BACKGROUND: It has been suggested that addition of obesity score to the APACHE-Ⅱ system can lead to more accurate prediction of severity of acute pancreatitis. However there is scanty information on the usefulness of...BACKGROUND: It has been suggested that addition of obesity score to the APACHE-Ⅱ system can lead to more accurate prediction of severity of acute pancreatitis. However there is scanty information on the usefulness of the combined APACHE-O scoring system in Asian patients. This study aimed to compare the accuracy of Ranson, APACHE-Ⅱ and APACHE-O systems in assessing severity of acute pancreatitis in a local Chinese population. METHODS: One hundred and one consecutive patients with acute pancreatitis were prospectively studied. Body mass index (BMI) was measured on admission. Ranson score, APACHE-Ⅱ and APACHE-O scores were recorded on admission and at 48 hours. By adopting the cut-off levels and definitions advocated in the Atlanta consensus for severe disease, the diagnostic accuracy of the three scoring systems was compared by the area under the curve (AUC) under the receiver operator characteristic curve. RESULTS: Of the 101 patients, 12 (11.9%) patients suffered from severe pancreatitis. Obesity was uncommon and only two patients (2.0%) had BMI >30. Eighty-two (81.2%) patients were normal weight (BMI≤25) whereas 17 (16.8%) were overweight ( BMI 25-30 ). Overweight or obesity (BMI >25) was not associated with severe pancreatitis (P= 0.40). The AUC for admission scores of Ranson, APACHE-Ⅱ, and APACHE-O systems was 0. 549, 0. 904 and 0. 904, respectively. The AUC for 48-hour scores of Ranson, APACHE-Ⅱ and APACHE-O systems was 0.808, 0.955 and 0.951, respectively. CONCLUSIONS: The APACHE-Ⅱ scoring system is more accurate than the Ranson scoring system of the prediction of severity in acute pancreatitis. Addition of obesity score does not significantly improve the predictive accuracy of the APACHE-Ⅱ system in our local population with a low prevalence of obesity.展开更多
Background:Aspirin has demonstrated safety and efficacy for venous thromboembolism(VTE)prophylaxis following total hip arthroplasty(THA);however,inconsistent dose regimens have been reported in the literature.This stu...Background:Aspirin has demonstrated safety and efficacy for venous thromboembolism(VTE)prophylaxis following total hip arthroplasty(THA);however,inconsistent dose regimens have been reported in the literature.This study aimed to evaluate and compare the safety and efficacy of 100 mg aspirin twice daily with rivaroxaban in VTE prophylaxis following THA.Methods:Patients undergoing elective unilateral primary THA between January 2019 and January 2020 were prospectively enrolled in the study and randomly allocated to receive 5 weeks of VTE prophylaxis with either oral enteric-coated aspirin(100 mg twice daily)or rivaroxaban(10 mg once daily).Medication safety and efficacy were comprehensively evaluated through symptomatic VTE incidence,deep vein thrombosis(DVT)on Doppler ultrasonography,total blood loss(TBL),laboratory bloodwork,Harris hip score(HHS),post-operative recovery,and the incidence of other complications.Results:We included 70 patients in this study;34 and 36 were allocated to receive aspirin and rivaroxaban prophylaxis,respectively.No cases of symptomatic VTE occurred in this study.The DVT rate on Doppler ultrasonography in the aspirin group was not significantly different from that in the rivaroxaban group(8.8%vs.8.3%,χ^(2)=0.01,P=0.91),confirming the non-inferiority of aspirin for DVT prophylaxis(χ^(2)=2.29,P=0.01).The calculated TBL in the aspirin group(944.9 mL[658.5-1137.8 mL])was similar to that in the rivaroxaban group(978.3 mL[747.4-1740.6mL])(χ^(2)=1.55,P=0.12).However,there were no significant inter-group differences in HHS at post-operative day(POD)30(Aspirin:81.0[78.8-83.0],Rivaroxaban:81.0[79.3-83.0],χ^(2)=0.43,P=0.67)and POD 90(Aspirin:90.0[89.0-92.0],Rivaroxaban:91.5[88.3-92.8],χ^(2)=0.77,P=0.44),the incidence of bleeding events(2.9%vs.8.3%,χ^(2)=0.96,P=0.33),or gastrointestinal complications(2.9%vs.5.6%,χ^(2)=1.13,P=0.29).Conclusion:In terms of safety and efficacy,the prophylactic use of 100 mg aspirin twice daily was not statistically different from that of rivaroxaban in preventing VTE and reducing the risk of blood loss following elective primary THA.This supports the use of aspirin chemoprophylaxis following THA as a less expensive and more widely available option for future THAs.Trial Registration:Chictr.org,ChiCTR18000202894;http://www.chictr.org.cn/showproj.aspx?proj=33284.展开更多
文摘BACKGROUND: It has been suggested that addition of obesity score to the APACHE-Ⅱ system can lead to more accurate prediction of severity of acute pancreatitis. However there is scanty information on the usefulness of the combined APACHE-O scoring system in Asian patients. This study aimed to compare the accuracy of Ranson, APACHE-Ⅱ and APACHE-O systems in assessing severity of acute pancreatitis in a local Chinese population. METHODS: One hundred and one consecutive patients with acute pancreatitis were prospectively studied. Body mass index (BMI) was measured on admission. Ranson score, APACHE-Ⅱ and APACHE-O scores were recorded on admission and at 48 hours. By adopting the cut-off levels and definitions advocated in the Atlanta consensus for severe disease, the diagnostic accuracy of the three scoring systems was compared by the area under the curve (AUC) under the receiver operator characteristic curve. RESULTS: Of the 101 patients, 12 (11.9%) patients suffered from severe pancreatitis. Obesity was uncommon and only two patients (2.0%) had BMI >30. Eighty-two (81.2%) patients were normal weight (BMI≤25) whereas 17 (16.8%) were overweight ( BMI 25-30 ). Overweight or obesity (BMI >25) was not associated with severe pancreatitis (P= 0.40). The AUC for admission scores of Ranson, APACHE-Ⅱ, and APACHE-O systems was 0. 549, 0. 904 and 0. 904, respectively. The AUC for 48-hour scores of Ranson, APACHE-Ⅱ and APACHE-O systems was 0.808, 0.955 and 0.951, respectively. CONCLUSIONS: The APACHE-Ⅱ scoring system is more accurate than the Ranson scoring system of the prediction of severity in acute pancreatitis. Addition of obesity score does not significantly improve the predictive accuracy of the APACHE-Ⅱ system in our local population with a low prevalence of obesity.
基金supported by the National Nature Science Foundation in China(No.81871740).
文摘Background:Aspirin has demonstrated safety and efficacy for venous thromboembolism(VTE)prophylaxis following total hip arthroplasty(THA);however,inconsistent dose regimens have been reported in the literature.This study aimed to evaluate and compare the safety and efficacy of 100 mg aspirin twice daily with rivaroxaban in VTE prophylaxis following THA.Methods:Patients undergoing elective unilateral primary THA between January 2019 and January 2020 were prospectively enrolled in the study and randomly allocated to receive 5 weeks of VTE prophylaxis with either oral enteric-coated aspirin(100 mg twice daily)or rivaroxaban(10 mg once daily).Medication safety and efficacy were comprehensively evaluated through symptomatic VTE incidence,deep vein thrombosis(DVT)on Doppler ultrasonography,total blood loss(TBL),laboratory bloodwork,Harris hip score(HHS),post-operative recovery,and the incidence of other complications.Results:We included 70 patients in this study;34 and 36 were allocated to receive aspirin and rivaroxaban prophylaxis,respectively.No cases of symptomatic VTE occurred in this study.The DVT rate on Doppler ultrasonography in the aspirin group was not significantly different from that in the rivaroxaban group(8.8%vs.8.3%,χ^(2)=0.01,P=0.91),confirming the non-inferiority of aspirin for DVT prophylaxis(χ^(2)=2.29,P=0.01).The calculated TBL in the aspirin group(944.9 mL[658.5-1137.8 mL])was similar to that in the rivaroxaban group(978.3 mL[747.4-1740.6mL])(χ^(2)=1.55,P=0.12).However,there were no significant inter-group differences in HHS at post-operative day(POD)30(Aspirin:81.0[78.8-83.0],Rivaroxaban:81.0[79.3-83.0],χ^(2)=0.43,P=0.67)and POD 90(Aspirin:90.0[89.0-92.0],Rivaroxaban:91.5[88.3-92.8],χ^(2)=0.77,P=0.44),the incidence of bleeding events(2.9%vs.8.3%,χ^(2)=0.96,P=0.33),or gastrointestinal complications(2.9%vs.5.6%,χ^(2)=1.13,P=0.29).Conclusion:In terms of safety and efficacy,the prophylactic use of 100 mg aspirin twice daily was not statistically different from that of rivaroxaban in preventing VTE and reducing the risk of blood loss following elective primary THA.This supports the use of aspirin chemoprophylaxis following THA as a less expensive and more widely available option for future THAs.Trial Registration:Chictr.org,ChiCTR18000202894;http://www.chictr.org.cn/showproj.aspx?proj=33284.
