Predictive value of soluble CD40L combined with APACHE II score in elderly patients with sepsis in the emergency department.

BACKGROUND: The prognostic performance of soluble CD40L (sCD40L) for illness severity in infectious diseases is rarely reported. We investigated the ability of sCD40L combined with Acute Physiology and Chronic Health Evaluation II (APACHE II) score to evaluate mortality in septic patients in the emergency department(ED). METHODS: We enrolled 222 septic patients in the ED of Beijing Chao-Yang Hospital from October 2020 to April 2021. Their serum sCD40L, PCT, lactate (Lac), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score were used to predict the prognosis of septic patients in terms of 28-day mortality. Serum sCD40L was detected by Human XL Cytokine Luminex. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to assess the prognostic value of the variables. RESULTS: One hundred ninety-five patients met the inclusion criteria, divided into survival group (55 cases) and non-survival group (140 cases). sCD40L, PCT, Lac, SOFA and APACHE II score were found to independently predict 28-day mortality (P < 0.05). The AUC values of sCD40L, PCT, Lac, SOFA and APACHE II score were 0.662,0.727,0.704, 0.719 and 0.716, respectively. There was no difference in the diagnostic value of sCD40L compared with the PCT, Lac, SOFA score or APACHE II score (Z1 = 1.19, P = 0.234; Z2 = 0.77, P = 0.441; Z3 = 1.05, P = 0.294; Z4 = 0.97, P = 0.332). However, the combined evaluation of sCD40L + APACHE II (AUC:0.772, Z = 2.10, P = 0.036) was much better than sCD40L alone in predicting 28-day mortality. CONCLUSION: The predictive value of sCD40L + APACHE II is better than sCD40L alone for 28-day mortality. sCD40L combined with APACHE II score is valuable for predicting 28-day mortality in elderly patients with sepsis.

Valve repair after infective endocarditis secondary to perforation caused by Streptococcus gordonii: A case report.

BACKGROUND: We report a case of infective endocarditis (IE) in a patient with congenital heart valve lesions accompanied by IE, which was diagnosed based on blood culture analysis that revealed the presence of a gram-negative bacterium, Streptococcus gordonii. CASE SUMMARY: The patient had a history of precordial valve disease diagnosed by cardiac ultrasound, as well as a 4-mo history of fever. He was subjected to comprehensive anti-infection and anti-heart failure treatment in the internal medicine department. Further examination revealed sudden dislodgement from and perforation through the aortic valve by the superfluous organisms, as well as occurrence of bacterial emboli dislodgement, which caused bacteremia and infectious shock. He recovered and was discharged from the hospital after surgical and postoperative anti-infection treatments. CONCLUSION: We review the treatment process and highlight inspirations and reflections from this case; suggest possible future changes in treatment modalities.

Value of Neutrophil:Lymphocyte Ratio Combined with Sequential Organ Failure Assessment Score in Assessing the Prognosis of Sepsis Patients.

BACKGROUND: We aimed to evaluate risk factors and assessment values in patients with sepsis and to explore a method of improving prognosis-prediction efficiency for patients with sepsis. METHODS: Patients with sepsis admitted to the Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University from January 2020 to December 2020 were enrolled. Demographic data of patients and laboratory values at admission were collected. Sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) scores were calculated within 24 hours of admission and logistic regression used to analyze risk factors of death within 28 days, as well as the combined predictor of SOFA score and neutrophil:lymphocyte ratio (NLR). Predicted values of various indicators for 28-day mortality in sepsis patients were analyzed using receiver-operating characteristic curves. RESULTS: A total of 302 patients were included in this study, of whom 64 (21.2%) died. Age, Pct, CRP, Lac, NLR (OR 1.054, 95% CI 1.032-1.076), SOFA score (OR 1.434, 95% CI 1.293-1.591), APACHE II score (OR 1.231, 95% CI 1.166-1.300), and NLR combined with SOFA (SOFA+NLR×0.149: OR 1.455, 95% CI 1.318-1.605) were risk factors of 28-day mortality in sepsis patients, and areas under the curve of NLR combined with SOFA score were significantly higher than each of NLR and SOFA scores and similar to APACHE II scores. The sensitivity and specificity of NLR combined with SOFA and APACHE II scores to predict the 28-day prognosis of sepsis patients were better than the other indicators. CONCLUSION: NLR combined with SOFA was a risk factor of the death of sepsis patients and its predictive efficacy similar to that of the APACHE II score, which is superior to other predictive indices.

Predictive Value of Immune Cell Subsets for Mortality Risk in Patients With Sepsis.

This study investigates the prognostic value of immune cell subsets in assessing the risk of death in patients with sepsis. This retrospective study collected 169 patients from March 2020 to February 2021 at our hospital. Baseline data were collected from patients. The absolute values (Abs) and percentages (%) of immune cell subsets for lymphocytes, T cells, CD4+ cells, CD8+, B cells, NK cells, and NKT cells were measured using flow Cytometry. Among the included patients, 43 patients were in the nonsurvivor group and 126 patients were in the survivor group. The age of patients in the nonsurvivor survivor was higher than that of survivor group patients (P = .020). SOFA, APACHE II, C-reactive protein, and procalcitonin were higher in the nonsurvivor group than in the survivor group (all P values < .05). Multivariate regression analysis showed that lymphocytes (%) and SOFA were independent risk factors affecting patients' prognosis. Lymphocytes (%) have the highest area under the receiver operating characteristic (ROC) curve (0.812). The model area under the ROC curve for immune cell subsets was 0.800, with a sensitivity of 72.09%, and specificity of 79.27% (z = 7.796, P < .001). Analysis of patient prognosis by immune cell subsets diagnostic showed statistically significant differences in the grouping of cut-off values for all 5 indicators (all P < .05). The lymphocytes (%) and SOFA score are independent risk factors affecting the prognosis of patients. A moderate predictive power for mortality in sepsis patients by immune cell subsets model.