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.
Objective To investigate the values of pneumonia severity index ( PSI) , CURB-65,plasma procalcitonin ( PCT) , C-reactive protein ( CRP) measurements for evaluation the severity of healthcare-associated pneumonia ( HCAP) .Methods A retrospective observational study was conducted on 92 hospitalized patients with HCAP admitted between June 2010 and December 2011. They were divided into different groups according to different severity assessment criteria. The variance and correlation of PCT,CRP,WBC and percent of neutrophil ( Neu% ) levels were compared among different groups. ROC curvewas established to analyze PSI, CURB-65, PCT and CRP levels for predicting the motality of HCAP patients.Results In the severe HCAP group, PSI and CURB-65 scoring and serum PCT, CRP, WBC, Neu% levels were significantly higher than those in the non-severe HCAP group( P lt; 0. 05) . In the high-risk HCAP group, PCT, CRP, WBC and Neu% levels were significantly higher than those in the low-risk HCAP group according to the PSI and CURB-65 scoring criteria( P lt;0. 05) .WBC and Neu% levels were also significantly higher than those in the moderate-risk group. PSI and CURB-65 scoring were positively correlated with PCT and CRP levels. PSI scoring gt;120 points or CURB-65 scoring gt;2 points on admission were predictors of mortality. Conclusions PSI and CURB-65 scoring are correlated with severity of HCAP. Combining serum PCT and CRP levels can improve the predictive accuracy of the severity of HCAP.
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.
ObjectiveTo compare the effectiveness of radiofrequency ablation (RFA) combined with transilluminated powered phlebectomy (TIPP) vs. high ligation and stripping (HLS) combined with TIPP in patients with varicose veins of lower limbs.MethodsA retrospective analysis was made on the clinical data of 190 patients (206 limbs) of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018, of them 88 patients (96 limbs) in RFA combined with TIPP group and other 102 patients (110 limbs) in HLS combined with TIPP group. The treatment effectiveness and quality of life was assessed with venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) in three months and one year after surgery. Doppler ultrasound was used to evaluate the closure of great saphenous vein.ResultsBaseline characteristics were similar between the two groups (P>0.05). The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time, intraoperative bleeding, hospital stay time, postoperative bed time, resumption time of activities, as well as incidences of skin induration and limb numb (P<0.05). Occlusion rates of great saphenous vein in 3 months was 93.8% (90/96) in the RFA combined with TIPP group and 97.3% (107/110) in the HLS combined with TIPP group, and in one year was 91.7% (88/96) and 97.3% (107/110) respectively, there was no significant difference between the two groups at the same time point (P>0.05). The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in 3 months and 1 year follow up (P<0.05), but there was no significant differences between the two groups at the same time point (P>0.05).ConclusionsRFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs. Compared with HLS, RFA has the same good effectiveness and quality of life, but it has the advantages of short operation time, rapid postoperative recovery, and less postoperative complications.
ObjectiveTo investigate predictive value of a new blood biochemical scoring system (CPWAG scoring system) on severity and mortality of acute pancreatitis (AP).MethodsThe AP patients who met the inclusion and exclusion criteria in our hospital from January 2017 to June 2019 were collected, then were divided into severe acute pancreatitis (SAP) group and non-SAP group according to the latest Atlanta classification. The differences of clinical characteristics and related blood biochemical indicators between the SAP group and the non-SAP group were compared. Univariate logistic regression analysis was used to screen blood biochemical risk indicators related to SAP. The receiver operating characteristic (ROC) curve was used to obtain the best cut-off value corresponding to the maximum Youden index of statistical significant risk factors and was assigned as 0 or 1 point according to different situations. At the same time, the pleural effusion of the BISAP score was included and assigned as 0 (yes) or 1 (no) point, then the CPWAG score was obtained by adding the point of the above indexes.The areas under the ROC curve (AUC) of the CPWAG, BISAP, APACHEⅡ, CTSI, and Ranson scoring systems in predicting severity and death of AP patients were also compared.ResultsA total of 451 patients with AP were included in this study, including 85 patients with SAP and 366 patients with non-SAP. Compared with the non-SAP group, the etiology of AP was mainly biliary (P<0.05), with higher levels of white blood cell count (WBC), C reactive protein (CRP), procalcitonin (PCT), and glucose (P<0.05), greater red blood cell distribution width value (P<0.05), longer prothrombin time (PT) and hospital stay (P<0.05), lower albumin (ALB) and blood calcium levels (P<0.05), higher BISAP, APACHEⅡ, CTSI and Ranson points (P<0.05), and higher proportions of patients with pleural effusion, multiple organ dysfunction syndrome, and death (P<0.05) in the SAP group. The highest score of the CPWAG scoring system included CRP, PCT, WBC, ALB, glucose, blood calcium, and pleural effusion was 7. With the increase of CPWAG score, the proportion of SAP and death patients showed an increasing trend (P<0.001). The AUC of the CPWAG scoring system in predicting SAP was 0.866, which was higher than those of Ranson (AUC=0.722, Z=5.317, P<0.001), APACHEⅡ (AUC=0.706, Z=5.019, P<0.001), and CTSI (AUC=0.805, Z=1.962, P=0.005) scoring system, but which had no statistically significant difference as compared with the BISAP scoring system (AUC=0.819, Z=1.816, P=0.070). The AUC of the CPWAG scoring system in predicting death had a high ability (AUC=0.823), which had no significant differences as compared with the Ranson, APACHEⅡ, CTSI, and BISAP scoring systems (P>0.05).ConclusionThe CPWAG score is valuable in predicting the severity and mortality of AP patients, allowing accurate and early assessment of AP patients.
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 value of fibrinogen to albumin ratio (FAR) combined with pulmonary embolism severity index (PESI) in the assessment of severity and prognosis of patients with acute pulmonary thromboembolism (APTE). Methods A retrospective study of hospitalized patients with confirmed APTE admitted to the Affiliated Hospital of Southwest Medical University from September 2013 to August 2021, divided into low-risk, intermediate-risk, and high-risk groups according to the Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism, and divided into survival groups and death groups according to the 30-day prognosis. The general data of all patients and relevant blood laboratory tests within 2 hours after admission were collected to calculate PESI and FAR. FAR and PESI levels were compared in APTE patients with different severity of disease and different prognosis. Independent risk factors for 30-day mortality in APTE patients were analyzed using logistic regression. Subject working characteristic curves were drawn to assess the differences in sensitivity, specificity and area under the curve of FAR, PESI and FAR combined with PESI in predicting 30-day death. Results Total of 235 APTE patients were included, divided into 85 in the low-risk group, 110 in the intermediate-risk group, and 40 in the high-risk group; 192 in the survival group and 43 in the death group according to 30-day survival. The differences in age, albumin (ALB), high-sensitivity troponin, D-dimer, fibrinogen (FIB), FAR, and PESI of APTE patients with different disease severity were statistically significant (P<0.05). FAR increased progressively with increasing severity of disease (P<0.05), and correlation analysis showed a positive correlation between FAR and PESI (r=0.614, P<0.05). Elevated FIB, FAR, PESI and decreased ALB were independent risk factors for 30-day death in patients with APTE (P<0.05). FAR, PESI, and FAR combined with PESI all had predictive value for 30-day death in APTE patients, and FAR combined with PESI predicted the largest area under the 30-day death curve. Conclusions FAR correlated with the severity and prognosis of APTE patients. FAR combined with PESI was more valuable in assessing the 30-day prognosis of APTE patients than FAR alone or PESI alone.
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.
Objective To explore the correlation between body mass index (BMI) and disease severity in patients with spinocerebellar ataxia type 3 (SCA3). Methods Patients who visited the Department of Neurology of the First Affiliated Hospital of Fujian Medical University with a confirmed diagnosis of SCA3 between July 2022 and August 2023 were selected as a case group, and healthy individuals between June 2024 and October 2024 were selected as a control group, and the BMI levels of the two groups were compared. Patient demographics and clinical statistics were collected, the severity of ataxia in SCA3 patients was assessed using the Scale for the Assessment and Rating of Ataxi, and the relationship between BMI and disease severity was evaluated. Results A total of 101 patients and 101 healthy individuals were included. The BMI levels of SCA3 patients were significantly lower than those of normal controls (t=−2.370, P=0.019). The results of the multiple linear regression model showed that the BMI, disease duration and smoking history had an effect on the disease severity of SCA3 patients (P<0.05), and disease duration and disease severity had a significant effect on the disease progression in SCA3 patients (P<0.05). Conclusion There may be a correlation between BMI and disease severity in SCA3 patients, and controlling the BMI level may help to control the disease in SCA3 patients.
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.