Prognostic significance of malnutrition in the elderly with community acquired pneumonia: A propensity score matched analysis

변기섭,여혜주,윤성훈,이승은,전두수,김윤성,조우현,이승현 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Background: Community acquired pneumonia (CAP) is one of the main causes of morbidity and mortality in the elderly. Malnutrition is regarded as one of poor prognostic factors of CAP. The aim of this study is to evaluate the prevalence and prognostic significance of malnutrition in the Korean elderly population with CAP. Method: A prospectively collected database was analyzed retrospectively between November 2014 and September 2015. 198 patients with CAP were divided into elderly (age ≥ 65, n=131) and non-elderly group (age < 65, n=67). Malnutrition was defined by clinical nutrtionists according to consensus criteria of the Academy of Nutritional and Dietics. The clinical outcomes were compared between each group. Result: The proportion of malnourished patients was significantly higher in the elderly group (53.4% vs 11.9%, p < 0.001). In the elderly group, the malnourished group showed significantly higher mean age than well-nourished group (77.2 vs 73.5, p=0.001). The ICU admission rate, using vasopressor and mechanical ventilator were much higher in malnourished group (14.3% vs 1.6%, p=0.009, 11.4 % vs 1.6 %, p=0.027, 12.9 % vs 1.6 %, p=0.016). After propensity score matching, the rate of discharge to home and the survival rate were significantly lower in the malnourished group (68.6 % vs 96.7 %, p<0.001; 1 ysr: 62.9 % vs 90.2 %, p<0.001; 2 ysr: 54.3 % vs 82.0 %, p=0.001). Conclusion: About half of elderly CAP patients initially had malnutrition. The malnutrition in the elderly with CAP was associated with more severe disease activity and poor clinical outcome.

전신 홍반 루푸스 환자의 질환의 활성화 및 기간에 따른 경동맥 경직도와 경동맥 동맥경화 증가

변기섭,이지현,조경임,이홍직,여현정,김민정,임호준 고신대학교(의대) 고신대학교 의과대학 학술지 2014 고신대학교 의과대학 학술지 Vol.29 No.2

Objective: The link among carotid intima-media thickness (IMT), vascular elastic property and the disease activity of systemic lupus erythematosus (SLE) is not well defined. We investigated the association between carotid atherosclerosis, elastic properties of the carotid arterial wall and clinical parameters of SLE. Methods: Fifty-one SLE patients and fifty healthy controls were included. Peak systolic global circumferential and posterior radial strains of carotid artery were measured to assess the elastic properties. Beta stiffness index was used as conventional method for the distensibility of the carotid artery. Information concerning SLE duration, cumulative dose of steroids and/or immunosuppressive drug intake was recorded, and SLE activity was assessed by SLE disease activity index (SLEDAI) score. Results: Carotid plaques were more common in SLE patients. SLE patients with plaques were older and showed the increased mean IMT, high sensitivity C-reactive protein (hs CRP), IgG anti-cardiolipin antibody (aCL), and longer disease duration compared with those without plaques. Peak systolic global circumferential and posterior radial strain as well β stiffness index were significantly lower in SLE group. Age, disease duration, hsCRP, IgG aCL showed significant correlations with mean IMT and parameters of carotid elastic property (all P’s<0.05). Conclusions: Carotid atherosclerosis was more common in SLE patients, and carotid arterial stiffness had significant correlation with disease duration, hsCRP and IgG aCL level. Speckle tracking strain imaging is a comparative method for the assessment of elastic properties of carotid artery of SLE patients.

Prognostic significance of malnutrition for long-term mortality in community-acquired pneumonia: a propensity score matched analysis

여혜주,변기섭,한준희,김준현,이승은,윤성훈,전두수,김윤성,조우현 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.4

Background/Aims: The impact of malnutrition on the outcome of hospitalized adults with community-acquired pneumonia (CAP) has not been fully investigated. This study evaluated the prevalence and prognostic significance of malnutrition in a Korean population with CAP. Methods: In total, 198 patients with CAP from November 2014 to September 2015 were analyzed retrospectively. We assessed the prevalence of malnutrition and the risk factors for 2-year mortality. Furthermore, we divided the patients into two groups: elderly (age ≥ 65 years, n = 131) and non-elderly (age < 65 years, n = 67). Subgroup analyses were performed in the elderly group through propensity score matching. Results: The prevalence of malnutrition was 39.4%, and the proportion of patients with malnutrition was significantly higher (53.4% vs. 11.9%, p < 0.001) in the elderly group than in the non-elderly group. In-hospital mortality, 1-year mortality, and 2-year mortality rates were 4.5%, 19.2%, and 26.8%, respectively. Multivariate Cox regression analyses revealed that malnutrition (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.39 to 4.60; p = 0.002) and the Charlson comorbidity index score (OR, 1.30; 95% CI, 1.17 to 1.45; p < 0.001) were associated with 2-year mortality. Conclusions: Malnutrition was common and associated with a poor long-term outcome in patients with CAP, particularly the elderly. A routine nutritional assessment at admission is mandatory as a first step for appropriate nutritional therapy.

Prognostic value of sarcopenic obesity for long-term mortality in patients who undergo venoveno extracorporeal membrane oxygenation for acute respiratory failure

김태화,변기섭,조우현,이승은,윤성훈,전두수,김윤성,여혜주 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.0

Background: It is unclear whether sarcopenic obesity, a combination of low muscle mass and high fat mass, is responsible for long-term mortality in patients who require extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. Methods: From June 2014 to March 2017, we reviewed findings in 127 patients who underwent CT imaging before ECMO initiation. Skeletal muscle area was calculated from psoas muscle cross-sectional area (in squared centimeters) on pre-ECMO CT images at the level of the third lumbar vertebra divided by the square of the patient’s height in meters to give the skeletal muscle index (SMI). Results: The patients were divided into two groups: low SMI (n=47) and high SMI (n=80). The mean age was lower in high SMI group than low SMI group (60.2 vs 53.9, p=0.002). The mean BMI and SMI were higher in high SMI group than low SMI group (BMI; 21.6 vs 24.1, p=0.001, SMI; 3.9 vs 7.4, p<0.001). As well, the mean CCI score was lower in the high SMI group than low SMI group (3.0 vs 2.2, p=0.024). Multivariate analysis showed that male (OR 3.04, 95% CI 1.22-7.60, p=0.017), RESP score (OR 1.29, 95% CI 1.07-1.56, p=0.009), CRRT (OR 6.18, 95% CI 2.46-15.50, p<0.001), and low SMI (OR 2.55, 95% CI 1.01-6.41, p=0.047) were associated 1 year mortality. Kaplan-Meier analysis showed that low SMI predicted mortality (χ2=4.14 p=0.042). Especially, patients with low SMI and high BMI had a higher risk of mortality (χ2=10.7, p=0.013). Conclusions: Sarcopenic obesity predicted worse 1 year mortality in patients who underwent ECMO.

P-81 Therapeutic efficacy comparison of second-generation EGFR-TKI (afatinib) and first-generation EGFR-TKIs (gefitinib/erlotinib) in Advanced EGFR-positive Non-Small-cell Lung Cancer in the real world

강래형,윤성훈,서현택,옥혜성,변기섭,전두수 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Objective: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) are routinely used to treat non small cell lung cancer (NSCLC) in patients with activating mutations of the EGFR gene. The aim of the study was to compare the efficacies of second-generation EGFR-TKI (afatinib) and first-generation EGFR-TKIs (gefitinib/erlotinib) in the real world. Method: A retrospective analysis of 93 NSCLC patients treated with second-generation EGFR-TKI (afatinib, n=53) and first-generation EGFR-TKIs (gefitinib/erlotinib, n=42) was performed. EGFR mutations were analyzed using PNA clamp. We assessed the response of tumor and progression-free survival with the type of EGFR gene mutation. Result: Second-generation EGFR-TKI (afatinib) versus First-generation EGFR-TKIs (gefitinib/erlotinib) showed that the objective response rates were 73% versus 63% (p=0.962) and median progression-free survival (PFS) was 11 versus 13.6 months (p= 0.385). Discontinuation rate due to drug-related adverse events was 7 patient (16%) versus 4 patient (8%). The type of EGFR mutation had no impact on median PFS and response rate. Demographic and clinical factors had no impact on PFS or response rate in patients treated with EGFR TKIs. Conclusion: Second-generation EGFR-TKI (afatinib) and first-generation EGFR-TKIs (gefitinib/erlotinib) showed similar efficacies based on treatment response, median PFS (regardless of the type of EGFR gene mutation).

AHP와 ANP 방법론을 이용한 그린 ICT 정책의 전략적 우선순위 도출 방안

심용호 ( Yong Ho Shim ),변기섭 ( Gi Seob Byun ),이봉규 ( Bong Gyou Lee ) 한국인터넷정보학회 2011 인터넷정보학회논문지 Vol.12 No.1

최근, 세계적으로 에너지 소비 증가와 온난화 현상의 진행으로 정치, 경제, 사회 및 환경 부분에 직접적인 영향을 받는 글로벌 환경위기에 직면하고 있다. 이러한 문제를 해결하기 위해 세계 각 국에서는 그린 ICT 정책을 마련하고 있다. 국내에서도 환경 오염 문제를 해결하고, 에너지 효율을 높일 수 있는 그린 ICT 정책 도입을 통한 대책을 마련해야 한다. 따라서 본 연구의 목적은 국내 그린 ICT 정책 도입 후 효율을 최대화 하기 위해 고려해야 할 정책 목표의 우선순위를 전략적으로 도출하는 것이다. 이를 위해 `저탄소 녹색성장 기본법`을 바탕으로 경제성, 효율성, 환경성, 기술성, 안정성 등의 주요 변수를 도출하였고, 각각의 변수 별 세부 변수를 도출하였다. 도출된 변수들의 우선순위 분석을 위해 관련 정책 전문가를 대상으로 AHP 방법과 ANP 방법으로 각각 설문조사를 실시하였다. 설문 결과와 AHP 방법론으로 그린 ICT 정책의 우선순위를 도출한 결과 환경성, 기술성, 경제성, 효율성, 안정성의 순으로 도출되었고, ANP 방법론으로 결과를 도출한 결과 기술성, 효율성, 경제성, 환경성, 안정성의 순으로 도출되었다. 이와 같이 본 논문은 AHP와 ANP 방법론을 이용하여 그린 ICT 정책 목표의 우선순위를 학술적으로 분석하였다. 따라서 향후 관련 정책 수립 시 실용적인 가이드라인이 될 수 있다. Recently, the world faces a global environmental crisis by the increase of energy consumption and global warming. Since the crisis directly affects political, economic, social, and environmental areas, many countries prepare Green ICT policy to overcome it. However, although Green IT policy provides many benefits by solving environmental pollution and increasing energy efficiency, Korean government did not prepare measures by the policy. The purpose of this study is to suggest priorities of political goals for maximizing the efficiency after introducing Green ICT policy in Korea. Major variables are drawn for the analysis, and they are eco-friendliness, technology evolution, economic efficiency, energy efficiency, and stable supply of energy. The variables are suggested based on `Low Carbon, Green Growth Act`, then the survey was conducted to policy expert using AHP(Analytic Hierarchy Process) and ANP(Analytic Network Process) for prioritizing variables. As a result of the AHP, it is derived in the order of eco-friendliness, technology evolution, economic efficiency, energy efficiency, and stable supply of energy. The ANP result shows in the order of technology evolution, energy efficiency, economic efficiency, eco-friendliness, and stable supply of energy. The research is conducted to analyze the priorities of goals for Green IT policy, and the analysis results are possible to use as a practical guideline for establishing associated policies in the future.

Performance of interferon- release assay in the diagnosis of tuberculous pericarditis: a meta-analysis

서현택,김윤성,강래형,옥혜성,변기섭,윤성훈,여혜주,이승은 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Background: Recently, there have been several articles investigated the diagnostic value of IGRA in the diagnosis of tuberculous pericarditis. IGRA has been reported that a high sensitivity and specificity in these articles. Thus, we conducted the present meta-analysis to comprehensively evaluate the overall diagnostic accuracy of IGRA upon tuberculous pericarditis. Methods: We conducted electronic English-language literature searches of MEDLINE via PubMed, Embase and Cochrane Library database from the earliest available date of indexing through May 31, 2017. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves parameters. Results: Across 8 studies (591 patients), the pooled sensitivity for IGRA methods was 0.92 (95% CI; 0.87-0.95) without heterogeneity (χ2=14.31 , p=0.05) and a pooled specificity of 0.88 (95% CI; 0.75-0.94) with heterogeneity (χ2=9.71, p= 0.21). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 17.5 (95% CI; 9.9-30.9) and negative likelihood ratio (LR-) of 0.08 (95% CI; 0.05-0.14). The pooled DOR was 214 (95% CI; 105-436). Conclusion: IGRA demonstrated good sensitivity and specificity for diagnosis of TB pericarditis. At present, the literature regarding remains the use of IGRA for diagnosis of TB pericarditis still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of IGRA prediction of TB pericarditis.

Effect of renin-angiotensin-system blockers on contrast-medium-induced acute kidney injury after coronary angiography

구자준,김재준,강지훈,김경년,변기섭,김미경,김태익 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.2

Background/Aims: With the increasing incidence of cardiovascular disease, angiocardiographyusing contrast-enhancing media has become an essential diagnosticand therapeutic tool, despite the risk of contrast-medium-induced acutekidney injury (CIAKI). CIAKI may be exacerbated by renin-angiotensin-system(RAS) blockers, which are also used in a variety of cardiovascular disorders. Thisstudy evaluated the effects of RAS blockade on CIAKI after coronary angiography. Methods: Patients who underwent coronary angiography in our hospital betweenMay 2009 and July 2011 were reviewed. Serum creatinine levels before and aftercoronary angiography were recorded. CIAKI was diagnosed according to an increasein serum creatinine > 0.5 mg/dL or 25% above baseline. Results: A total of 1,472 subjects were included in this study. Patients takingRAS blockers were older, had a higher baseline creatinine level, lower estimatedglomerular filtration rate (eGFR), and had received a greater volume of contrastmedium. After propensity score matching, no difference was observed betweenthe RAS (+) and RAS (–) groups. Multiple logistic regression identified RAS blockade,age, severe heart failure, contrast volume used, hemoglobin level, and eGFRas predictors of CIAKI. Multiple logistic regression after propensity matchingshowed that RAS blockade was associated with CIAKI (odds ratio, 1.552; p = 0.026). Conclusions: This study showed that the incidence of CIAKI was increased in patientstreated with RAS blockers.

P-9 Safety of surgical tracheostomy during extracorporeal membrane oxygenation

김현석,김윤성,전두수,이승은,윤성훈,여혜주,이승현,변기섭,조우현 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-

Backgrounds: The risks of bleeding during extracorporeal membrane oxygenation (ECMO) may deter up to many centers from performing tracheostomy. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients on ECMO, we reviewed the clinical correlation of preoperative coagulation status and bleeding complication related ST during ECMO. Methods: From 1 April 2012 to 31 March 2016, 38 patients were performed ST during ECMO. We retrospectively reviewed and analyzed the medical records including complications related ST. Results: The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 X 109/L, 1.2 and 62 s. Nine patients received a maximum of 16 bags of platelets, and 2 patients received a maximum of 3 units of fresh frozen plasma.Twenty three patients used heparin, but 15 patients supported ECMO without anticoagulation. Of the 23 patients with anticoagulation therapy, 13 patients were briefly paused the heparin infusion before ST. Two patients suffered from ST-related major bleeding requiring surgical hemostasis. Minor bleeding after ST occurred in 2 cases. There was no significant difference according to the anticoagulation management. No fatality was attributable to ST. Conclusion: The complication rates of ST in the patients on ECMO were low and comparable to those of other critically ill patients. Therefore, ST performed by experienced operators with careful optimization of the coagulation state is a relatively safe procedure and ST on ECMO should not be hesitated due to bleeding tendency.

이비인후-두경부외과의 멀티미디어 교육프로그램 개발

왕수건,이일우,전준,문영일,이재우,변기섭,이도헌 대한이비인후과학회 2003 대한이비인후과학회지 두경부외과학 Vol.46 No.3