ObejectiveTo summarize the research progress of risk factors contributing to postoperative pulmonary infection in gastric cancer, so as to provide reference for medical decision-makers and clinical practitioners to effectively control the incidence of postoperative pulmonary infection in gastric cancer, ensure medical safety and improve the quality of life of patients. MethodThe researches at home and abroad on the factors contributing to pulmonary infection after gastric cancer surgery in recent years were reviewed and analyzed. ResultsThere was currently no uniform diagnostic standard for pulmonary infection. The incidence of postoperative pulmonary infection for gastric cancer varied in the different countries and regions. The pathogenic bacteria that caused postoperative pulmonary infection of gastric cancer was mainly gram-negative bacteria, especially Pseudomonas aeruginosa, Escherichia coli, Acinetobacter boulardii, and Klebsiella pneumoniae. The patient’s age, history of smoking, preoperative pulmonary function, preoperative laboratory indicators, preoperative comorbidities, preoperative nutritional status, preoperative weakness, anesthesia, tumor location, surgical modality, duration of surgery, blood transfusion, indwelling gastrointestinal decompression tube, wound pain, and so on were possible factors associated with postoperative pulmonary infection of gastric cancer. ConclusionsThe incidence of postoperative pulmonary infection for gastric cancer is not promising. Based on the recognition of related factors, it is proposed that it is necessary to develop a risk prediction model for postoperative pulmonary infection of gastric cancer to identify high-risk patients. In addition to the conventional intervention strategy, taking the pathogenesis as the breakthrough, finding the key factors that lead to the occurrence of postoperative pulmonary infection of gastric cancer is the fundamental way to reduce its occurrence.
Objective To explore the influencing factors for pulmonary infection after radical resection of colon cancer. Methods A cohort study included 56 patients who underwent radical resection of colon cancer in People’s Hospital of Daye City from Oct. 2014 to Oct. 2016 were followed-up prospectively, to observe the occurrence of pulmonary infection, and collectting the related factors for pulmonary infection in addition. Results The clinical data of 53 patients were finalized and the clinical data of these patients were complete. Among them, 13 patients suffered from pulmonary infection after radical resection of colon cancer, and 40 patients had no obvious exacerbation and no complicated pulmonary infection. Results of logistic regression showed that, value of forced expiratory volume in1 second/forced vital capacity (OR=1.174, P=0.033), operative time (OR=1.638, P=0.012), levels of postoperative copeptin (OR=1.328, P=0.032), and procalcitonin (OR=1.465, P=0.042) were risk factors for pulmonary infection after radical resection of colon cancer. Receiver operating characteristic curve (ROC) showed that, operative time was 6.207-hour, postoperative copeptin level was 10.420 pmol/L, and the postoperative procalcitonin level was 3.676 ng/mL, which had the best predictive effect on predicting pulmonary infection after radical resection of colon cancer. Conclusions Value of forced expiratory volume in 1 second/forced vital capacity, operative time, levels of copeptin and procalcitonin after operation are the independent influencing factors for pulmonary infection after radical resection of colon cancer, and it has best prognostic outcome when the operative time is 6.207-hour, postoperative copeptin level is 10.420 pmol/L, and the postoperative procalcitonin level is 3.676 ng/mL.
Objective To explore the related factors of postoperative pulmonary infection (PPI) in patients undergoing laparoscopic colorectal cancer surgery, and analyze the perioperative management strategy of pulmonary infection combined with the concept of enhanced recovery after surgery (ERAS). Methods Total of 687 patients who underwent laparoscopic colorectal cancer surgery in the colorectal cancer professional treatment group of Gastrointestinal Surgery Center of West China Hospital of Sichuan University from January 2017 to May 2019 were retrospectively included. According to the occurrence of PPI, all the included cases were divided into infection group (n=97) and non-infection group (n=590). The related factors and prevention strategies of PPI were analyzed. Results The rate of PPI among patients underwent laparoscopic resection in our study was 14.1% (97/687). Compared with the non-infection group, the proportions of patients with preoperative complications other than cardiopulmonary, receiving preoperative neoadjuvant radiotherapy and/or chemotherapy, preoperative Eastern Cooperative Oncology Group (ECOG) score 1–2, preoperative Nutrition Risk Screening 2002 (NRS2002) score 1–3, tumor located in the left colon and rectum, combined organ resection, operative time >3 h and postoperative TNM stage Ⅱ patients in the infection group were higher (P<0.05). However, the proportions of patients who used intraoperative lung protective ventilation strategy and incision infiltration anesthesia in the infection group were lower than those in the non-infection group (P<0.05). In the infection group, the proportions of patients who received regular sputum excretion, atomization therapy, balloon blowing/breathing training, stomatology nursing after operation and postoperative analgesia were all significantly lower than those of the non-infection group (P<0.05), whereas the proportions of patients receiving antibiotics and intravenous nutrition after operation were significantly higher than those in the non-infection group (P<0.05). Logistic regression analysis showed that low preoperative NRS2002 score, intraoperative protective ventilation strategy, postoperative respiratory training, and postoperative regular sputum excretion were the protective factors of PPI, while preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor located in the left colon and rectum, late TNM staging and postoperative antibiotics were risk factors for pulmonary infection.Conclusions Preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor location in the left colon and rectum, late TNM staging and postoperative antibiotics are risk factors for pulmonary infection in patients with laparoscopic colorectal cancer. Preoperative good nutritional status, intraoperative protective ventilation strategy, postoperative respiratory training and regular sputum excretion may reduce the incidence of PPI to a certain extent.
ObjectiveTo assess the value of simplified clinical pulmonary infection score (sCPIS) in predicting prognosis of patients with ventilator-associated pneumonia (VAP). MethodsThe clinical data of 52 patients with VAP,admitted in ICU between January 2011 and December 2012,were retrospectively analyzed. The sCPIS was calculated at the onset,and on 3rd,5th and 7th day after onset of VAP. Results24 cases survived and 28 cases died in 28-day's hospitalization. 28-day mortality was 53.8%. A significant decrease in sCPIS scores was found on 3rd,5th and 7th day after onset compared with at the onset of VAP in the survivors(4.8±1.2,4.0±1.1,3.3±1.6 vs. 5.5±1.4,P<0.05). An increase in sCPIS scores was found on 3rd,5th and 7th days after onset compared with at the onset of VAP in the non-survivors (6.8±1.3,7.5±1.4,7.8±1.2 vs. 5.8±1.5,P<0.05). The sCPIS determined at the time of VAP diagnosis and on 3rd,5th and 7th day after onset was significantly higher in the non-survivors than that in the survivors respectively (P<0.05). The duration of mechanical ventilation and the length of ICU stay were longer in the non-survivors than those in the survivors[(18.4±5.2) d vs. (12.0±4.1) d,(22.5±8.5) d vs. (16±6.3) d,P<0.05]. ConclusionSerial measurement of sCPIS is valuable in evaluating the severity of illness and predicting the prognosis.
The morbidity and mortality of pulmonary infection are high among infectious diseases worldwide. Rapid and accurate etiological diagnosis is the key to timely and effective treatment. Metagenomic next-generation sequencing (mNGS) technology has brokenthrough the limitations of traditional pathogenic microorganism detection methods and improved the detection rate of pathogens. In this paper, the application and advantages of mNGS technology in the diagnosis of bacteria, fungi, viruses and mixed infections in the lungs are analyzed, and the challenges and breakthroughs in RNA detection, wall breaking of firmicutes and host DNA clearance are described, in order to achieve targeted and accurate etiological diagnosis through mNGS, so as to effectively treat pulmonary infections.
Objective To explore the correlation between the levels of nitrite / nitrate( NO2 /NO3) in exhaled breath condensate ( EBC) and pulmonary infection in mechanically ventilated patients. Methods The clinical data from ventilated patients in critical care units of Peking University People’s Hospital from November 2006 to August 2007 were collected and analyzed. The patients’clinical pulmonary index score ( CPIS) were calculated. EBC of those patients were collected via endotracheal tube or tracheostomy cannula,and the concentrations of NO2 /NO3 were assayed. The level of NO2 /NO3 in different CPIS patients in 24 hours’ventilation, weaning proportion in 3 days and mortality in different NO2 /NO3 level patients were compared. The correlation of the CPIS and level of NO2 /NO3 were explored between survival and non-survival patients. Results A total of 76 patients were enroled. The NO2 /NO3 levels in patients of CPIS≤3, CPIS 3-6 and CPIS gt;6 in 24 hours of ventilation were ( 23. 31 ±5. 79) , ( 28. 72 ±9. 10) and ( 35. 42 ±12. 10) μmol / L respectively, with significantly differences between each other ( P lt; 0. 01) . The lower the patients’concentration of NO2 /NO3 was, the earlier the weaning and the lower the mortality were. The NO2 /NO3 levels on 4th and 7th day were detected in 24 survival patients and 23 non-survival patients. The difference of NO2 /NO3 levels between the survival patients and non-survival patients became significant on 7th day [ ( 29. 32 ±9. 52) μmol / L vs. ( 37. 22 ±12. 03) μmol / L, P lt; 0. 01] . Linear correlation analysis showed that the NO2 /NO3 level was positively correlated with CPIS ( r = 0. 76, P lt; 0. 01) . Conclusions The NO2 /NO3 level of EBC in ventilated patients is positively correlated to the severity of pulmonary infection, thus may be used as a new predictor for weaning and prognosis.
Objective To develop and validate a nomogram prediction model for pulmonary infection in patients following cardiac valve replacement surgery, providing a reference for early screening of high-risk populations and implementing targeted preventive measures. Methods Clinical data of patients who underwent cardiac valve replacement surgery at the Second Affiliated Hospital of Anhui Medical University from January 2020 to October 2023 were collected. Patients were randomly assigned to a modeling group and a validation group in a 7 : 3 ratio. Based on the occurrence of pulmonary infection post-surgery, patients were divided into a pulmonary infection group and a non-pulmonary infection group. Risk factors for pulmonary infection after cardiac valve replacement were analyzed using least absolute shrinkage and selection operator (LASSO) regression and logistic regression to establish a risk prediction model, which was subsequently validated. Model evaluation was conducted using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Results A total of 689 patients were included, comprising 354 males and 335 females, with a median age of 58.0 (50.0, 68.0) years. The incidence of pulmonary infection was 16.0% (110/689). Independent risk factors for pulmonary infection following cardiac valve replacement included emergency admission, smoking history, chronic obstructive pulmonary disease, duration of cardiopulmonary bypass, duration of tracheal intubation, and postoperative renal injury. The AUC for the modeling group was 0.911 [95%CI (0.877, 0.946) ], with a Hosmer-Lemeshow χ2-value of 6.577 (P=0.583) in the modeling group. The AUC value was 0.891 [95%CI (0.840, 0.941) ], with a Hosmer-Lemeshow χ2-value of 5.486 (P=0.705) in the validation group. The model demonstrated good discrimination, calibration, and net benefit. Conclusion The established nomogram prediction model has significant predictive value and can be applied to risk assessment and individualized treatment for pulmonary infection in patients following cardiac valve replacement surgery.
Whipple’s disease is a multisystemic disease caused by Tropheryma (T.) whipplei that primarily affects the gastrointestinal tract. In literature, T. whipplei can also cause pulmonary infections. The detection of T. whipplei depends on nucleic acid-based test. With the application of next-generation sequencing (NGS), cases with T. whipplei detected from respiratory tract samples by NGS are increasingly found but there is lack of recognized diagnostic criteria for these cases. Within the context, we propose a grading diagnostic scheme for the situation that T. whipplei is detected from respiratory tract samples, based on clinical experience and diagnostic thinking, and referring to the international classifications of invasive fungal infections. The scheme comprises five levels: confirmed, probable, possible, impossible, and excluded. There were 26 such cases from West China Hospital of Sichuan University and we used our diagnostic scheme to define probable in 6 cases, possible in 9 cases, impossible in 8 cases, and excluded in 3 cases. Based on this, we also propose specific suggestions for sample collection and testing, patient management, and further research directions. These recommendations are preliminary based on the existing cases from West China Hospital of Sichuan University and therefore needs to be verified, modified, optimized, and even reconstructed when more clinical evidence and further clinical studies become available.
ObjectiveTo analyze the clinical characteristics of acute pancreatitis (AP) complicated with pulmonary infection and to explore the value of BISAP, APACHEⅡ and CTSI scores combined with C-reactive protein (CRP) in early diagnosis and prognosis of AP complicated with pulmonary infection.MethodsFour hundreds and eighty-four cases of AP treated in the Affiliated Hospital of North Sichuan Medical College from January 2018 to January 2020 were selected. After screening, 460 cases were included as the study object, and the patients with pulmonary infection were classified as the infection group (n=114). Those without pulmonary infection were classified as the control group (n=346). The baseline data, clinical characteristics, laboratory test indexes, length of stay, hospitalization cost, and outcome of the two groups were collected, and the risk factors and early predictive indexes of pulmonary infection in patients with AP were analyzed.ResultsHospitalization days and expenses, outcome, fluid replacement within 24 hours, drinking, smoking, age, APACHEⅡ score, BISAP score, CTSI score, hemoglobin (Hb), albumin (ALB), CRP, procalcitonin (PCT), total bilirubin (TB), lymphocyte count, international standardized ratio (INR), blood glucose, and blood calcium, there were significant differences between the two groups (P<0.05). There were no significant difference in BMI, sex, recurrence rate, fatty liver grade, proportion of patients with hypertension and diabetes between the two groups (P>0.05). The significant indexes of univariate analysis were included in multivariate regression analysis, the results showed that Hb≤120 g/L, CRP≥56 mg/L, PCT≥1.65 ng/mL, serum calcium≤2.01 mmol/L, BISAP score≥3, APACHEⅡ score≥8, CTSI score≥3, and drinking alcohol were independent risk factors of AP complicated with pulmonary infection. The working characteristic curve of the subjects showed that the area under the curve (AUC) of CRP, BISAP score, APACHEⅡ score and CTSI score were 0.846, 0.856, 0.882, 0.783, respectively, and the AUC of the four combined tests was 0.952. The AUC of the four combined tests was significantly higher than that of each single test (P<0.05).Conclusions The CRP level, Apache Ⅱ score, bisap score and CTSI score of AP patients with pulmonary infection are significantly higher, which are closely related to the severity and prognosis of AP patients with pulmonary infection. The combined detection of the four items has more predictive value than the single detection in the early diagnosis and prognosis evaluation of AP complicated with pulmonary infection. Its application in clinic is of great significance to shorten the duration of hospitalization and reduce the cost of hospitalization and mortality.
ObjectiveTo systematically evaluate the risk factors for pulmonary infection after cardiac surgery. MethodsA computer search was performed to collect researches on risk factors for pulmonary infection in patients after cardiac surgery from the databases, including CNKI, Wanfang, VIP, CBM, PubMed, The Cochrane Library, EBSCO, CINAHL, Web of Science, EMbase from the inception to August 2023. Two researchers independently extracted data and assessed the literature according to the inclusion and exclusion criteria, and the quality of the literature was evaluated using the Newcastle-Ottawa Scale (NOS). The meta-analysis was performed using RevMan 5.4 software. ResultsA total of 23 studies covering 24348 patients were selected, including 21 case-control studies and 2 cohort studies. The NOS scores were≥6 points. The results of meta-analysis showed that age (OR=2.16, 95%CI 1.80 to 2.59, P<0.001), smoking history (OR=1.91, 95%CI 1.67 to 2.18, P<0.001), pulmonary disease (OR=1.61, 95%CI 1.40 to 1.85, P<0.001), diabetes mellitus (OR=1.62, 95%CI 1.26 to 2.08, P<0.001), operation time (OR=2.54, 95%CI 1.86 to 3.46, P<0.001), cardiopulmonary bypass (CPB) (OR=3.78, 95%CI 2.11 to 6.77, P<0.001), CPB time (OR=2.30, 95%CI 1.94 to 2.71, P<0.001), blood transfusion (OR=2.55, 95%CI 2.04 to 3.20, P<0.001), postoperative mechanical ventilation time (OR=2.78, 95%CI 2.34 to 3.30, P<0.001), tracheal intubation time (OR=3.93, 95%CI 2.45 to 6.31, P<0.001) and repeated tracheal intubation (OR=8.74, 95%CI 4.17 to 18.30, P<0.001) were independent risk factors for pulmonary infection in patients after cardiac surgery. ConclusionAge, smoking history, pulmonary disease, diabetes mellitus, operation time, CPB, CPB time, blood transfusion, postoperative mechanical ventilation time, tracheal intubation time, and repeated tracheal intubation are risk factors for pulmonary infection in patients after cardiac surgery. It can be used as a reference to strengthen perioperative evaluation and nursing of high-risk patients and reduce the incidence of pulmonary infection.