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￭ S-333 ￭
Effect of selenium deficiency on thyroid hormone and cardiovascular diseases in hemodialysis patient
Jeju National University School of Medicine, Jeju, Korea
*Yong Tae Kim, So Mi Kim
Introduction: Trace element, selenium deficiency is known to associate with impairment of thyroid hormone and cardiovascular diseases such as coro- nary artery disease, cardiomyopathy or sudden death. In hemodialysis (HD) patients, various causes may contribute to selenium deficiency, including decreased dietary intake, malabsorption, alteration of metabolism, and removal through dialysis itself. Therefore, we tried to investigate the effect of se- lenium deficiency on thyroid hormone and cardiovascular diseases in HD patients. Methods: This cross-sectional study enrolled 83 end-stage renal disease patients who underwent HD in Jeju National University Hospital. The patients were divided into two groups based on serum selenium levels: 62 patients were normal leveland 22 patients were selenium deficient. Thyroid hormones such as TSH, free T4 were measured. And presence of car- diovascular diseases, including ischemic heart disease (IHD), heart failure or cardiomyopathy using echocardiography, coronary computed tomography or coronary angiography were evaluated. Results: There were no significant differences in baseline characteristics including age, sex, presence of dia- betes mellitus, hypertension medication between the two groups. Thyroid hormone impairment, includinghypothyroidism and subclinical hypo- thyroidism showed higher tendency in selenium deficient group than that in non- selenium deficient group. (27% vs.10%, p＝0.06) The prevalence of ischemic heart disease was significantly higher in selenium deficient group than that in the non-selenium deficient group. (59% vs. 21%, p＝0.04) But there was no difference in heart failure defined as ejection fraction with below 40%, and cardiomyopathy between the two groups. All patients with thy- roid hormone impairment showed high prevalence of IHD and the coincidence of thyroid impairment and IHD was significantly higher than that in se- lenium deficient group than that in non-selenium deficient group. (18% vs. 4%, p＝0.014). Conclusions: This study showed the significant high preva- lence of thyroid hormone impairment and IHD in HD patients with selenium deficiency. Selenium deficiency may be affect heart disease, associating with thyroid hormone impairment
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Delta Neutrophil Index is a Predictor of Disease Severity in Patients with Acute Pyelonephritis
Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
*Geun Woo Ryu, Hyung Woo Kim, Seohyun Park, Sul A Lee, Jonghyun Jhee, Su-Young Jung, Hyung Jung Oh, Jung Tak Park, Seung Hyeok Han, Shin-Wook Kang, Tae-Hyun Yoo
Background: Delta neutrophil index (DNI) is the fraction of immature granulocytes provided by a complete blood count analyzer. Previous studies demonstrated that DNI is a novel marker to predict outcomes in sepsis patients. Therefore, this study aimed to evaluate DNI as a predictor of disease se- verity in patients with acute pyelonephritis (APN). Methods: Patients diagnosed with APN at Severance Hospital from December 2009 to July 2012 were retrospectively investigated. DNI levels were measured at the time of admission. The patients were classified into two groups according to the me- dian value of DNI at baseline. Severe APN was diagnosed with one or more of these conditions including bacteremia, acute kidney injury, hypotension requiring use of vasopressors and admission of intensive care unit. Independent risk factors for severe APN were determined by multiple logistic re- gression analysis. Receiver operating characteristic (ROC) curves were plotted for DNI, white blood cell (WBC) count and C-reactive protein (CRP).
Results: A total of 258 patients were included in this study. The median age was 61.0 (19.0-87.0), 237 patients (91.9%) were female, and the median DNI level was 2.5%. Severe APN was significantly more prevalent in high DNI group. Multivariate analysis showed that DNI, WBC count and CRP level independently predicted severe APN. DNIwas a better predictive marker of severe APN than WBC count, as reflectd by area under the ROC curve analysis (0.697 [95% CI, 0.637-0.753] vs. 0.562 [95% CI, 0.499-0.624], p＝0.0013). DNI was not inferior to CRP levels to predict severe APN (0.697 [95% CI, 0.637-0.753] vs. 0.633 [95% CI, 0.571-0.692], p＝0.1185). Conclusions: DNI level at admission is a valuable predictor of disease severity in patients with APN.
