Risk factors of mortality in road traffic injury patients with acute respiratory distress syndrome

Background Among the deaths due to trauma, about one half of the patients suffer from road traffic injury （RTI）. Most of RTI patients complicate acute respiratory distress syndrome （ARDS） and severe multiple injuries. ARDS is a major contributor to morbidity and mortality in trauma patients. Although many injuries and conditions are believed to be associated with ARDS independent risk factors in trauma patients, their relative importance in development of the syndrome are undefined. We hypothesize that not all of the traditional risk factors impacting mortality are independently associated with patients strictly identified by traffic injury. This study aimed to sieve distinctive risk factors in our RTI population, meanwhile, we also hypothesize that there may exist significantly different risk factors in these patients.
Methods This was a retrospective cohort study regarding RTI as a single cause for emergency intensive care unit （EICU） admission. Patients identified as severe RTI with post-traumatic ARDS were enrolled in a prospectively maintained database between May 2002 and April 2007 and observed. Twenty-three items of potential risk impacting mortality were calculated by univariate and multivariate Logistic analyses in order to find distinctive items in these severe RTI patients.
Results There were 247 RTI patients with post-traumatic ARDS admitted to EICU during the study period. The unadjusted odds ratio （OR） and 95% confidence intervals （CI） of mortality were associated with six risk factors out of 23： APACHE II score, duration of trauma factor, pulmonary contusion, aspiration of gastric contents, sepsis and duration of mechanical ventilation. The adjusted ORs with 95% Cl were denoted with respect to surviving beyond 96 hours EICU admission （APACHE II score, duration of trauma factor, aspiration of gastric contents）, APACHE II score beyond 20 EICU admission （duration of trauma factor, sepsis, duration of mechanical ventilation） and mechanical ventilation beyond 7 days EIC     

Risk factors related to hospital mortality in patients with isolated traumatic acute subdural haematoma: analysis of 308 patients undergone surgery

Background Acute subdural haematoma （ASDH） is a common traumatic brain injury with a relatively high mortality rate. However, few studies have examined the factors predicting the outcome of isolated traumatic ASDH. This clinical study examined the hospital mortality and analyzed the risk factors for mortality in patients treated surgically for isolated traumatic ASDH.
Methods We collected 308 consecutive patients who underwent neurosurgery for isolated traumatic ASDH between January 1999 and December 2007 and used multivariate Logistic regression analysis to evaluate the influence of 11 clinical variables on hospital mortality.
Results The overall hospital mortality was 21.75% （67/308）. Age （OR=1.807）, preoperative Glasgow Coma Score （OR=0.316）, brain herniation （OR=2.181） and the time from trauma to decompression （OR=1.815） were independent predictors of death, while no independent association was observed between hospital mortality and haematoma volume, midline shift, acute brain swelling or brain herniation duration, although these variables were correlated with hospital mortality in univariate analyses.
Conclusions This study identified the risk factors for hospital mortality in patients who underwent surgical treatment for isolated traumatic ASDH. An increased risk of death occurs in patients who are over 50 years of age and have lower preoperative Glasgow Coma Scores, the presence of brain herniation and a long interval between trauma and decompression. The findings should help clinicians determine management criteria and improve survival.     

Repair of left ventricular aneurysm: ten-year experience in Chinese patients

Background A large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm （LVA）. This study aimed to explore the early and long-term clinical outcomes and to identify predictors for survivals and hospital re-admission after the repair of left ventricular aneurysm. Methods We followed up 497 patients who had undergone LVA repair from a single center in China between 1995 and 2005. The perioperative parameters were recorded. Risk factors for early mortality and long-term results were analyzed by multivariate Logistic regression. Cox＇s proportional hazard model was used to calculate risk factors for major adverse cardiac and cerebrovascular events, cause of death and re-admission. Kaplan-Meier curve was employed to analyze long-term survival. Results The operative mortality was 2.0%. The long-term mortality was 11.1% and cardiac causes contributed to 61.8% of the overall long-term mortality. Four hundred and thirty-two patients survived during the follow-up period and 37.5% of them had been re-admitted at least one time. One hundred and five patients experienced major adverse cardiac and cerebrovascular events. Survival analysis exhibited that the probability of survival at 1 and 5 years after operation was 96% and 86% respectively. Previous atrial fibrillation was the independent risk factor for early mortality. Independent risk factors for long-term mortality were poor left ventricular ejection fraction and stroke, and risk factors for cardiac mortality were intraventricular block, stroke and poor left ventricular ejection fraction. Stroke, intraventricular block and advanced age were independent risk factors for major adverse cardiac and cerebrovascular events, and New York Heart Association （NYHA） class Ill-IV was the only risk factor for hospital re-admission. Conclusions Postinfarction LVA can be repaired and satisfying early and long-term clinical outcome can be obtained. Endoventricular circular plasty technique is the better choice than linear repair in patients with large LVA. Survival is affected in patients with poor heart function, intraventricular block and stroke.     

Early liver retransplantation versus late liver retransplantation: analysis of a single-center experience

Background Orthotopic liver retransplantation （re-OLT） is the only effective therapy for irreversible failure of a liver graft. Early and late graft failure gives way to two different clinical conditions that should be discussed separately. This study was designed to compare early and late re-OLT for patients with poor graft function after primary transplantation at our center and sum up our clinical experience in re-OLT.
Methods The clinical data of 31 re-OLTs at our center from January 2004 to February 2007 were analyzed retrospectively, consisting of the first group with 14 cases of early re-OLT and the second group with 17 cases of late re-OLT.
Results Biliary tract complications were the main indications for early re-OLT （57.1%） and late re-OLT （52.9%）. Other common indications were vascular complications in early re-OLT and recurrence of primary diseases in late re-OLT. No significant differences were found between the groups with regard to the volume of bleeding during operation, cold ischemia time, operative duration, and perioperative mortality; except for the model of end-stage liver disease （MELD） score. Outcome was fatal for 7 patients in early re-OLT and 9 patients in late re-OLT. Two deaths were due to multiple organ failure with 3 deaths due to severe sepsis-related disease in early re-OLT, and 4 deaths were due to severe sepsis-related disease with 3 deaths due to recurrence of hepatocellular carcinoma （HCC） in late re-OLT. One and 2-year actuarial survival rates after re-OLT were 55.2% and 36.9%, respectively, for patients in early re-OLT, and 65.1% and 52% respectively, for patients in late re-OLT. No significant differences were found regarding survival rates between the two groups.
Conclusions Similar clinical results can be achieved in early and late re-OLT. Proper indications and optimal operation timing, adequate preoperative preparation, experienced surgical procedures, and effective perioperative anti-infection strategy contribute to the improvement of overall sur     

Is the use of cardiopulmonary bypass for isolated coronary artery bypass an independent predictor of mortality and morbidity in patients with severe left ventricular dysfunction?

Background Patients presenting with severe left ventricular dysfunction （SLVD） undergoing conventional coronary artery bypass grafting （CCABG） are at an increased risk of perioperative mortality and morbidity. The aim of this study was to assess the risk factors responsible for mortality and morbidity among patients with SLVD by comparing CCABG and oft-pump coronary artery bypass surgery （OPCAB）.
Methods We retrospectively evaluated 186 consecutive patients with SLVD who underwent coronary artery bypass grafting （CABG）, including 102 by CCABG and 84 by OPCAB. Registry database, medical notes, and charts were studied for preoperative and postoperative data of the patients. Different variables and risk factors （preoperative, intraoperative, and postoperative） were evaluated and compared. The morbidity and mortality outcomes were compared in the two groups. The follow-up results and quality of life were assessed after surgery.
Results The two groups had similar percentage of patients with preoperative high-risk profiles and no significant differences were found between groups in baseline variables such as age or comorbidities. There was a significant difference in the number of grafts used between the two groups. CCABG patients received （3.6±0.5） grafts per patient, while OPCAB patients had （2.7±0.6） grafts （P 〈0.05）. Completeness of revascularization was also significantly different between the two groups （CCABG 91.1% vs OPCAB 73.8%, P 〈0.05）. The hospital mortality was similar in the two groups （4.8% in OPCAB vs 5.9% in CCABG）. The risk-adjusted mortality, according to the calculated propensity score, did not reach statistical significance in the two groups. In this study, OPCAB seemed to have a beneficial effect on reducing reoperation for bleeding, blood transfusion requirement, and the length of stay at ICU. But the incidence of perioperative myocardial infarction was more common in the off-pump group （P 〈0.05）. The degree of improvement in angina and qual     

FACTORS ASSOCIATED WITH QUALITY OF LIFE IN ACUTE EXACERBATION OF COPD

Objective To measure the QOL in patients with AECOPD and the frequency of potential risk factors, and to evaluate the association of risk factors with poor QOL in patients with AECOPD. Methods A study sample of 196 patients with moderate to severe COPD admitted for acute exacerbations to two large general hospitals were studied. The St George QOL （SGQOL） scale, socio-demographic , clinical and patient care characteristics, including depression and spirometry were ascertained in the stable state before discharge and at one-month post discharge. Results There was a high prevalence of current or ex-heavy smokers, depression and consumption of psychotropic drugs, and low prevalence of care giver support, pulmonary rehabilitation and vaccination. The mean scores for the different domains were 55. 9 for Symptoms; 65. 1 for Activity; 32.9 for Impact; and the mean of overall Total scores was 46. 5. Multiple regression analysis showed that CMH, male, depression, previous frequent hospital readmissions and poor therapy compliance were independently related to worse Symptoms Scores. Previous frequent readmissions, depression, severe dyspnea and older age （ 〉 72 years） were related to worse Activity Scores of SGQOL. Depression, previous frequent readmissions, severe dyspnea, long COPD duration（ ≥ 5years） and severe smoking were related to worse Impact Scores of SGQOL. Depression, previous frequent readmissions, severe dyspnea and long COPD duration （ ≥ 5years ） were independently related to worse Total Scores of SGQOL. Conclusion Poor QOL in patients with COPD exacerbation was associated with disease severity, psychosocial and health care factors which are modifiable.     

Purified protein derivative skin testing on HIV/AIDS patients and logistic regression analysis of its risk factors

Objective： To understand the reactivity of purified protein derivative skin test（PPD test） in HIV-infected persons and to determine the influential factors associated with PPD. Methods： 174 HIV/AIDS patients registered in the local center for disease control and prevention（CDC） participated this study from April to June in 2006. Questionnaire,CD4 count and thoracic roentgenogram were performed for all participants. Results： In this study, response rate of questionnaires was 83.65%. The majority of these participants had a different degree of immunodeficiency that accounted for 93.64%. Female patients had a higher CD4 count than that of males. The total positive rate of PPD was 38.15%. Analysis of single factor in our study indicated that CD4 count, previous tubereulosis history, tuberculosis contact history and thoracic roentgenogram manifestation of patients were related to their PPD diameters. Further analysis of multiple factors also supports the previous conclusion that CD4 count and previous tuberculosis history of patients were risk factors in the PPD test. Conclusion： The PPD test of HIV/AIDS patients could be affected by several factors. For persons infected with HIV, the confirmation of latent tuberculosis infection （LTBI） should be considered the combination effect of previous MTB infection and body cellular immune function.     

Relationship between lower urinary tract symptoms and objective measures of benign prostatic hyperplasia: a Chinese survey

Background The enlarged prostate leads to obstruction and lower urinary tract symptoms （LUTS）, which comprise frequency, urgency, weak stream, straining and nocturia. This study was conducted in a large series of patients to evaluate the relationship between LUTS as stipulated in the International Prostate Symptom Score （IPSS） and the objective parameters related to benign prostatic hyperplasia （BPH）.
Methods We enrolled 1295 BPH patients from seven centers. The patients were either at first diagnosis of BPH or had discontinued medical treatment for at least 3 months. Those with several other diseases that may be potential risk factors affecting urinary symptoms were excluded from the study. Age, IPSS, prostate volume, peak flow rate, urine volume and post-voiding residual urine volume were measured. The relationship between IPSS and objective parameters were quantified by means of Spearman correlation coefficients. The differences in these parameters between the groups with mild, moderate or severe symptoms were also evaluated.
Results Statistically significant correlations were found between IPSS and objective parameters by means of Spearman correlation coefficients. When the patients were divided into three groups with different severities of symptoms, there were significant differences in peak flow rate, urine volume, prostate volume, residue urine volume and quality of life, whereas average age and prostate-specific antigen levels were similar. However, there was evident overlap of these parameters between the groups. The same results were found when the irritative or obstructive subscore of IPSS was considered.
Conclusions The correlation between objective parameters of BPH and LUTS is significant. However, it is hard to predict the severity of symptoms by these parameters.     

EARLY SURGERY TO PATIENTS SUFFERING FULMINANT ACUTE PANCREATITIS WITH ABDOMINAL COMPARTMENT SYNDROME

Objective To retrospectively analyze and compare conservative versus surgical treatment of patients with fulminant acute pancreatitis （ FAP ） plus abdominal compartment syndrome （ ACS ）. Methods From January 1998 to September 2005, 21 patients with FAP plus ACS were retrospectively analyzed. Ten patients were conservatively treated by means of intensive care medicine without surgery, and 11 patients received open surgical management and suction drainage. Results Seven of the 10 non-surgical patients died, comprising one with mild, four with moderate and two with severe ACS （70% mortality rate）. Of the 11 patients receiving open surgical management in the early phase （ within 3 days of disease initiation ）, three died, comprising one with moderate and two with severe ACS （27.3% mortality rate）. The difference in mortality rates was found to be statistically significant. Conclusion Our data indicate patients suffering FAP with severe ACS should be treated with open management of the abdomen in the early phase （ within 3 days）, even in the absence of infection. This approach appears superior to that of conservative management. Surgical treatment resulted in abdominal decompression and subsequently significantly decreased the mortality rate and improved overall prognosis.     

Predictive value of different scoring systems for early postoperative mortality in patients with a second coronary artery bypass grafting

Background Coronary artery bypass graft （CABG） has been developed over many years.Recently,an increasing number of patients need a second surgery for relapse of symptoms.In consideration of the high surgical risk,accurate preoperative evaluation is needed.The aim of the study was to assess the predictive value of three different risk scoring system for early postoperative mortality rate in patients with redo-CABG.Methods Seventy-seven patients who underwent redo-CABG in Fu Wai Hospital from January 1997 to June 2013 were enrolled.All patients were retrospectively scored for early postoperative mortality rate using EuroSCORE,STS score and SinoSCORE.Overall expected mortality rates were compared with observed mortality rates.Discrimination was evaluated using receiver operating characteristic （ROC） curves and area under a ROC curve （AUC）.Results Four patients died after a redo-CABG 5%.The mortality rates predicted by EuroSCORE,STS score and SinoSCORE were 5.0%,2.2% and 1.4%,respectively.The AUC of the three kinds of score were 0.465,0.543 and 0.528,respectively,indicating a poor correlation between the observed and predicted mortality rates.Conclusion The predictive value of EuroSCORE,STS score and SinoSCORE is poor for early postoperative mortality rate in patients with redo-CABG.     

严重创伤合并急性肺损伤恶化进展至急性呼吸窘迫综合征的临床危险因素分析

目的 研究影响严重创伤合并急性肺损伤恶化进展为急性呼吸窘迫综合征的潜在危险因素.方法 回顾性分析严重创伤患者375例,通过单因素和多因素逻辑回归分析法对20个潜在影响急性肺损伤恶化进展的危险因素进行研究.结果 所有严重创伤合并急性肺损伤患者纳入研究,分析得出6个影响急性肺损伤进展为急性呼吸窘迫综合征的危险因素是:脓毒症、创伤持续时间、APACHE Ⅱ评分、弥漫性血管内凝血(DIC)、胃肠返流、高龄;同时发现这些特定的危险因素对不同的分层患者人群具有不同的影响程度.结论 脓毒症、DIC和创伤持续时间对急性肺损伤恶化进展为急性呼吸窘迫综合征的影响是始终贯穿于整个治疗期;胃肠返流和APACHE Ⅱ评分对病情进展的预测仅仅存在于创伤后的早期阶段;由于严重的创伤性打击和肺功能的衰退,高龄仍旧是影响急性肺损伤进展的独立危险因素.具备这些危险因素的患者必须尽可能早的接受积极治疗以阻止进一步恶化.     

重症胸外伤并发成人呼吸窘迫综合征的高危因素分析

目的探讨重症胸外伤并发成人呼吸窘迫综合征的高危因素。方法对242例重症胸外伤并发成人呼吸窘迫综合征患者的年龄、性别、慢性肺疾病、肺挫伤、呕吐误吸、腹内伤、吸烟、格拉斯哥昏迷（GCS）评分、损伤严重程度（ISS）评分进行相关分析。结果年龄≥53岁,合并慢性肺疾病、肺挫伤、呕吐误吸、腹内伤、吸烟、GCS评分〈8分和ISS值≥16分是重症胸外伤并发成人呼吸窘迫综合征的高危因素（P〈0.05）。结论高龄、合并肺疾病、肺挫伤、呕吐误吸、腹内伤、吸烟、GCS评分〈8分和ISS值≥16分是重症胸外伤并发成人呼吸窘迫综合征的高危因素,在临床上应引起足够的关注。     

ICU急性肺损伤患者的病因及相关危险因子

目的：探讨ICU内急性肺损伤（ALI）的病因及相关的危险因子。方法：总结我院ICU26例ALI患者的临床资料，并对存活组与死亡组的原发病因、临床特点、临床特点、呼吸指数（MRI）、肺损伤分数（LIS）等指标进行比较。结果：提示ICU内ALI者最常见的病因为脓毒血症和多发性创伤；脓毒血症、多发性创伤及紧急复苏后发生ALI的死亡率最高，而吸入性肺炎、药物过量后发生ALI的死亡率最低；外伤较内科ALI患者死亡率低；年长者死亡率明显高于年轻者；死亡组并发休克、感染、多脏器功能不全、代谢性酸中毒等因素增高。结论：对于脓毒血症、多发性创伤和紧急复苏后的患者，尤其是合并有休克、感染等，应该高度重视，严密监测，以防治ALI的发生，早期诊断和治疗ALI是降低本病死亡率的有效措施。     

以EICU为主体救治多发伤并严重骨盆骨折31例

目的探讨合并严重骨盆骨折多发伤的治疗方法及疗效。方法对急诊ICU(EICU)为主体救治的31例合并严重骨盆骨折多发伤患者救治过程、死亡率及预后进行随访评价。结果 31例患者中行外固定或内固定27例,死亡4例,死亡率12.90%。治疗结果按刘利民等评价标准:优13例,良8例,中4例,差2例,优良率77.78%。结论以EICU为主体,整合医院优势力量,是提高合并严重骨盆骨折多发伤救治成功率和预后的关键。     

影响芦山地震伤员住院时间的多因素分析

目的 研究影响或预测芦山地震伤员住院时间的相关因素,为地震后一线医院床位资源的评估提供参考。方法 回顾性分析芦山地震期间四川大学华西医院收治且记录完整的263例地震伤员的临床信息。统计可能影响或可能预测伤员住院时间的10个指标〔性别、年龄、院前时间、多发伤、并发感染、合并慢性疾病、以及创伤严重度评分（ISS评分）、修正创伤评分（RTS评分）、CRAMS评分、院前伤情评分（PHI评分)〕和住院时间,进行多元逐步回归分析,筛查可能导致或预测住院时间延长的指标。结果 合并感染的地震创伤员,ISS评分越高住院时间越延长,而院前时间越长,其住院时间反而缩短。多元线性回归方程为:住院时间（h）=498.36+671.41×感染+43.87×ISS评分-5.12×院前时间。结论 地震后一线医院可根据伤员并发感染、ISS评分以及院前时间等情况,早期评估伤员病情严重程度,预测住院时间和床位资源使用情况,根据需要及时将患者转送至后方医院。     

伴钝性腹部创伤的多发伤患者死亡危险因素分析

<正>随着工业、交通运输业的发展,创伤的发生率越来越高,成为普通人群中第四位,45岁以下人群中首要的死亡原因[1]。严重创伤往往是多发伤,当其它部位与腹部创伤同时存在时,可因腹外损伤症状典型,而忽略了腹部检查,造成漏诊,后果严重。腹部创伤居创伤死亡第三位,其中85%为钝性腹部创伤[2]。钝性腹部创伤因病情复杂诊断相对困难,同时变化快,死亡率高,被当作是诊断和治疗的一项挑战[3]。如何及时准确的判断伴有钝性腹部创伤的多发伤的严重     

严重多发伤患者血浆TNF水平变化的临床意义

目的：探讨严重多发伤患者血浆TNF水平变化的临床意义及其与APACHEⅡ评分的关系。方法：采用酶联免疫分析法测定33例严重多发伤患者及20例健康体检者的血浆TNF水平，同时对33例严重多发伤患者进行APACHEⅡ评分。结果：多发伤患者血浆TNF水平显著高于正常对照组（P＜0．01），多发伤患者中合并多脏器功能障碍综合征（MODS）者血浆TNF水平及APACHEⅡ评分显著高于未合并MODSD者（ 均P＜0．01）；死亡组血浆TNF水平及ARACHEⅡ评分显著高于存活组（均P＜0．01）；ARACHEⅡ评分与血浆TNF水平呈显著正相关（P＜0．05）。结论：严重多发伤患者血浆TNF水平与ARACHEⅡ评分有良好的相关性，测定TNF水平有助于判断预后，对早期诊断MODS可起预警作用。     

创伤患者感染鲍曼不动杆菌危险因素及其死亡率的调查研究

目的探讨创伤患者感染鲍曼不动杆菌的危险因素。方法收集该院2006～2009年的创伤患者330例,采用损伤严重程度计分(ISS)及格拉斯哥昏迷评分表(GCS)进行回顾性分析。结果 330例创伤患者中感染鲍曼不动杆菌36例。鲍曼不动杆菌感染的危险因素单因素分析显示较高的ISS评分(P=0.02)、较低的入院时GSC评分(P=0.03)、较长的入住重症监护室(ICU)时间(P=0.000 01)、机械通气时间(P=0.000 01)、内固定术(P=0.003)等,以及多因素分析显示机械通气时间与内固定术是感染鲍曼不动杆菌的独立危险因素,感染鲍曼不动杆菌有较高的病死率,病死率高低与ISS及GCS评分有关。结论延长机械通气时间与内固定术是导致严重创伤患者鲍曼不动杆菌感染的主要危险因素,但感染鲍曼不动杆菌并不影响患者病死率。     

短时连续性静-静脉血液透析滤过对重症急性胰腺炎并急性肺损伤的治疗研究

目的 研究早期短时连续性静-静脉血液透析滤过(SCVVHDF)对重症急性胰腺炎(SAP)合并急性肺损伤(ALI)的治疗效果.方法 选取2006年9月-2009年12月我院急诊ICU收治的36例合并ALI的SAP患者,分为SCVVHDF组和对照组,对比分析两组患者生命体征、氧合指数、急性生理和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、机械通气时间、ICU住院时间及病死率.结果 治疗后24 h、48 h、72 h、120 h SCVVHDF组患者心率与呼吸频率较对照组明显降低,差异有统计学意义(P＜0.05).治疗后24 h、48 h SCVVHDF组患者体温较对照组明显降低,差异有统计学意义(P＜0.05).治疗后24 h、48 h、72 h、120 h SCVVHDF组氧合指数较对照组明显升高,差异有统计学意义(P＜0.05).治疗后72 h、120 h SCVVHDF组APACHEⅡ评分较对照组明显降低,差异有统计学意义(P＜0.05).SCVVHDF组机械通气时间及ICU住院时间较对照组明显缩短,差异有统计学意义(P＜0.05).SCVVHDF组病死率较对照组明显下降,差异有统计学意义(P＜0.05).结论 SCVVHDF治疗能促进SAP合并ALI患者肺功能的恢复,减少机械通气时间,缩短ICU住院天数,减少住院病死率,是一项重要的辅助治疗措施.