ObjectiveTo investigate the relationship between the red blood cell distribution width (RDW) and the severity of acute exacerbation of bronchiectasis in elderly patients.MethodsThe clinical data of 216 elderly patients with acute exacerbation of bronchiectasis admitted from January 2015 to October of 2018 were analyzed retrospectively. The severity of acute exacerbation of bronchiectasis in the elderly was evaluated by bronchiectasis severity index (BSI) score. Meanwhile, 50 elderly people receiving qualified medical examination were collected as a healthy control group in the same period. The distributions of BSI score, RDW, procalcitonin (PCT), neutrophil percentage (NEU%) and C-reactive protein (CRP) were described in the patients with different risk degree. The severity of acute exacerbation of bronchiectasis in the elderly was evaluated by BSI. The patients were divided into three groups by BSI score: a low risk group, a middle risk group, and a high risk group. The indexes were described including the distribution of stratified BSI score, RDW, PCT, NEU%, CRP at different risk levels. The correlation of each index was analyzed by Spearman correlation. The threshold value of RDW was calculated by general linear regression, and the influencing factors of BSI score were analyzed by multivariate linear regression analysis.ResultsThe higher the risk stratification, the higher the BSI score, RDW, PCT, NEU% and CRP were. RDW was positively correlated with PCT, NEU% and CRP (r values were 0.425, 0.311, 0.177, respectively, P<0.05). BSI score was positively correlated with RDW, PCT, NEU%, and CRP (r values were 0.425, 0.394, 0.650, 0.578, respectively, P<0.05). RDW was positively correlated with PSI score (r=0.425, P<0.05). The thresholds of RDW were 11.45% and 14.03%. Multiple linear regression showed that RDW, PCT, NEU% and CRP were all influential factors of BSI score and explained 52.3% of the total mutation rate.ConclusionRDW is related to the severity of acute exacerbation of bronchiectasis in the elderly, and can predict the severity of acute exacerbation of bronchiectasis in the elderly.
ObjectiveTo investigate correlation of bedside index for severity in acute pancreatitis(BISAP) and computed tomography severity index(CTSI), modified computed tomography severity index(MCTSI), or extra-pancreatic inflammation on CT(EPIC) score, respectively, in assessing severity of acute pancreatitis. MethodsForty-five patients confirmed SAP from July 2015 to November 2015 in West China Hospital of Sichuan University were prospectively included into this study. Contrast-enhanced multi-detector-row CT scan was performed for all the patients. The abnormal imaging features, such as pancreatic and peri-pancreatic inflammatory changes, involvement of other organs and local complications, were observed and used to calculate three CT severity indexes(CTSI, MCTSI, and EPIC). The clinical data were also colle-cted to calculate BISAP and as compared with CT severity indexes. Correlation between the CT indexes points and BISAP score was estimated using the Spearman test. Interobserver agreement for CTSI, MCTSI or EPIC was calculated using the Kappa statistic. ResultsThe results of BISAP score were as follows: 4 cases gradeⅠ, 22 cases gradeⅡ, 19 cases gradeⅢ. The results of CTSI score were as follows: 6 cases gradeⅠ, 22 cases gradeⅡ, 17 cases gradeⅢ. The results of MCTSI score were as follows: 1 case gradeⅠ, 13 cases gradeⅡ, 31 cases gradeⅢ. The results of EPIC score were as follows: 6 cases gradeⅠ, 11 cases gradeⅡ, 28 cases gradeⅢ. The score of BISAP, CTSI, MCIST, or EPIC was 2.41±0.82, 6.02±1.96, 7.91± 2.11, and 5.57±1.52, respectively. Interobserver agreements for CTSI, MCTSI, and EPIC were good(CTSI: Kappa=0.748, 95% CI 0.000-0.076, P < 0.01; MCTSI: Kappa=0.788, 95% CI 0.000-0.076, P < 0.01; EPIC: Kappa=0.768, 95% CI 0.000-0.076, P < 0.01). Spearman statistic showed there was a positive correlation between CTSI score(rs=0.439, P=0.003), MCTSI score(rs=0.640, P=0.000), or EPIC(rs=0.503, P=0.001) and BISAP score. ConclusionThere is a positive correlation between MCTSI or EPIC and BISAP score, and MCTSI is more strongly correlated with BISAP as compared with EPIC.
ObjectiveTo evaluate the predictive value of the high-sensitivity cardiac troponin I (hs-cTnI) in patients with acute pulmonary embolism (APE). MethodsIn a retrospective cohort study,272 consecutive patients with APE were reviewed and the 30-days death and in-hospital adverse events were evaluated. The patients were classified according to hs-cTnI value into a high hs-cTnI group and a low hs-cTnI group. The simple pulmonary embolism severity index (sPESI) was used for clinical risk determination. The adverse event was defined as intravenous thrombolytic therapy,noninvasive ventilator support to maintain oxygen saturation >90% and suffered with severe complications. The correlations of hs-cTnI with sPESI score,30-days adverse events and mortality were analyzed. The Kaplan-Meier curves and the log-rank test were used to compare time-to-event survival. Stepwise multivariate logistic regression analysis models were used to determine the incremental prognostic value of sPESI score and hs-cTnI. ResultsThe incidence of 30-day death (6.1%),renal failure (14.6%),bleeding (13.4%) and thrombolytic therapy (7.9%) were higher in the high hs-cTnI group than those in the low hs-cTnI group (P values were 0.009,<0.001,0.018 and 0.003,respectively). The patients with sPESI ≥1 and low hs-cTnI had greater free adverse events survival (P=0.005). hs-cTnI provided incremental predictive value for in-hospital adverse events,beyond the sPESI score (P<0.001). Conclusionhs-cTnI has excellent negative predictive value of APE prognosis,especially when used combined with sPESI score.
Objective To systematic investigate whether phase angle of bioelectrical impedance is associated with the functionality, severity, and prognosis of individuals afflicted with chronic obstructive pulmonary disease (COPD). Methods Relevant literature from the PubMed, Embase, Web of Science, Scopus, CNKI, and WanFang databases was retrieved, and literature screening and data extraction in accordance with standardized methods were conducted. Literature quality was assessed by utilizing Mixed Methods Appraisal Tool. Subsequently, data pertaining to the results was extracted for summarization and induction, and descriptive analyzed through qualitative synthesis. Results A total of 11 studies, encompassing 2189 subjects, were included in this review, and the overall quality of the literature was deemed relatively high. Of these studies, three examined the correlation between phase angle and the severity of COPD, eight studies examined the correlation between phase angle and pulmonary and physical function in COPD, and seven studies reported the association between phase angle and adverse outcomes such as hospitalization time, nutritional risk, acute exacerbation and mortality in COPD. The collective findings suggestted that reduced levels of phase angle are linked to severe illness, diminished function, and unfavorable prognosis among individuals with COPD. Phase angle emerged as an independent predictor of lung function, physical exercise endurance, acute exacerbation and mortality in COPD patients. Conclusion The phase angle level of COPD patients is associated with their disease severity, function, and prognosis, and is an potential available indicator for clinical management of COPD patients.
ObjiectiveTo obtain reliable evidence of diagnosis and treatment through evaluating the validity of pneumonia severity index (PSI), CURB-65 and acute physiology and chronic health evaluationⅡ(APACHEⅡ) scores in predicting risk stratification, severity evaluation and prognosis in elderly community-acquired pneumonia (CAP) patients.MethodsClinical and demographic data were collected and retrospectively analyzed in 125 in-hospital patients with CAP admitted in Shanghai Dahua Hospital from January 2012 to April 2015. The severity of pneumonia was calculated with PSI, CURB-65 and APACHEⅡgroups during 1 to 3 days after admission. Mortality and intensive care unit (ICU) admission rates were evaluated among patients in each scores and was categorized into three classes, namely mild, moderate and severe groups during 1 to 3 days after admission. Mortality and ICU admission rates were evaluated among patients in each severity level. Through evaluating the sensitivity, specificity, the predicting values and the area under receiver operating characteristic (ROC) curve (AUC) among PSI, CURB-65 and APACHEⅡ, the validity and consistency of these three scoring systems were assessed.ResultsUsing PSI, CURB-65 and APACHEⅡ scoring systems, the patients were categorized into mild severity (48.8%, 64.0% and 52.8%, respectively), moderate severity (37.6%, 23.2% and 32.0%, respectively) and severe severity (13.6%, 12.8% and 15.2%, respectively). In PSI, CURB-65 and APACHEⅡ systems, the mortality in high risk groups was 41.3%, 62.5% and 47.4%, respectively; The ICU-admission rate in high risk groups was 88.3%, 100.0% and 94.7%, respectively. The sensitivity of PSI, CURB-65 and APACHEⅡ was 50.0%, 71.4% and 64.3% in predicting mortality, and was 46.8%, 50.0% and 59.3% in predicting ICU-admission, respectively. PSI, CURB-65 and APACHEⅡ showed similar specificity (approximately 90%) in predicting mortality and ICU admission. ROC was conducted to evaluate the sensitivity of PSI, APACHEⅡ and CURB-65 in predicting mortality and ICU admission. The AUC had no significant difference among these three scoring systems. The AUC of PSI, CURB-65 and APACHEⅡwas 0.893, 0.871, 0.880, respectively for predicting mortality, and was 0.949, 0.837, 0.949, respectively for predicting ICU admission. There was no significant difference among these three scoring in predicting mortality and ICU admission (all P>0.05).ConclusionsPSI, CURB-65 and APACHEⅡ performed similarly and achieved high predictive values in elderly patients with CAP. The three scoring systems are consistent in predicting mortality risk in elderly CAP patients. The CURB-65 is more sensitive in predicting the risk of death, and more early in identifing patients with high risk of death. The APACHEⅡ is more sensitive in predicting the risk of ICU admission, and has good value in identifying severe patients and choosing the right treatment sites.
ObjectivesTo compare the efficacy of acute physiology and chronic health evaluationⅡ (APACHEⅡ), national early warning score (NEWS), pulmonary embolism severity index (PESI) and Charlson comorbidity index (CCI) on pulmonary embolism (PE) prognosis.MethodsClinical data of patients with PE treated in The Second Xiangya Hospital of Central South University from 2010 to 2017 were retrospectively analyzed. They were divided into death group and survival group, and four clinical scores were calculated. The differences of risk factors between the two groups were compared. Logistic regression analysis was used to obtain the independent risk factors related to mortality. The ROC working curve was used to compare the capability of four clinical scores for PE mortality. SPSS 24.0 and Medcalc 18.2.1 software were used for statistical analysis. ResultsA total of 318 patients with PE were included, and the mortality rate was 13.2%. The APACHEⅡ, NEWS, PESI and CCI of the death group were higher than those of the survival group. There were significant differences between two groups (P<0.05). It was confirmed by logistic regression analysis that cerebrovascular disease, heart rate, leukocyte, troponin T, arterial partial pressure of oxygen, right ventricular dysfunction (RVD) were independent risk factors for 90-day mortality. The areas under the ROC curve of APACHEⅡ, CCI, PESI, NEWS were 0.886, 0.728, 0.715 and 0.731, respectively. The area under the ROC curve of APACHEⅡ was the largest, which was better than NEWS, CCI and PESI (P<0.05), and there was no significant difference among NEWS, CCI and PESI.ConclusionsAPACHEⅡ may be the best predictor of mortality in PE patients, which is superior to NEWS, CCI and PESI.
Objective To investigate the load distribution on the more painful and less painful limbs in patients with mild-to-moderate and severe bilateral knee osteoarthritis (KOA) and explore the compensatory mechanisms in both limbs among bilateral KOA patients with different severity levels. Methods A total of 113 participants were enrolled between July 2022 and September 2023. This cohort comprised 43 patients with mild-to-moderate bilateral KOA (Kellgren-Lawrence grade 2-3), 43 patients with severe bilateral KOA (Kellgren-Lawrence grade 4), and 27 healthy volunteers (healthy control group). The visual analogue scale (VAS) score for pain, the Hospital for Special Surgery (HSS) score, passive knee range of motion (ROM), and hip-knee-ankle angle (HKA) were used to assess walking pain intensity, joint function, and lower limb alignment in KOA patients, respectively. Motion trajectories of reflective markers and ground reaction force data during walking were captured using a gait analysis system. Musculoskeletal modeling was then employed to calculate biomechanical parameters, including the peak knee adduction moment (KAM), KAM impulse, peak joint contact force (JCF), and peak medial/lateral contact forces (MCF/LCF). Statistical analyses were performed to compare differences in clinical and gait parameters between bilateral limbs. Additionally, one-dimensional statistical parametric mapping was utilized to analyze temporal gait data. Results Mild-to-moderate KOA patients showed the significantly higher HSS score (67.7±7.9) than severe KOA patients (51.9±8.9; t=8.747, P<0.001). The more painful limb in all KOA patients exhibited significantly greater HKA and higher VAS scores compared to the less painful limb (P<0.05). While bilateral knee ROM did not differ significantly in mild-to-moderate KOA patients (P>0.05), the severe KOA patients had significantly reduced ROM in the more painful limb versus the less painful limb (P<0.05). Healthy controls showed no significant bilateral difference in any biomechanical parameters (P>0.05). All KOA patients demonstrated longer stance time on the less painful limb (P<0.05). Critically, severe KOA patients exhibited significantly higher peak KAM, KAM impulse, and peak MCF in the more painful limb (P<0.05), while mild-to-moderate KOA patients showed the opposite pattern with lower peak KAM and KAM impulse in the more painful limb (P<0.05) and a similar trend for peak MCF. Conclusion Patients with mild-to-moderate KOA effectively reduce load on the more painful limb through compensatory mechanisms in the less painful limb. Conversely, severe bilateral varus deformities in advanced KOA patients nullify compensatory capacity in the less painful limb, paradoxically increasing load on the more painful limb. This dichotomy necessitates personalized management strategies tailored to disease severity.
Objective To study the factors that affect the prognosis of status epilepticus (SE) and to improve the understanding of clinicians. Methods A retrospective analysis of 57 patients with SE witch from the General Hospital of Ningxia Medical University and Cardio-cerebrovascular Disease Hospital were carried out to collect their clinical data. The data were analyzed by SPSS 17.0 software. The prognosis of the patients was assessed by the Status epilepticus severity score (STESS) scale. Results A total of 57 patients were included, 53 cases improved, 4 cases were automatically discharged. Telephone follow-up showed that 4 cases of automatic discharge were dead. The mortality rate of SE was 7.02%. The most common cause of SE was acute cerebrovascular disease (17.54%), followed by intracranial infection (10.53%); The most common incidence were the occasional medication, self-medication, withdrawal (15.79%). Age, state of consciousness and concurrent infection were associated with prognosis (improvement/death) (P<0.05). STESS score of 0 to 2 points were 45 patients, all improved; score of 3 to 5 points were 12 patients, 8 patients improved, 4 patients died. There were significant differences in the prognosis between the two groups (P<0.05). Conclusions Age, state of consciousness, concurrent infection were related to prognosis, more than 65 years, the state of consciousness for the sleeping or coma had the poor prognosis. STESS scale can predict the prognosis of patients effectively.
ObjectiveTo explore the consistency and clinical application value of Balthazar CT classification and extra-pancreatic inflammation on computed tomography (EPIC) score in the diagnosis of acute pancreatitis (AP). MethodsA total of 100 continuous patients with AP were included in the Hainan Academy of Traditional Chinese Medicine from April 2019 to April 2021, who were divided into mild (n=41), moderate (n=37), and severe (n=22) AP, and all of them underwent the abdominal CT examination. The Balthazar CT classification score, EPIC score, and acute physiology and chronic health evaluation Ⅱ (APACHE-Ⅱ) score were compared and the correlations were analyzed among 3 groups. The consistency of Balthazar CT classification score or EPIC score and clinical classification was analyzed. ResultsThere were statistical differences in the Balthazar CT classification score [(1.58±0.29) points vs. (2.43±0.36) points vs. (3.20±0.51) points, F=13.261, P<0.001], EPIC score [(2.56±0.30) points vs. (4.29±0.77) points vs. (5.68±0.82) points, F=14.672, P<0.001], and APACHE-Ⅱ score [(21.40±6.22) points vs. (29.13±7.31) points vs. (39.37±8.18) points, F=13.906, P<0.001] among mild, moderate, and severe 3 groups. The points of the three indexes increased statistically with the severity of AP (P<0.05). The Balthazar CT classification score was positively correlated with APACHE-Ⅱ score and EPIC score (r=0.537, P<0.001; r=0.609, P<0.001), and EPIC score was positively correlated with APACHE-Ⅱ score (r=0.582, P<0.001). The Kappa values of Balthazar CT classification score or EPIC score and clinical classification for assessing the severity of AP were 0.731 and 0.704, respectively. ConclusionsFrom the preliminary results of this study, Balthazar CT classification score and EPIC score increase obviously with the aggravation of AP and which has a higher consistency, and are positively correlated with APACHE-Ⅱ score. It is suggested that abdominal CT has a good clinical application value in the assessment of severity of AP.
ObjectiveTo investigate the disease severity and comorbidities in outpatient with asthma from urban area in China.MethodsA face-to-face, questionnaire-based survey was carried out in outpatient department in 30 general hospitals from 30 provinces in China mainland except for Tibet during October 2015 to May 2016, and asthma patients who meet the including criteria were enrolled. Data of demographic characteristics, smoking status, disease severity, and comorbidities were collected.ResultsA total of 3 875 cases were included. According to GINA criteria, the proportion of diseases severity was as following: intermittent status 52.5% (2 033/3 875), mild persistent 24.5% (951/3 875), moderate persistent 16.9% (656/3 875), and severe persistent 6.1% (235/3 875). The overweight rate was 32.9% (1 274/3 875), the rate of obesity was 10.3% (401/3 875), and the smoking rate was 20.1% (777/3 875). Obesity and smoking were related to poor asthma control. 75.9% (2 941/3 875) of the patients had comorbidities: allergic rhinitis 43.4% (1682/3 875), hypertension 16.4% (634/3 875), nasosinusitis 8.7% (338/3 875), chronic obstructive pulmonary disease 7.3% (283/3 875), bronchiectasis 3.0% (118/3 875), and rhinopolypus 2.9% (114/3 875).ConclusionsThe majority of asthma patients from outpatient department are mild asthma patients. The proportion of allergic rhinitis and bronchiectasis in asthma patients is higher than mean level. Asthma patients with comorbidities of obesity and smoking is related to poor asthma control.