Background Sepsis-related adult respiratory distress syndrome (ARDS) is a life-threatening condition characterised by a high mortality rate. This underscores the pressing requirement to identify and develop potential therapeutic targets for the severe condition. This study investigated the genetic predisposition to sepsis-related ARDS in this study. Methods We utilised summary-based Mendelian randomisation (SMR), two-sample MR (TSMR), mediating MR, and multivariate MR (MVMR) analysis to explore the genetic susceptibility of sepsis-related ARDS by integrating over 10 000 cis-expression quantitative trait loci (cis-eQTLs) and over 100 000 participants. Subsequently, we performed drug target analysis to identify potentially druggable cis-eQTL genes. Results The SMR analysis identified 677 cis-eQTL genes associated with sepsis. Further TSMR validation filtered 72 cis-eQTL genes causally associated with sepsis. Sepsis was causally associated with ARDS (beta = 1.80, standard error (SE) = 0.36, P < 0.001). After conducting the mediating MR and MVMR analysis, 50 cis-eQTL genes were reported to be causally associated with sepsis-related ARDS. Subsequent drug target analysis confirmed the role of four targets (PSMA4, PDK2, RPS18, and NDUFV3) as druggable genes for sepsis-related ARDS. Conclusions Through an extensive analysis, we identified potential drug targets for sepsis-related ARDS. Additional research is imperative to substantiate our discoveries and to pave the way for the development of novel pharmaceuticals aimed at these specific targets.

BACKGROUND:It is unclear whether different modes of continuous renal replacement therapy (CRRT) impact post-filter ionized calcium concentrations during regional citrate anticoagulation (RCA) when using calcium-containing replacement fluid. METHODS:This prospective, single-center, observational cohort study will screen all patients receiving CRRT for eligibility. General clinical information will be collected before commencing CRRT treatment. Patients will be randomly assigned to either the continuous veno-venous hemofiltration (CVVH) or continuous veno-venous hemodialysis (CVVHD) group and switch to the alternative mode in the subsequent treatment session. Pre-filter and post-filter ionized calcium, systemic total and ionized calcium, and effluent total calcium will be measured 2 h after the initiation of CRRT. Electrolyte levels, arterial blood gases, hourly citrate dose, and total citrate dose will be recorded every 6 h until the end of CRRT. The primary outcome is the difference in ionized calcium concentrations at each site over time between the two modes. DISCUSSION:This study will build upon clinical practice to explore the differential effects of various CRRT modes on ionized and total calcium in patients undergoing RCA-CRRT with calcium-containing replacement solutions.

Conventional vital signs lack the specificity for intraoperative nociception. The Surgical Pleth Index (SPI), calculated from photoplethysmographic waveforms, provides a quantitative measure of nociceptive status ranging from 0 to 100. Elevated SPI values correspond to increased nociceptive intensity. While some evidence suggests that SPI may help predict pain, its accuracy in forecasting postoperative pain requires further validation. This study aimed to assess the capacity of the Surgical Pleth Index (SPI) to predict moderate to severe pain following surgery. We conducted a systematic literature search across three databases to identify studies investigating SPI’s predictive value for postoperative pain. A random-effects model was applied to pool summary estimates of sensitivity, specificity, and the area under the summary receiver operating characteristic curve (SROC-AUC). Analysis included ten studies encompassing 1,042 patients. Pooled sensitivity and specificity were 0.74 (95% CI: 0.67–0.80) and 0.65 (95% CI: 0.55–0.74), respectively. The SROC-AUC reached 0.76, suggesting a moderate level of predictive accuracy. Significant heterogeneity was observed and not explained by differences in SPI cutoff values. The SPI demonstrates moderate accuracy in forecasting moderate-to-severe postoperative pain and may serve as a useful adjunct to conventional clinical assessment. The Surgical Pleth Index has been suggested as a reliable monitor for nociceptive states. The Surgical Pleth Index (SPI) demonstrated moderate accuracy in predicting moderate-to-severe postoperative pain. Current evidence supports its role as a validated supplementary instrument to guide analgesic administration during surgery. Core Tip: This meta-analysis confirms that the Surgical Pleth Index (SPI) provides moderate predictive accuracy for moderate-to-severe postoperative pain and, as such, has a complementary role in guiding intraoperative analgesia, provided its outputs are interpreted within the context of a comprehensive clinical assessment.

Abstract Background: Sepsis poses a severe threat in critical care, often leading to septic cardiomyopathy. This study aimed to explore the genes related to mitochondrial damage in septic cardiomyopathy, observe their changes during sepsis, and analyze the possible pathogenesis of this disease. Methods: Bioinformatics methods were used to identify differentially expressed genes (DEGs) and enrichment pathways associated with mitochondrial damage in patients with septic cardiomyopathy. Subsequently, clinical specimens and cardiomyocytes were verified and compared to clarify the expression of these genes and their change trend in the pathogenesis of septic myocardial injury to explore the possible relationship between these genes and septic myocardial mitochondrial dysfunction. Results: In this study, using diverse datasets, 398 differentially expressed genes (DEGs) related to sepsis were identified, and 11 key genes (GNAS, MRPL2, TIMM17b, SLC25A3, SDHA, PRPF6, LMF2, IMMT, CS, UCP2, and CASP2) were significantly associated with these genes. Functional analysis highlighted the importance of the TIM23 complex in septic mitochondrial injury. Real-time fluorescence quantitative PCR was performed on 11 genes and TIMM23 expression in 24-48 hours in clinical specimens, and the expression of TIMM17b and TIMM23 was increased in the sepsis group, while the expression of the other 10 DEGs was decreased. Further verification via cell experiments revealed that the expression of 11 DEGs and 5 TIM23 complex member genes, TIMM23, TIMM17A, TIMM44, PAM16 and TIMM50, increased in the 6-hour group, while their expression decreased significantly in the 24-hour group; moreover, the expression of only TIMM17b was still greater than that in the normal control group. The expression of other genes was lower than or close to that of the normal control group. Conclusion: This integrative study not only provides a comprehensive overview of DEGs associated with sepsis but also emphasizes the importance of the TIM23 complex. The identified genes and pathways offer potential targets for further mechanistic studies and therapeutic interventions in the context of sepsis-related complications.

Background: While central venous pressure (CVP) measurement is used to guide fluid management for high-risk surgical patients during the perioperative period, its relationship to patient prognosis is unknown. Methods: This single-center, retrospective observational study enrolled patients undergoing high-risk surgery from February 1, 2014 to November 31, 2020, who were admitted to the surgical intensive care unit (ICU) directly after surgery. Patients were divided into the following three groups according to the first CVP measurement (CVP1) after admission to the ICU: low, CVP1 <8 mmHg; moderate, 8 mmHg <= CVP1 <= 12 mmHg; and high, CVP1 >12 mmHg. Perioperative fluid balance, 28-day mortality, length of stay in the ICU, and hospitalization and surgical complications were compared across groups. Results: Of the 775 high-risk surgical patients enrolled in the study, 228 were included in the analysis. Median (interquartile range) positive fluid balance during surgery was lowest in the low CVP1 group and highest in the high CVP1 group (low CVP1: 770 [410, 1205] mL; moderate CVP1: 1070 [685, 1500] mL; high CVP1: 1570 [1008, 2000] mL; all P <0.001). The volume of positive fluid balance during the perioperative period was correlated with CVP1 (r= 0.336, P <0.001). The partial arterial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO(2)) ratio was significantly lower in the high CVP1 group than in the low and moderate CVP1 groups (low CVP1: 400.0 [299.5, 443.3] mmHg; moderate CVP1: 362.5 [330.0, 434.9] mmHg; high CVP1: 335.3 [254.0, 363.5] mmHg; all P <0.001). The incidence of postoperative acute kidney injury (AKI) was lowest in the moderate CVP1 group (low CVP1: 9.2%; moderate CVP1: 2.7%; high CVP1: 16.0%; P=0.007). The proportion of patients receiving renal replacement therapy was highest in the high CVP1 group (low CVP1: 1.5%; moderate CVP1: 0.9%; high CVP1: 10.0%; P= 0.014). Logistic regression analysis showed that intraoperative hypotension and CVP1 >12 mmHg were risk factors for AKI within 72 h after surgery (adjusted odds ratio[aOR]= 3.875, 95% confidence interval[CI]: 1.378-10.900, P= 0.010 and aOR=1.147, 95%CI: 1.006-1.309, P=0.041). Conclusions: CVP that is either too high or too low increases the incidence of postoperative AKI. Sequential fluid therapy based on CVP after patients are transferred to the ICU post-surgery does not reduce the risk of organ dysfunction caused by an excessive amount of intraoperative fluid. However, CVP can be used as a safety limit indicator for perioperative fluid management in high-risk surgical patients.

OBJECTIVE To explore the changes of serum procalcitonin (PCT) level in patients with moderate and severe acute respiratory distress syndrome (ARDS) after cardiac surgery under cardiopulmonary bypass (CPB), and try to find out the best cut-off of PCT to predict the progression to moderate and severe ARDS. METHODS Medical records of patients undergoing cardiac surgery with CPB in Fujian Provincial Hospital from January 2017 to December 2019 were retrospectively analyzed. Adult patients who were admitted in intensive care unit (ICU) for more than 1 day and had PCT values on the first postoperative day were enrolled. Clinical data such as patient demographics, past history, diagnosis, and New York Heart Association (HYHA) classification, and the operation mode, procedure duration, CPB duration, aortic clamp duration, intraoperative fluid balance, calculation of 24 hours postoperative fluid balance and vasoactive-inotropic score (VIS); 24 hours postoperative C-reactive protein (CRP), N-terminal B-type natriuretic peptide precursor (NT-proBNP) and PCT levels were collected. Two clinicians independently made the diagnosis of ARDS according to the Berlin definition, and the diagnosis was established only in patients with a consistent diagnosis. The differences in each parameter were compared between patients with moderate to severe ARDS and those without or with mild ARDS. Analysis of the ability of PCT to predict moderate to severe ARDS was evaluated by receiver operator characteristic curve (ROC curve). Multivariate Logistic regression was conducted to determine the risk factors of the development of moderate to severe ARDS. RESULTS 108 patients were finally enrolled, including 37 patients with mild ARDS (34.3%), 35 patients with moderate ARDS (32.4%), 2 patients with severe ARDS (1.9%), and 34 patients without ARDS. Compared with patients with no or mild ARDS, patients with moderate to severe ARDS were older (years old: 58.5±11.1 vs. 52.8±14.8, P < 0.05), with a higher proportion of combined hypertension [45.9% (17/37) vs. 25.4% (18/71), P < 0.05], longer operative time (minutes: 363.2±120.6 vs. 313.5±97.6, P < 0.05), and higher mortality (8.1% vs. 0, P < 0.05), but there were no differences in the VIS score, incidence of acute renal failure (ARF), CPB duration, aortic clamp duration, and intraoperative bleeding, transfusion volume, and fluid balance between the two groups. Serum PCT and NT-proBNP levels in patients with moderate to severe ARDS at postoperative day 1 were significantly higher than those in patients with no or mild ARDS [PCT (μg/L): 16.33 (6.96, 32.56) vs. 2.21 (0.80, 5.76), NT-proBNP (ng/L): 2 405.0 (1 543.0, 6 456.5) vs. 1 680.0 (1 388.0, 4 667.0), both P < 0.05]. ROC curve analysis showed that the area under the curve (AUC) for PCT to predict the occurrence of moderate to severe ARDS was 0.827 [95% confidence interval (95%CI) was 0.739-0.915, P < 0.05]. When PCT cut-off value was 7.165 μg/L, the sensitivity was 75.7% and the specificity was 84.5%, for differentiating patients who developed moderate to severe ARDS from who did not. Multivariate Logistic regression showed that age and the elevated PCT concentration were independent risk factors for the development of moderate to severe ARDS [age: odds ratio (OR) = 1.105, 95%CI was 1.037-1.177, P = 0.002; PCT: OR = 48.286, 95%CI was 10.282-226.753, P < 0.001]. CONCLUSIONS Patients with moderate to severe ARDS undergoing CPB cardiac surgery have a higher serum concentration of PCT than patients with no or mild ARDS. Serum PCT level may be a promising biomarker to predict the development of moderate to severe ARDS, the cut-off value is 7.165 μg/L.

目的:研究膈肌刺激对呼吸机依赖重症颅脑损伤患者膈肌功能的影响.方法:采用随机数字表法将福建省立医院2020年1月-2022年12月收治的80例呼吸机依赖重症颅脑损伤患者分为两组.对照组(n=40)行常规对症治疗,研究组(n=40)在对照组基础上行膈肌刺激治疗.比较两组膈肌功能、呼吸状况、氧化应激反应、预后情况.结果:治疗后,研究组膈肌厚度、平静呼吸及深吸气后膈肌位移均高于对照组(P<0.05);治疗后研究组最大吸气压、呼气压及超氧化物歧化酶(SOD)水平均高于对照组,浅快呼吸指数(RSBI)及丙二醛(MDA)、谷胱甘肽(GSH)水平均低于对照组(P<0.05);研究组重新上机率低于对照组,重症监护病房(ICU)治疗时间短于对照组(P<0.05).结论:膈肌刺激能够有效改善呼吸机依赖重症颅脑损伤患者膈肌功能与呼吸状况,减轻氧化应激反应,改善其预后.

BACKGROUND:It is unclear whether the magnitude and duration of elevated central venous pressure (ECVP) greater than ten mmHg has the same impact on mortality in sepsis patients.METHODS:Critically ill patients with sepsis were identified from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The duration and the magnitude of ECVP were calculated. Normalized ECVP load was defined as the ECVP load (the sum of ECVP value times its duration) divided by the total duration of ECVP. The primary endpoint was 28-day mortality. Kaplan-Meier survival analysis was used to compare survival between patients with high or low normalized ECVP load.RESULTS:A total of 1071 sepsis patients were included. Higher normalized ECVP load was associated with higher mortality rate; in contrast, the duration of ECVP was not associated with mortality. A linear relationship between normalized ECVP load and mortality was identified. Patients with higher normalized ECVP load had less urine output and more positive fluid balance.CONCLUSION:The magnitude, but not the duration of ECVP, is associated with mortality in sepsis patients. ECVP should be considered as a valuable and easily accessible safety parameter during fluid resuscitation.

BACKGROUND:Limiting driving pressure and mechanical power is associated with reduced mortality risk in both patients with and without acute respiratory distress syndrome. However, it is still poorly understood how the intensity of mechanical ventilation and its corresponding duration impact the risk of mortality.METHODS:Critically ill patients who received mechanical ventilation were identified from the Medical Information Mart for Intensive Care (MIMIC)-IV database. A visualization method was developed by calculating the odds ratio of survival for all combinations of ventilation duration and intensity to assess the relationship between the intensity and duration of mechanical ventilation and the mortality risk.RESULTS:A total of 6251 patients were included. The color-coded plot demonstrates the intuitive concept that episodes of higher dynamic mechanical power can only be tolerated for shorter durations. The three fitting contour lines represent 0%, 10%, and 20% increments in the mortality risk, respectively, and exhibit an exponential pattern: higher dynamic mechanical power is associated with an increased mortality risk with shorter exposure durations.CONCLUSIONS:Cumulative exposure to higher intensities and/or longer duration of mechanical ventilation is associated with worse outcomes. Considering both the intensity and duration of mechanical ventilation may help evaluate patient outcomes and guide adjustments in mechanical ventilation to minimize harmful exposure.

Aims To evaluate the clinical and genetic virulence characteristics of critically ill patients with hypervirulent Klebsiella pneumoniae (hvKP) and classic KP (cKP) infection. Methods and Results The patients included in this retrospective study (n = 225) were grouped according to their hvKP (n = 114) or cKP (n = 111) status, and their clinical characteristics were analysed and compared. Cox multivariate analysis was conducted to determine the risk factors for hvKP infection. Length of hospital stay, length of intensive care unit stay, duration of mechanical ventilation and 28-day survival rate were similar between the groups. However, the incidence of septic shock was higher in the hvKP group (16.7%) than in the cKP group (8.1%). Conclusions There was a high rate of hvKP infection in this population. Compared to patients with cKP infection, those with hvKP infection showed a higher probability of having septic shock; nevertheless, survival and length of hospital stay were similar between the groups. Risk factors for hvKP infection included hospital-acquired infection and renal insufficiency. Significance and Impact of the Study This study presents relevant information on the characteristics of hvKP infection in a Chinese population, and this promotes early diagnosis and supports the view that the prevalence of hvKP is high in China.

ObjectThis study attempted to explore the effects of vaccination on disease severity and the factors for viral clearance and hospitalization in omicron-infected patients.MethodsThe clinical manifestations of 3,265 Omicron-infected patients (BA.2 lineage variant; the Omicron group) were compared with those of 226 Delta-infected patients (the Delta group). A Multi-class logistic regression model was employed to analyze the impacts of vaccination doses and intervals on disease severity; a logistic regression model to evaluate the risk factors for hospitalization; R 4.1.2 data analysis to investigate the factors for time for nucleic acid negativization (NAN).ResultsCompared with the Delta group, the Omicron group reported a fast transmission, mild symptoms, and lower severity incidence, and a significant inverse correlation of vaccination dose with clinical severity (OR: 0.803, 95%CI: 0.742-0.868, p<0.001). Of the 7 or 5 categories of vaccination status, the risk of severity significantly decreased only at ≥21 days after three doses (OR: 0.618, 95% CI: 0.475-0.803, p<0.001; OR: 0.627, 95% CI: 0.482-0.815, p<0.001, respectively). The Omicron group also reported underlying illness as an independent factor for hospitalization, sore throat as a protective factor, and much shorter time for NAN [15 (12,19) vs. 16 (12,22), p<0.05]. NAN was associated positively with age, female gender, fever, cough, and disease severity, but negatively with vaccination doses.ConclusionBooster vaccination should be advocated for COVID-19 pandemic-related control and prevention policies and adequate precautions should be taken for patients with underlying conditions.

目的 基于三种可解释的机器学习算法建立开颅手术患者重症监护室(Intensive Care Unit,ICU)住院时间是否超过8 d的预测模型(Predictive Model,PM),挖掘影响ICU住院时间的风险因素.方法 选择2005—2018年在福建省立医院接受过开颅手术的患者677例,基于机器学习的逻辑回归、随机森林以及梯度下降决策树算法对患者的67个字段建立PM,根据模型评估最优模型,并对其进行解释分析.结果 梯度下降决策树模型效果最优,准确率为85％,受试者工作特征曲线下的面积为0.90.结论 本文建立的PM具有有效性,可为临床医生提供辅助决策建议,方便提早做出相应干预与决定,减轻患者与医疗机构的负担.

BackgroundSepsis-induced cardiomyopathy significantly increased the mortality of patients with sepsis. The diagnostic criteria for septic cardiomyopathy has not been unified, which brings serious difficulties to clinical treatment. This study aimed to provide evidence for the early identification and intervention in patients with sepsis by clarifying the relationship between the ultrasound phenotype of septic cardiomyopathy and the prognosis of patients with sepsis.MethodsThis was a multicenter, prospective cohort study. The study population will consist of all eligible consecutive patients with sepsis or septic shock who meet the Sepsis 3.0 diagnostic criteria and were aged ≥18 years. Clinical data and echocardiographic measurements will be recorded within 2 h, at the 24th hour, at the 72nd hour, and on the 7th day after admission. The prevalence of each phenotype will be described as well, and their association with prognosis will be analyzed statistically.DiscussionTo achieve early recognition, prevent reinjury, achieve precise treatment, and reduce mortality in patients with sepsis, it is important to identify septic cardiac alterations and classify the phenotypes at all stages of sepsis. First, there is a lack of studies on the prevalence of each phenotype in Chinese populations. Second, each phenotype and its corresponding prognosis are not clear. In addition, the prognosis of patients with normal cardiac ultrasound phenotypes vs. those with suppressed or hyperdynamic cardiac phenotypes is unclear. Finally, this study was designed to collect data at four specific timing, then the timing of occurrence, duration, changes over time, impact to outcomes of each phenotype will probably be found. This study is expected to establish a standard and objective method to assess the ultrasound phenotype of septic cardiomyopathy due to its advantages of visualization, non-invasiveness and reproducibility, and to provide more precise information for the hemodynamic management of septic patients. In addition, this research will promote the clinical application of critical care ultrasound, which will play an important role in medical education and make ultrasound the best method to assess cardiac changes in sepsis.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT05161104, identifier NCT05161104.

Objective To establish an early warning scoring system for septic shock in patients with digestive tract perforation (DTP) and evaluate its diagnostic efficacy. Methods Patients with surgically confirmed or clinically diagnosed DTP admitted to the Department of Intensive Care Medicine of Fujian Provincial Hospital from June 2012 to October 2021 were retrospectively analyzed. General demographic characteristics, perforation-related information, vital signs, common laboratory indicators, and common ICU scores (Glasgow Coma Scale score, Acute Physiology and Chronic Health Evaluation-II score,Sequential Organ Failure Assessment score) were collected. The patients were divided into shock group and non-shock group according to whether the patients had septic shock during hospitalization. The risk factors of septic shock were screened by basic statistical analysis and multivariate Logistic regression analysis. The receiver operating characteristic curve was drawn to determine the cut-off value of the continuous indicators and discretized with reference to clinic, and the corresponding score was set according to the β regression coefficient of each variable. Results A total of 176 patients with DTP were included. The average age of the patients was 64.13 ± 14.67 years old, and 74.40% were males. The incidence of septic shock was 30.11% (53/176). Multivariate Logistic regression analysis showed that the highest heart rate≥105 beats/min, Glasgow Coma Scale score≤14 points, lactic acid≥5.75 mmol/L, procalcitonin≥41.47 ug/L, C-reactive protein≥222.5 mg/L were independent risk factors for septic shock in patients with DTP. The total score of clinical diagnostic scoring system of septic shock in patients with DTP was 6 points, including the highest heart rate≥105 beats/min (1 point), lactic acid≥5.75 mmol/L (two points), procalcitonin≥41.47 ug/L (one point), C-reactive protein≥222.5 mg/L (1 point), and Glasgow Coma Scale score≤14 points (1 point). The area under ROC curve (AUC) of this scoring system was 0.789 and the 95% confidence interval was 0.717–0.860 (P < 0.001); when the optimal cut-off value was 2.5, the sensitivity and specificity were 54.70 and 87.80%, respectively. Conclusion This new score system has its certain clinical value and has important guiding significance for clinicians to judge the prognosis of patients with DTP in time.

Background Mycobacterium tuberculosis infection remains a public health concern worldwide. The diagnosis and treatment of disseminated M. tuberculosis is very difficult, so we shared our experiences and lessons learned in this case report. Case Presentation A 36-year-old female with a history of epilepsy presented to our hospital with fever, upper abdominal pain, muscle soreness in limbs for 7 days, and shortness of breath for 4 days. On admission, she presented with acute respiratory distress syndrome (ARDS) and liver dysfunction. Due to the critical nature of her clinical presentation, the patient was admitted directly to the Intensive Care Unit (ICU), received mechanical ventilation in prone position and VV-ECMO treatment. Her condition improved gradually, and the ECMO was removed after 7 days and she was weaned off the ventilator after 8 days. However, her fever recurred and she underwent PET-CT examination, liver contrast ultrasound, acid-fast staining and second-generation sequencing of cerebrospinal fluid, which confirmed M. tuberculosis infection. Conclusion This case report briefly described the treatment and diagnosis of a critically ill patient with intra and extra-pulmonary tuberculosis infection. Timely and appropriate treatment is crucial to save lives, but the timing of ECMO treatment needs to be carefully considered for patients with ARDS caused by tuberculosis.

目的 探讨重症患者红细胞分布宽度(RDW)和RDW变化值(ΔRDW)与脓毒症相关急性肾损伤(AKI)的关系.方法 回顾性纳入2016年1月-2018年8月符合Sepsis 3.0脓毒症诊断的患者159例.收集患者的一般资料,包括入院时的基础RDW、7 d内ΔRDW、相关辅助检查和最终结局.对脓毒症患者并发AKI的危险因素进行单因素及多因素logistic回归分析,比较各因素对脓毒症患者并发AKI的预测价值.结果 (1)入院后7个24 h内ΔRDW≥1.30％组患者的AKI发生率较ΔRDW＜1.30％组升高,差别有统计学意义(P＜0.05).(2)多因素logistic回归分析显示,在校正基础血肌酐、高血压病及糖尿病病史的情况下,ΔRDW与脓毒症患者并发AKI相关,基础肌酐值也对AKI存在影响.使用受试者工作曲线(ROC曲线)对各个指标的预测价值进行分析发现,ΔRDW对脓毒症患者并发AKI有中度预测价值,最佳预测值＞1.45％.ΔRDW和PCT的联合指标对脓毒症患者并发AKI的预测价值优于单一指标.结论 ΔRDW＞1.45％对于预测脓毒症患者并发AKI有较好的临床价值.

Background The present study aimed to evaluate the association between normalized lactate load, an index that incorporates the magnitude of change and the time interval of such evolution of lactate, and 28-day mortality in sepsis and non-sepsis patients. We also compared the accuracy of normalized lactate load in predicting mortality between these two populations. Methods Data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. We defined lactate load as the sum of the area under the lactate concentration curve; we also defined normalized lactate load as the lactate load divided by time. The performance of maximum lactate, mean lactate and normalized lactate load in predicting 28-day mortality in sepsis and non-sepsis patients were compared by receiver-operating characteristic curves analysis. Results A total of 21,333 patients were included (4219 sepsis and 17,114 non-sepsis patients). Non-survivors had significantly higher normalized lactate load than survivors in sepsis and non-sepsis patients. The maximum lactate, mean lactate, and normalized lactate load AUCs were significantly greater in sepsis patients than in non-sepsis patients. Normalized lactate load had the greatest AUCs in predicting 28-day mortality in both sepsis and non-sepsis patients. Sensitivity analysis showed that the AUC of normalized lactate load increased in non-sepsis patients when more lactate measurement was obtained, but it was not improved in sepsis patients. Conclusions Normalized lactate load has the strongest predictive power compared with maximum or mean lactate in both sepsis and non-sepsis patients. The accuracy of normalized lactate load in predicting mortality is better in sepsis patients than in non-sepsis patients.

目的:探究低分子肝素钙联合常规重症急性胰腺炎治疗对重症急性胰腺炎的疗效.方法:将2020年5月-2021年12月福建医科大学省立临床医学院80例重症急性胰腺炎患者根据随机数字表法分为对照组和观察组,每组40例.对照组进行常规重症急性胰腺炎治疗,观察组则在常规治疗基础上加用低分子肝素钙.比较两组临床疗效(总有效率)、治疗前后的急性胰腺炎的CT严重度指数(CTSI)结果、血小板活化指标[P-选择素(CD62P)、血小板激活复合物-1(PAC-1)及血小板膜糖蛋白(CD61)]及炎症反应指标(粒细胞与血小板相关指标、血清细胞因子).结果:观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05).两组治疗前CTSI结果、血小板活化指标及炎症反应指标比较,差异均无统计学意义(P>0.05);观察组治疗1、2周后CTSI结果均优于对照组,血小板活化指标及炎症反应指标均低于对照组,差异均有统计学意义(P<0.05).结论:低分子肝素钙联合常规治疗在重症急性胰腺炎患者中的应用效果较好,且可显著改善血小板活化及炎症反应程度,在重症急性胰腺炎患者中的应用价值相对较高.

神经外科中枢神经系统感染(neurosugical central nervous system infections,NCNSIs)的流行病学及发病机制有别于社区获得性中枢神经系统感染.本综述分析了NCNSIs在现行诊断标准下存在的临床及病原学诊断阳性率低的困境,并介绍了脑脊液降钙素原、乳酸及肝素结合蛋白等提示感染的生物标志物的研究现状,以及二代宏基因组测序技术等快速病原学诊断方法.

Background: Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes. Methods: We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was allcause mortality within 28 days of enrollment. Results: Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference -0.40 [95% CI -0.71 to - 0.09]; P= 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P= 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P=0.42) between groups. Conclusions: In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.