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Wu H, Jia S, Liao B, Ji T, Huang J, Luo Y, Cao T, Ma K. Establishment of a mortality risk nomogram for predicting in-hospital mortality of sepsis: cohort study from a Chinese single center. Front Med (Lausanne) 2024; 11:1360197. [PMID: 38765257 PMCID: PMC11100418 DOI: 10.3389/fmed.2024.1360197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/18/2024] [Indexed: 05/21/2024] Open
Abstract
Objective To establish a mortality risk nomogram for predicting in-hospital mortality of sepsis patients in the Chinese population. Methods Data were obtained from the medical records of sepsis patients enrolled at the Affiliated Huadu Hospital, Southern Medical University, between 2019 and 2021. A total of 696 sepsis patients were initially included in our research, and 582 cases were finally enrolled after screening and divided into the survival group (n = 400) and the non-survival group (n = 182) according to the incidence of mortality during hospitalization. Twenty-eight potential sepsis-related risk factors for mortality were identified. Least absolute shrinkage and selection operator (LASSO) regression was used to optimize variable selection by running cyclic coordinate descent with k-fold (tenfold in this case) cross-validation. We used binary logistic regression to build a model for predicting mortality from the variables based on LASSO regression selection. Binary logistic regression was used to establish a nomogram based on independent mortality risk factors. To validate the prediction accuracy of the nomogram, receiver operating characteristic curve (ROC) analysis, decision curve analysis (DCA) and restricted cubic spline (RCS) analysis were employed. Eventually, the Hosmer-Lemeshow test and calibration curve were used for nomogram calibration. Results LASSO regression identified a total of ten factors, namely, chronic heart disease (CHD), lymphocyte count (LYMP), neutrophil-lymphocyte ratio (NLR), red blood cell distribution width (RDW), C reactive protein (CRP), Procalcitonin (PCT), lactic acid, prothrombin time (PT), alanine aminotransferase (ALT), total bilirubin (Tbil), interleukin-6 (IL6), that were incorporated into the multivariable analysis. Finally, a nomogram including CHD, LYMP, NLR, RDW, lactic acid, PT, CRP, PCT, Tbil, ALT, and IL6 was established by multivariable logistic regression. The ROC curves of the nomogram in the training and validation sets were 0.9836 and 0.9502, respectively. DCA showed that the nomogram could be applied clinically if the risk threshold was between 29.52 and 99.61% in the training set and between 31.32 and 98.49% in the testing set. RCS showed that when the value of independent risk factors from the predicted model exceeded the median, the mortality hazard ratio increased sharply. The results of the Hosmer-Lemeshow test (χ2 = 0.1901, df = 2, p = 0.9091) and the calibration curves of the training and validation sets showed good agreement with the actual results, which indicated good stability of the model. Conclusion Our nomogram, including CHD, LYMP, NLR, RDW, lactic acid, PT, CRP, PCT, Tbil, ALT, and IL6, exhibits good performance for predicting mortality risk in adult sepsis patients.
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Affiliation(s)
- Hongsheng Wu
- Hepatobiliary Pancreatic Surgery Department, Huadu District People’s Hospital of Guangzhou, Guangzhou, China
| | - Shichao Jia
- Information Network Center, Huadu District People’s Hospital of Guangzhou, Guangzhou, China
| | - Biling Liao
- Hepatobiliary Pancreatic Surgery Department, Huadu District People’s Hospital of Guangzhou, Guangzhou, China
| | - Tengfei Ji
- Hepatobiliary Pancreatic Surgery Department, Huadu District People’s Hospital of Guangzhou, Guangzhou, China
| | - Jianbin Huang
- Hepatobiliary Pancreatic Surgery Department, Huadu District People’s Hospital of Guangzhou, Guangzhou, China
| | - Yumei Luo
- Hepatobiliary Pancreatic Surgery Department, Huadu District People’s Hospital of Guangzhou, Guangzhou, China
| | - Tiansheng Cao
- Hepatobiliary Pancreatic Surgery Department, Huadu District People’s Hospital of Guangzhou, Guangzhou, China
| | - Keqiang Ma
- Hepatobiliary Pancreatic Surgery Department, Huadu District People’s Hospital of Guangzhou, Guangzhou, China
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Ma K, Zhang Y, Hao J, Zhao J, Qi Y, Liu C. Correlation analysis of systemic immune inflammatory index, Serum IL-35 and HMGB-1 with the severity and prognosis of sepsis. Pak J Med Sci 2023; 39:497-501. [PMID: 36950402 PMCID: PMC10025737 DOI: 10.12669/pjms.39.2.6651] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/15/2022] [Accepted: 12/24/2022] [Indexed: 01/27/2023] Open
Abstract
Objective To investigate the correlation between systemic immune inflammatory (SII) index, serum interleukin-35 (IL-35) and high mobility Group-Box one (HMGB-1) with the severity and prognosis of sepsis. Methods A retrospective analysis was performed on the clinical data of 209 patients with sepsis admitted to Ganzhou City People's Hospital from October 2019 to October 2021. One hundred eighteen patients in Group-A had common sepsis, and 91 patients in Group-B had septic shock, which were subdivided into the survival Group-And the mortality Group-According to the 28d prognosis. The levels of SII, IL-35 and HMGB-1 in different groups were compared, and their correlation with the severity and prognosis of sepsis was analyzed. Result The levels of SII, IL-35 and HMGB-1 in Group-A were significantly lower than those in Group-B (p<0.05). The levels of SII, IL-35 and HMGB-1 in the survival group were significantly lower than those in the death group (p<0.05). Spearman correlation analysis showed that the levels of SII, IL-35, and HMGB-1 were significantly positively correlated with the severity of sepsis (p<0.05), and significantly positively correlated with the prognosis of patients with sepsis (p<0.05). Conclusion SII, IL-35 and HMGB-1 are remarkably correlated with the severity and prognosis of patients with sepsis. With the increasing in SII, IL-35 and HMGB-1 levels, patients will suffer from severe disease progression and poor prognosis, which require more clinical attention.
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Affiliation(s)
- Ke Ma
- Ke Ma, Clinical Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei, China
| | - Yajuan Zhang
- Yajuan Zhang, Clinical Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei, China
| | - Jian Hao
- Jian Haom, Clinical Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei, China
| | - Jing Zhao
- Jing Zhao, Clinical Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei, China
| | - Ying Qi
- Ying Qi, Clinical Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei, China
| | - Cong Liu
- Cong Liu, Clinical Laboratory, Ganzhou City People’s Hospital, Ganzhou 341000, Jiangxi, China
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Zeng J, Wan J, He W, Zhu Y, Zeng H, Liu P, Gong M, Liu F, Shao Q, Xia L, Zhu Y, Chen Y, Lu N. Prognostic Value of Arterial Lactate Metabolic Clearance Rate in Moderate and Severe Acute Pancreatitis. DISEASE MARKERS 2022; 2022:9233199. [PMID: 36408464 PMCID: PMC9668450 DOI: 10.1155/2022/9233199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/19/2022] [Indexed: 05/22/2024]
Abstract
PURPOSE High lactate levels at hospital admission are significantly associated with poor prognosis in acute pancreatitis patients. Early high lactate clearance is a vital marker for predicting persistent organ failure and mortality in critical illness; however, its value in acute pancreatitis remains unclear. METHOD Data were collected from patients who were diagnosed with moderately severe acute pancreatitis and severe acute pancreatitis from January 2017 to December 2020. Initial lactate (within 2 hours after admission) and repeat lactate at 24 hours after admission were measured to determine lactate clearance. Low clearance was defined as a reduction in repeat lactate of less than 30% compared to the first measurement. High clearance was defined as a repeat lactate decrease ≥30% of the first measurement or both first and second lactate levels <2 mmol/L. Baseline data, laboratory data, mortality rate, persistent organ failure rate, and other outcomes such as the incidence of septic pancreatic necrosis and sepsis and the length of hospital stay and intensive care unit (ICU) stay were compared in the low and high lactate clearance groups. Multivariate logistic regression analyses were used to assess the value of lactate clearance for predicting death. RESULT Among 4425 acute pancreatitis patients, 3040 patients were diagnosed with moderate or severe acute pancreatitis, and 1028 patients had initial lactate measured. Finally, 390 patients who had initial and 24-hour repeat lactate data were included in the study. Patients who had elevated initial lactate had poor outcomes, and 51 patients in the initial elevated lactate group died. In the lactate normalization group analysis, 293 patients had 24-hour lactate normalization; compared with patients in the nonnormalization group, they had a lower rate of mortality (12.6% vs. 33%). In the lactate clearance group analysis, 70 (21.9%) patients had a low clearance after 24 hours; compared with patients in the high clearance group, they had a higher rate of developing persistent multiorgan failure (P = 0.045), and the incidence of death was higher (15% vs. 28.6%, P = 0.007). Multivariate logistic analysis showed that 24-hour lactate clearance (OR: 2.007; 95% CI:1.032-3.903, P = 0.04), elevated initial lactate (OR: 2.011; 95% CI:1.023-3.953, P = 0.043), blood urea nitrogen (OR: 2.316; 95% CI:1.061-5.056, P = 0.035), and white blood count (OR: 1.982; 95% CI:1.026-3.829, P = 0.042) were independent predictors of hospital mortality. CONCLUSION The 24-hour clearance of lactate is a reliable marker to predict the outcome of moderate and severe acute pancreatitis, and low lactate clearance may indicate that the patient's condition will worsen, requiring aggressive treatments to improve patient outcomes.
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Affiliation(s)
- Jiji Zeng
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China
| | - Jianhua Wan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China
| | - Wenhua He
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China
| | - Yong Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China
| | - Hao Zeng
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China
| | - Pi Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China
| | - Min Gong
- Department of Digestive Internal Medicine, Southern Medical University Pingxiang Hospital, Pingxiang, China
| | - Fen Liu
- Department of Intensive Care Unit, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiang Shao
- Department of Intensive Care Unit, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liang Xia
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China
| | - Youxiang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China
| | - Nonghua Lu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China
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Vorwerk H, Engenhart-Cabillic R. Students' learning behavior in digital education for radiation oncology. Strahlenther Onkol 2021; 198:12-24. [PMID: 34842943 PMCID: PMC8760198 DOI: 10.1007/s00066-021-01858-2] [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: 04/22/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
Purpose Digitalization of medical education is an important trend in terms of reforming and modernizing the global education environment. It has been long requested by students and politicians. The goal of this study was to assess the student perception of a newly developed digital educational program in radiation oncology (RO) using an interactive e‑book combined with short learnings clips on a YouTube channel combined with periodic videoconferences and a forum for queries. Methods We performed five evaluations during and at the end of two terms with multiple-choice and free-text answers. We evaluated student perception of our new digital learning scenario in three semesters: one pre-clinical and two clinical semesters. In addition, we analyzed all comments from the kMED forum, the YouTube channel, or the e‑mail contacts. We analyzed the learning behavior of the students based on access to the videos and the number and quality of the reflective questions answered as well as the results of the final examinations. Results The students accepted the offer for asynchronous teaching and mainly learned on weekdays (74% of the videos), but also on weekends (23%) and less on public holidays (4%). The answer quality of the reflective questions was good with over 50% correct answers on the first attempt. Learning to be on one’s own authority was very difficult for the students, even in the last clinical semesters of the medical study. Without direct intervention by the teacher, access to the learning material by the students was limited and delayed. Therefore, voluntary interim tests were performed during the first analysis term, which led to an increased number of student accesses to the videos and higher number of answers. Nevertheless, in the first analysis term, the average results in the final exam of the students who did not perform the interim test were below average at 59.1%, and the students who performed the test had better results at 69.5% but this was also not satisfactory. In the second analysis term, we taught with the same digital teaching model but with an additional scheme for learning over the term, 2‑week compulsory intermediate tests, and frequent videoconferences to answer any questions. In this term, we measured a success rate of 93% in the final exam. All annotations were very positive regarding the new educational project. The evaluations showed high acceptance of the new education program. The students stated they would prefer the new education course to be continued in future. Conclusion Digital teaching methods make not only the type and quality of teaching transparent, but also the learning behavior of the students. Our analysis has shown that, in addition to the quality of the teaching, the clear structure and specification of the learning content per learning week as well as regular monitoring of what has been learned are of decisive importance for the learning success of the students. Supplementary Information The online version of this article (10.1007/s00066-021-01858-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hilke Vorwerk
- Radiotherapy and Radio-oncology, University Clinic Marburg and Giessen (Marburg facility), Baldingerstraße, 35033, Marburg, Germany.
| | - Rita Engenhart-Cabillic
- Radiotherapy and Radio-oncology, University Clinic Marburg and Giessen (Marburg facility), Baldingerstraße, 35033, Marburg, Germany
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Baishya N, Mamouei M, Budidha K, Qassem M, Vadgama P, Kyriacou PA. Investigations into the Effects of pH on Quantitative Measurements of Lactate in Biological Media Using ATR-FTIR Spectroscopy. Molecules 2020; 25:molecules25163695. [PMID: 32823662 PMCID: PMC7466057 DOI: 10.3390/molecules25163695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 01/03/2023] Open
Abstract
Quantification of lactate/lactic acid in critical care environments is essential as lactate serves as an important biochemical marker for the adequacy of the haemodynamic circulation in shock and of cell respiration at the onset of sepsis/septic shock. Hence, in this study, ATR-FTIR was explored as a potential tool for lactate measurement, as the current techniques depend on sample preparation and fails to provide rapid response. Moreover, the effects of pH on PBS samples (7.4, 7, 6.5 and 6) and change in solution conditions (PBS to whole blood) on spectral features were also investigated. A total 189 spectra from five sets of lactate containing media were obtained. Results suggests that lactate could be measured with more than 90% accuracy in the wavenumber range of 1500–600 cm−1. The findings of this study further suggest that there exist no effects of change in pH or media, when estimating lactate concentration changes in this range of the Mid-IR spectral region.
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Affiliation(s)
- Nystha Baishya
- Research Center for Biomedical Engineering, University of London, Northampton Square, London EC1V 0HB, UK; (M.M.); (K.B.); (M.Q.); (P.A.K.)
- Correspondence: ; Tel.: +44-(0)20-7040-3878
| | - Mohammad Mamouei
- Research Center for Biomedical Engineering, University of London, Northampton Square, London EC1V 0HB, UK; (M.M.); (K.B.); (M.Q.); (P.A.K.)
| | - Karthik Budidha
- Research Center for Biomedical Engineering, University of London, Northampton Square, London EC1V 0HB, UK; (M.M.); (K.B.); (M.Q.); (P.A.K.)
| | - Meha Qassem
- Research Center for Biomedical Engineering, University of London, Northampton Square, London EC1V 0HB, UK; (M.M.); (K.B.); (M.Q.); (P.A.K.)
| | - Pankaj Vadgama
- Interdisciplinary Research Centre (IRC) in Biomedical Materials, Queen Mary University of London, Mile End Road, London E1 4NS, UK;
| | - Panayiotis A. Kyriacou
- Research Center for Biomedical Engineering, University of London, Northampton Square, London EC1V 0HB, UK; (M.M.); (K.B.); (M.Q.); (P.A.K.)
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