Kyung Soo Chung

Efficacy of IP-10 as a biomarker for monitoring tuberculosis treatment.

OBJECTIVESnIP-10 has been proposed as a promising alternative marker for the diagnosis of tuberculosis (TB).nnnMETHODSnIn this exploratory study, we assessed the levels of serum IP-10 and TB antigen-dependent IP-10 at the time of diagnosis and after completing treatment in 32 patients with active TB.nnnRESULTSnSignificant changes in concentration between the time of diagnosis and the completion of therapy were observed for serum IP-10 (P < 0.001; median: 140.4 and 105.7 pg/ml, respectively) and TB antigen-dependent IP-10 (P = 0.002; median: 20,000 and 13,720 pg/ml, respectively). The proportion of TB antigen-dependent IP-10 responders did not change significantly between baseline and the completion of therapy (P = 0.35), whereas the proportion of serum IP-10 responders was significantly different (P = 0.001).nnnCONCLUSIONSnSerum IP-10 and TB antigen-dependent IP-10 responses to QFT-GIT antigens might be a useful biomarker for monitoring the efficacy of therapy in patients with active TB.

Risk Factors for Occurrence and 30-Day Mortality for Carbapenem-Resistant Acinetobacter baumannii Bacteremia in an Intensive Care Unit

To assess the risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia and for 30-day mortality in patients with CRAB bacteremia in the intensive care unit (ICU), we conducted a retrospective study in the ICU at Severance Hospital in Korea from January 2008 to December 2009. Patients who acquired CRAB bacteremia in the ICU were enrolled as the case group and patients whose specimens of blood culture, sputum/endotracheal aspirate and urine revealed no AB were enrolled as controls. The case group comprised 106 patients and 205 patients were included as controls. Risk factors independently associated with CRAB bacteremia included prior chemotherapy or radiotherapy treatment (Odds ratio [OR], 3.6; P = 0.003), recent central venous catheter insertion (OR, 5.7; P < 0.001) or abdominal drainage insertion (OR, 21.9; P = 0.004), the number of antibiotics treated with (OR, 1.3; P = 0.016), and respiratory failure in the ICU (OR, 2.5; P = 0.035). The 30-day mortality was 79.8%. Renal failure during ICU stay was independently associated with 30-day mortality (OR, 3.7; P = 0.047). It is important to minimize invasive procedures, and to restrict excessive use of antibiotics, especially in immunocompromised patients, in order to prevent the development of CRAB bacteremia. Greater concern for CRAB bacteremia patients is needed when renal failure develops during ICU stay.

Clinical Practice Guideline of Acute Respiratory Distress Syndrome

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Factors associated with the quality of life of Korean COPD patients as measured by the EQ-5D

Purpose This study evaluated the health-related quality of life measured using the EuroQol five-dimension questionnaire (EQ-5D) and the degree of airway obstruction in a Korean population using Korea National Health and Nutritional Examination Survey (KNHANES IV–V, 2007–2010) data.MethodsA cross-sectional analysis examined 2356 subjects (1178 COPD patients, 1178 control subjects) aged ≥40xa0years and performed reliable spirometry as part of KNHANES IV–V. Baseline EQ-5D visual analog scale (VAS) and EQ-5D utility scores were obtained. A Tobit censored regression model was used to evaluate factors affecting EQ-5D in COPD patients.ResultsThe EQ-5D VAS and EQ-5D utility scores were significantly different among the COPD severity groups (Pxa0<xa00.05). The mean EQ-5D VAS scores for patients with mild, moderate, and severe COPD were 73.0 (SD 18.6), 70.8 (19.1), and 60.9 (23.4), respectively. The mean utility scores were 0.90 (0.14) for patients with mild COPD, 0.89 (0.14) for patients with moderate COPD, and 0.84 (0.15) for patients with severe COPD. Factors influencing the EQ-5D utility score in patients with COPD were age, gender, household income, education level, severe airflow obstruction, and comorbidities.ConclusionsThe EQ-5D score could be a useful instrument for evaluating the quality of life of COPD patients in Korea. In Korean COPD patients, the main determinants of EQ-5D scores include older age, female gender, lower household income, lower education level, severe airflow obstruction, and many comorbid diseases.

Prediction of methicillin-resistant Staphylococcus aureus in patients with non-nosocomial pneumonia

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only hospital acquired pneumonia, but also non-nosocomial pneumonia. However, the risk factors for non-nosocomial MRSA pneumonia are not clearly defined. Our objective was to identify risk factors at admission that were associated with non-nosocomial MRSA pneumonia.MethodsWe evaluated 943 patients admitted to a university-affiliated hospital with culture-positive bacterial pneumonia developed outside the hospital from January 2008 to December 2011. We compared the clinical characteristics between MRSA and non-MRSA pneumonia, and identified risk factors associated with MRSA pneumonia.ResultsOf 943 patients, MRSA was identified in 78 (8.2%). Higher mortality was observed in MRSA than in non-MRSA patients (33.3% vs. 21.5%; P = 0.017). In a logistic regression analysis, MRSA pneumonia was observed more frequently in patients with a previous history of MRSA infection (OR = 6.05; P < 0.001), a PSI score ≥120 (OR = 2.40; P = 0.015), intravenous antibiotic treatment within 30 days of pneumonia (OR = 2.23; P = 0.018). By contrast, non-MRSA pneumonia was observed more often in patients with a single infiltrate on chest radiography (OR = 0.55; P = 0.029).ConclusionsAnti-MRSA antibiotics could be considered in hospitalized non-nosocomial patients with several risk factors identified herein. The presence or absence of these factors would provide useful guidance in selecting initial empirical antibiotics.

Characterization of microbiome in bronchoalveolar lavage fluid of patients with lung cancer comparing with benign mass like lesions.

OBJECTIVESnDisruption in the stability of respiratory microbiota is known to be associated with many chronic respiratory diseases. However, only few studies have examined microbiomes in lung cancer. Therefore, we characterized and compared the microbiomes of patients with lung cancer and those with benign mass-like lesions.nnnMATERIALS AND METHODSnBronchoalveolar fluid was collected prospectively to evaluate lung masses in patients who had undergone bronchoscopies from May to September 2015. Twenty-eight patients (20 male, 8 female) were enrolled: 20 diagnosed with lung cancer and 8 diagnosed with benign diseases. Samples were analysed by 16S rRNA-based next-generation sequencing.nnnRESULTSnThe participants mean age was 64±11years. Bacterial operational taxonomic units were classified into 26 phyla, 44 classes, 81 orders, 153 families, 288 genera, and 797 species. The relative abundance of two phyla (Firmicutes and TM7) was significantly increased in patients with lung cancer (p=0.037 and 0.035, respectively). Furthermore, two genera (Veillonella and Megasphaera) were relatively more abundant in lung cancer patients (p=0.003 and 0.022, respectively). The area under the curve of a combination of these two genera used to predict lung cancer was 0.888 (sensitivity=95.0%, specificity=75.0% and sensitivity=70.0%, specificity=100.0%; p=0.002).nnnCONCLUSIONnThe results indicate that differences exist in the bacterial communities of patients with lung cancer and those with benign mass-like lesions. The genera Veillonella and Megasphaera showed the potential to serve as biomarkers to predict lung cancer. Thus, the lung microbiota may change the environment in patients with lung cancer.

Prediction of short- and long-term survival for advanced cancer patients after ICU admission

BackgroundIntensive care unit (ICU) admission of advanced cancer patients is controversial because it is associated with poor short-term prognosis. However, ICU admission of these patients might also result in administration of specific anticancer treatments and evaluation of tumor characteristics, which could influence long-term outcomes. Herein, we investigate whether there is a relationship between ICU admission and long-term outcomes for advanced cancer patients.MethodsWe analyzed 116 advanced cancer patients who were admitted to the ICU at Severance Hospital, Yonsei University, between January 2010 and December 2012. We excluded palliative care-only patients. We analyzed demographic, clinical, and survival data of patients admitted to the ICU, and we identified patient characteristics that were measured upon presentation to ICU to determine whether any of these are prognostic or predictive factors of short- or long-term survival.ResultsThe median age of our study sample was 64xa0years. Sixty-nine (59.5xa0%) patients were male. Lung, breast, and stomach were the most common primary tumor sites. Eighty-seven (75xa0%) patients had received active anticancer treatment within the past 30xa0days. The main cause of ICU admission was acute respiratory failure (73xa0%); thus, 102 (87.9xa0%) patients were managed with conventional mechanical ventilation, 99 (85.3xa0%) patients in vasopressor and 31 (26.7xa0%) patients received continuous renal replacement therapy (CRRT). Twenty-four (20.7xa0%) patients were in postresuscitation status before ICU admission. The ICU, hospital, and 6-month survival rates were 51.7, 31.0, and 15.5xa0%, respectively. APACHE II score (HR 2.86, 95xa0% CI 1.00–8.15, Pu2009<u20090.050) and need for CRRT (HR 2.14, 95xa0% CI 1.24–3.70, Pu2009<u20090.007) were associated with ICU mortality in a Cox-regression model. Eastern Cooperative Oncology Group (ECOG) performance status (HR 1.64, 95xa0% CI 1.03–2.62, Pu2009<u20090.010) was associated with poor prognosis, and controlled disease status (HR 0.372, 95xa0% CI 0.21–0.67, Pu2009<u20090.001) was found to be a good prognostic factor for 6-month survival after ICU admission.ConclusionsClinical factors associated with acute, critical status upon ICU admission, such as APACHE II score and need of CRRT, were associated with a higher risk of ICU mortality and short-term mortality than factors directly associated with the patient’s cancer. To understand the relationship between ICU admission and long-term survival, however, we have to apply more comprehensive approach that also considers tumor characteristics and disease control status.

Prognostic Implications of Serum Lipid Metabolism over Time during Sepsis.

Background. Despite extensive research and an improved standard of care, sepsis remains a disorder with a high mortality rate. Sepsis is accompanied by severe metabolic alterations. Methods. We evaluated 117 patients with sepsis (severe sepsis [n = 19] and septic shock [n = 98]) who were admitted to the intensive care unit. Serum cholesterol, triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), free fatty acid (FFA), and apolipoprotein (Apo) A-I levels were measured on days 0, 1, 3, and 7. Results. Nonsurvivors had low levels of cholesterol, TG, HDL, LDL, and Apo A-I on days 0, 1, 3, and 7. In a linear mixed model analysis, the variations in TG, LDL, FFA, and Apo A-I levels over time differed significantly between the groups (p = 0.043, p = 0.020, p = 0.005, and p = 0.015, resp.). According to multivariate analysis, TG levels and SOFA scores were associated with mortality on days 0 and 1 (p = 0.018 and p = 0.008, resp.). Conclusions. Our study illustrated that TG levels are associated with mortality in patients with sepsis. This may be attributable to alterations in serum lipid metabolism during sepsis, thus modulating the host response to inflammation in critically ill patients.

Relationship between blood levels of heavy metals and lung function based on the Korean national health and nutrition examination survey IV–V

Background Heavy metal exposure may contribute to inflammation in the lungs via increased oxidative stress, resulting in tissue destruction and obstructive lung function (OLF). In this study, we evaluated the relationship between lead and cadmium levels in blood, and lung function in the Korean population. Methods Pooled cross-sectional data from 5,972 subjects who participated in the Korean National Health and Nutrition Examination Survey 2008–2012 were used for this study. OLF was defined as forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.7. Graphite-furnace atomic absorption spectrometry was used to measure levels of lead and cadmium in blood. Results Adjusted means for age, sex, body mass index, and smoking status in blood lead and cadmium levels were increased with age and were higher in men and current smokers. The FEV1/FVC ratio was lower in the highest quartile group of lead (78.4% vs 79.0%; P=0.025) and cadmium (78.3% vs 79.2%; P<0.001) concentrations, compared with those in the lowest quartile groups. Multiple linear regression demonstrated an inverse relationship between the FEV1/FVC ratio and concentrations of lead (estimated −0.002; P=0.007) and cadmium (estimated −0.005; P=0.001). Of the 5,972 subjects, 674 (11.3%) were classified into the OLF group. Among current smokers, the risk of OLF was higher in subjects in the highest quartile group of cadmium concentration than in those in the lowest quartile group (odds ratio 1.94; 95% confidence interval 1.06–3.57). Conclusion We demonstrated a significant association between the FEV1/FVC ratio and blood concentrations of lead and cadmium in the Korean population. The risk for OLF was elevated with increasing concentrations of cadmium among current smokers.

Glucagon Levels, Disease Severity, and Outcome in Severe Sepsis:

ABSTRACT Purpose: Few studies on plasma glucagon levels in patients with sepsis have been performed. We aimed to assess clinical value of glucagon levels in comparison with clinical parameters and severity scores in patients with severe sepsis or septic shock. Methods: A total of 112 patients who were admitted to intensive care unit with severe sepsis or septic shock were included. Plasma levels of glucagon on days 0, 1, 3, and 7 were serially measured in 112 patients with severe sepsis or septic shock. Results: Compared with survivors, patients who died within 28 days had significantly higher glucagon levels on every day of examination. Glucagon levels were positively correlated with and Acute Physiology and Chronic Health Evaluation II score (day 0, r = 0.288, P < 0.01) and Sequential Organ Failure Assessment (day 0, r = 0.482, P< 0.01; day 1, r = 0.588, P < 0.01; day 3, r = 0.480, P < 0.01; day 7, r = 0.454, P < 0.01). Receiver operating characteristic analysis showed that the area under the curve of glucagon levels to predict 28-day survival was 0.65 (95% confidence interval [CI], 0.55–0.75; P = 0.005), similar to the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. Multivariate analysis revealed that glucagon levels of greater than 70 pg/mL (hazard ratio, 1.85; 95% CI, 1.03–3.29) and chronic liver disease (hazard ratio, 1.97; 95% CI, 1.02–3.79) were associated with mortality. Conclusions: Glucagon levels might reflect disease severity and clinical outcomes in patients with severe sepsis or septic shock.