A systematic review of the applicability of emergency department assessment of chest pain score-accelerated diagnostic protocol for risk stratification of patients with chest pain.

The emergency department assessment of chest pain score-accelerated diagnostic protocol (EDACS-ADP) are commonly used for risk stratification in undifferentiated patients with acute chest pain. This systematic review aimed to investigate EDACS-ADP for risk stratification of emergency department (ED) patients with chest pain. The PubMed, Web of Science, Medline, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched for related studies without restrictions on the publication year. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias, and Stata 16.0 was used to determine the combined sensitivity, specificity, positive diagnostic likelihood ratio (DLR), and negative DLR. Twelve studies comprising 14 290 patients were identified. Of these, 7537 (52.74%) patients were considered low risk, and 67 (0.89%) had major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and cardiovascular death within 30 days of the patients' ED presentation. EDACS-ADP showed a combined sensitivity of 0.97 (95% confidence interval [CI]: 0.95-0.99); specificity, 0.58 (0.53-0.63); positive DLR, 2.34 (2.08-2.63); negative DLR, 0.04 (0.02-0.09); diagnostic odds ratio, 53.11 (26.45-106.63); and summary receiver operating characteristic area under the curve, 0.83 (0.79-0.86). Despite the large statistical heterogeneity of the results, EDACS-ADP identified a considerable number of low-risk patients for early discharge, with a specificity >50% and an incidence of MACE within 30-days of patients' ED presentation <1%. Thus, it is a useful tool with a potential for clinical application.

[Correlation between gastrointestinal dysfunction and both severity and prognosis in patients suffering from heatstroke].

OBJECTIVE: To investigate the relationship between gastrointestinal dysfunction and both severity and prognosis in patients with heatstroke ( HS ). METHODS: A retrospective analysis was conducted. Clinical data from 39 patients with HS seeking for treatment in Department of Critical Care Medicine of Chinese PLA General Hospital from January 2013 to September 2014 were enrolled. The patients were divided into two groups: gastrointestinal dysfunction group and non-gastrointestinal dysfunction group. The acute physiology and chronic health evaluation II ( APACHEII) score within 24 hours of admission and 28-day mortality were compared between two groups. In gastrointestinal dysfunction group, the gastrointestinal dysfunction score, the duration days of gastrointestinal dysfunction, the length of intensive care unit ( ICU ) stay, and the duration of mechanical ventilation were collected. Pearson correlation analysis was used to analyze the relationship between gastrointestinal function and the severity of the ailment as well as the prognosis. RESULTS: Among 39 patients with HS, 32 of them showed gastrointestinal dysfunction with an incidence of 82.05%. In gastrointestinal dysfunction group, the gastrointestinal dysfunction score was 2.3±0.8, the duration of gastrointestinal dysfunction was ( 17.3±15.2 ) days, the length of ICU stay was ( 37.8±25.0 ) days, and the duration of mechanical ventilation was ( 27.8±14.0 ) days. APACHEII score in gastrointestinal dysfunction group was significantly higher than that of the non-gastrointestinal dysfunction group ( 26.30±6.00 vs. 17.40±6.00, t = 3.555, P = 0.001 ). The 28-day mortality in gastrointestinal dysfunction group was slightly higher than that of the non-gastrointestinal dysfunction group without statistically significant difference [ 43.75% ( 14/32 ) vs. 14.29% ( 1/7 ), P = 0.216 ]. It was shown by Pearson analysis that gastrointestinal dysfunction score was positively correlated with APACHEII score ( r = 0.727, P = 0.000 ), and the duration of gastrointestinal dysfunction was positively correlated with the length of ICU stay ( r = 0.797, P = 0.000 ) and the duration of mechanical ventilation ( r = 0.634, P = 0.000 ). CONCLUSIONS: The results suggest that gastrointestinal function in patients with HS reflects the severity and prognosis of the ailment.

[Clinical study of prognostic value of interleukin-6 in severe acute pancreatitis].

OBJECTIVE: To investigate the value of serum interleukin-6 (IL-6) level as a prognostic indicator in severe acute pancreatitis (SAP) patients. METHODS: Data of 62 cases of SAP admitted to Department of Critical Care Medicine from January 2006 to September 2012 were retrospectively analyzed. They were divided into two groups: non-survivor group (n=15) and survivor group (n=47). Serum levels of IL-6 at 24, 48, 72 hours after admission were compared between two groups. Correlation between IL-6 value and acute physiology and chronic health evaluation II (APACHE II) score and CT severity index (CTSI) at 48 hours were analyzed. The receiver-operating characteristic curve (ROC curve) was plotted at 48 hours to analyze the accuracy of IL-6 value as a prognostic indicator in the initial stage of SAP. RESULTS: The IL-6 values were elevated obviously followed by a lowering in non-survivor group. However, it continued to decrease gradually in survivor group. The IL-6 values of non-survivor group were significantly higher than those of survivor group at 48 hours and 72 hours after admission (545.5 ± 265.7 ng/L vs. 147.2 ± 107.0 ng/L, 243.0 ± 133.6 ng/L vs. 119.0 ± 69.5 ng/L, both P<0.01). IL-6 ROC had an area under curve (AUC) of 0.930 at 48 hours. In both groups, IL-6 values and APACHEII score showed a positive correlation (r=0.930, P=0.003; r=0.964, P=0.000), and also between IL-6 values and CTSI (r=0.915, P=0.000; r=0.921, P=0.005) at 48 hours. CONCLUSION: IL-6 can be a useful indicator of the prognosis in the initial stage of SAP (48 hours).