ABSTRACT
Resumo Fundamento A patologia subjacente da ectasia da artéria coronária (EC) isolada não foi totalmente elucidada. Objetivo Nosso objetivo foi examinar a relação entre o índice de inflamação imune sistêmica (Sıı), que corresponde à multiplicação da razão neutrófilos-linfócitos (RNL) e as contagens de plaquetas, e EC isolada. Método A população do estudo retrospectivo incluiu 200 pacientes com EC isolada, 200 consecutivos com doença arterial coronariana obstrutiva e 200 consecutivos com angiografia coronária normal. Um valor de p bicaudal <0,05 foi considerado significativo. Resultados Sıı, RNL, razão plaqueta-linfócito (RPL) e razão monócito-colesterol de lipoproteína de alta densidade (MHR) foram significativamente maiores no grupo EC em comparação com os outros grupos (todos p<0,001). Na análise multivariada, Sıı (p<0,001, OR = 1,005, IC 95% =1,004-1,005) foi considerado um preditor independente de EC isolada. Na análise da curva Receiver Operating Characteristic (ROC), Sıı teve uma área sob a curva maior em comparação com RNL, RPL e MHR. O valor de Sıı >517,35 tem 79% de sensibilidade, 76% de especificidade para a predição do EC [AUC: 0,832, (p<0,001)]. Sıı teve correlação significativa com o número de artérias coronárias ectásicas e classificação de Markis (r: 0,214 p=0,002; r:-0,195, p=0,006, respectivamente). Conclusão Até onde sabemos, este é o primeiro estudo em que Sıı foi significativamente associado à presença isolada de EC e gravidade anatômica.
Abstract Background The underlying pathology of isolated coronary artery ectasia (CE) has not been fully elucidated. Objective We aimed to examine the relationship between the systemic immune inflammation index (Sıı), which corresponds to the multiplying of the neutrophil-to-lymphocyte ratio (NLR) and the platelet counts, and isolated CE. Method The retrospective study population included 200 patients with isolated CE, 200 consecutive with obstructive coronary artery disease, and 200 consecutive with a normal coronary artery angiogram. A 2-sided p-value of <0.05 was considered significant. Results Sıı, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-high density lipoprotein cholesterol ratio (MHR) were significantly higher in the CE group compared with the other groups (all p<0.001). In multivariate analysis, Sıı (p<0.001, OR = 1.005, 95% CI =1.004-1.005) was found to be an independent predictor of isolated CE. In Receiver Operating Characteristic curve analysis, Sıı had a higher Area Under the Curve than NLR, PLR, and MHR. Sıı value of >517.35 has 79% sensitivity, 76% specificity for the prediction of the CE [AUC: 0.832, (p<0.001)]. Sıı had a significant correlation with the number of ectatic coronary arteries and Markis classification (r:0.214 p=0.002; r:-0.195, p=0.006, respectively). Conclusion To the best of our knowledge, this is the first study that Sıı was significantly associated with isolated CE presence and anatomical severity.
ABSTRACT
Objective:To analyze the clinical features of persistent inflammation-immunosuppression-catabolic syndrome(PICS)in patients with lung cancer and explore possible risk factors.Methods:The total of 109 lung cancer patients with hospital stay >14 d in the First Affiliated Hospital of Soochow University from September 2017 to June 2020 were selected as study subjects.According to the PICS diagnostic criteria, the patients were divided into the PICS group(43 cases)and non-PICS group(66 cases). The clinical characteristics and prognosis of the two groups of patients were compared, and the risk factors of PICS during hospitalization were analyzed.Results:PICS occurred in 43 of the 109 subjects(39.40%). The in-hospital mortality rate was significantly higher in the PICS group than in the non-PICS group(39.53% vs.7.58%, χ2=16.508, P<0.001). Multivariate logistic regression analysis showed that age>60 years( P=0.039), pulmonary infection( P=0.042), clinical stage Ⅳ( P=0.006), small cell lung cancer( P=0.017), albumin<30 g/L( P=0.001)were independent risk factors for PICS in lung cancer patients.A subgroup analysis of patients receiving chemotherapy showed that chemotherapy cycle>4( P=0.034)was risk factors for PICS in lung cancer patients. Conclusions:Patients with lung cancer complicated with PICS have a high in-hospital mortality rate.The risk factors for lung cancer complicated with PICS include old age, pulmonary infection, clinical stage Ⅳ, small cell lung cancer, albumin<30 g/L, and chemotherapy cycles>4.
ABSTRACT
Objective To investigate the clinical characteristics,risk factors and prognosis of patients with persistent inflammation,immune-suppression and catabolism syndrome(PICS)secondary to sepsis in medical intensive care unit(MICU)in initial stage,in order to increase the understanding of PICS and provide the reference experience for the early screening of high-risk patients.Methods A total of 298 elderly patients diagnosed as sepsis admitted into MICU from Aug.2013 to Dec.2016 were retrospectively studied.Of them,97 patients meeting inclusion criteria were ultimately enrolled and separated into the PICS group and the non-PICS group.General and clinical data and laboratory indexes at first day admitted into MICU were compared between the two groups.The indexes between the two groups were analyzed statistically by multivariate logistic regression analysis.The survival-time distributions were estimated by Kaplan-Meier model,and the difference in prognosis was compared between the two groups.Results Of 97 patients,36 patients (37.1％)met the diagnosis of PICS.The acute physiological function and chronic health evaluation Ⅱ (APACHE Ⅱ) score had a significant difference between the two groups(27.7±5.8 vs.22.9±6.0,P＜0.01).The grade of acute gastrointestinal injury(AGI)were significantly higher in the PICS group than in the non-PICS group(P ＜0.05).Platelet counts,helper T cell counts and CD4+/CD8+ ratios were significantly lower in the PICS group than in the non-PICS group[(164.39 ± 84.29) × 109/L vs.(235.16 ± 126.89) × 109/L,(238.97± 181.11)/μl vs.(385.93±308.22)/μl,(1.58 ± 1.13) vs.(2.12± 1.23),all P ＜0.05)].Multivariable logistic regression analysis revealed that APACHE Ⅱ score was an independent risk factor for PICS and its optimal cut-off value for predicting PICS was 26.5.Kaplan-Meier analysis showed that the overall survival was poorer in the PICS group than in non-PICS group in the whole observation phase.The further Kaplan-Meier analysis on survival time of subdivisions showed that the survival of patients at 90-day and 180-day after admission and in stage 1-3 during one year had significant differences between the two groups (P ＜ 0.05).While the survival of patients at 28-day after admission had no significant difference between the two groups(P＞0.05).Conclusions The elderly patients with persistent inflammation,immune-suppression,and catabolism syndrome(PICS) secondary to sepsis in medical intensive care unit(MICU)show the higher levels of APACHE Ⅱ score and AGI grade,and lower values of platelet counts,CD4+ T cell counts and CD4+/CD8+ ratio in initial stage.And APACHE Ⅱ score is an independent risk factor for PICS in elderly sepsis patients,and the optimal cut-off value of APACHE Ⅱ score for predicting PICS is 26.5.The prognosis for advanced stage and long term prognosis are poor.It is essential to use APACHE Ⅱ and so on,to timely identify and intervene PICS.