The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 425
Slide Session
OS-057 Pulmonary Vascular Diseases Risk Factors Associated with Provoked Pulmonary Embolism
Hyun Jung Kim1, Endri Gjonbrataj1, Hye In Jung1, Won-Il Choi1 Department of Internal Medicine, Keimyung University School of Medicine, Korea1
Background: Pulmonary embolism (PE) is classifi ed as provoked and unprovoked ac- cording to the transient risk factors in the subset forms of deep vein thrombosis (DVT).
The risk factors of unprovoked DVT have been well studied. However, there has been paucity of data on risk factors for developing provoked PE other than predisposing ones, such as immobilization or surgery. This study aimed to investigate risk factors associated with provoked PE, including the alteration of factors associated with coag- ulation.
Methods: This retrospective cohort study included 237 patients with PE. Patients that had transient risk fac¬tors at diagnosis were classifi ed as provoked PE, while all others were classifi ed as unprovoked PE. The baseline clinical characteristics and factors as- sociated with coagulation were compared. We evaluated risk associated with provoked PE.
Results: Among 237 PE cases, 73 (30.8%) cases were diagnosed as provoked PE.
Respiratory failure, infection, DIC score and RV/LV ratio were signifi¬cantly higher in provoked PE than it was in unprovoked PE. Proteins and activity associated with coagu¬lation were signifi cantly lower in provoked PE than in unprovoked PE including protein C antigen, protein S antigen, protein S activity, anti-throm¬bin III antigen and factor VIII. Multivariate analysis showed infection (odds ratio [OR], 3.2; 95% confi - dence interval [CI], 1.4-7.4) and protein S activity (OR, 0.97; CI 0.95-0.99) were signif- icantly associated with provoked PE.
Conclusions: Infection and protein S activity were important factors associated with Provoked PE.
OS-058 Pulmonary Vascular Diseases Central Emboli Rather than Saddle Emboli Predict Adverse Outcomes in Patients with Acute Pulmonary Embolism
Keum Ju Choi1, Seung-Ick Cha1, Seung-Soo Yoo1, Jaehee Lee1, Shin-Yup Lee1, Chang- Ho Kim1, Jae-Yong Park1
Kyungpook National University Hospital, Korea1
Background: In patients with acute pulmonary embolism (PE), the prognostic implica- tions of saddle or central emboli, as observed on computed tomography (CT), remain to be established. The aim of the present study was to assess whether the presence of saddle and central emboli could be used to predict clinical outcomes in patients with PE.
Methods: The authors retrospectively reviewed 743 consecutive patients hospitalized at a tertiary referral center with a diagnosis of PE based on multi-detector row CT scan.
Results: All the clinical variables did not differ between saddle emboli (5.8% [n=43]) and right or left pulmonary artery emboli (29.7% [n=221]), and the frequency of an adverse outcome was not signifi cantly different between the two groups. Saddle em- boli and right or left pulmonary artery emboli were grouped into central emboli (35.5%
[n=264]). Patients were allocated to an adverse outcome group (10.5% [n=78]) or a control group (89.5% [n=665]). Multivariate analysis demonstrated that PE severity index (PESI) score (class IV-V), N-terminal-pro-B-type natriuretic peptide level (=1,406 pg/mL), right ventricular dilation on CT (right ventricle/left ventricle diameter ratio =1), and central emboli signifi cantly predicted an adverse outcome. The addition of central emboli to other established prognostic factors such as PESI enhanced the positive pre- dictive values and positive likelihood ratios of an adverse outcome for acute PE Conclusions: Rather than saddle emboli, central emboli could be an independent prog- nostic factor of adverse outcomes in patients with acute PE and provide additional prognostic value when combined with other prognostic factors
OS-059 Bronchoscopy
Value of Flexible Bronchoscopy in Patients with Persistent Ground Glass Opacity Nodules
Byung Woo Jhun1, Kyung-Jong Lee1, Gee Young Suh1, Man Pyo Chung1, Hojoong Kim1, O Jung Kwon1, Kyung Soo Lee2, Joungho Han3, Sang-Won Um1
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea1, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea2, Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea3 Background: There are no accurate data on the diagnostic value of preoperative fl exi- ble bronchoscopy (FB) for persistent ground glass opacity (GGO) nodules.
Methods: We retrospectively searched a database for subjects who had ‘GGO,’
‘non-solid nodule,’ ‘part-solid nodule,’ or ‘sub-solid nodule’ in radiological reports of chest computed tomography between February 2004 and March 2012. Patients who had infi ltrative GGO, focal GGO larger than 3 cm, or were lost to follow-up were ex- cluded. We assessed the diagnostic value of preoperative FB in patients with persistent GGO nodules who underwent planned surgical resection.
Results: In total, 296 GGO nodules were evaluated by FB in 264 patients with persis- tent GGO nodules who underwent preoperative FB and planned surgical resection. The median size of the GGO nodules was 18 mm, and 135 (46%) were pure GGO and 161 (54%) were mixed GGO. No visible tumor or unsuspected endobronchial metastasis was identifi ed by preoperative FB. Only 3 (1%, 3/208) GGO nodules were identifi ed preoperatively as malignant by bronchial washing cytology, which were all mixed GGO;
no other accompanying etiology was identifi ed by FB. Of all GGO nodules, 271 (91%) were subsequently confi rmed as malignant and 25 (9%) were confi rmed as benign by surgical resection. Consequently, the overall diagnostic sensitivity and negative predic- tive value of preoperative FB on a per-nodule basis were 1% (3/271) and 8% (25/293), respectively. The preoperative FB did not change the planned surgical strategy.
Conclusions: Preoperative FB should not be routinely recommended in surgical candi- dates with persistent GGO nodules, especially pure GGO nodules.
OS-060 Bronchoscopy
Clinical Impact of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonia
Hyun Woo Lee1, Yeon Joo Lee1, Se Joong Kim1, Jong Sun Park1, Ho Il Yoon1, Jae-Ho Lee1, Choon-Taek Lee1, Young-Jae Cho1
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National Uni- versity Bundang Hospital, Korea1
Background: There had been few evidences supporting the proper timing of bronchos- copy infl uencing on clinical outcomes including mortality in mechanically ventilated patients with aspiration pneumonia.
Method: Mechanically ventilated patients with aspiration pneumonia in medical inten- sive care unit at tertiary hospital from March 2003 to December 2013 were retrospec- tively reviewed. All of pneumonias were confi rmed by historical and clinical probability with defi nite fi ndings of chest computed tomography compatible with aspiration. By defi nition, patients who were done bronchoscopy within 24 hours after intubation were categorized as early bronchoscopy group. We compared demographics, clinical parame- ters and outcomes including mortality between two groups.
Results: 182 patients were diagnosed as aspiration pneumonia with their probability.
Early group (n=93) showed no signifi cant differences in demographic features including acute physiology and chronic health evaluation II scores compared with late group. Early group showed signifi cant lower in-ICU mortality and in-hospital mortality (6.5 vs. 26.1%
and 10.8 vs. 33.0%, P<0.001, respectively) regardless of the appropriateness of proper antibiotics. In addition, their sequential organ failure assessment score and clinical pul- monary infection score on day 7 tended to decrease more rapidly. Patients in early bron- choscopy group had been extubated more successfully, and showed shorter length of mechanical ventilation and stay in ICU. Interestingly, they had more previous aspiration history, be done brochoscopy frequently, and admitted on weekday rather than holiday or weekend. Cox regression analysis showed only the early timing of bronchoscopy was associated with lower 90 day mortality (Odds ratio, 0.261; 95% CI, 0.111-0.613).
Conclusions: Early bronchoscopy could result in more benefi cial effect on clinical out- comes in mechanically ventilated patients with aspiration pneumonia.
