预后营养指数和营养控制状态评分对老年重度创伤性脑损伤的预后预测价值

目的 探讨预后营养指数（prognostic nutritional index,PNI）和营养控制状态（controlling nutritional status,CONUT）评分对老年重度创伤性脑损伤（traumatic brain injury,TBI）患者的预后预测价值。方法 选取2019年1月至2020年12月南通市海安市人民医院收治的108例老年TBI患者，根据改良的Rankin量表（mRS）评估患者发病后6个月的神经功能，分为预后良好组（mRS<3分, n=46）和预后不良组（mRS≥3分, n=62）。收集患者的一般资料和临床特征并计算PNI和CONUT评分。通过二元logistic回归分析患者功能预后的影响因素。采用受试者工作特征（ROC）曲线明确PNI和CONUT评分鉴别患者功能预后的最佳截断值及曲线下面积（AUC）。结果 与预后良好组相比，预后不良组患者年龄较大、Glasgow评分较高、CONUT评分较高、PNI评分较低（P<0.05）。Logistic回归分析提示，PNI(OR=0.64,P=0.007)、CONUT评分（OR=1.44, P=0....     

Derivation of a bioclinical prognostic index in severe head injury

We investigated the problem of outcome prediction from seven risk factors in 40 severely head injured patients-13 favorable and 27 unfavorable outcomes. By applying stepwise logistic discriminant analysis to the patients' data, we selected three significant risk variables: cerebrospinal fluid (CSF) CK-BB isoenzyme activity recorded on admission, severely raised intracranial pressure (more than 40 mmHg) and age, respectively. CSF CK-BB activity, which quantifies the initial neurological damage, proved to be the best prognostic factor. The presence of severe intracranial hypertension was always associated with a bad outcome, whereas its absence was not necessarily indicative of good prognosis. Finally, we combined the three selected variables into a single risk index, which allowed correct predictions in 92% of patients with favorable outcome and in 85% of patients with unfavorable outcome (total predictive efficiency 88%).     

预后营养指数与靶向治疗中晚期肝癌患者的预后关系

目的:探讨预后营养指数(prognostic nutritional index,PNI)对接受靶向治疗的中晚期肝细胞肝癌(肝癌)患者总体生存期的影响.方法:收集2017年1月至2020年5月复旦大学附属中山医院厦门医院肝肿瘤内科收治的90例接受靶向治疗的肝癌患者的临床资料并随访其生存期,根据血生化结果计算PNI值,分...     

鼻咽癌患者放化疗前预后营养指数与预后的相关性

目的探讨鼻咽癌患者放化疗前预后营养指数(prognostic nutritional index,PNI)与预后的关系。方法回顾性分析四川省肿瘤医院初诊鼻咽癌患者153例,收集放化疗前患者的血液学指标及临床资料并随访。用Kaplan-Meier法分析放化疗前血液学指标、PNI对鼻咽癌总生存时间的影响,进一步用Cox风险比例回归模型进行多因素分析。结果患者3、5、10年总生存率分别为89.54%、83%、75.16%。单因素及多因素分析结果提示,放化疗前PNI、白细胞计数(WBC)是鼻咽癌患者预后的独立危险因素。PNI低水平组(≤49.45)鼻咽癌患者3、5、10年总生存率低于高水平组(PNI49.45)。结论 PNI和WBC是鼻咽癌的独立预后指标,与鼻咽癌患者的总生存时间相关。     

慢性肾衰竭患者开始透析时血清白蛋白浓度与肾功能水平相关性分析

目的明确慢性肾衰竭患者开始透析时血清白蛋白浓度(SALB)与肾功能水平(GFR)之间是否存在线性相关。方法通过查阅中南大学湘雅二医院与湖南省人民医院两大血液透析中心1998～2005年间开始第一次透析的所有514例慢性肾衰竭患者的病案获得血清白蛋白和肾功能检查等实验室数据及其他人口统计学数据。将患者按不同标准分组并计算整个患者群及不同分组情况下的血清白蛋白浓度与肾功能水平之间是否存在线性相关关系。结果①整体而言,血清白蛋白浓度和肾功能水平之间并无直线相关;②当GFR<8.5时,GFR与SALB呈正直线相关。而当GFR>8.5ml/min时,两者之间无线性相关;③进一步以不同原发病分组以后,慢性肾小球肾炎组与总体表现出同样的趋势;而糖尿病组和高血压组等其他组由于病例数较少未发现这种线性相关关系;④性别、年龄、体重、透析方式等对这种相关关系是否成立无影响。结论①肾功能水平下降到一定水平以后会引起低白蛋白血症;并且当GFR<8.5ml/min左右,SALB随GFR下降而下降,两者呈线性正相关;②制定科学的开始透析的肾功能标准,在出现严重的营养不良前及时透析对提高患者的生活质量和降低死亡率有重要意义。     

血清腹水白蛋白梯度的临床应用价值

目的 研究血清腹水白蛋白梯度(SAAG)在腹水性质鉴别中的的临床应用价值.方法 选择诊断明确的腹水患者72例,分为门脉高压组40例、非门脉高压组32例,分别测定其血清与腹水中总蛋白和白蛋白的值并进行比较.结果 门脉高压组患者SAAG为(19.18±5.22)g/L,非门脉高压组患者SAAG为(7.82±3.12)g/L,两组比较差异有显著性意义(P＜0.001).SAAG对门脉高压诊断的敏感度95%(38/40),特异度96.9%(31/32),准确度95.8%(69/72),阳性预测值97.4%(38/39),阴性预测值93.9%(31/33),均明显高于腹水总蛋白诊断渗、漏出液分类方法.结论 血清腹水白蛋白梯度对鉴别门脉高压性腹水和非门脉高压性腹水具有重要的临床价值,值得临床推广应用.     

D-二聚体联合血清白蛋白对急诊科老年脓毒症患者预后的评估

目的 观察老年脓毒症患者D-二聚体(D-dimer)、血清白蛋白(ALB)的变化,评估两者对老年脓毒症患者预后的临床预测价值。方法 采用回顾性研究,收集2019年1月至2020年11月上海交通大学医学院附属第九人民医院急诊科收治的老年脓毒症(根据脓毒症-3标准定义)患者103例,根据出院时的预后分为存活组(78例)和死亡组(25例),使用独立样本t检验比较两组患者入院24 h内血白细胞(WBC)、血小板(PLT)、C反应蛋白(CRP)、D-dimer和ALB的水平。通过logistic回归分析影响患者预后的独立危险因素。应用ROC曲线和曲线下面积(AUC)评价D-dimer、ALB、及以D-dimer和ALB联合预测因子(D-dimer/ALB)对老年脓毒症患者预后的评估价值。结果 死亡组D-dimer水平[(9.39±7.74) mg/L比(2.08±1.71) mg/L]显著高于存活组(P <0.01),死亡组ALB水平[(29.84±4.24) g/L比(32.54±4.89) g/L]显著低于存活组(P=0.011)。多因素logistic回归分析显示,D-dimer(O...     

Association of a low serum albumin with infection and increased mortality in critically Ill patients

214 patients among 282 consecutive admissions had at least one measurement of serum albumin (SA) during their stay on the ICU and were classified according to their stay on the ICU and were classified according to their lowest value of SA. Mean SA was 2.88±0.74 g/100 ml. Survivors had a mean SA (3.18±0.60) higher than non-survivors (2.35±0.68 g/100 ml) (p<0.05). 64% of patients were admitted with an abnormally low SA (less than 3.5 g/100 ml) and in 56% of these the initial value was higher than the last. Mortality increased in the groups with lower SA and the level of SA was associated with infection (x²=73.9) and mortality (x²=69.7) (p<0.05). The percentage of infected patients who died increased in groups with lower SA.     

血清-腹水白蛋白梯度在腹水病因鉴别诊断中的价值

目的 探讨血清-腹水白蛋白梯度(SAAG)在腹水病因鉴别中的应用价值.方法 回顾性分析以腹水待查入院的124例患者的病史,按出院诊断分为门静脉高压相关疾病组(70例)和非门静脉高压相关疾病组(54例);以同一天测定的血清白蛋白水平和腹水白蛋白水平计算SAAG,比较两组SAAG与诊断的关系.结果 门静脉高压相关疾病组的SAAG[(24±7)g/L]显著高于非门静脉高压相关疾病组[(8±4)g/L](P＜0.01).以SAAG≥11 g/L为界限值,诊断门静脉高压相关性腹水的敏感性为95.7%,特异性为98.1%,准确性为96.8%,阳性预期值为98.5%,阴性预期值为94.6%.结论 SAAG鉴别法的鉴别符合率明显高于传统腹水鉴别法,但不能取代腹水有核细胞计数和细胞学等检查.联合检测能有效提高腹水原因诊断准确率.     

血清丁酰胆碱酯酶与白蛋白在肝硬化Child-Pugh分级中的价值比较

目的 对肝硬化患者血清丁酰胆碱酯酶活性水平和血清白蛋白浓度同时进行检测,研究二者在肝硬化Child-Pugh分级中的相互关系及临床价值。方法 血清丁酰胆碱酯酶(BuChE)以酶速率比色法,白蛋白(Alb)以溴甲酚绿法在全动自动生化分析仪上测定。结果 肝硬化患者在严格按照Child-Pugh分级标准划分而成的A、B、C三级中,各级血清BuChE活性均明显下降,且结果差异有显著意义(F=43.54,P<0.001)。各级中下降程度依次为Child-A0.05)。结论 S-BuChE与肝硬化患者肝脏实质性损害有关,可反映肝细胞损害的严重程度,与Alb有同样重要的价值,且有反映肝病病情变化及不受输白蛋白影响等优点。     

骨科患者术后死亡及并发症相关因素分析与护理对策

目的：探讨分析骨科患者术后死亡及并发症发生的危险因素。方法回顾性分析935例骨科住院接受手术治疗的患者,统计术后死亡及并发症发生情况,对导致严重结局的危险因素行多因素logistic回归分析,针对危险因素提出预防性护理措施。结果935例患者中,围手术期内发生术后并发症82例,占8．77％;32例死亡,占3．42％。经logistic多元回归分析,术前肾功能不全、呼吸系统慢性疾病、心功能不全、房颤、心肌供血不足、脑血管病史是导致骨科患者术后死亡及并发症的独立危险因素（P＜0．05）。结论术前肾功能不全、呼吸系统慢性疾病、心功能不全、房颤、心肌供血不足、脑血管病史6个因素为骨科术后死亡及并发症发生的独立危险因素,护理人员应针对危险因素给予积极预防和干预。     

Inverse association between serum albumin and future risk of venous thromboembolism: interrelationship with high sensitivity C-reactive protein

Purpose: We aimed to assess the prospective association of serum albumin with venous thromboembolism (VTE) risk and evaluate if the association is independent of or modified by inflammation, as measured by high sensitivity C-reactive protein (hsCRP).

Design: We analysed data of 2176 men aged 42–61 years free from VTE in the Kuopio Ischemic Heart Disease study, with serum albumin concentrations measured at baseline using Coulter’s bromocresol purple colorimetric assays. Hazard ratios (HRs) (95% confidence intervals [CI]) were calculated for VTE.

Results: There were 109 validated cases of VTE recorded during a median follow-up of 24.9 years. The risk of VTE increased linearly below a serum albumin concentration of ～48?g/l. In Cox regression analysis adjusted for established risk factors and other potential confounders, the HR (95% CI) for VTE per 1 standard deviation lower serum albumin was 1.23 (1.02–1.47). The association remained persistent on further adjustment for hsCRP 1.22 (1.01–1.46). Furthermore, the association was not modified by hsCRP and persisted on exclusion of men with elevated hsCRP levels.

Conclusions: In middle-aged Caucasian men, low serum albumin is associated with an increased risk of VTE, consistent with a linear dose-response relationship. The association is independent of and not modified by inflammation.

• Key messages

• ??Serum albumin may be associated with future risk of venous thromboembolism (VTE); however, the shape, nature, magnitude and consistency of the association is uncertain.

• ??In a population-based prospective cohort study, low serum albumin was associated with an increased risk of VTE in a linear dose-response manner and this association was independent of and not modified by inflammation.

• ??Serum albumin concentrations may play a role in the development of VTE.

     

维持性血液透析患者白蛋白和C反应蛋白水平与预后的关系

目的 分析和探讨卫生部北京医院2008 年血液透析患者血清白蛋白和C 反应蛋白(C-reactiveprotein,CRP)水平及其与预后的关系.方法总结本院2008 年93 例在透患者的血清白蛋白及CRP 水平,将93 例患者按照CRP 与白蛋白水平分组,截至2010 年底,统计各组患者的死亡率,记录死亡原因,绘制存活曲线.结果 2008 年本院在透患者总体血清白蛋白水平有所改善,年初和年末平均值分别为(38.42 ± 2.81)g/L 和(39.41 ± 2.77)g/L,差异有统计学意义(P=0.002);男性各时点血清白蛋白平均值均优于女性,年末时男女分别为(39.56 ± 3.26)g/L 和(39.24 ± 2.12)g/L;年末总达标率为91.0%;＜ 60 岁组患者白蛋白达标率明显优于≥ 60 岁组患者(X2=6.746,P=0.014).在透患者总体CRP 水平逐渐下降,年初和年末分别为(0.53 ± 0.46)mg/dl 和(0.38 ± 0.20)mg/dl,差异有统计学意义(t =2.276,P ＜ 0.05);CRP 与白蛋白水平呈显著负相关关系(r =-0.238,P ＜ 0.01).患者死亡原因主要为感染性休克和心脑血管疾病( 8 2.3 % ).存活分析提示血清白蛋白和C R P 均异常的患者死亡率最高,为66.7%,白蛋白异常组患者死亡率高于CR P 异常组,分别为50.0% 和18.8%,差异有统计学意义(X 2 =72.563,P ＜ 0.01).结论 2008 年本院在透患者的血清白蛋白水平年末较年初有较大改善.男性各时点白蛋白水平均优于女性.＜ 60 岁组患者白蛋白达标率明显优于≥ 60 岁组.CRP 与白蛋白水平呈显著负相关的关系,低白蛋白血症较高CRP 水平更影响血液透析患者的预后.     

血清糖化白蛋白和同型半胱氨酸与冠状动脉病变的相关性

目的 探讨冠状动脉病变程度与血清糖化白蛋白（glycated albumin,GA）、同型半胱氨酸（homocysteine,Hcy）的关系及临床意义。方法 行冠状动脉造影检查患者151例,依据检查结果分为冠心病组121例和非冠心病组30例,冠心病组根据病变血管支数、Gensini积分、SYNTAX积分分为不同亚组,分析冠心病组和非冠心病组、冠心病不同亚组GA、Hcy水平差异。结果 冠心病组血清GA、Hcy、高密度脂蛋白胆固醇、陈旧性心肌梗死构成比分别为（15.38±3.68）%、（15.55±7.23）μmol/L、（0.93±0.22）mmol/L、18.2%,非冠心病组分别为（13.88±2.0）%、（12.73±4.42）μmol/L、（1.06±0.21）mmol/L、3.3%,2组比较差异有统计学意义（P〈0.05）;不同病变血管支数冠心病患者GA、Hcy水平比较差异无统计学意义（P〉0.05）;冠心病组Gensini积分、SYNTAX积分与血清GA、Hcy水平呈正相关（r值为0.4969~0.6731,P〈0.05）。结论 GA与Hcy联合检测对冠状动脉病变程度有预测价值。     

Blood urea nitrogen-to-serum albumin ratio and A-DROP are useful in assessing the severity of Pneumocystis pneumonia in patients without human immunodeficiency virus infection

IntroductionThere is an increasing incidence of Pneumocystis pneumonia (PcP) among individuals without human immunodeficiency virus (HIV) infection (non-HIV PcP). However, prognostic factors for patients with non-HIV PcP have not been identified. Moreover, A-DROP (for classifying the severity of community-acquired pneumonia) or the blood urea nitrogen-to-serum albumin ratio (BUN/Alb), which is reported to be a predictor of mortality of community-acquired pneumonia, has not been established as an efficient prognostic factor in patients with non-HIV PcP. In this study, we analyzed the prognostic factors for non-HIV PcP and evaluated the prognostic ability of A-DROP and the BUN/Alb ratio.MethodsThis retrospective study involved a chart review of the medical records of 102 patients diagnosed with non-HIV PcP between January 2003 and May 2019 at five medical facilities.ResultsOverall, 102 patients were involved in this study. The 30-day mortality rate for non-HIV PcP was 20.5% in this study population. Compared with survivors, non-survivors had significantly lower serum albumin levels and significantly higher age, corticosteroid dosage at the PcP onset, alveolar–arterial oxygen gradient, A-DROP score, lactate dehydrogenase levels, blood urea nitrogen levels, and BUN/Alb ratio. Multivariate analysis showed that a high BUN/Alb ratio at treatment initiation was significantly associated with 30-day mortality risk. The receiver operating characteristic curves showed that A-DROP score had the highest prognostic ability in estimating 30-day mortality.ConclusionsIn patients with non-HIV PcP, a high BUN/Alb ratio is an independent prognostic predictor of mortality risk, and A-DROP is useful for classifying the severity.     

血清白蛋白水平对急性期脑血管意外患者运动功能恢复的影响

探讨血清白蛋白对急性期脑血管意外患者运动功功能恢复的影响。方法：采用单盲前瞻性研究方法，将病情严重程度相同的４０例患者按ＳＡＬ分为高白蛋白组和低白蛋白组，分析比较两组患者在急性期运动功能恢复情况。结果：ＡＨ组的合并症发生率显著低于低白蛋白组；而高蛋白治疗后的ＭＡＳ积分及积分之差，ＭＢＩ积分这差均显著性高于低白蛋白组。     

高荧光细胞和血清腹水白蛋白梯度在恶性腹水诊断中的价值

目的 探讨高荧光细胞(HFC)和血清腹水白蛋白梯度(SAAG)诊断恶性腹水的价值.方法 选取202例出现腹水的患者,依据脱落细胞学检查结果分为恶性腹水组(36例)和良性腹水组(166例),分析HFC和SAAG在良、恶性腹水组中的分布差异.采用受试者工作特征(ROC)曲线评价各项指标单项及联合检测诊断恶性腹水的效能.结果...     

Global end-diastolic volume, serum osmolarity, and albumin are risk factors for increased extravascular lung water

Background

The transpulmonary thermodilution technique allows the determination of cardiac preload (global end-diastolic volume index) and quantification of pulmonary edema (extravascular lung water index [EVLWI]). Pulmonary edema commonly develops in critically ill patients; however, the underlying pathophysiology, that is, hydrostatic (cardiac) or permeability-induced (noncardiac), often remains unclear. In this study, hemodynamic and serum parameters of osmolarity and oncotic pressure were analyzed to identify risk factors for increased EVLWI.

Methods

A retrospective, single-center analysis in an intensive care unit of a university hospital was performed. No interventions were made for the study. Forty-two critically ill patients were included, and 126 simultaneous hemodynamic measurements and serum determinations were analyzed by logistic regression and Spearman rank correlation coefficient analysis.

Results

Global end-diastolic volume index (P = .001), serum albumin (P = .006), and serum osmolarity (P = .029) were significant factors for increased EVLWI (defined as >10 mL/kg).

Conclusion

Hypervolemia, hypoalbuminemia, and high plasma osmolarity are associated with increased EVLWI.     

Epidemiology and prognostic factors of critically ill patients treated with hemodiafiltration

PURPOSE: The objective of this study is to study the epidemiology, outcome, and prognostic factors of critically ill patients treated with continuous venovenous hemodiafiltration (CVVHDF). MATERIALS AND METHODS: Observational cohort was done in a French 16-bed intensive care unit (ICU) from a university-affiliated urban hospital. All patients requiring, in the opinion of the treating physician, the initiation of CVVHDF were included in the study. RESULTS: One hundred ninety-seven patients with acute renal failure (ARF) treated with CVVHDF were studied. The incidence of ARF treated with CVVHDF was 5.9% in the ICU with a mortality rate of 71.6%. A multivariate analysis identified 3 independent factors associated with fatal outcome: mechanical ventilation, sepsis, and septic shock requiring vasoactive drug. In contrast, 2 independent factors predicted a favorable outcome: nonoliguric ARF and serum creatinine concentration higher than 34 mg/L at CVVHDF initiation. A flowchart determined by the chi2 Automatic Interaction and Detection statistical method allowed for the identification of patients' subgroups with different mortality rates ranging from 25% to 100%. CONCLUSIONS: In our series, ARF treated with CVVHDF was associated with a high overall ICU mortality rate (71.6%). However, our prognostic flowchart identified patients with low mortality rates for which renal replacement therapy must be initiated with no discussion as soon as required.