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
Liver failure is a group of clinical syndromes with a mortality rate of>50%.The accurate evaluation of severity in patients with liver failure has been a meaningful and hot topic in clinical research and an importa...Liver failure is a group of clinical syndromes with a mortality rate of>50%.The accurate evaluation of severity in patients with liver failure has been a meaningful and hot topic in clinical research and an important guide for liver transplantation.Numerous prognosis studies have emerged in recent years with high accuracy and adequate validity.Nonetheless,different models utilize distinct parameters and have unequal efficiencies,leading to a specific value and unique application situations for each model.This review focused on the progress in recent prognostic studies including the model for end-stage liver disease,sequential organ failure assessment and its derivative models,the Chinese Group on the Study of Severe Hepatitis B Acute-on-Chronic Liver Failure,the Tongji prognostic predictor model,and other emerging prognostic models and predictors.This review aims to assist clinicians understand the framework of recent models and choose the appropriate model and treatment.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
Critically ill cirrhotic patients have high in-hospital mortality and utilize significant health care resources as a consequence of the need for multiorgan support.Despite this fact,their mortality has decreased in re...Critically ill cirrhotic patients have high in-hospital mortality and utilize significant health care resources as a consequence of the need for multiorgan support.Despite this fact,their mortality has decreased in recent decades due to improved care of critically ill patients.Acute-on-chronic liver failure(ACLF),sepsis and elevated hepatic scores are associated with increased mortality in this population,especially among those not eligible for liver transplantation.No score is superior to another in the prognostic assessment of these patients,and both liver-specific and intensive care unit-specific scores have satisfactory predictive accuracy.The sequential assessment of the scores,especially the Sequential Organ Failure Assessment(SOFA)and Chronic Liver Failure Consortium(CLIF)-SOFA scores,may be useful as an auxiliary tool in the decision-making process regarding the benefits of maintaining supportive therapies in this population.A CLIF-ACLF>70 at admission or at day 3 was associated with a poor prognosis,as well as SOFA score>19 at baseline or increasing SOFA score>72.Additional studies addressing the prognostic assessment of these patients are necessary.展开更多
BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsi...BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsis and 20 age-matched healthy controls were enrolled in the study.Patients with sepsis were further subdivided into a sepsis group and a septic shock group.nCD64 expression,serum procalcitonin(PCT)level,C-reactive protein(CRP)level,and white blood cell(WBC)count were obtained for each patient,and Sequential Organ Failure Assessment(SOFA)scores were calculated.RESULTS:nCD64 expression was higher in the sepsis group with confirmed infection than in the control group.The receiver operating characteristic(ROC)curve of nCD64 was higher than those of SOFA score,PCT,CRP and WBC for diagnosing infection.The area under the curve(AUC)of nCD64 combined with SOFA score was the highest for all parameters.The AUC of nCD64 for predicting 28-day mortality in sepsis was signifi cantly higher than those of PCT,CRP,and WBC,but slightly lower than that of SOFA score.The AUC of nCD64 or PCT combined with SOFA score was signifi cantly higher than that of any single parameter for predicting 28-day mortality.CONCLUSION:nCD64 expression and SOFA score are valuable parameters for early diagnosis of infection and prognostic evaluation of sepsis patients.展开更多
Sepsis and septic shock are catastrophic disease entities that portend high mortality in patients with cirrhosis.In cirrhosis,hemodynamic perturbations,immune dysregulation,and persistent systemic inflammation with al...Sepsis and septic shock are catastrophic disease entities that portend high mortality in patients with cirrhosis.In cirrhosis,hemodynamic perturbations,immune dysregulation,and persistent systemic inflammation with altered gut microbiota in the background of portal hypertension enhance the risk of infections and resistance to antimicrobials.Patients with cirrhosis develop recurrent lifethreatening infections that progress to multiple organ failure.The definition,pathophysiology,and treatment options for sepsis have been ever evolving.In this exhaustive review,we discuss novel advances in the understanding of sepsis,describe current and future biomarkers and scoring systems for sepsis,and delineate newer modalities and adjuvant therapies for the treatment of sepsis from existing literature to extrapolate the same concerning the management of sepsis in cirrhosis.We also provide insights into the role of gut microbiota in initiation and progression of sepsis and finally,propose a treatment algorithm for management of sepsis in patients with cirrhosis.展开更多
BACKGROUND Sepsis is a severe clinical syndrome related to the host response to infection.The severity of infections is due to an activation cascade that will lead to an auto amplifying cytokine production:The cytokin...BACKGROUND Sepsis is a severe clinical syndrome related to the host response to infection.The severity of infections is due to an activation cascade that will lead to an auto amplifying cytokine production:The cytokine storm.Hemoadsorption by CytoSorb®therapy is a new technology that helps to address the cytokine storm and to regain control over various inflammatory conditions.AIM To evaluate prospectively CytoSorb®therapy used as an adjunctive therapy along with standard of care in septic patients admitted to intensive care unit(ICU).METHODS This was a prospective,real time,investigator initiated,observational multicenter study conducted in patients admitted to the ICU with sepsis and septic shock.The improvement of mean arterial pressure and reduction of vasopressor needs were evaluated as primary outcome.The change in laboratory parameters,sepsis scores[acute physiology and chronic health evaluation(APACHE II)and sequential organ failure assessment(SOFA)]and vital parameters were considered as secondary outcome.The outcomes were also evaluated in the survivor and nonsurvivor group.Descriptive statistics were used;a P value<0.05 was considered RESULTS Overall,45 patients aged≥18 and≤80 years were included;the majority were men(n=31;69.0%),with mean age 47.16±14.11 years.Post CytoSorb®therapy,26 patients survived and 3 patients were lost to follow-up.In the survivor group,the percentage dose reduction in vasopressor was norepinephrine(51.4%),epinephrine(69.4%)and vasopressin(13.9%).A reduction in interleukin-6 levels(52.3%)was observed in the survivor group.Platelet count improved to 30.1%(P=0.2938),and total lung capacity count significantly reduced by 33%(P<0.0001).Serum creatinine and serum lactate were reduced by 33.3%(P=0.0190)and 39.4%(P=0.0120),respectively.The mean APACHE II score was 25.46±2.91 and SOFA scores was 12.90±4.02 before initiation of CytoSorb®therapy,and they were reduced significantly post therapy(APACHE II 20.1±2.47;P<0.0001 and SOFA 9.04±3.00;P=0.0003)in the survivor group.The predicted mortality in our patient population before CytoSorb®therapy was 56.5%,and it was reduced to 48.8%(actual mortality)after CytoSorb®therapy.We reported 75%survival rate in patients given treatment in<24 h of ICU admission and 68%survival rates in patients given treatment within 24-48 h of ICU admission.In the survivor group,the average number of days spent in the ICU was 4.44±1.66 d;while in the nonsurvivor group,the average number of days spent in ICU was 8.5±15.9 d.CytoSorb®therapy was safe and well tolerated with no adverse events reported.CONCLUSION CytoSorb®might be an effective adjuvant therapy in stabilizing sepsis and septic shock patients.However,it is advisable to start the therapy at an early stage(preferably within 24 h after onset of septic shock).展开更多
Objective:To analyze the effect of blood glucose control mursing in intensive care umit (ICU)patients.Methods:The clinical data of 70 severe patients in ICU of ou hospital fom January 2019 to May 2020 were retrospecti...Objective:To analyze the effect of blood glucose control mursing in intensive care umit (ICU)patients.Methods:The clinical data of 70 severe patients in ICU of ou hospital fom January 2019 to May 2020 were retrospectively analyzed.The climical data of 34 patients with routine intervention were divided into the control group,and the clinical data of 36 patients with routine intervention and blood glucose control mursing were divided into the observation group,all were intervened for 14 days.The blood glucose levels and prognosis of the two groups were compared before intervention and at the end of 14 days of intervention,the time required o achieve the standard blood glucose level of the two groups was recorded Results:After 14 days of intervention,the fasting blood glucose level of the observation group was lower than the control group,the difference was satisically significant(P<0.05);the time of blood glucose reaching the standard in the observation group was shorter than that in the control group,the difference was statistically significant(P<0.05);on the 14th day of intervention,the sequential organ failure asessment score(SOFA)score of the two groups was lower than before intervention,the SOFA score of the observation group was lower than control group,the difference was statistically significant(P<0.05).Conclusion:The effect of blood glucose control mursing in ICU is better,which effectively controlled the blood glucose level of patients and improved the prognosis of patients.展开更多
Rationale: Recent studies have reported the effectiveness of the early introduction of rehabilitation for preventing muscle weakness in patients in the intensive care unit (ICU). The early introduction of full-scale r...Rationale: Recent studies have reported the effectiveness of the early introduction of rehabilitation for preventing muscle weakness in patients in the intensive care unit (ICU). The early introduction of full-scale rehabilitation by a physical therapist is difficult in some cases because of disease severity and/or patient conditions. However, mild mobilization by a nurse (MMN), as a part of standard care performed, may have a positive effect on patient recovery. We examined the effect of the early introduction of MMN on the recovery of patients in the ICU. Methods: We retrospectively examined patients admitted to Niigata University Hospital’s ICU during between April 2014 and March 2015 who were receiving mechanical ventilation for 7 days or more. Patients were divided into two groups according to the date of initiation of MMN: group L comprised patients for whom MMN was started after 72 hours and group E comprised patients for whom MMN was started within 72 hours after ICU admission. The data were analyzed using the Fisher test, Mann-Whitney U test, and Wilcoxon test. Statistical significance was defined as P Results: Sixty-three patients were included: 42 patients in group L and 21 in group E. There was no significant difference between the two groups in patients’ background, including the type of illness, steroid use, presence of sepsis or diabetes, and sequential organ failure assessment (SOFA) score on ICU admission;however, the SOFA score at ICU discharge was significantly decreased in group E compared to that in group L (6.21 versus 4.30;P = 0.034). Conclusion: Our results indicate that MMN may reduce disease severity if started within 72 hours after ICU admission.展开更多
Clinical scoring systems are required to predict complications,severity,need for intensive care unit admission,and mortality in patients with acute pancreatitis.Over the years,many scores have been developed,tested,an...Clinical scoring systems are required to predict complications,severity,need for intensive care unit admission,and mortality in patients with acute pancreatitis.Over the years,many scores have been developed,tested,and compared for their efficacy and accuracy.An ideal score should be rapid,reliable,and validated in different patient populations and geographical areas and should not lose relevance over time.A combination of scores or serial monitoring of a single score may increase their efficacy.展开更多
Currently,there is a lack of sepsis screening tools that can be widely used worldwide.Pulmonary sepsis can be of sufficient concern to physicians due to their noticeable symptoms,which usually rely less on screening t...Currently,there is a lack of sepsis screening tools that can be widely used worldwide.Pulmonary sepsis can be of sufficient concern to physicians due to their noticeable symptoms,which usually rely less on screening tools.AIM To investigate the efficiency of the international normalized ratio(INR)for the early rapid recognition of adult nonpulmonary infectious sepsis.METHODS This is a prospective observational study.A total of 108 sepsis patients and 106 nonsepsis patients were enrolled according to relevant inclusion and exclusion criteria.Commonly used clinical indicators,such as white blood cell,neutrophil count,lymphocyte count,neutrophil-lymphocyte count ratio(NLCR),platelets(PLT),prothrombin time,INR,activated partial thromboplastin time,and quick Sequential“Sepsis-related”Organ Failure Assessment(qSOFA)scores were recorded within 24 h after admission.The diagnostic performances of these clinical indicators were analyzed and compared through multivariate logistic regression analysis,Spearman correlation,and receiver operating characteristic curve analysis.The INR value of the sepsis group was significantly higher than that of the nonsepsis group.INR has superior diagnostic efficacy for sepsis,with an area under the curve value of 0.918,when those preexisting diseases which significantly affect coagulation function were excluded.The diagnostic efficacy of the INR was more significant than that of NLCR,PLT,and qSOFA(P<0.05).Moreover,INR levels of 1.17,1.20,and 1.22 could be used to categorize the relative risk of nonpulmonary infections sepsis into three categories:low,medium and high risk,respectively.CONCLUSION The INR is a promising and easily available biomarker for diagnosis,and it can be used as one of the indicators for early screening of adult nonpulmonary infectious sepsis.When its value is higher than the optimal cutoff value(1.22),high vigilance is required for adult nonpulmonary infectious sepsis.展开更多
Background:Hospital-acquired pneumonia(HAP)is the most common hospital-acquired infection in China with substantial morbidity and mortality.But no specific risk assessment model has been well validated in patients wit...Background:Hospital-acquired pneumonia(HAP)is the most common hospital-acquired infection in China with substantial morbidity and mortality.But no specific risk assessment model has been well validated in patients with HAP.The aim of this study was to investigate the published risk assessment models that could potentially be used to predict 30-day mortality in HAP patients in non-surgical departments.Methods:This study was a single-center,retrospective study.In total,223 patients diagnosed with HAP from 2012 to 2017 were included in this study.Clinical and laboratory data during the initial 24 hours after HAP diagnosis were collected to calculate the pneumonia severity index(PSI);consciousness,urea nitrogen,respiratory rate,blood pressure,and age≥65 years(CURB-65);Acute Physiology and Chronic Health Evaluation II(APACHE II);Sequential Organ Failure Assessment(SOFA);and Quick Sequential Organ Failure Assessment(qSOFA)scores.The discriminatory power was tested by constructing receiver operating characteristic(ROC)curves,and the areas under the curve(AUCs)were calculated.Results:The all-cause 30-day mortality rate was 18.4%(41/223).The PSI,CURB-65,SOFA,APACHE II,and qSOFA scores were significantly higher in non-survivors than in survivors(all P<0.001).The discriminatory abilities of the APACHE II and SOFA scores were better than those of the CURB-65 and qSOFA scores(ROC AUC:APACHE II vs.CURB-65,0.863 vs.0.744,Z=3.055,P=0.002;APACHE II vs.qSOFA,0.863 vs.0.767,Z=3.017,P=0.003;SOFA vs.CURB-65,0.856 vs.0.744,Z=2.589,P=0.010;SOFA vs.qSOFA,0.856 vs.0.767,Z=2.170,P=0.030).The cut-off values we defined for the SOFA,APACHE II,and qSOFA scores were 4,14,and 1.Conclusions:These results suggest that the APACHE II and SOFA scores determined during the initial 24 h after HAP diagnosis may be useful for the prediction of 30-day mortality in HAP patients in non-surgical departments.The qSOFA score may be a simple tool that can be used to quickly identify severe infections.展开更多
Background:The objective of this study was to evaluate the clinical efficacy of thiamine and vitamin C with or without hydrocortisone coadministration on the treatment of sepsis and septic shock.Methods:MEDLINE,EMBASE...Background:The objective of this study was to evaluate the clinical efficacy of thiamine and vitamin C with or without hydrocortisone coadministration on the treatment of sepsis and septic shock.Methods:MEDLINE,EMBASE and CENTRAL databases were searched for randomized controlled trials(RCTs)that made a comparative study between the combination therapy of vitamin C and thiamine with or without hydrocortisone and the administration of placebo in patients with sepsis or septic shock.Two reviewers independently performed study selection,data extraction and quality assessment.Both short-term mortality and change in the sequential organ failure assessment(SOFA)score from baseline(delta SOFA)were set as the primary outcomes.Secondary endpoints included intensive care unit(ICU)mortality,new onset of acute kidney injury,total adverse events,ICU and hospital length of stay,duration of vasopressor usage and ventilator-free days.Meanwhile,trial sequential analysis was conducted for primary outcomes.Results:Eight RCTs with 1428 patients were included in the current study.The results showed no significant reduction of short-term mortality in sepsis and septic shock patients who received combination therapy of vitamin C and thiamine with or without hydrocortisone compared to those with placebo{risk ratio(RR),1.02[95%confidence interval(CI),0.87 to 1.20],p=0.81,I2=0%;risk difference(RD),0[95%CI,−0.04 to 0.05]}.Nevertheless,the combination therapy was associated with significant reduction in SOFA score[mean difference(MD),−0.63,(95%CI,−0.96 to−0.29,p<0.001,I^(2)=0%]and vasopressors duration(MD,−22.11[95%CI,−30.46 to−13.77],p<0.001,I2=6%).Additionally,there were no statistical differences in the pooled estimate for other outcomes.Conclusions:In the current meta-analysis,the combination therapy of vitamin C and thiamine,with or without hydrocortisone had no impact on short-term mortality when compared with placebo,but was associated with significant reduction in SOFA score among patients with sepsis and septic shock.展开更多
Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreve...Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreversible fatal respiratory failure.Lung transplantation(LT)as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.Methods:From February 10 to March 10,2020,three male patients were urgently assessed and listed for transplantation.After conducting a full ethical review and after obtaining assent from the family of the patients,we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.Results:Two of the three recipients survived post-LT and started participating in a rehabilitation program.Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved.The pathological results of the explanted lungs were concordant with the critical clinical manifestation,and provided insight towards better understanding of the disease.Government health affair systems,virology detection tools,and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.Conclusions:LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis.If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT,LT provided the final option for these patients to avoid certain death,with proper protection of transplant surgeons and medical staffs.By ensuring instant seamless care for both patients and medical teams,the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.展开更多
Background:Sepsis is the leading cause of intensive care unit(ICU)admission.The purpose of this study was to explore the prognostic value of the Sequential Organ Failure Assessment(SOFA)score,the Acute Physiological a...Background:Sepsis is the leading cause of intensive care unit(ICU)admission.The purpose of this study was to explore the prognostic value of the Sequential Organ Failure Assessment(SOFA)score,the Acute Physiological and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,and procalcitonin(PCT),albumin(ALB),and lactate(LAC)levels in patients with sepsis.Methods:Consecutive adult patients with suspected or documented sepsis at ICU admission were recruited.Their basic vital signs and related auxiliary examinations to determine their PCT and ALB levels and APACHE Ⅱ score were recorded at ICU admission,and their LAC levels and SOFA scores were recorded for one week after admission.The influence of these variables on hospital mortality was evaluated.Logistic regression was used to derive the Sepsis Hospital Mortality Score(SHMS),a prediction equation describing the relationship between predictors and hospital mortality.The median survival time was calculated by the Kaplan–Meier method.In the validation group,the kappa value was calculated to evaluate the stability of the derived formula.Results:This study included 894 sepsis patients admitted to 18 ICUs in 16 tertiary hospitals.Patients were randomly assigned to an experimental group(626 cases)and validation group(258 cases).In addition,a nonsurvival group(248 patients)of the experimental group was established according to the outcome at the time of discharge.The hospital mortality rate in the experimental group was 39.6%(248/626).Univariate and multivariate regression analyses revealed that the APACHE Ⅱ score(odds ratio[OR]=1.178),△SOFA(OR=1.186),△LAC(OR=1.157),and SOFA mean score(OR=1.086)were independently associated with hospital mortality.The SHMS was calculated as logit(p)=4.715–(0.164×APACHE Ⅱ)–(0.171×△SOFA)–(0.145×△LAC)–(0.082×SOFA mean).A receiver operating characteristic curve was constructed to further investigate the accuracy of the SHMS,with an area under the curve of 0.851(95%confidence interval[CI]0.821–0.882;p<0.001)for hospital mortality.In the low-risk group and high-risk groups,the corresponding median survival times were 15 days and 11 days,respectively.Conclusion:The APACHE Ⅱ score,△SOFA,△LAC and SOFA mean score were independently associated with hospital mortality in sepsis patients and accurately predicted the hospital mortality rate and median survival time.Data on the median survival time in sepsis patients could be provided to clinicians to assist in the rational use of limited medical resources by facilitating prudent resource allocation.Trial registration:ChiCTR-ECH-13003934,retrospectively registered on August 03,2013.展开更多
Background:To identify the distinct trajectories of the Sequential Organ Failure Assessment(SOFA)scores at 72 h for patients with sepsis in the Medical Information Mart for Intensive Care(MIMIC)-IV database and determ...Background:To identify the distinct trajectories of the Sequential Organ Failure Assessment(SOFA)scores at 72 h for patients with sepsis in the Medical Information Mart for Intensive Care(MIMIC)-IV database and determine their effects on mortality and adverse clinical outcomes.Methods:A retrospective cohort study was carried out involving patients with sepsis from the MIMIC-IV database.Group-based trajectory modeling(GBTM)was used to identify the distinct trajectory groups for the SOFA scores in patients with sepsis in the intensive care unit(ICU).The Cox proportional hazards regression model was used to investigate the relationship between the longitudinal change trajectory of the SOFA score and mortality and adverse clinical outcomes.Results:A total of 16,743 patients with sepsis were included in the cohort.The median survival age was 66 years(interquartile range:54-76 years).The 7-day and 28-day in-hospital mortality were 6.0%and 17.6%,respectively.Five different trajectories of SOFA scores according to the model fitting standard were determined:group 1(32.8%),group 2(30.0%),group 3(17.6%),group 4(14.0%)and group 5(5.7%).Univariate and multivariate Cox regression analyses showed that,for different clinical outcomes,trajectory group 1 was used as the reference,while trajectory groups 2-5 were all risk factors associated with the outcome(P<0.001).Subgroup analysis revealed an interaction between the two covariates of age and mechanical ventilation and the different trajectory groups of patients’SOFA scores(P<0.05).Conclusion:This approach may help identify various groups of patients with sepsis,who may be at different levels of risk for adverse health outcomes,and provide subgroups with clinical importance.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.
基金This study was supported by the Science and Technology Planning Project of Guangdong Province,China(No.2019B020228001)the 5010 Project of Sun Yat-sen University(No.2018024).
文摘Liver failure is a group of clinical syndromes with a mortality rate of>50%.The accurate evaluation of severity in patients with liver failure has been a meaningful and hot topic in clinical research and an important guide for liver transplantation.Numerous prognosis studies have emerged in recent years with high accuracy and adequate validity.Nonetheless,different models utilize distinct parameters and have unequal efficiencies,leading to a specific value and unique application situations for each model.This review focused on the progress in recent prognostic studies including the model for end-stage liver disease,sequential organ failure assessment and its derivative models,the Chinese Group on the Study of Severe Hepatitis B Acute-on-Chronic Liver Failure,the Tongji prognostic predictor model,and other emerging prognostic models and predictors.This review aims to assist clinicians understand the framework of recent models and choose the appropriate model and treatment.
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.
文摘Critically ill cirrhotic patients have high in-hospital mortality and utilize significant health care resources as a consequence of the need for multiorgan support.Despite this fact,their mortality has decreased in recent decades due to improved care of critically ill patients.Acute-on-chronic liver failure(ACLF),sepsis and elevated hepatic scores are associated with increased mortality in this population,especially among those not eligible for liver transplantation.No score is superior to another in the prognostic assessment of these patients,and both liver-specific and intensive care unit-specific scores have satisfactory predictive accuracy.The sequential assessment of the scores,especially the Sequential Organ Failure Assessment(SOFA)and Chronic Liver Failure Consortium(CLIF)-SOFA scores,may be useful as an auxiliary tool in the decision-making process regarding the benefits of maintaining supportive therapies in this population.A CLIF-ACLF>70 at admission or at day 3 was associated with a poor prognosis,as well as SOFA score>19 at baseline or increasing SOFA score>72.Additional studies addressing the prognostic assessment of these patients are necessary.
文摘BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsis and 20 age-matched healthy controls were enrolled in the study.Patients with sepsis were further subdivided into a sepsis group and a septic shock group.nCD64 expression,serum procalcitonin(PCT)level,C-reactive protein(CRP)level,and white blood cell(WBC)count were obtained for each patient,and Sequential Organ Failure Assessment(SOFA)scores were calculated.RESULTS:nCD64 expression was higher in the sepsis group with confirmed infection than in the control group.The receiver operating characteristic(ROC)curve of nCD64 was higher than those of SOFA score,PCT,CRP and WBC for diagnosing infection.The area under the curve(AUC)of nCD64 combined with SOFA score was the highest for all parameters.The AUC of nCD64 for predicting 28-day mortality in sepsis was signifi cantly higher than those of PCT,CRP,and WBC,but slightly lower than that of SOFA score.The AUC of nCD64 or PCT combined with SOFA score was signifi cantly higher than that of any single parameter for predicting 28-day mortality.CONCLUSION:nCD64 expression and SOFA score are valuable parameters for early diagnosis of infection and prognostic evaluation of sepsis patients.
文摘Sepsis and septic shock are catastrophic disease entities that portend high mortality in patients with cirrhosis.In cirrhosis,hemodynamic perturbations,immune dysregulation,and persistent systemic inflammation with altered gut microbiota in the background of portal hypertension enhance the risk of infections and resistance to antimicrobials.Patients with cirrhosis develop recurrent lifethreatening infections that progress to multiple organ failure.The definition,pathophysiology,and treatment options for sepsis have been ever evolving.In this exhaustive review,we discuss novel advances in the understanding of sepsis,describe current and future biomarkers and scoring systems for sepsis,and delineate newer modalities and adjuvant therapies for the treatment of sepsis from existing literature to extrapolate the same concerning the management of sepsis in cirrhosis.We also provide insights into the role of gut microbiota in initiation and progression of sepsis and finally,propose a treatment algorithm for management of sepsis in patients with cirrhosis.
文摘BACKGROUND Sepsis is a severe clinical syndrome related to the host response to infection.The severity of infections is due to an activation cascade that will lead to an auto amplifying cytokine production:The cytokine storm.Hemoadsorption by CytoSorb®therapy is a new technology that helps to address the cytokine storm and to regain control over various inflammatory conditions.AIM To evaluate prospectively CytoSorb®therapy used as an adjunctive therapy along with standard of care in septic patients admitted to intensive care unit(ICU).METHODS This was a prospective,real time,investigator initiated,observational multicenter study conducted in patients admitted to the ICU with sepsis and septic shock.The improvement of mean arterial pressure and reduction of vasopressor needs were evaluated as primary outcome.The change in laboratory parameters,sepsis scores[acute physiology and chronic health evaluation(APACHE II)and sequential organ failure assessment(SOFA)]and vital parameters were considered as secondary outcome.The outcomes were also evaluated in the survivor and nonsurvivor group.Descriptive statistics were used;a P value<0.05 was considered RESULTS Overall,45 patients aged≥18 and≤80 years were included;the majority were men(n=31;69.0%),with mean age 47.16±14.11 years.Post CytoSorb®therapy,26 patients survived and 3 patients were lost to follow-up.In the survivor group,the percentage dose reduction in vasopressor was norepinephrine(51.4%),epinephrine(69.4%)and vasopressin(13.9%).A reduction in interleukin-6 levels(52.3%)was observed in the survivor group.Platelet count improved to 30.1%(P=0.2938),and total lung capacity count significantly reduced by 33%(P<0.0001).Serum creatinine and serum lactate were reduced by 33.3%(P=0.0190)and 39.4%(P=0.0120),respectively.The mean APACHE II score was 25.46±2.91 and SOFA scores was 12.90±4.02 before initiation of CytoSorb®therapy,and they were reduced significantly post therapy(APACHE II 20.1±2.47;P<0.0001 and SOFA 9.04±3.00;P=0.0003)in the survivor group.The predicted mortality in our patient population before CytoSorb®therapy was 56.5%,and it was reduced to 48.8%(actual mortality)after CytoSorb®therapy.We reported 75%survival rate in patients given treatment in<24 h of ICU admission and 68%survival rates in patients given treatment within 24-48 h of ICU admission.In the survivor group,the average number of days spent in the ICU was 4.44±1.66 d;while in the nonsurvivor group,the average number of days spent in ICU was 8.5±15.9 d.CytoSorb®therapy was safe and well tolerated with no adverse events reported.CONCLUSION CytoSorb®might be an effective adjuvant therapy in stabilizing sepsis and septic shock patients.However,it is advisable to start the therapy at an early stage(preferably within 24 h after onset of septic shock).
文摘Objective:To analyze the effect of blood glucose control mursing in intensive care umit (ICU)patients.Methods:The clinical data of 70 severe patients in ICU of ou hospital fom January 2019 to May 2020 were retrospectively analyzed.The climical data of 34 patients with routine intervention were divided into the control group,and the clinical data of 36 patients with routine intervention and blood glucose control mursing were divided into the observation group,all were intervened for 14 days.The blood glucose levels and prognosis of the two groups were compared before intervention and at the end of 14 days of intervention,the time required o achieve the standard blood glucose level of the two groups was recorded Results:After 14 days of intervention,the fasting blood glucose level of the observation group was lower than the control group,the difference was satisically significant(P<0.05);the time of blood glucose reaching the standard in the observation group was shorter than that in the control group,the difference was statistically significant(P<0.05);on the 14th day of intervention,the sequential organ failure asessment score(SOFA)score of the two groups was lower than before intervention,the SOFA score of the observation group was lower than control group,the difference was statistically significant(P<0.05).Conclusion:The effect of blood glucose control mursing in ICU is better,which effectively controlled the blood glucose level of patients and improved the prognosis of patients.
文摘Rationale: Recent studies have reported the effectiveness of the early introduction of rehabilitation for preventing muscle weakness in patients in the intensive care unit (ICU). The early introduction of full-scale rehabilitation by a physical therapist is difficult in some cases because of disease severity and/or patient conditions. However, mild mobilization by a nurse (MMN), as a part of standard care performed, may have a positive effect on patient recovery. We examined the effect of the early introduction of MMN on the recovery of patients in the ICU. Methods: We retrospectively examined patients admitted to Niigata University Hospital’s ICU during between April 2014 and March 2015 who were receiving mechanical ventilation for 7 days or more. Patients were divided into two groups according to the date of initiation of MMN: group L comprised patients for whom MMN was started after 72 hours and group E comprised patients for whom MMN was started within 72 hours after ICU admission. The data were analyzed using the Fisher test, Mann-Whitney U test, and Wilcoxon test. Statistical significance was defined as P Results: Sixty-three patients were included: 42 patients in group L and 21 in group E. There was no significant difference between the two groups in patients’ background, including the type of illness, steroid use, presence of sepsis or diabetes, and sequential organ failure assessment (SOFA) score on ICU admission;however, the SOFA score at ICU discharge was significantly decreased in group E compared to that in group L (6.21 versus 4.30;P = 0.034). Conclusion: Our results indicate that MMN may reduce disease severity if started within 72 hours after ICU admission.
文摘Clinical scoring systems are required to predict complications,severity,need for intensive care unit admission,and mortality in patients with acute pancreatitis.Over the years,many scores have been developed,tested,and compared for their efficacy and accuracy.An ideal score should be rapid,reliable,and validated in different patient populations and geographical areas and should not lose relevance over time.A combination of scores or serial monitoring of a single score may increase their efficacy.
基金the Joint Scientific Research Project of Chongqing Science and Technology Commission and Health Commission,No.2019MSXM019 and No.2021MSXM033Natural Science Project of Science and Technology Department of Tibet Autonomous Region,No.XZ2019ZR-ZY55(Z)+1 种基金Chongqing Natural Science Foundation Project,No.cstc2020jcyjmsxmX0124and COVID-19 Emergency Projects of Chongqing Medical University,No.X1-2611.
文摘Currently,there is a lack of sepsis screening tools that can be widely used worldwide.Pulmonary sepsis can be of sufficient concern to physicians due to their noticeable symptoms,which usually rely less on screening tools.AIM To investigate the efficiency of the international normalized ratio(INR)for the early rapid recognition of adult nonpulmonary infectious sepsis.METHODS This is a prospective observational study.A total of 108 sepsis patients and 106 nonsepsis patients were enrolled according to relevant inclusion and exclusion criteria.Commonly used clinical indicators,such as white blood cell,neutrophil count,lymphocyte count,neutrophil-lymphocyte count ratio(NLCR),platelets(PLT),prothrombin time,INR,activated partial thromboplastin time,and quick Sequential“Sepsis-related”Organ Failure Assessment(qSOFA)scores were recorded within 24 h after admission.The diagnostic performances of these clinical indicators were analyzed and compared through multivariate logistic regression analysis,Spearman correlation,and receiver operating characteristic curve analysis.The INR value of the sepsis group was significantly higher than that of the nonsepsis group.INR has superior diagnostic efficacy for sepsis,with an area under the curve value of 0.918,when those preexisting diseases which significantly affect coagulation function were excluded.The diagnostic efficacy of the INR was more significant than that of NLCR,PLT,and qSOFA(P<0.05).Moreover,INR levels of 1.17,1.20,and 1.22 could be used to categorize the relative risk of nonpulmonary infections sepsis into three categories:low,medium and high risk,respectively.CONCLUSION The INR is a promising and easily available biomarker for diagnosis,and it can be used as one of the indicators for early screening of adult nonpulmonary infectious sepsis.When its value is higher than the optimal cutoff value(1.22),high vigilance is required for adult nonpulmonary infectious sepsis.
基金University of Michigan Health System-Peking University Health Science Center Joint Institute for Translational and Clinical Research(No.BMU2019JI006)Peking University Third Hospital(No.BYSYDL2019007)。
文摘Background:Hospital-acquired pneumonia(HAP)is the most common hospital-acquired infection in China with substantial morbidity and mortality.But no specific risk assessment model has been well validated in patients with HAP.The aim of this study was to investigate the published risk assessment models that could potentially be used to predict 30-day mortality in HAP patients in non-surgical departments.Methods:This study was a single-center,retrospective study.In total,223 patients diagnosed with HAP from 2012 to 2017 were included in this study.Clinical and laboratory data during the initial 24 hours after HAP diagnosis were collected to calculate the pneumonia severity index(PSI);consciousness,urea nitrogen,respiratory rate,blood pressure,and age≥65 years(CURB-65);Acute Physiology and Chronic Health Evaluation II(APACHE II);Sequential Organ Failure Assessment(SOFA);and Quick Sequential Organ Failure Assessment(qSOFA)scores.The discriminatory power was tested by constructing receiver operating characteristic(ROC)curves,and the areas under the curve(AUCs)were calculated.Results:The all-cause 30-day mortality rate was 18.4%(41/223).The PSI,CURB-65,SOFA,APACHE II,and qSOFA scores were significantly higher in non-survivors than in survivors(all P<0.001).The discriminatory abilities of the APACHE II and SOFA scores were better than those of the CURB-65 and qSOFA scores(ROC AUC:APACHE II vs.CURB-65,0.863 vs.0.744,Z=3.055,P=0.002;APACHE II vs.qSOFA,0.863 vs.0.767,Z=3.017,P=0.003;SOFA vs.CURB-65,0.856 vs.0.744,Z=2.589,P=0.010;SOFA vs.qSOFA,0.856 vs.0.767,Z=2.170,P=0.030).The cut-off values we defined for the SOFA,APACHE II,and qSOFA scores were 4,14,and 1.Conclusions:These results suggest that the APACHE II and SOFA scores determined during the initial 24 h after HAP diagnosis may be useful for the prediction of 30-day mortality in HAP patients in non-surgical departments.The qSOFA score may be a simple tool that can be used to quickly identify severe infections.
基金supported by grants from the National Natural Science Foundation of China(Nos.81730057,81801935,82002071)the Key Project of Military Medical Innovation Program of Chinese PLA(No.18CXZ026)+3 种基金the National Key Research and Development Program of China(No.2017YFC1103302)CAMS Innovation Fund for Medical Sciences(2019-I2M-5-076)Achievements Supportive Fund(2018-CGPZ-B03)Chinese Postdoctoral Science Foundation Grant(2019 M664003).
文摘Background:The objective of this study was to evaluate the clinical efficacy of thiamine and vitamin C with or without hydrocortisone coadministration on the treatment of sepsis and septic shock.Methods:MEDLINE,EMBASE and CENTRAL databases were searched for randomized controlled trials(RCTs)that made a comparative study between the combination therapy of vitamin C and thiamine with or without hydrocortisone and the administration of placebo in patients with sepsis or septic shock.Two reviewers independently performed study selection,data extraction and quality assessment.Both short-term mortality and change in the sequential organ failure assessment(SOFA)score from baseline(delta SOFA)were set as the primary outcomes.Secondary endpoints included intensive care unit(ICU)mortality,new onset of acute kidney injury,total adverse events,ICU and hospital length of stay,duration of vasopressor usage and ventilator-free days.Meanwhile,trial sequential analysis was conducted for primary outcomes.Results:Eight RCTs with 1428 patients were included in the current study.The results showed no significant reduction of short-term mortality in sepsis and septic shock patients who received combination therapy of vitamin C and thiamine with or without hydrocortisone compared to those with placebo{risk ratio(RR),1.02[95%confidence interval(CI),0.87 to 1.20],p=0.81,I2=0%;risk difference(RD),0[95%CI,−0.04 to 0.05]}.Nevertheless,the combination therapy was associated with significant reduction in SOFA score[mean difference(MD),−0.63,(95%CI,−0.96 to−0.29,p<0.001,I^(2)=0%]and vasopressors duration(MD,−22.11[95%CI,−30.46 to−13.77],p<0.001,I2=6%).Additionally,there were no statistical differences in the pooled estimate for other outcomes.Conclusions:In the current meta-analysis,the combination therapy of vitamin C and thiamine,with or without hydrocortisone had no impact on short-term mortality when compared with placebo,but was associated with significant reduction in SOFA score among patients with sepsis and septic shock.
基金This study was supported by grants from the Chen Jingyu team of“Sanming Project of Medicine”in Shenzhen(No.SZSM201812058)the Foundation for Special Projects of COVID-19 Prevention and Control in Wuxi City.
文摘Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreversible fatal respiratory failure.Lung transplantation(LT)as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.Methods:From February 10 to March 10,2020,three male patients were urgently assessed and listed for transplantation.After conducting a full ethical review and after obtaining assent from the family of the patients,we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.Results:Two of the three recipients survived post-LT and started participating in a rehabilitation program.Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved.The pathological results of the explanted lungs were concordant with the critical clinical manifestation,and provided insight towards better understanding of the disease.Government health affair systems,virology detection tools,and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.Conclusions:LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis.If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT,LT provided the final option for these patients to avoid certain death,with proper protection of transplant surgeons and medical staffs.By ensuring instant seamless care for both patients and medical teams,the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.
基金supported by the National Science and Technology Support Program(2012BAI11B05).
文摘Background:Sepsis is the leading cause of intensive care unit(ICU)admission.The purpose of this study was to explore the prognostic value of the Sequential Organ Failure Assessment(SOFA)score,the Acute Physiological and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,and procalcitonin(PCT),albumin(ALB),and lactate(LAC)levels in patients with sepsis.Methods:Consecutive adult patients with suspected or documented sepsis at ICU admission were recruited.Their basic vital signs and related auxiliary examinations to determine their PCT and ALB levels and APACHE Ⅱ score were recorded at ICU admission,and their LAC levels and SOFA scores were recorded for one week after admission.The influence of these variables on hospital mortality was evaluated.Logistic regression was used to derive the Sepsis Hospital Mortality Score(SHMS),a prediction equation describing the relationship between predictors and hospital mortality.The median survival time was calculated by the Kaplan–Meier method.In the validation group,the kappa value was calculated to evaluate the stability of the derived formula.Results:This study included 894 sepsis patients admitted to 18 ICUs in 16 tertiary hospitals.Patients were randomly assigned to an experimental group(626 cases)and validation group(258 cases).In addition,a nonsurvival group(248 patients)of the experimental group was established according to the outcome at the time of discharge.The hospital mortality rate in the experimental group was 39.6%(248/626).Univariate and multivariate regression analyses revealed that the APACHE Ⅱ score(odds ratio[OR]=1.178),△SOFA(OR=1.186),△LAC(OR=1.157),and SOFA mean score(OR=1.086)were independently associated with hospital mortality.The SHMS was calculated as logit(p)=4.715–(0.164×APACHE Ⅱ)–(0.171×△SOFA)–(0.145×△LAC)–(0.082×SOFA mean).A receiver operating characteristic curve was constructed to further investigate the accuracy of the SHMS,with an area under the curve of 0.851(95%confidence interval[CI]0.821–0.882;p<0.001)for hospital mortality.In the low-risk group and high-risk groups,the corresponding median survival times were 15 days and 11 days,respectively.Conclusion:The APACHE Ⅱ score,△SOFA,△LAC and SOFA mean score were independently associated with hospital mortality in sepsis patients and accurately predicted the hospital mortality rate and median survival time.Data on the median survival time in sepsis patients could be provided to clinicians to assist in the rational use of limited medical resources by facilitating prudent resource allocation.Trial registration:ChiCTR-ECH-13003934,retrospectively registered on August 03,2013.
文摘Background:To identify the distinct trajectories of the Sequential Organ Failure Assessment(SOFA)scores at 72 h for patients with sepsis in the Medical Information Mart for Intensive Care(MIMIC)-IV database and determine their effects on mortality and adverse clinical outcomes.Methods:A retrospective cohort study was carried out involving patients with sepsis from the MIMIC-IV database.Group-based trajectory modeling(GBTM)was used to identify the distinct trajectory groups for the SOFA scores in patients with sepsis in the intensive care unit(ICU).The Cox proportional hazards regression model was used to investigate the relationship between the longitudinal change trajectory of the SOFA score and mortality and adverse clinical outcomes.Results:A total of 16,743 patients with sepsis were included in the cohort.The median survival age was 66 years(interquartile range:54-76 years).The 7-day and 28-day in-hospital mortality were 6.0%and 17.6%,respectively.Five different trajectories of SOFA scores according to the model fitting standard were determined:group 1(32.8%),group 2(30.0%),group 3(17.6%),group 4(14.0%)and group 5(5.7%).Univariate and multivariate Cox regression analyses showed that,for different clinical outcomes,trajectory group 1 was used as the reference,while trajectory groups 2-5 were all risk factors associated with the outcome(P<0.001).Subgroup analysis revealed an interaction between the two covariates of age and mechanical ventilation and the different trajectory groups of patients’SOFA scores(P<0.05).Conclusion:This approach may help identify various groups of patients with sepsis,who may be at different levels of risk for adverse health outcomes,and provide subgroups with clinical importance.
