Objective To explore the value of quick Sequential Organ Failure Assessment (qSOFA) score and blood markers in differentiating and predicting emergency heat stroke from sepsis, and to construct a rapid differentiation model. Methods A retrospective cohort study was conducted, including heat stroke patients and sepsis patients admitted to the Chongqing Emergency Medical Center between January 2021 and December 2024. The qSOFA score and blood marker indicators at admission were collected, with the “final diagnosis (sepsis or heat stroke) within 48 hours after admission” as the study endpoint. The logistic regression analysis method was selected to screen for independent predictive factors, construct a joint prediction model, and evaluate the discriminant efficacy using the area under the curve (AUC) of the receiver operating characteristic. Results A total of 133 sepsis patients and 66 heat stroke patients were included. The qSOFA score showed differentiation ability in univariate analysis (P=0.002), but had no independent predictive value after adjusting for diabetes, age, and gender (P=0.565). The results of multiple logistic regression analysis showed that procalcitonin (PCT), C-reactive protein (CRP), and monocyte count (MONO) were independent predictive factors (P<0.05). The combined prediction model of PCT, CRP, and MONO (AUC=0.984) showed higher discriminatory efficacy than PCT (AUC=0.809), CRP (AUC=0.886), and MONO (AUC=0.671). Conclusions The prediction model constructed by combining PCT, CRP, and MONO has good efficiency in differentiating sepsis from heat stroke, providing a reliable clinical decision-making tool for early accurate differentiation in the emergency department.
Objective To systematically evaluate the correlation between serum 25-hydroxyvitamin D [25(OH)D] level and mortality risk in adult with sepsis. Methods We searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases for studies on the correlation between serum 25(OH)D and mortality risk in adults with sepsis. The search period was from the establishment of databases to December 2023. Meta-analysis was conducted using RevMan 5.4 software. Results A total of 9 studies were included, with a total of 2267 patients. The meta-analysis results showed that sepsis patients with low serum 25(OH)D levels (<30 ng/mL), insufficient levels (20-30 ng/mL), and deficient levels (<20 ng/mL) had a higher mortality risk compared to those with normal levels (relative risk=1.96, 1.62, 2.21, P<0.05). Subgroup analysis based on different sepsis diagnostic criteria, regions, and research types also showed that sepsis patients with lower serum 25(OH)D levels (<30 ng/mL) had a higher mortality risk compared to those with normal levels (P<0.05). Conclusions Adult sepsis patients with low serum 25(OH)D levels have a higher mortality risk than those with normal levels.
Objective To explore the predictive value of simplified acute physiological score Ⅱ (SAPS-Ⅱ) combined with lactate clearance rates (LCR) at different moments for mortality in sepsis patients. Methods A total of 188 patients with sepsis admitted in the hospital from April 2020 to February 2023 were selected, who were evaluated using the SAPS-Ⅱ scale. Spectrophotometry was used to detect blood lactate at baseline, after 6h, 12h, 24h, and 48h, then the LCR after 6h, 12h, 24h, and 48h were calculated. The patients were divided into a survival group (n=139) and a death group (n=37) based on 28 day outcome. Logistic regression analysis was used to explore the risk factors of sepsis death, and the efficacy of SAPS-Ⅱ scores combined with LCR at different moments in predicting patient death was analyzed using receiver operating characteristic (ROC) curve. Results Twelve patients fell off, and 37 died in the remaining 176 patients, the mortality rate was 21.02%. The age, temperature, random blood glucose, blood urea nitrogen, serum creatinine, and SAPS- Ⅱ scores in the death group were significantly higher than those in the survival group (P<0.05), while platelet count and LCR at all moments were significantly lower than those in the survival group (P<0.05). The LCR of the death group continued to decrease with time. The trend of changes in the survival group were opposite, and the differences in the two groups between each two moments were statistically significant (P<0.05). The SAPS-Ⅱ scores and LCR at all moments were risk factors for patient death (P<0.05). The SAPS-Ⅱ score and LCR at all moments had predictive value for patient death, and the area under ROC curve of the combined prediction was 0.921 (95%CI 0.825 - 1.000), which was higher than the individual prediction and LCR at each moment combined with SAPS II score prediction (P<0.05). Conclusion The SAPS-Ⅱ scores and LCR at different moments are all related to death of sepsis patients, and the combined prediction of death by the above indicators is highly effective.
Objective To investigate the diagnosis and treatment strategy of urosepsis caused by ureteral calculi in solitary kidney. Methods The clinical data of patients with urosepsis caused by ureteral calculi in solitary kidney in the Department of Urology of Chengdu 363 Hospital Affiliated to Southwest Medical University from March 2015 to March 2020 were analyzed retrospectively. Results A total of 23 patients were included. One patient received ureteroscopic holmium laser lithotripsy, after which urosepsis and renal function deteriorated, then got better after anti-infection and hemodialysis treatment in intensive care unit; 17 patients received implantation of ureteral stent by cystoscopy, and 5 patients received percutaneous nephrostomy by ultrasound guiding, the 22 patients received ureteroscopic lithotripsy or flexible ureteroscopic lithotripsy electively. One patients had subcapsular renal hematoma postoperatively and worse renal insufficiency, the rest 22 patients had improved renal function. All patients were cured clinically. Conclusions For solitary kidney patients who have urosepsis caused by ureteral calculi, emergency treatment is necessary. The relief of urinary obstruction must be based on effective anti-infection. Choosing cystoscopic ureteral stent implantation or percutaneous nephrostomy depends on patients’ individualization. Ureterscopic lithotripsy simultaneously is not recommended. Ureteral intubation before cystoscopic ureteral stent implantation is important, which can increase the success rate of ureteral stent implantation.
ObjectiveTo study the feasibility of using paper hand towels instead of sterilized hand towels in non-rinse surgical hand antisepsis, and make a hygienic and economic evaluation on sterilized hand towels and paper hand towels.MethodsFrom July to September 2016, a cluster sampling method was used to study the hand samples of all health care workers who performed surgical hand sanitization in the operating room on Thursday. According to their work contents, they were asigned into the intervention group (using paper hand towels to dry hands) and the control group (using sterilized hand towels to dry hands); further, according to the odd or even number of the staff identification number, the intervention group was divided into Group A (using Likang hand towels to dry hands) and Group B (using Qingfeng hand towels to dry hands). The packing specifications and costs of hand-drying items in the warehouse were surveyed, as well as the average number of medical workers performing an operation and the number of sheets of sterilized hand towels or paper hand towels used per person, and the cost of different hand dryers for each procedure was calculated. Finally, the hygienic and economic effects of using paper hand towels were evaluated.ResultsThere were 30, 39, and 30 hand hygiene samples collected in the control group, Group A, and Group B, respectively. The total bacterial count of each group was less than 5 cfu/cm2, which met the hygienic requirements of surgical hand disinfection in the manual hygiene standard for medical personnel (WS/T 313－2019), i.e., the passing rate of each group was 100%. According to the calculation that each operation required at least 4 medical workers, each operation consumed 8 sterilized hand towels at a cost of 15.2 yuan; if using paper hand towels, each operation consumed 16 sheets at a cost of 0.8 yuan.ConclusionThe hygienic effect of surgical hand disinfection is not affected by the use of paper hand towels before applying hand sanitizer, while the operating cost of hospital operating room can be significantly reduced by using paper hand towels instead of sterilized hand towels.
Sepsis-associated acute kidney injury (SAKI) is a common complication of patients in intensive care unit, and also an independent risk factor leading to high mortality of sepsis patients. SAKI leads to an extended hospital stay for patients, resulting in a huge medical burden. The pathogenesis of SAKI is complex, and systemic inflammatory response plays an important role in it. At present, blood adsorption is the main method for treating SAKI in intensive care units, but there is no consensus on the relevant treatment strategies. This article summarizes new perspectives and research conclusions on the application of blood adsorption technology in the treatment of SAKI, aiming to provide new references for the blood adsorption treatment strategies of SAKI.
Objective To investigate the effects of ulinastatin on Treg/Th17 and immune status in patients with severe sepsis.Methods A total of 80 patients with severe sepsis, who were hospitalized in ICU during October 2011 to July 2012, were randomly divided into a routine group and a ulinastatin group. The patients in the ulinastatin group were intravenously administered 30mg ulinastatin three times per day for 5 days in addition to routine bundle treatment. The expression of Treg, Th17 and HLA-DR were detected on the first day in ICU and 5 days after treatment. 20 healthy individuals served as controls. Results Compared with the control group, the severe sepsis group had overexpression of Treg and Th17 ( P lt;0. 01) , higher ratio of Treg/Th17( P lt;0. 01) , and decreased HLA-DR expression of CD14 monocyte ( P lt; 0. 01) . In the severe sepsis patients, ulinastatin injection reduced the abnormal expression of Treg and Th17 ( P lt; 0. 01) , decreased the ratio of Treg/Th17( P lt; 0. 01) , and improved the expression of HLA-DR ( P lt; 0. 01) more effectively compared with the routine treatment. Ulinastatin also lowered 28-day mortality of the patients with sepsis, but the difference between the ulinastatin group and the routine group was not significant. Conclusions In severe sepsis patients, there were abnormal overexpression of Treg and Th17, imbalance of Treg/Th17, and underexpression of HLA-DR which imply an immune suppression. Ulinastatin can decrease the expression of Treg and Th17, inverses the ratio of Treg/Th17, and improve the expression of HLA-DR, so as to improve the prognosis of severe sepsis patients.
Objective To investigate the protective effect of aprotinin on liver injury in septic rats and its mechanism. Methods Thirty male SPF rats were randomly divided into sham operation group, cecum ligation and puncture (CLP) group and aprotinin intervention group (10 rats in each group). The sham operation group was treated with cecal exploration, CLP group and aprotinin group were treated with CLP method to establish sepsis rat model. The rats in each group were sacrificed 24 hours after operation, and the morphological changes of liver tissue in rats were observed, the serum liver function indicators and inflammatory cytokines levels were detected, and the protein expression of Toll-like receptor (TLR4)/nuclear factor κB (NF-κB) signaling pathway in liver tissue was detected. ResultsIn the CLP group, septic rats exhibited significant inflammatory cell infiltration in hepatic tissue and disordered hepatocyte morphology. Compared with the CLP group, the aprotinin group exhibited nearly normal hepatocyte morphology with significant improvement in vacuolar degeneration. Compared with the sham operation group, the serum aspartate aminotransferase, alanine aminotransferase, tumor necrosis factor-α, interleukin-6 were increased, and the expression of TLR4 and p-NF-κB protein in liver tissue was up-regulated in the CLP group (P<0.05). Compared with the CLP group, serum aspartate aminotransferase, alanine aminotransferase, tumor necrosis factor-α, interleukin-6 were decreased, and the expression of TLR4 and p-NF-κB protein in liver tissue was decreased in the aprotinin group (P<0.05). ConclusionAprotinin may play a protective role against sepsis related liver injury by inhibiting TLR4 / NF-κB signaling axis, reducing the production of inflammatory factors and alleviating inflammatory reactions.
Sepsis 已經成為危重癥醫學中較為常見的一種綜合征，它定義為因病原體感染而引起的全身性炎癥反應綜合征。嚴重Sepsis患者預后不佳，治療上也較為困難，特別是合并Septic Shock和多器官功能不全綜合征（MODS）的患者，死亡率仍然較高，因此近年來在臨床及研究上均已引起明顯的重視。為了能促進Sepsis的研究及治療，國際上多個醫學專科分會聯合發起“拯救Sepsis運動（Surviving Sepsis Campaign, SSC）”，并于2004年首次發表了相應的指南，即Surviving Sepsis Campaign Guideline for Management of Severe Sepsis and Septic Shock。今年初SSC再次發表了新版的指南，主要是結合近年的研究成果而在原版的基礎上進行適當的補充和更新，以指導臨床上嚴重Sepsis的搶救及治療。
Cytokine storm is a life-threatening hyperinflammatory response. Current limited evidence-based research findings suggest that cytokine adsorption technologies do not reduce mortality in patients undergoing cardiac surgery or those with septic shock, nor do they improve hemodynamics or lower interleukin-6 levels. These negative outcomes may be related to improper timing and method of use, insufficient adsorption efficacy and non-specific adsorption of antibiotics, albumin, platelets, and other substances. This article summarizes the optimal timing for initiating and terminating cytokine adsorption therapy, treatment modality selection, as well as treatment duration and frequency, aiming to provide clinical guidance.