Objective To study the predicting value of four different scoring systems such as the acute physiology and chronichealth evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score and systemic inflammatory response syndrome (SIRS) score for the prognosis of septic patients. Methods A retrospective analysis were conducted. Septic patients in intensive care unit (ICU) of the First People's Hospital of Chenzhou form July 1st, 2012 to June 30th, 2016 were enrolled.Patients were divided into survival group and death group according to 28-day outcome. The difference of clinic data, the worst clinical index value within 24 hours, whether mechanical ventilation performed on first day, length of stay in ICU, APACHE Ⅱ score, SOFA score, qSOFA score and SIRS score were compared between the two groups. The significant different factors of sepsis outcome in univariate analysis were analyzed by multiple logistic regression, and the ability of four scoring systems was tested by receiver operating characteristic (ROC) curve.Results 311 patients were enrolled in this study (221 survivals, 90 deaths, 28-day mortality rate 28.9%). Univariate analysis showed age, mechanical ventilation ratio, urine output, length of stay in ICU and the fastest heart beat rate (HR), the lowest systolic blood pressure (SBP), the lowest mean arterial pressure (MAP), HCO3-, minimum arterial blood oxygen partial pressure (PaO2), minimum oxygenation index (PaO2/FiO2), the maximum fraction of inspired oxygen (FiO2), Na+, the highest concentration of blood urea nitrogen (BUN), the highest concentration of serum creatinine (SCr), minimum concentration of plasma albumin (Alb), Glasgow coma score (GCS) score, APACHE Ⅱ score, SOFA score, qSOFA score, within 24 hours after diagnosis were significantly different between two groups (allP < 0.05). Multiple logistic regression showed age [odds ratio (OR) = 1.388, 95% confidence interval (95%CI) = 1.074-1.794,P = 0.012], PaO2/FiO2 (OR = 0.459, 95%CI = 0.259-0.812,P = 0.007), concentration of plasma Alb (OR = 0.523, 95%CI = 0.303-0.903,P = 0.020), GCS score (OR = 0.541, 95%CI = 0.303-0.967,P = 0.038) and SOFA scores (OR = 3.189, 95%CI = 1.813-5.610,P = 0.000) were independent risk factors for sepsis outcome. ROC curve test showed the APACHE Ⅱ score, SOFA score and qSOFA score had the ability to predict the outcome in critical ill patients with sepsis, the SOFA score of the most powerful, the area under the ROC curve (AUC) was 0.700,when the cut-off value was 7.5 points, the sensitivity was 73.3% and specificity was 58.8%.Conclusions APACHE Ⅱ score, SOFA score and qSOFA score have the predictive properties for septic patients. SOFA score is an independent prognostic risk factor of sepsis, while qSOFA score can be widely used in clinical practice as the advantage of quick evaluating.

Objective To investigate the impact of hemoglobin(Hb)level on the risk of all-cause mortality in elderly patients with stable coronary artery disease(SCAD)treated by percutaneous coronary intervention(PCI).Methods A retrospective cohort study was conducted on 195 elderly SCAD patients treated by PCI in our hospital from June 2016 to December 2017,a total of 180 case were followed up.They were divided into four groups based on quartiles of Hb levels:Q1 group[≤122(108.28±12.53)g/L,n=47],Q2 group[122＜Hb≤137(130.07±4.33)g/L,n=43],Q3 group[137＜Hb≤148(142.67±3.10)g/L,n=46],and Q4 group[＞148(158.36±8.50)g/L,n=44].Their clinical data were collected and compared among the groups.All patients were followed up,with all-cause mortality as endpoint.Cox regression analysis was used to evaluate the impact of Hb level on all-cause mortality in elderly SCAD patients treated by PCI.Results For the 180 patients with complete follow-up,the median follow-up time was 703(415,1121)d,and the incidence of all-cause mortality was 10.00％(totally 18 deaths).And the incidence was 25.50％(12 deaths),7.00％(3 death),4.30％(2 deaths)and 2.30％(1 death)in Q1,Q2,Q3,and Q4 groups,respectively,with statistically significant differences(P＜0.01).Univariate Cox regression analysis showed age was a risk factor for all-cause death(P＜0.01),while Hb level,BMI,smoking history,dyslipidemia,and aspirin use were a risk facotr for all-cause death(P＜0.05,P＜0.01).Further multivariate Cox regression analysis revealed Hb level was a risk facotr for all-cause death(HR=0.96,95％CI:0.93-0.99,P＜0.01).The risk of all-cause mortality was 3.68 times higher in the Q1 group than the Q2 group(HR=3.68,95％CI:1.01-13.45,P＜0.05),and there was no correlation in the incidence between the Q3 and Q4 groups(P＞0.05).Conclusion Low Hb level is an independent predictor for all-cause mortality in elderly SCAD pa-tients after PCI.

Objective:To investigate the prognostic significance of anemia in elderly patients with stable coronary artery disease treated by percutaneous coronary intervention(PCI).Methods:In this retrospective cohort study, 180 patients with stable coronary artery disease aged ≥60 years undergone percutaneous coronary intervention and with complete clinical data, admitted to Nanjing Meishan Hospital between June 2016 and December 2017, were selected.Baseline clinical data of the patients were collected, including hemoglobin, C-reactive protein, lipids, fasting glucose, glycated hemoglobin, blood creatinine, and left ventricular ejection fraction on cardiac color ultrasound.The endpoints of the follow-up included major adverse cardiac events(MACE), such as all-cause death, non-fatal myocardial infarction, and non-fatal stroke.According to the hemoglobin level, participants were divided into an anemia group(n=32)and a non-anemia group(n=148). Clinical data of the two groups were compared, and the Kaplan-Meier method and multivariate analysis with the Cox regression method were used to evaluate the effect of anemia on the occurrence of MACE in elderly patients with stable coronary artery disease treated by PCI.Results:The median duration of the follow-up of the 180 patients was 702.5 days and MACE occurred in 27(15.0%). Compared with the non-anemia group, the anemia group had a higher age, C-reactive protein level and MACE ratio, lower levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol and the glomerular filtration rate, and higher proportions of patients with smoking history and patients with dyslipidemia( P<0.05). Kaplan-Meier curves suggested that the incidence of MACE in the anemia group was higher than that in the non-anemia group[37.5%(12/32) vs.10.1%(15/148), P<0.05]. Multivariate analysis with the Cox regression method showed that the risk of MACE in the anemia group was 2.91 times higher than that in the non-anemia group( HR=2.91, 95% CI: 1.13-7.48, P<0.05). Conclusions:Anemia is an independent predictor of MACE in elderly patients with stable coronary artery disease after PCI.

Objective: To investigate the effect of mechanical ventilation in prone position combined with lung recruitment on severe acute respiratory distress syndrome (ARDS). Methods: From February 2015 to February 2017, 82 patients with ARDS admitted to ICU of the Second Hospital of Shanxi Medical University were divided into two groups according to random number table, with 41 cases in each group.The study group was treated with mechanical ventilation in prone position combined with lung recruitment therapy, and the control group was treated with mechanical ventilation in supine position combined with lung recruitment therapy.The differences of heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP), partial pressure of oxygen (PaO₂), oxygenation index (PaO₂/FiO₂), plateau pressure (Pplat), and static pulmonary compliance (Cst) were compared between the two groups before treatment (T0), and 1h (T1), 2h (T2), 6h (T3) after treatment. Results: The PaO₂ and PaO₂/FiO₂ levels of the two groups increased significantly after lung recruitment.In the study group at different time after treatment, PaO₂[(69.17±7.51)mmHg, (74.64±6.78)mmHg, (82.52±10.37)mmHg], PaO₂/FiO₂ [(116.91±15.57)mmHg, (123.06±16.34)mmHg, (135.23±18.41)mmHg]were higher than those in the control group[PaO₂: (64.23±7.72)mmHg, (68.51±8.05)mmHg, (73.43±9.12)mmHg; PaO₂/FiO₂: (106.50±12.97)mmHg, (115.42±13.19)mmHg, (123.42±14.95)mmHg], the differences were statistically significant (t=3.225, 3.254, 4.245, 3.954, 3.886, 4.135, all P<0.05). HR and CVP increased at T2-T3, T3 decreased, MAP decreased at T2-T3, and T3 increased in both two groups.HR at T1-T3 in the study group were (123.17±13.41)times/min, (114.64±10.08)times/min, (102.52±6.57)times/min, which were lower than those in the control group[(129.23±12.75)times/min, (117.51±10.35)times/min, (108.43±9.77)times/min], the differences between the two groups were statistically significant (t=3.884, 4.215, 4.667, all P<0.05). Conclusion Prone position mechanical ventilation combined with lung recruitment can effectively improve the oxygenation status of severe ARDS, and has less effect on hemodynamics, and the effect is better than supine position mechanical ventilation combined with lung recruitment.