ObjectiveTo explore the independent factors related to clinical severe events in community acquired pneumonia patients and to find out a simple, effective and more accurate prediction method.MethodsConsecutive patients admitted to our hospital from August 2018 to July 2019 were enrolled in this retrospective study. The endpoint was the occurrence of severe events defined as a condition as follows intensive care unit admission, the need for mechanical ventilation or vasoactive drugs, or 30-day mortality during hospitalization. The patients were divided into severe event group and non-severe event group, and general clinical data were compared between two groups. Multivariate logistic regression analysis was performed to identify the independent predictors of adverse outcomes. Receiver operating characteristic (ROC) curve was constructed to calculate and compare the area under curve (AUC) of different prediction methods.ResultsA total of 410 patients were enrolled, 96 (23.4%) of whom experienced clinical severe events. Age (OR: 1.035, 95%CI: 1.012 - 1.059, P=0.003), high-density lipoprotein (OR: 0.266, 95%CI: 0.088 - 0.802, P=0.019) and lactate dehydrogenase (OR: 1.006, 95%CI: 1.004 - 1.059, P<0.001) levels on admission were independent factors associated with clinical severe events in CAP patients. The AUCs in the prediction of clinical severe events were 0.744 (95%CI: 0.699 - 0.785, P=0.028) and 0.814 (95%CI: 0.772 - 0.850, P=0.025) for CURB65 and PSI respectively. CURB65-LH, combining CURB65, HDL and LDH simultaneously, had the largest AUC of 0.843 (95%CI: 0.804 - 0.876, P=0.022) among these prediction methods and its sensitivity (69.8%) and specificity (81.5%) were higher than that of CURB65 (61.5% and 76.1%) respectively.ConclusionCURB65-LH is a simple, effective and more accurate prediction method of clinical severe events in CAP patients, which not only has higher sensitivity and specificity, but also significantly improves the predictive value when compared with CURB65.
Objective To explore the characteristics and the related factors of the lipid profiles in patients with ankylosing spondylitis (AS). Methods Sixty AS patients and 60 healthy controls were included retrospectively from January 2005 to January 2015. Information including general data, physical examination, and blood sample were collected; triacylglycerol (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), high-density lipoprotein cholesterol (HDL-C), and C-reactive protein (CRP) were assessed. Results TG increased in 46.7% (28/60) patients, and HDL-C decreased in 50.0% (30/60). Compared with the control group, AS patients had lower levels of HDL-C, TC and LDL-C, and higher levels of TG, VLDL-C, VLDL-C/LDL-C ratio, LDL-C/HDL-C ratio, and TC/HDL-C ratio; the differences above were all statistically significant (P<0.01). Spearman correlation test demonstrated that HDL-C level was correlated negatively with serum CRP (rs=–0.359, P=0.005). Multiple linear regression model demonstrated that CRP was associated with HDL-C in AS patients (P=0.019). Conclusions Dyslipoproteinemia is a common feature in AS patients. The main characteristic is the increase of TG and decrease of HDL-C, related with inflammation. It suggests a high risk of atherosclerosis.
Objective To investigate the changes and clinical significance of high-density lipoprotein (HDL)-mediated cholesterol efflux capacity (CEC) in patients with diabetes mellitus. Methods Patients with diabetes attending West China Hospital of Sichuan University between January 2022 and June 2024 and healthy physical examination subjects during the same period (serving as the control group) were selected. The diabetic group was further divided into high glycated hemoglobin (HbA1c) with normal fasting plasma glucose (FPG) group and high HbA1c with high FPG group. CEC levels were compared among groups, correlations between CEC and glucose/lipid metabolism indices were analyzed, and binary logistic regression was used to assess the independent association between CEC and diabetes. Results A total of 260 patients with diabetes were enrolled, and 203 patients in the control group. Among them, there were 88 cases in the high HbA1c with normal FPG group and 172 cases in the high HbA1c with high FPG group. Compared with the control group [30.52% (26.99%, 32.25%)], CEC levels in the high HbA1c with normal FPG group [26.01% (23.81%, 28.21%)] and the high HbA1c with high FPG group [24.02% (17.40%, 27.49%)] were significantly lower (P<0.001). At the same HbA1c stratum, higher FPG was associated with lower CEC; at the same FPG stratum, higher HbA1c was associated with lower CEC. Correlation analysis showed that CEC was negatively correlated with FPG (r=?0.434, P<0.001) and HbA1c (r=–0.444, P<0.001), positively correlated with apolipoprotein A-Ⅰ (r=0.363, P<0.001), positively correlated with HDL-cholesterol (r=0.103, P=0.028). Multivariate logistic regression analysis showed that CEC was still associated with diabetes [odds ratio=0.785, 95% confidence interval (0.732, 0.842), P<0.001]. Conclusions HDL-mediated CEC is significantly impaired in patients with diabetes, and the degree of impairment worsens with increasing blood glucose and HbA1c levels. Routine lipid parameters cannot reflect HDL function, and CEC may serve as an independent indicator for evaluating the risk of diabetes and its cardiovascular complications.