Post operational recovery from cardiac surgery can be affected by many factors, including preoperative, intraoperative, and postoperative factors. Prolonged mechanical ventilation (PMV) , one of the major complications, has been widely accepted as a measure to evaluate the performance and outcomes of cardiac surgeries. Great progress has been made in the studies of risk factors contributing to PMV following cardiac surgeries in recent years. However, no clear and effective measures and approaches are available yet to prevent PMV. In this review, the authors try to summarize the risk factors that are associated with PMV throughout the perioperative period of cardiac surgery, as well as possible interventions when applicable.
Objective To explore clinical features and risk factors of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) patients with pulmonary involvement. Methods A retrospectively study of clinical data of 113 AAV patients with pulmonary involvement was conducted in the First Affiliated Hospital of Soochow University from January 2015 to December 2020. The differences in general characteristics, treatment and prognosis of different types of AAV with pulmonary involvement were compared. In addition, the clinical characteristics and survival status between the pulmonary involvement group and the non-pulmonary involvement group (n=69) were analyzed. Multivariate logistic regression model was used to analyze the risk factors. Results A total of 113 patients (57 males and 56 females) of AAV with pulmonary involvement were enrolled, including 86 cases of microscopic polyangiitis (MPA), 21 cases of granulomatosis polyangiitis (GPA), 6 cases of eosinophilia granulomatosis (EGPA). The average age was (67±11) years old. There was no significant difference in the age and gender distribution. The clinical manifestations were non-specific. Interstitial lung disease was common imaging feature of MPA, multiple nodules or mass was common in GPA, the incidence of sinusitis in EGPA was significantly higher (P<0.05). Seventy-three patients were complicated with extrapulmonary involvement. The most common organ involved was the kidney, followed by the cardiovascular and nervous system. The most important organs involved in MPA, EGPA and GPA were kidney, heart, and ear, nose, throat respectively. Compared with the non-pulmonary involvement group, the proportions of Birmingham vasculitis activity score (BVAS) ≥15 points, higher antineutrophil cytoplasmic antibody titer and lower complement C3 or C4, pulmonary infection, mechanical ventilation and plasmapheresis in the pulmonary involvement group were significantly higher (P<0.05). Forty patients died during the follow-up. One-year cumulative survival was further calculated using the Kaplan-Meier method, which demonstrated that pulmonary involvement was a risk factor for higher mortality in AAV patients. Compared with the survival group, the proportions of coronary heart disease, multiple organs involvement (n≥3), BVAS≥15 points, serum creatinine≥500 μmol/L, hemoglobin≤90 g/L, C-reactive protein≥10 mg/L, pulmonary infection, requiring mechanical ventilation, continuous renal replacement therapy and plasmapheresis in the death group were significantly higher (P<0.05). Conclusions AAV with pulmonary involvement is more common in the elderly, the morbidity is similar between male and female, and the clinical manifestations are usually non-specific. The chest imaging manifestations are mainly pulmonary interstitial changes, multiple nodules and masses. Multiple organs involvement occurs more often. BVAS≥15 points is independent risk factor for pulmonary involvement in AAV patients. The prognosis of AAV patients with pulmonary involvement is relatively poor. Combined with coronary heart disease, pulmonary infection and CRP≥10 mg/L are independent risk factors of poor prognosis.
Objective To analyze the risk factors for death in children with interruption of aortic arch (IAA) and ventricular septal defect (VSD) after one-stage radical surgery. Methods A retrospective analysis was performed on patients with IAA and VSD who underwent one-stage radical treatment in the First Hospital of Hebei Medical University from January 2006 to January 2017. Cox proportional hazards regression model was used to analyze the risk factors for death after the surgery. Results A total of 152 children were enrolled, including 70 males and 82 females. Twenty-two patients died with a mean age of 30.73±9.21 d, and the other 130 patients survived with a mean age of 37.62±11.06 d. The Cox analysis showed that younger age (OR=0.551, 95%CI 0.320-0.984, P=0.004), low body weight (OR=0.632, 95%CI 0.313-0.966, P=0.003), large ratio of VSD diameter/aortic root diameter (VSD/AO, OR=2.547, 95%CI 1.095-7.517, P=0.044), long cardiopulmonary bypass time (OR=1.374, 95%CI 1.000-3.227, P=0.038), left ventricular outflow tract obstruction (LVOTO, OR=3.959, 95%CI 1.123-9.268, P=0.015) were independent risk factors for postoperative death. Conclusion For children with IAA and VSD, younger age, low body weight, large ratio of VSD/AO, long cardiopulmonary bypass time and LVOTO are risk factors for death after one-stage radical surgery.
Objective To investigate the risk factors for Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections, and construct a clinical model for predicting the risk of CRKP infections. Methods A retrospective analysis was performed on Klebsiella pneumoniae infection patients hospitalized in the Third Hospital of Hebei Medical University from May 2020 to May 2021. The patients were divided into a CRKP group (117 cases) and a Carbapenem-sensitive Klebsiella pneumoniae (CSKP) group (191 cases). The predictors were screened by full subset regression using R software (version 4.3.1). The truncation values of continuous data were determined by Youden index. Nomogram and score table model for CRKP infections risk prediction was constructed based on binary logistic regression. The receiver operator characteristic (ROC) curve and area under curve (AUC) were used to evaluate the accuracy of models. Calibration curve and decision curve were used to evaluate the performance of models. Results308 patients with Klebsiella pneumoniae infections were included. A total of 8 predictors were selected by using full subset regression and truncation values were determined according to Youden index: intensive care unit (ICU) stay at time of infection>2 days, male, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score>15 points, hospitalization stay at time of infection>10 days, any history of Gram-negative bacteria infection in the last 6 months, heart disease, lung infection, antibiotic exposure history in the last 6 months. The AUC of CRKP prediction risk curve model was 0.811 (95%CI 0.761 - 0.860). When the optimal cut-off value of the constructed CRKP prediction risk rating table was 6 points, the AUC was 0.723 (95%CI 0.672 - 0.774). The Bootstrap method was used for internal repeated sampling for 1000 times for verification. The model calibration curve and Hosmer-Lemeshow test (P=0.618) showed that these models have good calibration degree. The decision curve showed that these models have good clinical effectiveness. Conclusion The prediction model of CRKP infections based on the above 8 risk factors can be used as a risk prediction tool for clinical identification of CRKP infections.
ObjectiveTo explore the risk factors affecting sentinel lymph node (SLN) metastasis in patients with early-stage (N0) breast cancer and establish a predictive model for SLN metastasis, so as to assist in decision-making of axillary surgery in clinical practice. MethodsThe unilateral early-stage breast cancer patients who underwent surgical treatment and SLN biopsy at the Affiliated Hospital of Southwest Medical University from September 2020 to December 2023 were selected as the study subjects. The univariate and multivariable logistic regression analyses were adopted to analyze the relevant risk factors of SLN metastasis, then a predictive model evaluating the risk of SLN metastasis was constructed. The area under receiver operating characteristic curve (AUC) was used to assess the distinguishing ability of risk factors for SLN metastasis. ResultsA total of 351 patients with early-stage breast cancer patients who met the inclusion criteria were enrolled, 136 of whom with SLN metastasis, the SLN metastasis rate was 38.7%. The results of the multivariate logistic regression analysis showed that the maximum tumor diameter >2.5 cm, estrogen receptor (ER) positive, Ki-67 >20%, and vascular invasion were the risk factors affecting SLN metastasis [maximum tumor diameter: OR(95%CI)=1.897(1.186, 3.034), P=0.008; ER positive: OR(95%CI)=2.721(1.491, 4.967), P=0.001; Ki-67 >20%: OR(95%CI)=1.825(1.125, 2.960), P=0.015; vascular invasion: OR(95%CI)=2.858(1.641, 4.976), P<0.001]. The AUC for the SLN metastasis by these four factors was 0.693(0.637, 0.749), with a sensitivity and specificity of 70.59% and 57.21%, respectively. ConclusionsThe results from this study suggest that SLN biopsy is recommended to guide postoperative adjuvant treatment strategies for cN0 early-stage breast cancer patients with a maximum tumor diameter >2.5 cm, ER positivity, Ki-67>20%, and vascular invasion. However, the predictive model constructed based on these four factors in this study has a general ability to distinguish the occurrence of SLN metastasis, then the reasons can be further analyzed in the future.
ObjectiveTo analyze the characteristics and risk factors of lymph node metastasis in thoracic esophageal squamous cell carcinoma (ESCC).MethodsThe clinical data of 407 patients with ESCC who underwent radical resection of esophageal carcinoma from December 2012 to October 2018 in our hospital were retrospectively analyzed. There were 390 males and 17 females with a median age of 63 (38-82) years. Esophageal lesions were found in 26 patients of upper thoracic segment, 190 patients of middle thoracic segment and 191 patients of lower thoracic segment. ResultsAmong the patients, 232 (57.0%) were found to have cervical, thoracic and/or abdominal lymph node metastasis. The lymphatic metastasis rates of cervical, upper, middle, lower mediastinal nodes and abdominal nodes were 0.7%, 8.8%, 21.4%, 16.7% and 37.1%, respectively. The adjacent lymph node metastasis alone occurred in 50.0% patients, and the multistage or skip lymph node metastasis accounted for 29.3% and 20.7%, respectively. Multivariate analysis showed that the length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion were independent risk factors for lymph node metastasis.ConclusionThe rates of lymph node metastasis are similar in the upper, middle and lower thoracic ESCC. The main pattern of lymph node metastasis is the adjacent lymph node metastasis, followed by multistage and skip lymph node metastases. The length of esophageal lesion, T stage, degree of tumor differentiation, vascular cancer embolus and nerve invasion are independent factors for lymph node metastasis. The operation and dissection range should be selected according to the location of tumor and the characteristics of the lesion.
Objective To explore the risk factors, clinical characteristics and pathogenic bacteria of late-onset septicemia (LOS) in neonates, so as to guide clinical diagnosis and treatment. Methods Collect LOS in neonates admitted to the Department of Pediatrics, Chaohu Hospital of Anhui Medical University between January 2015 and February 2020, and set them as the observation group. The neonates born at the same time and hospitalized without septicemia were selected as the control group. The general situation and risk factors of the two groups of neonates were analyzed, and the clinical manifestations, complications and pathogenic bacteria of LOS in neonates were analyzed. Results 182 neonates were enrolled, 91 in each group. There were significant differences between the two groups in mechanical ventilation, indwelling peripherally inserted central catheter, parenteral nutrition, tracheal intubation, neonatal asphyxia, gestational age<37 weeks, birth weight<2.0 kg (P<0.05). Logistic regression analysis showed that gestational age<37 weeks [odds ratio (OR)=3.010, 95% confidence interval (CI) (1.489, 6.085), P=0.002], parenteral nutrition [OR=3.506, 95%CI (1.681, 7.312), P=0.001] were independent risk factors for LOS. The main clinical manifestations of LOS were abnormal temperature, feeding difficulties, jaundice, apnea, hypersensitive C-reactive protein and procalcitonin increase. The neonates with LOS were prone to necrotizing enterocolitis and purulent meningitis. A total of 74 pathogenic bacteria were cultured from neonates with LOS, including 49 Gram-positive bacterium, 21 Gram-negative bacteria and 4 fungi. The critical and death cases were mainly infected by Gram-negative bacteria. Conclusions A number of factors are related to LOS. Gestational age<37 weeks and parenteral nutrition are independent risk factors for LOS. In order to avoid LOS, attention should be paid to prevention, aseptic concept should be strengthened, and drugs should be used reasonably.
ObjectiveTo analyze the risk factors of anastomotic leakage after esophagectomy.MethodsThe clinical data of 1 328 patients with esophageal cancer, who underwent esophagectomy in the First Affiliated Hospital of Henan University of Science and Technology from January 2010 to December 2016, were retrospectively analyzed. There were 726 males and 602 females, at an average age of 67.2±14.1 years. According to whether there was anastomotic leakage after operation, patients were divided into two groups: an anastomotic leakage group (167 patients) and a non-anastomotic leakage group (1 161 patients). Univariate and multivariate logistic regression analysis was used to identify related risk factors of anastomotic leakage after operation.Results The incidence of postoperative anastomotic leakage was 12.6% (167/1 328). Univariate analysis showed that body mass index, arrhythmia, chronic obstructive pulmonary disease (COPD), diabetes, preoperative albumin level, preoperative chemotherapy and chemoradiotherapy, lesion location, anastomosis types and postoperative pulmonary infection were associated with statistically significant increase in risk of cervical anastomotic leakage (P<0.05). Logistic regression analysis showed that preoperative COPD, lesion location and postoperative pulmonary infection were independent risk factors of cervical anastomotic leakage after esophagectomy (P<0.05).ConclusionThe occurrence of cervical anastomotic leakage after esophageal cancer is related to many factors. The preoperative COPD, the lesion location and the postoperative pulmonary infection are independent high risk factors. Paying attention to these factors and doing perioperative management can effectively reduce the occurrence of anastomotic leakage.
Objective To identify and analyze risk factors for acute renal failure (ARF) following lung transplantation and to develop a predictive model. Methods Data for this study were obtained from the United Network for Organ Sharing (UNOS) database, encompassing patients who underwent unilateral or bilateral lung transplantation between 2015 and 2022. We analyzed both preoperative and postoperative clinical characteristics of the patients. A combined approach utilizing random forest and least absolute shrinkage and selection operator (LASSO) regression was employed to identify key factors associated with the incidence of ARF post-transplantation, based on which a nomogram model was developed. The predictive performance of the constructed model was evaluated in both training and validation sets, using receiver operating characteristic (ROC) curves and area under the curve (AUC) metrics to verify and compare model effectiveness. ResultsA total of 15 110 lung transplantation patients were included in the study, consisting of6 041 males and 9 069 females, with a median age of 62.00 years (interquartile range: 54.00 to 67.00). The analysis revealed statistically significant differences between postoperative renal dialysis and non-dialysis patients regarding preoperative lung diagnosis, estimated glomerular filtration rate (eGFR), mechanical ventilation, preoperative ICU treatment, extracorporeal membrane oxygenation (ECMO) support, infections occurring within two weeks prior to transplantation, Karnofsky Performance Status (KPS) score, waitlist duration, double-lung transplantation, and ischemia time (P<0.05). Five key variables associated with ARF after lung transplantation were identified through random forest and LASSO regression: recipients’ eGFR, preoperative ICU treatment, ECMO support, bilateral lung transplantation, and ischemia time. A nomogram model was subsequently established. Model evaluation demonstrated that the constructed predictive model achieved high accuracy in both training and validation sets, with favorable AUC values, confirming its validity and reliability. ConclusionThis study identifies common risk factors for ARF following lung transplantation and introduces an effective predictive model with potential clinical applications.
ObjectiveTo investigate the independent risk factors associated with postoperative acute respiratory distress syndrome in patients undergoing type A aortic dissection surgery.MethodsThe clinical data of 147 patients who underwent acute type A aortic dissection surgery in the First Affiliated Hospital of Anhui Medical University from 2015 to 2019 were retrospectively analyzed. There were 110 males at age of 51.9±10.1 years and 37 females at age of 54.3±11.1 years. According to whether the patients developed ARDS after surgery, all of the patients were divided into a ARDS group or a non-ARDS group. Logistic regress analysis was utilized to establish the predictive mode to identify the independent risk factors related to ARDS.ResultsOf the patients, 25 developed postoperative ARDS. Among them, 5 patients were mild ARDS, 13 patients were moderate, and 7 patients were severe ARDS. Multivariate logistic regression analysis showed that deep hypothermic circulatory arrest time [odds ratio (OR)=1.067, 95% confidence interval (CI) 1.014-1.124, P=0.013], cardiopulmonary bypass time (OR=1.012, 95%CI 1.001-1.022, P=0.027) and perioperative plasma input (OR=1.001, 95%CI 1.000-1.002, P=0.011) were independently associated with ARDS in patients undergoing acute A aortic dissection surgery. Receiver operating characteristic (ROC) curve analysis demonstrated a good discrimination ability of the logistic regression model, with an area under the curve of 0.835 (95%CI 0.740-0.929, P=0.000).ConclusionDuration of deep hypothermic circulatory arrest, cardiopulmonary bypass time and perioperative plasma are independent risk factors for postoperative ARDS in patients undergoing type A aortic dissection surgery.