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BACKGROUND@#Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients.@*METHODS@#Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes.@*RESULTS@#Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality.@*CONCLUSION@#Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients.@*CLINICAL TRIAL REGISTRATION@#Chinese Clinical Trail Registry, No. ChiCTR2100044625.
Subject(s)
Humans , Blood Pressure , Pulmonary Disease, Chronic Obstructive/therapy , Cohort Studies , Respiration, Artificial , Inpatients , Hospital MortalityABSTRACT
Objective To investigate the effect and possible mechanism of tissue inhibitor of Metalloproteinases-l(TIMP-1) siRNA on human umbilical vein endothelial cells injury induced by serum of septic patient.Methods Serum samples were separately collected from septic patients and healthy controls.Human umbilical vein endothelial cells (HUVECs) were randomly divided into blank group (normal culture cells),control group (culture medium with 10％ control serum),septic group (culture medium with 10％ septic serum),negative control group (negative siRNA + 10％ septic serum),and TIMP-l siRNA group (TIMP-1 siRNA + 10％ septic serum).The survival rate of endothelial cells was detected by MTT assay.The levels of matrix Metalloproteinase-9 (MMP-9) and TIMP-1 in supernatant of culture medium were measured by enzyme-linked immunosorbent assay (ELISA).The levels of MMP-9,TIMP-1 and Thrombomoduline (TM) in endothelial cells were examined by Western blot.Results Compared with control group,the cell survival rate of septic group decreased 12 hours after the addition of serum (P＜0.05) and reached minimum 48 hours later.The levels of MMP-9 and TIMP-1 in supernatant of culture medium of septic group significantly increased (P＜0.01).The levels of MMP-9 and TIMP-1 increased in the septic group (P＜0.01),while the level of TM reduced at the same time in septic group (P＜0.01).Compared with septic group,the cell survival rate ofTIMP-1 siRNA group decreased (P＜0.05).The level of MMP-9 in supematant of culture medium of TIMP-1 siRNA group increased (P＜0.05),while the level of TIMP-1 decreased (P＜0.05).The level of MMP-9 increased in TIMP-1 siRNA group (P＜0.01),whereas the levels of TIMP-1 and TM reduced in TIMP-1 siRNA group (P＜0.01).Conclusions TIMP-1 plays a protective role in endothelial cells injury induced by septic serum.
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Objective To explore the mechanism of shengmai injection on relieving ischemia reperfusion injury and antagonizing systemic inflammatory response syndrome by regulating cytokines when it was applied at the early stage of cardiopulmonary resuscitation(CPR).Methods 40 cases suffering from cardiac arrest and had their heart beat recovered through CPR for more than 24 hours were randomly divided into SMI group and control group(20 cases for each).The patients in the two groups were treated with common therapeutics based on the CPR,but the patients in SMI group were intravenously dropped with SMI in the early period of PLS phase,then the changes of serum concentration of TNF-α and IL-81h,2h,6h,12h and24h after CPR in the two groups was compared.Results The concentrations of serum TNF-α and IL-8 stepped up gradually after resuscitation and the levels of TNF-αand IL-8 in SMI group were lower than that of the control group at 1h,2h,6h,12h and 24h after resuscitation(P＜0.05).Conclusion SMI functions to relieve ischemia reperfusion injury by regulating cytokines and antagonizing systemic inflammatory response syndrome.