Additive harmful effects of acute kidney injury and acute heart failure on mortality in hospitalized patients

Organ crosstalk between the kidney and the heart has been suggested. Acute kidney injury (AKI) and acute heart failure (AHF) are well-known independent risk factors for mortality in hospitalized patients. This study aimed to investigate if these conditions have an additive effect on mortality in hospitalized patients, as this has not been explored in previous studies. Methods: We retrospectively reviewed the records of 101,804 hospitalized patients who visited two tertiary hospitals in the Republic of Korea over a period of 5 years. AKI was diagnosed using serum creatinine-based criteria, and AHF was classified using International Classification of Diseases codes within 2 weeks after admission. Patients were divided into four groups according to the two conditions. The primary outcome was all-cause mortality. Results: AKI occurred in 6.8% of all patients (n = 6,920) and AHF in 1.2% (n = 1,244). Three hundred thirty-one patients (0.3%) developed both conditions while AKI alone was present in 6,589 patients (6.5%) and AHF alone in 913 patients (0.9%). Among the 5,181 patients (5.1%) who died, 20.8% died within 1 month. The hazard ratio for 1-month mortality was 29.23 in patients with both conditions, 15.00 for AKI only, and 3.39 for AHF only. The relative excess risk of interaction was 11.85 (95% confidence interval, 2.43–21.27), and was more prominent in patients aged <75 years and those without chronic heart failure. Conclusion: AKI and AHF have a detrimental additive effect on short-term mortality in hospitalized patients.

Association of hypoalbuminemia with short-term and long-term mortality in patients undergoing continuous renal replacement therapy

Background@#Hypoalbuminemia reflects several pathological conditions, including nutritional deficiencies and chronic inflammation. However, its relationship with short-term and long-term mortality in patients undergoing continuous renal replacement therapy (CRRT) remains unclear. The present study aimed to assess the effect of hypoalbuminemia on mortality in a large cohort of patients undergoing CRRT. @*Methods@#The study retrospectively reviewed 1,581 patients who underwent CRRT for the treatment of acute kidney injury from 2010 to 2016. The patients were categorized by tertiles of serum albumin levels at CRRT initiation. The odds ratios and hazard ratios for the risk of all-cause mortality were calculated before and after adjustment for multiple covariates. @*Results@#The mean albumin level was 2.7 ± 0.6 g/dL at CRRT initiation. During a median follow-up period of 14 days (maximum, 4 years), 1,040 patients (65.8%) died. The risk of overall mortality was higher in the first tertile group than in the third tertile group (hazard ratio, 1.9 [1.63-2.21]). When the mortality rate was stratified by timeframe, the risk was steadily higher in the first tertile group than in the third tertile group (odds ratios: 3.0 [2.34-3.87] for 2-week mortality, 2.7 [2.12-3.52] for 1-month mortality, 2.7 [2.08-3.53] for 6-month mortality, and 2.8 [2.11- 3.62] for 1-year mortality). Additionally, the rates of intensive care unit mortality and in-hospital mortality were higher in the first tertile group than in the third tertile group. @*Conclusion@#The initial hypoalbuminemia was independently associated with short-term and long-term mortality in patients undergoing CRRT. Thus, the serum albumin level should be monitored during CRRT.

Efficacy of low-dose spironolactone on top of angiotensin receptor blockade in patients with glomerulonephritis

BACKGROUND: Previous studies have shown that aldosterone antagonists have a proteinuria-lowering effect in patients with proteinuria and progressive proteinuric disease not adequately controlled by the use of angiotensin receptor blockers (ARBs). Aldosterone antagonists, in combination with ARBs, might improve proteinuria in patients with glomerulonephritis (GN). METHODS: In the present retrospective study, we evaluated the proteinuria-lowering effect and drug safety of low-dose spironolactone (12.5 mg/day) in 42 patients with GN being treated with an ARB. RESULTS: Proteinuria decreased from a mean total-protein-to-creatinine (TP/Cr) ratio of 592.3 ± 42.0 mg/g at baseline to 335.6 ± 43.3 mg/g after three months of treatment with spironolactone (P < 0.001). After the initial three months, the mean TP/Cr ratio increased progressively at six, nine, and 12 months; however, it was still less than the baseline value (P = 0.001, < 0.001, and < 0.001, respectively). Although serum Cr levels increased significantly at three and nine months compared with baseline (P = 0.036 and 0.026, respectively), there was no time effect of treatment (P = 0.071). Serum potassium levels tended to increase with time (P = 0.118), whereas systolic and diastolic blood pressures decreased with time (P = 0.122 and 0.044, respectively). CONCLUSION: Low-dose spironolactone in combination with an ARB reduced proteinuria in patients with GN, which could represent a novel treatment option in individuals whose proteinuria is not optimally controlled by the use of ARBs alone.

A Case of Skin Sclerosis Associated with Docetaxel Chemotherapy for Non-Small Cell Lung Cancer

A 64-year-old woman was diagnosed with non-small cell lung cancer. Her disease was stage 4 (T2N2M1) with squamous cell carcinoma. She had been treated with docetaxel and carboplatin. After a completion of 11 cycle of chemotherapy, edema appeared on both feet and had spread rapidly up to the pretibial area without response to diuretics. Sclerotic changes and pigmentation followed but both knees and other parts of the body were spared. There was no evidence of vascular occlusions. On serologic tests, antinuclear, anti-centromere, and anti-topoisomerase I antibodies were all negative. A skin biopsy revealed diffuse infiltration of lymphocytes and discretely thickened collagen bundles in the superficial dermis. After discontinuing docetaxel chemotherapy, she was treated with prednisolone and D-penicillamine and sclerotic changes on the lower legs were improved.

The differences of clinical profiles by house dust mite sensitization in patients with asthmatics in Soonchunhyang University Hospital cohort

PURPOSE: The majority of patients with allergic disease are highly sensitized to house dust mites (HDM). There is few data to observe sensitization rate to HDM in asthmatics in Korea. The aim of this study was to observe the differences of clinical profiles by HDM sensitization in patients with asthmatics in Soonchunhyang University Hospital (SCH) cohort. METHODS: We recruited 2,345 asthmatic patients in SCH cohort. Lung function, body mass index and sputum and blood eosinophils, and PC20, and clinical profiles were compared by HDM sensitization. RESULTS: Dermatophagoides farinae (Derf) and/or Dermatophagoides pteronyssinus (Derp) (+) sensitization rate was higher prevalence in male than in female. Compared with nonatopy asthmatics, Derf and/or Derp (+) asthmatics had early onset of age [Derf and/or Derp (+) vs. Derf and Derp (-) vs. atopy (-); 32.5+/-0.51 vs. 36.1+/-0.88 vs. 43.1+/-0.54, P<0.05]. Derf and/or Derp (+) asthmatics had shorter duration of asthma symptom than that of nonatopy asthmatics. Derf and/or Derp (+) asthmatics had lower forced expiratory volume in one second and forced vital capacity than those of Derf and Derp (-) asthmatics. PC20 in Derf and/or Derp (+) asthmatics had lower than those of Derf and Derp (-) and nonatopy asthmatics [Derf and/or Derp (+) vs. Derf and Derp (-) vs. atopy (-); 5.4+/-0.24 mg/mL vs. 6.59+/-0.52 mg/mL vs. 7.19+/-0.33 mg/mL, P<0.05]. Blood eosinophils number in Derf and/or Derp (+) asthmatics had higher than that of nonatopy asthmatics (414.7+/-131.1 vs. 350.6+/-14.0, P<0.05). Total immunoglobulin E (IgE) in Derf and/or Derp positive asthmatics had higher than that of Derf and Derp negative and nonatopy asthmatics. There was no difference of body mass index among three groups. CONCLUSIONS: Our data indicate that atopy asthmatics sensitized to Derf and/or Derp had early onset of age, high total IgE and airway responsiveness, and eosinophilic inflammation.

The Clinical Significance of Simplified Scoring Criteria as a Diagnostic Tool for Overlap Syndrome in Korea / 대한내과학회지

BACKGROUND/AIMS: The diagnosis of primary billiary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap syndrome remains challenging. In 2008, a simplified scoring system was proposed by the International Autoimmune Hepatitis Group, which aimed for wider applicability in routine clinical practice. We evaluated the performance of the new simplified AIH scoring criteria as a diagnostic tool for overlap syndrome. METHODS: We retrospectively reviewed the clinical histories, chemistry, autoimmune studies, and liver biopsy results of 25 patients diagnosed with PBC who visited Soonchunhyang University Hospital, Bucheon and Seoul, between November 2004 and December 2009. Parameters relevant to the revised and simplified scoring criteria were recorded, and outcomes were compared between those with and without features of overlap syndrome. RESULTS: Of 25 patients with a definite diagnosis of PBC, five (20%) were diagnosed with overlap syndrome using the revised criteria, and 18 patients (72%) were diagnosed with the simplified criteria. Those patients diagnosed according to the simplified scoring criteria revealed an increased frequency of anti-nuclear antibody (p = 0.030) and serum IgG levels (p = 0.092). Additionally, advanced fibrosis was significantly more frequent in patients with overlap syndrome (p = 0.017). CONCLUSIONS: The simplified scoring criteria seemed to be useful as a diagnostic tool to recognize overlap syndrome in Korea. However, a relatively small number of patients were included in our study, so further clinical trials based on larger populations should be performed.

Clinical Aspects of Peritonitis in Peritoneal Dialysis Patient: A Single Center Experience

OBJECTIVE: Peritonitis is one of major complication of peritoneal dialysis. It is the most important reason for removal of peritoneal catheter, death, or converting to hemodialysis. There is a debate that peritonitis decreases residual renal function. Thus, the authors carried out a study to grasp the prognosis of peritonitis which affects residual renal function (RRF) and assessed the risk factors of its clinical course. METHODS: Among 245 patients who had been on peritoneal dialysis in Soonchunhyang University Bucheon Hospital from April 2001 to March 2012, the author selected 91 patients who had kept on peritoneal dialysis for more than 3 months and experienced more than one episode of peritonitis. The medical records and laboratory findings were reviewed. RESULTS: During the average period of 36.3+/-22.8 months of peritoneal dialysis, total of 182 episodes of peritonitis developed in 91 study subjects. Among them, the 15 cases (8.2%) did not improve despite of intraperitoneal antibiotics and peritoneal catheter was subsequently removed. Eight patients were dead because of peritonitis related complications. The lactic dehydrogenase (LDH) level of peritoneal fluid at the third day of treatment had a significant correlation with peritonitis treatment failure (odds ratio [OR], 1.079; P=0.009) and death (OR, 1.071; P=0.049), respectively. The RRF after peritonitis became significantly low (P=0.011) compared to before peritonitis. But the slopes of declining rate of RRF were not different between before and after peritonitis (P=0.932). CONCLUSION: The LDH level of peritoneal fluid at the third day of treatment was correlated with treatment failure or death. The declining rate of RRF was not affected after peritonitis.

Two Cases of Ascending Aortic Intramural Hematoma Combined with Cardiac Tamponade Treated with Different Strategies

Aortic intramural hematoma (IMH) is classically defined as a variation of aortic dissection where blood collects within the aortic media without the presence of an intimal flap. Ascending IMH is known to have worse clinical outcomes than IMH of the descending aorta or aortic arch. Therefore, some patients with higher risk of disease progression require surgical corrections. However, the indications and the benefits of surgical management of ascending IMH, compared with medical treatment only, have not yet been established. We present two cases of IMH in the ascending aorta that presented with cardiac tamponade; patients were treated differently according to risk factors.