RÉSUMÉ
Objective:To compare the predictive ability of Sequential Organ Failure Assessment(SOFA)scores for the prognosis of sepsis between elderly and non-elderly patients.Methods:Medical information of patients with sepsis based on the diagnostic criteria for sepsis were screened from the database of critical care units of the Beth Israel Deaconess Medical Center in the United States during 2001 to 2012.Hospital mortality was chosen as the primary outcome for the prognosis of sepsis, and receiver operating characteristics(ROC)curve analysis was performed to compare the differences in predictive ability of SOFA scores for the prognosis of sepsis between the elderly(≥60 years)and the non-elderly on admission.Parameters related to age, heart rate and body temperature were added into the SOFA scoring systems, and the differences in predictive ability of SOFA scores versus the modified SOFA scores for sepsis were compared by using ROC curve analysis.Multivariable regression models were used to assess the associations of the modified SOFA scores with clinical outcomes in the elderly sepsis patients.Results:A total of 10 206 patients with sepsis were included in this study, including 6 928(67.88%)elderly patients and 3 278(32.12%)non-elderly patients.ROC curve analysis showed that the power of admission SOFA score for predicting hospital mortality in elderly sepsis patients(AUC=0.67, 95% CI: 0.65-0.68)was lower than in non-elderly sepsis patients(AUC=0.75, 95% CI: 0.72-0.78). AS compared with the SOFA scores, the modified SOFA scores after increasing the parameters related to age, heart rate and body temperature significantly improved the predictive power for hospital mortality of sepsis patients, only in elderly(AUC: 0.67 vs.0.69, P<0.01), but not in non-elderly patients(AUC: 0.75 vs.0.75, P=0.77). After adjusting for potential confounders and in elderly sepsis patients, multivariate regression analysis showed that the modified SOFA scores were significantly associated with multiple clinical outcomes, including hospital mortality( OR=1.17, 95% CI: 1.15-1.19, P<0.01), 28-day mortality( HR=1.12, 95% CI: 1.10-1.13, P<0.01), 90-day mortality( HR=1.10, 95% CI: 1.08-1.11, P<0.01). Conclusions:The predictive ability of SOFA scores for the prognosis of sepsis is lower in elderly patients than in non-elderly patients.The predictive value of SOFA scores for the prognosis of elderly sepsis patients can be improved by increasing parameters related to age, heart rate and body temperature.
RÉSUMÉ
Objective To explore the diagnosis and treatment of Kaposiform hemangioendothelioma (KHE),deepen the understanding of KHE and Kasabach-Merritt phenomenon (KMP),and discuss the optimal treatment for KHE.Methods From January 2008 to August 2016,13 cases of KHE were confirmed by surgery or biopsy pathology and admitted to the First Affiliated Hospital of Sun Yat-Sen University,and the clinical diagnosis and treatment were analyzed retrospectively.Results There were 13 patients(7 males and 6 females) with a median age of 1.0 years(0.2-10.0 years),and 84.6%(11/13 cases) were infants and young children,76.9% (10/13 cases) involved with deep tissue,23.1% (3/13 cases) were associated with KMP and they were younger than 1 year old,and 15.4% (2/13 cases) coexisted with hemangioma or lymphangioma.The location,extent and infiltration depth of the lesion were observed by imaging examinations and histopathology showed nodule shaped spindle tumor cells.Radical resection was considered if possible.Dose of Vincristine (0.5 mg/m2 weekly) and Propranolol [1 mg/(kg·d)] were administered.The prognosis was different in thirteen cases undergoing different treatments.After 3 months to 9 years follow-up,41.7% (5/12 cases) survived after tumor treatment.Conclusions KHE happens mostly in infants and young children,with varying clinical manifestations and a high recurrence rate.The diagnosis of KHE is based on histological examination,computed tomography and magnetic resonance imaging while it still need explicit pathological diagnosis is needed.KHE may be accompanied by hemangioma or lymphangioma.Prognosis is affected by many factors and the comprehensive treatment is required.KMP should be remedied preferentially,individual treatment protocol and long term follow-up are necessary.