Preoperative prediction of early mortality after surgery for spinal metastases.

This study aims to evaluate patient demographics and laboratory parameters that may aid in predicting the risk of bowel resection in incarcerated abdominal wall hernias. Additionally, it investigates independent risk factors associated with the need for bowel resection. We retrospectively analyzed data from 709 patients, categorizing them into two groups: Group 1 (incarcerated hernia without strangulation, no bowel resection required) and Group 2 (incarcerated hernia with strangulation, requiring bowel resection). We collected data on age, gender, BMI, hernia type, comorbidities, bowel obstruction status, preoperative blood tests (including complete blood count and biochemistry), operative time, hospital stay, and mesh use. We specifically examined white blood cell (WBC) count, C-reactive protein (CRP), lactate dehydrogenase (LDH), and lactate levels. Additionally, we calculated the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), and hematological immune-inflammatory index (HII). Of the 709 patients, 624 (88%) were in Group 1, and 85 (12%) were in Group 2. Advanced age, elevated WBC, CRP, NLR, PLR, SII, and LDH values were significantly associated with bowel resection (p < 0.005). Multivariate logistic regression analysis identified lactate levels (OR = 22.252, 95% CI: 9.550-51.849, p < 0.001), presence of femoral hernia (OR = 3.515, 95% CI: 1.014-12.191, p = 0.048), and bowel obstruction (OR = 54.922, 95% CI: 24.787-121.694, p < 0.001) as independent risk factors for bowel resection. Advanced age and elevated WBC, CRP, NLR, PLR, SII, and LDH values are effective predictors of bowel resection in incarcerated abdominal wall hernias. Furthermore, bowel obstruction, femoral hernia, and lactate levels serve as independent risk factors for bowel resection.

Routine preoperative testing is discouraged before low-risk surgery because testing does not provide any beneficial effect in terms of patient outcome. However, few studies have assessed the utilization of hospital health care resources in terms of preoperative tests in a real-world setting. Here, we aimed to assess the prevalence and factors associated with preoperative blood tests before low-risk surgery in Japan. In this retrospective observational study, we used the nationwide insurance claims data of Japan. Patients who underwent low-risk surgeries between April 1, 2012 and March 31, 2016, were included. Our primary outcome was the receipt of any preoperative tests within 60 days before an index procedure: complete blood count, basic metabolic panel, coagulation tests, and liver function tests. We performed a descriptive analysis to estimate the proportions of preoperative blood tests, and examined the associations between patient-level and institutional-level factors and preoperative blood tests, using multilevel logistic regression analysis. Interinstitutional variation in the utilization of preoperative tests was summarized using the median odds ratio (OR). The study sample included 59,818 patients (mean [standard deviation] age, 44.0 [11.3] years; 33,574 [56.1%] women) from 9746 institutions. The overall proportion of each test was: complete blood count, 58.7%; metabolic panel, 47.8%; coagulation tests, 36.6%; and liver function tests, 48.5%. The proportion receiving any preoperative tests in the overall sample was 59.5%. Multilevel logistic regression analysis indicated that preoperative blood tests were associated with the Charlson comorbidity index score (score ≥3: adjusted OR, 4.21; 95% confidence interval [CI], 3.69-4.80), anticoagulant use (adjusted OR, 4.12; 95% CI, 2.35-7.22), type of anesthesia (general anesthesia: adjusted OR, 5.69; 95% CI, 4.85-6.68; regional anesthesia: adjusted OR, 3.76; 95% CI, 3.28-4.30), surgical setting (inpatient procedure: adjusted OR, 3.64; 95% CI, 3.30-4.00), and number of beds (≥100 beds: adjusted OR, 3.61; 95% CI, 3.19-4.08). The median institutional-specific proportion of preoperative tests was 40.0% (interquartile range, 0%-100%). The median OR for interinstitutional variation in ordering preoperative tests was 4.34. These findings were consistent across a sensitivity analysis. Preoperative blood tests were performed before 59.5% of low-risk surgeries. Preoperative tests were associated with the type of anesthesia, patient characteristics, and medical facility status. There was a substantial interinstitutional variation in the utilization of preoperative tests.

A Predictive Nomogram for Atypical Meningioma Based On Preoperative Magnetic Resonance Imaging and Routine Blood Tests

Objective: To compare the characteristics of Mycoplasma pneumoniae necrotizing pneumonia (MPNP) and bacterial necrotizing pneumonia (BNP), and explore the biomarkers for differentiation of MPNP from BNP. Methods: A retrospective, observational study of 52 necrotizing pneumonia (NP) cases who were hospitalized in our hospital from January 2008 to December 2017 was conducted. According to the pathogen causing NP, patients were divided into two groups, BNP and MPNP, and the clinical manifestations, laboratory data, imaging findings, hospital course and prognosis between these groups were analyzed. Results: This study enrolled 19 boys and 33 girls, and the median ages of patients were 4.4 (0.1-13.8) years old. Of the totally of 52 NP patients, 19 were in the BNP group (9 boys and 10 girls), 33 were in the MPNP group (10 boys and 23 girls). The mean age of MPNP patients was much older than that of BNP patients (5.2 (2.3-13.2) years vs. 1.8 (0.1-13.8) years, Z=-0.128, P<0.01). The number of patients with tachypnea and pleural effusion septation were significantly higher in BNP patients than those in MPNP patients (15 cases vs. 4 cases, χ(2)=23.222, P<0.01; 14 cases vs. 1 case, χ(2)=29.326, P<0.01), which more needed to oxygentherapy (18 cases vs. 12 cases, χ(2)=16.833, P<0.01) and undergo chest drainage (9 cases vs. 4 cases, χ(2)=5.829, P=0.022); while the number of patients required bronchoalveolar lavage was higher in MPNP patients than that in BNP patients (5 cases vs. 32 cases, χ(2)=29.326, P<0.01). The values of white blood cell (WBC) (23.2 (5.2-67.1)×10(9)/L vs. 9.7 (6.3-18.7)×10(9)/L, Z=-4.855, P<0.01), procalcitonin (PCT) (3.69 (0.23-90.15) mg/L vs. 0.28 (0.02-1.44) mg/L, Z=-3.207, P=0.001), C reactive protein (CRP) (160 (94-220) mg/L vs. 90 (5-134) mg/L, Z=-4.337, P<0.01), interleukin (IL)-10 (11.7 (4.2-401.5) ng/L vs. 4.8 (2.0-23.4) ng/L, Z=-2.278, P=0.023), pleural fluid cell count (5 200 (120-50 000)×10(6)/L vs. 790 (68-6 920)×10(6)/L, Z=-3.125, P=0.002), pleural fluid lactic dehydrogenase (LDH) (3 990 (589-29 382) U/L vs. 2 211 (673-3 993) U/L, Z=-2.488, P=0.013) in BNP group were significantly higher than those in MPNP group; while the values of pleural fluid glucose(0.43 (0.03-18.00) mmol/L vs. 5.95 (4.27-7.87) mmol/L, Z=-2.795, P=0.005), serum tumor necrosis factor (TNF)-α (2.3 (1.0-2.8) ng/L vs. 2.6 (1.3-109.2) ng/L, Z=-2.113, P=0.035) and interferon (IFN)-γ (4.8 (2.6-7.7) ng/L vs. 11.9 (2.9-154.6) ng/L, Z=-2.455, P=0.014) were lower in BNP group than those in MPNP group. Meanwhile, the mean time from the onset of symptoms to the discovery of necrotic lesions was longer in MPNP group than that in BNP group ((20.6±6.4) days vs. (14.6±6.2) days, t=3.029, P=0.004). After treatments, all patients were discharged without death, WBC and PCT recovered more quickly in MPNP group than those in BNP group (12 (0-24) days vs. 0 (0-23) days, Z=-4.484, P<0.01; 10 (5-15) days vs. 0 (0-23) days, Z=-3.244, P=0.001). As to prognosis, 34 cases were followed up, and the results showed that patients recovered without surgical intervention, and chest lesions were resolved within 3.0 (1.0-8.0) months, and the time to necrosis disappearance was similar in the BNP group and MPNP greup (3.0 (1.0-8.0) months vs. 3.0 (1.0-8.0) months, Z=-0.128, P=0.001). In receiver operator characteristic curve analysis, the cut-off values for the age, WBC, CRP, PCT, pleural fluid cell count and pleural fluid glucose were set at 2.4 years of age, 17.2×10(9)/L, 157 mg/L, 1.505 mg/L, 2 630×10(6)/L and 3.73 mmol/L, respectively. Conclusions: NP is found to be severe and prolonged, yet, reversible through proper therapy, such as rational antibiotics application. The age, WBC, CRP, PCT, pleural fluid cell count and pleural fluid glucose could be used as biomarkers to differentiate MPNP from BNP in children.

Several preoperative blood and biochemical parameters are associated with postoperative survival in many kinds of tumors. The aim of this study is to study the predictive value of several routine preoperative blood and biochemical parameters on the prognosis patients with rhabdomyosarcoma (RMS).We retrospectively recruited 55 patients diagnosed with RMS and had surgery at West China Hospital, Sichuan University between January 2010 and December 2018. Baseline characteristics of the patients, tumor features, surgery details, and values of several examinations were extracted. A long-term follow-up was conducted by phone call. A novel statistical analysis was subsequently carried out to look for the relationship of preoperative parameters and patients’ prognosis.The ROC analysis showed an area under curve (AUC) of 0.608, 0.620, 0.626, 0.591, and 0.518 for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), lactic dehydrogenase (LDH), and alkaline phosphatase (ALP) respectively, and the cut-off value of 2.843, 162.961, and 0.239 for NLR, PLR, and MLR respectively. The survival analysis showed that certain blood and biochemical parameters could cause differences in overall survival (OS) (P = .005 for NLR, P = .005 for PLR, and P = .007 for MLR) and progression free survival (PFS) (P = .029 for NLR, P = .008 for PLR, and P = .013 for MLR).Several preoperative blood and biochemical parameters are novel prognostic factors in RMS patients. Specifically, a higher NLR, PLR, and MLR value will predict a statistically shorter OS and PFS.In the future, surgeons should care more about NLR, PLR, and MLR values and several other parameters in patients’ preoperative normal blood and biochemical tests to predict the postoperative conditions.

Background and Aims Chronic inflammation is an important non-traditional risk factor for morbidity and mortality in patients with terminal kidney disease. Associated occurrence of malnutrition, inflammation and atherosclerosis was observed in patients on dialyses and marked as MIA syndrome, a vicious circle in which pro inflammatory cytokines play a key role. It is known that there were individual differences in creation of cytokines, and it is assumed that polymorphisms in the promoter regions of cytokine genes can have a key role in the predisposition to chronic inflammation and its consequences. We investigated association between interleukin-6 -174 G&amp;gt;C, interleukin-10 -1082 G&amp;gt;A, inteleukin-10 -819 T&amp;gt;C genotypes with the survival of patients with terminal renal failure. Method In this study, a total of 128 patients were examined, 77 on the regular hemodialysis (HD) and 51 on the peritoneal dialysis (PD) program of the UKCS Nephrology Clinic in Belgrade. Age, gender, BMI, duration of HD/PD, C-reactive protein (CRP), albumin and IL-6 and IL-10 concentration in serum were analyzed. Analysis of IL6 -174G&amp;gt;C and IL10 -819T&amp;gt;C polymorphisms was performed by the allele-specific PCR method, and analysis of the IL10 -1082G&amp;gt;A polymorphism by the PCR/RFLPs method. The patients were followed for 36 months and during that time 37 patients died. Results Univariate analysis showed that significant predictors of mortality were age (OR= 1.16,95%CI 1.061-1.269, p=0.001), albumin concentration (OR= 0.81, 95%CI 0.656-0.999, p=0.049), CRP (OR= 1.06, 95%CI 1003-1.124, p=0.039) and IL-6 (OR= 1.12, 95%CI 1.038-1.216, p=0.004), as well as IL-6176G&amp;gt;C gene polymorphism (OR= 0.82, 95%CI 0.097-0.805, p=0.018), while in multivariate logistic model separated only the concentration of IL-6 and the polymorphism in the gene for IL-6 -174 G&amp;gt;C. Estimated arithmetic mean of survival in subjects with the IL-6 -174GG genotype was 33.1 months (95%CI 30.8-35.3), GC 34.6 months (95% CI 33.6-35.7) and CC 26.1 (95% CI 20.0-32.2). There is statistically significant difference in survival time in relation to IL-6 -174 G&amp;gt;C genotype (chi-square=11.398; p=0.003). Estimated arithmetic mean survival in patients with the IL-10 -1082 GG genotype was 32.6 months (95% CI 30.5-35.2), in GA 31.5 (95% CI 29.2-33.8) and in AA 36.0 (95% CI 35.9-36.1). Exists statistically significant difference in survival time in relation to 1082G&amp;gt;A genotype (chi-square=9.669; p=0.008). Conclusion Monitoring of survival in 128 patients during 36 months showed that significant worse survival was experienced in patients with IL -6 -174 CC genotype, while polymorphisms in IL 10 gene-1082 G&amp;gt;A and -819T&amp;gt;C did not significantly affect survival. In this group of patients, beside IL-6-174 CC genotype, concentrations of IL-6, C reactive protein and albumin were significant predictors of mortality as well as Kt/V.

e17579 Background: Our purpose was to evaluate changes in blood parameters in patients with laryngeal squamous cell carcinoma (LSCC) during polychemotherapy (PCT) with cetuximab. Methods: Levels of white blood cells (WBC), immature granulocytes (IG) and neutrophils (Ne), as well as levels of C-reactive protein (CRP), lactate dehydrogenase (LDH) and creatinine were studied in the blood of 20 patients with stage I-III LSCC before therapy with cetuximab/cisplatin+5-fluorouracil and on days 2, 9 and 16 of the therapy. The control group (21 patients) received similar PCT without cetuximab. Treatment was assessed using the RECIST criteria. Results: Partial response was observed in 16 (80%) patients of the main group and in 5 (23.8%) controls, stabilization - 4 (20%) and 12 (57.4%), respectively, progression – in 4 (19%) patients of the control group. Patients of the main group with treatment effect showed WBC increase by 2 times after every cetuximab injection (days 2, 9, 16) compared with the initial levels due to Ne and IG increase by 2.7 and 4 times, respectively. WBC and IG levels measured on days 2, 9 and 16 were 13.40±2.86×109/L, 13.52±1.88×109/L, 12.25±2.08×109/L and 0.044±0.021×109/L, 0.056±0.015×109/L, 0.060±0.008×109/L, respectively (p &lt; 0.001). A transient increase in the indexes was replaced by their decrease to the initial values, with the values similar to the reference ones by the end of the treatment. At the same time, we observed decrease in CRP and creatinine levels up to the reference levels (7.69±3.28 mg/L and 74.75±6.54 umol/L, respectively); LDH did not increase. Stabilization was characterized by unchanged WBC levels, positive dynamics of IG and slow decline of CRP level exceeding the reference one (10.0 mg/L) by the treatment end. Reduction of WBC and increase in IG and CRP levels were noted in the controls regardless of the PCT results which could be explained by severity of intoxication syndrome, partially due to the disease and partially due to PCT toxicity. Conclusions: A dual transient increase in WBC and IG levels, reduction of CRP and creatinine during the treatment and unchanged LDH indicate minimization of myelotoxic and general toxic effects of PCT in combination with cetuximab.

Thymidine kinase (s-TK), lactate dehydrogenase (LDH), and carcinoembryonic antigen (CEA) were determined in pretreatment serum from 125 patients with small cell carcinoma of the lung. The distribution of marker levels into three ranges, when including all patients were as follows: s-TK less than 5 units 49%, 5-less than 10 units 25%, greater than or equal to 10 units 26%; LDH less than 6.7 mukat 31%, 6.7-less than 13.4 mukat 48%, greater than or equal to 13.4 mukat 21%; CEA less than 7.5 micrograms/l 51%, 7.5-less than 15 micrograms/l 25%, greater than or equal to 15 micrograms/l 24%. The percentages of patients with limited and with extensive disease within each range were s-TK less than 5 82/18, 5-less than 10 29/71, greater than or equal to 10 9/91; LDH less than 6.7 76/24, 6.7-less than 13.4 51/49, greater than or equal to 13.4 21/79; CEA less than 7.5 70/30, 7.5-less than 15 39/61, greater than or equal to 15 23/77. Analyses in relation to metastases present showed that patients with skeletal and bone marrow metastases had significantly higher s-TK and LDH than those without, while this was not the case for CEA. A strong correlation between s-TK and LDH level, a weaker correlation between CEA and s-TK, and no correlation between CEA and LDH level, was found. Both the level of s-TK and LDH correlated to the patients' performance, as defined by the Karnofsky index. These correlations were mainly confined to the patients with extensive disease. Analyses of the prognostic capacity of variables showed that s-TK, stage, and Karnofsky index could divide the patients into groups with highly significant difference in survival time, while LDH and CEA were of less value. Longitudinal studies showed that the serum markers mirrored the disease activity, with the exception that highly increased s-TK was found during remission induction for some patients. It was concluded that the expression of pathologic levels for the serum markers were dependent on different biological parameters. Of the serum markers, only s-TK was judged useful for estimation of disease spread and prognosis of the individual patient.

Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience.

Summary Introduction. The expanded use of imaging technology has led to improvements in the early diagnosis of kidney cancer. However, providing correct diagnoses regarding the malignant potential of small renal lesions remains problematic for clinicians. In addition to imaging, pre-operative investigations usually include a complete blood count and biochemistry tests. Aim of the study. To evaluate whether the pre-operative blood cell count, cell ratios, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) can be helpful in predicting the malignancy of visually suspicious renal masses prior to surgery. Material and methods. Data on pre-operative blood tests were retrospectively collected from 84 cases of stage I renal cell carcinoma (RCC) and 55 benign lesions from patients hospitalized after a radiological finding of renal cancer and following nephrectomy. The predictive ability of various blood tests for malignant potential was analysed using the following statistical methods: the Mann- Whitney U test, receiver operating characteristic (ROC) curves and binary logistic regression. Results. The mean CRP levels, monocyte (Mo) counts, platelet (PLT) counts and monocyte/lymphocyte ratios (MLRs) varied significantly between the patients with stage I RCC and patients that had benign renal lesions with a small effect size. Among these tests, the highest AUCs were displayed by CRP [0.704, 95% confidence interval: 0.567 - 0.807] and MLR [0.736, 0.612 - 0.861]. Based on the ROC curves, optimal cut-off values of 0.26 for MLR and 1.75 mg/L for CRO were selected. A binary logistic regression was used to determine if the combination of CRP and MLR could be used to predict whether patients with renal lesions had cancer resulting in increase of area under the curve (AUC) to 0.798 [0.690 -0.905]. Conclusions. In cases of diagnostic difficulties observing small renal lesions radiologically, the combination of elevated CRP levels and MLRs above 0.26 may help to confirm the presence of renal cancer.

Objective To investigate the early predictors of Mycoplasma pneumoniae pneumonia (MPP) in children with blockage of airway mucous plug. Methods Retrospective analysis was executed on the clinical data of 130 children, who were diagnosed as MPP and treated with fiberoptic bronchoscopy at the Department of Pediatrics, the First Hospital of Jilin University, from September 2016 to January 2017.The patients were divided into the mucus plug group (60 cases)and the control group(70 cases) according to the performance of flexible bronchoscopy.The general information, clinical manifestations, laboratory examination, radiological features, bronchofibroscopic findings and treatment were compared between 2 groups.The multiple Logistic regression analysis and receiver operating characteristic (ROC) curve were used for the single factor with clinical and statistical significance to identify the early predictors of the MPP with blockage of airway mucus plug. Results Compared with the control group, the fever peak [39.8 ℃(39.5 ℃, 40.0 ℃) vs. 39.5 ℃(39.0 ℃, 39.8 ℃)], the fever duration[(11.3±3.1) d vs.(7.8±2.4) d], hospitalization time[(13.5±3.8) d vs.(8.5±3.2) d], white blood cells (WBC)[(9.4±3.7)×109/L vs.(8.2±2.9)×109/L], the percentage of neutrophils (NE) (0.698±0.112 vs.0.623±0.119), C-reactive protein (CRP) [48.2 (19.8, 91.0) mg/L vs.12.4 (7.1, 25.4) mg/L], lactic dehydrogenase(LDH) [466.5(371.5, 639.0) U/L vs. 323.0(273.2, 376.8) U/L], the proportion of combined with pleural effusion(56.7% vs.17.1%), atelectasis(23.3% vs.7.1%), necrosis (16.7% vs.0)and involved lobes more than 2 (40.0% vs. 21.4%) were higher in the mucus plug group, and these indicators had significantly statistical differences(Z=-3.394, t=-6.957, -8.021, -2.046, -3.672, Z=-6.402, -6.433, χ2=22.074, 6.786, 12.639, 5.306, all P<0.05). The multiple Logistic regression analysis showed that the febrile time, CRP and LDH were independent predictors for the MPP with blockage of airway mucus plug.The ROC curve analysis showed that the cut-off values of the 3 predictors were febrile time≥9.5 d[area under curve (AUC)=0.810, 95% confidence interval(CI): 0.738-0.883], CRP≥30.4 mg/L(AUC=0.826, 95%CI: 0.757-0.895), and LDH≥343.5 U/L (AUC=0.828, 95%CI: 0.756-0.900). Conclusion The fever duration ≥9.5 d, increased CRP (≥30.4 mg/L), and increased serum LDH (≥343.5 U/L) can be applied as one of the early predictors for MPP in children with mucus plug. Key words: Mycoplasma pneumoniae pneumonia; Fiberoptic bronchoscope; Predictor; Mucus plug; Child

BACKGROUND In the 2021 WHO Brain Tumor Classification 5th Edition, it became possible to diagnose glioblastoma (GBM) molecularly if a patient had any of the following genetic abnormalities in genetic analysis: TERT promoter mutation, EGFR amplification, and chromosome 7 gain/10 deletion (7+/10-). However, there have been few reports on the clinical features and prognostic impact of these genetic abnormalities in GBM, so we retrospectively examined them in our hospital cases. METHODS Of 56 cases of Grade IV gliomas that underwent surgery at the University of Tokyo Hospital between 2018 and 2022, 51 cases were included, excluding 5 cases (8.9%) with IDH mutations. Clinical and image information was extracted from medical records. Tumor DNA was extracted from tumor samples, and TERT promoter mutations were analyzed by the Sanger method, and EGFR amplification and chromosome 7 gain/10 deletion (7+/10-) were analyzed by the MLPA method. RESULTS The male/female ratio of the 51 cases was 20:31, the mean age at surgery was 64.1 years (range 21-93). TERT mutations were observed in 69.4%, EGFR amplification in 43.3%, and 7+/10- in 46.7%. When comparing survival times only for primary cases, there was no significant difference in overall survival time between the presence or absence of TERT mutations, EGFR amplification, and 7+/10- (p=0.8, 0.2, 0.5). When comparing cases in which none of the three genetic abnormalities were present with cases in which one or more genetic abnormalities were present, no significant difference in survival time was observed (p=0.1). CONCLUSION This study did not find any significant difference in prognosis between the presence or absence of genetic abnormalities in histological GBM. Further research using a larger number of samples is needed to make more accurate prognostic predictions.

Objective To identify the relevant factors for the loculation clinically in children with parapneumonic pleural effusion(PPE). Methods The clinical data of 172 children with PPE were retrospectively reviewed from January 2012 to March 2015 in Children's Hospital of Hebei Province.Based on the findings of chest ultrasound, the subjects were divided into 2 groups, the loculation group(78 cases) and the control group(94 cases). The comparison was made between the 2 groups in gender, age, course of disease and fever before admitting into hospital, the location of the effusion, white blood cells(WBC) and the percentage of neutrophils(N), blood platelet(PLT), lactate dehydrogenase(LDH), C-reactive protein(CRP), mycoplasma(MP), the routine and biochemical examination of pleural fluid, including white cell count(WBCp), the percentage of polymorphonuclear cell(PMN), lactate dehydrogenase(LDHp), glucose(GLU), adenosine deaminase(ADA), lactic acid(LAC) and C-reactive protein(CRPp). If the result of single factor regression showed P<0.01, the indicators were analyzed by the multifactor Logistic regression.The receiver operator characteristic(ROC) curve was drawn to evaluate the prediction ability of Logistic regression models. Results (1)The result of single factor regression indicated that the risk factors included age, WBC, PLT, LDH, MP, WBCp, PMN, GLU and LAC(all P<0.05).(2)The result of multifactor Logistic regression showed that the factors included PLT(OR=3.437, P=0.007), LDH(OR=0.306, P=0.006), GLU(OR=0.324, P=0.037), MP(OR=0.375, P=0.022)and LAC(OR=3.656, P=0.003).(3)The area under the ROC curve was 0.876, P= 0.000, which indicated that the regression models had over medium diagnostic accuracy. Conclusions When PLT>434.5×109/L, LDH 3.83 mmol/L, it may indicate that the formation of loculation for the PPE children. Key words: Parapneumonic pleural effusion; Loculation; Relevant factors; Logistic regression analysis; Child

BackgroundThe levels of serum D-dimer (D-D) in children with Mycoplasma pneumoniae pneumonia (MPP) were assessed to explore the clinical significance of D-D levels in refractory MPP (RMPP).MethodA total of 430 patients with MPP were enrolled between January 2015 and December 2015 and divided into a general MPP (GMPP) group (n = 306) and a RMPP group (n = 124). Clinical data, D-D level, white blood cell (WBC) count, proportion of neutrophils (N%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) were compared between the two groups. Multivariate logistic regression was performed to identify independent predictors of RMPP.Results(1) Hospitalization time, preadmission fever duration, total fever duration, WBC, N %, CRP, LDH, ESR, ALT, AST, and D-D were significantly higher in the RMPP group than those in the GMPP group (all P < 0.05). (2) Correlation analysis showed that D-D was positively correlated with WBC, CRP, ESR, and LDH, and could be used to jointly evaluate the severity of the disease. (3) Multivariate logistic regression analysis identified preadmission fever duration, CRP, LDH and DD as independent risk factors for RMPP (all P < 0. 05). D-D had the highest predictive power for RMPP (P < 0.01). The D-D level also had a good ability to predict pleural effusion and liver injury (all P < 0.01).ConclusionSerum D-D levels were significantly increased in patients with RMPP, indicating that excessive inflammatory response and vascular endothelial injury with prolonged duration existed in this patient population. Increased levels of serum D-D may be used as an early predictor of RMPP and the occurrence of complications. Our findings provide a theoretical basis for the early diagnosis of RMPP, early intervention and excessive inflammatory response in the pathogenesis of mycoplasma.

Characteristics of pregnant patients with COVID-19 and liver injury