Usefulness of initial red blood cell distribution width as a prognostic factor for predicting 30-day mortality in acute decompensated heart failure patients

OBJECTIVE: This study evaluated the efficacy of the initial red blood cell distribution width (RDW) level in the emergency department (ED) to predict the 30-day mortality in patients with acute decompensated heart failure (ADHF). METHODS: A retrospective analysis study of patients who visited the ED and were diagnosed with ADHF from January 2015 to December 2016 was conducted. The patients were divided into the 30-day survival group and non-survival group. The data were obtained from the medical records of the patients, and the blood test results were taken from the initial blood test at the ED. The data and blood test results were compared between the 30-day survival and non-survival groups. Multivariate logistic regression analysis was performed to determine the risk factors for mortality. RESULTS: A total of 626 patients were included. The mean age was 78.5 years and the overall mortality was 15.5%. The non-survival group had higher RDW levels than the survival group (18.0% vs. 14.6%). In a multivariate logistic regression analysis, RDW (odds ratio, 2.242; 95% confidence interval [CI], 1.673−3.005; P<0.001) were considered to be a useful factor for predicting the prognosis. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.848 (95% CI, 0.811–0.886; P<0.001), and the sensitivity and specificity of predicting mortality was 76.3% and 78.1%, respectively, after setting the RDW cutoff value to 15.95%. CONCLUSION: The initial RDW level is a useful prognostic marker for predicting the 30-day mortality in ADHF patients.

Evaluation of clinical usefulness of pneumococcal urinary antigen test: single center experience

OBJECTIVE: A pneumococcal urinary antigen (PUA) test, which can be performed quickly and easily, is performed frequently in emergency rooms because of its high sensitivity and specificity. On the other hand, it is a relatively expensive test, and it is not known how it affects the clinicians' prescription of antibiotics. This study evaluated the clinical utility of the PUA test. METHODS: This study was conducted retrospectively on patients aged ≥18 years, who underwent a PUA test and were hospitalized with a diagnosis of pneumonia in an emergency room from January to December 2016. The patients were divided into a PUA test positive group and negative group, and the clinical characteristics and antibiotic regimen were compared. RESULTS: A total of 533 patients were enrolled, of which 54 were positive and 479 were negative. The antibiotic prescriptions were similar in the positive and negative groups. After the PUA test result, only two of the positive group used the antibiotics recommended by the Infectious Diseases Society of America and the American Thoracic Society for Streptococcus pneumoniae. Furthermore, there was an appropriate change in eight patients after the blood culture test, but the PUA test result was judged to be meaningful in only two patients. CONCLUSION: The results of the PUA test did not affect the clinician's antibiotic prescription significantly. A prescription standard for the PUA test is needed, and it should be performed after admission rather than in the emergency room.

The Validity of the Triage Tool as a Method to Screen Severe Alcoholic Intoxication Patients in the Emergency Department

PURPOSE: Altered mental status is common to alcohol intoxicated patients, resulting in difficulties to perform detailed physical examination and history taking. With this condition, the development of appropriate tools for evaluation was required. This study was conducted to investigate a better method for predicting the prognosis among alcohol intoxicated patients in the emergency department by modifying the Korean Triage Acuity Scale (KTAS). METHODS: We retrospectively reviewed the medical records of 1,155 alcohol intoxicated patients who presented to the ED between January and December of 2013. The correlation between admission and demographical characteristics of patients was analyzed. We applied the clinical values to KTAS (overdose category) and modified KTAS (alcoholic intoxication category). The efficiency of two triage methods was compared by using the receiver operating characteristic (ROC) curve analysis. RESULTS: Among these 1,155 patients, 201 were admitted and 954 were discharged. The sensitivity and specificity of the overdose category were 0.736 and 0.623, respectively. Those of the alcoholic intoxication category were 0.647 and 0.979, respectively. The area under ROC curves for overdose category and alcoholic intoxication category were 0.679±0.020 and 0.813±0.021, respectively (95% confidence interval, p<0.001). CONCLUSION: This study showed that the sensitivities of the overdose category and the alcoholic intoxication category were similar. However, the specificity of the alcoholic intoxication category was higher than that of the overdose category. Therefore, the alcoholic intoxication category was superior to the overdose category in predicting the prognosis among alcohol intoxicated patients.