Objective To define risk factors of nosocomical pneumonia (NP) in elderly in-patients. Methods Two hundred elderly in-patients were selected in the Geriatric Department of West China Hospital from January 1999 to June 2002. Among them, 100 patients developed NP during their hospital days and the others didn’t have the episodes of NP at the same time. The following factors were analyzed: sex, age, multiple underline diseases and their severity, smoking, activity of daily life, conscious status, aspiration, nasogastrial intubations, antibiotics use and hospitalization. SPSS 10.0 was used for Logistic regression analysis to determine the factors significantly associated with the development of NP. Results The following factors were significantly associated with the development of NP in the logistic regression analysis: aspiration [OR 28.452, 95%CI (3.793 to 213.447)],multiple diseases [OR 17.157, 95%CI (2.734 to 107.651)], multiple antibiotics use [OR 6.396, 95%CI (1.861 to 21.980)], smoking [OR 1.774, 95%CI (1.211 to 2.600)] and prolonged hospitalization [OR 1.134, 95%CI (1.081 to 1.189)]. Conclusions Aspiration, multiple diseases, multiple antitiotics use, smoking and prolonged hospitalization are closely related to NP in elderly in-patients. Cautionary medical measures and shortening hospitalization were the key factors to decrease the incidence of NP for the patients in Geriatric Department.
ObjectiveTo evaluate the disease characteristics,medical consultation model and barrier to get basic medical service rural patients with chronic obstructive pulmonary disease(COPD) in Chinese western. MethodsThe subjects were collected from a COPD epidemiology study conducted in Western rural district.The factors which were associated with disease characteristics,medical consultation model,and barrier to get basic medical service were analyzed by questionnaire,individual conversation,and laboratory tests. ResultsThis study enrolled 343 COPD patients confirmed by spirometry test.118 subjects consulted their doctors frequently because of apparent symptom.73(62%) subjects had symptom with 5 to 10 years,while 22(19%) subjects with more than 10 years.Among the symptomatic COPD subjects,only 2(2%) cases were diagnosed as COPD previously,15(13%) subjects with chronic bronchitis,and only 1(1%) subject underwent spirometry test.110(93%) subjects were prescribed as antibiotics,68(58%) subjects with theophylline,5(4%) subjects with ICS+LABA.COPD education was acceptable in most subjects(98%),however,the regular follow-up was acceptable in only 26% of subjects. ConclusionLack of disease information,inappropriate medical consultation model,and irregular COPD management in primary care are the major factors which influence diagnosis and treatment of COPD in Western rural area of China.
ObjectiveTo investigate the pathogenesis, clinical manifestations, diagnosis and treatment of common variable immune deficiency (CVID).MethodsOne case of CVID with cellular immunodeficiency leading to bronchiectasis and liver cirrhosis was analyzed retrospectively. Relevant literatures were also searched through WanFang Database, China National Knowledge Infrastructure and PubMed, Ovid, Embase, Cochrane using the key words " common variable immunodeficiency”, " common variable hypogammaglobulinemia” in Chinese and English.ResultsA 52-year-old female patient, complained of cough, expectoration for 20 years, edema for 7 years and aggravated for 3 months with a history of recurrent respiratory infections was hospitalized in the West China Hospital of Sichuan University. The chest computed tomography revealed bronchiectasis, liver cirrhosis and portal hypertension. Laboratory tests showed remarkable hypogammaglobulinemia. The CD4+ T-cell count was below the normal range. Probable diagnosis of CVID was made based on clinical characteristics and laboratory tests. Immunoglobulin infusion with a dose of 20 g was given and the symptoms were relieved. About 288 case reports including 8 000 patients were searched. Most of them were reported individually. Conclusions CVID has a low morbidity and is rare in China. It is mostly caused by genetic factors. When there are recurrent infections in common areas of body, infections in rare areas or infections of conditioned pathogen, clinicians should be vigilant and give intervention as soon as possible. Family and genetic researches could be done when permitted.
ObjectiveTo investigate the value of neutrophil/lymphocyte ratio (NLR) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by detecting the relationship between NLR and other well-known inflammatory biomarkers.MethodsRetrospective study of 610 AECOPD cases was performed. In order to analyze the influence of NLR level on disease condition, treatment plan and prognosis, the clinical data with acute exacerbation were collected and the value of NLR in AECOPD were analyzed.ResultsThe level of NLR was higher in the group with pneumonia than that in the non-pneumonia group (P<0.05), and the more severe the pulmonary inflammation, the higher the NLR level (P<0.05). The level of NLR was higher in the group with heart failure and the group treated with ventilator and glucocorticoid (P<0.05). The NLR level was higher in the group of hospital stay over 14 days than the group of hospital stay less than 14 days (P<0.05). The NLR value of the death group was higher than that of the survival group (P<0.05). With the increase of NLR value, the mortality rate in hospital increased gradually. Compared with C-reactive protein and interleukin-6, NLR had the highest odds ratio by binary regression analysis. Cutoff value of NLR was 5.92 by analysis of receiver-operating characteristic curve with a sensitivity of 88% and a specificity of 51%, and the area under the curve in predicting in-hospital death was 0.727 (OR=4.112, 95% confidence interval 0.609 - 0.849, P=0.02).ConclusionsNLR can be used as an inflammatory marker to evaluate the severity of AECOPD and to predict the prognosis.
ObjectiveTo analyze risk factors, clinical features and outcome factors of invasive pulmonary aspergillosis (IPA) in severe H1N1 patients so as to achieve early diagnosis and improve prognosis.MethodsFifty severe H1N1 influenza patients with IPA admitted to West China Hospital and 64 severe H1N1 influenza patients in the same period matched by age and gender were collected. Patient characteristics, laboratory examinations, radiological imaging, microbiology data and prognostic indicators were involved into analysis.ResultsThe mortality of severe H1N1 influenza patients with IPA was significantly higher than those without IPA (51.6% vs. 32.0%, P=0.036). However, the incidence of IPA in severe H1N1 influenza patients was not related with the patient's age, gender, underlying disease, glucocorticoid use and CD4+ T cell count. Serum C-reactive protein level [(125.0±88.8) vs. (86.1±80.1) mg/L, P=0.038] and interleukin-6 level [(148.7±154.2) vs. (81.7±110.2) μg/L, P=0.039] of severe H1N1 influenza patients with IPA were significantly higher than those without IPA. Besides, more patients presented with fever (81.3% vs. 64.0%, P=0.038) and dyspnea (51.6% vs. 24.0%, P=0.003) in severe H1N1 patients with IPA. The radiological imaging of severe H1N1 patients with IPA were mostly characterized by combining with nodular changes on the basis of ground-glass opacity.ConclusionThe occurrence of IPA in severe H1N1 influenza patients may be related with pulmonary excessive inflammatory response secondary to viral invasion rather than basic condition of the patient.
Objective To investigate the risk factors, clinical characteristics and prognostic factors of venous thrombosis (and pulmonary embolism) in patients with idiopathic hypereosinophilia (IHE) so as to provide a theoretical basis for clinical prevention of venous thrombosis and improve prognosis.Methods Thirty-nine patients with IHE admitted to West China Hospital of Sichuan University from January 2010 to January 2022 were collected in this retrospective case-control study to explore the risk factors of venous thrombosis (including pulmonary embolism) and thrombosis recurrence after treatment. Results There were 17 (43.5%) patients combined with venous thrombosis of 39 patients with IHE. In the patients with vascular involvement, pulmonary embolism was the initial expression of IHE accounted for 29% (5/17). patients of IHE with pulmonary embolism were younger [44 (24.5 - 51.0) vs. 56 (46.3 - 67.8) year, P=0.035] and had higher peak absolute eosinophil counts [11.7 (7.2 - 26.5)×109/L vs. 3.8 (2.9 - 6.7)×109/L, P=0.020] than those without pulmonary embolism. After a mean follow-up of 13 months (2 - 21 months), thrombosis recurred in 35.3% (6/17) of patients. Persistent increasing in eosinophils (>0.5×109/L) was an independent risk factor for thrombus recurrence (odds ratio 13.33, 95% confidential interval 1.069 - 166.374). Conclusions Thrombosis is a common vascular impaired complication in IHE , and increased eosinophilia is a risk factor for thrombosis and thrombus recurrence after therapy. Controlling and monitoring the eosinophilic cell levels in patients with IHE may avoid severe comorbidities.