Evaluation of the curative effect and prognostic risk of ultrasound intervention combined with supportive therapy in diabetic patients with severe cholecystitis
10.3760/cma.j.cn431274-20240105-00035
- VernacularTitle:超声介入联合支持治疗对糖尿病合并重症胆囊炎患者的疗效及预后风险评估
- Author:
Wenlong NIE
1
;
Xuelian SUN
Author Information
1. 首都医科大学附属北京友谊医院急诊科，北京 100050
- Keywords:
Diabetes mellitus;
Cholecystitis, acute;
Ultrasonography, interventional;
Shock, septic
- From:
Journal of Chinese Physician
2024;26(11):1677-1680
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the therapeutic effect of ultrasound intervention combined with support in the treatment of diabetic patients with severe cholecystitis and the risk factors of septic shock.Methods:A total of 81 diabetic patients with severe cholecystitis treated in the emergency department of Beijing Friendship Hospital from January to December 2021 were retrospectively selected and divided into sepsis group ( n=41) and septic shock group ( n=40). The clinical data of the patients were collected, and the curative effect of ultrasound intervention combined with supportive treatment for diabetic patients with severe cholecystitis was analyzed. logistic regression and receiver operating characteristic (ROC) curve were used to predict the risk factors for diabetic patients with severe cholecystitis to develop septic shock. Results:In the sepsis group, 5 cases were positive in bile culture and 2 cases were positive in blood culture. In the septic shock group, 28 cases were positive in bile culture and 12 cases were positive in blood culture. The concentration of glycosylated hemoglobin (HbA 1c) before treatment, gallbladder width and final 28-day all-cause mortality in the sepsis group were lower than those in the shock group (all P<0.05). Before treatment, procalcitonin (PCT), lactic acid (Lac), shock index (SI) and Sequential Organ Failure Assessment (SOFA) scores in the sepsis group were lower than those in the sepsis shock group (all P<0.05). The mean arterial pressure (MAP) was higher than that of the shock group ( P<0.01). After treatment for the sepsis group and the septic shock group, white blood cell (WBC), neutrophilic granulocyte percentage (NEU%), platelet (PLT), PCT, C-reactive protein (CRP), total bilirubin (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), MAP, heart rate (HR), Lac, SI and SOFA scores were improved (all P<0.05). After treatment, D-dimer decreased in the sepsis group ( P<0.05), but there was no significant difference in D-dimer between the sepsis shock group and before treatment ( P=0.729 5). Multivariate logistic regression showed that HbA 1c, PCT and MAP were independent risk factors for septic shock in diabetic patients with severe cholecystosis ( OR=9.19, 1.32, 0.58, all P<0.05). The area under ROC curve of SOFA score, HbA 1c and PCT for predicting septic shock due to cholecystitis in diabetic patients were 0.878, 0.918 and 0.715. Conclusions:Ultrasound intervention combined with supportive treatment can significantly alleviate the condition of patients with severe cholecystitis, but early intervention is still needed to reduce the risk of death. HbA 1c and PCT can be used as independent risk factors for septic shock in diabetic patients with severe cholecystitis.
