scholarly journals The Clinical Characteristics of ARDS in Children With Hematological Neoplasms

2021 ◽  
Vol 9 ◽  
Author(s):  
Qiao Zhang ◽  
Wen-ting Hu ◽  
Fan Yin ◽  
Han Qian ◽  
Ying Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Clinical Characteristics ◽  
Length Of Hospital Stay ◽  
Fluid Volume ◽  
Survival Group ◽  
Total Length ◽  
Hematological Neoplasms ◽  
Independent Risk Factors ◽  
Overall Mortality

In order to explore the clinical characteristics of pediatric patients admitted to the pediatric intensive care unit (PICU) who suffered from hematological neoplasms complicated with acute respiratory distress syndrome (ARDS), we retrospectively analyzed 45 ARDS children with hematological neoplasms who were admitted to the PICU of Shanghai Children's Medical Center from January 1, 2014, to December 31, 2020. The 45 children were divided into a survival group and a non-survival group, a pulmonary ARDS group and an exogenous pulmonary ARDS group, and an agranulocytosis group and a non-agranulocytosis group, for statistical analysis. The main clinical manifestations were fever, cough, progressive dyspnea, and hypoxemia; 55.6% (25/45) of the children had multiple organ dysfunction syndrome (MODS). The overall mortality rate was 55.6% (25/45). The vasoactive inotropic score (VIS), pediatric critical illness scoring (PCIS), average fluid volume in the first 3 days and the first 7 days, and the incidence of MODS in the non-survival group were all significantly higher than those in the survival group (P < 0.05). However, total length of mechanical ventilation and length of hospital stay and PICU days in the non-survival group were significantly lower than those in the survival group (P < 0.05). The PCIS (OR = 0.832, P = 0.004) and the average fluid volume in the first 3 days (OR = 1.092, P = 0.025) were independent risk factors for predicting death. Children with exogenous pulmonary ARDS were more likely to have MODS than pulmonary ARDS (P < 0.05). The mean values of VIS, C-reactive protein (CRP), and procalcitonin (PCT) in children with exogenous pulmonary ARDS were also higher (P < 0.05). After multivariate analysis, PCT was independently related to exogenous pulmonary ARDS. The total length of hospital stay, peak inspiratory pressure (PIP), VIS, CRP, and PCT in the agranulocytosis group were significantly higher than those in the non-agranulocytosis group (P < 0.05). Last, CRP and PIP were independently related to agranulocytosis. In conclusion, children with hematological neoplasms complicated with ARDS had a high overall mortality and poor prognosis. Children complicated with MODS, positive fluid balance, and high VIS and PCIS scores were positively correlated with mortality. In particular, PCIS score and average fluid volume in the first 3 days were independent risk factors for predicting death. Children with exogenous pulmonary ARDS and children with agranulocytosis were in a severely infected status and more critically ill.

scholarly journals The Clinical Characteristics of Acute Myocardial Infarction with Ventricular Septal Perforation and the Prognosis Comparison of Different Treatment Methods

2020 ◽  
Author(s):  
Chun Fu ◽  
Zhou Zhao ◽  
Yu Chen ◽  
Youzhong An ◽  
Jian Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Complete Revascularization ◽  
Septal Perforation ◽  
Survival Group ◽  
Term Survival ◽  
Related Risk ◽  
Incomplete Revascularization ◽  
Independent Risk Factors

Abstract Background: To explore the clinical characteristics of acute myocardial infarction (AMI) with ventricular septal perforation (VSR) and the prognosis comparison of different treatment methods, as well as the analysis of related risk factors.Methods: From January 2006 to February 2020, 29 patients with AMI and VSR diagnosed in the people's Hospital of Peking University were selected as the study object, among them, 16 cases were male (55.2%), 13 cases were female (44.8%), the average age was 64.69 ± 10.32 years old, and they were divided into survival group (n=16) and non-survival group (n=13) according to whether they survive within 30 days of surgical or drug conservative treatment.The clinical characteristics, coronary angiography and treatment of the two groups were summarized, and the prognosis and related risk factors were analyzed.Results: There was no significant difference in the basic clinical characteristics between the two groups(P>0.05)；Compared with the results of coronary angiography in the two groups, the proportion of the culprit vessel which was a simple anterior descending branch in the non-survival group was higher than that in the survival group, there was a statistical difference between the two groups(P<0.05)；The peri-operative data of the two groups showed that the proportion of patients with complete revascularization, simultaneous bypass and recanalization of culprit vessels in the survival group was significantly higher than that in the non- survival group (P < 0.05)；However, the incidence of postoperative low cardiac output and mortality during hospitalization in the survival group were significantly lower than those in the non-survival group (P < 0.05)；Logistic regression analysis showed that complete revascularization (OR = 0.021, 95% CI 0.001-0.374, P = 0.009), recanalization of culprit vessels (OR = 0.045, 95% CI 0.004-0.548, P = 0.015) were independent risk factors for 30 day mortality。Kaplan-Meier survival curve showed that during the follow-up period, the long-term survival rate of patients with operation and complete revascularization was significantly higher than that of patients with drug conservative treatment and incomplete revascularization, there was a statistical difference between the two groups (P < 0.05).Conclusions: Whether complete revascularization and recanalization of culprit vessels or not are independent risk factors for 30 day mortality in patients with AMI and VSR；the long-term survival rate of patients after surgery and complete revascularization is significantly higher than that of patients with conservative medical treatment and incomplete revascularization. Surgery and complete revascularization are important factors affecting the long-term prognosis of patients with AMI and VSR.

scholarly journals A Multi-Centre Survey on Hospital Malnutrition: Result of PNSI Study

2020 ◽  
Author(s):  
Somayeh Poudineh ◽  
Forough Shayesteh ◽  
Jamshid Kermanchi ◽  
Ali-Akbar Haghdoost ◽  
Parisa Torabi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Malignant Disease ◽  
Heart Surgery ◽  
Length Of Hospital Stay ◽  
Male Gender ◽  
Adverse Outcomes ◽  
University Hospitals ◽  
Cross Sectional ◽  
Independent Risk Factors

Abstract Background: Disease-related malnutrition is associated with adverse outcomes such as increased rates of morbidity and mortality, prolonged hospital stay, and extra costs of health care. This study was conducted to assess nutritional status among patients and to determine the risk factors for malnutrition in Iran university hospitals. Methods: Persian Nutritional Survey In Hospitals (PNSI) was a cross-sectional study that conducted in 20 university hospitals across Iran. All the patients with age range of 18 to 65 years, who were admitted or discharged, were assessed by subjective global assessment (SGA). Results: In total, 2306 patients were evaluated for malnutrition. Mean values of age and body mass index were 44.7±14 years and 25.2±6 kg/m2, respectively. Malnutrition (SGA-B & C) was identified in 23.9% of the patients, 26.2% and 21% of whom were among the admitted and discharged patients, respectively. The prevalence of malnutrition was higher in burns (78%) and heart surgery (58%) patients. Malnutrition was not associated with age (P=0.1). Multivariate analysis presented male gender (OR=1.023, P<0.001), malignant disease (OR=1.409, P<0.001), length of hospital stay (OR=1.206, P<0.001), and polypharmacy (OR=1.066, P<0.001) as independent risk factors for malnutrition.Conclusion: One out of four patients in the studied university hospitals was suffering from malnutrition; thus, appropriate measures should be taken to ameliorate this condition. Male gender, malignant disease, length of hospital stay, and polypharmacy were identified as independent risk factors for malnutrition.

scholarly journals Fatal hemorrhagic pneumonia in patients with hematologic diseases and Stenotrophomonas maltophilia bacteremia: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lixia Zhu ◽  
Lulu Wang ◽  
Yuping Zhang ◽  
Rongrong Chen ◽  
Xueying Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stenotrophomonas Maltophilia ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Hematologic Diseases ◽  
Hemorrhagic Pneumonia ◽  
Independent Risk Factors ◽  
High Level ◽  
Clinical Records ◽  
Overall Mortality

Abstract Background Fatal hemorrhagic pneumonia is one of the most severe manifestations of Stenotrophomonas maltophilia (SM) infections. Here, we aimed to investigate the clinical characteristics of SM bacteremia and to identify the risk factors of hemorrhagic pneumonia caused by SM in patients with hematologic diseases. Methods The clinical records of 55 patients diagnosed with hematologic diseases and SM bacteremia were retrospectively reviewed. We compared patients’ clinical characteristics and outcomes between the hemorrhagic pneumonia group and non-hemorrhagic pneumonia group. Results Twenty-seven (49.1%) patients developed hemorrhagic pneumonia. The overall mortality rate of SM bacteremia was 67.3%. Hemorrhagic pneumonia (adjusted HR 2.316, 95% CI 1.140–4.705; P = 0.020) was an independent risk factor of 30-day mortality in hematological patients with SM bacteremia. Compared with the non-hemorrhagic pneumonia group, patients in the hemorrhagic pneumonia group were older and showed clinical manifestations as higher proportions of isolated SM in sputum culture, neutropenia and elevated procalcitonin (PCT). Multivariate analysis showed that neutropenia, high levels of PCT, prior tigecycline therapy within 1 month were independent risk factors associated with hemorrhagic pneumonia. Conclusions Neutropenia, high level of PCT and prior tigecycline therapy within 1 month were significant independent predictors of hemorrhagic pneumonia in hematologic patients with SM bacteremia. Due to no effective antibiotics to prevent hemorrhagic pneumonia, prophylaxis of SM infection and its progression to hemorrhagic pneumonia is particularly important.

scholarly journals The Clinical Characteristics of Acute Myocardial Infarction with Ventricular Septal Perforation and the Prognosis Comparison of Different Treatment Methods

2021 ◽  
Vol 24 (4) ◽  
pp. E757-E763
Author(s):  
Chun Fu ◽  
Qing Gao ◽  
Zhou Zhao ◽  
Yu ◽  
Jian Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Complete Revascularization ◽  
Septal Perforation ◽  
Survival Group ◽  
Term Survival ◽  
Related Risk ◽  
Incomplete Revascularization ◽  
Independent Risk Factors

Objective: To explore the clinical characteristics of acute myocardial infarction (AMI) with ventricular septal perforation (VSR), the prognosis comparison of different treatment methods, and analysis of related risk factors. Methods: From January 2006 to February 2020, 29 patients with AMI and VSR diagnosed in the People's Hospital of Peking University were selected as the study group. Among them, 16 cases were male (55.2%), 13 cases were female (44.8%), and the average age was 64.69 ± 10.32 years old. They were divided into two groups: the survival group (N = 16) and non-survival group (N = 13), according to whether they survived within 30 days of surgical or drug conservative treatment. The clinical characteristics, coronary angiography, and treatment of the two groups were summarized, and the prognosis and related risk factors were analyzed. Results: There was no significant difference in the basic clinical characteristics between the two groups (P > 0.05). Compared with the results of coronary angiography in the two groups, the proportion of the culprit vessel, which was a simple anterior descending branch in the non-survival group, was higher than that in the survival group. There was a statistical difference between the two groups (P < 0.05). The perioperative data of the two groups showed that the proportion of patients with complete revascularization, simultaneous bypass, and recanalization of culprit vessels in the survival group was significantly higher than that in the non-survival group (P < 0.05). However, the incidence of postoperative low cardiac output and mortality during hospitalization in the survival group were significantly lower than those in the non-survival group (P < 0.05). Logistic regression analysis showed that complete revascularization (OR = 0.021, 95% CI 0.001-0.374, P = 0.009) and recanalization of culprit vessels (OR = 0.045, 95% CI 0.004-0.548, P = 0.015) were independent risk factors for 30-day mortality. Kaplan-Meier survival curve showed that during the follow-up period, the long-term survival rate of patients with operation and complete revascularization was significantly higher than that of patients with drug conservative treatment and incomplete revascularization. There was a statistical difference between the two groups (P < 0.05). Conclusion: Complete revascularization and recanalization of culprit vessels are independent risk factors for 30-day mortality in patients with AMI and VSR. The long-term survival rate of patients after surgery and complete revascularization is significantly higher than that of patients with conservative medical treatment and incomplete revascularization. Surgery and complete revascularization are important factors affecting the long-term prognosis of patients with AMI and VSR.

Indications and practice of enteral nutrition

2014 ◽  
Vol 155 (51) ◽  
pp. 2028-2033 ◽  
Author(s):  
Judit Hallay ◽  
Dániel Nagy ◽  
Béla Fülesdi
Keyword(s):  
Risk Factors ◽  
Treatment Outcome ◽  
Enteral Nutrition ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Nutrition Therapy ◽  
Present Review ◽  
Hospitalised Patients ◽  
Impact On Treatment ◽  
Efficacy Of Treatment

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient’s condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy. Orv. Hetil., 2014, 155(51), 2028–2033.

scholarly journals O6: EARLY ANASTOMOTIC BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
SJ Tingle ◽  
ER Thompson ◽  
SS Ali ◽  
IK Ibrahim ◽  
E Irwin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Hospital Stay ◽  
Graft Survival ◽  
Cox Regression ◽  
Risk Groups ◽  
Biliary Complications ◽  
Anastomotic Strictures ◽  
Selection Of Variables ◽  
Independent Risk Factors

Abstract Introduction Biliary leaks and anastomotic strictures are common early biliary complications (EBC) following liver transplantation. However, their impact on outcomes remains controversial and poorly described. Method The NHS registry on adult liver transplantation between 2006 and 2017 was retrospectively reviewed (n=8304). Multiple imputations were performed to account for missing data. Adjusted regression models were used to assess predictors of EBC, and their impact on outcomes. 35 potential variables were included, and backwards stepwise selection enabled unbiased selection of variables for inclusion in final models. Result EBC occurred in 9.6% of patients. Adjusted cox regression revealed that EBCs have a significant and independent impact on graft survival (Leak HR=1.325; P=0.021, Stricture HR=1.514; P=0.002, Leak plus stricture HR=1.533; P=0.034) and patient survival (Leak HR=1.218; P=0.131, Stricture HR=1.578; P&lt;0.001, Leak plus stricture HR=1.507; P=0.044). Patients with EBC had longer median hospital stay (23 versus 15 days; P&lt;0.001) and increased chance for readmission within the first year (56% versus 32%; P&lt;0.001). On adjusted logistic regression the following were identified as independent risk factors for development of EBC: donation following circulatory death (OR=1.280; P=0.009), accessory hepatic artery (OR=1.324; P=0.005), vascular anastomosis time in minutes (OR=1.005; P=0.032) and ethnicity ‘other’ (OR=1.838; P=0.011). Conclusion EBCs prolong hospital stay, increase readmission rates and are independent risk factors for diminished graft survival and increased mortality in liver transplantation. We have identified factors that increase the likelihood of EBC occurrence; further research into interventions to prevent EBCs in these at-risk groups is vital to improve liver transplantation outcomes. Take-home message Using a large registry database we have shown that early anastomotic biliary complications are independent risk factors for decreased graft survival and increased mortality after liver transplantation. Research into interventions to prevent biliary complications in high risk groups are essential to improve liver transplant outcomes.

The Clinical Characteristics of Obese Patients with Acanthosis Nigricans and Its Independent Risk Factors

2017 ◽  
Vol 125 (03) ◽  
pp. 191-195 ◽  
Author(s):  
Yueye Huang ◽  
Jiaqi Chen ◽  
Xingchun Wang ◽  
Yan Li ◽  
Shezhen Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Acanthosis Nigricans ◽  
Obese Patients ◽  
Independent Risk Factors

scholarly journals Risk factors for high length of hospital stay and in-hospital mortality in hip fractures in the elderly

2021 ◽  
Vol 65 (5) ◽  
pp. 322-330
Author(s):  
J. Salvador Marín ◽  
F.J. Ferrández Martínez ◽  
C. Fuster Such ◽  
J.M. Seguí Ripoll ◽  
D. Orozco Beltrán ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
High Length

scholarly journals Nomogram for Predicting COVID-19 Disease Progression Based on Single-Center Data: Observational Study and Model Development (Preprint)

2020 ◽  
Author(s):  
Tao Fan ◽  
Bo Hao ◽  
Shuo Yang ◽  
Bo Shen ◽  
Zhixin Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Disease Onset ◽  
Lasso Regression ◽  
Prediction Ability ◽  
Calibration Curves ◽  
Independent Risk Factors ◽  
Critical Patients

BACKGROUND In late December 2019, a pneumonia caused by SARS-CoV-2 was first reported in Wuhan and spread worldwide rapidly. Currently, no specific medicine is available to treat infection with COVID-19. OBJECTIVE The aims of this study were to summarize the epidemiological and clinical characteristics of 175 patients with SARS-CoV-2 infection who were hospitalized in Renmin Hospital of Wuhan University from January 1 to January 31, 2020, and to establish a tool to identify potential critical patients with COVID-19 and help clinical physicians prevent progression of this disease. METHODS In this retrospective study, clinical characteristics of 175 confirmed COVID-19 cases were collected and analyzed. Univariate analysis and least absolute shrinkage and selection operator (LASSO) regression were used to select variables. Multivariate analysis was applied to identify independent risk factors in COVID-19 progression. We established a nomogram to evaluate the probability of progression of the condition of a patient with COVID-19 to severe within three weeks of disease onset. The nomogram was verified using calibration curves and receiver operating characteristic curves. RESULTS A total of 18 variables were considered to be risk factors after the univariate regression analysis of the laboratory parameters (<i>P</i>&lt;.05), and LASSO regression analysis screened out 10 risk factors for further study. The six independent risk factors revealed by multivariate Cox regression were age (OR 1.035, 95% CI 1.017-1.054; <i>P</i>&lt;.001), CK level (OR 1.002, 95% CI 1.0003-1.0039; <i>P</i>=.02), CD4 count (OR 0.995, 95% CI 0.992-0.998; <i>P</i>=.002), CD8 % (OR 1.007, 95% CI 1.004-1.012, <i>P</i>&lt;.001), CD8 count (OR 0.881, 95% CI 0.835-0.931; <i>P</i>&lt;.001), and C3 count (OR 6.93, 95% CI 1.945-24.691; <i>P</i>=.003). The areas under the curve of the prediction model for 0.5-week, 1-week, 2-week and 3-week nonsevere probability were 0.721, 0.742, 0.87, and 0.832, respectively. The calibration curves showed that the model had good prediction ability within three weeks of disease onset. CONCLUSIONS This study presents a predictive nomogram of critical patients with COVID-19 based on LASSO and Cox regression analysis. Clinical use of the nomogram may enable timely detection of potential critical patients with COVID-19 and instruct clinicians to administer early intervention to these patients to prevent the disease from worsening.

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