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Article ; Online: Changes in practice for mechanically ventilated patients

Jin Won Huh

The Korean Journal of Internal Medicine, Vol 37, Iss 3, Pp 553-

effect of the pain, agitation, and delirium guidelines

2022 Volume 554

Keywords	Medicine ; R
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	The Korean Association of Internal Medicine
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Predictors of Repeat Medical Emergency Team Activation in Deteriorating Ward Patients

Ju-Ry Lee / Youn-Kyung Jung / Sang-Bum Hong / Jin Won Huh

Journal of Clinical Medicine, Vol 11, Iss 1736, p

A Retrospective Cohort Study

2022 Volume 1736

Abstract: Recurrent clinical deterioration and repeat medical emergency team (MET) activation are common and associated with high in-hospital mortality. This study assessed the predictors for repeat MET activation in deteriorating patients admitted to a general ... ...

Abstract	Recurrent clinical deterioration and repeat medical emergency team (MET) activation are common and associated with high in-hospital mortality. This study assessed the predictors for repeat MET activation in deteriorating patients admitted to a general ward. We retrospectively analyzed the data of 5512 consecutive deteriorating hospitalized adult patients who required MET activation in the general ward. The patients were divided into two groups according to repeat MET activation. Multivariate logistic regression analyses were used to identify the predictors for repeat MET activation. Hematological malignancies (odds ratio, 2.07; 95% confidence interval, 1.54–2.79) and chronic lung disease (1.49; 1.07–2.06) were associated with a high risk of repeat MET activation. Among the causes for MET activation, respiratory distress (1.76; 1.19–2.60) increased the risk of repeat MET activation. A low oxygen saturation-to-fraction of inspired oxygen ratio (0.97; 0.95–0.98), high-flow nasal cannula oxygenation (4.52; 3.56–5.74), airway suctioning (4.63; 3.59–5.98), noninvasive mechanical ventilation (1.52; 1.07–2.68), and vasopressor support (1.76; 1.22–2.54) at first MET activation increased the risk of repeat MET activation. The risk factors identified in this study may be useful to identify patients at risk of repeat MET activation at the first MET activation. This would allow the classification of high-risk patients and the application of aggressive interventions to improve outcomes.
Keywords	hospital rapid response team ; risk factors ; mortality ; critical care ; Medicine ; R
Subject code	610
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Pseudomonas aeruginosa -Derived DnaJ Induces the Expression of IL−1β by Engaging the Interplay of p38 and ERK Signaling Pathways in Macrophages

Dae-Kyum Kim / Jin-Won Huh / Hyeonseung Yu / Yeji Lee / Yongxin Jin / Un-Hwan Ha

International Journal of Molecular Sciences, Vol 24, Iss 21, p

2023 Volume 15957

Abstract: As members of pathogen-associated molecular patterns, bacterial heat shock proteins (HSPs) are widely recognized for their role in initiating innate immune responses. This study aimed to examine the impact of DnaJ, a homolog of HSP40 derived from ... ...

Abstract	As members of pathogen-associated molecular patterns, bacterial heat shock proteins (HSPs) are widely recognized for their role in initiating innate immune responses. This study aimed to examine the impact of DnaJ, a homolog of HSP40 derived from Pseudomonas aeruginosa ( P. aeruginosa ), on the regulation of IL−1β expression in macrophages. We demonstrated that DnaJ modulates macrophages to secrete IL−1β by activating NF-κB and MAPK signaling pathways. Specifically, ERK was identified as a positive mediator for IL−1β expression, while p38 acted as a negative mediator. These results suggest that the reciprocal actions of these two crucial MAPKs play a vital role in controlling IL−1β expression. Additionally, the reciprocal actions of MAPKs were found to regulate the activation of inflammasome-related molecules, including vimentin, NLRP3, caspase-1, and GSDMD. Furthermore, our investigation explored the involvement of CD91/CD40 in ERK signaling-mediated IL−1β production from DnaJ-treated macrophages. These findings emphasize the importance of understanding the signaling mechanisms underlying IL−1β induction and suggest the potential utility of DnaJ as an adjuvant for stimulating inflammasome activation.
Keywords	HSP40 homolog ; IL−1β ; inflammasome ; MAPK ; NF-κB ; Biology (General) ; QH301-705.5 ; Chemistry ; QD1-999
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Using deep learning with attention mechanism for identification of novel temporal data patterns for prediction of ICU mortality

Wendong Ge / Jin-Won Huh / Yu Rang Park / Jae-Ho Lee / Young-Hak Kim / Guohai Zhou / Alexander Turchin

Informatics in Medicine Unlocked, Vol 29, Iss , Pp 100875- (2022)

2022

Abstract: Background and objectives: Changes in a patient's condition over time are a backbone of clinical decision making. However, most currently used methods for identification of patients in intensive care units (ICUs) at high risk for death do not make ... ...

Abstract	Background and objectives: Changes in a patient's condition over time are a backbone of clinical decision making. However, most currently used methods for identification of patients in intensive care units (ICUs) at high risk for death do not make effective use of the temporal dimension of available data. We therefore conducted a study to determine whether longitudinal data analysis using recurrent neural networks (RNN) with attention mechanism can identify novel temporal data patterns predictive of adverse outcomes. Methods: We analyzed data on patients admitted to the Medical Intensive Care Unit (MICU) of Asan Medical Center between 2010 and 2017. Static (demographics, diagnoses, procedures, medications) and longitudinal (vitals, laboratory tests, Glasgow Coma Scale) variables were included in the analysis. We used an RNN model with long short-term memory (RNN-LSTM) with attention mechanism to identify and test novel data patterns predictive of ICU death. We also compared accuracy of prediction of ICU mortality between a logistic regression and RNN-LSTM models with and without attention. Results: Among 4896 patients admitted to the MICU, 548 (11.19%) died. RNN-LSTM model with attention identified several high-risk longitudinal variable patterns that were predictive of ICU mortality in a confirmatory analysis, including sustained low blood oxygen content (OR 2.33; 95% CI 1.16 to 4.70) and high frequency of serum sodium measurements (OR 1.27; 95% CI 1.04 to 1.56). RNN-LSTM models with and without attention achieved numerically, but not statistically significantly higher c-statistics for prediction of ICU mortality compared to logistic regression. Conclusions: RNN-LSTM model with attention identified novel temporal data patterns predictive of ICU mortality. These predictors were both statistically significant and clinically plausible, likely representing progressive respiratory failure (sustained low oxygen saturation) and close monitoring of a clinically deteriorating patient (frequent sodium measurements).
Keywords	Predictive modeling ; Temporal data ; Deep learning ; Recurrent neural networks ; Attention ; Computer applications to medicine. Medical informatics ; R858-859.7
Subject code	310
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Effect of an Electronic Medical Record-Based Screening System on a Rapid Response System

Se Hee Lee / Chae-Man Lim / Younsuck Koh / Sang-Bum Hong / Jin Won Huh

Journal of Clinical Medicine, Vol 9, Iss 2, p

8-Years’ Experience of a Single Center Cohort

2020 Volume 383

Abstract: An electronic medical record (EMR)-based screening system has been developed as a trigger system for a rapid response team (RRT) that traditionally used direct calling. We compared event characteristics, intensive care unit (ICU) admission, and 28-day ... ...

Abstract	An electronic medical record (EMR)-based screening system has been developed as a trigger system for a rapid response team (RRT) that traditionally used direct calling. We compared event characteristics, intensive care unit (ICU) admission, and 28-day mortality following RRT activation of the two trigger systems. A total of 10,026 events were classified into four groups according to the activation time (i.e., daytime or on-call time) and the triggering type (i.e., calling or screening). Among surgical patients, the ICU admission was lowest for the on-call screening group (26.2%). Compared to the on-call screening group, the on-call calling group and daytime calling group showed higher ICU admission with an odds ratio (OR) of 2.07 (95% CI 1.50–2.84, p < 0.001) and OR of 2.68 (95% CI 1.91–3.77, p < 0.001), respectively. The 28-day mortality was lowest for the on-call screening group (8.7%). Compared to the on-call screening group, on-call calling (OR 1.88, 95% CI 1.20–2.95, p = 0.006) and daytime calling (OR 1.89, 95% CI 1.17–3.05, p < 0.001) showed higher 28-day mortality. The EMR-based screening system might be useful in detecting at-risk surgical patients, particularly during on-call time. The clinical usefulness of an EMR-based screening system can vary depending on patients’ characteristics.
Keywords	clinical deterioration ; early medical intervention ; electronic health records ; hospital rapid response team ; intensive care units ; medical records system ; computerized ; Medicine ; R
Subject code	610
Language	English
Publishing date	2020-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Rapid Response System Improves Sepsis Bundle Compliances and Survival in Hospital Wards for 10 Years

Sunhui Choi / Jeongsuk Son / Dong Kyu Oh / Jin Won Huh / Chae-Man Lim / Sang-Bum Hong

Journal of Clinical Medicine, Vol 10, Iss 4244, p

2021 Volume 4244

Abstract: Background: Hospitalized patients can develop septic shock at any time. Therefore, it is important to identify septic patients in hospital wards and rapidly perform the optimal treatment. Although the sepsis bundle has already been reported to improve ... ...

Abstract	Background: Hospitalized patients can develop septic shock at any time. Therefore, it is important to identify septic patients in hospital wards and rapidly perform the optimal treatment. Although the sepsis bundle has already been reported to improve survival rates, the controversy over evidence of the effect of in-hospital sepsis continues to exist. We aimed to estimate the outcomes and bundle compliance of patients with septic shock in hospital wards managed through the rapid response system (RRS). Methods: A retrospective cohort study of 976 patients with septic shock managed through the RRS at an academic, tertiary care hospital in Korea from 2008 to 2017. Results: Of the 976 enrolled patients, the compliance of each sepsis bundle was high (80.8–100.0%), but the overall success rate of the bundle was low (58.3%). The compliance rate for achieving the overall sepsis bundle increased from 26.5% to 70.0%, and the 28-day mortality continuously decreased from 50% to 32.1% over 10 years. We analyzed the two groups according to whether they completed the overall sepsis bundle or not. Of the 976 enrolled patients, 569 (58.3%) sepsis bundles were completed, whereas 407 (41.7%) were incomplete. The complete bundle group showed lower 28-day mortality than the incomplete bundle group (37.1% vs. 53.6%, p < 0.001). In the multivariate multiple logistic regression model, the 28-day mortality was significantly associated with the complete bundle (adjusted odds ratio (OR), 0.61; 95% confidence intervals (CI), 0.40–0.91; p = 0.017). The obtaining of blood cultures (adjusted OR, 0.45; 95% CI, 0.33–0.63; p < 0.001) and lactate re-measurement (adjusted OR, 0.69; 95% CI, 0.50–0.95; p = 0.024) in each component of the sepsis bundle were associated with the 28-day mortality. Conclusions: The rapid response system provides improving sepsis bundle compliances and survival in patients with septic shock in hospital wards.
Keywords	sepsis ; shock ; septic ; rapid response systems ; hospital-onset sepsis ; hospital rapid response team ; Medicine ; R
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Effect of corticosteroid therapy in the early phase of acute respiratory distress syndrome

Moon Seong Baek / Yunkyoung Lee / Sang-Bum Hong / Chae-Man Lim / Younsuck Koh / Jin Won Huh

The Korean Journal of Internal Medicine, Vol 36, Iss 1, Pp 145-

a propensity-matched cohort study

2021 Volume 153

Abstract: Background/Aims It is unclear whether corticosteroid use in patients with acute respiratory distress syndrome (ARDS) improves survival. This study aimed to investigate whether the administration of corticosteroids to patients in the early phase of ... ...

Abstract	Background/Aims It is unclear whether corticosteroid use in patients with acute respiratory distress syndrome (ARDS) improves survival. This study aimed to investigate whether the administration of corticosteroids to patients in the early phase of moderate to severe ARDS is associated with improved outcomes. Methods We analyzed the data of patients who received corticosteroids within 7 days of the onset of ARDS between June 2006 and December 2015 at a single tertiary teaching hospital. A total of 565 patients admitted with moderate to severe ARDS were eligible. The outcomes of patients treated with methylprednisolone 40 to 180 mg/day or equivalent (n = 404) were compared to those who did not receive steroids (n = 161). The primary and secondary outcomes were 28- and 90-day mortality rates, respectively. Propensity scores were used to adjust for baseline covariates. Results The overall mortality at 28 days was not significantly different between the corticosteroid-treated and control groups (43.8% vs. 41%, p = 0.541). At 90 days, the overall mortality rate was higher in the corticosteroid-treated group than in the control group (59.2% vs. 48.4%, p = 0.021). However, on propensity score matching, corticosteroid therapy was not associated with a higher 28-day mortality rate (odds ratio, 1.031; 95% confidence interval, 0.657 to 1.618; p = 0.895) and 90 days (odds ratio, 1.435; 95% confidence interval, 0.877 to 2.348; p = 0.151). Conclusions Corticosteroid therapy was not associated with 28- or 90-day mortality in the early phase of moderate to severe ARDS on propensity score matching analysis.
Keywords	respiratory distress syndrome ; adult ; corticosteroid ; mortality ; Medicine ; R
Subject code	310
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	The Korean Association of Internal Medicine
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Predictive value of pre-arrest albumin level with GO-FAR score in patients with in-hospital cardiac arrest

Seok-In Hong / Youn-Jung Kim / Yeon Joo Cho / Jin Won Huh / Sang-Bum Hong / Won Young Kim

Scientific Reports, Vol 11, Iss 1, Pp 1-

2021 Volume 7

Abstract: Abstract We investigated whether combining the pre-arrest serum albumin level could improve the performance of the Good Outcome Following Attempted Resuscitation (GO-FAR) score for predicting neurologic outcomes in in-hospital cardiac arrest patients. ... ...

Abstract	Abstract We investigated whether combining the pre-arrest serum albumin level could improve the performance of the Good Outcome Following Attempted Resuscitation (GO-FAR) score for predicting neurologic outcomes in in-hospital cardiac arrest patients. Adult patients who were admitted to a tertiary care hospital between 2013 and 2017 were assessed. Their pre-arrest serum albumin levels were measured within 24 h before the cardiac arrest. According to albumin levels, the patients were divided into quartiles and were assigned 1, 0, 0, and, − 2 points. Patients were allocated to the derivation (n = 419) and validation (n = 444) cohorts. The proportion of favorable outcome increased in a stepwise manner across increasing quartiles (p for trend < 0.018). Area under receiver operating characteristic curve (AUROC) of the albumin-added model was significantly higher than that of the original GO-FAR model (0.848 vs. 0.839; p = 0.033). The results were consistent in the validation cohort (AUROC 0.799 vs. 0.791; p = 0.034). Net reclassification indices of the albumin-added model were 0.059 (95% confidence interval [CI] − 0.037 to 0.094) and 0.072 (95% CI 0.013–0.132) in the derivation and validation cohorts, respectively. An improvement in predictive performance was found by adding the ordinal scale of pre-arrest albumin levels to the original GO-FAR score.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Heterologous ChAdOx1-BNT162b2 vaccination in Korean cohort induces robust immune and antibody responses that includes Omicron

Hye Kyung Lee / Jinyoung Go / Heungsup Sung / Seong Who Kim / Mary Walter / Ludwig Knabl / Priscilla A. Furth / Lothar Hennighausen / Jin Won Huh

iScience, Vol 25, Iss 6, Pp 104473- (2022)

2022

Abstract: Summary: Heterologous ChAdOx1-BNT162b2 vaccination induces a stronger immune response than BNT162b2-BNT162b2. Here, we investigated the molecular transcriptome, germline allelic variants of immunoglobulin loci, and anti-Omicron antibody levels in 46 ... ...

Abstract	Summary: Heterologous ChAdOx1-BNT162b2 vaccination induces a stronger immune response than BNT162b2-BNT162b2. Here, we investigated the molecular transcriptome, germline allelic variants of immunoglobulin loci, and anti-Omicron antibody levels in 46 office and lab workers from the Republic of Korea following ChAdOx1-BNT162b2 vaccination. Anti-spike-specific IgG antibody levels against the ancestral SARS-CoV-2 strain increased from 70 AU/ml to 14,000 AU/ml to 142,000 AU/ml one, three and seven days following the second vaccination. Titers against VOC, including Omicron, were two-fold to three-fold lower, yet higher than those measured following BNT162b2-BNT162b2 vaccination. RNA-seq of peripheral immune cells demonstrated activation of interferon pathways with increased IGHV clonal transcripts encoding neutralizing antibodies. scRNA-seq revealed enriched B cell and CD4+ T cell responses in both ChAdOx1-BNT162b2 and BNT162b2-BNT162b2 recipients, but a stronger clonal expansion of memory B cells with ChAdOx1-BNT162b2. In summary, heterologous ChAdOx1-BNT162b2 provides an innate and adaptive immune response that exceeds homologous BNT162b2 vaccination.
Keywords	Health sciences ; Immunology ; Immune response ; Science ; Q
Subject code	570
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Derivation and validation of modified early warning score plus SpO2/FiO2 score for predicting acute deterioration of patients with hematological malignancies

Ju-Ry Lee / Youn-Kyoung Jung / Hwa Jung Kim / Younsuck Koh / Chae-Man Lim / Sang-Bum Hong / Jin Won Huh

The Korean Journal of Internal Medicine, Vol 35, Iss 6, Pp 1477-

2020 Volume 1488

Abstract: Background/Aims Scoring systems play an important role in predicting intensive care unit (ICU) admission or estimating the risk of death in critically ill patients with hematological malignancies. We evaluated the modified early warning score (MEWS) for ... ...

Abstract	Background/Aims Scoring systems play an important role in predicting intensive care unit (ICU) admission or estimating the risk of death in critically ill patients with hematological malignancies. We evaluated the modified early warning score (MEWS) for predicting ICU admissions and in-hospital mortality among at-risk patients with hematological malignancies and developed an optimized MEWS. Methods We retrospectively analyzed derivation cohort patients with hematological malignancies who were managed by a medical emergency team (MET) in the general ward and prospectively validated the data. We compared the traditional MEWS with the MEWS plus SpO2/FiO2 (MEWS_SF) score, which were calculated at the time of MET contact. Results In the derivation cohort, the areas under the receiver-operating characteristic (AUROC) curves were 0.81 for the MEWS (95% confidence interval [CI], 0.76 to 0.87) and 0.87 for the MEWS_SF score (95% CI, 0.87 to 0.92) for predicting ICU admission. The AUROC curves were 0.70 for the MEWS (95% CI, 0.63 to 0.77) and 0.76 for the MEWS_SF score (95% CI, 0.70 to 0.83) for predicting in-hospital mortality. In the validation cohort, the AUROC curves were 0.71 for the MEWS (95% CI, 0.66 to 0.77) and 0.83 for the MEWS_SF score (95% CI, 0.78 to 0.87) for predicting ICU admission. The AUROC curves were 0.64 for the MEWS (95% CI, 0.57 to 0.70) and 0.74 for the MEWS_SF score (95% CI, 0.69 to 0.80) for predicting in-hospital mortality. Conclusions Compared to the traditional MEWS, the MEWS_SF score may be a useful tool that can be used in the general ward to identify deteriorating patients with hematological malignancies.
Keywords	clinical deterioration ; hematologic neoplasms ; modified early warning score ; prediction ; spo2/fio2 ratio ; Medicine ; R
Subject code	616
Language	English
Publishing date	2020-11-01T00:00:00Z
Publisher	The Korean Association of Internal Medicine
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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