The subset of patients with acute heart failure able to secrete relaxin-2 at pregnancy concentrations could have a longer survival: a pilot study

Objective: To investigate how many patients with acute heart failure (AHF) hypersecrete relaxin-2 concentrations similar to those of pregnant women and determine their long-term outcome.

Methods: In consecutive AHF patients relaxin-2 was quantified by ELISA sandwich method. Patients were divided into pregnancy-like group (PLG, relaxin-2 ≥?500?pg/mL) and control group (CG, relaxin-2 10?days), combined endpoint (death, rehospitalisation, ED revisit) 30?days after discharge, and 30-day, one-year and three-year death rates.

Results: We included 814 patients [81 (SD?=?9) years; 53.0% women] followed during 1.9 (SD 2.8) years; 517 (63.5%) died. Twenty patients (2.5%) formed the PLG (median relaxin-2?=?1459?pg/mL; IQR?=?1722) and 794 the CG (median?=?26; IQR?=?44). There was no interaction with variables included on adjustment (age, sex, ischaemic cardiomyopathy, NT-proBNP, glycaemia, and sodium). PLG patients did not have better short-term secondary endpoints, but did show a significantly lower three-year mortality [OR_adjusted?=?0.17 (0.05–0.5), p?=?0.003].

Conclusions: The small proportion of AHF patients achieving relaxin-2 concentrations similar to those observed in pregnancy may survive longer.     

Antibiotic Treatment of Severe Exacerbations of Chronic Obstructive Pulmonary Disease with Procalcitonin: A Randomized Noninferiority Trial

Background

The duration of antibiotic treatment of exacerbations of COPD (ECOPD) is controversial. Serum procalcitonin (PCT) is a biomarker of bacterial infection used to identify the cause of ECOPD.

Methods and Findings

We investigated whether a PCT-guided plan would allow a shorter duration of antibiotic treatment in patients with severe ECOPD. For this multicenter, randomized, non-inferiority trial, we enrolled 184 patients hospitalized with ECOPD from 18 hospitals in Italy. Patients were assigned to receive antibiotics for 10 days (standard group) or for either 3 or 10 days (PCT group). The primary outcome was the rate of ECOPD at 6 months. Having planned to recruit 400 patients, we randomized only 183: 93 in the PCT group and 90 in the standard group. Thus, the completed study was underpowered. The ECOPD rate at 6 months between PCT-guided and standard antibiotic treatment was not significant (% difference, 4.04; 90% confidence interval [CI], −7.23 to 15.31), but the CI included the non-inferiority margin of 15. In the PCT-guided group, about 50% of patients were treated for 3 days, and there was no difference in primary or secondary outcomes compared to patients treated for 10 days.

Conclusions

Although the primary and secondary clinical outcomes were no different for patients treated for 3 or 10 days in the PCT group, the conclusion that antibiotics can be safely stopped after 3 days in patients with low serum PCT cannot be substantiated statistically. Thus, the results of this study are inconclusive regarding the noninferiority of the PCT-guided plan compared to the standard antibiotic treatment. The study was funded by Agenzia Italiana del Farmaco (AIFA-FARM58J2XH). Clinical trial registered with www.clinicaltrials.gov (NCT01125098).

Trial Registration

ClinicalTrials.gov NCT01125098     

监测血清降钙素原水平以优化重症肺炎的抗感染治疗策略

目的通过监测血清降钙素原（procalcitonin,PCT）在重症肺炎患者中的表达,以优化重症肺炎的抗感染治疗策略。方法选取2011年3月至2013年3月住南京医科大学附属南京医院ICU的重症肺炎患者60例,随机分为常规治疗组（30例）和PCT监测治疗组（30例）。常规治疗组根据病情决定抗菌药物的使用,PCT指导治疗组根据血清PCT水平作为停用抗菌药物的标准。观察两组患者的PSI评分、治疗有效率、住院病死率、住院时间、住院总费用及抗菌药物疗程、抗菌药物费用等。结果PCT监测治疗组的抗感染治疗的疗程、抗菌药物费用以及住院总费用方面,明显低于常规治疗组。而有效率、28d住院病死率及住院时间两组间未见明显差异。结论通过监测PCT可以缩短抗感染药物的疗程,此举避免了抗生素的过度使用并减轻了患者的经济负担。     

The GALA study: relationship between galectin-3 serum levels and short- and long-term outcomes of patients with acute heart failure

Objective: We tested the hypothesis that early measurement of galectin-3 at the emergency department (ED) during an episode of acute heart failure (AHF) allows predicting short- and long-term outcomes.

Methods: We performed an exploratory study including 115 patients consecutively diagnosed with AHF in a single ED. Clinical and analytical variables were recorded. The primary endpoint was 30-day all-cause mortality, and secondary endpoints were 30-day composite outcome (death, rehospitalization or ED reconsultation, whichever first) and 1-year mortality.

Results: Seven patients (6.1%) died within 30?days and 43 (37.4%) within 1?year. The 30-day composite endpoint was observed in 21.1% of patients. Galectin-3 was correlated with NT-proBNP and the glomerular filtration rate but not with age and s-cTnI. Measured at time of ED arrival, galectin-3 showed good discriminatory capacity for 30-day mortality (AUC ROC: 0.732; 95% CI 0.512–0.953; p?=?0.041) but not for 1-year mortality (0.521; 0.408–0.633; p?=?0.722). Patients with galectin-3 concentrations?>42?μg/L had an OR?=?7.67(95%CI?=?1.57-37.53; p?=?0.012) for 30-day mortality. Conversely, NT-proBNP only showed predictive capacity for 1-year mortality (0.642; 0.537–0.748; p?=?0.014). Patients with NT-proBNP concentrations?>5400?ng/L had an OR?=?4.34 (95%CI?=?1.93-9.77; p?<?0.001) for 1-year mortality. These increased short- (galectin-3) and long-term (NT-proBNP) risks remained significant after adjustment for age or renal function. s-cTnI failed in both short- and long term death prediction. No biomarker predicted the short-term composite endpoint.

Conclusion: These results suggest that galectin-3 could help to monitor the risk of short-term mortality in unselected patients with AHF attended in the ED.     

EAHFE – TROPICA2 study. Prognostic value of troponin in patients with acute heart failure treated in Spanish hospital emergency departments

Objective: Evaluate the use of different cardiac troponin (cTn) immunoassays and the prognostic value of increased cTn values in patients diagnosed with acute heart failure (AHF) in the emergency department (ED).

Method: The epidemiology acute heart failure emergency-TROPonin in acute heart failure2 (EAHFE-TROPICA2) is a retrospective study including patients with AHF admitted in 34 Spanish EDs with cTn values determined in the ED. We studied the prevalence of elevated troponin (value above the established reference limit) for the different types of troponin. We also assessed crude and adjusted primary (1-year all-cause death) and secondary (30 d ED revisit due to AHF) outcomes for every type of cTn and different magnitudes of troponin elevation.

Results: We analysed 4705 episodes of AHF. Troponin was elevated in 48.4% of the cases (25.3% in cTnI, 37.9% in cTnT and 82.2% in hs-cTnT). Mortality at one year was higher in patients with elevated troponin (adjusted HR 1.61; CI 95% 1.38–1.88) regardless of the type of cTn determined. Elevated troponin was not related to ED revisit within 30 d after discharge (1.01; 0.87–1.19).

Conclusions: The use of conventional troponin in the ED is useful to predict one-year mortality in patients with AHF. Highly sensitive cTnT (hs-cTnT) elevations less than double the reference value have no impact on patient outcome.     

血清PCT、CRP及IL-6联合检测诊断细菌性血流感染的临床价值分析

目的:探讨血清降钙素原(PCT)、C反应蛋白(CRP)及白介素-6(IL-6)联合检测诊断细菌性血流感染(BSI)的临床价值。方法:选取我院2015年8月到2016年10月收治的疑似细菌性BSI患者216例,入院后均送检血培养,根据培养结果将其分为阳性组(102例)和阴性组(114例)。统计细菌性BSI阳性率、革兰阳性菌感染率和革兰阴性菌感染率;检测血清PCT、CRP、IL-6水平,并比较两组患者的差异,同时绘制ROC曲线并计算出各指标及联合检测的灵敏度、特异度、阳性预测值、阴性预测值及约登指数值。结果:所有疑似BSI患者的细菌阳性检出率为47.22%,革兰阳性菌感染率与革兰阴性菌感染率对比无差异(P0.05);阳性组的血清PCT、CRP、IL-6水平均明显高于阴性组(P0.05);血清IL-6的AUC明显大于PCT和CRP(P0.05);PCT、CRP及IL-6联合检测的灵敏度、特异度、阳性预测值、阴性预测值及约登指数均明显高于单项检测(P0.05)。结论:血清PCT、CRP及IL-6对于BSI均有着一定诊断价值,而各指标联合检测诊断BSI的临床价值更高。     

Prognostic and diagnostic value of elevated serum concentration of procalcitonin in patients with suspected heart failure. A review and meta-analysis

Purpose: The diagnostic and prognostic significance of procalcitonin remains uncertain in HF patients. We reviewed and performed a meta-analysis of studies that measured PCT in HF patients, with or without infection.

Materials and methods: We identified seven studies (9514 patients, 5810 with diagnoses of HF) eligible for our analysis, out of 247 examined. We estimated the serum PCT concentrations in patients with and without HF and/or infection and examined the mortality rates of patients with versus without elevated serum PCT concentrations.

Results: The mean age of the study samples ranged between 58 and 81?years, the men proportion between 47% and 66%, the follow-up duration between 22 and 180?days. The median PCT concentration in patients with HF and concomitant infections tended to be higher (0.26?ng/l [0.06, 0.46]) than in patients with HF alone (0.10?ng/l [0.08, 0.12]; p?=?0.059).

The mortality of patients suffering from HF and whose serum PCT concentrations were elevated was significantly higher than that of patients suffering from HF whose PCT concentrations were normal at 30 (2.66 [1.74, 4.05]), 90 (2.12 [1.59, 2.83]) and 180?days (2.06 [1.13, 3.78]).

Conclusions: In patients with HF, an elevated serum PCT concentration predicted the short-term risk of death.     

降钙素原联合SOFA评分对老年脓毒症患者预后的评估价值

目的:探讨降钙素原(procalcitonin,PCT)联合SOFA评分(sequential organ failure assessment,SOFA)对老年脓毒症患者预后的评估价值。方法:选择首都医科大学宣武医院急诊抢救室收治的105例老年脓毒症患者,入院后给予血常规、血清PCT水平、血气分析及生化全项等检查,并进行急性生理及慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ)和SOFA评分。根据预后将患者分成死亡组27例和存活组78例,比较两组组患者血清PCT水平、白细胞(WBC)、SOFA评分和APACHEⅡ评分,同时比较和分析APACHEⅡ评分、血清PCT水平、SOFA评分、PCT和SOFA评分联合预测患者死亡的受试者工作特征曲线(Receiver operating characteristic curve,ROC)下面积。结果:死亡组患者血清PCT水平、SOFA评分和APACHEⅡ评分均明显高于存活组(P0.05),两组WBC比较无统计学差异(P=0.132);PCT预测患者死亡的ROC曲线下面积为0.694(P=0.001),SOFA预测患者死亡的ROC曲线下面积为0.660(P=0.012),APACHE II评分预测患者死亡的ROC曲线下面积为0.852(P=0.001),大于PCT和SOFA评分(P0.05),PCT和SOFA评分联合预测患者死亡的ROC曲线下面积0.761(P=0.001),与APACHE II评分比较无统计学差异(P=0.139)。结论:血清PCT水平联合SOFA评分预测老年脓毒症患者预后的临床价值与APACHE II评分相当,均明显优于血清PCT水平和SOFA评分单项检测。     

共刺激分子CD86对急诊脓毒症发生的预测价值

摘要 目的：：探讨共刺激分子CD86评估急诊感染患者发生脓毒症的价值。方法：以2019年9月至2020年9月上海交通大学医学院附属仁济医院急诊科监护室和病房收治的年龄≥18岁且存在感染或临床高度怀疑感染的患者为研究对象。按照Sepsis-3.0标准,将患者分为脓毒症组和非脓毒症组。记录所有患者的临床资料,入院时24小时内检测所有患者的静脉血血常规、外周血单核细胞（PBMC）的CD86和HLA-DR表达水平、C反应蛋白（CRP）、降钙素原（PCT）、白蛋白（ALB）、乳酸(Lac)、血清白介素水平,计算CRP/ALB比值、中性粒细胞/淋巴细胞比值(NLR),血小板/淋巴细胞比值(PLR),淋巴细胞/单核细胞比值(LMR)并记录。组间比较上述各指标的差异,然后进一步采用Logistics回归模型进行多因素分析。结果：入选患者共91例,脓毒症患者49例（死亡15例,占30.6%）,非脓毒症患者42例（0死亡）;脓毒症组CD86%、N（中性粒细胞）、CRP/ALB、NLR、IL-6、IL-10、SIL-2R、CRP、PCT均高于非脓毒症感染（P<0.05）,而HLA-DR、LY（淋巴细胞）、PLT（血小板）、ALB、LMR在脓毒症组中则较非脓毒症组降低（P<0.05）。多因素Logistics回归分析建立CD86模型和HLA-DR模型,发现在CD86模型中,CD86,呼吸频率（RR）,LY,PCT是发生脓毒症的独立预测因子（P<0.05）,OR值分别为1.539(1.148-2.064),1.141(1.009-1.290),0.280(0.097-0.811)和1.036(1.005-1.068);在HLA-DR模型中,HLA-DR和LY是发生脓毒症的独立预测因子（P<0.05）,OR值分别为0.971(0.953-0.988)和0.290（0.117-0.718）。最后将CD86模型、HLA-DR模型和APACHII评分进行ROC曲线分析,曲线下面积（AUC）分别为0.870（0.796-0.944）、0.793（0.700-0.887）、0.754（0.653-0.855）。结论：脓毒症患者PBMC的CD86水平升高,HLA-DR水平降低,CD86和HLA-DR可以早期预测急诊脓毒症的发生。     

Estimating the probability of bacterial infection using a novel biomarker among pediatric patients in the emergency department

Context: IL-27 is a novel biomarker to identify bacterial infection in children.

Objective: IL-27 was evaluated among pediatric emergency department (ED) patients and compared with procalcitonin (PCT).

Methods and results: Children undergoing blood, urine, or cerebrospinal fluid cultures had IL-27 and PCT assays performed. Bacterial infection was defined as a positive culture or a clinical diagnosis based on chart review. IL-27 and PCT were increased among patients with bacterial infection and demonstrated comparable AUC’s (0.62 versus 0.61). A decision tree incorporating IL-27, PCT, and white blood cell count improved the AUC (0.80).

Conclusion: IL-27 is a viable candidate biomarker to identify bacterial infection among ED patients and is comparable with PCT.     

Prediction of all-cause mortality with hypoalbuminemia in patients with heart failure: a meta-analysis

Abstract

Objective: The prognostic utility of serum albumin level for mortality in heart failure patients has received considerable attention. This meta-analysis sought to examine the prognostic significance of hypoalbuminemia for prediction of all-cause mortality in patients with heart failure.

Materials and methods: Pubmed and Embase databases were systematically searched up to 10 March 2019 to identify eligible studies. Epidemiological studies reporting a multivariable-adjusted risk estimate of all-cause mortality associated with hypoalbuminemia in acute or chronic heart failure patients were included.

Results: Nine studies from 10 articles involving 16,763 heart failure patients were included in the final analysis. Hypoalbuminemia was associated with an increased in-hospital mortality (risk ratio [RR] 4.90; 95% confidence interval [CI] 2.96–8.10) and long-term all-cause mortality (RR 1.75; 95% CI 1.35–2.27) in acute heart failure patients. Chronic heart failure patients with hypoalbuminemia exhibited a 3.5-fold (95% CI 1.29–9.73) higher risk for long-term all-cause mortality.

Conclusions: Hypoalbuminemia is possibly an independent predictor of all-cause mortality in patients with acute or chronic heart failure. However, the current findings should be further confirmed in future prospective studies. Moreover, future well-designed randomized controlled trials would be required to investigate whether correcting hypoalbuminemia in heart failure patients has potential to improve survival outcome.     

糖尿病合并尿路感染患者尿液降钙素原水平及其临床意义

目的:探讨糖尿病合并尿路感染患者尿液降钙素原(PCT)水平及其临床意义。方法:选取2017年8月至2018年12月中山大学附属第五医院内分泌与代谢病科收治的糖尿病患者78例,以其中合并真性细菌尿者39例作为观察组,未合并尿路感染39例作为对照组,比较两组患者的临床资料以及相关实验室检查结果,同时留取尿液标本,观察组分别留取使用抗生素治疗前、后的尿液标本。采用酶联免疫吸附测定(ELISA)法检测尿液PCT浓度。分别比较观察组与对照组以及观察组治疗前后的尿液PCT水平,分析尿液PCT水平对于诊断糖尿病合并尿路感染的临床价值。结果:观察组尿液PCT水平为0.030 (0.025,0.039) ng/m L,明显高于对照组0.017 (0.011,0.021) ng/m L(P0.05);观察组有症状尿路感染与无症状细菌尿(ABU)的尿液PCT水平比较差异无统计学意义(P0.05),但其均显著高于对照组(P0.05);观察组使用抗生素治疗后的尿液PCT水平为0.031 (0.025,0.040) ng/mL,与治疗前相比较差异无统计学意义(P0.05)。尿液PCT对糖尿病合并尿路感染诊断的敏感度为82.05%,特异度为79.49%,阳性预测值为80.00%,阴性预测值81.58%,ROC曲线下面积为0.81 (95%CI为0.71-0.89, P0.0001)。结论:尿液PCT水平对糖尿病合并尿路感染有一定的诊断参考价值,但对于抗生素疗效的评估价值还需进一步深入研究。     

Verification of a proteomic biomarker panel to diagnose minor stroke and transient ischaemic attack: phase 1 of SpecTRA,a large scale translational study

Objective: To derive a plasma biomarker protein panel from a list of 141 candidate proteins which can differentiate transient ischaemic attack (TIA)/minor stroke from non-cerebrovascular (mimic) conditions in emergency department (ED) settings.

Design: Prospective clinical study (#NCT03050099) with up to three timed blood draws no more than 36?h following symptom onset. Plasma samples analysed by multiple reaction monitoring-mass spectrometry (MRM-MS).

Participants: Totally 545 participants suspected of TIA enrolled in the EDs of two urban medical centres.

Outcomes: 90-day, neurologist-adjudicated diagnosis of TIA informed by clinical and radiological investigations.

Results: The final protein panel consists of 16 proteins whose patterns show differential abundance between TIA and mimic patients. Nine of the proteins were significant univariate predictors of TIA [odds ratio (95% confidence interval)]: L-selectin [0.726 (0.596–0.883)]; Insulin-like growth factor-binding protein 3 [0.727 (0.594–0.889)]; Coagulation factor X [0.740 (0.603–0.908)]; Serum paraoxonase/lactonase 3 [0.763 (0.630–0.924)]; Thrombospondin-1 [1.313 (1.081–1.595)]; Hyaluronan-binding protein 2 [0.776 (0.637–0.945)]; Heparin cofactor 2 [0.775 (0.634–0.947)]; Apolipoprotein B-100 [1.249 (1.037–1.503)]; and von Willebrand factor [1.256 (1.034–1.527)]. The scientific plausibility of the panel proteins is discussed.

Conclusions: Our panel has the potential to assist ED physicians in distinguishing TIA from mimic patients.     

Comparing the prognostic performance of ASSIST to interleukin-6 and procalcitonin in patients with severe sepsis or septic shock

Abstract

Context: We recently derived and validated a multi-biomarker-based model (ASSIST) to stratify patients with sepsis based on initial mortality risk.

Objective: The objective of this study was to compare the performance of ASSIST to interleukin-6 (IL6) and procalcitonin (PCT).

Methods: The area-under-the-receiver operating characteristic curve for predicting 28-d mortality using ASSIST was compared with that of IL6 (n?=?452) and PCT (n?=?235).

Results: The area under the curve for ASSIST was greater than that of IL6 and PCT.

Conclusions: ASSIST estimated the probability of mortality more reliably than IL6 and PCT in this cohort of patients with sepsis.     

细菌性血流感染所致脓毒症患者血清PCT、APOM、sTREM-1与预后的关系研究

摘要 目的：探讨细菌性血流感染（BSI）所致脓毒症患者血清降钙素原（PCT）、载脂蛋白M（APOM）、可溶性髓系细胞触发受体-1（sTREM-1）与预后的关系。方法：选取2021年1月～2023年10月首都医科大学附属北京朝阳医院收治的细菌性BSI所致脓毒症患者185例（脓毒症组）,根据28d内预后情况分为死亡组（61例）和存活组（124例）,另选取同期体检健康志愿者87例（对照组）。采用电化学发光法检测血清PCT水平,酶联免疫吸附法检测血清APOM、sTREM-1水平。单因素及多因素Logistic回归模型分析影响细菌性BSI所致脓毒症患者预后的因素。受试者工作特征（ROC）曲线分析血清PCT、APOM、sTREM-1对细菌性BSI所致脓毒症患者预后的预测价值。结果：与对照组比较,脓毒症组血清PCT、sTREM-1水平升高,APOM水平降低（P＜0.05）。185例细菌性BSI所致脓毒症患者28d死亡死亡率为32.97%（61/185）。与存活组比较,死亡组血清PCT、sTREM-1水平升高,APOM水平降低（P＜0.05）。多因素分析结果显示：革兰阴性菌感染、脓毒性休克、中性粒细胞/淋巴细胞比值（NLR）升高、序贯器官衰竭评估（SOFA）评分增加、急性生理和慢性健康评估Ⅱ（APACHEⅡ）评分增加、血清PCT升高和sTREM-1升高为细菌性BSI所致脓毒症患者死亡的独立危险因素,血清APOM升高为独立保护因素（P＜0.05）。血清PCT、APOM、sTREM-1联合检测预测细菌性BSI所致脓毒症患者死亡的曲线下面积为0.908,大于血清PCT、APOM、sTREM-1单独检测预测的0.785、0.779、0.783。结论：细菌性BSI所致脓毒症患者血清PCT、sTREM-1水平升高和APOM水平降低与预后不良的发生有关,血清PCT、APOM、sTREM-1联合检测对细菌性BSI所致脓毒症患者死亡有较高的预测价值。     

Provider Decisions to Treat Respiratory Illnesses with Antibiotics: Insights from a Randomized Controlled Trial

RationaleLower respiratory tract illness (LRTI) frequently causes adult hospitalization and antibiotic overuse. Procalcitonin (PCT) treatment algorithms have been used successfully in Europe to safely reduce antibiotic use for LRTI but have not been adopted in the United States. We recently performed a feasibility study for a randomized clinical trial (RCT) of PCT and viral testing to guide therapy for non-pneumonic LRTI.ObjectiveThe primary objective of the current study was to understand factors influencing PCT algorithm adherence during the RCT and evaluate factors influencing provider antibiotic prescribing practices for LRTI.ResultsDiagnosis of pneumonia on admission was the only variable significantly associated with non-adherence [7% (adherence) vs. 26% (nonadherence), p = 0.01]. Surveys confirmed possible infiltrate on chest radiograph as important for provider decisions, as were severity of illness, positive sputum culture, abnormal CBC and fever. However, age, patient expectations and medical-legal concerns were also at least somewhat important to prescribing practices. Physician agreement with the importance of viral and PCT testing increased from 42% to 64% (p = 0.007) and 49% to 74% (p = 0.001), respectively, after the study.ConclusionsOptimal algorithm adherence will be important for definitive PCT intervention trials in the US to determine if PCT guided algorithms result in better outcomes than reliance on traditional clinical variables. Factors influencing treatment decisions such as patient age, presence of fever, patient expectations and medical legal concerns may be amenable to education to improve PCT algorithm compliance for LRTI.     

Pre-procedural elevated cardiac troponin predict risk of long-term all-cause mortality after transcatheter aortic valve replacement: a meta-analysis of prospective studies

Abstract

Background: The purpose of this meta-analysis was to evaluate the relationship between elevated cardiac troponin pre-transcatheter aortic valve replacement (TAVR) and long-term all-cause mortality.

Methods: Prospective studies with the endpoint of all-cause mortality were included. We primarily used the fixed-effect model weighted by inverse variance. Meta-regression and subgroup analyses were conducted to explore the potential sources of heterogeneity by specified study characteristics.

Results: Seven prospective studies comprising of 3049 subjects were included in our meta-analysis. Pre-procedural elevated cardiac troponin was associated with increased risk of long-term mortality post TAVR [hazard ratio (HR) 2.25, 95% CI 1.83–2.78, p?=?0.000, I² = 30.3%, p for heterogeneity 0.197]. In addition, subgroup analyses have shown that the group with an younger age (<82?y) seemed to have a higher risk of all-cause mortality than the group with older age (≥82?y) [HR 4.08 (2.41 to 6.89) VS 2.01 (1.60 to 2.53), p?=?0.016 for subgroup difference].

Conclusions: Pre-procedural elevated cardiac troponin was associated with increased long-term all-cause mortality in patients undergoing TAVR.     

Association between red blood cell distribution width and long-term mortality among patients undergoing percutaneous coronary intervention with previous history of cancer

Abstract

Background: The number of patients suffering from coronary heart disease with cancer is rising. There is scarce evidence concerning the biomarkers related to prognosis among patients undergoing percutaneous coronary intervention (PCI) with cancer. Thus, the aim of this study was to investigate the association between red blood cell distribution width (RDW) and prognosis in this population.

Methods: A total of 172 patients undergoing PCI with previous history of cancer were enrolled in this retrospective study. The endpoint was long-term all-cause mortality. According to tertiles of RDW, the patients were classified into three groups: Tertile 1 (RDW <12.8%), Tertile 2 (RDW ≥12.8% and <13.5%) and Tertile 3 (RDW ≥13.5%).

Results: During an average follow-up period of 33.3 months, 29 deaths occurred. Compared with Tertile 3, mortality of Tertile 1 and Tertile 2 was significantly lower in the Kaplan–Meier analysis. In multivariate Cox regression analysis, RDW remained an independent risk factor of mortality (HR: 1.938, 95% CI: 1.295–2.655, p?<?0.001). The all-cause mortality in Tertile 3 was significantly higher than that in Tertile 1 (HR: 5.766; 95% CI: 1.426–23.310, p?=?0.014).

Conclusions: An elevated RDW level (≥13.5%) was associated with long-term all-cause mortality among patients undergoing PCI with previous history of cancer.     

重症慢性阻塞性肺病急性发作期患者血清PCT, hs-CRP及D-D的表达及意义

目的:探究重症慢性阻塞性肺病(COPD)急性发作期患者血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)和D-二聚体(D-D)的表达及意义。方法:选取2014年9月-2016年9月我院收治的146例COPD患者作为研究对象,其中73例COPD急性发作期(AECOPD)患者纳入急性期组,73例COPD缓解期患者纳入缓解期组,另选取同期来我院体检的40例健康者作为对照组。比较三组研究对象的血清PCT、hs-CRP和D-D水平,同时比较急性期组细菌感染与无细菌感染患者、不同肺功能分级的患者血清PCT、hs-CRP和D-D水平的差异。结果:急性期组与缓解期组患者的血清PCT、hs-CRP和D-D水平较对照组显著升高(P0.05),急性期组的血清PCT、hs-CRP和D-D水平较缓解期组显著升高,差异有统计学意义(P0.05)。合并细菌感染组血清PCT、hs-CRP水平均显著高于无细菌感染组(P0.05),而D-D水平则无统计学差异(P0.05)。不同肺功能分级患者间的血清PCT、hs-CRP和D-D水平比较差异显著(P0.05),且肺功能分级越高水平越高(P0.05)。结论:AECOPD患者的血清PCT、hs-CRP和D-D水平均显著的升高,三者联合检测能够有效反映患者病情严重程度,并有利于诊断患者是否存在有细菌感染。