Objective To analyze the death constitution of inpatients in The Tibet Autonomous Region People's Hospital from 2014 to 2015 and to provide baseline data for further rational drug use. Methods The medical records of death inpatients between 2014 and 2015 were collected. We classified all diseases according to the international classification of diseases coding (ICD-10) and analyzed the general situation, main death discharge diagnosis and single death diseases. Distribution of inpatients frequency, constituent ratio, cumulative frequency of death diseases were calculated by EXCEL 2007 software. Results (1) A total of 40 147 patients were discharged and 339 (8.44‰) inpatients died between 2014 and 2015. The sex ratio of male to female was 2.08 to 1 for death inpatients. (2) Death constitution of four diseases' categories were over 10%, including circulatory system diseases, exogenous injury or poisoning system diseases, respiratory system diseases, and digestive system diseases. (3) Death constitution of 3 diseases' categories were between 5% to 10%, including tumor, abnormal signs and symptoms, urogenital system diseases. (4) The main death cause single diseases were cerebral hemorrhage diseases, myocardial infarction, respiratory failure, damage, pneumonia, cancer, neonatal hypoxic-ischemic encephalopathy. Conclusion The main death inpatients of the Tibet Autonomous Region People's Hospital are of the age 25 to 59, and the main death cause diseases are circulatory system diseases.
ObjectiveTo investigate the role of D-dimer in predicting the prognosis of the patients with acute pancreatitis (AP). MethodsThe medical records of 324 patients with a diagnosis of AP in West China Hospital from April to June 2014 were retrospectively analyzed. ResultsOverall mortality rate was 3%, the median hospital stay was (11±3) days, and the median Intensive Care Unit stay was (1±1) day. The prothrombin time, activated partial prothrombin time, fibrinogen, international normalized ratio, antithrombinⅢ, D-dimer, C-reactive protein, and procalitonin level in the organ failure (OF) patients were significantly higher than those in the non-OF patients (P<0.05). The D-dimer, C-reactive protein, and procalcitonin level in the patients with infection were significantly higher than those in the non-infectious onse (P<0.05). The D-dimer and procalcitonin level in the death group were significantly higher than those in the survivor group (P<0.05). D-dimer and procalcitonin level increased as the grade of AP increased (P<0.05); the difference in C-reactive protein between the light and middle type was not significant (P>0.05), while was significant between middle and severe, and light and severe (P<0.05). The area under the receiver operating characteristic curve (AUC) of OF predicted by D-dimer was higher than C-reactive protein and procalcitonin; AUC of infection predicted by D-dimer was lower than procalcitonin; AUC of death predicted by D-dimer was higher than C-reactive protein but lower than procalcitonin. ConclusionD-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the complications and death of AP. D-dimer provide a more accurate assessment of prognosis than C-reactive protein and procalcitonin in patients with AP.
Objective To access and identify risk factors related to death and injuries in earthquakes. Method We searched The Cochrane Library, SCI, PubMed, CBM and CNKI from establishment to June 2008 to identify cohort, case-control and cross-sectional studies involving risk factors related to death and injuries in earthquakes. The methodological quality of included cohort and case-controlled studies were assessed, and the potential risk factors of earthquake related death and injuries were systematically enumerated. Results Two cohort, 2 case-control and 4 cross-sectional studies were included. Some included studies might be associated with selection bias. Risk factors for earthquake death and injuries included age, gender, mental disease, physical disabled, socioeconomics status, type/ age/ height/ collapse of building, motor vehicle driver and geographical location when the earthquake occurred. Conclusions Death and injuries in earthquakes may be attributed to 3 categories: demographic characteristics, building features, and seismic/ geographical/ location factors. However, the conclusion of this review and its implications may be limited by the potential selection bias of included studies and the regional characteristics of the included populations. Original studies from Chinese seismic areas are especially needed.
Objective To analyze the death cause of residents in Zigong from 1985 to 2009, so as to provide the government with scientific information of health strategies, and disease prevention and control. Methods The death surveillance data in Zigong residents from 1985 to 2009 were collected, and the indexes such as all death mortality rate, infant mortality rate, maternal mortality rate, disease-specific mortality rate, age-specific mortality rate, and life expectancy were analyzed. Results The all death mortality rate had fluctuation of plus or minus 6‰, and the male mortality rate was higher than the female (χ2=8 059.769, P=0.000). The six main influencing factors of the death of Zigong residents were as follows: respiratory system diseases, circulatory system diseases, tumour, injury and poisoning regarded as external cause diseases, digestive system diseases, and infectious diseases and parasitic diseases. The mortality rates of different districts were statistically different (χ2=1 643.926, P=0.000), and Fushun County was the highest among them after standardization. The curve of mortality rate in different sex and age groups was changed alike letter “U”. The mortality rate was ascending with the age in the group of over 15 years old, the ascending trend was more evident especially after 50 years old. The infant mortality declined steadily and was well controlled. The maternal mortality declined obviously. The average life expectancy for the whole city was 74.72, which showed an ascending trend. Conclusion The chronic diseases are the main death cause of residents in Zigong. The prevention and controlling of acute infectious diseases and parasitic diseases should be persistently performed for declining both incidence rate and mortality rate. The Zigong city is gradually stepping into aging society, which requires the great development of senior work.
Objective To study the neural mechanism of hypotension or shock state in acute cholangitis in severe type (ACST) and its value of clinical application. Methods A technique of blocking abdominal splanchnic nervi via right adipose capsule of kidney was carried out on 28 patients by injecting 1% lidocaine before urgent operation. Results After blocking the relevant nervi, hypotension or shock state in 23 patients were improved significantly (Ｐ＜0.05). The death rate was lower (14.3%) after having performed biliary decompressions with laparotomy. Conclusion Patients′ hypotension or shock state at the early phase of ACST is the result of neural reflex in which the splanchnic nervi is its afferent pathway. Blocking the relevant nervi before urgent operation, the valuable opportunity of emergency treatment can be obtainded and the complication and death rate are reduced significantly.
ObjectiveTo investigate the high-risk factors for death in infants with severe pneumonia. MethodsWe analyzed hospitalized infants and young children diagnosed with severe pneumonia from January 2011 to December 2013, and investigated the risk factors for death. ResultsA total of 1 411 infants with severe pneumonia were included in the analysis. The mortality rate was 3.12%. In single factor analysis, the following factors were significant:age, severe infection, artificial feeding, congenital heart diseases, bad habitation, repeated infection history, surgical history, multi-organ dysfunction, internal environment disorder, multiple drug-resistant strains infection. The results of Logistic multiple regression analysis showed that there were statistical significance in severe infection, repeated infection history, Multiple drug-resistant strains infection, multi-organ dysfunction, and internal environment disorder. ConclusionInfants with severe pneumonia should be intensively monitored and actively treated for reducing the mortality rate if they have one of the following high-risk factors:age, congenital heart diseases, repeated infection history, multiple drug-resistant strains infection, surgical history, multi-organ dysfunction, and internal environment disorder.
ObjectiveTo analyze the influencing and prognostic factors for in-hospital death of creatine kinase-MB after cardiac surgery for congenital heart disease in pediatric. MethodsClinical data of 708 children with body weight less than 15 kg who underwent cardiac surgery at Fu Wai Hospital between January 2012 and December 2013 were retrospectively analyzed. There were 269 males (38.0%) and 439 females (62.0%). The postoperative maximum CK-MB was calculated for analysis and patients were devided into three groups:a group A (CK-MB≤25 IU/L), a group B (25 IU/L < CK-MB≤125 IU/L) and a group C (CK-MB > 125 IU/L). ResultsPostoperative CK-MB level was independently associated with cyanotic congenital heart disease (P=0.002), the aorta cross clamp (P=0.030), the cardiopulmonary bypass time (P=0.002), the cross clamp time (P=0.016), the re-establish of bypass (P < 0.001), deep hypothermic circulatory arrest (P=0.024). There was statistical difference in mortality between the 3 groups (P < 0.001). The receiver operating characteristic curve showed that CK-MB has predictive value for in-hospital death (P < 0.001) and the cutoff value is 168.5 IU/L, with a sensitivity of 54.2%, specificity of 90.8%, positive predictive value of 17.3% and negative predictive value of 98.4%. CK-MB level above 168.5 IU/L was an independent risk factor for in-hospital death (OR=6.364, P < 0.001). ConclusionElevation of CK-MB after cardiac surgery is independently influenced by several variables. Pediatric with major CK-MB elevation has high risk of in-hospital death.
Objective To explore the association between plasma IgG and acute exacerbation (AE) or death risk in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 262 COPD patients treated in our hospital from February 2018 to February 2020 were recruited in our study. All patients were divided into AE≥2 group and AE≤1 group according to AE frequency during follow-up of 1 year. Basic data and laboratory data such as IgG, IgA and IgM of two groups were comparatively analyzed. Univariate analysis and COX regression were performed to analyze the related factors of frequency of AE≥2 times in 1 year. Depicting restricted cubic spline was performed to analyze the relation between IgG and AE by R software. All patients were also divided into high IgG group, low IgG group, high IgA group and low IgA group based on median of patients’ baseline plasma IgG and IgA level, depicting survival curve by Kaplan-Meier to analyse differences between the groups with different IgG or IgA level in the risk of AE and death respectively. ResultsFinally, there were 14 patients lost to follow-up and 248 cases were included (AE≤1 group contained 154 cases, AE≥2 group contained 94 cases) until February 28, 2021. Age and COPD Assessment Test (CAT) scores in the AE≥2 group were higher than those in the AE≤1 group; Albumin, IgG and IgA level in the AE≥2 group were lower than those in the AE≤1 group; Neutrophil to lymphocyte ratio (NLR) in the AE≥2 group was higher than that in the AE≤1 group (all P<0.05). There were 99 and 114 cases of AE in the high IgG and low IgG groups respectively within 1 year. Kaplan Meier survival analysis showed that risk of AE in the high IgG group and high IgA group were lower than that in the low IgG group and the low IgA group (log rank χ2=23.791, 67.153, both P=0.000). Risk of death in the high IgG group was lower than that in the low IgG group (log rank χ2=6.214, P=0.013), there was no statistically difference in the risk of death in the high IgA group compared to the low IgA group (log rank χ2=2.400, P=0.121). Multivariate Cox regression analysis showed that CAT score (HR=1.096, P=0.001) and NLR (HR=2.061, P=0.000) were independent risk factors of frequency of AE≥2 times in 1 year for COPD patients, albumin (HR=0.921, P=0.006) and IgG (HR=0.572, P=0.000）were the independent protective factors. Restricted cubic spline analysis showed that combining the COX regression model, after adjusting for IgA, albumin, NLR and other variables, there was non-linear relationship between IgG level and AE (P=0.000).Conclusion Plasma IgG level is related to AE in COPD patients, and may become a reliable predictor of acute exacerbation risk in the future.
Objective To identify the key influencing factors of death anxiety in rural elderly and their mechanisms of action. Methods A total of 701 rural elderly individuals from 6 prefecture-level cities (prefectures) in Sichuan Province were selected for a questionnaire survey on death anxiety, health-related physical fitness, and subjective well-being. A structural equation model was constructed to thoroughly analyze the influencing factors of death anxiety and their mechanisms of action. Results Higher levels of health-related physical fitness, higher levels of subjective well-being, and having more children were the top three protective factors against death anxiety among elderly people in rural Sichuan, with effect values of −0.392, −0.287, and −0.154, respectively. In contrast, suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. Suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. The structural equation model fitting results showed that the medical insurance type of rural elderly in Sichuan (β=−0.062, P=0.002), suffering from chronic diseases (β=0.127, P=0.001), hospitalization due to health reasons in the past year (β=0.086, P=0.002), and educational level (β=−0.067, P=0.001) had indirect effects on death anxiety through health-related physical fitness. Not seeking medical treatment due to financial difficulties in the past year had an indirect effect on death anxiety through subjective well-being (β=0.060, P=0.002). The number of children had both a direct effect on death anxiety (β=−0.119, P=0.004) and an indirect effect through subjective well-being (β=−0.034, P=0.001). Health-related physical fitness had both a direct effect on death anxiety (β=−0.278, P=0.001) and an indirect effect through subjective well-being (β=−0.114, P=0.002). Conclusion Multiple factors directly or indirectly affect the level of death anxiety in the rural elderly population. Health-related physical fitness, subjective well-being, and the number of children are important protective factors. Moreover, health-related physical fitness and subjective well-being act as mediating variables in the chain of effects of multiple factors on death anxiety.
Objective To analyze the reasons for the perioperative death of endovascular repair of acute aortic dissection （AD）. Methods The clinical data of 176 patients with acute AD and received endovascular repair from July 2001 to October 2012 were analyzed retrospectively. Results Among 176 patients with acute AD， 8 patients died during perioperatively， received endovascular repair in 1-5 days after admission （mean 2.4 d）， and all of them admitted before 2008. Two cases were type A and 6 cases were type B. All cases with hypertension and 3 cases with pleural effusion. Three cases died on the day of operation， among them 2 cases occurred in 1 h after operation， the other 1 case occurred in 2 h after operation. Four cases died in 2 days after operation and 1 case died in 4 days after operation. Four cases died of rupture of the aortic dissection， 2 cases died of cerebral infarction， 1 case died of multiple organ failure， and 1 case died of gastrointestinal bleeding. Conclusion To avoid performing endovascular repair during the acute phase and improving operation skills may help to avoid the occurrence of perioperative death.