Mother-to-child transmission is one of the primary ways of HBV transmission, and reducing mother-to-child transmission is a global issue. Tenofovir alafenamide fumarate (TAF) and tenofovir disoproxil fumarate (TDF) are widely recognized as the main antiviral drugs for the treatment of hepatitis B. TDF has been shown to be effective and relatively safe in reducing serum HBV-DNA levels in pregnant women and preventing the incidence of mother-to-child transmission. However, there is limited data on the effectiveness and safety of TAF in preventing mother-to-child transmission. In this review, a brief overview of the domestic and international use of TAF during pregnancy is summarized.
Objective:To understand the characteristics of HIV-1 genotypes and primary drug resistance among newly reported HIV-1 infected people in Ningbo in 2022.Methods:Plasma samples were collected from newly reported HIV-1 infected patients before ART in Ningbo from January to December 2022. RNA was extracted, RT-PCR and nested PCR were used to amplify the pol gene sequences of HIV-1 strains. The genotypes were identified by phylogenetic tree construction. Drug resistance of these strains were analyzed by the online tool of the Stanford University HIV-1 Drug Resistance Database. Results:A total of 628 HIV-1 infected people were newly reported in Ningbo in 2022, of which 426 sequences were successfully obtained, revealing 15 different genotypes. The two predominant subtypes were CRF07_BC (42.0%, 179/426) and CRF01_AE (30.5%, 130/426), followed by unique recombinant form(URF)(01_AE/07_BC) (7.0%, 30/426), CRF08_BC (6.6%, 28/426), CRF55_01B (4.9%, 21/426), CRF85_BC (2.3%, 10/426), B (2.1%, 9/426), C (1.9%, 8/426), URF(B/C) (0.7%, 3/426), URF(01_AE/C) (0.5%, 2/426), URF(01_AE/B) (0.5%, 2/426), CRF59_01B (0.2%, 1/426), CRF64_BC (0.2%, 1/426), CRF67_B (0.2%, 1/426), and A1 (0.2%, 1/426). The overall primary drug resistance rate was 6.3% (27/426), with resistance rates to non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, and protease inhibitors of 3.8% (16/426), 1.9% (8/426), and 0.9% (4/426), respectively.Conclusions:HIV-1 genotypes of newly reported HIV-1 infected people in Ningbo in 2022 are diverse, including a relatively high proportion of URFs. The overall drug resistance rate of patients before ART is intermediate.
沙门菌骨髓炎在临床上较为少见，仅占所有类型骨髓炎的0.45%，且常发生于血红蛋白病、恶性肿瘤、免疫缺陷、免疫抑制剂使用的患儿中，在无任何诱发因素的既往健康儿童中较为罕见 [1]。本研究回顾性分析2012年1月至2022年1月西安市儿童医院收治的3例既往健康儿童感染沙门菌骨髓炎的临床资料，并复习国内外相关文献，探讨既往健康儿童感染沙门菌骨髓炎的临床特点及治疗方法，以提高对该病的认识。
Sepsis refers to life-threatening organ dysfunction caused by a dysregulated host response to infection, and has become one of the most common causes of death in intensive care units. Previous animal experiments and clinical studies have shown that sepsis not only causes excessive inflammation, but also leads to immune system dysfunction and impaired antimicrobial immunity. Therefore, immunotherapy is a fundamental approach to enhance host resistance to infection. The main mechanisms of immune response, the approaches of immune monitoring, and the potential immunotherapies for sepsis, attempting to provide some insights for immune monitoring and immunotherapy of sepsis are summarized in this article.
Objective:To understand the characteristics associated with casual heterosexual behavior among male college students in Zhejiang.Methods:A random sampling method was used to select 2 446 male university students with heterosexual behavior from 13 universities in 11 cities of Zhejiang Province in 2018 as survey respondents. A self-developed online questionnaire was used to collect information on the demographic characteristics, sexual attitudes, sexual behavior, education and interventions, and sexual partners of the respondents. Rate differences were used to compare the differences between the group with casual sexual behaviour and the group without casual sexual behaviour.Results:Among the 2 446 heterosexual male students, 455 students had casual sexual behaviour with the age of (20.09±1.38) years, and 1 991 students had not engaged in casual sexual behaviour with the age of (20.24±1.41) years. The proportions of students with casual sex who were ≤19 years old (34.3%, 156/455), from urban areas (43.5%, 198/455), had a monthly living expense ≤1 000 yuan (29.9%, 136/455) or ≥1 501 (40.4%, 184/455), had received publicity such as HIV testing in school in the last year (67.5%, 307/455), had received self-assessment of HIV risk in school in the last year (48.1%, 219/455), had engaged in one-night stands (78.0%, 355/455), had engaged in commercial sex (53.4%, 243/455), had high self-efficacy for using condom during sex (42.2%, 183/455), and had accepted voluntary HIV counseling and testing in the last year (8.4%, 38/455) were significantly higher than those in students without casual sex( P=0.036, 0.010, 0.038, 0.009, 0.002, <0.001, <0.001, <0.001, 0.002 and 0.002). The proportions of students in the fourth year of college (10.1%, 46/455), with a monthly living expense between 1 001 and 1 500 yuan (29.7%, 135/455), who believed that daily life and learning could lead to HIV transmission (80.2%, 365/455), who knew that correct and consistent condom use could reduce the risk of HIV infection and transmission (95.2%, 433/455), who knew that seeking HIV counseling and testing after engaging in high-risk behavior (93.8%, 427/455), and who had no self-efficacy for using condom during sex (22.8%, 99/434) were lower than those in the group without casual sexual behavior ( P<0.001, <0.001, <0.001, =0.006, 0.019 and 0.004). Conclusions:The prevalence of casual sexual behavior is high among male college students engaged in heterosexual behavior in Zhejiang. Those who engage in casual sexual behavior have a more open attitude toward sex, inconsistent knowledge and behavior, lower HIV testing rates, and lower condom use during sex with regular partners.
Hepatic encephalopathy is a common complication and the main cause of death in patients with liver cirrhosis or liver failure, and it often recurrences after medication. Human intestinal microbiota comprises diverse species and has large quantity, which is closely related to the immune system and the normal physiological function of intestinal tract. In recent years, there have been many reports of fecal microbiota transplantation in the treatment of various intestinal and extraintestinal diseases, such as recurrent Clostridium difficile infection, inflammatory bowel disease, non-alcoholic fatty liver disease, cirrhosis and other diseases. The clinical research progresses of fecal microbiota transplantation in the treatment of liver cirrhosis or liver failure complicated with hepatic encephalopathy are reviewed in this article, so as to provide reference for the treatment of hepatic encephalopathy.
Objective:To prepare specific monoclonal antibodies against Yamagata-lineage influenza B virus hemagglutinin (HA) and establish a dual antibody sandwich ELISA method for detecting Yamagata-lineage influenza B virus.Methods:BALB/c mice were immunized with Yamagata-lineage influenza B virus (B/Phuket/3073/2013) antigen. The spleen cells of the immunized mice were fused with myeloma SP2/0 cells, and positive hybridoma cells were obtained through four limited dilutions and established. A dual antibody sandwich ELISA method for detecting Yamagata-lineage influenza B virus was established by using monoclonal antibodies 1F7 and 2H6 as capture and detection antibodies, respectively.Results:In this method, the encapsulation amount of antibody 1F7 captured on a 96 well plate was 40 ng/well, and the working concentration of antibody 2H6 detected was 100 ng/well. This method showed strong specificity for only Yamagata-lineage influenza B virus. Sensitivity analysis showed high sensitivity with the minimum detection values of 2 -1 HAU/100 μL and 1.22 ng/mL for virus allantoic fluid and virus purified HA protein, respectively. The repeatability test showed that the coefficients of variation in intra-and inter-assay were less than 5%. Conclusions:The ELISA method established in this study has strong specificity, high sensitivity, and good repeatability, providing technical support for the rapid diagnosis and quantitative detection of Yamagata-lineage influenza B virus.
Objective:To explore the clinical and pathogenic features of co-infection in children with pertussis.Methods:Children diagnosed with pertussis and completed multiple PCR detection of respiratory pathogens were selected in Shenzhen Children's Hospital from 2018 to 2022. According to the pathogen composition, they were divided into pertussis infection group and co-infection group, and the clinical characteristics of the two groups were analyzed. Risk factors for co-infection were anaylzed by binary Logistic stepwise regression analysis method.Results:A total of 208 children were included, with 64 cases in pertussis infection group and 144 cases in co-infection group. Among 144 cases of co-infection, 106 patients (73.61%, 106/144) were co-infected with a single pathogen, and the main pathongen was rhinovirus(63.21%, 67/106). Age >3 months ( OR=2.262, 95% CI: 1.185-4.316) and wheezing ( OR=2.771, 95%CI: 1.177-6.522) were risk factors for co-infection in children with pertussis. Conclusions:The rate of co-infection is relatively high among hospitalized children with pertussis. Co-infection is more likely to occur in children over 3 months old or with the symptom of wheezing.
为加强和规范狂犬病暴露预防处置工作，降低狂犬病发病率，保护人民群众身体健康，根据《中华人民共和国传染病防治法》《中华人民共和国疫苗管理法》等有关规定，结合我国狂犬病疫苗和被动免疫制剂研制进展，制定本规范。
Talaromyces marneffei ( T.marneffei) is a dimorphic opportunistic pathogenic fungus, which mainly infects populations with AIDS and other immunodeficiency disorders, causing disseminated talaromycosis. T.marneffei rarely invades central nervous system, but case reports have increased recently. The clinical characteristics of this disease are atypical, leading to many difficulties in the diagnosis. Moreover, because the treatment options are not determined, the mortality rate is high. This article intends to review the epidemiological and clinical characteristics, diagnosis and treatment strategies, as well as the prognosis of central nervous system infection caused by T.marneffei, in order to improve the understanding and diagnosis and treatment levels of the disease.
Objective:To explore the predictive and diagnostic value of serum endotoxin and IL-6 in AIDS patients complicated with bacterial bloodstream infection.Methods:From August 2008 to August 2021, a total of 81 patients with AIDS complicated with bacterial infection were collected in General Hospital of Ningxia Medical University. According to the result of serum culture, the patients were divided into bloodstream infection group (35 cases) and local infection group (46 cases). General data and related laboratory tests of all the patients were collected, including CD4 +T lymphocyte count, microbial culture results, endotoxin, IL-6, lymphocyte count and neutrophil count. The differences between the two groups in general data and infected bacteria spectrum were compared. The differences in endotoxin and IL-6 levels within 24 hours of the first blood culture from the patients suspected bloodstream infection were analyzed to explore their early predictive value for AIDS patients with bloodstream infection. Receiver operating characteristic (ROC) curve was draw to compare their diagnostic value alone and in combination. Results:The endotoxin level in bloodstream infection group was 0.09 (0.07, 0.12) EU/mL, which was higher than that in local infection group [0.05 (0.04, 0.05) EU/mL], and the difference was statistically significant ( Z=-5.88, P<0.001). The level of IL-6 in bloodstream infection group was (37.66±26.32) pg/mL, which was higher than that in local infection group[(24.64±13.84) pg/mL], and the difference was statistically significant ( t=2.67, P=0.010). Compared with the local infection group, the area under ROC curve (AUC) of endotoxin in bloodstream infection group was 0.88, with the critical sensitivity of 82.9% and the specificity of 84.8%. The AUC of serum IL-6 in bloodstream infection group was 0.64, with the critical sensitivity of 40.0% and the specificity of 95.7%. The AUC of combined diagnosis was 0.91. Conclusions:The level of endotoxin is helpful in distinguishing bloodstream infection in AIDS caused by Gram-negative bacteria and Gram-positive bacteria. The early predictive and diagnostic value of endotoxin for AIDS complicated by bloodstream infection is better than that of IL-6. The combined evaluation of endotoxin and IL-6 is more helpful for the early diagnosis of bacterial bloodstream infection in AIDS.
Objective:To evaluate the safety of domestically produced pneumococcal 15-valent conjugate vaccine (PCV15) in healthy adults, children and infants.Methods:From January to August 2020, a single-center, single-arm trial was conducted at Hebei Clinical Vaccine Research Center, and a total of 100 subjects aged 2 months (at least 6 weeks old) or older were enrolled. The subjects were divided into five age groups: ≥18 years group, 1-5 years group, 7-11 months group, 3 months group, and 2 months (at least 6 weeks old) group, with 20 subjects in each group. Subjects in the ≥18 years and 1-5 years age groups received a single dose of the experimental vaccine, and those in the 7-11 months age group received the vaccine according to a 2-dose schedule of 0, 2 months. Those in the 3 months and 2 months age groups received the vaccine according to a 3-dose schedule of 0, 1, 2 months and 0, 2, 4 months, respectively. Adverse reactions within 30 days after vaccination were observed by regular follow-up and active reporting.Results:After one dose of the vaccine, 14 cases and 10 cases of adverse reactions occurred in ≥18 years and 1-5 years age groups, respectively. After two doses, there were 11 cases showing vaccine-related mild adverse reactions in the 7-11 months age group. In the 2-3 months age group, 26 cases (65.00%, 26/40) of adverse reactions occurred, with the occurrence of 12 cases and 14 cases in the 3 months and 2 months age groups, respectively. Systemic reactions were the main manifestation, including fever (57.50%, 23/40) and gastrointestinal reaction (diarrhea 15.00%, 6/40). Adverse reactions were mainly mild to moderate, and most occurred within 7 days after vaccination and lasted for a short time.Conclusions:The domestically produced pneumococcal 15-valent conjugate vaccine has good safety and high acceptability in various age groups.
Objective:To understand the incidence and mortality of pulmonary tuberculosis in Taizhou City, and provide basis for formulating tuberculosis prevention and control strategies.Methods:Descriptive epidemiological research methods were used to analyze the data of tuberculosis patients reported on the tuberculosis network registry in Taizhou City from 2011 to 2021.Results:A total of 31 683 cases of tuberculosis were reported in Taizhou City from 2011 to 2021, and the reported incidence rate was 47.11/100 000, showing a declining trend ( χ2trend = 739.49, P < 0.001). The onset peak was from March to August, accounting for 56.06% (17 760/31 683). Wenling County and Linhai County had a large number of cases, accounting for 41.69% (13 210/31 683). The average annual incidence rates in Tiantai County, Xianju County, and Wenling County were high, at 56.61/100 000, 53.49/100 000, and 52.85/100 000, respectively. Among these patients, the male to female ratio was 2.43∶1, and the majority were aged 20-59 years accounting for 77.37%(24 513/31 683). The incidence rate was high in the elderly population aged over 60 years. The dominant occupation was farmers(53.39%,16 917/31 683). Conclusions:The reported incidence rate of pulmonary tuberculosis in Taizhou City shows a declining trend. Further efforts are needed to strengthen tuberculosis prevention and control in high-epidemic areas. The elderly population aged over 60 years and farmers should be paid more attention, and need active screening and health education.
Objective:To investigate the preterm birth rate of HIV-infected pregnant women for different antiretroviral treatment options in Chengdu, and to identify the influencing factors.Methods:HIV-infected women who had delivered in Chengdu from 2015 to 2020 were enrolled, and they accepted different antiviral treatment regimens during pregnancy. Multivariate Logistic regression analysis was used to analyze the factors associated with prematurity.Results:A total of 373 HIV-infected pregnant women were enrolled, among whom the proportions of zidovudine (AZT) + lamivudine (3TC)+ lopinavir/ritonavir (LPV/r) protocol, tenofovir (TDF)+3TC+LPV/r protocol, TDF+3TC+ efavirenz (EFV) protocol were 52.6% (196/373), 28.4% (106/373) and 19.0% (71/373), respectively. The incidence rates of preterm birth were 16.8% (33/196), 7.5% (8/106) and 15.5% (11/71), respectively. The difference of prematurity rates based on protease inhibitor versus EFV regimen was not statistically significant( χ2=0.18, P=0.675). By multivariate Logistic regression analysis, different treatment options affected preterm birth after controlling the influencing factors of non-local residence and premature rupture of fetal membranes. Compared with TDF+3TC+ LPV/r protocol, AZT+3TC+LPV/r protocol had a higher risk of preterm birth ( ORadjusted=2.446, 95% CI: 1.077-5.622). Conclusions:Based on the monitoring data of blockade of mother to child transmission of HIV in Chengdu region, AZT+3TC+LPV/r protocol has the highest risk for preterm birth, while the risk of TDF+3TC+LPV/r protocol is low.
Clostridioides difficile can cause hospital-acquired antibiotic-associated diarrhea, which is one of the urgent threat of antimicrobial resistance. The prevalent strains of Clostridioides difficile vary across different regions globally. In Europe and America, the high-virulent RT027 is predominant, while in China, the most common strains are ST3, ST37, and ST54. The susceptibility of Clostridioides difficile to antimicrobial drugs varies in different regions worldwide. Most strains remain sensitive to metronidazole and vancomycin, but have high resistance to quinolones and clindamycin, and multidrug-resistant strains are common. The resistant strains commonly found in Europe and America are of type RT027, whereas in China, they are of type ST3, ST35, ST37, and ST54. Effective management of antimicrobial drugs and control of hospital infections are key measures for curb the resistance and outbreak of Clostridioides difficile.
With the widespread usage of carbapenems, carbapenem-resistant Enterobacteriaceae (CRE) are prevalent in different degrees globally. CRE strains affect the susceptibility of carbapenems through various ways such as the production of carbapenemase. The dominant epidemic CRE strains in different countries and regions are different, for instance KPC-carrying CRE is dominant in Asia and America, while OXA-carrying CRE is dominant in Africa. The clinical treatment of CRE mainly includes antibiotic use alone or in combination, and new treatment methods such as fecal microbiota transplantation, phage therapy and new drug developments are also being explored. In this paper, recent progress in molecular epidemiological characteristics and treatment of CRE are reviewed, so as to provide clues for the control of related diseases.
人偏肺病毒感染是人体感染人偏肺病毒(hu-man meta pneumo virus,hMPV)后引起的一种急性呼吸道传染病,全年散发,多发生于冬末及春初.hMPV感染大多表现为轻度自限性疾病,部分患者因出现毛细支气管炎、肺炎、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重和支气管哮喘急性发作等并发症需要住院治疗,免疫功能低下者可进展为重症肺炎,出现急性呼吸窘迫综合征(acute respiratory distress syn-drome,ARDS)或多器官功能不全等,甚至导致死亡.为进一步规范hMPV感染的临床诊治工作,结合国内外研究成果及我国既往hMPV感染诊治经验,制定本诊疗方案.
Objective:To understand the prevention and protective effect of public health emergency response on other infectious diarrhea.Methods:Data of other infectious diarrhea in Shangcheng District, Hangzhou City from 2010 to 2021 were selected from the China Disease Control and Prevention Information System. The round distribution method was used to analyze the time aggregation of other infectious diarrhea in children under 5 years old and the population aged 5 and above in Shangcheng District from 2010 to 2019. The descriptive epidemiological method was used to analyze the peak changes of other infectious diarrhea in children under 5 years old and the population aged 5 and above in this area under the state of public health emergency response from 2020 to 2021. Based on the incidence data from 2010 to 2019, the optimal summation autoregressive moving average(ARIMA) product seasonal model was constructed to predict the incidence of other infectious diarrhea in the region in 2020 under non-emergency response conditions, and the predicted results were compared with the actual data in the same period in 2020.Results:From 2010 to 2019, the incidence of other infectious diarrhea in children under 5 years old and other groups aged 5 and above in Shangcheng District was unimodal, with the peaks at December 17th and July 28th, respectively. From 2020 to 2021, after the public health emergency response to the outbreak of COVID-19, there was no significant peak of the incidence among the population aged 5 years and above, and the peak of the incidence among children under 5 years old was significantly delayed compared with previous years. The optimal ARIMA model showed that the actual incidence rate of other infectious diarrhea in children under 5 years old and groups aged 5 years and above in 2020 decreased by 63.76% and 41.74%, respectively compared with the predicted incidence rates.Conclusions:The preventive and control measures taken in the emergency response to public health emergencies may have a prevention effect on other infectious diarrhea.
Objective:To systematically evaluate the spontaneous clearance rates of genital Chlamydia trachomatis infection and their associated factors in order to provide evidence for epidemiological research and clinical intervention. Methods:The literatures related to spontaneous clearance of Chlamydia trachomatis infections were systematically searched in databases of PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Veep with a time-frame from the establishment of the databases to June 2022. The quality of the included literatures was evaluated according to the Newcastle-Ottawa Scale (NOS). RevMan5.4 and Stata14.0 software were used to perform Meta-analysis of spontaneous clearance of Chlamydia trachomatis infections and subgroup analysis according to potential factors associated to the clearance. Results:Sixteen papers with a total of 2 530 cases were finally included. Meta-analysis indicated that the overall spontaneous clearance rate of genital Chlamydia trachomatis infection was 37.28% (95% CI: 21.24%-53.32%). The spontaneous clearance rate was 31.79% (95% CI: 7.62%-55.96%) for males and was lower than females ( χ 2=83.69, P<0.001) ; and was 38.23% (95% CI: 20.17%-56.29%) for patients ≤30 years and was lower than patients>30 years ( χ 2=6.83, P=0.009) ; and was 34.00% (95% CI: 21.00%-46.00%) for follow-up of <1 year group and was lower than≥1 year group ( χ 2=93.24, P<0.001). The spontaneous clearance rates in vaginal infection, cervical infection and urethral infection were 36.00%(95% CI: 9.00%-63.00%), 35.00%(95% CI: 14.00%-56.00%) and 33.00% (95% CI: 9.00%-57.00%), respectively and the difference was statistically significant. Conclusions:The available evidence suggests that the spontaneous clearance rate of genital Chlamydia trachomatis infection is 37.28%, and the gender, age, follow-up time interval and infection site are risk factors for spontaneous clearance of genital Chlamydia trachomatis infection.
Objective:To investigate the early prognostic value of central venous-arterial carbon dioxide tension (GAP) combined with GAP to arterial-central venous oxygen content ratio (GAP ratio) in patients with septic shock.Methods:A total of 571 ICU patients with septic shock in Ningbo Medical Centre Lihuili Hospital from January 2018 to April 2022 were selected as the research objects for the retrospective study. According to the GAP and GAP ratio at the time of admission, patients were divided into four groups: group A (180 cases): GAP ≤6 mmHg (1 mmHg=0.133 kPa) and GAP ratio ≤1.8; group B (35 cases): GAP>6 mmHg and GAP ratio ≤1.8; group C (113 cases): GAP ≤6 mmHg and GAP ratio>1.8; group D (243 cases): GAP>6 mmHg and GAP ratio>1.8. According to 28-day mortality, the patients were divided into survival group (339 cases) and death group (232 cases). The basic data, clinical and prognostic indicators of patients in each group were recorded and analyzed. Binary Logistic regression was used to analyze the risk factors influencing the prognosis of patients with septic shock. The receiver operating characteristic curve (ROC) was drawn to analyze the early prognostic value of GAP and GAP ratio for septic shock.Results:There were significant differences in lactate, cardiac output (CO), vasoactive-inotropic score (VIS), acute physiology and chronic health evaluation (APACHE-Ⅱ), sequential organ failure assessment (SOFA), extubation rate, and 28-day mortality among different groups ( Z=18.89, F=101.29, Z=131.58, F=24.19, F=24.82, χ2=197.19, χ2=191.58, all P<0.001). The levels of CO in group A and group C were (5.2±1.5) L/min and (4.8±1.5) L/min, respectively, which were higher than that in group D with significant differences ( t=15.87 and 13.80, both P<0.001). The VIS, APACHE-Ⅱ, SOFA and 28-day mortality rate in group D were 20.8(10.9, 33.5), (23.8±9.1), (13.4±7.0) and 72.0%, respectively, which were higher than those in the other three groups with significant differences ( Z=11.76, 5.46 and 5.41; t=8.21, 3.70 and 3.86; t=8.54, 3.69 and 4.46; χ2=191.05, 37.38 and 42.34; all P<0.05). The extubation rate in group D was 24.7%, which was lower than those in the other three groups with significant differences ( χ2=172.55, 47.56 and 56.92, all P<0.001). Binary Logistic regression analysis showed that lactate, VIS, GAP, and GAP ratio were independent risk factors for death with OR values of 1.14, 1.12, 1.42 and 6.51, respectively. ROC curve analysis showed that the Youden index of GAP was 0.53, the area under the curve (AUC) for predicting death in patients with septic shock was 0.84(95% CI: 0.81-0.88), and the cut-off value was 6.48 mmHg with the sensitivity of 76.3% and the specificity of 76.4%. The Youden index of GAP ratio was 0.62, the AUC was 0.88(95% CI: 0.86-0.91), and the cut-off value was 2.11 with the sensitivity of 76.3% and the specificity of 85.8%. The Youden index of GAP combined with GAP ratio was 0.70, which had a good predictive value with the AUC of 0.94(95% CI: 0.92-0.96), the sensitivity of 83.2%, and the specificity of 86.7%. Conclusions:GAP combined with GAP ratio has a good clinical application value in the early prognostic evaluation of patients with septic shock.
