Objective To test the serum albumin level in patients having the peritoneal dialysis,and investigate its relationship with C-reactive protein(CRP)level or other inflammatory complications. Methods Sixty patients having peritoneal dialysis treatment were divided into two groups based on the serum albumin(ALB)level,patients had normal ALB level were included into group A,while the patients with serum hypoproteinemia were included into group B. The serum level of CRP,transferin(TF)and nutritional status were compared between two groups,and their relationship with clinical complications were evaluated. Results The serum CRP level in patients of group B(8.40 ± 1.32)mg/L was significantly higher than group A(2. 14 ±0.87)mg/L(P ＜0. 01). Patients from group B had more inflammation complications,such as peritonitis(6. 7%),pneumonia(13. 3%),cardiovascular disease(16.7%). Conclusions The continuous ambulatory peritoneal dialysis patients accompanied with hypoproteinemia are more likely to have inflammation complications and cardiovascular diseases,which should cause more attention on their malnutrition-inflammation- CVD(MIA)syndrome diagnosis and treatment.

Objective To determine whether anticoagulation markers can improve mortality prediction in patients of surgical intensive care unit (ICU).Methods A case-control study was adopted,252 patients from Tongji hospital's surgical ICU and 30 healthy control individuals were investigated.The protein C,antithrombin,thrombomodulin,and other coagulation/ inflammatory markers were detected.The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score were obtained.Markers level comparison among survivors,non-survivors and controls were conducted with single factor variance analysis,Kruskal-Wallis test or Mann-Whitney U test.Results Between survivors and non-survivors after 28-day hospitalization,there were significant difference on protein C levels[(70.2 ±22.7)％ vs (48.6 ±29.8)％,t=2.84,P＜0.01],APACHE Ⅱ scores[(21.0±8.2) vs (29.5 ±10.9),t =-2.51,P＜0.05] and prothrombin times[(12.9-± 3.5) s vs (18.8 ± 10.2) s,t =-2.13,P ＜ 0.05].Combining protein C levels with APACHE Ⅱ score could obtain a higher mortality prediction efficiency in patients of surgical ICU than any single marker (AUC =0.806).That protein C concentration less than 47.5％ [OR =6.40,95％confidence interval(CI) 2.526-16.216,P ＜0.001] and APACHE Ⅱ score (OR =1.123,95％ CI 1.012 -1.250,P ＜ 0.05) were the independent risk factors for surgical ICU death.Conclusion Decrease of protein C levels predict increase of mortality risk in patients of surgical ICU,combining protein C with APACHE Ⅱ score can improve the prognostic accuracy for patients of surgical ICU.(Chin J Lab Med,2013,36:339-342)

Objective To study the alteration of microbial population distribution and resistance of clinical bacterial isolates in patients with severity muhiple injuries. Methods The distributed Features of 432 strains of infection germs detected among the patients with severe muhiple iniuries admitted into hospital from January 2004 to December 2006 were statistically analyzed during. Results In the total 432 strains,the G accounted for 62.9%(272/432),dominated mainly by pathogens including Pseudomonas aeruginosa,Acinetobacter baumanni I and Escherichia Coli.The G+accounted for 37%(160/432),mainly including Staphylococcus anreus,enterococci and coagulase negative staphylococcus (CNS).Mixed infection rate was 41.1%.The isolating rate of enterococci.CNS and Sten Matophilia was obviously upgraded. Conclusions The source of infection in patients with severity multiple injuries is Gram-negative bacterium,suggesting that surveillance of bacterial resistance and rational use of antimicrobial agents should be emphasized during clinical therapy.

Objective To investigate the incidence of prozone phenomenon of rapid plasma reagin (RPR) test in syphilis serolog-ic testing and its correlation with the intensity of chemiluminescent microparticle immunoassay (CMIA) results.Methods A total of 101493 patients in our hospital from January 2014 to December 2015 were performed syphilis serologic testing by CMIA ,RPR and treponema pallidum particle agglutination (TPPA).The incidence rate of prozone phenomenon in RPR testing was evaluated.Its in-fluencing factors were investigated by using the Logistic regression.Results Among 101493 serum samples ,2180 cases were posi-tive by CMIA and 767 cases were positive by RPR ,the incidence rate of prozone phenomenon was 3.3% (26/767)in RPR.The Lo-gistic regression results indicated that the incidence of prozone phenomenon was significantly correlated with CMIA S /CO values and RPR titer ,but had no correlation with sex ,age and seasonality.Conclusion Although the incidence of prozone phenomenon is low in syphilis serologic testing ,but it is enough important.The patients with higher S/CO value in CMIA test have a higher inci-dence rate of RPR prozone phenomenon.

Objective:To explore the predictive efficacy of prothrombin time (PT) with regarding for the severity and prognosis of septic patients, along with comparing with other routine coagulation parameters.Methods:A retrospective analysis was conducted. The clinical data of 302 septic patients who were admitted to the intensive care unit (ICU) of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 1 to December 31 in 2019 were enrolled. Demographic and basic clinical data were collected. Laboratory data, including PT, activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer, fibrin (fibrinogen) degradation product (FDP), antithrombin (AT), platelet count (PLT) at ICU admission were recorded, and sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score within 24 hours of admission to ICU were also collected. What's more, some major clinical events, such as septic shock, disseminated intravascular coagulation (DIC), etc. during ICU stay were also monitored. A follow-up 28 days observation of prognosis was performed. The patients were divided into the septic shock group and the non-septic shock group according to the occurrence of septic shock, and they were divided into the survival group and the non-survival group according to the 28-day prognosis. The differences in terms of above parameters between each two groups were compared. Spearman correlation method was used to analyze the correlation between routine coagulation parameters and SOFA score or APACHEⅡ score. Receiver operator characteristic curve (ROC curve) was plotted to determine the predictive efficacy of each routine coagulation parameter with regarding to predict septic shock and 28-day mortality. Based on the cut-off value of PT, the septic patients were divided into two risk stratifications, and then the major clinical and end point outcome were compared. Kaplan-Meier survival curve analysis was applied to investigate the difference of the 28-day cumulated survival rate based on the different risk stratifications of PT level. Finally, multivariate Logistic regression analysis was used to explore whether prolonged PT level was an independent risk factor for septic shock and 28-day mortality.Results:The 302 patients were all enrolled, including 120 patients with septic shock and 182 patients without. Seventy-five patients died within 28 days, while 227 survived. Comparing with the non-septic shock group or the survival group, the septic shock group or the non-survival group patients both had longer PT, APTT and TT, higher D-dimer, FDP and lower PLT, FIB and AT. Correlation analysis revealed that PT and PLT were better correlated with SOFA score ( r values were 0.503 and -0.524, both P < 0.01), and PT was better correlated with APACHEⅡ score ( r = 0.407, P < 0.01). ROC curve analysis showed that PT had the most powerful predictive efficacy for septic shock and 28-day mortality. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) were 0.831 (0.783-0.879) and 0.739 (0.674-0.805), respectively. The cut-off value were 16.8 s and 16.3 s, respectively, with the sensitivity of 64.2%, 72.0% and the specificity of 89.0%, 70.9%, respectively. Risk stratification based on PT level revealed that the patients with PT > 16.5 s ( n = 103) had higher rate of 28-day mortality, incidence of septic shock and DIC, and score of SOFA and APACHEⅡ comparing to those with PT ≤ 16.5 s ( n = 199). Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate was significantly lower in the patients with PT > 16.5 s than those with PT ≤ 16.5 s (52.43% vs. 86.93%; Log-Rank test: χ 2 = 49.428, P < 0.001). Multivariate Logistic regression analysis revealed that PT > 16.5 s was an independent risk factor both for septic shock and 28-day mortality [model 1 (enrolled SOFA score): odds ratio ( OR) and 95% CI were 6.003 (3.040-11.855), 4.842 (2.114-11.089); model 2 (enrolled APACHEⅡ score): OR and 95% CI were 7.675 (4.007-14.702), 5.160 (2.258-11.793)]. Conclusions:Compared with other routine coagulation parameters, PT has the potential best predictive value for evaluating the severity of sepsis and the prognosis. When a patient is diagnosed with sepsis and has a result of PT longer than 16.5 s at ICU admission, the patient may have a higher risk of progression to septic shock and short-term death.

Sepsis has been a focus and difficulty in both clinical and laboratory research. Early pathogen identification, host immune status assessment, and abnormal coagulation function, the three critical issues in the laboratory diagnosis of sepsis, have made continuous breakthroughs in recent years. Many challenges in the field remain. An in-depth analysis of these key issues in sepsis can improve the understanding of the importance of sepsis diagnosis and assist in increasing the survival rate of patients.