[A comparison of clinical characteristics between acute fatty liver of pregnancy and hemolysis, elevated liver enzymes and low platelets syndrome].

OBJECTIVE: To compare and analyze the clinical characteristics between acute fatty liver of pregnancy (AFLP) and the hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. METHODS: This is a retrospective cohort study. The clinical data of 13 cases with AFLP and 34 cases with HELLP syndrome were collected from three tertiary referral centers in Yunnan (the First Affiliated Hospital of Kunming Medical University, the Second Affiliated Hospital of Kunming Medical University, and Yan'an Hospital of Kunming City) from January 2016 to December 2021. The patients were diagnosed to AFLP and HELLP syndrome according to the Swansea criteria and the Tennessee classification system. The general characteristics, clinical features, laboratory results within 24 hours after admission, complications, maternal and neonatal outcomes were compared to analysis the differences between the two groups. RESULTS: (1) Maternal characteristics: compared with HELLP syndrome group, AFLP group had lower body mass index (BMI) and blood pressure at admission (both P < 0.01). (2) Clinical features: the most common symptoms in AFLP patients were skin jaundice, abdominal pain, nausea and vomiting, edema. The main manifestations of patients with HELLP syndrome were albuminuria, hypertension, edema, headache. Some patients had multiple symptoms concurrently. (3) Laboratory results: compared with HELLP syndrome group, the levels of platelet count (PLT), total bilirubin (TBil), direct bilirubin (DBil), γ-glutamyl transferase (γ-GGT), alkaline phosphatase (ALP), total bile acid (TBA), serum creatinine (SCr) and international standardized ratio (INR) in AFLP group were significantly increased within 24 hours after admission [PLT (×109/L): 107.69±51.13 vs.76.71±43.25,TBil (µmol/L): 121.60 (83.20, 170.00) vs.15.25 (7.22, 29.05), DBil (µmol/L): 86.50 (58.60, 104.00) vs. 4.30 (2.22,10.10), γ-GGT (U/L): 87.00 (37.00, 127.00) vs. 41.00 (19.00,64.42), ALP (U/L): 199.10 (109.00, 349.20) vs. 125.50 (90.50, 155.25), TBA (µmol/L): 51.50 (16.20, 117.40) vs. 4.15 (2.02, 6.95), SCr (µmol/L): 155.80 (129.00, 237.00) vs. 79.00 (65.43, 113.70), INR: 1.28 (1.17, 1.63) vs. 0.94 (0.88, 1.08), all P < 0.05], prothrombin time (PT) was significantly prolonged [seconds: 16.10 (14.50, 19.20) vs. 12.40 (11.43, 13.40), P < 0.05]. The level of blood glucose (GLU), fibrinogen (FIB) and the activity of antithrombin III (AT III) decreased significantly [GLU (mmol/L): 5.18±1.33 vs. 6.33±1.19, FIB (g/L): 1.96±1.46 vs. 3.81±1.58, AT III (%): 40.61±25.84 vs. 66.39±24.11, all P < 0.05]; (4) Complications: compared with HELLP syndrome group, the incidence of patients with hypoglycemia [30.77% (4/13) vs. 0% (0/34)], acute liver failure [53.85% (7/13) vs. 5.88% (2/34)], acute renal insufficiency [69.23% (9/13) vs. 8.82% (3/34)], coagulopathy [76.92% (10/13) vs. 38.24% (13/34)], disseminated intravascular coagulation (DIC) [53.85% (7/13) vs. 5.88% (2/34)], and multiple organ dysfunction syndrome (MODS) [53.85% (7/13) vs. 5.88% (2/34)] were significantly higher in AFLP group (all P <0.05). (5) Maternal and neonatal outcome: all patients delivered after admission. The total length of hospital and intensive care unit stay were significantly longer in the AFLP group than in the HELLP syndrome group [days: 17.00 (11.00, 25.00) vs. 9.00 (7.00, 12.00), 12.00 (4.00, 22.00) vs. 3.91 (0, 7.00), both P < 0.01]. Two AFLP patients died, including one due to intracranial venous thrombosis and one due to multiple organ failure and cardiopulmonary arrest. There were no deaths in the HELLP syndrome group. CONCLUSIONS: There are significant differences in maternal characteristics, laboratory results and complications between AFLP and HELLP syndrome. TBil, γ-GGT, SCr, FIB, INR and AT III activity may help to distinguish the two diseases.

[Feasibility of pulse oxygen saturation for the condition evaluation of acute respiratory distress syndrome patients in the Lijiang region].

OBJECTIVE: To explore the feasibility of using pulse oxygen saturation (SpO2) to evaluate the condition of patients with acute respiratory distress syndrome (ARDS) in the Lijiang region. METHODS: Patients with ARDS who visited the department of emergency of People's Hospital of Lijiang from August to December 2020 were selected as study subjects. Patients were divided by severity into mild ARDS group [200 mmHg (1 mmHg = 0.133 kPa) ≤ oxygenation index (PaO2/FiO2, P/F) ≤ 300 mmHg] and moderate to severe ARDS group (P/F ≤ 200 mmHg). The general condition, clinical diagnosis, arterial blood gas analysis results of the patients were recorded, and the differences of the above indexes between the two groups of ARDS were compared. Spearman correlation analysis was used to analyze the correlation between SpO2 and arterial oxygen saturation (SaO2). SpO2 was carried into the Ellis equation and the Rice equation to calculate the derived P/F and analyze the correlation between the derived P/F and the P/F measured in arterial blood gas analysis; receiver operator characteristic curve (ROC curves) were plotted, the sensitivity and specificity of SpO2/fraction of inspiration oxygen (SpO2/FiO2, S/F) instead of P/F to assess oxygenation in patients with ARDS was calculated. To evaluate the feasibility of SpO2 for the condition evaluation of patients with ARDS in the Lijiang region. RESULTS: Compared with the mild ARDS group, the arterial partial pressure of oxygen (PaO2), SaO2 and hemoglobin (Hb) were significantly decreased in the moderate to severe ARDS group [PaO2 (mmHg): 50.5 (39.3, 56.5) vs. 60.0 (55.0, 67.5), SaO2: 0.86 (0.73, 0.91) vs. 0. 93 (0.90, 0.96), Hb (g/L): 142±27 vs. 156±24, respectively, all P < 0.05]. Correlation analysis revealed a significant positive correlation between SpO2 and SaO2 in ARDS patients residing at high altitude (R = 0.650, P = 0.000). The P/F derived by the Rice formula was significantly and positively correlated with the P/F derived from arterial blood gas analysis (R = 0.802, P = 0.000). The deduced P/F in mild and moderate to severe ARDS groups were all significantly correlated with the measured P/F (R values were 0.562, 0.647, both P = 0.000). The P/F derived using the Ellis formula showed a significant positive correlation with the P/F derived from arterial blood gas analysis (R = 0.822, P = 0.000). The deduced P/F of mild ARDS group and moderate to severe ARDS group were all positively correlated with the measured P/F (R values were 0.556, 0.589, P values were 0.000, 0.010). There was a significant positive correlation between S/F and P/F in ARDS patients (R = 0.828, P = 0.000), and the regression equation was S/F = 1.33 P/F+52.41. ROC curve analysis showed that S/F had some predictive value for patients with mild and moderate to severe ARDS, and area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.903 (0.829-0.977), 0.936 (0.870-1.000), both P = 0.000. When the cut-off value was 452 mmHg, S/F had a sensitivity of 100% and a specificity of 80.9% for predicting mild ARDS. When the cut-off value was 319 mmHg, S/F predicted moderate to severe ARDS with 95.1% sensitivity and 86.2% specificity. CONCLUSIONS: At high altitude, SpO2 and SaO2 have been correlated in patients with ARDS, and P/F derived using SpO2 and measured P/F were significantly correlated in patients with ARDS, especially in those with moderate to severe ARDS. SpO2 may be useful in the assessment of severity of illness in patients with ARDS at high altitude.

[Feasibility of difference between hematocrit and albumin for identifying severity of scrub typhus disease].

OBJECTIVE: To explore the feasibility of difference between hematocrit and albumin (HCT-ALB) to evaluate the severity in patients with severe scrub typhus (Tsutsugamushi disease). METHODS: The clinical data of 408 patients with scrub typhus in 37 hospitals located in 15 prefectures of Yunnan Province from January 1st, 2017 to December 31st, 2018 were retrospectively collected. The patients were divided into the non-severe scrub typhus disease group (n = 265) and the severe scrub typhus disease group (n = 143) according to the diagnostic criteria. Volunteers attending Kunming City Medical Center in Yunnan Province for routine physical examination were enrolled as healthy control group (n = 230). HCT, ALB, lactate dehydrogenase (LDH), uric acid (UA), and acute physiology and chronic health evaluations II (APACHE II) and sequential organ failure assessment (SOFA) within 24 hours after admission were collected. HCT-ALB difference was calculated. Pearson method was used to analyze the correlation between HCT-ALB difference and LDH, UA, APACHE II and SOFA scores in patients with severe scrub typhus disease; the receiver operating characteristic (ROC) curve was used to analyze the value of HCT-ALB difference in the diagnosis of severe scrub typhus disease. RESULTS: (1) There was no significant difference in gender composition between patients with non-severe scrub typhus disease group and severe scrub typhus disease group, but the age of the severe scrub typhus disease group was significantly higher than that of the non-severe scrub typhus disease group (years old: 53.57±15.23 vs. 35.03±23.47, P < 0.01). (2) Compared with the healthy control group, the HCT, ALB of the non-severe scrub typhus disease group and severe scrub typhus disease group were significantly decreased [HCT: (36.54±6.82)%, (38.13±7.60)% vs. (46.20±4.42)%; ALB (g/L): 35.53±5.87, 26.90±6.10 vs. 47.75±4.28, all P < 0.01], and the HCT-ALB difference was significantly increased (5.28±3.90, 11.26±6.62 vs. 1.55±5.32, both P < 0.01). Compared with the non-severe scrub typhus disease group, the HCT of the severe scrub typhus disease group was significantly increased [(38.13±7.60)% vs. (36.54±6.82)%, P < 0.01], the ALB was significantly decreased (g/L: 26.90±6.10 vs. 35.53±5.87, P < 0.01), and the HCT-ALB difference was significantly increased (11.26±6.62 vs. 5.28±3.90, P < 0.01). (3) Pearson correlation analysis showed that HCT-ALB difference was positively correlated with LDH and UA in patients with severe scrub typhus disease (r values were 0.316 and 0.284, respectively, both P < 0.01), and negatively correlated with APACHE II score and SOFA score (r values were -0.229 and -0.198, respectively, both P < 0.05). (4) ROC curve analysis showed that the area under the curve (AUC) of HCT-ALB difference in the diagnosis of severe scrub typhus disease was 0.786, standard error was 0.024, P = 0.000, and 95% confidence interval (95%CI) was 0.739-0.832. When the best diagnostic value was 8.56, the sensitivity was 81.1%, the specificity was 60.8%, and the Youden index was 0.419. CONCLUSIONS: HCT-ALB difference is an indicator to evaluate the severe scrub typhus disease. When HCT-ALB difference is above 8.56, it can be used as an indicator to identify severe scrub typhus disease.

[The vicissitude of pathogenic bacteria isolated from critically ill patients in an intensive care unit during a period of using antibiotics].

OBJECTIVE: To observe the changing spectrum of the pathogenic bacteria during seven-day antibiotics targeted therapy in an intensive care unit (ICU). METHODS: In a group of 100 patients of hospital-acquired pneumonia (HAP) with identified pathogenic bacteria undergoing antibiotic treatment according to susceptibility test, the changes in the species of the pathogens and their ratio in their sputum specimens were studied, and the relationship were analyzed the characteristic between the changes and the age, the time of medication and the length of stay. RESULTS: Among all the bacterial isolates (n=295) in ICU, the percentage of Gram-negative bacillus was 62.4% (184/295). The prevalent causative microorganisms isolated were Pseudomonas aeruginosa 22.4% (66/295), MRSA/MRSE 20.7% (61/295) and Acinetobacter spp. 10.5% (31/295). When one or more than one potent antibiotic in accord with the result of sensitivity test, change in ratio of pathogens occurred in 160, and change in species in 126. When the use of antibiotics was prolonged, the change in the former became less often. The change in ratio was less in 3-5 days than that of 6-7 days, the ratio was 72.7%, 62.5%, 60.0% (P<0.01) respectively on the 3rd day, the 4th day and the 5th day, showing that susceptible pathogenic bacteria became less gradually, indicating that the treatment was effective . However, the change in species of pathogenic bacteria began more obvious, and it was more predominant on the 6th day and the 7th day, which was 66.0%, 77.1% (P<0.01) respectively, showing emergence of new non-susceptible pathogenic bacteria. With increase in the use of different antibiotics, the species of pathogenic bacteria showed to increase an increasing tendency of change. When Gram-negative bacillus infection was treated, antibiotic resistant bacteria such as Candida albicans and MRSA usually appeared. But when Gram-positive bacillus infections were treated, Candida albicans, Pseudomonas aeruginosa and Enterobacter cloacae readily appeared. There was relationship between the change in pathogenic bacteria and age, and the length of stay of the patients. The more older in age and the longer the length of stay, the change in pathogenic bacteria was more predominant. CONCLUSION: New antibiotic resistant pathogenic bacteria appears after seven-day antibiotic-targeted therapy in ICU. The change of species of pathogenic bacteria is related to the duration and type of using antibiotic, and also the age and length of stay. The longer time of use and the more different types of antibiotic used, the older in age and the longer in length of stay, the change in species of pathogenic bacteria is more predominant. Monitoring the dynamic change of pathogenic bacteria, adjusting the antibiotic promptly and rational use of antibiotics are very important to decrease the change in species and antibiotic resistance of the bacteria.