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Characteristics of the Cerebrospinal Fluid in Septic Patients with Critical Illness Polyneuropathy - A Retrospective Cohort Study

Yanyang Zhang

Yanyang Zhang

Beijing, China
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Zhang, Yanyang
, 
Jinfu Ma

Jinfu Ma

Beijing, China
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Ma, Jinfu
, 
Qing Zhao

Qing Zhao

Beijing, China
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Zhao, Qing
 y 
Hui Liu

Hui Liu

Beijing, China
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Liu, Hui
  
30 abr 2024
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Categoría del artículo: Research Article
Publicado en línea: 30 abr 2024
Páginas: 130 - 138
Recibido: 13 feb 2024
Aceptado: 13 abr 2024
DOI: https://doi.org/10.2478/jccm-2024-0018
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© 2024 Yanyang Zhang et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Workflow of enrollment. In total, 116 septic patients with CIP and 59 patients without CIP were included. CIP, critical illness polyneuropathy.
Workflow of enrollment. In total, 116 septic patients with CIP and 59 patients without CIP were included. CIP, critical illness polyneuropathy.

Fig. 2.

Survival analysis was conducted before and after PSMA. A. Survival analysis before PSMA; the 28-day mortality was higher in the CIP group than in the non-CIP group (P = 0.02). B. Survival analysis after PSMA; no significant difference was found between the CIP and non-CIP groups (P = 0.4). CIP, critical illness polyneuropathy; PSMA, propensity score matching analysis.
Survival analysis was conducted before and after PSMA. A. Survival analysis before PSMA; the 28-day mortality was higher in the CIP group than in the non-CIP group (P = 0.02). B. Survival analysis after PSMA; no significant difference was found between the CIP and non-CIP groups (P = 0.4). CIP, critical illness polyneuropathy; PSMA, propensity score matching analysis.

Fig. 3.

ROC analysis of three indicators and their combined mode used in the diagnosis of CIP. The AUCs of IL1, TNF-α, WBC, and IL1+ TNFa + WBC, were 0.878, 0.867, 0.843, and 0.926. ROC, receiver operating characteristic; AUC, area under curve; CIP, critical illness polyneuropathy; CSF, cerebrospinal fluid; IL, interleukin; TNF, tumor necrosis factor; WBC, white blood cell.
ROC analysis of three indicators and their combined mode used in the diagnosis of CIP. The AUCs of IL1, TNF-α, WBC, and IL1+ TNFa + WBC, were 0.878, 0.867, 0.843, and 0.926. ROC, receiver operating characteristic; AUC, area under curve; CIP, critical illness polyneuropathy; CSF, cerebrospinal fluid; IL, interleukin; TNF, tumor necrosis factor; WBC, white blood cell.

CSF Measurement in Septic Participants Before and After PSMA

Characteristics Before PSM After PSM
All (n=175) CIP (n=116) Non-CIP (n=59) P All (n = 118) CIP (n=59) Non-CIP (n=59) P
Age (year) 57.4±15.1 57.7±15.0 56.9±15.4 0.76 57.3±15.3 57.7±15.4 56.9±15.4 0.79
SOFA 10.8±4.5 11.5±4.6 9.2±4.0 <0.01 9.5±4.1 9.7±4.3 9.2±4.0 0.52
APACHE II 18.1±5.8 19.0±5.9 16.4±5.1 <0.01 16.5±5.0 16.7±4.9 16.4±5.1 0.77
Lactate (mmol/L) 6.7±4.1 7.5±4.2 5.2±3.4 <0.01 5.5±3.5 5.8±3.7 5.2±3.4 0.41
Diabete history 67 39 28 0.11 56 29 27 0.85
CSF
Glucose (mmol/L) 3.98±1.11 3.98±1.12 3.96±1.10 0.99 4.0±1.2 4.1±1.2 4.0±1.1 0.69
Protein (mg/L) 1369.3±841.0 1705.8±744.2 707.6±593.2 <0.01 1123.5±772.1 1539.4±706.2 707.6±593.2 <0.01
Cl-(mmol/L) 123.4±4.9 123.0±5.0 124.1±4.7 0.16 123.9±5.0 123.7±5.3 124.1±4.7 0.62
WBC (× 106/L) 3.2±1.6 4.0±1.5 1.5±0.8 <0.01 2.8±1.6 4.0±1.2 1.5±0.8 <0.01
Lipopolysaccharide (eu/mL) 0 0 0 NA 0 0 0 NA
fungus 0 0 0 NA 0 0 0 NA
bacteria 0 0 0 NA 0 0 0 NA
Interleukin-1 (pg/m L) 23.0±12.6 29.4±10.0 10.5±5.8 <0.01 20.0±12.3 29.4±9.5 10.5±5.8 <0.01
Interleukin-6 (pg/m L) 1089.9±526.4 1264.1±429.0 747.3±535.1 <0.01 993.9±534.7 1240.4±408.5 747.3±535.1 <0.01
Interleukin-8 (pg/mL) 9558.9±4715.4 10949.5±3818.1 6824.7±5131.1 <0.01 8471.6±4838.6 10118.5±3921.8 6824.7±5131.1 <0.01
Tumor neucrosis factor-α (pg/mL) 17.7±7.2 21.7±4.1 9.9±5.2 <0.01 15.6±7.4 21.3±4.2 9.9±5.2 <0.01

Data of Electromyography

Variables Amplitude Decrease Conduction Velocity Decrease Abnormal Nerves
Motor Sensory Motor Sensory
Upper limb (n, %) 163 (93.1)
Median 57 (32.6) 106 (60.6) 27 (15.4) 15 (8.6)
Ulnar 55 (31.4) 52 (29.7) 26 (14.9) 50 (28.6)
Lower limb (n, %) 171 (97.7)
Tibial 72 (41.1) - 49 (28.0) -
Common peroneal 95 (54.3) - 58 (33.1) -
Sural NA 31 (17.7) - 11 (6.3)

ROC Analysis of 3 Indicators and Their Combined Mode in CSF

Variables Cut-off value AUC (95% CI) P Sensitivity (%) Specificity (%)
IL1 (pg/mL) 19.250 0.878 (0.815–0.941) <0.01 81.4 86.4
TNF-α (pg/mL) 17.050 0.867 (0.803–0.931) <0.01 76.3 83.1
WBC (× 106/L) 2.500 0.843 (0.772–0.914) <0.01 79.7 78.0
IL1+ TNFa + WBC 41.900 0.926 (0.879–0.974) <0.01 84.3 93.2

Demographics and Clinical Data

Characteristics CIP Patients Non-CIP Patients P
Counts 116 59
Cause of sepsis 0.77
Intestinal puncture or fistulation 21 (18.1) 10 (16.9)
Colon obstruction or fistulation 23 (19.8) 9 (15.3)
Pulmonary infection 16 (13.8) 9 (15.3)
Severe pancreatitis 9 (7.8) 3 (5.1)
Thoracic and mediastinum infection 7 (6.0) 2 (3.4)
Bile duct infection 3 (2.6) 3 (5.1)
Intrauterine infection 3 (2.6) 2 (3.4)
Diarrhea associated with antibiotics 7 (6.0) 6 (10.2)
Liver abscess 7 (6.0) 8 (13.6)
Spleen rupture and infection 6 (5.2) 2 (3.4)
Blood stream infection 14 (12.1) 5 (8.5)
General information
Age (years) 57.7±15.0 56.9±15.4 0.76
Female 49 (42.2) 32 (54.2) 0.13
Diabetes history 39 (33.6) 28 (47.5) 0.08
BMI (kg/m2) 21.7±4.2 20.8±3.7 0.17
Hemoglobin (g/L) 110.2±20.1 112.1±17.5 0.54
WBC (× 109/L) 10.8±2.9 10.5±3.1 0.54
Blood sugar (mmol/L) 8.1±3.3 7.8±3.7 0.59
Albumin (g/L) 27.4±7.9 28.3±7.3 0.47
Lactate (mmol/L) 7.5±4.2 5.2±3.4 <0.01
SOFA 11.5±4.6 9.2±4.0 <0.01
APACHE II 19.0±5.9 16.4±5.1 <0.01
Outcomes
MV assistance 67 22 0.01
Death in 28 days 29 6 0.02
ICU length of stay (day) 19.4±8.6 16.5±5.3 0.01
Hospital length of stay (day) 27.2±16.1 23.9±7.7 0.08

Conditional Logistical Regression Analysis

Variables β OR 95% CI Z value Wald chi-square values P
Lactate 0.083 1.087 0.941–1.256 1.13 1.27 0.26
SOFA 0.059 1.061 0.934–1.204 0.91 0.83 0.36
Age 0.004 1.004 0.979–1.03 0.29 0.08 0.78
CSF
Protein 0.001 1.001 0.998–1.004 0.46 0.21 0.64
WBC 2.688 14.696 2.204–98 2.78 7.71 0.006*
IL-1 0.337 1.401 1.089–1.801 2.62 6.88 0.009*
TNF-a 0.426 1.531 1.165–2.012 3.056 9.34 0.002*
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Temas de la revista:
Medicina, Medicina Clínica, Medicina Interna, Medicina Interna, otros, Anestesiología, Medicina de urgencias y cuidados intensivos, Cirugía, Cirugía, otros
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