Clinical features and prognostic factors in elderly patients with sepsis in the emergency intensive care unit.

PURPOSE: The objective of this research is to analyze the clinical progression and identify prognostic factors among elderly patients with sepsis admitted to the emergency intensive care unit (EICU). METHODS: A total of 211 patients with sepsis, aged 65 years or above, were selected for inclusion in the study. These patients were admitted to the EICU of the Emergency Department at Harrison International Peace Hospital Affiliated to Hebei Medical University from August 2018 to June 2023. The clinical features, Acute Physiology and Chronic Health Evaluation (APACHE) Π score, Sequential Organ Failure Assessment (SOFA) score, and routine laboratory test indicators were documented. All patients were followed up for 28 days. The factors associated with mortality in both the sepsis group and septic shock group were analyzed by receiver operating characteristic (ROC) curve, MedCalc software, and Kaplan-Meier curve. RESULTS: Among the 211 patients, 101 were identified as having septic shock. A significant elevation in blood urea nitrogen-to-albumin ratio (BAR) and inflammatory indicators, APACHE II score, and SOFA score was observed in the septic shock group compared to the sepsis group (P<0.001). Moreover, the sepsis group exhibited a higher proportion of males (P=0.002), while there was no statistically significant difference in age (P=0.467). Further analysis revealed that BAR within 24 h after admission exhibited a positive correlation with infection indicators procalcitonin (PCT) and C-reactive protein (CRP), as well as disease severity scores APACHE Π and SOFA. Additionally, BAR was found to be positively associated with the 28-day mortality rate in patients with sepsis (r = 0.169, P=0.001). The results of the ROC curve analysis showed that BAR exhibited the highest predictive capability for 28-day mortality in elderly patients with sepsis who were admitted to the EICU (AUC=0.614). The Kaplan-Meier survival curve, which identified the optimal cut-off value (≥0.3) of BAR as the most accurate predictor of 28-day mortality in this individual, revealed a significantly higher mortality rate among patients with BAR≥0.3 (χ2 = 12.340, P=0.000). CONCLUSION: The elderly patients with sepsis in the EICU are generally over the age of 70, with a higher prevalence of males than females, and the albumin level is generally low on admission. Furthermore, BAR is significantly and positively correlated with infectious indexes and has a high predictive value for their mortality outcomes.

[Predictive value of neutrophil/lymphocyte ratio combined with soluble growth stimulating expression gene 2 protein on the occurrence of in-hospital major adverse cardiaovascular events in patients with myocardial injury from moderate-severe acute carbon monoxide poisoning: a single-center prospective observational study].

OBJECTIVE: To investigate the predictive neutrophil/lymphocyte ratio (NLR) combined with soluble growth stimulating expression gene 2 protein (sST2) on in-hospital major adverse cardiovascular events (MACE) in patients with myocardial injury following moderate-severe acute carbon monoxide poisoning (ACOP). METHODS: A single-cente prospective observational approach was conducted. Moderate-severe ACOP patients with myocardial damage from November 2016 to February 2020 in department of emergency medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University were enrolled. The baseline data of the patients, NLR and sST2 (T0 sST2) on admission, sST2 at 3 days after admission (T3 d sST2), and the other myocardial injury and biochemical indicators were collected. According to whether MACE occurred, the patients were divided into MACE group and non-MACE group. The clinical data of the two groups were compared. Pearson correlation analysis was used to analyze the correlation of each index. Binary Logistic regression was used to analyze the independent risk factors of in-hospital MACE in patients with moderate-severe ACOP myocardial injury. The receiver operator characteristic curve (ROC curve) was drawn and area under ROC curve (AUC) was calculated to analyze the predictive value of NLR, sST2, and NLR combined with sST2 for the occurrence of in-hospital MACE in patients with moderate-severe ACOP myocardial injury. RESULTS: A total of 278 patients with moderate-severe ACOP myocardial injury were included in the final analysis, and the incidence of MACE was 11.51% (32/278). Cardiac troponin I (cTnI), lactic acid (Lac), NLR, and T3 d sST2 in the MACE group were significantly higher than those in the non-MACE group [cTnI (µg/L): 0.83±0.15 vs. 0.46±0.37, Lac (mmol/L): 2.96±1.14 vs. 2.43±1.35, NLR: 13.14±4.37 vs. 9.49±4.21, T3 d sST2 (µg/L): 59.88±23.42 vs. 39.83±12.60, all P < 0.05], there was no significant difference in T0 sST2 between the MACE group and the non-MACE group (µg/L: 269.09±90.89 vs. 240.14±113.02, P > 0.05). Pearson correlation analysis showed that there were significantly positive correlations in NLR with acute physiology and chronic health evaluation II (APACHE II), T3 d sST2 with APACHE II, and NLR with T3 d sST2 (r values were 0.226, 0.209, 0.193, all P < 0.01). Binary Logistic regression analysis showed that T3 d sST2 and NLR were both independent risk factors for MACE in moderate-severe ACOP patients with myocardial injury [odds ratio (OR) and 95% confidence interval (95%CI) respectively was 1.064 (1.039-1.090), 1.176 (1.066-1.298), both P < 0.01]. ROC curve analysis showed that the predictive efficacy of NLR combined with T3 d sST2 for the occurrence of in-hospital MACE in patients with ACOP myocardial injury (AUC = 0.876) was better than that of NLR (AUC = 0.754) and T3 d sST2 (AUC = 0.813). When the optimal critical value of NLR was 10.02 and that of T3 d sST2 was 43.50 µg/L, the sensitivity of predicting the occurrence of MACE in patients with moderate-severe ACOP myocardial injury was 69.8% and 86.2% respectively, and the specificity was 74.3% and 70.4%, respectively. The specificity and sensitivity of the combined detection was 83.4% and 79.8%, respectively. CONCLUSIONS: NLR and T3 d sST2 were independent predictors of in-hospital MACE in moderate-severe ACOP patients with myocardial injury, and combined application of NLR and T3 d sST2 had good predictive value. For patients with moderate-severe ACOP myocardial injury with NLR > 10.02 and T3 d sST2 > 43.50 µg/L, the occurrence of in-hospital MACE should be alert.

A combination of NLR and sST2 is associated with adverse cardiovascular events in patients with myocardial injury induced by moderate to severe acute carbon monoxide poisoning.

BACKGROUND: Indicators of adverse cardiovascular events in patients with acute carbon monoxide (CO) poisoning-induced myocardial injury have not yet been elucidated. HYPOTHESIS: This study aimed at determining the risk factors for adverse cardiovascular events in patients with acute CO poisoning-induced myocardial injury. METHODS: We enrolled patients with moderate-to-severe acute CO poisoning-induced myocardial injury. Based on the occurrence of adverse cardiovascular events, the patients were assigned into event and non-event group. Binary logistic regression analysis was performed to analyze the potential risk factors for cardiovascular adverse events. RESULTS: A total of 413 eligible patients were enrolled. Among them, 61 (14.8%) patients presented adverse cardiovascular events and were assigned to the event group while 352 patients were assigned to the non-event group. Univariate analysis revealed that cTnI, Lac, and NLR levels at admission and sST2 at day 3 in the event group were significantly higher compared to those in the non-event group. Subsequent multivariate analysis revealed that sST2 at day 3 and NLR at admission were independent risk factors for adverse cardiovascular events in patients with acute CO poisoning-induced myocardial injury. Finally, the sensitivity, specificity, and AUC of sST2 at day 3 combined with NLR for event prediction were 79.5%, 82.8%, and 0.858, respectively. CONCLUSION: A combination of sST2 at day 3 and NLR is a potential predictor for the occurrence of adverse cardiovascular events in patients with acute CO poisoning-induced myocardial injury. Therefore, cardiovascular risk stratification should be taken into consideration, especially in patients with acute CO poisoning-induced myocardial injury.

[Curative effect of paraquat detoxification recipe combined with continuous hemoperfusion in the treatment of patients with APP and clinical value of Presepsin].

OBJECTIVE: To investigate the clinical effect of paraquat (PQ) detoxification recipe combined with continuous hemoperfusion (HP) in the treatment of patients with acute paraquat poisoning (APP) and clinical significance of soluble CD14 subtype (sCD14-st, Presepsin). METHODS: A prospective randomized controlled trial was conducted. 152 patients with moderate APP admitted to Department of Emergency Medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University from July 2013 to June 2017 were enrolled, and they were randomly divided into three groups. The patients in HP group (group A, n = 35) only received 2-hour HP for 3 times, 8 hours each time, those in PQ detoxification recipe combined with HP group (group B, n = 50) received PQ detoxification recipe 1 (once per 2 hours until no PQ component was found in faeces) and 2 (3 times a day for 14 days) beside HP. The others in PQ detoxification recipe combined with persistent HP group (group C, n = 67) received continuous HP until the PQ component in serum was not detected. The parameters of organ function and inflammatory factor, and blood Presepsin and PQ contents were determined before and after treatment. The curative effect and 28-day mortality were recorded. The correlations between serum Presepsin level and PQ content as well as 28-day mortality were analyzed with Pearson correlation analysis. Receiver operating characteristic curve (ROC) was plotted to analyze the predictive value of Presepsin on prognosis. RESULTS: The total effective rate of group C was significantly higher than that of groups A and B [70.1% (47/67) vs. 34.3% (12/35), 54.0% (27/50)], and 28-day mortality was significantly lowered [29.8% (20/67) vs. 65.7% (23/35), 46.0% (23/50), both P < 0.05]. There was no significant difference in alanine aminotransferase (ALT), MB isoenzyme of creatine kinase (CK-MB), serum creatinine (SCr), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukins (IL-6 and IL-10) before treatment among the three groups. Five days after treatment, the above parameters in the three groups were increased as compared with those before treatment, but the increase degree in group C was the lowest. At 7 days after treatment, the parameters were decreased, especially in group C. There was no significant difference in serum Presepsin and PQ levels before treatment among the three groups. With the prolongation of treatment time, the Prespsin levels in groups A, B, and C were increased, and peaked at 12 hours (µg/L: 4.28±0.20, 3.87±0.25, 3.53±0.23), then gradually decreased,and the PQ contents were lower than those before treatment from 8 hours (mg/L: 1.76±0.12 vs. 2.12±0.17, 1.57±0.08 vs. 2.24±0.16, 1.25±0.10 vs. 2.14±0.18), with a time dependence pattern, especially in group C (all P < 0.05) . Correlation analysis showed that blood Presepsin level was positively correlated with PQ content and 28-day mortality (r1 = 0.917, r2 = 0.864, both P = 0.001), suggesting that the higher the PQ content was, the higher the Presepsin level, and the higher the 28-day mortality was. ROC curve analysis showed that the area under ROC curve (AUC) of Presepsin predicting 28-day mortality was 0.863; when the cut-off value was 1.22 µg/L, the sensitivity was 83.3%, the specificity was 81.4%, the positive predictive value was 77.46%, and the negative predictive value was 86.42%. CONCLUSIONS: Early administration of PQ detoxification recipe combined with continuous HP treatment can effectively reduce Presepsin level, decrease the mortality of patients with moderate APP, improve the prognosis. Presepsin can assess the prognosis of patients with APP.

[Investigation on the changes of dependent signal on the amplitude of low frequency fluctuations at blood oxygen level in brain after acupuncture Neiguan (PC 6)].

OBJECTIVE: To investigate the relationship of the acupoint and its functional location in the brain. METHODS: Ten healthy participants were examined with the resting state functional magnetic resonance imaging (fM-RI). The scanning includes the resting state 1 (R 1), acupuncture stimulating (AP) Neiguan (PC 6) and the resting state 2 (R 2). All data were analyzed with the amplitude of low frequency fluctuations (ALFF). RESULTS: 1) During the R1, the regions with active signal on the ALFF contained bilateral superior frontal gyrus, medial frontal gyrus and some part of cerebellum (including right declive, culme, tonsil and left uvula), as well as left precuneus, right superiour temporal gyrus. 2) As for AP, the active regions with higher ALFF were bilateral superior frontal gyrus and right cuneus, as well as left middle frontal gyrus, declivis and right semi-lunar lobule. 3) The main difference on ALFF between R1 and AP appeared within bilateral cingulated gyrus and declivis, left lingualgurus, and cuneus, as well as right precuneus, fusiform gyrus, superior frontal gyrus, medial frontal gyrus and superior temporal gyrus, etc. CONCLUSION: After acupuncture stimulating the left Neiguan (PC 6), the active regions on ALFF are detected on bilateral cingulated gyrus, right superior frontal gyrus and medial frontal gyrus, as well as bilateral declivis and left lingual gurus, etc. These regions have the close relationship with the mental disorder and nervous diseases, which might be the possible neural mechanism of acupuncture stimulating Neiguan (PC 6) for treating some of related mental disorder and nervous diseases.