Short-term Prognosis Of Patients Research Articles

Peripheral Blood Cell Ratios as Prognostic Predictors of Mortality in Patients with Hepatitis B Virus-Related Decompensated Cirrhosis.

We sought to determine the correlations between peripheral blood cell ratios (neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-lymphocyte ratio (MPVLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-neutrophil ratio (PNR), and platelet-to-white blood cell ratio (PWR)) and short-term prognosis in patients with hepatitis B virus (HBV)-associated decompensated cirrhosis (HBV-DeCi). A total of 144 HBV-DeCi patients were enrolled. Demographic characteristics and laboratory data for the patients were acquired from their medical records. Multivariate regression analysis was applied to determine risk factors for unfavorable outcomes. The predictive performance of different ratios was examined by receiver operating characteristic curve analysis. Liver function was assessed by the Model for End-Stage Liver Disease (MELD) score. Twenty-one HBV-DeCi patients (14.6%) had died at 30 days. Survival was associated with lower NLR, MLR, MPVLR, and MELD score and higher PWR and PNR than non-survival. Multivariate analyses identified NLR and MELD score as independent prognostic predictors. The ability of NLR to predict mortality was higher than that of MLR, PNR, MPVLR, and PWR, but slightly lower than that of MELD score. The present results suggest that peripheral blood cell ratios can be useful for predicting mortality in HBV-DeCi patients. These ratios should be considered together with other measures for evaluation of prognosis in HBV-DeCi patients and are conducive to clinical practice.

Association between the initial blood lactate level and prognosis in patients with stroke treated with intravenous thrombolysis

Aim: Decreased oxygen in cerebral tissues induces anaerobic glycolysis and lactate production increases. It has been demonstrated that blood lactate level is an independent risk factor for poor outcome in patients with acute ischemic stroke (AIS). In this study, the association between initial blood lactate level and short-term prognosis in patients with AIS treated with intravenous thrombolysis was evaluated.Materials and Methods: Three hundred and sixty one patients treated with intravenous thrombolytic treatment (IVT) were included in the study. Initial symptoms, comorbid diseases and localization of ischemia were recorded. Blood samples were obtained after stroke symptoms within 4.5 hours. Lactate levels were tested before IVT. Disability was calculated with National Institutes of Health Stroke Scale (NIHSS). At 24th and 72th hours, cerebral hemorrhagic transformation was evaluated with brain computed tomography. In-hospital mortality rate was determined. Patients were divided into 2 groups according to difference of NIHSS score (clinical improvement=NIHSS score decreased 4 points or more and no clinical improvement=other patients). Patients were divided into 2 groups according to lactate levels (low=lactate ≤2 mmol/L and high=lactate> 2 mmol/L).Results: A total of 361 patients, 188 (52.1%) female and 173 (47.9%) male were included in the study. Lactate level and base excess (BE) were higher in patients with severe disability (p 0.001). Serum pH and bicarbonate (HCO3) levels were lower in this group (p 0.001, p=0.006). Lactate cut off value was calculated as 1.72 (59% sensitivity, 58% specificity). Serum lactate level was higher in patients with cerebral hemorrhagic transformation (p=0.028). Lactate cut off value was calculated as 1.79 (56.0% sensitivity, 61.0% specificity).Conclusion: Lactate is a valuable parameter in ischemia. Blood lactate level is associated with disability and cerebral hemorrhagic transformation in patients with AIS treated with IVT.

Serum Clusterin: A Potential Marker for Assessing the Clinical Severity and Short-Term Prognosis of Hepatitis B Virus-Related Acute-on-Chronic Liver Failure.

Background Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by acute deterioration of liver function and high short-term mortality. Clusterin, with biological functions similar to small heat shock proteins, can protect cells from apoptosis induced by various stressors. The aim of this study was to detect the level of serum clusterin in hepatitis B virus- (HBV-) related ACLF and to assess the predictive value of clusterin for the short-term prognosis of HBV-ACLF. Methods We detected serum clusterin by ELISA in 108 HBV-ACLF patients, 63 HBV-non-ACLF patients, and 44 normal controls. Results Serum clusterin was markedly lower in HBV-ACLF patients (median, 51.09 μg/mL) than in HBV-non-ACLF patients (median, 188.56 μg/mL) and normal controls (median, 213.45 μg/mL; all P < 0.05). Nonsurviving HBV-ACLF patients who died within 90 days had much lower clusterin levels than did surviving patients, especially those who died within 28 days (nonsurvival group vs. survival group: 39.82 ± 19.34 vs. 72.26 ± 43.52, P < 0.001; survival time ≤ 28 vs. survival time > 28: median 28.39 vs. 43.22, P = 0.013). The results showed that for identifying HBV-ACLF, the sensitivity of clusterin (93.7%) was similar to the sensitivities of the international normalized ratio (INR; 94.4%) and total bilirubin (TBIL; 94.8%), but its specificity (90.7%) was higher than that of prothrombin activity (PTA; 65.8%) and TBIL (69.8%) and was similar to INR (88.9%). As the concentration of clusterin increased, the mortality of HBV-ACLF patients decreased significantly from 59.3% to 7.0%. Clusterin had better ability for predicting the prognosis of HBV-ACLF patients than did the model for end-stage liver disease (MELD) score and the chronic liver failure consortium (CLIF-C) ACLF score (MELD vs. clusterin: P = 0.012; CLIF-C ACLF vs. clusterin: P = 0.031). Conclusion Serum clusterin is a potential biomarker for HBV-ACLF which can be used to assess clinical severity and the short-term prognosis of patients with this disease and may help clinicians identify HBV-ACLF with greater specificity and improved prognostic accuracy than existing prognostic markers.

Association of Diabetes and Admission Blood Glucose Levels with Short-Term Outcomes in Patients with Critical Illnesses.

BackgroundAssociation of diabetes and admission glucose on the short-term prognosis in patients with critical illnesses are currently ambiguous. We aimed to determine whether diabetes and admission glucose affects short-term prognosis of critically ill patients.MethodsWe performed a retrospective analysis of data on 46,476 critically ill patients from the critical care database. Association of diabetes with 28-day mortality was assessed by inverse probability weighting based on the propensity score. Smoothing splines and threshold effect analysis were applied to explore the relationship between admission glucose and clinical outcomes.ResultsOf the 33,680 patients enrolled in the study, 8,701 (25.83%) had diabetes. In the main analysis, the 28-day mortality was reduced by 29% (hazard ratio (HR)=0.71, 95% confidence interval (CI) 0.67–0.76) in patients with diabetes compared to those without diabetes. The E-value of 2.17 indicated robustness to unmeasured confounders. Significant interactions were observed for glucose at ICU admission, admission type, and insulin use (Interaction P <0.05). A V-shaped relationship was observed between admission glucose and 28-day mortality in non-diabetic patients, with the lowest 28-day mortality corresponding to a glucose level of 101.75 mg/dl (95% CI 94.64–105.80 mg/dl), and admission hypoglycemia or hyperglycemia should be avoided, especially in patients admitted to the surgical intensive care unit (SICU), cardiac surgery recovery unit (CSRU), and coronary care unit (CCU); for diabetic patients, elevated admission glucose does not appear to be associated with a poor prognosis and perhaps may be beneficial except for CCU and CSRU.ConclusionThe non-detrimental effect of diabetes on the short-term prognosis of critically ill patients was further confirmed, which would reduce 28-day mortality by approximately 29%. For non-diabetic patients, the admission glucose level corresponding to the lowest 28-day mortality was 101.75 mg/dl (95% CI 94.64–105.80 mg/dl); however, for diabetics, the appropriate admission glucose threshold remains unresolved.

Short-Term Prognosis of Patients with Cardiorenal Syndrome Type 1-Induced AKI Requiring Continuous Renal Replacement Therapy

Short-Term Prognosis of Patients with Cardiorenal Syndrome Type 1-Induced AKI Requiring Continuous Renal Replacement Therapy

Can routine biochemical tests be a short-term prognostic biomarker in patients operated for chronic subdural hematoma?

Objectives: The effect of routine blood biochemistry parameters on the short-term prognosis of patients with chronic subdural hematoma (CSDH) has not been evaluated in literature before. In this study, it was aimed to establish markers for determination of short-term prognosis using data of patients who were operated for CSDH. Methods: During admission to hospital, data of patients including age, sex, antiaggregan and/or anticoagulant drugs usage, comorbidity, Glasgow Coma Scale (GCS) and Glasgow Outcome Scale scores were evaluated. Location and thickness of CSDH were recorded using brain CT or MR images. Blood leukocyte, neutrophil, lymphocyte, eosinophil, basophil, platelet count results, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio results, activated prothrombin time and INR values, serum glucose, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, sodium, potassium, blood urea nitrogen and creatinine level values were also recorded. Patients were divided into two groups according to CSDH located “unilaterally (n=19)” and “bilaterally (n=12)”. In addition, patients with unilateral CSDH were divided into two groups as CSDH located at the "right hemisphere (n=6)” and "left hemisphere (n=13)". Results: It was concluded that short-term prognosis of patients with unilateral or bilateral CSDH was similar. Correlation analysis showed no correlation between short-term prognosis and demographic, clinical and laboratory findings. However, Likelihood Ratio test revealed that GCS score could be a biomarker in order to predict short-term prognosis of these patients, albeit weak (X2=6.138, p=0.046). Conclusion: It was thought that GCS scores could be effective in predicting short-term prognosis in patients with CSDH but routine biochemistry laboratory parameters could not predict short-term prognosis of these patients.

Acute-on-chronic liver failure as defined by the European (EASL-CLIF) versus North American (NACSELD) diagnostic criteria in their prediction of short-term prognosis in patients with decompensated cirrhosis admitted into hospital

Acute-on-chronic liver failure as defined by the European (EASL-CLIF) versus North American (NACSELD) diagnostic criteria in their prediction of short-term prognosis in patients with decompensated cirrhosis admitted into hospital

Value of a new predictive model in evaluating short-term prognosis of patients with hepatitis B virus related acute-on-chronic liver failure

To establish a predictive model and investigate its value in evaluating short-term prognosis of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF). Patients with HBV-ACLF admitted to Tianjin Second People's Hospital and Beijing Youan Hospital, Capital Medical University from May 2015 to October 2018 were enrolled. The data of gender, age, laboratory markers at admission, model for end-stage liver disease (MELD) score and clinical complications were collected for analysis. According to the prognosis on 12-week, patients were divided into survival group and death group. Univariate analysis and binary Logistic regression analysis were used to test the risk factors for short-term prognosis of the patients with HBV-ACLF, and a prediction model was established. The accuracy of each index and the established model were verified by the receiver operating characteristic (ROC) curve. A total of 148 patients with HBV-ACLF were enrolled in the study, 91 cases survived while 57 cases died during the 12-week period. The age, total bilirubin (TBIL), neutrophil percentage (NEUT%), hepatitis B surface antigen (HBsAg), MELD score of death group were higher than those of survival group [age (years old): 50.00 (44.50, 55.00) vs. 43.00 (34.00, 53.00), TBIL (μmol/L): 310.30 (240.70, 405.70) vs. 266.40 (184.20, 360.20), NEUT%: (74.52±13.05)% vs. (66.64±12.35)%, lgHBsAg (kU/L): 3.72 (3.29, 3.92) vs. 2.97 (2.49, 3.78), MELD score: 24.27 (19.71, 27.40) vs. 21.88 (18.83, 24.38), all P < 0.05], while albumin (ALB), total cholesterol (CHO), prothrombin activity (PTA) and alpha-fetoprotein (AFP) were lower than those of survival group [ALB (g/L): 29.80 (27.05, 31.05) vs. 30.80 (28.00, 33.90), CHO (mmol/L): 1.98 (1.50, 2.38) vs. 2.49 (2.05, 3.01), PTA: (30.37±7.09)% vs. (32.94±6.03)%, AFP (μg/L): 21.54 (9.28, 51.54) vs. 66.16 (24.50, 152.80), all P < 0.05]. Logistic regression analysis showed that NEUT%, HBsAg and AFP were independent risk factors for short-term prognosis of patients with HBV-ACLF [odds ratio (OR) was 77.843, 1.439, 0.995, respectively, all P < 0.05]. According to the results of regression analysis, the NHA-ACLF model (NEUT%+HBsAg+AFP) was established. The formula was logit (NHA-ACLF) = -5.441+5.688×NEUT%+0.430×lgHBsAg-0.005×AFP. The area under the ROC curve (AUC) of the NHA-ACLF model for pred HBV-ACLF patients was 0.790, which was better than NEUT% (AUC = 0.696), lgHBsAg (AUC = 0.670), AFP (AUC = 0.703) and MELD score (AUC = 0.640). When the cut-off value of NHA-ACLF model score was 0.459, the sensitivity was 73.7%, and the specificity was 79.1%. NEUT%, HBsAg and AFP are independent predictive indicator for short-term prognosis in patients with HBV-ACLF. Compared with MELD score, the risk assessment model NHA-ACLF has a greater value in predicting the short-term prognosis of patients with HBV-ACLF.

Risk factors for renal failure and short-term prognosis in patients with spontaneous intracerebral haemorrhage complicated by acute kidney injury

BackgroundAlthough acute kidney injury (AKI) is a known risk factor for adverse clinical outcomes in patients with spontaneous intracerebral haemorrhage (SICH), little is known about the predisposing factors that contribute to renal failure and short-term prognosis in the setting of SICH already complicated by AKI. In this study, we aimed to identify the renal failure factors in SICH patents with AKI.MethodsFive hundred forty-three patients with SICH complicated by differential severities of AKI who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2016 to December 2018 were retrospectively studied. Logistic regression and receiver operator characteristic (ROC) curve analysis were performed to determine the best predictive and discriminative variables. Multivariate Cox regression analysis was performed to identify prognostic factors for renal recovery.ResultsIn the multivariable adjusted model, we found that hypernatremia, metabolic acidosis, elevated serum creatine kinase, hyperuricaemia, proteinuria, and the use of colloids and diuretics were all independent risk factors for the occurrence of stage 3 AKI in SICH patients. The area under the curve analysis indicated that hypernatremia and hyperuricaemia were predictive factors for stage 3 AKI, and the combination of these two parameters increased their predictability for stage 3 AKI. Kaplan-Meier survival curves revealed that the renal recovery rate in SICH patients with stages 1 and 2 AKI was significantly higher than that in SICH patients with stage 3 AKI. Multivariate Cox regression analysis suggested that hypernatremia and the occurrence of stage 3 AKI are predictors for poor short-term renal recovery.ConclusionsThese findings illustrate that hypernatremia and hyperuricaemia represent potential risk factors for the occurrence of stage 3 AKI in SICH patients. Those patients with hypernatremia and stage 3 AKI were associated with a poor short-term prognosis in renal recovery.

Endothelial progenitor cells predict long-term outcome in patients with coronary artery disease: Ten-year follow-up of the PROCREATION extended study

BackgroundLevels of circulating endothelial progenitor cells (EPCs) are associated with the short-term prognosis of patients with coronary artery disease (CAD). No previous study, however, has ascertained if EPCs are related also to long-term outcome. We performed a pre-specified analysis of the PROCREATION (PROgenitor Cells role in Restenosis and progression of coronary ATherosclerosis after percutaneous coronary intervention) study in order to assess if EPCs predict the 10-year prognosis. Methods and resultsConsecutive stable patients with CAD who were included in the PROCREATION study were evaluated. Patients underwent an extended 10-year follow-up to assess major adverse cardiac or cerebrovascular events (MACCE), i.e. death, stroke, myocardial infarction, and revascularization. During follow-up, MACCE occurred in 79 of 149 patients (53%). Most clinical and angiographic baseline variables were similar in patients with or without MACCE, apart from age, diabetes, chronic kidney disease, ejection fraction, and extent of CAD. Comparison of EPCs, conversely, showed that patients with MACCE had greater levels of CD34+/KDR+/CD45- cells (p=0.0002) and CD133+/KDR+/CD45- cells (p=0.0001). Multivariate analysis showed that factors independently associated with 10-year MACCEs were age (p=0.001), ejection fraction (p=0.018), and CD34+/KDR+/CD45- cells (p=0.024). ConclusionSubpopulations of EPCs can improve long-term risk factor characterization in patients with CAD. (ClinicalTrials.gov: NCT01575431)

Role of reciprocal changes in predicting short term prognosis of patients of acute STEMI

Background: Recent studies indicate that STEMI with reciprocal changes is associated with more myocardial area at risk, larger infarct size and less ejection fraction as compared to STEMI without reciprocal changes. We undertook this study for correlating clinical outcome and complications in patients with and without reciprocal changes in ECG in acute STEMI.Methods: Eighty patients were divided into two groups of forty each. One having reciprocal changes in ECG and one without reciprocal changes. The KILLIP class of each patient at time of admission was noted. Patients were monitored for development of any complication, Left ventricular ejection fraction (LVEF) and mortality. BNP levels, Trop I levels, Hba1c levels were obtained at time of admission. Echocardiography was done on the second day of the admission.Results: The patients with reciprocal changes were found to be having a higher KILLIP class on admission. The LVEF of patients with reciprocal changes and who subsequently went on to develop complications was lower than those without reciprocal changes. The number of patients having unsuccessful thrombolysis was significantly higher in the group with reciprocal changes.Conclusions: There was significant association of reciprocal changes in ECG with higher Hba1c, higher KILLIP class and higher incidence of unsuccessful thrombolysis. Moreover, the sensitivity of other markers of poor clinical outcomes, such as BNP and LVEF increases in patients having reciprocal changes in their ECG. The monitoring in such patients should thus be more intensive.

Impact of left ventricle remodeling on perioperative risk and short-term prognosis in patients with heart failure and reduced ejection fraction undergoing coronary artery bypass grafting

Objective: To explore the impact of left ventricle remodeling on perioperative risk and short-term survival in patients with heart failure and reduced ejection fraction (HFrEF) undergoing coronary artery bypass grafting (CABG). Methods: A total of 78 coronary artery disease (CAD) patients (54 males, 24 females) with symptoms and signs of heart failure and a left ventricular ejection fraction (LVEF)<40% were consecutively enrolled from January 2014 to December 2018 in Beijing Anzhen Hospital. The average age was (59±8) years old. Transthoracic echocardiography was performed to measure LVEF and left ventricle end-systolic volume index (LVESVI) during hospitalization, and the average LVESVI was (92±18) ml/m(2). According to the mean value of LVESVI, the patients were divided into 2 groups: mild left ventricle remodeling group (group M, n=46, LVESVI<92 ml/m(2)) and severe left ventricle remodeling group (group S, n=32, LVESVI≥92 ml/m(2)). The follow-up period was (30±12) months. Operative mortality, perioperative complications and long-term survival were compared between the two groups. Results: Perioperative mortality was 5.1% (4/78), which was significantly higher in group S than that of group M (9.4% vs 2.2%, P=0.03). The proportion of patients with intra-aortic balloon pump (IABP) was higher in group S than that of group M during the perioperative period (62.5% vs 36.9%, P<0.01). Compared with patients in group M, those with severe left ventricle remodeling were more susceptible to atrial fibrillation after surgery (25.0% vs 6.5%, P=0.02). The mean follow-up time was (30±12) months. There was no difference in major adverse cardiac event (MACE)-free survival in 12 month, 24 month and 36 month between the two groups (100% vs 100%, 87.9% vs 92.1%, 80.3% vs 78.3%, P=0.68). Conclusion: Left ventricular remodeling increases the perioperative mortality and complications of patients with ischemic HFrEF undergoing CABG, but it has no impact on short-term survival.

Effect of Elevated Pulmonary Artery Systolic Pressure on Short-Term Prognosis in Patients With Acute Myocardial Infarction.

Pulmonary artery systolic pressure (PASP) may increase because of cardiac alterations that result in increased filling pressures after acute myocardial infarction (AMI). We hypothesized that PASP might be a useful maker to predict the risk of cardiac death after AMI. We carried out a retrospective study from 2013 to 2017 involving 5401 patients with AMI. Patients were grouped according to their admission PASP result, and the primary end point was cardiac death in 6 months after AMI. Pulmonary artery systolic pressure was associated with age, AMI site, Killip classification, and decreased ejection fraction. After adjustments for clinical and echocardiographic parameters in a Cox model, PASP was found to be significantly related to cardiac death. In receiver operating characteristic analysis, PASP >30 mm Hg had a sensitivity of 59.8% and a specificity of 62.5% for predicting 6-month cardiac death after AMI. In conclusion, PASP at the index admission may be a useful marker predicting short-term cardiac death. These results have implications for future research and management of patients with AMI.

The value of heat shock protein (HSP) 60 on in-hospital and short-term prognosis in patients with acute ST segment elevation myocardial infarction

Aim: HSP60 has previously been shown to be an independent risk factor for congestive heart failure. Recently, increased HSP60 values have been shown to be associated with increased mortality in patients hospitalized with acute heart failure. The purpose of our study was to determine whether HSP 60 is an independent predictor of in-hospital or short-term mortality in patients with acute ST segment elevation myocardial infarction (STEMI) and to assess whether it may be used as an early predictor of in-hospital heart failure or cardiogenic shock development in the same population. Methods: A total of 221 patients over 18 years of age presenting within 12 hours after the onset of symptoms with STEMI between 2011 and 2013 were enrolled to our study. Our study was designed as a prospective cohort. Several clinical conditions, such as clinical heart failure, development of cardiogenic shock and death during hospitalization were recorded together with the data pertaining to the length of hospital stay, MI localization, revascularization strategy and risk factors associated with coronary heart disease. Patients were called 1 month after discharge to find out if anyone had died. Results: HSP 60 values were significantly higher in patients who died during hospitalization (P=0.004) or within 1 month after discharge (P=0.020). These results were independent from other factors associated with mortality following STEMI. Significant association was found between HSP60 value and in-hospital development of cardiogenic shock (P=0.03) or heart failure (P=0.03). Conclusion: HSP60 was found to be independently associated with increased mortality in patients admitted for STEMI and therefore may be used as a promising predictor of mortality.

Serum Copeptin Levels Predict the Return of Spontaneous Circulation and the Short-Term Prognosis of Patients with Out-of-Hospital Cardiac Arrest: A Randomized Control Study.

Early and accurate prediction of survival to hospital discharge following resuscitation after cardiac arrest (CA) is a major challenge. Biomarkers can be used for early and accurate prediction of survival and prognosis following resuscitation after CA, but none of those identified so far are sufficient by themselves. The goal of this study was to investigate the predictive power of the serum copeptin level for determining the return of spontaneous circulation (ROSC) and prognosis of patients with non-traumatic out-of-hospital cardiac arrest (OHCA) who underwent cardiopulmonary resuscitation (CPR). A total of 76 consecutive consenting adult patients who were diagnosed as non-traumatic OHCA and 63 age- and sex-matched healthy controls were enrolled. The patients were divided into two groups based on whether or not they had ROSC. The ROSC group was divided into two sub-groups according to whether death occurred within 24 hours or after 24 hours following ROSC. Serum copeptin, high-sensitivity cardiac troponin (hs-cTnI), creatine kinase-muscle/brain (CK-MB), glucose, and blood gas values were compared between the groups. Serum copeptin levels were significantly higher in the patient group than control group (P <.001). Receiving operator characteristic analysis revealed a cut-off copeptin level of 27.29pmol/L, with 98.7% sensitivity and 100.0% specificity, for distinguishing patients from controls. Serum copeptin levels were significantly lower in the ROSC group than non-ROSC group (P = .018). Additionally, the mean serum hs-cTnI level was significantly higher in the ROSC group than non-ROSC group (P = .032). However, there were no significant differences in the mean serum glucose level and CK-MB levels or arterial blood gas levels between the ROSC and non-ROSC groups (all P >.05).Ten (38.5%) of the patients died within the first 24 hours after ROSC, whereas 16 (61.5%) survived longer than 24 hours. Serum copeptin levels were significantly lower in patients who survived longer than 24 hours compared with those who died within the first 24 hours. Moreover, the mean CPR duration was significantly lower in patients surviving more than 24 hours compared with less than 24 hours. The serum copeptin level may serve as a guide in diagnostic decision making to predict ROSC in patients undergoing CPR and determining the short-term prognosis of patients with ROSC.

Association between Particulate Matter Exposure and Short-term Prognosis in Patients with Pneumonia

ABSTRACT Particulate matter (PM) and other air pollutants are reportedly associated with both lung and systemic inflammation; however, an association between air pollutants and pneumonia outcomes has not been well established. Therefore, we evaluated the effect of air pollutants on the short-term outcomes of emergency department patients with pneumonia. We collected data on PM2.5 (aerodynamic diameter 17 years who had visited the emergency department with a principal diagnosis of pneumonia. In-hospital mortality and the association of air pollutant exposure with the need for invasive respiratory and/or vasopressor support (IRVS) within 72 h were evaluated. Interquartile range (IQR) increments of PM2.5 and PM10 were associated with an increased IRVS risk with odds ratios (ORs) of 1.211 (95% confidence interval [CI], 1.031–1.419) and 1.194 (95% CI, 1.020–1.394) on lag 1, respectively, and per-IQR increments of NO2 were associated with an increased IRVS risk with an OR of 1.146 (95% CI, 1.004–1.308) on lag 2. IQR increments of PM2.5 and NO2 were associated with an increased in-hospital mortality risk with ORs of 1.202 (95% CI, 1.100–1.429) and 1.175 (95% CI, 1.014–1.360), respectively. During the warm season, IQR increments of PM2.5, PM10, and NO2 corresponded with an increased IRVS risk, with ORs of 1.333 (95% CI, 1.078–1.644), 1.348 (95% CI, 1.090–1.665), and 1.321 (95% CI, 1.101–1.585), respectively. For patients with pneumonia, PM2.5, PM10, and NO2 exposures were risk factors for a poor prognosis. Exposure effects appeared to be greater during the warm season. Regulations focused on PM2.5, PM10, and NO2 levels should be considered to improve patient outcomes.

Analysis of prognostic risk factors and establishment of prognosis model in patients with hepatitis B virus-related acute-on-chronic liver failure

Objective To explore the risk factors for prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF), and to establish a prognostic model. Methods A total of 193 patients diagnosed with HBV-ACLF who were admitted to the Department of Infectious Diseases of the Third Hospital of Hebei Medical University were collected from 1st January 2013 to 1st November 2018 as a derivation cohort. Thirty-five patients diagnosed with HBV-ACLF who were admitted to the Fifth Hospital of Shijiazhuang during the period from 1st July 2017 to 1st November 2018 were collected as a validation cohort. The survival condition of all patients at week 12 of admission was observed. The risk factors associated with short-term prognosis were analyzed by using multivariate logistic regression analysis, and a logistic regression equation prediction model was established and verified. The diagnostic performance of the prognostic model was evaluated using the receiver operating characteristic (ROC) curve, and was compared with model for end-stage liver disease (MELD) scoring system, Child-Turcotte-Pugh (CTP) scoring system, sequential organ failure assessment (SOFA) scoring system and chronic liver failure (CLIF)-SOFA scoring system. Results Multivariate logistic regression analysis showed that age (odds ratio(OR)=2.133, 95% confidence interval(CI)1.033-4.405), total bilirubin (OR=3.371, 95%CI 1.610-7.060), serum creatinine (OR=4.448, 95%CI 1.697-11.661), hepatic encephalopathy (OR=5.313, 95%CI 2.463-11.461), and ascites (OR=2.959, 95%CI 1.410-6.210) were independent risk factors for predicting the short-term prognosis of patients with HBV-ACLF. The newly established logistic regression model (LRM)=-1.726+ 0.757×age+ 1.215×total bilirubin+ 1.049 2×serum creatinine+ 1.670×hepatic encephalopathy (with=1, without=0) + 1.085×ascites (with=1, without=0). The area under the ROC curve of the LRM for predicting the short-term prognosis of patients with HBV-ACLF was 0.82 (95%CI 0.76-0.88). Furthermore, the areas under the ROC curve of the models of MELD, CTP, SOFA, CLIF-SOFA were 0.67 (95%CI 0.60-0.75), 0.73 (95%CI 0.66-0.80), 0.77 (95%CI 0.70-0.83) and 0.72 (95%CI 0.65-0.80), respectively. The ROC-area under curve of the validation cohort was 0.81 (95%CI 0.65-0.97). Conclusions Age, total bilirubin, serum creatinine, hepatic encephalopathy, and ascites are independent risk factors for the prognosis of HBV-ACLF. The prognostic model established based on these factors can accurately predict the patients′ short-term prognosis, which is superior to MELD, CTP, SOFA and CLIF-SOFA. Key words: Hepatitis B; Acute-on-chronic liver failure; Regression analysis; Prognostic model

Mean Platelet Volume-To-Lymphocyte Ratio Predicts Poor Functional Outcomes Among Ischemic Stroke Patients Treated With Intravenous Thrombolysis.

Background and Purpose: According to previous studies, the mean platelet volume-to-lymphocyte ratio (MPVLR) represents a novel marker of a poor short-term prognosis in patients with a myocardial infarction who underwent primary percutaneous coronary intervention. We aimed to evaluate the association between MPVLR and clinical outcomes of patients with acute ischemic stroke who were treated with intravenous thrombolysis.Methods: Two hundred forty-one patients with ischemic stroke receiving intravenous thrombolysis were prospectively enrolled in this study. Blood samples for MPVLR were obtained at admission and at 18–24 h after treatment with intravenous thrombolysis. A poor functional outcome was defined as a modified Rankin scale score of 3–6 at 3 months after stroke.Results: At admission, the area under the curve of MPVLR to predict poor functional outcomes at 3 months was 0.613 [95% confidence interval (CI), 0.541–0.686; P = 0.003), and the best predictive MPVLR value was 5.8. Patients with an MPVLR ≥5.8 had a 3.141-fold increased risk of a poor outcome at 3 months (95% CI, 1.491–6.615; P = 0.003) compared to patients with an MPVLR <5.8. At 18–24 h after treatment with intravenous thrombolysis, the area under the curve of MPVLR to predict a poor outcome at 3 months was 0.697 (95% CI, 0.630–0.765, P < 0.001), and the best predictive MPVLR value was 6.9. The inclusion of MPVLR as a continuous (odds ratio, 1.145; 95% CI, 1.044–1.256, P = 0.004) and categorical variable (odds ratio, 6.555; 95% CI, 2.986–14.393, P < 0.001) was independently associated with poor outcomes at 3 months.Conclusions: Both the values of MPVLR at admission and 18–24 h after intravenous thrombolysis were independently associated with poor functional outcomes. MPVLR may serve as an activity marker for a poor prognosis in patients with acute ischemic stroke receiving intravenous thrombolysis.

Electrocardiographic Changes and Short term Prognosis in Patients with Acute left Circumflex Artery Occlusion versus Right Coronary Artery Occlusion

Electrocardiographic Changes and Short term Prognosis in Patients with Acute left Circumflex Artery Occlusion versus Right Coronary Artery Occlusion

Prediction of serum M30 and M65 levels for the short-term prognosis of patients with hepatitis B virus related acute-on-chronic liver failure during artificial liver support system therapy

Objective To analyze the dynamic changes of serum M30 and M65 levels in patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) during artificial liver support system(ALSS) therapy, and to explore their predictive efficiency and clinical values for short-term prognosis of HBV-ACLF. Methods Seventy-six patients with HBV-ACLF who underwent ALSS therapy for the first time from May 2016 to May 2019 in the First Hospital of Jiaxing were selected.The patients were divided into improvement group (38 cases) and non-recovered group (38 cases)according to their prognosis, and 38 healthy persons were selected as control group during the same period.The serum levels of M30 and M65 were detected by enzyme-linked immunosorbent assay(ELISA). The predictive values of M30 and M65 levels for short-term prognosis in patients receiving ALSS were calculated by receiver operating characteristic analysis curve (ROC). M30 and M65 levels before and after ALSS were compared by two-way repeated measures analysis of variance. Results The levels of M30 and M65 in the improvement group, non-recovered group and control group were significantly different before the first ALSS therapy (F=109.36 and 90.42, respectively, both P 0.05). However, after twice ALSS therapy, the levels of M30 and M65 in non-recovered group were significantly higher than those in improvement group (t=30.699 and 64.777, respectively, both P<0.01). Moreover, after the second ALSS therapy, the levels of M30 and M65 were both significantly lower compared to those after the first-time therapy in the improvement group (t=3.350 and 5.932, respectively, both P<0.01). The areas under curve (AUC) of M30, M65 and the combination of M30 and M65 for prognosis prediction were 0.796, 0.844 and 0.906, respectively. The AUC of combination of M30 and M65 was significantly higher than M30 or M65 alone (Z=2.163 and 2.141, respectively, P=0.031 and 0.032, respectively). The cut-off values of M30 and M65 were 591.91 and 924.50 U/L, respectively. The sensitivity and specificity of combined M30 and M65 were 94.7% and 82.5%, respectively. Conclusions Serum M30 and M65 levels can predict the short-term prognosis of HBV-ACLF patients after ALSS therapy.The combination of M30 and M65 is of better diagnostic value. Key words: Liver, artificial; HBV-related acute-on-chronic liver failure; M30; M65