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1.
Prensa méd. argent ; Prensa méd. argent;110(4): 149-155, 20240000. tab, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1579519

ABSTRACT

Introducción: La fuga anastomótica es una complicación que evoluciona asociada a una mayor morbilidad, mortalidad, uso de cuidados intensivos, estadía hospitalaria, elevado costo sanitario y además en caso de cirugía oncológica, impacto en la recidiva local y en la supervivencia. Lugar de Aplicación: Servicio de Cirugía General "Pablo Luis Mirizi". Hospital Nacional de Clínicas, UNC. Córdoba. Argentina. Material y Métodos: Se realizó el estudio en forma prospectiva, longitudinal, correlacional, observacional registrando 78 pacientes operados entre marzo del 2014 a marzo del 2023. Se dividieron todos los tipos de anastomosis en colónicas y no colónicas, según la técnica quirúrgica realizada. Se definieron como fuga anastomótica menor a las detectadas por imágenes, y fuga anastomótica mayor cuando precisan reintervención o drenaje percutáneo. Resultados: 32 fueron masculinos (43,8 %), y 41 femeninos (56,2%), con un promedio de edad de 69,9 años. Se realizaron 19 cirugías por guardia de urgencia (26%) y 54 programadas (74%). La morbilidad global fue de 36,98%. 14 pacientes del total (19,17 %) presentaron fístula anastomótica, de los cuales en 9 (12,3% del total) se observó una fuga mayor con necesidad de reoperación, y en 5 (6,8% del total) una menor con tratamiento conservador. No se observó diferencias estadísticamente significativas entre anastomosis colónicas y no colónicas, y la presencia de fístulas anastomóticas mayores. (P=0,09). Conclusión: Los valores séricos de PCR cuentan con fiabilidad aceptable para predecir fístula mayor con sensibilidad tolerable en los días 4 al 6 post quirúrgico de cirugías mayores en las que se realiza algún tipo de anastomosis digestiva


Background: Anastomotic leakage is a complication that evolves associated with increased morbidity, mortality, use of intensive care, hospital stay, high health care cost and, in the case of oncological surgery, impact on local recurrence and survival. Desing: Pablo Luis Mirizi General Surgery Service. National Hospital of Clinics, UNC. Córdoba. Argentina. Methods: The study was carried out prospectively, longitudinally, correlationally, observationally, registering 78 patients operated between March 2014 and March 2023. All types of anastomoses were divided into colonic and non-colonic, depending on the surgical technique performed. They were defined as anastomotic leakage minor to those detected by imaging, and major anastomotic leakage when requiring reoperation or percutaneous drainage. Results: 32 were male (43.8%), and 41 female (56.2%), with an average age of 69.9 years. 19 surgeries were performed by emergency room (26%) and 54 scheduled (74%). Overall morbidity was 36.98%. 14 patients (19.17%) had anastomotic fistula, of which 9 (12.3% of the total) had a major leak requiring reoperation, and 5 (6.8% of the total) had a smaller leak with conservative treatment. No statistically significant differences were observed between colonic and non-colonic anastomoses, and the presence of major anastomotic fistulas. (P=0.09). Conclusión: Los valores séricos de PCR cuentan con fiabilidad aceptable para predecir fístula mayor con sensibilidad tolerable en los días 4 al 6 post quirúrgico de cirugías mayores en las que se realiza algún tipo de anastomosis digestiva.


Subject(s)
Humans , Male , Female , C-Reactive Protein , Digestive System Fistula/surgery , Anastomotic Leak/surgery
2.
J. Health Biol. Sci. (Online) ; 12(1): 1-9, jan.-dez. 2024. ilus, tab
Article in English | LILACS | ID: biblio-1577394

ABSTRACT

Objective: to conduct a literature review on possible serum markers in patients with UC to identify potential biomarkers. Methods: the descriptors "Colitis Ulcerative", "Biomarkers", and "Diagnosis" were used for the search in the PUBMED, LILACS, SciELO, and SCOPUS databases. After applying the inclusion and exclusion criteria in the databases, the 32 articles were classified as samples. Results: research indicates that biomarkers can play distinct roles in assessing activity and diagnosing UC. For instance, the peptide nesfatin-1 showed elevated serum levels during active periods of the disease, while the peptide trefoil factor 3 showed promise in predicting UC activity. It is worth highlighting that C-reactive protein (CRP) is a commonly used marker in which high values are observed in patients during the active phase of the disease; however, studies suggest the need to redefine CRP cutoff values to better predict endoscopic remission. Other approaches, such as the analysis of proteins, specific fatty acids, and proteins related to the extracellular matrix, have also been explored, highlighting their potential as biomarkers. Conclusion: in summary, there is a diversity of possible clinically important biomarkers that play different roles in the assessment and diagnosis of UC. However, it is essential to conduct further research to validate these biomarkers and achieve greater reliability.


Objetivo: realizar uma revisão da literatura sobre possíveis marcadores séricos em pacientes com RU com o objetivo de identificar potenciais biomarcadores. Métodos: os descritores "Colitis Ulcerative", "Biomarkers" e "Diagnosis" foram utilizados para a busca nas bases de dados PUBMED, LILACS, SciELO e SCOPUS. Após a aplicação dos critérios de inclusão e exclusão nas bases de dados, os 32 artigos foram classificados como amostras. Resultados: a pesquisa indica que os biomarcadores podem desempenhar papéis distintos na avaliação da atividade e no diagnóstico da RU. Por exemplo, o peptídeo nesfatin-1 apresentou níveis séricos elevados durante os períodos ativos da doença, enquanto o peptídeo trefoil factor 3 mostrou-se promissor na predição da atividade da RU. Vale destacar que a proteína C-reativa (PCR) é um marcador comumente utilizado, no qual valores elevados são observados em pacientes durante a fase ativa da doença; no entanto, estudos sugerem a necessidade de redefinir os valores de corte da PCR para melhor predizer a remissão endoscópica. Outras abordagens, como a análise de proteínas, ácidos graxos específicos e proteínas relacionadas à matriz extracelular, também têm sido exploradas, destacando seu potencial como biomarcadores. Conclusão: em resumo, há uma diversidade de possíveis biomarcadores de importância clínica que desempenham diferentes papéis na avaliação e diagnóstico da CU. No entanto, é essencial conduzir mais pesquisas para validar esses biomarcadores para obter maior confiabilidade.


Subject(s)
Biomarkers , Colitis, Ulcerative , Peptides , C-Reactive Protein , Polymerase Chain Reaction , Colitis , Serum , Fatty Acids , Trefoil Factor-3
3.
Article in Spanish | LILACS, CUMED | ID: biblio-1565599

ABSTRACT

Introducción: La pandemia de COVID-19 continúa desafiando a los sistemas de salud. La estratificación de los pacientes afectados a partir de biomarcadores, estrategia menos invasiva, aún es controversial. Objetivo: Comprobar la capacidad discriminante de la ferritina, proteína C reactiva y dímero D entre pacientes con COVID-19 moderados y severos. Métodos: Se aplicó un diseño transversal entre junio y noviembre de 2021. Las variables cualitativas y la edad fueron registradas por revisión de la historia clínica. La determinación de los biomarcadores mencionados fue realizada en el momento de inclusión en el estudio con el empleo de reactivos Roche en el analizador Hitachi cobas c 311. Se empleó el programa estadístico SSPS para el análisis de datos. Resultados: Existió predominio de hipertensos en ambos grupos. La vacunación y el sexo femenino prevalecieron entre los moderados, mientras los hombres y las enfermedades crónicas entre los graves. Se manifestaron mayores niveles de los tres biomarcadores analizados en el grupo grave (Mann-Whitney p 0,5; p < 0,05). Conclusiones: La presencia de comorbilidades crónicas y de individuos no vacunados predominó entre los pacientes graves. Se demostró una estrecha correlación entre los biomarcadores analizados en ambos grupos de pacientes. Los biomarcadores mostraron capacidad discriminante entre la enfermedad COVID-19 moderada y grave(AU)


Introduction: The COVID-19 pandemic continues to challenge healthcare systems. The stratification of affected patients from biomarkers, a less invasive strategy, is still controversial. Objective: To check the discriminating capacity of ferritin, C-reactive protein and D-dimer in patients with moderate and severe COVID-19. Methods: A cross-sectional design was applied from June to November 2021. The qualitative variables and age were recorded by review of the patient's clinical records. The determination of the aforementioned biomarkers was carried out at the time of inclusion in the study using the Roche reagents in the HITACHI Cobas C 311 analyzer. The SPSS statistical program was used for analyzing dates. Results: There was a predominance of hypertensive patients in both groups. Vaccination and female sex prevailed among the moderate ones, while men and chronic diseases among the severe ones. Higher levels of the three analyzed biomarkers were observed in the severe group (Mann-Whitney test p < 0.05). The association between these was significant in both groups (Spearman correlation, p < 0.05). 366 μg/L of ferritin; 36.25 mg/L of C- reactive protein and 1.02 μg/mL of D-dimer, acceptably distinguished between severe and moderate (area under the curve ˃ 0.5; p < 0.05). Conclusions: The presence of chronic comorbidities and unvaccinated individuals predominated among severe patients. A close correlation was shown between the biomarkers analyzed in both patient groups. Biomarkers showed discriminating capacity between moderate and severe COVID-19 disease(AU)


Subject(s)
Humans , Male , Female , C-Reactive Protein , Fibrin Fibrinogen Degradation Products , Ferritins , COVID-19/epidemiology , Cross-Sectional Studies
4.
J. coloproctol. (Rio J., Impr.) ; 43(4): 276-279, Oct.-Dec. 2023. tab
Article in English | LILACS | ID: biblio-1528941

ABSTRACT

Inflammatory bowel disease (IBD) is a problem that directly affects the quality of life of patients suffering from this condition. Monitoring the serum level of infliximab (IFX) (TDM) is an important tool for guiding therapeutic decisions in IBD patients. The purpose of this study was to determine the significance of quantitatively measuring the serum level of IFX (TDM) and antibody to IFX (ATI). Methods and materials: Prospective observational study involving 40 IBD patients on IFX therapy, including 14 Proactive (week 06 of the induction phase) and 26 Reactive (maintenance phase). Immediately prior to the infusion, blood samples were drawn and measured using a Bulhlmann rapid test instrument. Serum concentrations of IFX were categorized as supratherapeutic (>7.0 micrograms/ml), therapeutic (between 3.0 and 7.0 micrograms/ml), and subtherapeutic (3.0 micrograms/ml). When the serum concentration of IFX was 3 mcg/ml (subtherapeutic), the ATI was measured. 25 patients with CD and 15 patients with UC were evaluated. Only three of the twenty patients with subtherapeutic serum levels had a positive ATI, and both were reactive; two had CD and one had UC. There was a statistically significant difference between reactive and proactive patients with respect to levels of CRP (p = 0.042), with proactive DNS patients suffering greater alterations in CRP and albumin. (AU)


Subject(s)
Humans , Male , Female , Inflammatory Bowel Diseases/therapy , Drug Monitoring , C-Reactive Protein , Retrospective Studies , Albumins , Infliximab/therapeutic use
5.
Int. j. med. surg. sci. (Print) ; 10(2): 1-12, jun. 2023. tab, graf
Article in Spanish | LILACS | ID: biblio-1580746

ABSTRACT

La hipertensión y la diabetes son dos de los principales factores de riesgo para el desarrollo de enfermedades cardiovasculares, y ambas patologías se superponen de manera significativa en sus mecanismos fisiopatológicos. El objetivo de este estudio fue determinar la concentración de marcadores inflamatorios y de disfunción endotelial en pacientes con hipertensión y diabetes mellitus tipo 2, comparar con individuos sanos y determinar si la coexistencia de ambas patologías tiene un efecto diferente en el comportamiento de estos marcadores. Se realizó una investigación de tipo descriptiva, correlacional, de corte transversal, en el periodo comprendido desde el mes de julio del año 2022 a febrero del año 2023. Se seleccionaron 120 individuos para este estudio: (30 sujetos controles, 30 con diabetes mellitus tipo 2, 30 hipertensos y 30 con diabetes más hipertensión). A cada sujeto se le extrajo una muestra de sangre en ayunas para la determinación de colesterol total, triglicéridos, HDL colesterol, LDL colesterol, proteína C reactiva ultrasensible (PCR-us), hemoglobina glicosilada, sICAM-1, sE-selectina, IL-6 y TNF-α. Se encontró un incremento significativo en la concentración de sICAM-1, sE-selectina, IL-6 y TNF-α en los pacientes diabéticos, hipertensos y en los diabéticos con hipertensión al compararlos con los controles (p<0.0001). La coexistencia de diabetes e hipertensión no representó una elevación significativa en la concentración de los marcadores de disfunción endotelial e inflamación. En conclusión, nuestros resultados sugieren la activación endotelial, así como un estado inflamatorio en pacientes con diabetes e hipertensión, indicada por niveles elevados de moléculas de adhesión circulantes y citocinas proinflamatorias. La presencia simultánea de diabetes e hipertensión no tuvo un efecto aditivo en los niveles de éstas moléculas.


Hypertension and diabetes are two of the main risk factors for the development of cardiovascular disease, and both pathologies overlap significantly in their pathophysiological mechanisms. The aim of this study was to determine the concentration of inflammatory markers and endothelial dysfunction in patients with hypertension and type 2 diabetes mellitus, to compare with healthy individuals, and to determine whether the coexistence of both pathologies has a different effect on the behavior of these markers. A descriptive, correlational, cross-sectional research was carried out from July 2022 to February 2023. A total of 120 individuals were selected for this study (30 controls, 30 with type 2 diabetes mellitus, 30 with hypertension and 30 with diabetes plus hypertension). Each subject had a fasting blood sample drawn for determination of total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, ultrasensitive C-reactive protein (hs-CRP), glycosylated hemoglobin, sICAM-1, sE-selectin, IL-6 and TNF-α. A significant increase in the concentration of sICAM-1, sE-selectin, IL-6 and TNF-α was found in diabetic, hypertensive and diabetic patients with hypertension when compared to controls (p<0.0001). The coexistence of diabetes and hypertension did not represent a significant elevation in the concentration of markers of endothelial dysfunction and inflammation. In conclusion, our results suggest endothelial activation as well as an inflammatory state in patients with diabetes and hypertension, indicated by elevated levels of circulating adhesion molecules and proinflammatory cytokines. The simultaneous presence of diabetes and hypertension did not have an additive effect on the levels of these molecules.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Endothelium, Vascular/physiopathology , Diabetes Mellitus, Type 2/physiopathology , Hypertension/physiopathology , Time Factors , Blood Pressure , C-Reactive Protein/metabolism , Biomarkers , Epidemiology, Descriptive , Cross-Sectional Studies , Sensitivity and Specificity , Correlation of Data , Hemodynamics
6.
Rev. chil. infectol ; Rev. chil. infectol;40(2): 85-93, abr. 2023. tab, graf
Article in Spanish | LILACS | ID: biblio-1441410

ABSTRACT

INTRODUCCIÓN: En los últimos años se han estudiado diversos biomarcadores para determinar los casos graves de COVID-19. La proteína C-reactiva (PCR) ha mostrado alta sensibilidad en la identificación de pacientes con enfermedad grave y utilidad comparable a la tomografía. OBJETIVO: Determinar la utilidad de la PCR para predecir gravedad de la infección por SARS-CoV-2 en pacientes hospitalizados en el Centro Médico Naval del Perú durante el periodo enero-septiembre del año 2021. MÉTODOS: Se empleó un diseño de tipo cuantitativo, observacional, analítico, retrospectivo, y de tipo prueba diagnóstica. Se calculó un tamaño muestral de 503 pacientes, quienes fueron divididos en dos grupos de acuerdo a su gravedad. RESULTADOS: Se determinó un punto de corte óptimo de 10,92 mg/L de los valores de PCR para el diagnóstico de enfermedad grave por COVID-19. Se calculó un área bajo la curva (AUC) de 0,762 y se obtuvieron valores de sensibilidad, especificidad, valores predictores positivo, negativo y precisión diagnóstica de 78,88%, 66,4%; 41,42%; 87,01%; y 67,27%, respectivamente. El normograma de Fagan mostró una probabilidad posprueba de 41%. En el modelo ajustado fueron significativas la PCR (ORa = 4,853; IC95% 2,987-7,886; p = 0,001), además de la ferritina (ORa = 1,001; IC 95%: 1,001-1,002; p = 0,001) e hipotiroidismo (OR ajustado = 4,899; IC 95%: 1,272-18,872; p = 0,021). CONCLUSIONES: El presente estudio mostró la asociación entre la PCR y la gravedad de infección por SARS-CoV-2 en un modelo ajustado, mostrando su potencial utilidad y contribuyendo a determinar el punto de corte de la PCR en población peruana y su comparación a nivel internacional.


BACKGROUND: Recently, many biomarkers have been studied to determine severe cases of COVID-19. C-reactive protein (CRP) has shown high sensitivity in identifying patients with severe disease and utility comparable to computed tomography. AIM: To determine the usefulness of CRP to predict the severity of SARS-CoV-2 infection in patients hospitalized at the Naval Medical Center of Peru during the period January-September in the year 2021. METHODS: A quantitative, observational, analytical, retrospective, and diagnostic test type design was used. A sample size of 503 patients was calculated, which were divided into two groups according to their severity. RESULTS: An optimal cut-off point of 10.92 mg/L for CRP levels was determined for the diagnosis of severe COVID-19. An area under the curve (AUC) of 0.762 was calculated and sensitivity, specificity, positive and negative predictive values and diagnostic accuracy values of 78.88%, 66.4%; 41.42%; 87.01%; and 67.27%; respectively. Fagan's normogram showed a post-test probability of 41%. In the adjusted model, CRP (aOR = 4.853; 95% CI 2.987-7.886; p = 0.001), ferritin (aOR = 1.001; 95% CI: 1.001-1.002; p = 0.001) and hypothyroidism (adjusted OR = 4899; 95% CI: 1272-18872; p = 0.021) showed significance. CONCLUSIONS: The present study showed an association between CRP and the severity of SARS-CoV-2 infection in an adjusted model, showing its potential utility and contributing to determine the cut-off point of CRP in the Peruvian population and its international comparison.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , C-Reactive Protein/analysis , COVID-19/diagnosis , Peru , Biomarkers , Multivariate Analysis , Predictive Value of Tests , Regression Analysis , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Area Under Curve , Diagnostic Tests, Routine , Patient Acuity , Hospitalization
7.
Rev. chil. infectol ; Rev. chil. infectol;40(2): 94-98, abr. 2023. tab, graf
Article in Spanish | LILACS | ID: biblio-1441413

ABSTRACT

INTRODUCCIÓN: Las infecciones asociadas a diálisis peritoneal constituyen una de las causas de morbimortalidad más importante en estos pacientes y la terapia antimicrobiana empírica y dirigida adecuada es fundamental para mejorar el resultado, por lo que es importante establecer la microbiología local. OBJETIVO: Revisar la experiencia clínica de cinco años del Hospital Carlos Van Buren de Valparaíso, Chile, describiendo las características clínicas y microbiológicas de los pacientes con episodios de peritonitis asociada a diálisis peritoneal. METODOLOGÍA De forma retrospectiva se accedió a los registros clínicos de aquellos pacientes mayores de 18 años que presentaron al menos un evento de peritonitis asociada a diálisis peritoneal. RESULTADOS: De un total de 26 episodios, 62% de los pacientes fueron de sexo femenino, con un promedio de edad de 53 años. La principal comorbilidad fue la hipertensión arterial (100%), y el dolor abdominal fue el síntoma más frecuente (85%), con una mortalidad general de 7,7%. En el laboratorio la leucocitosis, la proteína C reactiva (PCR) y la velocidad de hemosedimentación (VHS) fueron los hallazgos más importantes. Predominaron las cocáceas grampositivas (54%), seguido de bacilos gramnegativos no fermentadores y Enterobacterales en igual proporción (11,5% cada grupo). Casos aislados de Candida albicans y Pasteurella canis fueron identificados, y en 15% de los casos el cultivo resultó negativo. CONCLUSIÓN: Se pudo conocer las características clínicas y microbiológicas locales de esta patología, para así redefinir las directrices de manejo en la institución.


BACKGROUND: Infections associated with peritoneal dialysis are one of the most important causes of morbidity and mortality in these patients, and adequate empirical and targeted antimicrobial therapy are essential to improve the outcome, so it is important to establish the local microbiology. AIM: To review the clinical experience of 5 years at the Carlos Van Buren Hospital in Valparaíso, Chile, in order to know the clinical and microbiological characteristics of patients with episodes of peritonitis associated with peritoneal dialysis. METHODS: Retrospectively, the clinical records of those patients over 18 years of age who presented at least one peritonitis event associated with peritoneal dialysis were accessed. RESULTS: Of a total of 26 episodes, 62% of the patients were female, with a mean age of 53 years. The main comorbidity was arterial hypertension (100%), and abdominal pain was the most frequent symptom (85%), with an overall mortality of 7.7%. In the laboratory parameters, leukocytosis, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were the most important findings. Gram-positive cocci (54%) predominated, followed by Gram-negative non-fermenting and enterobacterial bacilli in the same proportion (11.5% each group). Isolated cases of Candida albicans and Pasteurella canis were identified, and in 15% of the cases the culture was negative. CONCLUSION: It was possible to know the local clinical and microbiological characteristics of this pathology, in order to redefine management guidelines for our institution.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Peritonitis/microbiology , Peritoneal Dialysis/adverse effects , Peritonitis/etiology , Blood Sedimentation , C-Reactive Protein , Retrospective Studies , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification
8.
Rev. colomb. cir ; 38(2): 289-299, 20230303. tab, fig
Article in Spanish | LILACS | ID: biblio-1425202

ABSTRACT

Introducción. La fuga anastomótica es la complicación más grave del tratamiento quirúrgico del cáncer de colon por su alta morbimortalidad. El diagnóstico evidente, manifestado por la salida de contenido intestinal por drenajes o la herida quirúrgica, ocurre tardíamente (entre el 6º y 8º día). El objetivo de este trabajo fue estudiar la variación de los valores de la proteína C reactiva postoperatoria para hacer un diagnóstico precoz. Métodos. Estudio observacional, analítico, retrospectivo, de una cohorte de pacientes con neoplasia, en quienes se realizó cirugía oncológica con anastomosis intestinal, entre enero de 2019 y diciembre de 2021. Se midieron los valores en sangre de proteína C reactiva postoperatoria (1°, 3° y 5° días). Resultados. Se compararon 225 casos operados que no presentaron fuga con 45 casos con fuga. En los casos sin fuga, el valor de proteína C reactiva al 3º día fue de 148 mg/l y al 5º día de 71 mg/l, mientras en los casos con fuga, los valores fueron de 228,24 mg/l y 228,04 mg/l, respectivamente (p<0,05). Para un valor de 197 mg/l al 3º día la sensibilidad fue de 77 % y para un valor de 120 mg/l al 5º día la sensibilidad fue de 84 %. Conclusión. El mejor resultado de proteína C reactiva postoperatoria para detectar precozmente la fuga anastomótica se observó al 5º día. El valor de 127 mg/l tuvo la mejor sensibilidad, especificidad y valor predictivo negativo, lo cual permitiría el diagnóstico temprano y manejo oportuno de esta complicación


Introduction. Anastomotic leak is the most serious complication of surgical treatment of colon cancer due to its high morbidity and mortality. The obvious diagnosis manifested by the exit of intestinal content through drains or the operative wound, occurs late (between the 6th and 8th day). The objective of this work was to study the postoperative C-reactive protein values to make an early diagnosis. Methods. Observational, analytical, retrospective study of a cohort of patients undergoing colorectal surgery for neoplasia, between January 2019 and December 2021, who underwent oncological surgery with intestinal anastomosis and measured CRP blood values on 1st, 3rd and 5th post-operative days. Results. Two-hundred-twenty-five operated cases that did not present leaks were compared with 45 cases with leaks, with CRP values on the 3rd and 5th day of 148mg/l and 71mg/l in cases without leakage and CRP values of 228.24mg/l and 228.04 mg/l in cases with leakage on the 3rd and 5th day, respectively (p<0.05), CRP value of 197mg/l on the 3rd day has a sensitivity of 77%; CRP value of 120mg/l on the 5th day, has a sensitivity of 84%. Conclusions. The best result for CPR to early diagnosis of anastomotic leak was observed on the 5th day, having the value of 127 mg/l the best sensitivity, specificity and NPV, which would allow early diagnosis and timely management


Subject(s)
Humans , C-Reactive Protein , Early Diagnosis , Anastomotic Leak , Postoperative Complications , Anastomosis, Surgical , Colorectal Neoplasms
9.
Beijing Da Xue Xue Bao ; (6): 923-928, 2023.
Article in Chinese | WPRIM | ID: wpr-1010150

ABSTRACT

OBJECTIVE@#To investigate the risk factors of different types of Henoch-Schönlein purpura (HSP) in Tibetan patients at high altitude, as to provide reference for correctly identifying high-risk patients.@*METHODS@#A retrospective study was used to analyze the 304 HSP patients admitted to Tibet Autonomous Region People's Hospital from April 2014 to March 2022. The gender, age, allergic history, family history, clinical type, laboratory indexes (hemoglobin, platelet count, eosinophil, C-reactive protein (CRP), albumin, immunoglobulin G, immunoglobulin A, complement C3 and C4) were analyzed retrospectively. Univariate and multivariate Logistic regression analysis to screen for risk factors affecting different types of HSP.@*RESULTS@#Renal HSP patients showed higher IgA [(9.2±1.7) g/L vs. (6.4±2.4) g/L, P=0.015], lower complement C3 [(203.3±21.6) mg/dL vs. (301.1±19.5) mg/dL, P=0.043], and complement C4 [(33.5±2.3) mg/dL vs. (53.0±7.2) mg/dL, P=0.032]. The patients with abdominal HSP showed lower levels of hemoglobin [(119.6±19.6) g/L vs. (146.6±47.3) g/L, P=0.038] and plasma albumin [24.8 (22.1, 33.9) g/L vs. 32.6 (24.6, 35.1) g/L, P=0.045]. The patients with articular HSP exhibited higher CRP [13.5 (0.2, 20.6) g/L vs. 7.5 (0.1, 15.2) g/L, P=0.036] and erythrocyte sedimentation rate (ESR) [24 (5, 40) mm/h vs. 15 (4, 30) mm/h, P=0.049]. Elevated IgA and decreased complement C4 were risk factors for renal HSP, anemia and decreased plasma albumin were risk factors for abdominal HSP, and elevated CRP was a risk factor for articular HSP.@*CONCLUSION@#The clinical characteristics of different types of HSP in plateau areas were different. Patients with high IgA, low complement C4, anemia, hypoalbuminemia, and significantly elevated CRP should be highly vigilant. Early and effective intervention can improve the clinical efficacy, avoid severe development, and improve the prognosis.


Subject(s)
Humans , Retrospective Studies , Tibet/epidemiology , Complement C3/analysis , IgA Vasculitis/complications , Altitude , Complement C4 , C-Reactive Protein/analysis , Immunoglobulin A , Risk Factors , Anemia , Hemoglobins/analysis , Serum Albumin/analysis
10.
Beijing Da Xue Xue Bao ; (6): 1007-1012, 2023.
Article in Chinese | WPRIM | ID: wpr-1010160

ABSTRACT

OBJECTIVE@#To investigate the predictive value of blood cell ratios and inflammatory markers for adverse prognosis in patients with primary Sjögren's syndrome (PSS) combined with coronavirus disease 2019 (COVID-19).@*METHODS@#We retrospectively collected clinical data from 80 patients with PSS and COVID-19 who visited the Rheumatology and Immunology Department of the First Affiliated Hospital of Nanchang University from December 2022 to February 2023. Inclusion criteria were (1) meeting the American College of Rheumatology (ACR) classification criteria for Sjögren's syndrome; (2) confirmed diagnosis of COVID-19 by real-time reverse transcription polymerase chain reaction or antigen testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); (3) availability of necessary clinical data; (4) age > 18 years. According to the clinical classification criteria of the "Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (trial the 10th Revised Edition)", the patients were divided into the mild and severe groups. Disease activity in primary Sjögren' s syndrome was assessed using the European League Against Rheumatism (EULAR) Sjögren' s syndrome disease activity index (ESSDAI). Platelet-lymphocyte ratio (PLR), C-reactive protein-lymphocyte ratio (CLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and other laboratory data were compared between the two groups within 24-72 hours post-infection.@*RESULTS@#The mild group consisted of 66 cases with an average age of (51. 52±13. 16) years, and the severe group consisted of 14 cases with an average age of (52.64±10.20) years. Disease activity, CRP, platelets, PLR, and CLR were significantly higher in the severe group compared with the mild group (P < 0.05). Univariate analysis using age, disease activity, CRP, platelets, PLR, and CLR as independent variables indicated that disease activity, CRP, PLR, and CLR were correlated with the severity of COVID-19 (P < 0.05). Multivariate logistic regression analysis further confirmed that PLR (OR=1.016, P < 0.05) and CLR (OR=1.504, P < 0.05) were independent risk factors for the severity of COVID-19 in the critically ill patients. Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) for PLR and CLR was 0.708 (95%CI: 0.588-0.828) and 0.725 (95%CI: 0.578-0.871), respectively. The sensitivity for PLR and CLR was 0.429 and 0.803, respectively, while the highest specificity was 0.714 and 0.758, respectively. The optimal cutoff values for PLR and CLR were 166.214 and 0.870, respectively.@*CONCLUSION@#PLR and CLR, particularly the latter, may serve as simple and effective indicators for predicting the prognosis of patients with PSS and COVID-19.


Subject(s)
Humans , Adult , Middle Aged , Sjogren's Syndrome/diagnosis , Retrospective Studies , C-Reactive Protein , COVID-19 , SARS-CoV-2
11.
Article in Chinese | WPRIM | ID: wpr-1010601

ABSTRACT

OBJECTIVE@#To evaluate the value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for assessing disease activity in patients with rheumatoid arthritis (RA) treated with tofacitinib.@*METHODS@#This retrospective study was conducted among 98 RA patients in active stage treated with tofacitinib in Third Xiangya Hospital and 100 healthy control subjects from the Health Management Center of the hospital from 2019 to 2021. We collected blood samples from all the participants for measurement of erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and other blood parameters 1 month before and 6 months after tofacitinib treatment. We further evaluated PLR and NLR before and after tofacitinib treatment in the RA patients, and analyzed their correlations with RA disease activity.@*RESULTS@#PLR and NLR increased significantly in RA patients as compared with the healthy controls. In the RA patients, PLR and NLR were positively correlated with the levels of hs- CRP, ESR, IL- 6, Disease Activity Score of 28 joints-ESR (DAS28-ESR), anti-cyclic citrullinated peptide (CCP), and rheumatoid factor (RF) before and after tofacitinib treatment. Tofacitinib treatment for 6 months significantly decreased hs-CRP, ESR, IL-6, CCP, RF and DAS28-ESR levels in the RA patients.@*CONCLUSION@#NLR and PLR can be useful biomarkers for assessing disease activity in RA patients treated with tofacitinib.


Subject(s)
Humans , Neutrophils , Retrospective Studies , C-Reactive Protein/analysis , Interleukin-6/metabolism , Arthritis, Rheumatoid , Lymphocytes
12.
Chinese Critical Care Medicine ; (12): 975-979, 2023.
Article in Chinese | WPRIM | ID: wpr-1010894

ABSTRACT

OBJECTIVE@#To evaluate the clinical value of Dachengqi decoction in the treatment of sepsis complication with gastrointestinal dysfunction via gastric antrum cross-sectional area (CSA) measured by bedside ultrasound.@*METHODS@#A parallel group randomized controlled trial was conducted. A total of 80 patients with sepsis with gastrointestinal dysfunction admitted to the Second Affiliated Hospital of Nanjing University of Chinese Medicine from January 2021 to October 2022 were enrolled. According to whether patients agree to use Dachengqi decoction after admission, all patients were divided into Dachengqi decoction group (observation group) and conventional treatment group (control group) by 1 : 1 randomization, each group has 40 patients. Both groups were treated with fluid resuscitation, anti-infection, maintaining stable respiratory circulation, early nourishing feeding, promoting gastrointestinal motility, and regulating intestinal flora. The observation group was treated with Dachengqi decoction on the basis of western medicine, 30 mL decoction was taken in the morning and evening. Both groups were treated for 7 days. The CSA of the two groups was measured by bedside ultrasound before and after treatment. The gastric residual volume (GRV1 and GRV2) were calculated by formula and traditional gastric tube withdrawal method. The gastrointestinal dysfunction score, acute physiology and chronic health evaluation II (APACHE II), intraperitoneal pressure (IAP), serum preprotein (PA), albumin (Alb), white blood cell count (WBC), procalcitonin (PCT), hypersensitivity C-reactive protein (hs-CRP), length of intensive care unit (ICU) stay and incidence of aspiration were detected to evaluate the clinical efficacy of Dachengqi decoction, the correlation and advantages and disadvantages between CSA measured by bedside ultrasound and other evaluation indicators of gastrointestinal dysfunction in sepsis were also analyzed.@*RESULTS@#There were no significant differences in the indicators before treatment between the two groups, which were comparable. In comparison with the pre-treatment period, CSA, GRV, gastrointestinal dysfunction score, APACHE II score, IAP, WBC, PCT, and hs-CRP of the two groups after treatment were significantly decreased, PA and Alb were significantly increased, and the observation group decreased or increased more significantly than the control group [CSA (cm2): 4.53±1.56 vs. 6.04±2.52, GRV1 (mL): 39.85±8.21 vs. 53.05±11.73, GRV2 (mL): 29.22±5.20 vs. 40.91±8.97, gastrointestinal dysfunction score: 0.87±0.19 vs. 1.35±0.26, APACHE II score: 11.54±3.43 vs. 14.28±3.07, IAP (cmH2O, 1 cmH2O ≈ 0.098 kPa): 9.79±2.01 vs. 13.30±2.73, WBC (×109/L): 9.35±1.24 vs. 12.35±1.36, PCT (μg/L): 3.68±1.12 vs. 6.43±1.45, hs-CRP (mg/L): 24.76±5.41 vs. 46.76±6.38, PA (mg/L): 370.29±45.89 vs. 258.33±34.58, Alb (g/L): 38.83±5.64 vs. 33.20±4.98, all P < 0.05]. The length of ICU stay (days: 10.56±3.19 vs. 14.24±3.45) and incidence of aspiration (12.5% vs. 25.0%) were lower than those in the control group (both P < 0.05). Correlation analysis showed that CSA measured by bedside ultrasound was positively correlated with GRV2, gastrointestinal dysfunction score, APACHE II score, and IAP (r values were 0.84, 0.78, 0.75, 0.72, all P < 0.01) and negatively correlated with PA and Alb (r values were -0.64 and -0.62, both P < 0.01).@*CONCLUSIONS@#The Dachengqi decoction can significantly improve the clinical symptoms of septic patients with gastrointestinal dysfunction, reduce systemic inflammatory response, improve nutritional status, and shorten ICU hospital stay. Bedside ultrasound monitoring of CSA is a simple, accurate and effective means to evaluate gastrointestinal dysfunction, which is worthy of further clinical promotion.


Subject(s)
Humans , C-Reactive Protein/analysis , Pyloric Antrum , Sepsis/therapy , Plant Extracts , Procalcitonin , Albumins , Prognosis , Intensive Care Units , Retrospective Studies
13.
Chinese Critical Care Medicine ; (12): 1033-1038, 2023.
Article in Chinese | WPRIM | ID: wpr-1010901

ABSTRACT

OBJECTIVE@#To investigate the correlation of procalcitonin (PCT), interleukin-6 (IL-6) and antithrombin III (AT III) with the severity of sepsis, and to compare the predictive value of the above indicators alone or in combination.@*METHODS@#A retrospective cohort study was conducted. Eighty-five patients with sepsis admitted to the department of intensive care medicine of Shandong Provincial Hospital Affiliated to Shandong First Medical University from April 2021 to September 2022 were enrolled. General information, sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation II (APACHE II) score within 24 hours of admission, inflammatory indicators [PCT, IL-6, serum amyloid A (SAA), neutrophil to lymphocyte ratio (NLR), and C-reactive protein (CRP)] and coagulation indicators (D-dimer and AT III) levels at admission, and 28-day prognosis were collected. The differences of the above indicators were compared among patients with different prognosis at 28 days and different severity of sepsis. The correlation between PCT, IL-6, AT III and the severity of sepsis was analyzed by Spearman rank correlation method. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of PCT, IL-6 and AT III alone or in combination on the 28-day death of patients with sepsis.@*RESULTS@#Eighty-five patients were enrolled finally, 67 cases survived and 18 cases died at 28 days. The mortality was 21.2%. There were no statistical significant differences in gender, age and other general data between the two groups. The patients in the death group were more serious than those in the survival group, and PCT, IL-6, and CRP levels were significantly higher than those in the survival group [PCT (μg/L): 4.34 (1.99, 14.42) vs. 1.17 (0.31, 3.94), IL-6 (ng/L): 332.40 (50.08, 590.18) vs. 61.95 (31.64, 194.20), CRP (mg/L): 149.28 (75.34, 218.60) vs. 83.23 (48.22, 174.96), all P < 0.05], and AT III activity was significantly lower than that in the survival group [(53.67±28.57)% vs. (80.96±24.18)%, P < 0.01]. However, there were no significant differences in D-dimer, NLR and SAA between the two groups. Among the 85 patients, 36 had sepsis with single organ dysfunction, 29 had sepsis with multiple organ dysfunction, and 20 had septic shock with multiple organ dysfunction. With the increase of the severity of sepsis, PCT and IL-6 levels gradually increased [PCT (μg/L): 0.36 (0.19, 1.10), 3.00 (1.22, 9.94), 4.34 (2.18, 8.86); IL-6 (ng/L): 43.99 (20.73, 111.13), 100.00 (45.37, 273.00), 332.40 (124.4, 693.65)], and the activity of AT III decreased gradually [(89.81±21.42)%, (71.97±24.88)%, and (53.50±25.41)%], all with statistically significant differences (all P < 0.01). Spearman rank correlation analysis showed that PCT and IL-6 levels in sepsis patients were significantly positively correlated with the severity of the disease (r values were 0.562 and 0.517, respectively, both P < 0.01), and AT III activity was significantly negatively correlated with the severity of the disease (r = -0.523, P < 0.01). ROC curve analysis showed that PCT, IL-6, and AT III alone or in combination had some predictive value for the death of sepsis patients at 28 days. The area under the ROC curve (AUC) of the above three indicators in combination was higher than that of the individual tests (0.818 vs. 0.722, 0.725, and 0.770), with a sensitivity of 83.3% and a specificity of 73.1%.@*CONCLUSIONS@#PCT, IL-6, and AT III were significantly correlated with the severity of sepsis patients. The combined assay of the above three indicators can effectively improve the prediction of the prognosis of sepsis patients.


Subject(s)
Humans , Procalcitonin , Interleukin-6 , Antithrombin III , Retrospective Studies , Multiple Organ Failure , ROC Curve , Sepsis/diagnosis , Prognosis , C-Reactive Protein/analysis , Anticoagulants
14.
Chinese Critical Care Medicine ; (12): 1207-1211, 2023.
Article in Chinese | WPRIM | ID: wpr-1010927

ABSTRACT

OBJECTIVE@#To investigate the predictive value of pancreatitis activity scoring system (PASS) combined with Neutrophil to lymphocyte ratio (NLR) and C-reactive protein (CRP) for infected pancreatic necrosis (IPN) in patients with severe acute pancreatitis (SAP).@*METHODS@#Clinical data of SAP patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to January 2023 were retrospectively collected, including basic information, vital signs at admission, first laboratory indexes within 48 hours of admission. The PASS scores at admission and 24, 48 and 72 hours after admission were calculated. According to the diagnostic criteria of IPN, the patients were divided into the non-IPN group and the IPN group, and the independent risk factors of SAP complicating IPN were determined by using univariate analysis and multifactorial Logistic regression. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of NLR, CRP, and PASS score, alone and in combination for IPN in patients with SAP.@*RESULTS@#A total of 149 SAP patients were enrolled, including 102 in the non-IPN group and 47 in the IPN group. The differences in PASS score at each time point, NLR, CRP, procalcitonin (PCT), blood urea nitrogen, blood chloride, and days of hospitalization between the two groups were statistically significant. Multifactorial Logistic regression analysis showed that 72 hours admission PASS score [odds ratio (OR) = 1.034, 95% confidence interval (95%CI) was 1.005-1.065, P = 0.022], NLR (OR = 1.284, 95%CI was 1.139-1.447, P = 0.000), and CRP (OR = 1.015, 95%CI was 1.006-1.023, P = 0.001) were independent risk factors for IPN in patients with SAP. ROC curve analysis showed that the area under the ROC curve (AUC) of the PASS score at 72 hours of admission, NLR, and CRP alone in predicting IPN in SAP patients were 0.828, 0.771, and 0.701, respectively. The AUC of NLR combined with CRP, PASS combined with NLR, and PASS combined with CRP were 0.818, 0.895, and 0.874, respectively. The combination of PASS score at 72 hours after admission, NLR, and CRP had a better predictive ability for IPN in patients with SAP (AUC = 0.922, 95%CI was 0.877-0.967), and the sensitivity was 72.3% when the cut-off value was 0.539.@*CONCLUSIONS@#The predictive value of the PASS score at 72 hours after admission, NLR and CRP in combination for IPN in SAP patients is better than that of the combination of each two and individual detection and has better test efficacy.


Subject(s)
Humans , Pancreatitis, Acute Necrotizing/diagnosis , C-Reactive Protein/metabolism , Acute Disease , Neutrophils/metabolism , Retrospective Studies , ROC Curve , Lymphocytes , Prognosis
15.
Chinese Critical Care Medicine ; (12): 1245-1249, 2023.
Article in Chinese | WPRIM | ID: wpr-1010934

ABSTRACT

OBJECTIVE@#To explore the prognostic value of early multiple detection indicators in combination with sequential organ failure assessment (SOFA) in sepsis patients.@*METHODS@#A retrospective analysis was conducted. Patients with sepsis admitted to the department of critical care medicine of Huanggang Central Hospital of Yangtze University from May 2020 to May 2022 were selected as the research subjects. Coagulation indicators, inflammatory factors, blood routine, liver and kidney function, and blood gas analysis were collected at admission. Organ dysfunction was assessed based on the SOFA score within 24 hours after admission. Patients were divided into a survival group and a death group according to the outcome of 28 days in ICU. Differences in the above indicators between the two groups were compared. Multifactorial Logistic regression analysis was used to analyze prognostic factors of 28-day mortality in sepsis patients. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive performance of various indicators, the SOFA score, and the combine model for the 28-day outcome in patients with sepsis.@*RESULTS@#A total of 101 patients with sepsis were enrolled, 56 patients survived and 45 patients died. Compared to the survival group, patients in the death group were older, the proportion of patients with septic shock was larger, the SOFA score, and the proportion of pulmonary infection were higher, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly prolonged, the prothrombin activity (PTA) was significantly shortened, and antithrombin (AT) was significantly decreased, the levels of hypersensitivity C-reactive protein (hs-CRP), blood urea nitrogen (BUN), total bilirubin (TBil), and lactic acid (Lac) were significantly increased, while the platelet count (PLT) was significantly decreased. Multifactorial Logistic regression analysis showed that pulmonary infection [odds ratio (OR) = 0.010, 95% confidence interval (95%CI) was 0.001-0.164, P = 0.001], AT (OR = 0.944, 95%CI was 0.910-0.978, P = 0.002), hs-CRP (OR = 1.008, 95%CI was 1.001-1.015, P = 0.017), Lac (OR = 1.619, 95%CI was 1.195-2.193, P = 0.002), and SOFA score (OR = 1.363, 95%CI was 1.076-1.727, P = 0.010) were independent prognostic factors for 28-day mortality in patients. A combined model was constructed using pulmonary infection, AT, hs-CRP, Lac, and SOFA score. ROC curve analysis showed that the area under the ROC curve (AUC) for the combine model in predicting sepsis prognosis was 0.936 (95%CI was 0.869-0.975, P < 0.001), which was higher in value compared to single indicators (AUC of AT, hs-CRP, Lac, and SOFA score were 0.775, 0.666, 0.802, 0.796, respectively, all P < 0.05).@*CONCLUSIONS@#The predictive ability of the SOFA score for sepsis patient outcomes is limited. The combine model combining infection site, AT, hs-CRP, and Lac shows better predictive ability.


Subject(s)
Humans , Organ Dysfunction Scores , Retrospective Studies , C-Reactive Protein , ROC Curve , Sepsis/metabolism , Prognosis , Anticoagulants , Antithrombin III , Intensive Care Units
16.
Chinese Critical Care Medicine ; (12): 1281-1285, 2023.
Article in Chinese | WPRIM | ID: wpr-1010940

ABSTRACT

OBJECTIVE@#To investigate the high risk factors of failure of autologous arteriovenous fistula (AVF) in hemodialysis patients.@*METHODS@#A retrospective study was conducted, patients with maintenance hemodialysis (MHD) undergoing AVF admitted to General Hospital of Western Theater Command from January 2021 to December 2022 were enrolled, including 107 patients with normal AVF and 168 patients with AVF dysfanction. According to the causes of AVF failure, the patients were divided into AVF stenosis group (n = 103) and AVF thrombosis group (n = 65). Age, gender, body mass index (BMI) and comorbidities (hypertension, diabetes, coronary heart disease) and other clinical data of all patients were collected. Hemoglobin, hematocrit, white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein (CRP), high density lipoprotein, low density lipoprotein, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) within 1 month of AVF use in normal dialysis patients and 1 week before AVF failure. Multivariate Logistic regression was used to analyze the independent risk factors of AVF dysfuction in MHD patients. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of risk factors on AVF dysfuction in MHD patients.@*RESULTS@#(1) There were significant differences in age, BMI, hypertension, hemoglobin, hematocrit, PLR and CRP [age (years): 56.94±14.32, 58.83±14.05, 51.57±13.19; BMI (kg/m2): 22.83±3.10, 21.27±4.98, 23.35±2.72; hypertension: 93.20%, 64.62%, 86.92%; hemoglobin (g/L): 110.82±22.16, 88.70±24.00, 87.95±23.45; hematocrit: 0.350±0.069, 0.282±0.076, 0.275±0.071; PLR: 197.35±113.59, 192.55±138.25, 162.12±73.25; CRP (mg/L): 10.01±4.02, 8.18±5.42, 3.17±1.30, all P < 0.05], among AVF stenosis group, AVF thrombosis group and AVF normal group, there were statistically significant differences no statistically significant difference was found in other indexes among three groups. (2) Multivariate Logistic regression analysis showed that hypertension [odds ratio (OR) = 4.849, 95% confidence interval (95%CI) was 1.278-18.397, P = 0.020], elevated CRP levels (OR = 2.104, 95%CI was 1.533-2.888, P = 0.000) were associated with AVF stenosis. Elevated CRP levels (OR = 1.984, 95%CI was 1.442-2.730, P = 0.000) was an independent risk factor for AVF thrombosis. Analysis of ROC curve showed that the area under the curve (AUC) of AVF dysfunction predicted by CRP was 0.712, 95%CI was 0.637-0.786, P = 0.000; CRP cut-off value was 1.8 mg/L, the sensitivity was 67.0%, the specificity was 83.7%.@*CONCLUSIONS@#Elevated CRP is an independent risk factor for AVF failure in hemodialysis patients, which can be used to predict the occurrence of AVF failure.


Subject(s)
Humans , Retrospective Studies , Constriction, Pathologic , Renal Dialysis/adverse effects , Lymphocytes , C-Reactive Protein , Risk Factors , Hypertension , Hemoglobins , Thrombosis , ROC Curve , Prognosis
17.
Chinese Journal of Pediatrics ; (12): 685-689, 2023.
Article in Chinese | WPRIM | ID: wpr-1013155

ABSTRACT

Objective: To investigate the clinical characteristics, serogroups and antimicrobial resistance of invasive non-typhoid Salmonella infection in children at Xiamen. Methods: Retrospective cohort study. The clinical manifestations, treatment, prognosis, serogroups and antimicrobial resistance of 29 hospitalized children with invasive non-typhoid Salmonella infection confirmed by blood, cerebrospinal fluid, bone marrow and other sterile body fluids or deep pus culture at the Department of Infectious Diseases, the Department of Orthopedics and the Department of General Surgery in Xiamen Children's Hospital from January 2016 to December 2021 were analyzed. According to the clinical diagnosis criteria, the patients were divided into sepsis group and non-sepsis group (bacteremia and local suppurative infection). The inflammatory markers, serogroups distribution and drug resistance were compared between the two groups. Comparison between groups using Mann-Whitney U test and χ2 test. Results: Among the 29 cases, there were 17 males and 12 females, with an onset age of 14 (9, 25) months, and 10 cases (34%) of patients were younger than 1 year old, 15 cases (52%) under 1 to 3 years old, and 4 cases (14%) greater than or equal 3 years old. The onset time of 25 cases (86%) was from April to September. The diseases included 19 cases (66%) septicemia (2 of which were combined with suppurative meningitis), 10 cases (34%) non-sepsis group, including 7 cases bacteremia and 3 cases local suppurative infection (2 cases of osteomyelitis, 1 case of appendicitis with peritonitis). The clinical manifestations were fever in 29 cases (100%), diarrhea and abdominal pain in 18 cases (62%), cough and runny nose in 10 cases (34%). Eighteen cases (62%) were cured and 11 cases (38%) were improved by effective antibiotics treatment. C-reactive protein in sepsis group was significantly higher than that in non-sepsis group (25.2 (16.1, 56.4) vs. 3.4 (0.5, 7.5) mg/L, Z=-3.81, P<0.001).The serogroups of C, B and E were the most prevalent among non-typhoid Salmonella isolates, accounting for 10 cases (34%), 9 cases (31%) and 7 cases (24%) respectively. Antibacterial drug sensitivity test showed that the sensitivity rates of imipenem, ertapenem and piperaciratazobactam were all 100% (31/31), those of ceftazidime, ceftriaxone, and cefepime were 94% (29/31), 94% (29/31) and 97% (30/31) respectively. The drug resistance rates of ampicillin, ampicillin-sulbactam and trimethoprim-sulfamethoxazole were 51% (16/31), 48% (15/31) and 48% (15/31) respectively, those of cefazolin, cefotetan, tobramycin, gentamicin and amikacinwere all 100% (31/31). There were no significant differences in the drug resistance rates of ceftazidime, ceftriaxone, aztreonam, ampicillin-sulbactam, ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin between the sepsis group and the non-sepsis group (χ2=0.31,0.31,0.00,0.02,0.02,0.02,0.26, all P>0.05). Conclusions: Invasive non-typhoid Salmonella infection in children at Xiamen mainly occurred in infants younger than 3 years old.The main clinical manifestations are fever, abdominal pain and diarrhea. C-reactive protein can be served as the laboratory indicators for indicating sepsis. The third generation of cephalosporins is recommended as the first choice for treatment.


Subject(s)
Infant , Male , Female , Child , Humans , Child, Preschool , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Ceftazidime/therapeutic use , Retrospective Studies , C-Reactive Protein , Drug Resistance, Bacterial , Salmonella Infections/microbiology , Ampicillin/therapeutic use , Salmonella , Diarrhea/drug therapy , Bacteremia , Abdominal Pain , Microbial Sensitivity Tests
18.
Zhongguo dangdai erke zazhi ; Zhongguo dangdai erke zazhi;(12): 1052-1058, 2023.
Article in Chinese | WPRIM | ID: wpr-1009846

ABSTRACT

OBJECTIVES@#To investigate the risk factors for performing bronchoalveolar lavage (BAL) in children with Mycoplasma pneumoniae pneumonia (MPP) and pulmonary consolidation, and to construct a predictive model for performing BAL in these children.@*METHODS@#A retrospective analysis was performed for the clinical data of 202 children with MPP who were hospitalized in the Department of Pediatrics, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, from August 2019 to September 2022. According to whether BAL was performed, they were divided into BAL group with 100 children and non-BAL group with 102 children. A multivariate logistic regression analysis was used to identify the risk factors for performing BAL in MPP children with pulmonary consolidation. Rstudio software (R4.2.3) was used to establish a predictive model for performing BAL, and the receiver operator characteristic (ROC) curve, C-index, and calibration curve were used to assess the predictive performance of the model.@*RESULTS@#The multivariate logistic regression analysis demonstrated that the fever duration, C-reactive protein levels, D-dimer levels, and presence of pleural effusion were risk factors for performing BAL in MPP children with pulmonary consolidation (P<0.05). A nomogram predictive model was established based on the results of the multivariate logistic regression analysis. In the training set, this model had an area under the ROC curve of 0.915 (95%CI: 0.827-0.938), with a sensitivity of 0.826 and a specificity of 0.875, while in the validation set, it had an area under the ROC curve of 0.983 (95%CI: 0.912-0.996), with a sensitivity of 0.879 and a specificity of 1.000. The Bootstrap-corrected C-index was 0.952 (95%CI: 0.901-0.986), and the calibration curve demonstrated good consistency between the predicted probability of the model and the actual probability of occurrence.@*CONCLUSIONS@#The predictive model established in this study can be used to assess the likelihood of performing BAL in MPP children with pulmonary consolidation, based on factors such as fever duration, C-reactive protein levels, D-dimer levels, and the presence of pleural effusion. Additionally, the model demonstrates good predictive performance.


Subject(s)
Child , Humans , Mycoplasma pneumoniae , Retrospective Studies , C-Reactive Protein/analysis , Pneumonia, Mycoplasma/diagnosis , Bronchoalveolar Lavage , Pleural Effusion
19.
Zhongguo dangdai erke zazhi ; Zhongguo dangdai erke zazhi;(12): 1259-1264, 2023.
Article in Chinese | WPRIM | ID: wpr-1009878

ABSTRACT

OBJECTIVES@#To investigate the clinical value of complement-3a receptor 1 (C3aR1) and neutrophil extracellular traps (NETs) in predicting sepsis-induced coagulopathy (SIC).@*METHODS@#A prospective study was conducted among 78 children with sepsis who attended Xuzhou Children's Hospital Affiliated to Xuzhou Medical University from June 2022 to June 2023. According to the presence or absence of SIC, they were divided into two groups: SIC (n=36) and non-SIC (n=42) . The two groups were compared in terms of clinical data and the levels of C3aR1 and NETs. The factors associated with the occurrence of SIC were analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the performance of C3aR1 and NETs in predicting SIC.@*RESULTS@#Compared with the non-SIC group, the SIC group had significantly higher levels of C-reactive protein, interleukin-6 (IL-6), interleukin-10, C3aR1, and NETs (P<0.05). The multivaiate logistic regression analysis showed that the increases in C3aR1, NETs, and IL-6 were closely associated with the occurrence of SIC (P<0.05). The ROC curve analysis showed that C3aR1 combined with NETs had an area under the curve (AUC) of 0.913 in predicting SIC (P<0.05), which was significantly higher than the AUC of C3aR1 or IL-6 (P<0.05), while there was no significant difference in AUC between C3aR1 combined with NETs and NETs alone (P>0.05).@*CONCLUSIONS@#There are significant increases in the expression levels of C3aR1 and NETs in the peripheral blood of children with SIC, and the expression levels of C3aR1 and NETs have a high clinical value in predicting SIC.


Subject(s)
Child , Humans , Extracellular Traps , Interleukin-6 , Prospective Studies , Sepsis/complications , C-Reactive Protein , Blood Coagulation Disorders , ROC Curve , Prognosis
20.
Journal of Experimental Hematology ; (6): 1516-1522, 2023.
Article in Chinese | WPRIM | ID: wpr-1010002

ABSTRACT

OBJECTIVE@#To analyze factors associated with intestinal acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation(allo-HSCT) in children and to develop a prediction model for intestinal aGVHD after allo-HSCT in children.@*METHODS@#The clinical data of 62 children who underwent allo-HSCT at the Department of Hematology of the People's Hospital of Xinjiang Uygur Autonomous Region from February 2018 to September 2021 were retrospectively analyzed. Intestinal aGVHD was evaluated according to the Mount Sinai Acute GVHD International Consortium (MAGIC) grading criteria, the variables were screened by LASSO (least absolute shrinkage and selection operator) regression analysis with 10-fold cross-validation, and developed a model for predicting intestinal aGVHD after allo-HSCT in children.@*RESULTS@#A total of 33 (53.2%) of the 62 children developed intestinal aGVHD, of which 25 were degree II and 8 were degree III-IV. The results of screening variables by 10-fold cross-validated LASSO regression showed that the significant variables included ethnic minorities (OR =7.229; 95%CI: 2.337-22.354), platelet (PLT) (OR =0.971; 95%CI: 0.932-0.993), uric acid (UA) (OR =0.971; 95%CI: 0.935-0.988), C-reactive protein (CRP) (OR =1.217; 95%CI: 1.053-1.545), and viral infection (OR =10; 95%CI: 3.021-32.668), and these variables were independently associated with intestinal aGVHD in children (all P <0.05). A prediction model was constructed based on above variables. The area under the receiver operating characteristic (ROC) curve (AUC) of the model was calculated, and the AUC value was 0.985 (0.966-1), the Brier score was 0.055. The evaluation showed that the model has a high degree of discrimination and calibration.@*CONCLUSION@#Ethnic minorities, low PLT, low UA, high CRP, and viral infections are independently associated with intestinal aGVHD in children, and early attention should be paid to these high-risk children.


Subject(s)
Humans , Child , Retrospective Studies , Hematopoietic Stem Cell Transplantation/adverse effects , Graft vs Host Disease/diagnosis , Risk Factors , C-Reactive Protein , Acute Disease
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