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Article: Early parenteral nutrition comparing to enteral nutrition cannot reduce 28-day mortality in critically ill patients: a retrospective comparative cohort study based on the MIMIC‑IV database.

Zou, Bo / Xi, Fengchan / Yu, Wenkui

2023 Volume 11, Issue 2, Page(s) 77

Abstract: Background: Enteral nutrition (EN) is recommended as the first choice by guidelines for critical ill patients. But the timing of safe and effective delivery of parenteral nutrition (PN) is unclear and the results of previous studies are controversial. ... ...

Abstract	Background: Enteral nutrition (EN) is recommended as the first choice by guidelines for critical ill patients. But the timing of safe and effective delivery of parenteral nutrition (PN) is unclear and the results of previous studies are controversial. There is insufficient evidence for the use of early PN, so we designed this cohort study to compared the clinical outcomes of critical ill patients who received early PN with those who did not. Methods: This retrospective study conducted using the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients who received nutrition therapy within 3 days of ICU admission were included and we categorized them as patients who received any kind of PN (PN group) or only enteral nutrition (EN group). Confounding factors were adjusted by propensity-score matching (PSM). The primary outcome was the 28-day mortality rate, and secondary outcomes included length of stay (LOS) in the hospital and ICU, hospital infection, and mechanical ventilation time. Results: A total of 5,019 patients (PN group, 357; EN group, 4,662) were included in the analyses. The 28-day mortality rates showed no significant intergroup difference (EN, 22.3% Conclusions: PN within 3 days of ICU admission did not reduce the 28-day mortality rate and could extend hospital LOS. This study supports further fundamental and clinical research to ascertain the effect of PN for ICU patients.
Language	English
Publishing date	2023-01-03
Publishing country	China
Document type	Journal Article
ZDB-ID	2893931-1
ISSN	2305-5847 ; 2305-5839
ISSN (online)	2305-5847
ISSN	2305-5839
DOI	10.21037/atm-22-6408
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Article: Longitudinal D-Dimer Trajectories and the Risk of Mortality in Abdominal Trauma Patients: A Group-Based Trajectory Modeling Analysis.

Sun, Chuanrui / Xi, Fengchan / Li, Jiang / Yu, Wenkui / Wang, Xiling

Journal of clinical medicine

2023 Volume 12, Issue 3

Abstract: This study aimed to identify the long-term D-dimer trajectory patterns and their associations with in-hospital all-cause mortality in abdominal trauma patients. This is a retrospective cohort study of general adult abdominal trauma patients admitted to ... ...

Abstract	This study aimed to identify the long-term D-dimer trajectory patterns and their associations with in-hospital all-cause mortality in abdominal trauma patients. This is a retrospective cohort study of general adult abdominal trauma patients admitted to Jinling Hospital (Nanjing, China) between January 2010 and April 2020. Group-based trajectory modeling was applied to model D-dimer trajectories over the first 50 days post-trauma. A multivariable logistic regression was performed to estimate the associations between D-dimer trajectories and in-hospital all-cause mortality. A total of 309 patients were included. We identified four distinct D-dimer trajectories: group 1 (57.61%; "stable low"), group 2 (28.16%; "moderate-decline"), group 3 (8.41%; "high-rapid decline"), and group 4 (5.83%; "high-gradual decline"). The SOFA score (
Language	English
Publishing date	2023-01-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12031091
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Article ; Online: Real-Time Prediction of Sepsis in Critical Trauma Patients: Machine Learning-Based Modeling Study.

Li, Jiang / Xi, Fengchan / Yu, Wenkui / Sun, Chuanrui / Wang, Xiling

JMIR formative research

2023 Volume 7, Page(s) e42452

Abstract: Background: Sepsis is a leading cause of death in patients with trauma, and the risk of mortality increases significantly for each hour of delay in treatment. A hypermetabolic baseline and explosive inflammatory immune response mask clinical signs and ... ...

Abstract	Background: Sepsis is a leading cause of death in patients with trauma, and the risk of mortality increases significantly for each hour of delay in treatment. A hypermetabolic baseline and explosive inflammatory immune response mask clinical signs and symptoms of sepsis in trauma patients, making early diagnosis of sepsis more challenging. Machine learning-based predictive modeling has shown great promise in evaluating and predicting sepsis risk in the general intensive care unit (ICU) setting, but there has been no sepsis prediction model specifically developed for trauma patients so far. Objective: To develop a machine learning model to predict the risk of sepsis at an hourly scale among ICU-admitted trauma patients. Methods: We extracted data from adult trauma patients admitted to the ICU at Beth Israel Deaconess Medical Center between 2008 and 2019. A total of 42 raw variables were collected, including demographics, vital signs, arterial blood gas, and laboratory tests. We further derived a total of 485 features, including measurement pattern features, scoring features, and time-series variables, from the raw variables by feature engineering. The data set was randomly split into 70% for model development with stratified 5-fold cross-validation, 15% for calibration, and 15% for testing. An Extreme Gradient Boosting (XGBoost) model was developed to predict the hourly risk of sepsis at prediction windows of 4, 6, 8, 12, and 24 hours. We evaluated model performance for discrimination and calibration both at time-step and outcome levels. Clinical applicability of the model was evaluated with varying levels of precision, and the potential clinical net benefit was assessed with decision curve analysis (DCA). A Shapley additive explanation algorithm was applied to show the effect of features on the prediction model. In addition, we trained an L2-regularized logistic regression model to compare its performance with XGBoost. Results: We included 4603 trauma patients in the study, 1196 (26%) of whom developed sepsis. The XGBoost model achieved an area under the receiver operating characteristics curve (AUROC) ranging from 0.83 to 0.88 at the 4-to-24-hour prediction window in the test set. With a ratio of 9 false alerts for every true alert, it predicted 73% (386/529) of sepsis-positive timesteps and 91% (163/179) of sepsis events in the subsequent 6 hours. The DCA showed our model had a positive net benefit in the threshold probability range of 0 to 0.6. In comparison, the logistic regression model achieved lower performance, with AUROC ranging from 0.76 to 0.84 at the 4-to-24-hour prediction window. Conclusions: The machine learning-based model had good discrimination and calibration performance for sepsis prediction in critical trauma patients. Using the model in clinical practice might help to identify patients at risk of sepsis in a time window that enables personalized intervention and early treatment.
Language	English
Publishing date	2023-03-31
Publishing country	Canada
Document type	Journal Article
ISSN	2561-326X
ISSN (online)	2561-326X
DOI	10.2196/42452
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Article: Association of longitudinal changes in skeletal muscle mass with prognosis and nutritional intake in acutely hospitalized patients with abdominal trauma: a retrospective observational study.

Xi, Fengchan / You, Yong / Ding, Weiwei / Gao, Tao / Cao, Yang / Tan, Shanjun / Yu, Wenkui

Frontiers in nutrition

2023 Volume 10, Page(s) 1085124

Abstract: Background: The objective of this study was to explore whether longitudinal changes in skeletal muscle mass, from hospital admission to 3 weeks post-trauma, are associated with poor prognosis and nutritional intake in acutely hospitalized patients with ...

Abstract	Background: The objective of this study was to explore whether longitudinal changes in skeletal muscle mass, from hospital admission to 3 weeks post-trauma, are associated with poor prognosis and nutritional intake in acutely hospitalized patients with abdominal trauma. Methods: A single-center retrospective observational review was conducted on 103 patients with abdominal trauma admitted to the Affiliated Jinling Hospital, Medical School of Nanjing University between January 2010 and April 2020. Skeletal muscle mass was assessed by abdominal computed tomography (CT) performed within 14 days before surgery and on post-trauma days 1-3 (week 0), 7-10 (week 1), 14-17 (week 2), and 21-24 (week 3). The skeletal muscle index (SMI) at L3, change in SMI per day (ΔSMI/day), and percent change in SMI per day (ΔSMI/day [%]) were calculated. The receiver-operating characteristic (ROC) curve was used to evaluate the discriminatory performance of ΔSMI/day (%) for mortality. Linear correlation analysis was used to evaluate the associations between ΔSMI/day (%) and daily caloric or protein intake. Results: Among the included patients, there were 91 males and 12 females (mean age ± standard deviation 43.74 ± 15.53 years). ΔSMI Conclusion: Loss of skeletal muscle mass is associated with poor prognosis and nutritional intake in patients admitted to hospital with abdominal trauma.
Language	English
Publishing date	2023-05-31
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2776676-7
ISSN	2296-861X
ISSN	2296-861X
DOI	10.3389/fnut.2023.1085124
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Article: High Fat-to-Muscle Ratio Was Associated with Increased Clinical Severity in Patients with Abdominal Trauma.

Li, Jiang / Xi, Fengchan / He, Yuanchen / Sun, Chuanrui / Yu, Wenkui / Wang, Xiling

Journal of clinical medicine

2023 Volume 12, Issue 4

Abstract: Overweight and moderate obesity confer a survival benefit in chronic diseases such as coronary artery disease and chronic kidney disease, which has been termed the "obesity paradox". However, whether this phenomenon exists in trauma patients remains ... ...

Abstract	Overweight and moderate obesity confer a survival benefit in chronic diseases such as coronary artery disease and chronic kidney disease, which has been termed the "obesity paradox". However, whether this phenomenon exists in trauma patients remains controversial. We performed a retrospective cohort study in abdominal trauma patients admitted to a Level I trauma center in Nanjing, China between 2010 and 2020. In addition to the traditional body mass index (BMI) based measures, we further examined the association between body composition-based indices with clinical severity in trauma populations. Body composition indices including skeletal muscle index (SMI), fat tissue index (FTI), and total fat-to-muscle ratio (FTI/SMI) were measured using computed tomography. Our study found that overweight was associated with a four-fold risk of mortality (OR, 4.47 [95% CI, 1.40-14.97],
Language	English
Publishing date	2023-02-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12041503
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Article ; Online: Subcutaneous Adipose Tissue Is Associated with Acute Kidney Injury after Abdominal Trauma Based on the Generalized Propensity Score Approach: A Retrospective Cohort Study.

Xi, Fengchan / Li, Jiang / He, Yuanchen / Sun, Chuanrui / Wang, Xiling / Yu, Wenkui

Obesity facts

2023 Volume 16, Issue 3, Page(s) 255–263

Abstract: Introduction: Obesity is associated with an increased risk of acute kidney injury (AKI) after trauma. However, the associations between different adipose tissue depots and AKI remain unknown. Our study aimed to quantify the effect of abdominal adiposity ...

Abstract	Introduction: Obesity is associated with an increased risk of acute kidney injury (AKI) after trauma. However, the associations between different adipose tissue depots and AKI remain unknown. Our study aimed to quantify the effect of abdominal adiposity on AKI in trauma patients. Methods: We performed a retrospective cohort study of abdominal trauma patients who were admitted to our hospital from January 2010 to March 2020. Abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured at the level of the third lumbar vertebra using computed tomography. Causal modeling based on the generalized propensity score was used to quantify the effects of body mass index (BMI), VAT, and SAT on AKI. Results: Among 324 abdominal trauma patients, 67 (20.68%) patients developed AKI. Patients with AKI had higher BMI (22.46 kg/m2 vs. 22.04 kg/m2, p = 0.014), higher SAT areas (89.06 cm2 vs. 83.39 cm2, p = 0.151), and higher VAT areas (140.02 cm2 vs. 91.48 cm2, p = 0.001) than those without AKI. By using causal modeling, we found that the risk of developing AKI increased by 8.3% (p = 0.001) and 4.8% (p = 0.022) with one unit increase in BMI (per 1 kg/m2) and ten units increase in SAT (per 10 cm2), respectively. However, VAT did not show a significant association with AKI (p = 0.327). Conclusion: SAT, but not VAT, increased the risk of AKI among abdominal trauma patients. Measurement of SAT might help identify patients at higher risk of AKI.
MeSH term(s)	Humans ; Retrospective Studies ; Propensity Score ; Obesity ; Subcutaneous Fat/diagnostic imaging ; Intra-Abdominal Fat/diagnostic imaging ; Acute Kidney Injury/etiology ; Body Mass Index
Language	English
Publishing date	2023-03-15
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2417831-7
ISSN	1662-4033 ; 1662-4025
ISSN (online)	1662-4033
ISSN	1662-4025
DOI	10.1159/000530000
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Zs.A 6736: Show issues

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Article ; Online: Extracorporeal membrane oxygenation would provide a new approach to anesthesia for giant thyroid tumor resection: A case report.

Xi, Feng-Chan / Song, Yu-Qing / Li, Wei-Qin / Yu, Wen-Kui

Asian journal of surgery

2020 Volume 43, Issue 11, Page(s) 1123–1125

MeSH term(s)	Airway Management/methods ; Anesthesia/methods ; Dyspnea/etiology ; Extracorporeal Membrane Oxygenation/methods ; Female ; Humans ; Imaging, Three-Dimensional ; Middle Aged ; Thyroid Gland/diagnostic imaging ; Thyroid Gland/pathology ; Thyroid Gland/surgery ; Thyroid Neoplasms/complications ; Thyroid Neoplasms/diagnostic imaging ; Thyroid Neoplasms/pathology ; Thyroid Neoplasms/surgery ; Thyroidectomy/methods ; Tomography, X-Ray Computed ; Tracheal Stenosis/etiology
Language	English
Publishing date	2020-10-01
Publishing country	China
Document type	Case Reports ; Letter
ZDB-ID	1068461-x
ISSN	0219-3108 ; 1015-9584
ISSN (online)	0219-3108
ISSN	1015-9584
DOI	10.1016/j.asjsur.2020.08.017
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Zs.B 2831: Show issues

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Article ; Online: Low skeletal muscle mass predicts poor clinical outcomes in patients with abdominal trauma.

Xi, Fengchan / Tan, Shanjun / Gao, Tao / Ding, Weiwei / Sun, Jianfeng / Wei, Caiyun / Li, Weiqin / Yu, Wenkui

Nutrition (Burbank, Los Angeles County, Calif.)

2021 Volume 89, Page(s) 111229

Abstract: Objective: The aim of this study was to investigate whether low skeletal muscle mass is associated with clinical outcomes in patients with abdominal trauma.: Methods: Patients presenting to our institution with abdominal trauma from January 2010 to ... ...

Abstract	Objective: The aim of this study was to investigate whether low skeletal muscle mass is associated with clinical outcomes in patients with abdominal trauma. Methods: Patients presenting to our institution with abdominal trauma from January 2010 to April 2020 were retrospectively included. Low skeletal muscle mass was defined, using computed tomography, as skeletal muscle index (SMI) at the third lumbar vertebra below the lowest sex-specific quartile within 1 wk of admission. Clinical outcomes such as complications, hospital stay, and hospital cost were recorded, and univariate and multivariate analyses were performed. Results: Among 684 patients, 451 were eligible. Of these, 112 (24.8%) were classified as having low skeletal muscle mass, based on SMI diagnostic cutoff values (42.08 cm Conclusions: Low skeletal muscle mass could be an independent predictor of poor clinical outcomes in patients with abdominal trauma.
MeSH term(s)	Female ; Hospital Costs ; Humans ; Length of Stay ; Male ; Muscle, Skeletal/diagnostic imaging ; Muscle, Skeletal/pathology ; Prognosis ; Retrospective Studies ; Sarcopenia/pathology
Language	English
Publishing date	2021-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	639259-3
ISSN	1873-1244 ; 0899-9007
ISSN (online)	1873-1244
ISSN	0899-9007
DOI	10.1016/j.nut.2021.111229
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Zs.A 2290: Show issues

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Article ; Online: A Comparison of Gastric and Jejunal Feeding in Hypercatabolism Associated With Hypothalamic AMPK-Autophagy-POMC in Endotoxemic Rats.

Cao, Chun / Li, Xiaohua / Yang, Xiaodong / Xi, Fengchan / Gao, Tao / Xing, Chungen / Yu, Wenkui

JPEN. Journal of parenteral and enteral nutrition

2019 Volume 44, Issue 3, Page(s) 481–490

Abstract: Background: Hypercatabolism is associated with increased infectious rates and mortality in critically ill patients. Enteral nutrition (EN) is usually used to counteract hypercatabolism. However, the impact of different routes of EN on hypercatabolism ... ...

Abstract	Background: Hypercatabolism is associated with increased infectious rates and mortality in critically ill patients. Enteral nutrition (EN) is usually used to counteract hypercatabolism. However, the impact of different routes of EN on hypercatabolism remains unknown. Here, we compared the impact of gastric feeding (GF) and jejunal feeding (JF) on gastrointestinal hormones and hypercatabolism, which is associated with hypothalamic adenosine 5'-monophosphate-activated protein kinase (AMPK)-autophagy-proopiomelanocortin (POMC). Methods: Sixty adult male Sprague-Dawley rats were divided into 5 groups: Sham and lipopolysaccharide (LPS) groups fed a standard chow diet, a pair-fed group that was a subset of saline-treated rats pair-fed with the LPS group, and LPS + JF and LPS + GF groups (received EN via jejunal and gastric tube, respectively, for 3 days [100 kcal/kg/d]). Hypercatabolism was measured by insulin resistance, muscle protein synthesis, and atrophy. Serum gastrointestinal hormones, hypothalamic ghrelin, growth hormone secretagogue receptor-1α (GHS-R1α), and AMPK-autophagy-POMC markers were also detected. Results: GF increased serum total, acylated, desacylated, and hypothalamic ghrelin and decreased glucagon-like peptide-1 (GLP-1). But no effect on pancreatic polypeptide (PYY) and hypothalamic GHS-R1α was observed. JF showed no effect on hypothalamic ghrelin, GHS-R1α, and serum total, acylated, and desacylated ghrelin and even further aggravated GLP-1 and PYY. GF could effectively augment hypothalamic AMPK-autophagy-POMC and hypercatabolism. However, JF showed no effect on hypothalamic AMPK-autophagy-POMC and hypercatabolism. Conclusions: GF could activate hypothalamic AMPK-autophagy and suppress POMC expression via gastrointestinal hormones to ameliorate hypercatabolism compared with JF, which suggested that GF may be the preferred route of EN in endotoxemic rats.
MeSH term(s)	AMP-Activated Protein Kinases/metabolism ; Animals ; Autophagy ; Enteral Nutrition ; Humans ; Hypothalamus/metabolism ; Male ; Pro-Opiomelanocortin/metabolism ; Rats ; Rats, Sprague-Dawley
Chemical Substances	Pro-Opiomelanocortin (66796-54-1) ; AMP-Activated Protein Kinases (EC 2.7.11.31)
Language	English
Publishing date	2019-05-30
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	800861-9
ISSN	1941-2444 ; 0148-6071
ISSN (online)	1941-2444
ISSN	0148-6071
DOI	10.1002/jpen.1613
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Zs.A 1524: Show issues

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Article ; Online: Sarcopenia associated with 90-day readmission and overall survival after abdominal trauma.

Xi, Fengchan / Tan, Shanjun / Gao, Tao / Ding, Weiwei / Song, Yuqing / Yang, Jie / Li, Weiqin / Yu, Wenkui

Asia Pacific journal of clinical nutrition

2020 Volume 29, Issue 4, Page(s) 724–731

Abstract: Background and objectives: It is widely recognized that sarcopenia increases postoperative complications in trauma patients. However, the effects on prognosis remain unclear. This study aimed to evaluate the impact of sarcopenia on 90-day readmission ... ...

Abstract	Background and objectives: It is widely recognized that sarcopenia increases postoperative complications in trauma patients. However, the effects on prognosis remain unclear. This study aimed to evaluate the impact of sarcopenia on 90-day readmission and overall survival (OS) in abdominal trauma patients. Methods and study design: 485 consecutive patients who underwent abdominal surgery after trauma in our institution were enrolled. Sarcopenia was diagnosed with low muscle mass and low muscle strength-handgrip. Multivariate logistic regression analysis was performed to identify factors that contributed to 90-day readmission and OS. Cox logistic regression analysis was used to assess the relationship between sarcopenia and OS. Results: Sarcopenia was present in 120 of 485 patients (24.7%) with abdominal trauma within one week after admission based on the diagnostic cut-off values (40.9 cm2/m2 for men and 36.8 cm2/m2 for women). 90-day readmission was significantly higher in the sarcopenia group (p=0.019), and OS lower in the sarcopenia group (p=0.025). Sarcopenia was an independent predictor of 90-day readmission [odds ratio (OR): 5.34, 95% confidence interval (CI): 2.52-11.3]. Conclusions: Sarcopenia was associated with high 90-day readmission and low OS in abdominal trauma patients, and it was an independent risk factor for 90-day readmission.
MeSH term(s)	Female ; Hand Strength ; Humans ; Male ; Patient Readmission ; Prognosis ; Retrospective Studies ; Sarcopenia/epidemiology ; Tomography, X-Ray Computed
Language	English
Publishing date	2020-12-20
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1460012-2
ISSN	1440-6047 ; 0964-7058
ISSN (online)	1440-6047
ISSN	0964-7058
DOI	10.6133/apjcn.202012_29(4).0007
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