Risk factors for progressing to critical illness in patients with hospital-acquired COVID-19

Kyung-Eui Lee,Jinwoo Lee,Sang-Min Lee,Hong Yeul Lee 대한내과학회 2024 The Korean Journal of Internal Medicine Vol.39 No.3

Background/Aims: Risk factors for progression to critical illness in hospital-acquired coronavirus disease 2019 (COVID-19) remain unknown. Here, we assessed the incidence and risk factors for progression to critical illness and determined their effects on clinical outcomes in patients with hospital-acquired COVID-19. Methods: This retrospective cohort study analyzed patients admitted to the tertiary hospital between January 2020 and June 2022 with confirmed hospital-acquired COVID-19. The primary outcome was the progression to critical illness of hospital- acquired COVID-19. Patients were stratified into high-, intermediate-, or low-risk groups by the number of risk factors for progression to critical illness. Results: In total, 204 patients were included and 37 (18.1%) progressed to critical illness. In the multivariable logistic analysis, patients with preexisting respiratory disease (OR, 3.90; 95% CI, 1.04–15.18), preexisting cardiovascular disease (OR, 3.49; 95% CI, 1.11–11.27), immunocompromised status (OR, 3.18; 95% CI, 1.11–9.16), higher sequential organ failure assessment (SOFA) score (OR, 1.56; 95% CI, 1.28–1.96), and higher clinical frailty scale (OR, 2.49; 95% CI, 1.62–4.13) showed significantly increased risk of progression to critical illness. As the risk of the groups increased, patients were significantly more likely to progress to critical illness and had higher 28-day mortality. Conclusions: Among patients with hospital-acquired COVID-19, preexisting respiratory disease, preexisting cardiovascular disease, immunocompromised status, and higher clinical frailty scale and SOFA scores at baseline were risk factors for progression to critical illness. Patients with these risk factors must be prioritized and appropriately isolated or treated in a timely manner, especially in pandemic settings.

A LightGBM and XGBoost Learning Method for Postoperative Critical Illness Key Indicators Analysis

( Lei Han ),( Yiziting Zhu ),( Yuwen Chen ),( Guoqiong Huang ),( Bin Yi ) 한국인터넷정보학회 2023 KSII Transactions on Internet and Information Syst Vol.17 No.8

Accurate prediction of critical illness is significant for ensuring the lives and health of patients. The selection of indicators affects the real-time capability and accuracy of the prediction for critical illness. However, the diversity and complexity of these indicators make it difficult to find potential connections between them and critical illnesses. For the first time, this study proposes an indicator analysis model to extract key indicators from the preoperative and intraoperative clinical indicators and laboratory results of critical illnesses. In this study, preoperative and intraoperative data of heart failure and respiratory failure are used to verify the model. The proposed model processes the datum and extracts key indicators through four parts. To test the effectiveness of the proposed model, the key indicators are used to predict the two critical illnesses. The classifiers used in the prediction are light gradient boosting machine (LightGBM) and eXtreme Gradient Boosting (XGBoost). The predictive performance using key indicators is better than that using all indicators. In the prediction of heart failure, LightGBM and XGBoost have sensitivities of 0.889 and 0.892, and specificities of 0.939 and 0.937, respectively. For respiratory failure, LightGBM and XGBoost have sensitivities of 0.709 and 0.689, and specificity of 0.936 and 0.940, respectively. The proposed model can effectively analyze the correlation between indicators and postoperative critical illness. The analytical results make it possible to find the key indicators for postoperative critical illnesses. This model is meaningful to assist doctors in extracting key indicators in time and improving the reliability and efficiency of prediction.

TV 다큐멘터리가 생성한 정신장애 담론: 구별짓기의 완성

장혜경 ( Hae Kyung Chang ),우아영 ( Ah Young Woo ) 한국사회복지연구회 2011 사회복지연구 Vol.42 No.1

본 연구는 TV시사다큐멘터리가 정신장애와 정신장애인에 대해 어떤 담론을 생산하고 있는지를 알아보고 있다. 담론은 현실을 규정하고 해석하여 현실을 재구성하는 힘을 가지므로, 다큐멘터리가 생성하는 정신장애담론은 언어표현의 방식과 내용을 통해 지배담론의 형상과 지배담론이 현실을 어떻게 재구성하는지를 포착할 수 있는 중요한 단서가 된다. 이를 위해 공중파 방송사들의 시사다큐멘터리 중 정신장애를 다루고 있는 프로그램 4개를 Fairclough의 비판적 담론분석방법으로 분석하였다. 분석 결과, TV 다큐멘터리가 생성하고 있는 정신장애 담론은 ``구별짓기의 완성``이었다. 텍스트 수준에서 구별의 이유를, 담론적 실천에서는 구별의 주체와 방법을, 사회적 실천에서는 구별짓기의 일상화를 보여주고 있었다. 다큐멘터리의 정신장애 담론은 정신장애인에 대한 관습적이고 통념적 담론을 반복적으로 재생산하고 정신장애인을 담론생산의 장으로부터 배제하면서 그들의 주체적 위치를 상실시킨다. 정신장애에 대한 지배담론의 구조와 질서를 전복할 수 있는 대안담론은 정신장애인 들이 담론생산의 주체 위치를 회복할 때 가능해 질 수 있는 것이다. 또한 연구자와 실천가들도 지배담론의 효과에 민감하며 대안담론의 생산에 적극적으로 가담할 때 대안담론 구성의 가능성을 열 수 있을 것이다. This paper discuss the type of discourse associated with mental illness and individuals with mental illness in the context of TV documentary. Discourse is an linguistic product which prescribes and interprets the reality and reconstructs the reality systematically. Therefore, TV documentary contents illuminate the dominant discourse associate with mental illness through the diverse types of representation. We picked four TV documentaries from each public channels and analyzed these documentaries using Fairclough`s Critical Discourse Analysis. Faircough suggests the analysis frame consisting of three level. The analysis reveals that TV documentaries produce the discourse "the completion of Distinction" associated with mental illness and individuals with mental illness. TV documentaries suggest the reason why we distinct them from us in textual level. In discourse practice level, they suggest the method and the principal agent of distinction. For social practice, TV documentaries reinforce the dual attitude of viewer. Alternative discourse associated with mental illness and individuals with mental illness will be constructed when individuals with mental illness recovers the status of principal agents and produces strong voices about themselves.

Pathophysiology and protective approaches of gut injury in critical illness

( Chang Yeon Jung ),( Jung Min Bae ) 영남대학교 의과대학 2021 Yeungnam University Journal of Medicine Vol.38 No.1

The gut is a complex organ that has played an important role in digestion, absorption, endocrine functions, and immunity. The gut mucosal barriers consist of the immunologic barrier and nonimmunologic barrier. During critical illnesses, the gut is susceptible to injury due to the induction of intestinal hyperpermeability. Gut hyperpermeability and barrier dysfunction may lead to systemic inflammatory response syndrome. Additionally, gut microbiota are altered during critical illnesses. The etiology of such microbiome alterations in critical illnesses is multifactorial. The interaction or systemic host defense modulation between distant organs and the gut microbiome is increasingly studied in disease research. No treatment modality exists to significantly enhance the gut epithelial integrity, permeability, or mucus layer in critically ill patients. However, multiple helpful approaches including clinical and preclinical strategies exist. Enteral nutrition is associated with an increased mucosal barrier in animal and human studies. The trophic effects of enteral nutrition might help to maintain the intestinal physiology, prevent atrophy of gut villi, reduce intestinal permeability, and protect against ischemia-reperfusion injury. The microbiome approach such as the use of probiotics, fecal microbial transplantation, and selective decontamination of the digestive tract has been suggested. However, its evidence does not have a high quality. To promote rapid hypertrophy of the small bowel, various factors have been reported, including the epidermal growth factor, membrane permeant inhibitor of myosin light chain kinase, mucus surrogate, pharmacologic vagus nerve agonist, immune-enhancing diet, and glucagon-like peptide-2 as preclinical strategies. However, the evidence remains unclear.

Is it possible to reduce intra-hospital transport time for computed tomography evaluation in critically ill cases using the Easy Tube Arrange Device?

Kyung Hyeok Song,조성욱,이진웅,조용철,정원준,유연호,유승,김승환,유인술,주기혁 대한응급의학회 2018 Clinical and Experimental Emergency Medicine Vol.5 No.1

Objective Patients are often transported within the hospital, especially in cases of critical illness for which computed tomography (CT) is performed. Since increased transport time increases the risks of complications, reducing transport time is important for patient safety. This study aimed to evaluate the ability of our newly invented device, the Easy Tube Arrange Device (ETAD), to reduce transport time for CT evaluation in cases of critical illness. Methods This prospective randomized control study included 60 volunteers. Each participant arranged five or six intravenous fluid lines, monitoring lines (noninvasive blood pressure, electrocardiography, central venous pressure, arterial catheter), and therapeutic equipment (O2 supply device, Foley catheter) on a Resusci Anne mannequin. We measured transport time for the CT evaluation by using conventional and ETAD method. Results The median transport time for CT evaluation was 488.50 seconds (95% confidence interval [CI], 462.75 to 514.75) and, 503.50 seconds (95% CI, 489.50 to 526.75) with 5 and 6 fluid lines using the conventional method and 364.50 seconds (95% CI, 335.00 to 388.75), and 363.50 seconds (95% CI, 331.75 to 377.75) with ETAD (all P<0.001). The time differences were 131.50 (95% CI, 89.25 to 174.50) and 148.00 (95% CI, 116.00 to 177.75) (all P<0.001). Conclusion The transport time for CT evaluation was reduced using the ETAD, which would be expected to reduce the complications that may occur during transport in cases of critical illness.

Critical Illness Neuromyopathy Complicating Cardiac Surgery

백완기,김영삼,Joung Taek Kim,Byoung-Nam Yoon 대한중환자의학회 2018 Acute and Critical Care Vol.33 No.1

Critical illness neuromyopathy (CINM) is a sporadically reported disease in the setting of an intensive care unit developing in the process of managing a critical illness. The disease primarily affects the motor and sensory axons and results in severe limb weakness rendering ventilator weaning extremely difficult. We report a case of CINM after cardiac valve surgery. Quadriplegia developed after the operation and resolved slowly over the following 2 months. The patient was discharged home free of neurologic symptoms.

Prognostic Implication of Adrenocortical Response during the Course of Critical Illness

Jin Hwa Song,Jung Hee Kim,Sang-Min Lee,Jin woo Lee, M.D. 대한중환자의학회 2019 Acute and Critical Care Vol.34 No.1

Background:Critical illness-related corticosteroid insufficiency (CIRCI) and adrenocorticotropic hormone (ACTH)-cortisol dissociation are hormonal conditions frequently observed in patients in the intensive care unit (ICU). The aim of this study was to evaluate the association between ACTH-cortisol dissociation and clinical outcomes of critically ill patients. Methods:We retrospectively reviewed the medical records of 94 ICU patients who underwent two rapid cosyntropin tests during hospital admission and compared the clinical aspects of patients with and without ACTH-cortisol dissociation. ACTH-cortisol dissociation was defined as plasma ACTH and serum cortisol concentrations of <22 pmol/L and >600 nmol/L, respectively. Results:Dissociation was present in 30 of the 94 patients (31.9%). Patients with ACTH-cortisol dissociation in the initial test had significantly higher hospital mortality rate than those in the control group (55% vs. 25.7%, P=0.013) There was no difference in hospital mortality between patients classified as having CIRCI and those who were not. In multivariate adjusted Cox regression analysis, the mortality risk was higher in the group with ACTH-cortisol dissociation (hazard ratio, 2.98; 95% confidence interval, 1.34 to 6.63; P=0.007). Patients with dissociation in two consecutive stimulation tests showed the highest hospital mortality rate among groups classified according to stimulation test results (100% vs. 31.3%). Conclusions:The hospital mortality was higher in ICU patients diagnosed with ACTH-cortisol dissociation. It is clinically feasible to evaluate the presence of ACTH-cortisol dissociation by analyzing rapid ACTH stimulation test results in critically ill patients.

The Unique Relationship between Neuro-Critical Care and Critical Illness-Related Corticosteroid Insufficiency : Implications for Neurosurgeons in Neuro-Critical Care

Yoon Hee Choo,Moinay Kim,Jae Hyun Kim,Hanwool Jeon,Hee-Won Jung,Eun Jin Ha,Jiwoong Oh,Youngbo Shim,Seung Bin Kim,Han-Gil Jung,So Hee Park,Jung Ook Kim,Junhyung Kim,Hyeseon Kim,Seungjoo Lee 대한신경외과학회 2023 Journal of Korean neurosurgical society Vol.66 No.6

The brain houses vital hormonal regulatory structures such as the hypothalamus and pituitary gland, which may confer unique susceptibilities to critical illness-related corticosteroid insufficiency (CIRCI) in patients with neurological disorders. In addition, the frequent use of steroids for therapeutic purposes in various neurological conditions may lead to the development of steroid insufficiency. This abstract aims to highlight the significance of understanding these relationships in the context of patient care and management for physicians. Neurological disorders may predispose patients to CIRCI due to the role of the brain in hormonal regulation. Early recognition of CIRCI in the context of neurological diseases is essential to ensure prompt and appropriate intervention. Moreover, the frequent use of steroids for treating neurological conditions can contribute to the development of steroid insufficiency, further complicating the clinical picture. Physicians must be aware of these unique interactions and be prepared to evaluate and manage patients with CIRCI and steroid insufficiency in the context of neurological disorders. This includes timely diagnosis, appropriate steroid administration, and careful monitoring for potential adverse effects. A comprehensive understanding of the interplay between neurological disease, CIRCI, and steroid insufficiency is critical for optimizing patient care and outcomes in this complex patient population.

중증질환으로 인한 소득상실리스크와 정책적 시사점

김대환 ( Dae Hwan Kim ),강성호 ( Sung Ho Kang ) 한국보험학회 2015 保險學會誌 Vol.102 No.-

중증질환은 가계경제에 큰 부담으로 작용하고 나아가 가정파탄 및 빈곤전락의 주된 원인으로 알려져 있다. 이에 정부는 중증질환으로 인한 환자의 의료비 부담을 경감시키기 위해 산정특례제를 도입하고 이들 질환에 대한 보장성을 지속적으로 강화해 왔으나, 중증질환에 대한 정부의 정책은 의료비 보장에만 국한되어 있다. 패널자료를 활용한 실증분석 결과 암, 심장질환, 뇌혈관질환과 같은 중증질환이 발병한 이후 의료비가 급증하기도 하지만 단기간에 소득이 급감하고 근로활동이 중단되는 소득상실리스크가 상당한 것으로 나타났다. 그러므로 중증질환으로 인한 소득상실을 보장하기 위한 공사적 안전망 확보가 중요하며, 이를 위해 저소득층에 특화된 상병수당제도를 도입하거나 단체계약을 활용한 정액형 건강보험을 활용하는 방안이 고려될 수 있겠다. The main critical illnesses such as cancer, cerebrovascular diseases, and cardiac disorder are the primary factor to drive families into bankruptcy and penury. The public health insurance introduced and have enforced a policy which covers the medical costs induced by those critical illnesses more than other types of illnesses. This study investigates various risks related with those critical illnesses and the empirical results from the panel analysis show that individuals experience unemployment and drastic salary reduction even in a short term as well as drastically rising medical costs. This empirical results prove the fallacy of the government policy which covers only the medical costs. Therefore, the public and private safety nets are important to cover various economic risks such as unemployment and salary reduction as well as medical costs. To cover such risks, we suggest to introduce sickness benefits or revitalize lump-sum private health insurance.

The Clinical Characteristics and Risk Factors of Critical Illness-related corticosteroid adrenal insufficiency

박승용,정재석,최영훈,김소리,박성주,이용철,이흥범 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Introduction: Relative adrenal insufficiency (RAI) has been reported as a predictor of mortality in critical illnesses including septic patient, its effects on clinical outcome and risk factors for critically ill patients are controversial. We conducted the present study to assess the clinical characteristics and risk factors of RAI in critically ill patients. Methods: We retrospectively assessed the medical records of 237 patients who checked a random cortisol in the Medical Intensive Care Unit (MICU) at the Third University Hospital, from January 2016 to February 2017. Results: Of the 237 cases, 62 patients with a risk of RAI (random cortisol levels <34 ug/dL) were included, and ultimately 48 patients had relative adrenal insufficiency (77.4%). The length of MICU stay day (12.7±10.2 vs. 10.3±9.6, p=0.437) and mortality rate (27/48 vs. 10/14, p=0.308) were not statistically different between two groups (RAI + vs RAI -, respectively). In subjects who had random cortisol levels of 15 μg/dL to 34 μg/dL (n=33), the incidence of RAI was 19 (57.6%) and a positive result of cosyntropin stimulation test was associated with sepsis-related syndrome (16/33, 84.2%, OR 9.27, 95% CI 1.25-68.70) Conclusions: In critically ill patients, RAI is relatively common but it was not associated with deteriorated outcomes in this study. However, in subjects with random cortisol levels between 15 μg/dL and 34 μg/dL, sepsis-related syndrome may be a risk factor for relative adrenal insufficiency.