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Usategui-Martín R, Zalama-Sánchez D, López-Izquierdo R, Delgado Benito JF, Del Pozo Vegas C, Sánchez Soberón I, Martín-Conty JL, Sanz-García A, Martín-Rodríguez F. Prehospital lactate-glucose interaction in acute life-threatening illnesses: metabolic response and short-term mortality. Eur J Emerg Med 2024; 31:173-180. [PMID: 37988474 DOI: 10.1097/mej.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND AND IMPORTANCE Lactate is an already recognized biomarker for short-term mortality. However, how glycemia and diabetes affect the predictive ability of lactate needs to be revealed. OBJECTIVE To determine how hypoglycemia, normoglycemia, and hyperglycemia modify the predictive ability of lactate for short-term mortality (3 days). The secondary objective was to evaluate the predictive ability of lactate in diabetic patients. DESIGN, SETTINGS AND PARTICIPANTS Prospective, observational study performed between 26 October 2018 and 31 December 2022. Multicenter, EMS-delivery, ambulance-based study, considering 38 basic life support units and 5 advanced life support units referring to four tertiary care hospitals (Spain). Eligible patients were adults recruited from among all phone requests for emergency assistance who were later evacuated to emergency departments. OUTCOMES MEASURE AND ANALYSIS The primary outcome was in-hospital mortality from any cause within the third day following EMS attendance. The main predictors considered were lactate, blood glucose levels and previous diabetes. MAIN RESULTS A total of 6341 participants fulfilled the inclusion criteria. 68 years (IQR: 51-80); 41.4% were female. The 3-day in-hospital mortality rate was 3.5%. The predictive capacity of lactate for 3-day mortality was only significantly different between normo-glycemia and hyperglycemia. The best predictive result was for normo-glycemia - AUC = 0.897 (95% CI: 0.881-0.913) - then hyperglycemia - AUC = 0.819 (95% CI: 0.770-0.868) and finally, hypoglycemia - AUC = 0.703 (95% CI: 0.422-0.983). The stratification according to diabetes presented no statistically significant difference, and the predictive results were AUC = 0.924 (95% CI: 0.892-0.956), AUC = 0.906 (95% CI: 0.884-0.928), and AUC = 0.872 (95% CI: 0.817-0.927) for nondiabetes, uncomplicated cases, and end-organ damage diabetes, respectively. CONCLUSION Our results demonstrated that glycemia, but not diabetes, alters the predictive ability of lactate. Therefore, hyperglycemia should be considered when interpreting lactate, since this could improve screening to detect cryptic shock conditions.
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Affiliation(s)
| | | | - Raúl López-Izquierdo
- Faculty of Medicine. University of Valladolid
- Emergency Department. Hospital Universitario Rio Hortega, Valladolid
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid
| | | | - Carlos Del Pozo Vegas
- Faculty of Medicine. University of Valladolid
- Emergency Department. Hospital Clínico Universitario
| | | | - José L Martín-Conty
- Faculty of Health Sciences, University of Castilla la Mancha
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla la Mancha
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine. University of Valladolid
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid
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Niczewski M, Gawęda S, Kluszczyk P, Rycerski M, Syguła D, Danel A, Szmigiel S, Mendrala K, Oraczewska A, Kijonka C, Nowicka M, Wita M, Cyzowski T, Brożek G, Dyrbuś M, Skoczyński S. The Predictive Role of Lactate in the Emergency Department in Patients with Severe Dyspnea. Emerg Med Int 2024; 2024:6624423. [PMID: 38455374 PMCID: PMC10919975 DOI: 10.1155/2024/6624423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/23/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
Objective An accurate identification of patients at the need for prioritized diagnostics and care are crucial in the emergency department (ED). Blood gas (BG) analysis is a widely available laboratory test, which allows to measure vital parameters, including markers of ventilation and perfusion. The aim of our analysis was to assess whether blood gas parameters in patients with dyspnea at an increased risk of respiratory failure admitted to the ED can predict short-term outcomes. Methods The study group eventually consisted of 108 patients, with available BG analysis. The clinical and laboratory parameters were retrospectively evaluated, and three groups were distinguished-arterial blood gas (ABG), venous blood gas (VBG), and mixed blood gas. The primary endpoint was short-term, all-cause mortality during the follow-up of median (quartile 1-quartile 3) 2 (1-4) months. The independent risk factors for mortality that could be obtained from blood gas sampling were evaluated. Results The short-term mortality was 35.2% (38/108). Patients who died were more frequently initially assigned to the red triage risk group, more burdened with comorbidities, and the median SpO2 on admission was significantly lower than in patients who survived the follow-up period. In the multivariable analysis, lactate was the strongest independent predictor of death, with 1 mmol/L increasing all-cause mortality by 58% in ABG (95% CI: 1.01-2.47), by 80% in VBG (95% CI: 1.13-2.88), and by 68% in the mixed blood gas analysis (95% CI: 1.22-2.31), what remained significant in VBG and mixed group after correction for base excess. In each group, pH, pO2, and pCO2 did not predict short-term mortality. Conclusions In patients admitted to the ED due to dyspnea, at risk of respiratory failure, lactate levels in arterial, venous, and mixed blood samples are independent predictors of short-term mortality.
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Affiliation(s)
- Maciej Niczewski
- Department of Internal Medicine and Metabolic Diseases, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Szymon Gawęda
- Student Scientific Society, Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Paulina Kluszczyk
- Student Scientific Society, Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mikołaj Rycerski
- Student Scientific Society, Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Daria Syguła
- Student Scientific Society, Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Anna Danel
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Szymon Szmigiel
- 1st Department of Lung Diseases and Tuberculosis, Provincial Specialist Hospital in Czerwona Góra, Chęciny, Poland
| | - Konrad Mendrala
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Oraczewska
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Czarosław Kijonka
- Emergency Department, Upper Silesian Medical Center, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Monika Nowicka
- Emergency Department, Upper Silesian Medical Center, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał Wita
- First Chair and Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Cyzowski
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Brożek
- Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maciej Dyrbuś
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Szymon Skoczyński
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Martín-Rodríguez F, Vaquerizo-Villar F, López-Izquierdo R, Castro-Villamor MA, Sanz-García A, Del Pozo-Vegas C, Hornero R. Derivation and validation of a blood biomarker score for 2-day mortality prediction from prehospital care: a multicenter, cohort, EMS-based study. Intern Emerg Med 2023; 18:1797-1806. [PMID: 37079244 PMCID: PMC10116443 DOI: 10.1007/s11739-023-03268-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
Identifying potentially life-threatening diseases is a key challenge for emergency medical services. This study aims at examining the role of different prehospital biomarkers from point-of-care testing to derive and validate a score to detect 2-day in-hospital mortality. We conducted a prospective, observational, prehospital, ongoing, and derivation-validation study in three Spanish provinces, in adults evacuated by ambulance and admitted to the emergency department. A total of 23 ambulance-based biomarkers were collected from each patient. A biomarker score based on logistic regression was fitted to predict 2-day mortality from an optimum subset of variables from prehospital blood analysis, obtained through an automated feature selection stage. 2806 cases were analyzed, with a median age of 68 (interquartile range 51-81), 42.3% of women, and a 2-day mortality rate of 5.5% (154 non-survivors). The blood biomarker score was constituted by the partial pressure of carbon dioxide, lactate, and creatinine. The score fitted with logistic regression using these biomarkers reached a high performance to predict 2-day mortality, with an AUC of 0.933 (95% CI 0.841-0.973). The following risk levels for 2-day mortality were identified from the score: low risk (score < 1), where only 8.2% of non-survivors were assigned to; medium risk (1 ≤ score < 4); and high risk (score ≥ 4), where the 2-day mortality rate was 57.6%. The novel blood biomarker score provides an excellent association with 2-day in-hospital mortality, as well as real-time feedback on the metabolic-respiratory patient status. Thus, this score can help in the decision-making process at critical moments in life-threatening situations.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, Facultad de Medicina, Universidad de Valladolid, Av. Ramón y Cajal, 7, 47003, Valladolid, Spain.
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain.
| | - Raúl López-Izquierdo
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Miguel A Castro-Villamor
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Ancor Sanz-García
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain
| | - Carlos Del Pozo-Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, Facultad de Medicina, Universidad de Valladolid, Av. Ramón y Cajal, 7, 47003, Valladolid, Spain
- CIBER-BBN, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
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Li H, Chen J, Xing X, Lou D. Association of lactate detection with in-hospital mortality in critically ill patients with acute myocardial infarction: a retrospective cohort study. BMJ Open 2023; 13:e069129. [PMID: 37085300 PMCID: PMC10124257 DOI: 10.1136/bmjopen-2022-069129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES To assess the associations of lactate level or lactate clearance at different time points with in-hospital mortality in critically ill patients with acute myocardial infarction (AMI). DESIGN A cohort study. SETTING The Medical Information Mart for Intensive Care III database. PARTICIPANT 490 AMI patients. INTERVENTION None. PRIMARY AND SECONDARY OUTCOME MEASURES In-hospital mortality of patients. RESULTS In total, 120 (24.49%) patients died at the end of follow-up. After adjusting for confounders, increased risk of in-hospital mortality in patients with AMI was observed in those with high lactate level (24 hours) (HR=1.156, 95%CI: 1.002 to 1.333). Increased lactate clearance (24 hours) was correlated with a decreased risk of in-hospital mortality in patients with AMI (HR=0.995, 95% CI: 0.994 to 0.997). The area under the curves (AUCs) of lactate level (24 hours) and lactate clearance (24 hours) were 0.689 (95% CI: 0.655 to 0.723) and 0.672 (95% CI: 0.637 to 0.706), respectively. The AUC of lactate level (24 hours) and lactate clearance (24 hours) was higher than lactate level (baseline). CONCLUSIONS Increased lactate level (24 hours) was associated with an elevated risk of in-hospital mortality in patients with AMI and increased lactate clearance (24 hours) was correlated with a decreased risk of in-hospital mortality in patients with AMI despite the age and genders.
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Affiliation(s)
- Hongwu Li
- Department of Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Jingyi Chen
- Emergency Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinyue Xing
- Emergency Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Danfei Lou
- Emergency Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Kanjee Z, Berg K, Bell TD, Reynolds EE. How Would You Resuscitate This Patient With Septic Shock? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2023; 176:253-259. [PMID: 36780653 DOI: 10.7326/m22-3385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Sepsis is a potentially life-threatening systemic dysregulatory response to infection, and septic shock occurs when sepsis leads to systemic vasodilation and subsequent tissue hypoperfusion. The Surviving Sepsis Campaign published updated guidelines in 2021 on the management of sepsis and septic shock. Here, in the context of a patient with septic shock, 2 critical care specialists discuss and debate conditional guideline recommendations on using lactate to guide resuscitation, the use of balanced crystalloids versus normal saline, and the use of corticosteroids.
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Affiliation(s)
- Zahir Kanjee
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Z.K., E.E.R.)
| | - Katherine Berg
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.B.)
| | - Taison D Bell
- Division of Pulmonary and Critical Care Medicine, and Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia (T.D.B.)
| | - Eileen E Reynolds
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Z.K., E.E.R.)
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Emergency Evaluation and Management of Sepsis and Septic Shock. PHYSICIAN ASSISTANT CLINICS 2023. [DOI: 10.1016/j.cpha.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Jouffroy R, Gilbert B, Thomas L, Bloch-Laine E, Ecollan P, Boularan J, Bounes V, Vivien B, Gueye PN. Association between prehospital shock index variation and 28-day mortality among patients with septic shock. BMC Emerg Med 2022; 22:87. [PMID: 35590250 PMCID: PMC9118768 DOI: 10.1186/s12873-022-00645-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Septic shock (SS) hyperdynamic phase is characterized by tachycardia and low-blood pressure reflecting the relative hypovolemia. Shock index (SI), the ratio between heart rate and systolic blood pressure, is a simple objective tool, usable for SS prognosis assessment. This study aims to evaluate the relationship between prehospital SI variation and 28-day mortality of SS patients initially cared for in prehospital setting by a mobile intensive care unit (mICU). METHODS From April 6th, 2016 to December 31st, 2020, 406 patients with SS requiring prehospital mICU were retrospectively analyzed. Initial SI, i.e. first measurement after mICU arrival to the scene, and final SI, i.e. last measurement of the prehospital stage, were used to calculate delta SI (initial SI-final SI) and to define positive and negative delta SI. A survival analysis after propensity score matching compared the 28-day mortality of SS patients with positive/negative delta SI. RESULTS The main suspected origins of infection were pulmonary (42%), digestive (25%) and urinary (17%). The 28-day overall mortality reached 29%. Cox regression analysis revealed a significant association between 28-day mortality and delta SI. A negative delta SI was associated with an increase in mortality (adjusted hazard ratio (HRa) of 1.88 [1.07-3.31] (p = 0.03)), whereas a positive delta SI was associated with a mortality decrease (HRa = 0.53 [0.30-0.94] (p < 10-3)). CONCLUSION Prehospital hemodynamic delta SI among SS patients cared for by a mICU is associated with 28-day mortality. A negative prehospital delta SI could help physicians to identify SS with higher risk of 28-day mortality.
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Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. .,IRMES - Institute for Research in Medicine and Epidemiology of Sport, INSEP, Paris, France. .,INSERM U-1018, Centre de Recherche en Epidémiologie Et Santé Des Populations - U1018 INSERM, Paris Saclay University, Paris, France. .,Université de Paris, 7329, Paris, EA, France. .,Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Basile Gilbert
- Department of Emergency Medicine, University Hospital of Toulouse, SAMU 31, Toulouse, France
| | - Léa Thomas
- Hôpital d'Instruction Des Armées Bégin, Paris, France
| | - Emmanuel Bloch-Laine
- Emergency Department, Cochin Hospital, Paris, France & Emergency Department, SMUR, Hôtel Dieu Hospital, Paris, France
| | - Patrick Ecollan
- Intensive Care Unit, SMUR, Pitie Salpêtriere Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | | | - Vincent Bounes
- Department of Emergency Medicine, University Hospital of Toulouse, SAMU 31, Toulouse, France
| | - Benoit Vivien
- Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Papa-Ngalgou Gueye
- SAMU 972 CHU de Martinique Pierre Zobda Quitman Hospital, Fort-de-France Martinique, France
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Tontu F, Asar S, Oren Bilgin B. Effect of pH, lactate, electrolyte, and strong ion difference variability on prediction of intensive care unit mortality: A retrospective study. JOURNAL OF ACUTE DISEASE 2022. [DOI: 10.4103/2221-6189.357458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Chen WY, Zhang ZH, Tao LL, Xu Q, Wei X, Chen MS. Afterload-related cardiac performance identifies cardiac impairment and associates with outcome in patients with septic shock: a retrospective cohort study. J Intensive Care 2021; 9:33. [PMID: 33849653 PMCID: PMC8042871 DOI: 10.1186/s40560-021-00549-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background Septic patients with cardiac impairment are with high mortality. Afterload-related cardiac performance (ACP), as a new tool for diagnosing septic cardiomyopathy (SCM), still needs to be evaluated for its impact on the prognosis for patients with septic shock. Methods In this retrospective study, 100 patients with septic shock undertaken PiCCO monitoring were included. The ability of ACP, cardiac index (CI), and cardiac power index (CPI) to discriminate between survivors and non-survivors was tested by comparing the area under the receiver operating characteristic curve (AUROC) analysis. Cox proportional hazards regression analyses were performed to assess the associations of ACP with day-28 mortality. Curve estimation was used to describe the relationship between the hazard ratio (HR) of death and ACP. Results ACP had a strong linear correlation with CI and CPI (P < 0.001). ACP demonstrated significantly greater discrimination for day-28 mortality than CI before adjusted [AUROC 0.723 (95% CI 0.625 to 0.822) vs. 0.580 (95% CI 0.468 to 0.692), P = 0.007] and CPI after adjusted [AUROC 0.693 (95% CI 0.590 to 0.797) vs. 0.448 (0.332 to 0.565), P < 0.001]. Compared with ACP > 68.78%, HR for ACP ≤ 68.78% was 3.55 (1.93 to 6.54) (P < 0.001). When adjusted with age, APACHE-II score, Vasoactive Inotropic Score, Lactate, CRRT, day-1 volume, fibrinogen and total bilirubin as possible confounders, and decrease ACP are still associated with increasing day-28 mortality (P < 0.05). An exponential relationship was observed between ACP12h and HR of day-28 death. Conclusions Our results suggested thatACP could improve mortality predictions when compared to CI and CPI. Decreased ACP was still an independent risk factor for increased day-28 mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00549-5.
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Affiliation(s)
- Wei-Yan Chen
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Intensive Care Unit, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhen-Hui Zhang
- Intensive Care Unit, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li-Li Tao
- Intensive Care Unit, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qi Xu
- Intensive Care Unit, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xing Wei
- Intensive Care Unit, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min-Sheng Chen
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China. .,Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China. .,Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China. .,Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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