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Readmission to Medical Intensive Care Units: Risk Factors and Prediction
조용숙,조영재,이연주,박종선,윤호일,이재호,이춘택 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.2
Purpose: The objectives of this study were to find factors related to medical intensivecare unit (ICU) readmission and to develop a prediction index for determining patients who are likely to be readmitted to medical ICUs. Materials and Methods: We performed a retrospective cohort study of 343 consecutive patients who were admittedto the medical ICU of a single medical center from January 1, 2008 to December31, 2012. We analyzed a broad range of patients’ characteristics on the day of admission, extubation, and discharge from the ICU. Results: Of the 343 patients discharged from the ICU alive, 33 (9.6%) were readmitted to the ICU unexpectedly. Using logistic regression analysis, the verified factors associated with increased risk of ICU readmission were male sex [odds ratio (OR) 3.17, 95% confidence interval (CI) 1.29‒8.48], history of diabetes mellitus (OR 3.03, 95% CI 1.29‒7.09), applicationof continuous renal replacement therapy during ICU stay (OR 2.78, 95% CI 0.85‒9.09), white blood cell count on the day of extubation (OR 1.13, 95% CI 1.07‒1.21), and heart rate just before ICU discharge (OR 1.03, 95% CI 1.01‒1.06). We established a prediction index for ICU readmission using the five verified risk factors (area under the curve, 0.76, 95% CI 0.66‒0.86). Conclusion: By using specificrisk factors associated with increased readmission to the ICU, a numerical index could be established as an estimation tool to predict the risk of ICU readmission.
P-59 NGAL as a Complementary Biomarkers for differentiating ACO from non-ACO COPD
조용숙,권성옥,김우진 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-
Background: There is no standardized definition or biomarkers of asthma-COPD overlap(ACO) yet. This study aimed to measure the potential biomarker in overlap patients: plasma levels of neutrophil gelatinase-associated lipocalin(NGAL). Methods: We used Korean cohort in COPD in Dusty Area(CODA) and defined ACO by positive bronchodilator response or previously diagnosed asthma. Plasma levels of NGAL were determined by enzyme immunoassay. Results: Among 137 COPD patients, 77 were ACO and 60 were non-ACO COPD. Plasma NGAL level was 15.6±6.6 and 15.9±7.9 ng/mL for non-ACO and ACO patients respectively, but significantly higher in female patients with ACO than non-ACO subjects (17.0±6.4 and 11.1±4.5 ng/mL; P=.01). Serum level of NGAL was significantly correlated with blood eosinophil and emphysema index on chest CT scan. In female patients, NGAL has predictive ability to discriminate ACO from non-ACO COPD (AUROC, 0.77) and NGAL level 14.3 ng/mL might be a cut-off level (sensitivity 67% and specificity 80%). Also, plasma NGAL level showed similar predictive ability with eosinophil (AUROC for NGAL, 0.77 and for eosinophil 0.76). But, plasma level of NGAL was not an independent factor for differentiating ACO from non-ACO COPD on multivariate analysis adjusted by sex, blood eosinophil and emphysema index (aOR, 1.03; 95% CI, 0.51-2.06; P=.94). Conclusion: Although Plasma NGAL level was not confirmed as an independent predictor for identifying ACO, it significantly higher in female patients with ACO than non-ACO and has similar predictive ability to blood eosinophil.
조용숙,최준수,이진국,유광하,박혜윤,박용범 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-
Background and Objective: Fractional exhaled nitric oxide (FENO) is regarded as potential biomarkers for identifying eosinophilic inflammation in chronic obstructive pulmonary disease (COPD). We aimed to evaluate the clinical implication of FENO and how it affects prescription behaviour of inhaled corticosteroids in Korean COPD cohort. Methods: We analysed the level of FENO and its association with clinical features in two COPD cohorts. Changes of prescription rate of Inhaled corticosteroids (ICS) before and after FENO measurement were identified. Results: A total of 216 COPD patients divided into high (≥ 25 ppb, N=111) and low (<25 ppb, N=105) FENO group. Compared to low FENO group, odds ratio (95% CI) for previous history of asthma and/or accompanied wheezing were 1.92 (1.03-3.58) and 2.49 (1.08-5.72), respectively. ICS was prescribed to 79 and 68 patients before and after FENO measurement and more frequently to high FENO group than low group. Among 137 patients without ICS before, 56 of 71 patients in high FENO group were newly prescribed ICS after FENO measurements. On the other hands, among 79 patients with ICS before, 17 of 39 patients in low FENO group were excluded from ICS prescription after FENO measurements. Conclusion: FENO help clinician to distinguish eosinophilic phenotype of COPD and affect clinician’s decision on whether use of ICS or not. Further studies are needed to identify how this affects the patient’s outcome such as exacerbation risk and ICS responder prediction.
조용숙,이진국,jung hur 대한결핵및호흡기학회 2022 Tuberculosis and Respiratory Diseases Vol.85 No.3
Background: We evaluated the effect of particulate matter (PM) and cigarette smoke extract (CSE) on bronchial epithelial cell survival, as well as oxidative stress and autophagy levels. Moreover, we aimed to assess the effect of the antioxidant N-acetylcysteine (NAC) on the adverse effects of PM and CSE exposure.Methods: Normal human bronchial epithelial cells (BEAS-2B cells) were exposed to urban PM with or without CSE, after which cytotoxic effects, including oxidative stress and autophagy levels, were measured. After identifying the toxic effects of urban PM and CSE exposure, the effects of NAC treatment on cell damage were evaluated.Results: Urban PM significantly decreased cell viability in a concentration-dependent manner, which was further aggravated by simultaneous treatment with CSE. Notably, pretreatment with NAC at 10 mM for 1 hour reversed the cytotoxic effects of PM and CSE co-exposure. Treatment with 1, 5, and 10 mM NAC was shown to decrease reactive oxygen species levels induced by exposure to both PM and CSE. Additionally, the autophagy response assessed via LC3B expression was increased by PM and CSE exposure, and this also attenuated by NAC treatment.Conclusion: The toxic effects of PM and CSE co-exposure on human bronchial epithelial cells, including decreased cell viability and increased oxidative stress and autophagy levels, could be partly prevented by NAC treatment.
조용숙,최선미,이진우,박영식,이창훈,임재준,유철규,김영환,한성구,이상민 대한결핵및호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.3
Background: Acute respiratory distress syndrome (ARDS) is related to high mortality and morbidity. There are no proven therapeutic measures however, to improve the clinical course of ARDS, except using low tidal volume ventilation. Metformin is known to have pleiotropic effects including anti-inflammatory activity. We hypothesized that pre-admission metformin might alter the progress of ARDS among intensive care unit (ICU) patients with diabetes mellitus (DM). Methods: We performed a retrospective cohort study from January 1, 2005, to April 30, 2005 of patients who were admitted to the medical ICU at Seoul National University Hospital because of ARDS, and reviewed ARDS patients with DM. Metformin use was defined as prescribed within 3-month pre-admission. Results: Of 558 patients diagnosed with ARDS, 128 (23.3%) patients had diabetes and 33 patients were treated with metformin monotherapy or in combination with other antidiabetic medications. Demographic characteristics, cause of ARDS, and comorbid conditions (except chronic kidney disease) were not different between metformin users and nonusers. Several severity indexes of ARDS were similar in both groups. The 30-day mortality was 42.42% in metformin users and 55.32% in metformin nonusers. On multivariable regression analysis, use of metformin was not significantly related to a reduced 30-day mortality (adjusted β-coefficient, –0.19; 95% confidence interval, –1.76 to 1.39; p=0.816). Propensity score-matched analyses showed similar results. Conclusion: Pre-admission metformin use was not associated with reduced 30-day mortality among ARDS patients with DM in our medical ICU.