Objective To explore the distribution characteristics and prognostic risk factors of critically ill patients who has long-term hospitalization in intensive care unit ( ICU) . Methods A retrospective study was carried out to evaluate 119 critically ill patients from January 2003 to July 2009 by extracting data from computerized hospital information system. The patients were divided into a survival group and a non-survival group based on discharging outcomes. A binary logistic regression analysis wasintroduced to investigate potential risk factors of prognosis. Results Age, type of payment, entity of disease,and length of ICU stay were significantly different between the two groups ( P lt; 0. 05) in independent-Samples T test. Logistic regressions indicated that age, length of ICU stay and plasma infusion were independent predictors for worse outcome. Conclusions Age, length of ICU stay and plasma infusion may directly influence the prognosis of patients with prolonged stay in ICU. Intensive therapies should be emphasized for those patients at high risk.
ObjectiveTo analyze perioperative prognostic factors of pediatric patients undergoing surgical correction of ventricular septal defect (VSD)and severe pulmonary arterial hypertension (PAH).
MethodsForty pediatric patients with VSD and severe PAH (mean pulmonary artery pressure (PAPm) < 50 mm Hg)who underwent surgical repair in Beijing Anzhen Hospital from 2004 to 2012 were included in the study. There were 21 male and 19 female patients with their age of 7.2±3.3 years and body weight of 19.6±7.1 kg. All the patients were randomly divided into 2 groups:Group Ⅰ (Group=0, n=20, M/F:12/8, continuous nitroglycerin administration via central venous catheter (CVC)and GroupⅡ (Group=1, n=20, M/F:9/11, continuous prostaglandin E1 (PGE1)administration via CVC). The duration of intubation (Tintubation)was used as the dependent variable (Y). Patient age, cardiopulmonary bypass time (TCPB), postoperative PAPm, pulmonary vascular resistance index (PVRI), systemic to pulmonary pressure ratio (Ps/p), Group, left ventricular stroke work index (LVSWI)and right ventricular stroke work index (RVSWI)were used as independent variables (X). Multivariate liner regression analysis model was used to evaluate the influence of X on Y.
ResultsThere was no perioperative death or severe complication in this group. Perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH included group[x1, P=0.004, 95% CI (-71, -16)], TCPB[x2, P=0.011, 95% CI (0.9, 5.8)], posto-perative PAPm (x3, P=0.004 with 95% CI 3.2 to 13.3), RVSWI (x4, P=0.003 with 95% CI-16.9 to-4.3)and PVRI (x5, P=0.03 with 95% CI-0.29 to-0.02). The standardized regression equation was:Y=-0.60x1+0.54x2+2.22x3-1.70x4-0.15x5.
ConclusionPGE1 administration, TCPB, postoperative PAPm, RVSWI and PVRI are predominant perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH.
Objective To investigate the prognostic factors and hospitalization cost in patients diagnosed as central line-associated bloodstream infection( CLABSI) in intensive care unit( ICU) .Methods A retrospective study was made to investigate the CLABSI epidemic data in ICU from June 2006 to June 2009. Clinical and physiological parameters were summarized and compared between these patients, which were divided into two groups based on the clinical outcome. Meanwhile, events including blood transfusion,mechanical ventilation, as well as cost of hospitalization were also reviewed. Logistic regression method was introduced to investigate the potential prognostic risk factors. Results There were 49 patients were diagnosed as nosocomial CLABSI, in which 19 cases( 38. 8% ) died in the hospital and 30( 61. 2% ) weresurvival. In univariate analysis, differences in body temperature, central venous pressure, acute physiology and chronic health evaluation( APACHEⅡ ) score, blood transfusion amount, pH value, D-dimer, blood serum alanine transarninase, blood urea nitrogen level, serumcreatinine, serumpotassiumbetween the survivors andthe non-survivors were significant( P lt;0. 05) . However, no significant differences were observed between the two groups in in-hospital days, ICU days and hospitalization cost ( all P gt; 0. 05) . With multiple logistic regressions, higher APACHEⅡ score( OR 0. 78; 95% confidence interval: 0. 66-0. 94; P = 0. 007) , APTTlevel( OR 0. 87; 95% confidence interval: 0. 77-0. 98; P = 0. 026) and serum potassium( OR 0. 09; 95% confidence interval: 0. 01-0. 80; P = 0. 031) were independent predictors of worse outcome. Conclusions Disease severity and coagulation situation may directly predict the prognosis of nosocomial CLABSI patients.But current investigation did not demonstrate significant differences in ICU length of stay and respective cost between the CLABSI patients with different prognosis.
Survival prognosis in patients with terminal cancer plays an important role in clinical decision-making, policy formulation, and end-stage patient with relatives. To date, foreign researchers have developed multiple survival prediction models based on patient clinical performance, biomarkers and other indicators, along with a large number of studies which have been externally verified, including Palliative Performance Scale (PPS), Palliative Prognostic Score (PaP), Delirium-Palliative Prognostic Score (D-PaP), and Palliative Prognostic Index (PPI), etc. China's research on this topic remains in the primary stage. Therefore, this article reviews the prognostic factors of terminal cancer and survival prediction models as well as applications, in order to provide references for the subsequent construction of survival prediction models for patients with terminal cancer in line with Chinese characteristics.
Objective To systematically review the prognostic value of progesterone receptor (PR) for survival in ovarian cancer. Methods PubMed, EMbase, MEDLINE, The Cochrane Library (Issue 1, 2016), CNKI, VIP, CBM and WanFang Data databases were searched for cohort studies on the correlation between PR expression and prognosis of ovarian cancer from inception to June 1st 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 studies involving 1 881 patients were included. The results of meta-analysis showed that the PR positive patients was superior than the PR negative patients on overall survival (OS) (HR=0.64, 95%CI 0.44 to 0.93,P=0.02), disease free survival (DFS) (HR=0.64, 95%CI 0.48 to 0.85,P=0.002), progression free survival (PFS) (HR=0.62, 95%CI 0.47 to 0.82,P=0.000 9) and remission rate of chemotherapy (OR=1.91, 95%CI 1.28 to 2.86,P=0.002). When analysis based on the clinical pathogesis stages, PR expression was higher in clinical stages Ⅰ-Ⅱ than stage Ⅲ-Ⅳ (OR=2.38, 95%CI 1.71 to 3.32,P<0.000 01), and was higher in cell differentiation G1-G2 than G3 (OR=2.48, 95%CI 1.72 to 3.56,P<0.000 01), while no significant difference was found in groups of serous ovarian cancervs. non serous ovarian cancer (OR=1.28, 95%CI 0.89 to 1.83,P=0.18). Conclusion The current evidence shows that the expression of PR protein have predictive value for the prognosis of ovarian cancer. Due to limited quantity and quality of included studies, the above conclusions are still needed to verified by more high quality studies.
ObjectivesTo explore the efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage.MethodsA total of 122 patients with hypertension-related intracerebral hemorrhage treated in our hospital from October 2015 to May 2019 were categorized into experimental group (n=62) and control group (n=60). The experimental group was treated with endoscopic intracerebral hematoma removal, while the control group was treated with traditional craniotomy. The operative indexes, postoperative recovery, serum endothelin, IL-6, CRP levels and the incidence of postoperative complications were observed and compared between the two groups, and the relevant factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation were analyzed.ResultsThe operation time, intraoperative blood loss, hematoma clearance rate, ICU treatment time, the volume of brain edema 7 days after operation, the postoperative intracranial pressure, NIHSS score and ADL score in experimental group were significantly superior to those in control group. The levels of serum endothelin, IL-6 and CRP in the experimental group were significantly lower than those in the control group after operation. The incidence of complications in the experimental group was lower than that in control group. Univariate analysis showed that the prognosis of patients undergoing neuroendoscopic evacuation of intracerebral hematoma was significantly correlated with the history of hypertension, preoperative GCS score, the amount of bleeding and whether been broken into the ventricle (P<0.05), but not with age, sex and location of hemorrhage (P>0.05). Multivariate logistic regression analysis showed that the history of hypertension above 10 years, blood loss above 50 mL, intraventricular rupture and preoperative GCS score were the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.ConclusionsCompared with traditional craniotomy, neuroendoscopic evacuation of intracerebral hematoma has the advantages of better curative effect and lower incidence of postoperative complications in the treatment of hypertension-related intracerebral hemorrhage. The history of hypertension above 10 years, bleeding volume above 50 mL, breaking into the ventricle and preoperative GCS score are the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.
Objective To study the risk factors and prognosis of hospital acquired pneumonia( HAP)caused by carbapenem-resistant Acinetobacter baumannii( CRAB) . Methods By a case-control study, the data of 44 cases of HAP caused by CRAB fromJan 2005 to Dec 2007 in Nanfang Hospital were analyzed. 66 cases of HAP caused by Carbapenem-susceptible A. baumannii ( CSAB) were selected randomly at the same time as control. Univariate analysis( T test and chi-square test) and multivariate logistic regression were used for statistics analysis. Results Univariate analysis revealed that five factors associated with the infection caused by CRAB were APACHE Ⅱ score ≥ 16, chronic pulmonary disease ( COPD/ bronchiectasis ) , imipenem/meropenem and fluoroquinolone used 15 days before isolation of CRAB, and early combination therapy of antibiotics. Multivariate logistic regression analysis identified two independent factors as APACHEⅡ score ≥16( OR=6. 41, 95% CI 2. 20-18. 67) and imipenem/meropenemused 15 days before isolation of CRAB( OR =6. 33,95% CI 1. 83-21. 87) . Of 44 cases of CRAB infections, 14 patients died and 30 patients survived. Univariate analysis revealed that two factors associated with poor prognosis were organ failure and clinical pulmonary infection score( CPIS) rise after three-day treatment. According to multivariate logistic regression analysis, only CPIS rise after three-day treatment ( OR =7. 01, 95% CI 1. 23-40. 03) was an independent predictive factor. Conclusions APACHEⅡ score ≥ 16 and imipenem/meropenem used 15 days before isolation of CRAB were independent risk factors for CRAB infection. CPIS rise after three-day treatment was a predictive factor for the prognosis of CRAB infection.
Objective To investigate the outcome and prognostic factors of hospital mortality in patients with acute cerebrovascular disease requiring mechanical ventilation.Methods Data from 94 patients with acute cerebrovascular disease in central intensive care unit(ICU) were collected and retrospectively analyzed.Prognostic factors of hospital mortality were analyzed by univariate statistics and multivariate logistic regression.Results Hospital mortality was 53.2%(50/94).There was significance diference in parameters such as APACHE II score，blood glucose，lengh of hospital stay，lengh of ICU stay，time of mechanical ventilation，incision of trachea，lung infections，lesion loci and its naturer between the survival and non-survival groups（all Plt;0.05）.Multivariate logistic regression revealed that blood glucose，lung infections，diseased region under tentorium of cerebellum，time of mechanical ventilation were independent prognostic risk factors of hospital mortality(all Plt;0.05).Whereas the lengh of ICU stay was protective factor(Plt;0.05).Conclusion The hospital mortality is considerably high in patients with acute cerebrovascular disease requiring mechanical ventilation. The prognostic factors such as blood glucose and lung infections should be evaluate cautiously and prevented aggressively.
Macular edema (ME) secondary to central retinal vein occlusion（CRVO) often cause severe visual impairment. Intravitreal anti-vascular endothelial growth factor agents and steroids can effectively eliminate ME and improve visual function, but the visual outcome is affected by multiple factors. Retinal blood flow, especially the macular microcirculation, has significant correlation with visual outcome. Ischemic CRVO, especially patients with severe damage in the deep and superficial vascular layer of the macular zone, usually have poor visual outcome. In addition, the integrity of the multi-layer retinal structure closely correlates with the visual outcome. Patients with intact ellipsoid zone, external limit membrane beneath the fovea have good visual recovery. Additionally, good baseline visual acuity, positive response to treatment in early phase, young age and timely treatment usually brings about better visual outcome.
【Abstract】ObjectiveTo analyze the factors influencing the prognosis of patients with bile duct carcinoma after resection. MethodsThe clinical data of 120 patients with bile duct carcinoma receiving resection in our hospital from 1980 to 2004 were collected retrospectively and clinicopathologic factors that might influence survival were analysed. A multiple factor analysis was performed through Cox proportional hazard model. ResultsThe overall 1year, 3year and 5year survival rates were 71.7%, 32.5% and 19.2% respectively. The single factor analysis showed that the major significant factors influencing survival of these patients were histological type of the lesions, lymph node metastasis, pancreatic infiltration, duodenal infiltration, resected surgical margin, perineural infiltration, peripheral vascular infiltration and depth of tumor infiltration (P＜0.05). Lymph node metastasis, pancreatic infiltration and perineural infiltration were found to be the the statistically significant factors influencing survival by multiple factor analysis through the Cox model. ConclusionThe most important prognostic factors for bile duct carcinoma after resection were lymph node metastasis, pancreatic infiltration and perineural infiltration.
