Objective To study the neural mechanism of hypotension or shock state in acute cholangitis in severe type (ACST) and its value of clinical application. Methods A technique of blocking abdominal splanchnic nervi via right adipose capsule of kidney was carried out on 28 patients by injecting 1% lidocaine before urgent operation. Results After blocking the relevant nervi, hypotension or shock state in 23 patients were improved significantly (Ｐ＜0.05). The death rate was lower (14.3%) after having performed biliary decompressions with laparotomy. Conclusion Patients′ hypotension or shock state at the early phase of ACST is the result of neural reflex in which the splanchnic nervi is its afferent pathway. Blocking the relevant nervi before urgent operation, the valuable opportunity of emergency treatment can be obtainded and the complication and death rate are reduced significantly.
Objective To explore the association between plasma IgG and acute exacerbation (AE) or death risk in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 262 COPD patients treated in our hospital from February 2018 to February 2020 were recruited in our study. All patients were divided into AE≥2 group and AE≤1 group according to AE frequency during follow-up of 1 year. Basic data and laboratory data such as IgG, IgA and IgM of two groups were comparatively analyzed. Univariate analysis and COX regression were performed to analyze the related factors of frequency of AE≥2 times in 1 year. Depicting restricted cubic spline was performed to analyze the relation between IgG and AE by R software. All patients were also divided into high IgG group, low IgG group, high IgA group and low IgA group based on median of patients’ baseline plasma IgG and IgA level, depicting survival curve by Kaplan-Meier to analyse differences between the groups with different IgG or IgA level in the risk of AE and death respectively. ResultsFinally, there were 14 patients lost to follow-up and 248 cases were included (AE≤1 group contained 154 cases, AE≥2 group contained 94 cases) until February 28, 2021. Age and COPD Assessment Test (CAT) scores in the AE≥2 group were higher than those in the AE≤1 group; Albumin, IgG and IgA level in the AE≥2 group were lower than those in the AE≤1 group; Neutrophil to lymphocyte ratio (NLR) in the AE≥2 group was higher than that in the AE≤1 group (all P<0.05). There were 99 and 114 cases of AE in the high IgG and low IgG groups respectively within 1 year. Kaplan Meier survival analysis showed that risk of AE in the high IgG group and high IgA group were lower than that in the low IgG group and the low IgA group (log rank χ2=23.791, 67.153, both P=0.000). Risk of death in the high IgG group was lower than that in the low IgG group (log rank χ2=6.214, P=0.013), there was no statistically difference in the risk of death in the high IgA group compared to the low IgA group (log rank χ2=2.400, P=0.121). Multivariate Cox regression analysis showed that CAT score (HR=1.096, P=0.001) and NLR (HR=2.061, P=0.000) were independent risk factors of frequency of AE≥2 times in 1 year for COPD patients, albumin (HR=0.921, P=0.006) and IgG (HR=0.572, P=0.000）were the independent protective factors. Restricted cubic spline analysis showed that combining the COX regression model, after adjusting for IgA, albumin, NLR and other variables, there was non-linear relationship between IgG level and AE (P=0.000).Conclusion Plasma IgG level is related to AE in COPD patients, and may become a reliable predictor of acute exacerbation risk in the future.
Objective To investigate the causes of death and evaluation of injury severity in patients with thoracic trauma so as to enhance the diagnosis and treatment of thoracic trauma. Methods A retrospective study was carried out in 687 patients with thoracic trauma, which were divided into different groups according to their condition of injury (chest injury group and multiple injuries group) and outcome (survival group and death group) and penetrating into pleural cavity (penetrating injury group and blunt trauma group), then trauma scores(revised trauma score,abbreviated injury scale,injury severity score,probability of survival)were compared respectively. In addition, the highrisk causes of trauma death were analyzed. Results Among 687 cases, there are 488 cases with blunt trauma and 199 cases with penetrating injury. The causes of trauma death in blunt trauma group were brain injury (10 cases) and acute respiratory failure (6 cases) and multiple organ dysfunction syndrome (4 cases) and hypovolemic shock (1 case). The causes of trauma death in penetrating trauma group were hypovolemic shock (9 cases). There were statistically difference of trauma score in the death group and the survival group（GCS：t=4.648,P=0.000; RTS:t=4.382,P=0.000;thoracic AIS：t=2.296,P=0.027;ISS：t=4.871，P=0.000; Ps：t=4.254,P=0.000）. There was no statistically difference of thoracic AIS in the chest injury group and the multiple injuries group (t=0.723, P=34.567), and there were statistical significances in RTS（t=2.553,P=0.032）, ISS（t=10.776,P=0.000）, Ps（t=3.868,P=0.007）. There were statistically difference of RTS（t=3.161,P=0.007）and ISS （t=4.118,P=0.005） in the blunt trauma survival group and penetrating injury survival group, and there was no statistical significance in Ps（t=0.857,P=97.453）. The blunt trauma death group had statistical difference compared with penetrating injury death group in trauma score（GCS：t=4.016,P=0.001，RTS:t=3.168,P=0.006;thoracic AIS：t=2.303, P=0.043;ISS：t=4.218,P=0.002;Ps：t=4.624,P=0.001）. The mortality of trauma was gradually increased with the trauma scores. The mortality was 10.7% when whole ISS was 20.25. The mortality in penetrating injury group was higher than that in blunt trauma group with the same ISS between two groups. Conclusion Applying trauma score is conducive to the judgement of trauma severity and optimizing clinical treatment. The death causes in blunt trauma group were more complex than in penetrating injury group. Severe trauma and multiple injuries are the main death causes of thoracic trauma.
ObjectiveTo investigate the clinical characteristics and predicting factors for death in critically ill patients with severe community-acquired pneumonia (CAP).
MethodA total of 143 hospitalized patients with severe CAP between January 2009 and December 2012 were included and their clinical data were retrospectively analyzed. According to the clinical outcome, patients were divided into survival group and death group, and their clinical features and laboratory test results were compared, and multivariate regression analysis was conducted to search for predicting factors for death.
ResultsIn this study, a total of 118 patients survived and 25 patients died, and the mortality rate was 17.5%. The number of underlying diseases in the two groups were different, and death group had more patients with 3 kinds of diseases than the survival group[76.0% (19/25) vs. 22.8% (13/57), P<0.05]. The intubation rate in the death group was significantly higher than that in the survival group[84.0% (21/25) vs. 33.1% (39/118), P<0.05], and the arterial blood pH value (7.15±0.52 vs. 7.42±0.17, P<0.05), HCO3- concentration[(18.07±6.25) vs. (25.07±5.44) mmol/L, P<0.05], PaO2[(58.92±35.18) vs. (85.92±32.19) mm Hg (1 mm Hg=0.133 kPa), P<0.05] and PaO2/FiO2[(118.23±98.02) vs. (260.17±151.22) mm Hg, P<0.05)] in the death group were significantly lower than those in the survival group. And multivariate regression analysis indicated that the number of underlying diseases[OR=0.202, 95%CI (0.198, 0.421), P=0.003], PaO2[OR=1.203, 95%CI (1.193, 1.294), P=0.011] and PaO2/FiO2[OR=0.956, 95%CI (0.927, 0.971), P=0.008] were independent predictors of death in the patients with severe pneumonia.
ConclusionsPatients who died of severe pneumonia often had severe illnesses before admission, and the number of underlying diseases and PaO2 have highly predictive value for death.
ObjectiveTo analyze the influencing and prognostic factors for in-hospital death of creatine kinase-MB after cardiac surgery for congenital heart disease in pediatric.
MethodsClinical data of 708 children with body weight less than 15 kg who underwent cardiac surgery at Fu Wai Hospital between January 2012 and December 2013 were retrospectively analyzed. There were 269 males (38.0%) and 439 females (62.0%). The postoperative maximum CK-MB was calculated for analysis and patients were devided into three groups:a group A (CK-MB≤25 IU/L), a group B (25 IU/L < CK-MB≤125 IU/L) and a group C (CK-MB > 125 IU/L).
ResultsPostoperative CK-MB level was independently associated with cyanotic congenital heart disease (P=0.002), the aorta cross clamp (P=0.030), the cardiopulmonary bypass time (P=0.002), the cross clamp time (P=0.016), the re-establish of bypass (P < 0.001), deep hypothermic circulatory arrest (P=0.024). There was statistical difference in mortality between the 3 groups (P < 0.001). The receiver operating characteristic curve showed that CK-MB has predictive value for in-hospital death (P < 0.001) and the cutoff value is 168.5 IU/L, with a sensitivity of 54.2%, specificity of 90.8%, positive predictive value of 17.3% and negative predictive value of 98.4%. CK-MB level above 168.5 IU/L was an independent risk factor for in-hospital death (OR=6.364, P < 0.001).
ConclusionElevation of CK-MB after cardiac surgery is independently influenced by several variables. Pediatric with major CK-MB elevation has high risk of in-hospital death.
Objective To analyze the reasons for the perioperative death of endovascular repair of acute aortic dissection （AD）. Methods The clinical data of 176 patients with acute AD and received endovascular repair from July 2001 to October 2012 were analyzed retrospectively. Results Among 176 patients with acute AD， 8 patients died during perioperatively， received endovascular repair in 1-5 days after admission （mean 2.4 d）， and all of them admitted before 2008. Two cases were type A and 6 cases were type B. All cases with hypertension and 3 cases with pleural effusion. Three cases died on the day of operation， among them 2 cases occurred in 1 h after operation， the other 1 case occurred in 2 h after operation. Four cases died in 2 days after operation and 1 case died in 4 days after operation. Four cases died of rupture of the aortic dissection， 2 cases died of cerebral infarction， 1 case died of multiple organ failure， and 1 case died of gastrointestinal bleeding. Conclusion To avoid performing endovascular repair during the acute phase and improving operation skills may help to avoid the occurrence of perioperative death.
Objective To systematically review the risk factors for death in children with tuberculous meningitis (TBM). Methods The CNKI, VIP, WanFang Data, CBM, Cochrane Library, Web of Science, PubMed, EMbase and CINAHL databases were electronically searched to collect studies on the risk factors for death in children with TBM from inception to October 2022. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. Results A total of 15 studies involving 2 597 patients were included. The results of meta-analysis showed that male (OR=2.41, 95%CI 1.61 to 3.61, P<0.01), no history of BCG vaccination (OR=3.74, 95%CI 1.96 to 7.12, P<0.01), TBM stage (stage Ⅲ) (OR=2.04, 95%CI 1.26 to 3.28, P<0.01), HIV infection (OR=3.28, 95%CI 1.20 to 8.93, P=0.02), convulsion (OR=3.61, 95%CI 3.31 to 3.94, P<0.01), disturbance of consciousness (OR=3.58, 95%CI 2.40 to 5.34, P<0.01), cerebrospinal fluid protein concentration increased (OR=1.87, 95%CI 1.39 to 2.51, P<0.01), hydrocephalus (OR=2.44, 95%CI 1.60 to 3.71, P<0.01) and short hospitalization (OR=2.89, 95%CI 2.05 to 4.06, P<0.01) were risk factors for death in children with TBM. Under 5 years old, negative PPD skin test, positive meningeal irritation sign, malnutrition and history of contact with TB may not be associated with the death of TBM in children. Conclusion Male, no history of BCG vaccination, TBM stage (stage Ⅲ), HIV infection, convulsions, disturbance of consciousness, cerebrospinal fluid protein concentration increased, hydrocephalus and short hospitalization are risk factors for death in children with TBM. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo investigate the high-risk factors for death in infants with severe pneumonia.
MethodsWe analyzed hospitalized infants and young children diagnosed with severe pneumonia from January 2011 to December 2013, and investigated the risk factors for death.
ResultsA total of 1 411 infants with severe pneumonia were included in the analysis. The mortality rate was 3.12%. In single factor analysis, the following factors were significant:age, severe infection, artificial feeding, congenital heart diseases, bad habitation, repeated infection history, surgical history, multi-organ dysfunction, internal environment disorder, multiple drug-resistant strains infection. The results of Logistic multiple regression analysis showed that there were statistical significance in severe infection, repeated infection history, Multiple drug-resistant strains infection, multi-organ dysfunction, and internal environment disorder.
ConclusionInfants with severe pneumonia should be intensively monitored and actively treated for reducing the mortality rate if they have one of the following high-risk factors:age, congenital heart diseases, repeated infection history, multiple drug-resistant strains infection, surgical history, multi-organ dysfunction, and internal environment disorder.
Objective To identify the key influencing factors of death anxiety in rural elderly and their mechanisms of action. Methods A total of 701 rural elderly individuals from 6 prefecture-level cities (prefectures) in Sichuan Province were selected for a questionnaire survey on death anxiety, health-related physical fitness, and subjective well-being. A structural equation model was constructed to thoroughly analyze the influencing factors of death anxiety and their mechanisms of action. Results Higher levels of health-related physical fitness, higher levels of subjective well-being, and having more children were the top three protective factors against death anxiety among elderly people in rural Sichuan, with effect values of ?0.392, ?0.287, and ?0.154, respectively. In contrast, suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. Suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. The structural equation model fitting results showed that the medical insurance type of rural elderly in Sichuan (β=?0.062, P=0.002), suffering from chronic diseases (β=0.127, P=0.001), hospitalization due to health reasons in the past year (β=0.086, P=0.002), and educational level (β=?0.067, P=0.001) had indirect effects on death anxiety through health-related physical fitness. Not seeking medical treatment due to financial difficulties in the past year had an indirect effect on death anxiety through subjective well-being (β=0.060, P=0.002). The number of children had both a direct effect on death anxiety (β=?0.119, P=0.004) and an indirect effect through subjective well-being (β=?0.034, P=0.001). Health-related physical fitness had both a direct effect on death anxiety (β=?0.278, P=0.001) and an indirect effect through subjective well-being (β=?0.114, P=0.002). Conclusion Multiple factors directly or indirectly affect the level of death anxiety in the rural elderly population. Health-related physical fitness, subjective well-being, and the number of children are important protective factors. Moreover, health-related physical fitness and subjective well-being act as mediating variables in the chain of effects of multiple factors on death anxiety.
ObjectiveTo investigate the role of D-dimer in predicting the prognosis of the patients with acute pancreatitis (AP).
MethodsThe medical records of 324 patients with a diagnosis of AP in West China Hospital from April to June 2014 were retrospectively analyzed.
ResultsOverall mortality rate was 3%, the median hospital stay was (11±3) days, and the median Intensive Care Unit stay was (1±1) day. The prothrombin time, activated partial prothrombin time, fibrinogen, international normalized ratio, antithrombinⅢ, D-dimer, C-reactive protein, and procalitonin level in the organ failure (OF) patients were significantly higher than those in the non-OF patients (P<0.05). The D-dimer, C-reactive protein, and procalcitonin level in the patients with infection were significantly higher than those in the non-infectious onse (P<0.05). The D-dimer and procalcitonin level in the death group were significantly higher than those in the survivor group (P<0.05). D-dimer and procalcitonin level increased as the grade of AP increased (P<0.05); the difference in C-reactive protein between the light and middle type was not significant (P>0.05), while was significant between middle and severe, and light and severe (P<0.05). The area under the receiver operating characteristic curve (AUC) of OF predicted by D-dimer was higher than C-reactive protein and procalcitonin; AUC of infection predicted by D-dimer was lower than procalcitonin; AUC of death predicted by D-dimer was higher than C-reactive protein but lower than procalcitonin.
ConclusionD-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the complications and death of AP. D-dimer provide a more accurate assessment of prognosis than C-reactive protein and procalcitonin in patients with AP.
