Objective To study the mortality and prognostic factors of post-operative acute respiratory failure in cancer patients. Methods There were 1632 postoperative cancer patients from2004 to 2006 in the ICU of Cancer Hospital, in which 447 patients were complicated with acute respiratory failure ( intubation or tracheotomy and mechanical ventilation) . The clinical data was retrospectively analyzed. Stepwise logistic regression analysis was used to identify variables associated with mortality for acute respiratory failure. Results In 447 patients with acute respiratory failure ( male 260, female 187) , 106 cases died with a mortality of 6. 5% . Single factor analysis showed that acute morbodities ( shock, infection, organ failure) , intervention ( continuous renal replacement therapy, vasopressor drugs) , the 28-day ICU free days and APACHE scores ( ≥ 20) had significant differences between the survivor and non-survivor. Multiple logistic regression analysis showed that duration of operation( P = 0. 008, OR 1. 032, 95% CI 1. 008-1. 057) , APACHEⅡ≥20 scores( P =0. 000, OR12. 200, 95% CI 2. 896-51. 406) , organ function failure( P =0. 000, OR 13. 344,95% CI 3. 791-7. 395) were associated with mortality of acute respiratory failure. Conclusion Duration of operation, organ function failure, and APACHE Ⅱ scores were risk prognostic factors for postoperative cancer patients with acute respiratory failure.
ObjectiveTo assess the mortality, acute exacerbations, exercise capacity, symptoms and significant physiological parameters (lung function, respiratory muscle function and gas exchange) of patients with severe stable chronic obstructive pulmonary disease (COPD) with respiratory failure treated by noninvasive positive pressure ventilation (NPPV).MethodsA meta-analysis of randomized controlled trials was carried out by searching PubMed, Cochrane library, Embase, OVID, Chinese Biomedical Literature Database and the bibliographies of the retrieved articles up to February 2017. Studies of patients with severe stable COPD with respiratory failure receiving long-term noninvasive positive pressure ventilation and comparison with oxygen therapy were conducted, and at least one of the following parameters were reviewed: frequency of acute exacerbations, mortality, lung function, respiratory muscle function, gas exchange, 6-minute walk test.ResultsSix studies with 695 subjects met the inclusion criteria and were analyzed. The PaCO2 was significantly decreased in patients who received long-term NPPV. No significant difference was found between long-term NPPV and oxygen therapy in mortality, frequency of acute exacerbations, gas exchange, lung function, respiratory muscle function and exercise capacity. The subgroup analysis showed that NPPV improves survival of patients when it is targeted at greatly reducing hypercapnia.ConclusionCurrent evidence suggests that there is no significant improvement by application of NPPV on severe stable COPD with respiratory failure patients, but NPPV may reduce patients’ mortality with the aim of reducing hypercapnia.
ObjectivesTo explore the clinical characteristics and risk factors for 30-day mortality of community-acquired pneumonia (CAP) patients with chronic obstructive pulmonary disease (COPD).MethodsThis was a multicentre, retrospective study. Data of patients hospitalized with CAP from four tertiary hospitals in Beijing, Shandong and Yunnan from January 1, 2013 to December 31, 2015 were reviewed. Patients with (COPD-CAP) and without (non COPD-CAP) COPD were compared, including demographic and clinical features, treatment and outcomes. Univariate analysis and multivariate Logistic regression analysis were performed to identify risk factors for 30-day mortality in COPD-CAP patients.ResultsThree thousand three hundred and sixty-six CAP patients were entered into final analysis, COPD-CAP accounted for 12.9% (435/3 366). Compared to non COPD-CAP patients, COPD-CAP patients were more male and more frequent with CURB-65 score 2 and pneumonia severity index (PSI) risk class Ⅲ to Ⅴ. Pseudomonas aeruginosa was the most common etiology and more common in COPD-CAP patients than non COPD-CAP patients. Though the proportion of respiratory failure and heart failure were higher in COPD-CAP patients, there was no significant difference in the 30-day mortality. The 30-day mortality of COPD-CAP patients was 5.7% (25/435). Logistic regression analysis confirmed aspiration (OR 9.505, 95%CI 1.483 - 60.983, P=0.018), blood procalcitonin ≥2.0 ng/mL (OR 5.934, 95%CI 1.162 - 30.304, P=0.032) and PSI risk class (OR 2.533, 95%CI 1.156 - 5.547, P=0.020) were independent risk factors for 30-day mortality in COPD-CAP patients.ConclusionsCOPD-CAP patients present specific characteristics. Besides PSI risk class, clinicians should pay high attention to the aspiration and blood procalcitonin, which could increase the 30-day mortality in COPD-CAP patients.
ObjectiveTo analyze the effect of noninvasive positive pressure ventilation (NPPV) on the treatment of severe acute pancreatitis (SAP) combined with lung injury [acute lung injury (ALI)/acute respiratory distress syndrome (ARDS)] in emergency treatment. MethodsFifty-six patients with SAP combined with ALI/ARDS treated between January 2013 and March 2015 were included in our study. Twenty-eight patients who underwent NPPV were designated as the treatment group, while the other 28 patients who did not undergo NPPV were regarded as the control group. Then, we observed patients' blood gas indexes before and three days after treatment. The hospital stay and mortality rate of the two groups were also compared. ResultsBefore treatment, there were no significant differences between the two groups in terms of pH value and arterial partial pressure of oxygen (PaO2) (P>0.05). Three days after treatment, blood pH value of the treatment group and the control group was 7.41±0.07 and 7.34±0.04, respectively, with a significant difference (P＜0.05); the PaO2 value was respectively (60.60±5.11) and (48.40±3.57) mm Hg (1 mm Hg=0.133 kPa), also with a significant difference (P＜0.05). The hospital stay of the treatment group and the control group was (18.22±3.07) and (23.47±3.55) days with a significant difference (P＜0.05); and the six-month mortality was 17% and 32% in the two groups without any significant difference (P>0.05). ConclusionIt is effective to treat patients with severe acute pancreatitis combined with acute lung injury in emergency by noninvasive positive pressure ventilation.
Objective Sedation and/or analgesia is often applied during noninvasive positive pressure ventilation (NIPPV) to make patients comfortable, and thus improve the synchronization between patients and ventilator. Nevertheless, the effect of sedation and/or analgesia on the clinical outcome of the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation remains controversial. Methods A retrospective study was conducted on patients with AECOPD who received NIPPV after extubation in seven intensive care units in West China Hospital, Sichuan University between December 2013 and December 2017 . A logistic regression model was used to analyze the association between the use of sedation and/or analgesia and clinical outcomes including rate of NIPPV failure (defined as the need for reintubation and mechanical ventilation), hospital mortality, and length of intensive care unit stay after extubation. Results A total of 193 patients were included in the analysis, and 62 cases of these patients received sedation and/or analgesia during NIPPV. The usage of sedation and/or analgesia could result in failure of NIPPV (adjusted odd ratio [OR] 0.10, 95% confidence interval [CI] 0.02 - 0.52, P=0.006) and death (adjusted OR=0.13, 95%CI 0.04 - 0.42, P=0.001). Additionally, intensive care unit stay after extubation was longer in the patients who did not receive sedation and/or analgesia than those who did (11.02 d vs. 6.10 d, P< 0.01). Conclusion The usage of sedation and/or analgesia during NIPPV can decrease both the rate of NIPPV failure and hospital mortality in AECOPD patients after extubation.
Objective To understand the epidemiological characteristics of lung cancer death in adults of Zhuhai in order to provide decision-making evidence for lung cancer control and prevention. Methods The data of Mortality Registration System from 2004 to 2005 in Zhuhai were applied to analyze the epidemiological features of lung cancer death in adults. Results From 2004 to 2005, the average mortality from lung cancer and the standardized rate in adults of Zhuhai were 25.3/lakh and 30.3/lakh, respectively. Lung cancer ranked the first on the list of death causes in all cases of cancer death. The standardized rate of the male and female population was 40.1/lakh and 19.2/lakh, respectively. The standardized rate of males was higher than that of females (u=7.23, Plt;0.01). The average mortality from lung cancer increased with age, especially in males over 60 years old. The standardized mortality from lung caner in Xiangzhou, Doumen and Jinwan was 30.5/lakh, 31.1/lakh and 27.3/lakh, respectively. No statistical significance was found in these areas. Conclusion Lung cancer is one of the major malignant tumors among Zhuhai people. Lung cancer mortality is increasing with population aging. Based on the main risk factors of lung cancer, effective preventive measures including tobacco control and environment improvement should be taken.
Objective To investigate the correlation between monocyte-lymphocyte ratio (MLR) and intensive care unit (ICU) results in ICU hospitalized patients. Methods Clinical data were extracted from Medical Information Mart for Intensive Care Ⅲ database, which contained health data of more than 50000 patients. The main result was 30-day mortality, and the secondary result was 90-day mortality. The Cox proportional hazards model was used to reveal the association between MLR and ICU results. Multivariable analyses were used to control for confounders. Results A total of 7295 ICU patients were included. For the 30-day mortality, the hazard ratio (HR) and 95% confidence interval (CI) of the second (0.23≤MLR<0.47) and the third (MLR≥0.47) groups were 1.28 (1.01, 1.61) and 2.70 (2.20, 3.31), respectively, compared to the first group (MLR<0.23). The HR and 95%CI of the third group were still significant after being adjusted by the two different models [2.26 (1.84, 2.77), adjusted by model 1; 2.05 (1.67, 2.52), adjusted by model 2]. A similar trend was observed in the 90-day mortality. Patients with a history of coronary and stroke of the third group had a significant higher 30-day mortality risk [HR and 95%CI were 3.28 (1.99, 5.40) and 3.20 (1.56, 6.56), respectively]. Conclusion MLR is a promising clinical biomarker, which has certain predictive value for the 30-day and 90-day mortality of patients in ICU.
目的 探討腦出血患者病死率與發病早期不同血壓水平的關系。 方法 選擇2006年2月－2012年6月在我院住院、符合入選標準及排除標準的患者120例, 經頭顱CT證實為基底節區腦出血，血腫體積20～40 mL，收縮壓＜200 mm Hg（1 mm Hg=0.133 kPa），舒張壓＜110 mm Hg。 按照中國高血壓分級標準（1級高血壓：收縮壓140～159 mm Hg或舒張壓90～99 mm Hg；2級高血壓：收縮壓160～179 mm Hg或舒張壓100～109 mm Hg；3級高血壓：收縮壓≥180 mm Hg或舒張壓≥110 mm Hg）將患者分組，各組采用降顱內壓、營養神經、維持水電解質平衡、對癥治療及康復治療和康復護理等常規治療，觀察2周內各組病死率。 結果 1級高血壓組與2級高血壓組2周內病死率比較，差異無統計學意義（χ2=0.075，P=0.785）；1級高血壓組與3級高血壓組2周內病死率比較，差異有統計學意義（χ2=5.698，P=0.017）；2級高血壓組與3級高血壓組2周內病死率比較，差異有統計學意義（χ2=4.528，P=0.033）。 結論 對于早期血壓較高的腦出血患者，進行積極的降壓治療，將血壓控制在2級高血壓水平，可以明顯降低病死率。
Objective To develop a machine learning (ML) model to predict the risk of death in intensive care unit (ICU) patients with chronic obstructive pulmonary disease (COPD), explain the factors related to the risk of death in COPD patients, and solve the "black box" problem of ML model. Methods A total of 8088 patients with severe COPD were selected from the eICU Collaborative Research Database (eICU-CRD). Data within the initial 24 hours of each ICU stay were extracted and randomly divided, with 70% for model training and 30% for model validation. The LASSO regression was deployed for predictor variable selection to avoid overfitting. Five ML models were employed to predict in-hospital mortality. The prediction performance of the ML models was compared with alternative models using the area under curve (AUC), while SHAP (SHapley Additive exPlanations) method was used to explain this random forest (RF) model. Results The RF model performed best among the APACHE IVa scoring system and five ML models with the AUC of 0.830 (95%CI 0.806 - 0.855). The SHAP method detects the top 10 predictors according to the importance ranking and the minimum of non-invasive systolic blood pressure was recognized as the most significant predictor variable. Conclusion Leveraging ML model to capture risk factors and using the SHAP method to interpret the prediction outcome can predict the risk of death of patients early, which helps clinicians make accurate treatment plans and allocate medical resources rationally.