Objective To study the mortality and prognostic factors of post-operative acute respiratory failure in cancer patients. Methods There were 1632 postoperative cancer patients from2004 to 2006 in the ICU of Cancer Hospital, in which 447 patients were complicated with acute respiratory failure ( intubation or tracheotomy and mechanical ventilation) . The clinical data was retrospectively analyzed. Stepwise logistic regression analysis was used to identify variables associated with mortality for acute respiratory failure. Results In 447 patients with acute respiratory failure ( male 260, female 187) , 106 cases died with a mortality of 6. 5% . Single factor analysis showed that acute morbodities ( shock, infection, organ failure) , intervention ( continuous renal replacement therapy, vasopressor drugs) , the 28-day ICU free days and APACHE scores ( ≥ 20) had significant differences between the survivor and non-survivor. Multiple logistic regression analysis showed that duration of operation( P = 0. 008, OR 1. 032, 95% CI 1. 008-1. 057) , APACHEⅡ≥20 scores( P =0. 000, OR12. 200, 95% CI 2. 896-51. 406) , organ function failure( P =0. 000, OR 13. 344,95% CI 3. 791-7. 395) were associated with mortality of acute respiratory failure. Conclusion Duration of operation, organ function failure, and APACHE Ⅱ scores were risk prognostic factors for postoperative cancer patients with acute respiratory failure.
【Abstract】ObjectiveTo analyze the factors influencing the prognosis of patients with bile duct carcinoma after resection. MethodsThe clinical data of 120 patients with bile duct carcinoma receiving resection in our hospital from 1980 to 2004 were collected retrospectively and clinicopathologic factors that might influence survival were analysed. A multiple factor analysis was performed through Cox proportional hazard model. ResultsThe overall 1year, 3year and 5year survival rates were 71.7%, 32.5% and 19.2% respectively. The single factor analysis showed that the major significant factors influencing survival of these patients were histological type of the lesions, lymph node metastasis, pancreatic infiltration, duodenal infiltration, resected surgical margin, perineural infiltration, peripheral vascular infiltration and depth of tumor infiltration (P＜0.05). Lymph node metastasis, pancreatic infiltration and perineural infiltration were found to be the the statistically significant factors influencing survival by multiple factor analysis through the Cox model. ConclusionThe most important prognostic factors for bile duct carcinoma after resection were lymph node metastasis, pancreatic infiltration and perineural infiltration.
Objective To systematically review the prognostic value of progesterone receptor (PR) for survival in ovarian cancer. Methods PubMed, EMbase, MEDLINE, The Cochrane Library (Issue 1, 2016), CNKI, VIP, CBM and WanFang Data databases were searched for cohort studies on the correlation between PR expression and prognosis of ovarian cancer from inception to June 1st 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 studies involving 1 881 patients were included. The results of meta-analysis showed that the PR positive patients was superior than the PR negative patients on overall survival (OS) (HR=0.64, 95%CI 0.44 to 0.93,P=0.02), disease free survival (DFS) (HR=0.64, 95%CI 0.48 to 0.85,P=0.002), progression free survival (PFS) (HR=0.62, 95%CI 0.47 to 0.82,P=0.000 9) and remission rate of chemotherapy (OR=1.91, 95%CI 1.28 to 2.86,P=0.002). When analysis based on the clinical pathogesis stages, PR expression was higher in clinical stages Ⅰ-Ⅱ than stage Ⅲ-Ⅳ (OR=2.38, 95%CI 1.71 to 3.32,P<0.000 01), and was higher in cell differentiation G1-G2 than G3 (OR=2.48, 95%CI 1.72 to 3.56,P<0.000 01), while no significant difference was found in groups of serous ovarian cancervs. non serous ovarian cancer (OR=1.28, 95%CI 0.89 to 1.83,P=0.18). Conclusion The current evidence shows that the expression of PR protein have predictive value for the prognosis of ovarian cancer. Due to limited quantity and quality of included studies, the above conclusions are still needed to verified by more high quality studies.
Objective To investigate the outcome and prognostic factors of hospital mortality in patients with acute cerebrovascular disease requiring mechanical ventilation.Methods Data from 94 patients with acute cerebrovascular disease in central intensive care unit(ICU) were collected and retrospectively analyzed.Prognostic factors of hospital mortality were analyzed by univariate statistics and multivariate logistic regression.Results Hospital mortality was 53.2%(50/94).There was significance diference in parameters such as APACHE II score，blood glucose，lengh of hospital stay，lengh of ICU stay，time of mechanical ventilation，incision of trachea，lung infections，lesion loci and its naturer between the survival and non-survival groups（all Plt;0.05）.Multivariate logistic regression revealed that blood glucose，lung infections，diseased region under tentorium of cerebellum，time of mechanical ventilation were independent prognostic risk factors of hospital mortality(all Plt;0.05).Whereas the lengh of ICU stay was protective factor(Plt;0.05).Conclusion The hospital mortality is considerably high in patients with acute cerebrovascular disease requiring mechanical ventilation. The prognostic factors such as blood glucose and lung infections should be evaluate cautiously and prevented aggressively.
ObjectiveTo explore the clinical features and prognostic factors of diffuse brain stem glioma in children. MethodsA retrospective analysis was conducted on pediatric diffuse brain stem glioma diagnosed by pathology in West China Hospital of Sichuan University between January 2016 and May 2019. The demographic data, clinical manifestations, MRI findings, pathological results, and treatment were included in the prognosis study.ResultsA total of 39 cases of pediatric diffuse brain stem glioma confirmed by pathology were enrolled, including 21 males and 18 females aged between 3 and 14 years with an average of (8.1±2.8) years and mostly between 5 and 10 years (29 cases). The mean maximum diameter of gliomas was (4.46±0.81) cm. Among the 39 cases, there were 15 cases complicated with hydrocephalus and 16 cases whose tumors completely surrounded the basilar artery. The median survival time was 6 months. The one-year survival rate was 15.4%, and the two-year survival rate was 5.1%. Univariate analyses showed that the tumor enhancement and completely enclosed basilar artery had significant impact on the prognosis (P<0.05). Multiple Cox regression analysis showed that whether the basilar artery was completely wrapped was related to the prognosis [hazard ratio=4.596, 95% confidence interval (1.839, 11.488), P=0.001]. ConclusionsPediatric diffuse brain stem gliomas are common in children aged 5-10 years with poor prognosis. Whether the tumor completely surrounds the basilar artery is closely related to the short overall survival time.
ObjectiveTo analyze perioperative prognostic factors of pediatric patients undergoing surgical correction of ventricular septal defect (VSD)and severe pulmonary arterial hypertension (PAH). MethodsForty pediatric patients with VSD and severe PAH (mean pulmonary artery pressure (PAPm) < 50 mm Hg)who underwent surgical repair in Beijing Anzhen Hospital from 2004 to 2012 were included in the study. There were 21 male and 19 female patients with their age of 7.2±3.3 years and body weight of 19.6±7.1 kg. All the patients were randomly divided into 2 groups:Group Ⅰ (Group=0, n=20, M/F:12/8, continuous nitroglycerin administration via central venous catheter (CVC)and GroupⅡ (Group=1, n=20, M/F:9/11, continuous prostaglandin E1 (PGE1)administration via CVC). The duration of intubation (Tintubation)was used as the dependent variable (Y). Patient age, cardiopulmonary bypass time (TCPB), postoperative PAPm, pulmonary vascular resistance index (PVRI), systemic to pulmonary pressure ratio (Ps/p), Group, left ventricular stroke work index (LVSWI)and right ventricular stroke work index (RVSWI)were used as independent variables (X). Multivariate liner regression analysis model was used to evaluate the influence of X on Y. ResultsThere was no perioperative death or severe complication in this group. Perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH included group[x1, P=0.004, 95% CI (-71, -16)], TCPB[x2, P=0.011, 95% CI (0.9, 5.8)], posto-perative PAPm (x3, P=0.004 with 95% CI 3.2 to 13.3), RVSWI (x4, P=0.003 with 95% CI-16.9 to-4.3)and PVRI (x5, P=0.03 with 95% CI-0.29 to-0.02). The standardized regression equation was:Y=-0.60x1+0.54x2+2.22x3-1.70x4-0.15x5. ConclusionPGE1 administration, TCPB, postoperative PAPm, RVSWI and PVRI are predominant perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH.
Macular edema (ME) secondary to central retinal vein occlusion（CRVO) often cause severe visual impairment. Intravitreal anti-vascular endothelial growth factor agents and steroids can effectively eliminate ME and improve visual function, but the visual outcome is affected by multiple factors. Retinal blood flow, especially the macular microcirculation, has significant correlation with visual outcome. Ischemic CRVO, especially patients with severe damage in the deep and superficial vascular layer of the macular zone, usually have poor visual outcome. In addition, the integrity of the multi-layer retinal structure closely correlates with the visual outcome. Patients with intact ellipsoid zone, external limit membrane beneath the fovea have good visual recovery. Additionally, good baseline visual acuity, positive response to treatment in early phase, young age and timely treatment usually brings about better visual outcome.
Objective To investigate the prognostic factors and hospitalization cost in patients diagnosed as central line-associated bloodstream infection( CLABSI) in intensive care unit( ICU) .Methods A retrospective study was made to investigate the CLABSI epidemic data in ICU from June 2006 to June 2009. Clinical and physiological parameters were summarized and compared between these patients, which were divided into two groups based on the clinical outcome. Meanwhile, events including blood transfusion,mechanical ventilation, as well as cost of hospitalization were also reviewed. Logistic regression method was introduced to investigate the potential prognostic risk factors. Results There were 49 patients were diagnosed as nosocomial CLABSI, in which 19 cases( 38. 8% ) died in the hospital and 30( 61. 2% ) weresurvival. In univariate analysis, differences in body temperature, central venous pressure, acute physiology and chronic health evaluation( APACHEⅡ ) score, blood transfusion amount, pH value, D-dimer, blood serum alanine transarninase, blood urea nitrogen level, serumcreatinine, serumpotassiumbetween the survivors andthe non-survivors were significant( P lt;0. 05) . However, no significant differences were observed between the two groups in in-hospital days, ICU days and hospitalization cost ( all P gt; 0. 05) . With multiple logistic regressions, higher APACHEⅡ score( OR 0. 78; 95% confidence interval: 0. 66-0. 94; P = 0. 007) , APTTlevel( OR 0. 87; 95% confidence interval: 0. 77-0. 98; P = 0. 026) and serum potassium( OR 0. 09; 95% confidence interval: 0. 01-0. 80; P = 0. 031) were independent predictors of worse outcome. Conclusions Disease severity and coagulation situation may directly predict the prognosis of nosocomial CLABSI patients.But current investigation did not demonstrate significant differences in ICU length of stay and respective cost between the CLABSI patients with different prognosis.
ObjectiveTo overview the various molecular biological index to judge the prognosis of intrahepatic cholangiocarcinoma (ICC), in order to promote ICC patients follow-up treatment, improve survival rate, and quality of life of the patients. Methods"ICC" and "prognostic factor" were searched as key words by PubMed and CNKI series full-text database retrieval systems from 2000 to 2015. Totally 48 English papers and 15 Chinese papers were obtained. Choice criteria:the molecular biological index that affect the prognosis of ICC patients, and can effectively guide treatment. According to the choice criteria, 45 papers were finally analyzed. ResultsThe indicators of Homer1, mucin 1 (MUC1)\mucin 4 (MUC4), lactate dehydrogenase A (LDH-A), Beclin1, Smad4, protein tyrosine kinase-7 (PTK7), IMP3, cytokeratin 7 (CK7)/cytokeratin 20 (CK20), and sphingosine kinase 1 (SPHK1) could be used as prognostic factors in the survival of patients with ICC, and to determine tumor size and stage, vascular invasion, nerve injury, and lymph node metastasis, are of great clinical significance. ConclusionThese indicators have a significant meanning in the prognosis of ICC and the adjustment of the follow-up treatment.
Survival prognosis in patients with terminal cancer plays an important role in clinical decision-making, policy formulation, and end-stage patient with relatives. To date, foreign researchers have developed multiple survival prediction models based on patient clinical performance, biomarkers and other indicators, along with a large number of studies which have been externally verified, including Palliative Performance Scale (PPS), Palliative Prognostic Score (PaP), Delirium-Palliative Prognostic Score (D-PaP), and Palliative Prognostic Index (PPI), etc. China's research on this topic remains in the primary stage. Therefore, this article reviews the prognostic factors of terminal cancer and survival prediction models as well as applications, in order to provide references for the subsequent construction of survival prediction models for patients with terminal cancer in line with Chinese characteristics.