3D Visualization of Whole Brain Vessels and Quantification of Vascular Pathology in a Chronic Hypoperfusion Model Causing White Matter Damage.

Chronic cerebral hypoperfusion is an important pathological factor in many neurodegenerative diseases, such as cerebral small vessel disease (CSVD). One of the most used animal models for chronic cerebral hypoperfusion is the bilateral common carotid artery stenosis (BCAS) mouse. For the therapy of CSVD and other diseases, it will be beneficial to understand the pathological alterations of the BCAS mouse, particularly vascular pathological changes. A mouse model of BCAS was used, and 8 weeks later, cognitive function of the mice was examined by using novel object recognition test and eight-arm radial maze test. 11.7 T magnetic resonance imaging (MRI) and luxol fast blue staining were used to evaluate the injury of the corpus callosum (CC), anterior commissure (AC), internal capsule (IC), and optic tract (Opt) in the cerebral white matter of mice. Three-dimensional vascular images of the whole brain of mice were acquired using fluorescence micro-optical sectioning tomography (fMOST) with a high resolution of 0.32 × 0.32 × 1.00 µm3. Then, the damaged white matter regions were further extracted to analyze the vessel length density, volume fraction, tortuosity, and the number of vessels of different internal diameters. The mouse cerebral caudal rhinal vein was also extracted and analyzed for its branch number and divergent angle in this study. BCAS modeling for 8 weeks resulted in impaired spatial working memory, reduced brain white matter integrity, and myelin degradation in mice, and CC showed the most severe white matter damage. 3D revascularization of the whole mouse brain showed that the number of large vessels was reduced and the number of small vessels was increased in BCAS mice. Further analysis revealed that the vessel length density and volume fraction in the damaged white matter region of BCAS mice were significantly reduced, and the vascular lesions were most noticeable in the CC. At the same time, the number of small vessels in the above white matter regions was significantly reduced, while the number of microvessels was significantly increased in BCAS mice, and the vascular tortuosity was also significantly increased. In addition, the analysis of caudal rhinal vein extraction revealed that the number of branches and the average divergent angle in BCAS mice were significantly reduced. The BCAS modeling for 8 weeks will lead to vascular lesions in whole brain of mice, and the caudal nasal vein was also damaged, while BCAS mice mainly mitigated the damages by increasing microvessels. What is more, the vascular lesions in white matter of mouse brain can cause white matter damage and spatial working memory deficit. These results provide evidence for the vascular pathological alterations caused by chronic hypoperfusion.

Urban Residents' Acceptance Intention to Use Recycled Stormwater-An Examination of Values, Altruism, Social and Cultural Norms, and Perceived Health Risks.

Public acceptance is the basic premise for the implementation of stormwater reuse projects anywhere in the world. Based on the theory of planned behaviour, this study constructed a hypothesized model of urban residents' intention to use recycled stormwater for non-potable residential purposes. Having received 669 valid questionnaires from urban residents in Taiyuan City, a Structural Equation Model was used to analyze their acceptance intention to use recycled stormwater. Results of the study showed that the degree of human contact with recycled stormwater influenced respondents' acceptance intention to use it for that purpose, which is consistent with previous studies. The impact of factors, including valuation of stormwater, emotions, perceived health risks, or trust in government, on respondents' acceptance intention to use recycled stormwater was found to be not significant, which adds to the inconsistent literature. The unique contributions of the study to literature include that altruism and social and cultural norms were found to have significantly positive impacts on residents' acceptance intention to use the water, while social and cultural norms demonstrated a more significant impact. This finding is perceived to relate to the collectivism of Chinese culture; however, to what extent the relation could be requires further research to verify. The study also makes contributions to methodology by using social networking (WeChat Moments) to collect data in social science studies.

Clinical Value of FeNO for Pulmonary Hypertension Diagnosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

OBJECTIVE: To investigate the clinical value of fractional exhaled nitric oxide (FeNO) in the diagnosis of pulmonary hypertension (PH) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: In this study, the medical records of AECOPD patients were retrospectively reviewed. The patients were divided into AECOPD and AECOPD + PH groups based on the absence or presence of PH. Moreover, FeNO and other indexes were compared between the two groups. The value of FeNO in diagnosing AECOPD with PH was determined using the ROC curve. RESULTS: A total of 83 patients were enrolled (56 in the AECOPD group and 27 in the AECOPD + PH group). The level of FeNO was significantly lower in the AECOPD + PH group than in the AECOPD group (P = 0.022). Moreover, FeNO level (25.22 ± 8.45 ppb) was higher in the mild PH subgroup than in the moderate (16.64 ± 5.67 ppb, P = 0.005) or severe (11.75 ± 2.36, P = 0.002) PH subgroups. FeNO level was positively correlated with C-reactive protein in AECOPD patients while negatively correlated with brain natriuretic peptide in the AECOPD + PH group. ROC analysis showed that the optimal cutoff value of FeNO in the diagnosis of AECOPD with PH was 24.5 ppb. CONCLUSION: FeNO level at admission can act as an indicator for PH diagnosis in AECOPD patients.

The Protective Effect of Quercetin on Endothelial Cells Injured by Hypoxia and Reoxygenation.

Background: Cerebral small vessel disease (CSVD) is a group of clinical syndromes covering all pathological processes of small vessels in the brain, which can cause stroke and serious dementia. However, as the pathogenesis of CSVD is not clear, so the treatment is limited. Endothelial cell dysfunction is earlier than clinical symptoms, such as hypertension and leukosis. Therefore, the treatment of endothelial cells is expected to be a new breakthrough. Quercetin, a flavonoid present in a variety of plants, has the function of anti-inflammation and anti-oxidation. This study aimed to investigate the protective effect of quercetin on endothelial cell injury and provide a basic theory for subsequent application in the clinic. Methods: Human brain microvascular endothelial cells (HBMECs) were cultured in vitro, and the injury model of endothelial cells was established by hypoxia and reoxygenation (H/R). The protective effects of quercetin on HBMECs were studied from the perspectives of cell viability, cell migration, angiogenesis and apoptosis. In order to further study the mechanism of quercetin, oxidative stress and endoplasmic reticulum stress were analyzed. What's more, blood-brain barrier (BBB) integrity was also studied. Results: Quercetin can promote the viability, migration and angiogenesis of HBMECs, and inhibit the apoptosis. In addition, quercetin can also activate Keap1/Nrf2 signaling pathway, reduce ATF6/GRP78 protein expression. Further study showed that quercetin could increase the expression of Claudin-5 and Zonula occludens-1. Conclusions: Our experiments show that quercetin can protect HBMECs from H/R, which contains promoting cell proliferation, cell migration and angiogenesis, reducing mitochondrial membrane potential damage and inhibiting cell apoptosis. This may be related to its antioxidation and inhibition of endoplasmic reticulum stress. At the same time, quercetin can increase the level of BBB connexin, suggesting that quercetin can maintain BBB integrity.

The Synergistic Effect of Ginkgo biloba Extract 50 and Aspirin Against Platelet Aggregation.

PURPOSE: We aimed to investigate potential synergistic antiplatelet effects of Ginkgo biloba extract (GBE50) in combination with aspirin using in vitro models. METHODS: Arachidonic acid (AA), platelet activating factor (PAF), adenosine 5'-diphosphate (ADP) and collagen were used as inducers. The antiplatelet effects of GBE50, aspirin and 1:1 combination of GBE50 and aspirin were detected by microplate method using rabbit platelets. Synergy finder 2.0 was used to analyze the synergistic antiplatelet effect. The compounds in GBE50 were identified by UPLC-Q/TOF-MS analysis and the candidate compounds were screened by TCMSP database. The targets of candidate compounds and aspirin were obtained in TCMSP, CCGs, Swiss target prediction database and drugbank. Targets involving platelet aggregation were obtained from GenCLiP database. Compound-target network was constructed and GO and KEGG enrichment analyses were performed to identify the critical biological processes and signaling pathways. The levels of thromboxane B2 (TXB2), cyclic adenosine monophosphate (cAMP) and PAF receptor (PAFR) were detected by ELISA to determine the effects of GBE50, aspirin and their combination on these pathways. RESULTS: GBE50 combined with aspirin inhibited platelet aggregation more effectively. The combination displayed synergistic antiplatelet effects in AA-induced platelet aggregation, and additive antiplatelet effects occurred in PAF, ADP and collagen induced platelet aggregation. Seven compounds were identified as candidate compounds in GBE50. Enrichment analyses revealed that GBE50 could interfere with platelet aggregation via cAMP pathway, AA metabolism and calcium signaling pathway, and aspirin could regulate platelet aggregation through AA metabolism and platelet activation. ELISA experiments showed that GBE50 combined with aspirin could increase cAMP levels in resting platelets, and decreased the levels of TXB2 and PAFR. CONCLUSION: Our study indicated that GBE50 combined with aspirin could enhance the antiplatelet effects. They exerted both synergistic and additive effects in restraining platelet aggregation. The study highlighted the potential application of GBE50 as a supplementary therapy to treat thrombosis-related diseases.

The Protective Effect of Liquiritin in Hypoxia/Reoxygenation-Induced Disruption on Blood Brain Barrier.

Background: Stroke is the second leading cause of death in human life health, but current treatment strategies are limited to thrombolytic therapy, and because of the tight time window, many contraindications, and only a very small number of people can benefit from it, new therapeutic strategies are needed to solve this problem. As a physical barrier between the central nervous system and blood, the blood-brain barrier (BBB) maintains the homeostasis of the central nervous system. Maintaining the integrity of the BBB may emerge as a new therapeutic strategy. Liquiritin (LQ) is a flavonoid isolated from the medicinal plant Glycyrrhiza uralensis Fisch. ex DC. (Fabaceae), and this study aims to investigate the protective effects of LQ on brain microvascular endothelial cells (BMECs), to provide a new therapeutic strategy for stroke treatment, and also to provide research ideas for the development of traditional Chinese medicine (TCM). Methods: The protective effects of LQ on HBMECs under the treatment of hypoxia reoxygenation (H/R) were investigated from different aspects by establishing a model of H/R injury to mimic ischemia-reperfusion in vivo while administrating different concentrations of LQ, which includes: cell proliferation, migration, angiogenesis, mitochondrial membrane potential as well as apoptosis. Meanwhile, the mechanism of LQ to protect the integrity of BBB by antioxidation and inhibiting endoplasmic reticulum (ER) stress was also investigated. Finally, to search for possible targets of LQ, a proteomic analysis approach was employed. Results: LQ can promote cell proliferation, migration as well as angiogenesis and reduce mitochondrial membrane potential damage and apoptosis. Meanwhile, LQ can also reduce the expression of related adhesion molecules, and decrease the production of reactive oxygen species. In terms of mechanism study, we demonstrated that LQ could activate Keap1/Nrf2 antioxidant pathway, inhibit ER stress, and maintain the integrity of BBB. Through differential protein analysis, 5 disease associated proteins were found. Conclusions: Studies have shown that LQ can promote cell proliferation, migration as well as angiogenesis, and reduce cell apoptosis, which may be related to its inhibition of oxidative and ER stress, and then maintain the integrity of BBB. Given that five differential proteins were found by protein analysis, future studies will revolve around the five differential proteins.

Fiscal Decentralization and Local Environmental Pollution in China.

Fiscal decentralization is one of the tools for the central government to engage local governments in environment management. However, its effects are inconclusive. This paper aims to examine the impact of fiscal decentralization on environmental pollution and the role of government environmental preference in China's provinces. The results show that fiscal revenue decentralization exacerbates local environmental pollution more seriously than expenditure decentralization. This negative environmental effect of fiscal decentralization could be moderated by government environmental preference. Based on our findings, it is recommended that China's local governments should improve environmental preference so that fiscal decentralization can create a win-win situation for the economy and environment. Furthermore, the different effects of fiscal revenue and expenditure decentralization create a necessity for differentiated management of fiscal decentralization by the central and local governments.

Rapid Screening and Identification of Chemical Constituents From Ophiopogon japonicus by High-Performance Liquid Chromatography Coupled to Electrospray Ionization and Quadrupole Time-of-Flight Mass Spectrometry.

Ophiopogon japonicus (Thunb.) Ker-Gawl (Liliaceae), which is named as "Maidong" in China, is widely used in traditional Chinese medicine for treating fever, cough, inflammation, epistaxis, constipation, respiratory disease and gastrointestinal disorders. However, the systematic analysis of chemical constituents of O. japonicus has not been well established because of the complexity and trace. In this paper, an effective and reliable high-performance liquid chromatography coupled to electrospray ionization and quadrupole time-of-flight mass spectrometry method was successfully developed to separate and identify the chemical constituents from O. japonicus. As a result, a total of 30 compounds including steroidal saponins, homoisoflavonoids, allylbenzene, cholest and cryptomeridiol were screened or tentatively identified. Of them, three new steroidal saponins were found and tentatively characterized in O. japonicus. This study provides a meaningful material basis for further quality control and pharmacological research.

Jugular venous catheter-associated thrombosis and fatal pulmonary embolism: A case report.

INTRODUCTION: Central venous catheters related thrombosis (CRT) insertion has been shown to increase the risk of venous thromboembolism, particularly pulmonary embolism (PE). Nevertheless, deaths cased due to PE have been rarely reported. PATIENT CONCERNS: A central venous catheter was introduced through the right jugular vein during the operation due to severe septic shock from a 57-year-old male patient. Two days after surgery, the hemodynamics was stable. On the 7th day, and low molecular weight heparin calcium (4100 units, once a day) was added for anticoagulation to prevent venous thromboembolism. On the 15th day, during the process of central venous catheter removal, the patient suddenly lost consciousness, suffered cardiac arrest, and received emergency cardiopulmonary resuscitation. DIAGNOSIS: Jugular venous catheter-associated thrombosis and fatal PE. An acute bedside ultrasound showed a thrombus drifting with the blood stream in the right jugular vein. The lower section of the xiphoid process by echocardiography showed decreased systolic amplitude of the right atrium and right ventricle, widened and fixed inferior vena cava, and no variation with respiration. Para-sternal left ventricular long axis section showed that the right ventricular outflow tract was significantly extended, and the contraction amplitude of the anterior and posterior walls of the left ventricle decreased. Left ventricular short axis section indicated a right ventricle enlargement and ventricular septum deviation of left ventricle, showing "D" sign. Apical 4-chamber view showed that the right ventricular ratio increased and the contractile capacity decreased. INTERVENTIONS: One and a half million units of urokinase were immediately given trough intravenous drip. OUTCOMES: Twenty minutes after thrombolysis, the patient's autonomic heart rhythm was recovered, but continued to suffer from hypotension and coma, followed by multiple organ failure, and died 50 hours later. CONCLUSION: Recent clinical practice guidelines recommend against the routine use of any anticoagulant thromboprophylaxis in patients with central venous catheters, but for patients at particularly high risk for CRT, consideration can be given to using higher doses of anticoagulant as prophylaxis, although there are virtually no data to support this approach.

Neurodevelopmental Toxicity of Polystyrene Nanoplastics in Caenorhabditis elegans and the Regulating Effect of Presenilin.

As one of the most widely used materials, plastic polymer fragments can abrasively degrade into microplastic (MP) and smaller nanoplastic (NP) particles. The present study aimed to investigate the influence of particle size on neurodevelopmental toxicity induced by polystyrene nanoplastics (PS-NPs) in Caenorhabditis elegans and to explore the underlying potential mechanism. C. elegans were exposed to different concentrations of PS-NPs with various sizes (25, 50, and 100 nm) for 72 h. Our results showed that all of these PS-NPs could dose-dependently induce an increase in reactive oxygen species production and mitochondrial damage in C. elegans, resulting in inhibition of body length, head thrashes, body bending, and dopamine (DA) contents. A weaker neurotoxicity was found in 25 nm PS-NPs compared to 50 and 100 nm PS-NPs, which might be due to preferential cellular distribution and greater polymerization capability of the smaller particles. In addition, all these PS-NPs could induce lipofuscin accumulation and apoptosis independent of particle size, suggesting that oxidative damage and mitochondrial dysfunction may not be the only way responsible for NP-induced neurotoxic effects. Furthermore, the mutant test targeting two presenilin genes (sel-12 and hop-1) showed that sel-12 and hop-1 were involved in regulation of PS-NP-induced neurodevelopmental toxicity and mitochondrial damage. In conclusion, PS-NPs could induce neurodevelopmental toxicity dependent on particle sizes mediated by mitochondrial damage and DA reduction. Enhanced expression of presenilin plays a role in PS-NP-induced oxidative stress and neurodevelopmental toxicity.

[Etiological analysis of 61 286 hospitalized specimens from a tertiary hospital over 5 years].

OBJECTIVE: To investigate the detection and distribution of hospitalized specimens from a tertiary hospital over 5 years. METHODS: Specimens of sputum, urine, blood, secretions and puncture fluid were collected from patients admitted to the Harrison International Peace Hospital from November 2013 to November 2018. The origin of specimens, the distribution of departments and the distribution of pathogenic bacteria isolated were analyzed retrospectively. RESULTS: A total of 61 286 specimens were sent for examination during the 5 years. The top 5 specimens were sputum culture (n = 18 302, 29.9%), sputum smear (n = 11 253, 18.4%), blood culture (n = 9 713, 15.8%), urine culture (n = 6 448, 10.5%) and secretion culture (n = 6 133, 10.0%), accounting for 84.6% (51 849/61 286). Sputum specimens accounted for 48.2% (29 555/61 286) with the largest proportion. The number of specimens from medical wards was much higher than that from surgical wards (specimens: 25 468 vs. 10 521), respiratory medicine, department of critical care medicine and emergency intensive care unit (EICU) were important sources of pathogenic specimens in the hospital, accounting for 29.8% (18 243/61 286) in total. The average positive rate of all specimens was 23.5% (14 424/61 286). The positive rates of sputum culture and urine culture were 29.7% (5 428/18 302) and 35.4% (2 281/6 448), respectively, while the positive rate of blood culture was only 6.6% (643/9 713). Escherichia coli was the most common pathogen in all specimens except for sputum culture and fecal culture. Escherichia coli [40.6% (926/2 281)], Klebsiella pneumoniae [9.2% (210/2 281)], Pseudomonas aeruginosa [8.2% (188/2 281)], Enterococcus faecalis (group D) [6.6% (151/2 281)] and Candida albicans [3.2% (73/2 281)] were the most common pathogens in urine culture. Klebsiella pneumoniae [24.1% (1 309/5 428)], Acinetobacter baumannii [21.3% (1 154/5 428)], Pseudomonas aeruginosa [15.1% (818/5 428)], Escherichia coli [6.5% (351/5 428)] and Maltose oligotrophomonas maltose [5.8% (316/5 428)] were the most common pathogens in sputum culture. Escherichia coli [36.5% (235/643)], Klebsiella pneumoniae [10.9% (70/643)], Pseudomonas aeruginosa [4.8% (31/643)], Staphylococcus epidermidis [3.4% (22/643)] and Staphylococcus humanis [3.3% (21/643)] were the most common pathogens in blood culture. CONCLUSIONS: Specimens sent for examination by inpatients are mainly from internal medicine wards, mainly from sputum, blood and urine, and the detected pathogens are mainly Gram-negative bacteria.

Procalcitonin, C-reactive protein, PaCO2, and noninvasive mechanical ventilation failure in chronic obstructive pulmonary disease exacerbation.

It is unclear whether procalcitonin (PCT) is correlated with noninvasive ventilation (NIV) failure. This retrospective case-control study aimed to compare PCT levels, C-reactive protein (CRP) levels, and PaCO2 in patients (05/2014-03/2015 at the Harrison International Peace Hospital, China) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and NIV failure/success.This was a retrospective case-control study of patients with AECOPD who required NIV between May 2014 and March 2015. All consecutive patients with AECOPD admitted at the Department of Critical Care Medicine and transferred from the general ward were included in the study. Hemogram, PCT, erythrocyte sedimentation rate (ESR), arterial blood gas (ABG), and CRP levels were measured ≤1 hour before NIV was used. NIV was considered to have failed if at least one of the following criteria was met: cardiac arrest or severe hemodynamic instability; respiratory arrest or gasping; mask intolerance; difficulty in clearing bronchial secretions; or worsening of ABGs or sensorium level during NIV. The factors associated with NIV failure were determined.A total of 376 patients were included: 286 with successful NIV and 90 wither NIV failure. The multivariate analysis showed that PCT (OR = 2.0, 95%CI: 1.2-3.2, P = .006), CRP (OR = 1.2, 95%CI: 1.1-1.3, P < .001), and PaCO2 (OR = 1.1, 95%CI: 1.1-1.2, P < .001) ≤1 hour before NIV were independently associated with NIV failure. The optimal cutoff were 0.31 ng/mL for PCT (sensitivity, 83.3%; specificity, 83.7%), 15.0 mg/mL for CRP (sensitivity, 75.6%; specificity, 93.0%), and 73.5 mm Hg for PaCO2 (sensitivity, 71.1%; specificity, 100%). The area under the curve (AUC) was 0.854 for PCT, 0.849 for CRP, and 0.828 for PaCO2. PCT, CRP, and PaCO2 were used to obtain a combined prediction factor, which achieved an AUC of 0.978 (95%CI: 0.961-0.995).High serum PCT, CRP, and PaCO2 levels predict NIV failure for patients with AECOPD. The combination of these three parameters might enable even more accurate prediction.

Early use of noninvasive techniques for clearing respiratory secretions during noninvasive positive-pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease and hypercapnic encephalopathy: A prospective cohort study.

Noninvasive positive-pressure ventilation (NPPV) might be superior to conventional mechanical ventilation (CMV) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Inefficient clearance of respiratory secretions provokes NPPV failure in patients with hypercapnic encephalopathy (HE). This study compared CMV and NPPV combined with a noninvasive strategy for clearing secretions in HE and AECOPD patients.The present study is a prospective cohort study of AECOPD and HE patients enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital in China.A total of 74 patients received NPPV and 90 patients received CMV. Inclusion criteria included the following: physician-diagnosed AECOPD, spontaneous airway clearance of excessive secretions, arterial blood gas analysis requiring intensive care, moderate-to-severe dyspnea, and a Kelly-Matthay scale score of 3 to 5. Exclusion criteria included the following: preexisting psychiatric/neurological disorders unrelated to HE, upper gastrointestinal bleeding, upper airway obstruction, acute coronary syndromes, preadmission tracheostomy or endotracheal intubation, and urgent endotracheal intubation for cardiovascular, psychomotor agitation, or severe hemodynamic conditions.Intensive care unit participants were managed by NPPV. Participants received standard treatment consisting of controlled oxygen therapy during NPPV-free periods; antibiotics, intravenous doxofylline, corticosteroids (e.g., salbutamol and ambroxol), and subcutaneous low-molecular-weight heparin; and therapy for comorbidities if necessary. Nasogastric tubes were inserted only in participants who developed gastric distension. No pharmacological sedation was administered.The primary and secondary outcome measures included comparative complication rates, durations of ventilation and hospitalization, number of invasive devices/patient, and in-hospital and 1-year mortality rates.Arterial blood gases and sensorium levels improved significantly within 2 hours in the NPPV group with lower hospital mortality, fewer complications and invasive devices/patient, and superior weaning off mechanical ventilation. Mechanical ventilation duration, hospital stay, or 1-year mortality was similar between groups.NPPV combined with a noninvasive strategy to clear secretions during the first 2 hours may offer advantages over CMV in treating AECOPD patients complicated by HE.

[Analysis of death risk factors for nosocomial infection patients in an ICU: a retrospective review of 864 patients from 2009 to 2015].

OBJECTIVE: To investigate the mortality risk factors of nosocomial infection patients in intensive care unit (ICU), and to guide clinicians to take effective control measures. METHODS: A retrospectively cohort study was conducted. The relevant information of patients with nosocomial infection treated in ICU of Hengshui Harrison International Peace Hospital Affiliated to Hebei Medical University from June 2009 to December 2015 was analyzed. The patients who admitted to ICU again, with length of ICU stay less than 48 hours, without first etiology of screening within 48 hours of ICU admission, or without complete pathogenic information were excluded. The gender, age, diagnosis, length of ICU stay, invasive operation, nutritional status, acute physiology and chronic health evaluation II (APACHEII) score, sequential organ failure assessment (SOFA) score, distribution and drug resistance of the pathogens, and procalcitonin (PCT) levels at 7 days after nosocomial infection were recorded. The risk factors leading to death in patients with nosocomial infection were analyzed by logistic regression, and the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of all risk factors on the outcome of patients with nosocomial infection. RESULTS: In 864 enrolled patients with male of 54.75% and mean age of (63.50±15.80) years, 732 (84.72%) patients survived and 132 (15.28%) died. Compared with survivors, the non-survivors had higher age (years: 65.47±15.32 vs. 58.15±13.27), incidence of urgent trachea intubation (32.58% vs. 22.81%), deep venous catheterization (83.33% vs. 63.25%), and multiple drug-resistant infection (65.91% vs. 33.20%), longer length of ICU stay (days: 13.56±4.29 vs. 10.29±4.32) and duration of coma (days: 7.36±2.46 vs. 5.48±2.14), lower albumin (g/L: 23.64±8.47 vs. 26.36±12.84), higher APACHEII score (19.28±5.16 vs. 17.56±5.62), SOFA score (8.55±1.34 vs. 6.43±2.65), and PCT (µg/L: 3.06±1.36 vs. 2.53±0.87, all P < 0.05). There was no significant difference in gender and urinary tract catheterization between survivors and non-survivors (both P > 0.05). The low respiratory tract was the most common site of infection followed by urinary tract and bloodstream in both groups. It was shown by logistic regression analysis that prolonged ICU stay [odds ratio (OR) = 2.039, 95% confidence interval (95%CI) = 1.231-3.473, P = 0.002], APACHEII score (OR = 1.683, 95%CI = 1.002-9.376, P = 0.000), SOFA score (OR = 2.060, 95%CI = 1.208 -14.309, P = 0.041), PCT (OR = 2.090, 95%CI = 1.706-13.098, P = 0.004), and multi-drug resistant pathogens infection (OR = 5.245, 95%CI = 2.213-35.098, P = 0.027) were independent risk factors for ICU mortality in patients with nosocomial infection. The area under ROC curve (AUC) of length of ICU stay, APACHEII score, SOFA score, and PCT level for predicting death of nosocomial infection patients was 0.854, 0.738, 0.786, and 0.849, respectively, the best cut-off value was 16.50 days, 22.45, 6.37 and 3.38 µg/L, respectively, the sensitivity was 83.6%, 90.0%, 81.1%, and 89.6%, and the specificity was 70.3%, 75.6%, 71.3%, and 85.4%, respectively. CONCLUSIONS: Prolonged ICU stay, nosocomial infection with secondary sepsis and multiple organ dysfunction syndrome were the leading causes of death for nosocomial infection patients in ICU. Prolonged ICU stay, APACHE II score, SOFA score, and PCT level could effectively predict death risks for nosocomial infection patients.