Objective To explore the predictive factors for long-term adverse prognosis in patients with tuberculosis meningitis. Methods We retrospectively analyzed the clinical data (general clinical data, laboratory test results, and imaging findings) of hospitalized cases of tuberculosis meningitis admitted to West China Hospital of Sichuan University from 00:00:00 on August 1st, 2011 to 23:59:59 on July 31st, 2012. We collected data of prognosis results after 6 years of illness by telephone follow-up, and quantified outcome measures by modified Rankin Scale (mRS) score (0–6 points). According to the mRS score, the cases obtaining 0 points≤mRS<3 points were divided into the good prognosis group and the cases obtaining 3≤mRS≤6 points were divided into the poor prognosis group, logistic regression analysis was executed to find the independent risk factors affecting long-term poor prognosis. Results A total of 119 cases were included, including 63 males and 56 females; the average age was (35±17) years. Among them, 53 patients had poor prognosis and 66 patients had good prognosis. After univariate analysis, the age (t=–3.812, P<0.001), systolic blood pressure at admission (t=–2.009, P=0.049), Glasgow Coma Scale score (t=3.987, P<0.001), Medical Research Council (MRC) staging system (Z=–4.854, P<0.001), headache (χ2=4.101, P=0.043), alter consciousness (χ2=10.621, P=0.001), cognitive dysfunction (χ2=4.075, P=0.044), cranial nerve palsy (χ2=5.853, P=0.016), peripheral nerve dysfunction (χ2=14.925, P<0.001), meningeal irritation (χ2=7.174, P=0.007), serum potassium (t=3.080, P=0.003), cerebrospinal fluid protein content (Z=–2.568, P=0.010), cerebrospinal fluid chlorine (t=2.543, P=0.012), hydrocephalus (χ2=11.766, P=0.001), and cerebral infarction (χ2=6.539, P=0.012) were associated with long-term poor prognosis of tuberculosis meningitis. Multivariate analysis showed that age [odds ratio (OR)=1.061, 95% confidence interval (CI) (1.027, 1.096), P<0.001], peripheral nerve dysfunction [OR=3.537, 95%CI (1.070, 11.697), P=0.038], MRC Stage Ⅱ[OR=9.317, 95%CI (1.692, 51.303), P=0.010], MRC Stage Ⅲ [OR=43.953, 95%CI (3.996, 483.398), P=0.002] were the independent risk factors for long-term poor prognosis of tuberculosis meningitis. Hydrocephalus [OR=2.826, 95%CI (0.999, 8.200), P=0.050] might be an independent risk factor for long-term poor prognosis of tuberculosis meningitis. Conclusions Age, MRC staging system (Stage Ⅱ, Stage Ⅲ) and peripheral neurological dysfunction are chronic poor-prognostic independent risk factors for tuberculosis meningitis. Hydrocephalus may be associated with long-term adverse prognosis of tuberculosis meningitis
Objective To investigate the relationship between thrombocytopenia after the restoration of spontaneous circulation and short-term prognosis of patients with in-hospital cardiac arrest. Methods The demographic data, post-resuscitation vital signs, post-resuscitation laboratory tests, and the 28-day mortality rate of patients who experienced in-hospital cardiac arrest at the Emergency Department of West China Hospital, Sichuan University between January 1st, 2016 and December 31st, 2016 were retrospectively analyzed. Logistic regression was used to analyze the correlation between thrombocytopenia after the return of spontaneous circulation and the 28-day mortality rate in these cardiac arrest patients. Results Among the 285 patients included, compared with the normal platelet group (n=130), the thrombocytopenia group (n=155) showed statistically significant differences in red blood cell count, hematocrit, white blood cell count, prothrombin time, activated partial thromboplastin time, and international normalized ratio (P<0.05). The 28-day mortality rate was higher in the thrombocytopenia group than that in the normal platelet group (84.5% vs. 71.5%, P=0.008). Multiple logistic regression analysis indicated that thrombocytopenia [odds ratio =2.260, 95% confidence interval (1.153, 4.429), P=0.018] and cardiopulmonary resuscitation duration [odds ratio=1.117, 95% confidence interval (1.060, 1.177), P<0.001] were independent risk factors for 28-day mortality in patients with in-hospital cardiac arrest. Conclusion Thrombocytopenia after restoration of spontaneous circulation is associated with poor short-term prognosis in patients with in-hospital cardiac arrest.
ObjectiveTo investigate the risk factors affecting the 28-day neurological outcome after admission of patients with sepsis complicated with consciousness disorder, create a simple scoring system, and evaluate its predictive value for the poor neurological outcome.MethodsWe retrospectively collected and analyzed the demographic data, clinical data, 28-day survival status and neurologic outcome of patients with sepsis complicated with disturbance of consciousness admitted to the Emergency Department of West China Hospital of Sichuan University between June 1st, 2017 and May 31st, 2018. Independent risk factors for the 28-day neurologic outcome of patients with disturbance of consciousness were obtained through univariate analyses and multiple logistic regression analysis, and then the continuous variables of risk factors were converted to binary variables according to the cut-off values from receiver operating characteristic (ROC) curve analysis, a simple scoring system was established and it’s predictive value for 28-day neurological outcome of patients with sepsis complicated with consciousness disorder was assessed.ResultsA total of 149 patients with sepsis complicated with consciousness disorder were included in this study, including 103 males (69.1%) and 46 females (30.9%), with an average age of (58.2±18.6) years old. There were 72 patients (48.3%) with poor outcome of neurological function on Day 28 after admission. Multiple logistic regression analysis revealed that total bile acid [odds ratio (OR)=1.040, 95% confidence interval (CI) (1.004, 1.077), P=0.027], blood ammonia [OR=1.014, 95%CI (1.001, 1.027), P=0.030], pulmonary infection [OR=3.255, 95%CI (1.401, 7.566), P=0.006], and Glasgow Coma Score (GCS) [OR=0.837, 95%CI (0.739, 0.949), P=0.005] were independent influencing factors for the poor neurological function in patients with sepsis complicated with consciousness disorder on Day 28 after admission. The area under the ROC curve predicting the 28-day poor neurological function was 0.754 [95%CI (0.676, 0.832)], and the sensitivity and specificity were 79.2% and 63.6%, respectively.ConclusionFor emergency patients with sepsis complicated with consciousness disorder, a simple scoring system based on early GCS, pulmonary infection, serum ammonia, and total bile acid has a favorable predictive value for short-term neurological function.
ObjectiveTo investigate the prognostic value of acute kidney injury (AKI) in patients with severe pneumonia complicated with sepsis.MethodsWe retrospectively analyzed the demographic data, vital signs, laboratory examination and other data of 462 patients with severe pneumonia complicated with sepsis in the Department of Emergency West China hospital, Sichuan University from July 2015 to June 2016, as well as the 7-day and 28-day mortality, 28-day mechanical ventilation rate and 28-day intensive care unit (ICU) hospitalization rate. Multivariate logistic regression analysis was used to determine the correlation between AKI and 28-day mortality in patients with severe pneumonia complicated with sepsis at admission.ResultsA total of 462 patients with severe pneumonia complicated with sepsis were retrospectively enrolled in this study. AKI patients at admission had a higher proportion of 7-day (24.6% vs. 9.7%, P<0.001) and 28-day mortality (44.3% vs. 21.2%, P<0.001), 28-day mechanical ventilation rate (63.9% vs. 45.9%, P=0.009) and 28-day ICU admission rate (65.6% vs. 39.4%, P<0.001) than non-AKI patients. There was a significant difference between the two groups (P<0.05). The scores of systemic infection-related organ failure assessment and acute physiology and chronic health evaluationⅡof AKI patients at admission were significantly higher than those of non-AKI patients at admission (P<0.05). Multivariate logistic regression analysis showed that AKI at admission was an independent risk factor for 28-day mortality in patients with severe pneumonia complicated with sepsis [odds ratio: 2.266, 95% confidence interval (1.058, 4.854), P=0.035].ConclusionAKI at admission is helpful for identifying high-risk pneumonia patients complicated with sepsis, and thus may guide the clinical managements of precise medicine.
American Heart Association issued American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in October 2020. A sixth link, recovery, has been added to both the adult out-of-hospital cardiac arrest chain and in-hospital cardiac arrest chain in this version of the guidelines to emphasize the importance of recovery and survivorship for resuscitation outcomes. Analogous chains of survival have also been developed for adult out-of-hospital cardiac arrest and in-hospital cardiac arrest. The major new and updated recommendations involve the early initiation of cardiopulmonary resuscitation by lay rescuers, early administration of epinephrine, real-time audiovisual feedback, physiologic monitoring of cardiopulmonary resuscitation quality, double sequential defibrillation not supported, intravenous access preferred over intraosseous, post-cardiac arrest care and neuroprognostication, care and support during recovery, debriefings for rescuers, and cardiac arrest in pregnancy. This present review aims to interpret these updates by reviewing the literature and comparing the recommendations in these guidelines with previous ones.