Objective To investigate the difference of anticoagulant efficacy of heparin and citric acid during continuous renal replacement therapy (CRRT) in patients with severe acute pancreatitis, and analyze their effects of on filter life span, length of hospital stay and mortality. Methods Patients with severe acute pancreatitis in Intensive Care Unit of the First Affiliated Hospital of Hebei North University between January 2018 and July 2022 were retrospectively enrolled, and they were divided into heparin group (control group) and citric acid group (research group) according to anticoagulation methods. The differences of anticoagulant catheter blockage during CRRT, filter life span, length of hospital stay, and 90-day mortality between the two groups were analyzed. Results A total of 108 patients were enrolled, including 56 in the research group and 52 in the control group. In pre-CRRT treatment, the balance value of fluid intake and outflow in the research group was significantly lower than that in the control group (P<0.05). The 108 patients received 217 times of CRRT treatment totally, with a median length of treatment of 63 h (range 44-87 h). The severity of catheter blockage in the research group was lower than that in the control group (P=0.003). The filter life span was longer in the research group than that in the control group [42.5 vs. 29.0 h; hazard ratio=1.83, 95% confidence interval (1.23, 2.73), P<0.001]; in the comparison of 90-day mortality, there was no significant difference between the two groups (P>0.05). The mean use of filters in the research group was less than that in the control group (1.93±0.09 vs. 2.17±0.14, P<0.001). The downtime of CRRT due to filter life in the research group was obviously shorter than that in the control group [120 (0, 720) vs. 300 (0, 890) min, P=0.029], while the duration of CRRT in the research group was remarkably better than that in the control group [10.6 (4.9, 27.7) vs. 8.1 (3.6, 25.0) d, P=0.024], and the risk of filter replacement due to special conditons in the research group was lower than that in the control group (46.4% vs. 65.4%, P=0.048). There was no statistically significant difference in the length of intensive care unit hospitalization or total hospitalization between the two groups (P>0.05). Conclusion Both heparin and citric acid could assist the treatment of CRRT, while citric acid might be apt to improve local coagulation and systemic inflammatory response.
ObjectiveTo explore the clinical value of the soluble urokinase type plasminogen activator receptor (suPAR) level in bronchoalveolar lavage fluid (BALF) for evaluateting the disease severity and prognosis of severe community-acquired pneumonia (SCAP).
MethodsEighty-four patients with SCAP were recruited as a SCAP group from the respiratory department, ICU and RICU between April 2014 and April 2016. According to their organ dysfunction, the SCAP patients were subdivided into a MODS group and a non-MODS group. Depending on the treatment response on the 7th day of treatment, they were subdivided into an effective group and an ineffective group. According to the survival condition within 28 days, they were subdivided into a survival group and a death group. Meanwhile, 50 cases with non-severe common community acquired pneumonia were recruited as a control group. On the admission day, all cases were evaluated by PSI score and APACHE Ⅱscore. The serum suPAR level were detected by ELISA on the 1st day in hospital. The suPAR and procalcitonin (PCT) levels in the patient's BALF and serum were detected on the 1st, 3rd, 7th day, discharge or death day. The symptoms and signs, biochemical and pulmonary imaging changes were also observed.
ResultsThere were no differences in the sex, age, body weight, duration of pneumonia, or complicated diseases such as hypertension, coronary heart disease and cerebral vascular diseases between the SCAP group and the control group (all P > 0.05). The suPAR levels in serum and BALF of the SCAP group were higher than those of the control group with significant differences (all P < 0.05). The suPAR level in BALF was obviously higher than that in serum in the SCAP group with significant difference (P < 0.05), and slightly higher than that in serum in the control group with no significant difference (P > 0.05). The level of suPAR in BALF of the MODS group was significantly higher than that in the non-MODS group with significant difference (P < 0.05), but there was no significant difference in the PCT level between the two groups (P > 0.05). The suPAR level in the ineffective treatment group was significantly higher than that in the effective treatment group on the 7th day in hospital with significant difference (P < 0.05). The suPAR levels in BALF of the death group were higher than those in the survival group at each time point after admittion with significant difference (all P < 0.05), and the PCT levels had no significant difference between the two groups within 1 week of each time point (all P > 0.05). The suPAR level in BALF of the SCAP group was positively correlated with APACHEⅡ score and PSI score (r=0.578, P=0.0085; r=0.565, P=0.0071), and plasma PCT level was weakly correlated with the APACHEⅡ score and PSI score (r1=-0.0137, r2=-0.0152).
ConclusionThe SuPAR level in BALF of patients with SCAP is closely related to the severity and prognosis, and can be used as an index to assess the severity and prognosis.
Objective To investigate the quality of the randomized controlled trials (RCTs) of traditional Chinese medicine (TCM) integrated with western medicine for severe acute respiratory syndrome (SARS). Method All the randomized controlled trials of traditional Chinese medicine integrated with western medicine for SARS worldwide were gained by electronic searching and hand searching. The quality of the RCTs was analyzed by the quality grade evaluation used in Cochrane handbook.The sample size, the baseline data, the results indexes were also analyzed. Results Seven RCTs included 501 SARS cases were identified. The quality grade of one RCT is B, the other six RCTs were graded C. None pre-specified sample size. One RCT tested the differences of the baseline data by statistic method. One RCT reported quality of life as result index. None reported the adverse events.Conclusions Current RCTs of TCM integrated with western medicine can’t provide b evidence for clinical practice because of the poor quality.
Objective
To evaluate the methodological and reporting quality of systematic reviews/meta-analyses related to the efficacy and safety of corticosteroid-assisted treatment for severe pneumonia.
Methods
PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data and VIP databases were searched by computer, and the systematic reviews/meta-analyses of corticosteroid hormone as an auxiliary means for the treatment of severe pneumonia which were published from establishment of the databases to October 25th, 2018 were searched. A Measurement Tool to Assess Systematic Review-2 (AMSTAR-2) was used to assess the methodological quality of the included studies, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to evaluate the quality of literature reports.
Results
A total of 16 systematic reviews/meta-analyses were included, all of which were non-Cochrane systematic reviews. In terms of methodological quality assessed by AMSTAR-2, there was no plan in all studies; only one study explained the reasons for inclusion in the study type; eight studies did not describe the dose and follow-up time of the intervention/control measures in detail; three studies did not indicate the evaluation tools and did not describe the risk bias; six studies did not explicitly examine publication bias. In terms of reporting quality assessed by PRISMA, all studies had no pre-registered study protocol or registration number; thirteen studies did not describe the specific amount of articles retrieved from each database; three studies did not present their retrieval strategies or excluded reasons in detail; no funding sources were identified in included studies; eight studies reported both whether the study was funded and whether there was a conflict of interest.
Conclusions
At present, there are many systematic review/meta-analysis studies on the efficacy and safety of corticosteroid-assisted treatment for severe pneumonia, and the overall quality of the study has been gradually improved. However, the common problems in the study are relatively prominent. The follow-up period and dose of intervention in the study of severe pneumonia are different, so the baseline is difficult to be unified. Suggestions: strengthening the training of researchers, standardize the research process, and report articles in strict accordance with the PRISMA statement; subgroup analysis being conducted according to the dose and duration of the hormone.
Objective
To determine the role of serum cystatin C in evaluating the severity and predicting in-hospital mortality in patients with community-acquired pneumonia (CAP).
Methods
The clinical data of 176 patients with CAP treated between January 2015 and October 2016 were collected in a retrospective way. The CURB-65 score was used to assess the severity. The serum levels of cystatin C and C-reactive protein (CRP) on admission were measured. The correlations between cystatin C and CURB-65 score and between cystatin C and CRP were calculated. Receiver operating characteristic curve was used to determine the ability of cystatin C in predicting in-hospital mortality.
Results
The serum level of cystatin C increased with the increasing CURB-65 score (P<0.001). The serum level of cystatin C was correlated positively with CRP level (rs=0.190, P<0.011). There were 22 patients died in hospital, the mean serum cystatin C level of non-survivor was significantly higher than that of survivors [(1.51±0.56)vs. (1.02±0.29) mg/L, P<0.001]. At a cut-off 1.18 mg/L, the sensitivity and specificity of cystatin C in predicting in-hospital mortality were 68.18% and 81.17%, respectively. The area under the receiver operating characteristic curve was 0.793. The combination of cystatin C and CRP increased the predictive accuracy for in-hospital mortality.
Conclusion
Cystatin C level increases with the increaseing severity of CAP, and it may be a clinical biomarker to evaluate the severity and prognosis of patients with CAP.
Objective To explore the effects of ulinastatin (UTI) on renal apoptosis and expression of bcl-2 in rats with severe acute pancreatitis (SAP). Methods Sixty rats weighing 250-300 g were randomized divided into 3 groups: pseudo-operation group (SO group, n=20), SAP group (n=20) and UTI treated group (UTI group, n=20). The model of SAP was established by retrograde injection of 5% sodium taurocholate solution into the biliopancreatic duct in the rats. Serum Cr and BUN were determined. The left kidneys were resected for light and electronic microscopic study. Renal cell apoptosis was determined by TUNEL. Expression of bcl-2 was detected by immunohistochemical staining of SABC. Results Serum Cr, BUN, renal cell apoptotic index and bcl-2 expression were markedly increased in SAP group compared with SO group （P＜0.05， P＜0.01）, Renal tissue injuries were aggravated in SAP group under light and electronic microscopic study as well. In UTI group, serum Cr, BUN and renal cell apoptotic index were decreased significantly while the expression of bcl-2 increased remarkably and renal tissue injuries relieved compared with SAP group （P＜0.05）. Positive correlations were found between the renal cell apoptotic index and BUN as well as Cr (r=0.807, P＜0.05; r=0.812, P＜0.05). Conclusion The protective effect of UTI on SAP renal injury is probably through increasing bcl-2 expression and decreasing apoptosis.
ObjectiveTo discuss the risk factors of acute respiratory distress syndrome (ARDS) in patients with severe pneumonia.MethodsData of 80 patients with severe pneumonia admitted in our ICU were analyzed retrospectively, and they were divided into two groups according to development of ARDS, which was defined according to the Berlin new definition. The age, gender, weight, Acute Physiology and Chronic Health EvaluationⅡscore, lactate, PSI score and LIPS score, etc. were collected. Statistical significance results were evaluated by multivariate logistic regression analysis after univariate analysis. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of the parameter for ARDS after severe pneumonia.ResultsForty patients with severe pneumonia progressed to ARDS, there were 4 moderate cases and 36 severe cases according to diagnostic criteria. Univariate analysis showed that procalcitonin (t=4.08, P<0.001), PSI score (t=10.67, P<0.001), LIPS score (t=5.14, P<0.001), shock (χ2=11.11, P<0.001), albumin level (t=3.34, P=0.001) were related to ARDS. Multivariate logistic regression analysis showed that LIPS ［odds ratio (OR) 0.226, 95%CI=4.62-5.53, P=0.013］ and PSI (OR=0.854, 95%CI=132.2-145.5, P=0.014) were independent risk factors for ARDS. The predictive value of LIPS and PSI in ARDS occurrence was significant. The area under ROC curve (AUC) of LIPS was 0.901, the cut-off value was 7.2, when LIPS ≥7.2, the sensitivity and specificity were both 85.0%. AUC of PSI was 0.947, the cut-off value was 150.5, when PSI score ≥150.5, the sensitivity and specificity were 87.5% and 90.0% respectively.ConclusionsPSI and LIPS are independent risk factors of ARDS in patients with severe pneumonia, which may be references for guiding clinicians to make an early diagnosis and treatment plan.
Objective To explore the value of combination APACHE II, Ranson with BalthazarCT Scoring System predicting the prognosis of severe acute pancreatitis (SAP). Methods The relationship between APACHE II, Ranson, Balthazar CT scoring systems and mortality of severe acute pancreatitis (SAP) patients admitted to the intensive care unit (ICU) of West China Hospital from January 1st, 2007 to December 31st, 2008 was analyzed. Results There was statistical difference between high and low score groups in the APACHE II, Ranson, BalthazarCT scoring systems. Combination APACHE II, Ranson with Balthazar CT scoring system, there was statistical difference between high and low Balthazar CT score group both in APACHE II and Ranson scoring systems. Conclusion APACHE II, Ranson combined with Balthazar scoring systems can be used as a more important clinical reference in evaluating the diagnosis and prognosis of severe acute pancreatitis.
ObjectiveTo summary the effect of parenteral nutrition combined with enteral nutrition on patients with severe acute pancreatitis.
MethodsThe clinical data of 200 patients with severe acute pancreatitis admitted in our hospital in recent 10 years were retrospectively analyzed. Of which 88 cases were treated by traditional nutritional support therapy (traditional nutrition group), the rest of 112 cases of patients with early parenteral nutrition to later period gradually combined with enteral nutrition comprehensive nutritional support strategy (comprehensive nutrition group).
ResultsThe APACHEⅡscores and serum level of C-reactive protein (CRP) of patients in comprehensive nutrition group were significantly lower than patients in traditional nutrition group (P < 0.05), while the serum albumin level was significantly higher than that of traditional nutrition group (P < 0.05). In the incidence of complications and mortality, the average length of stay and total cost of comprehensive nutrition group were significantly lower than patients with traditional nutrition group (P < 0.05), the cure rate was significantly higher than that of traditional nutrition group (P < 0.05).
ConclusionThe combination of parenteral nutrition and enteral nutrition of nutrition support model not only can shorten the duration of symptoms but also alleviate the burden of patients and reduce complications and mortality.
Coronavirus disease 2019 has been widespread in Hubei province since the beginning of 2020. Many medical teams went to aid Hubei from the whole country. The medical team of West China Hospital of Sichuan University arrived in Jianghan district of Wuhan on January 25, 2020. As one of the earliest teams arriving Hubei, we explored the measures for infection prevention and control of resident, in order to reduce the risk for infection of medical team. The infection prevention and control experiences on the establishment of infection control team, process management, behavior management, clean disinfection, infection monitoring and emergency response and emergency response to exposure of the medical team of West China Hospital were summarized in this article.
