Objective To investigated the early risk factors of AIDS severe pneumonia complicated with acute respiratory distress syndrome in order to carry out early recognition and intervention of ARDS and improve the prognosis of patients. Methods The clinical data of 232 patients with severe AIDS pneumonia admitted to Chengdu Public Health Clinical Medical Center from January 2017 to December 2020 were retrospectively analyzed, including general data, vital signs, laboratory examination indexes, basic diseases, etc. Firstly influential indexes for complicated with ARDS were screened by single factor logistic regression analysis, then the multicollinearity assessment indicators were filtered out in multi-factor logistic stepwise regression analysis, finally the receiver operating characteristic (ROC) curves were drawn and the predictive value of the indicators were assessed. Results Thirty-three of 232 AIDS patients with severe pneumonia were complicated with ARDS. The mortality rate in ARDS group was 81.8%. The intra-group mortality of non-ARDS group was 33.7%. Single factor logistic regression analysis showed that pH, acute physiology and chronic health evaluation Ⅱ grade, sequential organ failure assessment grade, white blood cell count, lactate dehydrogenase, α-hydroxybutyric acid dehydrogenase (α-HBDH), alanine aminotransferase (ALT), aspartic acid aminotransferase (AST), calcium, fibrinogen degradation produc (FDP) and D-dimer, total 11 indicators were associated with the incidence of ARDS. The multicollinearity analysis of the 11 indicators showed that there was no multicollinearity problem among the other 9 indicators except the variance inflation factor of ALT and AST which was greater than 10. Multivariate logistic stepwise regression analysis showed α-HBDH (OR=1.001, 95% confidence interval 1.000 - 1.002, P=0.045) and D-dimer (OR=1.044, 95% confidence interval 1.006 - 1.083, P=0.024) were independent factors. ROC curve indicated the following: alpha hydroxy butyric acid dehydrogenase (the area under ROC curve=0.667, P=0.002, the optimal threshold was 391 U/L, the corresponding sensitivity and specificity was 78.8% and 61.8%, respectively), D-dimer (the area under ROC curve=0.602, P=0.062, the optimal threshold was 4.855 μg/mL, the corresponding sensitivity and specificity was 42.4% and 82.9%, respectively). Conclusion AIDS severe pneumonia complicated with ARDS is associated with many factors, among whichα-HBDH (≥391 U/L) and D-dimer (≥ 4.855 μg/mL) on admission are independent risk factors, which have great early predictive value and can provide reference for early clinical identification of ARDS high-risk patients.
ObjectivesTo explore a reliable and simple predictive tool for 30-day mortality of influenza A community-acquired pneumonia (CAP).MethodsA multicenter retrospective study was conducted on 178 patients hospitalized with influenza A CAP, including 144 alive patients and 34 dead patients. Receiver operating characteristic (ROC) curves were performed to verify the accuracy of severity scores as 30-day mortality predictors in the study patients.ResultsThe 30-day mortality of influenza A CAP was 19.1%. The actual mortality of PSI risk class Ⅰ-Ⅱ and CURB-65 score 0-1 were 14.5% and 15.7%, respectively, which were much higher than the predicted mortality. Logistic regression confirmed blood urea nitrogen >7 mmol/L (U), albumin <35 g/L (A) and peripheral blood lymphocyte count <0.7×10 9/L (L) were independent risk factors for 30-day mortality of influenza A CAP. The area under the ROC curve (AUC) of UAL (blood urea nitrogen >7 mmol/L+ albumin <35 g/L+ peripheral blood lymphocyte count <0.7×10 9/L) was 0.891, which was higher than CURB-65 score (AUC=0.777, P=0.008 3), CRB-65 score (AUC=0.590, P<0.000 1), and PSI risk class (AUC=0.568,P=0.000 1).ConclusionUAL is a reliable and simple predictive tool for 30-day mortality of influenza A CAP.
ObjectiveTo study the distributions of virulence genes of Klebsiella pneumoniae (KP) and the distribution of hypervirulent KP (HvKP), and assess the performance of a single gene to predict HvKP.MethodsPolymerase chain reaction (PCR) method was used to analyze 12 virulence-related genes (entB, irp2, iroN, iucA, mrkD, fimH, c-rmpA, p-rmpA2, p-rmpA, wzy-K1, allS and peg-344) and drug-resistance gene blaKPC among 376 clinical KP strains collected from January 2016 to December 2018. Sequence types (ST) of KP were determined after sequencing and comparison, following the detection of 7 house-keeping genes (gapA, infB, mdh, pgi, phoE, rpoB and tonB) by PCR method. Statistical analyses were made for the distributions of virulence genes of KP and the distribution of HvKP with GraphPad Prism 8 software.ResultsAmong the 376 KP strains, the positive rates of entB, irp2, iroN, iucA, mrkD, fimH, c-rmpA, p-rmpA2, p-rmpA, wzy-K1, allS and peg-344 were 100.0%, 76.9%, 22.1%, 28.2%, 97.6%, 97.1%, 1.6%, 24.5%, 21.0%, 7.4%, 4.8% and 31.6%, respectively. The positive rates of the aforementioned virulence genes in the blaKPC-positive group (n=167) were 100.0%, 94.0%, 7.2%, 16.8%, 97.0%, 96.4%, 0.0%, 15.0%, 6.6%, 0.0%, 0.0% and 21.0%, respectively, and those in the blaKPC-negative group (n=209) were 100.0%, 63.2%, 34.0%, 37.3%, 98.1%, 97.6%, 2.9%, 32.1%, 32.5%, 13.4%, 8.6% and 40.2%, respectively; there was no statistically significant difference in entB, mrkD or fimH between the two groups (P>0.05), the positive rate of irp2 was higher in the blaKPC-positive group than that in the blaKPC-negative group (P<0.05), and the positive rates of the rest virulence-related genes were lower in the blaKPC-positive group than those in the blaKPC-negative group (P<0.05). The rate of HvKP in the blaKPC-negative group was higher than that in the blaKPC-positive group (38.3% vs. 18.0%, P<0.05). As a marker of HvKP, iucA showed high sensitivity and specificity (90.9% and 97.7%), followed by p-rmpA2 (83.6% and 100.0%) and iroN (73.6% and 99.2%). ST11 accounted for 87.4% in the blaKPC-positive group, while ST23, ST20, ST54 and ST29 were the four primary types in the blaKPC-negative group, accounting for 23.4% totally.ConclusionsDifferent virulence genes mean different distributions in KP. blaKPC-negative KP is more virulent than blaKPC-positive KP. iucA and p-rmpA2 could serve as good predicators of HvKP. Armed with extreme virulence and drug-resistance, blaKPC-positive HvKP is of great clinical concern.
ObjectiveTo analyze the choice of initial antibiotic treatment for health care-associated pneumonia (HCAP). MethodA retrospective study was conducted in patients with HCAP hospitalized in the Emergency Department of West China Hospital from January 1st to December 31st, 2014. A total of 156 HCAP patients were divided into anti-multidrug-resistant treatment group (group A, n=72) and quinolone monotherapy group (group B, n=84). The baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics and clinical outcomes were compared between the two groups. ResultsIn group B, there were 46 males and 38 females with the age of (59.9±10.9) years, and the pneumonia severity index (PSI) score was 89.5±22.7; in group A, there were 44 males and 28 females with the age of (62.2±12.2) years, and the PSI score was 94.4±23.6. The differeces between the two groups were not significant (P>0.05). The duration of using antibiotics in group B was (14.5±3.7) days, which was longer than that in group A[(12.8±3.8) days, P=0.005]. The detection rate of multidrug-resistant bacteria, the proportion of changing antibiotics, the average length of hospitalization, the proportion of using mechanical ventilation, the proportion of patients transferred into Intensive Care Unit and 30 days mortality in group B was 17.9%, 34.5%, (16.9±3.6) days, 11.9%, 9.5%, and 4.8%, respectively; which were similar to those in group A[15.3%, 22.2%, (17.3±3.9) days, 16.8%, 12.5%, and 4.2%, respectively] (P>0.05). ConclusionsIt is unnecessary for all HCAP patients to receive anti-multidrug-resistant treatment. We should regard the risk factors and the popular local features of microbiology to determine the choice of antibiotic treatment.
Since the outbreak of the coronavirus disease (COVID-19), more than 200 interventional clinical trials have been registered in Chinese Clinical Trial Registry (www.chictr.org.cn) and the US Clinical Trials Registry (www.clinicaltrials.gov), testing or going to test treatments of COVID-19 in China from January 23rd, 2020 to March 5th, 2020. This situation has drawn attentions from various sectors of society. This article summarizes the basic design features of 249 registered COVID-19 clinical trials in China, compares them with National Clinical Trials Network practices in the USA, and describes a concept of national clinical trials network as a strategy to enhance quality and efficiency of clinical research in cases like COVID-19 outbreak as well as other disease fields.