Abstract： Objective To validate the value of Cleveland Clinical Score to predict acute renal failure（ARF） requiring renal replacement therapy （RRT） and in-hospital death in Chinese adult patients after cardiac surgery. Methods A retrospective analysis was conducted for all the patients who underwent cardiac surgery from January 2005 to December 2009 in Renji Hospital of School of Medicine, Shanghai Jiaotong University. A total of 2 153 adult patients, 1 267 males and 886 females，were included. Their age ranged from 18 to 99 years with an average age of 58.70 years. Cleveland Clinical Score was used to predict ARF after cardiac surgery. ARF was defined as the need for RRT. Based on Cleveland Clinical Score, the patients were divided into four risk categories of increasing severity：0 to 2 point（n=979）, 3 to 5 point （n=1 116）, 6 to 8 point（n=54）, 9 to 13 point（n=4）. The rates of ARF, multiple organ system failure （MOSF）, and mortality were compared among the 4 categories. The predictive accuracy of postoperative ARF and hospital mortality was assessed by area under the receiver operating characteristic curve （AUC-ROC）. Results In the four categories, the rate of postoperative ARF was 0.92%, 1.88%, 12.96%, and 25.00%, respectively； MOSF rate was 1.23%, 1.88%, 3.70%, and 25.00%, respectively; mortality was 0.92%, 4.21%, 25.93%, and 50.00%, respectively. There was significant dif ference among the four categories in ARF rate （χ2=55.635, P=0.000），MOSF rate（χ2=16.080, P=0.001）, and mortality （χ2=71.470, P=0.000）. The AUC-ROC for Cleveland Clinical Score predicting ARF rate and hospital mortality was 0.775 （95%CI 0.713 to 0.837, P=0.000）and 0.764（95%CI, 0.711 to 0.817, P=0.000）, respectively. Conclusion Cleveland Clinical Score can accurately predict postoperative ARF and hospital mortality in a large, unselected Chinese cohort of adult patients after cardiac surgery. It can be used to provide evidence for effective preventive measures for patients at high risk of postoperative ARF.
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.
ObjectivesTo evaluate the predicting value of bedside pulmonary ultrasound in bronchopulmonary dysplasia (BPD) in premature infants.MethodsPremature infants with gestational age below 28 weeks or birth weight below 1 500 g admitted to NICU of Chengdu Women and Children’s Central Hospital from June 2018 to June 2019 were included. Pulmonary bedside ultrasound monitoring was performed on the 3rd, 7th, 14th and 28th day after admission, and the characteristic ultrasound images were recorded and scored. BPD were diagnosed by NICHD standard. The clinical data and pulmonary ultrasound data were compared and analyzed. Then diagnostic value of bedside pulmonary ultrasound in BPD of premature infants were analyzed.ResultsA total of 81 children involving 32 BPD and 49 non-BPD were included. The sensitivity (Sen), specificity (Spe) and area under curve (AUC) of receiver operating characteristic (ROC) of the "alveolar-interstitial syndrome" within 3 days after birth and the "fragment sign" on 28 days after birth were 81.25%, 51.02%, 0.66 and 31.25%, 97.96%, 0.65, respectively. The lung ultrasound scores in the BPD group on the 3rd, 7th, 14th, and 28th day after birth were 71.99.%, 68.39%, 0.71; 87.50%, 57.14%, 0.72; 78.13%, 73.47%, 0.76 and 56.25 %, 75.51%, 0.66. Sen, Spe and ROC AUC of comprehensive evaluation of lung ultrasound predicted the occurrence of BPD been 81.25%, 63.27%, and 0.85.ConclusionsThe comprehensive evaluation of combination of "alveolar interstitial syndrome" image characteristics within 3 days after birth, "fragment sign" image characteristics after 28 days, and lung ultrasound score at different times after birth can predict the premature infants with bronchopulmonary dysplasia.
ObjectiveTo develop a score system to predict the probability of failure of monotherapy in epilepsy patients with initial treatment, and then provide pillars for early use of polytherapy.MethodsThis is a retrospective analysis of the clinical data of 189 patients with epilepsy treated in Department of Neurology, the Third Xiangya Hospital of Central South University from January 2019 to July 2020. Patients were divided into monotherapy acceptable group and monotherapy poor effect group according to their drug treatment plan and drug efficacy. The influencing factors were screened out by single factor analysis and binary logistic regression analysis. And on the basis of this β value, a quantitative scoring table for predicting the unsatisfying treatment effect of monotherapy is developed. And the receiver operating curve (ROC curve) was used to evaluate the effectiveness of the scale.ResultsBased on a standard of 75% reduction in seizures during the observation period, 138 cases (73%) were effective with monotherapy plan, while 51 cases (23%) were unsatisfactory. Regression analysis showed that multiple forms of seizures, status epilepticus (t2), brain damage, and the number of seizures ≥ 7 times before treatment are independent risk factors for poor outcome of monotherapy. The resulting score sheet has a total score of 12 points; the area under the ROC curve is 0.779, and the critical score is 6 points (sensitivity: 0.314; specificity: 0.957). Patients with more than this score have a strong probability of poor response in monotherapy.ConclusionThis prediction model can effectively assess the risk of unsatisfactory therapeutic effect of monotherapy in epilepsy patients who are initially treated, and thus has reference function for the early selection of polytherapy.