Prognostic factors for community-acquired pneumonia in middle-aged and elderly patients treated with integrated medicine

OBJECTIVE:To identify prognostic factors in middle-aged and elderly patients with community-acquired pneumonia(CAP) who underwent integrated interventions involving traditional Chinese medicine(TCM) and modern medicine.METHODS:Patients aged ≥45 years and diagnosed with CAP were divided into a middle-aged cohort(45-59 years) and an elderly cohort(≥60 years),and clinical data comprising 75 predictor variables in seven classes were collected.After replacing missing data,calibrating multicenter differences and classifYing quantitative data,univariate and multivariate analysis were performed.RESULTS:On multivariate analysis,eight independent risk factors-respiration rate,C reactive protein(CRP),cost of hospitalization,anemia,gasping,confusion,moist rales and pneumonia severity index(PSI)-were correlated with the outcome "not cured" in the elderly cohort.Nine factors-neutrophil percentage(Neu%),blood urea nitrogen(BUN),time to clinical stability,appetite,anemia,confusion,being retired or unemployed,Gram-negative bacterial infection and educational level-were correlated with not cured in the middle-aged cohort.CONCLUSION:Independent predictive risk factors correlated with adverse outcomes in elderly patients were higher respiration rate,CRP≥four times the mean or median for the patient's center,cost of hospitalization>11,323 RMB and PSI>II,plus anemia,gasping,confusion and moist rales;those in middle-aged patients were higher Neu%,BUN≥mean or median,loss of appetite,anemia,confusion,being retired or unemployed and lower educational level.Gram-negative bacterial infection and time to clinical stability>9 days were protective factors.

Multiple organ dysfunction syndrome due to ingestion of fish gall bladder

OBJECTIVE: To investigate changes in renal function, urine N-acetyl-beta-D-glucosaminidase enzyme (N-AG),liver function, myocardial enzymes, the pathology of renal damage and the mechanism of acute renal failure (ARF) associated with fish gall bladder poisoning. METHODS: Eleven patients with acute fish gall bladder poisoning were consecutively admitted to our hospital from September 1997 to October 1999. Renal function, urine N-AG enzyme, liver function, and myocardial enzymes were assayed before and after treatment. One patient consented to a kidney biopsy and the pathology of renal damage was observed under light and electron microscopes. RESULTS: All patients had multiple organ dysfunction syndrome (MODS) and 11 patients suffered from ARF. Ten patients had liver dysfunction, ten patients had poisonous myocarditis, and 8 patients had gastrointestinal dysfunction. Renal function, urine N-AG enzyme, liver function, and myocardial enzymes were significantly improved after treatment compared with those of before treatment (P