SCI 발표논문

1. 882021

   제1저자 이소령, 박찬순 · 교신저자 최의근

   Lee SR^*, Park CS^*, Choi EK, Ahn HJ, Han KD, Oh S, Lip GYH

   Hypertension Burden and the Risk of New-Onset Atrial Fibrillation: A Nationwide Population-Based Study.

   Hypertension. 2021;77(3):919-928.

   Abstract

   The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. We aimed to investigate the relationship between hypertension burden and the development of incident AF. Using the Korean National Health Insurance Service database, we identified 3 726 172 subjects who underwent 4 consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22 012 patients (0.59% of the total study population; 1.168 per 1000 person-years). Using the blood pressure (BP) values at each health checkup, we determined the burden of hypertension (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n=742 806), 19% (n=704 623), 19% (n=713 258), 21% (n=766 204), and 21% (n=799 281). Compared with normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semiquantitative analyses with further stratification of stage 1 (systolic BP of 130-139 mm Hg or diastolic BP of 80-89 mm Hg) and stage 2 (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. In this study, both a sustained exposure and the degree of increased BP were associated with an increased risk of incident AF. Tailored BP management should be emphasized to reduce the risk of AF.

   PubMed IF 9.8 순환기내과
2. 872021

   제1저자 김민관 · 교신저자 김형관

   Kim M, Kim B, Choi YJ, Lee HJ, Lee H, Park JB, Lee SP, Han KD, Kim YJ, Kim HK

   Sex differences in the prognosis of patients with hypertrophic cardiomyopathy.

   Sci Rep. 2021;11(1):4854.

   Abstract

   We investigated sex-related differences in the prognosis of patients with hypertrophic cardiomyopathy (HCM) using the Korea National Health Insurance Service database. From 2010 to 2016, 9524 patients diagnosed with HCM and had more than 1-year follow-up period were analyzed. The primary endpoint was the composite of cardiovascular death or new-onset heart failure (HF) admission. Propensity score-matching analysis was performed to adjust for different baseline characteristics. With a 4.4-years' median follow-up interval (range 2.0-6.6 years) and male predominance (77.6%), women with HCM were older (52.6 ± 9.7 vs. 51.4 ± 9.1, p < 0.001), had lower incomes, more comorbidities based on Charlson comorbidity index. Women with HCM had a higher incidence of the primary endpoint than men (incidence rate: 34.15 vs. 22.83 per 1000 person-years, log-rank p < 0.001). Multivariable Cox analysis showed that female sex was a poor prognostic factor for the primary endpoint (HR 1.43, 95% CI 1.24-1.64, p < 0.001). This was mainly driven by a higher incidence of new-onset HF admission (HR 1.55, 95% CI 1.34-1.80). However, there was no difference in the incidence of cardiovascular death between the sexes. This result was concordant in the propensity score-matched cohort. In conclusion, women with HCM have worse prognosis, which was mainly driven by a higher new-onset HF admission.

   PubMed IF 4.9 순환기내과
3. 862021

   제1저자 임수 · 교신저자 임수

   Lim S, Bae JH, Kwon HS, Nauck MA

   Reply to: Autonomic dyshomeostasis in patients with diabetes mellitus during COVID-19.

   Nat Rev Endocrinol. 2021;17(3):189-190.

   PubMed IF 39.1 내분비대사내과
4. 852021

   제1저자 박지명 · 교신저자 이창현, 이현우

   Park J, Kim HJ, Lee CH, Lee CH, Lee HW

   Impact of long-term exposure to ambient air pollution on the incidence of chronic obstructive pulmonary disease: A systematic review and meta-analysis.

   Environ Res. 2021;194:110703.

   Abstract

   BACKGROUND It is well known that air pollution causes respiratory morbidity and mortality by inducing airway inflammation. However, whether long-term exposure to air pollution is associated with increased incidence of chronic obstructive pulmonary disease (COPD) is controversial.

   METHODS We conducted a systematic review and meta-analysis with a random-effects model to calculate the pooled risk estimates of COPD development per 10 μg/m³ increase in individual air pollutants. PubMed, Embase, and Cochrane Library were searched from the date of their inception to August 2019 to identify long-term (at least three years of observation) prospective longitudinal studies that reported the risk of COPD development due to exposure to air pollutants. The air pollutants studied included particulate matter (PM_2.5 and PM₁₀) and nitrogen dioxide (NO₂).

   RESULTS Of the 436 studies identified, seven met our eligibility criteria. Among the seven studies, six, three, and five had data on PM_2.5, PM₁₀, and NO₂, respectively. The meta-analysis results showed that a 10 μg/m³ increase in PM_2.5 is associated with increased incidence of COPD (pooled HR 1.18, 95% CI 1.13-1.23). We also noted that a 10 μg/m³ increase in NO₂ is marginally associated with increased incidence of COPD (pooled HR 1.07, 95% CI 1.00-1.16). PM₁₀ seems to have no significant impact on the incidence of COPD (pooled HR 0.95, 95% CI 0.83-1.08), although the number of studies was too small. Meta-regression analysis found no significant effect modifiers.

   CONCLUSIONS Long-term exposure to PM_2.5 and NO₂ can be associated with increased incidence of COPD.

   PubMed IF 8.2 호흡기내과
5. 842021

   제1저자 김희진 · 교신저자 김나영

   Kim HJ, Kim N, Kim HW, Park JH, Shin CM, Lee DH

   Promising aberrant DNA methylation marker to predict gastric cancer development in individuals with family history and long-term effects of H. pylori eradication on DNA methylation.

   Gastric Cancer. 2021;24(2):302-313.

   Abstract

   OBJECTIVE It remains unknown whether individuals with a family history (FH) of gastric cancer (GC) are associated with aberrant DNA methylation. The aim of this study was to investigate the association between aberrant DNA methylation and FH of GC.

   DESIGN Using quantitative MethyLight assay, MOS, miR124a-3, NKX6-1, EMX1, CDH1, and TWIST1 methylation levels in the noncancerous gastric mucosa was compared between subjects with and without FH based on GC and Helicobacter pylori (Hp) infection. Changes in the methylation levels were evaluated over time after Hp eradication.

   RESULTS In Hp-positive GC patients, MOS (P < 0.001), CDH1 (P < 0.001), and TWIST1 (P = 0.004) methylation were decreased in subjects with FH (n = 64) than in those without FH (n = 58). In Hp-positive controls, MOS methylation was lower in subjects with FH (n = 73) than in those without FH (n = 50) (P = 0.042), while miR124a-3 (P = 0.006), NKX6-1 (P < 0.001), and CDH1 (P < 0.001) methylation were higher in subjects with FH. CDH1 methylation constantly decreased from 2 years in GC patients and 3-4 years in controls after Hp eradication (all P < 0.001). A persistent decrease in methylation over time was not observed in other genes after eradication.

   CONCLUSION The methylation of MOS and CDH1 provided an association between aberrant DNA methylation and gastric carcinogenesis in FH of GC, a useful marker for GC risk in individuals with FH. Furthermore, CDH1 methylation decreased after Hp eradication.

   PubMed IF 6.1 소화기내과
6. 832021

   제1저자 최평균, 김계형 · 교신저자 박완범, 이종윤

   Choe PG, Kim KH, Kang CK, Suh HJ, Kang E, Lee SY, Kim NJ, Yi J, Park WB, Oh MD

   Antibody Responses 8 Months after Asymptomatic or Mild SARS-CoV-2 Infection.

   Emerg Infect Dis. 2021;27(3):928-931.

   Abstract

   Waning humoral immunity in coronavirus disease patients has raised concern over usefulness of serologic testing. We investigated antibody responses of 58 persons 8 months after asymptomatic or mildly symptomatic infection with severe acute respiratory syndrome coronavirus 2. For 3 of 4 immunoassays used, seropositivity rates were high (69.0%-91.4%).

   PubMed IF 7.9 감염내과
7. 822021

   제1저자 김혜미, 김학령 · 교신저자 김명아

   Kim HM, Kim HL, Kim MA, Oh S, Kim M, Park SM, Yoon HJ, Byun YS, Park SM, Shin MS, Hong KS, Shim WJ

   Additional roles of diastolic parameters in the diagnosis of obstructive coronary artery disease.

   Coron Artery Dis. 2021;32(2):145-151.

   Abstract

   BACKGROUND A recent guideline emphasizes the role of four indicators, including annular e´ velocity, E/e´, left atrial (LA) size, and peak tricuspid regurgitation (TR) velocity, in the assessment of left ventricular (LV) diastolic dysfunction. This study was performed to determine the relationships among these four parameters and obstructive coronary artery disease (CAD).

   METHODS The study data were obtained from a nation-wide registry, composed of 1307 patients (age, 60.4 ± 10.8 years; 964 women) with normal LV ejection fraction (LVEF) who underwent invasive coronary angiography in the suspicion of CAD. Septal e´, E/e´, LA dimension (LAd), and TR velocity were assessed by transthoracic echocardiography.

   RESULTS Compared with patients without obstructive CAD, those with obstructive CAD showed changes in diastolic parameters indicating more progressed LV diastolic dysfunction in univariate analyses. In multiple logistic regression analysis, low septal e´ velocity (<7 cm/s) was identified as an independent risk factor associated with obstructive CAD (odd ratio, 1.91; 95% confidence interval, 1.08-3.36; P = 0.026). Receiver-operating characteristic curve analysis showed that septal e´ velocity had the most powerful value in the detection of obstructive CAD than the other three diastolic parameters (P < 0.01 for each comparison). Septal e´ velocity significantly increased diagnostic value of treadmill exercise test (TET) in the detection of obstructive CAD (P < 0.001 for integrated discrimination improvement index).

   CONCLUSIONS Among the four diastolic parameters, septal e´ velocity had the most powerful relationship with obstructive CAD in stable patients with normal LVEF. The addition of septal e´ velocity could improve the diagnostic value of TET.

   PubMed IF 2.2 순환기내과
8. 812021

   제1저자 홍승욱, 박재우 · 교신저자 윤혁

   Hong SW, Park J, Yoon H, Yang HR, Shin CM, Park YS, Kim N, Lee DH, Kim JS

   Comparison of loss of response between anti-tumor necrosis factor alone and combined use with immunomodulators in patients with inflammatory bowel disease.

   Korean J Intern Med. 2021;36(Suppl 1):S9-S17.

   Abstract

   BACKGROUND/AIMS Combination therapy with immunomodulators (IMMs) was proposed as a strategy to prevent the development of loss of response (LOR) to anti-tumor necrosis factor (TNF) for patients with inflammatory bowel disease (IBD). However, the effect is unclear in patients already exposed to IMMs. The aim of this study was to evaluate whether combination therapy with IMMs is superior to monotherapy for prevention of LOR to anti-TNF.

   METHODS This was a retrospective study of patients in Seoul National University Bundang Hospital with IBD between January 2009 and October 2018. LOR was defined as clinical deterioration after maintenance of anti-TNF for at least 6 months. We investigated the difference in incidence of LOR to anti-TNF between the monotherapy and combination groups. We additionally assessed factors affecting LOR development to anti-TNF.

   RESULTS A total of 116 patients with IBD were included in this study (monotherapy 61 patients; combination 55 patients). Overall, LOR to anti-TNF occurred in 31 patients during the follow-up period. The combination of an anti-TNF agent and IMM showed no significant difference in the incidence of LOR compared to anti-TNF agent monotherapy (hazard ratio [HR], 1.64; 95% confidence interval [CI], 0.786 to 3.148; p = 0.182). Female sex was significantly associated with the development of LOR to anti-TNF (HR, 3.032; 95% CI, 1.467 to 6.268; p = 0.003).

   CONCLUSION Anti-TNF and IMM combination therapy did not prove efficacious in preventing the development of LOR in IBD patients. Female sex was associated with the development of LOR to anti-TNF; further studies are required to confirm these results.

   PubMed IF 2.2 소화기내과
9. 802021

   제1저자 김경아 · 교신저자 정숙향

   Kim KA, Kim YS, Park SH, Chung WJ, Choi DH, Jang ES, Jeong SH

   Environmental risk factors and comorbidities of primary biliary cholangitis in Korea: a case-control study.

   Korean J Intern Med. 2021;36(2):313-321.

   Abstract

   BACKGROUND/AIMS The risk factors for the development of primary biliary cholangitis (PBC) is unclear. This study aimed to investigate the risk factors associated with PBC in Korea through a questionnaire survey.

   METHODS Consecutively enrolled 103 PBC patients from six referral hospitals and 100 age- and sex-matched community controls participated in this study. A standardized questionnaire survey including demographics, lifestyle, individual and familial medical history and reproductive history was prospectively collected and analyzed.

   RESULTS The PBC patients had a mean age of 58.3 years and a female proportion of 86.4%. The age- and sex-matched controls had a similar educational level and economic status to the PBC patients. Among the lifestyle factors, the multivariable analysis showed smoking including both first-hand and second-hand (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.06 to 3.93), history of autoimmune diseases (OR, 2.46; 95% CI, 1.06 to 6.35), and family history of PBC (OR, 17.76; 95% CI, 1.77 to 2,418.74) were significantly associated with PBC, whereas alcohol intake was negatively associated with PBC. Among reproductive factors, the number of induced abortions was significantly associated with PBC, while the number of full-term deliveries was negatively associated with PBC.

   CONCLUSION A family history of PBC, accompanying autoimmune diseases, and smoking were significantly associated with PBC. More induced abortions and less full-term deliveries were associated with PBC in women. In contrast, mild to moderate alcohol intake was negatively associated with PBC. Further studies are warranted to validate the results of this study and to search for clues about the pathogenesis of PBC.

   PubMed IF 2.2 소화기내과
10. 792021

    제1저자 황영재, 신동우 · 교신저자 김나영

    Hwang YJ, Shin DW, Kim N, Yoon H, Shin CM, Park YS, Lee DH

    Sex difference in bowel preparation quality and colonoscopy time.

    Korean J Intern Med. 2021;36(2):322-331.

    Abstract

    BACKGROUND/AIMS The length of colon is known to be longer in females than in males. In addition, the morphology of colon cancer is different between males and females. The aim of this study was to investigate sex differences in Boston bowel preparation score (BBPS) and colonoscopy insertion time.

    METHODS This study retrospectively analyzed medical records and colonoscopy readings of subjects who underwent colonoscopy at Seoul National University Bundang Hospital from March 2015 to April 2018. BPPS was used to evaluate the degree of colon cleanness before colonoscopy. Statistical analysis was performed to compare demographic, clinical, and outcome variables between two groups.

    RESULTS The study group consisted of a total of 12,561 patients (6,148 females and 6,413 males). Mean age was 57.8 ± 13.5 years for females and 57.5 ± 13.8 years for males (p = 0.695). Females showed better bowel preparation than males (mean total score: 7.4 ± 1.8 vs. 7.2 ± 1.9, p = 0.001; total score ≥ 6: 5,340 [86.9%] vs. 5,437 [84.8%], p = 0.001; BBPS ≥ 2 for all segments: 5,048 [82.1%] vs. 5,097 [79.5%], p < 0.001). However, cecal intubation time (8.3 ± 6.2 minutes vs. 6.2 ± 6.1 minutes, p < 0.001) and withdrawal time (7.9 ± 3.5 minutes vs. 7.4 ± 3.1 minutes, p < 0.001) were longer in males.

    CONCLUSION There were sex differences in BBPS, cecal intubation time, and withdrawal time for subjects undergoing colonoscopy.

    PubMed IF 2.2 소화기내과
11. 782021

    제1저자 한희주, 변자민 · 교신저자 신동엽

    Han H, Byun JM, Shin DY, Yoon SS, Koh Y, Hong J, Kim I, Lee C, Yoo H, Yun H, Kim MJ, Cho SI, Seong MW, Park SS

    Leukemic stem cell phenotype is associated with mutational profile in acute myeloid leukemia.

    Korean J Intern Med. 2021;36(2):401-412.

    Abstract

    BACKGROUND/AIMS Understanding leukemic stem cell (LSC) is important for acute myeloid leukemia (AML) treatment. However, association of LSC with patient prognosis and genetic information in AML patients is unclear.

    METHODS Here we investigated the associations between genetic information and the various LSC phenotypes, namely multipotent progenitor (MPP)-like, lymphoid primed multipotent progenitor (LMPP)-like and granulocyte-macrophage progenitors (GMP)-like LSC in 52 AML patients.

    RESULTS In secondary AML patients, MPP-like LSC was significantly higher than de novo AML (p = 0.0037). The proportion of MPP-like LSC was especially high in post-myeloproliferative neoplasm AML (p = 0.0485). There was no correlation between age and LSC phenotype. Mutations of KRAS and NRAS were observed in MPP-like LSC dominant patients, TP53 and ASXL1 mutations in LMPP-like LSC dominant patients, and CEBPA, DNMT3A and IDH1 mutations in GMP-like LSC dominant patients. Furthermore, KRAS mutation was significantly associated with MPP-like LSC expression (p = 0.0540), and TP53 mutation with LMPP-like LSC expression (p = 0.0276). When the patients were separated according to the combined risk including next generation sequencing data, the poorer the prognosis, the higher the LMPP-like LSC expression (p = 0.0052). This suggests that the dominant phenotype of LSC is one of the important factors in predicting the prognosis and treatment of AML.

    CONCLUSION LSC phenotype in AML is closely associated with the recurrent mutations which has prognostic implication. Further research to confirm the meaning of LSC phenotype in the context of genetic aberration is warranted.

    PubMed IF 2.2 혈액종양내과
12. 772021

    제1저자 정지현 · 교신저자 김형관

    Jung JH, Kim HK, Park JB, Lee SP, Koo BK, Kim YJ, Kim HS, Sohn DW

    Progression of ascending aortopathy may not occur after transcatheter aortic valve replacement in severe bicuspid aortic stenosis.

    Korean J Intern Med. 2021;36(2):332-341.

    Abstract

    BACKGROUND/AIMS We evaluated changes in the ascending aorta dimension post-transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BiAV) and tricuspid aortic valve (TAV) patients.

    METHODS Patients with severe aortic stenosis undergoing TAVR at Seoul National University Hospital were consecutively recruited. Patients with less than 12 months' follow-up and/or with an ascending aorta size larger than 50 mm were excluded. The ascending aorta size was measured on a parasternal long axis view using transthoracic echocardiography.

    RESULTS Among the 67 patients who were included (age: 76.5 ± 6.5 years; male: 52.2%; AV area: 0.67 ± 0.15 cm2), 19 (28.4%) had BiAV; 48 (71.6%) had TAV. The median (interquartile ranges) follow-up duration was 398 days (361 to 451). BiAV patients were younger (73.2 ± 7.2 vs. 77.8 ± 5.8, p = 0.008), and had lower incidences of chronic renal disease (5.3% vs. 35.4%, p = 0.014) and history of coronary intervention (15.8% vs. 50.0%, p = 0.013), than TAV patients. On pre-procedural echocardiography, the ascending aorta dimensions in BiAV patients were larger than those in TAV patients (40.5 ± 3.8 mm vs. 35.9 ± 4.2 mm, p < 0.005). The ascending aorta dimension changed minimally during follow-up; post-TAVR, the ascending aorta's growth rate was -0.11 ± 1.9 and 0.26 ± 1.8 mm/yr in patients with BiAV and TAV, respectively (p = 0.50). Progression of the ascending aorta's dimension postTAVR was not clinically significant in BiAV patients.

    CONCLUSION The concern about the progression of aortopathy in BiAV patients post-TAVR may not be a clinical issue. This should be confirmed in studies with a larger population and with a longer follow-up duration.

    PubMed IF 2.2 순환기내과
13. 762021

    제1저자 장은선 · 교신저자 정숙향

    Jang ES, Kim KA, Kim YS, Kim IH, Lee BS, Lee YJ, Chung WJ, Jeong SH

    Effectiveness and safety of elbasvir/grazoprevir in Korean patients with hepatitis C virus infection: a nationwide real-world study.

    Korean J Intern Med. 2021;36(Suppl 1):S1-S8.

    Abstract

    BACKGROUND/AIM This study aimed to establish the real-world effectiveness and safety of grazoprevir/elbasvir (EBR/GZR) therapy in South Korea.

    METHODS A total of 242 patients with chronic hepatitis C virus (HCV) genotype 1 or 4 infection who started EBR/GZR were consecutively enrolled from seven tertiary hospitals. Retrospective analysis of the fractions of patients that achieved sustained virological response (SVR) was performed, and the incidence of adverse events was noted.

    RESULTS The mean age of enrolled patients was 59.0 ± 12.6 years and 47.5% were males. Patients with HCV genotype 1b accounted for 93.8% (n = 227), and patients with HCV of unspecified genotype 1 accounted for 5.8% (n = 14). Hypertension was the most common comorbid disease (29.8%) followed by diabetes (22.7%) and chronic kidney disease (CKD, 12.4%). SVR rates of treatment-naïve and treatment-experienced patients were 85.5% (182/213) and 93.1% (27/29), respectively, in the intention-to-treat analyses, whereas in the per-protocol analyses, those were 97.8% (179/183) and 100% (28/28), respectively. Fewer patients with HCV genotype 1 of unspecified subtype achieved SVR (81.8%, n = 11) compared to the patients with SVR infected with genotype 1b (99%, n = 198, p < 0.001). All patients with CKD showed SVR. Itching (12%) and dyspepsia (4.1%) were common adverse events. Of the four patients who discontinued the antiviral therapy, one experienced mild fatigue but neither treatment withdrawal was because of an adverse event.

    CONCLUSION EBR/GZR showed high real-world effectiveness and safety in Korean patients with chronic HCV infection regardless of the previous antiviral treatment, liver cirrhosis, or CKD status.

    PubMed IF 2.2 소화기내과
14. 752021

    제1저자 이진우, 조성진 · 교신저자 조영진

    Lee J, Jo SJ, Cho Y, Lee JH, Oh IY, Park JJ, Cho YS, Choi DJ

    Effects of renin-angiotensin system blockers on the risk and outcomes of severe acute respiratory syndrome coronavirus 2 infection in patients with hypertension.

    Korean J Intern Med. 2021;36(Suppl 1):S123-S131.

    Abstract

    BACKGROUND/AIMS There are concerns that the use of renin-angiotensin system (RAS) blockers may increase the risk of being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or progressing to a severe clinical course after infection. This this study aimed to investigate the influence of RAS blockers on the risk and severity of SARS-CoV-2 infection.

    METHODS We conducted a retrospective cohort study analyzing nationwide claims data of 215,184 adults who underwent SARS-CoV-2 tests in South Korea. The SARS-CoV-2 positive rates and clinical outcomes were evaluated according to the use of RAS blockers in patients with hypertension (n = 64,243).

    RESULTS In total, 38,919 patients with hypertension were on RAS blockers. The SARS-CoV-2 positive rates were significantly higher in the RAS blocker group than in the control group after adjustments (adjusted odds ratio [OR], 1.22; 95% confidence interval [CI], 1.10 to 1.36; p < 0.001), and matching by propensity score (adjusted OR, 1.16; 95% CI, 1.03 to 1.32; p = 0.017). Among the 1,609 SARS-CoV-2-positive patients with hypertension, the use of RAS blockers was not associated with poor outcomes, such as mortality (adjusted OR, 0.81; 95% CI, 0.56 to 1.17; p = 0.265), and a composite of admission to the intensive care unit and mortality (adjusted OR, 0.95; 95% CI, 0.73 to 1.22; p = 0.669). Analysis in the propensity scorematched population showed consistent results.

    CONCLUSION In this Korean nationwide claims dataset, the use of RAS blockers was associated with a higher risk to SARS-CoV-2 infection but not with higher mortality or other severe clinical courses.

    PubMed IF 2.2 호흡기내과
15. 742021

    제1저자 이해영, 안주희 · 교신저자 오명돈

    Lee HY^*, Ahn J^*, Park J, Kyung Kang C, Won SH, Wook Kim D, Park JH, Chung KH, Joh JS, Bang JH, Hee Kang C, Bum Pyun W, Oh MD, Korean Society of Hypertension, National Committee for Clinical Management of Emerging Infectious Diseases

    Beneficial Effect of Statins in COVID-19-Related Outcomes-Brief Report: A National Population-Based Cohort Study.

    Arterioscler Thromb Vasc Biol. 2021;41(3):e175-e182.

    Abstract

    OBJECTIVE Although statins are widely prescribed lipid-lowering drugs, there are concerns about the safety of their use in the context of coronavirus disease 2019 (COVID-19), since statins increase the expression of ACE2 (angiotensin-converting enzyme 2). This study aimed to disclose the association between statins and 60-day COVID-19 mortality. Approach and Results: All patients hospitalized with laboratory-confirmed COVID-19 were enrolled in this study from January 19 to April 16, 2020, in Korea. We evaluated the association between the use of statins and COVID-19-related mortality in the overall and the nested 1:2 propensity score-matched study. Furthermore, a comparison of the hazard ratio for death was performed between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia between January and June 2019 in Korea. The median age of the 10 448 COVID-19 patients was 45 years. Statins were prescribed in 533 (5.1%) patients. After adjusting for age, sex, and comorbidities, Cox regression showed a significant decrease in hazard ratio associated with the use of statins (hazard ratio, 0.637 [95% CI, 0.425-0.953]; P=0.0283). Moreover, on comparing the hazard ratio between COVID-19 patients and the retrospective cohort of hospitalized pneumonia patients, the use of statins showed similar benefits.

    CONCLUSIONS The use of statins correlates significantly with lower mortality in patients with COVID-19, consistent with the findings in patients with pneumonia. Graphic Abstract: A graphic abstract is available for this article.

    PubMed IF 8.8 순환기내과
16. 732021

    제1저자 Hsieh Yun-Cheng, 주세경 · 교신저자 김원

    Hsieh YC, Joo SK, Koo BK, Lin HC, Kim W

    Muscle alterations are independently associated with significant fibrosis in patients with nonalcoholic fatty liver disease.

    Liver Int. 2021;41(3):494-504.

    Abstract

    BACKGROUND & AIM Anthropometric data are associated with nonalcoholic fatty liver disease (NAFLD) development and progression. We investigated whether the quantity and quality of muscle and visceral fat assessed by computed tomography (CT) are associated with fibrosis severity in NAFLD.

    METHODS In a prospective biopsy-confirmed NAFLD cohort of 521 patients, we measured skeletal muscle index (SMI), muscle attenuation (MA) and visceral adipose tissue index (VATI) via CT. Low skeletal muscle mass (LSMM) was defined using previously validated cut-offs. Myosteatosis and visceral adiposity were defined as the lowest and highest quartile, respectively. Significant fibrosis was defined as F2-F4 in liver histology.

    RESULTS Patients with significant fibrosis had lower SMI and MA and higher VATI than those without. The significant fibrosis prevalence was significantly higher in subjects with LSMM (45.1% vs 30.8%, P = .005), myosteatosis (46.1% vs 29.7%, P = .001) and visceral adiposity (46.9% vs 29.9%, P = .001) than those without. The significant fibrosis risk increased with increasing numbers of body composition components (24.5%, 35.6%, 53.0% and 72.7% in patients with 0, 1, 2 and 3 components respectively). Multivariable analysis revealed that LSMM (OR, 1.72; 95% CI, 1.05-2.84), myosteatosis (OR, 1.65; 95% CI, 1.01-2.68) and visceral adiposity (OR, 1.75; 95% CI, 1.09-2.83) were independent predictors of significant fibrosis. Subjects with sarcopenia had a higher risk of significant fibrosis (OR, 2.17; 95% CI, 1.03-4.56).

    CONCLUSION Muscle alterations and visceral adiposity assessed by CT are associated with significant fibrosis in NAFLD. LSMM and myosteatosis have additive values in prediction of significant fibrosis.

    PubMed IF 6.2 소화기내과
17. 722021

    제1저자 이희선 · 교신저자 최수연

    Lee H, Park HE, Yoon JW, Choi SY

    Clinical Significance of Body Fat Distribution in Coronary Artery Calcification Progression in Korean Population.

    Diabetes Metab J. 2021;45(2):219-230.

    Abstract

    BACKGROUND Although obesity differs according to ethnicity, it is globally established as a solid risk factor for cardiovascular disease. However, it is not fully understood how obesity parameters affect the progression of coronary artery calcification (CAC) in Korean population. We sought to evaluate the association of obesity-related parameters including visceral adipose tissue (VAT) measurement and CAC progression.

    METHODS This retrospective observational cohort study investigated 1,015 asymptomatic Korean subjects who underwent serial CAC scoring by computed tomography (CT) with at least 1-year interval and adipose tissue measurement using non-contrast CT at baseline for a routine checkup between 2003 and 2015. CAC progression, the main outcome, was defined as a difference of ≥2.5 between the square roots of the baseline and follow-up CAC scores using Agatston units.

    RESULTS During follow-up (median 39 months), 37.5% of subjects showed CAC progression of a total population (56.4 years, 80.6% male). Body mass index (BMI) ≥25 kg/m2, increasing waist circumferences (WC), and higher VAT/subcutaneous adipose tissue (SAT) area ratio were independently associated with CAC progression. Particularly, predominance of VAT over SAT at ≥30% showed the strongest prediction for CAC progression (adjusted hazard ratio, 2.20; P<0.001) and remained of prognostic value regardless of BMI or WC status. Further, it provided improved risk stratification of CAC progression beyond known prognosticators.

    CONCLUSION Predominant VAT area on CT is the strongest predictor of CAC progression regardless of BMI or WC in apparently healthy Korean population. Assessment of body fat distribution may be helpful to identify subjects at higher risk.

    PubMed IF 8.2 순환기내과
18. 712021

    제1저자 곽순구 · 교신저자 김형관

    Kwak S, Kwon S, Lee SY, Yang S, Lee HJ, Lee H, Park JB, Han K, Kim YJ, Kim HK

    Differential risk of incident cancer in patients with heart failure: A nationwide population-based cohort study.

    J Cardiol. 2021;77(3):231-238.

    Abstract

    BACKGROUND Heart failure (HF) and cancer are currently two leading causes of mortality, and sometimes coexist. However, the relationship between them is not completely elucidated. We aimed to investigate whether patients with HF are predisposed to cancer development using the large Korean National Health Insurance claims database.

    METHODS This study included 128,441 HF patients without a history of cancer and 642,205 age- and sex-matched individuals with no history of cancer and HF between 1 January 2010 and 31 December 2015.

    RESULTS During a median follow-up of 4.06 years, 11,808 patients from the HF group and 40,805 participants from the control were newly diagnosed with cancer (cumulative incidence, 9.2% vs. 6.4%, p < 0.0001). Patients with HF presented a higher risk for cancer development compared to controls in multivariable Cox analysis [hazard ratio (HR) 1.64, 95% confidence interval (CI) 1.61-1.68]. The increased risk was consistent for all site-specific cancers. To minimize potential surveillance bias, additional analysis was performed by eliminating participants who developed cancer within the initial 2 years of HF diagnosis (i.e. 2-year lag analysis). In the 2-year lag analysis, the higher risk of overall cancer remained significant in patients with HF (HR 1.09, 95% CI 1.05-1.13), although the association was weaker. Among the site-specific cancers, three types of cancer (lung, liver/biliary/pancreas, and hematologic malignancy) were consistently at higher risk in patients with HF. An exploratory analysis showed that patients with repeated HF hospitalization had a higher risk of cancer development compared to those without, in a pattern of stepwise increases across the three groups [controls vs. HF without re-hospitalization vs. HF with re-hospitalization ≥1; HR (95% CI), 1.00 (reference) vs. 1.55 (1.51-1.59) vs. 1.96 (1.89-2.03), respectively].

    CONCLUSIONS Cancer incidence is higher in patients with HF than the general population. Active surveillance of coexisting malignancy needs to be considered in these patients.

    PubMed IF 3.5 순환기내과
19. 702021

    제1저자 이예진 · 교신저자 이창훈

    Lee YJ, Han KD, Kim DH, Lee CH

    Determining the association between repeatedly elevated serum gamma-glutamyltransferase levels and risk of respiratory cancer: A nationwide population-based cohort study.

    Cancer Med. 2021;10(4):1366-1376.

    Abstract

    BACKGROUND Although elevated serum gamma-glutamyltransferase (GGT) is a known indicator of increased risk of several cancers, the clinical value of repeated measurements of GGT has not been determined. Therefore, we aimed to investigate whether repeatedly elevated serum GGT levels are associated with the risk of respiratory cancer incidence.

    METHODS We included participants who had undergone the Korean Health screening four times during 2009-2012 and had previously undergone four consecutive examinations. Those who were diagnosed with respiratory cancer before the date of examination were excluded. The participants obtained one GGT point if their GGT levels were in the highest quartile (the quartile 4 group). We analyzed the association between GGT points and respiratory cancer incidence by Cox proportional hazard models.

    RESULTS During mean follow-up of 6.39 ± 1.2 years, 3,559,109 participants were enrolled. Of them, 8,944 (0.34%) men and 1,484 (0.14%) women were newly diagnosed with respiratory cancer. In multivariate analysis adjusted for confounding factors, male participants with 4 GGT points had a significantly higher hazards of developing respiratory cancer than those with 0 GGT points (hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.31-1.48). Among female, participants with the highest points of GGT also had sixfold increased risk of developing laryngeal cancer. However, no significant association was observed between GGT points and lung cancer incidence among women (HR: 0.95; 95% CI: 0.81-1.11).

    CONCLUSION Repeatedly elevated serum levels of GGT were associated with a higher risk of respiratory cancer incidence, especially in men. This finding suggests that physicians can identify a person with a higher risk of respiratory cancer through a simple repeated measurement of GGT.

    PubMed IF 3.5 호흡기내과
20. 692021

    제1저자 박찬순, 한경도 · 교신저자 최의근

    Park CS^*, Han KD^*, Choi EK, Kim DH, Lee HJ, Lee SR, Oh S

    Lifestyle is associated with atrial fibrillation development in patients with type 2 diabetes mellitus.

    Sci Rep. 2021;11(1):4676.

    Abstract

    We evaluated the impacts of lifestyle behaviors, namely smoking, alcohol consumption, and physical activity, on the development of new-onset AF in patients with DM. Using the Korean Nationwide database, we identified subjects diagnosed with type 2 DM and without previous history of AF between 2009 and 2012. Self-reported lifestyle behaviors were analyzed. Among 2,551,036 included subjects, AF was newly diagnosed in 73,988 patients (median follow-up 7.1 years). Both ex-smokers (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.02-1.07) and current smokers (HR 1.06, 95% CI 1.03-1.08) demonstrated a higher risk of AF than never smokers. Patients with moderate (15-29 g/day) (HR 1.12, 95% CI 1.09-1.15) and heavy (≥ 30 g/day) (HR 1.24, 95% CI 1.21-1.28) alcohol consumption exhibited an increased risk of AF, while subjects with mild alcohol consumption (< 15 g/day) (HR 1.01, 95% CI 0.99-1.03) had an AF risk similar to that of non-drinkers. Patients who engaged in moderate-to-vigorous physical activity showed a lower risk of AF (HR 0.93, 95% CI 0.91-0.94) than those who did not. This study suggests that smoking, alcohol consumption, and physical activity are associated with new-onset AF in patients with DM, and lifestyle management might reduce the risk of AF in this population.

    PubMed IF 4.9 순환기내과
21. 682021

    제1저자 김진희 · 교신저자 임수

    Kim JH, Lee GY, Maeng HJ, Kim H, Bae JH, Kim KM, Lim S

    Effects of Glucagon-Like Peptide-1 Analogue and Fibroblast Growth Factor 21 Combination on the Atherosclerosis-Related Process in a Type 2 Diabetes Mouse Model.

    Endocrinol Metab (Seoul). 2021;36(1):157-170.

    Abstract

    BACKGROUND Glucagon-like peptide-1 (GLP-1) analogues regulate glucose homeostasis and have anti-inflammatory properties, but cause gastrointestinal side effects. The fibroblast growth factor 21 (FGF21) is a hormonal regulator of lipid and glucose metabolism that has poor pharmacokinetic properties, including a short half-life. To overcome these limitations, we investigated the effect of a low-dose combination of a GLP-1 analogue and FGF21 on atherosclerosis-related molecular pathways.

    METHODS C57BL/6J mice were fed a high-fat diet for 30 weeks followed by an atherogenic diet for 10 weeks and were divided into four groups: control (saline), liraglutide (0.3 mg/kg/day), FGF21 (5 mg/kg/day), and low-dose combination treatment with liraglutide (0.1 mg/kg/day) and FGF21 (2.5 mg/kg/day) (n=6/group) for 6 weeks. The effects of each treatment on various atherogenesisrelated pathways were assessed.

    RESULTS Liraglutide, FGF21, and their low-dose combination significantly reduced atheromatous plaque in aorta, decreased weight, glucose, and leptin levels, and increased adiponectin levels. The combination treatment upregulated the hepatic uncoupling protein-1 (UCP1) and Akt1 mRNAs compared with controls. Matric mentalloproteinase-9 (MMP-9), monocyte chemoattractant protein-1 (MCP-1), and intercellular adhesion molecule-1 (ICAM-1) were downregulated and phosphorylated Akt (p-Akt) and phosphorylated extracellular signal-regulated kinase (p-ERK) were upregulated in liver of the liraglutide-alone and combination-treatment groups. The combination therapy also significantly decreased the proliferation of vascular smooth muscle cells. Caspase-3 was increased, whereas MMP-9, ICAM-1, p-Akt, and p-ERK1/2 were downregulated in the liraglutide-alone and combination-treatment groups.

    CONCLUSION Administration of a low-dose GLP-1 analogue and FGF21 combination exerts beneficial effects on critical pathways related to atherosclerosis, suggesting the synergism of the two compounds.

    PubMed IF 5.1 내분비대사내과
22. 672021

    제1저자 황성혜 · 교신저자 김세중

    Hwang SH, Lee S, Park JY, Jeon JS, Cho YJ, Kim S

    Potential of Drug Efficacy Evaluation in Lung and Kidney Cancer Models Using Organ-on-a-Chip Technology.

    Micromachines (Basel). 2021;12(2):mi12020215.

    Abstract

    Organ-on-a-chip (OoC) is an exponential technology with the potential to revolutionize disease, toxicology research, and drug discovery. Recent advances in OoC could be utilized for drug screening in disease models to evaluate the efficacy of new therapies and support new tools for the understanding of disease mechanisms. Rigorous validation of this technology is required to determine whether OoC models may represent human-relevant physiology and predict clinical outcomes in target disease models. Achievements in the OoC field could reveal exciting new avenues for drug development and discovery. This review attempts to highlight the benefits of OoC as per our understanding of the cellular and molecular pathways in lung and kidney cancer models, and discusses the challenges in evaluating drug efficacy.

    PubMed IF 3.5 신장내과
23. 662021

    제1저자 강민정 · 교신저자 오국환

    Kang M, Kang E, Ryu H, Hong Y, Han SS, Park SK, Hyun YY, Sung SA, Kim SW, Yoo TH, Kim J, Ahn C, Oh KH

    Measured sodium excretion is associated with CKD progression: results from the KNOW-CKD study.

    Nephrol Dial Transplant. 2021;36(3):512-519.

    Abstract

    BACKGROUND Diet is a modifiable factor of chronic kidney disease (CKD) progression. However, the effect of dietary salt intake on CKD progression remains unclear. Therefore, we analyzed the effect of dietary salt intake on renal outcome in Korean patients with CKD.

    METHODS We measured 24-h urinary sodium (Na) excretion as a marker of dietary salt intake in the prospective, multi-center, longitudinal KoreaN cohort study for Outcome in patients With CKD (KNOW-CKD). Data were analyzed from CKD patients at Stages G3a to G5 (n = 1254). We investigated the association between dietary salt intake and CKD progression. Patients were divided into four quartiles of dietary salt intake, which was assessed using measured 24-h urinary Na excretion. The study endpoint was composite renal outcome, which was defined as either halving the estimated glomerular filtration rate or developing end-stage renal disease.

    RESULTS During a median (interquartile range) follow-up of 4.3 (2.8-5.8) years, 480 (38.7%) patients developed the composite renal event. Compared with the reference group (Q2, urinary Na excretion: 104.2 ≤ Na excretion < 145.1 mEq/day), the highest quartile of measured 24-h urinary Na excretion was associated with risk of composite renal outcome [Q4, urinary Na excretion ≥192.9 mEq/day, hazard ratio 1.8 (95% confidence interval 1.12-2.88); P = 0.015] in a multivariable hazards model. Subgroup analyses showed that high-salt intake was particularly associated with a higher risk of composite renal outcome in women, in patients <60 years of age, in those with uncontrolled hypertension and in those with obesity.

    CONCLUSIONS High salt intake was associated with increased risk of progression in CKD.

    PubMed IF 8.3 신장내과
24. 652021

    제1저자 박지명, 이연주 · 교신저자 이상민

    Park J^*, Lee YJ^*, Hong SB, Jeon K, Moon JY, Kim JS, Kang BJ, Ahn JJ, Lee DH, Park J, Cho JH, Lee SM

    The association between hospital length of stay before rapid response system activation and clinical outcomes: a retrospective multicenter cohort study.

    Respir Res. 2021;22(1):60.

    Abstract

    BACKGROUND Rapid response system (RRS) is being increasingly adopted to improve patient safety in hospitals worldwide. However, predictors of survival outcome after RRS activation because of unexpected clinical deterioration are not well defined. We investigated whether hospital length of stay (LOS) before RRS activation can predict the clinical outcomes.

    METHODS Using a nationwide multicenter RRS database, we identified patients for whom RRS was activated during hospitalization at 9 tertiary referral hospitals in South Korea between January 1, 2016, and December 31, 2017. All information on patient characteristics, RRS activation, and clinical outcomes were retrospectively collected by reviewing patient medical records at each center. Patients were categorized into two groups according to their hospital LOS before RRS activation: early deterioration (LOS < 5 days) and late deterioration (LOS ≥ 5 days). The primary outcome was 28-day mortality and multivariable logistic regression was used to compare the two groups. In addition, propensity score-matched analysis was used to minimize the effects of confounding factors.

    RESULTS Among 11,612 patients, 5779 and 5883 patients belonged to the early and late deterioration groups, respectively. Patients in the late deterioration group were more likely to have malignant disease and to be more severely ill at the time of RRS activation. After adjusting for confounding factors, the late deterioration group had higher 28-day mortality (aOR 1.60, 95% CI 1.44-1.77). Other clinical outcomes (in-hospital mortality and hospital LOS after RRS activation) were worse in the late deterioration group as well, and similar results were found in the propensity score-matched analysis (aOR for 28-day mortality 1.66, 95% CI 1.45-1.91).

    CONCLUSIONS Patients who stayed longer in the hospital before RRS activation had worse clinical outcomes. During the RRS team review of patients, hospital LOS before RRS activation should be considered as a predictor of future outcome.

    PubMed IF 5.7 호흡기내과
25. 642021

    제1저자 이서영, 김학령 · 교신저자 김명아

    Lee SY, Kim HL, Kim MA, Park JJ, Choi DJ, Kim JJ, Jeon ES, Cho MC

    Obesity paradox in Korean male and female patients with heart failure: A report from the Korean Heart Failure Registry.

    Int J Cardiol. 2021;325:82-88.

    Abstract

    BACKGROUND Although the survival benefit of obesity has been suggested in patients with heart failure (HF), the impact of sex on obesity paradox is less clear. This study was performed to investigate whether there is a sex difference in the association between body mass index (BMI) and long-term clinical outcomes in patients hospitalized for HF.

    METHOD A total of 2616 patients hospitalized for HF (Mean age 66 years and 52% males) from the nation-wide registry database were analyzed. Patients were categorized using baseline BMI as normal (18.5 to 22.9 kg/m²), overweight (23 to 27.4 kg/m²) and obese (≥ 27.5 kg/m²). Their all-cause mortality and long-term composite events, including all-cause mortality and HF readmission, were assessed according to the BMI groups.

    RESULTS During the median follow-up period of 1499 days, there were 662 patients (25.3%) with all-cause mortality and 1071 patients (40.9%) with composite events. Compared to the normal weight group, the overweight (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.51-0.99; P = 0.045) and obese (HR, 0.53; 95% CI, 0.29-0.95; P = 0.032) group showed lower all-cause mortality rates even after adjusting for confounding factors in the male patients. Otherwise, BMI was not associated with composite events in males; it was not associated with all-cause mortality or composite events in females in the multivariable analyses (P > 0.05 for each).

    CONCLUSIONS Among patients with HF, a greater BMI was associated with low all-cause mortality in males, but not in females. Obesity paradox should be considered in the management of HF patients.

    PubMed IF 3.3 순환기내과
26. 632021

    제1저자 이소령, 한경도 · 교신저자 최의근

    Lee SR^*, Han KD^*, Choi EK, Oh S, Lip GYH

    Nonalcoholic fatty liver disease and the risk of atrial fibrillation stratified by body mass index: a nationwide population-based study.

    Sci Rep. 2021;11(1):3737.

    Abstract

    We evaluated the association between nonalcoholic fatty liver disease (NAFLD) and incident atrial fibrillation (AF) and analyzed the impact of NAFLD on AF risk in relation to body mass index (BMI). A total of 8,048,055 subjects without significant liver disease who were available fatty liver index (FLI) values were included. Subjects were categorized into 3 groups based on FLI: < 30, 30 to < 60, and ≥ 60. During a median 8-year of follow-up, 534,442 subjects were newly diagnosed as AF (8.27 per 1000 person-years). Higher FLI was associated with an increased risk of AF (hazard ratio [HR] 1.053, 95% confidence interval [CI] 1.046-1.060 in 30 ≤ FLI < 60, and HR 1.115, 95% CI 1.106-1.125 in FLI ≥ 60). In underweight subjects (BMI < 18.5 kg/m²), higher FLI raised the risk of AF (by 1.6-fold in 30 ≤ FLI < 60 and by twofold in FLI ≥ 60). In normal- and overweight subjects, higher FLI was associated with an increased risk of AF, but the HRs were attenuated. In obese subjects, higher FLI was not associated with higher risk of AF. NAFLD as assessed by FLI was independently associated with an increased risk of AF in nonobese subjects with BMI < 25 kg/m². The impact of NAFLD on AF risk was accentuated in lean subjects with underweight.

    PubMed IF 4.9 순환기내과
27. 622021

    제1저자 문정민, 이진용 · 교신저자 고성준, 박현선

    Moon JM, Lee JY, Koh SJ, Park H, Kang S, Soh H, Lee HJ, Im JP, Kim JS

    Incidence of Psoriasis in Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Matched Cohort Study.

    Dermatology. 2021;237(3):330-337.

    Abstract

    BACKGROUND Emerging data suggest that inflammatory bowel disease (IBD) and psoriasis are associated, sharing common genetic predispositions and immunological mechanisms. However, concrete data on psoriasis risk in IBD patients compared to the general population are limited.

    OBJECTIVE We investigated the risk of developing psoriasis in IBD patients compared to controls without IBD.

    METHODS Using the Korean National Health Insurance Database, patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 2005 and 2008 were age- and sex-matched 1:4 to non-IBD subjects from 2003 to 2018. IBD patients were defined by combining the International Classification of Diseases 10th revision code and at least one prescription of IBD-specific medications. Disease phenotypes, including psoriasis severity and psoriatic arthritis, were also identified. We investigated newly diagnosed psoriasis from 2009 to 2018. Incidence rates and risk of psoriasis were assessed with multivariate Cox regression models. Subgroup analyses for age and sex, and sensitivity analysis involving tumor necrosis factor (TNF) inhibitor-naïve patients were performed.

    RESULTS During nearly a decade of follow-up, 20,152 IBD patients were identified (14,619 [72.54%] UC and 5,533 [27.46%] CD). Among them, 439 patients were newly diagnosed with psoriasis (incidence rate of 217.68 per 100,000 person-years and 228.62 per 100,000 person-years for UC and CD, respectively). The psoriasis risk was higher in IBD patients than in the matched controls (adjusted hazard ratio, aHR, 2.95, 95% confidence interval, CI, 2.60-3.33). Moreover, IBD patients aged <30 years were at an increased risk (aHR 3.35, 95% CI 2.58-4.35), a trend that was unchanged across all psoriasis phenotypes. Sensitivity analysis of TNF inhibitor-naïve patients revealed consistent results.

    CONCLUSIONS IBD patients were more likely to develop psoriasis compared to non-IBD subjects, including younger patients at an elevated risk regardless of TNF inhibitor use. This advocates the interplay between IBD and psoriasis; thus, inspection of cutaneous manifestation and dermatological consultation may be helpful in IBD patients at risk.

    PubMed IF 3.6 소화기내과
28. 612021

    제1저자 이원재 · 교신저자 조구영

    Lee W, Choi W, Kang SH, Hwang IC, Choi HM, Yoon YE, Cho GY

    Long-term Prognosis of Mild to Moderate Aortic Stenosis and Coronary Artery Disease.

    J Korean Med Sci. 2021;36(6):e47.

    Abstract

    BACKGROUND There is an incomplete understanding of the natural course of mild to moderate aortic stenosis (AS). We aimed to evaluate the natural course of patients with mild to moderate AS and its association with coronary artery disease (CAD).

    METHODS We retrospectively analyzed 787 patients diagnosed with mild to moderate AS using echocardiography between 2004 and 2010. Cardiac death and aortic valve replacement (AVR) for AS were assessed.

    RESULTS A median follow-up period was 92 months. Compared to the general population, patients with mild to moderate AS had a higher risk of cardiac death (hazard ratio [HR], 17.16; 95% confidence interval [CI], 13.65-21.59; P < 0.001). Established CAD was detected in 22.4% and associated with a significantly higher risk of cardiac mortality (adjusted HR, 1.62; 95% CI, 1.04-2.53; P = 0.033). The risk of cardiac death was lower when patients were taking statin (adjusted HR, 0.64; 95% CI, 0.41-0.98; P = 0.041), which was clear only after 7 years. Both patients with CAD and on statin tended to undergo more AVR, but the difference was not statistically significant (the presence of established CAD; adjusted HR, 1.63; 95% CI, 0.51-3.51; P = 0.214 and the use of statin; adjusted HR, 1.86; 95% CI, 0.76-4.58; P = 0.177).

    CONCLUSION Mild to moderate AS does not have a benign course. The presence of CAD and statin use may affect the long-term prognosis of patients with mild to moderate AS.

    PubMed IF 3.2 순환기내과
29. 602021

    제1저자 강지훈 · 교신저자 박경우

    Kang J, Park KW, Lee HS, Zheng C, Rhee TM, Ki YJ, Chang M, Han JK, Yang HM, Kang HJ, Koo BK, Kim HS

    Relative Impact of Clinical Risk Versus Procedural Risk on Clinical Outcomes After Percutaneous Coronary Intervention.

    Circ Cardiovasc Interv. 2021;14(2):e009642.

    Abstract

    BACKGROUND The clinical outcome after percutaneous coronary intervention (PCI) is affected by various clinical and procedural risk factors. We investigated the relative impact of clinical and procedural risks on clinical outcomes after PCI.

    METHODS A total of 13 172 patients were enrolled from the Grand-DES registry. The population was grouped into tertiles (high-, intermediate-, low-risk) according to the number of prespecified clinical and procedural risk factors, respectively. The primary end point was major adverse cardiac and cerebrovascular events (MACCE) at 3 years post-PCI.

    RESULTS MACCE occurred in 1109 (8.4%) patients during the follow-up period (median duration: 1126 days). Compared with procedural risk, clinical risk showed superior predictive power (area under the curve: 0.678 versus 0.570, P<0.001, for clinical and procedural risks, respectively) and greater magnitude of effect in the multivariate analysis for MACCE (Clinical risk: hazard ratio, 1.953 [95% CI, 1.809-2.109], P<0.001; procedural risk: hazard ratio, 1.240 [95% CI, 1.154-1.331], P<0.001). In subgroup analyses within each clinical risk tertile, procedural risk had no significant impact on MACCE in the lowest clinical risk tertile. An annual landmark analysis revealed that clinical and procedural risks were both significant predictors of MACCE, which occurred within the first and second year post-PCI. However, for MACCE occurring in the third year post-PCI, only clinical risk but not procedural risk was a significant predictor of events.

    CONCLUSIONS Clinical and procedural risks were both significant predictors for ischemic clinical events in patients undergoing PCI. However, clinical risk had a greater and more prolonged effect on outcomes than procedural risk. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03507205.

    PubMed IF 7.2 순환기내과
30. 592021

    제1저자 송진화 · 교신저자 임재준

    Song JH, Kim BS, Kwak N, Han K, Yim JJ

    Impact of body mass index on development of nontuberculous mycobacterial pulmonary disease.

    Eur Respir J. 2021;57(2):13993003.00454-2020.

    Abstract

    The incidence and prevalence of nontuberculous mycobacterial pulmonary disease (NTM-PD) have been increasing worldwide. The risk of NTM-PD may be higher in undernourished populations. In this study, we tried to elucidate the impact of body mass index (BMI) and its change on development of NTM-PD.We performed a retrospective cohort study including South Koreans aged >40 years who underwent biennial National Health Insurance System (NHIS) health check-ups in both 2005 and 2009 or 2006 and 2010. We monitored eligible individuals from the study initiation date (NHIS health check-up date in 2009 or 2010) until the diagnosis of NTM-PD or until December 31, 2017. Enroled individuals were classified based on BMI at initiation date. By calculating hazard ratios, we compared NTM-PD incidence per 100000 person-years by BMI group and by BMI change.A total of 5670229 individuals were included in the final analysis. Compared with the BMI <18.5 kg·m^-2 group, the incidence of NTM-PD gradually decreased with increased BMI (adjusted hazard ratio 0.38, 95% confidence interval (CI) 0.35-0.42 for BMI 18.5-22.9; 0.17, 95% CI 0.15-0.19 for BMI 23-24.9; 0.1, 95% CI 0.09-0.11 for BMI 25-29.9; and 0.1, 95% CI 0.07-0.13 for BMI ≥30). A BMI decrease of ≥1 kg·m^-2 over 4 years increased the incidence of NTM-PD (adjusted hazard ratio 1.08, 95% CI 1.01-1.16) whereas a BMI increase of ≥1 kg·m^-2 decreased the incidence of NTM-PD (adjusted hazard ratio 0.77, 95% CI 0.71-0.83).In conclusion, BMI was inversely related to development of NTM-PD and weight loss increased the risk of NTM-PD.

    PubMed IF 23.8 호흡기내과

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