目的探讨急救系统风险预测模型(development and validation of risk-adjusted outcomes for systems of emergency medical care,DAVROS)和改良早期预警评分(modified early warning score,MEWS)对急诊危重患者短期病死率的预测价值,...目的探讨急救系统风险预测模型(development and validation of risk-adjusted outcomes for systems of emergency medical care,DAVROS)和改良早期预警评分(modified early warning score,MEWS)对急诊危重患者短期病死率的预测价值,并进行比较研究.方法对急诊抢救室1143例危重患者进行DAVROS评分和MEWS评分,以入抢救室后7日病死率作为研究终点,比较两种评分模型预测患者短期死亡风险的准确性.结果入抢救室患者中,循环系统疾病占比为35.3%,7日内实际病死率为15.5%.生存组和死亡组患者主要病理生理学数据间差异有统计学意义.死亡组DAVROS评分[3.39(0.94~10.79)vs.0.58(0.24~1.41)]、MEWS评分[4.00(3.00~6.00)vs.2.00(1.00~4.00)]和DAVROS评分预测患者7日病死率77.2%[(48.9%~91.5%)vs.36.7%(19.4%~58.4%)]高于生存组,差异均有统计学意义(P<0.001).DAVROS评分和MEWS评分预测患者短期死亡风险的ROC曲线下面积分别为0.774(95%CI0.736~0.812)和0.723(95%CI0.683~0.763),两者差异有统计学意义(Z=2.591,P=0.0096).结论DAVROS评分用于预测急诊危重患者短期病死率的准确性优于MEWS评分,两者联合预测急诊患者死亡风险的准确性尚需进一步研究证实.展开更多
目的系统评价脑卒中后30 d内短期死亡风险预测模型的偏倚风险及适用性,为后续选择或开发规范的风险预测模型提供依据。方法计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据库、PubMed、Web of Science、Embase、Cochrane...目的系统评价脑卒中后30 d内短期死亡风险预测模型的偏倚风险及适用性,为后续选择或开发规范的风险预测模型提供依据。方法计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据库、PubMed、Web of Science、Embase、Cochrane Library、CINAHL中与卒中后30 d内短期死亡风险预测模型相关的研究,检索时限为建库至2023年12月5日。由2名研究者独立进行文献筛选及文献质量评价。结果最终纳入12项研究,共31个模型经过了内部验证,其中7个模型在内部验证的基础上进行了外部验证。有26个模型报告了区分度,18个模型报告了校准方法。建模频次最高的预测因子为:年龄、高血压、房颤、糖尿病及GCS评分。由于样本量不足、缺失变量处理不当等方法学问题及建模信息报告不充分导致纳入的研究均被评为高偏倚风险。结论脑卒中患者短期死亡风险预测模型研究仍处于发展阶段,虽具有较好的适用性,但偏倚风险较高,未来研究应依据PROBAST及TRIPOD进行研究设计及报告,规避本研究总结的共性问题,降低偏倚风险。展开更多
目的探讨重症监护室(intensive care unit,ICU)/呼吸重症监护室(respiratory intensive care unit,RICU)重症肺炎患者入院时血清磷酸盐水平与短期(<30 d)病死率之间的关系。方法纳入2019年11月—2021年9月福建医科大学附属泉州第一医...目的探讨重症监护室(intensive care unit,ICU)/呼吸重症监护室(respiratory intensive care unit,RICU)重症肺炎患者入院时血清磷酸盐水平与短期(<30 d)病死率之间的关系。方法纳入2019年11月—2021年9月福建医科大学附属泉州第一医院ICU/RICU收治的重症肺炎患者。通过Logistic分析和受试者操作特征(receiver operator characteristic,ROC)曲线验证血清磷酸盐水平是否为ICU/RICU重症肺炎患者短期死亡的独立危险因素。根据磷酸盐浓度对患者进行分类,探讨血清磷酸盐水平与短期病死率的关系。结果对生存组54例患者和非生存组46例患者入院时各项基线指标进行比较,结果显示生存组与非生存组间血清磷酸盐含量差异有统计学意义[0.9(0.8,1.2)mmol/L比1.2(0.9,1.5)mmol/L,P<0.05]。单因素及多因素Logistic分析表明血清磷酸盐水平升高是短期死亡的独立危险因素。ROC曲线分析显示血清磷酸盐预测重症肺炎患者短期死亡的能力与肺炎严重指数(pneumonia severity index,PSI)接近。将血清磷酸盐与PSI评分、CURB65评分及序贯器官衰竭评分合并后,上述评分对短期死亡的预测能力均得到提升。高磷血症组患者的短期病死率明显高于正常血磷组及低磷血症组(85.7%比47.3%和25.8%,P<0.05)。结论入院时血清磷酸盐水平对ICU/RICU重症肺炎患者短期死亡有较好的预测作用。入住ICU或者RICU时伴有高磷血症的重症肺炎患者具有较高的短期死亡风险。展开更多
Aim:The study aimed to investigate the short-term outcomes of hospitalized patients with chronic liver disease(CLDs)and assess the prognostic impact of predisposition and precipitants,which currently remains unclear.M...Aim:The study aimed to investigate the short-term outcomes of hospitalized patients with chronic liver disease(CLDs)and assess the prognostic impact of predisposition and precipitants,which currently remains unclear.Methods:The study included 3970 hospitalized patients with CLDs from two prospective longitudinal multicenter studies(NCT02457637 and NCT03641872)conducted in highly endemic hepatitis B virus(HBV)areas.Competing risk analysis was used to evaluate the effect of predispositions,including the etiology and severity of CLDs and precipitants;on sequential 28,90,and 365-day liver transplantation(LT)-free mortality.Results:Among all enrolled patients,76.8%of adverse outcomes(including death and LT)within one year occurred within 90 days.Compared with alcoholic etiology,the association of HBV etiology with poorer outcomes was remarkably on the 28th day(hazard ratio[HR],1.81;95%confidence interval[CI],1.07-3.06;p=0.026);however,and dimin-ished or became insignificant at 90 days and 365 days.Cirrhosis increased the adjusted risk for 365-day(HR,1.50;CI,1.13-1.99;p=0.004)LT-free mortality when compared with noncirrhosis.In patients with cirrhosis,prior decompensation(PD)independently increased the adjusted risk of 365-day LT-free mortality by 1.25-fold(p=0.021);however,it did not increase the risk for 90-day mortality.Neither the category nor the number of precipitants influenced the adjusted risk of 28 or 90-day LT-free mortality.Conclusions:The 90-day outcome should be considered a significant endpoint for evaluating the short-term prognosis of hospitalized patients with CLD.Predisposing factors,other than etiology,mainly affected the delayed(365-day)outcome.Timely effective therapy for CLD etiology,especially antiviral treatments for HBV,and post-discharge long-term surveillance monitoring in cirrhotic patients undergoing PD are suggested to enhance disease management and reduce mortality.展开更多
AIM:To establish the short term outcomes of heart failure(HF)patients in the community who have concurrent chronic obstructive pulmonary disease(COPD).METHODS:We evaluated 783 patients(27.2%)with left ventricular syst...AIM:To establish the short term outcomes of heart failure(HF)patients in the community who have concurrent chronic obstructive pulmonary disease(COPD).METHODS:We evaluated 783 patients(27.2%)with left ventricular systolic dysfunction under the care of a regional nurse-led community HF team between June 2007 and June 2010 through a database analysis.RESULTS:One hundred and one patients(12.9%)also had a diagnosis of COPD;94% of patients were treated with loop diuretics,83% with angiotensin converting enzyme inhibitors,74% with β-blockers;10.6% with bronchodilators;and 42% with aldosterone an-tagonists.The mean age of the patients was 77.9 ± 5.7 years;43% were female and mean New York Heart Association class was 2.3 ± 0.6.The mean follow-up was 28.2 ± 2.9 mo.β-blocker utilization was markedly lower in patients receiving bronchodilators compared with those not taking bronchodilators(overall 21.7% vs 81%,P < 0.001).The 24-mo survival was 93% in patients with HF alone and 89% in those with both comorbidities(P = not significant).The presence of COPD was associated with increased risk of HF hospitalization [hazard ratio(HR):1.56;95% CI:1.4-2.1;P < 0.001] and major adverse cardiovascular events(HR:1.23;95% CI:1.03-1.75;P < 0.001).CONCLUSION:COPD is a common comorbidity in ambulatory HF patients in the community and is a powerful predictor of worsening HF.It does not however appear to affect short-term mortality in ambulatory HF patients.展开更多
Since the London fog in 1952, numerous epidemioLogical studies have revealed that both short-term and long-term exposure to air pollutants is associated with the development of diseases[1]. Up to date, the assessment ...Since the London fog in 1952, numerous epidemioLogical studies have revealed that both short-term and long-term exposure to air pollutants is associated with the development of diseases[1]. Up to date, the assessment of air quality on health and air quality standard establishment in developing countries were mainly relied on extrapolation based on the results from long-term cohort studies conducted in Europe and North America.展开更多
文摘目的探讨急救系统风险预测模型(development and validation of risk-adjusted outcomes for systems of emergency medical care,DAVROS)和改良早期预警评分(modified early warning score,MEWS)对急诊危重患者短期病死率的预测价值,并进行比较研究.方法对急诊抢救室1143例危重患者进行DAVROS评分和MEWS评分,以入抢救室后7日病死率作为研究终点,比较两种评分模型预测患者短期死亡风险的准确性.结果入抢救室患者中,循环系统疾病占比为35.3%,7日内实际病死率为15.5%.生存组和死亡组患者主要病理生理学数据间差异有统计学意义.死亡组DAVROS评分[3.39(0.94~10.79)vs.0.58(0.24~1.41)]、MEWS评分[4.00(3.00~6.00)vs.2.00(1.00~4.00)]和DAVROS评分预测患者7日病死率77.2%[(48.9%~91.5%)vs.36.7%(19.4%~58.4%)]高于生存组,差异均有统计学意义(P<0.001).DAVROS评分和MEWS评分预测患者短期死亡风险的ROC曲线下面积分别为0.774(95%CI0.736~0.812)和0.723(95%CI0.683~0.763),两者差异有统计学意义(Z=2.591,P=0.0096).结论DAVROS评分用于预测急诊危重患者短期病死率的准确性优于MEWS评分,两者联合预测急诊患者死亡风险的准确性尚需进一步研究证实.
基金Clinical Research Plan of SHDC,Grant/Award Number:SHDC2020CR1037BShanghai Municipal Key Clinic Specialty,Grant/Award Number:shslczdzk00602+16 种基金National Key R&D Program of China,Grant/Award Number:2017YFC0908100National Science and Technology Major Project,Grant/Award Numbers:2018ZX10302206,2018ZX10723203,2017ZX10202202Shanghai Municipal Education Commission–Guofeng Clinical Medicine Grant Support,Grant/Award Number:20152213National Natural Science Foundation of China,Grant/Award Numbers:82170629,81930061,81900579,81970550,82070613,82070650,81972265,81870425,81774234Shanghai Hospital Development Commission,Grant/Award Number:16CR1024BChongqing Natural Science Foundation,Grant/Award Number:CSTC2019jcyjzdxmX0004Beijing Municipal Science&Technology Commission,Grant/Award Number:Z191100006619033Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program,Grant/Award Number:2017BT01S131Clinical Research Program of Nanfang Hospital,Southern Medical University,Grant/Award Numbers:2018CR037,2020CR026Clinical Research Startup Program of Southern Medical University by High-level University Construction Funding of Guangdong Provincial Department of Education,Grant/Award Number:LC2019ZD006President Foundation of Nanfang Hospital,Southern Medical University,Grant/Award Number:2019Z003Foundation for Innovative Research Groups of Hubei Provincial Natural Science Foundation,Grant/Award Number:2018CFA031Hubei Province's Outstanding Medical Academic Leader Program and Project of Hubei University of Medicine,Grant/Award Numbers:FDFR201902,2020XGFYZR05Fundamental Research Funds for the Central Universities,Grant/Award Number:2021FZZX001-41Guangdong Basic and Applied Basic Research Foundation,Grant/Award Number:2020A1515010052Natural Fund of Guangdong Province,Grant/Award Number:2016A030313237Guangzhou City Science and Technology Project,Grant/Award Number:201607010064。
文摘Aim:The study aimed to investigate the short-term outcomes of hospitalized patients with chronic liver disease(CLDs)and assess the prognostic impact of predisposition and precipitants,which currently remains unclear.Methods:The study included 3970 hospitalized patients with CLDs from two prospective longitudinal multicenter studies(NCT02457637 and NCT03641872)conducted in highly endemic hepatitis B virus(HBV)areas.Competing risk analysis was used to evaluate the effect of predispositions,including the etiology and severity of CLDs and precipitants;on sequential 28,90,and 365-day liver transplantation(LT)-free mortality.Results:Among all enrolled patients,76.8%of adverse outcomes(including death and LT)within one year occurred within 90 days.Compared with alcoholic etiology,the association of HBV etiology with poorer outcomes was remarkably on the 28th day(hazard ratio[HR],1.81;95%confidence interval[CI],1.07-3.06;p=0.026);however,and dimin-ished or became insignificant at 90 days and 365 days.Cirrhosis increased the adjusted risk for 365-day(HR,1.50;CI,1.13-1.99;p=0.004)LT-free mortality when compared with noncirrhosis.In patients with cirrhosis,prior decompensation(PD)independently increased the adjusted risk of 365-day LT-free mortality by 1.25-fold(p=0.021);however,it did not increase the risk for 90-day mortality.Neither the category nor the number of precipitants influenced the adjusted risk of 28 or 90-day LT-free mortality.Conclusions:The 90-day outcome should be considered a significant endpoint for evaluating the short-term prognosis of hospitalized patients with CLD.Predisposing factors,other than etiology,mainly affected the delayed(365-day)outcome.Timely effective therapy for CLD etiology,especially antiviral treatments for HBV,and post-discharge long-term surveillance monitoring in cirrhotic patients undergoing PD are suggested to enhance disease management and reduce mortality.
文摘AIM:To establish the short term outcomes of heart failure(HF)patients in the community who have concurrent chronic obstructive pulmonary disease(COPD).METHODS:We evaluated 783 patients(27.2%)with left ventricular systolic dysfunction under the care of a regional nurse-led community HF team between June 2007 and June 2010 through a database analysis.RESULTS:One hundred and one patients(12.9%)also had a diagnosis of COPD;94% of patients were treated with loop diuretics,83% with angiotensin converting enzyme inhibitors,74% with β-blockers;10.6% with bronchodilators;and 42% with aldosterone an-tagonists.The mean age of the patients was 77.9 ± 5.7 years;43% were female and mean New York Heart Association class was 2.3 ± 0.6.The mean follow-up was 28.2 ± 2.9 mo.β-blocker utilization was markedly lower in patients receiving bronchodilators compared with those not taking bronchodilators(overall 21.7% vs 81%,P < 0.001).The 24-mo survival was 93% in patients with HF alone and 89% in those with both comorbidities(P = not significant).The presence of COPD was associated with increased risk of HF hospitalization [hazard ratio(HR):1.56;95% CI:1.4-2.1;P < 0.001] and major adverse cardiovascular events(HR:1.23;95% CI:1.03-1.75;P < 0.001).CONCLUSION:COPD is a common comorbidity in ambulatory HF patients in the community and is a powerful predictor of worsening HF.It does not however appear to affect short-term mortality in ambulatory HF patients.
基金supported by the National Basic Research Program (973 program) of China (2011CB503802)the Gong-Yi Program of the Chinese Ministry of Environmental Protection (201209008)+2 种基金Shanghai Municipal Committee of Science and Technology (12dz1202602)Shanghai Health Bureau (GWDTR201212)the Scholarship Award for Excellent Doctoral Student granted by Ministry of Education (2011)
文摘Since the London fog in 1952, numerous epidemioLogical studies have revealed that both short-term and long-term exposure to air pollutants is associated with the development of diseases[1]. Up to date, the assessment of air quality on health and air quality standard establishment in developing countries were mainly relied on extrapolation based on the results from long-term cohort studies conducted in Europe and North America.
