Objective To explore the predictive factors for long-term adverse prognosis in patients with tuberculosis meningitis. Methods We retrospectively analyzed the clinical data (general clinical data, laboratory test results, and imaging findings) of hospitalized cases of tuberculosis meningitis admitted to West China Hospital of Sichuan University from 00:00:00 on August 1st, 2011 to 23:59:59 on July 31st, 2012. We collected data of prognosis results after 6 years of illness by telephone follow-up, and quantified outcome measures by modified Rankin Scale (mRS) score (0–6 points). According to the mRS score, the cases obtaining 0 points≤mRS<3 points were divided into the good prognosis group and the cases obtaining 3≤mRS≤6 points were divided into the poor prognosis group, logistic regression analysis was executed to find the independent risk factors affecting long-term poor prognosis. Results A total of 119 cases were included, including 63 males and 56 females; the average age was (35±17) years. Among them, 53 patients had poor prognosis and 66 patients had good prognosis. After univariate analysis, the age (t=–3.812, P<0.001), systolic blood pressure at admission (t=–2.009, P=0.049), Glasgow Coma Scale score (t=3.987, P<0.001), Medical Research Council (MRC) staging system (Z=–4.854, P<0.001), headache (χ2=4.101, P=0.043), alter consciousness (χ2=10.621, P=0.001), cognitive dysfunction (χ2=4.075, P=0.044), cranial nerve palsy (χ2=5.853, P=0.016), peripheral nerve dysfunction (χ2=14.925, P<0.001), meningeal irritation (χ2=7.174, P=0.007), serum potassium (t=3.080, P=0.003), cerebrospinal fluid protein content (Z=–2.568, P=0.010), cerebrospinal fluid chlorine (t=2.543, P=0.012), hydrocephalus (χ2=11.766, P=0.001), and cerebral infarction (χ2=6.539, P=0.012) were associated with long-term poor prognosis of tuberculosis meningitis. Multivariate analysis showed that age [odds ratio (OR)=1.061, 95% confidence interval (CI) (1.027, 1.096), P<0.001], peripheral nerve dysfunction [OR=3.537, 95%CI (1.070, 11.697), P=0.038], MRC Stage Ⅱ[OR=9.317, 95%CI (1.692, 51.303), P=0.010], MRC Stage Ⅲ [OR=43.953, 95%CI (3.996, 483.398), P=0.002] were the independent risk factors for long-term poor prognosis of tuberculosis meningitis. Hydrocephalus [OR=2.826, 95%CI (0.999, 8.200), P=0.050] might be an independent risk factor for long-term poor prognosis of tuberculosis meningitis. Conclusions Age, MRC staging system (Stage Ⅱ, Stage Ⅲ) and peripheral neurological dysfunction are chronic poor-prognostic independent risk factors for tuberculosis meningitis. Hydrocephalus may be associated with long-term adverse prognosis of tuberculosis meningitis
ObjectiveTo investigate the predictive factors of portal vein thrombosis (PVT) before and after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension. MethodsSixty-one cases of liver cirrhosis with portal hypertension who underwent splenectomy and gastroesophageal devascularization were enrolled retrospectively. The patients were divided into PVT group and non-PVT group based on the presence or absence of postoperative PVT on day 7. The clinical factors related with PVT were analyzed. ResultsThere were 25 cases in the DVT group and 36 cases in the non-DVT group. The results of univariate analysis showed that the preoperative platelet (P=0.006), activated partial thromboplastin time (P=0.048), prothrombin time (P=0.028), and international normalized ratio (P=0.029), postoperative fibrin degradation product (P=0.002) and D-dimer (P=0.014) on day 1, portal venous diameter (P=0.050) had significant differences between the DVT group and non-DVT group. The results of logistic multivariate regression analysis showed that the preoperative platelet (OR=0.966, 95% CI 0.934-1.000, P=0.048) and postoperative fibrin degradation product on day 1(OR=1.055, 95% CI 1.011-1.103, P=0.017) were correlated with the PVT. The PVT might happen when preoperative platelet was less than 34.5×109/L (sensitibity 80.6%, specificity 60.0%) or postoperative fibrin degradation product on day 1 was more than 64.75 mg/L (sensitibity 48.0%, specificity 91.7%). ConclusionPreoperative platelet and postoperative fibrin degradation product on day 1 might predict PVT after splenectomy and gastroesophageal devascularization for liver cirrhosis with portal hypertension.
ObjectiveTo establish a forecasting model for inpatient cases of pediatric limb fractures and predict the trend of its variation.MethodsAccording to inpatient cases of pediatric limb fractures from January 2013 to December 2018, this paper analyzed its characteristics and established the seasonal auto-regressive integrated moving average (SARIMA) model to make a short-term quantitative forecast.ResultsA total of 4 451 patients, involving 2 861 males and 1 590 females were included. The ratio of males to females was 1.8 to 1, and the average age was 5.655. There was a significant difference in age distribution between males and females (χ2=44.363, P<0.001). The inpatient cases of pediatric limb fractures were recorded monthly, with predominant peak annually, from April to June and September to October, respectively. Using the data of the training set from January 2013 to May 2018, a SARIMA model of SARIMA (0,1,1)(0,1,1)12 model (white noise test, P>0.05) was identified to make short-term forecast for the prediction set from June 2018 to November 2018, with RMSE=8.110, MAPE=9.386, and the relative error between the predicted value and the actual value ranged from 1.61% to 8.06%.ConclusionsCompared with the actual cases, the SARIMA model fits well with good short-term prediction accuracy, and it can help provide reliable data support for a scientific forecast for the inpatient cases of pediatric limb fractures.
Objective To investigate the differences between six parts of China in prediction models of lung function.Methods The predicted values of 360 healthy volunteers underwent pulmonary functiontest in east China were compared with that of north China, northeast China, northwest China, southwest China, south China and Asian American. Results In the male group, the prediction values of east China were as follows: VC ( 4. 19 ±0. 33) L, coefficient correlation( r) to the other five regions were 0. 803-0. 983,the differences to the other five regions were 1. 90% -4. 30% ; FVC ( 4. 06 ±0. 35) L, r to the others were 0. 912-0. 981, the differences to the other four regions were 0-2. 46% except for south China of 8. 10% , to Asian American ×0. 88 and Asian American ×0. 94 were 1. 97% and 4. 68% ; FEV1 ( 3. 34 ±0. 40) L, r to the others were 0. 963-0. 992, the differences to north China and east China were 0. 9% and 3. 59% , to southwest China and south China were gt;5% , to Asian American ×0. 88 and Asian American×0. 94 were 6. 89% and 0. 6% ; FEV1 /FVC ( 80. 87 ±3. 84) % , r to the others were 0. 989-0. 999, the differences to north China, northeast China and south China were 0. 42% -3. 04% , to the others were gt;5% . In the female group, the prediction values of east China were as follows: VC ( 3. 00 ±0. 33) L, r to the other five regions were 0. 899-0. 993, the differences to the other five regions were 0. 33% -3. 67% ; FVC( 2. 92 ±0. 34) L, r to the other five regions were 0. 929-0. 990, the differences to the other five regions were 1. 02% -2. 40%, to Asian American ×0. 88 and Asian American ×0. 94 were 4. 79% and 6. 16% ; FEV1 ( 2. 38 ±0. 39) L, r to the other five regions were 0. 958-0. 994, the differences to northeast China, southwest China, south China were 0. 84% -3. 36% , to north china was 7. 19% , to Asian American ×0. 88 and Asian American ×0. 94 were 2. 10% and 4. 62% ; FEV1 /FVC ( 82. 04 ±3. 94) % , r to the others were 0. 991-1. 000, the differences to the other four regions were 1. 34% -4. 55% except for southwest China was 7. 59% . Conclusions VC and FVC predicted values are coincident between six parts of China. FEV1 /FVC predicted values are coincident in the four parts of China except for westnorth and westsouth China. FEV1 predicted values are different. The oversea predicted values should be used with appropriate conversion factors.
Objective To explore the predicted precision of discharged patients number using curve estimation combined with trend-season model. Methods Curve estimation and trend-season model were both applied, and the quarterly number of discharged patients of 363 hospital from 2009 to 2015 was collected and analyzed in order to predict discharged patients in 2016. Relative error between predicted value and actual number was also calculated. Results An optimal quadratic regression equation Yt=3 006.050 1+202.350 8×t–3.544 4×t2 was established (Coefficient of determination R2=0.927, P<0.001), and a total of 23 462 discharged patients were predicted based on this equation combined with trend-season model, with a relative error of 1.79% compared to the actual number. Conclusion The curve estimation combined with trend-season model is a convenient and visual tool for predicting analysis. It has a high predicted accuracy in predicting the number of hospital discharged patients or outpatients, which can provide a reference basis for hospital operation and management.
ObjectiveTo evaluate the value of parathyroid hormone (PTH) in predicting hypocalcemia at different time after thyroidectomy. MethodsThe literatures in CBM, WanFang, CNKI, VIP in Chinese, and OVID, PUBMED, EMBASE, and MEDLINE in English were searched. Hand searches and additional searches were also conducted. The studies of predicting hypocalcemia after thyroidectomy by detecting postoperative PTH at different time were selected, and the quality and tested the heterogeneity of included articles were assessed. Then the proper effect model to calculate pooled weighted sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were selected. The summary receiver operating characteristic (SROC) curve was performed and the area under the curve (AUC) was computed. ResultsTwenty-three articles entered this systematic review, 21 articles were English and 2 articles were Chinese. Fifteen of 23 articles were designed to be prospective cohort study (PC) and 8 of 23 articles were retrospective study (Retro). These articles were divided into two groups. Group 1 was the studies of detecting postoperative PTH in 1 hour, which included 2 012 cases (494 of them occurred hypocalcemia). Group 2 was the studies of detecting postoperative PTH between 4-12 hours, which included 693 cases (266 of them occurred hypocalcemia). The publication bias of 2 groups were smaller that founded through the literature funnel. Meta analysis showed that in addition to merge SEN, between the 2 groups with merge SPE, LR+, LR-, and AUC differences were statistically significant (P < 0.01);the forecast effect of group 1 was better than group 2, and the AUC was the largest area when the PTH value in 1 hour after operation was below 16 ng/L. ConclusionDetection of postoperative PTH value is an effective method for predicting postoperative hypocalcemia. The 1 hour after operation for detecting PTH value below 16 ng/L to predict postoperative hypocalcemia have the best effect.
Objective To evaluate the predicted value of APACHEⅡ score at admission for deep fungal infection（DFI） in patients with severe acute pancreatitis （SAP）.Methods The clinical data of 132 patients with SAP from January 2006 to June 2011 in our hospital were analyzed retrospectively. The receiver operating characteristic curve （ROC） was used for evaluating the predicted value.Results Thirty-nine patients with SAP infected DFI （29.5%）,of which 36 patients （92.3%） infected with Candida albicans,2 patients （5.1%） with Candida tropicalis,1 patient （2.6%） with pearl bacteria.And,among these 39 patients,27 patients （69.2%） infected at single site,12 patients （30.8%） infected at multi-site. The APACHEⅡ score in 39 patients with DFI was higher than that of 93 patients without DFI （17.1±3.8 versus 9.7±2.1, t=14.316,P=0.000）.The ROC for APACHEⅡ score predicting DFI was 0.745（P=0.000）, 95%CI was 0.641－0.849.When the cut off point was 15,it showed the best forecast performance,with specificity 0.81, sensitivity 0.72,Youden index 0.53. Conclusions The APACHEⅡ score at admission can preferably predict DFI in patients with SAP； when the APACHEⅡ score is greater than 15,it prompts highly possible of DFI,so preventive anti-fungal treatment may be necessary.
ObjectiveTo systematically review the risk prediction models for the occurrence of low anterior resection syndrome in patients with rectal cancer after surgery. MethodsThe PubMed, Web of Science, Embase, Cochrane Library, Scopus, CINHAL, CNKI, CBM, WanFang Data and VIP databases were electronically searched to collect studies related to the objectives from inception to June 13, 2023. Two reviewers independently screened the literature, extracted data using the critical appraisal and data extraction for systematic reviews of prediction modelling studies (CHARMS) checklist, and assessed quality of the included studies using prediction model risk of bias assessment tool (PROBAST). ResultsA total of 14 studies were included, all studies reported model discrimination, and 10 studies reported calibration. The models were internally validated in 8 studies, externally validated in 5 studies. The most common predictors included in the models were tumour distance from the anal verge, neoadjuvant therapy, anastomotic leak and BMI. Only 5 studies had good overall applicability, and all studies had a high risk of bias, with the risk of bias mainly stemming from the field of participants, outcomes and analysis. ConclusionThere are still many shortcomings in the risk prediction models for the occurrence of low anterior resection syndrome in patients with rectal cancer after surgery. Future studies may consider external validation and recalibration of existing models. New prediction models should be built and validated according to methodological guidelines.
Objective To analyze risk factors of acute kidney injury （AKI） after cardiac surgery in adults and develop a clinical score system to predict postoperative AKI. Methods Clinical data of 3 500 consecutive patients undergoing cardiac surgery from June 2010 to April 2011 in Beijing Anzhen Hospital of Capital Medical University were retrospectively analyzed. According to whether they had postoperative AKI，all these patients were divided into AKI group and non-AKI group. AKI group was consisted of 1 407 patients （40.2%） with a mean age of 58±12 years，including 1 004 male patients （71.4%）. The non-AKI group was consisted of 2 093 patients （59.8%） with a mean age of 55±13 years，including 1 259 male patients （60.2%）. Predictive score system of postoperative AKI was established by univariate analysis between the AKI and non-AKI group and multivariate logistic regression and then verified. Results The predictive score system was as followed：male gender （2 points），every 5 years older than 60 years （1 point），diabetes mellitus （2 points），preoperative use of angiotensin converting enzyme inhibitor or angiotensin AT1 receptor blocker （1 point），every 10 ml / （min·1.73 m2） of preoperative estimated glomerular filtration rate （eGFR） under 90 ml / （min·1.73m2） （1 point），preoperative NYHA class Ⅳ （3 points），cardiopulmonary bypass time＞120 minutes （2 points），intraoperative hypotension duration＞60 minutes （2 points），postoperative hypotension duration＞60 minutes （3 points），postoperative peak dosage of intravenous furosemide＞100 mg/day （3 points），postoperative peak dosage of intravenous furosemide 60-100 mg/day （2 points），and postoperative mechanical ventilation time＞24 hours （2 points）. The predictive score system presented a good discrimination ability with the area under the receiver operating characteristic（ROC）curve of 0.738 with 95% CI 0.707 to 0.768，while it also presented a good calibration with Hosmer-Lemeshow statistic （P=0.305）. Conclusion A clinical predictive score system for AKI after cardiac surgery in adults is established，which may help clinicians implement early preventive interventions.
ObjectiveTo evaluate the value of blood urea nitrogen to creatinine ratio (UCR) in predicting the condition and prognosis of severe pneumonia patients.MethodsA total of 408 patients with severe pneumonia hospitalized in the intensive care unit (ICU) of Fangcun branch of Guangdong Provincial Hospital of traditional Chinese medicine from January 1, 2017 to August 1, 2020 were retrospectively collected. The patients were divided into a survival group (320 cases) and a death group (88 cases) according to the outcome of hospitalization. This study analyzed the relationship between UCR level and general information, condition, and treatment needs of severe pneumonia patients; and compared UCR, the value of neutrophil to lymphocyte ratio, the levels of hematocrit, C-reactive protein, procalcitonin and D-dimer, and the scores of Acute Physiology and Chronic Health EvaluationⅡ and Pneumonia Severity Index between the survival group and the death group. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of the above indicators. Logistic regression was used to analyze the risk factors of death of severe pneumonia.ResultsThe age of the patients died of severe pneumonia was higher than that of the survival patients (P<0.05); The mortality rate of severe hospital acquired pneumonia was higher than that of severe community acquired pneumonia (P<0.05); The level of UCR was higher in the patients over 70 years old (P<0.05); UCR level of the severe pneumonia patients with acute exacerbation of chronic obstructive pulmonary disease or multiple organ dysfunction syndrome during hospitalization was higher (P<0.05); The UCR level was higher in the patients with severe pneumonia whose ICU stay was more than 10 days (P<0.05); The UCR level of the severe pneumonia patients with mechanical ventilation longer than 180 hours was higher (P<0.05); UCR level of the severe pneumonia patients who died during hospitalization was higher than that of the survival group (P<0.05); The area under ROC curve of UCR for predicting death in the patients with severe pneumonia was 0.648 (95%CI 0.576 - 0.719), the cut-off value was 108.74, the sensitivity was 47.7%, and the specificity was 77.8% (P<0.05). PSI > level 3 (OR=4.297, 95%CI 2.777 - 6.651) and UCR > 108.74 (OR=0.545, 95%CI 0.332 - 0.896) were independent risk factors for death in the patients with severe pneumonia (P<0.05).ConclusionUCR has certain value in evaluating the condition and prognosis of severe pneumonia patients.