Dynamic 14-day Platelet Count Predicts 28-day Mortality in Sepsis: A Single-Center Retrospective Cohort Study.

Interleukin-37 as a biomarker of mortality risk in patients with sepsis

To explore the predictive efficacy of prothrombin time (PT) with regarding for the severity and prognosis of septic patients, along with comparing with other routine coagulation parameters. A retrospective analysis was conducted. The clinical data of 302 septic patients who were admitted to the intensive care unit (ICU) of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 1 to December 31 in 2019 were enrolled. Demographic and basic clinical data were collected. Laboratory data, including PT, activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer, fibrin (fibrinogen) degradation product (FDP), antithrombin (AT), platelet count (PLT) at ICU admission were recorded, and sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score within 24 hours of admission to ICU were also collected. What's more, some major clinical events, such as septic shock, disseminated intravascular coagulation (DIC), etc. during ICU stay were also monitored. A follow-up 28 days observation of prognosis was performed. The patients were divided into the septic shock group and the non-septic shock group according to the occurrence of septic shock, and they were divided into the survival group and the non-survival group according to the 28-day prognosis. The differences in terms of above parameters between each two groups were compared. Spearman correlation method was used to analyze the correlation between routine coagulation parameters and SOFA score or APACHE II score. Receiver operator characteristic curve (ROC curve) was plotted to determine the predictive efficacy of each routine coagulation parameter with regarding to predict septic shock and 28-day mortality. Based on the cut-off value of PT, the septic patients were divided into two risk stratifications, and then the major clinical and end point outcome were compared. Kaplan-Meier survival curve analysis was applied to investigate the difference of the 28-day cumulated survival rate based on the different risk stratifications of PT level. Finally, multivariate Logistic regression analysis was used to explore whether prolonged PT level was an independent risk factor for septic shock and 28-day mortality. The 302 patients were all enrolled, including 120 patients with septic shock and 182 patients without. Seventy-five patients died within 28 days, while 227 survived. Comparing with the non-septic shock group or the survival group, the septic shock group or the non-survival group patients both had longer PT, APTT and TT, higher D-dimer, FDP and lower PLT, FIB and AT. Correlation analysis revealed that PT and PLT were better correlated with SOFA score (r values were 0.503 and -0.524, both P < 0.01), and PT was better correlated with APACHE II score (r = 0.407, P < 0.01). ROC curve analysis showed that PT had the most powerful predictive efficacy for septic shock and 28-day mortality. The area under the ROC curve (AUC) and 95% confidence interval (95%CI) were 0.831 (0.783-0.879) and 0.739 (0.674-0.805), respectively. The cut-off value were 16.8 s and 16.3 s, respectively, with the sensitivity of 64.2%, 72.0% and the specificity of 89.0%, 70.9%, respectively. Risk stratification based on PT level revealed that the patients with PT > 16.5 s (n = 103) had higher rate of 28-day mortality, incidence of septic shock and DIC, and score of SOFA and APACHE II comparing to those with PT ≤ 16.5 s (n = 199). Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate was significantly lower in the patients with PT > 16.5 s than those with PT ≤ 16.5 s (52.43% vs. 86.93%; Log-Rank test: χ2 = 49.428, P < 0.001). Multivariate Logistic regression analysis revealed that PT > 16.5 s was an independent risk factor both for septic shock and 28-day mortality [model 1 (enrolled SOFA score): odds ratio (OR) and 95%CI were 6.003 (3.040-11.855), 4.842 (2.114-11.089); model 2 (enrolled APACHE II score): OR and 95%CI were 7.675 (4.007-14.702), 5.160 (2.258-11.793)]. Compared with other routine coagulation parameters, PT has the potential best predictive value for evaluating the severity of sepsis and the prognosis. When a patient is diagnosed with sepsis and has a result of PT longer than 16.5 s at ICU admission, the patient may have a higher risk of progression to septic shock and short-term death.

Background and objectiveSepsis is a major health burden that leads to significant morbidity and mortality. Early diagnosis and severity prediction using various scoring systems can reduce the mortality rate, particularly in developing nations. There are two aims of this study. One is to evaluate the prognostic accuracy of the Sequential Organ Failure Assessment (SOFA) score and serum lactate levels in patients with sepsis to predict mortality. The other aim is to evaluate the relationship between the SOFA score and lactate so that we may be able to use lactate as a surrogate predictor of organ dysfunction and mortality in sepsis.MethodsAn observational prognostic accuracy study was conducted in the Department of General Surgery, Intensive Care Unit (ICU), Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India, between 1 July 2021 and 1 October 2022. We selected 128 patients, calculated their SOFA and lactate levels, and divided them into survivors and non-survivors according to their outcomes after seven days of assessment. The SOFA score and serum lactate levels were assessed as predictors of mortality, and their correlation was studied.ResultsWe observed a significant decreasing trend in the value of the mean SOFA, maximum SOFA, mean lactate, and maximum lactate among survivors, whereas an increasing trend for the same was observed in non-survivors. The receiver operating characteristic (ROC) analysis showed the best diagnostic accuracy of the mean lactate (area under the curve {AUC}=0.996, 95% confidence interval {CI}=0.964-1.00, p≤0.0001). The maximum lactate (AUC=0.987, 95% CI=0.949-0.999, p≤0.0001) and mean SOFA scores (AUC=0.986, 95% CI=0.948-0.999, p≤0.0001) were good at predicting the mortality in sepsis. A slightly lower diagnostic accuracy was found for the maximum SOFA score (AUC=0.969, 95% CI=0.923-0.992, p≤0.0001). There was a strong correlation between the mean lactate and the mean SOFA with a correlation coefficient of 0.883 and p=0.0001. A good correlation was found between maximum lactate and maximum SOFA too (correlation coefficient=0.873, p≤0.0001).ConclusionThis study highlights the different predictors of mortality in the patients with sepsis. The maximum lactate was the most accurate in predicting mortality in sepsis. It also demonstrates how serum lactate, due to its strong correlation with the SOFA score, can be used in its place to predict mortality in sepsis and organ dysfunction.

To investigate the assessment values of procalcitonin (PCT), lactic acid (LAC), sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation II (APACHE II) score in patients with sepsis. 140 patients with suspicious bacterial infection admitted to emergency department of Beijing Chaoyang Hospital of the Capital Medical University from August 2017 to June 2018 were enrolled. They were divided into three groups according to diagnostic criteria of Sepsis-3: non-sepsis group (n = 58), sepsis group (n = 66) and septic shock group (n = 16). The PCT, LAC, SOFA score, APACHE II score, 28-day prognosis, and positive detection rate of PCT and LAC were compared among three groups. Independent predictors of 28-day mortality were analyzed by Logistic regression; predictive values of PCT, LAC, SOFA score and APACHE II score for 28-day mortality in sepsis patients were analyzed by receiver operating characteristic (ROC) curve. PCT, LAC, SOFA score, APACHE II score at admission, and 28-day mortality in sepsis group and septic shock group were significantly higher than those in non-sepsis group, and PCT, LAC, APACHE II score, and 28-day mortality in sepsis shock group were further higher than those in sepsis group [PCT (μg/L): 38.1±12.6 vs. 4.6±2.3, LAC (mmol/L): 3.3±2.1 vs. 2.4±2.1, APACHE II score: 14.9±2.4 vs. 9.5±4.3, 28-day mortality: 75.0% vs. 24.2%, all P < 0.05]. The positive detection rate of PCT and LAC in sepsis group and septic shock group were higher than those in non-sepsis group (positive detection rate of PCT: 56.1%, 81.3% vs. 32.8%; positive detection rate of LAC: 42.4%, 62.5% vs. 13.7%; all P < 0.01). Logistic regression analysis showed that PCT, LAC, SOFA score and APACHE II score were independent predictors of 28-day mortality [PCT: odds ratio (OR) = 0.933, 95% confidence interval (95%CI) = 0.878-0.991; LAC: OR = 0.539, 95%CI = 0.347-0.838; SOFA score: OR = 0.291, 95%CI = 0.514-0.741; APACHE II score: OR = 0.808, 95%CI = 0.669-0.976; all P < 0.05]. ROC curve analysis showed that the area under ROC curve (AUC) of PCT, LAC, SOFA score and APACHE II score predicting 28-day mortality was 0.76, 0.86, 0.81 and 0.87, respectively. The assessment values of APACHE II score and LAC were higher than PCT in predicting 28-day mortality (Z1 = 2.56, Z2 = 2.45, both P < 0.01), and the performance of SOFA score was similar to PCT. PCT, LAC, SOFA score and APACHE II score were reliable indexes to evaluate disease severity for patients diagnosed with infection. The assessment values of APACHE II score and LAC in 28-day mortality were superior to SOFA score and PCT.

HIV-associated talaromycosis (HAT) is a severe fungal infection for which established severity assessment methods are lacking. The Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores were evaluated in 464 patients with HAT to assess their associations with inflammatory markers, hospital stay, and 30-day mortality. SOFA scores were negatively correlated with blood culture positivity time (r = -0.470, P < 0.001) and positively correlated with IL-6, IL-10, and CRP (all P < 0.001). Patients with fungemia had higher SOFA scores (2.3 ± 2.4 vs. 1.2 ± 0.6, P < 0.001). Mortality increased with qSOFA scores: 8.9% (score 0), 16.5% (score 1), and 55.0% (score ≥2; P < 0.001). For SOFA, mortality was 4.5% (scores 0-1), 6.8% (2-3), 22.0% (4-5), 52.2% (6-7), and 85.7% (≥8; P < 0.001), repectively. Survivors' SOFA scores improved by day 7 (1.6 ± 1.6 to 1.0 ± 1.4, P < 0.001), while non-survivors worsened by day 7 (4.8 ± 3.4 to 5.1 ± 5.6, P = 0.027) compared to day 0. Among the surviving patients, the hospital stay days were 21.0 (14.0-27.0) for scores 0-1, 22.0 (16.0-29.0) for scores 2-3, 27.0 (20.3-43.5) for scores 4-6 and 29.0 (5.5-38.0) for scores ≥6 (P = 0.005). Multivariate analysis identified qSOFA [adjusted odds ratio (AOR):1.564, P = 0.018], SOFA [AOR:1.533, P = 0.001], and non-amphotericin B deoxycholate (non-AmBd) therapy [AOR:2.732, P = 0.026] were independent predictors of 30-day mortality. SOFA and qSOFA both predicted poor outcomes in patients with HAT. Early diagnosis and preemptive AmBd therapy should be prioritized for patients with HAT who had high SOFA/qSOFA scores.

To explore the risk factors influencing the prognosis by analyzing clinical data of patients with acute paraquat intoxication, and to assess the prognostic values of acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, and Acute Kidney Injury Network (AKIN) stage. The clinical data of patients with acute paraquat intoxication admitted into the First People's Hospital of Xianyang City during October 2005 to May 2015 were retrospectively analyzed. The patients were divided into death group and survival group according to 28-day outcome after poisoning. The gender, age, body weight index, toxin dose, time elapsed from poisoning to gastric lavage, time elapsed from poisoning to hemoperfusion (HP), times of HP treatment, white blood cell count (WBC), alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TBil), serum creatinine (SCr), blood urea nitrogen (BUN), creatine kinase (CK) were determined at admission. Arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), arterial lactate (Lac), and APACHE II score, SOFA score and AKIN stage were recorded and compared between two groups. The receiver operating characteristic (ROC) curve was plotted for APACHE II score, SOFA score and AKIN stage to analyze the prognostic value for patients with acute paraquat intoxication. There were 118 cases in total, with 64 survivors and 54 deaths in 28 days, and the fatality rate was 45.76%. Compared with survival group, the toxic dose (mL: 66.29 ± 27.40 vs. 29.16 ± 19.40), time elapsed from poisoning to gastric lavage (minutes: 60.37 26.68 vs. 41.17 ± 14.82), WBC count ( X 10⁹/L: 16.86 ± 2.77 vs. 10.25 ± 2.60), ALT (U/L: 53.94 ± 10.85 vs. 36.40 ± 9.21), SCr (μmol/L: 159.69 ± 42.85 vs. 81.73 ± 34.40) at admission as well as Lac (mmol/L: 3.06 ± 1.33 vs. 1.71 ± 0.88), APACHE II score (6.46 ± 2.38 vs. 3.31 ± 1.51), SOFA score (3.31 ± 1.06 vs. 2.21 ± 0.76) 48 hours after admission were significantly higher in the death group (all P < 0.01). PaO₂ and PaCO₂ 48 hours after admission were significantly lower in death group than those in the survival group [PaO₂ (mmHg, 1 mmHg = 0.133 kPa): 64.07 ± 13.04 vs. 75.40 ± 13.27, PaCO₂ (mmHg): 26.20 ± 8.89 vs. 31.25 ± 6.29, both P < 0.01]. There were 18, 15, 11 and 10 patients in AKIN 0, 1, 2, 3 stage 48 hours after admission respectively in death group, and 38, 15, 7, 4 in survival group. The difference between two groups was statistically significant (P < 0.01). There were no statistically significant differences in gender, age, body mass index, time elapsed from poisoning to HP, levels of HP, and AST, TBil, BUN and CK at admission between the two groups. At 48 hours after admission, the area under the ROC curve (AUC) of APACHE II score predicting the prognosis of patients with acute paraquat poisoning was 0.875 [95% confidence interval (95%CI) = 0.814-0.935, P = 0.000]. When the cut-off point of APACHE II score was 4, the sensitivity and specificity were 79.6% and 79.7%, and the best Youden index was 0.593. The AUC of SOFA score was 0.776 (95% CI = 0.692-0.859, P = 0.000). When the cut-off point of FOFA score was 3, the sensitivity was 72.2%, the specificity 67.2%, and the best Youden index 0.394. The AKIN stage of ROC curve had an area of 0.656 (95% CI = 0.556-0.755, P = 0.004). When the cut-off point of AKIN stage was 1, the sensitivity was 66.7%, the specificity was 59.4%, and the best Youden index was 0.261. Amount of the poison, time elapsed from poisoning to gastric lavage, and WBC, ALT, SCr at admission as well as PaO₂, PaCO₂ and Lac 48 hours after admission are the risk factors for prediction of the prognosis of acute paraquat intoxication. APACHE II score, SOFA score and AKIN stage can be used to assess the prognosis of acute paraquat poisoning, and APACHE II score is better than SOFA score and AKIN stage.

This study evaluated the association and prognostic significance of the systemic inflammation response index (SIRI) with mortality in sepsis. In this cohort study, the sepsis patients were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) and MIMIC-IV intensive care unit (ICU) databases. SIRI was calculated by using the neutrophil, monocyte, and lymphocyte counts. The outcomes were 28-day mortality, 1-year mortality, and 28 days to 1-year mortality. The Cox proportional hazards model with a hazard ratio (HR) and a 95% confidence interval (CI) was used to investigate the association and prognostic value of SIRI with mortality in sepsis. Subgroup analyses of the associations of SIRI with 28-day and 1-year mortality in sepsis were based on age, gender, Simplified Acute Physiology Score II (SAPSII), Sequential Organ Failure Assessment (SOFA), and presence or absence of septic shock. The receiver operating characteristic (ROC) curve was used to compare the predictive performances of SIRI, SOFA and SAPS II for mortality in sepsis. Of the 4239 patients included, 1339 patients suffered from 28-day mortality, 2085 patients suffering from 1-year mortality, and 746 (25.72%) suffered from 28 days to 1-year mortality. High SIRI levels exhibited higher risks of 28-day mortality (HR: 1.15, 95% CI: 1.03-1.29, P = .010), 1-year mortality (HR: 1.14, 95% CI: 1.04-1.24, P = .003), and 28 days to 1-year mortality (HR: 1.16, 95% CI: 1.01-1.35, P = .047) in sepsis. A higher SIRI was reported related to 28-day mortality and 1-year mortality in sepsis patients with female gender, with SOFA < 8, with SAPS II < 44, and in sepsis patients without sepsis shock. The AUC of SIRS, SOFA, and SAPS II in predicting 28-day mortality in sepsis were 0.726, 0.591, and 0.644, respectively. The AUC of SIRI in predicting 1-year mortality in sepsis was 0.761, higher than the AUC values of SOFA and SAPS II. A higher AUC value of SIRI compared with SOFA, and SAPS II in predicting 28 days to 1-year mortality was observed. Elevated SIRI was associated with an increased risk of mortality in sepsis. SIRI is an independent prognostic biomarker of mortality in sepsis.

Objective To explore the predictive value of early changes in platelet counts in the prognosis of severe pneumonia in aged patients. Methods This retrospective study included elderly patients with severe pneumonia, who were ≥65 years old and whose length of ICU stay ≥72 hours, admitted to the intensive care unit(ICU)of NO.2 People's Hospital of Changzhou from January 2014 to January 2017.They were divided into a survival group and a death group according to the 28-day outcome.General information and serum platelet levels at 0, 24, 36, and 72 hours after admission were collected.Receiver operating characteristic curve(ROC)was plotted according to platelet counts, changes in platelet counts and rates of change in platelet counts to evaluate their predictive value for 28-day prognosis.Kaplan-Meier survival curve was used to analyze the 28-day cumulative survival rate between different groups of patients, who were further divided according to platelet counts at 0 and 72 hours after admission to ICU, changes in platelet counts and rates of change in platelet counts at 72 hours after admission. Results (1)One hundred elderly patients with severe pneumonia were enrolled, among whom 41 cases were in the death group, thus with a mortality of 41.0%.The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), sequential organ failure assessment(SOFA), C-reactive protein(CRP), and procalcitonin(PCT)in the death group were significantly higher than those in the survival group.2)Serum platelet levels showed a downward trend in both the death group and the survival group.The level of serum platelets at 72 hours after admission to ICU in the death group was significantly lower than that in the survival group(80.00×109/L vs.171.00×109/L, Z=5.786, P<0.05); changes in platelet counts and rates of change in platelet counts in the death group were significantly higher than those in the survival group, especially at 72 hours after admission to ICU(△PLT72: -79.00×109/L vs.-38.00×109/L, Z=4.938, P<0.05; △PLT 72%: -43.6% vs.-17.7%, Z=6.816, P<0.05). (3)ROC curve analysis showed that platelet levels, changes in platelet counts, and rates of change in platelet counts could predict 28-day mortality in aged patients with severe pneumonia.The largest area under ROC curve was 0.902 when plotted with the rate of platelet counts at 72 hours after admission to ICU.Using the cut-off value of -36.14% in the rate of change at 72 hours after admission to evaluate the predictive value in 28-day mortality, the sensitivity and specificity were 89.8% and 75.6%, respectively.(4)Kaplan-Meier survival analysis showed that the 28-day survival rate was significantly higher and the length of survival was significantly greater when platelet counts at 0 and 72 hours after admission to ICU were higher than the cut-off value, and this also occurred in changes in platelet count and rates of change at 72 hours after admission to ICU. Conclusions Continuous decline in serum platelet levels indicates poor prognosis.When combined with platelet counts, changes in platelet counts and rates of change in platelet counts at 72 hours after admission to ICU, it may play an important role in assessing the prognosis of aged patients with severe pneumonia. Key words: Blood platelets; Pneumonia; Prognosis

BackgroundNeutrophil gelatinase-associated lipocalin (NGAL) is a diagnostic marker for acute kidney injury (AKI). NGAL expression is highly induced not only in kidney injury but also in bacterial infection, inflammation, and cancer. The factors regulating NGAL expression are proinflammatory cytokines, and plasma NGAL levels have been increased in septic shock. However, there are no reports of urine neutrophil gelatinase-associated lipocalin (uNGAL) levels after open esophagectomy.MethodsWe prospectively enrolled critically ill patients, including patients with sepsis (n = 45) and patients who underwent open esophagectomy (n = 40). We compared vital signs, PaO2/FIO2, serum C-reactive protein (CRP) levels, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and uNGAL levels between the sepsis group and the esophagectomy group. Then, we investigated whether uNGAL is associated with the severity of illness and organ failure, and whether uNGAL is a reliable screening test for AKI.ResultsThe median uNGAL levels, APACHE II score, SOFA score, and serum CRP levels were significantly (p < 0.001) higher in the sepsis group than in the esophagectomy group on ICU day 1. In the sepsis group, uNGAL levels were significantly (p < 0.05) correlated with APACHE II score and SOFA score on intensive care unit (ICU) day 1, 2, and 3. In the esophagectomy group, uNGAL levels were significantly (p < 0.05) correlated with SOFA score on ICU day 3 and 4. In the sepsis group, 1 patient developed AKI stage 2 and 6 patients developed AKI stage 3. No patients developed AKI in the esophagectomy group. In a total of 85 patients of this study, 80 patients had an abnormal value of uNGAL and only 7 patients (8.7%) of those 80 patients developed AKI.ConclusionsuNGAL levels were correlated with the severity of illness and organ failure in critically ill patients. The value of uNGAL increases under the surgical and inflammatory responses, thereby losing a significance of a screening test of AKI in critically ill patients.

Prognostic Value of B-type Natriuretic Peptide With the Sequential Organ Failure Assessment Score in Septic Shock

ABSTRACTBackgroundSequential Organ Failure Assessment (SOFA) score is routinely used in the intensive care unit (ICU) to describe severity of organ dysfunction, for prognostication and sepsis diagnosis, and in clinical trials. Inter‐rater variability and scalability are known challenges in manual assessment. We aimed to develop and validate an algorithm for automatic SOFA calculation and evaluated its predictive abilities on 30‐day mortality.MethodsRetrospective multi‐center cohort study on all adult patients admitted to four ICUs at the Karolinska University Hospitals in 2015–2018. Data from 2018 collected in one ICU was used for algorithm development. The algorithm was validated by comparing the results of automated SOFA score calculation to those obtained by manual SOFA scoring by experienced intensivists on 300 randomly chosen ICU days from the remaining cohort. Intra‐class correlation coefficient (ICC [95% confidence interval (CI)]) was calculated as primary validation outcome. Area under the receiver operating characteristic curve (AUROC [95% CI]) was used for assessment of 30‐day mortality prediction on the remaining cohort (excluding only the development cohort).ResultsA total of 6953 ICU admissions were included. The algorithm was developed on 613 admissions during 2018. Data from the remaining cohort with 6340 admissions (5076 patients, 36,625 ICU days) were used for mortality prediction. On algorithm validation of the full SOFA score, the ICC was 0.99 (0.98–1.00). For 30‐day mortality, the best predictive abilities were found with maximum SOFA score (AUROC 0.79 [0.78–0.81]) and with SOFA score on Day 2 (AUROC 0.79 [0.77–0.80]).ConclusionA trustworthy automated SOFA score dataset can be produced with comprehensive high‐frequency electronic health records curation and rigorous artifact control, with accuracy comparable to manual scoring by senior intensivists. Association between SOFA score and 30‐day mortality in a large, real‐world clinical cohort aligns with findings from previous clinical trials. The results support the use of automated SOFA scoring as a reliable tool for clinical research, quality monitoring, and potentially real‐time clinical decision support.Editorial CommentIn this article, the authors report results of a retrospective multicenter study, where they used a large cohort of adult ICU patients for developing and validating an automated algorithm for calculating SOFA scores. In validation, they found that the automatically calculated score was comparable to scores manually calculated by experienced clinicians. The automatically calculated maximum SOFA and Day 2 SOFA scores performed well in predicting 30‐day mortality.

ObjectiveThis study was performed to compare the predictive performance of serum procalcitonin (PCT), N-terminal brain natriuretic propeptide (NT-proBNP), interleukin-6 (IL-6), prothrombin time (PT), thrombin time (TT), and Sequential Organ Failure Assessment (SOFA) score in the intensive care unit (ICU).MethodsThis retrospective cohort study enrolled 150 patients with sepsis and septic shock and 30 control patients without sepsis. Each patient was followed until death or 28 days. Correlations between variables were assessed with Spearman’s rho test. The Kruskal–Wallis and Mann–Whitney U tests were used for between-group comparisons.ResultsReceiver operating characteristic curve analysis of the SOFA score, PCT, NT-proBNP, IL-6, PT, and TT showed an area under the curve of 0.872, 0.732, 0.711, 0.706, 0.806, and 0.691, respectively, for diagnosing sepsis. Binary logistic regression demonstrated that the SOFA score was an independent predictor of 28-day mortality and septic shock. The correlation coefficient (r) between SOFA and PCT, NT-proBNP and SOFA, IL-6 and SOFA, PT and SOFA, and TT and SOFA was 0.79, 0.52, 0.57, 0.56, and 0.58, respectively.ConclusionWhile the SOFA score is the gold standard, analysis of multiple biomarkers could increase the performance capacity for diagnosis and prognosis in patients with sepsis in the ICU.

To evaluate the value of lung ultrasonography score (LUS) on assessing extravascular lung water (EVLW) and prognosis in patients with acute respiratory distress syndrome (ARDS). The clinical data of 46 patients meeting ARDS Berlin definition admitted to intensive care unit (ICU) of Ningbo Yinzhou People's Hospital from July 2016 to December 2019 were retrospectively collected. The general data, vital signs, blood lactic acid (Lac), oxygenation index (OI), LUS, extravascular lung water index (EVLWI), sequential organ failure assessment (SOFA) score, clinical pulmonary infection score (CPIS) and the length of ICU stay were collected. According to the prognosis of patients during ICU treatment, the patients were divided into survival group and non-survival group, and the clinical characteristics between the two groups were compared. The correlation between LUS and OI, EVLWI, SOFA, and CPIS were analyzed by Pearson correlation analysis. Receiver operator characteristic (ROC) curve was plotted to determine the prognostic value of LUS for ARDS patients during ICU treatment. Forty-six patients were enrolled in the analysis, of whom 32 patients survived (69.6%), and 14 patients died (30.4%) during ICU treatment. There was no significant difference in gender, age, left ventricular ejection fraction (LVEF) or heart rate (HR) between the two groups. Compared with the survival group, the mean arterial pressure (MAP) and OI in the non-survival group were significantly lowered [MAP (mmHg, 1 mmHg = 0.133 kPa): 57.48±33.34 vs. 85.45±19.56, OI (mmHg): 74.50±18.40 vs. 233.06±28.28, both P < 0.05], while Lac, LUS, EVLWI, SOFA and CPIS were significantly increased [Lac (mmol/L): 6.78±2.56 vs. 2.21±1.42, LUS score: 23.57±2.03 vs. 15.58±2.24, EVLWI (mL/kg): 22.93±2.56 vs. 12.96±2.18, SOFA score: 20.21±3.35 vs. 12.43±2.97, CPIS score: 8.07±1.38 vs. 4.59±1.04, all P < 0.01], and the length of ICU stay was significantly shortened (days: 9.33±3.28 vs. 16.89±4.12, P < 0.05]. Pearson correlation analysis showed that a significant negative linear correlation was found between LUS and OI (r = -0.823, P < 0.01), and positive linear correlations were found between LUS and EVLWI, SOFA, CPIS (r values were 0.745, 0.614, 0.757, respectively, all P < 0.01). ROC curve analysis showed that both LUS and EVLWI could predict the prognosis of ARDS patients during ICU treatment, and the areas under ROC curve (AUC) of LUS and EVLWI were 0.936 and 0.991, respectively. When the cut-off of LUS score was 20.5, the sensitivity and specificity were 85.7% and 81.2% respectively. LUS score has a good correlation with EVLWI monitored by pulse index continuous cardiac output (PiCCO), which can reflect lung water content. LUS score can be used as an early prognostic indicator for ARDS patients.

Objective To compare the predictive value of sequential organ failure assessment (SOFA) scores at different time points for hospital mortality of patients in intensive care unit (ICU) and to provide research evidence for the rational selection of SOFA scores in actual clinical work. Methods Adult ICU patients with a length of hospital stay greater than 72 h were included from the American Critical Care Database. The basic information and related indicators were extracted and SOFA scores at different time points were calculated. Hospital mortality was chosen as the outcome and multivariable logistic regression analysis was performed to assess the associations between SOFA scores at different time points and the outcome. ROC curve analysis was also conducted and the area under the curve was calculated to evaluate their prognostic value. Results A total of 11 968 patients were included finally, of which male patients accounted for 56.15% with an average age of (64.75±16.63) years old and a hospital mortality rate of 10.41% (1246/11 968). Multivariable logistic regression analysis showed that SOFA scores at different time points were all closely related to hospital mortality (P<0.0001). ROC curve analysis showed that SOFA scores at different time points had different predictive value for hospital mortality and T72 (AUC=0.7246, 95%CI: 0.7101-0.7391) had the highest AUC. Conclusion For adult ICU patients whose length of hospital stay is greater than 72 h, SOFA scores at 72 h after admission may have better prognostic value. Key words: Sequential organ failure assessment scores; Critical care; Prognosis

To observe the effects of self-made Qingyuan Shenghua decoction on coagulation dysfunction in patients with sepsis, and to explore its possible mechanism. Eighty patients with sepsis and coagulation dysfunction admitted to the department of critical care medicine of Chengdu First People's Hospital from March 2018 to April 2020 were enrolled. The patients were divided into control group and observation group according to random number table method, with 40 cases in each group. Patients in both groups received basic treatment for sepsis. On this basis, the observation group was administrated with self-made Qingyuan Shenghua decoction, one dose a day, 100 mL in the morning and 100 mL in the evening; the control group was given the same amount of normal saline. Both groups were treated for 7 days. Prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen (Fib), D-dimer, platelet count (PLT), white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) were measured before and after treatment, and acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) were calculated. The length of intensive care unit (ICU) stay, the incidence of multiple organ dysfunction syndrome (MODS) and 28-day mortality was recorded. The indexes of coagulation function and inflammation in the two groups were significantly improved after treatment, the improvement of various indexes in the observation group were better than those in the control group [PT (s): 16.01±1.08 vs. 19.21±1.38, APTT (s): 55.33±15.29 vs. 79.41±12.69, INR: 1.30±0.21 vs. 1.65±0.22, Fib (g/L): 2.87±0.89 vs. 5.44±1.13, D-dimer (mg/L): 2.56±1.67 vs. 6.41±2.42, PLT (×109/L): 125.79±18.51 vs. 95.46±18.50, WBC (×109/L): 7.50±0.78 vs. 12.75±4.09, CRP (mg/L): 21.27±9.32 vs. 65.44±13.40, PCT (μg/L): 1.15±0.58 vs. 6.31±1.29], and the differences were statistically significant (all P < 0.05). After treatment, APACHE II and SOFA scores in the two groups decreased significantly compared with those before treatment, and the decrease in the observation group were more obvious than those in the control group (APACHE II score: 10.29±1.86 vs. 15.35±2.06, SOFA score: 5.51±1.08 vs. 7.65±1.58, both P < 0.05). The length of ICU stay was shortened in the observation group than that in the control group (days: 12.22±9.48 vs. 20.22±15.35, P < 0.05). The incidence of MODS [35.0% (14/40) vs. 47.5% (19/40)] and the 28-day mortality [45.0% (18/40) vs. 47.5% (19/40)] was lower than that of the control group, but there was no statistical difference (both P > 0.05). Self-made Qingyuan Shenghua decoction can effectively improve the prognosis of patients with coagulation dysfunction and sepsis, and its mechanism may be related to inhibition of inflammatory reaction and improvement of coagulation function.