Abstract Background Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, if not recognized early and managed promptly, it can lead to septic shock, multiple organ failure and death. Sepsis is associated with high mortality, and the early recognition of the signs of tissue hypo perfusion is crucial in its management. Aim The aim of the study was to compare between PCO2 gap, serum lactate and procalcitonin as predictors of clinical outcomes in ICU septic patients regarding 28 days mortality or developing septic shock or multiorgan failure (MOF). Patients and Method This prospective observational study was carried out in the ICU of Ain Shams university hospitals and Egypt air hospital. The study was done on 80 cases. Inclusion criteria: Adult septic patients ≥ 21 years old. Exclusion criteria: Patients with history of chronic obstructive pulmonary disease and bronchial asthma or died <48 h of admission. Method: All patients were subjected to complete history taking and Physical examinations to exclude systemic diseases. Investigational Studies: Routine laboratory investigations: complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), liver and kidney functions, PT, PTT and INR. Serum lactate: was done on admission then after 48 hours. PCO2 arterial and central venous (PCo2gap): was done on admission then after 48 hours. Procalcitonin: on admission then after 48 hours. APACHE ΙΙ and SOFA scores were recorded on admission. Results patients were classified in to 2 groups according to mortality: survivors group & non survivors group, survivors were n = 60(75%) and non survivors were n = 20(25%). Regarding serum lactate on 1st day of admission and after 48 h, it revealed that survivors group showed significant reduction in serum lactate level at 48 h compared to baseline (p < 0.001). while in non-survivors group there was statistically significant increase in serum lactate after 48 h than at 1st day of admission (P < 0.001), the cutoff point of s. lactate on 1st day was >3.97 mmo/l showed sensitivity of 90% and specificity of 93.33%, while after 48 hours the cutoff point of s.lactate was >2.68mmo/l showed sensitivity of 100% and specificity of 100%. Regarding PCO2 gap on 1st day of admission and after 48 h, it revealed that survivors group showed significant reduction in PCO2 gap after 48 h compared to baseline (p < 0.001). However, non-survivors group showed an increase in PCO2 gap after 48 h compared to baseline with statistical significance (p < 0.001), the cutoff point of PCO2 gap on 1st day was >7.48 mmHg gave sensitivity of 90% and specificity of 90%. While the cutoff point of PCO2 gap after 48 h. was >6.2 mmHg gave sensitivity of 95% and specificity of 95%. Regarding procalcitonin on 1st day of admission and after 48 h, it revealed that survivors group showed significant reduction in procalcitonin after 48 h compared to baseline (p < 0.001). Non-survivors group showed significant increase in procalcitonin after 48 h compared to baseline (p < 0.001), the cutoff point of procalcitonin on 1st day was >2.336 ng/ml gave sensitivity of 90% and specificity of 81.67%. While the cutoff point of procalcitonin after 48h. was >2.14 ng/ml gave sensitivity of 90% and specificity of 85%. Regarding APACHE II severity score on 1st day it revealed that survivors group ranged between 5-17, while in non survivors group ranged between 15-26, revealed that higher APACHE II score associated significantly with increased mortality in non-survivors compared to survivors group (P < 0.0001). Regarding SOFA severity score on 1st day of admission in survivors group ranged between 1-13,while in non survivors group ranged between 10-17. SOFA score was significantly higher in non-survivors compared to survivors group (P < 0.0001). MOF were 25(41.7%) in survivors group and 20(100%) in non-survivors group, there was statistical significant higher frequency of MOF in non-survivors group than survivors group (P < 0.001). Patients who developed septic shock and required vasopressors were 43(71.7%) in survivors group and 20(100%) in non-survivors group, there was statistical significant higher frequency of vasopressors requirement in non-survivors group than survivors group (P = 0.007). Conclusion PCO2 gap, serum lactate and procalcitonin in addition to severity scores (APACHE II & SOFA scores) were identified as predictors of clinical outcome in ICU septic patients. Serum lactate followed by PCO2 gap then procalcitonin had comparable prognostic accuracy with severity scores (on admission and after 48 h).

Aim: To compare the APACHE II, SAPS II and SOFA scoring systems as predictors of mortality in ICU patients in terms of sensitivity, specificity and accuracy. Methodology: A prospective observational study. Intensive care unit from May 13, 2018 to September 15, 2021. For 1368 patients included in study, results for APACHE II, SAPS II and SOFA were calculated with the worst values recorded. At the end of ICU stay, patient outcome was labelled as survivors and non-survivors. The cut off value for APACHE II, SAPS II and SOFA was taken as 50% of the highest possible score, with <50% expected to survive and with ≥50% expected to die during their ICU stay. Cross tables were made against real outcome of the patients, and sensitivity, specificity and accuracy for APACHE II, SAPS II and SOFA were calculated. Results: Sensitivity, specificity and accuracy were 77.53%, 94.28% and 85.45% for APACHE II scoring system; 47.29%, 87.32%, and 66.23% for SAPS II scoring system; and 73.37%, 60.28%, and 67.18% for SOFA scoring system, respectively. Conclusion: Apache Ii scoring system has highest sensitivity, specificity and accuracy in mortality prediction in ICU patients as compared to SAPS II and SOFA scoring systems, with SAPS II being least sensitive and accurate. Keywords: Sensitivity, specificity, accuracy, Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment (SOFA), Intensive care units (ICU), Mortality.

Background: Since April 2020, the number of newly diagnosed cases and death cases of COVID-19 have decreased significantly in China but increased rapidly abroad Early diagnosis and treatment are of great concern to improving the prognosis of COVID-19 patients Objective: To investigate the clinical features and prognostic risk factors of adult patients with COVID-19, offering a reference for clinical diagnosis and treatment of this disease Methods: A retrospective design was used Participants were 93 adult cases of COVID-19 who were treated in Beijing Youan Hospital between January and February 2020 They were categorized into common, severe and critical types by the most serious conditions during hospitalization, in accordance with the Diagnosis and Treatment Protocol for COVID-19(Trial Version 7)issued by the National Health Commission of the People's Republic of China Indications such as general information, major clinical manifestations, baseline laboratory parameters, APACHE II and SOFA scores within 24 hours of admission, imaging findings, comorbidities and complications, treatments and outcomes were collected Results: There were 57 cases of common type(61 3%), 22 of severe type(23 7%)and 14 of critical type(15 0%) The male ratio was slighter higher in critical group, and female ratio was slighter higher in other groups, but sex composition showed no significant differences across the groups(P>0 05) The median age for common, severe and critical groups was 45 0, 62 0 and 81 0 years, respectively, showing significant differences(P0 05) Dyspnea occurred in all severe or critical cases, showing a higher incidence than common cases(100 0% vs 31 6%)(P<0 05) The incidence of lymphocytopenia in critical group was 100%, which was significantly higher than that in common group(49 1%)or severe group(59 1%)(P<0 05) Acute liver injury was the most common complication(58 1%)in all cases, but its incidence was obviously increased in severe group (77 3%) or critical group(92 9%), than that of common group(42 1%)(P<0 05) Chinese medicine therapy was used in 75 3% of all cases, but the severe cases had a higher rate of treating with Chinese medicine than critical cases(90 9% vs 50 0%, P<0 05) The rate of corticosteroid use in severe cases(63 6%)or critical cases(64 3%)was significantly increased than that of common cases(5 3%)(P<0 05) Six patients(6 5%)were treated with invasive ventilation, but only 1 of them(16 7%)was successfully extubated ultimately Nine patients(9 7%)died in hospital due to all causes Logistic regression analysis revealed that age ≥74 years〔OR(95%CI)=33 714(3 021, 376 211), P=0 004〕and baseline SOFA≥2 5〔OR(95%CI)=15 447(1 331, 179 260), P=0 029〕were independent risk factors for in-hospital death Conclusion: COVID-19 mainly manifests as respiratory infections Severe patients are apt to appear tissue injury and dysfunction of organs like liver, kidney and heart, etc The majority of patients have a favorable outcome Age and baseline SOFA score would help to label the prognosis of patients at an early stage Copyright © 2021 by the Chinese General Practice

Background: Acute pancreatitis is a common gastrointestinal disease and timely severity stratification is crucial in reducing the mortality and morbidity of the patients. Many markers have been studied for their role as a single predictor of the severity of the disease. Our study is aimed to evaluate the performance of C-reactive protein (CRP) testing as a single biomarker in predicting the severity of acute pancreatitis. Methods: Retrospective observational study with data collection and content analysis design. Patients were divided according to the acute physiology and chronic health evaluation (APACHE II) score into two categories, mild and severe. CRP testing was obtained within 48 h of hospital admission. Results: Our results showed that out of 99 patients, 82 patients had a mild attack of acute pancreatitis, while 17 patients had a severe form of the disease. The mean CRP level of patients with severe acute pancreatitis was significantly higher than the mean CRP level of patients with the mild form of the disease. There was a fair agreement between CRP level and the APACHE II score. Conclusion: C-reactive protein (CRP) test obtained within 48 hours of hospital admission is a helpful tool in predicting the severity of acute pancreatitis.

Objective To analyze the clinical characteristics of critical COVID-19, and we improve the understanding of the diagnosis and treatment of severe cases. Methods Death cases with critical COVID-19 in Public Health Clinical Medical Center of Chengdu from January to May 2020 were collected, and their clinical data and imaging features were retrospectively analyzed. Results The three cases of severe type COVID-19 deaths, all have basic diseases, such as coronary heart disease, with or without lung diseases, renal disfunction , they all have symptoms of fever, cough, sputum. Athospital admission, APACHE II score and PSI rating were high-risk, laboratory examination results suggested lactate dehydrogenase, creatine kinase, troponin, brain natriuretic peptide, C-reactive protein and serum amyloid A were significantly increased, and T lymphocyte count droped apparently, chest imaging suggested pulmonary grinding glass patch shadow. After admission, the patients were given active antiviral, anti-bacterial, immunological and invasive mechanical ventilation support. All 3 patients had severe complications such as septic shock and multiple organ failure syndrome, and the average time from onset to death was 13.7 days. Conclusion Old-age people combined with heart disease and other basic diseases, and immunodeficiency are the high-risk groups of critical COVID-19. 摘要：目的 分析危重型新型冠状病毒肺炎死亡病例的临床特征, 提高对重症病例诊治的认识。 方法 收集 2020 年 1 月—5 月成都市公共卫生临床医疗中心接诊的危重型新型冠状病毒肺炎死亡病例资料, 回顾性分析其临床资 料和影像学特征。 结果 3 例危重型 COVID-19 死亡病例均有冠心病、伴或不伴肺部疾病、肾功能障碍等基础疾病, 均 有发热、咳嗽、咳痰症状, 入院 APACHE II 评分和 PSI 评分均为高危, 实验室检查结果提示肌酸激酶、肌钙蛋白、脑钠肽、C-反应蛋白及血清淀粉样蛋白 A 明显升高, 而 T 淋巴细胞计数明显下降, 胸部影像学提示双肺磨玻璃斑片影。入院后 给予积极的抗病毒、抗细菌、增强免疫治疗及有创机械通气呼吸支持。3 例患者均并发脓毒性休克及多器官功能衰竭 综合征等严重并发症, 起病到死亡的平均时间为 13.7 d。 结论 高龄、合并心脏病等基础疾病、免疫功能低下者是危重 型新型冠状病毒肺炎死亡的高危人群。

Objective To explore the effects of age on the use of lactate clearance rate (LCR) to predict prognosis in septic shock patients. Methods Septic shock patients who were admitted into the intensive care unit (ICU) of the Affiliated Hospital of Xuzhou Medical University from January 2015 to August 2018, with complete clinical data, were selected for retrospective analysis. According to their ages, they were divided into a non-elderly group (aged 18-74 years) and an elderly group (≥75 years old). Moreover, according to the outcome of hospitalization, the patients were divided into a survival group and a death group. The level of arterial blood lactate (Lac) was measured when the patients were diagnosed with septic shock (0 h), and 12 h and 24 h after treatment, while the LCRs at 12 h and 24 h were calculated. The scores of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Sequential Organ Failure Assessment (SOFA), the length of hospitalization stay and outcomes were recorded. The differences of above indicators in each group were analyzed. Results A total of 483 septic shock patients were collected, in which 286 patients met inclusion criteria, including 111 cases in the elderly group and 175 in the non-elderly group. There were 61 cases (55.0%) of death in the elderly group and 55 cases (31.4%) of death in the non-elderly group. The COX regression analysis and survival time curve showed that age was an independent risk factor for the prognosis of septic shock patients. The risk of death in the elderly group was 1.95 times higher than that in the non-elderly group. Patients in the death group in different age ranges presented higher APACHE Ⅱ scores, SOFA scores, and blood Lac levels as well as lower 24 h LCR than those in the survival group (P 0.05). APACHE Ⅱ score, SOFA score and blood Lac level were positively related with hospitalization mortality, but negatively related with LCR. Conclusions Age, APACHE Ⅱ score, SOFA score, Lac level and LCR are related factors of hospitalization outcome, where age is an independent risk factor for the prognosis of septic shock patients. LCR cannot be used to accurately evaluate the prognosis of elderly patients with septic shock. Key words: Septic shock; Lactate clearance rate; Prognosis; Age

The aim of this study was to explore the relationship between serum MALAT1 level and clinical features of elderly patients with severe pneumonia and its impact on patients' survival. A total of 150 elderly patients with severe pneumonia were enrolled in this study. According to patients' prognosis, enrolled subjects were divided into two groups, including death group (n=63) and survival group (n=87). The clinical data and indicators of subjects were collected, and χ2 and t-tests were used for statistical analysis. MALAT1 expression in the serum of all subjects was examined through the qPCR assay. Meanwhile, the predictive value of MALAT1 for patient death was assessed by the receiver operating characteristic curve (ROC). PT, APTT, DD, APACHE II scores, and MODS scores in death group were remarkably higher, while HB, HCT, TT, and PaO2/FiO2 were conversely lower than those in survival group (p<0.05). QRT-PCR results revealed significantly increased MALAT1 expression in death group when compared with survival group, especially in those patients with a history of smoking and COPD (p<0.05). In addition, ROC analysis confirmed the predictive value of MALAT1 for the prognosis of elderly patients with severe pneumonia. MALAT1 is highly expressed in the serum of elderly patients with severe pneumonia. Furthermore, it may serve as a marker for the prediction of survival of these patients.

To summarize the clinical experiences and indications of extracorporeal membrane oxygenation (ECMO) for severe ARDS caused by novel 2009 influenza A (H1N1) virus. All ECMO cases with severe ARDS associated with novel 2009 influenza A (H1N1) virus were analyzed in 5 intensive care units (ICUs) from 5 different hospitals in Beijing and Tianjin. A physician experienced in ECMO handling collected the relevant data, including general conditions pre and post-EMCO, efficacy and complication parameters, ventilator settings of mechanical ventilation and clinical outcomes. The statistical software of SPSS (version 11.5) was used for data analysis. 18 cases of novel H1N1 influenza with severe ARDS received ECMO. There were 9 males and 9 females (all pregnant). The mean age was (33 ± 11) years old. Eight were complicated with pulmonary barotraumas (6 of pneumothorax). Prior to ECMO, the patients underwent noninvasive and invasive positive pressure ventilation for 1 day and 60 hours respectively. Physiological parameters 2-6 hours prior to ECMO use were: (53 ± 14) mm Hg of PaO2/FiO2, (17 ± 5) cm H2O of positive end expiratory pressure (PEEP), 3.80 ± 0.29 of Murray lung injury score, (7.38 ± 0.10) of arterial pH, (3.3 ± 2.3) mmol/L of serum lactate, 16 ± 8 of APACHE II score. All patients treated venous-venous ECMO (VV-ECMO) for a mean duration of 8 days (range: 2 - 168). Settings of mechanical ventilation (prior to ECMO vs 2 hours post-ECMO) were: peak airway pressure (31 ± 7) vs (25 ± 6) cm H2O, respiratory rate (15 ± 4) vs (22 ± 6) breaths/min, FiO2 0.8 - 1.0 vs 0.35 - 0.50, PEEP (16 ± 5) vs (12 ± 4) cm H2O. Arterial blood gas (pH, PaO2 and PaCO2) post-ECMO of 2 hours and 24-hour significantly improved (P < 0.05). Seven patients died during ECMO, 11 patients were successfully weaned from ECMO. And 8 of them survived and were discharged. One patient stayed in ICU and 2 died in ICU. As an effective measure of respiratory supports, ECMO may provide pulmonary rest and improve gas exchanges in severe ARDS induced by novel H1N1 Influenza.

Objective To investigate the clinical effect of intra-abdominal pressure monitoring on jejunal nutrition in critically ill patients. Methods From March 2017 to September 2018, 124 critically ill patients who needed early jejunal nutrition in ICU of our hospital were selected and randomly divided into observation group (63 cases) and control group (61 cases) according to the digital table.The observation group adjusted enteral nutrition according to IAP monitoring, while the control group was routinely observed and guided enteral nutrition.Intra-abdominal pressure was compared between the two groups.The changes of blood lactic acid, endotoxin and APACHE Ⅱ score were compared between the two groups. Results After treatment for 7 days and 14 days, the intra-abdominal pressure of the observation group[(14.28±2.36)mmHg, (12.08±1.78)mmHg] were lower than those of the control group [(16.05±2.55)mmHg and (15.21±2.11)mmHg] (t=4.013, 8.939, all P<0.05). After treatment for 14 days, the blood lactic acid, endotoxin, APACHE Ⅱ score in the observation group were (2.19±0.73)mmol/L, (0.71±0.21)U/L and (10.02±1.54), which were lower than those in the control group [(3.98±0.95)mmol/L, (0.92±0.23)U/L and (13.06±1.72)] (t=11.788, 5.313, 10.376, all P<0.05). The incidences of abdominal distension (9.52%) and gastric retention (7.94%) in the observation group were significantly lower than those in the control group (28.57%, 27.87%) (χ2=7.930, 8.437, all P<0.05). Conclusion Early jejunal nutrition under the monitoring of intra-abdominal pressure in critically ill patients can help to reduce intra-abdominal hypertension, promote the rehabilitation of patients, reduce the incidence of complications of jejunal nutrition and improve patients’ tolerance, which is worthy of clinical promotion. Key words: Enteral nutrition; Pressure; Abdominal cavity; Lactic acid; Endotoxins; APACHE Ⅱ score

Objective To study the role of Th17 cells proportions and the cytokines levels in the diagnosis and treatment of acute pancreatitis (AP). Methods Patients with AP (n=82) treated in our hospital between August 2017 and August 2018 were divided into the mild AP group (MAP, n=36), the moderately severe AP group (MSAP, n=26) and the severe AP group (SAP, n=20). Twenty-five healthy subjects were chosen as the control group. The proportions of Th17 cells and the levels of cytokines including IL-17, IL-21, IL-22 and IL-23 in peripheral blood from the four groups were analyzed. The APACHE II and Ranson scores were used to evaluate the illness severity. Spearman correlation analysis was conducted to detect the correlation between the Th17 cells, cytokines, and inflammatory factor, APACHE II and Ranson scores. Results Compared with the control group, the proportion of Th17 cells and the levels of IL-17, IL-21, IL-22 and IL-23 in the peripheral blood of MAP, MSAP and SAP groups were significantly increased (SAP>MSAP>MAP, P<0.05). The levels of inflammatory cytokines IL-6, IL-8 and TNF-α, and the scores of APACHE II and Ranson in the SAP group were significantly higher than those in the MSAP group and MAP group (P<0.05). The proportion of Th17 cells and their cytokine levels were positively correlated with IL-6, IL-8, TNF-α, APACHE II and Ranson scores. The levels of Th17 cytokines returned to normal in AP patients after treatment. Conclusion Th17 cells and the cytokines have certain clinical significance in evaluating early inflammatory response, severity of illness, and therapeutic effect in AP patients. Key words: Pancreatitis, acute; Th17 cells; Cytokines; Inflammatory response; Disease assessment

Objective To investigate the changes of serum procalcitonin (PCT) level in patients with severe trauma, and to analyze its relationship with multiple organ failure (MODS). Methods From October 2013 to October 2018, the serum PCT levels were measured in 40 patients with severe trauma complicated with MODS (MODS group: 40 cases) and 62 patients without MODS (non-MODS group: 62 cases) in Yuncheng Central Hospital.The relationship between PCT and severity of trauma score (ISS), sequential organ failure (SOFA), acute physiology and chronic health status score (APACHE Ⅱ) and prognosis was analyzed.The predictive value of PCT in the prognosis of patients with MODS and severe trauma combined with MODS was analyzed by ROC. Results The serum PCT levels of the MODS group were (8.25±2.35)μg/L, (7.26±2.49)μg/L, (3.62±1.75)μg/L on the 1st, 3rd and 7th day after admission, respectively, which were higher than those of the control group (t=7.561, 9.561, 8.251, all P<0.05). The serum PCT level in the MODS group increased with the increase of APACHE Ⅱ score and ISS score (F=12.108, 9.173, all P<0.05). The serum PCT level in the death group was higher than that in the survival group[(11.82±3.75)μg/L vs.(4.92±1.26)μg/L], and the difference was statistically significant (t=7.959, P<0.05). The area under MODS curve predicted by PCT for severe trauma patients was 0.848, with sensitivity and specificity of 80.00%(32/40), 82.50%(33/40), respectively.The area under MODS curve predicted by PCT was 0.747, with sensitivity and specificity of 77.50%(31/40), 72.50%(29/40), respectively. Conclusion The serum PCT level in patients with severe trauma complicated with MODS is significantly higher than that in patients without MODS, and its level is closely related to trauma, disease progression and prognosis.It is of great value to predict the occurrence and prognosis of MODS. Key words: Wounds and injuries; Procalcitonin; Multiple organ failure; Injury severity score; ROC curve; Prognosis; Diagnosis

Objective To explore the clinical value of liver function indicators in predicting the severity of disease in patients with acute pancreatitis (AP), and to provide a reference for clinical treatment. Methods A retrospective study was conducted and 142 patients with acute pancreatitis were included. The disease severity was evaluated according to the RANSON score and the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and severe pancreatitis was used as the outcome index. Univariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed on single indicators that were statistically significant between mild and severe patients to determine the distinguishing value for disease severity. Results The RANSON score was graded: 43 cases of severe patients (RANSON≥3) and 99 cases of mild patients (RANSON<3); the difference in albumin (ALB) levels between the two groups was statistically significant (P<0.05). Univariate logistic regression analysis and ROC curve analysis were performed on ALB (OR=0.88, P<0.001). The area under the ROC curve and its 95% CI were 0.73 (0.63, 0.83). APACHE Ⅱ score classification: 94 cases of severe patients (APACHE Ⅱ score≥8) and 48 cases of mild patients (APACHE Ⅱ score<8). The difference in alanine aminotransferase (ALT) levels in the two groups were statistically significant (P<0.05). Univariate factor logistic regression analysis and ROC curve analysis were performed on ALT (OR=1.001, P=0.314). The area under the ROC curve and its 95% CI were 0.61 (0.50, 0.71). Conclusions ALB and ALT are valuable biomarkers for predicting the severity of AP. Key words: Liver function tests; Acute pancreatitis; Severity of illness

Objective To study the value of CRP, PCT and APACHE Ⅱ for upper urinary calculi with urogenic sepsis. Methods A retrospective analysis was made on clinical data of 71 cases of upper urinary calculi with urogenic sepsis from January 2015 to June 2018 in our hospital. All patients were divided into urogenic sepsis group and severe sepsis group. Gender, age, time of operation, CRP, PCT and APACHE Ⅱ values of the two groups were compared. Results The CRP values of the patients in the two groups was(45.92±12.31)mg/L and(61.31±18.82)mg/L, the PCT values of the patients in the two groups was(3.80±0.62)ng/mL and(5.55±1.47)ng/mL.There was significant difference in the APACHE Ⅱ score of the patients between the two groups(P<0.05). Conclusions The combined use of CRP, PCT and APACHE II score has a high value in evaluating the condition of patients with upper urinary calculi secondary to urogenic sepsis. Key words: Urinary Calculi; Sepsis; C-Reactive Protein; Calcitonin; Health Status Indicators

Objective To explore a predictive model for outcomes of severe acute pancreatitis (SAP) patients. Methods A retrospective study was conducted of 102 SAP patients from January 1,2016 to April 30,2018 from Taizhou Hospital in this study. The participants were divided into survival group and death group according to the outcome of 90 days after admission,88 cases were in survival group including 57 males and 31 females, aged 55.5 (40.3-69.8) years; 14 cases were in death group including 5 males and 9 females, aged 63.0 (50.8-80.8) years. Clinical data and laboratory indicators were compared between the two groups. Statistical analyses were performed to compare categorical variables. Chi-square automatic interaction detector (CHAID) was used to construct the prediction model of SAP patients′ outcomes. The study cohort consisted of SAP patients from August 1st 2018 to July 1st 2019 were collected to validate the prediction model. Results (1)Statistical analyses were performed by chi square test and Mann-Whitney U test. There were statistically significant differences in the proportion of cardiovascular and cerebrovascular diseases, mechanical ventilation and septic shock, and also the Charlson complication index (CCI), the Ranson score and APACHEⅡscore(χ2=5.554, P=0.018; χ2=5.585,P=0.018;P=0.008;Z=-3.007,P=0.003;Z=-2.982, P=0.003; Z=-3.257, P=0.001), death group were higher than survival group. (2) The MPV, CRP, MCHC, pH, pCO2 and positive rates of NRBC were statistically different between survival group and death group(Z=-2.466,P=0.014;Z=-2.689,P=0.007;Z=-2.238,P=0.025;Z=-1.977,P=0.048;Z=-2.239, P=0.025;P=0.000).The NRBC-positive rate in the death group was higher than that in the survival group, while the other indexes were lower in the survival group.(3)The decision tree CHAID method obtains the prediction scheme: when it meets the Ranson score≤3, the SAP patients were judged to be alive; when it meets the Ranson score>3 and the NRBC in peripheral blood was negative, the SAP patients were judged to be alive; when it meets the Ranson score>3, the NRBC was positive and the APACHEⅡscore≤21, the SAP patients were judged to be alive; when it meets the Ranson score>3, NRBC was positive and APACHE Ⅱ>21, the SAP patients were adverse prognosis. (4) 50 SAP patients were collected in the validation group, with 43 actual survivors and 7 deaths. The accuracy rate of predicting the outcomes of SAP patients in validation group with the scheme was 94.0% (47/50). Conclusion The NRBC combined with Ranson score system and APACHE II score system can predict the outcomes of SAP patients. Key words: Acute disease; Pancreatitis; Erythroblasts; APACHE

Objective To study the clinical significance of early usage of continuous blood purification on the treatment of severe craniocerebral injury. Methods 85 Patients with severe brain injury admitted in our department were randomly divided into continuous blood purification treatment group (experiment group, 42 patients) and conventional treatment group (control group, 43 patients). patients in continuous blood purification treatment group were treated by continuous blood purification and traditional treatment from 1-7 days, traditional treatment group only were treated by the traditional treatment methods. To detect tumor necrosis factor (TNF)-α, neuron specific enolase (NSE) and pNF-H in 1 and 5 day. On the 28th day Apache Ⅱ score, ICU stay time and GCS score of two groups. To detect 6 months survival rate of two groups. Spss15.0 software was used for statistical analysis, The measurement data are subject to T test The survival rate and quality of life comparison between the two groups was compared by χ2 test, P<0.05 was considered statistically significant. Results Incidence of 5 days of TNF-α (4.85±0.45) ng/L (t=6.890, P 0.05). Conclusion Early continuous blood purification treatment improves the survival rate and quality of life of patients with severe brain injury which have higher clinical value. Key words: Continuous blood purification; Sever brain injury; Early treatment

Comparison of MPI and APACHE II in the Prognosis of Perforating Peritonitis

Objective To investigate the characteristics of pathogens and risk factors of severe acute pancreatitis (SAP) complicated with infection, so as to provide reference for clinical diagnosis and treatment. Methods From February 2011 to January 2018, at the First Affiliated Hospital of Chongqing Medical University, 438 patients with SAP were selected. The samples including ascites, sputum and blood were collected and cultured. Distribution and drug resistance of pathogens were analyzed. Chi-square test and logistic regression analysis were used for analyzing the risk factors related to SAP complicated with infection. Results The total infection rate of SAP was 49.09% (215/438), of which the bacterial infection rate was 44.29% (194/438) and the fungal infection rate was 22.60% (99/438). A total of 625 pathogens were cultured, including 333 (53.28%) strains of Gram-negative bacteria, 171 (27.36%) strains of Gram-positive bacteria and 121 (19.36%) strains of fungi. Gram-negative bacteria were extremely resistant to β-lactams antibiotics, among them Acinetobacter baumannii was the highest (63.93% to 100.00%), and resistance rate to enzyme inhibitors was slightly lower (11.54% to 48.15%). The resistance rates of Gram-positive bacteria to penicillin and erythromycin were both high, which were 92.86% to 100.00% and 81.25% to 95.00%, respectively, and Gram-positive bacteria resistant to vancomycin, linezolid, and tigecycline were not found. The resistance rate of fungi was generally low (0 to 28.57%). The results of logistic regression analysis showed that multiple organ dysfunction syndrome (MODS) (odds ratio (OR)=2.031, 95% confidence interval (CI)1.230 to 3.356), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score≥11 (OR=1.780, 95%CI 1.129 to 2.806), fasting time more than three weeks (OR=3.437, 95%CI 2.119 to 5.574), mechanical ventilation (OR=2.697, 95%CI 1.643 to 4.427) and surgery (OR=3.464, 95%CI 1.806 to 6.643) were the independent risk factors of SAP complicated with infection (all P<0.05). The results of stratified analysis indicated that MODS, fasting time more than three weeks, mechanical ventilation and surgery were the independent risk factors of more locus infection (all P<0.05). Conclusions The infection rate of SAP is high and the risk factors are complex. Early prevention, improvement of the pathogen detection and guiding the reasonable use of antibiotics are necessary. For patients with invasive procedures and treatment, aseptic awareness should be strengthen to prevent iatrogenic infection. Key words: Infection; Drug resistance; Risk factors; Severe acute pancreatitis

INTRODUÇÃO: A Neuromuscular Electrical Stimulation (NMES) é um importante aliado do paciente crítico, favorecendo contrações ativas mesmo em estado que requer imobilidade.OBJETIVO: Verificar a segurança da aplicação da NMES em Unidades de Terapia Intensiva (UTIs) de um hospital público da cidade de Salvador. MÉTODO: Trata-se de estudo piloto, de intervenção. Os dados foram coletados no período de fevereiro a junho de 2018, com amostra por conveniência em uma população de pacientes críticos intubados e em uso de vasopressores. Foi aplicada uma única sessão de 45 minutos de NMES em ambos os quadríceps (músculo reto femoral e vasto lateral), sendo coletados os seguintes dados hemodinâmicos 5 minutos antes da aplicação e logo após a terapêutica: frequência cardíaca, pressão arterial sistólica, diastólica e média; e frequência respiratória. Estes dados foram avaliados seguindo recomendações de segurança já descritas previamente. Para análise estatística, as variáveis foram descritas através de médias e desvio-padrão, mediana e intervalo interquartílico e percentuais obtidos nas variáveis do estudo. A distribuição dos dados foi avaliada pelo teste Shapiro-Wilk, e os testes Mann Whitney e T de student foram utilizados. RESULTADOS: A amostra foi composta por 8 pacientes sendo 1 excluído. Destes, 85,7% era do sexo feminino, sendo o diagnóstico clínico de Sepse evoluindo para choque em 85,7%, média da idade de 61±9,5 anos e APACHE II de 29±5,5. Não foram evidenciadas diferenças estatísticas em relação aos dados hemodinâmicos coletados pré e pós eletroestimulação. Estes dados são semelhantes aos resultados encontrados por outros autores em populações sem uso de vasopressores. CONCLUSÃO: É possível sugerir que a aplicação da NMES no doente crítico em uso de vasopressores é uma técnica segura e viável desde que respeitando os limites estabelecidos e parâmetros corretos baseados em evidências.

Objective To compare the therapeutic value of transnasal gastroscopy and conventional gastroscopy for infective pancreatic necrosis(IPN) through percutaneous endoscopic necrosectomy(PEN). Methods A total of 24 IPN patients who received PEN for IPN from December 2015 to March 2019 were divided into the conventional gastroscopy group (n=15) and the transnasal gastroscopy group (n=9). The clinical therapeutic indicators such as vital signs, APACHE Ⅱ score changes, operation duration, difference in preoperative and postoperative volumes of peripancreatic necrosis and other indicators were compared between the two groups. Results There was no significant difference in the variation curve fitting of APACHE Ⅱ scores between the two groups (t=0.378, P=0.710). The operation time of the transnasal gastroscopy group was significantly shorter than that of the conventional gastroscopy group (119.7±47.4 min VS 172.8±56.2 min, P=0.018). Peripancreatic necrotic volume significantly decreased after operation in the transnasal gastroscopy group (404.03±170.73 mL VS 468.9±137.37 mL, P=0.002), and in the conventional gastroscopy group (499.44±227.17 mL VS 722.50±292.96 mL, P<0.001). There was no significant difference in the decrease extent in the conventional gastroscopy group and the transnasal gastroscopy group (223.06±212.92 mL VS 64.87±54.94 mL, P= 0.094). Conclusion On the condition of poor drainage of percutaneous catheter drainage, PEN can significantly reduce the range of necrotic lesions. Transnasal gastroscopy has the advantages in operation time in PEN and clearing deep abscess cavities over conventional gastroscopy. Key words: Pancreatitis; Percutaneous endoscopic necrosectomy; Infective pancreatic necrosis

Objective To observe the species distribution, clinical features, efficacy and safety of anti-fungus therapy in advanced elderly patients with fungemia. Methods Clinical data of patients aged 70 years and over with fungemia admitted into geriatric intensive care unit (GICU) of our hospital from Nov. 2012 to Nov. 2017 were retrospectively analyzed. The specie distribution, liver toxicity, differences in biochemical liver and renal functions before and after 28 days of treatment between the caspofungin group and the azole group (fluconazole plus voriconazole), and 28-d survival rate and its risk factors for death were analyzed. Results A total of 72 patients were enrolled, with a median age of 85.5 years (83, 90), a median score of Acute Physiology and Chronic Health Enquiry (APACHE-Ⅱ) of 25.5 (20.3, 31.5), a median score of Sequential Organ Failure Assessment (SOFA) 7 (4.0, 9.8). There were 33 patients (45.8%) with diabetes, 2 patients (2.8%) with hematological diseases, 44 patients (61.1%) with solid tumors and 18 patients (25.0%) with renal insufficiency. Thirty patients (41.7%) needed mechanical ventilation. The detection rate of Candida parapsilosis was 73.6% (53 cases), Candida famata 9.7% (7 cases), Candida tropicalis 5.6% (4 cases), Candida albicans 2.8% (2 cases), Candida glabrata 2.8% (2 cases) and others 5.6% (4 cases). The incidence rate of total liver toxicity was 23.6% after anti-fungus treatment. After 28 days of treatment, 29 patients survived in the caspofungin group (n=42) and 16 patients survived in the azole group (n=30). There were no significant differences in liver and renal function between the two groups before and after treatment. Logistic regression analysis showed that solid tumors (OR: 19.904, 95%CI: 1.944-203.808) and the median APACHE Ⅱ score were the independent risk factors for 28-day death in advanced patients with fungemia. Conclusions Fungemia is becoming more and more prominent in the GICU, which requires clinician’s constant attention in order to provide more basis for the treatment of fungemia in elderly patients. Key words: Intensive care; Fungemia