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Objective:To evaluate the effect of venous excess ultrasound score (VExUS Score) in the acute kidney injury(AKI) in Patients with sepsis, so as to reduce the risk of disease and improve the prognosis of patients.Methods:This experiment was a single-center prospective cohort study. Include septic patients with AKI who were admitted to the Department of Emergency Intensive Care Unit of the First Affiliated Hospital of Anhui Medical University from February 2022 to February 2023, Those with inadequate window, inferior vena cava (IVC) thrombus, age<18 years and known case of cirrhosis with portal hypertension were excluded from the study. Patients underwent ultrasound examination with serial determination till AKI resolved or patient is initiated on dialysis.Results:Totally 86 patients were enrolled for the study. The mean age was (60.43±15.48) with 50 (58.1%) males. Mean sequential organ failure assessment (SOFA) score was (6.23±1.87). 38 patients (44.2%) were in AKI stage 1, while 24 patients (27.9%) were in AKI stage 2 and stage 3 each. 52 patients (60.5%) had VExUS grade Ⅲ. Resolution of AKI injury showed significant correlation with improvement in VExUS grade ( p value 0.003). Similarly, there was significant association between changes in VExUS grade and fluid balance ( p value 0.005). There was no correlation between central venous pressure (CVP), left ventricular function, and right ventricular function with change in VExUS grade. Conclusions:The study shows a significant correlation between the VExUS Score and AKI staging, With improvement in kidney function, there is decline in the VExUS grade as well. Moreover VExUS Score might reliably demonstrate venous congestion and aid in the clinical decision to perform fluid removal.
RESUMO
Objective To analyze the epidemiology and clinical characteristics of acquired immunodeficiency syndrome (AIDS) and pulmonary tuberculosis (TB) co-infection.Methods A retrospective study was conducted with the clinical data of patients diagnosed with AIDS and TB in Shanghai Public Health Clinical Center during the period from 2011 to 2015.The outcome of the patients were evaluated by outpatient and telephone follow-up.The data were analyzed by descriptive analysis using SPSS 22.0 software package.Results A total of 359 patients with AIDS/TB co-infection were included in this analysis,including 325 males and 34 females,the highest proportion in 30-44 age group.The diagnosis was delayed in about 42.6％ of the patients.The clinical symptoms were mainly fever,cough and weight loss,but hemoptysis uncommon.Both lungs were affected in most cases,with lesions in at least 3 lung fields,but rare pulmonary cavity.T-SPOT.TB test showed lower positive rate.CD4+T lymphocyte count was 50 cells/μL or less in 50.7％ of the patients at their first test.About 43.5％ of the 69 patients with antimicrobial susceptibility data showed resistance to therapy.Majority (93.2％) of the patients with known viral status received antiretroviral treatment.Extra-pulmonary tuberculosis was identified in 282 cases.The complication and opportunistic infection included central nervous system infection,syphilis,hepatitis B virus infection,hepatitis C virus infection,pulmonary infection,and drug-induced liver injury.Of the 333 patients with known outcome,53 died,most (79.2％,42/53) within 6 months.Conclusions The patients with AIDS/TB co-infection showed higher proportion of young people.The CT finding was atypical.The patients showed lower positive rate for T-SPOT TB test and lower CD4+T lymphocyte count at their first test.Most patients had extra-pulmonary tuberculosis and other complications or opportunistic infections.