Long-term change in real-world clinical practice in IPF and its impact on survival: results from consecutive nationwide registries

( Sung Woo Moon ),( Song Yee Kim ),( Behalf Of Ild Study Group ),( Moo Suk Park ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: The Korean Interstitial Lung Disease Study Group created two nationwide, multicentre consecutive registries on idiopathic pulmonary fibrosis (IPF). Comparing these registries, this study aimed to evaluate the long-term change in clinical features, diagnostic modalities, and prognostic factors of IPF in the real world. Methods: We enrolled patients from the first registry (2008 group, January 2002-September 2008) and the second registry (2018 group, January 2012-August 2018). Survival curves were estimated using the Kaplan-Meier method. To evaluate the risk factor for the mortality in each registry, Cox regression models were used. Results: The 2008 and the 2018 groups comprised 1839 and 1345 patients, respectively. The 2018 group was younger (P=0.025), had fewer symptoms (P<0.001), had less honeycombing (P<0.001), and was less frequently diagnosed with surgical biopsy (P<0.001). Further, in the 2018 group, steroid use and conservative care declined, while the N-acetylcysteine use increased. Pirfenidone and nintedanib were only used in the 2018 group. 2018 group showed better survival. There was no significant difference in survival between the 2008 group and the 2018 subgroup group who did not use anti-fibrotic agent (P=0.197). In the evaluation of the risk factor for mortality in each registry, significant factors were higher gender-age-physiologic (GAP) score, and history of cancer in the 2008 group, while they were higher GAP score, history of hepatitis, history of cancer, honeycombing on HRCT, and steroid use in the 2018 group. Pirfenidone use (P<0.001) was related with lower mortality in the 2018 group. Conclusions: Actual clinical practice in the diagnosis and treatment of IPF patients have changed in adherence with guidelines, novel medications, and social circumstances, and the survival of IPF patients have improved. Proper guidelines for the diagnosis and management of IPF based on accumulated data and observations are crucial and must be combined with newer treatment.

Influence of Insurance Benefit Criteria on the Administration Rate of Osteoporosis Drugs in Postmenopausal Females

이재협,이혜연,문성환,이일섭,Korean Post Menopausal Women Study Group 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.1

Background: Preventive measures need to be implemented to lower the incidence of osteoporotic fractures. Osteoporotic fractures increase morbidity and mortality as well as impose a socioeconomic burden; however, current research is limited to the administration rates of osteoporosis drugs for Korean postmenopausal females. Methods: This study represents a nationwide, observational, and cross-sectional survey that investigates the administration rates of osteoporosis drugs based upon a bone mineral density (BMD) test performed on Korean postmenopausal patients who visited outpatient orthopedic clinics. BMD test results were examined in postmenopausal female patients (50 to 80 years of age); subsequently, the patients were classified into an osteoporosis group, osteopenia group, and normal group. The administration rates of osteoporosis drugs and bisphosphonates were then analyzed. The osteoporosis group was subdivided into a T-score less than −3.0 group and a T-score between −3.0 and −2.5 group that were separately analyzed. Results: Based on the lumbar spine BMD, the rate of administration of osteoporosis drugs in the osteoporosis group was 42.1%, which was significantly higher compared to the osteopenia group or normal group. A significantly low bone mineral density was observed in patients who were administered bisphosphonates. Based on the lumbar spine BMD, the administration rate of osteoporosis drugs in the group with a T-score between −3.0 and −2.5 (34.2%) was significantly lower than the group with a T-score less that −3.0 (46.2%). The bisphosphonate administration rate was also significantly low; however, the administration rate for osteoporosis drugs was significantly lower than that of the osteopenia group. Conclusions: Only about 40% of Korean postmenopausal female patients with osteoporosis were administered osteoporosis drugs. The administration rate in patients with a T-score between −3.0 and −2.5 was particularly low and active treatment to prevent osteoporotic fractures is required in this group.

Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study

김태희,김정수,최은영,장유진,최원일,황재준,문재영,이광하,김세원,강형구,심윤수,박태선,박승용,박성훈,조재화,Korean NIV Study Group 대한중환자의학회 2020 Acute and Critical Care Vol.35 No.4

Background: The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs. Methods: Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included. Results: A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups. Conclusions: In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

Urinary Angiotensinogen in addition to Imaging Classification in the Prediction of Renal Outcome in Autosomal Dominant Polycystic Kidney Disease

박혜인,Kim Juhee,조아진,Kim Do Hyoung,이영기,Ryu Hyunjin,김현숙,Oh Kook-Hwan,오윤규,Hwang Young-Hwan,Lee Kyu-Beck,Kim Soo Wan,Kim Yeong Hoon,Lee Joongyub,안규리,KNOW-CKD Investigators Group 대한의학회 2020 Journal of Korean medical science Vol.35 No.22

Background: Intrarenal renin-angiotensin system (RAS) is known to play the major role in the development of hypertension and renal progression in autosomal dominant polycystic kidney disease (ADPKD). Urinary angiotensinogen to creatinine ratio (AGT/Cr) was suggested as a novel biomarker to reflect intrarenal RAS activity. This study was performed to evaluate urinary AGT/Cr as a predictive biomarker for renal function decline in addition to imaging classification in a prospective ADPKD cohort. Methods: From 2011 to 2016, a total of 364 ADPKD patients were enrolled in the prospective cohort called the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). Among them, a total of 207 subjects in chronic kidney disease stage 1–4 with baseline urinary AGT and total kidney volume and subsequent renal function follow-up data over more than 1 year were included in the analysis. Patients were defined as slow progressors (SP) if they are classified as 1A or 1B by imaging classification whereas rapid progressors (RP) if they are classified as 1C–1E. Patients were divided according to AGT/Cr quartiles and annual estimated glomerular filtration rate (eGFR) slope was compared among highest quartile (hAGT group) and the rest of quartiles (lAGT group). Patients were divided into 4 groups to evaluate the predictive value of urinary AGT/Cr in addition to imaging classification: SP/lAGT, SP/hAGT, RP/lAGT, and RP/hAGT. The Cox regression model was used to evaluate the hazard ratio (HR) between groups. Results: The mean age was 45.9 years and 88.9% had hypertension. Baseline eGFR was 79.0 ± 28.4 mL/min/1.73 m2 and median height-adjusted total kidney volume was 788.2 (471.2;1,205.2) mL/m. The patients in the hAGT group showed lower eGFR (72.4 ± 24.8 vs. 81.1 ± 29.2 mL/min/1.73 m2 , P = 0.039), lower plasma hemoglobin (13.0 ± 1.4 vs. 13.7 ± 1.6 g/dL, P = 0.007), higher urinary protein to creatinine ratio (0.14 [0.09, 0.38] vs. 0.07 [0.04, 0.12] g/g, P = 0.007) compared to the lAGT group. The hAGT group was an independent risk factor for faster eGFR decline after adjusting for gender, RP, baseline eGFR, and other known risk factors. During median follow-up duration of 4.6 years, a total of 29 renal events (14.0%) occurred. The SP/hAGT group showed significantly higher risk of developing renal outcome compared to SP/lAGT group (HR, 13.4; 95% confidence interval, 1.282–139.324; P = 0.03). Conclusion: Urinary AGT/Cr can be a useful predictive marker in the patients with relatively small ADPKD. Various biomarkers should be considered to define RP when implementing novel treatment in the patients with ADPKD.

Flexible Initial Dosing of Atorvastatin Based Upon Initial Low-Density Lipoprotein Cholesterol Levels in Type 2 Diabetic Patients

Atorvastatin Study Group in Korea,손호영,고승현 대한내과학회 2008 The Korean Journal of Internal Medicine Vol.23 No.1

Background/Aims : We used flexible starting doses and early titration of atorvastatin to determine the rate of achievement of a low-density lipoprotein cholesterol (LDL-C) target for hyperlipidemic patients with type 2 diabetes mellitus. Methods : This study was a multicenter, open-label, prospective trial of atorvastatin therapy in hyperlipidemic patients with type 2 diabetes. The patients were divided into three groups according to initial LDL-C levels (130-149, 150-159 and≥160 mg/dL), and 10, 20, and 40 mg of atorvastatin was administered to each group, respectively. If LDL-C did not reach the 100 mg/dL target level at four weeks after initiation of treatment, the doses were increased by one step. Endothelial function tests and plasminogen activator inhibitor (PAI)-1 levels were measured in 41 patients. Results : Groups of 62, 18, and 69 patients were started on 10, 20, and 40 mg of atorvastatin, respectively, and 91% of the patients achieved the LDL-C target after four weeks of treatment. The overall percentage of patients achieving the LDL-C target after eight weeks of treatment was 89.3%: 87.5% in the 10 mg group, 86.4% in the 20 mg group, 93.9% in the 40 mg group, and 66.7% in the 80 mg group. A statistically significant reduction was observed in the mean percentage change in flow-mediated endothelium-dependent dilatation after eight weeks of treatment (p<0.0001). Conclusions : Flexible initial dosing and early aggressive titration of atorvastatin according to LDL-C levels is an efficient and safe strategy for achieving the target level and for improving endothelial dysfunction in hyperlipidemic patients with type 2 diabetes.

Worldwide comparison of ovarian cancer survival: Histological group and stage at diagnosis (CONCORD-2)

the CONCORD Working Group,Matz, M.,Coleman, M.P.,Carreira, H.,Salmeron, D.,Chirlaque, M.D.,Allemani, C. Academic Press 2017 Gynecologic oncology Vol.144 No.2

Objective: Ovarian cancer comprises several histological groups with widely differing levels of survival. We aimed to explore international variation in survival for each group to help interpret international differences in survival from all ovarian cancers combined. We also examined differences in stage-specific survival. Methods: The CONCORD programme is the largest population-based study of global trends in cancer survival, including data from 60 countries for 695,932 women (aged 15-99years) diagnosed with ovarian cancer during 1995-2009. We defined six histological groups: type I epithelial, type II epithelial, germ cell, sex cord-stromal, other specific non-epithelial and non-specific morphology, and estimated age-standardised 5-year net survival for each country by histological group. We also analysed data from 67 cancer registries for 233,659 women diagnosed from 2001 to 2009, for whom information on stage at diagnosis was available. We estimated age-standardised 5-year net survival by stage at diagnosis (localised or advanced). Results: Survival from type I epithelial ovarian tumours for women diagnosed during 2005-09 ranged from 40 to 70%. Survival from type II epithelial tumours was much lower (20-45%). Survival from germ cell tumours was higher than that of type II epithelial tumours, but also varied widely between countries. Survival for sex-cord stromal tumours was higher than for the five other groups. Survival from localised tumours was much higher than for advanced disease (80% vs. 30%). Conclusions: There is wide variation in survival between histological groups, and stage at diagnosis remains an important factor in ovarian cancer survival. International comparisons of ovarian cancer survival should incorporate histology.

Impact of Young Age at Diagnosis on Survival in Patients with Surgically Treated Renal Cell Carcinoma: a Multicenter Study

강호원,서성필,김원태,윤석중,이상철,김원재,황의창,강석호,홍성후,정진수,권태균,김현회,곽철,변석수,김용준,KOrean Renal Cell Carcinoma (KORCC) Group 대한의학회 2016 Journal of Korean medical science Vol.31 No.12

The prognostic significance of age in renal cell carcinoma (RCC) is a subject of debate. The aim of the present multi-institutional study was to evaluate the impact of age on clinicopathological features and survival in a large cohort of patients with RCC. A total of 5,178 patients who underwent surgery for RCC at eight institutions in Korea between 1999 and 2011 were categorized into three groups according to age at diagnosis as follows: young age (< 40 years, n = 541), middle-age (≥ 40 and < 60 years, n = 2,551), and old age (≥ 60 years, n = 2,096) groups. Clinicopathological variables and survival rates were compared between the three groups. Young patients had lower stage tumors with a low Fuhrman grade, a lower rate of lymphovascular invasion than patients in the other age groups. Regarding histologic type, the young age group had a lower percentage of clear cell histology and a greater incidence of Xp11.2 translocation RCC. Kaplan-Meier estimates showed that cancer-specific survival was significantly better in the young age group than in the other groups (log rank test, P = 0.008). However, age at diagnosis was not an independent predictor of survival in multivariate analysis. In conclusion, young age at diagnosis was associated with favorable pathologic features, although it was not an independent prognostic factor for survival in patients with surgically-treated RCC. Age itself should not be regarded as a crucial determinant for the treatment of RCC.

Risk Factors for Acute Exacerbations in Elderly Asthma: What Makes Asthma in Older Adults Distinctive?

Kyoung-Hee Sohn,Woo-Jung Song,Jong-Sook Park,박흥우,Tae Bum Kim,Choon-Sik Park,조상헌,Elderly Asthma Cohort in Korea Group 대한천식알레르기학회 2020 Allergy, Asthma & Immunology Research Vol.12 No.3

Purpose: Asthma in the elderly (EA; ≥ 65 years of age) is increasing, adding a heavy socioeconomic burden to the healthcare system. However, little is known about risk factors associated with acute exacerbations in EA patients. The objective of this study was to investigate risk factors for acute exacerbation in EA compared to non-elderly asthma (NEA). Methods: We combined data from 3 adult asthma cohorts under a unified protocol and database. Asthmatic patients with regular follow-up during a 1-year period were selected from the cohorts to identify the risk factors predicting acute exacerbations in EA compared to NEA. Results: We selected a total of 1,086 patients from the merged cohort. During the observation period, 503 and 583 patients were assigned to the EA and NEA groups, respectively. The exacerbation rate was 31.0% in the EA and 33.2% in the NEA group. Multivariate logistic regression analysis revealed fixed airway obstruction, chronic rhinosinusitis (CRS), and male sex as independent risk factors for exacerbation in the EA group. In the NEA group, exacerbation increased along with an increase in eosinophil count. Bayesian analysis of the interactions among clinical factors revealed that forced expiratory volume in 1 second/forced vital capacity was directly related to exacerbation in the EA group, and eosinophil count was related to exacerbation in the NEA group. Conclusions: We suggest that fixed airway obstruction and CRS as the important clinical factors predicting acute exacerbations in EA, whereas in NEA, eosinophil count was the strong predictor of exacerbation.

Safety and Efficacy of Low-Volume Preparation in the Elderly: Oral Sulfate Solution on the Day before and Split-Dose Regimens (SEE SAFE) Study

Min Seob Kwak,Jae Myung Cha,Hyo-Joon Yang,Dong Il Park,Kyeong Ok Kim,Jun Lee,Jeong Eun Shin,Young Eun Joo,Jongha Park,Jeong-Sik Byeon,Hyun Gun Kim,Intestinal Cancer Study Group of the Korean Associati 거트앤리버 소화기연관학회협의회 2019 Gut and Liver Vol.13 No.2

Background/Aims: The use of a low-volume bowel cleansing agent is associated with a greater willingness to undergo repeat colonoscopy. Oral sulfate solution (OSS) is a recently approved low-volume agent; however, its efficacy and safety in the elderly population remain unclear. We aimed to evaluate the efficacy, safety, and acceptability of the OSS preparation, in comparison to those of a standard polyethylene glycol (PEG; 4 L) preparation, in elderly patients. Methods: A multicenter, randomized, investigator-blinded study was conducted. Participants were randomized to receive OSS or 4-L PEG with a split-dose regimen. Bowel cleansing efficacy was assessed using the Boston Bowel Preparation Scale (BBPS). Acceptance, satisfaction, and preparation-related symptoms were recorded. Additionally, blood parameters were analyzed for electrolyte abnormalities and nephrotoxicity. Results: A total of 193 patients were analyzed. No group differences in overall bowel cleansing efficacy were observed, with “adequate” preparations achieved in 95.9% (93/97) and 94.8% (91/96) of patients in the OSS and 4L PEG groups, respectively (p=0.747). However, mean BBPS scores for the entire (p=0.010) and right colon (p=0.001) were significantly higher in the OSS group than in the 4-L PEG group. The severity of clinical adverse events and frequency of acute kidney injury were similarly low, and no clinically meaningful electrolyte changes were identified. Self-reported scores regarding amount (p<0.001) and feeling (p=0.007), as well as overall satisfaction (p=0.001) and willingness to repeat the preparation (92.8% vs 67.7%, p<0.001), were significantly better in the OSS group than in the 4-L PEG group. Conclusions: In elderly individuals, OSS with a split-dose regimen has greater acceptability and comparable efficacy in bowel cleansing compared to 4-L PEG. (Clinical trials registration number: NCT03112967)

Current status of pain and sedation therapy on noninvasive mechanical ventilation in Korean Intensive Care Units : a multi-center observational study

조재화,김태희,남현승,최은영,장유진,최원일,황재준,문재영,이광하,김세원,강형구,심윤수,박태선,박승용,박성훈,( Korean Niv Study Group ) 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Introduction: The use of sedative drugs may be an important therapeutic intervention in patients with high risks such as mask intolerance, delirium, and agitation. However, there is little data on sedation during NIV maintenance. The Korean noninvasive mechanical ventilation study group has prospectively collected NIV use data from ICUs. Objectives: We analyzed status and safety in the management of pain, sedation on NIV therapy in Korean ICU. Methods: The twenty ICUs intensivists among Korean nationwide hospitals were participated and collected data of NIV from June 2017 to April 2018. We analyzed using chi-square test and Fisher’s exact test on categorical variables and Mann-Whitney U test on continuous variables. Results: The 155 patients were included during those periods. We divided the intervention group (n=26) that who received management of sedation and control group (n=129). The PaCO2 and PF ratio before NIV and 30 minutes after NIV were not different between intervention and control group. There was no statistically significant difference in success rate of NIV weaning, complications, length of ICU stay, ICU and hospital survival rate. However, duration of NIV apply were shorter in intervention than in control (1.5 days versus 4 days, p=0.001). Conclusion: In the NIV patients, pain and sedation therapy might have no harmful effect on complications, NIV weaning success, and mortality compared to the control group. Pain and sedation might have reduced the duration of NIV. Thus control of pain, sedation during NIV might be safe with close monitoring.