BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nu...BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.展开更多
BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive...BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.展开更多
Objective To investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. Methods In total 1 397 type 2 ...Objective To investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. Methods In total 1 397 type 2 diabetic patients aged 50 years and older were enrolled and determined ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in 15 Class III Grade A hospitals in 7 major cities of China. Results Mean patient age was 63.7±8.2 years and mean duration of diabetes mellitus was 9.39±7.4 years. Two hundreds and seventy-two (19.47%) patients were diagnosed as PAD by ABI <0.9, 122 (18.37%) in male and 150 (20.46%) in female. PAD patients had a significantly longer duration of diabetes mellitus, higher hemoglobin Alc, and a significantly lower mean body mass index than non-PAD ones. Aging, smoking, and systolic blood pressure were found to be positively related with the prevalence of PAD. In terms of lipid profiles, no variable was found to relate with PAD. Notably, baPWV showed as the same significant guiding index for PAD, almost matched with ABI. Conclusions PAD is a common complication in China type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for diabetic patients with high risk factors.展开更多
Objective To estimate the frequency of various risk factors for overall stroke and to identify risk factors for cerebral infarction (CI) versus intracerebral hemorrhage (ICH) in a large hospital-based stroke registry....Objective To estimate the frequency of various risk factors for overall stroke and to identify risk factors for cerebral infarction (CI) versus intracerebral hemorrhage (ICH) in a large hospital-based stroke registry. Methods Data from a total of 3901 patients, consisting of 3525 patients with CI and 376 patients with ICH were pros-pectively coded and entered into a computerized data bank. Results Hypertension and smoking were the most prominent factors affecting overall stroke followed by mild internal carotid artery stenosis (< 50%), hypercholesterolemia, transient ischemic attacks (TIAs), diabetes mellitus, and cardiac ischemia. Univariate analysis showed that factors in male significantly associated with CI versus ICH were old age, a family history of stroke, and intermittent claudication; whereas in female the factors were oral contraception and migraine. By multivariate analysis, in all patients, the factors significantly associated with CI as opposed to ICH were smoking, hyperch-olesterolemia, migraine, TIAs, atrial fibrillation, structural heart disease, and arterial disease. Hypertension was the only significant factor related with ICH versus CI.Conclusions The factors for ischemic and hemorrhagic stroke are not exactly the same. Cardiac and arterial disease are the most powerful factors associated with CI rather than ICH.展开更多
BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected ...BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS: Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat(ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suff ered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen(BUN), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactic dehydrogenase(LDH), myoglobin(Mb), procalcitonin(PCT), and galactomannan were related to poor prognosis(hazard ratio [HR]>1, P<0.05).CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.展开更多
BACKGROUND:Neuroendocrine dysfunction after traumatic brain injury(TBI)has received increased attention due to its impact on the recovery of neural function.The purpose of this study is to investigate the incidence an...BACKGROUND:Neuroendocrine dysfunction after traumatic brain injury(TBI)has received increased attention due to its impact on the recovery of neural function.The purpose of this study is to investigate the incidence and risk factors of adrenocortical insuffi ciency(AI)after TBI to reveal independent predictors and build a prediction model of AI after TBI.METHODS:Enrolled patients were grouped into the AI and non-AI groups.Fourteen preset impact factors were recorded.Patients were regrouped according to each impact factor as a categorical variable.Univariate and multiple logistic regression analyses were performed to screen the related independent risk factors of AI after TBI and develop the predictive model.RESULTS:A total of 108 patients were recruited,of whom 34(31.5%)patients had AI.Nine factors(age,Glasgow Coma Scale[GCS]score on admission,mean arterial pressure[MAP],urinary volume,serum sodium level,cerebral hernia,frontal lobe contusion,diff use axonal injury[DAI],and skull base fracture)were probably related to AI after TBI.Three factors(urinary volume[X4],serum sodium level[X5],and DAI[X8])were independent variables,based on which a prediction model was developed(logit P=-3.552+2.583X4+2.235X5+2.269X8).CONCLUSIONS:The incidence of AI after TBI is high.Factors such as age,GCS score,MAP,urinary volume,serum sodium level,cerebral hernia,frontal lobe contusion,DAI,and skull base fracture are probably related to AI after TBI.Urinary volume,serum sodium level,and DAI are the independent predictors of AI after TBI.展开更多
Objective To investigate the independent risk factors of traumatic brain injury （TBI） prognosis. Methods A retrospective analysis was performed in 885 hospitalized TBI patients from January 1, 2003 to January 1, 20...Objective To investigate the independent risk factors of traumatic brain injury （TBI） prognosis. Methods A retrospective analysis was performed in 885 hospitalized TBI patients from January 1, 2003 to January 1, 2010 in the First Affiliated Hospital of Medical College of Xi＇an Jiaotong LIniversity. Sin- gle-factor and logistic regression analysis were conducted to evaluate the association of different variables with TBI outcome. Results The single-factor analysis revealed outcome, including age （P=0.044 for the age group （P〈0.O01）, cerebrospinal fluid leakage （P〈0.001）, reflex （P〈0.001）, shock （P〈0.001）, associated （P〈0.001）, cerebral contusion （P〈0.001）, diffuse significant association between several variables and TB1 40-60, P〈0.00l for the age group ≥60）, complications Glasgow Coma Scale （GCS） （P〈0.001）, pupillary light extra-cranial lesions （P=0.01）, subdural hematoma axonal injury （P〈0.001）, and subarachnoid hemorrhage （P〈0.001）, suggesting the influence of those factors on the prognosis of TBI. Furthermore, logistic regression analysis identified age, GCS score, pupillary light reflex, subdural hematoma, and subarachnoid hemorrhage as independent risk factors of TB1 prognosis. Conclusion Age, GCS score, papillary light reflex, subdural hematoma, and subarachnoid hemorrhage may be risk factors influencing the prognosis of TBI. Paying attention to those factors might improve the outcome of TBI in clinical treatment.展开更多
BACKGROUND： This study was undertaken to determine the prevalence of organ failure and its risk factors in patients with severe acute pancreatitis （SAP） .METHODS： A retrospective analysis was made of 186 patients ...BACKGROUND： This study was undertaken to determine the prevalence of organ failure and its risk factors in patients with severe acute pancreatitis （SAP） .METHODS： A retrospective analysis was made of 186 patients with SAP who were had been hospitalized in the intensive care unit of Jinzhong First People’s Hospital between March 2000 and October 2009. The patients met the diagnostic criteria of SAP set by the Surgical Society of the Chinese Medical Association in 2006. The variables collected included age, gender, etiology of SAP, the number of comorbidit, APACHEII score, contrast-enhanced CT （CECT） pancreatic necrosis, CT severity index （CTSI） , abdominal compartment syndrome （ACS） , the number of organ failure, and the number of death. The prevalence and mortality of organ failure were calculated. The variables were analyzed by unconditional multivariate logistic regression to determine the independent risk factors for organ failure in SAP.RESULTS： Of 186 patients, 96 had organ failure. In the 96 patients, 47 died. There was a significant association among the prevalence of organ failure and age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI, and ACS. An increase in age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis were correlated with increased number of organ failure. Age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI and ACS were assessed by unconditional multivariate logistic regression.CONCLUSIONS： Organ failure occurred in 51.6% of the 186 patients with SAP. The mortality of SAP with organ failure was 49.0%. Age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI and ACS are independent risk factors of organ failure.展开更多
Background: Musculoskeletal injuries(MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during...Background: Musculoskeletal injuries(MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training,operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available.Methods: A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed(using the “snowball method”). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made.Results: In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the “order of importance” and including concepts that are modifiable/nonmodifiable, as well as extrinsic/intrinsic risk factors.Conclusions: This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.展开更多
BACKGROUND:This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.METHODS:The data of 190 critically ill cancer patients with ...BACKGROUND:This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.METHODS:The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed.The data of 321 patients with no acute respiratory insufficiency as controls were also collected.Clinical variables of the first 24 hours after admission to intensive care unit were collected,including age,sex,comorbid disease,type of surgery,admission type,presence of shock,presence of acute kidney injury,presence of acute lung injury/acute respiratory distress syndrome,acute physiologic and chronic health evaluation(APACHE Ⅱ) score,sepsis-related organ failure assessment(SOFA),and PaO_2/FiO_2 ratio.Duration of mechanical ventilation,length of intensive care unit stay,intensive care unit death,length of hospitalization,hospital death and one-year survival were calculated.RESULTS:The incidence of acute respiratory insufficiency was 37.2%(190/321).Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases(P=0.001),surgeryrelated infection(P=0.004),hypo-volemic shock(P<0.001),and emergency surgery(P=0.018),were independent risk factors of postoperative acute respiratory insufficiency.Compared with the patients without acute respiratory insufficiency,the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay(P<0.001),a prolonged length of hospitalization(P=0.006),increased intensive care unit mortality(P=0.001),and hospital mortality(P<0.001).Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency(P=0.029,RR:8.522,95%CI:1.243-58.437,B=2.143,SE=0.982,Wald=4.758).Compared with the patients without acute respiratory insufficiency,those with acute respiratory insufficiency had a shortened one-year survival rate(78.7%vs.97.1%,P<0.001).CONCLUSION:A history of chronic obstructive pulmonary diseases,surgery-related infection,hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency.Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency.Compared with patients without acute respiratory insufficiency,those with acute respiratory insufficiency had adverse shortterm outcome and a decreased one-year survival rate.展开更多
Acute kidney injury following percutaneous coronary intervention （PCI） is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury （AKI） in patients after intracoronary stent ...Acute kidney injury following percutaneous coronary intervention （PCI） is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury （AKI） in patients after intracoronary stent implantation are still unknown. A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included： 1） pre-operative ones： age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate （eGFR）, hyperuricemia, proteinuria, emergency operation, hydration, medications （ACEI/ARBs, statins）; 2） intraoperative ones： dose of contrast media, operative time, hypotension; and 3） postoperative one： hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis. Of the 325 patients, 51（15.7%） developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters （left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration）, emergency operation, intraoperative parameters （operative time, hypotension） and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age （OR=0.253, 95%CI=0.088-0.727）, pre-operative proteinuria （OR=5.351, 95%CI=2.128-13.459）, pre-operative left ventricular insufficiency （OR=8.704, 95%CI=3.170-23.898）, eGFR〈60 ml/min/1.73 m2 （OR=6.677, 95%CI=1.167-38.193）, prolonged operative time, intraoperative hypotension （OR=25.245, 95%CI=1.001-1.034） were independent risk factors ofAKl. AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the significant risk factors ofAKl.展开更多
Warfarin is a commonly used anticoagulant with a narrow therapeutic range and risk of hemorrhagic complications. After CYP2C9 and VKORC1, CYP4F2 was confirmed as the third principle genetic determinant of warfarin dos...Warfarin is a commonly used anticoagulant with a narrow therapeutic range and risk of hemorrhagic complications. After CYP2C9 and VKORC1, CYP4F2 was confirmed as the third principle genetic determinant of warfarin dose variability.展开更多
Objective To investigate the levels of cardiovascular disease risk factors and their relations to clinical phenotype associated with coronary artery disease(CAD).Methods The subjects were recruited from five independe...Objective To investigate the levels of cardiovascular disease risk factors and their relations to clinical phenotype associated with coronary artery disease(CAD).Methods The subjects were recruited from five independent cardiovascular centers.Coronary angiography was employed to define the CAD with stenosis in each major vessel ≥70% and control with stenosis <10% in every lesion.The classic risk factors including family history,body mass index,smoking habits,hypertension,diabetes mellitus,and serum lipid levels were surveyed according to established criteria.Associations between risk levels and clinical phenotypes were assessed by case control and correlation analysis.Results A total of 762 individuals were collected,including 481 men and 281 women,aged from 17 to 81(mean 60±10) years.The patients with CAD accounted for 55.5% of all participants,and controls 44.5%,respectively.Compared with the pattern in published data,our study showed that mean serum high density lipoprotein cholesterol(HDL-C) level was significantly lower(P<0.001) and triglycerides was significantly higher(P<0.001),while total cholesterol(TC) and low density lipoprotein cholesterol levels were comparative(both P>0.05).The prevalence of low HDL-C(<40 g/L) and hypertriglyceridemia(>150 g/L) were 27.2% and 41.4%,respectively.Mean serum levels of HDL-C and apolipoprotein A1 were significantly higher in female subjects than in male(P<0.001).Lower HDL-C functioned as an independent risk factor for CAD only in men(RR=2.8,95%CI:1.5-4.2,P<0.001),yet increased non-HDL cholesterol combined with diabetes mellitus and obesity seemed to play a key role in the development ofCAD in women.Similarity in risk association with CAD was found for hypertension and TC/HDL ratio in male and female subjects,while family history had no relationship with the presence of CAD.Conclusion It is remarkable that emphasis of intervention in future should be given on the prevalent low serum HDL-C and its strong risk correlation with the presence of CAD in male subjects of Chinese Han population.展开更多
The widespread use of gastrointestinal bleeding prophylaxis in critically ill patients was one of the most controversial issues. Since few studies reported the incidence of gastrointestinal bleeding in mechanically ve...The widespread use of gastrointestinal bleeding prophylaxis in critically ill patients was one of the most controversial issues. Since few studies reported the incidence of gastrointestinal bleeding in mechanically ventilated patients, this study aimed to identify the incidence and risk factors related to gastrointestinal bleeding in patients undergoing mechanical ventilation for more than 48 hours. A total of 283 IOU patients who had received mechanical ventilation for longer than 48 hours at a provincial hospital affiliated to Shandong University from January 1,2007 to December 31, 2009 were analyzed retrospectively. Those were excluded from the study if they had a history of gastrointestinal bleeding or ulceration, recent gastrointestinal surgery, brain death and active bleeding from the nose or throat. Demographic data of the patients included patient age, diagnosis on admission, duration of ICU stay, duration of ventilation, patterns and parameters of ventilation, ICU mortality, APACHE II score, multiple organ dysfunction, and indexes of biochemistry, kidney function, liver function and coagulation function. Risk factors of gastrointestinal bleeding were analyzed by univariate analysis and multiple logistic regression analysis. In the 242 patients who were given mechanical ventilation longer than 48 hours, the incidence of gastrointestinal bleeding was 46.7%. The bleeding in 3.3% of the patients was clinically significant. Significant risk factors were peak inspiratory pressure 〉30cmH2O, renal failure, liver failure, PLT count〈50xl09/L and prolonged APTT. Enteral nutrition had a beneficial effect on gastrointestinal bleeding. However, the multiple logistic regression analysis revealed that the independent risk factors of gastrointestinal bleeding were as follows： high pressure ventilator setting 〉 30cmH2O（RR=3.478, 95%CI=2.208-10.733）, renal failure（RR=1 .687, 95%CI=1.098-3.482）, PLT count〈50×10^9/L （RR=3.762, 95%CI=2.346-14.685）, and prolonged APTT（RR=5.368, 95%CI=2.487-11.266）. Enteral nutrition（RR=0.436, 95%CI= 0.346-0.764） was the independent protective factor. The incidence of gastrointestinal bleeding was high in the patients who received mechanical ventilation, and bleeding usually occurred within the first 48 hours. High pressure ventilator setting, renal failure, decreased PLT count and prolonged APTT were the significant risk factors of gastrointestinal bleeding. However, enteral nutrition was the independent protective factor.展开更多
BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI ...BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic(ROC)curve.RESULTS The incidence of cardiac surgery–associated acute kidney injury(CSA-AKI)was 24.17%,and 0.53%of AKI patients required dialysis(AKI-D).Among the derivation cohort,multivariable logistic regression showed that age≥70 years,body mass index(BMI)≥25 kg/m2,estimated glomerular filtration rate(eGFR)≤60 mL/min per 1.73 m2,ejection fraction(EF)≤45%,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump(IABP)implantation,postoperative low cardiac output syndrome(LCOS)and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to32 points with three risk categories.The AKI frequencies were as follows:0-8 points(15.9%),9-17 points(36.5%)and≥18 points(90.4%).The area under of the ROC curve was 0.730(95%CI:0.691-0.768)in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735(95%CI:0.655-0.815).The model was well calibrated according to the Hosmer-Lemeshow test(P=0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions.展开更多
Objective：To search for risk factors that affect mother-to-infant transmission of hepatitis B virus（HBV）. Methods：To obtain studies eligible for meta-analysis, China biological medicine discs and MEDLINE citations...Objective：To search for risk factors that affect mother-to-infant transmission of hepatitis B virus（HBV）. Methods：To obtain studies eligible for meta-analysis, China biological medicine discs and MEDLINE citations were surveyed. Mother HBV DNA or HBeAg positivity,neonate HBeAg positivity, mode of delivery, threatened abortion and threatened premature labor were processed with meta analysis. Criteria for selection of published studies for meta analysis were based on principle by Abdolmaleky HM. Odds ratio （OR） was calculated and summarized by fixed effect model or random-effects model using RevMan software. The heterogeneity of the group of ORs was assessed using an X^2 test. The significance of the pooled OR was determined by the u-test. The strength of association was assessed using the OR. An OR〉1. 0 indicated a positive association between the risk factor and neonate HBV infection. Results： After meta analysis of factors concerned, a significant association was found between the positivity of HBeAg in mother and neonate, of HBV DNA in mother peripheral serum, and HBV mother-to-infant transmission, with a pooled OR equal to 19.43 （95% CI=8. 77-43. 06）, 36.5 （95% CI= 19.85-67. 11）, and 36.5 （95 % CI= 19.85-67.11 ） respectively. Mode of delivery, threatened abortion and threatened premature labor proved not to be of risk factors on the mother-to-infant transmission of HBV. Conclusion： Mother HBV DNA or HBeAg positivity and neonate HBeAg positivity were proved to be of risk factors affecting the transmission of HBV from mother to fetal.展开更多
Objective To examine the association of atherosclerotic cardiovascular disease(ASCVD)and its risk factors with cognitive impairment in older adults.Methods Six hundred and fourteen subjects,aged≥65 years,from one cen...Objective To examine the association of atherosclerotic cardiovascular disease(ASCVD)and its risk factors with cognitive impairment in older adults.Methods Six hundred and fourteen subjects,aged≥65 years,from one center(2016–2018)underwent clinical,laboratory assessments and the Montreal Cognitive Assessment(Mo CA).Using regression analysis,the relationship between ASCVD and its risk factors was evaluated in subjects with and without cognitive impairment(MoCA score<26).Results Older age(b=-1.3 per 5 years,95%CI:-1.7 to-0.9,P<0.001),history of stroke(b=-1.6,95%CI:-3.0 to-0.3,P=0.01),and myocardial infarction(MI;b=-2.2,95%CI:-3.6 to-0.8,P=0.003)were independently associated with lower MoCA scores,whereas more education(b=1.5 per 3 years,95%CI:1.1 to 1.9,P<0.001),higher body mass index(BMI;b=0.5 per 3 kg/m^2,95%CI:0.0 to 1.0,P=0.04),higher estimated glomerular filtration rate(eGFR;b=0.8 per 15 U,95%CI:0.1 to 1.4,P=0.03),left ventricular ejection fraction(LVEF;b=0.4 per 5%,95%CI:0 to 0.8,P=0.04)and statin use(b=1.3,95%CI:0.3 to 2.3,P=0.01)were associated with a higher MoCA score.Cognitive impairment was independently associated with older age(OR=1.51 per 5 yrs,95%CI:1.28 to 1.79,P<0.001),less education(OR=0.55 per 3 years,95%CI:0.45 to 0.68,P<0.001),lower BMI(OR=0.78 per 3 kg/m^2,95%CI:0.62 to 0.98,P=0.03)and higher levels of high sensitivity c-reactive protein(hsCRP;OR=1.08 per 1 mg/L,95%CI:1.02 to 1.15,P=0.01).Conclusions Beyond age,cognitive impairment was associated with prior MI/stroke,higher hsCRP,statin use,less education,lower eGFR,BMI and LVEF.展开更多
With beta-lactam drugs and immunosuppressants widely used, the infection caused by Acinetobacter baumannfi （Ab） has become more and more serious with multidrug resistant Acinetobacter baumannfi （MDRAb） emerging an...With beta-lactam drugs and immunosuppressants widely used, the infection caused by Acinetobacter baumannfi （Ab） has become more and more serious with multidrug resistant Acinetobacter baumannfi （MDRAb） emerging and worsening rapidly. Compared with other patients, the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, prolonged hospitalization and invasive operations. Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children. A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb （NMDRAb） pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children＇s Hospital. Clinical data were analyzed with univariate and multivariate Logistic regression. In 176 clinical strains of Acinetobacter baumannfi isolated, there were 128 strains of MDRAb, accounting for 72.73%. Drug susceptibility tests showed that the resistance rates of 13-1actam antibiotics were more than 70% except for cefoperazone sulbactam. The rates to carbapenems were higher than 90%. They were significantly higher than those of NMDRAb. Amikacin, levofloxacin, ciprofloxacin and minocycline had the lowest drug-resistance rates （〈20%）. Multivariate Logistic regression revealed that ICU stay, the time of mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia. MDRAb is an important opportunistic pathogen to pneumonia in PICU, and its drug-resistance is severe. It increases significantly the mortality of patients. It is important to take the effective prevention measures for controlling it.展开更多
Objective To forecast the future burden and its attributable risk factors of infective endocarditis(IE).Methods We analyzed the disease burden of IE and its risk factors from 1990 to 2019 using the Global Burden of Di...Objective To forecast the future burden and its attributable risk factors of infective endocarditis(IE).Methods We analyzed the disease burden of IE and its risk factors from 1990 to 2019 using the Global Burden of Disease 2019 database and projected the disease burden from 2020 to 2030 using a Bayesian age-period-cohort model.Results By 2030,the incidence of IE will increase uncontrollably on a global scale,with developed countries having the largest number of cases and developing countries experiencing the fastest growth.The affected population will be predominantly males,but the gender gap will narrow.The elderly in high-income countries will bear the greatest burden,with a gradual shift to middle-income countries.The incidence of IE in countries with middle/high-middle social-demographic indicators(SDI) will surpass that of high SDI countries.In China,the incidence rate and the number of IE will reach 18.07 per 100,000 and 451,596 in 2030,respectively.IEassociated deaths and heart failure will continue to impose a significant burden on society,the burden on women will increase and surpass that on men,and the elderly in high-SDI countries will bear the heaviest burden.High systolic blood pressure has become the primary risk factor for IE-related death.Conclusions This study provides comprehensive analyses of the disease burden and risk factors of IE worldwide over the next decade.The IE-associated incidence will increase in the future and the death and heart failure burden will not be appropriately controlled.Gender,age,regional,and country heterogeneity should be taken seriously to facilitate in making effective strategies for lowering the IE disease burden.展开更多
To investigate the association of carotid arterial intima- media thickness (IMT) with principal cardiovascular risk factors in the elderly. Methods. Carotid arterial IMT was measured by high resolution B mode ultrasou...To investigate the association of carotid arterial intima- media thickness (IMT) with principal cardiovascular risk factors in the elderly. Methods. Carotid arterial IMT was measured by high resolution B mode ultrasound in 94 elderly subjects (old- aged group), and compared with subjects aged Results. In comparison with the middle- aged group, the prevalence of coronary heart disease, cerebral vascular disease, hypertension and diabetes mellitus was significantly higher, and serum cholesterol and systolic blood pressure were also significantly higher in old- aged group. Although there was no obvious difference in IMT between the two groups, carotid plaque and carotid wall thickening were more frequently found in old- aged group. Age, systolic blood pressure and serum cholesterol were shown as the independent determinants for carotid IMT in the total participants, whereas no such independent relation was found in old- aged group. Conclusion. Age is the major risk factor for carotid atherosclerosis in the elderly. In other words, the occurrence of carotid atherosclerosis is the result of advancing age combined with the effect of multiple cardiovascular risk factors.展开更多
文摘BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.
基金Science and Technology Development Plan Project of Suzhou(SKJYD2021035)Science and Technology Development Plan Project of Suzhou(SKJYD2022078)The Key Project Research Fund of the Second Affiliated Hospital of Wannan Medical College(YK2023Z04)。
文摘BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.
文摘Objective To investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. Methods In total 1 397 type 2 diabetic patients aged 50 years and older were enrolled and determined ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in 15 Class III Grade A hospitals in 7 major cities of China. Results Mean patient age was 63.7±8.2 years and mean duration of diabetes mellitus was 9.39±7.4 years. Two hundreds and seventy-two (19.47%) patients were diagnosed as PAD by ABI <0.9, 122 (18.37%) in male and 150 (20.46%) in female. PAD patients had a significantly longer duration of diabetes mellitus, higher hemoglobin Alc, and a significantly lower mean body mass index than non-PAD ones. Aging, smoking, and systolic blood pressure were found to be positively related with the prevalence of PAD. In terms of lipid profiles, no variable was found to relate with PAD. Notably, baPWV showed as the same significant guiding index for PAD, almost matched with ABI. Conclusions PAD is a common complication in China type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for diabetic patients with high risk factors.
文摘Objective To estimate the frequency of various risk factors for overall stroke and to identify risk factors for cerebral infarction (CI) versus intracerebral hemorrhage (ICH) in a large hospital-based stroke registry. Methods Data from a total of 3901 patients, consisting of 3525 patients with CI and 376 patients with ICH were pros-pectively coded and entered into a computerized data bank. Results Hypertension and smoking were the most prominent factors affecting overall stroke followed by mild internal carotid artery stenosis (< 50%), hypercholesterolemia, transient ischemic attacks (TIAs), diabetes mellitus, and cardiac ischemia. Univariate analysis showed that factors in male significantly associated with CI versus ICH were old age, a family history of stroke, and intermittent claudication; whereas in female the factors were oral contraception and migraine. By multivariate analysis, in all patients, the factors significantly associated with CI as opposed to ICH were smoking, hyperch-olesterolemia, migraine, TIAs, atrial fibrillation, structural heart disease, and arterial disease. Hypertension was the only significant factor related with ICH versus CI.Conclusions The factors for ischemic and hemorrhagic stroke are not exactly the same. Cardiac and arterial disease are the most powerful factors associated with CI rather than ICH.
基金supported by the National Natural Science Foundation of China (81801948)。
文摘BACKGROUND: To investigate the clinical characteristics and risk factors of human immunodeficiency virus(HIV)-negative patients with Talaromyces marneffei(T. marneffei) infection.METHODS: We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS: Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat(ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suff ered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen(BUN), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactic dehydrogenase(LDH), myoglobin(Mb), procalcitonin(PCT), and galactomannan were related to poor prognosis(hazard ratio [HR]>1, P<0.05).CONCLUSIONS: Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.
基金a grant from the National Clinical Specialty Construction Project of China(2013-544).
文摘BACKGROUND:Neuroendocrine dysfunction after traumatic brain injury(TBI)has received increased attention due to its impact on the recovery of neural function.The purpose of this study is to investigate the incidence and risk factors of adrenocortical insuffi ciency(AI)after TBI to reveal independent predictors and build a prediction model of AI after TBI.METHODS:Enrolled patients were grouped into the AI and non-AI groups.Fourteen preset impact factors were recorded.Patients were regrouped according to each impact factor as a categorical variable.Univariate and multiple logistic regression analyses were performed to screen the related independent risk factors of AI after TBI and develop the predictive model.RESULTS:A total of 108 patients were recruited,of whom 34(31.5%)patients had AI.Nine factors(age,Glasgow Coma Scale[GCS]score on admission,mean arterial pressure[MAP],urinary volume,serum sodium level,cerebral hernia,frontal lobe contusion,diff use axonal injury[DAI],and skull base fracture)were probably related to AI after TBI.Three factors(urinary volume[X4],serum sodium level[X5],and DAI[X8])were independent variables,based on which a prediction model was developed(logit P=-3.552+2.583X4+2.235X5+2.269X8).CONCLUSIONS:The incidence of AI after TBI is high.Factors such as age,GCS score,MAP,urinary volume,serum sodium level,cerebral hernia,frontal lobe contusion,DAI,and skull base fracture are probably related to AI after TBI.Urinary volume,serum sodium level,and DAI are the independent predictors of AI after TBI.
文摘Objective To investigate the independent risk factors of traumatic brain injury （TBI） prognosis. Methods A retrospective analysis was performed in 885 hospitalized TBI patients from January 1, 2003 to January 1, 2010 in the First Affiliated Hospital of Medical College of Xi＇an Jiaotong LIniversity. Sin- gle-factor and logistic regression analysis were conducted to evaluate the association of different variables with TBI outcome. Results The single-factor analysis revealed outcome, including age （P=0.044 for the age group （P〈0.O01）, cerebrospinal fluid leakage （P〈0.001）, reflex （P〈0.001）, shock （P〈0.001）, associated （P〈0.001）, cerebral contusion （P〈0.001）, diffuse significant association between several variables and TB1 40-60, P〈0.00l for the age group ≥60）, complications Glasgow Coma Scale （GCS） （P〈0.001）, pupillary light extra-cranial lesions （P=0.01）, subdural hematoma axonal injury （P〈0.001）, and subarachnoid hemorrhage （P〈0.001）, suggesting the influence of those factors on the prognosis of TBI. Furthermore, logistic regression analysis identified age, GCS score, pupillary light reflex, subdural hematoma, and subarachnoid hemorrhage as independent risk factors of TB1 prognosis. Conclusion Age, GCS score, papillary light reflex, subdural hematoma, and subarachnoid hemorrhage may be risk factors influencing the prognosis of TBI. Paying attention to those factors might improve the outcome of TBI in clinical treatment.
文摘BACKGROUND： This study was undertaken to determine the prevalence of organ failure and its risk factors in patients with severe acute pancreatitis （SAP） .METHODS： A retrospective analysis was made of 186 patients with SAP who were had been hospitalized in the intensive care unit of Jinzhong First People’s Hospital between March 2000 and October 2009. The patients met the diagnostic criteria of SAP set by the Surgical Society of the Chinese Medical Association in 2006. The variables collected included age, gender, etiology of SAP, the number of comorbidit, APACHEII score, contrast-enhanced CT （CECT） pancreatic necrosis, CT severity index （CTSI） , abdominal compartment syndrome （ACS） , the number of organ failure, and the number of death. The prevalence and mortality of organ failure were calculated. The variables were analyzed by unconditional multivariate logistic regression to determine the independent risk factors for organ failure in SAP.RESULTS： Of 186 patients, 96 had organ failure. In the 96 patients, 47 died. There was a significant association among the prevalence of organ failure and age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI, and ACS. An increase in age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis were correlated with increased number of organ failure. Age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI and ACS were assessed by unconditional multivariate logistic regression.CONCLUSIONS： Organ failure occurred in 51.6% of the 186 patients with SAP. The mortality of SAP with organ failure was 49.0%. Age, the number of comorbidity, APACHEII score, CECT pancreatic necrosis, CTSI and ACS are independent risk factors of organ failure.
文摘Background: Musculoskeletal injuries(MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training,operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available.Methods: A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed(using the “snowball method”). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made.Results: In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the “order of importance” and including concepts that are modifiable/nonmodifiable, as well as extrinsic/intrinsic risk factors.Conclusions: This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.
文摘BACKGROUND:This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.METHODS:The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed.The data of 321 patients with no acute respiratory insufficiency as controls were also collected.Clinical variables of the first 24 hours after admission to intensive care unit were collected,including age,sex,comorbid disease,type of surgery,admission type,presence of shock,presence of acute kidney injury,presence of acute lung injury/acute respiratory distress syndrome,acute physiologic and chronic health evaluation(APACHE Ⅱ) score,sepsis-related organ failure assessment(SOFA),and PaO_2/FiO_2 ratio.Duration of mechanical ventilation,length of intensive care unit stay,intensive care unit death,length of hospitalization,hospital death and one-year survival were calculated.RESULTS:The incidence of acute respiratory insufficiency was 37.2%(190/321).Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases(P=0.001),surgeryrelated infection(P=0.004),hypo-volemic shock(P<0.001),and emergency surgery(P=0.018),were independent risk factors of postoperative acute respiratory insufficiency.Compared with the patients without acute respiratory insufficiency,the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay(P<0.001),a prolonged length of hospitalization(P=0.006),increased intensive care unit mortality(P=0.001),and hospital mortality(P<0.001).Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency(P=0.029,RR:8.522,95%CI:1.243-58.437,B=2.143,SE=0.982,Wald=4.758).Compared with the patients without acute respiratory insufficiency,those with acute respiratory insufficiency had a shortened one-year survival rate(78.7%vs.97.1%,P<0.001).CONCLUSION:A history of chronic obstructive pulmonary diseases,surgery-related infection,hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency.Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency.Compared with patients without acute respiratory insufficiency,those with acute respiratory insufficiency had adverse shortterm outcome and a decreased one-year survival rate.
文摘Acute kidney injury following percutaneous coronary intervention （PCI） is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury （AKI） in patients after intracoronary stent implantation are still unknown. A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included： 1） pre-operative ones： age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate （eGFR）, hyperuricemia, proteinuria, emergency operation, hydration, medications （ACEI/ARBs, statins）; 2） intraoperative ones： dose of contrast media, operative time, hypotension; and 3） postoperative one： hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis. Of the 325 patients, 51（15.7%） developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters （left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration）, emergency operation, intraoperative parameters （operative time, hypotension） and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age （OR=0.253, 95%CI=0.088-0.727）, pre-operative proteinuria （OR=5.351, 95%CI=2.128-13.459）, pre-operative left ventricular insufficiency （OR=8.704, 95%CI=3.170-23.898）, eGFR〈60 ml/min/1.73 m2 （OR=6.677, 95%CI=1.167-38.193）, prolonged operative time, intraoperative hypotension （OR=25.245, 95%CI=1.001-1.034） were independent risk factors ofAKl. AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the significant risk factors ofAKl.
基金Acknowledgements This work was supported by grants from the National Natural Science Foundation of China （No. 30971259）, and the Scientific and Technological Innovation Fund for Young Investigation, Chinese PLA General Hospital （No. 09KMM23）.
文摘Warfarin is a commonly used anticoagulant with a narrow therapeutic range and risk of hemorrhagic complications. After CYP2C9 and VKORC1, CYP4F2 was confirmed as the third principle genetic determinant of warfarin dose variability.
基金Supported by a grant from Desert Foundation (2003),Salt Lake City,USA
文摘Objective To investigate the levels of cardiovascular disease risk factors and their relations to clinical phenotype associated with coronary artery disease(CAD).Methods The subjects were recruited from five independent cardiovascular centers.Coronary angiography was employed to define the CAD with stenosis in each major vessel ≥70% and control with stenosis <10% in every lesion.The classic risk factors including family history,body mass index,smoking habits,hypertension,diabetes mellitus,and serum lipid levels were surveyed according to established criteria.Associations between risk levels and clinical phenotypes were assessed by case control and correlation analysis.Results A total of 762 individuals were collected,including 481 men and 281 women,aged from 17 to 81(mean 60±10) years.The patients with CAD accounted for 55.5% of all participants,and controls 44.5%,respectively.Compared with the pattern in published data,our study showed that mean serum high density lipoprotein cholesterol(HDL-C) level was significantly lower(P<0.001) and triglycerides was significantly higher(P<0.001),while total cholesterol(TC) and low density lipoprotein cholesterol levels were comparative(both P>0.05).The prevalence of low HDL-C(<40 g/L) and hypertriglyceridemia(>150 g/L) were 27.2% and 41.4%,respectively.Mean serum levels of HDL-C and apolipoprotein A1 were significantly higher in female subjects than in male(P<0.001).Lower HDL-C functioned as an independent risk factor for CAD only in men(RR=2.8,95%CI:1.5-4.2,P<0.001),yet increased non-HDL cholesterol combined with diabetes mellitus and obesity seemed to play a key role in the development ofCAD in women.Similarity in risk association with CAD was found for hypertension and TC/HDL ratio in male and female subjects,while family history had no relationship with the presence of CAD.Conclusion It is remarkable that emphasis of intervention in future should be given on the prevalent low serum HDL-C and its strong risk correlation with the presence of CAD in male subjects of Chinese Han population.
文摘The widespread use of gastrointestinal bleeding prophylaxis in critically ill patients was one of the most controversial issues. Since few studies reported the incidence of gastrointestinal bleeding in mechanically ventilated patients, this study aimed to identify the incidence and risk factors related to gastrointestinal bleeding in patients undergoing mechanical ventilation for more than 48 hours. A total of 283 IOU patients who had received mechanical ventilation for longer than 48 hours at a provincial hospital affiliated to Shandong University from January 1,2007 to December 31, 2009 were analyzed retrospectively. Those were excluded from the study if they had a history of gastrointestinal bleeding or ulceration, recent gastrointestinal surgery, brain death and active bleeding from the nose or throat. Demographic data of the patients included patient age, diagnosis on admission, duration of ICU stay, duration of ventilation, patterns and parameters of ventilation, ICU mortality, APACHE II score, multiple organ dysfunction, and indexes of biochemistry, kidney function, liver function and coagulation function. Risk factors of gastrointestinal bleeding were analyzed by univariate analysis and multiple logistic regression analysis. In the 242 patients who were given mechanical ventilation longer than 48 hours, the incidence of gastrointestinal bleeding was 46.7%. The bleeding in 3.3% of the patients was clinically significant. Significant risk factors were peak inspiratory pressure 〉30cmH2O, renal failure, liver failure, PLT count〈50xl09/L and prolonged APTT. Enteral nutrition had a beneficial effect on gastrointestinal bleeding. However, the multiple logistic regression analysis revealed that the independent risk factors of gastrointestinal bleeding were as follows： high pressure ventilator setting 〉 30cmH2O（RR=3.478, 95%CI=2.208-10.733）, renal failure（RR=1 .687, 95%CI=1.098-3.482）, PLT count〈50×10^9/L （RR=3.762, 95%CI=2.346-14.685）, and prolonged APTT（RR=5.368, 95%CI=2.487-11.266）. Enteral nutrition（RR=0.436, 95%CI= 0.346-0.764） was the independent protective factor. The incidence of gastrointestinal bleeding was high in the patients who received mechanical ventilation, and bleeding usually occurred within the first 48 hours. High pressure ventilator setting, renal failure, decreased PLT count and prolonged APTT were the significant risk factors of gastrointestinal bleeding. However, enteral nutrition was the independent protective factor.
基金supported by National Natural S cience Foundation of China(81570373)。
文摘BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic(ROC)curve.RESULTS The incidence of cardiac surgery–associated acute kidney injury(CSA-AKI)was 24.17%,and 0.53%of AKI patients required dialysis(AKI-D).Among the derivation cohort,multivariable logistic regression showed that age≥70 years,body mass index(BMI)≥25 kg/m2,estimated glomerular filtration rate(eGFR)≤60 mL/min per 1.73 m2,ejection fraction(EF)≤45%,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump(IABP)implantation,postoperative low cardiac output syndrome(LCOS)and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to32 points with three risk categories.The AKI frequencies were as follows:0-8 points(15.9%),9-17 points(36.5%)and≥18 points(90.4%).The area under of the ROC curve was 0.730(95%CI:0.691-0.768)in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735(95%CI:0.655-0.815).The model was well calibrated according to the Hosmer-Lemeshow test(P=0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions.
文摘Objective：To search for risk factors that affect mother-to-infant transmission of hepatitis B virus（HBV）. Methods：To obtain studies eligible for meta-analysis, China biological medicine discs and MEDLINE citations were surveyed. Mother HBV DNA or HBeAg positivity,neonate HBeAg positivity, mode of delivery, threatened abortion and threatened premature labor were processed with meta analysis. Criteria for selection of published studies for meta analysis were based on principle by Abdolmaleky HM. Odds ratio （OR） was calculated and summarized by fixed effect model or random-effects model using RevMan software. The heterogeneity of the group of ORs was assessed using an X^2 test. The significance of the pooled OR was determined by the u-test. The strength of association was assessed using the OR. An OR〉1. 0 indicated a positive association between the risk factor and neonate HBV infection. Results： After meta analysis of factors concerned, a significant association was found between the positivity of HBeAg in mother and neonate, of HBV DNA in mother peripheral serum, and HBV mother-to-infant transmission, with a pooled OR equal to 19.43 （95% CI=8. 77-43. 06）, 36.5 （95% CI= 19.85-67. 11）, and 36.5 （95 % CI= 19.85-67.11 ） respectively. Mode of delivery, threatened abortion and threatened premature labor proved not to be of risk factors on the mother-to-infant transmission of HBV. Conclusion： Mother HBV DNA or HBeAg positivity and neonate HBeAg positivity were proved to be of risk factors affecting the transmission of HBV from mother to fetal.
基金funded by grants from Beijing Healthcare Committee Fund (19-8)Research Foundation of Beijing Friendship Hospital+1 种基金Capital Medical University (yyqdkt 2017-6)Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201838)。
文摘Objective To examine the association of atherosclerotic cardiovascular disease(ASCVD)and its risk factors with cognitive impairment in older adults.Methods Six hundred and fourteen subjects,aged≥65 years,from one center(2016–2018)underwent clinical,laboratory assessments and the Montreal Cognitive Assessment(Mo CA).Using regression analysis,the relationship between ASCVD and its risk factors was evaluated in subjects with and without cognitive impairment(MoCA score<26).Results Older age(b=-1.3 per 5 years,95%CI:-1.7 to-0.9,P<0.001),history of stroke(b=-1.6,95%CI:-3.0 to-0.3,P=0.01),and myocardial infarction(MI;b=-2.2,95%CI:-3.6 to-0.8,P=0.003)were independently associated with lower MoCA scores,whereas more education(b=1.5 per 3 years,95%CI:1.1 to 1.9,P<0.001),higher body mass index(BMI;b=0.5 per 3 kg/m^2,95%CI:0.0 to 1.0,P=0.04),higher estimated glomerular filtration rate(eGFR;b=0.8 per 15 U,95%CI:0.1 to 1.4,P=0.03),left ventricular ejection fraction(LVEF;b=0.4 per 5%,95%CI:0 to 0.8,P=0.04)and statin use(b=1.3,95%CI:0.3 to 2.3,P=0.01)were associated with a higher MoCA score.Cognitive impairment was independently associated with older age(OR=1.51 per 5 yrs,95%CI:1.28 to 1.79,P<0.001),less education(OR=0.55 per 3 years,95%CI:0.45 to 0.68,P<0.001),lower BMI(OR=0.78 per 3 kg/m^2,95%CI:0.62 to 0.98,P=0.03)and higher levels of high sensitivity c-reactive protein(hsCRP;OR=1.08 per 1 mg/L,95%CI:1.02 to 1.15,P=0.01).Conclusions Beyond age,cognitive impairment was associated with prior MI/stroke,higher hsCRP,statin use,less education,lower eGFR,BMI and LVEF.
文摘With beta-lactam drugs and immunosuppressants widely used, the infection caused by Acinetobacter baumannfi （Ab） has become more and more serious with multidrug resistant Acinetobacter baumannfi （MDRAb） emerging and worsening rapidly. Compared with other patients, the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit （PICU） because of immune deficiency, severe basic diseases, prolonged hospitalization and invasive operations. Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children. A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb （NMDRAb） pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children＇s Hospital. Clinical data were analyzed with univariate and multivariate Logistic regression. In 176 clinical strains of Acinetobacter baumannfi isolated, there were 128 strains of MDRAb, accounting for 72.73%. Drug susceptibility tests showed that the resistance rates of 13-1actam antibiotics were more than 70% except for cefoperazone sulbactam. The rates to carbapenems were higher than 90%. They were significantly higher than those of NMDRAb. Amikacin, levofloxacin, ciprofloxacin and minocycline had the lowest drug-resistance rates （〈20%）. Multivariate Logistic regression revealed that ICU stay, the time of mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia. MDRAb is an important opportunistic pathogen to pneumonia in PICU, and its drug-resistance is severe. It increases significantly the mortality of patients. It is important to take the effective prevention measures for controlling it.
文摘Objective To forecast the future burden and its attributable risk factors of infective endocarditis(IE).Methods We analyzed the disease burden of IE and its risk factors from 1990 to 2019 using the Global Burden of Disease 2019 database and projected the disease burden from 2020 to 2030 using a Bayesian age-period-cohort model.Results By 2030,the incidence of IE will increase uncontrollably on a global scale,with developed countries having the largest number of cases and developing countries experiencing the fastest growth.The affected population will be predominantly males,but the gender gap will narrow.The elderly in high-income countries will bear the greatest burden,with a gradual shift to middle-income countries.The incidence of IE in countries with middle/high-middle social-demographic indicators(SDI) will surpass that of high SDI countries.In China,the incidence rate and the number of IE will reach 18.07 per 100,000 and 451,596 in 2030,respectively.IEassociated deaths and heart failure will continue to impose a significant burden on society,the burden on women will increase and surpass that on men,and the elderly in high-SDI countries will bear the heaviest burden.High systolic blood pressure has become the primary risk factor for IE-related death.Conclusions This study provides comprehensive analyses of the disease burden and risk factors of IE worldwide over the next decade.The IE-associated incidence will increase in the future and the death and heart failure burden will not be appropriately controlled.Gender,age,regional,and country heterogeneity should be taken seriously to facilitate in making effective strategies for lowering the IE disease burden.
文摘To investigate the association of carotid arterial intima- media thickness (IMT) with principal cardiovascular risk factors in the elderly. Methods. Carotid arterial IMT was measured by high resolution B mode ultrasound in 94 elderly subjects (old- aged group), and compared with subjects aged Results. In comparison with the middle- aged group, the prevalence of coronary heart disease, cerebral vascular disease, hypertension and diabetes mellitus was significantly higher, and serum cholesterol and systolic blood pressure were also significantly higher in old- aged group. Although there was no obvious difference in IMT between the two groups, carotid plaque and carotid wall thickening were more frequently found in old- aged group. Age, systolic blood pressure and serum cholesterol were shown as the independent determinants for carotid IMT in the total participants, whereas no such independent relation was found in old- aged group. Conclusion. Age is the major risk factor for carotid atherosclerosis in the elderly. In other words, the occurrence of carotid atherosclerosis is the result of advancing age combined with the effect of multiple cardiovascular risk factors.
