目的 探讨替比夫定治疗乙肝e抗原（HBeAg）阳性慢性乙型肝炎（CHB）患者72周的疗效及预测因素的分析。 方法 选择2007年9月－2012年9月符合入选标准的82例CHB患者接受替比夫定治疗72周，于治疗前基线、治疗后每3个月查丙氨酸氨基转移酶（ALT）、乙肝病毒DNA（HBV DNA）、乙肝病毒血清标志物，观察治疗期间累计生化学应答率、完全病毒学应答率(CVR)、HBeAg血清学转换率（SR）及耐药率，分析基线ALT水平[分为＜5 ULN（正常值检测下限）组及≥5 ULN组]、HBV DNA水平（分为＜107 copies/mL组及≥107 copies/mL组）、24周HBV DNA水平（＜3 log 10 copies/mL组及≥3 log 10 copies/mL组），预测72周CVR及SR。 结果 172周累计生化学应答率、CVR、SR、耐药率分别为86.6%、81.7%、42.7%、18.2%；2基线ALT≥5 ULN对72周SR有预测价值（χ2=5.651，P=0.017），HBV DNA＜107 copies/mL对CVR有预测价值（χ2=7.083，P=0.008）；324周HBV DNA＜103 copies/mL对72周CVR及SR均有预测价值（χ2=27.339，5.131；P=0.000，0.023）。 结论 替比夫定初治HBeAg阳性CHB患者疗效及安全性好，治疗24周HBV DNA＜103 copies/mL是72周疗效的最佳预测指标。
Objective To study the predictive value of red blood cell distribution width in severity stratification of community-acquired pneumonia(CAP). Methods One-hundred and seventeen CAP patients admitted between August 2014 and August 2015 were recruited in the study.According to the severity of CAP evaluated by pneumonia severity index (PSI)and CURB score,the patients were divided into a severe group,a moderate group and a mild group with 39 cases in each group.Meanwhile 39 healthy volunteers were recruited as control.The blood red blood cell distribution width and high sensitive C-reactive protein(hs-CRP)levels were measured in all subjects. Results The PSI score and CURB score were significantly higher in the CAP patients than the control group and increased with the deterioration of the disease.The red blood cell distribution width and hs-CRP level were also significantly higher in the CAP patients than the control group and increased with the deterioration of the disease (P<0.05). Conclusion The red blood cell distribution width is correlated with the severity of CAP and has predictive value in CAP severity stratification.
ObjectiveTo evaluate clinical value of colon leakage score (CLS), a preoperative predictive scoring system, for risk of anastomotic leakage after left-sided colorectal cancer surgery. MethodsThe clinical data of 310 patients who underwent left-sided colorectal cancer surgery from January 2010 to December 2014 were studied retrospectively. Risk factors for postoperative anastomotic leakage were analyzed by univariate analysis. The sensitivity and specificity of CLS system were determined by receiver operating characteristic (ROC) curve analysis. Resultsa total of 14 patients were diagnosed as anastomotic leakage. The point of CLS for the patients with anastomotic leakage was significantly higher than that for the patients without anastomotic leakage (14.21±5.76 versus 4.43±3.36, t=9.474, P=0.000). The results of ROC curve analysis showed that the sensitivity and specificity of the CLS system were 92.9% and 88.6%, respectively. The area under the curve was 0.957 (95% CI 0.924-0.991). The best cut off value of CLS was 10 (The Youden index was 0.867). The results of univariate analysis showed that the age, preoperative hemoglobin level, status of intestinal obstruction, and blood loss were associated with postoperative anastomotic leakage (P<0.05). ConclusionThe preoperative predictive score system CLS could accurately predict occurrence of anastomotic leakage. While large, multicenter prospective randomized controlled trial is still needed to further confirm it.
Objective To evaluate the prognostic values of CURB-65 score and inflammatory factors in hospitalized patients with community-acquired pneumonia (CAP). Methods A retrospective study was conducted in hospitalized adult CAP patients in West China Hospital between January 1st, and December 31th, 2013. Data of CURB-65 score and serum levels of inflammatory factors (WBC, ESR, PCT, CRP, IL-6 and ALB) on admission and clinical outcomes were collected. The associations between CURB-65 score, inflammatory factors and clinical outcomes were examined. Logistic regression analysis was performed to develop combined models to predict in-hospital death of CAP patients, and ROC analysis was conducted to measure and compare the prognostic values of CURB-65 score, inflammatory factors or combined models. Results A total of 505 hospitalized CAP patients were included. 81 patients died during the hospitalization and the in-hospital mortality rate was 16.0%. Possible risk factors of in-hospital death included old age, male sex, hypertension, cardiovascular or cerebrovascular diseases, multi-lobular pneumonic infiltration, high risk scores, ICU admission, mechanical ventilation and severe pneumonia (all P values<0.05). Logistic regression analysis showed that CURB-65 score, ALB and IL-6 were the independent factors in predicting in-hospital death of CAP patients and the area under curve (AUC) of them while predicting in-hospital death were 0.75 (95%CI 0.69 to 0.81), 0.75 (95%CI 0.69 to 0.81) and 0.75 (95%CI 0.69 to 0.80), respectively. ROC analysis found that ALB and IL-6 could improve the AUC of CURB-65 score significantly while predicting the in-hospital death (P<0.05). When ALB and IL-6 were added to the CURB-65 score simultaneously, the AUC was improved to 0.84 (95%CI 0.80 to 0.87). When IL-6 or ALB was added to the CURB-65 score to form a new scale, the AUC of the new scale was significantly higher than that of the CURB-65 score in predicting in-hospital death (P<0.001). Conclusion The prognostic values of CURB-65 score and inflammatory factors may be not ideal when they are used alone in hospitalized CAP patients. IL-6 and ALB may significantly improve the prognostic value of CURB-65 score in predicting in-hospital death.
Objective This study aimed to investigate the predictive value of preoperative serum CA19-9 level for lymph node micrometastasis in patients with lymph node metastasis-negative gastric cancer and its effect on prognosis. Methods Clinicopathological data were retrospectively collected from 176 cases of gastric cancer who underwent D2 radical surgery in our hospital between January 2006 and December 2011, and also collected the patients’ lymph node tissue specimens. All patients were confirmed by pathologic examination of lymph node metastasis-negative. Quantitative real-time PCR (qRT-PCR) was used to detect the presence of lymph node micrometastasis in lymph node tissues. Sixty cases of gastric cancer were selected to construct the receiver operating characteristic curve (ROC) of preoperative serum CA19-9 level to predict lymph node micrometastasis, then established the threshold value. The remaining 116 cases were used to validate the rationality of this threshold. In addition, we explored the impact of preoperative serum CA19-9 level on the prognosis of patients with lymph node metastasis-negative gastric cancer, and explored the risk factors of lymph node micrometastasis. Results ① Results of ROC curve: the preoperative serum CA19-9 level of 15.5 U/mL was the threshold for predicting lymph node micrometastasis, with a sensitivity of 93.1%, specificity of 63.6%, and area under the curve (AUC) of 0.84 (P=0.003). With 15.5 U/mL as the threshold, 116 patients were divided into positive group and negative group. The lymph node micrometastasis rates in the 2 groups were different, which was higher in the positive group than that in the negative group (P<0.001). ② Effect of preoperative serum CA19-9 level on prognosis: the patients were divided into the positive group and the negative group with 15.5 U/mL as the threshold, and the log-rank test showed that the survival of the negative group was better than that of the positive group (P=0.001). ③ The risk factors for lymph node micrometastasis: the logistic regression model showed that preoperatively positive serum CA19-9 was an independent risk factor for lymph node micrometastasis in patients with gastric cancer [OR=1.860, 95% CI was (1.720, 2.343), P<0.001]. Conclusion Preoperative serum CA19-9 level can be used to predict lymph node micrometastasis in lymph node metastasis-negative patients with gastric cancer.
ObjectiveTo evaluate the predictive value of the diaphragm ultrasound for weaning from mechanical ventilation.MethodsThe patients who received mechanical ventilation in Fujian Provincial Hospital between February 2016 to December 2017 and met the criteria for a T-tube spontaneous breathing trial were included in the study. Then right diaphragmatic displacement (DD) and diaphragmatic thickening fraction (DTF) were evaluated using M-mode ultrasonography as well as the rapid shallow breathing index (RSBI, the ratio of respiratory rate to tidal volume). A new index was named as the diaphragmatic-RSBI (D-RSBI, the ratio of respiratory rate to DD). The patients were classified into a success group or a failure group according to the weaning outcomes. The receiver operating characteristic (ROC) curves were calculated to evaluate the predictive performance of each index.ResultsFifty-nine patients were weaned successfully and failure of weaning was found in 29 patients. There were no statistically significant differences in pre-weaning parameters including age, sex, systolic blood pressure, diastolic blood pressure, blood lipid index (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride), or fast blood glucose between the weaning success group and the weaning failure group (P>0.05), but there were statistically significant differences in body mass index and acute physiology and chronic health condition Ⅱ score between two groups (P<0.05). DD [(13.44±3.23)mm vs. (10.28±2.82)mm, DTF [(32.43±12.35)% vs. (27.64±5.77)%, P<0.05] and D-RSBI [(1.49±0.47) breaths·min–1·mm–1 vs. (2.55±0.87) breaths·min–1·mm–1, P<0.05] differed significantly between the weaning success group and the weaning failure group. A cutoff of DTF≥27.9% yielded a sensitivity of 98.3%, a specificity of 62.1%, and an area under the ROC curve (AUC) of 0.873. A cutoff of D-RSBI≤1.73 breaths·min–1·mm–1 yielded a sensitivity of 76.3%, a specificity of 93.1%, and an AUC of 0.887. By comparison, when RSBI was ≤50.9 breaths·min–1·mm–1, there was a sensitivity of 91.5%, a specificity of 86.2%, and an AUC of 0.927. There was no statistically significant difference in AUC between D-RSBI and RSBI (P>0.05).ConclusionsDiaphragm ultrasound is feasible to predict the outcome of weaning. DTF and D-RSBI are as same accurate as the traditional RSBI in predicting the weaning outcome, but more objective and suitable for clinical application.
ObjectiveTo evaluate the predictive value of C-reactive protein/albumin ratio (CAR) for postoperative complications of pancreaticoduodenectomy (PD).MethodsThe clinical data of 134 patients with pancreaticoduodenectomy (PD) in the Department of Pancreatic Surgery of The First Affiliated Hospital of Xinjiang Medical University from 2015 to 2018 were retrospectively collected, including general conditions and postoperative complications. The predictive value of CAR was calculated.ResultsOf the 134 patients, 38 patients suffered from postoperative pancreatic fistula (POPF), 32 patients suffered from abdominal infection, 5 patients suffered from biliary fistula, 63 patients suffered from delayed gastric emptying (DGE), 13 patients suffered from post pancreatectomy hemorrhage (PPH), 8 patients suffered from wound infection, and 1 patient suffered from chyle leakage. There was no significant difference in general conditions such as gender, age, BMI, American Society of Anesthesiologists (ASA) score, tumor nature, tumor diameter, operative time, intraoperative blood loss, diabetes history, jaundice history, and drinking history (P>0.05), but the hospital stay in the complication group was longer than that of the non-complication group (P<0.05). The value of CAR in the pancreatic fistula and abdominal infection group were significantly higher than those in the non-complication group at 1 d, 3 d and 5 d (exclude 1 day after surgery on POPF), the difference was statistically significant (P<0.05). On the 3rd day after surgery, the sensitivity of CAR predicting POPF was 79.95%, the specificity was 86.46%; the sensitivity of predicting abdominal infection was 75.00%, the specificity was 81.37%, and the result was better than using procalcitonin (PCT) alone, but similar with C-reactive protein (CRP) alone or CRP+PCT.ConclusionPostoperative CAR can better predict POPF and abdominal infection after PD, and the effect is better than PCT alone.
ObjectiveTo evaluate the value of blood urea nitrogen to creatinine ratio (UCR) in predicting the condition and prognosis of severe pneumonia patients.MethodsA total of 408 patients with severe pneumonia hospitalized in the intensive care unit (ICU) of Fangcun branch of Guangdong Provincial Hospital of traditional Chinese medicine from January 1, 2017 to August 1, 2020 were retrospectively collected. The patients were divided into a survival group (320 cases) and a death group (88 cases) according to the outcome of hospitalization. This study analyzed the relationship between UCR level and general information, condition, and treatment needs of severe pneumonia patients; and compared UCR, the value of neutrophil to lymphocyte ratio, the levels of hematocrit, C-reactive protein, procalcitonin and D-dimer, and the scores of Acute Physiology and Chronic Health EvaluationⅡ and Pneumonia Severity Index between the survival group and the death group. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of the above indicators. Logistic regression was used to analyze the risk factors of death of severe pneumonia.ResultsThe age of the patients died of severe pneumonia was higher than that of the survival patients (P<0.05); The mortality rate of severe hospital acquired pneumonia was higher than that of severe community acquired pneumonia (P<0.05); The level of UCR was higher in the patients over 70 years old (P<0.05); UCR level of the severe pneumonia patients with acute exacerbation of chronic obstructive pulmonary disease or multiple organ dysfunction syndrome during hospitalization was higher (P<0.05); The UCR level was higher in the patients with severe pneumonia whose ICU stay was more than 10 days (P<0.05); The UCR level of the severe pneumonia patients with mechanical ventilation longer than 180 hours was higher (P<0.05); UCR level of the severe pneumonia patients who died during hospitalization was higher than that of the survival group (P<0.05); The area under ROC curve of UCR for predicting death in the patients with severe pneumonia was 0.648 (95%CI 0.576 - 0.719), the cut-off value was 108.74, the sensitivity was 47.7%, and the specificity was 77.8% (P<0.05). PSI > level 3 (OR=4.297, 95%CI 2.777 - 6.651) and UCR > 108.74 (OR=0.545, 95%CI 0.332 - 0.896) were independent risk factors for death in the patients with severe pneumonia (P<0.05).ConclusionUCR has certain value in evaluating the condition and prognosis of severe pneumonia patients.
ObjectiveTo analyze the perdictive value of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) for malnutrition or postoperative complications in children with critical congenital heart disease (CHD).MethodsA total of 875 children with critical CHD who were hospitalized in West China Hospital, Sichuan University form August 2019 to February 2021, including 442 males and 433 females with a median age of 30 (12, 48) months, were assessed by STAMP in Health Information System. Clinical data of postoperative complications were collected.Results(1) Based on World Health Organization Z-score as gold standard, 24.5% had malnutrition risk, and 34.3% were diagnosed with malnutrition. According to STAMP, the children were with medium malnutrition risk of 37.9% and high malnutrition risk of 62.1%. There was a statistical difference of incidence rate of malnutrition and detection rate of STAMP malnutrition risk in gender, age, ICU stay or length of mechanical ventilation (P<0.05); (2) with the optimal cut-off point of 5.5 in STAMP for malnutrition, the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) were 68.3%, 84.3%, 48.1%, 88.3% and 0.82, respectively; (3) 12.0% of the children were with postoperative complications; (4) with the optimal cut-off point of 5.5 in STAMP for postoperative complications, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 83.8%, 73.1%, 18.8%, 99.1% and 0.85, respectively.ConclusionChildren with critical CHD have a higher incidence of malnutrition risk and postoperative complications. STAMP has a good perdictive value for malnutrition or postoperative complications, however, the sensitivity and specificity of STAMP are affected by the gold standard or the cut-off point.
Objective To explore the predictive value of Composite Congestion Score (CCS) in predicting adverse events within 180 days in patients with acute heart failure (AHF) in emergency intensive care unit (EICU). Methods The patients with AHF who were admitted to EICU of Zigong Fourth People’s Hospital between January 1, 2018 and December 31, 2020 were included consecutively. The patients were followed up for 180 days, and were divided into poor prognosis group and good prognosis group according to whether there were adverse events. Logistic regression equation was used to screen independent risk factors for predicting adverse events in patients with AHF within 180 days after leaving EICU. To compare the discrimination, calibration and clinical usefulness of independent risk factors at EICU discharge and the Acute Physiology and Chronic Health Assessment SystemⅡ (APACHEⅡ) score at EICU admission to predict the occurrence of adverse events of AHF. Results A total of 71 patients were included, including 32 patients with good prognosis and 39 patients with poor prognosis. Except for age, APACHEⅡscore at EICU admission and CCS score at EICU discharge (P<0.05), there was no significant difference in other indicators between the two groups (P>0.05). Logistic regression analysis showed that CCS score at EICU discharge [odds ratio (OR)=2.806, 95% confidence interval (CI) (1.428, 5.512), P=0.003], age [OR=1.086, 95%CI (1.017, 1.159), P=0.013] were independent risk factors for predicting death or returning to hospital within 180 days. Among them, the CCS score at EICU discharge combining with age had a positive improvement ability compared with the CCS score at EICU discharge, the age, and the APACHE Ⅱ score at EICU admission. The calibration curves of the four scoring methods for predicting adverse events within 180 days showed that the CCS score at EICU discharge had the highest calibration and the calibration of age was the lowest. The decision curve showed that the clinical usefulness of age, the CCS score at EICU discharge and the CCS score at EICU discharge combining with age was better than the APACHE Ⅱ score at EICU admission. Conclusions The CCS score of patients with AHF at EICU discharge is closely related to adverse events within 180 days. The CCS score is designed based on clinical variables, simple and practical. The combination of age and the CCS score at EICU discharge will further enhance its clinical application value.