| BackgroundPICS describes a group of critically ill elderly patients hit by sepsis,with the responses of sustained low-grade inflammation,progressive immunosuppression,metabolic disorders and organ failure,and the common clinical symptoms of recurrent nosocomial infections,severe malnutrition,excessive loss of lean body mass and poor wound healing.These patients heavily rely on acute care facilities,prolonged ICU stay and raised hospital charges,which trouble the ICU clinician.Currently there are still two dilemmas in the treatment of PICS:First is that we have inadequate knowledge about early clinical characteristic and prognosis of the elderly patients with sepsis followed by PICS,so it is still not clear that whether these patients need specific intervention and how to screen the high-risk ones;The second is that we lack of effective and reliable interventions for the patients with PICS.In view of the present situation,this study conducted a retrospective analysis on the elderly patients with sepsis followed by PICS,and observed the treatment effect of Thymosin al on these patients.Objectives1.Through the retrospective analysis,exploring the the early clinical characteristic,risk factors and prognosis of the elderly patients with sepsis followed by PICS,as well as demonstrating the significance of specific treatment on PICS.2.Analysing the effect of Thymosin ?1 on the condition and prognosis of the elderly patients with sepsis followed by PICS,to explore the therapeutic value of Thymosin ?1.Methods1.Chapter 1 A total of 298 elderly patients diagnosed with sepsis admitted to MICU from Aug.2013 to Dec.2016 were retrospectively studied,97 of these patients were ultimately enrolled.The patients developed PICS when they were admitted to ICU for more than 10 days were classified as PICS group(n=36),while the others were non-PICS group(n=61).Above all,the general clinical data and laboratory indexes in first day after admitted to MICU were analysed.A multivariate logistic regression model was used to determine the independent factors of PICS,among the significantly different factors between the two groups.We also performed a ROC curve to analyse its predictive value.Furthermore,the case fatality rates were abserved,and the survival time distributions were estimated with Kaplan-Meier model to distinguish the prognosis of these two groups.2.Chapter 2 A total of 68 elderly patients with sepsis followed by PICS admitted to MICU from Aug.2013 to Aug.2017 were studied.These patients were divided into intervention group(n=34)and control group(n=34).The intervention group were treated with Thymosin al for 2 weeks since they were diagnosed with PICS on the 11th day.We compared the difference of laboratory indexes between before and after treatment between the two groups,to analyse the effect of Thymosin?1 on the condition of patients.Moreover,we compared the general clinical data during the first 10 days since admission,to explore the different factors which could affect the prognostic analysis.In the final step,these different factors were introduced into Cox regression analysis together with the factor of Thymosin al,for the purpose of estimating the influence of Thymosin ?1 on prognosis of elderly patients with sepsis followed by PICS.Results1.Chapter 1 Among the 97 patients enrolled in this study,36 patients met the diagnosis of PICS,and the incidence of PICS in elderly patients with sepsis was 37.1%.APACHE ? score and AGI grade were significantly higher in PICS group compared with those in non-PICS group(P<0.05).By contrast,platelet counts,CD4+ T cell counts and CD4+/CD8 were significantly lower in PICS group(P<0.05).Multivariable logistic regression analysis revealed that among these five different factors,APACHE ? score is an independent risk factor in development of PICS and its optimal cut-off value is 26.5.Kaplan-meier analysis showed that the overall prognosis of the PICS group was poorer.The further Kaplan-meier analysis to subdivisions of survival time showed that,the prognoses of 90 days,180 days and 1 year since admission had significant differences(P<0.05),while the prognosis of 28 days since admission didn't have(P>0.05).2.Chapter 2 The difference of monocyte counts,CD4+/CD8+ and HLADR/CD14 between after and before Thymosin al treatment in intervention group were significantly higher than that in control group(P<0.05).Both in the single factor Cox analysis and multi-factors Cox analysis,the results showed that Thymosin al treatment had no significant effect on overall survival condition(P>0.05),while the degree of 10-day standard enteral feeding intake rate had(P<0.05).The further Cox analysis to subdivisions of survival time showed that,Thymosin ?1 treatment had significant effect on the prognosis of 90 days(P<0.05),but had no significant effect on the prognosis of 28 days,180 days and 1 year(P>0.05).Conclusions1.The elderly patients with sepsis followed by PICS showed higher APACHE? score and AGI grade,as well as lower platelet counts,CD4+ T cell counts and CD4+/CD8+ in their initial stages.These five factors are valuable to screen for high-risk patients of PICS.Furthermore,APACHE ? score is an independent risk factor of PICS for elderly patients with sepsis,and the optimum range of prediction is APACHE ? score>26.5.These elderly patients with sepsis followed by PICS could have terrible advanced prognosis and long-term prognosis,which should be more attention by clinic workers.2.Thymosin al can raise or restrain the decrease of monocyte counts,CD4+/CD8+ and HLA-DR/CD14 in the elderly patients with sepsis followed by PICS,which may benefit the condition of them.Furthermore,Thymosin al improve the advanced prognosis of these patients,but its effect on early prognosis and long-term prognosis is not clear.Besides,the condition of early enteral feeding may influence the effect of Thymosin al. |
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