ABSTRACT
Objective:To understand the current state of renal replacement therapy (RRT) in intensive care unit (ICU) of Tianjin public hospital, and to provide scientific evidence and direction for homogenized management and overall level improvement of RRT in Tianjin.Methods:The questionnaires were distributed to the chief or key staff of 33 ICUs from 32 public hospitals in Tianjin by clinical quality control center for critical care medicine of Tianjin and ICU of Tianjin Third Central Hospital. The RRT data of ICUs from January 2020 to December 2021 was collected, including the type and size of ICU, the number of patients undergoing RRT, reasons for initiating RRT, the RRT modes, the anticoagulation and the complications of RRT and so on.Results:A total of 33 valid questionnaires were obtained, with a recovery rate of 100%. The result showed that there were 38 803 patients admitted to the selected ICUs during investigation, and 5 456 of them (14.06%) received RRT. In most ICUs, the reasons of initiating RRT were renal failure, sepsis and volume overload. The mode of RRT was mainly continuous venovenous hemofiltration (CVVH), which was followed by continuous venovenous hemodiafiltration (CVVHDF). Carbonate replacement fluid was the first choice. Heparin was the dominant anticoagulant, and there was an increasing trend in the use of citrate anticoagulation simultaneously. However, heparin-free anticoagulation used mostly in bleeding patients. Overall, the RRT modes and anticoagulation methods were single. Thrombosis was the main iatrogenic factor interrupting RRT in most ICUs, and also the reasons for complications related to catheter or circulation pipeline. It still showed an ineffective anticoagulation of RRT even after increasing the dosage of anticoagulants.Conclusions:RRT is an important organ support method in ICU, which has been widely carried out in ICUs of Tianjin and continues to expand. Despite the positive performance, it still needs to be improved and standarized in some aspects, such as the diversification of RRT modes, anticoagulation, and the complication prevention.
ABSTRACT
ObjectiveTo investigate the serum level of ceruloplasmin in patients with different stages and etiologies of liver diseases. MethodsA total of 1077 patients with liver diseases who were hospitalized in Department of Hepatology, The First Hospital of Jilin University, from January 2012 to January 2018 were enrolled, and the serum level of ceruloplasmin was analyzed for the patients with different liver diseases. The Kruskal-Wallis H test was used to compare the level of ceruloplasmin between the patients with virus-related liver diseases with different liver functional states, and a Spearman correlation analysis was used to investigate the correlation of ceruloplasmin with other biomarkers. ResultsIn the Wilson’s disease group, 97.6% (41/42) of the patients had a serum ceruloplasmin level of ＜0.2 g/L and 881% (37/42) had a level of ＜0.1 g/L. In the non-Wilson’s disease group, 24.3% (251/1035) of the patients had a ceruloplasmin level of ＜0.2 g/L and 0.2% had a level of ＜0.1 g/L. There was a significant difference in the serum level of ceruloplasmin between the patients with virus-related liver diseases with different liver functional states, and the patients with chronic viral hepatitis, severe viral hepatitis, and viral hepatitis cirrhosis had a significantly lower level than those with acute viral hepatitis and virus-related liver cancer (P=0005, P＜0.001, P=0.001, P=0.027, P＜0.001, and P=0.001). In the patients without Wilson’s disease, serum ceruloplasmin was positively correlated with albumin and prealbumin (r=0.068 and 0.091, both P＜0.05) and was negatively correlated with prothrombin time (r=-0.297, P＜0.05). ConclusionCeruloplasmin often decreases significantly in patients with Wilson’s disease, with a slight reduction in patients with other types of liver diseases. For these patients, it should be determined whether the reduction in ceruloplasmin is caused by hepatocyte injury or the presence of Wilson’s disease.