2014年 · 第127卷第14期

Abstract：Background Minimal residual disease (MRD)-directedmodified donor lymphocyte infusion (mDLI) is used to treat relapse after hematopoietic stem cell transplantation (HSCT).For patients who experience an unsatisfactory response tomDLI,relapse is usually inevitable.Therefore,we sought to evaluate the efficacy ofinterferon α therapy in these patients.Methods Regular MRD monitoring was carried out after the HSCT.The patients who were MRD-positive underwent mDLI.Patients with an unsatisfactory response to mDLI received interferon α therapy (3 million units,twice weekly) with regular monitoring of MRD.To ensure the immunomodulatory effects of interferon α,immunosuppressant treatment would be stopped before interferon α treatment.Results Five patients with an unsatisfactory response to mDLI treatment received interferon α (3 had t(8;21) chromosomal translocation acute myeloid leukemia,and 2 had common acute leukemia).They had significantly reduced or resolved MRD.Four patients developed chronic graft-versus-host disease.Two of the 5 patients reported transient fevers,and no significant bone marrow suppression was observed.All of them were in continuous complete remission after interferon α treatment.The median survival time was 469 days (range 368-948 days).Conclusions In patients with an unsatisfactory response to MRD-directed mDLI,interferon α may directly or indirectly induce the graft-versus-leukemia effect to improve mDLI efficacy and clear MRD。

Abstract：Background It has been indicated that autologous hematopoietic stem cell transplantation (AHST) is a promising treatment to adults with type 1 diabetes,however,the application of AHST therapy to children with type 1 diabetes still needs more data.The aim of this study was to assess the clinical effect of immune intervention combined with AHST and conventional insulin therapy in the treatment of children with newly diagnosed type 1 diabetes.Methods This 1:2 matched case-control study was comprised of 42 children who were newly diagnosed with type 1 diabetes in the Department of Endocrinology,Beijing Children's Hospital from 2009-2010.The case group included 14 patients,who were treated with AHST within the first 3 months after being diagnosed with diabetes at request of their parents during 2009-2010.The control group included 28 patients with newly diagnosed type 1 diabetes at the same period of hospitalization.We compared the baseline and follow-up data of them,including ketoacidosis onset,clinical variables (glycosylated hemoglobin (HbA1c),insulin dosage and serum C-peptide).Results The clinical characteristics of the patients was comparable between the case group and the control group.At 6-12 months ((10.7±4.2) months) after AHST treatment,we found 11 patients in the case group did not stop the insulin therapy,three cases stopped insulin treatment for 2,3 and 11 months,respectively.No diabetic ketoacidosis (DKA) occurred after transplantation in all the patients in the case group.HbA1c in the control group was significant lower than that in the case group (P ＜0.01),while the insulin dosage and serum C-peptide were not significant different between the two groups (P ＞0.05).In order to eliminate the honeymoon effect,we performed final follow-up at the 3-5 years ((4.2±1.8) years) after AHST treatment,and found that HbA1c in the control group was still lower than that in the case group (P ＜0.01); however,the insulin dosage and serum C-peptide were not significantly different between the two groups (P ＞0.05).Moreover,the insulin dosage was not significant different from baseline to follow-up period in the case group.Conclusion AHST treatment showed no advantage in effectiveness in children with newly diagnosed type 1 diabetes,both in insulin dose and long term blood glucose control。

Abstract：Background The clinical significance of γ-H2AX in laryngeal squamous cell carcinoma (LSCC) has not yet been established.This study was performed to assess the expression of nuclear γ-H2AX in benign and malignant laryngeal lesions and to assess its clinicopathological significance.Methods A total of 70 LSCC tumor-normal tissue paired samples were evaluated for γ-H2AX expression using immunohistochemical staining.Their expression was correlated with different clinicopathological parameters.Results Nuclear γ-H2AX expression was frequently detected in LSCC tissues (P ＜0.001).High nuclear γ-H2AX levels were not associated with any clinicopathological characteristics of LSCC (P ＞0.05).Univariate Kaplan-Meier analysis showed that positive nuclear γ-H2AX expression was associated with a decreased overall survival (P=0.017).Multivariate Cox regression analysis showed that nuclear γ-H2AX expression was an independent risk factor for overall survival.Conclusion The expression of nuclear γ-H2AX might be closely related to the prognosis of LSCC。

Abstract：Background The efficacy and safety of immunosuppression for idiopathic membranous nephropathy (IMN) are still controversial.Recent studies showed tacrolimus is effective in the treatment of IMN.To evaluate the efficacy and safety of tacrolimus (rAC) for IMN,we conducted a meta-analysis of published medical literatures.Methods Studies addressing the effect of tacrolimus in IMN were searched on PUBMED,EMBASE,The Cochrane Library,and ClinicalTrials.gov (March 2013).Trials comparing tacrolimus with corticosteroid versus control group (cyclophosphamide with corticosteroid) were included.The quality of the studies was assessed using Jadad method.Statistical analyses were performed using Review Manager 5.2 and the results were summarized by calculating the dsk ratio (RR) for dichotomous data or the mean difference (MD) for continuous data with 95％ confident interval (Cl).Results A total of four studies (259 patients) were included.It was shown that therapy with tacrolimus plus corticosteroid had a higher complete remission rate compared to therapy with cyclophosplamide plus corticosteroid (RR=1.53,95％ Cl:1.05-2.24,P ＜0.05),but not significant on total remission,partial remission and adverse effects.Also,no significant alterations were observed in proteinuria and serum albumin level between the two groups.During the entire follow-up period,serum creatinine level remained stable in both groups without ≥50％ increase in its level.Conclusions TAC is more effective than cyclophosphamide (CTX) by achieving complete remission in patients with IMN.Multi-ethnic RCTs are needed to evaluate its long-term efficacy and safety。

Abstract：Objective The purpose of this review was to delineate our current knowledge of the close relationship between the abundance of epicardial adipose tissue (EAT) and the risk of all major cardiovascular disease,especially atrial fibrillation (AF).Data sources The data analyzed in this review were mainly from articles reported in PubMed published from 1972 to 2014.Study selection Original articles and critical reviews relevant to EAT and AF were selected.Results EAT,a particular form of metabolically active visceral fat deposited around the heart,is being regarded as an important independent predictor of cardio-metabolic diseases.EAT is composed of smaller adipocytes than other visceral fat depots and functioned like brown adipose tissue (BAT) to protect adjacent tissues.Improving the understanding of EAT in AF genesis and maintenance may contribute to prevent AF and reduce the complications associated with AF.Conclusion The findings suggest that EAT associates with AF severity and the recurrence of AF after catheter ablation even after adjustment forAF risk factors,but the precise mechanisms are not fully elucidated。

Abstract：Background Drug-eluting stents (DES) with durable polymer have significantly reduced restenosis and target vessel revascularization compared with bare metal stents.Durable polymer has been linked with persistent inflammation of vessel wall and delayed endothelial healing that may increase the risk of late and very late stent thrombosis.This study sought to evaluate the efficacy and safety of HELLOS completed biodegradable polymer sirolimus-eluting stent (SES) in de novo coronary lesions.Methods Totally,287 patients with one or two de novo coronary lesions (lesion length ≤38 mm and reference vessel diameter 2.5-4.0 mm) were enrolled in the HOPE study,a prospective,multicenter,randomized,non-inferiority trial.Patients were randomized to treatment either with HELIOS completed biodegradable polymer SES (n=142) or PARTNER durable polymer SES (n=145).The primary endpoint was angiographic in-stent late lumen loss (LLL) at 9-month follow-up.The secondary endpoint included stent thrombosis and major adverse cardiac events including cardiac death,myocardial infarction (MI) and target lesion revascularization (TLR).Results The 9-month in-stent LLL in the HELIOS group was similar to the PARTNER group,(0.16±0.22) mm vs.(0.19±0.30) mm (P=0.28).The difference and 95％ confidence interval were-0.03 (-0.09,0.04),and the P value for non-inferiority ＜0.01.Major adverse cardiovascular event (MACE) occurred in 7.9％ vs.8.2％,MI in 2.4％ vs.3.0％,TLR in 5.5％ vs.3.0％,and stent thrombosis in 0 vs.1.5％; and events were comparable between the HELIOS group and PARTNER group at three-year follow-up (all P ＞0.05).The three-year cardiac death was lower in the HELIOS group,but with no significant difference,0 vs.3.0％ (P=0.12).Conclusions In the HOPE trial,the novel completed biodegradable polymer SES HELIOS was non-inferior to the durable polymer SES PARTNER with respect to nine-month in-stent LLL in de novo coronary lesions.The incidence of other clinical endpoints was low for both of the stents in three-year follow-up。

Abstract：Background It is unclear whether the effect of video-assisted thoracoscopic surgery ablation is better than catheter ablation on paroxysmal atrial fibrillation (PAF) or not.This study aimed to compare the effects of catheter ablation and video-assisted thoracoscopic surgery ablation on PAF.Methods From March 2008 to March 2012,138 consecutive patients with PAF were randomly assigned to receive either video-assisted thoracoscopic surgery ablation (thoracoscopy group,n=66) or the traditional catheter ablation (catheter group,n=72).Results No patient died during the study and all were successfully followed and included in analysis.There were no significant differences in clinical and echocardiographic characteristics between the two groups.All patients were evaluated at 1 week,1 month,3 months,6 months,and 12 months after discharge by physical examination and related laboratory tests.Preoperative left atrium dimensions (LADs) of the recurrent AF were (47±4) mm in the thoracoscopy group and (46±8) mm in the catheter group,whereas the LADs were (40±5) and (39±9) mm,respectively,in non-recurrent PAF.Conclusions The short-term outcome of video-assisted thoracoscopic surgery ablation is safe and effective; and the indications are wider than those for catheter ablation.The larger left atrium diameter is related to the recurrence of atrial fibrillation。

Abstract：Background Whether two clopidogrel pretreatment strategies prior to elective percutaneous coronary intervention (PCI):a 300 mg loading dose (LD) in clopidogrel naive patients and a 75 mg maintenance dose (MD) once daily in patients on chronic clopidogrel therapy play the same role in the platelet inhibition in Chinese with different CYP2C19 genotypes remains unknown.We aim to evaluate the impact on platelet inhibition by clopidogrel pretreatment strategy and its interaction effect with CYP2C19 genotype.Methods Chinese patients undergoing PCI (n=840) were assigned to 2x2 groups in the trial according to different clopidogrel pretreatment strategies (470 patients in LD,370 patients in MD) and CYP2C19 genotypes (494 carriers of any CYP2C19 *2 or *3 loss-of-function allele,346 non-carriers).The primary outcome was platelet aggregation (PA) as measured by the 10 μmol/L adenosine diphosphate induced light transmission aggregation.Results Compared with MD group,LD strategy showed a significantly higher PA-((59.22±11.67)％ vs.(52.83±12.17)％,P ＜0.01),similar PA difference was observed in CYP2C19 loss-of-function carriers compared with non-carriers ((59.41±10.91)％ vs.(52.10±12.90)％,P ＜0.01).LD patients in either the CYP2C19 loss-of-function allele carrier or noncarrier group showed a significantly higher PA compared with MD group ((61.50±10.61)％ vs.(56.84±10.74)％,P ＜0.01;(56.06±12.34)％ vs.(46.88±11.78)％,P ＜0.01,respectively).A quantitative interaction effect was observed between clopidogrel pretreatment strategy and CYP2C19 genotype (P=0.001).Conclusion The 300 mg LD strategy results in a decreased effect on platelet inhibition compared with the 75 mg MD in Chinese patients receiving clopidogrel prior to PCI,especially in the CYP2C19 *2 or *3 loss-of-function allele non-carriers.(ClinicalTrials.gov number NCT01710436)

Abstract：Background Thoracic endovascular aortic repair (TEVAR) is an emerging treatment modality,which has been rapidly embraced by clinicians treating thoracic aortic disease.However,the clinical manifestations of systemic inflammatory response after TEVAR as post-implantation syndrome (PIS) resemble the perioperative infection.This study aimed to evaluate changes and diagnostic value of procalcitonin (PCT) and other traditional inflammatory markers for infections after TEVAR.Methods We conducted a prospective clinical study that enrolled 162 consecutive aortic dissection cases,who underwent TEVAR in our institution between July 2011 and November 2012.The PCT,C-response protein (CRP),erythrocyte sedimentation rate (ESR) and blood routine examination were monitored before the operation and on days 1,2,3 and 5 after the operation.The diagnosis of infection was confirmed by the infection control committee with reference to Hospital Acquired Infection Diagnostic Criteria Assessment,released by the Ministry of Health of the People's Republic of China.Results Post endovascular repair of thoracic aorta,PCT changes significantly at different time points (x2=1 3.225,P=0.021),without significant difference between the PIS group and the control group (0.24±0.04 vs.0.26±0.10,P=0.804).PCT values were significantly higher in the first day after TEVAR than the preoperative levels (0.18±0.03 vs.0.11±0.02,P ＜0.001).Compared with PIS patients,the level of PCT,CRP,White blood cell (WBC) and neutrophil (NEU) in the infection patients elevated significantly (relatively x2=6.062,P=0.048; x2=6.081,P=0.048; x2=11.030,P=0.004;x2=14.632,P=0.001).According to the ROC analysis,the PCT levels in the first day after TEVAR (AUC=0.785,P=0.012)had better predictive values of infection than WBC,NEU CRP and ESR (AUC=0.720,P=0.040; AUC=0.715,P=0.045;AUC=0.663,P=0.274; AUC=0.502,P=-0.991).The best predictive index was the changes of PCT between preoperative and postoperative (PCT),which possess AUC as 0.803 (P=0.014).And PCT=0.055 could be considered as an infection diagnosis cutoff value with a sensitivity of 83.3％ and specificity 69.0％.Conclusions PCT provides better diagnostic value of infection compared with other inflammatory markers.The potential applications of PCT in differential diagnosis of PIS and infection after percutaneous TEVAR deserve further studies。

Abstract：Background Anterior temporal lobectomy (ATL) is the most common surgical treatment for temporal lobe epilepsy (TLE),although long-term prognosis is often less favorable than short-term outcomes.This study aimed to examine the outcomes of patients with TLE 5 years after undergoing ATL,and to seek possible predictors of prognosis.Methods We examined the clinical records of 121 patients with TLE who underwent ATL in our institution between January 2005 and December 2008.The Engel seizure classification was used to divide patients into "seizure free" and "non-seizure free" groups.Univariate and multivariate Logistic regression analyses were used to identify potential prognostic indicators,including history,clinical features of seizures,and magnetic resonance imaging (MRI) and videoelectroencephalography (EEG) findings.Results The majority of patients were seizure free during the follow-up period:71.9％ 1 year after surgery; 71.6％ after 2 years; 75.8％ after 3 years; 78.8％ after 4 years after surgery and 68.8％ after 5 years.There were significant differences between seizure-free and non-seizure-free groups in terms of preoperative seizure duration,history of febrile seizures,type of seizure,and MRI and video-EEG findings (P ＜0.05),but not in terms of sex,age at seizure onset,age at surgery,side of surgery,auras,family history of seizure,or history of traumatic brain injury,perinatal anoxia or intracranial infection history (P ＞0.05).Multivariate Logistic regression analysis showed that a preoperative seizure duration ＜10 years,a history of febrile seizures,simple complex partial seizures,positive MRI findings,hippocampal sclerosis and unilateral localized video-EEG spikes predicted better outcome (P ＜0.05).Conclusions ATL appears to be an effective means of treating TLE.Patients undergoing ATL for TLE require careful and comprehensive assessment to ensure optimal outcomes and to allow patients to make informed decisions about their treatment。

Abstract：Background The global strategy for the diagnosis,management and prevention of chronic obstructive pulmonary disease (COPD) guidelines classify patients into four groups according to the number of symptoms and the level of future risk of acute exacerbation COPD (AECOPD).This study aimed to compare the results of different methods used in diagnosis of COPD and evaluate the accuracy of the assessment methods in guiding clinical practice.Methods A survey was conducted of 194 COPD outpatients between March and September 2012.Demographic characteristics,the number of exacerbations the patient has had within the previous 12 months,COPD assessment test (CAT),Modified British Medical Research Council (mMRC) scale,and results of the lung function tests were recorded.Results Of the 194 patients assessed,21 had a CAT score ≥10 and an mMRC grade ≤1,13 had a CAT score ＜10 and an mMRC grade ≥2.A predicted forced expiratory volume in one second (FEV1％) of ＜50％ with less than two acute exacerbations was observed in 39 patients,while a predicted FEV1％ of ≥50％ was noted in 20 patients with two or more acute exacerbations.The sensitivity of a predicted FEV1％ ＜50％ in predicting the risk of AECOPD in the future was 80.9％,while that in the real number of AECOPD events recorded was 62.8％,the difference being statistically significant (P=0.004).The sensitivity of CAT in predicting the severity of symptoms was 90％,while that of mMRC was 83.8％,and the difference was not statistically significant.Conclusions The COPD assessment method recommended by the global initiative for chronic obstructive pulmonary disease (GOLD) 2011 is complicated and should be simplified.CAT is more comprehensive and accurate than mMRC.The lung function classification is a better tool for predicting the risk of AECOPD in the future,and the number of AECOPD can be referred to when required。

Abstract：Background Laparoscopic cholecystectomy has been widely used in clinical practice during the recent decades; however,the effects of pneumoperitoneum and the surgery on the coagulation system are largely unknown.This clinical study aimed to observe any possible effects of pneumoperitoneum and the surgery on the coagulation system of patients.Methods This was a prospective observational study.The inclusion criteria included (1) patients with chronic cholecystitis and/or cholecystic polyps and (2) patients in the relief stage of acute cholecystitis.The exclusion criteria included (1) patients in the episodic stage of acute cholecystitis and those complicated with cholangiolithiasis; (2) patients with concomitant hematologic diseases,damages to the liver function,malignant tumors or immune system diseases,or patients complicated with thrombotic or hemorrhagic disorders; and (3) patients who had taken anticoagulant medication within a week before surgery.Fifty patients who were hospitalized into our department for elective laparoscopic cholecystectomy between November 2011 and February 2013 were eligible and enrolled into this study.Of the 50 patients,22 were male and 28 female.The age of the patients ranged from 29 to 78 (mean 56.7±11.5) years.The surgery for each of the 50 patients was performed with the same equipment and conditions.The surgeries for all the patients were performed under general anesthesia with the patients in a 30-degree head-up tilted posture,and the pressure of pneumoperitoneum was maintained at 13 mmHg.Venous blood specimens were taken from each patient before and at the end of pneumoperitoneum (i.e.,0 hour after surgery) and at 8 hours after surgery for determination of prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fib),thrombin time (Tr),and D-dimer (DD).The results of the determinations of these parameters were compared.Results (1) All the patients recovered well without any complications.(2) The pre-pneumoperitoneum values of the parameters of coagulation had normalized.(3) The PT values slightly increased (P ＞0.05) at the end of pneumoperitoneum (i.e.,0 hour after surgery) and decreased by 0.5 seconds at 8 hours after surgery as compared to the pre-pneumoperitoneum values (P ＜0.05).(4) APTT at 0 and 8 hours decreased by 1.4 seconds (P ＞0.05) and 3.7 seconds (P ＜0.05) respectively as compared to pre-pneumoperitoneum values,while the difference between the APTT values at 0 and 8 hours after surgery was not statistically significant (P ＞0.05).(5) FIB determined at 0 hour post-operation increased by 0.1 g/L as compared to pre-pneumoperitoneum values (P ＞0.05); however,the FIB values at 8 hours after operation increased by 1.2 g/L as compared to the pre-pneumoperitoneum values (P ＜0.05),and increased by 1.1 g/L as compared to 0 hour post-operation (P ＜0.05).(6) The TT values obtained at 0 and 8 hours post-operation were not significantly different as compared to the pre-pneumoperitoneum values (P ＞0.05).(7) The DD values gradually increased after operation; as compared to pre-pneumoperitoneum values,DD at 0 and 8 hours after operation increased by 210.8 ng/ml and 525.9 ng/ml respectively (P ＜0.05) and DD at 8 hours after operation increased by 315.1 ng/ml as compared to 0 hour post-operation (P ＜0.05).Conclusions The pneumoperitoneum for laparoscopic cholecycstectomy may lead to postoperative hypercoagulation in the patients,and thereby may increase the risks for development of postoperative thrombosis; Patients may have risks for occurrence of thrombosis within 8 hours after the operation,to which attention should be paid in favor of preventing thrombosis。

Abstract：Background Intravascular microbubble-enhanced acoustic cavitation is capable of disrupting the vascular walls of capillaries and small vessels.This study was designed to investigate the impact of microbubble-enhanced,pulsed and focused ultrasound (MEUS) on the blood perfusion of subcutaneous VX2 tumors in rabbits.Methods Subcutaneous VX2 cancers in twenty New Zealand rabbits were treated by combining high-pressure amplitude,pulsed and focused therapeutic ultrasound (TUS) and intravenous microbubble injections.The TUS transducer was operated with a peak negative pressure of 4.6 MPa and a duty cycle of 0.41％.Controls were subcutaneous VX2 cancers treated with TUS or microbubbles only.Contrast-enhanced ultrasound (CEUS) and intravenous Evans Blue (EB) perfusion were performed to assess the tumor circulation.The tumor microvascular disruption was assessed by histological examination.Results CEUS showed that the tumor circulation almost vanished after MEUS treatment.The average peak grayscale value (GSV) of tumor CEUS dropped significantly from 84.1±22.4 to 15.8±10.8 in the MEUS-treated tumors but no significant GSV changes were found in tumors in the two control groups.The mean tumor EB content of the MEUS-treated tumors was significantly lower than that of the controls.Histological examination found scattered tumor microvascular disruption with intercellular edema after MEUS treatment.Conclusion The tumor circulation of VX2 cancers can be arrested or significantly reduced by MEUS due to microvascular disruption。

Abstract：Background Allogeneic peripheral blood stem cell transplantation from unrelated donors (UR-PBSCT) is an alternative treatment for many hematologic diseases due to lack of human leukocyte antigen (HLA)-identical sibling donors.This study aimed to evaluate the impact of the degree of the HLA match on the clinical efficacy of UR-PBSCT.Methods Patients who underwent UR-PBSCT from September 2003 to September 2012 were retrospectively investigated.They were divided into three groups according to high-resolution molecular typing.SPSS version 17.0 was used to analysis and compare the statistics of engraftment,incidence of GVHD,other complications and survival among the groups.Results One hundred and eleven patients received UR-PBSCT,60 of them with an HLA matched donor (10/10),36 of them with a one locus mismatched donor (9/10),and 15 of them with a two loci mismatched donor (8/10).Similar basic characteristics were found in the three groups.No differences were found in engraftment of myeloid cells or platelets in the three groups (P＞0.05).Two-year cumulative incidence of relapse,overall survival (OS) and disease-free survival (DFS) among those three groups were similar (P＞0.05).The cumulative incidence of 100-day Ⅲ-Ⅳ aGVHD in the HLA matched group and the one HLA locus mismatched group were significantly lower than that in the two HLA loci mismatched group (3.3％,8.6％,and 26.7％,P=0.009).The occurrence rate of new pulmonary infections in the HLA matched group was lower than in the two HLA mismatched groups (26.67％,52.78％,and 41.18％,P=0.035).The cumulative incidence of 100-day and 2-year transplantation related mortality (TRM) in two HLA loci mismatched group was higher than in the HLA matched group and in the one HLA locus mismatched group,(8.4％,11.8％ and 33.3％,P=0.016) and (12.3％,18.7％ and 47.5％,P=0.002).Conclusions HLA mismatch will not significantly impact the engraftment or 2-year survival after UR-PBSCT,but two mismatched HLA loci may increase the cumulative incidence of severe aGVHD and TRM。

Abstract：Background Comorbidity is one of the most important determinants of short-term and long-term outcomes in septic patients.Charlson's weighted index of comorbidities (WIC) and the chronic health score (CHS),which is a component of the acute physiology and chronic health evaluation (APACHE) Ⅱ,are two frequently-used measures of comorbidity.In this study,we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit (ICU) patients with sepsis.Methods A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012.Clinical data were collected,including age,gender,underlying diseases,key predisposing causes,severity-of-sepsis,and hospital mortality.The APACHE Ⅱ,CHS,acute physiology score (APS),sequential organ failure assessment (SOFA) and WIC scores were assessed within the first 24 hours of admission.Univariate and multiple Logistic regression analyses were used to compare the performance of WIC and CHS.The area under the receiver operating characteristic curve (AUC) was used to predict hospital mortality over classes of risk.Results Of all the enrolled patients,224 patients survived and 114 patients died.The surviving patients had significantly lower WIC,CHS,APACHE Ⅱ,and SOFA scores than the non-surviving patients (P ＜0.05).Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age,severe sepsis,key predisposing causes such as pneumonia,a history of underlying diseases such as hypertension and congestive cardiac failure,and WIC,CHS and APS scores (P ＜0.05).The AUC for the hospital mortality were 0.564 (95％ confidence interval (Cl) 0.496-0.631) of CHS,0.663 (95％ Cl 0.599-0.727) of WIC,0.770 (95％ Cl 0.718-0.822) of APACHE Ⅱ,0.856 (95％ Cl 0.815-0.897) of the CHS combined with other administrative data,and 0.857 (95％ Cl 0.817-0.897) of the WIC combined with other administrative data.The diagnostic value of WIC was better than that of CHS (P=0.0015).Conclusions The WIC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis.WIC might be an even better predictor of the mortality of septic patients with comorbidities than CHS。