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Purpose Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections have been increasingly reported worldwide. We aimed to identify the risk factors for nosocomial CRKP infections and assess the clinical outcomes. Patients and Methods We conducted a case-control study with data collected from January 2016 to December 2018 in China. Controls were selected at a ratio of 1:1 from patients with nosocomial carbapenem-susceptible Klebsiella pneumonia (CSKP) infections. Risk factors for nosocomial CRKP infections and clinical outcomes were assessed with univariate and multivariate analyses. Results A total of one hundred forty-two patients with CRKP infections and one hundred forty-two patients with CSKP infections were enrolled in this study. Multivariate analysis showed that exposure to antibiotics within 3 months prior to admission (odds ratio OR, 2.585; 95% confidence interval [CI], 1.425–4.691; P=0.002), exposure to carbapenems (OR, 2.532; 95% CI, 1.376–4.660; P=0.003), exposure to fluoroquinolones (OR, 3.309; 95% CI, 1.326–8.257; P=0.010), and the presence of a nasogastric tube (OR, 2.796; 95% CI, 1.369–5.712; P=0.005) were independent risk factors for CRKP infections. The 30-day mortality rate in the CRKP group was 19.7%, while the in-hospital mortality rate was 28.9%. In the CRKP group, a higher creatinine level (OR, 1.009; 95% CI, 1.002–1.016; P = 0.013), being in shock at the time of a positive culture (OR, 4.454; 95% CI, 1.374–14.443; P = 0.013), and co-infection with other resistant bacteria (OR, 4.799; 95% CI, 1.229–18.740; P = 0.024) were independent predictors of in-hospital mortality in patients with CRKP infections. Kaplan–Meier curves showed that the CRKP group had a shorter survival time than the CSKP group. Conclusion Nosocomial CRKP infection was associated with exposure to carbapenems and fluoroquinolones within 3 months prior to hospitalization and the presence of a nasogastric tube. Patients infected with CRKP had higher 30-day and in-hospital mortality rates. A higher creatinine level, shock and co-infection with other resistant bacteria were independent predictors of in-hospital mortality in patients with CRKP infections.

Background. The present study aimed to investigate the prognostic value of serum ferritin in critically ill patients with sepsis by using the MIMIC-IV database. Methods. Data were extracted from the MIMIC-IV database. Adult patients who met the sepsis-3 criteria and had the test of ferritin were included. Patients were divided into subgroups according to the initial serum ferritin. The association between initial serum ferritin and in-hospital mortality was performed by using Lowessregression, logistic regression, and ROC analysis. Subgroup analysis was used to search for the interacting factors and verify the robustness of the results. Results. Analysis of the 2,451 patients revealed a positive linear relationship between serum ferritin and in-hospital mortality. Patients with high-ferritin had a higher risk of in-hospital mortality, but no significant association was found in the low-ferritin subgroup compared with those whose ferritin was in the normal reference range. Serum ferritin had moderate predictive power for in-hospital mortality (AUC = 0.651), with an optimal cut-off value of 591.5 ng/ml. Ferritin ≥591.5 ng/ml acted as an independent prognostic predictor of in-hospital mortality, which increased the risk of in-hospital mortality by 119%. Our findings were still robust in subgroup analysis, and acute kidney injury and anemia were considered interactive factors. Conclusion. High-level serum ferritin was an independent prognostic marker for the prediction of mortality in patients with sepsis. Further high-quality research is needed to confirm the relationship between ferritin and the prognosis of septic patients.

Background: A large number of recent studies have confirmed that the pulse oximetric saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio (SFR) correlate well with PaO2/FiO2 ratio (PFR). However, whether SFR can replace PFR for the diagnosis and evaluate the severity of ARDS patients with advanced respiratory support is unclearly. The purpose of this study is to explore potential value of SFR ratio as a new diagnostic tool for ARDS by establishing new processes in patients who require high levels of oxygen support.Methods: 341 patients were included in this study, SFR and PFR values were recorded in the same time. 161 patients were used to establish the model, and 180 patients were used to verify the validity of the model. 161 groups of data were divide into hypoxic group (group H) and non-hypoxic group (group N) according to whether SpO2 was greater than 97%. For group H, the regression equation was established to describe the relationship between SFR and PFR. and calculated the value of SFR when PFR is 300. For group N, the correlation between each observation data andPFR were analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of the index. Finally, a new diagnostic process was established for ARDS based on these results, and the reliability was verified with Berlin definition set as the gold standard for diagnosis and classification. Results: For group H, the diagnostic linear equation is PFR = 0.9162*SFR-21.39 ( R2=0.66 , P<0.0001 ). After calculation, when PFR is 300, SFR is 352. For group N, There is a significant negative correlation between FiO2 and PFR((R= -0.521,P<0.0001)). The AUC of using FiO2 to diagnose ARDS was 0.694 (95%CI 0.571~0.817, P ＜ 0.005). When the cutoff value of FiO2 was 39%, the sensitivity was 0.838 and the specificity was 0.545. Therefore, in this new diagnosis progress, when SpO2≤97%, if SFR≤352, ARDS may exist; when SpO2>97%, if FiO2min>39%, there may be ARDS. The sensitivity, specificity, NPV, PPV, and accuracy of the new diagnosis progress for ARDS were 91.1%, 76.7%, 89.6%, 79.6%, and 83.9%, respectively. Conclusion: There are potential value of SpO2 and FiO2 as a noninvasive diagnostic tool for ARDS by new processes in patients who are already receiving high levels of oxygen support.