Objective: This study aims to evaluate the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score on different days in predicting the mortality of critically ill patients to identify the best time point for the APACHE II score.Methods: The demographic and clinical data are retrieved from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset. APACHE II scores on days 1, 2, 3, 5, 7, 14, and 28 of hospitalization are calculated, and their performance is evaluated using the area under the receiver operating characteristic (AUROC) analysis. The cut-off for defining the high risk of mortality is determined using Youden's index. The APACHE II score on day 3 is the best time point to predict hospital mortality of ICU patients. The Hosmer-Lemeshow goodness-of-fit test is then applied to evaluate the calibration of the day 3 APACHE II score.Results: We recruited 6,374 eligible subjects from the MIMIC-IV database. Day 3 is the optimal time point for obtaining the APACHE II score to predict the hospital mortality of patients. The best cut-off for day 3 APACHE II score is 17. When APACHE II score ≥17, the sensitivity for the non-survivors and survivors is 92.8 and 82.2%, respectively, and the positive predictive value (PPV) is 23.1%. When APACHE II socre <17, the specificity for non-survivors and survivors is 90.1 and 80.2%, respectively, and the negative predictive value (NPV) is 87.8%. When day-3 APACHE II is used to predict the hospital mortality, the AUROC is 0.743 (P <0.001). In the ≥17 group, the sensitivity of non-survivors and survivors is 92.2 and 81.3%, respectively, and the PPV is 30.3%. In the <17 group, the specificity of non-survivors and survivors is 100.0 and 80.2%, respectively, and the NPV is 81.6%. The Hosmer-Lemeshow test indicated day-3 APACHE II has a high predicting the hospital mortality (X² = 6.198, P = 0.625, consistency = 79.4%). However, the day-1 APACHE II has a poor calibration in predicting the hospital mortality rate (X² = 294.898, P <0.001).Conclusion: Day-3 APACHE II score is an optimal biomarker to predict the outcomes of ICU patients; 17 is the best cut-off for defining patients at high risk of mortality.

Background: Patients diagnosed with chronic obstructive pulmonary disease (COPD) have increased risks for a series of physical and mental illnesses. Tumor necrosis factor-α (TNF-α) has been reported to participate in the development of COPD and its complications. However, the values of blood TNF-α level used in the diagnosis of COPD remains controversial. In view of this, we performed a systematic review and meta-analysis to evaluate the correlation between TNF-α level and COPD. Methods: We searched PubMed, Web of Science, Embase and CNKI up to May 2018. The selection criteria were set according to the PICOS framework. A random-effects model was then applied to evaluate the overall effect sizes by calculating standard mean difference (SMD) and its 95% confidence intervals (CIs). Results: A total of 40 articles containing 4189 COPD patients and 1676 healthy controls were included in this meta-analysis. The results indicated a significant increase in TNF-α level in the COPD group compared with the control group (SMD: 1.24, 95% CI: 0.78–1.71, p < 0.00001). According to the subgroup analyses, we noted that TNF-α level was associated with predicted first second of forced expiration (FEV₁) (%) and study region. However, no association between TNF-α level and COPD was found when the participants were nonsmokers, and the mean age was less than 60 years. Conclusions: Our results indicated that TNF-α level was increased in COPD patients when compared with healthy controls. Illness progression and a diagnosis of COPD might contribute to higher TNF-α levels. However, the underlying mechanism still remains unknown and needs further investigation. The reviews of this paper are available via the supplemental material section.

Introduction: The effect of high-flow nasal cannula (HFNC) on adult post cardiothoracic operation remains controversial. We conducted a meta-analysis of randomized controlled trials to evaluate the effect of HFNC and conventional oxygen therapy (COT) on postcardiothoracic surgery. Methods: A search was conducted in Embase, MEDLINE, Ovid, and Cochrane databases until December, 2017 for all the controlled study to compare HFNC with COT in adult postcardiothoracic surgery. Two authors extracted data and assessed the quality of each study independently. The meta-analysis was performed by using RevMan 5.3. The primary outcome was the rate of escalation of respiratory support rate and pulmonary complications; secondary outcome included the length of intensive care unit (ICU) stay and length of hospital stay and the rate of intubation. Results: Four studies that involved 649 patients were included in the analysis. No significant heterogeneity was found in outcome measures. Compared with COT, HFNC were associated with a significant reduction in the escalation of respiratory support (odds ratio [OR] = 0.44, 95% confidence interval [CI] = 0.29−0.66, P < .001) and pulmonary complications (OR = 0.28, 95% CI = 0.13−0.6, P = .001). There were no significant differences in the reintubation rate (OR = 0.33, 95% CI = 0.02−5.39, P = .43), length of ICU stay (weighted mean difference = 0.11; 95% CI = −0.44 −0.26, P = .14) or length of hospital stay (weighted mean difference = −0.15, 95% CI = −0.46 −0.17, P = .36) between the 2 groups. No severe complications were reported in either group. Conclusion: The HFNC could reduce respiratory support and pulmonary complications, and it could be safely administered for adult postcardiothoracic surgery. Further large-scale, randomized, and controlled trials are needed to update this finding.

BACKGROUND: FEV ₆ can be used as a convenient alternative to FVC. The aim of this study was to determine an alternative to the fixed cutoff points of FEV ₁ /FVC <0.70 suitable for FEV ₁ /FEV ₆ in primary care. METHODS: Pulmonary function testing was conducted on volunteers recruited from 4 community centers in Xi'an, China, between July and August 2012. Participants underwent 3 FVC maneuvers. The maneuver with the best FEV ₁ was retained. FVC, FEV ₁ , and FEV ₆ were measured by portable spirometer. The receiver operating characteristic curves that corresponded to the optimal combination of sensitivity and specificity for FEV ₁ /FEV ₆ were determined. A kappa test was used to compare the agreement between FEV ₁ /FVC and FEV ₁ /FEV ₆ . The positive predictive value and negative predictive value were also calculated. RESULTS: A total of 767 volunteers participated in this study, of whom 297 were male and 470 were female. Considering FEV ₁ /FVC <0.70 as the accepted standard for COPD, the area under the curve was 98% ( P < .001), and the FEV ₁ /FEV ₆ cutoff, corresponding to the greatest sum of sensitivity and specificity, was 0.72. For the total population, the FEV ₁ /FEV ₆ sensitivity, specificity, positive predictive value, and negative predictive value were 96.9, 98.8, 95.8, and 99.2%, respectively. The agreement between the 2 cutoff points was excellent, and the kappa value was 0.954. CONCLUSIONS: FEV ₁ /FEV ₆ <0.72 can be used in primary care as a valid alternative to FEV ₁ /FVC <0.70 as a fixed cutoff point for the detection of COPD in adults. This study suggests that FEV ₁ /FEV ₆ is an effective and well validated option that should be used in primary care to detect COPD, which is a rampant problem.

Background: Community-acquired pneumonia (CAP) leads to high morbidity and mortality among the elderly, with 3 million deaths annually worldwide. Multiple comorbidities significantly increase the risk. This study aims to identify independent risk factors for mortality in elderly patients with CAP to optimize individualized treatment strategies.Methods: This single-center retrospective study was conducted at First Affiliated Hospital of Xi’an Medical University. Clinical data from elderly patients diagnosed with CAP between December 2018 and December 2023 were retrospectively collected. Logistic regression analysis was used to determine risk factors for in-hospital mortality. A nomogram was constructed based on the final model for risk assessment.Results: A total of 613 eligible patients were included, with 68.2% being male, and a median age of 78 (IQR 70–86) years. The prevalence of hypertension, coronary heart disease (CHD), stroke, diabetes, malignancy, and chronic obstructive pulmonary disease (COPD) was 55.5, 39.8, 29.5, 27, 16.6, and 7%, respectively. The in-hospital mortality rate was 48%. Compared to survivors, non-survivors were older, had a higher proportion of males, faster heart rates, and higher rates of comorbidities. Multivariate logistic regression analysis identified age (OR 1.05, 95% CI [1.02–1.07], P < 0.01), BMI (OR 0.92, 95% CI [0.86–0.98], P < 0.01), stroke (OR 2.21, 95% [1.43–3.42], P < 0.01), ARDS (OR 4.0, 95% CI [2.17–7.37], P < 0.01), AKI (OR 2.98, 95% CI [1.77–5.01], P < 0.01), malignancy (OR 2.11, 95% CI [1.22–3.65], P < 0.01), elevated WBC (OR 1.20, 95% [1.14–1.27], P < 0.01), PLT (OR 0.995, 95% CI [0.993–0.998], P < 0.01), and albumin (OR 0.93, 95% CI [0.90–0.97], P < 0.01) as independent risk factors for in-hospital mortality. The area under the curve (AUC) of the multivariable model was 0.85 (95% CI [0.81–0.87], P < 0.01).Conclusion: Elderly CAP patients have a high prevalence of comorbidities and a high in-hospital mortality rate. Advanced age, low BMI, stroke, ARDS, AKI, malignancy, elevated WBC, decreased PLT, and low albumin were independent risk factors for in-hospital mortality.

In December, 2019, a new coronavirus named 2019-nCoV causing severe acute respiratory disease has emerged in the region of Wuhan, China [1, 2]. The National Health Commission of People's Republic of China named pneumonia infected with 2019-nCoV as Novel Coronavirus Pneumonia (NCP).Evidence have pointing to the person-to-person transmission [3–5]. As of February 8, 2020, China has reported 34 673 confirmed and more than 27 657 suspected cases of NCP across 34 Chinese provinces or municipalities, with 106 fatalities. Most of the studies focused on the epidemic situation in Wuhan, but few on provinces outside Wuhan. Shaanxi is located in the northwest of Hubei Province and adjacent to it, with a population of 38.64 million. Since the first case of NCP was confirmed in Shannxi by on January 23, 2020, 195 cases have been confirmed, but there is no relevant epidemiological study. In order to better understand the epidemic law of new coronavirus in Shaanxi Province, and provide the basis for the future development of control measures.This article aims to report the epidemiological outcomes of 195 confirmed case infected with 2019-nCoV in Shaanxi, and to compare the clinical features between patients with or without a history of exposure in Wuhan.