Haofeng Xiong

Corrigendum for the article The Predictive Value of Nomogram Model Based on Neutrophil-to-Lymphocyte Ratio (NLR) and Prothrombin Time-International Normalized Ratio (PT-INR)-to-Albumin Ratio (PTAR) for Early Bacterial Intra-Abdominal Infection After Orthotopic Liver Transplantation

BACKGROUND Orthotopic liver transplantation is the primary treatment for end-stage liver disease; however, postoperative infections, especially those caused by carbapenem-resistant Acinetobacter baumannii (CRAB), remain a major cause of mortality due to limited therapeutic options. Sulbactam-durlobactam (SUL-DUR), a novel b-lactam/b-lactamase inhibitor combination, has shown potent activity against CRAB. This report describes the first reported use of SUL-DUR in a liver transplant recipient with CRAB pneumonia and sepsis. CASE REPORT A 22-year-old woman with acute liver failure underwent auxiliary liver transplantation. Postoperatively, she developed CRAB pneumonia and septicemia confirmed by imaging, bronchoscopy, and metagenomic next-generation sequencing. She received combination therapy with SUL-DUR (1 g/1 g every 8 h), meropenem, eravacycline, and neutralized polymyxin B. Blood and sputum cultures confirmed CRAB susceptibility to SUL-DUR. Following treatment, inflammatory markers (CRP, IL-6, PCT) and pathogen loads markedly decreased, leading to complete clinical resolution without significant adverse effects. The patient was successfully discharged after rehabilitation. CONCLUSIONS SUL-DUR demonstrated excellent efficacy and safety in treating CRAB pneumonia and sepsis after liver transplantation. This case supports Phase III trial data and suggests the potential for use in high-risk, immunocompromised populations. Further studies are warranted to validate its clinical role and inform future guidelines for multidrug-resistant infections.

Purpose: To identify risk factors for bacterial intra-abdominal infections (IAIs) after orthotopic liver transplantation (OLT) and establish a nomogram prediction model based on preoperative neutrophil-to-lymphocyte ratio (NLR) and preoperative prothrombin time-international normalized ratio (PT-INR)-to-albumin ratio (PTAR). Patients and Methods: We retrospectively analyzed 261 patients who received OLT between January 2020 and April 2024 in Beijing Friendship Hospital. Independent risk factors for bacterial IAIs within 30 days postoperatively were identified by logical regression analysis. The area under the receiver operating characteristic (ROC) curve (AUC) was calculated to evaluate the predictive performance of NLR and PTAR as well as the nomogram model based on them. Hepatic function was evaluated using the Child–Turcotte–Pugh (CTP) score and the Model for End-Stage Liver Disease (MELD) score. Results: Fifty patients (19.2%, 50/261) developed postoperative bacterial IAIs. The majority of the 66 isolated strains were gram-negative (63.6%). Most infections (74.0%, 37/50) occurred within two weeks postoperatively. Multivariate logistic regression analysis identified preoperative NLR, preoperative PTAR, acute physiology and chronic health evaluation II (APACHE II) score, and biliary leakage as independent risk factors. A nomogram-based prediction model was constructed utilizing the identified independent risk factors. Internal validation was conducted through the bootstrap method. The Hosmer–Lemeshow test indicated no significant deviation from the goodness-of-fit (χ² = 7.349, P = 0.499 > 0.05). The calibration curve indicated excellent concordance between predicted and observed outcomes. The nomogram exhibited strong discriminative capability, evidenced by a C-index of 0.900 (95% CI: 0.828– 0.972) and an AUC of 0.912 (95% CI: 0.864– 0.960) for predicting abdominal infection, with an optimal diagnostic threshold of 0.221 (95% CI: 0.125– 0.265). Decision curve analysis revealed a positive net benefit across a wide range of threshold probabilities (0.03– 1.0), indicating the model’s substantial clinical utility. Conclusion: Both the preoperative NLR and the preoperative PTAR are independent risk factors for IAIs within 30 days after OLT. The nomogram model based on NLR and PTAR can effectively predict the occurrence of IAIs after OLT.

Purpose: To examine the clinical utility of metagenomic next-generation sequencing (mNGS) in individuals with early pulmonary infection following liver transplantation. Patients and Methods: mNGS and traditional detection results were retrospectively collected from 99 patients with pulmonary infection within one week following liver transplantation. These patients were admitted to the Department of Critical Liver Diseases at Beijing Friendship Hospital from February 2022 to February 2024, along with their general clinical data. Results: mNGS exhibited a significantly higher detection rate than traditional methods (92.93% vs 54.55%, P < 0.05) and was more effective in identifying mixed infections (67.68% vs 14.81%, P < 0.05). mNGS identified 303 pathogens in 92 patients, with Enterococcus faecium, Pneumocystis jirovecii, and human herpesvirus types 5 and 7 being the most prevalent bacteria, fungi, and viruses. A total of 26 positive cases were identified through traditional culture methods (sputum and bronchoalveolar lavage fluid), with 18 cases consistent with mNGS detection results, representing 69.23% consistency. Among the three drug-resistant bacteria that showed positivity in mNGS and traditional culture, the presence of drug-resistance genes—mecA in Staphylococcus aureus; KPC-2, KPC-9, KPC-18, KPC-26, OXA27, OXA423 in Klebsiella pneumoniae; and OXA488 and NDM6 in Pseudomonas aeruginosa—reliably predicted drug-resistance phenotype. The treatment regimen for 76 of the 92 patients with positive mNGS relied on these results; 74 exhibited significant symptom improvement, yielding a 97.37% recovery rate. The overall prognosis was favorable. Conclusion: mNGS offers rapid detection, a high positivity rate, insensitivity to antibiotics, and a superior ability to detect mixed infections in patients with early post-transplant pulmonary infections. Additionally, mNGS shows good consistency with traditional culture and can predict drug-resistant phenotypes to guide targeted antibiotic therapy for early-stage post-transplant pulmonary infection after liver transplantation. Patients whose antibiotic therapy is based on mNGS results have experienced decreased mortality rates and overall improved prognosis.

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Corrigendum to “Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study”: undefined

Background: Acute kidney injury (AKI) is a common complication among human immunodeficiency virus (HIV)-infected patients resulting in increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in Intensive Care Unit (ICU) and explore the influence factors correlated with CRRT and their prognosis.Methods: We performed a retrospective case-control study in the ICU of the Beijing Ditan Hospital Capital Medical University. From June 1, 2005 to May 31, 2017, 225 cases were enrolled in this clinical study.Results: 122 (54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1, 2 and 3 were 38 (31.1%), 21(17.2%) and 63(51.7%), respectively. 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By univariate logistics analysis, it showed that higher likelihood of diagnosis for respiratory failure (OR = 7.333,95% CI 1.467–36.664,p = 0.015), higher likelihood of diagnosis for septic shock (OR = 1.005,95% CI 1.001–1.01,p = 0.018), and higher likelihood to use vasoactive agents (OR = 10.667,95% CI 1.743–65.271,p = 0.001), longer mechanical ventilation duration (OR = 1.011,95% CI 1.002–1.019,p = 0.011), higher likelihood for diagnosis for PCP (OR = 7.50,95% CI 1.288–43.687,p = 0.025), higher SOFA score at ICU admission (OR = 1.183,95% CI 1.012–1.383,p = 0.035), longer duration of CRRT (OR = 1.014,95% CI 1.001–1.028,p = 0.034) contributed to a higher mortality at ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p = 0.595).Conclusions: There is a high incidence of AKI in HIV-infected patients admitted in our ICU. Patients with severe AKI were more prone to be admitted for CRRT and have a consequent poor prognosis.

Background: Acute kidney injury (AKI) is a common complication among human immunodeficiency virus (HIV)-infected patients resulting in increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in Intensive Care Unit (ICU) and explore the influence factors correlated with CRRT and their prognosis. Methods: We performed a retrospective case-control study in the ICU of the Beijing Ditan Hospital Capital Medical University. From June 1, 2005 to May 31, 2017, 225 cases were enrolled in this clinical study. Results: 122 (54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1, 2 and 3 were 38 (31.1%), 21(17.2%) and 63(51.7%), respectively. 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By univariate logistics analysis, it showed that higher likelihood of diagnosis for respiratory failure (OR=7.333,95% CI 1.467-36.664, p=0.015), higher likelihood of diagnosis for septic shock (OR=1.005,95% CI 1.001-1.01, p=0.018), and higher likelihood to use vasoactive agents (OR=10.667,95% CI 1.743-65.271, p=0.001), longer mechanical ventilation duration (OR=1.011,95% CI 1.002-1.019, p=0.011), higher likelihood for diagnosis for PCP (OR=7.50,95% CI 1.288-43.687, p=0.025), higher SOFA score at ICU admission (OR=1.183,95% CI 1.012-1.383, p=0.035), longer duration of CRRT (OR=1.014,95% CI 1.001-1.028, p=0.034) contributed to a higher mortality at ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p =0.595).Conclusion: There is a high incidence of AKI in HIV-infected patients admitted in our ICU. Patients with severe AKI were more prone to be admitted for CRRT and have a consequent poor prognosis.

Background :AKI is a common complication among human immunodeficiency virus (HIV)--infecting patients and resulting in increased morbidity and mortality. CRRT is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in ICU and explore the influence factors correlated with CRRT and prognosis.Methods: We performed a retrospective case-control study, in ICU of Beijing Ditan Hospital Capital Medical University, which is a top three hospital majoring in infectious diseases. From June 1,2005 to May 31,2017, 225 cases were enrolled in this research eventually.Results: 122(54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1/2/3 were respectively 38(31.1%)/23(18.9%)/61(50%). 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By multivariate logistics analysis, it showed that the use of vasoactive agents (OR=174.31,95% CI 1.743-65.271, p=0.018), diagnosis of PCP(OR=27.136,95% CI 1.855-397.066, p=0.016) and longer duration of CRRT (OR=1.034,95% CI 1.004-1.065, p=0.028) were independent risk factors for predicting patients’ death of CRRT in ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p =0.309).Conclusions: The incidence of AKI was 54.2% in HIV-infected patients admitted to the ICU, and about 26.2% AKI patients received CRRT during the stay of ICU.56.25%CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. The use of vasoactive agents, diagnosis of PCP were independent risk factors for predicting patients’ death of CRRT in ICU. The cumulative survival of AKI 3 patients between CRRT and non-CRRT groups shows no significant differences.

Background: Severe ill patients with 2019 novel coronavirus (2019-nCoV) infection progressed rapidly to acute respiratory failure. We aimed to select the most useful prognostic factor for severe illness incidence. Methods: The study prospectively included 61 patients with 2019-nCoV infection treated at Beijing Ditan Hospital from January 13, 2020 to January 31, 2020. Prognostic factor of severe illness was selected by the LASSO COX regression analyses, to predict the severe illness probability of 2019-CoV pneumonia. The predictive accuracy was evaluated by concordance index, calibration curve, decision curve and clinical impact curve. Results: The neutrophil-to-lymphocyte ratio (NLR) was identified as the independent risk factor for severe illness in patients with 2019-nCoV infection. The NLR had a c-index of 0.807 (95% confidence interval, 0.676–0.38), the calibration curves fitted well, and the decision curve and clinical impact curve showed that the NLR had superior standardized net benefit. In addition, the incidence of severe illness was 9.1% in age ≥ 50 and NLR < 3.13 patients, and half of patients with age ≥ 50 and NLR ≥ 3.13 would develop severe illness. Based on the risk stratification of NLR with age, the study developed a 2019-nCoV pneumonia management process. Conclusions: The NLR was the early identification of risk factors for 2019-nCoV severe illness. Patients with age ≥ 50 and NLR ≥ 3.13 facilitated severe illness, and they should rapidly access to intensive care unit if necessary.