Clinical Features of Spontaneous Bacterial Peritonitis: A 10-year Experience from a Single Center.

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is one of critical complications in liver cirrhosis patients with ascites. We aimed to review clinical course of SBP patients in a 10-year period from single center. METHODS: This study enrolled SBP patients between 2005 and 2015. Their medical records were reviewed. The laboratory findings of serum and ascites were examined, and characteristics of isolated microorganisms in ascites were analyzed. RESULTS: Total 51 patients were enrolled. Male patients were predominant (64.7%), and mean age was 59.20 years. The most common etiology of cirrhosis was alcohol (41.2%), followed by hepatitis B (39.2%). Microorganism was isolated from the ascites in 31 patients (60.78%). The proportions of Gram negative and Gram positive were 80.64% and 19.36%. The proportions of Escherichia coli, Klebsiella, and Streptococcus species were 29.41%, 19.61% and 11.76%. Among Escherichia colis, 4 cases were ESBL positive (7.84%). The most commonly used first-line antibiotic was cefotaxime (80.40%). Prophylactic antibiotics treatment was performed only in 8 patients, and SBP was recurred in 7 patients (13.72%). When comparing the SBP recurrence group and the non-recurrence group, there were no significant differences in laboratory findings of serum and ascitic fluid. CONCLUSIONS: SBP is still a critical complication in cirrhosis patients with ascites, and the clinical features of SBP have not been altered much compared with those in 1990's. The effective treatment of SBP is still very important for a better prognosis of cirrhosis patients.

Effect of low-dose valsartan on proteinuria in normotensive immunoglobulin A nephropathy with minimal proteinuria: a randomized trial.

BACKGROUND/AIMS: Immunoglobulin A nephropathy (IgAN) is a generally progressive disease, even in patients with favorable prognostic features. In this study, we aimed to investigate the antiproteinuric effect and tolerability of low-dose valsartan (an angiotensin II receptor blocker) therapy in normotensive IgAN patients with minimal proteinuria of less than 0.5 to 1.0 g/day. METHODS: Normotensive IgAN patients, who had persistent proteinuria with a spot urine protein-to-creatinine ratio of 0.3 to 1.0 mg/mg creatinine, were recruited from five hospitals and randomly assigned to either 40 mg of valsartan as the low-dose group or 80 mg of valsartan as the regular-dose group. Clinical and laboratory data were collected at baseline, and at 4, 8, 12, and 24 weeks after valsartan therapy. RESULTS: Forty-three patients (low-dose group, n = 23; regular-dose group, n = 20) were enrolled in the study. Proteinuria decreased significantly not only in the regular-dose group but also in the low-dose group. The change in urine protein-to-creatinine ratio at week 24 was -41.3% ± 26.1% (p < 0.001) in the regular-dose group and -21.1% ± 45.1% (p = 0.005) in the low-dose group. In the low-dose group, blood pressure was constant throughout the study period, and there was no symptomatic hypotension. In the regular-dose group, blood pressure decreased at weeks 8 and 12. No significant change in glomerular filtration rate, serum creatinine level, or serum potassium level was observed during the study period. CONCLUSIONS: Our results suggest that low-dose valsartan can significantly reduce proteinuria without causing any intolerability in normotensive IgAN patients with minimal proteinuria.

A randomized crossover study of single biweekly administration of epoetin-α compared with darbepoetin-α in chronic kidney disease patients not receiving dialysis.

BACKGROUND: Recent evidence demonstrates that high doses of epoetin-alpha (EPO-α) can be administrated at extended intervals, despite its relatively short serum half-life. However, no prospective randomized trials on the effects of extended dosing intervals of EPO-α compared with darbepoetin-alpha (DA-α) have been performed. This study was designed to investigate whether a single biweekly (Q2W) administration of a high dose of EPO-α is as effective as DA-α for anemia in chronic kidney disease (CKD) patients not receiving dialysis. METHODS: Sixty non-dialysis CKD patients were equally randomized to either Q2W subcutaneous EPO-α (10,000 unit) or DA-α (50 µg) therapy groups for the first 6 weeks. After a 6-week washout period, the participants of the EPO-α and DA-α treatment groups switched to the alternate regimen for 6 weeks. The mean hemoglobin (Hb) levels after erythropoiesis stimulating agent (ESA) therapy and percentage change in Hb levels from baseline to the end of the study were analyzed. RESULTS: The mean Hb levels of postESA therapy increased significantly compared with those of preESA therapy in both ESA regimens. The percentage increase in Hb levels and erythropoietin resistance index did not show a significant difference between the different ESA regimens. No difference was observed between the regimens regarding mean Hb levels after ESA therapy. Additionally, there were no serious adverse effects leading to withdrawal from treatment. CONCLUSION: Biweekly high doses of EPO-α therapy may be equally as effective as Q2W DA-α therapy in maintaining target Hb levels in non-dialysis CKD patients.

Effects of Korean Red Ginseng on Cardiovascular Risks in Subjects with Metabolic Syndrome: a Double-blind Randomized Controlled Study.

BACKGROUND: This study investigated the effects of Korean red ginseng (KRG) supplementation on metabolic parameters, inflammatory markers, and arterial stiffness in subjects with metabolic syndrome. METHODS: We performed a randomized, double-blind, placebo-controlled, single-center study in 60 subjects who were not taking drugs that could affect metabolic and vascular functions. Subjects were randomized into either a KRG (4.5 g/d) group or a placebo group for a 12-week study. We collected anthropometric measurements, blood for laboratory testing, and brachial-ankle pulse wave velocity (baPWV) at the initial (week 0) and final (week 12) visits. RESULTS: A total of 48 subjects successfully completed the study protocol. Oral administration of KRG did not significantly affect blood pressure, oxidative or inflammatory markers, or baPWV. CONCLUSION: We found no evidence that KRG had an effect on blood pressure, lipid profile, oxidized low density lipoprotein, fasting blood glucose, or arterial stiffness in subjects with metabolic syndrome. These findings warrant subsequent longer-term prospective clinical investigations with a larger population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00976274.

The relationship between pulse pressure and leukoaraiosis in the elderly.

Leukaraiosis and a higher level of pulse pressure are well-recognized as associated with cardiovascular disease, vascular angiopathy, and geriatric syndrome. A cross-sectional study was conducted to examine the relation between pulse pressure and leukoaraiosis based on brain magnetic resonance imaging (MRI) scans in the apparently healthy elderly (147 men aged 60-84 years and 89 women aged 60-82 years). The odds ratios (OR) and 95% confidence interval (CI) for leukoaraiosis were calculated using multivariate logistic regression analyses according to each quartile of pulse pressure. The percentage of leukoaraiosis gradually increased in accordance with pulse pressure quartiles: 5.1%, 8.6%, 16.1%, and 26.2% for men, and 4.5%, 8.7%, 13.0%, and 23.8% for women. In comparison with subjects in the lowest quartile, the OR (95%CI) for leukoaraiosis in the highest quartile was 6.80 (1.20-38.45) in men after adjusting for age, body mass index, fasting plasma glucose, HDL-cholesterol, triglyceride (TG), smoking status, and current drinking. However, the relationship was not evident in women after adjusting for the same co-variables. In conclusion, pulse pressure was found to be independently associated with leukoaraiosis regardless of classical cardiovascular risk factors in elderly men.

The association between arterial stiffness and colorectal adenomatous polyp in women.

BACKGROUND: Colorectal adenomatous polyp is a precancerous lesion, and some studies have documented its link with cardiovascular risk factors. This study aimed to investigate the association between arterial stiffness and colorectal adenomatous polyp. METHODS: Among 388 Korean women, we examined the association between brachial-ankle pulse wave velocity (baPWV) as a measurement of arterial stiffness and the presence of colorectal adenomatous polyp as determined by colonoscopy. baPWV values were categorized separately as follows: ≤1199 cm/s, 1200-1399 cm/s, 1400-1599 cm/s and ≥1600 cm/s. The odds ratios (ORs) and 95% confidence intervals (CIs) for colorectal adenomatous polyp were calculated across each group of PWVs. RESULTS: The prevalence of colorectal adenomatous polyp was 9.5%. After adjusting for age, body mass index (BMI), cigarette smoking, blood pressure, fasting plasma glucose, and triglycerides, the ORs (95% CIs) for colorectal adenomatous polyp according to each of the four groups of baPWV were 1.00, 2.89 (0.52-15.98), 3.27 (0.48-22.24), and 11.17 (1.17-106.99). CONCLUSIONS: A higher level of baPWV was found to be independently associated with the presence of colorectal adenomatous polyp, regardless of classic cardiovascular risk factors and other components of metabolic syndrome in women.

Relationship of neutrophil-lymphocyte ratio with arterial stiffness and coronary calcium score.

BACKGROUND: Emerging evidence suggests that the neutrophil/lymphocyte ratio (NLR) may be a useful marker of cardiovascular disease and a more powerful predictor than any other leukocyte subtypes. We determined whether NLR is related to atherosclerosis measured by brachial-ankle pulse wave velocity (baPWV) and coronary calcium score (CCS). METHODS: We examined the relationship of NLR with baPWV and CCS in 849 Korean adults in a health examination program. The odds ratios for a high baPWV or a high CCS were calculated using multivariate logistic regression analysis across NLR quartiles. A high baPWV was defined as >1500 cm/s (>75th percentile) and a high CCS was defined as over 100 (at least moderate atherosclerotic plaque burden). RESULTS: The ORs (95% CIs) for a high baPWV by NLR quartiles were 1.00, 0.76 (0.41-1.39), 1.08 (0.61-1.90), and 2.12 (1.18-3.83) after adjusting for confounding variables. Similarly, positive associations between NLR and a high CCS were also observed after adjusting for the same co-variables. CONCLUSION: A higher NLR was independently associated with arterial stiffness and CCS. Accordingly, a higher NLR may be a useful additional measure in assessing cardiovascular risks in clinical practice.

Sex differences in the relationship between leukocyte count and chronic kidney disease: the 2007 Korean National Health and Nutrition Examination Survey.

BACKGROUND: Chronic kidney disease (CKD) has emerged as an independent predictor for cardiovascular disease (CVD), which is now regarded as an inflammatory disease. This study aimed to determine the association of CKD with white blood cell (WBC) count as a marker of systemic inflammation. METHODS: We examined the association of WBC count with CKD in 2825 Korean adults (1155 men, 1670 women) in the 2007 Korean National Health and Nutrition Examination Survey (KNHANES). CKD was defined as either proteinuria or a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2). The odds ratios (ORs) for CKD were calculated using multivariate logistic regression analysis after adjusting for confounding variables across gender-specific WBC count quartiles. RESULTS: The proportion of CKD increased with increasing WBC quartiles, from 9.7% in the lowest quartile to 20.7% in the highest quartile for women. In multivariate logistic regression analysis, the corresponding odds ratios (95% confidence intervals [CIs]) for a CKD across WBC count quartiles among women were 1.00, 1.45 (0.91-2.31), 1.65 (1.03-2.63), and 2.11 (1.33-3.35), after adjusting for age, body mass index (BMI), systolic blood pressure, fasting plasma glucose, smoking status, current drinking high-density lipoprotein cholesterol (HDL-C), and triglyceride. In contrast, compared with women, men appeared to have no significant results of a relationship between WBC quartiles and CKD. CONCLUSIONS: Our study shows a significant association between WBC count and the risk for CKD in women. Accordingly, potential health benefits of early detection of a higher level of WBC count may be useful for CKD risk assessment in women.