Clinical implication of ICU-acquired hyponatremia

( Jae Kyeom Sim ),( Kyeongman Jeon ),( Ryoung-eun Ko ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Intensive care unit (ICU)-aquired dysnatremia is the disturbance of sodium level in patients whose sodium concentration was normal at ICU admission. Traditionally, researches about ICU-acquired dysnatremia have focused on hypernatremia, but ICU-acquired hyponatremia (IAH) has been frequently overlooked. We aimed to investigate the etiology, prognosis, and risk factors of IAH in medical ICU patients. Method: In this study, IAH was defined as hyponatremia (Na < 135mmol/L) developed within 48 hours after ICU admission. We retrospectively reviewed medical records of patients discharged from 2015 to 2019, and compared patients with IAH and normonatremia. Patients with abnormal sodium level on admission or dependence on renal replacement therapy were excluded. Primary outcome was ICU mortality. Result: Of 1409 patients, 265 (18.8%) patients had IAH. IAH patients were more severe than normonatremia patients in terms of sequential organ failure assessment (SOFA) and simplified acute physiology score 3 (SAPS 3) (8.8±4.22 vs 7.95±4.18, p=0.004; 56.36±17.41 vs 53.33±16.65, p=0.003)). Reasons for admission and underlying conditions were similar, but endocrine disorder (1.5% vs 0.2%, p=0.013) and underlying chronic kidney disease (1.9% vs 0.4%, p=0.025) were more common in IAH group. Baseline sodium level and renal function were significantly lower in IAH group (Na, 137.1±2.2mmol/ L vs 139.0±2.7mmol/L; BUN, 31.7±23.2mg/dl vs 28.6±21.1mg/dl; Cr, 1.6±1.5mg/dl vs 1.4±1.5mg/dl; glomerular filtration rate, 72.8±50.7ml/min/1.73m2 vs 82.3±67.97ml/min/1.73m2). SAPS3, endocrine disorder, and baseline sodium and potassium levels were associated with the development of IAH in multivariate logistic regression (1.015[1.006-1.024], p=0.001; 12.054[2.048-70.394], p=0.006; 0.735[0.689-0.784], p<0.001; 1.372[1.162-1.620], p<0.001, odds ratio [95% confidence interval], p-value, respectively). ICU mortality were not different between the both groups (17.4% vs 16.1%, p=0.645). However, IAH group showed trend of increased ICU length of stay (10.1±12.7 days vs 8.5±10.7 days, p=0.097). Conclusion: IAH was not an independent risk factor of ICU mortality, but a maker of disease severity and impaired renal function.

Comparative Analysis of Clinical Outcomes Using Propensity Score Matching: Coronavirus Disease 2019 vs. Seasonal Influenza in Korea

Sim Jae Kyeom,Lee Hye Sun,Yang Juyeon,Gwack Jin,Kim Bryan Inho,Cha Jeong-ok,Min Kyung Hoon,Lee Young Seok 대한의학회 2024 Journal of Korean medical science Vol.39 No.14

Background: The advent of the omicron variant and the formulation of diverse therapeutic strategies marked a new epoch in the realm of coronavirus disease 2019 (COVID-19). Studies have compared the clinical outcomes between COVID-19 and seasonal influenza, but such studies were conducted during the early stages of the pandemic when effective treatment strategies had not yet been developed, which limits the generalizability of the findings. Therefore, an updated evaluation of the comparative analysis of clinical outcomes between COVID-19 and seasonal influenza is requisite. Methods: This study used data from the severe acute respiratory infection surveillance system of South Korea. We extracted data for influenza patients who were infected between 2018 and 2019 and COVID-19 patients who were infected in 2021 (pre-omicron period) and 2022 (omicron period). Comparisons of outcomes were conducted among the pre-omicron, omicron, and influenza cohorts utilizing propensity score matching. The adjusted covariates in the propensity score matching included age, sex, smoking, and comorbidities. Results: The study incorporated 1,227 patients in the pre-omicron cohort, 1,948 patients in the omicron cohort, and 920 patients in the influenza cohort. Following propensity score matching, 491 patients were included in each respective group. Clinical presentations exhibited similarities between the pre-omicron and omicron cohorts; however, COVID-19 patients demonstrated a higher prevalence of dyspnea and pulmonary infiltrates compared to their influenza counterparts. Both COVID-19 groups exhibited higher in-hospital mortality and longer hospital length of stay than the influenza group. The omicron group showed no significant improvement in clinical outcomes compared to the pre-omicron group. Conclusion: The omicron group did not demonstrate better clinical outcomes than the pre-omicron group, and exhibited significant disease severity compared to the influenza group. Considering the likely persistence of COVID-19 infections, it is imperative to sustain comprehensive studies and ongoing policy support for the virus to enhance the prognosis for individuals affected by COVID-19.

Serum Procalcitonin for Differential Diagnosis of Acute Exacerbation and Bacterial Pneumonia in Patients With Interstitial Lung Disease

Sim, Jae Kyeom,Oh, Jee Youn,Lee, Eun Joo,Hur, Gyu Young,Lee, Seung Heon,Lee, Sung Yong,Lee, Sang Yeub,Kim, Je Hyeong,Shin, Chol,Shim, Jae Jeong,In, Kwang Ho,Kang, Kyung Ho,Min, Kyung Hoon Elsevier 2016 The American journal of the medical sciences Vol.351 No.5

<P>Background: Acute exacerbation and bacterial pneumonia are major life-threatening conditions in patients with interstitial lung disease (ILD). The rapid recognition of these 2 different conditions is important for their proper treatment. An elevated procalcitonin (PCT) level is commonly detected in patients with bacterial infections. This study assessed the usefulness of the serum PCT level as a biomarker for the differential diagnosis of acute exacerbation and bacterial pneumonia in patients with ILD. Materials and Methods: In this prospective observational study, we enrolled patients with ILD who had experienced recently progressive dyspnea and exhibited new infiltrations on chest radiographs. We classified these patients into an acute exacerbation group and a bacterial pneumonia group and compared their baseline characteristics and laboratory parameters, including the PCT level. Results: Of 21 patients with ILD, 9 patients had bacterial pneumonia. Both the groups showed similar baseline characteristics. The bacterial pneumonia group demonstrated a high PCT level. The PCT level in the acute exacerbation group was significantly lower than that in the bacterial pneumonia group (0.05 versus 0.91ng/mL, respectively; P < 0.001). Other parameters, such as the C-reactive protein level, leukocyte count and body temperature, were also lower in the acute exacerbation group. At a cutoff value of 0.1ng/mL, the sensitivity, specificity and negative predictive values of the serum PCT level were 88.9%, 100.0% and 92.3%, respectively. Conclusions: These findings suggest that the serum PCT level is useful in the differential diagnosis of acute exacerbation and bacterial pneumonia in patients with ILD.</P>

Clinical and molecular characteristics of pulmo-nary sarcomatoid carcinoma

( Jae Kyeom Sim ),( Sang Mi Chung ),( Jong Hyun Choi ),( Jee Youn Oh ),( Seung Heon Lee ),( Je Hyeong Kim ),( Kyung Hoon Min ),( Gyu Young Hur ),( Jae Jeong Shim ),( Kyung Ho Kang ),( Bong Kyung Shin 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.4

Background/Aims: Pulmonary sarcomatoid carcinoma (PSC) is a poorly differentiated non-small cell lung cancer (NSCLC) that contains components of spindle or giant cells. Owing to its low prevalence, there are insufficient data regarding its clinical features, therapeutic strategies and prognosis. Methods: The medical records of 26 patients diagnosed with PSC from January 2009 to June 2015 were reviewed and analyzed for clinicopathological characteristics, treatment modality, and outcomes. Results: The median age was 69.5 years. Twenty-three patients (88%) were male. Twenty-four patients (92%) were smokers. The median time from symptom onset to diagnosis was one month. Eighteen patients (69%) were diagnosed at an advanced stage. Pleomorphic carcinoma was the most common subtype, and epidermal growth factor receptor (EGFR) mutation was positive in two of 11 patients. Among 13 patients tested for programmed death ligand 1 (PD-L1) immunohistochemistry assay, eight showed high expression of PD-L1. The median overall survival (OS) of all patients was 9.5 months. In total, 12 patients were treated with chemotherapy: nine with platinum-based doublet therapy, two with tyrosine kinase inhibitor, and one with docetaxel. Seven patients showed partial response or stable disease. The median OS and progression-free survival of patients who received chemotherapy were 8.7 and 2.8 months, respectively. Conclusions: PSC was more common in males, smokers, and the elderly, with worse prognosis than ordinary NSCLC; chemotherapy response was favorable, and EGFR mutation status and PD-L1 expression may offer more therapeutic options.

Change in management and outcome of mechanical ventilation in Korea: a prospective observational study

Jae Kyeom Sim,Sang-Min Lee,Hyung Koo Kang,Kyung Chan Kim,김영삼,김윤성,리원연,Sunghoon Park,So Young Park,박주희,Yun Su Sim,이광하,이연주,Jin Hwa Lee,Heung Bum Lee,Chae-Man Lim,Won-Il Choi,Ji Young Hong,Won Jun Song,Ge 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.3

Background/Aims: There are few studies describing contemporary status of mechanical ventilation in Korea. We investigated changes in management and outcome of mechanical ventilation in Korea. Methods: International, prospective observational cohort studies have been conducted every 6 years since 1998. Korean intensive care units (ICUs) participated in 2010 and 2016 cohorts. We compared 2016 and 2010 Korean data. Results: Two hundred and twenty-six patients from 18 ICUs and 275 patients from 12 ICUs enrolled in 2016 and 2010, respectively. In 2016 compared to 2010, use of non-invasive ventilation outside ICU increased (10.2% vs. 2.5%, p = 0.001). Pressure-control ventilation was the most common mode in both groups. Initial tidal volume (7.1 mL/kg vs. 7.4 mL/kg, p = 0.372) and positive end-expiratory pressure (6 cmH2O vs. 6 cmH2O, p = 0.141) were similar, but peak pressure (22 cmH2O vs. 24 cmH2O, p = 0.011) was lower in 2016. More patients received sedatives (70.7% vs. 57.0%, p = 0.002) and analgesics (86.5% vs. 51.1%, p < 0.001) in 2016. The awakening (48.4% vs. 31.0%, p = 0.002) was more frequently attempted in 2016. The accidental extubation rate decreased to one tenth of what it was in 2010 (1.1% vs. 10.2%, p < 0.001). The ICU mortality did not change (31.4% vs. 35.6%, p = 0.343) but ICU length of stay showed a decreasing trend (9 days vs. 10 days, p = 0.054) in 2016. Conclusions: There were temporal changes in care of patients on mechanical ventilation including better control of pain and agitation, and active attempt of awakening.

Current Management for Patients with HAP/VAP due to Carbapenem-resistant Gram-negative Bacteria (CRGNB)

( Jae Kyeom Sim ) 대한결핵 및 호흡기학회 2023 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.136 No.0

Mechanical ventilation in patients with idiopathic pulmonary fibrosis in Korea: a nationwide cohort study

( Jae Kyeom Sim ),( Seok Joo Moon ),( Juwhan Choi ),( Jee Youn Oh ),( Young Seok Lee ),( Kyung Hoon Min ),( Gyu Young Hur ),( Sung Yong Lee ),( Jae Jeong Shim ) 대한내과학회 2024 The Korean Journal of Internal Medicine Vol.39 No.2

Background/Aims: The prognosis of patients with idiopathic pulmonary fibrosis (IPF) and respiratory failure requiring mechanical ventilation is poor. Therefore, mechanical ventilation is not recommended. Recently, outcomes of mechanical ventilation, including those for patients with IPF, have improved. The aim of this study was to investigate changes in the use of mechanical ventilation in patients with IPF and their outcomes over time. Methods: This retrospective, observational cohort study used data from the National Health Insurance Service database. Patients diagnosed with IPF between January 2011 and December 2019 who were placed on mechanical ventilation were included. We analyzed changes in the use of mechanical ventilation in patients with IPF and their mortality using the Cochran- Armitage trend test. Results: Between 2011 and 2019, 1,227 patients with IPF were placed on mechanical ventilation. The annual number of patients with IPF with and without mechanical ventilation increased over time. However, the ratio was relatively stable at approximately 3.5%. The overall hospital mortality rate was 69.4%. There was no improvement in annual hospital mortality rate. The overall 30-day mortality rate was 68.7%, which did not change significantly. The overall 90-day mortality rate was 85.3%. The annual 90-day mortality rate was decreased from 90.9% in 2011 to 83.1% in 2019 (p = 0.028). Conclusions: Despite improvements in intensive care and ventilator management, the prognosis of patients with IPF receiving mechanical ventilation has not improved significantly.

Utility of KL-6 as a Biomarker for PD-1/PD-L1 Blockade-related Pneumonitis in Non-small Cell Lung Cancer

( Jae Kyeom Sim ),( Juwhan Choi ),( Sung Yong Lee ) 대한결핵 및 호흡기학회 2023 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.136 No.0

Two Cases of Diagnosis and Removal of Endobronchial Hamartoma by Cryotherapy via Flexible Bronchoscopy

Sim, Jae Kyeom,Choi, Jong Hyun,Oh, Jee Youn,Cho, Jae Young,Moon, Eul Sun,Min, Hye Sook,Lee, Byung Hyun,Park, Min Seon,Hur, Gyu Young,Lee, Sung Yong,Shim, Jae Jeong,Kang, Kyung Ho,Min, Kyung Hoon The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.76 No.3

Although endobronchial hamartoma is a rare benign tumor, most patients with endobronchial hamartoma have respiratory symptoms such as obstructive pneumonia, hemoptysis, cough, or dyspnea due to bronchial obstruction. It can cause irreversible post-obstructive pulmonary destruction, thus early diagnosis and treatment is very important. Recently, there have been cases of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and electrocautery procedures for bronchoscopic treatment of malignant or benign central airway obstruction with comparable therapeutic efficacy and few complications. Bronchoscopic cryotherapy is a newly developed technique for management of central airway obstruction. Moreover, it provides diagnostic methods with improving diagnostic yield and safety. We report two cases of endobronchial hamartoma, each diagnosed and definitively treated with bronchoscopic techniques. Endobronchial biopsy and removal was successfully performed by cryotherapy via flexible bronchoscopy without notable complications. Follow-up bronchoscopic examinations excluded residual or recurrent disease.

Perioperative immunotherapy in stage IB-III non-small cell lung cancer: a critical review of its rationale and considerations

Jae Kyeom Sim,Juwhan Choi,Sung Yong Lee 대한내과학회 2023 The Korean Journal of Internal Medicine Vol.38 No.6

Lung cancer is a dismal disease as a leading cause of overall cancer death, but the development of immune checkpoint inhibitors (ICIs) in driver gene mutation negative metastatic non-small cell lung cancer (NSCLC) is changing the paradigm of lung cancer treatment. Recently, ICIs are expanding their treatment area to early-stage NSCLC and ICIs have also changed their treatment strategies of such patients. And it is important to appropriately select patients with resectable early-stage lung cancer through a multidisciplinary team approach and decrease the tumor relapse rate in the ICIs era. In this review article, we discuss the recently released neoadjuvant and adjuvant data of ICIs, their treatment rationale, and unmet needs in the treatment of early-stage NSCLC.