Jae-Uk Song

Risk factors to predict outcome in critically ill cancer patients receiving chemotherapy in the intensive care unit.

ObjectiveThe decision to start chemotherapy in critically ill cancer patients is extremely complex in the intensive care unit (ICU). Therefore, this study evaluated the outcomes and prognostic factors in critically ill cancer patients receiving chemotherapy in the ICU.MethodsA retrospective analysis was performed using 62 cancer patients who received chemotherapy in the ICU between October 2002 and December 2008. The dataset included 49 hematologic malignancies (79%) and 13 solid tumors (21%).ResultsTwenty (32%) patients were admitted to the ICU with septic shock, 15 (24%) with respiratory failure, and 14 (23%) with renal failure. The median SOFA and SAPS II scores at the time of chemotherapy were 10 (interquartile range, 6–14) and 53 (interquartile range, 41–68), respectively. Twenty-three (37%) patients had concomitant infections when chemotherapy was initiated. Thirty-eight (61%) patients received mechanical ventilation, and 19 (31%) patients underwent renal replacement therapy at the moment of chemotherapy. Overall, 25 (40%) patients died in the ICU; death occurred due to septic shock (13, 52%), cancer progression (9, 36%), or bleeding (2, 8%). ICU mortality after chemotherapy was correlated with respiratory failure requiring mechanical ventilation (OR, 6.26; 95% CI, 1.12–34.95) and a SOFA score of ≥10 (OR, 9.66; 95% CI, 1.43–65.47) upon initiating chemotherapy.ConclusionsChemotherapy in the ICU for critically ill cancer patients can be considered even when infection or organ failure is present. However, the severity of organ failure, including respiratory failure requiring mechanical ventilation, was associated with an increased mortality after chemotherapy during an ICU stay.

Reduced lung function is independently associated with increased risk of type 2 diabetes in Korean men

BackgroundReduced lung function is associated with incident insulin resistance and diabetes. The aim of this study was to assess the relationship between lung function and incident type 2 diabetes in Korean men.MethodsThis study included 9,220 men (mean age: 41.4 years) without type 2 diabetes at baseline who were followed for five years. Subjects were divided into four groups according to baseline forced vital capacity (FVC) (% predicted) and forced expiratory volume in one second (FEV1) (% predicted) quartiles. The incidence of type 2 diabetes at follow-up was compared according to FVC and FEV1 quartiles.ResultsThe overall incidence of type 2 diabetes was 2.2%. Reduced lung function was significantly associated with the incidence of type 2 diabetes after adjusting for age, BMI, education, smoking, exercise, alcohol, and HOMA-IR. Both FVC and FEV1 were negatively associated with type 2 diabetes (P < 0.05). In non-obese subjects with BMI < 25, the lowest quartile of FVC and FEV1 had a significantly higher odds ratio for type 2 diabetes compared with the highest quartile after adjusting for age and BMI (2.15 [95% CI 1.02-4.57] and 2.19 [95% CI 1.09-4.42]).ConclusionsReduced lung function is independently associated with the incidence of type 2 diabetes in Korean men.

Bronchoscopic features and bronchoscopic intervention for endobronchial hamartoma

Background and objective:  Bronchoscopic resection of endobronchial hamartomas has been reported to have a favourable outcome. This study describes the bronchoscopic features of endobronchial hamartoma and reports the clinical outcome of bronchoscopic intervention.

Risk Factors for Death during Pulmonary Tuberculosis Treatment in Korea: A Multicenter Retrospective Cohort Study

The data regarding risk factors for death during tuberculosis (TB) treatment are inconsistent, and few studies examined this issue in Korea. The purpose of this study was to evaluate baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea. A multicenter retrospective cohort study of 2,481 patients who received TB treatment at eight hospitals from January 2009 to December 2010 was performed. Successful treatment included cure (1,129, 45.5%) and treatment completion (1,204, 48.5%) in 2,333 patients (94.0%). Unsuccessful treatment included death (85, 3.4%) and treatment failure (63, 2.5%) occurred in 148 patients (6.0%). In multivariate analysis, male sex, anemia, dyspnea, chronic heart disease, malignancy, and intensive care unit (ICU) admission were significant risk factors for death during TB treatment. Therefore, male sex, anemia, dyspnea, chronic heart disease, malignancy, and ICU admission could be baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea. Graphical Abstract

Performance of the quick Sequential (sepsis-related) Organ Failure Assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis

BackgroundThe usefulness of the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) score in providing bedside criteria for early prediction of poor outcomes in patients with suspected infection remains controversial. We investigated the prognostic performance of a positive qSOFA score outside the intensive care unit (ICU) compared with positive systemic inflammatory response syndrome (SIRS) criteria.MethodsA systematic literature search was performed using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Data were pooled on the basis of sensitivity, specificity, and diagnostic OR. Overall test performance was summarized using a hierarchical summary ROC and the AUC. Meta-regression analysis was used to identify potential sources of bias.ResultsWe identified 23 studies with a total of 146,551 patients. When predicting in-hospital mortality in our meta-analysis, we identified pooled sensitivities of 0.51 for a positive qSOFA score and 0.86 for positive SIRS criteria, as well as pooled specificities of 0.83 for a positive qSOFA score and 0.29 for positive SIRS criteria. Discrimination for in-hospital mortality had similar AUCs between the two tools (0.74 vs. 0.71; P = 0.816). Using meta-regression analysis, an overall mortality rate ≥ 10% and timing of qSOFA score measurement could be significant sources of heterogeneity. For predicting acute organ dysfunction, although the AUC for a positive qSOFA score was higher than that for positive SIRS criteria (0.87 vs. 0.76; P < 0.001), the pooled sensitivity of positive qSOFA score was very low (0.47). In addition, a positive qSOFA score tended to be inferior to positive SIRS criteria in predicting ICU admission (0.63 vs. 0.78; P = 0.121).ConclusionsA positive qSOFA score had high specificity outside the ICU in early detection of in-hospital mortality, acute organ dysfunction, and ICU admission, but low sensitivity may have limitations as a predictive tool for adverse outcomes. Because between-study heterogeneity was highly represented among the studies, our results should be interpreted with caution.

Additional role of second washing specimen obtained during single bronchoscopy session in diagnosis of pulmonary tuberculosis

BackgroundFlexible bronchoscopy with bronchial washing is a useful procedure for diagnosis of pulmonary tuberculosis (TB), when a patient cannot produce sputum spontaneously or when sputum smears are negative. However, the benefit of gaining serial bronchial washing specimens for diagnosis of TB has not yet been studied. Therefore, we conducted a retrospective study to determine the diagnostic utility of additional bronchial washing specimens for the diagnosis of pulmonary TB in suspected patients.MethodsA retrospective analysis was performed on 174 patients [sputum smear-negative, n = 95 (55%); lack of sputum specimen, n = 79 (45%)] who received flexible bronchoscopy with two bronchial washing specimens with microbiological confirmation of pulmonary TB in Samsung Medical Center, between January, 2010 and December, 2011.ResultsPulmonary TB was diagnosed by first bronchial washing specimen in 141 patients (81%) out of 174 enrolled patients, and an additional bronchial washing specimen established diagnosis exclusively in 22 (13%) patients. Smear for acid-fast bacilli (AFB) was positive in 46 patients (26%) for the first bronchial washing specimen. Thirteen patients (7%) were positive only on smear of an additional bronchial washing specimen. Combined smear positivity of the first and second bronchial washing specimens was significantly higher compared to first bronchial washing specimen alone [Total cases: 59 (34%) vs. 46 (26%), p < 0.001; cases for smear negative sputum: 25 (26%) vs. 18 (19%), p = 0.016; cases for poor expectoration: 34 (43%) vs. 28 (35%), p = 0.031]. The diagnostic yield determined by culture was also significantly higher in combination of the first and second bronchial washing specimens compared to the first bronchial washing. [Total cases: 163 (94%) vs. 141 (81%), p < 0.001; cases for smear negative sputum: 86 (91%) vs. 73 (77%), p < 0.001; cases for poor expectoration: 77 (98%) vs. 68 (86%), p = 0.004].ConclusionsObtaining an additional bronchial washing specimen could be a beneficial and considerable option for diagnosis of TB in patients with smear-negative sputum or who cannot produce sputum samples.

Serum uric acid is positively associated with pulmonary function in Korean health screening examinees

Abstract Objectives: To determine whether level of serum uric acid (SUA) is linked to pulmonary function in health screening examinees without overt medical conditions. Methods: We performed a cross-sectional study on 69,928 Koreans that participated in an annual health check. Results: Percent predicted forced vital capacity (FVC%) and forced expiratory volume in 1 s (FEV1%) were positively correlated with SUA in both genders (FVC%: r = .361; FEV1%: r = .314 in males and FVC%: r = .413; FEV1%: r = .382 in females, all p < .001). When the 2nd, 3rd and lowest FEV1% quartile were compared to the highest quartile group (the reference) by regression analysis, the adjusted ORs for hyperuricemia in males were 0.876 (95% CI, 0.809–0.949), 0.631 (0.574–0.695), and 0.311 (0.278–0.349), respectively. The adjusted ORs for hyperuricemia when the 2nd, 3rd and lowest FEV1% quartile were compared to the highest quartile in males were 0.791 (95% CI, 0.729–0.859), 0.565 (0.513–0.623), and 0.302 (0.270–0.337), respectively (p for trend <.001). Similarly, the adjusted OR of having hyperuricemia in females decreased significantly across FEV1% and FVC% quartile groups compared to the reference. Conclusions: Hyperuricemia may have a positive effect on pulmonary function in middle aged healthy population.

Peptide Nucleic Acid Clamping and Direct Sequencing in the Detection of Oncogenic Alterations in Lung Cancer: Systematic Review and Meta-Analysis

Purpose Molecular testing in non-small cell lung cancer (NSCLC) aids in identifying oncogenic alterations. The aim of this study was to compare the rates of detection of oncogenic alterations and responsiveness to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) according to EGFR mutation status as determined by peptide nucleic acid (PNA) clamping or direct sequencing (DS). Materials and Methods We performed a systematic literature search using MEDLINE, EMBASE, and the Cochrane Central Register. Data from included studies were pooled to yield summary sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and receiver operating characteristic curves. A meta-regression analysis was conducted to identify potential sources of heterogeneity between selected studies. Results We identified 10 studies comprising 924 patients. Oncogenic alterations were detected in 340 of 924 cases (36.8%) with PNA clamping and in 250 of 924 (27.1%) with DS. The pooled sensitivities of PNA clamping and DS were 0.93 [95% confidence interval (CI): 0.90−0.95] and 0.69 (95% CI: 0.64−0.73), respectively. According to meta-regression analysis, none of the covariates were found to be significant sources of heterogeneity. With respect to treatment responses to EGFR-TKIs, there was no significant difference therein between EGFR mutations detected by PNA clamping and DS (53.4% vs. 50.8%; risk ratio, 0.99; 95% CI 0.83−1.19; p=0.874). Conclusion We demonstrated that PNA clamping has a higher sensitivity than DS for detecting oncogenic alterations in NSCLC. Our findings suggest that PNA clamping is a more useful method for clinical practice.

Decline in lung function is associated with elevated lipoprotein (a) in individuals without clinically apparent disease: A cross-sectional study: Lp(a) and lung function

Reduced lung function and high lipoprotein (a) (Lp(a)) levels are both recognized risk factors for cardiovascular disease. Few studies have investigated the association between serum Lp(a) and lung function in the general population. We evaluated the association between reduced lung function and high Lp(a) levels in healthy individuals without known medical disease diagnoses.

The Role of Prophylactic Cranial Irradiation in Patients With Extensive Stage Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Introduction: The role of prophylactic cranial irradiation (PCI) is controversial in patients with extensive stage small cell lung cancer. The aim of this study was to determine the impact of PCI in these patients. Methods: We performed a systematic review and meta‐analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane Central Register. The primary outcome was overall survival (OS). Results: We identified five studies comprising 984 patients, of whom 448 received PCI and 536 did not receive PCI. In pooled estimates, PCI did not statistically improve OS compared with controls (hazard ratio [HR] = 0.82; 95% confidence interval [CI]: 0.60–1.11; I2 = 77%; p = 0.19). However, the PCI group had a significant advantage in 1‐year survival compared to the no‐PCI group (37.1% versus 27.1%; risk ratio = 0.87; 95% CI: 0.80–0.95; I2 = 47%; p = 0.002), and the pooled estimates indicated that progression‐free survival and the risk of brain metastasis were associated with significant benefit in the PCI group (HR = 0.83; 95% CI: 0.70–0.98; I2 = 22%; p = 0.03; and HR = 0.34; 95% CI: 0.23–0.50; I2 = 0%; p < 0.001, respectively). Conclusions: Our findings suggest that PCI in patients with extensive stage small cell lung cancer may lead to a significant benefit in 1‐year survival, progression‐free survival, and the risk of brain metastasis, despite the lack of a significant advantage in OS.