A Comprehensive Analysis of 5-Year Outcomes in Patients with Cancer Admitted to Intensive Care Units

Jinkyeong Park,Kim Woo Jin,Hong Ji Young,Jeong Yun-jeong,Park Jinkyeong 대한결핵및호흡기학회 2022 Tuberculosis and Respiratory Diseases Vol.85 No.2

Background: The aim of this study was to evaluate the long-term (5-year) clinical outcomes of patients who received intensive care unit (ICU) treatment using Korean nationwide data.Methods: All patients aged >18 years with ICU admission according to Korean claims data from January 2008 to December 2010 were enrolled. These enrolled patients were followed up until December 2015. The primary outcome was ICU mortality.Results: Among all critically ill patients admitted to the ICU (n=323,765), patients with cancer showed higher ICU mortality (18.6%) than those without cancer (13.2%, p<0.001). However, there was no significant difference in ICU mortality at day 28 among patients without cancer (14.5%) and those with cancer (lung cancer or hematologic malignancies) (14.3%). Compared to patients without cancer, hazard ratios of those with cancer for ICU mortality at 5 years were: 1.90 (1.87–1.94) for lung cancer; 1.44 (1.43–1.46) for other solid cancers; and 3.05 (2.95–3.16) for hematologic malignancies.Conclusion: This study showed that the long-term survival rate of patients with cancer was significantly worse than that of general critically ill patients. However, short term outcomes of critically ill patients with cancer were not significantly different from those of general patients, except for those with lung cancer or hematologic malignancies.

Relationship between Use of Rehabilitation Resources and ICU Readmission and ER Visits in ICU Survivors: the Korean ICU National Data Study 2008-2015

Yun Hee Park,고령은,강단비,JinKyeong Park,Kyeongman Jeon,Jeong Hoon Yang,Chi-Min Park,Joongbum Cho,Young Sook Park,Hyejung Park,조주희,Eliseo Guallar,서지영,Chi Ryang Chung 대한의학회 2020 Journal of Korean medical science Vol.35 No.15

Background: Despite the increasing importance of rehabilitation for critically ill patients, there is little information regarding how rehabilitation therapy is utilized in clinical practice. Our objectives were to evaluate the implementation rate of rehabilitation therapy in the intensive care unit (ICU) survivors and to investigate the effects of rehabilitation therapy on outcomes. Methods: A retrospective nationwide cohort study with including > 18 years of ages admitted to ICU between January 2008 and May 2015 (n = 1,465,776). The analyzed outcomes were readmission to ICU readmission and emergency room (ER) visit. Results: During the study period, 249,918 (17.1%) patients received rehabilitation therapy. The percentage of patients receiving any rehabilitation therapy increased annually from 14% in 2008 to 20% in 2014, and the percentages for each type of therapy also increased over time. The most common type of rehabilitation was physical therapy (91.9%), followed by neuromuscular electrical stimulation (29.6%), occupational (28.6%), respiratory, (11.6%) and swallowing (10.3%) therapies. After adjusting for confounding variables, the risk of 30- day ICU readmission was lower in patients who received rehabilitation therapy than in those who did not (P < 0.001; hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.65–0.75). And, the risk of 30-day ER visit was also lower in patients who received rehabilitation therapy (P < 0.001; HR, 0.83; 95% CI, 0.77–0.88). Conclusion: In this nationwide cohort study in Korea, only 17% of all ICU patients received rehabilitation therapy. However, rehabilitation is associated with a significant reduction in the risk of 30-day ICU readmission and ER visit.

The long-term efficacy of domiciliary noninvasive positive pressure ventilation in COPD: A meta-analysis of randomized controlled trials

심윤수,( So Young Park ),( Kwang Ha Yoo ),( Yong Bum Park ),( Jinkyeong Park ),( Hye Yun Park ),( Yong Il Hwang ),( Dong Ah Park ) 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Backgrounds: Although noninvasive positive pressure ventilation (NIPPV) treatment for acute respiratory failure improves the outcome in COPD patients the results of studies in which COPD chronic respiratory distress was treated with NIPPV vary widely. We aimed to evaluate the long-term effect of domiciliary NIPPV. Methods: We performed an extensive search of the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases to identify randomized controlled trials (RCTs) pertaining to the long-term treatment of COPD with NIPPV ventilation over a period of more than 1 year. Results: The eight trials included in this study comprised data from 913 patients. The mortality rates for the NIPPV and control groups, were 29% (118/414) and 36% (151/419). This difference was statistically significant (RR, 0.79; 95% CI, 0.65-0.95, p = 0.01). The mortality rates in the four trials that included stable COPD patients were reduced on application of NIPPV (RR 0.71, 95% CI 0.56-0.91, p = 0.006). In a further subgroup analysis, mortality was reduced when the mean baseline PaCO2 level was high (RR 0.71, 95% CI 0.55-0.93, p = 0.01). The results of the subgroup analysis according to the mean IPAP level showed that the mortality rates in the NIPPV group in three trials were reduced (RR 0.72, 95% CI 0.54-0.96, p = 0.03). There was no difference in QOL between NIPPV and control groups (SMD -0.037, 95% CI -0.34-0.29, p = 0.85). There was no significant difference in the dropout rate between the two groups. (RR 0.99, 95% CI 0.72-1.36, p = 0.94). Conclusion: Domiciliary NIPPV should be considered in COPD patients especially when used in patients with a stable status and relatively higher PaCO2 level, and among those with a higher IPAP level.

The Long-term Efficacy of Domiciliary Noninvasive Positive-Pressure Ventilation in Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Randomized Controlled Trials

Yun Su Sim,So Young Park,Kwang Ha Yoo,Yong Bum Park,Chin Kook Rhee,Jinkyeong Park,Hye Yun Park,Yong Il Hwang,Dong Ah Park 대한결핵및호흡기학회 2022 Tuberculosis and Respiratory Diseases Vol.85 No.1

Background: We evaluated the long-term effects of domiciliary noninvasive positive-pressure ventilation (NIPPV) usedto treat patients with chronic obstructive pulmonary disease (COPD). Methods: Databases were searched to identify randomized controlled trials of COPD with NIPPV for longer than 1 year. Mortality rates were the primary outcome in this meta-analysis. The eight trials included in this study comprised datafrom 913 patients. Results: The mortality rates for the NIPPV and control groups were 29% (118/414) and 36% (151/419), suggesting astatistically significant difference (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65–0.95). Mortality rates werereduced with NIPPV in four trials that included stable COPD patients. There was no difference in admission, acuteexacerbation and quality of life between the NIPPV and control groups. There was no significant difference in withdrawalrates between the two groups (RR, 0.99; 95% CI, 0.72–1.36; p=0.94). Conclusion: Maintaining long-term nocturnal NIPPV for more than 1 year, especially in patients with stable COPD,decreased the mortality rate, without increasing the withdrawal rate compared with long-term oxygen treatment.

Free Paper Presentation : OS-45 ; The Economical Effect of Inhaler in Patients with Early Chronic Obstructive Pulmonary Disease

( Jinkyeong Park ),( Chin Kook Rhee ),( Yong Bum Park ),( Ki Suck Jung ),( Kwang Ha Yoo ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-

Background: Patients with chronic obstructive pulmonary disease (COPD) remain undiagnosed and potentially unknown until the more advanced stages of the disease. The rate of FEV1 decline was greater in patients with less severe disease than those with more severe disease. We aim to investigate the cost-effectiveness of inhaled treatment in early COPD. Methods: We reviewed the database of Korean adults recording less than 0.7 of FEV1/FVC from the Korean National Health and Nutritional Examination Survey (KNHANES) and Korean National Health Insurance (NHI) from 2007 to 2009. The early COPD was determined with more than 50% of FEV1. Results: 0f 1,919 patients who identified with early COPD in KNANES, 120 patients were confirmed that they visited hospital within the next year after diagnosis in NHI database. 58 (48%) patients were on inhaler for COPD. The others took oral medications. In patients using inhaler regularly, medical costs of outpatient clinic were significantly higher(P=0.012). However, totally medical costs including admission and emergency room were not different whether using inhaler or not. Multiple linear regression adjusting with age, sex, using inhaler, FEV1, income showed that smoking status was significant factors affecting the number of medical utilizations(β=4.26, P=0.008) and cost(β=658352, P=0.022). Conclusions: In early COPD patient, using inhaler did not cost more than taking the other type. The uncontrolled aggravating factors such as smoking increased directly medical costs in early COPD.

Liver Transplantation in Korea based on Big Data

( Jinkyeong Park ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Liver transplantation is the best and most common treatment for patients with end-stage liver disease. This mode of treatment gives the recipient a chance to have a new and almost normal liver, as well as freedom from previous disease. With the marked evolution in surgical and anaesthetic techniques, development of organ preservation solutions and advances in immunology, outcomes for liver transplantation have improved over time. As both knowledge and skills in this field develop, survival has increased, indications for transplantation have been broadened, and public awareness has been augmented with the hope of cure. However, great disparity exists between the need for liver organ grafts and available donors, such that waiting lists are growing and drop-out and mortality on waiting lists is increasing. After the first successful human liver transplantation in the world by Thomas E. Starzl in 1967, liver transplantation centres gradually increased in number; there are now liver transplantation centres throughout the world. As successes increased, worldwide acceptance followed and demand for liver transplantation was augmented as well; hence, the demand for liver transplantation increased exponentially with minimal increase in organ supply. To address this problem, Bismuth introduced the reduced-size graft in 1981. This innovation was followed by the introduction of the split-liver graft in 1988 by Pichlmayr. These methods helped alleviate some of the problems of organ shortage, but the continual demand for liver organ grafts remains and is increasing. The imbalance between organ supply and demand has prompted different solutions to prevent deaths from end-stage liver disease. The further advances in the field of LT in Korea requires unbiased and detailed information on the epidemiology of current LT in representative populations. The aim of this Study was thus to investigate the characteristics of LT recipients, as well as outcomes, in a comprehensive analysis of all LT recipients occurring in Korea in 2007-2015

Metagenomic Analysis of Plasma Microbial Extracellular Vesicles in Patients with Mechanical Ventilation: Pilot Study

( Jinkyeong Park ),( Youlim Kim ),( Chang Youl Lee ),( Myung Goo Lee ),( Jae Jun Lee ),( Ji Young Hong ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background Previous studies reported the significant association between pneumonia outcome and respiratory microbiome. Recently, there has been a rising interest in the roles of bacterial extracellular vesicles (EVs) in several diseases. We studied the composition and function of microbiota- derived EVs in plasma of patients with mechanical ventilation to evaluate whether they have specific features concerning the diagnosis and clinical outcomes. Methods The 114 plasma samples from 57 mechanically ventilated ICU patients (38 pneumonia, 22 nursing-home and hospitalassociated infection [NHAI] group) were prospectively collected on days 1 and 7 in a university hospital. After isolating the bacterial EVs from plasma samples, their nucleic acid was extracted for 16S rRNA gene pyrosequencing and then characterized using α-diversity, β-diversity, intergroup comparison of bacterial composition and predicted functions. Results The PCoA-based clustering of microbial EVs between pneumonia group and non-pneumonia group differed significantly. At the genus level, the proportions of Lactobacillus, Cultibacterium and Sphingomonas were significantly different between pneumonia group and non-pneumonia group. Also, the abundance of Lactobacillus and Bifidobacterium were drastically higher in non-NHAI group than NHAI group. There was a significant difference in the change of β diversity between 28-day survivors and 28-day no-survivors for Bray-Curtis distances (p =0.014). Functional profiling revealed significant difference between pneumonia group and non-pneumonia group. The longitudinal change of EVs gene showed the difference between 28-day survivors and 28-day non-survivors. Conclusions The bacterial microbiota-derived EVs in plasma demonstrated the potential in their use as novel diagnostic biomarkers and prediction markers in patients with mechanical ventilation. Further large prospective studies are needed to test the clinical utility of plasma microbiota-EVs in intubated patients.

TP-12 ; Thematic Poster ; The Effect of Fluticasone/Salmoterol Added to Tiotropium versus Tiotropium about Cough or Phlegm in the Patients with COPD: Post Hoc Analysis of the SUPER Study

( Jinkyeong Park ),( Sang Do Lee ),( Ki Suck Jung ),( Yeon Mok Oh ),( Hui Jung Kim ) 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

The patients with chronic obstructive pulmonary disease (COPD) show various symptoms. In addition to breathlessness, cough and phlegm are the major symptoms. Although many clinical trials revealed that breathlessness is improved by inhaled therapy in COPD patients, the effect of these inhalers on cough or phlegm was not evaluated.The SUPER study demonstrated the improvement in lung function of the fluticasone/salmeterol (FSC) added to tiotropium statistically superior to that of tiotropium alone. We performed a post hoc analysis of the SUPER study with particular focus on cough and phlegm.At baseline, 89 (tiotropium +FSC vs tiotropium 22% vs 21%) patients complained that they suffered cough in most days a week. 106 (27% vs. 25%) patients did in a few days a week. 151 (38% vs 36%) patients did in only with chest infection. 134 (tiotropium +FSC vs tiotropium 33% vs 32%) patients complained that they suffered phlegm in most days a week. 126 (31% vs 30%) patients did in a few days a week. 101 (25% vs 25%) patients did in only with chest infection. At the end of study, 148(40% vs 32%) patients showed the improvement on cough, 190(43.1% vs 49.0%) patients had no change, and 74 (17% vs 19%) patients aggravated the cough. 42 (38% vs 31%) patients showed the improvement on phlegm, 76 (15% vs 22%) patients had no change, and 194 (47% vs 48%) patients aggravated the phlegm. In the patients suffered cough in most days a week at the baseline, tiotropium+FSC group had significantly more improvement in cough than tiotropium alone (76% vs 55%, p=0.047). There was no effect of phlegm between groups. In COPD patients presenting with cough, tiotropium combined FSC treatment was more helpful than tiotropium alone. However the effect of triple inhaled treatment about phlegm in COPD patients were similar to tiotropium alone.The patients with chronic obstructive pulmonary disease (COPD) show various symptoms. In addition to breathlessness, cough and phlegm are the major symptoms. Although many clinical trials revealed that breathlessness is improved by inhaled therapy in COPD patients, the effect of these inhalers on cough or phlegm was not evaluated.The SUPER study demonstrated the improvement in lung function of the fluticasone/salmeterol (FSC) added to tiotropium statistically superior to that of tiotropium alone. We performed a post hoc analysis of the SUPER study with particular focus on cough and phlegm.At baseline, 89 (tiotropium +FSC vs tiotropium 22% vs 21%) patients complained that they suffered cough in most days a week. 106 (27% vs. 25%) patients did in a few days a week. 151 (38% vs 36%) patients did in only with chest infection. 134 (tiotropium +FSC vs tiotropium 33% vs 32%) patients complained that they suffered phlegm in most days a week. 126 (31% vs 30%) patients did in a few days a week. 101 (25% vs 25%) patients did in only with chest infection. At the end of study, 148(40% vs 32%) patients showed the improvement on cough, 190(43.1% vs 49.0%) patients had no change, and 74 (17% vs 19%) patients aggravated the cough. 42 (38% vs 31%) patients showed the improvement on phlegm, 76 (15% vs 22%) patients had no change, and 194 (47% vs 48%) patients aggravated the phlegm. In the patients suffered cough in most days a week at the baseline, tiotropium+FSC group had significantly more improvement in cough than tiotropium alone (76% vs 55%, p=0.047). There was no effect of phlegm between groups. In COPD patients presenting with cough, tiotropium combined FSC treatment was more helpful than tiotropium alone. However the effect of triple inhaled treatment about phlegm in COPD patients were similar to tiotropium alone.

The Influence of Asian Dust, Haze, Mist, and Fog on Hospital Visits for Airway Diseases

Park, Jinkyeong,Lim, Myoung Nam,Hong, Yoonki,Kim, Woo Jin The Korean Academy of Tuberculosis and Respiratory 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4

Background: Asian dust is known to have harmful effects on the respiratory system. Respiratory conditions are also influenced by environmental conditions regardless of the presence of pollutants. The same pollutant can have different effects on the airway when the air is dry compared with when it is humid. We investigated hospital visits for chronic obstructive pulmonary disease (COPD) and asthma in relation to the environmental conditions. Methods: We conducted a retrospective study using the Korean National Health Insurance Service claims database of patients who visited hospitals in Chuncheon between January 2006 and April 2012. Asian dust, haze, mist, and fog days were determined using reports from the Korea Meteorological Administration. Hospital visits for asthma or COPD on the index days were compared with the comparison days. We used two-way case-crossover techniques with one to two matching. Results: The mean hospital visits for asthma and COPD were $59.37{\pm}34.01$ and $10.04{\pm}6.18$ per day, respectively. Hospital visits for asthma significantly increased at lag0 and lag1 for Asian dust (relative risk [RR], 1.10; 95% confidence interval [CI], 1.01-1.19; p<0.05) and haze (RR, 1.13; 95% CI, 1.06-1.22; p<0.05), but were significantly lower on misty (RR, 0.89; 95% CI, 0.80-0.99; p<0.05) and foggy (RR, 0.89; 95% CI, 0.84-0.93; p<0.05) days than on control days. The hospital visits for COPD also significantly increased on days with Asian dust (RR, 1.29; 95% CI, 1.05-1.59; p<0.05), and were significantly lower at lag4 for foggy days, compared with days without fog (RR, 0.85; 95% CI, 0.75-0.97; p<0.05). Conclusion: Asian dust showed an association with airway diseases and had effects for several days after the exposure. In contrast to Asian dust, mist and fog, which occur in humid air conditions, showed the opposite effects on airway diseases, after adjusting to the pollutants. It would require more research to investigate the effects of various air conditions on airway diseases.

The Influence of Asian Dust, Haze, Mist, and Fog on Hospital Visits for Airway Diseases

( Jinkyeong Park ),( Myoung Nam Lim ),( Yoonki Hong ),( Woo Jin Kim ) 대한결핵 및 호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4

Background: Asian dust is known to have harmful effects on the respiratory system. Respiratory conditions are also influenced by environmental conditions regardless of the presence of pollutants. The same pollutant can have different effects on the airway when the air is dry compared with when it is humid. We investigated hospital visits for chronic obstructive pulmonary disease (COPD) and asthma in relation to the environmental conditions. Methods: We conducted a retrospective study using the Korean National Health Insurance Service claims database of patients who visited hospitals in Chuncheon between January 2006 and April 2012. Asian dust, haze, mist, and fog days were determined using reports from the Korea Meteorological Administration. Hospital visits for asthma or COPD on the index days were compared with the comparison days. We used two-way case-crossover techniques with one to two matching. Results: The mean hospital visits for asthma and COPD were 59.37 ± 34.01 and 10.04 ± 6.18 per day, respectively. Hospital visits for asthma significantly increased at lag0 and lag1 for Asian dust (relative risk [RR], 1.10; 95% confidence interval [CI], 1.01-1.19; p<0.05) and haze (RR, 1.13; 95% CI, 1.06-1.22; p<0.05), but were significantly lower on misty (RR, 0.89; 95% CI, 0.80-0.99; p<0.05) and foggy (RR, 0.89; 95% CI, 0.84-0.93; p<0.05) days than on control days. The hospital visits for COPD also significantly increased on days with Asian dust (RR, 1.29; 95% CI, 1.05-1.59; p<0.05), and were significantly lower at lag4 for foggy days, compared with days without fog (RR, 0.85; 95% CI, 0.75-0.97; p<0.05). Conclusion: Asian dust showed an association with airway diseases and had effects for several days after the exposure. In contrast to Asian dust, mist and fog, which occur in humid air conditions, showed the opposite effects on airway diseases, after adjusting to the pollutants. It would require more research to investigate the effects of various air conditions on airway diseases.