Analysis of Prognostic Factors Early in Emergency Department (ED) and Late in Intensive Care Unit (ICU) of the Critically Ill Patients Admitted in the ICU via ED / 대한구급학회지

BACKGROUND: Many critically ill patients in the ED are hospitalized to the ICU, but most prognosis predicting systems have been developed based on the physiochemical variables of the critically ill in the ICU. The objective of this study is to identify prognostic predictors early in the ED when compared with well-known predictors in the ICU and estimate their predictive abilities. METHODS: An observational prospective study was performed in an urban ED. Information of all the critically ill patients admitted to the ICU via the ED including vital signs, laboratory results, and physiochemical scoring systems were checked during 6 months and divided into the early stage for the ED and the late stage in the ICU. Poor outcome was defined as 28-days mortality. After checking for significant predictors among them through univariate analysis, we identified the most discriminating predictors in each stage using logistic regression and a decision tree analysis. RESULTS: A total of 246 patients were enrolled. In univariate analysis, the significant predictors including central venous pressure, fraction of inspired oxygen (FiO2), pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2), albumin, mortality in emergency department sepsis, acute physiology and chronic health evaluation II, simplified acute physiology score II, and sequential organ failure assessment scores were identified in the early stage, while PaO2/FiO2, base excess, unmeasured anion, albumin, anion gap, albumin-corrected anion gap, APACHEII, SAPSII, SOFA, and rapid emergency medicine score were identified in the late stage. Through a decision tree analysis, PaO2/FiO2 and SAPSII were revealed as the most discriminating predictors in the ED and ICU, respectively. CONCLUSIONS: The prognosis discriminating predictor in critical patients was different between the ED and ICU. Emergency physicians should pay more attention to the critical patients having low PaO2/FiO2.

Clinical Study of Idiopathic Thrombocytopenic Purpura: Focused on Reticulated Platelet / 대한소아혈액종양학회지

PURPOSE: Immune thrombocytopenic purpura (ITP) is divided into acute and chronic forms. Unfortunately, there have been no known specific laboratory or clinical predictors for the diagnosis of chronic ITP. This study was performed to elucidate the prognostic significance of various clinical and laboratory parameters, including reticulated platelet percentage. METHODS: We retrospectively analyzed 60 patients who were diagnosed as ITP at the Department of Pediatrics, Wonju Christian Hospital from January, 1989 to January, 2001. Various kind of clinical parameters such as age, sex, symptom duration, prior URI history, response to treatment, and laboratory parameters like platelet count at initial presentation, lowest platelet count, duration of thrombocytopenia, initial reticulated platelet percentage, antiplatelet antibody IgG and IgM, antinuclear antibody (ANA), direct and indirect Coombs' test were compared between acute and chronic ITP. RESULTS: Fifteen % of patients (9/60) was chronic ITP. The peak age incidence was from 1 to 3 year of age in both acute (29.4%) and chronic ITP (22.2%). The acute ITP was prevalent in spring season, May and June. There was no difference in the incidence of prior URI history between acute and chronic ITP. Higher proportion of chronic ITP patients (5/9; 55.5%) than acute ITP patients (7/51; 13%) had symptom duration longer than 1 month (P or =1 months duration of presenting symptoms and relapse after 2 months from initial presentation have the propensity of developing chronic ITP. Reticulated platelet percentage could not discriminate acute and chronic ITP. A more accurate detection method should be developed for reticulated platelets.

Clinical Significance of Serum basic Fibroblast Growth Factor (bFGF) in Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: We assessed the significance of basic fibroblast growth factor (bFGF) as candidate tumor marker and prognostic predictor for renal cell carcinoma. MATERIALS AND METHODS: The serum concentration of bFGF was determined in 51 patients with renal cell carcinoma and in 33 healthy adults by quantitative sandwich immunoassay. We examined the prognostic value of the serum bFGF level and its association with other clinicopathological parameters such as tumor stage and grade. RESULTS: The mean value of serum bFGF in patients with renal cell carcinoma (15.3+/-11.12pg/ml) was statistically higher than that of the control group (3.8+/-1.87pg/ml). The correlations between serum bFGF and tumor stage, distant metastasis, Fuhrman's nuclear grade and venous invasion, were found in this study. While a correlation between serum bFGF and lymphatic invasion was not found in it. Serum levels of bFGF after radical nephrectomy in 38 patients with renal cell carcinoma statistically decreased. BFGF had prognostic relevance for recurrence and development of metastasis in renal cell carcinoma. Fuhrman's nuclear grade had the most significant correlation to serum bFGF. The mean value of bFGF were noticed as 4.9+/-3.1pg/ml, 10.3+/-5.9 pg/ml, 18.2+/-11.8pg/ml, and 22.7+/-7.0pg/ml of patients in G1, G2, G3 and G4, respectively. In high grade tumors, bFGF levels were higher than that of low grade tumors (p=0.0001). CONCLUSIONS: Serum bFGF seems to be useful as diagnostic and assistant follow-up tumor marker in patients with renal cell carcinoma. And it seems to be effective as prognostic predictor for the recurrence and development of metastases in same patients.

The Usefulness of Clinical Scoring System as Prognostic Predictor in Neonatal Seizure

PURPOSE: Neonatal seizure is usually the presentation of underlying neurologic dysfunction rather than a disease and have high mortality and morbidity as sequalae. Therefore, the parameter predicting the neurologic prognosis is necessary. This study was performed to identify the usefulness of clinical scoring as predictor in neonatal seizure by analyzing outcomes. METHODS: From 1982 to 1994, 101 neonates were admitted to Neonatal Intensive Care Unit(NICU) of Ewha Womans University Tong Dae Mun Hospital due to neonatal seizure and their medical records were reviewed. The follow-up data were reviewed in only 43(42.6%)patients. We scored five clinical manifestations including birth weight, etiology, type of seizure, duration of seizure and neurologic examinations at seizure and differentiated the follow-up data into favorable outcome(normal) and unfavorable outcome(neurologic abnormality, delayed development, frequent seizure, death, or hopeless discharge). RESULTS: 1) Clinical manifestation: Most patients(81.2%) were full term. Seizure of most patients(88.1%) including all very low birth weight infants occured within seven day of age. The etiology of seizure were early hypocalcemia 29 cases(28.7%), severe hypoxia 26 cases(25.8%), electrolyte abnormality 13 cases(12.9%), septicemia 10 cases(9.9%), SAH or SDH 9 cases (8.9%) and hypoglycemia 9 cases(8.9%). The type of seizure were 61 cases(60.4%) of tonic type, 24 cases(23.8%) clonic type, 15 cases(14.8%) of subtle seizure, and 1 case of myoclonic seizure who had holoprosencephaly. The duration of seizure were 49 cases(48.5%) of repetitive brief, 34 cases(33.7 %) of more than 60 sec and 18 cases of single brief. The neulologic findings at seizure showed that 47 cases(46.5%) were normal, that 40 cases(39.6%) were markedly abnorml and that 10 cases(9.9%) were mildly abnormal. 2) The validity of clinical scoring to unfavorable outcome showed 90.9% of sensitivity, 47.6% of specificity, 64.5 of positive predictive value, and 83.3 of negative predictive value when the cut-off point of scores was 4. 3) The birth weight, the duration of seizure and neurologic findings at seizure were good parameters predicting unfavorable outcome (p< 0.05). CONCLUSIONS: The clinical scoring had high sensitivity and high negative predictive value as prognostic predictor. Especially, the birth weight, the duration of seizure, and neurologic finding at seizure were useful items.

Therapeutic results and prognostic predictors of childhood acute lymphoblastic leukemia: Cox regression analysis

Determining the current status of therapeutic results of acute lymphoblastic leukemia (ALL), and identifying the important clinical predictors of survival and relapse are essential for establishing therapeutic strategies. Sixty-two children with ALL who were admitted to Chonnam University Hospital from January 1983 to June 1991 were studied. With a mean follow-up period of 53.7 months, the overall 5-year survival rate (5YSR) was 46.1%. The overall rate of 5-year event-free survival (EFS) was 25.4% and significantly differed between risk groups: 48.7% for standard, 16.3% for high, and 12.5% for very high (p<.05). Overall 4-year survival after initial relapse was 34.2% and there was no significant difference in survival between those who relapsed during maintenance therapy and those who relapsed after completing maintenance. The Cox proportional hazards model identified central nervous system (CNS) irradiation (P<0.001) as having the most important influence upon EFS, followed by serum alanine aminotransferase level, platelet level, and age. On the other hand, CNS leukemia at diagnosis, followed by mediastinal mass, and hemoglobin level were found to be the most important prognostic predictors for relapse. On the basis that present results differ from those of developed countries, we suggest the necessity of a nation-wide cohort study to delineate the characteristics of Korean ALL in children, to make our own protocols, and ultimately to improve the therapeutic outcome.