Objective:To examine the potential of combining the blood urea nitrogen(BUN)/albumin(ALB)ratio(BAR)with soluble growth stimulation expressed gene 2(sST2)as an early warning indicator for myocardial injury in elderly patients with sepsis in the emergency intensive care unit(EICU).Methods:The clinical data of elderly patients with sepsis admitted to the EICU of the Emergency Medicine Department at Harrison International Peace Hospital of Hebei Medical University from August 2018 to August 2022 were prospectively analyzed.The patients were divided into two groups based on the presence or absence of myocardial injury: the myocardial injury group and the non-myocardial injury group.The general clinical data and laboratory indexes of the two groups were compared, and the BAR was calculated.The correlation between BAR and myocardial injury in elderly patients with sepsis was analyzed.Binary Logistic regression analysis was used to identify the risk factors for myocardial injury in elderly patients with sepsis in the EICU.MedCalc software was employed to determine the early warning value of the combined sST2 and BAR for myocardial injury in elderly patients with sepsis in the EICU.Results:A total of 165 cases were analyzed, with 106 cases(64.24%)showing myocardial injury.It was found that elderly sepsis patients with lung and abdominal infection were more likely to experience myocardial injury( P<0.05 for all).In comparison to the group without myocardial injury, the levels of inflammatory markers such as white blood cell count(WBC), neutrophil to lymphocyte ratio(NLR), lactic acid, and procalcitonin(PCT), as well as combined markers BAR and sST2, were higher in elderly sepsis patients with myocardial injury upon admission.Correlation analysis results revealed significant positive correlations between BAR and lactic acid, PCT, and C-reactive protein(CRP)within 24 hours of admission to EICU in elderly sepsis patients with myocardial injury.Among these correlations, the strongest was observed between BAR and PCT( r=0.417, P<0.001).Additionally, BAR exhibited a positive correlation with acute physiology and chronic health evaluation scoring system(APACHEⅡ)scores( r=0.241, P=0.002).Furthermore, BAR showed positive correlations with myocardial injury markers sST2 and cTnI( r=0.327, 0.307, P<0.05 for all).Logistic regression analysis revealed that septic shock( OR=2.406, P=0.008), decreased left ventricular ejection fraction(EF)( OR=0.939, P=0.015), BAR( OR=2.205, P=0.044), lactic acid( OR=1.137, P=0.014), and sST2 elevation( OR=1.016, P=0.020)were identified as independent risk factors for predicting myocardial injury in elderly patients with sepsis.The results of ROC analysis indicated that BAR had a high early warning value for the occurrence of myocardial injury in elderly patients with EICU sepsis[area under curve(AUC)0.651, P<0.05], with an optimal cut-off value of 0.32(sensitivity 77.4%, specificity 60.2%).Furthermore, the combined detection of BAR and sST2 demonstrated a higher early warning value for the occurrence of myocardial injury in elderly patients with sepsis(AUC 0.697, P<0.05).The mortality rate of patients with myocardial injury below a cut-off value of 0.32 was 36.00%(9/25), while the mortality rate of patients with myocardial injury equal to or above 0.32 was 66.67%(54/81).The difference between the two groups was statistically significant( χ2=8.624, P=0.003). Conclusions:Both BAR and sST2 are considered independent risk factors for myocardial injury in elderly patients with sepsis.The combined detection of BAR and sST2 provides a more accurate prediction for the occurrence of myocardial injury in these patients.

Objective:To investigate the effect of continuous hemoperfusion (HP) on the levels of soluble CD14 isoform (sCD14-st) and neutrophil gelatinase-associated lipocalin (NGAL) on patients with diquat (DQ) poisoning and its significance.Methods:A total of 86 patients with acute DQ poisoning admitted to the department of emergency medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to August 2021 were enrolled and divided into the intermittent HP group (40 cases) and the continuous HP group (46 cases) according to the random number table method. All patients received basic treatment and continuous veno-venous hemofiltration (CVVH) within 24 hours after admission. On this basis, the intermittent HP group received HP treatment within 2 hours, lasting 2 hours each time for every 8 hours, 3 times in all; the continuous HP group received continued HP treatment until there was no DQ component in urine samples. Serum NGAL levels were detected in all patients before treatment and at 3 hours, 12 hours, 24 hours, 2 days, 3 days, 5 days, and 7 days after treatment. At the same time, serum sCD14-st, blood lactate (Lac), arterial partial pressure of oxygen (PaO 2), serum creatinine (SCr), MB isoenzyme of creatine kinase (CK-MB) and interleukin-18 (IL-18) levels were detected before treatment and at 24 hours, 3 days, and 7 days after treatment. Kaplan-Meier survival curve was drawn to analyze the 28-day survival of patients. Results:Before treatment, there was no significant difference in serum NGAL, sCD14-st, Lac, PaO 2, SCr, CK-MB and IL-18 levels between the two groups. With the prolongation of treatment, the serum levels of NGAL, sCD14-st, Lac, SCr, CK-MB and IL-18 in the intermittent HP group increased at first and then decreased. Serum levels of NGAL, sCD14-st, CK-MB and IL-18 reached their peaks at 24 hours after treatment, and the Lac and SCr levels reached their peaks at 3 days after treatment. In addition, the levels of the above indexes at each time point in the continuous HP group were all significantly lower than those in the intermittent HP group [after 24 hours of treatment: NGAL (μg/L) was 345.90±30.75 vs. 404.24±38.79, sCD14-st (ng/L) was 1 941.88±298.02 vs. 2 656.35±347.93, CK-MB (U/L) was 30.67±9.11 vs. 43.28±8.06, IL-18 (ng/L) was 139.49±16.29 vs. 177.98±27.85; 3 days of treatment: Lac (mmol/L) was 2.98±0.26 vs. 3.72±0.49, SCr (μmol/L) was 125.01±24.24 vs. 156.74±28.88; all P < 0.05]. However, there was no significant difference in PaO 2 levels between the two groups at each time point after treatment. The Kaplan-Meier survival curve showed that the 28-day mortality of patients in the continuous HP group was significantly lower than that in the intermittent HP group [26.09% (12/46) vs. 52.50% (21/40); Log-Rank test: χ2 = 7.288, P = 0.007]. Conclusion:Continuous HP could effectively reduce serum sCD14-st, NGAL levels and 28-day mortality in patients with DQ poisoning, with good curative effect.

Objective:To explore the value of neutrophil gelatinase-associated lipocalin(NGAL)and neutrophil-to-lymphocyte and platelet ratio(NLPR)for early prediction of kidney injury with Diquat(DQ)poisoning in elderly patients.Methods:In this retrospective study, a total of 106 elderly patients with DQ poisoning treated in the Emergency Intensive Care Unit(EICU)of Harrison International Peace Hospital Affiliated to Hebei Medical University between October 2019 and October 2021 were divided into an acute kidney injury group(AKI group, n=62)and a non-acute kidney injury group(NAKI group, n=44). Meanwhile, 40 non-elderly patients with DQ poisoning served as the control group.Samples of 5 ml venous blood were collected from patients admitted to the EICU to measure NGAL and NLPR levels and Logistic regression analysis was conducted to analyze independent risk factors for AKI in elderly DQ poisoning patients.The area under the curve(AUC)was calculated via the receiver operating characteristic(ROC)curve, and the value of NGAL and NLPR for early prediction of AKI in elderly patients with DQ poisoning and patient prognosis was assessed.Results:Blood NGAL and NLPR levels in the AKI group were significantly higher than in the NAKI group[(387.1±46.6)μg/L vs.(103.5±18.6)μg/L, (13.5±3.4) vs.(5.3±1.1), t=38.243, 15.608, P<0.001 for both]. Logistic regression analysis results showed that elevated levels of NGAL( OR=1.009, 95% CI: 1.003-1.015, P<0.001)and NLPR( OR=1.263, 95% CI: 1.039-1.536, P<0.001)were risk factors for AKI in elderly patients with DQ poisoning.The areas under the ROC curves of NGAL, NLPR and NGAL+ NLPR for AKI prediction were 0.834, 0.803 and 0.873 respectively.The predictive power of NGAL and NLPR for the death of elderly patients with DQ poisoning was higher than that of creatinine clearance(Ccr). The sensitivity of the combination of the two to predict the risk of death was 0.850, the specificity was 0.828, and the AUC was 0.887. Conclusions:NGAL and NLPR are independent risk factors for the occurrence of AKI in elderly patients with DQ poisoning.Combined detection of NGAL and NLPR improves AKI prediction and prognosis assessment in elderly patients with DQ poisoning.

Objective:To explore the predictive value of peripheral perfusion index (PI) combined with central venous-arterial carbon dioxide tension to arterial-venous oxygen content ratio(Pv-aCO 2/Ca-vO 2)for prognosis after initial resuscitation of septic shock. Methods:A total of 76 cases of patients with septic shock from January 2019 to January 2021 in emergency intensive care unit (EICU) of Harrson international peace hospital affiliated to Hebei Medical University were enrolled. All recovered according to 2016 Severe Sepsis and Septic Shock Treatment International Guidelines 2016 (SSC 2016) , and PI was monitored, central vein and arterial blood gas analysis was performed, and the ratio of Pv-aCO 2/Ca-vO 2 was calculated.The PI and Pv-aCO 2/Ca-vO 2 at 3 h,hemodynamic variables,oxygen metabolism indexes,APACHEⅡ and SOFA score were recorded.Patients were divided into survival group and death group according to 28 d survival condition, the dfferences in demographics and clinical data were compared between two groups.The Kaplan-Meier urviving curve was created and the survival of the patients was analyzed by the Log-rank test. Risk factors associated with the prognosis were analyzed using the Cox regression analysis. The role of PI and Pv-aCO 2/Ca-vO 2 in prediting death was evaluated by receiver operating characteristic curves(ROC). Results:There were 37 cases in survival group and 39 cases in death group.Compared with death group, PI in survival group [(1.77±0.63) vs. (0.89±0.69)]was significantly higher,and Pv-aCO 2/Ca-vO 2[(1.52±0.52) vs. (2.57±0.86)] was significantly lower ( P<0.05). Kaplan-Meier survival curve showed that the median survival time in the high PI group [20.09 d (95% CI:16.95-23.24) vs.11.00d (95% CI:7.14-14.86)] was longer than that in the low PI group(χ 2=12.424, P=0.000),and that in low Pv-aCO 2/Ca-vO 2 group [23.74 d (95% CI:20.35-27.13) vs.12.85d (95% CI:9.75-15.95)] was longer than that in the high Pv-aCO 2/Ca-vO 2 group (χ 2=12.200, P=0.000) .Cox regression analysis showed that both PI ( RR=0.397, 95% CI: 0.230-0.687, P =0.001) and Pv-aCO 2/Ca-vO 2 ( RR=1.878, 95% CI: 1.169-3.019, P =0.009) were predictors of 28 d mortality.The area under the ROC curve of PI and Pv-aCO 2/Ca-vO 2 for predicting 28 d death in patients with septic shock were 0.828 (95% CI: 0.732-0.923) and 0.785 (95% CI: 0.6777-0.893)respectively. The optimal cutoff values were 0.52 (sensitivity 58.3% and specificity 94.4%) and 0.35 (sensitivity 88.9% and specificity 63.9%)respectively, and the AUC of the combined prediction of the two indicators was 0.903 (95% CI: 0.835-0.971). Conclusions:Combination of PI and Pv-aCO 2/Ca-vO 2 is better to predict the risk of adverse outcomes of septie shock patients,and may provide useful information for the resuscitation at early stage.

Objective:To observe the changes of blood systemic immune-inflammation index (SII) and monocyte to high-density lipoprotein cholesterol ratio (MHR) in patients with delayed encephalopathy after carbon monoxide poisoning (DEACMP) accepted transcranial direct current stimulation (tDCS) treatment, and to objectively evaluate the efficacy of tDCS in DEACMP.Methods:A total of 80 DEACMP patients admitted to our hospital from January 2020 to February 2022 were selected and randomly divided into observation group ( n=39) and routine group ( n=41). Conventional treatment was given to patients of both groups. On this basis, tDCS was given additionally to the observation group: the left dorsolateral prefrontal lobe was used as the positive stimulation site, and the right shoulder was used as the negative stimulation site; the treatment duration was 30 min/time, and the stimulation intensity was 1.5 mA, once per d; and sham stimulation was given to the routine group: the electrodes were stimulated with 1.5 mA current for 10 s and kept for 30 min, once per d. Patients of both groups were treated for 4 weeks. Before, and 4 weeks and 6 months after treatment, SII and MHR were detected; the electroencephalogram (EEG) results, and scores of Montreal Cognitive Assessment (MoCA) and activities of daily living (ADL) were observed. The total effective rate between the 2 groups after 4 weeks of treatment (total effective rate [%]=[number of cured cases+number of improved cases]/total number of cases×100%), and the correlations of SII and MHR before treatment with ADL scores and abnormal degree of EEG were analyzed. Results:The total effective rate in the observation group (92.3%, 30 were cured and 6 got improvement) was significantly higher than that in the routine group (73.2%, 22 were cured and 8 got improvement; χ2=5.070, P=0.024). Four weeks and 6 months after treatment, SII, MHR, abnormal rates of EEG and P300 latency in the observation group were significantly lower than those in the routine group, and the MoCA and ADL scores and P300 amplitude were statistically higher than those in the routine group ( P<0.05). Correlation analysis showed that SII and MHR before treatment were negatively correlated with ADL scores ( r=-0.805, P<0.001; r=-0.788, P<0.001); SII and MHR were positively correlated with abnormal degree of EEG ( r=0.803, P<0.001; r=0.719, P<0.001). Conclusion:The tDCS treatment can effectively reduce the inflammation levels and improve prognosis scores in DEACMP patients; SII and MHR can preliminarily evaluate the therapeutic effect of tDCS.

Objective:To analyze the correlation and predictive value between early BIS monitoring combined with lactic acid resolution (LCR) and delayed encephalopathy with acute severe carbon monoxide poisoning (ASCMP) .Methods:Select 96 cases of our hospital ASCMP patients were analyzed retrospectively in March 2020, and follow-up of 60 days, according to the outcome in patients with acute carbon monoxide poisoning (DEACMP) delayed encephalopathy group with good prognosis, compare two groups of general information, admission BIS average 24 h and 24 h after treatment the LCR, According to the 24h LCR test results, patients were divided into high LCR group (LCR>15%) and low LCR group (LCR≤15%) , analysis the BIS average, the correlation of the LCR with DEACMP and both individual and joint of DEACMP predictive value, Comparing clinical data of patients with high LCR and low LCR.Results:The mean BIS value of the DEACMP group 24 hours after admission was significantly lower than that of the group with good prognosis ( P< 0.05) . LCR of DEACMP group was significantly lower than that of the group with good prognosis after 24 h treatment ( P<0.05) . The prevalence of DEACMP in patients with high LCR was significantly lower than that with low LCR ( P<0.01) ; In the early stage, BIS mean, LCR and DEACMP were negatively correlated ( P< 0.05) , and the area under the curve predicted by BIS mean, LCR and their combination on DEACMP was 0.799, 0.847 and 0.902, respectively. Conclusion:Early BIS monitoring combined with LCR has a significant correlation with DEACMP, and the combined effect of the two is better. Early BIS combined with LCR detection can provide effective guidance for the prognosis assessment of ASCMP patients.

Objective:To explore the predictive value of low T3 syndrome (LT3S) for patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) .Methods:In May 2020, 137 severe acute carben monoxide poisoning (SACMP) patients were selected from Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2019 to January 2020 as subjects. Blood samples were taken after admission to test thyroid function. Followed up for 60 d, the patients were divided into DEACMP group (45 cases) and non DEACMP group (92 cases) according to their prognosis. Clinical data of patients in two groups were collected and compared. The Cox regression with multiple independent variables was used to analyze the independent risk factors of DEACMP. Pearson correlation analysis was used to evaluate the correlation between totall triiodochyronine (TT3) level and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score. The receiver operating characteristic (ROC) curve of TT3 and APACHE Ⅱ scores for predicting DEACMP were drawn.Results:Compared with non DEACMP group, the age, APACHE II score, LT3S rate and diabetes prevalence in DEACMP group were higher, and the Glasgow coma scale (GCS) score was lower ( P<0.05) . Cox regression analysis showed that age, APACHEⅡ score and LT3S were independent risk factors of DEACMP in patients with SACMP ( OR=1.040, 95% CI:1.005-1.077; OR=1.070, 95% CI: 1.002-1.143; OR=4.210, 95% CI: 1.707-10.379; P<0.05) . Pearson correlation analysis showed that TT3 level was negatively correlated with APACHE Ⅱ score ( r=-0.397, P=0.000) . ROC curve showed that the cut-off value of TT3 level for DEACMP prediction was 1.078 nmol/L, the area under curve (AUC) was 0.755, the sensitivity was 82.6%, and the specificity was 73.3%. The cut-off value of the APACHE Ⅱ score for predicting DEACMP was 16, and the AUC was 0.725, sensitivity was 93.3%, and specificity was 60.9%. Conclusion:This study showed that LT3S minght be an independent predictor of DEACMP in patients with SACMP. Thyroid function is closely related to the severity of SACMP patients.

Objective:To analyze the correlation and predictive value between early BIS monitoring combined with lactic acid resolution (LCR) and delayed encephalopathy with acute severe carbon monoxide poisoning (ASCMP) .Methods:Select 96 cases of our hospital ASCMP patients were analyzed retrospectively in March 2020, and follow-up of 60 days, according to the outcome in patients with acute carbon monoxide poisoning (DEACMP) delayed encephalopathy group with good prognosis, compare two groups of general information, admission BIS average 24 h and 24 h after treatment the LCR, According to the 24h LCR test results, patients were divided into high LCR group (LCR>15%) and low LCR group (LCR≤15%) , analysis the BIS average, the correlation of the LCR with DEACMP and both individual and joint of DEACMP predictive value, Comparing clinical data of patients with high LCR and low LCR.Results:The mean BIS value of the DEACMP group 24 hours after admission was significantly lower than that of the group with good prognosis ( P< 0.05) . LCR of DEACMP group was significantly lower than that of the group with good prognosis after 24 h treatment ( P<0.05) . The prevalence of DEACMP in patients with high LCR was significantly lower than that with low LCR ( P<0.01) ; In the early stage, BIS mean, LCR and DEACMP were negatively correlated ( P< 0.05) , and the area under the curve predicted by BIS mean, LCR and their combination on DEACMP was 0.799, 0.847 and 0.902, respectively. Conclusion:Early BIS monitoring combined with LCR has a significant correlation with DEACMP, and the combined effect of the two is better. Early BIS combined with LCR detection can provide effective guidance for the prognosis assessment of ASCMP patients.

Objective:To explore the predictive value of low T3 syndrome (LT3S) for patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) .Methods:In May 2020, 137 severe acute carben monoxide poisoning (SACMP) patients were selected from Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2019 to January 2020 as subjects. Blood samples were taken after admission to test thyroid function. Followed up for 60 d, the patients were divided into DEACMP group (45 cases) and non DEACMP group (92 cases) according to their prognosis. Clinical data of patients in two groups were collected and compared. The Cox regression with multiple independent variables was used to analyze the independent risk factors of DEACMP. Pearson correlation analysis was used to evaluate the correlation between totall triiodochyronine (TT3) level and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score. The receiver operating characteristic (ROC) curve of TT3 and APACHE Ⅱ scores for predicting DEACMP were drawn.Results:Compared with non DEACMP group, the age, APACHE II score, LT3S rate and diabetes prevalence in DEACMP group were higher, and the Glasgow coma scale (GCS) score was lower ( P<0.05) . Cox regression analysis showed that age, APACHEⅡ score and LT3S were independent risk factors of DEACMP in patients with SACMP ( OR=1.040, 95% CI:1.005-1.077; OR=1.070, 95% CI: 1.002-1.143; OR=4.210, 95% CI: 1.707-10.379; P<0.05) . Pearson correlation analysis showed that TT3 level was negatively correlated with APACHE Ⅱ score ( r=-0.397, P=0.000) . ROC curve showed that the cut-off value of TT3 level for DEACMP prediction was 1.078 nmol/L, the area under curve (AUC) was 0.755, the sensitivity was 82.6%, and the specificity was 73.3%. The cut-off value of the APACHE Ⅱ score for predicting DEACMP was 16, and the AUC was 0.725, sensitivity was 93.3%, and specificity was 60.9%. Conclusion:This study showed that LT3S minght be an independent predictor of DEACMP in patients with SACMP. Thyroid function is closely related to the severity of SACMP patients.

Objectives:To investigate the relationship between heart rate adjusted QT dispersion (QTcd) and soluble growth stimulating gene 2 protein (sST2) and the severity and prognosis of patients with acute carbon monoxide toxic heart disease.Methods:Retrospective analysis was performed on 135 patients with acute carbon monoxide toxic heart disease admitted to the Emergency Medical Department of our hospital from January 2017 to 2020. Blood sST2, creatine kinase isoenzyme (CK-MB) and troponin I(cTnI) concentrations were recorded at 3 h, 12 h, 2 d and 3 d immediately after admission.The patient was measured and calculated on the day of admission,2 d,3 d and QTcd at discharge.According to the toxicity of carbon monoxide in heart disease severity was divided into mild heart disease group (58 cases), moderate heart disease group (45 cases), severe heart disease group (32 cases), according to whether severe heart disease were divided into severe group (32 cases) and non severe group (103 cases), according to whether the patients death in patients with severe heart disease.Results:Thirty-two of the 135 patients had severe toxic heart disease, with an incidence of 23.7%.In the severe group, sST2, cTnI and CK-MB increased from 24 h and 2 d after admission, and the detected values were all higher than those of the non-severe group and the normal control group, with statistically significant differences ( P<0.05).Before treatment, there were statistically significant differences in sST2 and QTcd between the toxic group and the non-severe group and the normal control group ( P<0.05).After 2 d and 3 d poisoning, there were statistically significant differences between the two groups ( P<0.05). ROC curve analysis showed that the area under the sST2 curve was 0.726, 95% CI was 0.555-0.898, sensitivity was 56.3%, specificity was 94.1%, and truncation was 88.5 ng/mL.The area under the QTcd curve was 0.745, 95% CI was 0.602-0.889, sensitivity was 56.3%, specificity was 82.4%, and truncation value was 68.5 ms.The area under the combined detection curve was 0.939, 95% CI was 0.874-1.000, sensitivity was 81.3%, specificity was 91.2%. Conclusions:In patients with acute carbon monoxide toxic heart disease, the level of sST2 increased earlier than THAT of cTnI and CK-MB, and the combined observation of sST2 and QTcd can be used as an indicator for early prediction of acute carbon monoxide toxic heart disease and its severity.