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대한내과학회> The Korean Journal of Internal Medicine> Impact of liver cirrhosis on the clinical outcomes of patients with COVID-19: a nationwide cohort study of Korea

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Impact of liver cirrhosis on the clinical outcomes of patients with COVID-19: a nationwide cohort study of Korea

Dongsub Jeon , Minkook Son , Jonggi Choi
  • : 대한내과학회
  • : The Korean Journal of Internal Medicine 36권5호
  • : 연속간행물
  • : 2021년 09월
  • : 1092-1104(13pages)
The Korean Journal of Internal Medicine

DOI


목차

INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

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Background/Aims: The impact of liver cirrhosis (LC) on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) remains elusive. This study evaluated the association between LC and the development of severe complications from COVID-19.
Methods: We used the National Health Insurance claims data of Korea. We included 234,427 patients older than 19 years who tested for severe acute respiratory syndrome coronavirus 2. Patients with LC who were infected with COVID-19 (n = 67, LC+ COVID+) were matched with those with cirrhosis only (n = 332, LC+ COVID-) and those with COVID-19 only (n = 333, LC- COVID+) using a propensity score in a 1:5 ratio. The primary outcome was the development of severe complications.
Results: Of the matched patients, the mean age was 60 years and 59.7% were male. Severe complications occurred in 18, 54, and 60 patients in the LC+ COVID+, LC+ COVID-, and LC- COVID+ groups, respectively. After adjusting for comorbidities, there was no significant difference in the risk of developing severe complications from COVID-19 between the LC+ COVID+ and LC- COVID+ groups but significant difference exists between the LC+ COVID+ and LC+ COVID-. Older age, hypertension, cancer, chronic obstructive pulmonary disease, and a higher Charlson comorbidity index were associated with a higher risk of severe complications in patients with cirrhosis and COVID-19.
Conclusions: Our study suggests that LC was not independently associated with the development of severe complications, including mortality, in patients with COVID-19. Our results need to be evaluated through a large, prospective study.

UCI(KEPA)

I410-ECN-0102-2022-500-000780608

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 1226-3303
  • : 2005-6648
  • : 학술지
  • : 연속간행물
  • : 1986-2022
  • : 2726


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1Executive summary of the Korean Society of Nephrology 2021 clinical practice guideline for optimal hemodialysis treatment

저자 : Ji Yong Jung , Kyung Don Yoo , Eunjeong Kang , Hee Gyung Kang , Su Hyun Kim , Hyoungnae Kim , Hyo Jin Kim , Tae-jin Park , Sang Heon Suh , Jong Cheol Jeong , Ji-young Choi , Young-hwan Hwang , Miyoung Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 701-718 (18 pages)

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The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists' support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient's condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There are also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).

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2Current state and prospects of gout treatment in Korea

저자 : Eun Hye Park , Sang Tae Choi , Jung Soo Song

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 719-731 (13 pages)

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Effective management of gout includes the following: appropriate control of gout flares; lifestyle modifications; management of comorbidities; and long-term urate-lowering therapy (ULT) to prevent subsequent gout flares, structural joint damage, and shortening of life expectancy. In addition to traditional treatments for gout, novel therapies have been introduced in recent years. Indeed, new recommendations for the management of gout have been proposed by various international societies. Although effective and safe medications to treat gout have been available, management of the disease has continued to be suboptimal, with poor patient adherence to ULT and failure to reach serum urate target. This review outlines recent progress in gout management, mainly based on the latest published guidelines, and specifically provides an update on efficient strategies for implementing treatment, efficacy and safety of specific medications for gout, and cardiovascular outcomes of ULT. In particular, we reviewed gout management approaches that can be applied to a Korean population.

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3Perioperative and anesthetic management of patients with rheumatoid arthritis

저자 : Hae-rim Kim , Seong-hyop Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 732-739 (8 pages)

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Our understanding and management of rheumatoid arthritis (RA) have greatly improved, but perioperative and anesthetic management remain challenging. RA is not limited to joints; systemic evaluation is thus required when planning perioperative management. Especially, careful airway evaluation is needed; management of airway-related arthritis is challenging. A multidisciplinary approach is essential to prevent complications without exacerbating RA disease activity. Guidelines published in 2017 are available for perioperative management of anti-rheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. However, the guidelines focus only on anti-rheumatic medications, and do not consider all aspects of perioperative management (including anesthesia). Here, we discuss the perioperative and anesthetic management of patients with RA.

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4Predictors of recurrent acute myocardial infarction despite initially successful percutaneous coronary intervention: back to the basic

저자 : Seonghoon Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 740-741 (2 pages)

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5Call for evidence mapping in accordance with the changing features of invasive pulmonary aspergillosis during the coronavirus disease 2019 pandemic

저자 : Young Kyung Yoon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 742-744 (3 pages)

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6Improved anti-fibrotic effects by combined treatments of simvastatin and NS-398 in experimental liver fibrosis models

저자 : Seong Hee Kang , Hyung Joon Yim , Ji-won Hwang , Mi-jung Kim , Young-sun Lee , Young Kul Jung , Hyungshin Yim , Baek-hui Kim , Hae-chul Park , Yeon Seok Seo , Ji Hoon Kim , Jong Eun Yeon , Soon Ho Um ,

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 745-762 (18 pages)

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Background/Aims: Efficient anti-fibrotic therapies are required for the treatment of liver cirrhosis. Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) and cyclooxygenase-2 (COX-2) inhibitors have been reported to have anti-fibrotic effects. Here, we investigated whether combined treatment with a statin and a COX-2 inhibitor has synergistic anti-fibrotic effects.
Methods: The effects of treatment strategies incorporating both simvastatin and a COX-2 inhibitor, NS-398, were investigated using an immortalized human hepatic stellate cell line (LX-2) and a hepatic fibrosis mouse model developed using thioacetamide (TAA) in drinking water. Cellular proliferation was investigated via 5-bromo-2-deoxyuridine uptake. Pro- and anti-apoptotic factors were investigated through Western blotting and real-time polymerase chain reaction analysis.
Results: The evaluation of the anti-proliferative effects on LX-2 cells showed that the observed effects were more pronounced with combination therapy than with single-drug therapy. Moreover, hepatic fibrosis and collagen deposition decreased significantly in TAA-treated mice in response to the combined treatment strategy. The mechanisms underlying the anti-fibrotic effects of the combination therapy were investigated. The effects of the combination therapy were correlated with increased expression levels of extracellular signal-regulated kinase 1/2 signaling molecules, upregulation of the Bax/Bcl- 2 signaling pathway, inhibition of the transforming growth factor-β signaling pathway, and inhibition of tissue inhibitor of matrix metalloproteinases 1 and 2.
Conclusions: The combination of simvastatin and NS-398 resulted in a synergistic anti-fibrotic effect through multiple pathways. These findings offer a theoretical insight into the possible clinical application of this strategy for the treatment of advanced liver diseases with hepatic fibrosis.

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7Effect of L-carnitine on quality of life in covert hepatic encephalopathy: a randomized, double-blind, placebo-controlled study

저자 : Eileen L. Yoon , Sang Bong Ahn , Dae Won Jun , Yong Kyun Cho , Do Seon Song , Jae Yoon Jeong , Hee Yeon Kim , Young Kul Jung , Myeong Jun Song , Sung Eun Kim , Hyoung Su Kim , Soung Won Jeong , Sang Gyune K

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 757-770 (14 pages)

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Background/Aims: L-carnitine is potentially beneficial in patients with hepatic encephalopathy (HE). We aimed to evaluate the impact of L-carnitine on the quality of life and liver function in patients with liver cirrhosis and covert HE.
Methods: We conducted an investigator-initiated, prospective, multi-center, double-blind, randomized phase III trial in patients with covert HE. A total of 150 patients were randomized 1:1 to L-carnitine (2 g/day) or placebo for 24 weeks. Changes in quality of life and liver function were assessed at 6 months. The model for end-stage liver disease (MELD), the 36-Item Short Form Survey (SF-36), the psychometric hepatic encephalopathy score (PHES), and the Stroop Test were evaluated in all patients.
Results: The total SF-36 score significantly improved in the L-carnitine group after 24 weeks (difference: median, 2; interquartile range, 0 to 11; p < 0.001); however, these values were comparable between the two groups. Furthermore, there was a significant ordinal improvement in PHES scores among patients with minimal HE who were in the L-carnitine group (p = 0.007). Changes in the total carnitine level also positively correlated with improvements in the Stroop test in the L-carnitine group (color test, r = 0.3; word test, r = 0.4; inhibition test, r = 0.5; inhibition/switching test, r = 0.3; all p < 0.05). Nevertheless, the MELD scores at week 24 did not differ between the groups.
Conclusions: Twenty-four weeks of L-carnitine supplementation was safe but ineffective in improving quality of life and liver function.

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8Clinical outcomes of metachronous recurrence of gastric epithelial neoplasia based on Helicobacter pylori infection status and microsatellite stability

저자 : Yeon-ji Kim , Jaeyoung Kim , Woo Chul Chung

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 768-776 (9 pages)

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Background/Aims: Helicobacter pylori eradication may prevent the recurrence of gastric epithelial neoplasia after endoscopic treatment. However, H. pylori eradication therapy is unlikely to prevent gastric cancer. This study determined the long-term results and clinical outcomes of patients with gastric epithelial neoplasia based on H. pylori infection status and microsatellite stability (MSS).
Methods: Patients diagnosed with gastric epithelial neoplasia who underwent an endoscopic mucosal resection or submucosal dissection between 2004 and 2010 were included in this retrospective study. During the follow-up period (range, 4 to 14 years), disease recurrence was monitored, and tissue examinations were conducted for seven sets of microsatellite loci initially linked to the tumour suppressor gene locus. When H. pylori infection was identified, patients underwent eradication therapy.
Results: The patients (n = 120) were divided into three groups: H. pylori-negative with MSS, H. pylori-positive with MSS, and microsatellite instability (MSI). After H. pylori eradication, the rate of metachronous recurrence was significantly different in the MSI (28.2%) and MSS groups (3.7%, p < 0.01). The mean duration of recurrence was 77 months (range, 24 to 139) in the MSI group. There was no recurrence after eradication therapy in patients who were positive for H. pylori in the MSS group.
Conclusion: H. pylori eradication could help prevent gastric cancer recurrence in patients with stable microsatellite loci. Careful, long-term monitoring is required in patients with unstable microsatellite loci.

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9Predictors of recurrent acute myocardial infarction despite successful percutaneous coronary intervention

저자 : Sang Hun Lee , Myung Ho Jeong , Joon Ho Ahn , Dae Young Hyun , Kyung Hoon Cho , Min Chul Kim , Doo Sun Sim , Young Joon Hong , Ju Han Kim , Youngkeun Ahn , Jin Yong Hwang , Weon Kim , Jong Seon Park , C

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 777-790 (14 pages)

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Background/Aims: Recurrent acute myocardial infarction (AMI) is an adverse cardiac event in patients with a first AMI. The predictors of recurrent AMI after the first AMI in patients who underwent successful percutaneous coronary intervention (PCI) have not been elucidated.
Methods: We analyzed the data collected from 9,869 patients (63.2 ± 12.4 years, men:women = 7,446:2,423) who were enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and October 2015, had suffered their first AMI and had received successful PCI during the index hospitalization. Multivariable logistic regression analysis was performed to identify the independent predictors of recurrent AMI following the first AMI.
Results: The cumulative incidence of recurrent AMI after successful PCI was 3.6% (359/9,869). According to the multivariable logistic regression analysis, the significant predictive factors for recurrent AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multivessel disease.
Conclusions: In this Korean prospective cohort study, the independent predictors of recurrent AMI after successful PCI for the first AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multivessel disease.

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10Treatment delay and outcomes of ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention during the COVID-19 era in South Korea

저자 : Seok Oh , Myung Ho Jeong , Kyung Hoon Cho , Min Chul Kim , Doo Sun Sim , Young Joon Hong , Ju Han Kim , Youngkeun Ahn

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 4호 발행 연도 : 2022 페이지 : pp. 786-799 (14 pages)

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Background/Aims: Little is known about the clinical characteristics and treatment outcomes of ST-segment elevation myocardial infarction (STEMI) in Korea during the coronavirus disease 2019 (COVID-19) era. We aimed to evaluate the clinical characteristics and treatment outcomes of patients with STEMI in the COVID-19 era.
Methods: A total of 588 consecutive patients with STEMI who underwent primary percutaneous coronary intervention were included in this study. The patients were categorized into the COVID-19 (from January 20, 2020 to December 31, 2020) and control groups (from January 20, 2019 to December 31, 2019).
Results: The COVID-19 group showed pre-hospital and in-hospital delays than the control group. The control group underwent more thrombus aspiration and had a higher proportion of left main coronary artery diseases, while the COVID-19 group had a higher proportion of multivessel diseases with a marked increase in the number and total length of stents than the control group. As for the prescribed medications, the COVID-19 group was administered more beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins than the control group. The clinical outcomes were comparable between the groups, except for higher incidences of atrioventricular block and temporary pacemaker implantation in the COVID-19 group.
Conclusions: Reperfusion after STEMI treatment during the COVID-19 period was delayed; therefore, efforts should be made to improve on reperfusion.

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1Strategies for successful implementation and permanent maintenance of a rapid response system

저자 : Myung Jin Song , Yeon Joo Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1031-1039 (9 pages)

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Rapid response systems (RRSs) have been introduced to intervene with patients experiencing non-code medical emergencies and operate widely around the world. An RRS has four components: an afferent limb, an efferent limb, quality improvement, and administration. A proper triggering system, a hospital culture that embraces the RRS from the afferent limb, experienced primary responders, and dedicated physicians from the efferent limb are key for successful implementation. After initial implementation, quality improvement through objective outcome measures and self-evaluation are crucial, which lead to a better outcome when this process is well performed. Furthermore, better outcomes lead to more investment, which is essential for effective development of the system. The RRS is successfully maintained when these four components are closely interconnected.

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2Improving the care of inflammatory bowel disease (IBD) patients: perspectives and strategies for IBD center management

저자 : Jihye Park , Sinyoung Park , Shin Ae Lee , Soo Jung Park , Jae Hee Cheon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1040-1048 (9 pages)

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The incidence and prevalence rates of inflammatory bowel disease (IBD) have been increasing in East Asian countries over the past few decades. Accordingly, the general understanding and awareness of IBD among healthcare professionals has increased considerably in this region. This increase is ultimately associated with the evolving focus of IBD clinicians devoted to comprehensive patient care, especially in establishing IBD clinics/centers capable of providing multi-disciplinary counseling. Comprehensive IBD care at IBD clinics/centers usually includes surgical and medication decision-making, transition from pediatric to adult clinics, care of extraintestinal manifestations, care of infectious diseases in patients undergoing immunomodulatory or biologic therapies, and nutritional, psychosocial, socioeconomic, and pharmacological care. Team members com-prise specialists from various departments related to IBD and can be divided into core and ad hoc members. Usually, the scope of work in IBD clinics/centers involves patient care, patient outreach, and system management. Considering the environmental changes in IBD treatment, it is necessary to perform comprehensive IBD patient care in the form of a program based on competencies, rather than simply following the organization of previous IBD centers. The present review summarizes recent trends in IBD patient care and offers perspectives regarding IBD center management.

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3Young-onset type 2 diabetes in South Korea: a review of the current status and unmet need

저자 : Ye Seul Yang , Kyungdo Han , Tae Seo Sohn , Nam Hoon Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1049-1058 (10 pages)

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The prevalence of young-onset (diagnosis at age < 40 years) type 2 diabetes mellitus (T2DM) is increasing globally. Young-onset T2DM has a common pathophysiology of glucose dysregulation as in late-onset T2DM. However, it presents a greater association with obesity and a more rapid decline in β-cell function than late-onset T2DM. Accumulating evidence indicates that disease progression in young-onset T2DM is rapid, resulting in early and frequent development of microvascular and macrovascular complications, as well as premature death. Improper management and low adherence to medical therapy are important issues in young-onset T2DM. This review discusses the epidemiology, disease entity, and clinical issues associated with young-onset T2DM. We also present the prevalence and clinical characteristics of patients with young-onset T2DM in South Korea.

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4Development of a Korean-specific cardiovascular risk model in a cohort at high-risk of hypertension

저자 : Il Suk Sohn

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1059-1060 (2 pages)

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5Nosocomial exposure to tuberculosis: a snapshot of South Korea

저자 : Hayoung Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1061-1062 (2 pages)

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6Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasms

저자 : Soo-kyung Park , Hyeon Jeong Goong , Bong Min Ko , Haewon Kim , Hyo Sun Seok , Moon Sung Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1063-1074 (12 pages)

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Background/Aims: Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD.
Methods: Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed.
Results: Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the low- risk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group.
Conclusions: The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.

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7Risk stratification of patients with gastric lesions indefinite for dysplasia

저자 : Young Sin Cho , Il-kwun Chung , Yunho Jung , Su Jung Han , Jae Kook Yang , Tae Hoon Lee , Sang-heum Park , Sun-joo Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1074-1082 (9 pages)

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Background/Aims: There are no definite guidelines for the management of gastric lesions diagnosed as indefinite for dysplasia (IND) by endoscopic forceps biopsy (EFB). Therefore, this study aimed to evaluate the clinical outcomes of gastric IND and predictive factors for gastric neoplasm.
Methods: This study included 457 patients with a first diagnosis of gastric IND by EFB between January 2005 and December 2013. Patient characteristics and endoscopic and pathological data were reviewed and compared.
Results: Of the 457 gastric IND patients, 128 (28%) were diagnosed with invasive carcinoma, 21 (4.6%) with high-grade dysplasia, 31 (6.8%) with low-grade dysplasia, and 277 (60.6%) as negative for dysplasia. Of lesions observed, 180 (39.4%) showed upgraded histology. Multivariate analysis revealed that surface erythema (odds ratio [OR], 2.804; 95% confidence interval [CI], 1.741 to 4.516), spontaneous bleeding (OR, 2.618; 95% CI, 1.298 to 5.279), lesion size ≥ 1 cm (OR, 5.762; 95% CI, 3.459 to 9.597), and depressed morphology (OR, 2.183; 95% CI, 1.155 to 4.124) were significant risk factors for high-grade dysplasia or adenocarcinoma. The ORs associated with 2 and ≥ 3 risk factors were 7.131 and 34.86, respectively.
Conclusions: Precautions should be taken in the management of gastric IND patients, especially when risk factors, including surface erythema, spontaneous bleeding, lesion size ≥ 1 cm, and depressed morphology are present. Considering the combined effect of the presence of multiple risk factors on the incidence of high-grade dysplasia or adenocarcinoma, endoscopic resection should be recommended if a gastric IND patient has at two or more of these factors.

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8Risk of colorectal cancer in patients with positive results of fecal immunochemical test performed within 5 years since the last colonoscopy

저자 : Yoon Suk Jung , Jinhee Lee , Chang Mo Moon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1083-1091 (9 pages)

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Background/Aims: Annual fecal immunochemical tests (FITs) are often repeated within the recommended colonoscopy surveillance intervals. However, it remains unclear whether interval FITs are useful. To answer this question, we assessed the risk of colorectal cancer (CRC) according to the interval from the last colonoscopy to an FIT.
Methods: Using the Korean National Cancer Screening Program database, we collected data on patients who underwent FITs in 2011. Patients with positive FIT results were classified into three groups according to their previous colonoscopy interval: 0.5 to 5 years (group 1), 5 to 10 years (group 2), and ≥ 10 years or no colonoscopy (group 3). CRC incidence was defined as CRC diagnosed within 1 year after an FIT.
Results: Among 177,660 patients with positive FIT results, the incidence of CRC in groups 1, 2, and 3 was 0.72% (n = 214/29,575), 1.28% (n = 116/9,083), and 3.88% (n = 5,387/139,002), respectively. The age- and sex-adjusted risk for CRC was higher in groups 2 (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.43 to 2.25) and 3 (OR, 5.56; 95% CI, 4.85 to 6.38) than in group 1. Among patients who did and did not undergo a polypectomy during the previous colonoscopy, those in group 2 had a higher rate of CRC than those in group 1 (without polypectomy: 1.15% vs. 0.63%; OR, 1.79; 95% CI, 1.37 to 2.34) (with polypectomy: 2.37% vs. 0.93 %; OR, 2.30; 95% CI, 1.44 to 3.69).
Conclusion: In patients with positive FIT results who had undergone a colonoscopy within the past 5 years, the risk of CRC is very low, regardless of whether a polypectomy was performed, suggesting that interval FITs are not useful.

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9Impact of liver cirrhosis on the clinical outcomes of patients with COVID-19: a nationwide cohort study of Korea

저자 : Dongsub Jeon , Minkook Son , Jonggi Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1092-1104 (13 pages)

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Background/Aims: The impact of liver cirrhosis (LC) on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) remains elusive. This study evaluated the association between LC and the development of severe complications from COVID-19.
Methods: We used the National Health Insurance claims data of Korea. We included 234,427 patients older than 19 years who tested for severe acute respiratory syndrome coronavirus 2. Patients with LC who were infected with COVID-19 (n = 67, LC+ COVID+) were matched with those with cirrhosis only (n = 332, LC+ COVID-) and those with COVID-19 only (n = 333, LC- COVID+) using a propensity score in a 1:5 ratio. The primary outcome was the development of severe complications.
Results: Of the matched patients, the mean age was 60 years and 59.7% were male. Severe complications occurred in 18, 54, and 60 patients in the LC+ COVID+, LC+ COVID-, and LC- COVID+ groups, respectively. After adjusting for comorbidities, there was no significant difference in the risk of developing severe complications from COVID-19 between the LC+ COVID+ and LC- COVID+ groups but significant difference exists between the LC+ COVID+ and LC+ COVID-. Older age, hypertension, cancer, chronic obstructive pulmonary disease, and a higher Charlson comorbidity index were associated with a higher risk of severe complications in patients with cirrhosis and COVID-19.
Conclusions: Our study suggests that LC was not independently associated with the development of severe complications, including mortality, in patients with COVID-19. Our results need to be evaluated through a large, prospective study.

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10Clinical features and predictors of masked uncon-trolled hypertension from the Korean Ambulatory Blood Pressure Monitoring Registry

저자 : Hyun-jin Kim , Jeong-hun Shin , Yonggu Lee , Ju Han Kim , Sun Ho Hwang , Woo Shik Kim , Sungha Park , Sang Jae Rhee , Eun Mi Lee , Sang Hyun Ihm , Wook Bum Pyun , Jinho Shin

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1102-1119 (18 pages)

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Background/Aims: The clinical characteristics of patients with masked uncontrolled hypertension (MUCH) have been poorly defined, and few studies have investigated the clinical predictors of MUCH. We investigated the demographic, clinical, and blood pressure (BP) characteristics of patients with MUCH and pro-posed a prediction model for MUCH in patients with hypertension.
Methods: We analyzed 1,986 subjects who were enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry and taking antihypertensive drugs, and classified them into the controlled hypertension (n = 465) and MUCH (n = 389) groups. MUCH was defined as the presence of a 24-hour ambulatory mean systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg in patients treated with antihypertensive drugs, having normal office BP.
Results: Patients in the MUCH group had significantly worse metabolic profiles and higher office BP, and took significantly fewer antihypertensive drugs com-pared to those in the controlled hypertension group. Multivariate logistic regression analyses identified high office systolic BP and diastolic BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH, ≥ 116 g/㎡ for men, and ≥ 96 g/㎡ for women), high heart rate (≥ 75 beats/min), and single antihypertensive drug use as independent predictors of MUCH. A prediction model using these predictors showed a high diagnostic accuracy (C-index of 0.839) and goodness-of-fit for the presence of MUCH.
Conclusions: MUCH is associated with a high-normal increase in office BP and underuse of antihypertensive drugs, as well as dyslipidemia, prior stroke, and LVH, which could underscore achieving optimal BP control. The proposed model accurately predicts MUCH in patients with controlled office BP.

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