Background: There is a need to update the cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score to reflect the current practice in sepsis. We previously proposed the modified CV SOFA score from data on blood pressure, norepinephrine equivalent dose, and lactate as gathered from emergency departments. In this study, we externally validated the modified CV SOFA score in multicenter intensive care unit (ICU) patients. Methods: A multicenter retrospective observational study was conducted on ICU patients at six hospitals in Korea. We included adult patients with sepsis who were admitted to ICUs. We compared the prognostic performance of the modified CV/total SOFA score and the original CV/total SOFA score in predicting 28-day mortality. Discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and the calibration curve, respectively. Results: We analyzed 1,015 ICU patients with sepsis. In overall patients, the 28-day mortality rate was 31.2%. The predictive validity of the modified CV SOFA (AUROC, 0.712; 95% confidence interval [CI], 0.677–0.746; P < 0.001) was significantly higher than that of the original CV SOFA (AUROC, 0.644; 95% CI, 0.611–0.677). The predictive validity of modified total SOFA score for 28-day mortality was significantly higher than that of the original total SOFA (AUROC, 0.747 vs. 0.730; 95% CI, 0.715–0.779; P = 0.002). The calibration curve of the original CV SOFA for 28-day mortality showed poor calibration. In contrast, the calibration curve of the modified CV SOFA for 28-day mortality showed good calibration. Conclusion In patients with sepsis in the ICU, the modified SOFA score performed better than the original SOFA score in predicting 28-day mortality.

PURPOSE: There is limited data on the outcomes of radiofrequency ablation (RFA) for large diameter saphenous veins. This study aimed to determine whether the large-diameter great saphenous vein (GSV) affected closure rate, complications, and clinical and quality of life (QoL) improvement. METHODS: From January 2012 to September 2016, a total of 722 limbs were treated with ClosureFAST RFA in a single center. Patients were divided into 2 groups according to the vein diameter measured 3 cm below the saphenofemoral junction (group A ≤ 12 mm, group B > 12 mm). Vein closure was evaluated with duplex scan at 3–5 days, 1, 3, 6, and 12 months postoperatively. The incidence of complications, improvements in symptoms (measured by the Venous Clinical Severity Score [VCSS]) and QoL (measured by the Aberdeen Varicose Vein Symptom Severity Score [AVSS]) were evaluated. RESULTS: Groups consisted of 663 GSVs in group A (mean diameter, 6.00 ± 1.74 mm) and 59 in group B (mean diameter, 13.17 ± 1.28 mm). Vein closure rates at 12 months were 98.9% in group A and 100% in group B (P = 0.428). There was no significant difference in the incidence of complications. Both groups showed marked improvements in the VCSS and the AVSS with no significant differences. CONCLUSION: For large-diameter veins, RFA showed comparable outcomes in terms of closure rate, complications, clinical and QoL improvements.
Catheter Ablation ; Extremities ; Humans ; Incidence ; Quality of Life ; Saphenous Vein ; Varicose Veins ; Veins

OBJECTIVE: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center. METHODS: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality. RESULTS: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4–9 vs. 6; IQR, 4–8; P < 0.001). Mechanical ventilator (29% vs. 21%, P < 0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78–1.28; P=0.999) for the transferred group compared with the non-transferred group. CONCLUSION: The transferred group showed higher severity and needed more organ support procedures than the nontransferred group. However, inter-hospital transfer did not affect in-hospital mortality.
Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Logistic Models ; Mortality ; Observational Study* ; Odds Ratio ; Prognosis ; Prospective Studies ; Renal Replacement Therapy ; Retrospective Studies* ; Sepsis ; Shock ; Shock, Septic* ; Tertiary Care Centers* ; Ventilators, Mechanical

OBJECTIVE: To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). METHODS: This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. RESULTS: A total of 468 patients were enrolled (median age, 71.3 years; male, 55.1%; refractory hypotension, 82.9%; hyperlactatemia without hypotension, 17.1%). Respiratory infection was the most common source of infection (31.0%). The median Sepsis-related Organ Failure Assessment score was 7.5. The sepsis bundle compliance was 91.2% for lactate measurement, 70.3% for blood culture, 68.4% for antibiotic administration, 80.3% for fluid resuscitation, 97.8% for vasopressor application, 68.0% for central venous pressure measurement, 22.0% for central venous oxygen saturation measurement, and 59.2% for repeated lactate measurement. Among patients who underwent interventions for source control (n=117, 25.1%), 43 (36.8%) received interventions within 12 hours of ED arrival. The in-hospital, 28-day, and 90-day mortality rates were 22.9%, 21.8%, and 27.1%, respectively. The median ED and hospital lengths of stay were 6.8 hours and 12 days, respectively. CONCLUSION: This preliminary report revealed a mortality of over 20% in patients with septic shock, which suggests that there are areas for improvement in terms of the quality of initial resuscitation and outcomes of septic shock patients in the ED.
Central Venous Pressure ; Compliance ; Emergency Service, Hospital ; Humans ; Hyperlactatemia ; Hypotension ; Lactic Acid ; Male ; Mortality ; Oxygen ; Patient Care Bundles ; Prospective Studies ; Resuscitation ; Sepsis ; Shock* ; Shock, Septic*

The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Community-Acquired Infections/*mortality ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia/*mortality ; Prospective Studies ; Republic of Korea ; *Severity of Illness Index ; Young Adult

PURPOSE: The purposes of this study were to evaluate upper arm basilic vein transposition (BVT) arteriovenous fistula in terms of graft patency and surgical complications and to compare BVT with the forearm loop arteriovenous graft (AVG). METHODS: Between March 2003 and December 2008, 23 patients underwent BVT and 30 patients underwent AVG. The patency rates and complications were analyzed. RESULTS: Patients who underwent BVT had more previous history of operations for arteriovenous access (2.5+/-1.2 in BVT vs. 1.8+/-1.4 in AVG; P=0.038). A total of 10 cases of complications occurred in patients with BVT and 22 cases in patients with AVG (P=0.047). One-year and 2-year primary patency rates were 55.2%, and 36.3%, respectively, for BVT and 31.3% and 17.9%, respectively, for AVG (P=0.031). One-year and 2-year primary assisted patency rates were 85.2% and 66.7% for BVT, respectively and 67.2% and 43.8 for AVG, respectively (P=0.112). During follow-ups, less rescue procedures were performed in BVT than in AVG patients (P=0.055). One case of thrombolysis, 4 balloon angioplasty, and 1 stent insertion were performed in BVT, whereas 5 cases of thrombectomy, 3 thrombolysis, 4 balloon angioplasty, and 2 interposition grafting were performed in AVG. CONCLUSION: BVT had higher 1-year and 2-year patency rates and fewer complications compared to AVG. Lower numbers of intervention were required to maintain patency in BVT compared to AVG. BVT is a feasible procedure and can be considered before planning forearm loop AVG, particularly in a rescue vascular access.
Angioplasty, Balloon ; Arm ; Arteriovenous Fistula ; Follow-Up Studies ; Forearm ; Humans ; Ocimum basilicum ; Stents ; Thrombectomy ; Transplants ; Veins

This study was designed to compare the hospital-related costs of elective abdominal aortic aneurysm (AAA) treatment and cost structure between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in Korean health care system. One hundred five primary elective AAA repairs (79 OSRs and 26 EVARs) performed in the Seoul National University Hospital from 2005 to 2009 were included. Patient characteristics were similar between two groups except for older age (P = 0.004) and more frequent history of malignancy (P = 0.031) in EVAR group. Thirty-day mortality rate was similar between two groups and there was no AAA-related mortality in both groups for 5 yr after repair. The total in-hospital costs for the index admission were significantly higher in EVAR patients (mean, KRW19,857,119) than OSR patients (mean KRW12,395,507) (P < 0.001). The reimbursement was also significantly higher in EVAR patients than OSR patients (mean, KRW14,071,081 vs KRW6,238,895, P < 0.001) while patients payments was comparable between two groups. EVAR patients showed higher follow-up cost up to 2 yr due to more frequent imaging studies and reinterventions for type II endoleaks (15.4%). In the perspective of cost-effectiveness, this study suggests that the determination of which method to be used in AAA treatment be more finely trimmed and be individualized.
Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/economics/mortality/*surgery ; Blood Vessel Prosthesis Implantation/*economics ; Cost-Benefit Analysis ; Endoleak ; Female ; Follow-Up Studies ; Humans ; Insurance, Health, Reimbursement ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Republic of Korea ; Survival Analysis ; Treatment Outcome ; Vascular Surgical Procedures/*economics

PURPOSE: Endovascular surgery (EVS) has been rapidly increasing within the last two decades, changing the pattern of treatments for arterial disease. The purpose of this study was to report our initial experiences of EVS for lower extremity arterial occlusive diseases in the operation room performed solely by a vascular surgeon. METHODS: Between January 2009 and June 2010, 13 EVS were performed for lower extremity arterial occlusive diseases with a mobile C-arm. Three patients underwent simultaneous bypass surgery with balloon angioplasty. Clinical characteristics, treatments, and outcomes were retrospectively reviewed. RESULTS: Primary patency rates at 1 and 12 months following balloon angioplasty were 92.3% (12/13) and 88.9% (8/9), respectively. Only one patient had a thrombotic occlusion, resulting in an above-knee amputation. No procedure-related deaths occurred. CONCLUSION: We showed an initial acceptable result of EVS for lower extremity arterial occlusive diseases in the operation room. However, the data analyzed was of a small group with a short term follow-up period. More experiences, judicious planning, and efforts to optimize endovascular techniques to resolve complications are needed to be a true vascular and endovascular surgeon.
Amputation ; Angioplasty, Balloon ; Arterial Occlusive Diseases ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Lower Extremity ; Retrospective Studies

Primary venous aneurysm is a rarely encountered vascular disease in clinical practice. In contrast to deep venous aneurysm, superficial venous aneurysms are at low risk for thrombotic complications. Surgical excision is often recommended when they become symptomatic. We present here a case of true aneurysm of the great saphenous vein (GSV) in a 16-year-old girl who complained of a painful mass in the right inguinal area. Doppler sonography and CT-venography showed a vascular pool in the right inguinal area, and this was suspicious for being an aneurysm or a pseudoaneurysm that originated from the GSV. This saccular mass was completely excised and it was proved to be a true aneurysm of the great saphenous vein on the pathologic examination. Venous aneurysm should always be considered in the differential diagnosis of a subcutaneous mass, although it is a rare vascular anomaly.
Adolescent ; Aneurysm ; Aneurysm, False ; Diagnosis, Differential ; Humans ; Saphenous Vein ; Vascular Diseases

PURPOSE: Stigma is more likely to be reported by people with epilepsy with frequent seizures and associated with various physical and psychosocial factors. We determined risk factors associated with stigma, and investigated the impact of felt stigma on psychiatric comorbidities and quality of life (QOL) in patients with drug refractory epilepsy (DRE). METHODS: Patients with DRE of partial onset, who experienced a failure of at least two antiepileptic drugs (AEDs) and at least 1/month of seizure attack for recent 6 months, were enrolled in the study. We divided patients into two groups according to the presence of stigma. We compared demographic and clinical variables, mood, anxiety, psychiatric symptoms, and QOL between two groups. RESULTS: Among 75 patients with DRE of partial onset, 34 patients (45%) had stigma. Risk factors associated with stigma were age, history of psychiatric disease, duration of epilepsy, and duration of AEDs intake. However, seizure frequency was not associated with the occurrence of stigma. Mood, anxiety, and psychiatric symptoms were significantly higher in patients with stigma than those without stigma. QOL was significantly lower in patients with stigma than those without stigma. CONCLUSIONS: A longer duration of epilepsy with previous history of psychiatric diseases may be indispensable for the occurrence of stigma in patients with DRE. Early detection and appropriate treatment of psychiatric comorbidities can lessen the degree of stigma and improve QOL.
Anticonvulsants ; Anxiety ; Comorbidity ; Epilepsy ; Humans ; Quality of Life ; Risk Factors ; Seizures