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Yin R, Yang X, Yao Y. Risk factors for acute respiratory distress syndrome in sepsis patients: A meta-analysis. Heliyon 2024; 10:e37336. [PMID: 39309902 PMCID: PMC11414502 DOI: 10.1016/j.heliyon.2024.e37336] [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: 02/28/2024] [Revised: 08/21/2024] [Accepted: 09/02/2024] [Indexed: 09/25/2024] Open
Abstract
Background Acute Respiratory Distress Syndrome (ARDS) is a critical complication of sepsis, associated with high morbidity and mortality. Identifying risk factors for ARDS among sepsis patients is essential for early intervention and improving outcomes. Methods We conducted a comprehensive meta-analysis, reviewing studies that examined the association between various risk factors and ARDS development in sepsis patients. Databases such as PubMed, EMBASE, Cochrane Library, Medline, CINAHL, and Web of Science were searched up to January 2024, without language restrictions. Eligible studies included observational cohorts and case-control studies. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were calculated using a random-effects model. Heterogeneity was assessed through I2 statistics, and publication bias was evaluated via the Luis Furuya-Kanamori (LFK) index. Results 15 studies with more than 40,000 participants were analyzed. Significant risk factors for ARDS included pulmonary infection (OR: 2.696, 95 % CI: 1.655 to 4.390), septic shock (OR: 2.627, 95 % CI: 1.850 to 3.731), and pancreatitis (OR: 3.734, 95 % CI: 2.958 to 4.712). No significant associations were found between the development of ARDS in septic patients and the following risk factors: sex (OR: 1.106, 95%CI: 0.957-1.279), smoking status (OR: 1.214, 95%CI: 0.835-1.765), or steroid use (OR: 0.901, 95%CI: 0.617-1.314). APACHE-II and SOFA scores were predictive of ARDS development, emphasizing their utility in clinical assessments. Conclusion Pulmonary infection, septic shock, and pancreatitis significantly increase ARDS risk in sepsis patients. Our findings advocate for targeted management of these risk factors to mitigate ARDS development, emphasizing the importance of personalized care in sepsis management.
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Affiliation(s)
- Rui Yin
- Department of Critical Care Medicine, Binzhou People's Hospital, Binzhou, Shandong, China
| | - Xiaoshan Yang
- Department Rheumatology and Immunology, Binzhou People's Hospital, Binzhou, Shandong, China
| | - Yanfen Yao
- Department of Intensive Care Medicine, Shandong Provincial Third Hospital, Shandong University, Jinan, 250031, China
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Zhang L, Xu J, Li Y, Meng F, Wang W. Smoking on the risk of acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care 2024; 28:122. [PMID: 38616271 PMCID: PMC11017665 DOI: 10.1186/s13054-024-04902-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The relationship between smoking and the risk of acute respiratory distress syndrome (ARDS) has been recognized, but the conclusions have been inconsistent. This systematic review and meta-analysis investigated the association between smoking and ARDS risk in adults. METHODS The PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched for eligible studies published from January 1, 2000, to December 31, 2023. We enrolled adult patients exhibiting clinical risk factors for ARDS and smoking condition. Outcomes were quantified using odds ratios (ORs) for binary variables and mean differences (MDs) for continuous variables, with a standard 95% confidence interval (CI). RESULTS A total of 26 observational studies involving 36,995 patients were included. The meta-analysis revealed a significant association between smoking and an increased risk of ARDS (OR 1.67; 95% CI 1.33-2.08; P < 0.001). Further analysis revealed that the associations between patient-reported smoking history and ARDS occurrence were generally similar to the results of all the studies (OR 1.78; 95% CI 1.38-2.28; P < 0.001). In contrast, patients identified through the detection of tobacco metabolites (cotinine, a metabolite of nicotine, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a metabolite of tobacco products) showed no significant difference in ARDS risk (OR 1.19; 95% CI 0.69-2.05; P = 0.53). The smoking group was younger than the control group (MD - 7.15; 95% CI - 11.58 to - 2.72; P = 0.002). Subgroup analysis revealed that smoking notably elevated the incidence of ARDS with extrapulmonary etiologies (OR 1.85; 95% CI 1.43-2.38; P < 0.001). Publication bias did not affect the integrity of our conclusions. Sensitivity analysis further reinforced the reliability of our aggregated outcomes. CONCLUSIONS There is a strong association between smoking and elevated ARDS risk. This emphasizes the need for thorough assessment of patients' smoking status, urging healthcare providers to vigilantly monitor individuals with a history of smoking, especially those with additional extrapulmonary risk factors for ARDS.
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Affiliation(s)
- Lujia Zhang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Jiahuan Xu
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Yue Li
- Institute of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Fanqi Meng
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Wei Wang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China.
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Ma S, Li C, Gao Z, Xie J, Qiu H, Yang Y, Liu L. Effects of intravenous sivelestat sodium on prevention of acute respiratory distress syndrome in patients with sepsis: study protocol for a double-blind multicentre randomised controlled trial. BMJ Open 2023; 13:e074756. [PMID: 37709320 PMCID: PMC10503371 DOI: 10.1136/bmjopen-2023-074756] [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: 04/16/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Sepsis is one of the most common risk factors for acute respiratory distress syndrome (ARDS). Neutrophil elastase (NE) is believed to be an important mediator of ARDS. When sepsis occurs, a large number of inflammatory factors are activated and released, which makes neutrophils migrate into the lung, eventually leading to the occurrence of ARDS. Sivelestat sodium is an NE inhibitor that can inhibit the inflammatory reaction during systemic inflammatory response syndrome and alleviate lung injury. Therefore, we hypothesise that intravenous sivelestat sodium may prevent the occurrence of ARDS in patients with sepsis. METHODS AND ANALYSIS This is a prospective, investigator-initiated, double-blind, adaptive, multicentre, randomised, controlled clinical trial with an adaptive 'sample size re-estimation' design. Patients meeting the inclusion criteria who were transferred into the intensive care unit will be randomly assigned to receive sivelestat sodium or placebo for up to 7 days. The primary outcome is the development of ARDS within 7 days after randomisation. A total of 238 patients will be recruited based on a 15% decrease in the incidence of ARDS in the intervention group in this study. A predefined interim analysis will be performed to ensure that the calculation is reasonable after reaching 50% (120) of the planned sample size. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of ZhongDa Hospital affiliated to Southeast University (identifier: Clinical Ethical Approval No. 2021ZDSYLL153-P03). Results will be submitted for publication in peer-reviewed journals and presented at relevant conferences and meetings. TRIAL REGISTRATION NUMBER NCT04973670.
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Affiliation(s)
- Shaolei Ma
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Cong Li
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Zhiwei Gao
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
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Fan Y, Ye Z, Tang Y. Serum HMGB1 and soluble urokinase plasminogen activator receptor levels aid diagnosis and prognosis prediction of sepsis with acute respiratory distress syndrome. Biomark Med 2023; 17:231-239. [PMID: 37158106 DOI: 10.2217/bmm-2022-0899] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Objective: To study the clinical application of serum HMGB1 and soluble urokinase plasminogen activator receptor (suPAR) expression in sepsis with acute respiratory distress syndrome (ARDS). Methods: Clinical data of 303 septic patients with/without ARDS were documented. Levels of serum inflammatory markers and HMGB1/suPAR were measured. ARDS patients were subdivided into high and low HMGB1/suPAR expression groups and followed up. Results: Serum HMGB1 and suPAR were upregulated in ARDS patients and positively correlated with inflammatory markers. The combination of HMGB1 with suPAR surpassed HMGB1 or suPAR alone in aiding diagnosis of sepsis with ARDS. CRP, PCT, IL-6, HMGB1 and suPAR were independent risk factors for ARDS. High HMGB1/suPAR expression might be linked to poor prognosis. Conclusion: Serum HMGB1/suPAR levels might aid diagnosis and predict poor prognosis of septic patients with ARDS.
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Affiliation(s)
- Yuanhua Fan
- Department of Emergency, Qingpu Branch of Zhongshan Hospital of Fudan University, Shanghai, 201700, China
| | - Zhimei Ye
- Department of Emergency, Qingpu Branch of Zhongshan Hospital of Fudan University, Shanghai, 201700, China
| | - Yan Tang
- Department of Emergency, Qingpu Branch of Zhongshan Hospital of Fudan University, Shanghai, 201700, China
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Mayow AH, Ahmad F, Afzal MS, Khokhar MU, Rafique D, Vallamchetla SK, Palleti SK, Saleem F. A Systematic Review and Meta-Analysis of Independent Predictors for Acute Respiratory Distress Syndrome in Patients Presenting With Sepsis. Cureus 2023; 15:e37055. [PMID: 37143620 PMCID: PMC10153762 DOI: 10.7759/cureus.37055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
The current meta-analysis was conducted to determine the predictors of acute respiratory distress syndrome (ARDS) in patients with sepsis. The present meta-analysis was conducted in accordance with the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. We conducted a systematic search using the PubMed, Cochrane Library, and EMBASE databases for studies published between 1 January 2000 and 28 February 2023 that assessed the predictors of ARDS in patients with sepsis. We used key terms such as "predictors," "acute respiratory distress syndrome," and "sepsis" to search for relevant articles. Our search was limited to human studies published in English. A total of six studies were included in this meta-analysis. Of the six studies, four were retrospective and two were prospective. The pooled incidence of ARDS was 11.27%. We identified six factors with a consistent and statistically significant association with ARDS, including sequential organ failure assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, pulmonary sepsis, smoking, pancreatitis, and C-reactive protein. Age, diabetes, and chronic obstructive pulmonary disease (COPD) were not found to be significantly associated with ARDS in this patient population. It is important for healthcare providers to consider these predictors when assessing patients with sepsis and septic shock to identify those at high risk for developing ARDS and implement appropriate preventive measures.
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Yan L, Chen Y, Han Y, Tong C. Role of CD8 + T cell exhaustion in the progression and prognosis of acute respiratory distress syndrome induced by sepsis: a prospective observational study. BMC Emerg Med 2022; 22:182. [PMCID: PMC9675152 DOI: 10.1186/s12873-022-00733-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 10/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background CD8+ T cells are important for protective immunity against intracellular pathogens. Excessive amounts of antigen and/or inflammatory signals often lead to the gradual deterioration of CD8+ T cell function, a state called “exhaustion”. However, the association between CD8+ T cell exhaustion and acute respiratory distress syndrome (ARDS) has not been studied. This study was conducted to elucidate how CD8+ T cells and inhibitory receptors were related to the clinical prognosis of ARDS. Methods A prospective observational study in an emergency department enrolled patients who were diagnosed with sepsis-associated ARDS according to the sepsis-3 criteria and Berlin definition. Peripheral blood samples were collected within 24 h post recruitment. CD8+ T cell count, proliferation ratio, cytokine secretion, and the expression of coinhibitory receptors were assayed. Results Sixty-two patients with ARDS met the inclusion criteria. CD8+ T cell counts and proliferation rates were dramatically decreased in non-surviving ARDS patients. Increasing programmed cell death 1 (PD-1) expression on the CD8+ T cell surface was seen in patients with worse organ function, while an increasing level of T cell immunoglobulin mucin-3 (Tim-3) was associated with a longer duration of the shock. Kaplan–Meier analysis showed that low CD8+ T cell percentages and increased inhibitory molecule expression were significantly associated with a worse survival rate. Conclusions CD8+ T cells and coinhibitory receptors are promising independent prognostic markers of sepsis-induced ARDS, and increased CD8+ T cell exhaustion is significantly correlated with poor prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00733-2.
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Affiliation(s)
- Lei Yan
- grid.8547.e0000 0001 0125 2443Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032 China
| | - Yumei Chen
- grid.8547.e0000 0001 0125 2443Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032 China
| | - Yi Han
- grid.8547.e0000 0001 0125 2443Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032 China
| | - Chaoyang Tong
- grid.8547.e0000 0001 0125 2443Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032 China
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Analysis of the Relevant Vital Signs and Infection of Sepsis Patients and to Explore the Influencing Factors of Acute Lung Injury/Acute Respiratory Distress Syndrome. CONTRAST MEDIA & MOLECULAR IMAGING 2022. [DOI: 10.1155/2022/7718248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In order to analyze the relevant vital signs and infection of sepsis patients, the influencing factors of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) are explored. A total of 142 sepsis patients admitted to our hospital from January 2019 to January 2022 are divided into an ALI/ARDS group and a non-ALI/ARDS group according to the incidence of ALI/ARDS. Logistic analysis showed that pulmonary/abdominal infection, fungal origin of infection, Acinetobacter baumannii, low oxygenation index, high blood lactic acid value, APACHE II score, SOFA score, and LIPS score are the risk factors for sepsis-induced ALI/ARDS. The results indicate that pulmonary/abdominal infection, fungal origin of infection, Acinetobacter baumannii, low oxygenation index, high blood lactic acid, APACHE II score, SOFA score, and LIPS score are the risk factors for sepsis induced ALI/ARDS.
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Risk factors for acute respiratory distress syndrome in sepsis patients: a retrospective study from a tertiary hospital in China. BMC Pulm Med 2022; 22:238. [PMID: 35729588 PMCID: PMC9210689 DOI: 10.1186/s12890-022-02015-w] [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: 04/08/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Less is known about the risk factors for acute respiratory distress syndrome (ARDS) in sepsis patients diagnosed according to sepsis 3.0 criteria. Moreover, the risk factors for ARDS severity remain unclear. Methods We retrospectively collected the characteristics of sepsis patients from the intensive care unit of the First Affiliated Hospital of China Medical University from January 2017 to September 2018. Logistic regression was used in determining the risk factors. Results 529 patients with sepsis were enrolled and 179 developed ARDS. The most common infection sites were acute abdominal infection (n = 304) and pneumonia (n = 117). Multivariate analysis showed that patients with pancreatitis with local infection (odds ratio [OR], 3.601; 95% confidence interval [CI], 1.429–9.073, P = 0.007), pneumonia (OR 3.486; 95% CI 1.890–6.430, P < 0.001), septic shock (OR 2.163; 95% CI 1.429–3.275, P < 0.001), a higher sequential organ failure assessment (SOFA) score (OR 1.241; 95% CI 1.155–1.333, P < 0.001) and non-pulmonary SOFA score (OR 2.849; 95% CI 2.113–3.841, P < 0.001) were independent risk factors for ARDS. Moreover, pneumonia is associated with increased severity of ARDS (OR 2.512; 95% CI 1.039–6.067, P = 0.041). Conclusions We determined five risk factors for ARDS in sepsis patients. Moreover, pneumonia is significantly associated with an increased severity of ARDS.
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You T, Zhou YR, Liu XC, Li LQ. Risk Factors and Clinical Characteristics of Neonatal Acute Respiratory Distress Syndrome Caused by Early Onset Sepsis. Front Pediatr 2022; 10:847827. [PMID: 35419326 PMCID: PMC8995893 DOI: 10.3389/fped.2022.847827] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To identify risk factors associated with the development of acute respiratory distress syndrome (ARDS) in infants with early onset sepsis (EOS) and to describe the clinical features. METHODS A retrospective study was conducted at the Children's Hospital of Chongqing Medical University between January 2000 and October 2020. The infants were divided into ARDS and non-ARDS groups. Clinical characteristics and risk factors were compared between the two groups. RESULTS Two hundred fifty infants (58 with ARDS) were included. Smaller gestational age, lower birth weight (LBW), lower serum albumin level, a higher rate of preterm birth, premature rupture of membranes, antenatal steroid exposure, and lower Apgar score were associated with an increased development of ARDS by univariate analysis (P < 0.05). LBW (β = -0.001, P = 0.000, OR: 0.999, 95% CI: 0.998-0.999) and low serum albumin levels (β = -0.063, P = 0.022, OR: 0.939, 95% CI: 0.889-0.991) were identified as independent risk factors for the development of ARDS by logistic regression analysis. A higher frequency of complications, including persistent pulmonary hypertension, intraventricular hemorrhage, pulmonary hemorrhage, septic shock, and bronchopulmonary dysplasia, was found in the ARDS group (P < 0.05). The rate of mortality was higher for those in the ARDS group than for those in the non-ARDS group (46.6% vs. 15.6%, χ2 = 24.205, P = 0.000). CONCLUSION Acute respiratory distress syndrome (ARDS) in EOS could lead to a higher frequency of complications and mortality. The risk factors for the development of ARDS were LBW and low serum albumin levels.
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Affiliation(s)
- Ting You
- Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yan-Rong Zhou
- Jiulongpo People's Hospital of Chongqing, Chongqing, China
| | - Xiao-Chen Liu
- Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lu-Quan Li
- Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
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Rashid M, Ramakrishnan M, Muthu DS, Chandran VP, Thunga G, Kunhikatta V, Shanbhag V, Acharya RV, Nair S. Factors affecting the outcomes in patients with acute respiratory distress syndrome in a tertiary care setting. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022; 13:100972. [PMID: 37309426 PMCID: PMC10250822 DOI: 10.1016/j.cegh.2022.100972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/27/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The clinical profile and factors affecting outcomes in acute respiratory distress syndrome (ARDS) from adequately sample-sized Indian studies are still lacking. We aimed to investigate the clinical profile, treatment pattern, outcomes; and to assess factors affecting non-recovery in ARDS patients. Patients and methods A retrospective observational study was conducted among adult ARDS patients admitted during five year period (January 2014-December 2018) in a South Indian tertiary care setting. The relevant data were collected from the medical records to the data collection form. The univariate and multivariate logistic regression analyses were conducted to identify the predictors of outcomes using SPSS v20. Results A total of 857 participants including 496 males and 361 females with a mean age of 46.86 ± 15.81 years were included in this study. Fever (70.9%), crepitation (58.3%), breathlessness (56.9%), and cough (45%) were the major clinical presentation. Hypertension (25.2%), kidney disease (23.8%), and diabetes (22.3%) were the major comorbidities; and sepsis (37.6%), pneumonia (33.3%), and septic shock (27.5%) were the major etiological factors observed. Antibiotics and steroids were administered to 97.9% and 52.3% of the population, respectively. The recovery rate was 47.49%. The patients with scrub typhus, dengue, pancreatitis, and oxygen supplementation had significantly lower mortality. The factors such as advanced age, sepsis, septic shock, liver diseases, and ventilation requirements were observed to be the independent predictors of non-recovery in ARDS patients. Conclusion A comparable recovery rate was observed in our population. Advanced age, sepsis, septic shock, liver diseases, and ventilation requirements were the independent predictors of non-recovery.
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Affiliation(s)
- Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Manasvini Ramakrishnan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Deepa Sudalai Muthu
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Viji Pulikkel Chandran
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Vijayanarayana Kunhikatta
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Vishal Shanbhag
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Raviraja V Acharya
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sreedharan Nair
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
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Cui N, Jiang C, Chen H, Zhang L, Feng X. Prevalence, risk, and outcome of deep vein thrombosis in acute respiratory distress syndrome. Thromb J 2021; 19:71. [PMID: 34645471 PMCID: PMC8511290 DOI: 10.1186/s12959-021-00325-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few data exist on deep vein thrombosis (DVT) in patients with acute respiratory distress syndrome (ARDS), a group of heterogeneous diseases characterized by acute hypoxemia. STUDY DESIGN AND METHODS We retrospectively enrolled 225 adults with ARDS admitted to the Beijing Chao-Yang Hospital and the First Affiliated Hospital of Shandong First Medical University between 1 January 2015 and 30 June 2020. We analyzed clinical, laboratory, and echocardiography data for groups with and without DVT and for direct (pulmonary) and indirect (extrapulmonary) ARDS subgroups. RESULTS Ninety (40.0%) patients developed DVT. Compared with the non-DVT group, patients with DVT were older, had lower serum creatinine levels, lower partial pressure of arterial oxygen/fraction of inspired oxygen, higher serum procalcitonin levels, higher Padua prediction scores, and higher proportions of sedation and invasive mechanical ventilation (IMV). Multivariate analysis showed an association between age, serum creatinine level, IMV, and DVT in the ARDS cohort. The sensitivity and specificity of corresponding receiver operating characteristic curves were not inferior to those of the Padua prediction score and the Caprini score for screening for DVT in the three ARDS cohorts. Patients with DVT had a significantly lower survival rate than those without DVT in the overall ARDS cohort and in the groups with direct and indirect ARDS. CONCLUSIONS The prevalence of DVT is high in patients with ARDS. The risk factors for DVT are age, serum creatinine level, and IMV. DVT is associated with decreased survival in patients with ARDS.
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Affiliation(s)
- Na Cui
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, People's Republic of China
- Beijing Institute of Respiratory Medicine, Beijing, 100020, People's Republic of China
| | - Chunguo Jiang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, People's Republic of China
- Beijing Institute of Respiratory Medicine, Beijing, 100020, People's Republic of China
| | - Hairong Chen
- Department of Intensive Care Unit, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Ji'nan, People's Republic of China
| | - Liming Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, People's Republic of China.
- Beijing Institute of Respiratory Medicine, Beijing, 100020, People's Republic of China.
| | - Xiaokai Feng
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, People's Republic of China.
- Beijing Institute of Respiratory Medicine, Beijing, 100020, People's Republic of China.
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12
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Holliday ZM, Alnijoumi MM, Reed MA, Earhart AP, Schrum AG, Allen LAH, Krvavac A. Neutrophils and secondary infections in COVID-19 induced acute respiratory distress syndrome. New Microbes New Infect 2021; 44:100944. [PMID: 34567574 PMCID: PMC8452528 DOI: 10.1016/j.nmni.2021.100944] [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: 02/07/2021] [Revised: 07/23/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is the cause of the current global pandemic and has affected more than 188 countries worldwide. Infection by the virus can have diverse clinical manifestations, with one of the most severe clinical manifestation being respiratory failure and the development of acute respiratory distress syndrome. Clinical manifestations of acute respiratory distress syndrome secondary to SARS-CoV-2 are also diverse with a lack of diagnostic tools to distinguish between primary viral infection and secondary bacterial infections. This was a single-centre, retrospective case-control study of bronchoalveolar lavage fluid cell counts, flow cytometry and culture results from mechanically ventilated patients with SARS-CoV-2 (COVID-19) pneumonia and acute respiratory distress syndrome. Neutrophils were the predominant cell type in bronchoalveolar fluid samples up to 2 weeks into mechanical ventilation. There also was a strong correlation between positive respiratory cultures and significant elevation in bronchoalveolar fluid neutrophil counts/percentages and serum C-reactive protein levels. Absolute levels of T cell subtypes correlated with reduced lung compliance measurements. Patients with SARS-CoV-2 and severe respiratory disease are at risk for secondary infections. In some COVID-19 patients, serum C-reactive protein and bronchoalveolar fluid neutrophils may be correlated with a secondary infection.
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Affiliation(s)
- Z M Holliday
- Department of Medicine, University of Missouri, Columbia, MO, USA
| | - M M Alnijoumi
- Department of Medicine, University of Missouri, Columbia, MO, USA
| | - M A Reed
- Department of Medicine, University of Missouri, Columbia, MO, USA
| | - A P Earhart
- Department of Molecular Pathogenesis & Therapeutics Program, University of Missouri, Columbia, MO, USA
| | - A G Schrum
- Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, MO, USA.,Department of Surgery, School of Medicine, University of Missouri, Columbia, MO, USA.,Department of Biomedical Biological & Chemical Engineering, University of Missouri, Columbia, MO, USA
| | - L-A H Allen
- Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, MO, USA.,Department of Molecular Pathogenesis & Therapeutics Program, University of Missouri, Columbia, MO, USA
| | - A Krvavac
- Department of Medicine, University of Missouri, Columbia, MO, USA
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13
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Oh TK, Song IA. Impact of coronavirus disease-2019 on chronic respiratory disease in South Korea: an NHIS COVID-19 database cohort study. BMC Pulm Med 2021; 21:12. [PMID: 33407347 PMCID: PMC7787421 DOI: 10.1186/s12890-020-01387-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background The impact of underlying chronic respiratory diseases (CRDs) on the risk and mortality of patients with coronavirus disease 2019 (COVID-19) remains controversial. We aimed to investigate the effects of CRDs on the risk of COVID-19 and mortality among the population in South Korea.
Methods The NHIS-COVID-19 database in South Korea was used for data extraction for this population-based cohort study. Chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease (ILD), lung cancer, lung disease due to external agents, obstructive sleep apnea (OSA), and tuberculosis of the lungs (TB) were considered CRDs. The primary endpoint was a diagnosis of COVID-19 between January 1st and June 4th, 2020; the secondary endpoint was hospital mortality of patients with COVID-19. Multivariable logistic regression modeling was used for statistical analysis. Results The final analysis included 122,040 individuals, 7669 (6.3%) were confirmed as COVID-19 until 4 June 2020, and 251 patients with COVID-19 (3.2%) passed away during hospitalization. Among total 122,040 individuals, 36,365 individuals were diagnosed with CRD between 2015 and 2019: COPD (4488, 3.6%), asthma (33,858, 27.2%), ILD (421, 0.3%), lung cancer (769, 0.6%), lung disease due to external agents (437, 0.4%), OSA (550, 0.4%), and TB (608, 0.5%). Among the CRDs, patients either with ILD or OSA had 1.63-fold (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.17–2.26; P = 0.004) and 1.65-fold higher (OR 1.65, 95% CI 1.23–2.16; P < 0.001) incidence of COVID-19. In addition, among patients with COVID-19, the individuals with COPD and lung disease due to external agents had 1.56-fold (OR 1.56, 95% CI 1.06–2.2; P = 0.024) and 3.54-fold (OR 3.54, 95% CI 1.70–7.38; P < 0.001) higher risk of hospital mortality. Conclusions Patients with OSA and ILD might have an increased risk of COVID-19. In addition, COPD and chronic lung disease due to external agents might be associated with a higher risk of mortality among patients with COVID-19. Our results suggest that prevention and management strategies should be carefully performed.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Korea.
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Hasan SS, Capstick T, Ahmed R, Kow CS, Mazhar F, Merchant HA, Zaidi STR. Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis. Expert Rev Respir Med 2020; 14:1149-1163. [PMID: 32734777 PMCID: PMC7544968 DOI: 10.1080/17476348.2020.1804365] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The acute respiratory distress syndrome (ARDS) secondary to viral pneumonitis is one of the main causes of high mortality in patients with COVID-19 (novel coronavirus disease 2019). We systematically reviewed mortality in COVID-19 patients with ARDS and the potential role of systemic corticosteroids in COVID-19 patients. METHODS Electronic databases and country-specific healthcare databases were searched to identify relevant studies/reports. The quality assessment of individual studies was conducted using the Newcastle-Ottawa Scale. Country-specific proportion of individuals with COVID-19 who developed ARDS and reported death were combined in a random-effect meta-analysis to give a pooled mortality estimate of ARDS. RESULTS The overall pooled mortality estimate among 10,815 ARDS cases in COVID-19 patients was 39% (95% CI: 23-56%). The pooled mortality estimate for China was 69% (95% CI: 67-72%). In Europe, the highest mortality estimate among COVID-19 patients with ARDS was reported in Poland (73%; 95% CI: 58-86%) while Germany had the lowest mortality estimate (13%; 95% CI: 2-29%) among COVID-19 patients with ARDS. The median crude mortality rate of COVID-19 patients with reported corticosteroid use was 28.0% (lower quartile: 13.9%; upper quartile: 53.6%). CONCLUSIONS The high mortality in COVID-19 associated ARDS necessitates a prompt and aggressive treatment strategy which includes corticosteroids. Most of the studies included no information on the dosing regimen of corticosteroid therapy, however, low-dose corticosteroid therapy or pulse corticosteroid therapy appears to have a beneficial role in the management of severely ill COVID-19 patients.
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Affiliation(s)
- Syed Shahzad Hasan
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
- CONTACT Syed Shahzad Hasan University of Huddersfield, Queensgate, Huddersfield, West Yorkshire HD1 3DH, UK
| | - Toby Capstick
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
| | - Raees Ahmed
- Healing Lungs, HCA Conroe Hospital, Critical Care Unit, Conroe, TE, USA
| | - Chia Siang Kow
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Faizan Mazhar
- Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco”, University Hospital, Università Di Milano, Milan, Italy
| | - Hamid a Merchant
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Syed Tabish Razi Zaidi
- School of Healthcare, University of Leeds, Leeds, & Leeds Teaching Hospitals Trust, Leeds, UK
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15
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Yang Y, Yang L, Liu Z, Wang Y, Yang J. Long noncoding RNA NEAT 1 and its target microRNA-125a in sepsis: Correlation with acute respiratory distress syndrome risk, biochemical indexes, disease severity, and 28-day mortality. J Clin Lab Anal 2020; 34:e23509. [PMID: 32785981 PMCID: PMC7755762 DOI: 10.1002/jcla.23509] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/01/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
Background Sepsis is one of the main contributors to in‐hospital deaths. This study aimed to evaluate the clinical roles of long noncoding RNA (lncRNA) nuclear‐enriched abundant transcript 1 (NEAT1) and microRNA (miR)‐125a in sepsis. Methods LncRNA NEAT1 and miR‐125a in plasma samples from 102 sepsis patients and 100 healthy controls (HCs) were detected by reverse transcription‐quantitative polymerase chain reaction. In sepsis patients, general disease severity was assessed by acute physiology and chronic health evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score. Meanwhile, acute respiratory distress syndrome (ARDS) occurrence and mortality during 28 days were recorded. Results LncRNA NEAT1 was increased, but miR‐125a was decreased in sepsis patients compared to HCs, and in ARDS sepsis patients compared to non‐ARDS sepsis patients. The receiver's operative characteristic (ROC) curves revealed that higher lncRNA NEAT1 or lower miR‐125a had certain predictive value for ARDS risk. Further multivariate logistic regression revealed miR‐125a but not lncRNA NEAT1 was correlated with ARDS risk independently in sepsis patients. Additionally, lncRNA NEAT1 was positively, but miR‐125a was negatively correlated with APACHE II score and SOFA score in sepsis patients. Moreover, higher lncRNA NEAT1 and lower miR‐125a were observed in 28‐day deaths compared to 28‐day survivors and were correlated with increased accumulating mortality in sepsis patients. Conclusion LncRNA NEAT1 high expression and miR‐125a low expression correlate with increased ARDS risk, enhanced disease severity, higher 28‐day mortality, and negatively associate with each other in sepsis patients.
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Affiliation(s)
- Yongkai Yang
- Department of Critical Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liu Yang
- Department of Critical Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenqing Liu
- Department of Critical Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujun Wang
- Department of Critical Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junhui Yang
- Department of Critical Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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You T, Zhang H, Guo L, Ling KR, Hu XY, Li LQ. Differences in clinical characteristics of early- and late-onset neonatal sepsis caused by Klebsiella pneumoniae. Int J Immunopathol Pharmacol 2020; 34:2058738420950586. [PMID: 32816593 PMCID: PMC7444108 DOI: 10.1177/2058738420950586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 07/27/2020] [Indexed: 01/09/2023] Open
Abstract
To identify differences in the clinical characteristics of early- and late-onset sepsis (EOS and LOS) caused by Klebsiella pneumoniae (K. pneumoniae) and to describe the risk factors for multidrug-resistant K. pneumoniae (MDR-KP) infection. Infants with K. pneumoniae-induced sepsis who were admitted to a children's Hospital between Jan 2000 and Dec 2019 were included. All infants were divided into EOS and LOS groups, as well as MDR-KP and non-MDR-KP groups. Demographics, clinical characteristics, and risk factors were compared between the two groups. One hundred eighty infants (66 with EOS and 114 with LOS) were further analyzed, accounting for 36.8% of sepsis cases caused by MDR-KP. The frequency of respiratory failure, bronchopulmonary dysplasia, and intraventricular hemorrhage were more common in the LOS group and a higher rate of acute respiratory distress syndrome was more common in infants in the EOS group (P < 0.05). K. pneumoniae showed a low sensitivity to penicillin, beta-lactams and cephalosporins, and it showed a high sensitivity to levofloxacin, ciprofloxacin, and amikacin. Prematurity, low birth weight, longer antibiotic exposure time, long duration of peripheral catheter insertion, long mechanical ventilation time, and long parenteral nutrition time were associated with an increased rate of MDR-KP infection by univariate analysis (P < 0.05). The regression analysis identified a long antibiotic exposure time (OR = 1.37, 95% CI: 1.01-1.89) and long parenteral nutrition time (OR = 1.39, 95% CI: 1.01-1.89) as independent risk factors for a MDR-KP infection, and a greater gestational age and birth weight were associated with a lower risk of MDR-KP infection (OR = 0.57, 95% CI: 0.40-0.79). LOS caused by K. pneumoniae may lead to a higher frequency of complications. The risk factors for MDR-KP infection were longer duration of antibiotic exposure and parenteral nutrition. A greater gestational age and larger birth weight may decrease the risk of MDR-KP infection.
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Affiliation(s)
- Ting You
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Han Zhang
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Lu Guo
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Ke-Ran Ling
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Xiao-Yu Hu
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Lu-Quan Li
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
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