Korean Journal of Internal Medicine最新文献

Background/aims: Clinicians use several measures to determine whether patients will tolerate liberation from mechanical ventilation. This study aimed to evaluate the predictive value of the modified ROX index (mROX) for extubation failure. In addition, we sought to find its role in guiding personalized post-extubation non-invasive respiratory support.

Methods: Patients who received mechanical ventilation and underwent planned extubation between May 2015 and December 2021 in medical intensive care unit were included. The primary outcome was extubation failure, defined as reintubation or death within seven days of extubation. The mROX, calculated as the ratio of partial arterial oxygen pressure to fraction of inspired oxygen (PaO2/FiO2) divided by the respiratory rate, was used to predict extubation failure.

Results: Of the 606 patients, 160 (26.4%) experienced extubation failure. An mROX value below 11.12 was identified as an independent predictor of extubation failure, with an area under the receiver operating characteristic curve of 0.743, demonstrating greater accuracy than traditional indices. The prophylactic application of non-invasive ventilation or high-flow nasal oxygen was associated with a lower risk of extubation failure in the moderate-risk group (11.12 ≤ mROX < 17.55), with an adjusted odds ratio of 0.43 (95% confidence interval, 0.20-0.91); however, this association was not significant in the high-risk (mROX < 11.12) or low-risk (mROX ≥ 17.55) groups.

Conclusion: The mROX is a reliable and clinically useful method for predicting extubation failure. It facilitates improved stratification of extubation risk, allows for more tailored post-extubation non-invasive respiratory support, and may enhance clinical outcomes during the critical processes of ventilator liberation and extubation.

Background/aims: The prevalence of diabetes mellitus (DM) is increasing worldwide owing to aging. This nationwide study aimed to investigate the prevalence of DM and its management status among elderly Koreans.

Methods: We analyzed data from the Korea National Health and Nutrition Examination Survey (2019-2021) to assess the prevalence of DM, awareness, treatment rates, and glycemic control status among elderly Koreans aged ≥ 65 years.

Results: The prevalence of DM increased significantly from 2019 to 2021, reaching 30.9% among elderly Koreans by 2021. Women were older than men (73.7 ± 5.0 vs. 72.7 ± 4.9 years, p < 0.001) and had higher BMI than men (24.5 ± 3.0 vs. 25.1 ± 3.6 kg/m2, p < 0.001). The waist circumference was 91.5 ± 8.8 cm in men and 88.8 ± 9.2 cm in women (p < 0.005). The prevalence of obesity among patients with DM was 44.5%, significantly higher in women (47.4%) than men (41.2%; p = 0.003). Women also had higher rates of hypertension and hypercholesterolemia than men (hypertension: 74.0% vs. 66.5%, p < 0.005; hypercholesterolemia: 53.0% vs. 38.5%, p < 0.001). Women exhibited higher awareness rates of DM compared to men. Awareness and treatment rates were higher in older individuals compared to those aged 30-64 years. Regarding glycemic control, the target achievement rate was 61.0% for HbA1c < 7.0% in the total age group, with nearly 27.6% achieving strict control (HbA1c < 6.5%).

Conclusion: Our study underscores the rising DM prevalence among elderly Koreans and emphasizes the need for age-tailored management approaches to optimize care.

Patients with chronic kidney disease (CKD) have a significantly increased risk of developing cardiovascular disease (CVD), making dyslipidemia management a critical component of cardiovascular risk reduction in this population. However, as the estimated glomerular filtration rate declines, distinct pathophysiological mechanisms-unlike those observed in the general population-contribute to the development and progression of CVD. Consequently, dyslipidemia management in patients with CKD requires a tailored approach that considers altered lipid profiles, comorbid conditions, and potential safety concerns associated with pharmacological therapy. This review aimed to summarize key clinical trials evaluating lipid-lowering strategies in CKD and compare current international and regional clinical practice guidelines. We assessed cardiovascular outcomes associated with various lipid-lowering agents, including statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, fibrates, and omega-3 fatty acids. In addition, we discuss optimal therapeutic strategies across distinct patient subgroups, including those not treated with dialysis or kidney transplantation, those on dialysis, and kidney transplant recipients.

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is associated with a hypercoagulable state that increases thromboembolic complication risk. The interaction between inflammation and coagulation increases risk by upregulating coagulation factors, downregulating natural anticoagulants, and impairing fibrinolysis. Patients with IBD exhibit elevated levels of prothrombotic markers, including thrombin-antithrombin complexes, von Willebrand factor, and tissue factor, reflecting persistent coagulation activation. Furthermore, platelet abnormalities, such as thrombocytosis, enhanced platelet reactivity, and increased platelet-leukocyte aggregates, contribute to the prothrombotic state. Impaired fibrinolysis, characterized by elevated plasminogen activator inhibitor-1 (PAI-1) and decreased urokinase plasminogen activator (uPA) levels, results in reduced clot degradation and prolonged thrombus stability. Endothelial dysfunction and immune-mediated disruptions in anticoagulant pathways also exacerbate coagulation abnormalities. The thromboembolic risk in patients with IBD is influenced by disease activity, hospitalization, immobility, and specific therapeutic agents. Certain treatments, such as JAK inhibitors, increase the risk, whereas anti-TNF agents may offer protective effects. Given the notable impact of coagulation and platelet dysfunction on IBD pathophysiology and patient outcomes, a comprehensive understanding of these abnormalities is essential to optimize clinical management and reduce critical thromboembolic complications.

Background/aims: This study aimed to evaluate the treatment satisfaction and its determinants in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).

Methods: This cross-sectional study was conducted between September 2021 and December 2021. Data on demographics, clinical features, and responses to the Treatment Satisfaction Questionnaire for Medication (TSQM) and Euroquality of life 5 dimensions (EQ-5D) were collected.

Results: In total, 215 patients were included, comprising 114 with RA and 101 with SLE. The cohort was predominantly female (82.3%; 73.7% in patients with RA and 92.1% in patients with SLE). Only 16.7% reported being 'satisfied' with their sumtreatment (global satisfaction score of TSQM ≥ 80), with patients with RA (18.4%) and those with SLE (14.9%). Patients with RA showed significant differences in global satisfaction and factors such as educational attainment, household income, global assessment, disease activity, and EQ-5D visual analogue scale scores. In contrast, the incidence of SLE showed no significant differences except non-steroidal anti-inflammatory drugs users. In multivariable analyses, household income was independently associated with global satisfaction in patients with RA, but not in those with SLE. Sensitivity analysis, excluding patients with moderate to high disease activity, showed similar results.

Conclusion: Our study results suggest that despite the low disease activity, there is an unmet need for treatment satisfaction among patients with RA. To maximize treatment satisfaction in these patients, an individualized, patient-centered approach that considers various quality-of-life and socioeconomic factors beyond disease activity, is required. For lupus, additional comprehensive research on treatment satisfaction and its determinants is necessary.

Background/aims: Cardiovascular-kidney-metabolic (CKM) syndrome reflects the interplay between metabolic dysfunction, chronic kidney disease, and cardiovascular disease. Insulin resistance (IR) is a key driver of CKM and is associated with adverse cardiovascular outcomes. The triglyceride-glucose (TyG) index is a cost-effective surrogate marker of IR; however, its prognostic value across CKM syndrome stages remains unclear.

Methods: We conducted a retrospective cohort study using data of 1,497,913 adults enrolled in the Korean National Health Insurance Database between 2009 and 2012. The participants were stratified into four CKM stages (0/1, 2, 3, and 4) and further categorized into three TyG index tertiles: Group 1 (< 8.27), Group 2 (8.27-8.81), and Group 3 (> 8.81). The primary composite outcomes were all-cause mortality, heart failure, stroke, and myocardial infarction.

Results: Over an average follow-up period of 12.6 ± 1.50 years, individuals in the highest TyG tertile demonstrated a significantly higher risk of the composite primary outcome compared to those in the lowest tertile (hazard ratio, 1.116; 95% confidence interval, 1.101-1.131; p < 0.001). This dose-dependent relationship was consistent across CKM stages, with the strongest associations observed in the early CKM stages (0/1 and 2). An elevated TyG index is also associated with an increased risk of secondary outcomes, including all-cause death, heart failure, stroke, and myocardial infarction.

Conclusion: The TyG index independently predicted cardiovascular risk across the CKM syndrome stages. Its integration into routine clinical assessments could enhance early risk stratification and guide preventive strategies, particularly for patients in the early stages of CKM syndrome.