1
|
Yaow CYL, Chong RIH, Chan KS, Chia CTW, Shelat VG. Should Procalcitonin Be Included in Acute Cholecystitis Guidelines? A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040805. [PMID: 37109763 PMCID: PMC10144815 DOI: 10.3390/medicina59040805] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Acute cholecystitis (AC) is a common surgical emergency. Recent evidence suggests that serum procalcitonin (PCT) is superior to leukocytosis and serum C-reactive protein in the diagnosis and severity stratification of acute infections. This review evaluates the role of PCT in AC diagnosis, severity stratification, and management. Materials and Methods: PubMed, Embase, and Scopus were searched from inception till 21 August 2022 for studies reporting the role of PCT in AC. A qualitative analysis of the existing literature was conducted. Results: Five articles, including 688 patients, were included. PCT ≤ 0.52 ng/mL had fair discriminative ability (Area under the curve (AUC) 0.721, p < 0.001) to differentiate Grade 1 from Grade 2-3 AC, and PCT > 0.8 ng/mL had good discriminatory ability to differentiate Grade 3 from 1-2 AC (AUC 0.813, p < 0.001). PCT cut-off ≥ 1.50 ng/mL predicted difficult laparoscopic cholecystectomy (sensitivity 91.3%, specificity 76.8%). The incidence of open conversion was higher with PCT ≥ 1 ng/mL (32.4% vs. 14.6%, p = 0.013). A PCT value of >0.09 ng/mL could predict major complications (defined as open conversion, mechanical ventilation, and death). Conclusions: Current evidence is plagued by the heterogeneity of small sample studies. Though PCT has some role in assessing severity and predicting difficult cholecystectomy, and postoperative complications in AC patients, more evidence is necessary to validate its use.
Collapse
Affiliation(s)
- Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Ryan Ian Houe Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 637551, Singapore
| | - Christopher Tze Wei Chia
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore 637551, Singapore
| | - Vishal G Shelat
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 637551, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| |
Collapse
|
2
|
Li S, Yu S, Qin J, Peng M, Qian J, Zhou P. Prognostic value of platelet count-related ratios on admission in patients with pyogenic liver abscess. BMC Infect Dis 2022; 22:636. [PMID: 35864446 PMCID: PMC9306147 DOI: 10.1186/s12879-022-07613-x] [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: 01/30/2022] [Accepted: 07/11/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE The purpose of the current study was to evaluate the association between C-reactive protein-to-platelet ratio (CPR), neutrophil-to-lymphocyte*platelet ratio (NLPR) and fibrinogen-to-platelet ratio (FPR) and the prognoses of pyogenic liver abscess (PLA) patients. METHODS A cohort of 372 patients with confirmed PLA were enrolled in this retrospective study between 2015 and 2021. Laboratory data were collected on admission within 24 h. The demographic characteristics and clinical features were recorded. Risk factors for outcomes of PLA patients were determined via multivariate logistic regression analyses, and optimal cut-off values were estimated by using the receiver operating characteristic (ROC) curve analysis. RESULTS Out of 372 patients, 57.8% were men, 80 (21.5%) developed sepsis, and 33 (8.9%) developed septic shock. The levels of CPR, NLPR and FPR were significantly increased in the development of sepsis, and prolonged hospital stays in PLA patients. The multivariate logistic regression analysis indicated that the CPR (OR: 2.262, 95% CI: 1.586-3.226, p < 0.001), NLPR (OR: 1.118, 95% CI: 1.070-1.167, p < 0.001) and FPR (OR: 1.197, 95% CI: 1.079-1.329, p = 0.001) were independent risks of PLA patients with sepsis, and NLPR (OR: 1.019, 95% CI: 1.004-1.046, p = 0.019) was shown to be an independent predictor of prolonged hospital stays. The ROC curve results showed that the three biomarkers had different predictive values, and CPR proved to work best, with a ROC value of 0.851 (95% CI: 0.807-0.896, p < 0.001) for sepsis. CONCLUSION Higher levels of CPR, NLPR and FPR were associated with a higher risk of poor outcomes. Moreover, a high CPR level performed best when predicting the clinical outcome in PLA patients.
Collapse
Affiliation(s)
- Shixiao Li
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Sufei Yu
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Jiajia Qin
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Minfei Peng
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Jiao Qian
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Peng Zhou
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, No. 150, Ximen Street, Taizhou, 317000, Zhejiang, China.
| |
Collapse
|
3
|
Chan KS, Shelat V. Pyogenic Liver Abscess. THE IASGO TEXTBOOK OF MULTI-DISCIPLINARY MANAGEMENT OF HEPATO-PANCREATO-BILIARY DISEASES 2022:509-519. [DOI: 10.1007/978-981-19-0063-1_66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
|
4
|
Yu J, Ma J, Wang H, Shi Y, He S, Chen Y, Tang C. Clinical comparison of febrile and afebrile patients with pyogenic liver abscess: A two-centre retrospective study. Saudi J Gastroenterol 2021; 27:370-375. [PMID: 34657029 PMCID: PMC8656327 DOI: 10.4103/sjg.sjg_17_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND : Limited research has been conducted on afebrile pyogenic liver abscess (PLA). This poses a challenge in rapid diagnosis and early tailored care to physicians. In his study, we aimed to compare the clinical characteristics of afebrile and febrile patients with PLA. METHODS : We retrospectively analyzed the data of patients with PLA who were admitted to the emergency departments of two university hospitals between January 2014 and March 2020. Patients were classified into afebrile and febrile groups by using body temperature higher than 38°C as the reference standard. The demographic, clinical, and laboratory characteristics of both groups were compared. The primary outcome was all-cause in-hospital mortality and length of hospital stay. Multivariate analysis was performed to define factors associated with afebrile PLA. RESULTS : Of the 239 patients included in this study, 51 patients (21.3%) were afebrile and 188 patients (78.7%) were febrile. There were no differences between the abscess characteristics, laboratory manifestations, and disease severity of both groups; however, age and Charlson score differed between the groups (P = 0.009 and P = 0.011). The all-cause in-hospital mortality rate was much higher in the afebrile PLA group than in the febrile PLA group (9.8% vs. 2.1%, P = 0.011). Regarding the length of stay, no significant differences were noted in the febrile PLA group compared with the afebrile PLA group (18.5% vs 17.3%, P = 0.514). In multivariate analyses, only age greater than 65 years was significantly associated with afebrile PLA. CONCLUSIONS : Afebrile patients with PLA tend to be older, have higher Charlson scores, and in-hospital mortality rate than those with febrile patients. PLA patients older than 65 years are more likely to present without fever (<38°C) at the time of the emergency visit.
Collapse
Affiliation(s)
- Jie Yu
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Jun Ma
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Hairong Wang
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Xinhua Hospital, Kongjiang Road, Yangpu District, Shanghai, China
| | - Yujun Shi
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Shuangjun He
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Yi Chen
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Chao Tang
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China,Address for correspondence: Dr. Chao Tang, Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai - 200025, China. E-mail:
| |
Collapse
|
5
|
Alisjahbana B, Debora J, Susandi E, Darmawan G. Chromobacterium violaceum: A Review of an Unexpected Scourge. Int J Gen Med 2021; 14:3259-3270. [PMID: 34267544 PMCID: PMC8276824 DOI: 10.2147/ijgm.s272193] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
Chromobacterium violaceum is a common environmental bacterium that rarely causes disease in humans but has a high fatality rate if it does. Due to the rarity of the cases, clinicians are often unaware of the rapid progression of C. violaceum infection and its unexpected antibiotic resistance pattern, which contribute to the failure of patient management. Our review provides the clinical characteristics, possible sources of exposure, and comorbidities and determines factors associated with survival. We gathered information on 132 cases of C. violaceum causing disease in humans published between 1953 and 2020. Patients were predominantly male with a median age of 17.5, interquartile range (IQR) of 5.0-40.0 years, and a third of them were known to have immune deficiencies or comorbidities. Portals of entry were mainly through a wound in the leg and feet (28.0%), the torso (8.5%), or hands and arms (6.8%). It is not uncommon to acquire infection through unintended contact with contaminated water or dust through the mouth or inhalation. The median incubation period is 4.0 days (IQR 2.0-8.0 days) with a duration of clinical course of 17.5 days (IQR 8.0-30.8 days). The high rate of positive blood cultures (56.1%) and abscesses in internal organs (36.4%) shows the significant severity of this disease. Sepsis and Bacteremia were related to mortality with a risk ratio (RR) of 5.20 (95% CI, 0.831-32.58) and 2.14 (95% CI, 1.05-4.36), respectively. Appropriate antibiotic use prevented death at a RR 0.33 (95% CI, 0.21-0.52). Most patients who recovered and survived were treated with aminoglycosides, fluoroquinolones and carbapenems. This review shows the malignant nature of C. violaceum infection and the need for clinicians to be aware and provide prompt source management for patients. Appropriate empiric and targeted antibiotic regiment guided by susceptibility test results is of vital importance.
Collapse
Affiliation(s)
- Bachti Alisjahbana
- Internal Medicine Department, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia
| | - Josephine Debora
- Internal Medicine Department, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Evan Susandi
- Internal Medicine Department, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Guntur Darmawan
- Department of Internal Medicine, Faculty of Medicine, Krida Wacana Christian University, Jakarta, Indonesia
| |
Collapse
|
6
|
Song H, Wang X, Lian Y, Wan T. Analysis of the clinical characteristics of 202 patients with liver abscess associated with diabetes mellitus and biliary tract disease. J Int Med Res 2021; 48:300060520949404. [PMID: 32865074 PMCID: PMC7469731 DOI: 10.1177/0300060520949404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Clinical characteristics of patients with pyogenic liver abscess (PLA) of varying etiologies may be different. This study aimed to analyze the clinical characteristics, pathogenic bacteria, treatment, and prognosis of patients with PLA associated with diabetes and biliary disease. METHODS Clinical, imaging, and laboratory data from 202 inpatients with PLA were retrospectively analyzed. RESULTS Eighty-eight patients (43.6%) had a history of diabetes, 73 (36.1%) had a history of underlying biliary tract disease, and 24 (11.9%) had both the diseases. The level of C-reactive protein (CRP) increased in 99.2% (119/120) patients, and the level of procalcitonin (PCT) increased in 95.5% (148/155) patients. The main pathogen of PLA was Klebsiella pneumoniae. The incidence of bloodstream infection increased by 34.4% (22/64) in patients with PLA that was associated with diabetes mellitus, and that of K. pneumoniae infection was 88.6% (39/44). The readmission rate for patients with PLA with underlying biliary diseases was 10.2 to 12.5%. CONCLUSION The main pathogen of PLA is K. pneumoniae, which is sensitive to most antibiotics. Patients with PLA associated with diabetes were more likely to have bloodstream infections, and the recurrence rate of PLA with underlying biliary diseases was higher than without biliary duct disease.
Collapse
Affiliation(s)
- Huiwen Song
- Department of Infectious Diseases, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
| | - Xianbin Wang
- Department of Infectious Diseases, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
| | - Yubao Lian
- Department of Infectious Diseases, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
| | - Tuer Wan
- Department of Imaging Medicine, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
| |
Collapse
|
7
|
Lee SC, Kim SJ, Yu MH, Lee KJ, Cha YS. Uses of Inflammatory Markers for Differentiation of Intrahepatic Mass-Forming Cholangiocarcinoma from Liver Abscess: Case-Control Study. J Clin Med 2020; 9:jcm9103194. [PMID: 33019760 PMCID: PMC7599997 DOI: 10.3390/jcm9103194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pyogenic liver abscess (LA) is difficult to distinguish from intrahepatic mass-forming cholangiocarcinoma (IMCC) in the emergency department (ED). We evaluated the predictive ability of white blood cells (WBC) and C-reactive protein (CRP) levels, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and delta neutrophil index (DNI) in LA and IMCC in the ED. METHODS Forty patients with IMCC between January 2011 and December 2018 were included in this study. For each patient with IMCC, two control patients with LA were enrolled based on matching age and sex,-i.e., 80 patients with LA. RESULTS Inflammatory markers, including WBC, PLR, NLR, DNI, and CRP were significantly higher in the LA group than in the IMCC group. For both groups, the area under the curve (AUC) of the initial CRP value was significantly higher (AUC: 0.909) than that of the initial serum WBC count, PLR, and DNI levels. On multivariable logistic regression analysis with inflammatory markers, serum CRP (odds ratio, 1.290; 95% confidence interval, 1.148-1.449, p < 0.001) was the only significant predictor for differentiation between the LA and IMCC groups. CONCLUSION Serum CRP may be a potential inflammatory marker to differentiate IMCC from LA in the ED.
Collapse
Affiliation(s)
- Sun Chul Lee
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (S.C.L.); (S.J.K)
| | - Sun Ju Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (S.C.L.); (S.J.K)
| | - Min Heui Yu
- SENTINEL (Severance ENdocrinology daTa scIeNcE pLatform) Team, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Kyong Joo Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
- Correspondence: (K.J.L.); (Y.S.C.)
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (S.C.L.); (S.J.K)
- Correspondence: (K.J.L.); (Y.S.C.)
| |
Collapse
|
8
|
He S, Yu J, Wang H, Chen X, He Z, Chen Y. Percutaneous fine-needle aspiration for pyogenic liver abscess (3-6 cm): a two-center retrospective study. BMC Infect Dis 2020; 20:516. [PMID: 32677915 PMCID: PMC7364546 DOI: 10.1186/s12879-020-05239-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of ultrasonography-guided percutaneous fine-needle aspiration (PNA) for pyogenic liver abscess (PLA) remains without consensus, especially in abscesses 3 to 6 cm in diameter. The objective of this study was to evaluate the comparative effectiveness and safety of PNA combined with antibiotics. METHODS This was a retrospective study of patients with PLA that were from 3 to 6 cm in diameter who treated at two medical centers in Shanghai, China, from January 2014 to March 2019. Patients were divided into groups treated by PNA plus antibiotics or antibiotics alone. Patients demographics and clinical data related diagnosis, antibiotic treatment, and patient outcomes were analyzed. RESULTS Out of a total of 94 PLA patients, 42 (44.7%) patients received PNA combined with antibiotics, and 52 (55.3%) received antibiotics alone. There were no complications related to PNA. In the PNA group, 13 (31.7%) patients with negative blood culture and 8 (19.5%) patients without blood culture were microbiologically confirmed via aspiration. The time for temperature normalization (P < 0.001) and the reduction rate of C-reactive protein within the first week (P = 0.031) were significantly lower in the PNA group. In the multivariate analysis, treatment with PNA was more likely to result in clinical improvement of PLA (odds ratio = 0.33, 95% confidence intervals (CI): 0.11-0.96, P = 0.043). CONCLUSIONS PNA combined with antibiotics appears to be a safe, effective, and promising treatment for PLA of 3-6 cm in size. Furthermore, the technique allows for direct microbial sample, which can improve the selection of antibiotics.
Collapse
Affiliation(s)
- Shuangjun He
- Department of Emergency, South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai, 200025, China
| | - Jie Yu
- Department of Emergency, South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai, 200025, China
| | - Hairong Wang
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Xinhua Hospital, Shanghai, China
| | - Xuelian Chen
- Department of Emergency, South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai, 200025, China
| | - Zhanqiang He
- Department of Emergency, South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai, 200025, China
| | - Yi Chen
- Department of Emergency, South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai, 200025, China.
| |
Collapse
|
9
|
Xu S, Shi BQ, Chao LM, Tan YS, Zhang XJ. Prognostic nomogram for the combination therapy of percutaneous catheter drainage and antibiotics in pyogenic liver abscess patients. Abdom Radiol (NY) 2020; 45:393-402. [PMID: 31797027 DOI: 10.1007/s00261-019-02359-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify the predictors for recovery of pyogenic liver abscess (PLA) patients treated with percutaneous catheter drainage (PCD) and antibiotics, and then develop an effective nomogram to predict the recovery time. MATERIALS AND METHODS The retrospective study included consecutive PLA patients treated with PCD and antibiotics. We defined the overall recovery time (ORT) as the time from the PCD procedure to the time of clinical success or failure. Based on the ORT, its predictors were identified with univariate and multivariate analyses. Then, a nomogram was developed to predict the ORT, and was internally validated by using Harrell's c statistic. RESULTS A total of 116 patients and 142 PCD procedures with a median ORT of 15.0±10.6 days were included. Gas-formation (GF; HR: 0.486 [95% CI 0.312-0.757]; P = 0.001), diabetes mellitus (DM; HR: 0.455 [95% CI 0.303-0.682]; P<0.001), and preinterventional septic shock (PSS; HR: 0.276 [95% CI 0.158-0.483]; P < 0.001) were identified as predictors for the ORT of combination therapy after univariate and multivariate analyses, which indicated a significantly longer ORT than those patients without. The prognostic analyses demonstrated that the more predictors (GF, DM, and PSS) a patient exhibited, the longer ORT for the combination therapy. A nomogram was developed to predict the ORT and revealed high accuracy, with Harrell's c statistic of 0.73. CONCLUSION GF, DM, and PSS were predictors for the recovery of PLA patients treated with PCD and antibiotics. The nomogram was effective in predicting the ORT of combination therapy.
Collapse
Affiliation(s)
- Sheng Xu
- Department of Interventional Therapy, Inner Mongolia People's Hospital, 20 Zhaowuda Road, Huhhot, 010017, China.
| | - Bao-Qi Shi
- Department of Interventional Therapy, Inner Mongolia People's Hospital, 20 Zhaowuda Road, Huhhot, 010017, China
| | - Lu-Meng Chao
- Department of Interventional Therapy, Inner Mongolia People's Hospital, 20 Zhaowuda Road, Huhhot, 010017, China
| | - Yong-Sheng Tan
- Department of Interventional Therapy, Inner Mongolia People's Hospital, 20 Zhaowuda Road, Huhhot, 010017, China
| | - Xue-Jun Zhang
- Department of Interventional Therapy, Inner Mongolia People's Hospital, 20 Zhaowuda Road, Huhhot, 010017, China
| |
Collapse
|
10
|
The Delta Neutrophil Index Predicts the Development of In-hospital Hypotension in Initially Stable Patients with Pyogenic Liver Abscess. Sci Rep 2019; 9:12105. [PMID: 31431667 PMCID: PMC6702230 DOI: 10.1038/s41598-019-48588-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 08/08/2019] [Indexed: 12/21/2022] Open
Abstract
Prompt diagnosis and timely treatment are important for reducing morbidity and mortality from pyogenic liver abscess (PLA). The purpose of this study was to investigate the importance of the delta neutrophil index (DNI) reflecting the fraction of immature granulocytes as a predictor of the development of in-hospital hypotension in initially stable patients with PLA. We retrospectively identified 308 consecutive patients (>18 years) who were hemodynamically stable at presentation and diagnosed with PLA in the emergency department (ED) between January 2011 and September 2017. The outcome of interest was in-hospital hypotension 1–24 hours after admission to the ED. A high DNI at ED admission was an independent predictor of the development of in-hospital hypotension in initially stable patients with PLA (odds ratio [OR]: 1.44, 95.0% confidence interval [CI]: 1.06–1.95; P = 0.02). A DNI > 3.3% was associated with in-hospital hypotension at ED admission (OR: 5.37, 95.0% CI: 2.91–9.92; P < 0.001). The development of in-hospital hypotension was associated with an increased risk of 30-day mortality (HR: 8.55, 95.0% CI: 2.57–28.4; P < 0.001). A high DNI independently predicts the development of in-hospital hypotension in initially stable patients with PLA. In-hospital hypotension is associated with an increased risk of 30-day mortality.
Collapse
|
11
|
|