FIB-4 index is associated with mortality in critically ill patients with alcohol use disorder: Analysis from the MIMIC-IV database.

BACKGROUND: The relationship between fibrosis-4 (FIB-4) index and all-cause mortality in critically ill patients with alcohol use disorder (AUD) is unclear. The present study aimed to investigate the predictive ability of FIB-4 for all-cause mortality in critically ill AUD patients and the association between them. METHODS: A total of 2528 AUD patients were included using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. FIB-4 was calculated for each patient using the existing formula. The patients were equally divided into four groups based on the quartiles of FIB-4. Multivariate logistic regression and Cox proportional hazard model were used to evaluate the association of FIB-4 with in-hospital mortality, 28-day mortality and 1-year mortality. Kaplan-Meier curves were used to analyse the incidence of 28-day mortality among four groups. RESULTS: FIB-4 was positively associated with 28-day mortality of AUD patients with hazard ratio (HR) of 1.354 [95% confidence interval (CI) 1.192-1.538]. There were similar trends in the in-hospital mortality [odds ratio (OR): 1.440, 95% CI (1.239-1.674)] and 1-year mortality [HR: 1.325, 95% CI (1.178-1.490)]. CONCLUSION: Increased FIB-4 is associated with greater in-hospital mortality, 28-day mortality and 1-year mortality in critically ill AUD patients.

[Relation between level of expression of high mobility group protein B1 in hepatic tissue with the severity and prognosis of sepsis in rat].

OBJECTIVE: To investigate whether the levels of expression of high mobility group protein B1 (HMGB1) in hepatic tissue are related with severity and prognosis of sepsis in rat, in order to look for a dependable marker for monitoring and evaluating the efficiency of the treatment of sepsis. METHODS: Ninety SD rats (specific-pathogen free, male, 250-300 g) were randomly divided into sham operation group (group A), cecal ligation and puncture (CLP) group (group B) and CLP followed by ethyl pyruvate (EP) treatment group (group C). Laparo fury was done aseptically, and the cecum was returned to the abdomen (group A) or CLP was carried out (group B and C). The abdominal wall was then closed layer by layer. Normal saline (NS) 2 ml (group A and B) or EP 2 ml (130 mg/kg, group C) was intraperitoneally injected and repeated every 12 hours. Five animals were sacrificed at 0, 6, 12, 24, 48 and 72 hours after the operation, blood samples and 100 grams of hepatic tissue were harvested before the animal died. Before sacrifice, activity, food taking, piloerection, diarrhea, anophthalmia, respiration, distention of intestine, hyperemia, ascites, and omental adhesion to the cecum, and hyperemia of lung were observed. Another group of 20 rats were used to observe the survival rate after CLP. The level of HMGB1 mRNA expression in the hepatic tissue was assessed by reverse transcriptase-polymerase chain reaction (RT-PCR), and the levels of interleukin-1 beta (IL-1 beta), IL-6 and tumor necrosis factor-alpha (TNF-alpha) in plasma were determined by enzyme linked immunoadsorbent assay (ELISA). RESULTS: The mortality of sepsis was higher in group B than other groups (both P<0.01), that of group C was significantly lower than B but higher than A (both P<0.01). The levels of IL-1 beta, IL-6 and TNF-alpha in plasma rose to the peak at 6 hours after CLP in all groups, and group B>group C>group A (P<0.01), and they descended at 12 hours. The HMGB1 mRNA expression level in hepatic tissue was measurable at 6 hours and rose at 12 hours in group B, and maintained a high level up to 48 hours after CLP. The HMGB1 expression was positive correlated with IL-6 (r=0.91). The value in group C was significantly lower than group B at all time points (all P<0.01). The degree of severity and survival rate of sepsis were highly correlated with HMGB1 levels. CONCLUSION: As a late-released inflammatory mediator, HMGB1 plays a key role in lethal effect of sepsis, the surviving time and the severity degree of sepsis are highly correlated with HMGB1 expression level in hepatic tissue.