ObjectiveTo evaluate the value of blood urea nitrogen to creatinine ratio (UCR) in predicting the condition and prognosis of severe pneumonia patients.MethodsA total of 408 patients with severe pneumonia hospitalized in the intensive care unit (ICU) of Fangcun branch of Guangdong Provincial Hospital of traditional Chinese medicine from January 1, 2017 to August 1, 2020 were retrospectively collected. The patients were divided into a survival group (320 cases) and a death group (88 cases) according to the outcome of hospitalization. This study analyzed the relationship between UCR level and general information, condition, and treatment needs of severe pneumonia patients; and compared UCR, the value of neutrophil to lymphocyte ratio, the levels of hematocrit, C-reactive protein, procalcitonin and D-dimer, and the scores of Acute Physiology and Chronic Health EvaluationⅡ and Pneumonia Severity Index between the survival group and the death group. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of the above indicators. Logistic regression was used to analyze the risk factors of death of severe pneumonia.ResultsThe age of the patients died of severe pneumonia was higher than that of the survival patients (P<0.05); The mortality rate of severe hospital acquired pneumonia was higher than that of severe community acquired pneumonia (P<0.05); The level of UCR was higher in the patients over 70 years old (P<0.05); UCR level of the severe pneumonia patients with acute exacerbation of chronic obstructive pulmonary disease or multiple organ dysfunction syndrome during hospitalization was higher (P<0.05); The UCR level was higher in the patients with severe pneumonia whose ICU stay was more than 10 days (P<0.05); The UCR level of the severe pneumonia patients with mechanical ventilation longer than 180 hours was higher (P<0.05); UCR level of the severe pneumonia patients who died during hospitalization was higher than that of the survival group (P<0.05); The area under ROC curve of UCR for predicting death in the patients with severe pneumonia was 0.648 (95%CI 0.576 - 0.719), the cut-off value was 108.74, the sensitivity was 47.7%, and the specificity was 77.8% (P<0.05). PSI > level 3 (OR=4.297, 95%CI 2.777 - 6.651) and UCR > 108.74 (OR=0.545, 95%CI 0.332 - 0.896) were independent risk factors for death in the patients with severe pneumonia (P<0.05).ConclusionUCR has certain value in evaluating the condition and prognosis of severe pneumonia patients.
Objective To evaluate the effectiveness of percutanous fixation with helical bridge combined fixation system (BCFS) for treatment of long split fractures involving the middle and upper humerus. Methods Between February 2018 and February 2020, 15 patients of long split fractures involving the middle and upper humerus were treated. There were 6 males and 9 females, with an average age of 62 years (range, 37-82 years). The fractures were caused by slipping in 7 cases, falling from height in 3 cases, and traffic accident in 5 cases. According to AO classification, the shaft fractures were rated as type A in 4 cases, type B in 9 cases, and type C in 2 cases. And all fractures extended to proximal humerus; and the proximal fractures were rated as one-part fracture in 11 cases and two-part fracture in 4 cases according to Neer classification. The interval between injury and operation was 1-7 days (mean, 3.2 days). Nine patients underwent closed reduction and 6 patients underwent open reduction after lengthening the incisions. All fractures were percutaneously internal fixated with helical BCFS after reduction. The operation time, intraoperative blood loss, incision healing, and fracture healing were recorded. Constant-Murley score was used to evaluate shoulder joint function, and Mayo score was used to evaluate elbow joint function. ResultsThe operation time ranged from 55 to 175 minutes, with an average of 76.5 minutes; the intraoperative blood loss ranged from 80 to 300 mL, with an average of 185.5 mL. All incisions healed by first intention, without infection or radial nerve injury. All patients were followed up 12-23 months, with an average of 16 months. The fractures all reached clinical healing, and the healing time was 12-20 weeks, with an average of 14.5 weeks. At 1 year after operation, the Constant-Murley score of the affected side was 88.7±7.6, and there was no significant difference when compared with that of the healthy side (90.8±8.3) (t=1.421, P=0.052). According to the elbow Mayo score, the score of the affected side was 97.6±6.5, and there was no significant difference when compared with the healthy side (97.7±7.3) (t=0.433, P=0.913). ConclusionThe helical BCFS can avoid the dissection of deltoid insertion and prevent the iatrogenic radial nerve injury. With satisfied effectiveness, it is suggested for minimally invasive surgical treatment of long split fractures involving the middle and upper humerus.
Objective To explore the effects of Metabolic Syndrome (MS) and its components on the condition and prognosis of patients with Severe Pneumonia. Methods 306 patients with severe pneumonia admitted to the intensive care unit of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2020 to July 2023 were included as study subjects.The patients were divided into MS and non-MS groups according to whether they were combined with MS,and into survival and death groups according to 28-day prognosis,and the general data, laboratory indexes, condition and prognostic indexes of the two groups were compared; multifactorial logistic regression was used to analyze the independent risk factors for the prognosis of patients with severe pneumonia. ResultsThe levels of test indicators such as body mass index (BMI), fasting blood glucose (FBG), triglyceride (TG), blood lactate,white blood cell count(WBC),urea phosphate (Urea), creatinine (SCr),as well as the incidence of acute respiratory distress syndrome (ARDS), shock,multiple organ dysfunction syndrome (MODS), rate of endotracheal intubation and mortality, ICU treatment cost,and total treatment cost of the MS group were significantly higher than those of the non-MS group; the levels of high-density lipoprotein cholesterol (HDL-C) and oxygenation index (OI) of the MS group were significantly lower than those of the non-MS group (P<0.05).Multifactorial logistic regression analysis showed that the risk of death from severe pneumonia was 1.276 times higher in combined MS than in no combined MS (95%CI: 1.013, 5.114, P=0.047). Subgroup analyses also showed that the risk of death from non-viral severe pneumonia was 2.147 times higher in those with MS than those without (95%CI: 1.175, 8.428, P=0.023). ConclusionSevere pneumonia with MS may be more severe and may have a worse prognosis.