| Clinical characteristics and risk factors of sepsis in avian-origin influenza A(H7N9)Background and objective:In the March 2013,the information that a novel avian-origin influenza A(H7N9)virus infected human in China was reported.Then the H7N9 virus spreaded widely in China,which made extensive deaths in human.In the 2016,the definition of sepsis was updated and corrected,which led to extensive discussions in the academics and clinicians.Avian influenza A H7N9 virus infection and sepsis are both urgent,rapid-developing critical disease with a high mortality.Once the two diseases are coincident,the clinical characteristics and prognosis are still unclear.Unfortunately,there are no related research until now.Therefore,we described the clinical characteristics of H7N9 virus-related sepsis/septic shock,explored the risk factors of occurring and death.Finally,SOFA(Sequential[Sepsis-related]Organ Failure Assessment)and SIRS(systemic inflammatory response syndrome)in predicting the prognosis of patients infected with H7N9 avian influenza virus were evaluated.Methods:We retrospectively analyzed the data of patients admitted at the infectious disease wards of the First Affiliated Hospital,College ofMedicine,Zhejiang University,China,and diagnosed with avian-origin influenza A(H7N9)virus infection from March 2013 to May 2017.Elimination rules:Bacteria and fungi were cultivated from blood,respiratory tract specimens and other sterile fluids within 72 hours of admission;bacterial and fungal infection was presumed by the expert group according to clinical manifestations,laboratory findings and positive cultures.(1)A retrospective study was conducted on patients who diagnosed as H7N9 avian influenza.The sepsis and septic shock were determined,then the clinical characteristics and prognosis of the patients were studied.(2)The Logistic regression analysis was used to analyze the risk factors of sepsis and septic shock.Then the ROC curve(receiver operating characteristic curve)was used to verify the results.The risk factors for death of sepsis patients were analyzed by Cox regression analysis.(3)The differences of SOFA and SIRS in H7N9 avian influenza patients were studied,the prediction ability of SOFA and SIRS on prognosis were evaluated by using ROC curve.Results:(1)In H7N9 avian influenza patients,the incidence of sepsis and septic shock was 78.17%and 39.44%,respectively.The 30-days and 180-days mortality rate of sepsis were 19.82%and 34.23%,respectively.The 30-days and 180-days mortality rate of septic shock was 19.82%and 34.23%,respectively.Between H7N9 avian influenza patients,sepsis patients and septic shock patients,the statistical significance were observed on age,organ support.SOFA within 24 hours of admission,clinical laboratory findings within 24 hours of admission(included C-reactive protein,lactate dehydrogenase,D-dimer)(P<0.05)?(2)The level of lactate dehydrogenase(OR 1.014,95%confidence interval 1.004-1.023,P = 0.003)was an independent risk factor for predicting sepsis in the H7N9 avian influenza patients.The incidence of sepsis was predicted by lactate dehydrogenase,and area under the curve(AUC)was 0.890(95%confidence interval 0.819-0.960,P<0.001).The age(OR 1.062,95%confidence interval 1.020—1.105,P = 0.003),C-reactive protein(OR 1.009,95%confidence interval 1.001—1.017,P = 0.023),lactate dehydrogenase(OR 126.500,95%confidence interval,3.585—4463.733,P = 0.008)and D-dimer(OR 6.552,95%confidence interval,1.577—27.216,P = 0.010)within 24 hours of admission were independent risk factors of septic shock.The AUC were 0.619(95%confidence interval 0.526-0.713,P=0.017),0.707(95%confidence interval 0.620-0.793,P<0.001),0.752(95%confidence interval 0.673-0.831,P<0.001)and 0.790(95%confidence interval 0.714-0.866,P<0.001),respectively.Septic shock within 72 hours of adimission was an independent risk factor for predicting 30-days(Hazard ratio(HR)82.110,95%confidence interval 2.373-2841.497,P=0.015)and 180-days(HR 17.492,95%confidence interval 5.365-57.035,P<0.001)mortality in sepsis patients.(3)In 142 H7N9 avian influenza virus patients,the mortality in patients meet SOFA criteria was 34.23%(38/111),in patients meet SIRS criteria was 28.91%(37/128).There was no significant statistical difference(P = 0.376).SOFA and SIRS criteria were applied to predict mortality,the AUC were 0.781(P<0.001,95%confidence interval:0.704-0.858),0.642(P =0.010,95%confidence interval:0.540-0.745),respectively.Conclusions:The H7N9 avian influenza patients were easily accompanied by sepsis and septic shock.Once that occurred,the mortality rate were significantly increased.The above risk factors were easy to obtain in clinical practice,which can be used in early clinical identification and early warning of incidence and death in patients with sepsis and/or septic shock.Finally,in the early stage,SOFA was better than SIRS as a predictors of mortality in H7N9 avian influenza patients.Clinincal study of sepsis in invasive pulmonary aspergillus with liver failure:clinical characteristics,risk factors and outcomes Background and objective:Invasive pulmonary aspergillosis is a severe and often lethal infection.Previous studies had focused on immunosuppressed individuals,such as transplant patients and hematological Disease.Invasive aspergillosis had received little attention in liver failure patients.However,the studies of aspergillus-related sepsis were only concentrated in case reports,and further research was rare.The aim of this study was to investigate the clinical characteristics and prognosis of sepsis in liver failure patients with invasive pulmonary aspergillosis,to explore the risk factors of invasive pulmonary aspergillosis in an effort to reduce mortality.Methods:We retrospectively analyzed the data of patients admitted at the infectious disease wards of the First Affiliated Hospital,College of Medicine,Zhejiang University,China,and diagnosed with liver failure from January 2011 to December 2016.The data of patients were collected,included general condition,underlying diseases,causes and types of liver failure,treatment and prognosis.The data of patients who were diagnosed as invasive pulmonary aspergillosis,were also collected,included laboratory examinations,concomitant symptoms,SOFA within 72 hours of admission and diagnosis?The clinical characteristics and prognosis of the patients were studied,and the effect of different antifungal agents on prognosis were analyzed.Finally,the Logistic regression analysis was used to analyze the risk factors of invasive pulmonary aspergillosis in liver failure patients.Results:In total,1077 patients with liver failure were included in this study.Of the 1077 patients,53(4.9%)had invasive pulmonary aspergillosis.All 53 patients occured sepsis within 72 hours of diagnosis,and 5 of them had septic shock.The mean SOFA score within 72 hours of diagnosis was 9±2.93(5-19).Forty-four(83%)patients with sepsis died.There were no statistical significance in the effect of different antifungal agents on prognosis(P>0.05).The Logistic regression analysis showed hepatorenal syndrome(odds ratio = 2.549,95%confidence interval,1.253-5.189,P = 0.010),application of antimicrobial(OR = 4.559,95%confidence interval,1.851-11.228,P = 0.001),application of glucocorticoids(OR = 17.395,95%confidence interval,9.286-32.585,P<0.001)was the independent risk factors for invasive pulmonary aspergillosis.Conclusions:Invasive pulmonary aspergillosis is a fatal complication in patients with liver failure,which weas easily accompanied by sepsis.Hepatorenal syndrome,antibiotic use,and steroid exposure were independent risk factors for invasive pulmonary aspergillosis.When patients with liver failure have these risk factors and symptoms of pneumonia such as cough or hemoptysis,clinicians should be cautious about the possibility of aspergillus sepsis. |
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