A significant correlation was observed between increased daily protein and energy intake by patients and a reduced in-hospital mortality rate (HR = 0.41, 95%CI = 0.32-0.50, P < 0.0001; HR = 0.87, 95%CI = 0.84-0.92, P < 0.0001), shorter ICU stays (HR = 0.46, 95%CI = 0.39-0.53, P < 0.0001; HR = 0.82, 95%CI = 0.78-0.86, P < 0.0001), and shorter hospital stays (HR = 0.51, 95%CI = 0.44-0.58, P < 0.0001; HR = 0.77, 95%CI = 0.68-0.88, P < 0.0001). Protein and energy intake, enhanced daily, in patients with an mNUTRIC score of 5, is associated with a reduction in both in-hospital and 30-day mortality, as evidenced by correlation analysis (with provided hazard ratios and confidence intervals). The receiver operating characteristic curve further validated higher protein intake's predictive power for inpatient (AUC = 0.96) and 30-day mortality (AUC = 0.94), and likewise higher energy intake's predictive capability for both outcomes (AUC = 0.87 and 0.83, respectively). Among patients with mNUTRIC scores less than 5, increasing daily protein and energy intake was found to be associated with a decrease in 30-day mortality (hazard ratio = 0.76, 95% confidence interval 0.69 to 0.83, p < 0.0001).
There is a substantial correlation between increased average daily protein and energy intake in sepsis patients and lower rates of in-hospital and 30-day mortality, shorter periods of intensive care unit and hospital stays. A notable correlation exists in patients with high mNUTRIC scores, where a higher protein and energy intake demonstrates a potential to lower both in-hospital and 30-day mortality. Patients with low mNUTRIC scores are not likely to experience substantial improvements in their prognosis despite nutritional support.
A substantial rise in the daily protein and energy intake of sepsis patients is demonstrably linked to a decrease in in-hospital and 30-day mortality rates, alongside shorter intensive care unit and hospital stays. The correlation is more apparent in those with high mNUTRIC scores; increased protein and energy intake contribute to reduced in-hospital and 30-day mortality. Nutritional support does not yield a notable improvement in prognosis for those patients presenting with a low mNUTRIC score.
To scrutinize the elements contributing to pulmonary infections in elderly neurocritical patients housed within intensive care units, and to evaluate the predictive value of potential risk factors for these infections.
A retrospective analysis was undertaken of the clinical data for 713 elderly neurocritical patients, 65 years of age with a Glasgow Coma Score of 12, admitted to the Department of Critical Care Medicine at the Affiliated Hospital of Guizhou Medical University between 2016 and 2019. Based on the presence or absence of hospital-acquired pneumonia (HAP), the elderly neurocritical patients were divided into a HAP group and a non-HAP group. The two groups were contrasted based on differences in their initial data, medical regimens, and criteria for assessing outcomes. In a study of pulmonary infection, logistic regression analysis was used to investigate the influencing factors. The predictive value for pulmonary infection was evaluated through the creation of a predictive model, supported by the visualization of risk factors using a receiver operator characteristic (ROC) curve.
A total of 341 patients participated in the study, including a group of 164 non-HAP patients and 177 HAP patients. HAP demonstrated an exceptional incidence rate of 5191%. Compared to the non-HAP group, the HAP group demonstrated significantly increased rates of open airway, diabetes, PPI use, sedative use, blood transfusion, glucocorticoid use, and GCS 8 points. The open airway proportion was higher (95.5% vs. 71.3%), diabetes prevalence was higher (42.9% vs. 21.3%), PPI use was higher (76.3% vs. 63.4%), sedative use was higher (93.8% vs. 78.7%), blood transfusion was higher (57.1% vs. 29.9%), glucocorticoid use was higher (19.2% vs. 4.3%), and GCS 8 points were higher (83.6% vs. 57.9%), all with p < 0.05.
A conclusive distinction was found between L) 079 (052, 123) and 105 (066, 157), with the p-value falling below 0.001. A logistic regression analysis of elderly neurocritical patients revealed that open airways, diabetes, blood transfusions, glucocorticoids, and a Glasgow Coma Scale (GCS) score of 8 were independent risk factors for pulmonary infections. Specifically, open airways exhibited an odds ratio (OR) of 6522 (95% confidence interval [CI] 2369-17961), diabetes an OR of 3917 (95%CI 2099-7309), blood transfusion an OR of 2730 (95%CI 1526-4883), glucocorticoids an OR of 6609 (95%CI 2273-19215), and a GCS score of 8 an OR of 4191 (95%CI 2198-7991), all with P < 0.001. Conversely, lymphocyte counts (LYM) and platelet counts (PA) were protective factors against pulmonary infection, with LYM displaying an OR of 0.508 (95%CI 0.345-0.748) and PA an OR of 0.988 (95%CI 0.982-0.994), both with P < 0.001 in this elderly neurocritical patient population. ROC curve analysis indicated that the area under the ROC curve (AUC) for predicting HAP from these risk factors was 0.812 (95% CI 0.767-0.857, p < 0.0001). This was further characterized by a sensitivity of 72.3% and a specificity of 78.7%.
In elderly neurocritical patients, the presence of an open airway, diabetes, glucocorticoid use, blood transfusions, and a GCS of 8 points independently contribute to the risk of pulmonary infections. The prediction model, derived from the previously mentioned risk factors, exhibits a certain predictive ability for pulmonary infections in elderly neurocritical patients.
Among elderly neurocritical patients, independent factors contributing to pulmonary infection risk include open airways, diabetes, the use of glucocorticoids, blood transfusions, and a GCS of 8. The risk factors identified allow for the development of a predictive model which exhibits some capability in forecasting pulmonary infections in elderly neurocritical patients.
To assess the predictive power of initial serum lactate, albumin, and the lactate-to-albumin ratio (L/A) on the 28-day survival prospects of adult patients with sepsis.
A cohort study, looking back at adult sepsis patients, was carried out at the First Affiliated Hospital of Xinjiang Medical University from January to December 2020. Patient characteristics, such as gender, age, and comorbidities, along with lactate levels (within 24 hours of admission), albumin, L/A ratio, interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), and the 24-day post-admission prognosis were meticulously recorded. A study using a receiver operating characteristic (ROC) curve explored the predictive capacity of lactate, albumin, and L/A ratios to forecast 28-day mortality in patients with sepsis. Patient subgroups were defined using the ideal cut-off value; Kaplan-Meier survival curves were generated; and the 28-day cumulative survival of those with sepsis was investigated.
Among the 274 patients with sepsis who were included, 122 patients sadly passed away within 28 days, resulting in a 28-day mortality rate of 44.53%. selleckchem In the death group, age, pulmonary infection, shock, lactate, L/A, and IL-6 were significantly higher, while albumin was significantly lower than in the survival group. (Age: 65 (51-79) years vs. 57 (48-73) years; Pulmonary infection: 754% vs. 533%; Shock: 377% vs. 151%; Lactate: 476 (295-923) mmol/L vs. 221 (144-319) mmol/L; L/A: 0.18 (0.10-0.35) vs. 0.08 (0.05-0.11); IL-6: 33,700 (9,773-23,185) ng/L vs. 5,588 (2,526-15,065) ng/L; Albumin: 2.768 (2.102-3.303) g/L vs. 2.962 (2.525-3.423) g/L; All p < 0.05). In sepsis patients, the 28-day mortality prediction using the area under the ROC curve (AUC) and 95% confidence interval (95%CI) revealed 0.794 (95%CI 0.741-0.840) for lactate, 0.589 (95%CI 0.528-0.647) for albumin, and 0.807 (95%CI 0.755-0.852) for L/A. When lactate levels reached 407 mmol/L, the diagnostic test displayed a sensitivity of 5738% and a specificity of 9276%. To achieve optimal diagnostic accuracy, the albumin cut-off value was determined to be 2228 g/L, exhibiting a sensitivity of 3115% and a specificity of 9276%. In diagnosing L/A, a cut-off value of 0.16 demonstrated a sensitivity of 54.92% and a specificity of 95.39%. Mortality within the 28 days following sepsis was markedly higher in the L/A > 0.16 patient group (90.5%, 67 of 74 patients) compared to the L/A ≤ 0.16 group (27.5%, 55 of 200 patients), revealing a significant difference (P < 0.0001) in subgroup analysis. A considerably elevated 28-day mortality was seen in sepsis patients whose albumin levels were 2228 g/L or lower (776%, 38/49) as compared to those with higher albumin levels (373%, 84/225), with a statistically significant difference (P < 0.0001). selleckchem The 28-day mortality rate was significantly greater in the group with lactate values greater than 407 mmol/L compared to the group with lactate values of 407 mmol/L, a highly significant finding (864% [70/81] vs. 269% [52/193], P < 0.0001). The three observations exhibited consistency with the conclusions drawn from the Kaplan-Meier survival curve analysis.
Early serum lactate, albumin, and L/A ratio assessments all held significant value in predicting the 28-day outcomes for sepsis patients, the L/A ratio displaying more accurate prognostication than lactate or albumin alone.
In the context of sepsis, early serum lactate, albumin, and the L/A ratio all contributed to the prediction of a patient's 28-day outcome; surprisingly, the L/A ratio displayed better predictive ability compared to lactate or albumin levels alone.
Exploring the correlation between serum procalcitonin (PCT) levels, the acute physiology and chronic health evaluation II (APACHE II) score, and the projected outcome of elderly individuals with sepsis.
Patients with sepsis, admitted to the emergency and geriatric medicine departments of Peking University Third Hospital from March 2020 through June 2021, comprised the cohort for this retrospective study. Within 24 hours of admission, patients' electronic medical records were consulted to retrieve their demographic characteristics, routine laboratory results, and APACHE II scores. A retrospective analysis of the prognosis was performed, involving the period of hospitalization and the following year after the patient was discharged. Using both univariate and multivariate methods, an analysis of prognostic factors was performed. Kaplan-Meier survival curves were used to study the overall survival outcomes.
Among the 116 elderly patients who met the criteria, 55 survived, while 61 had succumbed to their conditions. On univariate analysis, In clinical assessment, lactic acid (Lac) is one variable to assess. hazard ratio (HR) = 116, 95% confidence interval (95%CI) was 107-126, P < 0001], PCT (HR = 102, 95%CI was 101-104, P < 0001), alanine aminotransferase (ALT, HR = 100, 95%CI was 100-100, P = 0143), aspartate aminotransferase (AST, HR = 100, 95%CI was 100-101, P = 0014), lactate dehydrogenase (LDH, HR = 100, 95%CI was 100-100, P < 0001), hydroxybutyrate dehydrogenase (HBDH, HR = 100, 95%CI was 100-100, P = 0001), creatine kinase (CK, HR = 100, 95%CI was 100-100, P = 0002), MB isoenzyme of creatine kinase (CK-MB, HR = 101, 95%CI was 101-102, P < 0001), Na (HR = 102, 95%CI was 099-105, P = 0183), blood urea nitrogen (BUN, HR = 102, 95%CI was 099-105, P = 0139), selleckchem fibrinogen (FIB, HR = 085, 95%CI was 071-102, P = 0078), neutrophil ratio (NEU%, HR = 099, 95%CI was 097-100, P = 0114), platelet count (PLT, HR = 100, 95%CI was 099-100, Total bile acid, abbreviated as TBA, and a probability, P, of 0.0108, are recorded.