ObjectiveThe role of platelet-to-lymphocyte ratio (PLR) as an indicator of inflammation has been the focus of research recently. We aimed to investigate theprognosticvalue of PLR for sepsis.DesignA retrospective cohort study.Setting and participantsData were extracted from the Multiparameter Intelligent Monitoring in Intensive Care III database. Data on 5537 sepsis patients were analysed.MethodsLogistic regression was used to explore the association between PLR and hospital mortality. Subgroup analyses were performed based on vasopressor use, acute kidney injury (AKI) and a Sequential Organ Failure Assessment (SOFA) score >10.ResultsIn the logistic model with linear spline function, a PLR >200 was significantly (OR 1.0002; 95% CI 1.0001 to 1.0004) associated with mortality; the association wasnon-significantfor PLRs ≤200 (OR 0.997; 95% CI 1.19 to 1.67). In the logistic model using the PLR as a design variable, only high PLRs were significantly associated with mortality (OR 1.29; 95% CI 1.09 to 1.53); the association with low PLRs wasnon-significant(OR 1.15; 95% CI 0.96 to 1.38). In the subgroups with vasopressor use, AKI and a SOFA score >10, the association between high PLR and mortality wasnon-significant; this remained significant in the subgroups without vasopressor use (OR 1.39; 95% CI 1.08 to 1.77) and AKI (OR 1.54; 95% CI 1.20 to 1.99) and with a SOFA score ≤10 (OR 1.51; 95% CI 1.17 to 1.94).ConclusionsHigh PLRs at admission were associated with an increased risk of mortality. In patients with vasopressor use, AKI or a SOFA score >10, this association wasnon-significant.

ObjectivesThis research aims to explore the association between serum osmolarity and mortality in patients who are critically ill with specific categories of disease.DesignA retrospective cohort study.Setting and participantsData were extracted from an online database named ‘Multiparameter Intelligent Monitoring in Intensive Care II’. 16 598 patients were included.MethodsPatients were divided into six disease subgroups based on the diagnosis at admission: cardiac, cerebral, vascular, gastrointestinal, respiratory and non-respiratory. The association between maximum osmolarity (osmolaritymax) and hospital mortality in each subgroup was evaluated using osmolaritymax as a design variable (six levels).ResultsAnalysis of the 16 598 patients revealed a ‘U’-shaped relationship between osmolarity and mortality with a threshold of 300 mmoL/L. For patients with non-respiratory disease, both hypo-osmolarity and hyperosmolaritymax were associated with increased mortality, with the OR increasing from osmolaritymax level 3 (OR: 1.98, 95% CI 1.69 to 2.33, p<0.001) to level 6 (OR: 4.45, 95% CI 3.58 to 5.53, p<0.001), using level 2 (290–309 mmoL/L) as the reference group. For patients with respiratory disease, however, neither hypo-osmolarity nor hyperosmolaritymax was significantly associated with mortality (levels 1 to 5) except for extreme hyperosmolaritymax (≥340 mmoL/L, OR: 2.03, 95% CI 1.20 to 3.42, p=0.007). ORs of mortality in the other four subgroups (cardiac, cerebral, vascular, gastrointestinal) were similar, with OR progressively increasing from level 3 to 6. In all six subgroups, vasopressin use was consistently associated with increased mortality.ConclusionsHyperosmolarity is associated with increased mortality in patients who are critically ill with cardiac, cerebral, vascular and gastrointestinal admission diagnoses, with thresholds at 300 mmoL/L. For patients with respiratory disease, however, no significant association was detected.

BackgroundThe effect of loop diuretic use in critically ill patients on vasopressor support or in shock is unclear. This study aimed to explore the relationship between loop diuretic use and hospital mortality in critically ill patients with vasopressor support.MethodsData were extracted from the Medical Information Mart for Intensive Care III database. Adult patients with records of vasopressor use within 48 h after intensive care unit admission were screened. Multivariable logistic regression and propensity score matching was used to investigate any association.ResultsData on 7828 patients were included. The crude hospital mortality was significantly lower in patients with diuretic use (166/1469 vs. 1171/6359, p <  0.001). In the extended multivariable logistic models, the odds ratio (OR) of diuretic use was consistently significant in all six models (OR range 0.56–0.75, p < 0.05 for all). In the subgroup analysis, an interaction effect was detected between diuretic use and fluid balance (FB). In the positive FB subgroup, diuretic use was significantly associated with decreased mortality (OR 0.64, 95% confidence interval (CI) 0.51–0.78) but was insignificant in the negative FB subgroup. In the other subgroups of mean arterial pressure, maximum sequential organ failure assessment score, and lactate level, the association between diuretic use and mortality remained significant and no interaction was detected. After propensity score matching, 1463 cases from each group were well matched. The mortality remained significantly lower in the diuretic use group (165/1463 vs. 231/1463, p < 0.001).ConclusionsAlthough residual confounding cannot be excluded, loop diuretic use is associated with lower mortality.Electronic supplementary materialThe online version of this article (10.1186/s13054-019-2309-9) contains supplementary material, which is available to authorized users.

Long-term high-dose NAC treatment may lead to a lower rate of exacerbations. But the effect of low-dose NAC treatment remains uncertain. Further researches are needed to confirm this outcome and to clarify its mechanisms.

BackgroundSystemic inflammation plays a critical role in the pathophysiological process of intracranial hemorrhage (ICH). Recently, the platelet-to-lymphocyte ratio (PLR) has become a research focus that indicates inflammation in various diseases. Thus, this study aimed to investigate the predictive value of PLR in patients with acute ICH.Material/MethodsThis study was performed in a single teaching hospital. Glasgow coma scale at hospital discharge (GCSdis) and modified Rankin score (MRS) at 6 months were recorded as short-term and long-term neurological outcomes. Ordered and binary logistic regression methods were used to explore the associations.ResultsFinally, data on 183 ICH patients were included. A knot of PLR around 100 was detected and applied in the extended ordered logistic regression models. For PLR >100, PLR on ICU admission was significantly associated with worse GCSdis (from Model 1: OR: 1.004, 95% CI 1.001–1.007 to Model 4: OR: 1.006, 95% CI 1.002–1.009) while the PLR on Emergency Department (ED) admission was insignificant. For PLR ≤100, neither the PLR on ICU or ED admission was associated with GCSdis level. In the quartile grouping analysis, PLR Q2 was used as a reference level. Both Q3 and Q4 on ICU admission were significantly associated with lower GCSdis level (OR, 3.30; 95%CI 1.38–7.88; and OR, 3.79; 95%CI 1.54–9.33, respectively), while Q1 was insignificant. All 4 quartiles of PLR on ED admission were not associated with GCSdis.ConclusionsOnly higher PLR value on ICU admission but not on ED admission was associated with worse GCSdis.