P-14 Low-dose corticosteroid infusion in acute respiratory distress syndrome

백문성,홍상범,임채만,고윤석,허진원 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Introduction: Recent studies suggested that use of low-dose corticosteroid may down-regulates systemic inflammation in patients with acute respiratory distress syndrome (ARDS). The aim of this study was to investigate whether that the administration of low-dose corticosteroid to patients with moderate to severe ARDS would improve clinical outcomes. Methods: Data were obtained from patients with ARDS who received corticosteroids within one week of ICU admission at a single tertiary teaching hospital between 2006 and 2015 retrospectively. Corticosteroids were converted to equivalent doses of methylprednisolone, and the range from 40mg to 200mg of corticosteroid was defined as corticosteroid group. The primary outcome was the 60-day mortality rate. Results: A total of 1,306 patients with ARDS admitted to the ICU, and 1,148 moderate to severe ARDS patients were included in the analysis. At 60 days, the overall hospital mortality rate was 53.1 % (54.9 % in the corticosteroid group and 48.8 % in the no corticosteroid group, respectively). After the multivariate logistic regressions, the factors independently associated with a 60-day mortality were SOFA score (OR: 1.12; 95% CI: 1.06-1.19), solid cancer (OR: 2.24; 95% CI: 1.478-3.43), hematologic malignancy (OR: 2.62; 95% CI: 1.44-4.75), and lactic acid (OR: 1.10; 95% CI: 1.02-1.19). Low-dose corticosteroid was not associated with 60-day mortality rates in ARDS patients. Conclusion: The outcome of patients with ARDS was associated with the underlying diseases (such as malignancy) and organ dysfunction rather than steroid treatment.

S-501 : 말초혈액 도말검사에서 우연히 발견된 미세사상충

백문성,윤귀현,손영우 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

흔히 수종다리라고 불려지던 림프사상충증(lymphatic filariasis)은 우리나라의 중요한 풍토병 중 하나였다. 주로 피하조직이나 림프관에 기생하는 사상충은 모기가 전파하며 우리나라에서는 말레이사상충(Burgia malayi)이 제주도, 경북 내륙지방, 전남 해안 주변에서 많이 발생하였으나 2007년 완전히 퇴치되었음을 세계보건기구에 보고하였다. 최근 담관염으로 입원한 환자의 말초혈액 도말검사에서 미세사상충 (microfilaria)을 발견하였기에 보고하는 바이다. 81세 남자가 1개월 전부터 지속된 발열, 오한, 근육통을 주소로 내원하였다. 상복부 압통과 복부 CT에서 총담관 확장 및 담관석, 경미한 담관벽의 비후 소견이 관찰되어 담관염으로 진단하였다. 그런데 입원 당시 시행한 말초혈액 도말검사에서 우연히 5개의 microfilariae가 발견되었다. 환자는 충남 예산 출생으로 경기도 군포에서 살아왔고 약 20년 전부터 중국, 대만, 하와이, 유럽 등지에 여행한 적이 있었다. 5년 전부터 양측 하지 부종이 2-3일 정도 지속되다가 호전되는 양상이 반복되었다. 신체 검사 상피부나 관절부위에 결절이나 림프절은 촉지되지 않았으나 grade 2+의 함요부종이 관찰되었다. 환자는 microfilaremia로 알벤다졸과 독시사이클린을 투여받았다. 한국에서 림프사상충증은 엄연히 박멸된 질환이지만 최근 동남아시아 등 해외 여행이 늘어나면서 림프사상충증의 발병 가능성은 여전히 존재하며 이에 대한 꾸준한 감시 및 주의가 필요할 것으로 보인다.

F-148 Intubation attempts and complications outside the operating room

백문성,허진원,임채만,고윤석,홍상범 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-

Endotracheal intubation outside the operating room is usually performed in the intensive care unit (ICU), emergency department (ED) or general ward (GW). Nonetheless the patients intubated in the GW are more unstable than the ICU or ED, only a few studies have been reported. Objective of this study is to identify preventable factors of multiple intubation attempts in the GW. We reviewed 1312 patients intubated in the GW by medical emergency team from Jan 2012 to DEC 2015. Multiple intubation attempts were defined as three or more attempts of endotracheal intubation, without reference to airway devices or operator`s expertise. A total of 1004 eligible patients were analyzed and 98 (9.8%) patients were underwent multiple intubation attempts. Hypoxic respiratory failure was the most common indication of intubation (58.8% vs. 58.2%, p=0.899). Difficult airway was more frequently observed in the patients with multiple attempts (17.6% vs. 58.2%, p<0.001). Although a number of internal medicine resident tried to intubate as a first intubator (59.8% vs. 68.4%, p=0.100), usually ICU fellows were final intubator (36.5% vs. 71.4%, p<0.001). Direct laryngoscope was more commonly selected device in patients with multiple attempts (45.8% vs. 71.4%). However, video laryngoscope was conclusive device (61.3% vs. 68.4%, p=0.169). The patients with multiple attempts had more adverse events than the others (23.0 % vs. 40.8%, p<0.001). Video laryngoscope and experienced intubator are important factors in successful intubation outside the operating room.

Mortality and prognostic prediction in very elderly patients with severe pneumonia

백문성,박소정,김철홍,최정희,현인규 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.0

Background: Although prognostic prediction scores for pneumonia such as CURB-65 score or pneumonia severity index (PSI) are widely used, there were a few studies in very elderly patients. ciate with in-hospital mortality of severe pneumonia in very elderly patients. Methods: During the 6-year study period (from October 2012 and May 2018), 176 patients aged 80 or older admitted to medical intensive unit were analysed retrospectively. Pneumonia severity was evaluated using CURB-65 score, PSI, sequential organ failure assessment (SOFA) scores, A-DROP, I-ROAD and lactate. The outcome was in-hospital mortality. Results: The median age was 85 years (IQR: 82-88) and in-hospital mortality was 53 (30.1%). Logistic regression showed that chronic lung, need for mechanical ventilation and haemodialysis, do-not-resuscitate (DNR) orders, and multiple lung involvement were independent predictors of in-hospital mortality of pneumonia. Using the receiver-operating characteristics curve for predicting mortality, the area under the curve in pneumonia was 0.64 for the SOFA score, 0.52 for the CURB-65 score, 0.55 for the PSI, 0.58 for the A-DROP, 0.53 for the I-ROAD and 0.65 for lactate. Conclusions: Prognostic prediction scores did not show excellent discrimination power in very elderly patients with severe pneumonia.

Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study

백문성,권영석,강상수,심대철,윤영상,김종호 대한중환자의학회 2024 Acute and Critical Care Vol.39 No.1

Background: The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis.Methods: Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models.Results: The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3–7) and the median PNI score was 39.6 (IQR, 33.8–46.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5–8; PNI: 35–38) or severe (CONUT: 9–12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0–1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24–1.87, P<0.001); for severe, HR=2.42 (95% CI, 1.95–3.02, P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09–1.53, P=0.003); for severe, HR=1.88 (95% CI, 1.67–2.12, P<0.001).Conclusions: The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.

Effect of Timing of Do-Not-Resuscitate Orders on the Clinical Outcome of Critically Ill Patients

백문성,Younsuck Koh,Sang-Bum Hong,Chae-Man Lim,Jin Won Huh 대한중환자의학회 2016 Acute and Critical Care Vol.31 No.3

Background: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. Methods: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. Results: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). Conclusions: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.

A Patient with Eosinophilic Gastroenteritis Presenting with Acute Pancreatitis and Ascites

백문성,목영미,한원철,김용성 거트앤리버 소화기연관학회협의회 2014 Gut and Liver Vol.8 No.2

Eosinophilic gastroenteritis (EGE) is a rare disease characterizedby focal or diffuse eosinophilic infiltration of the gastrointestinaltract, especially the stomach and duodenum. EGE has vague, nonspecific symptoms, including nausea,vomiting, abdominal pain, diarrhea, weight loss, ascites, andmalabsorption. Here, we report a patient with EGE presentingwith concurrent acute pancreatitis and ascites. A 68-yearoldwoman was admitted with abdominal pain, nausea,vomiting, and watery diarrhea. Laboratory findings revealedelevated serum titers of amylase, lipase, and peripheralblood eosinophil count. An abdominopelvic computed tomographyscan showed a normal pancreas, moderate amountof ascites, and duodenal thickening. A esophagogastroduodenoscopyshowed patchy erythematous mucosal lesions inthe 2nd portion of the duodenum. Biopsies from the duodenumindicated eosinophilic infiltration in the lamina propria. The patient was successfully treated with prednisolone andmontelukast. Despite its unusual occurrence, EGE may beconsidered in the differential diagnosis of unexplained acutepancreatitis, especially in a patient with duodenal edema onimaging or peripheral eosinophilia.

운동신경을 침범한 대상포진에 인한 편측 복벽마비

이상학,백문성,양현덕,장재훈,김용성 대한신경과학회 2014 대한신경과학회지 Vol.32 No.4

Vitamin D Inhibits Expression and Activity of Matrix Metalloproteinase in Human Lung Fibroblasts (HFL-1) Cells

김서화,김휘정,백문성,윤동식,박종설,윤병욱,오병수,박진경 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.77 No.2

Background: Low levels of serum vitamin D is associated with several lung diseases. The production and activationof matrix metalloproteinases (MMPs) may play an important role in the pathogenesis of emphysema. The aim of thecurrent study therefore is to investigate if vitamin D modulates the expression and activation of MMP-2 and MMP-9 inhuman lung fibroblasts (HFL-1) cells. Methods: HFL-1 cells were cast into three-dimensional collagen gels and stimulated with or without interleukin-1β (IL-1β) in the presence or absence of 100 nM 25-hydroxyvitamin D (25(OH)D) or 1,25-dihydroxyvitamin D (1,25(OH)2D) for48 hours. Trypsin was then added into the culture medium in order to activate MMPs. To investigate the activity of MMP-2 and MMP-9, gelatin zymography was performed. The expression of the tissue inhibitor of metalloproteinase (TIMP-1, TIMP-2) was measured by enzyme-linked immunosorbent assay. Expression of MMP-9 mRNA and TIMP-1, TIMP-2mRNA was quantified by real time reverse transcription polymerase chain reaction. Results: IL-1β significantly stimulated MMP-9 production and mRNA expression. Trypsin converted latent MMP-2 and MMP-9 into their active forms of MMP-2 (66 kDa) and MMP-9 (82 kDa) within 24 hours. This conversion wassignificantly inhibited by 25(OH)D (100 nM) and 1,25(OH)2D (100 nM). The expression of MMP-9 mRNA was alsosignificantly inhibited by 25(OH)D and 1,25(OH)2D. Conclusion: Vitamin D, 25(OH)D, and 1,25(OH)2D play a role in regulating human lung fibroblast functions in woundrepair and tissue remodeling through not only inhibiting IL-1β stimulated MMP-9 production and conversion to its activeform but also inhibiting IL-1β inhibition on TIMP-1 and TIMP-2 production.

Chlorhexidine-induced anaphylaxis in perioperative setting : confirmed by serum specific IgE

엄종현,강진구,백문성,김철홍,현인규,최정희 대한내과학회 2019 대한내과학회 추계학술대회 Vol.2019 No.1