[The value of changes in end-tidal carbon dioxide pressure induced by passive leg raising test in predicting fluid responsiveness in mechanically ventilated patients with septic shock].

OBJECTIVE: To test whether the changes of partial end-tidal carbon dioxide pressure (PETCO2) during passive leg raising (PLR) predict fluid responsiveness in mechanically ventilated patients with septic shock. METHODS: Forty-two mechanically ventilated patients with septic shock admitted from January 2012 to November 2012 were prospectively recruited.Hemodynamic parameters monitored by a pulse indicator continuous cardiac output (PiCCO) device and PETCO2 monitored by an expiratory-CO2 device were studied at baseline, after PLR, and after volume expansion. Fluid responsiveness was defined as an increase in cardiac index (CI) of 15% or greater after volume expansion. The correlation between PLR-induced CI change (ΔCIPLR) and PETCO2 (ΔPETCO2-PLR) was analyzed. The value of ΔPETCO2-PLR to predict fluid responsiveness was evaluated by receiver operating characteristic (ROC) curves. RESULTS: A total of 42 patients were enrolled in this study, of whom, 24 had a CI increase of ≥ 15% after volume expansion (responders). After PLR, CI and PETCO2 were both significantly increased in the response group compared with baseline [(21.4 ± 12.9)% of CI and (9.6 ± 4.7)% of PETCO2, P < 0.05], while no significant changes were observed (P > 0.05) in the non-response group. Both ΔCIPLR and ΔPETCO2-PLR were significantly higher in responder group than in the non-responder group (both P < 0.05). ΔCI and ΔPETCO2 after PLR were strongly correlated (r = 0.64, P < 0.05). In responders after PLR, the area under ROC curve of ΔPETCO2-PLR was 0.900 ± 0.056 (95%CI 0.775-1.000, P < 0.05). An increase of ≥ 5% in ΔPETCO2-PLR predicted fluid responsiveness with a sensitivity of 88.0% and specificity of 88.2%. CONCLUSIONS: The change of PETCO2 induced by passive leg raising is a non-invasive and easy way to predict fluid responsiveness in mechanically ventilated patients with septic shock.

[Supplemental Fuzhenghuayu capsule therapy for improving liver fibrosis markers in patients with chronic hepatitis B following unsatisfactory outcome of nucleos(t)ide analogue monotherapy].

OBJECTIVE: To investigate the ability of Fuzhenghuayu capsule to improve markers of liver fibrosis when provided as supplemental therapy in patients with chronic hepatitis B (CHB) who achieved complete virological response but unsatisfactory resolution of fibrosis markers with nucleos(t)ide analog (NAs) monotherapy. METHODS: One-hundred-and-ten patients with CHB-related liver fibrosis who had received NA for more than or equal to 2 years and achieved sustained virological response (SVR) but no improvement in liver fibrosis index were randomly divided into two equal groups: experimental group, continued oral NAs (one tablet, 1 time/day) with simultaneous Fuzhenghuayu capsule (1.5 g, 3 times/day) for 48 weeks; control group, continued oral NAs only for 48 weeks. Serum fibrosis markers (hyaluronic acid (HA), laminin (LN), amino terminal propeptide of type III procollagen (PIIIP) and IV collagen (IV-C)), liver fibrosis stages, B ultrasonic wave, and liver function were observed before (baseline) and after treatment and compared by statistical analysis. RESULTS: The baseline levels of fibrosis markers were not significantly different between the experimental and control groups. After treatment, the levels of all of the fibrosis markers were lower in the experimental group (P less than 0.05 vs. control group; HA t = 19.548, LN t = 2.264, PIIIP t = 2.230, and IV-C t = 6.649) and lower than the baseline levels (P less than 0.01; HA t = 12.458, LN t = 7.402, PIIIP t = 4.620, IV-C t = 8.937). The control group also showed a significant reduction in HA and LN levels after treatment (P less than 0.01 vs. baseline; t = 5.202 and 3.444), but PIIIP and IV-C were unaffected. The baseline liver fibrosis stages were not significantly different between the experimental and control groups. After treatment, only the experimental group showed significant improvement in liver fibrosis stages (P less than 0.01). The rates of excellent therapeutic outcome, effectiveness, and non-effectiveness were significantly different between the experimental group (11.3%, 43.4%, and 45.3%) and the control group (1.0%, 22.2%, and 75.6%) (x2 = 9.408, P less than 0.01). Similar trends were observed for improvements in B ultrasonic wave for liver and spleen and in markers of liver function. Finally, neither treatment group experienced adverse effects. CONCLUSION: For CHB patients who achieve SVR by antiviral treatment with NAs, but unsatifactory improvement in liver fibrosis indices, administration of supplemental Fuzhenghuayu capsule with continued NAs therapy may represent a safe and effective treatment.

[An analysis of clinical characteristics of septic acute kidney injury by using criteria of Kidney Disease: Improving Global Outcomes].

OBJECTIVE: To evaluate the value of Kidney Disease: Improving Global Outcomes (KDIGO) criteria in investigating clinical feature and prognosis of acute kidney injury (AKI) patients with sepsis in ICU. METHODS: Clinical data of patients with AKI defined by KDIGO criteria in ICU of Wuxi People's Hospital from June 2007 to June 2012 were collected. Clinical characteristics, prognosis and major risk factors of death of septic AKI patients were retrospectively analyzed. RESULTS: Of the enrolled 703 AKI patients, 395 (56.2%) were caused by sepsis (septic AKI), which indicated that sepsis mainly contributed to the causes of AKI. For septic AKI stratified by KDIGO classification, 146 (37.0%) patients belonged to AKI I, 154 (39.0%) to AKI II, and 95 (24.1%) to AKI III. Compared with the patients with non-septic AKI, septic AKI patients had greater APACHE II and SOFA score (25.1 ± 4.9 vs 20.5 ± 6.4, 12.9 ± 2.6 vs 10.4 ± 4.5; all P values < 0.05). Although there was no significant difference in baseline serum creatinine [(82.9 ± 22.2) µmol/L vs (83.1 ± 30.0) µmol/L, P > 0.05] between the two groups, patients with sepsis had higher serum creatinine [(143.5 ± 21.6) µmol/L vs (96.2 ± 15.5)µmol/L; P < 0.05], a higher proportion fulfilled KDIGO categories for both AKI II and III (63.0% vs 33.1%; P < 0.05), a higher renal replacement therapy (RRT) rate (22.3% vs 6.2%; P < 0.05) and a lower proportion of complete renal recovery (74.4% vs 82.8%) (all P values < 0.05). The 90-day mortality of septic AKI patients was higher than that of non-septic AKI patients (52.2% vs 34.1%; P < 0.05). Septic AKI, graded by KDIGO, was associated with an increased mortality. Logistic regression analysis showed that APACHEII score (OR = 5.451, 95%CI: 3.095 - 9.416), SOFA score (OR = 2.166, 95%CI: 1.964 - 4.515) and RRT (OR = 4.021, 95%CI: 2.975 - 6.324) were independent risk factors for mortality of septic AKI patients. CONCLUSION: Septic AKI patients have a higher burden of illness, worse renal function and higher mortality. APACHEII score, SOFA score and RRT are independent risk factors to septic AKI mortality.

[Urinary neutrophil gelatinase-associated lipocalin and urinary interleukin-18 in early diagnosis of acute kidney injury in critically ill patients].

OBJECTIVE: To determine whether urinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary interleukin-18 (uIL-18) are early markers of acute kidney injury (AKI) in critically ill patients. METHODS: Ninety-two critically ill patients were studied for one week after their enrollment into our hospital. During the study, 46 patients who met the RIFLE criteria were selected as AKI group and the remaining 46 patients without AKI taken as a control group. The two groups were matched for age, gender and illness severity. Urine samples were collected daily for one week. The receiver operating characteristic curve was used to evaluate the early diagnostic value of uNGAL, uIL-18 and serum creatinine (SCr). RESULTS: As compared with the levels obtained 3 days before the diagnosis of AKI, the uNGAL levels in the AKI group increased significantly (P < 0.05), while uIL-18 and SCr levels did not change 2 days prior to the diagnosis of AKI (all P > 0.05). uNGAL and uIL-18 levels increased significantly (all P < 0.05), while SCr levels did not change 1 day prior to the diagnosis of AKI in the AKI group (P > 0.05). The levels of uNGAL, uIL-18 and SCr did not change significantly in the control group during the study period (all P > 0.05). Three days before the diagnosis of AKI, concentrations of uNGAL, uIL-18 and SCr were not the predictive of AKI. Two days before the diagnosis of AKI, the area under the curve (AUC) of uNGAL was 0.840 (95%CI 0.672 - 1.009, P < 0.05), which indicated that uNGAL was the predictive of AKI while uIL-18 and SCr were not. One day before the diagnosis of AKI, the AUC of uNGAL and uIL-18 were 0.830 (95%CI 0.711 - 0.950, P < 0.05) and 0.818 (95%CI 0.697 - 0.938, P < 0.05), indicating that uNGAL and uIL-18 were the predictive of AKI while SCr was not. CONCLUSION: uNGAL and uIL-18 may be the early predictive markers of AKI in critically ill patients.