ObjectiveTo investigate the association between serum thyroid hormone levels and prognosis for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) without thyroid disease, and explore the prognostic value of serum thyroid hormone levels for patients with AECOPD.MethodsThe clinical data of 239 hospitalized cases of AECOPD [149 males, 90 females, aged 42-92 (77.7±8.9) years] from January 2013 to November 2017 were retrospectively analyzed. Serum thyroid hormone levels including total tetraiodothyronin (TT4), total triiodothyronin (TT3), thyroid stimulating hormone (TSH), free tetraiodothyronin (FT4) and free triiodothyronin (FT3) were measured by chemiluminescence immunoassay. All patients were divided into a survival group and a death group according to the prognosis. Serum thyroid hormone levels were compared between two groups. Correlations of serum thyroid hormone levels with the occurrence of death in AECOPD patients were analyzed. The prognostic value of serum thyroid hormone levels for AECOPD patients was explored by receiveroperating characteristic (ROC) curve analysis. And the best cut-off value of serum thyroid hormone level in predicting the risk of death was calculated.ResultsSerum TT4, TT3, FT4 and FT3 levels in the survival group were significantly higher than those in the death group [TT4: (89.35±21.45) nmol/L vs. (76.84±21.33) nmol/L; TT3: (1.05±0.34) nmol/L vs. (0.72±0.19) nmol/L; FT4: (16.17±2.91) pmol/L vs. (14.45±2.85) pmol/L; FT3: (3.06±0.81) pmol/L vs. (2.24±0.72) pmol/L; all P<0.05]. The differences of serum TSH level between two groups were not statistically significant [0.98 (0.54-1.83)vs. 0.57 (0.31-1.84), P>0.05]. Spearman correlation analysis showed that serum TT4, TT3, FT4 and FT3 levels were significant correlated with the occurrence of death (r values were 0.226, 0.417, 0.220, 0.387, respectively, P<0.05). And there was no significant correlation between serum TSH level and the occurrence of death (P>0.05). ROC curve analysis was done between serum thyroid hormone levels (TT4, TT3, TSH, FT4 and FT3) and the occurrence of death in the AECOPD patients. The areas under ROC curve were 0.659, 0.793, 0.588, 0.655 and 0.772, respectively. Serum TT3 was the best indicator for predicting the occurrence of death. When serum TT3 level was 0.85nmol/L, the Youden index was the highest (0.486), with a sensitivity of 70.2%, and a specificity of 78.3%. It was the best cut-offl value of serum TT3 to predict the risk of death in AECOPD patients.ConculsionsSerum thyroid hormone levels are significant associated with the prognostic for AECOPD patients. There is certain value of serum thyroid hormone levels in prognostic evaluation of AECOPD patients.
Objective To explore the application of regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) for patients with sepsis and hyperlactacidemia, and to provide a basis for the clinical application of RCA in such patients. Methods Sepsis patients who underwent RCA-CRRT at West China Hospital of Sichuan University between May 2021 and May 2023 were retrospectively included. Patients were divided into a normal lactate group (≤2.0 mmol/L) and a hyperlactacidemia group (>2.0 mmol/L) based on their initial lactate levels before CRRT, and subgroup analysis was performed on patients with moderate hyperlactacidemia (2 mmol/L<lactate level<4 mmol/L) and severe hyperlactacidemia (≥4.0 mmol/L). Propensity score matching (PSM) was used, and baseline characteristics and outcome measures of different groups of patients were compared. Results A total of 441 patients were included, with 228 in the normal lactate group and 213 in the hyperlactacidemia group. Before PSM, there were statistically significant differences in the proportion of liver failure, proportion of chronic kidney disease, mean arterial pressure, bicarbonate, total bilirubin, creatinine, activated partial thromboplastin time, international standardized ratio, procalcitonin, and interleukin-6 between the normal lactate group and the hyperlactacidemia group (P<0.05). After PSM, there were 162 patients in both the normal lactate group and the hyperlactacidemia group. There was no statistically significant difference in baseline characteristics between the two groups of patients (P>0.05). The incidence of citric acid accumulation in the normal lactate group and the hyperlactacidemia group was 13.0% and 25.9%, respectively (P<0.05). There was no statistically significant difference in the incidence of metabolic acidosis, metabolic alkalosis, hypernatremia, filter coagulation events, or in-hospital mortality between the two groups (P>0.05). Kaplan-Meier survival analysis showed that there was no statistically significant difference in the first extracorporeal circulation lifespan between the normal lactate group and the hyperlactacidemia group (P>0.05). Among 213 patients with hyperlactacidemia, 186 had moderate hyperlactacidemia and 27 had severe hyperlactacidemia. Before PSM, there were statistically significant differences in the proportion of male, proportion of diabetes, albumin level, international standardized ratio, and interleukin-6 between moderate and severe hyperlactacidemia groups (P<0.05). After PSM, there were 22 patients in both the moderate and severe hyperlactacidemia groups. There was no statistically significant difference in baseline characteristics between the two groups of patients (P>0.05). The incidence of citric acid accumulation was 18.2% and 50.0% in the moderate and severe hyperlactacidemia groups, respectively (P<0.05). There was no statistically significant difference in the incidence of metabolic acidosis, metabolic alkalosis, hypernatremia, filter coagulation events, or in-hospital mortality between the two groups (P>0.05). Kaplan-Meier survival analysis showed that there was no statistically significant difference in the first extracorporeal circulation lifespan between the moderate and severe hyperlactacidemia groups (P>0.05). Conclusion When RCA is used for CRRT anticoagulation in patients with sepsis and hyperlactacidemia, the incidence of citric acid accumulation is high (especially in patients with severe hyperlactacidemia), and should be closely monitored.
Objective The current study aimed to compare the differences in clinical characteristics and prognosis of elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between patients who were vaccinated and those not and to explore the clinical significance of vaccination for the elderly.Methods A total of 92 elderly patients (≥60 years old) with SARS-CoV-2 infection who were admitted to Chengdu Public Health Clinical Center from December 10, 2020, to May 2, 2022, were included, and they were grouped according to whether vaccinated. The differences in clinical manifestations, laboratory examinations, imaging, treatment, prognosis, hospitalization time, and nucleic acid conversion time between the two groups were compared in this study. Results A total of 92 elderly patients were included, with a male-to-female ratio of 1.3:1, and a median age of 66 (62, 71) years old. There were 79 patients in the vaccinated group and 13 in the unvaccinated group. The positive rate of total SARS-CoV-2 antibody in 92 patients was 91.3%, and those of IgG and IgM of SARS-CoV-2 antibody were 89.1% and 37%, respectively. The positive rates of total SARS-CoV-2 antibody and IgG of SARS-CoV-2 antibody in the vaccinated group were higher than those in the unvaccinated group (97.5% vs. 53.8%, 96.2% vs. 46.2%) (P<0.01), and COI values of total antibody, IgM and IgG were higher than those of unvaccinated group (P<0.01). The proportions of the initial symptoms of sputum, ground-glass opacity or patchy opacity involving both lungs in chest CT in the unvaccinated group were higher than those in the vaccinated group (P<0.05). The white blood cell counts and platelet counts in the vaccinated group were higher than those in the unvaccinated group, whereas the prothrombin time and D-dimer were lower than those in the unvaccinated group (P<0.05). COI values of total antibody in the 3-doses group were higher than those in the 2-doses group, and the white blood cell counts in the 3-doses group were higher than those in the 2-doses group (all P<0.05). During hospitalization, asymptomatic infection (58.2%) and general type (53.8%) was the most common in the vaccinated and unvaccinated group, respectively. Patients in the unvaccinated group were more likely to progress to severe status than the vaccinated group during hospitalization (15.4% vs. 0%, P=0.019). The unvaccinated group received more treatments of intravenous immune globulin, non-invasive and invasive mechanical ventilation, plasma after immunization of vaccine and convalescent plasma of SARS-CoV-2 infected patients than those of the vaccinated group (P<0.05). Patients in the unvaccinated group developed a higher proportion of respiratory failure, secondary infection, acute respiratory distress syndrome, and heart failure than in the vaccinated group (P< 0.05). The median lengths of hospitalization and nucleic acid conversion in the unvaccinated group were 22 (7, 32) days and 13 (2, 20) days, which were longer than those in the vaccinated group [8 (7, 12) days, 2 (2, 7) days] (all P<0.05). Conclusions Vaccination of SARS-CoV-2 can improve the positive rate of total SARS-CoV-2 antibody and IgG of SARS-CoV-2 antibody in elderly patients with SARS-CoV-2 infection, milder disease status, and can shorten the time of hospitalization and nucleic acid conversion. These results suggest that the COVID-19 vaccine can reduce the disease and improve the prognosis in the elderly.