲线(receiver operator characteristic curve,ROC)分析HMGB1、RAGE联合qSOFA评分对急性呼吸衰竭并发心肌损伤的评估价值。结果:心肌损伤组一秒率[第1秒用力呼气容积(forced expiratory volume in one second,FEV1)/用力肺活量(forced vital capacity,FVC)%]和动脉血氧分压(arterial partial pressure of oxygen,PaO2)显著低于非心肌损伤组,动脉血二氧化碳分压(arterial carbon dioxide partial pressure,PaCO_(2))显著高于非心肌损伤组,差异有统计学意义(P<0.05);心肌损伤组外周血HMGB1、RAGE水平和q SOFA评分均显著高于非心肌损伤组,差异有统计学意义(P<0.05);logistic回归分析显示,HMGB1、RAGE水平和qSOFA评分升高均为急性呼吸衰竭患者并发心肌损伤的独立危险因素(P<0.05);ROC分析显示,HMGB1、RAGE水平、qSOFA评分联合检测ROC曲线下面积(AUC)明显高于各指标单独检测,差异有统计学意义(P<0.05)。结论:HMGB1、RAGE水平和qSOFA评分升高均为急性呼吸衰竭患者并发心肌损伤的独立危险因素;HMGB1、RAGE水平和qSOFA评分均可对急性呼吸衰竭患者心肌损伤的发生进行评估,且联合评估的价值更高。
文摘BACKGROUND Sepsis is a severe medical condition that occurs when the body's immune system overreacts to an infection,leading to life-threatening organ dysfunction.The"Third international consensus definitions for sepsis and septic shock(Sepsis-3)"defines sepsis as an increase in sequential organ failure assessment score of 2 points or more,with a mortality rate above 10%.Sepsis is a leading cause of intensive care unit(ICU)admissions,and patients with underlying conditions such as cirrhosis have a higher risk of poor outcomes.Therefore,it is critical to recognize and manage sepsis promptly by administering fluids,vasopressors,steroids,and antibiotics,and identifying and treating the source of infection.AIM To conduct a systematic review and meta-analysis of existing literature on the management of sepsis in cirrhotic patients admitted to the ICU and compare the management of sepsis between cirrhotic and non-cirrhotic patients in the ICU.METHODS This study is a systematic literature review that followed the PRISMA statement's standardized search method.The search for relevant studies was conducted across multiple databases,including PubMed,Embase,Base,and Cochrane,using predefined search terms.One reviewer conducted the initial search,and the eligibility criteria were applied to the titles and abstracts of the retrieved articles.The selected articles were then evaluated based on the research objectives to ensure relevance to the study's aims.RESULTS The study findings indicate that cirrhotic patients are more susceptible to infections,resulting in higher mortality rates ranging from 18%to 60%.Early identification of the infection source followed by timely administration of antibiotics,vasopressors,and corticosteroids has been shown to improve patient outcomes.Procalcitonin is a useful biomarker for diagnosing infections in cirrhotic patients.Moreover,presepsin and resistin have been found to be reliable markers of bacterial infection in patients with decompensated liver cirrhosis,with similar diagnostic performance compared to procalcitonin.CONCLUSION This review highlights the importance of early detection and management of infections in cirrhosis patients to reduce mortality.Therefore,early detection of infection using procalcitonin test and other biomarker as presepsin and resistin,associated with early management with antibiotics,fluids,vasopressors and low dose corticosteroids might reduce the mortality associated with sepsis in cirrhotic patients.
