Objective To systematically review the correlation of activated partial thromboplastin time (APTT) and prognosis after ECMO treatment. Methods The PubMed, EMbase, MEDLINE, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on the correlation of APTT and prognosis after ECMO treatment from database inception to April 11th, 2022. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 22 studies, involving 2 913 patients were included. The level of APTT in the bleeding group was higher than that in the non-bleeding group during ECMO support treatment (MD=10.34, 95%CI 1.32 to 19.37, P=0.02). The APTT level in the thrombus group was lower than that in the non-thrombus group (MD=?3.58, 95%CI ?5.89 to ?1.27, P=0.002). The level of APTT in the death group was significantly higher than that in the survival group (MD=8.97, 95%CI 5.89 to 12.06, P<0.00001). Conclusion The APTT level of ECMO patients is closely related to the prognosis of bleeding, thrombosis and death. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.
With significantly increasing proportion of high-risk patients undergoing cardiovascular surgery, a quantitative risk stratification system of perioperative patients is needed for cardiovascular surgeons. European system for cardiac operative risk evaluation (EuroSCORE) is a widely-used risk prediction model for adult patients undergoing cardiovascular surgery in the world. Research data from Chinese Cardiac Surgery Registry show that the performance of EuroSCORE in the prediction of postoperative risk of Chinese cardiovascular surgical patients is not satisfactory. Thus, the first Chinese coronary operative risk evaluation model (Sino system for coronary operative risk evaluation,SinoSCORE) is established with latest cardiovascular surgery data by Collaboration Association of Cardiovascular Surgeon in China, and has been widely used in clinical practice. This review focuses on the application and prospect of EuroSCORE and SinoSCORE for the prediction of mortality after cardiovascular surgery in adults.
ObjectiveTo analyze the trend of disease burden changes in congenital birth defects in China from 1990 to 2019. MethodsUsing the global burden of disease study 2019 (GBD 2019), we analyzed the morbidity, mortality, and disability-adjusted life years (DALYs) of congenital birth defect diseases and their corresponding age-standardized rates and average annual percentage change (AAPC) to analyze the changes in the disease burden of congenital birth defects in China and compared them with global data from 1990 to 2019. ResultsIn 2019, the age-standardized incidence, mortality, and DALY in China were 147.41/100 000, 4.62/100 000, 480.95/100 000, respectively. Compared with 1990, the age-standardized incidence rate, age-standardized mortality rate, and age-standardized DALY rate increased by 12.08% and decreased by 70.38% and 66.82%, respectively. In recent years, although the age-standardized incidence of congenital birth defect disease in China is on the rise and higher than the global level, the disease burden is roughly on the decline and lower than the global level, which is closely related to earlier intervention and treatment of the disease resulting in a lower standardized mortality rate. ConclusionThe age-standardized mortality rate of children with congenital birth defects in China showed a decreasing trend from 1990 to 2019, and the burden of disease ranged from slightly higher than global to lower than global levels, but the age-standardized incidence rate was significantly higher, but the age-specific incidence rate has increased significantly.
Objective To analyze the causes of injury-related deaths of permanent residents in Zigong city, so as to provide scientific references for the prevention and control of injury deaths and for putting forward to relevant health policies as well. Methods Based on the death surveillance data of Zigong from 2001 to 2009, following indicators were analyzed, such as cause specific mortality, age specific mortality and potential years of life lost (PYLL). Results An accumulative total of 10 957 people died of injury from 2001 to 2009, and the crude mortality was 38.13/100 thousands, while the standardized mortality was 36.07/100 thousands. The highest mortality was at the age of more than 65 years of age. The first six injury death causes were as follows: drowning, transport accidents except motor vehicle, suicide, motor vehicle accidents, accidental falling and accidental poisoning. The PYLL of injury death was 334 325.50 person year, APYLL was 34.67 year, and the PYLL rate was 11.63‰ which was higher in male than that of female. Conclusion The epidemiological analysis of injury-related deaths shows an ascending trend, which is the main reason resulting in the loss of residents’ life. Injury has become one of the most serious problems of public health, and it should be prevented and controlled by formulating effective measures and strategies aiming at the injury death spectrum and the target population of Zigong city.
ObjectiveTo evaluate the prognosis factors for early death (within 60 days) of acute myocardial infarction (AMI) patients for early identification and prevention of the disease.
MethodsWe analyzed the information of AML patients who were admitted to the emergency department between May 2009 and July 2010, and analyzed their clinical data, such as gender, age, prehospital time, myocardial enzyme, electrocardiogram, complications, whether the patients had thrombolysis therapy, time of thrombolysis, end point observation and time of death, ect. Cox multivariate survival analysis was performed with the use of SPSS 18.0 software.
ResultsSeventy-one cases were collected with one of them excluded for fragmented data. After analysing, we found that patients' age and isoenzymes of creatine kinase (CK-MB) level were prognosis factors for early death. Further analysis showed that the relative risk (RR) of age was 1.166 (P=0.023), and the RR of CK-MB was 1.001 (P=0.004).
ConclusionPatients' age has predictive value for early death of AML. More attention should be paid to AML patients with advanced age. Detecting myocardial enzymes levels, especially the CK-MB level, is significant for predicting early death. Other indicators need to be further explored due to the possible limitation of our study.
Objective To compare surgical outcomes of Stanford type A acute aortic dissection between operations at midnight and daytime. Methods From January 2004 to March 2013，195 patients with Stanford type A acute aortic dissection received surgical treatment in Nanjing Hospital Affiliated to Nanjing Medical University （Nanjing Cardiovascular Disease Hospital）. Patients with identical or similar propensity scores were matched from 127 patients who underwent emergency operation at daytime and 68 patients who underwent emergency operation at midnight. A total of 58 pairs of matched patients which had the same or similar propensity score were selected in daytime surgery group （n=58，43 males and 15 females，47.7±14.6 years） and midnight surgery group （n=58，45 males and 13 females，48.3±14.6 years）. Operation time，postoperative chest drainage，mechanical ventilation time，postoperative incidence of dialysis and tracheostomy，length of ICU stay and in-hospital mortality were compared between the daytime group and midnight group. Results A total of 58 pair of patients were matched in this study. There was no statistical difference in postoperative incidence of tracheostomy ［19.0% （11/58） vs. 6.9% （4/58），P=0.053］ or in-hospital mortality ［8.6% （5/58） vs. 6.9%（4/58），P=0.729］ between the midnight group and daytime group. Operation time （485.7±93.5 minutes vs. 428.5±123.3 minutes，P=0.048），postoperative chest drainage （979.5±235.7 ml vs. 756.6±185.9 ml，P=0.031），mechanical ventilation time （67.9±13.8 hours vs. 55.7±11.9 hours，P=0.025），postoperative incidence of dialysis ［17.2% （10/58） vs. 5.2%（3/58），P=0.039］ and length of ICU stay （89.4±16.2 hours vs. 74.8±12.5 hours，P=0.023） of the midnight group weresignificantly longer or higher than those of the daytime group. A total of 107 patients were followed up for 4-6 months after discharge. During follow-up，there was no late death. Among the 13 patients who required postoperative dialysis，12 patientsno longer needed regular dialysis. Conclusion Emergency operation at midnight does not increase in-hospital mortalitybut increase some postoperative morbidity in patients with Stanford type A acute aortic dissection. Whether at midnight or daytime，better preoperative preparation and surgeons’ vigor are needed for timely surgical treatment for patients with Stanford type A acute aortic dissection.
ObjectiveTo observe the clinical characteristics, the characteristics of organ dysfunction and death related factors in the natural course of severe acute pancreatitis (SAP).
MethodsThe data of 302 cases of SAP from January 1999 to June 2007 in our hospital were retrospective analyzed. The APACHEⅡscore, state of each organ, and death related factors were recorded and analyzed according to the admission and on 1, 3, 5, 7, 14, and 28 d after admission, a total of 7 time points.
ResultsIn natural course of SAP, the APACHEⅡscore took on a double-peak type distribution, the peaks appearing nearly about one week and two weeks after the onset of SAP. Systemic inflammatory response syndrome (SIRS), hypoxemia, metabolic acidosis, hyperglycemia, and abdominal compartment syndrome were the main causes of early organ failure. Incidence of organ failure and infection increased significantly for patients with intestinal paralysis lasting longer than five days. The most affected organ failure was followed by respiratory organs, peripheral circulation, kidneys, and gastrointestinal tract. The mortality rate increased significantly for patients with organ failure more than 48 hours. Four cases of death (9.5%) caused by severe shock and cardiac arrest within 24 h after admission; 6 deaths (14.3%) led by persistent shock with ARDS or acute renal failure within 24-72 h; 14 cases of death (33.3%) arose from 3-10 d after onset, mainly for acute respiratory distress syndrome (ARDS), acute renal failure associated with multiple organ dysfunction syndrome (MODS); 18 cases (42.8%) of the death arose on 10 d after the onset, mainly for the MODS caused by intra-abdominal infections, bleeding, pancreatic fistula, and biliary fistula.
ConclusionsThe natural course of SAP can be divided into three phases:systemic inflammation, systemic infection, and recovery. Duration of intestinal paralysis is an important factor affecting the natural history of SAP. Early complications in patients with organ failure appeared as SIRS, metabolic acidosis, hyperglycemia, and abdominal hypertension. MODS led by SIRS is the leading cause in early death of SAP; MODS caused by pancreas and peripancreatic tissue infections, abdominal bleeding, pancreatic fistula, and biliary fistula are the main death factor in the late phase. Early recovery of gastrointestinal function can reduce the incidence of MODS.
Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
ObjectiveTo explore the risk factors for death in patients with bronchiectasis.
MethodsTwo hundred and eighty-three patients diagnosed with bronchiectasis at Daxing Hospital of Capital Medical University from January 2011 to December 2013 were collected and followed up to October 2015 after discharge. Patients' age, gender, body mass index (BMI), smoking history, dyspnea score, image data, sputum culture, blood gas analysis and the results of spirometry were collected. The risk factors for death were analyzed with COX regression analysis.
ResultsAmong 283 cases, 52 patients died. The 1-, 2-, 3-and 4-year cumulative survival rates were 97%, 86%, 71%, 45%, respectively. COX regression analysis showed that age≥70 years (RR=2.222, 95%CI 1.145-4.314), BMI < 18.5 kg/m2 (RR=2.328, 95%CI 1.205-4.497), bronchiectasis involving≥3 lobes in chest high-resolution computed tomography (RR=0.382, 95%CI 0.188-0.774) and FEV1% pred < 70% (RR=1.032, 95%CI 0.923-1.180) were the independent risk factors for death of patients with bronchiectasis (all P < 0.05).
ConclusionsThere are multiple risk factors contribute to death of patients with bronchiectasis. Early identification of risk factors shall improve the prognosis of patients with bronchiectasis.
Objective To analyze the outcome of arterial switch operation （ASO） for surgical repair of complete transposition of the great arteries （TGA）, and to investigate the risk factors influencing the mortality of ASO. Methods The clinical data of patients suffered from TGA and treated with ASO from the January 2003 to December 2004, and the clinical records in hospital including eehoeardiogram and operation record were collected. The clinical data were analyzed by chi-squared test and logistic muhivariable regression analysis, including the age undergone operation, body weight, diagnosis, anatomic type of coronary artery, cardiopulmonary bypass time, aortic crossclamping time, circulation arrest time, assisted respiration time after operation, the delayed closure of sternum and so on. The risk factors influencing the early mortality of the ASO were analyzed. Results Sixty seven patients were operated with ASO, five patients died during the peri-operative period. The outcome of univariate analysis indicated that risk factors influencing the mortality of ASO included： age（P=0. 004）, body weight （P=0. 042）, anatomic type of coronary artery （P= 0. 006） and extracorporeal circulation time （P= 0. 048）, the length of the CICU stay（P= 0. 004） and the hospital stay（P=0. 007） after operation in the TGA/VSD patients were longer than those in TGA/ IVS patients. The logistic muhivariable regression analysis indicated that the age at operation （P= 0. 012）, coronary arteries anomaly （P = 0.001 ）and the longer cardiopulmonary bypass time （P = 0. 002） were correlated with the increase of death rate. Conclusion It could be good results for TGA patients who was repaired with ASO. The age at operation, the coronary arteries anomaly and the longer cardiopulmonary bypass time are the risk factors influencing the mortality.
