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Qin J, Yang Y, Ai C, Ji Z, Chen W, Song Y, Zeng J, Duan M, Qi W, Zhang S, An Z, Lin Y, Xu S, Deng K, Lin H, Yan D. Antibiotic combinations prediction based on machine learning to multicentre clinical data and drug interaction correlation. Int J Antimicrob Agents 2024; 63:107122. [PMID: 38431108 DOI: 10.1016/j.ijantimicag.2024.107122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/13/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND With increasing antibiotic resistance and regulation, the issue of antibiotic combination has been emphasised. However, antibiotic combination prescribing lacks a rapid identification of feasibility, while its risk of drug interactions is unclear. METHODS We conducted statistical descriptions on 16 101 antibiotic coprescriptions for inpatients with bacterial infections from 2015 to 2023. By integrating the frequency and effectiveness of prescriptions, we formulated recommendations for the feasibility of antibiotic combinations. Initially, a machine learning algorithm was utilised to optimise grading thresholds and habits for antibiotic combinations. A feedforward neural network (FNN) algorithm was employed to develop antibiotic combination recommendation model (ACRM). To enhance interpretability, we combined sequential methods and DrugBank to explore the correlation between antibiotic combinations and drug interactions. RESULTS A total of 55 antibiotics, covering 657 empirical clinical antibiotic combinations were used for ACRM construction. Model performance on the test dataset showed AUROCs of 0.589-0.895 for various antibiotic recommendation classes. The ACRM showed satisfactory clinical relevance with 61.54-73.33% prediction accuracy in a new independent retrospective cohort. Antibiotic interaction detection showed that the risk of drug interactions was 29.2% for strongly recommended and 43.5% for not recommended. A positive correlation was identified between the level of clinical recommendation and the risk of drug interactions. CONCLUSIONS Machine learning modelling of retrospective antibiotic prescriptions habits has the potential to predict antibiotic combination recommendations. The ACRM plays a supporting role in reducing the incidence of drug interactions. Clinicians are encouraged to adopt such systems to improve the management of antibiotic usage and medication safety.
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Affiliation(s)
- Jia'an Qin
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuhe Yang
- College of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chao Ai
- Department of Clinical Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhaoshuai Ji
- Department of Clinical Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wei Chen
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yingchang Song
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiayu Zeng
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenjie Qi
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shutian Zhang
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhuoling An
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yang Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Sha Xu
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kejun Deng
- College of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
| | - Hao Lin
- College of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
| | - Dan Yan
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Qi Z, Dong L, Lin J, Duan M. Development and validation a nomogram prediction model for early diagnosis of bloodstream infections in the intensive care unit. Front Cell Infect Microbiol 2024; 14:1348896. [PMID: 38500500 PMCID: PMC10946253 DOI: 10.3389/fcimb.2024.1348896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose This study aims to develop and validate a nomogram for predicting the risk of bloodstream infections (BSI) in critically ill patients based on their admission status to the Intensive Care Unit (ICU). Patients and methods Patients' data were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database (training set), the Beijing Friendship Hospital (BFH) database (validation set) and the eICU Collaborative Research Database (eICU-CRD) (validation set). Univariate logistic regression analyses were used to analyze the influencing factors, and lasso regression was used to select the predictive factors. Model performance was assessed using area under receiver operating characteristic curve (AUROC) and Presented as a Nomogram. Various aspects of the established predictive nomogram were evaluated, including discrimination, calibration, and clinical utility. Results The model dataset consisted of 14930 patients (1444 BSI patients) from the MIMIC-IV database, divided into the training and internal validation datasets in a 7:3 ratio. The eICU dataset included 2100 patients (100 with BSI) as the eICU validation dataset, and the BFH dataset included 419 patients (21 with BSI) as the BFH validation dataset. The nomogram was constructed based on Glasgow Coma Scale (GCS), sepsis related organ failure assessment (SOFA) score, temperature, heart rate, respiratory rate, white blood cell (WBC), red width of distribution (RDW), renal replacement therapy and presence of liver disease on their admission status to the ICU. The AUROCs were 0.83 (CI 95%:0.81-0.84) in the training dataset, 0.88 (CI 95%:0.88-0.96) in the BFH validation dataset, and 0.75 (95%CI 0.70-0.79) in the eICU validation dataset. The clinical effect curve and decision curve showed that most areas of the decision curve of this model were greater than 0, indicating that this model has a certain clinical effectiveness. Conclusion The nomogram developed in this study provides a valuable tool for clinicians and nurses to assess individual risk, enabling them to identify patients at a high risk of bloodstream infections in the ICU.
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Affiliation(s)
| | | | | | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Xiao H, Zhang H, Wang G, Wang Y, Tan Z, Sun X, Zhou J, Duan M, Zhi D, Hang C, Zhang G, Li Y, Wu C, Zhang H, Xie M, Li C. COMPARISON AMONG PRESEPSIN, PROCALCITONIN, AND C-REACTIVE PROTEIN IN PREDICTING BLOOD CULTURE POSITIVITY AND PATHOGEN IN SEPSIS PATIENTS. Shock 2024; 61:387-394. [PMID: 37878488 DOI: 10.1097/shk.0000000000002243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
ABSTRACT Background: Sepsis is caused by the invasion of the bloodstream by microorganisms from local sites of infection, leading to high mortality. This study aimed to compare the predictive ability of the biomarkers presepsin, procalcitonin (PCT), and C-reactive protein for bacteraemia. Methods: In this retrospective, multicentre study, a dataset of patients with sepsis who were prospectively enrolled between November 2017 and June 2021 was analyzed. The performances of the biomarkers for predicting positive blood cultures and infection with specific pathogens were assessed by the areas under the receiver operating characteristic curves (AUCs). The independent effects of the pathogen and foci of infection on presepsin and PCT levels were assessed by linear logistic regression models. Results: A total of 577 patients with 170 positive blood cultures (29.5%) were enrolled. The AUC achieved using PCT levels (0.856) was significantly higher than that achieved using presepsin (0.786, P = 0.0200) and C-reactive protein (0.550, P < 0.0001) levels in predicting bacteraemia. The combined analysis of PCT and presepsin levels led to a significantly higher AUC than the analysis of PCT levels alone for predicting blood culture positivity (0.877 vs. 0.856, P = 0.0344) and gram-negative bacteraemia (0.900 vs. 0.875, P = 0.0216). In a linear regression model, the elevated concentrations of presepsin and PCT were both independently related to Escherichia coli , Klebsiella species, Pseudomonas species, and Streptococcus species infections and Sequential Organ Failure Assessment score. Presepsin levels were also associated with Acinetobacter species and abdominal infection, and PCT levels were positively associated with other Enterobacteriaceae and negatively associated with respiratory infection. Combined analysis of presepsin and PCT levels provided a high sensitivity and specificity in identifying E. coli or Klebsiella species infection. Conclusions: Presepsin and PCT were promising markers for predicting bacteraemia and common pathogens at the time of sepsis onset with a synergistic effect.
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Affiliation(s)
- Hongli Xiao
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hanyu Zhang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhimin Tan
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuelian Sun
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jie Zhou
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Deyuan Zhi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chenchen Hang
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Zhang
- Department of Emergency Medicine, China-Japan Friendship Hospital, Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Emergency Medicine, China-Japan Friendship Hospital, Peking Union Medical College, Beijing, China
| | - Caijun Wu
- Department of Emergency Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Haiyan Zhang
- Department of Emergency Medicine, The Hospital of Shunyi District Beijing, China Medical University, Beijing, China
| | - Miaorong Xie
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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He J, Jing D, Zhao S, Duan M. BAP31 Promotes Adhesion Between Endothelial Cells and Macrophages Through the NF-κB Signaling Pathway in Sepsis. J Inflamm Res 2024; 17:1267-1279. [PMID: 38434584 PMCID: PMC10906674 DOI: 10.2147/jir.s448091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose To investigate the role of B cell receptor associated protein 31 (BAP31) in the pathogenesis of sepsis. Methods Cecal ligation and puncture (CLP)-induced C57BL/6J mice, and LPS-challenged endothelial cells (HUVECs) were established to mimic a sepsis animal model and a sepsis cell model, respectively. Cre/LoxP and shRNA methods were used for BAP31 knockdown in vivo and in vitro respectively. Neutrophils/macrophages-endothelial cocultures were used to evaluate neutrophils or macrophages infiltration and adhesion to endothelial cells. Cox proportional hazards model was used to evaluate the survival time of mice. Western blotting (WB) and Quantitative real-time polymerase chain reaction (qRT-PCR) were used to detect toll-like receptor (TLR) signaling pathway, transforming growth factor β activated kinase 1 (TAK1) signaling pathway and phosphoinositide-3 kinases-protein kinase B (PI3K/AKT) signaling pathway. Results Deletion of BAP31 reduced CLP-induced mortality of mice, histological damage with less interstitial edema, and neutrophils and macrophages infiltration. IHC and IF showed that BAP31 knockdown significantly decreases the expressions of ICAM1 and VCAM1 both in vivo and in vitro. Coculture showed that LPS-induced neutrophils or macrophages adhesion to endothelial cells was significantly weakened in BAP31 knockdown cells. In addition, BAP31 knockdown of endothelial cells decreased the expression of CD80 and CD86 on the surface of macrophages as well as interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) during sepsis. Mechanistically, LPS-induced the activation of TLR4, MyD88 and TRAF6, and the phosphorylation of TAK1, PI3K, AKT, IκBα and IKKα/β, resulting in activation of nuclear factor kappa B (NF-κB) p65 in endothelial cells. However, BAP31 knockdown significantly reversed the expressions of associated proteins. Conclusion BAP31 up-regulated the expressions of ICAM1 and VCAM1 in endothelial cells leading to sepsis-associated organ injury. This may be involved in activation of TLR signaling pathway, TAK1 pathway, and PI3K-AKT signaling pathway.
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Affiliation(s)
- Jiawei He
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Danyang Jing
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shen Zhao
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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Su L, Liu S, Long Y, Chen C, Chen K, Chen M, Chen Y, Cheng Y, Cui Y, Ding Q, Ding R, Duan M, Gao T, Gu X, He H, He J, Hu B, Hu C, Huang R, Huang X, Jiang H, Jiang J, Lan Y, Li J, Li L, Li L, Li W, Li Y, Lin J, Luo X, Lyu F, Mao Z, Miao H, Shang X, Shang X, Shang Y, Shen Y, Shi Y, Sun Q, Sun W, Tang Z, Wang B, Wang H, Wang H, Wang L, Wang L, Wang S, Wang Z, Wang Z, Wei D, Wu J, Wu Q, Xing X, Yang J, Yang X, Yu J, Yu W, Yu Y, Yuan H, Zhai Q, Zhang H, Zhang L, Zhang M, Zhang Z, Zhao C, Zheng R, Zhong L, Zhou F, Zhu W. Chinese experts' consensus on the application of intensive care big data. Front Med (Lausanne) 2024; 10:1174429. [PMID: 38264049 PMCID: PMC10804886 DOI: 10.3389/fmed.2023.1174429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 11/09/2023] [Indexed: 01/25/2024] Open
Abstract
The development of intensive care medicine is inseparable from the diversified monitoring data. Intensive care medicine has been closely integrated with data since its birth. Critical care research requires an integrative approach that embraces the complexity of critical illness and the computational technology and algorithms that can make it possible. Considering the need of standardization of application of big data in intensive care, Intensive Care Medicine Branch of China Health Information and Health Care Big Data Society, Standard Committee has convened expert group, secretary group and the external audit expert group to formulate Chinese Experts' Consensus on the Application of Intensive Care Big Data (2022). This consensus makes 29 recommendations on the following five parts: Concept of intensive care big data, Important scientific issues, Standards and principles of database, Methodology in solving big data problems, Clinical application and safety consideration of intensive care big data. The consensus group believes this consensus is the starting step of application big data in the field of intensive care. More explorations and big data based retrospective research should be carried out in order to enhance safety and reliability of big data based models of critical care field.
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Affiliation(s)
- Longxiang Su
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengjun Liu
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaodong Chen
- Department of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Kai Chen
- Department of Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, Fujian, China
| | - Ming Chen
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yisong Cheng
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yating Cui
- Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qi Ding
- Department of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Renyu Ding
- Department of Intensive Care Unit, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tao Gao
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiaohua Gu
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital; Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hongli He
- Intensive Care Unit, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine of University of Electronic Science and Technology, Chengdu, China
| | - Jiawei He
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chang Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Rui Huang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaobo Huang
- Intensive Care Unit, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine of University of Electronic Science and Technology, Chengdu, China
| | - Huizhen Jiang
- Department of Information Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Jiang
- Department of Critical Care Medicine, Chongqing General Hospital, Chongqing, China
| | - Yunping Lan
- Intensive Care Unit, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine of University of Electronic Science and Technology, Chengdu, China
| | - Jun Li
- Department of Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, Fujian, China
| | - Linfeng Li
- Medical Data Research Institute, Chongqing Medical University, Chongqing, China
| | - Lu Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wenxiong Li
- Department of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yongzai Li
- Information Network Center, QiLu Hospital, ShanDong University, Jinan, China
| | - Jin Lin
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xufei Luo
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Feng Lyu
- Department of Computer Science and Engineering, Central South University, Changsha, China
| | - Zhi Mao
- Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - He Miao
- Department of Intensive Care Unit, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaopu Shang
- Department of Information Management, Beijing Jiaotong University, Beijing, China
| | - Xiuling Shang
- Department of Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, Fujian, China
| | - You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuwen Shen
- Intensive Care Unit of Cardiovascular Surgery Department, Qilu Hospital of Shandong University, Jinan, China
| | - Yinghuan Shi
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Qihang Sun
- British Chinese Society of Health Informatics, Beijing, China
| | - Weijun Sun
- Faculty of Automation, Guangdong University of Technology, Guangzhou, China
| | - Zhiyun Tang
- Department of Intensive Care Unit, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Emergency and Intensive Care Unit Center, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Haijun Wang
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongliang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Li Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences; School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Luhao Wang
- Department of Critical Care Medicine, Sun Yat-Sen University First Affiliated Hospital, Guangzhou, China
| | - Sicong Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhanwen Wang
- Intensive Care Unit, XiangYa Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiang Ya Hospital, Central South University, Changsha, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiang Ya Hospital, Central South University, Changsha, China
| | - Zhong Wang
- Department of Intensive Care Unit, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dong Wei
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Jianfeng Wu
- Intensive Care Unit, XiangYa Hospital, Central South University, Changsha, China
| | - Qin Wu
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Xuezhong Xing
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences; School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Jin Yang
- Department of Critical Care Medicine, Chongqing General Hospital, Chongqing, China
| | - Xianghong Yang
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangquan Yu
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital; Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Wenkui Yu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yuan Yu
- Intensive Care Unit of Cardiovascular Surgery Department, Qilu Hospital of Shandong University, Jinan, China
| | - Hao Yuan
- Department of Critical Care Medicine, Sun Yat-Sen University First Affiliated Hospital, Guangzhou, China
| | - Qian Zhai
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Hao Zhang
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lina Zhang
- Intensive Care Unit, XiangYa Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiang Ya Hospital, Central South University, Changsha, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiang Ya Hospital, Central South University, Changsha, China
| | - Meng Zhang
- Department of Critical Care Medicine, Chongqing General Hospital, Chongqing, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunguang Zhao
- Intensive Care Unit, XiangYa Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiang Ya Hospital, Central South University, Changsha, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiang Ya Hospital, Central South University, Changsha, China
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital; Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Lei Zhong
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feihu Zhou
- Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Weiguo Zhu
- Department of General Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Bai J, Liu J, Ji X, Wen A, Duan M. Therapeutic Drug Monitoring-Guided Vancomycin Therapy of a Pediatric Patient after Liver Transplantation: a Case Report. Clin Lab 2023; 69. [PMID: 37844049 DOI: 10.7754/clin.lab.2023.230209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Vancomycin administration is challenging in critically ill patients because of pharmacokinetic changes and requires careful therapeutic drug monitoring (TDM) to guide the appropriate dosing for an effective serum concentration and to avoid toxicity. METHODS We reported a one-year-old female pediatric patient with a body mass index of 15.4 had successful TDM-guided vancomycin therapy after a living donor liver transplantation for biliary atresia. RESULTS The patient was admitted to the Intensive Care Unit for sepsis after her second liver transplantation. Even with the administration of the maximum approved vancomycin dosage (40 mg/kg/day), the serum trough levels were less than the recommended therapeutic level. After several adjustments based on TDM, a continuous pump infusion of up to 800 mg/day was needed to reach the desired serum trough concentration of > 10 µg/mL. Sepsis was controlled, and the patient was transferred from the Intensive Care Unit to the general ward and finally discharged home on a regular follow-up plan. CONCLUSIONS TDM-guided vancomycin continuous infusion may be an effective therapeutic option for pediatric patients after liver transplantation.
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Wang Y, Liu P, Duan M. Prevalence, Risk Factors and Clinical Outcomes of Acute Kidney Injury after Paediatric Liver Transplantation. ARCH ESP UROL 2023; 76:548-554. [PMID: 37960953 DOI: 10.56434/j.arch.esp.urol.20237608.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Knowledge about acute kidney injury (AKI) in paediatric patients after liver transplantation is limited. This study focused on the prevalence and contributing factors of AKI and its impact on the postoperative outcomes of paediatric recipients. METHODS The data of 211 paediatric patients (<12 years old) who, from December 2018 to November 2020, received first-time liver transplantation for end-stage liver disease or advanced hepatic failure in our hospital were processed for retrospective analysis. According to the criteria of the Kidney Disease Improving Global Outcomes, all patients were dichotomised into AKI and non-AKI groups. The preoperative characteristics of the patients, laboratory test results, donor type and intraoperative parameters between the two groups were compared. The effects of AKI on the postoperative outcomes of paediatric recipients were analysed. The risk factors for AKI after liver transplantation were analysed by multivariate logistic regression. RESULTS The incidence of AKI within the first seven days after paediatric liver transplantation was 34.1%. AKI at stages I, II and III accounted for 69.4%, 22.2% and 8.3%, respectively. Compared with non-AKI patients, AKI patients had a higher proportion of hepatic cirrhosis (p = 0.039) and ascites (p = 0.003); Worse hepatic function (prolonged prothrombin time, activated partial thromboplastin time, decreased level of serum albumin and increased international normalised ratio and total bilirubin level); Higher paediatric end-stage liver disease (PELD) score (p = 0.008); And larger amount of intraoperative blood loss (p < 0.001), fluid positive balance (p = 0.035), red blood cells (RBCs) (p < 0.001) and fresh frozen plasma transfusion (p < 0.001). The multivariate logistic regression analysis demonstrated that ascites (odds ratio (OR): 2.273, p = 0.040), PELD (OR: 1.027, p = 0.013) and RBCs transfusion (OR: 1.033, p < 0.001) were independent contributing factors to AKI in paediatric patients who received liver transplantation. AKI contributed to prolonged hospital stays but did not increase hospital mortality. CONCLUSIONS The onset of AKI can markedly prolong the hospital stay, and is common in paediatric patients undergoing liver transplantation. Poor hepatic function and large RBC transfusion contribute to AKI after liver transplantation.
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Affiliation(s)
- Yajun Wang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, 100050 Beijing, China
| | - Pei Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, 100050 Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, 100050 Beijing, China
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Ren E, Xiao H, Li J, Yu H, Liu B, Wang G, Sun X, Duan M, Hang C, Zhang G, Wu C, Li F, Zhang H, Zhang Y, Guo W, Qi W, Yin Q, Zhao Y, Xie M, Li C. CLINICAL CHARACTERISTICS AND PREDICTORS OF MORTALITY DIFFER BETWEEN PULMONARY AND ABDOMINAL SEPSIS. Shock 2023; 60:42-50. [PMID: 37267265 DOI: 10.1097/shk.0000000000002151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
ABSTRACT Background: Pulmonary sepsis and abdominal sepsis have pathophysiologically distinct phenotypes. This study aimed to compare their clinical characteristics and predictors of mortality. Methods: In this multicenter retrospective trial, 1,359 adult patients who fulfilled the Sepsis-3 criteria were enrolled and classified into the pulmonary sepsis or abdominal sepsis groups. Plasma presepsin was measured, and the scores of Acute Physiology and Chronic Health Evaluation (APACHE) II, Mortality in Emergency Department Sepsis (MEDS), and Simplified Acute Physiology Score (SAPS) II were calculated at enrollment. Data on 28-day mortality were collected for all patients. Results: Compared with patients with abdominal sepsis (n = 464), patients with pulmonary sepsis (n = 895) had higher 28-day mortality rate, illness severity scores, incidence of shock and acute kidney injury, and hospitalization costs. Lactate level and APACHE II and MEDS scores were independently associated with 28-day mortality in both sepsis types. Independent predictors of 28-day mortality included Pa o2 /F io2 ratio (hazard ratio [HR], 0.998; P < 0.001) and acute kidney injury (HR, 1.312; P = 0.039) in pulmonary sepsis, and SAPS II (HR, 1.037; P = 0.017) in abdominal sepsis. A model that combined APACHE II score, lactate, and MEDS score or SAPS II score had the best area under the receiver operating characteristic curve in predicting mortality in patients with pulmonary sepsis or abdominal sepsis, respectively. Interaction term analysis confirmed the association between 28-day mortality and lactate, APACHE II score, MEDS score, SAPS II score, and shock according to the sepsis subgroups. The mortality of patients with pulmonary sepsis was higher than that of patients with abdominal sepsis among patients without shock (32.9% vs. 8.8%; P < 0.001) but not among patients with shock (63.7 vs. 48.4%; P = 0.118). Conclusions: Patients with pulmonary sepsis had higher 28-day mortality than patients with abdominal sepsis. The study identified sepsis subgroup-specific mortality predictors. Shock had a larger effect on mortality in patients with abdominal sepsis than in those with pulmonary sepsis.
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Affiliation(s)
- Enfeng Ren
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongli Xiao
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiebin Li
- Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Han Yu
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bo Liu
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuelian Sun
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chenchen Hang
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Zhang
- Department of Emergency Medicine, China-Japan Friendship Hospital, Peking Union Medical College, Beijing, China
| | - Caijun Wu
- Department of Emergency Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fengjie Li
- Department of Emergency Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- Department of Emergency Medicine, The Hospital of Shunyi District Beijing, China Medical University, Beijing, China
| | - Yun Zhang
- Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Guo
- Department of Emergency Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenjie Qi
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qin Yin
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yunzhou Zhao
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Miaorong Xie
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Liu S, Yao C, Xie J, Liu H, Wang H, Lin Z, Qin B, Wang D, Lu W, Ma X, Liu Y, Liu L, Zhang C, Xu L, Zheng R, Zhou F, Liu Z, Zhang G, Zhou L, Liu J, Fei A, Zhang G, Zhu Y, Qian K, Wang R, Liang Y, Duan M, Wu D, Sun R, Wang Y, Zhang X, Cao Q, Yang M, Jin M, Song Y, Huang L, Zhou F, Chen D, Liang Q, Qian C, Tang Z, Zhang Z, Feng Q, Peng Z, Sun R, Song Z, Sun Y, Chai Y, Zhou L, Cheng C, Li L, Yan X, Zhang J, Huang Y, Guo F, Li C, Yang Y, Shang H, Qiu H. Effect of an Herbal-Based Injection on 28-Day Mortality in Patients With Sepsis: The EXIT-SEP Randomized Clinical Trial. JAMA Intern Med 2023; 183:647-655. [PMID: 37126332 PMCID: PMC10152378 DOI: 10.1001/jamainternmed.2023.0780] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/28/2023] [Indexed: 05/02/2023]
Abstract
Importance Previous research has suggested that Xuebijing injection (XBJ), an herbal-based intravenous preparation, may reduce mortality among patients with sepsis. Objective To determine the effect of XBJ vs placebo on 28-day mortality among patients with sepsis. Design, Setting, and Participants The Efficacy of Xuebijing Injection in Patients With Sepsis (EXIT-SEP) trial was a multicenter, randomized double-blind, placebo-controlled trial conducted in intensive care units at 45 sites and included 1817 randomized patients with sepsis (sepsis 3.0) present for less than 48 hours. Patients aged 18 to 75 years with a Sequential Organ Failure Assessment score of 2 to 13 were enrolled. The study was conducted from October 2017 to June 2019. The final date of follow-up was July 26, 2019. Data analysis was performed from January 2020 to August 2022. Interventions The patients were randomized to receive either intravenous infusion of XBJ (100 mL, n = 911) or volume-matched saline placebo (n = 906) every 12 hours for 5 days. Main Outcomes and Measures The primary outcome was 28-day mortality. Results Among the 1817 patients who were randomized (mean [SD] age, 56.5 [13.5] years; 1199 [66.0%] men), 1760 (96.9%) completed the trial. In these patients, the 28-day mortality rate was significantly different between the placebo group and the XBJ group (230 of 882 patients [26.1%] vs 165 of 878 patients [18.8%], respectively; P < .001). The absolute risk difference was 7.3 (95% CI, 3.4-11.2) percentage points. The incidence of adverse events was 222 of 878 patients (25.3%) in the placebo group and 200 of 872 patients (22.9%) in the XBJ group. Conclusions and Relevance In this randomized clinical trial among patients with sepsis, the administration of XBJ reduced 28-day mortality compared with placebo. Trial Registration ClinicalTrials.gov Identifier: NCT03238742.
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Affiliation(s)
- Songqiao Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Chen Yao
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Hong Liu
- Department of Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongliang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhaofen Lin
- Department of Emergency and Critical Care, Shanghai Changzheng Hospital, Shanghai, China
| | - Bingyu Qin
- Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Difen Wang
- Department of Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Weihua Lu
- Department of Critical Care Medicine, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Yan Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Chi Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lei Xu
- Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin, China
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, China
| | - Feihu Zhou
- Department of Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhongmin Liu
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Guoqiang Zhang
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
| | - Lixin Zhou
- Department of Critical Care Medicine, First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Jian Liu
- Department of Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Aihua Fei
- Department of Emergency, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guoxiu Zhang
- Department of Emergency, The First Affiliated Hospital of Henan Science and Technology University, Luoyang, Henan, China
| | - Yimin Zhu
- Hunan Provincial Institute of Emergency Medicine, Hunan Provincial People’s Hospital, Changsha, Hunan, China
| | - Kejian Qian
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ruilan Wang
- Department of Emergency, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yafeng Liang
- Department of Critical Care Medicine, Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dawei Wu
- Department of Critical Care Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | - Rongqing Sun
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ying Wang
- Department of Respiration, Chinese PLA General Hospital of Rocket Forces, Beijing, China
| | - Xijing Zhang
- Department of Anesthesiology, Xijing Hospital, Xi'an, Shaanxi, China
| | - Quan Cao
- Department of Critical Care Medicine, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Mingshi Yang
- Department of Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Minggen Jin
- Department of Critical Care Medicine, Yanbian University Hospital, Yanji, Jilin, China
| | - Yan Song
- Department of Critical Care Medicine, Central Hospital of Shenyang Medical College, Shenyang, Liaoning, China
| | - Ling Huang
- Department of Critical Care Medicine, Yantaishan Hospital, Yantai, Shandong, China
| | - Fachun Zhou
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin North Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qun Liang
- Department of Critical Care Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Chuanyun Qian
- Department of Emergency, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhongzhi Tang
- Department of Emergency, Chinese PLA Wuhan General Hospital, Wuhan, Hubei, China
| | - Zhong Zhang
- Department of Critical Care Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong, China
| | - Qiming Feng
- Department of Emergency, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Zhiyong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Renhua Sun
- Department of Critical Care Medicine, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China
| | - Zhenju Song
- Department of Emergency, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunbo Sun
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanfen Chai
- Department of Emergency, Tianjin Medical University General Hospital, Tianjin, China
| | - Lihua Zhou
- Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Chen Cheng
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Zhangjiang Hi-Tech Park, Shanghai, China
| | - Li Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xiaoyan Yan
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yingzi Huang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Fengmei Guo
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Chuan Li
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Zhangjiang Hi-Tech Park, Shanghai, China
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
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Bai J, Wen A, Li Z, Li X, Duan M. Population pharmacokinetics and dosing optimisation of imipenem in critically ill patients. Eur J Hosp Pharm 2023:ejhpharm-2022-003403. [PMID: 36948580 DOI: 10.1136/ejhpharm-2022-003403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/06/2023] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE The objective of this study was to explore factors that affect the clearance of imipenem in critically ill patients and to provide a dosing regimen for such patients. METHODS A prospective open-label study enrolled 51 critically ill patients with sepsis. Patients were between the ages of 18 and 96. Blood samples were collected in duplicate before (0 hour) and at 0.5, 1, 1.5, 2, 3, 4, 6, and 8 hours after imipenem administration. The plasma imipenem concentration was determined by the high-performance liquid chromatography-ultraviolet detection (HPLC-UV) method. A population pharmacokinetic (PPK) model was developed using nonlinear mixed-effects modelling methods to identify covariates. Monte Carlo simulations were performed using the final PPK model to explore the effect of different dosing regimens on the probability of target attainment (PTA). RESULTS The imipenem concentration data were best described by a two-compartment model. Creatinine clearance (CrCl, mL/min) was a covariate that affected central clearance (CLc). Patients were divided into four subgroups based on different CrCl rates. Monte Carlo simulations were performed to assess the PTA differences between empirical dosing regimens (0.5 g every 6 hours (q6h), 0.5 g every 8 hours (q8h), 0.5 g every 12 hours (q12h), 1 g every 6 hours (q6h), 1 g every 8 hours (q8h), and 1 g every 12 hours (q12h)) and to determine the target achievement rate covariate. CONCLUSION This study identified covariates for CLc, and the proposed final model can be used to guide clinicians administering imipenem in this particular patient population.
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Affiliation(s)
- Jing Bai
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Aiping Wen
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhe Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xingang Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Pang R, Dong L, Liu J, Ji X, Zhuang H, Duan M. The study on role of endothelial cell autophagy in rats with sepsis-induced acute kidney injury. Heliyon 2023; 9:e13796. [PMID: 36873534 PMCID: PMC9976300 DOI: 10.1016/j.heliyon.2023.e13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Sepsis often causes acute kidney injury (AKI). Autophagy of renal tubular epithelial cells is considered a cytoprotective mechanism in septic AKI; however, the role of autophagy of renal endothelial cells is uninvestigated. The current study examined whether autophagy was induced by sepsis in renal endothelial cells and whether induction of autophagy in these cells attenuated the degree of AKI. Cecal ligation and puncture (CLP) was used as a model of sepsis in rats. Four experimental groups included: sham, CLP alone, CLP + rapamycin (RAPA), and CLP + dimethyl sulfoxide (DMSO), where RAPA was used as an activator of autophagy. CLP increased renal LC3-II protein levels with an additional transient increase by RAPA at 18 h. In addition, CLP induced autophagosome formation in renal endothelial cells had an additional increase induced by RAPA. Interestingly, the levels of bone morphogenetic protein and activin membrane-bound inhibitor (BAMBI), an endothelial cell-specific protein in the kidney, were also increased by CLP, albeit it was transiently downregulated by RAPA at 18 h. Serum thrombomodulin increased and renal vascular endothelial (VE)-cadherin decreased following CLP, and these changes were attenuated by RAPA. The renal cortex exhibited and inflammatory tissue damage after CLP, and RAPA alleviated these histopathological injuries. The current findings indicate that autophagy was induced by sepsis in renal endothelial cells, and upregulation of autophagy in these cells alleviated endothelial injury and AKI. In addition, BAMBI was induced by sepsis in the kidney, which may play a role in regulating endothelial stability in septic AKI.
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Affiliation(s)
- Ran Pang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Dong
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jingfeng Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaojun Ji
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haizhou Zhuang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Qi Z, Lu J, Liu P, Li T, Li A, Duan M. Nomogram Prediction Model of Hypernatremia on Mortality in Critically Ill Patients. Infect Drug Resist 2023; 16:143-153. [PMID: 36636369 PMCID: PMC9831528 DOI: 10.2147/idr.s387995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023] Open
Abstract
Objective To investigate the value of hypernatremia in the intensive care unit (ICU) for the risk prediction of mortality in severe patients. Methods Clinical data of critically ill patients admitted to the ICU of Beijing Friendship Hospital, were collected for retrospective analysis. Univariate and multivariate logistic regression analyses were employed to analyze the influencing factors. Nomograms predicting the mortality were constructed with R software and validated with repeated sampling. Results A total of 442 cases were eligible for this study. Hypernatremia within 48 hours of ICU admission, change in sodium concentration (CNa+) within 48 hours, septic shock, APACHE II score, hyperlactatemia within 48 hours, use of continuous renal replacement therapy (CRRT) within 48 hours, and the use of mechanical ventilation (MV) within 48 hours of ICU admission were all identified as independent risk factors for death within 28 days of ICU admission. These predictors were included in a nomogram of 28-day mortality in severe patients, which was constructed using R software. Conclusion The nomogram could predict the individualized risk of 28-day mortality based on the above factors. The model has better discrimination and accuracy and has high clinical application value.
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Affiliation(s)
- Zhili Qi
- Department of Critical Care Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Jiaqi Lu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Pei Liu
- Department of Critical Care Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Tian Li
- Department of Critical Care Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Ang Li
- Beijing Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Ang Li, Beijing Ditan Hospital, Capital Medical University, Beijing Ditan Hospital, 8 Jing Shun East Street, Beijing, People’s Republic of China, Email
| | - Meili Duan
- Department of Critical Care Medicine, Capital Medical University, Beijing, People’s Republic of China,Meili Duan, Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing, 10005, People’s Republic of China, Email
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Zhang M, Zhi D, Lin J, Liu P, Wang Y, Duan M. Flora characteristics and risk factors of lower respiratory tract infections in patients with severe craniocerebral trauma in the intensive care unit. Cesk Slov Neurol N 2022. [DOI: 10.48095/cccsnn2022375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lu J, Qi Z, Liu J, Liu P, Li T, Duan M, Li A. Nomogram Prediction Model of Serum Chloride and Sodium Ions on the Risk of Acute Kidney Injury in Critically Ill Patients. Infect Drug Resist 2022; 15:4785-4798. [PMID: 36045875 PMCID: PMC9420741 DOI: 10.2147/idr.s376168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aims to investigate the effect of serum chloride and sodium ions on AKI occurrence in ICU patients, and further constructs a prediction model containing these factors to explore the predictive value of these ions in AKI. Methods The clinical information of patients admitted to ICU of Beijing Friendship Hospital Affiliated to Capital Medical University was collected for retrospective analysis. Logistic regression analysis was used to analyzing the influencing factors. A nomogram for predicting AKI risk was constructed with R software and validated by repeated sampling. Afterwards, the effectiveness and accuracy of the model were tested and evaluated. Results A total of 446 cases met the requirements of this study, of which 178 developed AKI during their stay in ICU, with an incidence rate of 39.9%. Hypernatremia, heart failure, sepsis, APACHE II score, and initial creatinine value and BE value at ICU admission before the diagnosis of AKI were identified as independent risk factors for developing AKI during ICU stay. These predictors were incorporated into the nomogram of AKI risk in critically ill patients, which was constructed by using R software. Receiver operating characteristic curve analysis was further used and showed that the area under the curve of the model was 0.7934 (95% CI 0.742–0.8447), indicating that the model had an ideal value. Finally, further evaluated its clinical effectiveness. The clinical effect curve and decision curve showed that most areas of the decision curve of this model were greater than 0, indicating that this model owned a certain clinical effectiveness. Conclusion The nomogram based on hypernatremia, heart failure, sepsis, APACHE II score, and initial creatinine and BE value in ICU can predict the individualized risk of AKI with satisfactory distinguishability and accuracy.
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Affiliation(s)
- Jiaqi Lu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhili Qi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jingyuan Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Pei Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tian Li
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ang Li
- Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
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Zhou X, Bai G, Dong L, Zhuang H, Duan M. Successful Treatment of Severe Community-Acquired Pneumonia caused by Chlamydia Psittaci: a Case Report. Clin Lab 2022; 68. [PMID: 35536081 DOI: 10.7754/clin.lab.2021.211127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Community acquired pneumonia is a common and deadly condition, which remains a major cause of morbidity and mortality throughout the world. Chlamydia psittaci pneumonia is responsible for less than 5% of community-acquired pneumonia with a fatality rate of 1%. Nonetheless, it is underestimated due to low awareness of the disease and atypical clinical presentation in a majority of the cases. Metagenomic next-generation sequencing can help us diagnose and clarify the etiology in time. METHODS We reported a case of an 85-year-old man who presented with intermittent fever and cough with wheezing for 4 days and did a review of related literature. RESULTS The patient was admitted to our department due to severe CAP and multiple organ dysfunction. After admission, we applied an empirical antibiotic strategy, performed intubation and invasive ventilation, fluid resuscitation, vasoactive drugs and supportive care. On the third day of admission, metagenomic next-generation sequencing results of blood and bronchoalveolar lavage fluid suggested Chlamydia psittaci. We made a diagnosis of sever Chlamydia psittaci pneumonia and adjusted antibiotics to minocycline combined with azithromycin two days after admission. The patient was successfully cured with a good prognosis. CONCLUSIONS Detecting the pathogen as early as possible and achieving accurate diagnosis are essential in infected patients. We can benefit from careful application of metagenomic next-generation sequencing.
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Zhi D, Zhang M, Lin J, Liu P, Wang Y, Duan M. Role of HMGB1-PTEN Signaling in T Lymphocytes and Monocytes Upon Sepsis. Clin Lab 2022; 68. [PMID: 35536087 DOI: 10.7754/clin.lab.2021.211024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the role of high-mobility group box 1 (HMGB1)-phosphatase and tensin homolog deleted on chromosome ten (PTEN) signaling in T lymphocytes and monocytes upon sepsis. METHODS Thirty C57BL/6 male mice aged 8 - 10 weeks old were randomly divided into sham, model, and inhibitor groups (n = 10). The model of sepsis was established through cecal ligation and perforation. Sham group was only subjected to cecum exposure, and then the wound was sutured without cecal ligation. After the operation, the inhibitor group was intraperitoneally injected with HMGB1-specific inhibitor glycyrrhizic acid (dose: 10 mg/kg) every 6 hours for 4 consecutive times, while sham and model groups were intraperitoneally injected with an equal dose of normal saline. The histopathological changes, cell apoptosis in spleen and thymus tissues, proliferative activity and apoptosis of T lymphocytes, chemotactic activity of monocytes, expression levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and IL-10, and expressions of HMGB1 and PTEN in mice were detected using hematoxylineosin staining, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling staining, MTT assay, flow cytometry, transwell chemotaxis assay, enzyme-linked immunosorbent assay, and western blotting, respectively. RESULTS The cell apoptosis rate in spleen and thymus tissues, proliferative activity and apoptosis rate of T lymphocytes, chemotactic activity of monocytes, protein expressions of TNF-α, IL-6 and IL-10, and expressions of HMGB1 and PTEN significantly increased in the model group compared with those in the sham group (p < 0.05). However, the cell apoptosis rate in spleen and thymus tissues, T lymphocyte apoptosis rate, protein expressions of TNF-α and IL-6, and expressions of HMGB1 and PTEN were significantly lower, while the proliferative activity of T lymphocytes, chemotactic activity of monocytes and protein expression of IL-10 were significantly higher in the inhibitor group than those in the model group (p < 0.05). CONCLUSIONS Repressing HMGB1-PTEN signaling can effectively reduce the apoptosis rate of T cells, increase the proliferative activity of T cells, and enhance the function of monocytes in the case of sepsis.
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Li T, Ji X, Liu J, Guo X, Pang R, Zhuang H, Dong L, Duan M, Li A. Ulinastatin Improves Renal Microcirculation by Protecting Endothelial Cells and Inhibiting Autophagy in a Septic Rat Model. Kidney Blood Press Res 2022; 47:256-269. [PMID: 35016182 DOI: 10.1159/000521648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Increased permeability of the renal capillaries is a common consequence of sepsis-associated acute kidney injury. Vascular endothelial (VE)-cadherin is a strictly endothelial-specific adhesion molecule that can control the permeability of the blood vessel wall. Additionally, autophagy plays an important role in maintaining cell stability. Ulinastatin, a urinary trypsin inhibitor, attenuates the systemic inflammatory response and visceral vasopermeability. However, it is uncertain whether ulinastatin can improve renal microcirculation by acting on the endothelial adhesion junction. METHODS We observed the effect of ulinastatin in a septic rat model using contrast-enhanced ultrasonography (CEUS) to evaluate the perfusion of the renal cortex and medulla. Male adult Sprague Dawley rats were subjected to cecal ligation and puncture and divided into the sham, sepsis, and ulinastatin groups. Ulinastatin (50,000 U/kg) was injected into the tail vein immediately after the operation. The CEUS was performed to evaluate the renal microcirculation perfusion at 3, 6, 12, and 24 h after the operation. Histological staining was used to evaluate kidney injury scores. Western blot was used to quantify the expression of VE-cadherin, LC3II, and inflammatory factors (interleukin-1β, interleukin-6, and tumor necrosis factor-α) in kidney tissue, and enzyme-linked immunosorbent assay detected serum inflammatory factors and kidney function and early kidney injury biomarker levels. RESULTS Compared with the sham group, ulinastatin reduced the inflammatory response, inhibited autophagy, maintained the expression of VE-cadherin, and meliorated cortical and medullary perfusion. CONCLUSION Ulinastatin effectively protects the adhesion junction and helps ameliorate the perfusion of kidney capillaries during sepsis by the inhibition of autophagy and the expression of inflammatory factors.
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Affiliation(s)
- Tian Li
- Department of Critical Care Medicine, Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, China
| | - Xiaojun Ji
- Department of Critical Care Medicine, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Jingfeng Liu
- Department of Critical Care Medicine, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Xinjie Guo
- Department of Critical Care Medicine, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Ran Pang
- Department of Critical Care Medicine, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Haizhou Zhuang
- Department of Critical Care Medicine, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Lei Dong
- Department of Critical Care Medicine, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Ang Li
- Department of Critical Care Medicine, Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, China
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Liu S, Xing L, Zhang J, Wang K, Duan M, Wei M, Zhang B, Chang Z, Zhang H, Shang P. Expression pattern of CRYAB and CTGF genes in two pig breeds at different altitudes. ARQ BRAS MED VET ZOO 2022. [DOI: 10.1590/1678-4162-12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Tibetan pigs are characterized by significant phenotypic differences relative to lowland pigs. Our previous study demonstrated that the genes CRYAB and CTGF were differentially expressed in heart tissues between Tibetan (highland breed) and Yorkshire (lowland breed) pigs, indicating that they might participate in hypoxia adaptation. CRYAB (ɑB-crystallin) and CTGF (connective tissue growth factor) have also been reported to be associated with lung development. However, the expression patterns of CRYAB and CTGF in lung tissues at different altitudes and their genetic characterization are not well understood. In this study, qRT-PCR and western blot of lung tissue revealed higher CRYAB expression levels in highland and middle-highland Tibetan and Yorkshire pigs than in their lowland counterparts. With an increase in altitude, the expression level of CTGF increased in Tibetan pigs, whereas it decreased in Yorkshire pigs. Furthermore, two novel single-nucleotide polymorphism were identified in the 5′ flanking region of CRYAB (g.39644482C>T and g.39644132T>C) and CTGF (g.31671748A>G and g.31671773T>G). The polymorphism may partially contribute to the differences in expression levels between groups at the same altitude. These findings provide novel insights into the high-altitude hypoxia adaptations of Tibetan pigs.
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Affiliation(s)
- S. Liu
- Tibet Agriculture and Animal Husbandry College, People’s Republic of China; The Provincial and Ministerial co-founded collaborative innovation center for R & D in Tibet characteristic Agricultural and Animal Husbandry resources, People’s Republic of China
| | - L. Xing
- Tibet Agriculture and Animal Husbandry College, People’s Republic of China; The Provincial and Ministerial co-founded collaborative innovation center for R & D in Tibet characteristic Agricultural and Animal Husbandry resources, People’s Republic of China
| | - J. Zhang
- Tibet Agriculture and Animal Husbandry College, People’s Republic of China; The Provincial and Ministerial co-founded collaborative innovation center for R & D in Tibet characteristic Agricultural and Animal Husbandry resources, People’s Republic of China
| | - K. Wang
- Henan Agricultural University, People’s Republic of China
| | - M. Duan
- Tibet Agriculture and Animal Husbandry College, People’s Republic of China; The Provincial and Ministerial co-founded collaborative innovation center for R & D in Tibet characteristic Agricultural and Animal Husbandry resources, People’s Republic of China
| | - M. Wei
- Tibet Agriculture and Animal Husbandry College, People’s Republic of China; The Provincial and Ministerial co-founded collaborative innovation center for R & D in Tibet characteristic Agricultural and Animal Husbandry resources, People’s Republic of China
| | - B. Zhang
- China Agricultural University, People’s Republic of China
| | - Z. Chang
- Tibet Agriculture and Animal Husbandry College, People’s Republic of China
| | - H. Zhang
- China Agricultural University, People’s Republic of China
| | - P. Shang
- Tibet Agriculture and Animal Husbandry College, People’s Republic of China; The Provincial and Ministerial co-founded collaborative innovation center for R & D in Tibet characteristic Agricultural and Animal Husbandry resources, People’s Republic of China
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Li T, Liu JY, Liu JF, Duan M, Li A. The Correlation Between the Types of Initial Bacterial Infection and Clinical Prognosis in Patients With Septic AKI. Front Med (Lausanne) 2022; 8:800532. [PMID: 35155478 PMCID: PMC8828919 DOI: 10.3389/fmed.2021.800532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/24/2021] [Indexed: 12/29/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication of sepsis and is an independent risk factor for mortality. It is unclear whether different bacteria play different roles in the occurrence and development of sepsis-associated AKI (S-AKI). We observed the clinical characteristics and outcomes of patients that have types of bacterial infection, and different infections sites before the occurrence of AKI, respectively. Methods Data of patients who were diagnosed with sepsis and later developed AKI from 2008 to 2019 were retrieved from the MIMIC-IV 1.0 database. Patients were first divided into the two groups according to the bacterial culture results obtained prior to AKI occurrence: bacterial cultured positive (N = 1,785) and bacterial cultured negative (N = 8,777). Patients with bacteria culture positive were divided into culture bacteria Gram-positive (CGP, N = 1248) and Gram-negative (CGN, N = 537) groups. Results Overall, 1,785 patients were included in the present analysis. The patients in CGN group were older (70 vs. 66, p < 0.001), had lower body mass index (BMI) (27.0 vs. 28.4, p < 0.001), higher acute physiology III (APS III) score (63.0 vs. 58, p = 0.001), shorter time from positive microbial culture to diagnosis of AKI (2.94 vs. 3.16 days, p = 0.013) and longer intensive care unit (ICU) stay time (5.94 vs. 4.77 days, p < 0.001) compared with those in the CGP group (n = 1,248). In the culture gram-negative bacteria in patients with positive blood cultures (CGNb) group, the rate of vasopressors using (73.1 vs. 56.4%, P = 0.007), the Sequential Organ Failure Assessment (SOFA) score (10 vs. 9, p = 0.005), and the level of lactate (3.7 vs. 2.5, p = 0.001) were higher than those in the culture gram-positive bacteria in patients with positive blood cultures (CGPb) group. The time from positive microbial culture to the diagnosis of AKI was shorter (2.23 vs. 3 days, p = 0.001) in the CGNb group. However, there was no significant difference in the continuous renal replacement treatment (CRRT) application or short-term mortality rates between CGN and CGP groups. Conclusion The Gram types of bacteria cultured prior to S-AKI occurrence was not related to AKI stage, CRRT application, and short-term mortality. Compared with the Gram-positive bacterial infections, Gram-negative bacterial infections take a shorter time to develop into AKI, and had a higher disease severity score.
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Affiliation(s)
- Tian Li
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jing yuan Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jing feng Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Meili Duan
| | - Ang Li
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ang Li
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Li Z, Ma X, Gao S, Li Q, Luo H, Sun J, Du W, Su L, Wang L, Zhang Q, Li Z, Zhou X, Liu D, Wang X, Guan X, Kang Y, Xiong B, Qin B, Qian K, Wang C, Zhao M, Ma X, Yu X, Lin J, Pan A, Qiu H, Shen F, Li S, Ai Y, Xie X, Yan J, Wu W, Duan M, Wan L, Yang X, Liu J, Xu H, Jiang D, Xu L, Chen Z, Lin G, Yang Z, Hu Z. Association between hospital and ICU structural factors and patient outcomes in China: a secondary analysis of the National Clinical Improvement System Data in 2019. Crit Care 2022; 26:24. [PMID: 35062981 PMCID: PMC8780710 DOI: 10.1186/s13054-022-03892-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/08/2022] [Indexed: 01/09/2023]
Abstract
Background Hospital and ICU structural factors are key factors affecting the quality of care as well as ICU patient outcomes. However, the data from China are scarce. This study was designed to investigate how differences in patient outcomes are associated with differences in hospital and ICU structure variables in China throughout 2019.
Methods This was a multicenter observational study. Data from a total of 2820 hospitals were collected using the National Clinical Improvement System Data that reports ICU information in China. Data collection consisted of a) information on the hospital and ICU structural factors, including the hospital type, number of beds, staffing, among others, and b) ICU patient outcomes, including the mortality rate as well as the incidence of ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSIs), and catheter-associated urinary tract infections (CAUTIs). Generalized linear mixed models were used to analyse the association between hospital and ICU structural factors and patient outcomes.
Results The median ICU patient mortality was 8.02% (3.78%, 14.35%), and the incidences of VAP, CRBSI, and CAUTI were 5.58 (1.55, 11.67) per 1000 ventilator days, 0.63 (0, 2.01) per 1000 catheter days, and 1.42 (0.37, 3.40) per 1000 catheter days, respectively. Mortality was significantly lower in public hospitals (β = − 0.018 (− 0.031, − 0.005), p = 0.006), hospitals with an ICU-to-hospital bed percentage of more than 2% (β = − 0.027 (− 0.034, -0.019), p < 0.001) and higher in hospitals with a bed-to-nurse ratio of more than 0.5:1 (β = 0.009 (0.001, 0.017), p = 0.027). The incidence of VAP was lower in public hospitals (β = − 0.036 (− 0.054, − 0.018), p < 0.001). The incidence of CRBSIs was lower in public hospitals (β = − 0.008 (− 0.014, − 0.002), p = 0.011) and higher in secondary hospitals (β = 0.005 (0.001, 0.009), p = 0.010), while the incidence of CAUTIs was higher in secondary hospitals (β = 0.010 (0.002, 0.018), p = 0.015).
Conclusion This study highlights the association between specific ICU structural factors and patient outcomes. Modifying structural factors is a potential opportunity that could improve patient outcomes in ICUs. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03892-7.
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21
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Xiao H, Wang G, Wang Y, Tan Z, Sun X, Zhou J, Duan M, Zhi D, Tang Z, Hang C, Zhang G, Li Y, Wu C, Li F, Zhang H, Wang J, Zhang Y, Zhang X, Guo W, Qi W, Xie M, Li C. Potential Value of Presepsin Guidance in Shortening Antibiotic Therapy in Septic Patients: a Multicenter, Prospective Cohort Trial. Shock 2022; 57:63-71. [PMID: 34618727 DOI: 10.1097/shk.0000000000001870] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Long-term use of antibiotics for septic patients leads to bacterial resistance, increased mortality, and hospital stay. In this study, we investigated an emerging biomarker presepsin-guided strategy, which can be used to evaluate the shortening of antibiotic treatment in patients with sepsis without risking a worse outcome. METHODS In this multicenter prospective cohort trial, patients were assigned to the presepsin or control groups. In the presepsin group, antibiotics were ceased based on predefined cut-off ranges of presepsin concentrations. The control group stopped antibiotics according to international guidelines. The primary endpoints were the number of days without antibiotics within 28 days and mortality at 28 and 90 days. Secondary endpoints were the percentage of patients with a recurrent infection, length of stay in ICU and hospital, hospitalization costs, days of first episode of antibiotic treatment, percentage of antibiotic administration and multidrug-resistant bacteria, and SOFA score. RESULTS Overall, 656 out of an initial 708 patients were eligible and assigned to the presepsin group (n = 327) or the control group (n = 329). Patients in the presepsin group had significantly more days without antibiotics than those in the control group (14.54 days [SD 9.01] vs. 11.01 days [SD 7.73]; P < 0.001). Mortality in the presepsin group showed no difference to that in the control group at days 28 (17.7% vs. 18.2%; P = 0.868) and 90 (19.9% vs. 19.5%; P = 0.891). Patients in the presepsin group had a significantly shorter mean length of stay in the hospital and lower hospitalization costs than control subjects. There were no differences in the rate of recurrent infection and multidrug-resistant bacteria and the SOFA score tendency between the two groups. CONCLUSIONS Presepsin guidance has potential to shorten the duration of antibiotic treatment in patients with sepsis without risking worse outcomes of death, recurrent infection, and aggravation of organ failure. TRIAL REGISTRATION ChiCTR, ChiCTR1900024391. Registered 9 July 2019-Retrospectively registered, http://www.chictr.org.cn.
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Affiliation(s)
- Hongli Xiao
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guoxing Wang
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhimin Tan
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuelian Sun
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jie Zhou
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Deyuan Zhi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ziren Tang
- EICU of Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chenchen Hang
- EICU of Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Zhang
- EICU of Department of Emergency Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- EICU of Department of Emergency Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Caijun Wu
- EICU of Department of Emergency Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fengjie Li
- EICU of Department of Emergency Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- EICU of Department of Emergency Medicine, The Hospital of Shunyi District Beijing, China Medical University, Beijing, China
| | - Jing Wang
- EICU of Department of Emergency Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yun Zhang
- EICU of Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinchao Zhang
- EICU of Department of Emergency Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Guo
- EICU of Department of Emergency Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenjie Qi
- Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Miaorong Xie
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunsheng Li
- EICU of Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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He J, Lin J, Duan M. Application of Machine Learning to Predict Acute Kidney Disease in Patients With Sepsis Associated Acute Kidney Injury. Front Med (Lausanne) 2021; 8:792974. [PMID: 34957162 PMCID: PMC8703139 DOI: 10.3389/fmed.2021.792974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Sepsis-associated acute kidney injury (AKI) is frequent in patients admitted to intensive care units (ICU) and may contribute to adverse short-term and long-term outcomes. Acute kidney disease (AKD) reflects the adverse events developing after AKI. We aimed to develop and validate machine learning models to predict the occurrence of AKD in patients with sepsis-associated AKI. Methods: Using clinical data from patients with sepsis in the ICU at Beijing Friendship Hospital (BFH), we studied whether the following three machine learning models could predict the occurrence of AKD using demographic, laboratory, and other related variables: Recurrent Neural Network-Long Short-Term Memory (RNN-LSTM), decision trees, and logistic regression. In addition, we externally validated the results in the Medical Information Mart for Intensive Care III (MIMIC III) database. The outcome was the diagnosis of AKD when defined as AKI prolonged for 7-90 days according to Acute Disease Quality Initiative-16. Results: In this study, 209 patients from BFH were included, with 55.5% of them diagnosed as having AKD. Furthermore, 509 patients were included from the MIMIC III database, of which 46.4% were diagnosed as having AKD. Applying machine learning could successfully achieve very high accuracy (RNN-LSTM AUROC = 1; decision trees AUROC = 0.954; logistic regression AUROC = 0.728), with RNN-LSTM showing the best results. Further analyses revealed that the change of non-renal Sequential Organ Failure Assessment (SOFA) score between the 1st day and 3rd day (Δnon-renal SOFA) is instrumental in predicting the occurrence of AKD. Conclusion: Our results showed that machine learning, particularly RNN-LSTM, can accurately predict AKD occurrence. In addition, Δ SOFAnon-renal plays an important role in predicting the occurrence of AKD.
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Affiliation(s)
| | | | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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23
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Lin J, Zhuang HZ, Zhi DY, Qi Z, Bai J, Dong L, Liu S, Duan M. Impact of Cumulative Fluid Balance During Continuous Renal Replacement Therapy on Mortality in Patients With Septic Acute Kidney Injury: A Retrospective Cohort Study. Front Med (Lausanne) 2021; 8:762112. [PMID: 34869467 PMCID: PMC8636134 DOI: 10.3389/fmed.2021.762112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The clinicians often use continuous renal replacement therapy (CRRT) for the fluid management of patients with septic acute kidney injury (AKI). However, there is limited knowledge of the effects of changes in fluid balance (FB) on CRRT and its association with outcomes in patients with septic AKI. Objective: This study aimed to determine the association of cumulative FB (CFB) during treatment with 28-day all-cause mortality in the patients with septic AKI who require CRRT. Methods: This retrospective observational study examined patients who received CRRT due to septic AKI in a mixed intensive care unit (ICU) of a tertiary teaching hospital between January 2015 and December 2018. The patients were divided into three groups—negative FB, even FB, and positive FB—based on the CFB during CRRT. The primary outcome was 28-day all-cause mortality. Results: We examined 227 eligible patients and the mean age was 62.4 ± 18.3 years. The even FB group had a significantly lower 28-day mortality (43.0%, p = 0.007) than the positive FB group (72.7%) and the negative FB group (54.8%). The unadjusted and adjusted Cox regression models indicated that the positive FB group had an increased risk for 28-day all-cause mortality relative to the even FB group. A restricted cubic splines model indicated a J-shaped association between the CFB and 28-day all-cause mortality in the unadjusted model. Conclusion: Among the critically ill patients with septic AKI who require CRRT, those with positive FB had a higher mortality rate than those with even FB.
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Affiliation(s)
- Jin Lin
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hai Zhou Zhuang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - De Yuan Zhi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhili Qi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Bai
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Dong
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuai Liu
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Zhou X, Zeng N, Liu P, Liu Z, Duan M. Sex Differences in In-hospital Mortality of Patients With Septic Shock: An Observational Study Based on Data Analysis From a Cover Sheet of Medical Records in Beijing. Front Med (Lausanne) 2021; 8:733410. [PMID: 34708054 PMCID: PMC8542919 DOI: 10.3389/fmed.2021.733410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The goal of our study was to evaluate the association of sex and in-hospital mortality in patients with septic shock in Beijing, China. Materials and Methods: We analyzed 3,643 adult patients with septic shock from January 1, 2019, to Dec 31, 2019, in all secondary and tertiary hospitals in Beijing. Study data were retrospectively extracted from the Quality Control Center of Beijing Municipal Health Commission. Results: There were 2,345 (64.37%) male and 1,298 (35.63%) female patients. Compared to male patients, female patients with septic shock had a higher in-hospital mortality rate (55.54 vs. 49.29%, p < 0.01). The median length of hospitalization stay for male patients was 22.71 days, while that for female patients was 19.72 days (p > 0.01). Male patients had a higher prevalence of pulmonary infection (68.8 vs. 31.2%, p < 0.01). The B values of sex in univariate and multivariate logistic regression were −0.251 and −0.312, respectively. Men had a lower likelihood of hospital mortality than women (OR = 0.732, 95% CI = 0.635–0.844, p = 0.000). Conclusions: Female patients with septic shock had a higher risk of dying in the hospital than male patients.
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Affiliation(s)
- Xiao Zhou
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Na Zeng
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pei Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhuang Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Zhu Y, Duan M, Dijk HH, Freriks RD, Dekker LH, Mierau JO. Socio-economic disparities in self-reported, tested, and diagnosed COVID-19 status. Eur J Public Health 2021. [PMCID: PMC8574667 DOI: 10.1093/eurpub/ckab164.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Backgrounds
Studies in clinical settings showed a potential relationship between Socio-Economic Status (SES) and lifestyle factors with COVID-19, but it is still unknown whether this holds in the general population. In this study we investigated the associations of SES with self-reported, tested, and diagnosed COVID-19 status in the general population.
Methods
Participants were 49,474 men and women (46 ± 12 yrs) residing in the Northern Netherlands from the Lifelines cohort study. SES indicators and lifestyle factors (i.e., smoking status, physical activity, alcohol intake, diet quality, sleep time, and TV watching time) were assessed by questionnaire from the Lifelines Biobank. Self-reported, tested, and diagnosed COVID-19 status were obtained from the Lifelines COVID-19 questionnaire.
Results
There were 4,711 participants who self-reported having had a COVID-19 infection, 2,883 participants tested for COVID-19, and 123 positive cases diagnosed in this study population. After adjustment for age, sex, lifestyle factors, BMI, and ethnicity, we found that participants with low education or low income were less likely to self-report a COVID-19 infection (OR [95%CI]: low education 0.78 [0.71-0.86]; low income 0.86 [0.79-0.93]), and be tested for COVID-19 (OR [95%CI]: low education 0.58 [0.52-0.66]; low income 0.86 [0.78-0.95]) compared with high education or high income groups, respectively.
Conclusions
Our findings suggest that the low SES group was the most vulnerable population to COVID-19 infection and self-reported and tested COVID-19 status in the general population was better predicted by SES than by lifestyle factors.
Key messages
This study innovatively included a broader range of COVID-19 status, including self-reported and tested COVID-19 status, to better understand COVID-19 related socio-economic factors. This study added evidence to the socio-economically patterned COVID-19 status in a general population instead of in clinical settings.
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Affiliation(s)
- Y Zhu
- Internal Medicine, UMCG, Groningen, Netherlands
| | - M Duan
- Internal Medicine, UMCG, Groningen, Netherlands
| | - HH Dijk
- Economics and Business, University of Groningen, Groningen, Netherlands
| | - RD Freriks
- Economics and Business, University of Groningen, Groningen, Netherlands
| | - LH Dekker
- Internal Medicine, UMCG, Groningen, Netherlands
- Aletta Jacobs School of Public Health, University of Groningen, Groningen, Netherlands
| | - JO Mierau
- Economics and Business, University of Groningen, Groningen, Netherlands
- Aletta Jacobs School of Public Health, University of Groningen, Groningen, Netherlands
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Liu J, Wang Z, Li T, Guo X, Pang R, Duan M. [Effect of Xuebijing injection on endothelial microparticles and renal cortical microcirculation in septic rats]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2021; 33:1203-1208. [PMID: 34955129 DOI: 10.3760/cma.j.cn121430-20210302-00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To clarify the characteristics of renal cortical microcirculation and its relationship with the expression of plasma endothelial microparticle (EMP) in septic rats, and to evaluate the effect of Xuebijing injection as an adjuvant therapy of antibiotics on septic AKI. METHODS The 8-10 weeks old specific pathogen free (SPF) male Sprague-Dawley (SD) rats were divided into sham operation group (Sham group), positive drug control group and Xuebijing group by the random number table method, with 10 rats in each group. The cecal ligation and puncture (CLP) with large ligation (ligated 75% of the cecum) was used to prepare a rat high-grade sepsis model; in the Sham group, the cecum was stretched without ligation or puncture. Due to the high mortality of CLP with large ligation, Xuebijing injection (4 mL/kg, 12 hours per time) and imipenem/cilastatin injection (90 mg/kg, 6 hours per time) were administered to the rats in the Xuebijing group via the tail vein immediately after the model was produced. Normal saline and imipenem/cilastatin were administered to the rats by the same methods in the positive drug control group. The rats in the Sham group were treated with the same volume of normal saline as any of the other two groups at the same frequency. At 48 hours after model reproduction, the mean arterial pressure (MAP) and blood lactic acid (Lac) of the rats were measured. The renal cortical microcirculation was monitored by using side stream dark-field imaging. Renal hypoxia signals were assessed by pimonidazole chloride immunohistochemistry. Plasma EMP levels were determined by using flow cytometry, and then the correlation between EMP and microcirculation parameters of renal cortex was analyzed. At the same time, the serum creatinine (SCr) was measured, and the renal injury score (Paller score) was used to evaluate the severity of renal tissue pathological damage. RESULTS Compared with the Sham group, perfused vessel density (PVD), microvascular flow index (MFI) and MAP in the positive drug control group and the Xuebijing group decreased significantly, the positive expression of hypoxia probe (pimonidazole) increased, Lac, EMP, Paller score and SCr increased significantly. However, compared with the positive drug control group, the renal cortical microcirculation in the Xuebijing group was improved significantly, PVD and MFI were increased significantly [PVD (mm/mm2): 16.20±1.20 vs. 9.77±1.12, MFI: 2.46±0.05 vs. 1.85±0.15, both P < 0.05], Lac was reduced significantly (mmol/L: 4.81±1.23 vs. 6.08±1.09, P < 0.05), MAP increased slightly [mmHg (1 mmHg = 0.133 kPa): 84.00±2.00 vs. 80.00±2.00, P > 0.05], suggested that Xuebijing injection improved renal microcirculation perfusion in septic rats, and this effect did not depend on the change of MAP. The positive expression of pemonidazole in renal cortex of the Xuebijing group was significantly lower than that of the positive drug control group [(35.89±1.13)% vs. (44.93±1.37) %, P < 0.05], suggested that Xuebijing injection alleviated renal hypoxia. The plasma EMP levels of rats in the Xuebijing group were significantly lower than those in the positive drug control group (×106/L: 3.49±0.17 vs. 5.78±0.22, P < 0.05), and the EMP levels were significantly negatively correlated with PVD and MFI (r values were -0.94 and -0.95, respectively, both P < 0.05), indicated that the increase of plasma EMP was highly correlated with renal microcirculation disorder, and Xuebijing injection inhibited the increase of plasma EMP levels. The Paller score in the Xuebijing group was significantly lower than that in the positive drug control group (46.90±3.84 vs. 62.70±3.05, P < 0.05), and the level of SCr was also significantly lower than that in the positive drug control group (μmol/L: 121.1±12.4 vs. 192.7±23.9, P < 0.05), which suggested that Xuebijing injection relieved kidney injury and improved renal function in septic rats. CONCLUSIONS As an adjuvant therapy of antibiotics, Xuebijing injection could inhibit the expression of plasma EMP in rats with sepsis, improve renal cortex microcirculation, and reduce kidney injury.
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Affiliation(s)
- Jingfeng Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China. Corresponding author: Duan Meili,
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Wang H, Ji X, Wang AY, Wu PK, Liu Z, Dong L, Liu J, Duan M. Epidemiology of Sepsis-Associated Acute Kidney Injury in Beijing, China: A Descriptive Analysis. Int J Gen Med 2021; 14:5631-5649. [PMID: 34548815 PMCID: PMC8449640 DOI: 10.2147/ijgm.s320768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background Sepsis is the most common contributing factor towards development of acute kidney injury (AKI), which is strongly associated to poor prognostic outcomes. There are numerous epidemiological studies about sepsis-associated acute kidney injury (S-AKI), however current literature is limited with the majority of studies being conducted only in the intensive care unit (ICU) setting. The aim of this study was to assess the epidemiology of S-AKI in all hospitalized in-patients. Methods This was a retrospective population-based study using a large regional population database in Beijing city from January, 2005 to December, 2017. It included patients with S-AKI. Patients with pre-existing end-stage kidney disease (ESKD), previous history of kidney transplantation, or being pregnant were excluded. Patients’ demographic characteristics, incidence, risk factors and outcomes of S-AKI were analyzed. The contrast between different time periods, different levels of hospitals, and types of the hospitals (traditional Chinese medicine hospitals (TCMHs) and western medicine hospitals (WMHs)) was also compared using Mann–Whitney U-test. Results A total of 19,579 patients were included. The overall incidence of S-AKI in all in-patients was 48.1%. The significant risk factors by multivariate analysis for AKI included: age, male, being treated in a level-II hospital, pre-existing hypertension, chronic kidney disease (CKD), cirrhosis, atrial fibrillation (AF), ischemic heart disease (IHD), being admitted from emergency room, ICU admission, shock, pneumonia, intra-abdominal infection, bloodstream infection, respiratory insufficiency, acute liver injury, disseminated intravascular coagulation (DIC) and metabolic encephalopathy. The overall mortality rate in this cohort was 55%. The multivariate analysis showed that the significant risk factors for mortality included: age, being treated in a level-II hospital and TCMHs, being admitted from emergency room, pre-existing comorbidities (CKD, malignancy, cirrhosis and AF), shock, pneumonia, intra-abdominal infection, bloodstream infection, central nervous system (CNS) infection and respiratory insufficiency. Conclusion AKI is a common complication in patients with sepsis, and its incidence increases over time, especially when ICU admission is required. Exploring interventional strategies to address modifiable risk factors will be important to reduce incidence and mortality of S-AKI.
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Affiliation(s)
- Haiman Wang
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Xiaojun Ji
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Amanda Ying Wang
- Division of the Renal and Metabolic, George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.,Concord Clinical School, the University of Sydney, Sydney, Australia.,Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia
| | | | - Zhuang Liu
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Lei Dong
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Jingfeng Liu
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Meili Duan
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
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Liu J, Wang Z, Lin J, Li T, Guo X, Pang R, Dong L, Duan M. Xuebijing injection in septic rats mitigates kidney injury, reduces cortical microcirculatory disorders, and suppresses activation of local inflammation. J Ethnopharmacol 2021; 276:114199. [PMID: 33989736 DOI: 10.1016/j.jep.2021.114199] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Xuebijing injections originate from the traditional Chinese medicine (TCM) prescription XuefuZhuyu Decoction. It is composed of five Chinese herbal extracts; Carthami flos, Paeoniae radix rubra, Chuanxiong rhizoma, Salviae miltiorrhizae, and Angelicae Sinensis radix. The China Food and Drug Administration approved Xuebijing injections as a TCM preparation for the adjuvant treatment of sepsis. AIM OF THE STUDY This study aims to determine the effects of Xuebijing injections as an adjuvant to antibiotics for the treatment of renal microcirculatory dysfunction and renal inflammation in rats with sepsis. MATERIALS AND METHODS The rats received a sham operation (Sham), sham operation followed by Xuebijign injection (Sxbj), cecal ligation and puncture (CLP), or CLP followed by Xuebijing injection (Cxbj). Renal microvascular perfusion in the cortex and oxygenation were assessed at different times after sepsis induction. Renal levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and high mobility group box (HMGB)-1 were measured. Urinary TIMP-2 × IGFBP-7 and neutrophil gelatinase-associated lipocalin (NGAL) were measured as kidney biomarkers, and serum creatinine (SCr) was used to assess kidney injury. Tissue samples were stained for histologic evaluation. RESULTS The induction of sepsis increased local inflammation and decreased renal microvascular perfusion and oxygenation. Compared with the CLP group, the Cxbj group displayed improvements in microvascular perfusion and oxygenation (p < 0.05). The CLP group had significant increases in renal inflammatory biomarkers (IL-1β, IL-6, TNF-α, and HMGB-1; p < 0.05) and Xuebijing injection reduced the levels of these markers. The levels of urinary TIMP-2 × IGFBP-7, NAGL, and SCr were lower in the Cxbj group than in the CLP group (p < 0.05), and the CLP group had a higher Paller score than the Cxbj group (p < 0.05). However, the CLP and Cxbj groups had no significant difference in mortality. CONCLUSIONS This study into the early stages of sepsis in a rat model indicated that as an adjuvant therapy to antibiotics, Xuebijing injection improved renal perfusion and oxygenation, suppressed renal inflammation, and ameliorated kidney dysfunction. However, Xuebijing injection had no impact on mortality.
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Affiliation(s)
- Jingfeng Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Zhenzhou Wang
- National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration, Trauma Center, Peking University People's Hospital, Beijing, 100000, China.
| | - Jin Lin
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Tian Li
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Xinjie Guo
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Ran Pang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Lei Dong
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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Ma P, Liu J, Shen F, Liao X, Xiu M, Zhao H, Zhao M, Xie J, Wang P, Huang M, Li T, Duan M, Qian K, Peng Y, Zhou F, Xin X, Wan X, Wang Z, Li S, Han J, Li Z, Ding G, Deng Q, Zhang J, Zhu Y, Ma W, Wang J, Kang Y, Zhang Z. Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen. Crit Care 2021; 25:243. [PMID: 34253228 PMCID: PMC8273991 DOI: 10.1186/s13054-021-03682-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Septic shock comprises a heterogeneous population, and individualized resuscitation strategy is of vital importance. The study aimed to identify subclasses of septic shock with non-supervised learning algorithms, so as to tailor resuscitation strategy for each class. METHODS Patients with septic shock in 25 tertiary care teaching hospitals in China from January 2016 to December 2017 were enrolled in the study. Clinical and laboratory variables were collected on days 0, 1, 2, 3 and 7 after ICU admission. Subclasses of septic shock were identified by both finite mixture modeling and K-means clustering. Individualized fluid volume and norepinephrine dose were estimated using dynamic treatment regime (DTR) model to optimize the final mortality outcome. DTR models were validated in the eICU Collaborative Research Database (eICU-CRD) dataset. RESULTS A total of 1437 patients with a mortality rate of 29% were included for analysis. The finite mixture modeling and K-means clustering robustly identified five classes of septic shock. Class 1 (baseline class) accounted for the majority of patients over all days; class 2 (critical class) had the highest severity of illness; class 3 (renal dysfunction) was characterized by renal dysfunction; class 4 (respiratory failure class) was characterized by respiratory failure; and class 5 (mild class) was characterized by the lowest mortality rate (21%). The optimal fluid infusion followed the resuscitation/de-resuscitation phases with initial large volume infusion and late restricted volume infusion. While class 1 transitioned to de-resuscitation phase on day 3, class 3 transitioned on day 1. Classes 1 and 3 might benefit from early use of norepinephrine, and class 2 can benefit from delayed use of norepinephrine while waiting for adequate fluid infusion. CONCLUSIONS Septic shock comprises a heterogeneous population that can be robustly classified into five phenotypes. These classes can be easily identified with routine clinical variables and can help to tailor resuscitation strategy in the context of precise medicine.
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Affiliation(s)
- Penglin Ma
- Department of Critical Care Medicine, Guiqian International General Hospital, Guiyang, People's Republic of China
| | - Jingtao Liu
- Department of Critical Care Medicine, The 8th Medical Center of Chinese, PLA General Hospital, Beijing, 100091, People's Republic of China
| | - Feng Shen
- Department of Intensive Care Unit, Guizhou Medical University Affiliated Hospital, Guiyang, People's Republic of China
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Ming Xiu
- Department of Intensive Care Unit, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Heling Zhao
- Department of Critical Care Medicine, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Mingyan Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Jing Xie
- General Intensive Care Unit Department, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Peng Wang
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Man Huang
- General Intensive Care Unit, Second Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China
| | - Tong Li
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Kejian Qian
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yue Peng
- Department of Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Feihu Zhou
- Department of Critical Care Medicine, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Xin
- Surgical Intensive Care Unit, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xianyao Wan
- The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - ZongYu Wang
- Department of Intensive Care, Peking University Third Hospital, Beijing, People's Republic of China
| | - Shusheng Li
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jianwei Han
- Department of Critical Care Medicine, The 8th medical Center of Chinese, PLA General Hospital, Beijing, People's Republic of China
| | - Zhenliang Li
- Department of Critical Care, Beijing PingGu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Guolei Ding
- Intensive Care Unit, The Hospital of Shunyi District, Beijing, People's Republic of China
| | - Qun Deng
- Department of Critical Care Medicine, The 4th Medical Center of Chinese, PLA General Hospital, Beijing, People's Republic of China
| | - Jicheng Zhang
- Department of Critical Care Medicine, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Yue Zhu
- Department of Critical Care, Beijing Luhe Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenjing Ma
- Department of Critical Care, Beijing Miyun Hospital, Beijing, People's Republic of China
| | - Jingwen Wang
- Intensive Care Unit, Beijing Changping District Hospital, Beijing, People's Republic of China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, People's Republic of China.
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Wang Z, Liu J, Liu X, Guo X, Li T, Pang R, Duan M. Perfusion microvessel density in the cerebral cortex of septic rats is negatively correlated with endothelial microparticles in circulating plasma. Metab Brain Dis 2021; 36:1029-1036. [PMID: 33625638 DOI: 10.1007/s11011-021-00702-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
In sepsis, endothelial microparticles (EMPs) released from endothelial cells (ECs) participate in microcirculation dysfunction through pro-coagulant and pro-inflammatory effects, which can lead to sepsis-associated brain dysfunction. However, the relationship between EMPs and cerebral cortical perfusion microvessel density has not been explored. A closed cranial window was created in rats who were tended to until the cerebral cortex edema caused by preparation of the cranial window subsided, and the microvessel density was stable. A cecal ligation and puncture (CLP) sepsis procedure was then performed on day 6, post-surgery. At 12 and 24 h after the CLP, cerebral cortical perfusion microvessel density was measured with optical coherence tomography angiography (OCTA), followed by measurement of EMPs to evaluate the relationship between these factors. Microvessel density changed from 46.38 % ± 7.65 % on the day of surgery to 35.87 % ± 11.05 % on the second day and 36.71 % ± 11.38 % on the third day after surgery, and then increased daily. The microvessel density decreased to 27.20 % ± 8.50 % 24 h after CLP, which was significantly lower than that immediately and 12 h after CLP (P < 0.001). EMPs increased progressively at 12 and 24 h after CLP. Moreover, there was a negative correlation between EMPs and microvessel density (r=-0.56, P = 0.01). Edema and microvessel density decreased in the local cerebral cortex of the window and then gradually recovered after cranial window surgery. In sepsis, the perfusion microvessel density of the cerebral cortex negatively correlated with the EMPs. Therefore, the perfusion microvessel density can be indirectly evaluated by detecting the plasma EMP level.
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Affiliation(s)
- Zhenzhou Wang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Jingfeng Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Xi Liu
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
| | - Xinjie Guo
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Tian Li
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Ran Pang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xi Cheng District, Beijing, 100050, China.
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Zhi D, Zhang M, Lin J, Liu P, Wang Y, Duan M. Wedelolactone improves the renal injury induced by lipopolysaccharide in HK-2 cells by upregulation of protein tyrosine phosphatase non-receptor type 2. J Int Med Res 2021; 49:3000605211012665. [PMID: 33983070 PMCID: PMC8127797 DOI: 10.1177/03000605211012665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To explore the effects of wedelolactone (WEL) on sepsis-induced renal injury in the human renal proximal tubular epithelial cell line HK-2. Methods HK-2 cells were stimulated by 1 µg/ml lipopolysaccharide (LPS) to trigger renal injury in vitro. HK-2 cells were pretreated with or without WEL (0.1, 1 and 10 µM) before LPS stimulation. Protein and mRNA analyses were performed using enzyme-linked immunosorbent assays, Western blot analysis and quantitative reverse transcription–polymerase chain reaction. The MTT assay and flow cytometry were used to measure cell viability and the rate of cell apoptosis. Protein tyrosine phosphatase non-receptor type 2 (PTPN2) knockdown was induced by the transection of HK-2 cells with short hairpin RNA. Results Cell viability was significantly increased in a dose-dependent manner by WEL in LPS-induced HK-2 cells. WEL also decreased the levels of four inflammatory cytokines and cell apoptosis in LPS-induced HK-2 cells. The level of PTPN2 was increased after WEL treatment. PTPN2 knockdown partly abolished the inhibitory effects of WEL on cell apoptosis, the levels of inflammatory cytokines and on p38 mitogen-activated protein kinase/nuclear factor-kappaB signalling in LPS-induced HK-2 cells. Conclusion WEL improved renal injury by suppressing inflammation and cell apoptosis through upregulating PTPN2 in HK-2 cells. PTPN2 might be used as a potential therapeutic target for LPS-induced sepsis.
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Affiliation(s)
- Deyuan Zhi
- Department of Critical Care Medicine, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Meng Zhang
- Department of Critical Care Medicine, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Jin Lin
- Department of Critical Care Medicine, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Pei Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yajun Wang
- Department of Critical Care Medicine, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
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Zhang M, Duan M, Zhi D, Lin J, Liu P, Wang Y. Risk factors for 28-day mortality in patients with sepsis-related myocardial injury in intensive care units. J Int Med Res 2021; 49:3000605211004759. [PMID: 33884912 PMCID: PMC8072103 DOI: 10.1177/03000605211004759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to identify the risk factors for death in patients with
sepsis-related myocardial injury. Methods A retrospective study was conducted in 158 patients with sepsis-related
myocardial injury in a mixed medical intensive care unit from January 2009
to March 2020. The patients were divided into those who survived and those
who died on the basis of whether they survived after 28 days. Demographic
and clinical parameters were collected. Multivariate logistic regression was
performed. Results Sixty-nine (43.7%) patients died within 28 days after admission to the
intensive care unit. Multivariate logistic regression analysis showed that
the oxygenation index (odds ratio [OR]: 0.979, 95% confidence interval [CI]:
0.970–0.989), acute kidney injury (OR: 4.787, 95% CI: 1.674–13.693),
norepinephrine dose (OR: 1.706, 95% CI: 1.375–2.117), and abdominopelvic
cavity infection (OR: 0.257, 95% CI: 0.076–0.866) were significantly
associated with mortality within 28 days after admission in patients with
sepsis-related myocardial injury. Conclusions Patients with sepsis-related myocardial injury have a high mortality rate. A
high oxygenation index, occurrence of acute kidney injury, high
norepinephrine dose, and occurrence of abdominopelvic cavity infection are
independent risk factors for 28-day mortality in patients with
sepsis-related myocardial injury.
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Affiliation(s)
- Meng Zhang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Deyuan Zhi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jin Lin
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pei Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yajun Wang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Zhi D, Lin J, Dong L, Ji X, Zhuang H, Liu Z, Liu J, Duan M. Risk predictive role of hypernatremia for occurrence of sepsis-induced acute kidney injury. Ann Palliat Med 2021; 10:4705-4715. [PMID: 33966419 DOI: 10.21037/apm-21-792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Septic acute kidney injury (AKI), identified when sepsis and AKI present concurrently, is a syndrome of acute function impairment and organ damage, which accounts for ~50% AKI in the intensive care unit (ICU). METHODS This study retrospectively reviewed 591 patients who were diagnosed with sepsis and admitted to the ICU of Beijing Friendship Hospital from January 2009 to December 2014. According to the concentration of serum sodium, the 591 patients were further divided into 3 groups: normal group, hyponatremia group, and hypernatremia group. RESULTS The arterial partial pressure of carbon dioxide (PaCO2, P=0.014), concentration of sodium (Na+, P<0.001), and chloride ion (Cl-, P<0.001), blood urea nitrogen (BUN, P<0.001), acute physiology and chronic health evaluation (APACHE) score (P<0.001), sequential organ failure assessment (SOFA) score (P<0.001), and Glasgow score (P<0.001) showed significant differences. The SOFA score [P=0.040; odds ratio (OR) =1.261], body mass index (BMI, P=0.041; OR =1.229), P content (P=0.032; OR =7.180) and creatine kinase myocardial band (CK-MB, P=0.006; OR =1.168) may be risk factors for occurrence of AKI in patients with hypernatremia. The AKI (P<0.001; OR =6.850) and P content (P=0.027; OR =3.676) may be risk factors for death in patients with hypernatremia. The Na+ suggested a predictive ability for AKI (P<0.001; area under the curve (AUC): 0.586) but not for death (P=0.104). CONCLUSIONS Hypernatremia is independently associated with an increased risk and has a predictive ability of AKI in patients with sepsis.
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Affiliation(s)
- Deyuan Zhi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jin Lin
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Dong
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaojun Ji
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haizhou Zhuang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhuang Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jingfeng Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Xiao H, Wang G, Wang Y, Tan Z, Sun X, Zhou J, Duan M, Zhi D, Tang Z, Hang C, Zhang G, Li Y, Wu C, Li F, Zhang H, Wang J, Zhang Y, Zhang X, Guo W, Qi W, Xie M, Li C. Presepsin Guidance Reduces the Duration of Antibiotic Treatment in Patients with Sepsis: A Multicenter, Prospective Cohort Trial.. [DOI: 10.21203/rs.3.rs-432564/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Abstract
Background: Long-term use of antibiotics for septic patients leads to antibiotic resistance. This study aimed at assessing the benefit and safety of an emerging biomarker presepsin on guiding antibiotic courses for patients with sepsis. Methods: In this multicenter prospective cohort trial, patients were assigned to the presepsin or control groups. In the presepsin group, antibiotics were ceased based on predefined cut-off ranges of presepsin concentrations. The control group stopped antibiotics according to international guidelines. The primary endpoints were the number of days without antibiotics within 28 days (superiority analysis) and mortality at 28 and 90 days (non-inferiority analysis). The margin of non-inferiority was 10%.Results: Overall, 656 out of an initial 708 patients were eligible and assigned to the presepsin group (n=327) or the control group (n=329). Patients in the presepsin group had significantly more days without antibiotics than those in the control group (14.54 days [SD 9.01] vs 11.01 days [SD 7.73]; absolute difference 3.64 days, p =0.000). Mortality in the presepsin group was non-inferior to that in the control group at days 28 (17.7% vs 18.2%; absolute difference -0∙5%, 90% CI -5.4 to 4.4) and 90 (19.9% vs 19.5%; 0.4%, -4.7 to 5.5). Patients in the presepsin group had a significantly shorter mean length of stay in the hospital and lower hospitalization costs than control subjects.Conclusions: Presepsin guidance reduces the duration of antibiotic treatment in patients with sepsis without increasing mortality. Trial registration: ChiCTR, ChiCTR1900024391. Registered 9 July 2019. Retrospectively registered.
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Affiliation(s)
- Hongli Xiao
- Capital Medical University Affiliated Beijing Friendship Hospital
| | - Guoxing Wang
- Capital Medical University Affiliated Beijing Friendship Hospital
| | - Yan Wang
- Capital Medical University Affiliated Beijing Friendship Hospital
| | - Zhimin Tan
- Capital Medical University Affiliated Beijing Friendship Hospital
| | - Xuelian Sun
- Capital Medical University Affiliated Beijing Friendship Hospital
| | - Jie Zhou
- Capital Medical University Affiliated Beijing Friendship Hospital
| | - Meili Duan
- Capital Medical University Affiliated Beijing Friendship Hospital
| | - Deyuan Zhi
- Capital Medical University Affiliated Beijing Friendship Hospital
| | - Ziren Tang
- Beijing Chao-Yang Hospital: Beijing Chaoyang Hospital
| | - Chenchen Hang
- Beijing Chao-Yang Hospital: Beijing Chaoyang Hospital
| | | | - Yan Li
- China-Japan Friendship Hospital
| | - Caijun Wu
- Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital
| | | | | | - Jing Wang
- Beijing Xuanwu Hospital: Xuanwu Hospital
| | - Yun Zhang
- Beijing Tongren Hospital Otolaryngology and Head and Neck Surgery Center: Beijing Tongren Hospital
| | | | | | - Wenjie Qi
- Capital Medical University Affiliated Beijing Friendship Hospital
| | - Miaorong Xie
- Capital Medical University Affiliated Beijing Friendship Hospital
| | - Chunsheng Li
- Deparment of Emergency, Beijing Friendship Hospital, Capital Medical University
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Li Y, Cao L, Guo Z, Gu LL, Duan M, Wu EH, Gong JF, Zhu WM. [Characteristics and predictors of postoperative outcome of Crohn disease patients requiring abdominal surgery: a series of 1 048 cases from a single inflammatory bowel disease centre]. Zhonghua Wai Ke Za Zhi 2021; 59:40-45. [PMID: 33412632 DOI: 10.3760/cma.j.cn112139-20200304-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine the clinical characteristics, the potential relative factors for postoperative abdominal septic complications, and prognosis factors of surgical recurrence of Crohn disease (CD) patients after the first surgery. Methods: All the CD patients from Department of General Surgery, Jinling Hospital, Medical School of Nanjing University who had undergone at least one abdominal surgery from January 2007 to December 2017 were included for retrospective analysis. Hospital records were reviewed for information on clinical characteristics. Relative factors of postoperative abdominal septic complications were accessed by Logistic regression models, and prognosis factors of surgical recurrence were accessed by Cox proportional hazards regression models. Results: There were 1 048 patients included (733 males and 315 females), accounting for 1 513 operations. The age was 31(17) years and the length of resected small bowel was 30.0(40.0) cm at the first resection, 20.0(35.0) cm at the second resection, and 20.0(23.5) cm at the third resection. The length of resected small bowel was 25.0(40.0) cm at any resection. At the first abdominal surgery, 70.99%(744/1 048) patients were aged between 17 and 40 years, 66.98%(702/1 048) patients had ileocolonic disease, and 60.40%(633/1 048) patients had penetrating behavior. Penetrating behavior (OR=8.594, 95%CI: 3.397 to 21.740, P<0.01) and current smoking status (OR=2.671, 95%CI: 1.044 to 6.832, P=0.040) were significantly associated with an increased risk of postoperative septic complications, whereas staged operation (OR=0.360, 95%CI: 0.184 to 0.707, P=0.003) was associated with a decreased risk. Male gender (HR=1.500, 95%CI: 1.128 to 1.995, P=0.005), upper gastrointestinal disease (HR=1.526, 95%CI: 1.033 to 2.255, P=0.034), penetrating behavior (HR=1.506, 95%CI: 1.132 to 2.003, P=0.005) and emergency surgery (HR=1.812, 95%CI: 1.375 to 2.387, P<0.01) were significantly associated with an increased risk of postoperative surgical recurrence, whereas staged operation (HR=0.361, 95%CI: 0.227 to 0.574, P<0.01) was significantly associated with a decreased risk. Conclusions: In this cohort of CD patients receiving abdominal surgery from an inflammatory bowel disease center, the median age was 31 years and the median length of resected small bowel was 30 cm, at first resection. Patients who have risk factors of adverse postoperative outcome may be benefited from staged surgical approach.
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Affiliation(s)
- Y Li
- Department of General Surgery, General Hospital of Eastern Theater Command, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - L Cao
- Department of General Surgery, General Hospital of Eastern Theater Command, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Z Guo
- Department of General Surgery, General Hospital of Eastern Theater Command, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - L L Gu
- Department of General Surgery, General Hospital of Eastern Theater Command, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - M Duan
- Department of General Surgery, General Hospital of Eastern Theater Command, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - E H Wu
- Department of General Surgery, General Hospital of Eastern Theater Command, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - J F Gong
- Department of General Surgery, General Hospital of Eastern Theater Command, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - W M Zhu
- Department of General Surgery, General Hospital of Eastern Theater Command, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
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Zhang JF, Ye XL, Duan M, Zhou XL, Yao ZZ, Zhao JX. [Clinical characteristics of elderly and younger onset rheumatoid arthritis]. Zhonghua Yi Xue Za Zhi 2021; 100:3788-3792. [PMID: 33379844 DOI: 10.3760/cma.j.cn112137-20200506-01439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the clinical and laboratory characteristics and therapy methods of elderly onset rheumatoid arthritis (EORA) and younger onset rheumatoid arthritis (YORA). Methods: The clinical, laboratory and therapeutic data of 481 RA patients in the Department of Rheumatology and Immunology in Peking University Third Hospital from January 2013 to December 2018 were collected and used to analyze the difference of characteristics between EORA group and YORA group, which might be useful for better diagnosis and treatment of EORA patients. Quantitative data of normal distribution were compared with t test between the two groups. Results: There were 481 patients in this cohort, of which 137(28.5%) were EORA, 344(71.5%) were YORA, with a mean age of (59±14) years (19-87 years). There were 358 females (74.4%) and 123 males (25.6%). The percentage of male patients was obviously higher in EORA group (36.5% vs 21.2%, χ(2)=12.012, P<0.01), and the average disease course was obviously shorter (Z=-7.985, P<0.01). Disease Activity Score 28 (DAS28) score was higher in EORA group (5.6±1.3 vs 5.2±1.6, t=2.549, P<0.05), meanwhile the incidences of pleural effusion and interstitial lung disease (ILD) were higher (6.6% vs 1.7%, 29.9% vs 18.3%, respectively; χ(2)=7.550, 7.797, both P<0.05). The incidences of venous thrombosis, primary hypertension, diabetes mellitus, cerebrovascular disease, coronary heart disease (CHD), peripheral atherosclerosis and cataract in EORA group were all significantly higher than those in YORA group (all P<0.05). Erythrocyte sedimentation rate (ESR) and D-Dimer in EORA group were all remarkably higher (both P<0.05). The rate of using glucocorticoid in EORA group was higher but the rate of using methotrexate and anti-tumor necrosis factor-α agents were lower (χ(2)=5.271, 8.407, 9.356, all P<0.05). Conclusion: Compared to YORA group, the percentage of male patients and disease activity of EORA group are higher. The occurrence of pleural effusion, ILD, venous thrombosis, primary hypertension, diabetes mellitus, cerebrovascular disease, CHD, peripheral atherosclerosis and cataract in EORA group are higher than those in YORA group.
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Affiliation(s)
- J F Zhang
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
| | - X L Ye
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
| | - M Duan
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
| | - X L Zhou
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
| | - Z Z Yao
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
| | - J X Zhao
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
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Wang M, Jiang L, Zhu B, Li W, Du B, Kang Y, Weng L, Qin T, Ma X, Zhu D, Wang Y, Zhan Q, Duan M, Li W, Sun B, Cao X, Ai Y, Li T, Zhu X, Jia J, Zhou J, He Y, Xi X. The Prevalence, Risk Factors, and Outcomes of Sepsis in Critically Ill Patients in China: A Multicenter Prospective Cohort Study. Front Med (Lausanne) 2020; 7:593808. [PMID: 33392219 PMCID: PMC7774866 DOI: 10.3389/fmed.2020.593808] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/16/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Sepsis is a main cause of morbidity and mortality in critically ill patients. The epidemiology of sepsis in high-income countries is well-known, but information on sepsis in middle- or low-income countries is still deficient, especially in China. The purpose of this study was to explore the prevalence, characteristics, risk factors, treatment, and outcomes of sepsis in critically ill patients in tertiary hospitals in China. Methods: A multicenter prospective observational cohort study was performed with consecutively collected data from adults who stayed in any intensive care unit (ICU) for at least 24 h; data were collected from 1 January 2014 to 31 August 2015, and patients were followed until death or discharge from the hospital. Results: A total of 4,910 patients were enrolled in the study. Of these, 2,086 (42.5%) presented with sepsis or septic shock on admission to the ICU or within the first 48 h after admission to the ICU. ICU mortality was higher in patients with sepsis (13.1%) and septic shock (39.0%) and varied according to geographical region. Acinetobacter, Pseudomonas, and Staphylococcus infections were associated with increased ICU mortality. In addition, age, Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores, pre-existing cardiovascular diseases, malignant tumors, renal replacement therapy (RRT), and septic shock were independent risk factors for mortality in patients with sepsis. The prompt administration of antibiotics (OR 0.65, 95% CI 0.46-0.92) and 30 mL/kg of initial fluid resuscitation during the first 3 h (OR 0.43, 95% CI 0.30-0.63) improved the outcome in patients with septic shock. Conclusions: Sepsis was common and was associated with a high mortality rate in critically ill patients in tertiary hospitals in China. The prompt administration of antibiotics and 30 mL/kg fluid resuscitation decreased the risk of mortality.
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Affiliation(s)
- Meiping Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bo Zhu
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Wen Li
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Bin Du
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Li Weng
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | - Tiehe Qin
- Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Duming Zhu
- Surgical Intensive Care Unit, Department of Anaesthesiology, ZhongShan Hospital, FuDan University, Shanghai, China
| | - Yushan Wang
- Intensive Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Qingyuan Zhan
- Department of Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenxiong Li
- Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bing Sun
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiangyuan Cao
- Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Ningxia, China
| | - Yuhang Ai
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Tong Li
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xi Zhu
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Jianguo Jia
- Surgical Intensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianxin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
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Duan M, Han ZH, Huang T, Yang Y, Huang B. Characterization of gut microbiota and short-chain fatty acid in breastfed infants with or without breast milk jaundice. Lett Appl Microbiol 2020; 72:60-67. [PMID: 32893879 DOI: 10.1111/lam.13382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 12/17/2022]
Abstract
This study aims to investigate the gut microbiota and metabolites in breastfed infants with breast milk jaundice (BMJ) using gut microbiome-metabolomics. Breastfed newborns diagnosed with BMJ and those without BMJ (control group) were enrolled. Faecal samples were collected from the participants and subjected to high-throughput sequencing of the 16s rDNA V3 and V4 regions of the gut flora and metabolomics of short-chain fatty acids (SCFAs). Proteobacteria, Fimicutes and Actinobacteria were the main bacteria at the phylum level. Eshcerichia-Shigella and Enterobacteriacea were the main bacteria at the genus level. The difference between the two groups was compared. Compared to the control group, the amount of Streptococcus was significantly increased while the amount of Enterococcus was significantly decreased in the faeces from infants with BMJ. Functional prediction analysis of 16S found that biosynthesis of penicillin and cephalosporin significantly increased in the BMJ group. Gas chromatography-mass spectrometry detection of SCFAs revealed that levels of acetic acid and propionic acid were significantly lower in the BMJ group than in the control group. The reduced levels of acetic acid and propionic acid may be related to the increase in Streptococcus and decrease in Enterococcus, both of which may contribute to BMJ.
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Affiliation(s)
- M Duan
- Department of Neonate, The Third Affiliated Hospital of Zunyi Medical University/The First People's Hospital of Zunyi, Zunyi, China
| | - Z H Han
- Department of Emergency, The Third Affiliated Hospital of Zunyi Medical University/The First People's Hospital of Zunyi, Zunyi, China
| | - T Huang
- Department of Neonate, The Third Affiliated Hospital of Zunyi Medical University/The First People's Hospital of Zunyi, Zunyi, China
| | - Y Yang
- Department of Neonate, The Third Affiliated Hospital of Zunyi Medical University/The First People's Hospital of Zunyi, Zunyi, China
| | - B Huang
- Department of Pediatrics, The Third Affiliated Hospital of Zunyi Medical University/The First People's Hospital of Zunyi, Zunyi, China
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Zhi D, Zhang M, Lin J, Liu P, Duan M. GPR120 Ameliorates Apoptosis and Inhibits the Production of Inflammatory Cytokines in Renal Tubular Epithelial Cells. Inflammation 2020; 44:493-505. [PMID: 33009637 DOI: 10.1007/s10753-020-01346-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/17/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022]
Abstract
Acute kidney injury (AKI) is the most common complication of sepsis with a high mortality rate. In this study, we focus on the renal injury caused by the immune response of renal tubular epithelial cells and inflammation-induced renal tubular epithelial cell apoptosis. We studied the role of GRP120 in the inflammation and apoptosis of human renal cell line HK-2 and mouse primary renal tubular epithelial cells. GPR120 agonist GW9508 activated the GPR120 pathway. Inflammatory factors were detected using quantitative real-time PCR and enzyme-linked immunosorbent assay. Cell apoptosis experiments included the annexin V and PI double-staining method combined with flow cytometry, TUNEL method, and Western blot. The level of cytokines including TNF-α, IL-6, IL-1β, and iNOS was significantly decreased (P < 0.05) in HK-2 and TECs after the activation of the GPR120 pathway. Besides, the cell apoptosis of both cells increased. Overexpressed GPR120 and shGPR120 were established. Treatment with lipopolysaccharide (LPS) increased the level of cytokines including TNF-α, IL-6, IL-1β, and iNOS in HK-2 cell and TECs. Compared with control-LPS and negative control (NC)-LPS, the overexpression of GPR120 and shGPR120 could decrease and increase the level of secreted cytokines significantly (P < 0.05), respectively, after LPS-induced apoptosis. After H2O2- and LPS-induced apoptosis, respectively, compared with the control and NC groups, overexpressed GPR120 and shGPR120 could reduce and increase the expression of caspase-3, respectively. GPR120 could suppress the cellular immune response and apoptosis in renal tubular epithelial cells, thereby possibly protecting the kidney and relieving sepsis-induced AKI.
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Affiliation(s)
- Deyuan Zhi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Meng Zhang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Jin Lin
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Pei Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
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Duan M, Vinke PC, Navis GJ, Corpeleijn E, Dekker LH. Associations of ultra-processed food and its consumption patterns with incident type 2 diabetes. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To study the associations of the consumption of ultra-processed food (UPF) and its underlying habitual consumption patterns with incident type 2 diabetes (T2D) in a large population-based cohort.
Methods
In 70 421 participants (35-70 years, 58.6% women) from the Lifelines cohort study, dietary intake was assessed with a food frequency questionnaire. Principal component analysis (PCA) was performed to derive UPF consumption patterns. UPF was related to incident diabetes with adjustments for confounders, including overall diet quality.
Results
During a median follow-up of 41 months, the intake of UPF was associated with higher risk of type 2 diabetes (1128 cases, OR for a 10% increment in UPF intake 1.33 [95% CI 1.26, 1.41]), and remained significant after adjustment for confounders. PCA revealed four habitual UPF consumption patterns. A pattern high in cold savory snacks (OR 1.16 [95% CI 1.09, 1.22]) and a pattern high in warm savory snacks (OR 1.15 [95% CI 1.08, 1.21]) were associated with an increased diabetes risk; a pattern high in traditional Dutch cuisine was not associated with diabetes risk (OR 1.05 [95% CI 0.97, 1.14]); while a pattern high in sweet snacks and pastries was inversely associated with diabetes risk (OR 0.82 [95% CI 0.76, 0.89]). There was a clear inverse association between diabetes risk at baseline and the sweet snacks and pastries pattern (β = -0.104 [95% CI -0.113, -0.094]).
Conclusions
A higher consumption of UPF was associated with higher risk of type 2 diabetes. For consumption patterns, this association was most pronounced for the patterns that were high in savory snacks. Our findings emphasize that in addition to promoting the consumption of healthy food products, discouraging the consumption of UPF, specifically savory snacks, should be considered as part of future diabetes prevention strategies.
Key messages
Ultra-processed foods intake was associated with increased risk of type 2 diabetes. Consumption patterns of ultra-processed foods should be the focus for future policies.
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Affiliation(s)
- M Duan
- Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - P C Vinke
- Epidemiology, University Medical Center Groningen, Groningen, Netherlands
| | - G J Navis
- Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - E Corpeleijn
- Epidemiology, University Medical Center Groningen, Groningen, Netherlands
| | - L H Dekker
- Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
- Aletta Jacobs School of Public Health, University of Groningen, Groningen, Netherlands
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Duan M, Dekker LH, Carrero JJ, Navis GJ. Using Structural Equation Modelling to Untangle Pathways of Factors Associated with Type 2 Diabetes. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Risk factors for type 2 diabetes (T2D) are multi-facet and interrelated. We aimed to apply structural equation modelling to examine and quantify pathways of modifiable risk factors related to incident type 2 diabetes.
Methods
Analysis was based on 68 649 participants (35-80 years, without diabetes at baseline) from the Lifelines cohort study. We proposed a conceptual model that illustrates the pathways of risk factors related to incident type 2 diabetes: socio-economic status (income and education) → lifestyle behaviors (diet quality, physical activity, TV watching, and smoking) → clinical markers (blood lipids and obesity status) → incident type 2 diabetes. Structural equation modeling was performed to test this proposed model.
Results
After a median follow-up of 41 months, 1124 new cases of type 2 diabetes were identified. The best-fitting model indicated that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes (β: 0.213 ), followed by HDL-cholesterol (β: -0.141). Less TV watching and more physical activity were found to play an important role in improving clinical markers that were directly associated with type 2 diabetes. Education had the biggest direct effects on all lifestyle behaviors.
Conclusions
Using this innovative approach, our analysis provides a more nuanced assessment of the interplay of type 2 diabetes risk factors, compared to traditional risk estimates. Our results indicated that reducing large waist circumference may be prioritized as the main target for the prevention of type 2 diabetes, and lifestyle interventions are urgently warranted with additional support for those with a low education.
Key messages
Our study elucidated the multiple causal pathways to type 2 diabetes in a prospective setting. Our results identified the most critical targets for future prevention strategies for type 2 diabetes.
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Affiliation(s)
- M Duan
- Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - L H Dekker
- Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
- Aletta Jacobs School of Public Health, University of Groningen, Groningen, Netherlands
| | - J J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - G J Navis
- Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
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Li Z, Bai J, Wen A, Shen S, Duan M, Li X. Pharmacokinetic and Pharmacodynamic Analysis of Critically Ill Patients Undergoing Continuous Renal Replacement Therapy With Imipenem. Clin Ther 2020; 42:1564-1577.e8. [PMID: 32741646 DOI: 10.1016/j.clinthera.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE This study explores factors that affect behavior in critically ill patients receiving continuous renal replacement therapy (CRRT) with imipenem and provides dosing regimens for these patients. METHODS A prospective, open-label study was conducted in a clinical setting. Both blood and effluent samples were collected pairwise at the scheduled time points. Plasma and effluent imipenem concentrations were determined by HPLC-UV. A population pharmacokinetic model was developed using a nonlinear mixed-effects modeling method. The final model was evaluated by a bootstrap and visual predictive check. A population pharmacokinetic and pharmacodynamic analysis using Monte Carlo simulations was performed to explore the effects of empirically used dosing regimens (0.5 g q6h, 0.5 g q8h, 0.5 g q12h, 1 g q6h, 1 g q8h, and 1 g q12h) on the probability of target attainment. FINDINGS Thirty patients were included in the population model analysis. Imipenem concentration data were best described by a 3-compartment model (central, peripheral, and dialysis compartments). The clearance of the dialysis compartment (CLd) was used to characterize drug elimination from the dialyzer. Creatinine clearance (CrCl) was the covariate that influenced the central clearance (CLc), and the effects of dialysate flow (Qd) was significant for CLd. Model validation revealed that the final model had qualified stability and acceptable predictive properties. A pharmacokinetic and pharmacodynamic analysis was conducted by Monte Carlo simulation, and patients were categorized into 12 subgroups based on different CrCl values (<30, 31-60, 61-90, and >90 mL/min) and Qd values (300, 500, and 1000 mL/h). Under the same MIC value and administration regimen, probability of target attainment values decreased with an increase of CrCl and Qd. IMPLICATIONS CrCl and Qd had significant effects on CLc and CLd, respectively. The proposed final model may be used to guide practitioners in imipenem dosing in this specific patient population.
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Affiliation(s)
- Zhe Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Bai
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Aiping Wen
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Su Shen
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Meili Duan
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Xingang Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Li S, Zhao H, Sun Y, Wang P, Li H, Duan M. [Application of convalescent plasma for the treatment of adult patients with coronavirus disease 2019]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2020; 32:646-651. [PMID: 32684206 DOI: 10.3760/cma.j.cn121430-20200601-00479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The high incidence of coronavirus disease 2019 (COVID-19) and high mortality of critical patients have posed a great challenge to global public health resources. Currently there are no specific antiviral drugs and vaccines available for COVID-19, which has drawn the attention to the usefulness of convalescent plasma (CP) again, so the application of CP in the adult patients with COVID-19 is reviewed. The main contents include the possible mechanism of CP, the evidence of CP in the treatment of COVID-19 patients, the safety of clinical application of CP and the main factors affecting the clinical effect of CP, which may provide some basis for clinicians to choose CP for the treatment of adult patients with COVID-19.
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Affiliation(s)
- Shuangling Li
- Department of Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
| | - Hong Zhao
- Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China
| | - Yueming Sun
- Department of Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
| | - Peng Wang
- Department of Blood Transfusion, Peking University First Hospital, Beijing 100034, China
| | - Haixia Li
- Department of Laboratory, Peking University First Hospital, Beijing 100034, China
| | - Meili Duan
- Department of Critical Care Medicine, Peking Friendship Hospital, Beijing 100050, China. Corresponding author: Zhao Hong,
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Abstract
Objective: To examine the expression of T-box5 (TBX5) in colorectal cancer tissues and its clinical significance, and explore the effects of TBX5 on the invasion and metastasis of colorectal cancer cells and its mechanism. Methods: The expressions of TBX5 in cancer and adjacent normal tissues were tested by immunohistochemistry (IHC), and the relationship between TBX5 and clinicopathological features and prognosis of colorectal cancer was analyzed. Real-time quantitative PCR (RT-qPCR) and western blot were used to detect the expressions of TBX5 in different colorectal cancer cell lines. TBX5 overexpression plasmid was constructed and transfected into human colorectal cancer cell line HT-29, and cell counting kit-8 (CCK-8) was used to detect the activities of transfection HT-29 cells. Cell scratch test and Transwell assay were used to detect the migration and invasion abilities of cells, while RT-qPCR and western blot were used to detect the mRNA and protein expressions of PCNA, p21, p16, p27, MMP-2, MMP-7 and TIMP-1. Results: The positive rate of TBX5 protein in colorectal cancer tissues was 24.44% (22/90), significantly lower than 65.56% of adjacent normal tissues (P<0.001). The expression of TBX5 was significantly related to lymph node metastasis, depth of invasion and nerve invasion (P<0.05). The survival period of 22 patients with positive TBX5 expression was (60.2±2.4) months, better than (44.3±2.8) months of 68 patients with negative TBX5 expression (P<0.05). Among human colon cancer cell lines of HT29, SW620, SW480, LOVO and HCT116, the expression of TBX5 in HT29 cells was the weakest. After transfection, the expression of TBX5 in transfection group was significantly higher than those in control group and blank group (P=0.043 and P<0.001). Cell viability in transfection group was significantly lower than those in control group and blank group (both P<0.001). The ratio of cells in G(0)/G(1) phase was increased (P=0.009), while in G(2)/M phase was decreased (P<0.001). Cells' abilities of migration and invasion in transfection group were also significantly decreased (both P<0.001). Overexpression of TBX5 downregulated the expressions of PCNA, MMP-2 and MMP-7, while upregulated the expressions of p21, p16, p27 (P<0.05 for all). TBX5 had marginal effect on the expression of TIMP-1 (P>0.05). Conclusions: Downregulation of TBX5 is a marker of poor prognosis in patients with colorectal cancer. TBX5 may inhibit the progression of colorectal cancer by inhibiting proliferation, invasion and metastasis related genes.
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Affiliation(s)
- M J Dong
- Seventh Department of General Surgery, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Y Zhou
- Department of Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - M Duan
- Department of Laboratory, Hebei Zhengding County People's Hospital, Zhengding 050800, China
| | - Q M Gao
- Seventh Department of General Surgery, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - J H Zhao
- Seventh Department of General Surgery, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
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45
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Zhao M, Duan M. [Lactic acid, lactate clearance and procalcitonin in assessing the severity and predicting prognosis in sepsis]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2020; 32:449-453. [PMID: 32527351 DOI: 10.3760/cma.j.cn121430-20200129-00086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore the value of lactic acid (Lac), lactate clearance (LCR) and procalcitonin (PCT) in assessing the severity and predicting the prognosis in sepsis. METHODS 18-80-year-old patients with sepsis admitted to the department of critical care medicine of Beijing Friendship Hospital, Capital Medical University from April 2009 to December 2019 were enrolled. The gender, age, basic illness, infection site, organ function, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), Lac and PCT were collected on admission to intensive care unit (ICU), as well as Lac after 24 hours, 24-hour LCR, and 28-day prognosis. The patients were divided into sepsis group and septic shock group according to Sepsis-3 criteria. According to the 28-day prognosis, the septic shock patients were divided into survival group and death group, and the differences of each index between the two groups were compared. Multivariate Logistic regression was used to analyze the risk factors of death in septic shock patients. The receiver operating characteristic (ROC) curve was used to analyze the role of Lac, LCR, PCT, SOFA score and APACHE II score in predicting prognosis of the patients with septic shock. RESULTS A total of 998 patients with sepsis were enrolled, including 642 males and 356 females; with (59.56±13.22) years old. There were 478 patients with septic shock, among which 180 died and 298 survived during the 28-day observation. (1) Compared with the sepsis group, the age of the sepsis shock group was significantly higher (years old: 60.49±12.31 vs. 58.72±13.97), APACHE II score, SOFA score, Lac, PCT and 24 h Lac increased [APACHE II: 24.57±7.04 vs. 19.37±6.93, SOFA: 7.78±3.31 vs. 4.38±3.42, Lac (mmol/L): 3.00 (1.70, 5.00) vs. 1.40 (1.00, 2.30), PCT (μg/L): 0.05 (0.00, 4.00) vs. 0.00 (0.00, 1.10), 24-hour Lac (mmol/L): 2.60 (1.60, 4.40) vs. 1.40 (1.00, 2.20)], and the 28-day mortality was significantly higher [41.63% (199/478) vs. 19.42% (101/520)], with significant statistic differences (all P < 0.05). (2) Compared with the survival group, APACHE II score, SOFA score, Lac, 24-hour Lac significantly increased in the septic shock death group, and 24-hour LCR decreased [APACHE II: 26.19±6.52 vs. 22.25±6.07, SOFA: 9.07±2.90 vs. 7.50±3.10, Lac (mmol/L): 3.80 (2.50, 5.10) vs. 2.80 (2.00, 3.90), 24-hour Lac (mmol/L): 3.20 (2.20, 5.60) vs. 2.10 (1.60, 3.30), 24-hour LCR: 1.43 (-37.50, 30.77)% vs. 16.67 (0.00, 33.98)%, all P < 0.05]. In assessment of organ function, central venous pressure (CVP) and oxygenation index (PaO2/FiO2) were lower in death group [CVP (mmHg; 1 mmHg = 0.133 kPa): 5.00 (2.00, 8.00) vs. 6.00 (2.00, 9.00), PaO2/FiO2 (mmHg): 184.21±84.57 vs. 199.20±86.98], alanine aminotransferase (ALT) and serum creatinine (SCr) increased [ALT (U/L): 376.56±41.43 vs. 104.17±14.10, SCr (μmol/L): 213.53±8.06 vs. 181.91±5.03], with significant statistic differences (all P < 0.05). (3) Multivariate Logistic regression analysis showed that PaO2/FiO2, SCr, Lac and SOFA were independent risk factors of prognosis in septic shock [PaO2/FiO2: odds ratio (OR) = 0.997, 95% confidence interval (95%CI) was 0.996-0.999, P = 0.001; SCr: OR = 1.001, 95%CI was 1.000-1.002, P = 0.041; Lac: OR = 0.925, 95%CI was 0.871-0.982, P = 0.011; SOFA: OR = 1.178, 95%CI was 1.110-1.251, P = 0.000]. ROC curve analysis showed that SOFA, SOFA+APACHE II, Lac+24-hour LCR+PCT+SOFA+APACHE II could predict mortality in septic shock patients, and the area under the ROC curve (AUC) was 0.769 (95%CI was 0.740-0.798), 0.787 (95%CI was 0.759-0.815), 0.800 (95%CI was 0.773-0.827), respectively. The joint of the five indicators, Lac, 24-hour LCR, PCT, SOFA and APACHE II has the largest AUC. CONCLUSIONS Lac is an independent risk factor for death in patients with septic shock, however, the prognosis cannot be predicted. Comprehensive analysis of LCR, PCT, SOFA, APACHE II and the clinical organ functions are required for analysis.
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Affiliation(s)
- Mengya Zhao
- Department of ICU, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China. Corresponding author: Duan Meili,
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Duan M, Yang Y, Zheng XH. Meta-analysis of the treatment for neonatal respiratory distress syndrome by INSURE strategy. J BIOL REG HOMEOS AG 2020; 34:1027-1032. [PMID: 32640778 DOI: 10.23812/19-484-l-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- M Duan
- Department of Neonate, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
| | - Y Yang
- Department of Neonate, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
| | - X H Zheng
- Department of Neonate, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, Zunyi, China
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Li SJ, Wang L, Wang L, Wu B, Zhu L, Hu ZX, Duan M. [A real world study of hepatitis B virus genotypes in patients with chronic hepatitis B with different disease spectrum]. Zhonghua Gan Zang Bing Za Zhi 2020; 27:1001-1004. [PMID: 31941263 DOI: 10.3760/cma.j.issn.1007-3418.2019.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S J Li
- Department of Hepatology, Public Health Clinical Medical Center of Chengdu, Chengdu 610066, China
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Dong R, Tian H, Zhou J, Weng L, Hu X, Peng J, Wang C, Jiang W, Du X, Xi X, An Y, Duan M, Du B. External validity of Adult Sepsis Event's simplified eSOFA criteria: a retrospective analysis of patients with confirmed infection in China. Ann Intensive Care 2020; 10:14. [PMID: 32020406 PMCID: PMC7000563 DOI: 10.1186/s13613-020-0629-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background The US Centers for Disease Control and Prevention (CDC) recently released simplified eSOFA organ dysfunction criteria of Adult Sepsis Event for sepsis surveillance in the US. Our study aimed to compare the prevalence, characteristics, and outcomes of sepsis patients identified by eSOFA criteria versus Sequential Organ Failure Assessment (SOFA) Score (Sepsis-3) and assess the external validity of eSOFA criteria in China. Methods We conducted a retrospective cohort study of adult residents of Yuetan Subdistrict, Beijing, China, who were hospitalized from July 1, 2012 to June 30, 2014. Among patients with infection, sepsis was identified if there was a concurrent rise in SOFA score by 2 or more points (Sepsis-3) or the presence of 1 or more eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, doubling in creatinine, doubling in bilirubin to 2.0 mg/dL or above, 50% or greater decrease in platelet count to less than 100 cells/μL, or lactate equal to or above 2.0 mmol/L. Areas under the receiver operating characteristic curves (AUROCs) for in-hospital mortality were compared between sepsis patients detected by the two criteria, adjusting for baseline characteristics. Results Of 1716 hospitalized patients with infection, 935 (54.5%) met Sepsis-3 criteria, 573 (33.4%) met eSOFA criteria, while 475 (27.7%) met both criteria. Demographic and clinical characteristics of sepsis patients meeting Sepsis-3 or eSOFA criteria were similar. In-hospital mortality was higher with eSOFA criteria versus Sepsis-3 (46.6% vs. 32.0%, p < 0.001). eSOFA criteria had high PPV (82.9%), but low sensitivity (50.8%) for the diagnosis of Sepsis-3. Patients meeting both criteria had the highest in-hospital mortality rate (52.8%, all p < 0.001), while patients who only met eSOFA criteria had higher mortality rate than those meeting Sepsis-3 alone (16.3% vs. 10.4%, p = 0.097). The predicted probability for in-hospital mortality was higher with eSOFA criteria versus Sepsis-3 (AUROC 0.830 vs. 0.795, p = 0.001) adjusting for baseline characteristics. Conclusions The CDC Adult Sepsis Event’s eSOFA criteria identify a smaller, more severely ill cohort of sepsis patients with similar demographic and clinical characteristics as the more complex Sepsis-3 SOFA score. These results suggest similar performance of eSOFA criteria across diverse populations, with low sensitivity and high specificity for the diagnosis of Sepsis-3.
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Affiliation(s)
- Run Dong
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Hongcheng Tian
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.,Department of Critical Care Medicine, China Rehabilitation Research Center, Capital Medical University, 10 Jiaomen Beilu, Fengtai District, Beijing, 100068, People's Republic of China
| | - Jianfang Zhou
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.,Department of Critical Care Medicine, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Beijing, 100050, People's Republic of China
| | - Li Weng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Xiaoyun Hu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Jinmin Peng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Chunyao Wang
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Wei Jiang
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Xueping Du
- Department of General Internal Medicine, Fuxing Hospital, Capital Medical University, A20 Fu Xing Men Wai Street, Beijing, 100038, People's Republic of China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, A20 Fu Xing Men Wai Street, Beijing, 100038, People's Republic of China
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, 11 Xi Zhi Men South Street, Beijing, 100044, People's Republic of China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Beijing, 100050, People's Republic of China
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
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Tian H, Zhou J, Weng L, Hu X, Peng J, Wang C, Jiang W, Du X, Xi X, An Y, Duan M, Du B. Accuracy of qSOFA for the diagnosis of sepsis-3: a secondary analysis of a population-based cohort study. J Thorac Dis 2019; 11:2034-2042. [PMID: 31285896 DOI: 10.21037/jtd.2019.04.90] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background We aimed to evaluate the accuracy of quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) for the diagnosis of sepsis-3, and to analyze the prognosis of infected patients in wards over-diagnosed with qSOFA but missed by sepsis-3, and those missed by qSOFA but in accordance with sepsis-3 criteria. We also intended to validate the performance of qSOFA as one predictor of outcome in patients with suspicion of infection. Methods We reviewed the medical records of 1,716 adult patients with infection who were hospitalized from July 1st, 2012 to June 30th, 2014 in the Yuetan subdistrict of Beijing, China. Based on the sepsis-3 criteria and qSOFA score proposed by the Third International Consensus Definitions for Sepsis and Septic Shock, these patients were categorized into four groups: qSOFA(-)sepsis(-), qSOFA(+)sepsis(-), qSOFA(-)sepsis(+), and qSOFA(+)sepsis(+). Multivariate logistic regression analysis was used to determine the independent risk factors for in-hospital mortality. The area under the receiver operating characteristic curves (AUROCs) of the qSOFA(+) group were compared with the sepsis(+) group for in-hospital mortality, ICU admission, and invasive ventilation. Results Among the 1,716 patients with infection, there were 935 patients (54.5%) with sepsis, and 640 patients (37.3%) with qSOFA ≥2. There were 610 patients in the qSOFA(-)sepsis(-) group, 171 in the qSOFA(+)sepsis(-) group, 466 in the qSOFA(-)sepsis(+) group, and 469 in the qSOFA(+)sepsis(+) group. In the logistic regression analysis, increasing age, bedridden status, and malignancy were all independent risk factors of hospital mortality. Sepsis and qSOFA ≥2 were also independent risk factors of hospital mortality, with an adjusted OR of 3.85 (95% CI: 2.70-5.50) and 13.92 (95% CI: 9.87-16.93) respectively. qSOFA had a sensitivity of 50.2% and a specificity of 78.1% for sepsis-3. The false-positive [qSOFA(+)sepsis(-)] group had 38 patients (22.2%) die during hospitalization, and an adjusted OR of 9.20 (95% CI: 4.86-17.38). In addition, the false-negative [qSOFA(-)sepsis(+)] group had a hospital mortality rate of 7.3% (34/466) and an adjusted OR of 2.59 (95% CI: 1.39-4.83). In comparison, patients meeting neither qSOFA nor sepsis criteria had the lowest hospital mortality [2.6% (16/610)], whereas patients with both qSOFA ≥2 and sepsis had the highest hospital mortality [56.5% (265/469)], with an adjusted OR of 42.02 (95% CI: 24.31-72.64). The discrimination of in-hospital mortality using qSOFA (AUROC, 0.846; 95% CI, 0.824-0.868) was greater compared with sepsis-3 criteria (AUROC, 0.834; 95% CI, 0.805-0.863; P<0.001). Conclusions In our analysis, the sensitivity(Se) of qSOFA for the diagnosis of sepsis was lower, and qSOFA score ≥2 might identify a group of patients at a higher risk of mortality, regardless of being septic or not.
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Affiliation(s)
- Hongcheng Tian
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.,Department of Critical Care Medicine, China Rehabilitation Research Center, Capital Medical University, Beijing 100068, China
| | - Jianfang Zhou
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.,Department of Critical Care Medicine, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China
| | - Li Weng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiaoyun Hu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jinmin Peng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chunyao Wang
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei Jiang
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xueping Du
- Department of General Internal Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
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Lin J, Gallagher M, Bellomo R, Duan M, Trongtrakul K, Wang AY. SOFA coagulation score and changes in platelet counts in severe acute kidney injury: Analysis from the randomized evaluation of normal versus augmented level (RENAL) study. Nephrology (Carlton) 2019; 24:518-525. [DOI: 10.1111/nep.13387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jin Lin
- The George Institute for Global HealthUniversity of New South Wales Sydney New South Wales Australia
- Beijing Friendship HospitalCapital Medical University Beijing China
| | - Martin Gallagher
- The George Institute for Global HealthUniversity of New South Wales Sydney New South Wales Australia
- Concord Repatriation General Hospital Concord New South Wales Australia
| | - Rinaldo Bellomo
- The George Institute for Global HealthUniversity of New South Wales Sydney New South Wales Australia
- Department of Intensive CareAustin Hospital Melbourne Victoria Australia
| | - Meili Duan
- Beijing Friendship HospitalCapital Medical University Beijing China
| | - Konlawi Trongtrakul
- Department of Emergency Medicine, Faculty of Medicine Vajira HospitalNavamindradhiraj University Bangkok Thailand
| | - Amanda Ying Wang
- The George Institute for Global HealthUniversity of New South Wales Sydney New South Wales Australia
- Faculty of Medicine & Health SciencesMacquarie University Sydney New South Wales Australia
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