Objective To investigate the power of the simplified acute physiology score Ⅲ ( SAPSⅢ) for prediction of outcome for patients with severe sepsis admitted to the intensive care unit ( ICU ). Methods A retrospective study was conducted. 677 severe sepsis patients with age ≥ 18 years old and the survival time in emergency ICU≥24 hours admitted to the emergency ICU of Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2008 to December 2011 were enrolled. The acute physiology and chronic health evaluationⅡ ( APACHEⅡ), sequential organ failure assessment ( SOFA ), SAPSⅡ, SAPSⅢ, and mortality in emergency department sepsis ( MEDS ) scores were recorded based on the poorest value within 24 hours of ICU admission. The 28-day result as denoted as survival or death was considered as the end point of the study. The ability to predict mortality by the score systems was assessed by using receiver operating characteristic ( ROC ) curve analysis and binary logistic regression models. Results Among the 677 patients with severe sepsis, 284 cases died within 28 days after admission, and the mortality rate was 41.9%. Compared with survivors, the patients in non-survival group was older with higher APACHEⅡ, SOFA, SAPSⅡ, SAPSⅢ, and MEDS scores and higher ratio of underlying diseases, such as primary hypertension and renal dysfunction, and they had more organ injury, higher ratio of lung infection and bacterial infection ( P < 0.05 or P < 0.01 ). It was identified by logistic regression that the APACHEⅡ, SOFA, SAPSⅡ, SAPSⅢand MEDS scores were significantly independent factors in 28-day death prediction in patients with severe sepsis ( all P=0.000 ). The rank of areas under the ROC curve ( AUC ) from high to low were MEDS ( 0.970 ), APACHEⅡ( 0.893 ), SAPSⅢ ( 0.875 ), SOFA ( 0.871 ), and SAPSⅡ ( 0.860 ), respectively. SAPSⅢ score and APACHEⅡ, SOFA, SAPSⅡscores were found to have an equivalent capacity in predicting the prognosis ( all P>0.05 ). The MEDS score in predicting the prognosis was obviously better than that of APACHEⅡ, SOFA, SAPSⅡ, and SAPSⅢscores ( all P<0.05 ). The MEDS score showed the best sensitivity ( 91.5%), and specificity ( 89.1%). The 28-day mortality in cases of MEDS≥11 was 85.8%. Conclusions ①For patients with severe sepsis who were admitted to ICU, MEDS was superior to APACHEⅡ, SOFA, SAPSⅡ, and SAPSⅢscores in predicting prognosis. MEDS≥11 may indicate a higher mortality rate.②SAPSⅢscore has comparable predictive capability with APACHEⅡ, SOFA and SAPSⅡscores may be recommended for prediction of the prognosis of patients with severe sepsis in ICU. But the SAPSⅢscore is unsuitable for predicting the prognosis of patients with acute sepsis in ICU options, and it is not superior to that of SAPSⅢscore in predicting prognosis of patients with sepsis in the emergency ICU than other score systems.

Objective To discuss the differences of inflammatory parameters such as procalcitonin ( PCT ), C-reactive protein ( CRP ), endotoxin, white blood cell ( WBC ), neutrophil ratio ( Neut%) in blood of septic patients caused by bacterial bloodstream infection, and their correlation with the severity of disease. Methods 292 septic patients with positive blood culture were enrolled in Beijing Shijitan Hospital Affiliated to Capital Medical University from February 2012 to March 2015, and their gender, age, acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) score, bacterial species and other general information were retrospectively collected. The differences in inflammatory parameters ( PCT, CRP, endotoxin, WBC, Neut%) in septic patients caused by bacterial bloodstream infection were compared, their correlations with APACHEⅡ scores within 24 hours were analyzed, and their diagnostic efficacies were also analyzed. Results ①It was shown by Pearson correlation coefficients that positively statistical correlation was found between PCT ( r=0.638 ), CRP ( r=0.620 ), endotoxin ( r=0.284 ), WBC ( r=0.209 ) and APACHEⅡscore ( all P=0.000 ) in bacterial bloodstream infective patients ( n=292 ), and positively statistical correlation was found between PCT ( r=0.626 ), CRP ( r=0.616 ), Neut%( r=0.297 ) and APACHEⅡscore ( all P<0.01 ) in Gram positive bacterial ( G+) group ( n = 86 ), and positively statistical correlation was shown between PCT ( r=0.631 ), CRP ( r=0.616 ), endotoxin ( r=0.301 ), WBC ( r=0.226 ) and APACHEⅡscore ( all P<0.01 ) in Gram negative bacterial ( G-) group ( n=206 ).②It was shown that PCT and CRP of both G+/G-bacterial severe sepsis and septic shock subgroup were significantly higher than those of sepsis subgroup, respectively [ G+ group: PCT (μg/L ):0.92 ( 0.38, 4.75 ) vs. 0.43 ( 0.22, 1.00 ), CRP ( mg/L ):118.45±62.60 vs. 57.97±32.41;G-group:PCT (μg/L ):6.92 ( 1.94, 25.90 ) vs. 1.28 ( 0.27, 4.12 ), CRP ( mg/L ):130.99±60.18 vs. 49.18±26.87, all P<0.01 ], and the endotoxin and WBC in G-bacterial severe sepsis and septic shock subgroup were significantly higher than those of sepsis subgroup [ endotoxin ( ng/L ): 19.40 ( 9.62, 33.87 ) vs. 10.00 ( 5.00, 18.52 ), WBC ( ×109/L ): 12.13±6.72 vs. 9.61±5.01, both P<0.01 ]. The PCT and endotoxin in G-bacterial severe sepsis and septic shock subgroup were significantly higher than those in G+severe sepsis and septic shock subgroup [ PCT (μg/L ):6.92 ( 1.94, 25.90 ) vs. 0.92 ( 0.38, 4.75 ), endotoxin ( ng/L ):19.40 ( 9.62, 33.87 ) vs. 2.56 ( 1.11, 4.01 ), both P<0.01 ].③The diagnostic efficacy of inflammatory parameters for severe sepsis and septic shock subgroup were: PCT area under receiver operating characteristic ( ROC ) curve ( AUC ) = 0.683, the cut-off point = 0.55 μg/L, sensitivity 63.2%, specificity 69.0%; CRP AUC = 0.802, the cut-off point = 92.25 mg/L, sensitivity 73.7%, specificity 86.2%; WBC AUC = 0.614, the cut-off point = 7.35×109/L, sensitivity 75.4%, specificity 48.3%; Neut% AUC = 0.622, the cut-off point = 0.882, sensitivity 43.9%, specificity 79.3%in G+group. At the same time, it was shown that PCT AUC=0.780, the cut-off point=6.80μg/L, sensitivity 51.0%, specificity 93.9%; CRP AUC = 0.907, the cut-off point = 90.10 mg/L, sensitivity 73.2%, specificity 95.9%;endotoxin AUC=0.694, the cut-off point=17.54 ng/L, sensitivity 57.3%, specificity 75.5%;WBC AUC=0.611, the cut-off point = 10.54×109/L, sensitivity 54.1%, specificity 69.4%; Neut% AUC = 0.621, the cut-off point = 0.843, sensitivity 65.6%, specificity 61.2%in G-group. Conclusions The plasma PCT and CRP have the best correlation between inflammatory parameters and severity of disease in bloodstream infective sepsis patients. CRP has the best diagnostic effect in severe sepsis/septic shock patients with bloodstream infection.

Objective To discuss the influence of different ways of low-dose corticosteroids infusion on hemodynamics, changes in blood glucose level and prognosis in patients with refractory septic shock. Methods A prospective single-blind randomized controlled trial was conducted. Refractory septic shock patients admitted to the Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from April 1st, 2013 to October 31st, 2014 were enrolled for the study. The patients were divided into control group and research group by random number table. Besides conventional treatment for septic shock, patients in control group were given 200 mg/d hydrocortisone intravenous infusion lasting for 2 hours, while those of research group were given 8.33 mg/h hydrocortisone per hour with an intravenous pump. Treatment lasted for 5 continuous days for both groups. The changes in heart rate ( HR ), mean arterial pressure ( MAP ), central venous pressure ( CVP ) and arterial blood lactic acid in both groups were observed at the time of enroldment and 6 hours, 24 hours, 48 hours, and 5 days after the treatment. With a dynamic blood glucose monitor, mean blood glucose ( MBG ) level, largest amplitude of glycemic excursions ( LAGE ), glucose variability ( GV ), and the ratio of hyperglycaemia time were recorded. The duration of shock, length of intensive care unit ( ICU ) stay, total length of hospital stay, and 28-day mortality of both groups were recorded. Results Seventy-nine septic shock patients were assigned to the treatment, with 41 in control group, and 38 in research group. Compared with control group, 6-hour MAP in research group was obviously lowered [ mmHg ( 1 mmHg=0.133 kPa ):66.31±4.38 vs. 68.58±4.86, t=1.062, P=0.033 ], but there were no significant differences in HR, MAP, CVP, lactic acid clearance and norepinephrine ( NE ) utilization rates at other time points between two groups. No significant difference in MBG was found between research group and control group ( mmol/L:8.69±2.14 vs. 9.95±3.87, t=1.771, P=0.080 ), but LAGE, GV, the ratio of hyperglycemia time in research group were significantly lower than those of the control group [ LAGE ( mmol/L ): 17.18±8.97 vs. 22.71±11.80, t = 2.331, P = 0.022; GV ( mmol/L ): 2.57±1.05 vs. 3.16±1.37, t=2.136, P=0.036;the ratio of hyperglycemia time:( 43.1±11.7 )%vs. ( 49.4±15.3 )%, t=2.044, P=0.044 ]. There was no statistical difference in the following features between research group and control group, such as the duration of shock ( days:3.47±0.98 vs. 3.61±1.07, t=0.605, P=0.547 ), length of ICU stay ( days:8.74±3.12 vs. 9.97±3.37, t = 1.543, P = 0.120 ), total length of hospital stay ( days: 18.34±9.27 vs. 19.58±9.83, t = 0.576, P = 0.566 ) and 28-day mortality rate ( 23.68%vs. 26.83%,χ2=0.103, P=0.748 ). Conclusions Compared with slow intravenous infusion, a continuous intravenous supplementation of small amount of hydrocortisone to patients with refractory septic shock could stabilize blood glucose levels and maintain metabolic balance efficiently. However, in both groups there was no significant difference in the efficiency in stabilizing hemodynamics, shortening shock duration, reducing ICU or hospital days and decreasing 28-day mortality.

Objective To determine the value of differential time to positivity ( DTTP ) of blood culture for the diagnosis of catheter-related bloodstream infection ( CRBSI ) in patients with solid tumors in intensive care unit ( ICU ). Methods A retrospective study was conducted. 615 pairs of peripheral vein blood cultures and instantaneous catheter tip blood culture of 615 patients admitted to ICU of Tianjin Medical University Cancer Institute and Hospital were collected from August 2011 to March 2014. The DTTP method and ( or ) semi quantitative culture of catheter tip were compared. CRBSI was diagnosed when both cultures were positive for the same microorganism and DTTP ≥2 hours ( 120 minutes ). The result of this procedure was compared with that of organism obtained using the semi quantitative culture of blood at catheter tip with≥15 cfu. Based on the clinical diagnosis, the reliability of two kinds of laboratory examination was compared for the diagnosis of CRBSI by plotting receiver operator characteristic curve ( ROC curve ). Results The result of 615 cases suspected of having CRBSI were analyzed during the study period. Of these, 440 episodes were excluded because cultures were negative for blood obtained through peripheral vein and central vein. Eight episodes were excluded because only peripheral vein blood culture was positive and 57 episodes were excluded because of only central vein blood culture was positive, 68 pairs of blood cultures were excluded due to the presence of multiple catheters and repeated blood withdrawals. Two cases of polymicrobial cultures were excluded from the final analysis due to the difficulty in determining the time of positive result for each individual microorganism. Ten cases in 42 cases of suspected cases of CRBSI were excluded from analysis because catheter was not removed, therefore culture from catheter tip could not be obtained. Using the DTTP method, 14 out of 17 CRBSI cases were diagnosed with DTTP≥120 minutes, while 3 cases were missed;the semi quantitative catheter tip culture was positive in 13 cases, and in 4 cases it was neglected. In 2 cases of CRBSI it was missed by both methods. The area under the ROC curve ( AUC ) of DTTP, catheter tip culture and the combination method was 0.912, 0.882 and 0.941 for diagnosis of CRBSI, respectively. Validity values for the diagnosis of CRBSI for DTTP were:sensitivity 82.35%, specificity 92.31%, positive predictive value 93.33%and negative predictive value 80.00%, and they were higher than those of the catheter tip culture method only ( 76.47%, 84.62%, 86.67% and 73.33%). The specificity and positive predictive CRBSI combination of the two methods in the diagnosis value were up to 100%, the sensitivity ( 88.24%) and negative predictive value ( 86.67%) was also increased, but no significant differences were found with DTTP method (χ2=0.00, P=1.00;χ2=0.00, P=0.98;χ2=0.00, P=0.98;χ2=0.00, P=0.98 ). Conclusions DTTP can be a valid method recommended for CRBSI diagnosis in critically ill patients with acceptable sensitivity, good specificity as well as positive predictive value. DTTP combined with other clinical symptoms can not only avoid unnecessary catheter withdrawal, but it also can help obtain the optimal treatment time and strategy.

Objective To explore the effect of selective gut decontamination in regulation of inflammatory reaction compared with rhubarb and glycerine enema for catharsis in patients with systemic inflammatory response syndrome ( SIRS ), and to discuss its mechanisms. Methods A prospective randomized controlled trial was conducted. Fifty-seven patients with SIRS admitted to Department of General Surgery of Aviation General Hospital from June 2009 to June 2014 were enrolled. The patients were randomly divided into rhubarb decontaminate group, traditional decontaminate group and blank control group, with 19 cases in each group. Besides the treatment for primary disease, including anti-infection, operation, alleviate pain, nutritional support, and maintaining water and electrolyte balance, the patients in rhubarb decontaminate group received aqueous extract from rhubarb 15-20 g by gastric tube, enema, or peros, twice a day;and those in traditional decontaminate group received glycerine enema or glycerol enema, twice a day; while no gavage or enema was prescribed in blank control group. Peripheral blood was collected before and 72 hours after treatment. Enzyme linked immunosorbent assay ( ELISA ) was used to determine the concentration of lipopolysaccharide ( LPS ) and inflammatory mediators. Results Compared with blank control group and traditional decontaminate group, the levels of interleukins ( IL-1, IL-8 ), LPS, platelet activating factor ( PAF ), tumor necrosis factor-α( TNF-α), andγ-interferon ( IFN-γ) before treatment was similar to that of rhubarb decontaminate group [ IL-1 ( ng/L ): 53.154±5.783, 50.564±5.771, 51.082±6.403, F = 0.994, P = 0.377; IL-8 ( ng/L ): 70.492±6.146, 68.376±6.112, 68.673±8.384, F=0.514, P=0.601;LPS (μg/L ):11.630±2.449, 10.858±2.307, 10.463±2.145, F = 1.261, P = 0.291; PAF (μg/L ): 4.173±0.395, 4.051±0.362, 4.078±0.487, F = 0.446, P = 0.642; TNF-α( ng/L ):132.498±10.772, 129.735±12.881, 127.207±11.514, F=0.963, P=0.388;IFN-γ(μg/L ):45.645±4.558, 43.692±5.578, 43.767±5.028, F = 0.904, P = 0.411 ]. The above parameters after treatment were significantly lower than those before treatment in three groups. The effect on the LPS and pro-inflammatory factors of the rhubarb decontaminate group was more obvious than that of the blank control group and traditional decontaminate group [ LPS (μg/L ): 7.571±1.113 vs. 9.008±1.904, 8.874±1.808, F = 4.416, P = 0.017; IL-1 ( ng/L ): 45.309±3.563 vs. 48.731±4.466, 46.112±4.322, F = 3.557, P = 0.035; IL-8 ( ng/L ): 60.492±5.346 vs. 65.553±5.384, 63.437±5.462, F = 4.213, P = 0.020; PAF (μg/L ): 3.519±0.250 vs. 3.832±0.356, 3.766±0.309, F = 5.450, P = 0.007; TNF-α ( ng/L ): 114.988±8.772 vs. 123.230±10.433, 118.534±9.519, F = 3.525, P = 0.036; IFN-γ(μg/L ):38.683±3.190 vs. 41.831±4.122, 39.161±3.972, F=3.820, P=0.028 ]. Conclusion The usage of selective gut decontamination can inhibit the release of endotoxin and inflammatory mediators in patients with SIRS, and it will get a better effect using rhubarb, and the mechanism may be related to the protection of intestinal mucosal barrier function.

Objective To evaluate the diagnostic and prognostic value of the serum procalcitonin ( PCT ) level in the non-acquired immune deficiency syndrome ( AIDS ) immunocompromised critically ill patients suspected to have infection. Methods A retrospective study was conducted in the non-AIDS immunocompromised patients who were admitted to Department of Critical Care Medicine of Xiangya Hospital, Central South University during January 2011 to December 2014. Demographic characteristics, underlying disease, acute physiology and chronic health evaluationⅡ( APACHEⅡ) score at admission, and clinical records including baseline and peak levels of temperature, white blood count ( WBC ), PCT, and survival rate within 28 days, infection focus, infectious agents ( bacterial, fungi or mixed infection ), and the severity of infection ( sepsis, severe sepsis, or septic shock ) were recorded. Receiver operating characteristic ( ROC ) curve was plotted, and the diagnostic and protective value of above parameters was evaluated. Results A total of 98 patients ( 43 male and 55 female ) were enrolled in the study with a median age of 44 ( 28, 52 ) years old and a median APACHEⅡscore of 17 ( 11, 20 );47 with malignant hematological tumor, 45 with autoimmune diseases, and 6 post solid organ transplantation. Among them 53 patients ( 54.1%) died within 28 days. Twenty-seven patients were diagnosed as systemic inflammatory response syndrome ( SIRS ) without infection. Among 71 patients with infection, 45 were diagnosed as bacterial infection, 10 with fungal infection, and 16 with mixed infection. Sepsis was diagnosed in 7 patients, severe sepsis in 32 patients , and septic shock in 32 patients .①There was no statistical significance in the baseline and peak levels of PCT and WBC, or baseline level of temperature between the groups of SIRS patients without infection and infected patients. The peak level of temperature was significantly higher in the patients with infection as compared with that of the SIRS without infection patients [℃:39.4 ( 38.9, 40.0 ) vs. 38.8 ( 37.8, 39.2 ), Z=-3.268, P=0.001 ]. It was showed by subgroup analysis that in patients with hematological malignant disease or autoimmune diseases, higher level of body temperature was found in infection group compared with non-infection SIRS group [℃:39.5 ( 39.0, 40.0 ) vs. 39.0 ( 38.4, 39.4 ), Z=-2.349, P=0.019;39.0 ( 38.4, 39.5 ) vs. 38.2 ( 37.0, 38.9 ), Z=-2.221, P=0.026 ].②The baseline level of PCT (μg/L ) were 0.54 ( 0.20, 4.19 ), 2.78 ( 0.50, 9.54 ), 1.00 ( 0.45, 6.89 ), and 0.22 ( 0.07, 1.86 ) in non-infection SIRS patients or the patients with bacterial, fungal, and mixed infection, respectively. The peak level of PCT (μg/L ) were 4.19 ( 1.95, 13.42 ), 12.37 ( 3.82, 45.89 ), 1.82 ( 0.49, 17.86 ), and 5.14 ( 2.66, 12.62 ), respectively, in each subgroup. When the comparison was conducted among the patients with different infectious agent, the baseline level of PCT in patients with bacterial infection was significantly higher than that in SIRS patients without infection ( P=0.026 ) and mixed infection patients ( P=0.001 ), and the peak level of PCT was significantly higher than that in the SIRS patients without infection ( P=0.009 ) and the patients with fungal infection ( P=0.016 ). ROC curve showed that the higher value was found in the baseline and peak levels of PCT for diagnosis of septic shock in all patients [ area under ROC curve ( AUC ) of baseline level = 0.681±0.054, P = 0.001; AUC of peak level = 0.690±0.054, P=0.002 ], and the same value was also found in the baseline and peak levels of PCT for diagnosis of bacterial infection in the patients with malignant hematological tumor ( AUC of baseline level=0.687±0.080, P=0.008;AUC of peak level=0.697±0.079, P=0.021 ).③The peak level of PCT (μg/L ) were 4.05 ( 0.53, 31.22 ), 5.78 ( 2.14, 16.68 ), and 11.64 ( 2.94, 58.14 ) in subgroup of patients with sepsis, severe sepsis and septic shock, respectively, and they showed no statistical significance among subgroups ( P>0.05 ). A high serum level of peak PCT strongly indicated the presence of septic shock ( AUC=0.646±0.060, P=0.019 ), especially in the subgroup of patients with systemic autoimmune disease ( AUC=0.689±0.081, P=0.035 ).④The peak level of PCT (μg/L ) in the APACHEⅡ>18 group ( 38 cases ) was significantly higher than that of APACHEⅡ≤18 group [ 60 cases, PCT (μg/L ):11.64 ( 3.36, 39.39 ) vs. 4.42 ( 1.32, 14.70 ), P=0.016 ];there was a certain correlation between the peak level of PCT and the severity of the disease.⑤The peak level of PCT in death group was significantly higher than that of the survival group [μg/L:9.07 ( 3.05, 33.09 ) vs. 4.19 ( 1.26, 14.61 ), P=0.043 ]. ROC curve showed that the peak level of PCT might be valuable in predicting the prognosis in immunocompromised patients ( AUC=0.619±0.057, P=0.043 ). Conclusions The serum level of PCT is found to be a reliable marker for the diagnosis of bacterial infection in immunocompromised critical patients, especially in those with hematologic malignancy. Additionally, PCT provides a useful tool for evaluating the severity of infection and the prognosis of critically ill patients.

Objective To explore the value of dynamic monitoring of the neutrophils/lymphocyte ratio ( NLR ) in peripheral blood for the prognosis of patients with bloodstream infection ( BSI ). Methods A retrospective study was conducted. 205 patients who were≥18 years old, their length of hospital stay>24 hours, and they were treated in the China-Japanese Friendship Hospital from January 2013 to October 2014 were enrolled. According to the 28-day survival, the patients were divided into survival group ( n=160 ) and death group ( n=45 ). The white blood cell ( WBC ), neutrophils count ( NEU ), neutrophils ratio ( Neut%), lymphocyte count ( LYM ), lymphocyte ratio ( Lym%), and NLR in peripheral blood were recorded at 1, 3, 7 days after admission. Receiver-operating characteristic curve ( ROC ) was plotted for evaluating the value of these factors on the 28-day prognosis, and logistic regression analysis was used to evaluate the risk factors for predicting the outcome. Results ①On the 1st day, WBC, NEU, Neut%, NLR, and procalcitonin ( PCT ) in the death group were significantly higher than those in the survival group [ WBC (×109/L ):15.28±8.23 vs. 11.58±6.55, NEU (×109/L ):13.34±7.53 vs. 10.03±5.31, Neut%:0.886±0.076 vs. 0.845±0.102, NLR:21.20 ( 13.10, 28.80 ) vs. 12.08 ( 6.81, 20.47 ), PCT (μg/L ):3.13 ( 0.85, 10.12 ) vs. 1.34 ( 0.36, 5.81 ), P<0.05 or P<0.01 ], while hemoglobin ( Hb ), platelet count ( PLT ), albumin ( ALB ) content were significantly lower than those of the survival group [ Hb ( g/L ):86.09±19.83 vs. 107.89±22.82, PLT (×109/L ):157.51±117.81 vs. 195.44±97.28, ALB ( g/L ):24.11±6.94 vs. 31.99±6.89, P<0.05 or P<0.01 ]. On the 3rd day and 7th day, WBC, NEU and NLR in the death group were significantly higher than those of the survival group [ WBC (×109/L ):16.61±10.25 vs. 8.91±4.93, 16.05±9.46 vs. 8.79±4.45; NEU (×109/L ): 14.15±9.98 vs. 6.97±4.64, 14.36±9.03 vs. 6.59±4.07; NLR: 24.13 ( 8.49, 38.26 ) vs. 5.52 ( 3.58, 8.87 ), 17.74 ( 10.74, 32.85 ) vs. 4.35 ( 2.78, 7.27 ), all P<0.01 ], and the LYM and Lym%were significantly lower than those in the survival group [ LYM (×109/L ):0.61 ( 0.38, 1.04 ) vs. 1.05 ( 0.78, 1.43 ), 0.69 ( 0.35, 0.92 ) vs. 1.37 ( 0.93, 1.76 );Lym%:0.039 ( 0.024, 0.101 ) vs. 0.135 ( 0.094, 0.186 ), 0.056 ( 0.033, 0.082 ) vs. 0.170 ( 0.108, 0.237 ), all P<0.01 ].②It was shown by ROC curve that the maximum area under the ROC curve ( AUC ) of WBC, NEU, Neut%, LYM, Lym%, and NLR about prognosis of BSI were observed on 7 days ( 0.777, 0.819, 0.905, 0.755, 0.880, 0.887 ). Based on Neut%>0.855 on the 7th day as a predictor of cut-off value of death in 28 days, the sensitivity was 78.8%, specificity 89.1%, respectively. When Lym%<0.088 on the 7th day as a predictor of cut-off value of death on 28 days, the sensitivity was 89.5%, and specificity was 83.9%. When NLR>10.34 on the 7th day as a predictor of cut-off value of death in 28 days, the sensitivity was 81.8%, and specificity was 91.0%.③Survival analysis showed that the 28-day survival rate in the patients with 7-day NLR<10.34 was significantly higher than that in those with 7-day NLR>10.34 ( 95.0%vs. 34.1%,χ2=82.650, P=0.000 ).④It was shown by multi-factor logistic regression analysis that the levels of 1-day Hb and 7-day NLR were the independent prognostic predictors of 28-day mortality [ Hb: odds ratio ( OR ) = 0.946, 95% confidence interval ( 95%CI ) = 0.913-0.981, P = 0.003; 7-day NLR:OR=34.941, 95%CI=8.728-139.884, P=0.000 ]. Conclusions The trend of changes in NEU, LYM and NLR as shown by repeated routine blood examinations contributes to prediction of the outcome of patients with BSI. The levels of 1-day Hb and 7-day NLR are the independent prognostic predictors for 28-day mortality.

Objective To investigate whether early goal-directed therapy ( EGDT ) could lower the mortality rate in patients with severe sepsis and septic shock. Methods Articles with items sepsis, severe sepsis, septic shock, EGDT were retrieved from MEDLINE, EMBASE, Cochrane, Wanfang Data and CNKI. Inclusion criteria included randomized controlled trial, subjects concerning patients with severe sepsis or septic shock, endpoints with short-term mortality [ in-hospital, intensive care unit ( ICU ) or 28-day ] and long-term mortality ( 60-day or 90-day ). Related risk ( RR ) and 95% confidence interval ( 95%CI ) were used as indices to judge the difference in mortality rate between EGDT group and standard treatment group. RevMan 5.2 software was used for Meta analysis. Results There were 8 studies meeting inclusive criteria with a total of 4 853 patients. For patients with severe sepsis and septic shock, compared with the group with routine treatment, EGDT showed a decrease in the short-term mortality ( RR = 0.74, 95%CI=0.66-0.82, P<0.000 01 ), but did not decrease the long-term mortality ( RR=0.99, 95%CI=0.92-1.06, P=0.81 ). Conclusion EGDT strategy may decrease the short-term mortality in patients with severe sepsis and septic shock, but it showed no influence on the long-term mortality.

Objective To determine the role of activated status of peroxisome proliferator-activated receptorγ/nuclear factor-κB ( PPAR-γ/NF-κB ) in coagulation disorders induced by sepsis. Methods Forty male Sprague-Dawley ( SD ) rats were randomly divided into four groups, n = 10 in each group: control group, lipopolysaccharide ( LPS ) challenged group, rosiglitazone ( ROSI, selective agonist of PPAR-γ) pretreatment group, and GW9662 ( PPAR-γ antagonist ) pretreatment group. The sepsis model was reproduced by injection of 6 mg/kg LPS via sublingual vein, and the rats in control group were injected with 2 mL/kg normal saline. The rats in ROSI pretreatment group were given 0.3 mg/kg ROSI by sublingual venous injection followed by injection of LPS 30 minutes later;and in GW9662 pretreatment group rats were given 0.3 mg/kg GW9662 by sublingual venous injection followed by 0.3 mg/kg ROSI 15 minutes later, followed by injection of LPS 30 minutes later. Blood was collected at 4 hours after LPS administration, and the expressions of PPAR-γ and NF-κBp65 in peripheral blood mononuclear cell ( PBMC ) were determined with immunocytocheminal technique and graph analysis. Plasma prothrombin time ( PT ), activated partial thromboplastin time ( APTT ), fibrinogen ( FIB ), and D-dimer were determined simultaneously. Results① PPAR-γ/NF-κB pathway: the expressions of PPAR-γ and NF-κBp65 were lowered in control group, and they were expressed in cytoplasm. In LPS challenged group the expression of PPAR-γ ( gray value ) was slightly increased but with no significant difference as compared with control group ( 111.01±4.06 vs. 98.46±5.99, P >0.05 ). In ROSI pretreatment group the expression of PPAR-γ( gray value ) was significantly higher than that in LPS challenged group ( 214.38±5.79 vs. 111.01±4.06, P<0.01 ), with dislocation into nuclei. In GW9662 pretreatment group the expression of PPAR-γ ( gray value ) was lowered but without significant difference compared with that of control group ( 44.21±2.64 vs. 98.46±5.99, P>0.05 ). In LPS challenged group the expression of NF-κBp65 ( gray value ) was significantly higher than that in control group ( 249.48±6.86 vs. 105.81±10.19, P < 0.01 ), and it was translocated into the nuclei. In ROSI pretreatment group the expression of NF-κBp65 ( gray value ) was significantly lower than that in LPS challenged group ( 102.47±8.05 vs. 249.48±6.86, P < 0.01 ), and it lied in cytoplasm. In GW9662 pretreatment group the expression of NF-κBp65 ( gray value ) showed no significant difference as compared with that of LPS challenged group ( 214.84±7.91 vs. 249.48±6.86, P>0.05 ).②Coagulation:compared with control group, PT and APTT were significantly prolonged, FIB was significantly decreased, and D-dimer was significantly increased in LPS challenged group [ PT ( s ):18.32±2.03 vs. 12.22±1.38, APTT ( s ):40.05±2.72 vs. 26.64±2.73, FIB ( g/L ): 1.65±0.51 vs. 3.60±0.37, D-dimer ( mg/L ): 2.58±0.73 vs. 0.37±0.06, all P < 0.01 ]. Compared with LPS challenged group, APTT and PT were significantly shortened, FIB was significantly increased, and D-dimer was significantly lowered in ROSI pretreatment group [ PT ( s ):13.93±1.67 vs. 18.32±2.03, APTT ( s ):30.29±0.86 vs. 40.05±2.72, FIB ( g/L ):3.18±0.69 vs 1.65±0.51, D-dimer ( mg/L ):0.40±0.12 vs. 2.58±0.73, all P<0.01 ]. All parameters in GW9662 pretreatment group showed no significant difference as compared with those of LPS challenged group. Conclusions PPAR-γagonist ROSI may ameliorate coagulation disorders in septic rats. PPAR-γ/NF-κB transduction pathway plays an important role in septic coagulopathy.

Objective To investigate the role of endothelial progenitor cells ( EPCs ) transplantation in rats with sepsis induced by endotoxin ( lipopolysaccharides, LPS ). Methods Sixty clean grade Sprague-Dawley ( SD ) rats with genetic background were divided into three groups according to random number table method:control group, model group, and EPCs transplantation group, with 20 rats in each group. The sepsis model was reproduced by intravenous delivery of LPS 5 mg/kg. Rats in control group were injected with the same amount of normal saline. EPCs were isolated, and cultured and identified were fluorescently labeled with the green fluorescent protein ( GFP ) adenoviral transfection method. The EPC transplantation group was injected with LPS, then a fluorescently labeled EPCs suspension was injected via the tail vein 1 hour later. The expression of fluorescent markers of EPCs was detected with both small animal in vivo imaging instrument and frozen section. Seven days after transplantation, abdominal aorta blood was collected to determine interleukins ( IL-6 and IL-10 ) in peripheral blood with enzyme linked immunosorbent assay ( ELISA ), and the lung, liver, and kidney tissues were harvested, the wet/dry ratio of the lung ( W/D ) was calculated, and hematoxylin and eosin ( HE ) staining was performed to observe, the change in histopathology. Toll-like receptor 4 ( TLR4 ) mRNA expression in lung, liver, and kidney tissues was determined with real-time reverse transcription-polymerase chain reaction ( RT-PCR ). Results The positive rate of EPCs cells with double marking of CD133 and CD34 was 99.0% at the 5th generation of subculture by using flow cytometry. After the transplantation of EPCs labeled with the green fluorescent protein, the appearance of fluorescence indicated that EPCs were mainly localized in the chest, and a stronger fluorescence was observed near the blood vessels. EPCs transplantation could significantly reduce the inflammatory cell infiltration and cell damage in lung, liver, and kidney tissue in septic rats. Compared with control group, the expression of IL-6 and IL-10 in the peripheral blood, W/D ratio, and TLR4 mRNA in lung, liver, and kidney were increased significantly in the model group. Compared with model group, the expressions of IL-6 and IL-10 in the peripheral blood were significantly reduced after EPCs transplantation [ IL-6 (μg/L ):2.127±0.118 vs. 2.664±0.438, IL-10 ( ng/L ): 24.5±3.9 vs. 31.5±3.8, both P < 0.01 ]. EPCs transplantation reduced the W/D ratio of lung, liver and kidney tissues ( lung: 4.68±0.24 vs. 5.48±0.15, liver: 3.33±0.11 vs. 3.94±0.09, kidney: 4.08±0.20 vs. 4.84±0.21, all P < 0.05 ], and down-regulated the expression of TLR4 mRNA ( ×103, lung: 782±131 vs. 1 136±126, liver: 39.1±14.0 vs. 69.2±8.7, kidney: 52.2±15.2 vs. 83.5±17.1, all P < 0.01 ). Conclusions EPCs can enter the lung, liver and kidney tissues of the rat successfully after transplantation of EPCs via vein. EPCs transplantation can down-regulate pro-inflammatory process, help to recover the balance of pro-and anti-inflammatory processes, alleviate the damage to the lung, liver, and kidney tissue significantly.