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대한내과학회> The Korean Journal of Internal Medicine> Clinical features and predictors of masked uncon-trolled hypertension from the Korean Ambulatory Blood Pressure Monitoring Registry

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

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
  • : 대한내과학회
  • : The Korean Journal of Internal Medicine 36권5호
  • : 연속간행물
  • : 2021년 09월
  • : 1102-1119(18pages)
The Korean Journal of Internal Medicine

DOI


목차

INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

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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.

UCI(KEPA)

I410-ECN-0102-2022-500-000780613

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 1226-3303
  • : 2005-6648
  • : 학술지
  • : 연속간행물
  • : 1986-2022
  • : 2705


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1Emotional and cognitive changes in chronic kidney disease

저자 : Duk-soo Kim , Seong-wook Kim , Hyo-wook Gil

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 489-501 (13 pages)

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Chronic kidney disease (CKD) leads to cognitive impairment and emotional changes. However, the precise mechanism underlying the crosstalk between the kidneys and the nervous system is not fully understood. Inflammation and cerebrovascular disease can influence the development of depression in CKD. CKD is one of the strongest risk factors for cognitive impairment. Moreover, cognitive impairment occurs in CKD as patients experience the dysregulation of several brain functional domains due to damage caused to multiple cortical regions and to subcortical modulatory neurons. The differences in structural brain changes between CKD and non-CKD dementia may be attributable to the different mechanisms that occur in CKD. The kidney and brain have similar anatomical vascular systems, which may be susceptible to traditional risk factors. Vascular factors are assumed to be involved in the development of cognitive impairment in patients with CKD. Vascular injury induces white matter lesions, silent infarction, and microbleeds. Uremic toxins may also be directly related to cognitive impairment in CKD. Many uremic toxins, such as indoxyl sulfate, are likely to have an impact on the central nervous system. Further studies are required to identify therapeutic targets to prevent changes in the brain in patients with CKD.

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2Glomerular filtration rate as a kidney outcome of diabetic kidney disease: a focus on new antidiabetic drugs

저자 : Hyo Jin Kim , Sang Soo Kim , Sang Heon Song

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 502-519 (18 pages)

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Diabetes has reached epidemic proportions, both in Korea and worldwide and is associated with an increased risk of chronic kidney disease and kidney failure (KF). The natural course of kidney function among people with diabetes (especially type 2 diabetes) may be complex in real-world situations. Strong evidence from observational data and clinical trials has demonstrated a consistent association between decreased estimated glomerular filtration rate (eGFR) and subsequent development of hard renal endpoints (such as KF or renal death). The disadvantage of hard renal endpoints is that they require a long follow-up duration. In addition, there are many patients with diabetes whose renal function declines without the appearance of albuminuria, measurement of the eGFR is emphasized. Many studies have used GFR-related parameters, such as its change, decline, or slope, as clinical endpoints for kidney disease progression. In this respect, understanding the trends in GFR changes could be crucial for developing clinical management strategies for the prevention of diabetic complications. This review focuses on the clinical implication of the eGFR-related parameters that have been used so far in diabetic kidney disease. We also discuss the use of recently developed new antidiabetic drugs for kidney protection, with a focus on the GFR as clinical endpoints.

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3Omics-based biomarkers for diagnosis and prediction of kidney allograft rejection

저자 : Jeong-hoon Lim , Byung Ha Chung , Sang-ho Lee , Hee-yeon Jung , Ji-young Choi , Jang-hee Cho , Sun-hee Park , Yong-lim Kim , Chan-duck Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 520-533 (14 pages)

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Kidney transplantation is the preferred treatment for patients with end-stage kidney disease, because it prolongs survival and improves quality of life. Allograft biopsy is the gold standard for diagnosing allograft rejection. However, it is invasive and reactive, and continuous monitoring is unrealistic. Various biomarkers for diagnosing allograft rejection have been developed over the last two decades based on omics technologies to overcome these limitations. Omics technologies are based on a holistic view of the molecules that constitute an individual. They include genomics, transcriptomics, proteomics, and metabolomics. The omics approach has dramatically accelerated biomarker discovery and enhanced our understanding of multifactorial biological processes in the field of transplantation. However, clinical application of omics-based biomarkers is limited by several issues. First, no large-scale prospective randomized controlled trial has been conducted to compare omics-based biomarkers with traditional biomarkers for rejection. Second, given the variety and complexity of injuries that a kidney allograft may experience, it is likely that no single omics approach will suffice to predict rejection or outcome. Therefore, integrated methods using multiomics technologies are needed. Herein, we introduce omics technologies and review the latest literature on omics biomarkers predictive of allograft rejection in kidney transplant recipients.

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4Role of T cells in ischemic acute kidney injury and repair

저자 : Kyungho Lee , Hye Ryoun Jang

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 534-550 (17 pages)

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Ischemic acute kidney injury (AKI) is a common medical problem with significant mortality and morbidity, affecting a large number of patients globally. Ischemic AKI is associated with intrarenal inflammation as well as systemic inflammation; thus, the innate and adaptive immune systems are implicated in the pathogenesis of ischemic AKI. Among various intrarenal immune cells, T cells play major roles in the injury process and in the repair mechanism affecting AKI to chronic kidney disease transition. Importantly, T cells also participate in distant organ crosstalk during AKI, which affects the overall outcomes. Therefore, targeting T cell-mediated pathways and T cell-based therapies have therapeutic promise for ischemic AKI. Here, we review the major populations of kidney T cells and their roles in ischemic AKI.

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5Changes in practice for mechanically ventilated patients: effect of the pain, agitation, and delirium guidelines

저자 : Jin Won Huh

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 553-554 (2 pages)

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6Safety of direct oral anticoagulants compared to warfarin in cirrhotic patients with atrial fibrillation

저자 : Seo Yeon Yoo , Eunju Kim , Gi-byoung Nam , Danbi Lee , Ju Hyun Shim , Kang Mo Kim , Young-suk Lim , Han Chu Lee , Young-hwa Chung , Yung Sang Lee , Jonggi Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 555-566 (12 pages)

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Background/Aims: The safety of direct oral anticoagulants (DOACs) compared with warfarin in patients with both nonvalvular atrial fibrillation (AF) and clinically confirmed liver cirrhosis (LC) has not been well studied. We compared the risk of a major bleeding event between DOAC and warfarin treatments in this patient population.
Methods: A total of 238 cirrhotic patients with AF were retrospectively analyzed. The major bleeding event risk was compared between DOAC- and warfarin-treated groups. The median follow-up duration was 5.6 years.
Results: Among the 238 study patients with LC and AF, 128 (53.8%) received DOACs and 110 (46.2%) received warfarin. The mean patient age was 68.8 years, and 78.2% were men. A major bleeding event occurred in 10 and 20 patients in the DOAC and warfarin groups, respectively, most commonly caused by gastrointestinal bleeding (70.0%). The cumulative risk of major bleeding did not differ between the groups by log-rank test (p = 0.12). This finding did not change when using 60 propensity score-matched pairs. A multivariable Cox regression model indicated that the concomitant use of antiplatelet agents (adjusted hazard ratio [aHR], 2.06; 95% confidence interval [CI], 1.00 to 4.30; p = 0.048) and presence of esophageal or gastric varices confirmed by endoscopic examination (aHR, 2.31; 95% CI, 1.03 to 5.17; p = 0.04) were associated with major bleeding in the entire cohort.
Conclusions: A major bleeding event risk is not increased by DOAC compared with warfarin treatment. Antiplatelet agent use and varices are independently associated with a higher risk of major bleeding during anticoagulation.

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7Radiology plus ileocolonoscopy versus radiology alone in Crohn's disease: prognosis prediction and mutual agreement

저자 : Hye Kyung Hyun , Jongwook Yu , Eun Ae Kang , Jihye Park , Soo Jung Park , Jae Jun Park , Tae Il Kim , Won Ho Kim , Jae Hee Cheon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 567-579 (13 pages)

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Background/Aims: The optimal tools for monitoring Crohn's disease (CD) are controversial. We compared radiology plus ileocolonoscopy and radiology alone in terms of prognosis prediction and evaluated the agreement between radiologic and ileocolonoscopic findings in patients with CD.
Methods: Patients with CD who were followed up with computed tomography enterography (CTE) or magnetic resonance enterography (MRE) alone or CTE or MRE plus ileocolonoscopy were retrospectively recruited. Time to relapse was investigated to evaluate the difference in prognosis using the log-rank and Cox regression tests, and the agreement between radiologic and ileocolonoscopic findings was determined using a kappa value.
Results: A total of 501 patients with CD in clinical remission who underwent CTE or MRE and/or ileocolonoscopy were analyzed. Of these, 372 (74.3%) patients underwent CTE or MRE alone and 129 (25.7%) patients underwent CTE or MRE plus ileocolonoscopy. The cumulative maintenance rate of clinical remission between the two groups was not significantly different (p = 0.526, log-rank test). In multivariate analysis, age <40 years (hazard ratio [HR], 2.756; 95% confidence interval [CI], 1.263 to 6.013) and a history of steroid use (HR, 2.212; 95% CI, 1.258 to 3.577) were found to independently predict an increased risk for clinical relapse in patients with CD in clinical remission. Radiologic and ileocolonoscopic findings had a moderate degree of agreement (κ = 0.401, -0.094 to 0.142). The comparison of agreement between radiologic and ileocolonoscopic findings was the highest in the anastomotic site (κ = 0.749, -0.168 to 0.377).
Conclusions: Radiology plus ileocolonoscopy was not superior to radiology alone in predicting the prognosis of CD.

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8Is radiological healing alone enough? 'Can't take my eyes off' the mucosa

저자 : Su Hyun Park , Sang Hyoung Park

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 567-568 (2 pages)

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9Long-term effect of the eradication of Helicobacter pylori on the hemoglobin A1c in type 2 diabetes or prediabetes patients

저자 : Won Seok Kim , Yonghoon Choi , Nayoung Kim , Seon Hee Lim , Gitark Noh , Ki Wook Kim , Jaehyung Park , Hyeongho Jo , Hyuk Yoon , Cheol Min Shin , Young Soo Park , Dong Ho Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 579-596 (18 pages)

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Background/Aims: The long-term effect of Helicobacter pylori eradication on the metabolic syndrome or diabetes are unclear. The aim of this study was to evaluate the effect of H. pylori eradication on glycemic control in type 2 diabetes mellitus (T2DM) or prediabetes mellitus (preDM).
Methods: A total of 124 asymptomatic subjects with T2DM or preDM were divided into H. pylori-negative (n = 40), H. pylori-positive with non-eradicated (n = 34), and eradicated (n = 50) groups. We measured H. pylori status (culture, histology, and rapid urease test) and glycated hemoglobin A1c (A1C) levels and followed-up at the 1st year and the 5th year of follow-up.
Results: The A1C levels significantly decreased in the eradicated group compared to the negative group and the non-eradicated groups (at the 1st year, p = 0.024; at the 5th year, p = 0.009). The A1C levels decreased in male, and/or subjects < 65 years of age in subgroup analyses (in male subjects, p = 0.047 and p = 0.020 at the 1st and the 5th year; in subjects < 65 years of age, p = 0.028 and p = 0.006 at the 1st and the 5th year; in male subjects < 65 years of age, p = 0.039 and p = 0.032 at the 1st and the 5th year). The eradication of H. pylori was related to the decrease in A1C values throughout the follow-up period, compared to the non-eradicated group (p = 0.017).
Conclusions: H. pylori eradication was related to the decreasing of A1C levels in patients with T2DM or preDM over a long-term follow-up period, especially in male and subjects < 65 years of age.

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10Off-hour presentation and outcomes for percutaneous coronary intervention in acute myocardial infarction with Killip Ⅲ-Ⅳ

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

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 37권 3호 발행 연도 : 2022 페이지 : pp. 591-610 (20 pages)

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Background/Aims: Acute myocardial infarction (AMI) is conventionally recognized as an urgent medical condition requiring timely and effective reperfusion therapy. However, the results of studies on the clinical outcomes in AMI according to hospital visit timings are inconclusive. To explore the difference in long-term outcomes between off- and on-hour percutaneous coronary interventions (PCI) in patients with AMI of Killip functional classification III-IV (Killip III-IV AMI).
Methods: Data on the characteristics and clinical outcomes of 1,751 patients with Killip III-IV AMI between November 2011 and June 2015 from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry were analyzed. All participants were allocated into two groups: off-hour (weekdays from 6:00 PM to 8:00 AM, weekends, and legal holidays) and on-hour (weekdays from 8:00 AM to 6:00 PM) groups. The incidence of major adverse cardiac and cerebrovascular events, defined as a composite of all-cause mortality, nonfatal myocardial infarction, any revascularization, cerebrovascular accident, and stent thrombosis, was the primary endpoint.
Results: Among the 1,751 patients, 572 (39.1%) underwent PCI during on-hours and 892 (60.9%) during off-hours. At the 3-year follow-up, no significant difference was found in the clinical outcomes between the two groups in both the unadjusted and propensity-score weighing-adjusted analyses.
Conclusions: The outcomes of patients with Killip III-IV AMI admitted during off- and on-hours were similar.

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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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