Taeyoung Kong

Usefulness of the Delta Neutrophil Index as a Promising Prognostic Marker of Acute Cholangitis in Emergency Departments.

Purpose: Recent technological advances have led to analyses of the delta neutrophil index (DNI), which reflects the fraction of circulating immature granulocytes, using specific automated blood cell analyzers. We evaluated the significance of the DNI as a prognostic marker for early severity in patients with acute cholangitis. Methods: We retrospectively analyzed patients initially diagnosed with acute cholangitis at emergency department admission, followed by diagnostic confirmation, during a set period. The DNI was determined on each day of hospitalization. Clinical outcomes were the incidence of shock requiring vasopressor/inotrope and 28-day mortality. Results: We included 461 patients who met our inclusion criteria. According to multivariate Cox proportional hazard models, higher DNI at admission (hazard ratio [HR]: 1.102; 95% confidence interval [CI]: 1.053–1.153; P < 0.001), day 1 (HR: 1.069; 95% CI: 1.018–1.122; P = 0.008), and day 2 (HR: 1.118; 95% CI: 1.053–1.186; P < 0.001) were significant risk factors for 28-day mortality. Among patients with acute cholangitis, a DNI > 4.9% at admission (HR: 5.632; 95% CI: 1.977–16.045; P = 0.001) and day 1 (HR, 9.973; 95% CI: 2.666–37.302; P < 0.001) and higher DNI ( > 2.5%) on day 2 (HR, 16.942; 95% CI: 2.15–133.496; P = 0.007) were associated with increased 28-day mortality. Conclusion: Higher DNI levels are predictive markers of hemodynamic instability and 28-day mortality in patients with acute cholangitis. The accuracy of DNI for predicting hemodynamic instability and 28-day mortality is superior to that of other parameters.

Usefulness of mean platelet volume as a marker for clinical outcomes after out-of-hospital cardiac arrest: a retrospective cohort study

Essentials It is unknown whether mean platelet volume (MPV) estimates outcomes after cardiac arrest (CA). We investigated whether MPV was associated with 30‐day neurologic outcome and mortality after CA. Elevated MPV at admission was associated with poor neurological outcomes and mortality at 30 days. Identifying levels of MPV is helpful for estimating disease severity among resuscitated patients.

Usefulness of serial measurement of the red blood cell distribution width to predict 28-day mortality in patients with trauma

Background This is the first study to evaluate the association between the serially measured RDW values and clinical severity in patients surviving >24 h after sustaining trauma. We evaluated the serial measurement and cut‐off values of RDW to determine its significance as a prognostic marker of early mortality in patients with suspected severe trauma. Methods This study retrospectively analyzed prospective data of eligible adult patients who were admitted to the ED with suspected severe trauma. The RDW was determined on each day of hospitalization. The primary outcome was all‐cause mortality within 28‐days of ED admission. Results We included 305 patients who met our inclusion criteria. The multivariate Cox regression model demonstrated that higher RDW values on day 1 (hazard ratio [HR], 1.558; 95% confidence interval [CI], 1.09–2.227; p = 0.015) and day 2 (HR, 1.549; 95% CI, 1.046–2.294; p = 0.029) were strong independent predictors of short‐term mortality among patients with suspected severe trauma. Considering the clinical course of severe trauma patients, the RDW is an important ancillary test for determining severity. Specifically, we found that RDW values >14.4% on day 1 (HR, 4.227; 95% CI: 1.672–10.942; p < 0.001) and >14.7% on day 2 (HR, 6.041; 95% CI: 2.361–15.458; p < 0.001) increased the hazard 28‐day all‐cause mortality. Conclusion An increased RDW value is an independent predictor of 28‐day mortality in patients with suspected severe trauma. The RDW, routinely obtained as part of the complete blood count without added cost or time, can be serially measured as indicator of severity after trauma.

A bibliometric analysis of research productivity of emergency medicine researchers in South Korea

Objective During the past 20 years, over 1,400 doctors have been certified as emergency physicians in Korea. The number of scientific publications in the field of emergency medicine has also increased. This study aims to evaluate the research productivity of academic emergency physicians in South Korea. Methods Articles published from 1996 to 2015 by authors affiliated with Korean emergency departments were retrieved using Pubmed, Embase, and Web of Science. Research productivity was analyzed quantitatively to ascertain the number of articles for publication type and year. The performance of these articles was also analyzed qualitatively using impact factor, citation number, and Hirsch index. Bibliometric analysis was performed by researching Web of Science, Scopus, and Google Scholar. Results A total of 858 articles with 293 Korean authors as the first or corresponding authors were published across 191 journals. The number of publications increased continuously. The most common publication type was original article (n=618), the most commonly studied research topic was resuscitation medicine (n=110), and the average impact factor of the original articles was 2.158. The highest h-index was 17 and, using Web of Science, the maximum number of citations was found to be 85. Conclusion This study suggests that the research productivity of Korean authors in the emergency medicine field has progressed steadily during the last 10 years. However, qualitative indexes, such as the number of citations and h-index value, remain low.

Usefulness of the delta neutrophil index to predict 30-day mortality in patients with ST segment elevation myocardial infarction

This study aimed to evaluate the association between the delta neutrophil index (DNI), which reflects immature granulocytes, and the severity of ST-elevation myocardial infarction (STEMI), as well as to determine the significance of the DNI as a prognostic marker for early mortality and other clinical outcomes in patients with STEMI who underwent reperfusion. This retrospective, observational cohort study was conducted using patients prospectively integrated in a critical pathway program for STEMI. We included 842 patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (pPCI). Higher DNI values at time-I (within 2 h of pPCI; hazard ratio [HR], 1.075; 95% confidence interval [CI]: 1.046–1.108; p < 0.001) and time-24 (24 h after admission; HR, 1.066; 95% CI: 1.045–1.086; p < 0.001) were significant independent risk factors for 30-day mortality. Specifically, DNI values >2.5% at time-I (HR, 13.643; 95% CI: 8.13–22.897; p < 0.001) and > 2.9% at time-24 (HR, 12.752; 95% CI: 7.308–22.252; p < 0.001) associated with increased risks of 30-day mortality. In conclusion, an increased DNI value, which reflects the proportion of circulating immature granulocytes in the blood, was found to be an independent predictor of 30-day mortality and poor clinical outcomes in patients with acute STEMI post-pPCI.

Usefulness of the delta neutrophil index as an ancillary test in the emergency department for the early diagnosis of suspected acute promyelocytic leukemia

Abstract The delta neutrophil index (DNI) reflects the fraction of circulating immature granulocytes. We evaluated the usefulness of DNI values in patients with acute myeloid leukemia (AML) to distinguish the acute stage of acute promyelocytic leukemia (APL). We analyzed patients retrospectively who were first diagnosed with AML upon admission to the emergency department (ED). Thirty of the 134 patients (22.4%) were diagnosed with APL on ED admission. The univariate analysis and multivariate logistic regression models revealed that DNI values differed significantly between APL and non-APL AML patients on days 0, 1 and 2. Increased predictability for APL was associated with a DNI greater than 24.2% on ED admission, greater than 23.6% on day 1 and greater than 44% on day 2 in patients with AML. DNI values of patients with AML could discriminate the acute stage of APL from AML for immediate initiation of all-trans retinoic acid therapy.