• Title/Summary/Keyword: CURB-65

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Usefulness of Serum Cortisol in Assessment for the Severity of Community-Acquired Pneumonia (지역사회 획득 폐렴환자의 중증도 평가에서 혈청 코티졸의 유용성)

  • Yoon, Kyung-Hwa;Kim, Yeon-Jae;Kim, Mi-Young;Kim, Eun-Young;Bae, Myoung-Nam;Bae, Sang-Mook;Kim, Min-Su;Park, Hun-Pyo
    • Tuberculosis and Respiratory Diseases
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    • v.69 no.6
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    • pp.450-455
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    • 2010
  • Background: High cortisol levels are frequently observed in patients with severe infections are of prognostic value in sepsis. The aim of this study was to evaluate the clinical usefulness of serum cortisol in assessment for the severity of community-acquired pneumonia (CAP). Methods: This study analyzed the results of 52 CAP subjects admitted in Changwon Fatima Hospital between July 2008 to May 2010. Total serum cortisol, infection markers such as C-reactive protein (CRP), procalcitonin (PCT) and CURB (Confusion, Uremia, Respiratory rate, Blood pressure)-65 were examined retrospectively. Results: In clinically unstable subjects on admission day 4, baseline serum cortisol, CURB-65, and CRP were elevated significantly compared to those of stable subjects. Area under curve (AUC) of cortisol, CRP, and CURB-65 from ROC curves were 0.847, 0.783, and 0.724 respectively. In the subjects with serum cortisol ${\geq}22.82{\mu}g/dL$, CRP, PCT, CURB-65 score, and mortality were significantly elevated. Conclusion: These findings suggest that measurement of serum cortisol in early stage may provide helpful information in the assessment of CAP severity.

Usefulness of Plasma Procalcitonin to Predict Severity in Elderly Patients with Community-Acquired Pneumonia

  • Kim, Ji Hye;Seo, Joo Wan;Mok, Jeong Ha;Kim, Mi Hyun;Cho, Woo Hyun;Lee, Kwangha;Kim, Ki Uk;Jeon, Doosoo;Park, Hye-Kyung;Kim, Yun Seong;Kim, Hyung Hoi;Lee, Min Ki
    • Tuberculosis and Respiratory Diseases
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    • v.74 no.5
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    • pp.207-214
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    • 2013
  • Background: Community-acquired pneumonia (CAP) is one of the leading causes of death among the elderly. Several studies have reported the clinical usefulness of serum procalcitonin, a biomarker of bacterial infection. However, the association between the levels of procalcitonin and the severity in the elderly with CAP has not yet been reported. The aim of this study was to evaluate usefulness of procalcitonin as a predictor of severity and mortality in the elderly with CAP. Methods: This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010. Patients were divided into two groups (${\geq}65$ years, n=99; <65 years, n=56) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, confusion, uremia, respiratory rate, blood pressure, 65 years or older (CURB-65) and pneumonia severity of index (PSI). Results: The levels of procalcitonin were significantly correlated with the CURB-65, PSI in totals. Especially stronger correlation was observed between the levels of procalcitonin and CURB-65 in the elderly (procalcitonin and CURB-65, ${\rho}$=0.408 with p<0.001; procalcitonin and PSI, ${\rho}$=0.293 with p=0.003; procalcitonin and mortality, ${\rho}$=0.229 with p=0.023). The correlation between the levels of CRP or WBC and CAP severity was low. The existing cut-off value of procalcitonin was correlated with mortality rate, however, it was not correlated with mortality within the elderly. Conclusion: The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP. However, there was no association between the levels of procalcitonin and mortality in the elderly.

Inhaled Corticosteroids May Not Affect the Clinical Outcomes of Pneumonia in Patients with Chronic Obstructive Pulmonary Disease

  • Min-Seok Chang;In-So Cho;Iseul Yu;Sunmin Park;Seok Jeong Lee;Suk Joong Yong;Won-Yeon Lee;Sang-Ha Kim;Ji-Ho Lee
    • Tuberculosis and Respiratory Diseases
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    • v.87 no.3
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    • pp.319-328
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    • 2024
  • Background: Although inhaled corticosteroids (ICS) is reportedly associated with a higher risk of pneumonia in chronic obstructive pulmonary disease (COPD), the clinical implications of ICS have not been sufficiently verified to determine their effect on the prognosis of pneumonia. Methods: The electronic health records of patients hospitalized for pneumonia with underlying COPD were retrospectively reviewed. Pneumonia was confirmed using chest radiography or computed tomography. The clinical outcomes of pneumonia in patients with COPD who received ICS and those who received long-acting bronchodilators other than ICS were compared. Results: Among the 255 hospitalized patients, 89 met the inclusion criteria. The numbers of ICS and non-ICS users were 46 and 43, respectively. The CURB-65 (confusion, uremia, respiratory rate, blood pressure, age ≥65 years) scores at the initial presentation of pneumonia were comparable between the two groups. The proportions of patients with multilobar infiltration, pleural effusion, and complicated pneumonia in the radiological studies did not vary between the two groups. Additionally, the defervescence time, proportion of mechanical ventilation, intensive care unit admission, length of hospital stays, and mortality rate at 30 and 90 days were not significantly different between the two groups. ICS use and blood eosinophils count were not associated with all pneumonia outcomes and mortality in multivariate analyses. Conclusion: The clinical outcomes of pneumonia following ICS use in patients with COPD did not differ from those in patients treated without ICS. Thus, ICS may not contribute to the severity and outcomes of pneumonia in patients with COPD.

A Comparative Study of Nursing Home-Acquired Pneumonia with Community-Acquired Pneumonia

  • Cho, Young-Jae;Jung, Bong-Ki;Ahn, Joon-Seok
    • Tuberculosis and Respiratory Diseases
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    • v.70 no.3
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    • pp.224-234
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    • 2011
  • Background: Little data is available regarding hospitalized patients with nursing home-acquired pneumonia (NHAP). This is unfortunate because there is an increasing number of elderly persons who are living in nursing homes in Korea. The aim of this study was to compare clinical characteristics and treatment responses of NHAP with community-acquired pneumonia (CAP). Methods: Patients with pneumonia who were admitted from eight nursing homes or from their own homes were enrolled between May 2007 and April 2009. Their clinical characteristics and treatment responses were reviewed retrospectively, and differences between the two groups were analyzed. Results: Of 110 Patients with pneumonia, 66 (60%) were from nursing homes and their median age was 84. In the NHAP group, functional performance status was significantly poorer, classical symptoms of pneumonia were less severe, and multi-lobe involvement (on chest radiographs) was more frequent than in the CAP group. Patients with NHAP more frequently showed lymphocytopenia, anemia, hypoalbuminemia, hypoxemia, and elevated blood urea nitrogen on admission. The mean CURB-65 score was 2.2 in the NHAP group, higher than 1.7 in the CAP group (p=0.004), and multi-drug resistant pathogens were also highly identified in NHAP group (39% vs. 10%, p=0.036). The mean duration of antibiotic therapy was greater for the NHAP (12.6 days) than for the CAP group (6.6 days) (p<0.001). The mortality rate was 23% in NHAP group, which was significantly higher than 5% in the CAP group (p=0.014). Conclusion: NHAP should be more intensively investigated because of the higher frequency of multi-drug resistant pathogens and mortality than the CAP.

Implementation of blow situation with very shift-ductile-dot on the honk changing-status of constituted function

  • Kim, Jeong-lae;Hwang, Kyu-sung;Choi, Sung-Jai;Im, Yong-Soon
    • International Journal of Advanced Culture Technology
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    • v.10 no.2
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    • pp.187-193
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    • 2022
  • We is configured the honk changing-status technique that is to meld the square-built blow-shock status of the gleam-differential perception level (BIAL) on the honk perception lineament. The perception level condition by the honk perception lineament system is constituted with the blow-shock system. As to experimentation a ductile-dot of the gleam ductile-dot, we are found of the honk value with ductile-dot by the blow upper shift. The concept of perception level is constituted the reference of gleam-differential level for changing-status signal by the honk shock lineament. Further symbolizing a square-built changing-status of the BIAL, of the average in terms of the blow-shock lineament, and the honk ductile-dot shock that was the honk value of the far changing-status of the Ho-PL-FA-θAVG with 15.41±8.63 units, that was the honk value of the convenient changing-status of the Ho-PL-CO-θAVG with 8.70±3.06 units, that was the honk value of the flank changing-status of the Ho-PL-HO-θAVG with 2.65±1.19 units, that was the honk value of the edge changing-status of the Ho-PL-VI-θAVG with 0.51±0.18 units. The blow shock will be to investigate at the square-built ability of the blow-shock lineament with ductile-dot by the honk perception level on the BIAL, that is denote the gleam-differential lineament by the perception level system. We will be possible to curb of a lineament by the differential signal and to employ the honk data of blow shock level by the blow perception system.

Pandemic Influenza A/H1N1 Viral Pneumonia without Co-Infection in Korea: Chest CT Findings

  • Son, Jun-Seong;Kim, Yee-Hyung;Lee, Young-Kyung;Park, So-Young;Choi, Cheon-Woong;Park, Myung-Jae;Yoo, Jee-Hong;Kang, Hong-Mo;Lee, Jong-Hoo;Park, Bo-Ram
    • Tuberculosis and Respiratory Diseases
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    • v.70 no.5
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    • pp.397-404
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    • 2011
  • Background: To evaluate chest CT findings of pandemic influenza A/H1N1 pneumonia without co-infection. Methods: Among 56 patients diagnosed with pandemic influenza A/H1N1 pneumonia, chest CT was obtained in 22 between October 2009 and Februrary 2010. Since two patients were co-infected with bacteria, the other twenty were evaluated. Predominant parenchymal patterns were categorized into consolidation, ground glass opacity (GGO), and mixed patterns. Distribution of parenchymal abnormalities was assessed. Results: Median age was 46.5 years. The CURB-65 score, which is the scoring system for severity of community acquired pneumonia, had a median of 1. Median duration of symptoms was 3 days. All had abnormal chest x-ray findings. The median number of days after the hospital visit that Chest CT was performed was 1. The reasons for chest CT performance were radiographic findings unusual for pneumonia (n=13) and unexplained dyspnea (n=7). GGO was the most predominant pattern on CT (n=13, 65.0%). Parenchymal abnormalities were observed in both lungs in 13 cases and were more extensive in the lower lung zone than the upper. Central and peripheral distributions were identified in ten and nine cases, respectively. One showed diffuse distribution. Peribronchial wall thickening was found in 16 cases. Centrilobular branching nodules (n=7), interlobular septal thickening (n=4), atelectasis (n=1), pleural effusion (n=5), enlarged hilar and mediastinal lymph nodes (n=6 and n=7) were also noted. Conclusion: Patchy and bilateral GGO along bronchi with predominant involvement of lower lungs are the most common chest CT findings of pandemic influenza A/H1N1 pneumonia.

An Experimental Study for Clogging Factors Estimation of Grate Inlets in Urban Area (도시지역에서 빗물받이의 막힘계수 산정에 관한 실험적 연구)

  • Kim, Jung Soo;Kwon, In Sup;Yoon, Sei Eui;Lee, Jong Tae
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.26 no.2B
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    • pp.179-186
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    • 2006
  • Effective interception area of street grate inlets was decreased by clogging with trash, debris, and sand. It also decreased the interception capability of grate inlets and increased the inundation area in street. Therefore, it is necessary to analyze the clogging characteristics and interception capability change by clogging for appropriate design and management of grate inlets. Hydraulic experimental apparatus which can be changed the gutter transverse slopes, longitudinal slopes of street and clogging condition of grate inlet ($40{\times}50cm$) was installed for this study. 81 total experiments were conducted with 8 different clogging condition. The interception capacities of grate inlets clogged curb direction are smaller than those of clogged flow direction. As the longitudinal slopes of street increase, the interception capacity of grate inlet decreases due to splash-over phenomena. This is also observed at grate inlets which has no clogging condition. In general, 50% of clogging factor was selected in design of grate inlet in foreign country. The clogging factor for same clogging condition are suggested 0.25~0.65 in domestic urban area.

Prognostic Implication of Volumetric Quantitative CT Analysis in Patients with COVID-19: A Multicenter Study in Daegu, Korea

  • Byunggeon Park;Jongmin Park;Jae-Kwang Lim;Kyung Min Shin;Jaehee Lee;Hyewon Seo;Yong Hoon Lee;Jun Heo;Won Kee, Lee;Jin Young Kim;Ki Beom Kim;Sungjun Moon;Sooyoung, Choi
    • Korean Journal of Radiology
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    • v.21 no.11
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    • pp.1256-1264
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    • 2020
  • Objective: Lung segmentation using volumetric quantitative computed tomography (CT) analysis may help predict outcomes of patients with coronavirus disease (COVID-19). The aim of this study was to investigate the relationship between CT volumetric quantitative analysis and prognosis in patients with COVID-19. Materials and Methods: CT images from patients diagnosed with COVID-19 from February 18 to April 15, 2020 were retrospectively analyzed. CT with a negative finding, failure of quantitative analysis, or poor image quality was excluded. CT volumetric quantitative analysis was performed by automated volumetric methods. Patients were stratified into two risk groups according to CURB-65: mild (score of 0-1) and severe (2-5) pneumonia. Outcomes were evaluated according to the critical event-free survival (CEFS). The critical events were defined as mechanical ventilator care, ICU admission, or death. Multivariable Cox proportional hazards analyses were used to evaluate the relationship between the variables and prognosis. Results: Eighty-two patients (mean age, 63.1 ± 14.5 years; 42 females) were included. In the total cohort, male sex (hazard ratio [HR], 9.264; 95% confidence interval [CI], 2.021-42.457; p = 0.004), C-reactive protein (CRP) (HR, 1.080 per mg/dL; 95% CI, 1.010-1.156; p = 0.025), and COVID-affected lung proportion (CALP) (HR, 1.067 per percentage; 95% CI, 1.033-1.101; p < 0.001) were significantly associated with CEFS. CRP (HR, 1.164 per mg/dL; 95% CI, 1.006-1.347; p = 0.041) was independently associated with CEFS in the mild pneumonia group (n = 54). Normally aerated lung proportion (NALP) (HR, 0.872 per percentage; 95% CI, 0.794-0.957; p = 0.004) and NALP volume (NALPV) (HR, 1.002 per mL; 95% CI, 1.000-1.004; p = 0.019) were associated with a lower risk of critical events in the severe pneumonia group (n = 28). Conclusion: CRP in the mild pneumonia group; NALP and NALPV in the severe pneumonia group; and sex, CRP, and CALP in the total cohort were independently associated with CEFS in patients with COVID-19.

A Study on the Actual Conditions of Smoking in Middle and High School Students in One Region (일 지역 중·고등학생의 흡연실태)

  • Kim, Hyeon-Ok
    • Journal of the Korean Society of School Health
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    • v.12 no.1
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    • pp.149-167
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    • 1999
  • To investigate the actual conditions of smoking in middle and high school students in Chinan County, I used a sturctured questionnaire for 1,579 students attending twelve middle-high schools from December 1, 1998 to December 20, 1998. I collected and data correlated the using an $SPSS-PC^+$ 1. The smoking rate of middle-high schoo1 students in Chinan County was 17.9%, relatively high. This smoking rate was different according to the gender, grade, religion, and economic situation. In mals, high school students, non-religious, students low income family students, the smoking rate was higher. The smoking rate of high school students was almost the same as the smoking rate of adults, generally higher than that of foreign teenagers. Because the smoking rat of studinets in the third grade of middle school and in the first grade of high School was six times higher, increased education should be conducted during this time in an attempt to curb the sudden increase of the smoking rate. The smoking rate of girl students was 5.0%; this has increased mor than three times from ten years ago. Consequently, counter measures should be taken against the smoking of female students as well as juvenile smoking in general. In addition, the smoking rate of middle-high school students showed interesting differences when correnated with enviornmental factors. Students with low grades, who are not satisfied with school life, who don't have both parents, who have uncaring parents who nare too strict or too arbitary, who have smoking parents, or who have experienced smoking commonly smoked. Therefore, to lower the smoking rate we should improve the school environment, improve a student's interest in school life. And parents or siblings should lead by example and quit smoking at home. Schools should educate students more effectively concerning the harmful effects of smoking and create an accurate understanding of its dancers. From the beginning, we should teach students never ever to touch cigaretts. 2. The surve discovered that most students started out of curiosity, or solicitantion from friends or elders at middle school, and had been smoking one to five cigarettes for more than a year. They obtained cigarettes at stores and most of them have friends who smoke. As a result anti-smoking education should be conducted at elementary schools prior to middle school. More than 95% of the teenagers who smoke had friends who smote and smoked out of curiosity or the recommendation of elders. Thus, we must focus on teenagers who smoke in group, rather than individually. Fuyrthermore, the strict application of the regulation of tobacco sales as well as tobacco cooperation from retailers are needed. While students did not show any mood or academic achievement difference after beginning smoking, 58.1% of the students a health situdation that was worse. Juvenile smoking is more harmful to the juvenile than adult smoking is to the adult. This should be focused on in an anti-smoking campaign. 3. Students who smoke hada more positive attitude toward smoking than students who don't smoke. Students who smoke had a tendency to have a nuetral position and are not concerned about smoking compared to non-smoking students. The survey showed that the great number of students had a nuetral position. Because this nuetrality may increase Juvenile smoking, education that provides an exact understanding of smoking should be performed to build the correct attidude toward smoking. 4. Middle school students smoke when angry, gloomy, anxious, a lone and when they have some problems to solve, on when they feel inconveniened in other wores, they smoke to reliver stress. They also smok due to addiction. Because smoking is not a praetical method to relieve stress, a program which helps to acquire positive relief stress should be provided to help reduce smoking. 5. About 65% of students who smoke want to quit smoking because of health problem, 78% of them have tried mor than once to quit but failed due to weak will power and peer pressure from friends who smoke. Juvenile smoking is group, oriented. Thus, the program that advances less smoking will be the one that focuseds on groups. 6. As for advice to students who want to quit smoking, "persuasion" was used most commonly, followed by a "presentation on how to quit smoking". Another method were severe punishment. About 70% of the students wanted the anti-smoking guide at school. 7. Most students (73.5%) had a position that more anti-smoking education at school is needed. Obriously, then, anti-smoking education at middle-high schools should be reinfoced. Although the education which explains the harmful influence of tobacco is known as an efficient way prevent smoking; it does not influence students who already smoke. Therefore, for students who smoke, multi-dimensional approaches must be attempted that include physical training, phychokogical approache, consultation and discussion, medical chek-ups, audio-visual education technigues, and professonal instructors, in addition, because smoking students have more negative on lukewarm attitude to anti-smoking education anti-smoking education should be conducted through a communicative style by dedicated teachers who care about students. In order to increase the effectiveness of this program.

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