Prognostic utility of N-terminal pro-B-type natriuretic peptide in adult and elderly patients with community acquired pneumonia

Objective@#N-terminal pro-B-type natriuretic peptide (NT-proBNP) is suggested as a prognostic biomarker for communityacquired pneumonia (CAP). However, its predictive value for an individual adult and elderly CAP patients has not been fully investigated. @*Methods@#Patients with CAP aged 18 years and older, who visited the emergency department (ED) from March 1, 2016 to March 31, 2019, were included in this study. Patients were divided into the adult group and the elderly group (age ≥70 years). Data was collected from the ED-based registry, and medical charts were retrospectively reviewed. The registry data included sociodemographic and past medical characteristics, as well as laboratory findings including NT-proBNP and C-reactive protein (CRP), Pneumonia Severity Index (PSI), and CURB65 (confusion, urea, respiratory rate, blood pressure, and aged 65 or more). The independent potential of NT-proBNP to predict mortality was assessed in both groups using multivariable logistic regression, and its predictive ability was evaluated in terms of performance (using areas under the curve [AUCs]) and goodness-of-fit (using the Bayesian information criterion [BIC]). @*Results@#Totally, 325 CAP patients were evaluated, of which 208 (64%) belonged to the elderly group. NT-proBNP was identified as an independent predictor of CAP mortality in elderly patients, but not in adult patients. Moreover, AUC of the NT-proBNP for mortality was comparable to AUC of the PSI, but was higher than that of the CURB65, in elderly CAP patients. Similarly, the NT-proBNP had a better overall fit (lower BIC value) compared to the CURB65, for mortality. Additionally, both AUC and overall fit of the NT-proBNP for mortality were significantly superior to values obtained for CRP. @*Conclusion@#For elderly CAP patients in the ED, the NT-proBNP is an independent and useful predictor of mortality.

Clinical Significance of Urinary Neutrophil Gelatinase-associated Lipocalin Levels in Defining the Various Etiologies of Acute Kidney Injury in Liver Cirrhosis Patients / 대한소화기학회지

BACKGROUND/AIMS: A diagnosis of hepatorenal syndrome (HRS) is based on a differential evaluation of acute kidney injury (AKI), which may aggravate the clinical course. This study assessed the clinical significance of the urinary neutrophil gelatinase-associated lipocalin (u-NGAL) levels in a differential diagnosis of AKI in patients with liver cirrhosis (LC). METHODS: Patients with LC who developed AKI were enrolled prospectively. Clinically, patients with AKI were classified into prerenal azotemia (PRA), HRS, and acute tubular necrosis (ATN) groups. RESULTS: Fifty-five patients (male, 74.5%) with LC who exhibited AKI upon admission were enrolled; 28, 9, and 18 patients were included in the PRA, HRS, and ATN groups, respectively. The baseline model for end-stage liver disease (MELD) scores was similar in the subgroups. The median event creatinine level, measured at the time of the AKI diagnosis, was similar in the HRS and ATN subgroups. On the other hand, the median event u-NGAL level differed significantly between the three subgroups (PRA, HRS, and ATN: 37 vs. 134 vs. 2,625 ng/mL, p=0.003). In particular, the median u-NGAL level of the HRS group was clearly different from those of the PRA (p<0.001) and ATN (p<0.001) groups. Multivariable analysis revealed the natural logarithm of the u-NGAL level (hazard ratio [HR] 1.77, p=0.031) and the MELD score (HR 1.17, p=0.027) to be independent prognostic factors for in-hospital mortality in patients with LC and AKI. CONCLUSIONS: The median u-NGAL level differentiated HRS from ATN and served as a clinical indicator of in-hospital mortality for patients with LC and AKI.

Clinical Significance of Urinary Neutrophil Gelatinase-associated Lipocalin Levels in Defining the Various Etiologies of Acute Kidney Injury in Liver Cirrhosis Patients / 대한소화기학회지

BACKGROUND/AIMS: A diagnosis of hepatorenal syndrome (HRS) is based on a differential evaluation of acute kidney injury (AKI), which may aggravate the clinical course. This study assessed the clinical significance of the urinary neutrophil gelatinase-associated lipocalin (u-NGAL) levels in a differential diagnosis of AKI in patients with liver cirrhosis (LC).METHODS: Patients with LC who developed AKI were enrolled prospectively. Clinically, patients with AKI were classified into prerenal azotemia (PRA), HRS, and acute tubular necrosis (ATN) groups.RESULTS: Fifty-five patients (male, 74.5%) with LC who exhibited AKI upon admission were enrolled; 28, 9, and 18 patients were included in the PRA, HRS, and ATN groups, respectively. The baseline model for end-stage liver disease (MELD) scores was similar in the subgroups. The median event creatinine level, measured at the time of the AKI diagnosis, was similar in the HRS and ATN subgroups. On the other hand, the median event u-NGAL level differed significantly between the three subgroups (PRA, HRS, and ATN: 37 vs. 134 vs. 2,625 ng/mL, p=0.003). In particular, the median u-NGAL level of the HRS group was clearly different from those of the PRA (p<0.001) and ATN (p<0.001) groups. Multivariable analysis revealed the natural logarithm of the u-NGAL level (hazard ratio [HR] 1.77, p=0.031) and the MELD score (HR 1.17, p=0.027) to be independent prognostic factors for in-hospital mortality in patients with LC and AKI.CONCLUSIONS: The median u-NGAL level differentiated HRS from ATN and served as a clinical indicator of in-hospital mortality for patients with LC and AKI.

Attenuation-Based Automatic Tube Potential Selection in Cerebral Computed Tomography Angiography: Effects on Radiation Exposure and Image Quality

OBJECTIVE@#To investigate the feasibility of using the attenuation-based automatic tube potential selection (ATPS) algorithm for cerebral computed tomography angiography (CTA) and to assess radiation dose, vascular attenuation, and image quality compared to a conventional fixed 120-kVp protocol.@*MATERIALS AND METHODS@#Among 36 volunteers for cerebral CTA, a total of 18 were scanned with fixed 120 kVp and 140 effective mAs using automatic tube current modulation. The other 18 were scanned with an ATPS algorithm. Radiation doses, attenuation, contrast-to-noise ratio (CNR) of the cerebral arteries, subjective scores for arterial attenuation, edge sharpness of the artery, visibility of small arteries, venous contamination, image noise, and overall image quality were compared between the groups.@*RESULTS@#The volume CT dose index and effective dose of the ATPS group were lower than those of the fixed 120-kVp group. The ATPS group had significantly higher arterial attenuation and no significant difference in CNR, compared with the fixed 120-kVp. The ATPS group had higher subjective scores for arterial attenuation, edge sharpness of the artery, visibility of small arteries, and overall image quality.@*CONCLUSION@#The ATPS algorithm for the cerebral CTA reduced radiation dose by 43% while maintaining image quality and improved the attenuation of cerebral arteries by selecting lower tube potential.

The Cutcome of Living-related Renal Transplantation with Previously Positive but Currently Negative HLA Crossmatching / 대한신장학회잡지

PURPOSE: Previously positive but currently negative HLA crossmatching is considered to be a risk factor not in the first renal transplantation but in the second renal transplantation. The aim of this study is to analyse the outcome of living-related renal transplantation with previously positive but currently negative HLA crossmatching. METHODS: The results of first HLA crossmatching, demographic characteristics, the outcome of renal trasplantation were examined in four patients undergoing renal transplantation with previously positive but currently negative HLA crossmatching. RESULTS: The acute rejection was occurred in 3 patients. Azotemia was improved with the immunosuppressive therapy containing tacrolimus. There were no graft failures in four patients for 1 year. In the first HLA crossmatching, anti-human globulin T cell HLA crossmatching was positive in all patients with acute rejection. The period that positive HLA crossmatchings were converted to negative was longer in patients with acute rejections than without acute rejections (177 days vs 22 days). CONCLUSION: There were 3 acute rejections in 6 patients undergoing living related renal transplantations with previously positive and current negative HLA crossmatching. There were no graft failure for 1 year.