ObjectiveTo investigate the clinical characteristics and predicting factors for death in critically ill patients with severe community-acquired pneumonia (CAP). MethodA total of 143 hospitalized patients with severe CAP between January 2009 and December 2012 were included and their clinical data were retrospectively analyzed. According to the clinical outcome, patients were divided into survival group and death group, and their clinical features and laboratory test results were compared, and multivariate regression analysis was conducted to search for predicting factors for death. ResultsIn this study, a total of 118 patients survived and 25 patients died, and the mortality rate was 17.5%. The number of underlying diseases in the two groups were different, and death group had more patients with 3 kinds of diseases than the survival group[76.0% (19/25) vs. 22.8% (13/57), P<0.05]. The intubation rate in the death group was significantly higher than that in the survival group[84.0% (21/25) vs. 33.1% (39/118), P<0.05], and the arterial blood pH value (7.15±0.52 vs. 7.42±0.17, P<0.05), HCO3- concentration[(18.07±6.25) vs. (25.07±5.44) mmol/L, P<0.05], PaO2[(58.92±35.18) vs. (85.92±32.19) mm Hg (1 mm Hg=0.133 kPa), P<0.05] and PaO2/FiO2[(118.23±98.02) vs. (260.17±151.22) mm Hg, P<0.05)] in the death group were significantly lower than those in the survival group. And multivariate regression analysis indicated that the number of underlying diseases[OR=0.202, 95%CI (0.198, 0.421), P=0.003], PaO2[OR=1.203, 95%CI (1.193, 1.294), P=0.011] and PaO2/FiO2[OR=0.956, 95%CI (0.927, 0.971), P=0.008] were independent predictors of death in the patients with severe pneumonia. ConclusionsPatients who died of severe pneumonia often had severe illnesses before admission, and the number of underlying diseases and PaO2 have highly predictive value for death.
ObjectiveTo evaluate the predictors of generalized anxiety disorder (GAD) among teachers in 3 months after Lushan earthquake. MethodsA prospective cohort study was conducted to diagnostically evaluate the psychological sequelae and GAD during 14-20 days and 85-95 days after the earthquake. The possible predictive factors of psychological sequelae were assessed by a self-made questionnaire and the GAD was assessed by the GAD symptom criterion of M.I.N.I. in 3 months. The univariate and multivariate logistic regression analysis (ULRA, MLRA) were applied to analyze the predictors of GAD after the two-staged assessments. ResultsThere were a total of 319 teachers completed the two-staged assessments. The total response rate was 51.3%. Seventy teachers were diagnosed as GAD and the prevalence of GAD in 3 months was 21.9%. The predictive factors by ULRA included:male, older than 35 years old, having unlivable house, living in tents, sleeping difficulties, easy to feel sad, physical discomfort, loss of appetite, feeling short of social support, unable to calm down for working, feeling difficult for teaching, observing more inattention of students, and wanting to ask for a leave. The independent predictors by MLRA included:male, having unlivable house, feeling short of social support, and feeling difficult for teaching. ConclusionThe teachers have a higher likelihood of GAD after earthquake. It is essential to pay more attention to those male teachers, who feel short of social support and don't have a livable house thus to prevent the GAD at the early stage of post-earthquake.
ObjectiveTo investigate the value of plasma microRNA-216 (miR-216) in patients with acute pancreatitis as a clinical biomarker to early identify severe acute pancreatitis (SAP).MethodsPatients with acute pancreatitis who admitted to the hospital within 48 hours after the onset of disease between September and November 2014 were enrolled in this study. Plasam and clinical data of all the patients were collected. MiR-216 in the plasma was detected using quantitative real time-polymerase chain reaction.ResultsA total of 25 patients were enrolled. The Ct value of plasma miR-216 in SAP patients (32.40±1.43) was significantly upregulated than mild acute pancreatitis (MAP) (35.85±1.91, P<0.05) and moderately severe acute pancreatitis (MSAP) patients (35.90±2.44,P<0.05), respectively. The area under receiver operating characteristic curve for plasmamiR-216 in predicting SAP was 0.792 (P<0.05), which did not differ much from other conventional parameters such as C-reactive protein, urinary nitrogen, and cytokines (P>0.05).ConclusionPlasma miR-216 is significantly upregulated in SAP patients compared with MAP and MSAP, but it shows no inferior efficiency than the investigated conventional predictors in predicting SAP.
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
ObjectiveTo systematically review the predictors of enteral nutrition feeding intolerance in critically ill patients. MethodsThe PubMed, Web of Science, Cochrane Library, Embase, CNKI, WanFang Data, VIP and CBM databases were searched to collect relevant observational studies from the inception to 6 August, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. ResultsA total of 18 studies were included, including 28 847 patients. The results of the meta-analysis showed that gender, age, severity of illness, hypo-albuminemia, length of stay, postpyloric feeding, mechanical ventilation and mechanical ventilation time, use of prokinetics, use of sedation drugs, use of vasoactive drugs and use of antibiotics were predictors of enteral nutrition feeding intolerance in critically ill patients, among which postpyloric feeding (OR=0.46, 95%CI 0.29 to 0.71, P<0.01) was a protective factor. ConclusionAccording to the influencing factors, the medical staff can formulate a targeted enteral nutrition program at the time of admission to the ICU to reduce the occurrence of feeding intolerance. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.