BACKGROUND:The nonspecifi c clinical presentation of adrenal insuffi ciency(AI)frequently leads to misdiagnosis,often as psychiatric or gastrointestinal disorders.AI is classifi ed anatomically as primary AI(PAI),seco...BACKGROUND:The nonspecifi c clinical presentation of adrenal insuffi ciency(AI)frequently leads to misdiagnosis,often as psychiatric or gastrointestinal disorders.AI is classifi ed anatomically as primary AI(PAI),secondary AI(SAI),or tertiary AI(TAI).Without timely recognition,progression to adrenal crisis(AC)can result in life-threatening outcomes.This study aimed to systematically analyze the clinical features,etiologies,and outcomes of AI in Lhasa’s emergency population to improve diagnostic accuracy and optimize clinical management.METHODS:A retrospective analysis of emergency department admissions from January 2020 to August 2024 at People’s Hospital of Xizang Autonomous Region was conducted.AI diagnoses were identifi ed via International Classifi cation of Diseases,Tenth Revision,Clinical Modifi cation(ICD-10-CM)codes from electronic health records(EHR).Patients were grouped into incipient AC(IAC)or AC cohorts based on hemodynamic status.Demographic profi les,etiologies,clinical presentations,and laboratory results were analyzed.RESULTS:Forty-three AI patients were identifi ed.The population-standardized admission rate for AI increased from 9 to 16 per million person-years,with PAI cases doubling during this period.Adrenal tuberculosis(58.1%)and adrenal hematoma(18.6%)were the leading etiologies.Compared to the IAC group,the AC group demonstrated lower systolic blood pressure(SBP)(P=0.001)and diastolic blood pressure(DBP)(P<0.001);higher neutrophil count(P=0.048),eosinophil count(P=0.044),CRP(P=0.004),blood urea nitrogen(BUN)(P=0.007);lower sodium(P<0.001)and glucose levels(P=0.001).The hospital stay was longer in the AC group(20 d vs.14 d;P<0.001).CONCLUSION:AI incidence is rising in high-altitude regions,with adrenal tuberculosis remaining the most common cause.AC is associated with increased inflammatory responses,hemodynamic instability,and metabolic disturbances.Targeted interventions are required to improve outcomes.展开更多
BACKGROUND:Neuroendocrine dysfunction after traumatic brain injury(TBI)has received increased attention due to its impact on the recovery of neural function.The purpose of this study is to investigate the incidence an...BACKGROUND:Neuroendocrine dysfunction after traumatic brain injury(TBI)has received increased attention due to its impact on the recovery of neural function.The purpose of this study is to investigate the incidence and risk factors of adrenocortical insuffi ciency(AI)after TBI to reveal independent predictors and build a prediction model of AI after TBI.METHODS:Enrolled patients were grouped into the AI and non-AI groups.Fourteen preset impact factors were recorded.Patients were regrouped according to each impact factor as a categorical variable.Univariate and multiple logistic regression analyses were performed to screen the related independent risk factors of AI after TBI and develop the predictive model.RESULTS:A total of 108 patients were recruited,of whom 34(31.5%)patients had AI.Nine factors(age,Glasgow Coma Scale[GCS]score on admission,mean arterial pressure[MAP],urinary volume,serum sodium level,cerebral hernia,frontal lobe contusion,diff use axonal injury[DAI],and skull base fracture)were probably related to AI after TBI.Three factors(urinary volume[X4],serum sodium level[X5],and DAI[X8])were independent variables,based on which a prediction model was developed(logit P=-3.552+2.583X4+2.235X5+2.269X8).CONCLUSIONS:The incidence of AI after TBI is high.Factors such as age,GCS score,MAP,urinary volume,serum sodium level,cerebral hernia,frontal lobe contusion,DAI,and skull base fracture are probably related to AI after TBI.Urinary volume,serum sodium level,and DAI are the independent predictors of AI after TBI.展开更多
BACKGROUND: The present study aimed to determine the short-term and long-term outcomes of critically ill patients with acute respiratory insuffi ciency who had received sedation or no sedation.METHODS: The data of 91 ...BACKGROUND: The present study aimed to determine the short-term and long-term outcomes of critically ill patients with acute respiratory insuffi ciency who had received sedation or no sedation.METHODS: The data of 91 patients who had received mechanical ventilation in the first 24 hours between November 2008 and October 2009 were retrospectively analyzed. These patients were divided into two groups: a sedation group(n=28) and a non-sedation group(n=63). The patients were also grouped in two groups: deep sedation group and daily interruption and /or light sedation group.RESULTS: Overall, the 91 patients who had received ventilation ≥48 hours were analyzed. Multivariate analysis demonstrated two independent risk factors for in-hospital death: sequential organ failure assessment score(P=0.019, RR 1.355, 95%CI 1.051–1.747, B=0.304, SE=0.130, Wald=50483) and sedation(P=0.041, RR 5.015, 95%CI 1.072–23.459, B=1.612, SE=0.787, Wald=4.195). Compared with the patients who had received no sedation, those who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and hospital, and an increased in-hospital mortality rate. The Kaplan-Meier method showed that patients who had received sedation had a lower 60-month survival rate than those who had received no sedation(76.7% vs. 88.9%, Log-rank test=3.630, P=0.057). Compared with the patients who had received deep sedation, those who had received daily interruption or light sedation showed a decreased in-hospital mortality rate(57.1% vs. 9.5%, P=0.008). The 60-month survival of the patients who had received deep sedation was signifi cantly lower than that of those who had daily interruption or light sedation(38.1% vs. 90.5%, Log-rank test=6.783, P=0.009).CONCLUSIONS: Sedation was associated with in-hospital death. The patients who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and in hospital, and an increased in-hospital mortality rate compared with the patients who did not receive sedation. Compared with daily interruption or light sedation, deep sedation increased the in-hospital mortality and decreased the 60-month survival for patients who had received sedation.展开更多
Background:Adrenal insufficiency(AI)is a wellknown cause of potentially life-threatening disorders.Defects at each level of the hypothalamic-pituitary-adrenal axis can impair adrenal function,leading to varying degree...Background:Adrenal insufficiency(AI)is a wellknown cause of potentially life-threatening disorders.Defects at each level of the hypothalamic-pituitary-adrenal axis can impair adrenal function,leading to varying degrees of glucocorticoid(GC)deficiency.Iatrogenic AI induced by exogenous GCs is the most common cause of AI.The criteria for the diagnosis and management of iatrogenic AI,neonatal AI,and critical illness-related corticosteroid insuffi ciency(CIRCI)are not clear.Data sources:We reviewed the recent original publications and classical data from the literature,as well as the clinical,diagnostic and management strategies of pediatric AI.Results:Practical points in the diagnosis and management of AI with an emphasis on iatrogenic AI,neonatal AI,and CIRCI are provided.Given the lack of sensitive and practical biochemical tests for diagnosis of subtle AI,GC treatment has to be tailored to highly suggestive clinical symptoms and signs.Treatment of adrenal crisis is well standardized and patients almost invariably respond well to therapy.It is mainly the delay in treatment that is responsible for mortality in adrenal crisis.Conclusion:Education of patients and health care professionals is mandatory for timely interventions for patients with adrenal crisis.展开更多
基金supported by grants from the National Natural Science Foundation of China(82241052)Natural Science Foundation of Xizang Autonomous Region(XZZR202402133[W])Peking University People’s Hospital Scientifi c Research Development Funds(RDJP2023-29).
文摘BACKGROUND:The nonspecifi c clinical presentation of adrenal insuffi ciency(AI)frequently leads to misdiagnosis,often as psychiatric or gastrointestinal disorders.AI is classifi ed anatomically as primary AI(PAI),secondary AI(SAI),or tertiary AI(TAI).Without timely recognition,progression to adrenal crisis(AC)can result in life-threatening outcomes.This study aimed to systematically analyze the clinical features,etiologies,and outcomes of AI in Lhasa’s emergency population to improve diagnostic accuracy and optimize clinical management.METHODS:A retrospective analysis of emergency department admissions from January 2020 to August 2024 at People’s Hospital of Xizang Autonomous Region was conducted.AI diagnoses were identifi ed via International Classifi cation of Diseases,Tenth Revision,Clinical Modifi cation(ICD-10-CM)codes from electronic health records(EHR).Patients were grouped into incipient AC(IAC)or AC cohorts based on hemodynamic status.Demographic profi les,etiologies,clinical presentations,and laboratory results were analyzed.RESULTS:Forty-three AI patients were identifi ed.The population-standardized admission rate for AI increased from 9 to 16 per million person-years,with PAI cases doubling during this period.Adrenal tuberculosis(58.1%)and adrenal hematoma(18.6%)were the leading etiologies.Compared to the IAC group,the AC group demonstrated lower systolic blood pressure(SBP)(P=0.001)and diastolic blood pressure(DBP)(P<0.001);higher neutrophil count(P=0.048),eosinophil count(P=0.044),CRP(P=0.004),blood urea nitrogen(BUN)(P=0.007);lower sodium(P<0.001)and glucose levels(P=0.001).The hospital stay was longer in the AC group(20 d vs.14 d;P<0.001).CONCLUSION:AI incidence is rising in high-altitude regions,with adrenal tuberculosis remaining the most common cause.AC is associated with increased inflammatory responses,hemodynamic instability,and metabolic disturbances.Targeted interventions are required to improve outcomes.
基金a grant from the National Clinical Specialty Construction Project of China(2013-544).
文摘BACKGROUND:Neuroendocrine dysfunction after traumatic brain injury(TBI)has received increased attention due to its impact on the recovery of neural function.The purpose of this study is to investigate the incidence and risk factors of adrenocortical insuffi ciency(AI)after TBI to reveal independent predictors and build a prediction model of AI after TBI.METHODS:Enrolled patients were grouped into the AI and non-AI groups.Fourteen preset impact factors were recorded.Patients were regrouped according to each impact factor as a categorical variable.Univariate and multiple logistic regression analyses were performed to screen the related independent risk factors of AI after TBI and develop the predictive model.RESULTS:A total of 108 patients were recruited,of whom 34(31.5%)patients had AI.Nine factors(age,Glasgow Coma Scale[GCS]score on admission,mean arterial pressure[MAP],urinary volume,serum sodium level,cerebral hernia,frontal lobe contusion,diff use axonal injury[DAI],and skull base fracture)were probably related to AI after TBI.Three factors(urinary volume[X4],serum sodium level[X5],and DAI[X8])were independent variables,based on which a prediction model was developed(logit P=-3.552+2.583X4+2.235X5+2.269X8).CONCLUSIONS:The incidence of AI after TBI is high.Factors such as age,GCS score,MAP,urinary volume,serum sodium level,cerebral hernia,frontal lobe contusion,DAI,and skull base fracture are probably related to AI after TBI.Urinary volume,serum sodium level,and DAI are the independent predictors of AI after TBI.
文摘BACKGROUND: The present study aimed to determine the short-term and long-term outcomes of critically ill patients with acute respiratory insuffi ciency who had received sedation or no sedation.METHODS: The data of 91 patients who had received mechanical ventilation in the first 24 hours between November 2008 and October 2009 were retrospectively analyzed. These patients were divided into two groups: a sedation group(n=28) and a non-sedation group(n=63). The patients were also grouped in two groups: deep sedation group and daily interruption and /or light sedation group.RESULTS: Overall, the 91 patients who had received ventilation ≥48 hours were analyzed. Multivariate analysis demonstrated two independent risk factors for in-hospital death: sequential organ failure assessment score(P=0.019, RR 1.355, 95%CI 1.051–1.747, B=0.304, SE=0.130, Wald=50483) and sedation(P=0.041, RR 5.015, 95%CI 1.072–23.459, B=1.612, SE=0.787, Wald=4.195). Compared with the patients who had received no sedation, those who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and hospital, and an increased in-hospital mortality rate. The Kaplan-Meier method showed that patients who had received sedation had a lower 60-month survival rate than those who had received no sedation(76.7% vs. 88.9%, Log-rank test=3.630, P=0.057). Compared with the patients who had received deep sedation, those who had received daily interruption or light sedation showed a decreased in-hospital mortality rate(57.1% vs. 9.5%, P=0.008). The 60-month survival of the patients who had received deep sedation was signifi cantly lower than that of those who had daily interruption or light sedation(38.1% vs. 90.5%, Log-rank test=6.783, P=0.009).CONCLUSIONS: Sedation was associated with in-hospital death. The patients who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and in hospital, and an increased in-hospital mortality rate compared with the patients who did not receive sedation. Compared with daily interruption or light sedation, deep sedation increased the in-hospital mortality and decreased the 60-month survival for patients who had received sedation.
文摘Background:Adrenal insufficiency(AI)is a wellknown cause of potentially life-threatening disorders.Defects at each level of the hypothalamic-pituitary-adrenal axis can impair adrenal function,leading to varying degrees of glucocorticoid(GC)deficiency.Iatrogenic AI induced by exogenous GCs is the most common cause of AI.The criteria for the diagnosis and management of iatrogenic AI,neonatal AI,and critical illness-related corticosteroid insuffi ciency(CIRCI)are not clear.Data sources:We reviewed the recent original publications and classical data from the literature,as well as the clinical,diagnostic and management strategies of pediatric AI.Results:Practical points in the diagnosis and management of AI with an emphasis on iatrogenic AI,neonatal AI,and CIRCI are provided.Given the lack of sensitive and practical biochemical tests for diagnosis of subtle AI,GC treatment has to be tailored to highly suggestive clinical symptoms and signs.Treatment of adrenal crisis is well standardized and patients almost invariably respond well to therapy.It is mainly the delay in treatment that is responsible for mortality in adrenal crisis.Conclusion:Education of patients and health care professionals is mandatory for timely interventions for patients with adrenal crisis.
