BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marke...BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP.METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis.RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-off value,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM.CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.展开更多
Objective To investigate the impact of prior non-pancreatic cancer on the survival outcomes of patients with localized pancreatic neuroendocrine tumors(Pan NETs).Methods We reviewed the Surveillance,Epidemiology,and E...Objective To investigate the impact of prior non-pancreatic cancer on the survival outcomes of patients with localized pancreatic neuroendocrine tumors(Pan NETs).Methods We reviewed the Surveillance,Epidemiology,and End Results database and selected patients with localized Pan NETs diagnosed between 1973 and 2015.We divided the patients into two groups according to the presence or absence of prior non-pancreatic malignancy.Before and after propensity score matching,we compared the clinicopathological characteristics and studied the overall survival and cancer-specific survival.Results A total of 357(12.9%)of 2778 patients with localized Pan NETs had prior cancer.A total of 1211 cases with only a localized Pan NET and 133 cases with a localized Pan NET and prior cancer had complete data and met the inclusion criteria of the current study.Patients with prior cancer were associated with advanced age(>65 years,57.9%prior cancer vs.31.0%no prior cancer,P<0.001),later year of diagnosis(87.2%vs.80.2%,P=0.049),a higher proportion of poorly differentiated/undifferentiated grade tumors(4.5%vs.1.5%,P=0.025),and a higher proportion of no primary site surgery(19.5%vs.10.4%,P=0.003).Prostate(29.32%),breast(18.05%),other genitourinary and retroperitoneal(16.54%),and gastrointestinal(12.78%)cancers were the most common prior cancer types.Most of the prior cancers(95.49%)were localized and regional,and only 4.51%of the prior cancers were distant.Patients with interval periods between the prior cancer and Pan NET of≤36 months,36-60 months,60-120 months,and>120 months accounted for 33.08%,13.53%,24.06%,and 29.32%of all cases with prior cancers,respectively.Univariate and multivariate Cox proportional hazards analyses were performed.The presence/absence of prior cancers did not impact survival outcomes of patients with localized Pan NETs before and after propensity score matching(PSM).Further subgroups analysis showed that,patients with localized Pan NETs and prior distant cancer had worse cancer-specific survival than patients with prior local/regional cancer or patients without prior cancer(P<0.001).No significant differences in cancerspecific survival were observed in terms of the different sites of the prior cancers and the different interval periods of prior cancers and Pan NETs(P<0.05).Conclusions Patients with localized Pan NETs and a history of prior cancer had survival outcomes that were comparable to those of patients with no history of prior cancer.Patients with localized Pan NETs and prior cancer could be candidates for clinical trials if they satisfy all other conditions;aggressive and potentially curative therapies should be offered to these patients.展开更多
基金supported by the National Key Research and Development Program of China(2021YFC2501800)Leader Project of Henan Province Health Young and Middle-aged Professor(HNSWJW2020013).
文摘BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP.METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis.RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-off value,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM.CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.
基金funded by the National Natural Science Foundation of China-Youth Fund(81702855)the National Natural Science Foundation of China(81672862)。
文摘Objective To investigate the impact of prior non-pancreatic cancer on the survival outcomes of patients with localized pancreatic neuroendocrine tumors(Pan NETs).Methods We reviewed the Surveillance,Epidemiology,and End Results database and selected patients with localized Pan NETs diagnosed between 1973 and 2015.We divided the patients into two groups according to the presence or absence of prior non-pancreatic malignancy.Before and after propensity score matching,we compared the clinicopathological characteristics and studied the overall survival and cancer-specific survival.Results A total of 357(12.9%)of 2778 patients with localized Pan NETs had prior cancer.A total of 1211 cases with only a localized Pan NET and 133 cases with a localized Pan NET and prior cancer had complete data and met the inclusion criteria of the current study.Patients with prior cancer were associated with advanced age(>65 years,57.9%prior cancer vs.31.0%no prior cancer,P<0.001),later year of diagnosis(87.2%vs.80.2%,P=0.049),a higher proportion of poorly differentiated/undifferentiated grade tumors(4.5%vs.1.5%,P=0.025),and a higher proportion of no primary site surgery(19.5%vs.10.4%,P=0.003).Prostate(29.32%),breast(18.05%),other genitourinary and retroperitoneal(16.54%),and gastrointestinal(12.78%)cancers were the most common prior cancer types.Most of the prior cancers(95.49%)were localized and regional,and only 4.51%of the prior cancers were distant.Patients with interval periods between the prior cancer and Pan NET of≤36 months,36-60 months,60-120 months,and>120 months accounted for 33.08%,13.53%,24.06%,and 29.32%of all cases with prior cancers,respectively.Univariate and multivariate Cox proportional hazards analyses were performed.The presence/absence of prior cancers did not impact survival outcomes of patients with localized Pan NETs before and after propensity score matching(PSM).Further subgroups analysis showed that,patients with localized Pan NETs and prior distant cancer had worse cancer-specific survival than patients with prior local/regional cancer or patients without prior cancer(P<0.001).No significant differences in cancerspecific survival were observed in terms of the different sites of the prior cancers and the different interval periods of prior cancers and Pan NETs(P<0.05).Conclusions Patients with localized Pan NETs and a history of prior cancer had survival outcomes that were comparable to those of patients with no history of prior cancer.Patients with localized Pan NETs and prior cancer could be candidates for clinical trials if they satisfy all other conditions;aggressive and potentially curative therapies should be offered to these patients.
