[Death in geriatric pneumonia patients]

The risk factors and predictive modeling of mortality in patients with mental disorders combined with severe pneumonia

Background

We explored clinical characteristics and risk factors for mortality in patients with mental disorders combined with severe pneumonia and developed predictive models.

Methods

We retrospectively analyzed the data of 161 patients with mental disorders combined with severe pneumonia in the intensive care unit (ICU) of a psychiatric hospital from May 2020 to February 2023, and divided them into two groups according to whether they died or not, and analyzed their basic characteristics, laboratory results and treatments, etc. We analyzed the risk factors of patients' deaths using logistics regression, established a prediction model, and drew a dynamic nomogram based on the results of the regression analysis. Based on the results of regression analysis, a prediction model was established and a dynamic nomogram was drawn.

Results

The non-survivor group and the survivor group of patients with mental disorders combined with severe pneumonia were statistically different in terms of age, type of primary mental illness, whether or not they were intubated, whether or not they had been bedridden for a long period in the past, and the Montreal Cognitive Assessment (MoCA) scale, procalcitonin (PCT), albumin (ALB), hemoglobin (Hb), etc. Logistics regression analysis revealed the following: MoCA scale (OR = 0.932, 95% CI:0.872-0.997), age (OR = 1.077, 95%CI:1.029-1.128), PCT (OR = 1.078, 95% CI:10.006-10.155), ALB (OR = 0.971, 95%CI:0.893-1.056), Hb (OR = 0.971, 95% CI: 0.942-0.986) were statistically significant. The ROC curve showed that the model predicted patient death with an area under the curve (AUC) of 0.827 with a sensitivity of 73.4% and a specificity of 80.4%.

Conclusion

Low MoCA score, age, PCT, and low Hb are independent risk factors for death in patients with mental disorders with severe pneumonia, and the prediction model constructed using these factors showed good predictive efficacy.

Knockdown CRNDE alleviates LPS-induced inflammation injury via FOXM1 in WI-38 cells

OBJECTIVE

Pneumonia is the leading global cause of mortality and morbidity in children and elderly people worldwide. The lncRNA colorectal neoplasia differentially expressed (CRNDE) plays an important role in the human development and disease progression. The present study was aimed to investigate the effect of CRNDE on LPS-induced injuries in WI-38 cells and explore the potential mechanism.

METHODS

WI-38 cells were treated with LPS to induce injuries. The expression of CRNDE and FOXM1 in WI-38 cells were altered by transient transfection assay. Cell viability was measured by CCK-8 assay and cell apoptosis was detected by flow cytometry assay and western blot. The levels of inflammatory cytokines were assessed by ELISA and western blot. Furthermore, western blot analysis was performed to detect the expression levels of NF-κB and JAK/STAT pathway-related proteins.

RESULTS

LPS exposure induced cell injuries and increased CRNDE expression in WI-38 cells. CRNDE overexpression enhanced cell injuries in WI-38 cells with significantly reducing cell viability, increasing cell apoptosis and inflammatory cytokines levels. In addition, CRNDE overexpression further activated the NF-κB and JAK/STAT pathways in LPS-injured WI-38 cells. Inversely, opposite results were observed in CRNDE inhibition treatment group. Interestingly, FOXM1 was up-regulated by CRNDE and FOXM1 silence blocked the effect of CRNDE overexpression in cell apoptosis, inflammation and activation of NF-κB and JAK/STAT signaling pathways.

CONCLUSION

This study demonstrated that CRNDE overexpression accelerated LPS-induced apoptosis and inflammation via up-regulation of FOXM1 in WI-38 cells.

Inspissated oral secretions and a review of their clinical, biological, and physiological significance

People with some chronic diseases may dehydrate and develop thick, viscous inspissated oronasal secretions that include cellular debris. This material can lead to ductal or airway obstructions that can prove to be life threatening. Asthma, allergy with superinfection, cystic fibrosis, intubated ventilation, burn injuries, and medication-induced complications are discussed in this paper. Many patients with chronic debilitating conditions may also be unable to communicate, and so may be unable to verbally convey that they have a compromised airway or an obstruction. Therefore, it is essential to maintain hydration and good oral hygiene that not only addresses the teeth and prostheses, but also the oral mucosal surfaces. People who are institutionalized and bed-ridden, in particular, need to be closely monitored to prevent adverse sequellae. A daily oral sweep with a 4 × 4 surgical sponge moistened with chlorhexidine may prevent aspiration pneumonia or a fatality due to an airway obstruction. Human oronasal secretions are involved with immunity, digestion, lubrication, and speech. Saliva is the most volumetrically important. These secretions moisturize inspired and expired air but can lose water, causing an increase in viscosity. The viscous secretions trap particles, food debris, and bacterial colonies, thereby increasing inspissations that may obstruct the airway.