Objective To discuss the effect of residual renal function on prognosis of maintenance dialysis in patients with end-stage renal disease ( ESRD) .Methods 90 cases of patients of maintenance hemodialysis were selected and divided into group A and group B based on different eGFR levels at the beginning of dialysis, 51 cases in group A of eGFR≤5 mL/( min· 1.73 m2 ) , while 39 cases in group B of eGFR>5 mL/( min· 1.73 m2 ).The renal function of two groups were observed,all patients underwent a five-year clinical follow-up and mortality rates, hemoglobin (Hb), serum albumin ( Alb) , C reactive protein ( CRP) of patients in both groups were observed.Results The renal function of urea nitrogen, serum creatinine, blood uric acid, urinary protein and urine creatinine in group B before dialysis was better than those in group A (all P<0.05).The Hb and Alb levels of group A were significantly lower than those of group B, while the CRP levels was significantly higher than that of group B (all P<0.05).The mortality rate of group A was 43.14%,compared with 20.51% of group B,and there was no significant difference.The two main reasons of death was cardiovascular and pulmonary infection, accounted for 50.00% and 33.33%, respectively.Conclusion Residual renal function of patients with ESRD before dialysis has important clinical significance for prognosis judgment.When eGFR level is lower before dialysis, the mortality rate of patients is higher in five years, prone to cardiovascular and cerebrovascular, with poor nutritional status, which is more vulnerable to infection.

Objective To investigate the effect of triglyceride-glucose(TyG)index on the prognosis of elderly patients with decompensated heart failure(HF).Methods Clinical data of 305 patients(≥75 years old)with decompensated HF admitted to our hospital from January 2020 to Decem-ber 2023 were collected and retrospectively analyzed.According to the median TyG index,they were divided into high TyG index group(≥9.11,n=155)and low TyG index group(＜9.11,n=150).The results of laboratory tests,ambulatory blood pressure monitoring(ABPM),and echo-cardiography(ECG)were obtained from the electronic medical record system of our hospital.All patients were followed up by telephone within 28 d after discharge.The clinical characteristics were compared between the two groups.Spearman correlation analysis was used to analyze the re-lationship of TyG index with cardiac function and ABPM indicators of the patients.Kaplan-Meier survival curve was plotted to analyze the influence of the TyG index on the prognosis,and ROC curve was drawn to analyze the predictive value of the TyG index for 28-day mortality in these elderly patients.Results The high TyG index group had significantly higher mortality,thicker in-terventricular septum thickness(IVST),larger proportions of diabetes and hypertension,and higher levels of fasting blood glucose,cholesterol,triacylglycerol,NT-proBNP and coefficients of variation(CV)in 24-h SBP and 24-h DBP,and lower HDL-C level when compared to the low TyG index group(P＜0.05,P＜0.01).Spearman correlation analysis revealed that the TyG index was significantly positively correlated with IVST(r=0.526,P＜0.01),24-h SBP CV(r=0.342,P＜0.01),24-h DBP CV(r=0.302,P＜0.01)and NT-proBNP level(r=0.443,P＜0.01).Further-more,Kaplan-Meier survival analysis indicated that a significantly higher 28-day cumulative sur-vival rate was observed in the low TyG index group than the high TyG index group(94.67％vs 83.23％,log rank X2=10.436,P=0.001).Additionally,ROC curve analysis showed that the AUC value of TyG index in predicting 28-day mortality in elderly patients with decompensated HF was 0.692(95％CI:0.597-0.786).When the cutoff value of TyG inde x was 9.22,the sensitivity was 76.50％,and the specificity was 63.50％.Conclusion High TyG index indicates poor prognosis in elderly patients aged over 75 years with decompensated HF,and increment of TyG index may be helpful to identify high-risk HF population.

OBJECTIVE: To investigate the relationship between malnutrition and delirium and its effect on prognosis in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. METHODS: A prospective observational study was conducted. Patients with severe pneumonia aged ≥ 60 years old who underwent invasive mechanical ventilation admitted to department of critical care medicine of the Second People's Hospital of Lianyungang from January 2021 to December 2022 were enrolled. The confusion assessment method (CAM) was used to evaluate the delirium of the patients in intensive care unit (ICU). The score of CAM ≥ 1 was defined as delirium. Mini nutritional assessment short-form (MNA-SF) was used to assess the nutritional status of patients, and MNA-SF score ≤ 7 was defined as malnutrition. Patients were divided into delirium group and non-delirium group according to whether delirium occurred. The differences in clinical indicators, length of ICU stay, duration of mechanical ventilation and wake-up time after drug withdrawal were compared between the two groups. After 28 days of short-term follow-up, the patients were divided into death group and survival group, and the differences in the incidence of delirium and malnutrition between the two groups were compared. Binary multivariate Logistic regression analysis was used to screen the risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. Kaplan-Meier survival curve was used to analyze the effect of delirium on prognosis. RESULTS: A total of 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation were enrolled, of whom 98 survived and 34 died within 28 days, with a mortality of 25.76%. The incidence of malnutrition and delirium in the death group was significantly higher than that in the survival group (61.76% vs. 37.76%, 64.71% vs. 26.53%, both P < 0.05), and the MNA-SF score was significantly lower than that in the survival group (6.32±1.80 vs. 8.72±2.23, P < 0.01). Procalcitonin (PCT), interleukin-6 (IL-6) and blood lactic acid (Lac) in the death group were significantly higher than those in the survival group [PCT (μg/L): 4.47 (2.69, 10.39) vs. 2.77 (1.28, 5.94), IL-6 (ng/L): 204.08 (126.12, 509.85) vs. 120.46 (60.67, 290.99), Lac (mmol/L): 5.14 (2.75, 8.60) vs. 3.13 (2.16, 4.30), all P < 0.05], and the wake-up time after drug withdrawal was significantly longer than that in the survival group (minutes: 33.94±8.51 vs. 28.92±7.03, P < 0.01). Among 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation, 48 patients had delirium during ICU stay, and 84 patients did not have delirium. The incidence of delirium was 36.36%. The 28-day mortality in the delirium group was significantly higher than that in the non-delirium group (45.83% vs. 14.29%, P < 0.01), and the MNA-SF score was significantly lower than that in the non-delirium group (6.46±1.77 vs. 9.05±2.15, P < 0.01), the length of ICU stay, duration of mechanical ventilation, and wake-up time after drug withdrawal were also significantly longer than those in the non-delirium group [length of ICU stay (days): 13.40±9.59 vs. 10.06±7.81, duration of mechanical ventilation (hours): 197.06±89.80 vs. 138.81±82.30, wake-up time after drug withdrawal (minutes): 35.85±7.01 vs. 26.99±6.12, all P < 0.05]. Binary multivariate Logistic regression analysis showed that malnutrition [odds ratio (OR) = 7.527, 95% confidence interval (95%CI) was 2.585-21.917], Lac (OR = 5.345, 95%CI was 1.733-16.483), wake-up time after drug withdrawal (OR = 6.653, 95%CI was 2.021-21.904) were independent risk factors for delirium during ICU stay in elderly patients with severe pneumonia undergoing invasive mechanical ventilation (all P < 0.01). Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate of patients in the delirium group was significantly lower than that in the non-delirium group (54.17% vs. 85.71%), and the difference was statistically significant (Log-Rank test: χ² = 16.780, P < 0.001). CONCLUSIONS The risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation during ICU stay include malnutrition, Lac, and wake-up time after drug withdrawal. The occurrence of delirium is closely related to poor prognosis.
Aged ; Humans ; Middle Aged ; Respiration, Artificial ; Interleukin-6 ; Pneumonia ; Intensive Care Units ; Delirium/etiology* ; Procalcitonin ; Prognosis ; Malnutrition ; Retrospective Studies