BACKGROUND: Cardiogenic shock (CS) after acute myocardial infarction (AMI) develops in 5~10% of patients and it is associated with high mortality. The aim of this study is to assess the predictive factors of mortality for patients with AMI and CS. METHODS: Two hundred fifty five AMI patients with CS (the mean age was 66.0 +/- 11.0 years, M: F=156: 99) out of 1, 268 AMI patients who admitted at Chonnam National University Hospital between July 2000 and June 2002 were analyzed according to the clinical characteristics, coronary angiographic findings and MACE during admission and for the 1-year clinical follow-up. RESULTS: Among the enrolled patients, 129 patients survived without MACE (Group I, mean age 64.2 +/- 10.6 years, M: F=76: 53), and 126 patients had MACE (Group II, mean age 68.1 +/- 10.0 years, M: F=80: 46) during admission or during the 1-year follow-up period. There were significant differences in age between the Groups I and II (64.2 +/- 10.6 vs. 68.1 +/- 11.0 years, respectively, p=0.004) and the previous MI history (0 vs. 17.4%, respectively, p< 0.001). The left ventricular ejection fraction (EF) was lower in Group II (Group I vs. II: 49.1 +/- 13.0 vs. 39.1 +/- 12.9%, p< 0.001). The levels of troponin (Tn) I and C-reactive protein (CRP) were higher in Group II (Group I vs. II: 29.2 +/- 7.72 vs. 50.8 +/- 5.17 ng/dL, p=0.017, 3.8 +/- 0.48 vs. 9.9 +/- 1.21 mg/dL, p< 0.001 respectively). Left main stem lesion (LMSL) was more common in Group II than in Group I (0.7% vs. 22.0%, respectively, p=0.004). In-hospital death was associated with low Thrombolysis In Myocardial Infarction (TIMI) flow after coronary revascularization. CONCLUSION: Old age, a previous MI history, high Tn and CRP, low EF and LMSL are associated with higher MACE for patients with AMI and CS. Coronary revascularization with TIMI 3 flow lowers the in-hospital mortality.
Aged ; Female ; Hospital Mortality ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Myocardial Infarction/complications/*mortality ; Prognosis ; Shock, Cardiogenic/etiology/*mortality

OBJECTIVETo evaluate the clinical outcomes of patients with acute myocardial infarction (AMI) complicating cardiogenic shock underwent various treatments.

METHODSFrom January, 2002 to May, 2007, 47 AMI patients with cardiogenic shock were treated in our department by optimal medication (dopamine, epinephrine, norepinephrine, etc.), intra-aortic balloon pump (IABP), mechanical ventilation when indicated, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Outcome and factors related to mortality for these patients were analyzed in this retrospective study.

RESULTSBesides optimal medication and IABP in all patients, 31 patients underwent PCI (66.0%), 6 patients received emergency CABG (12.8%). The overall in-hospital mortality rate was 36.2% (17/47), 6 patients (14.9%) died before coronary revascularization and 11 patients (21.3%) died after revascularization. Nine patients died of pump failure and 8 patients died of renal and (or) respiratory failure. Regression analysis showed that acute renal failure (r = 0.734, P = 0.000), acute respiratory failure (r = 0.606, P = 0.000) and diabetes (r = 0.372, P = 0.012) were positively related to in-hospital mortality.

CONCLUSIONDespite improvements in treatment options for AMI patients complicating cardiogenic shock, in-hospital mortality remained high, especially for patients complicating further with acute renal failure and acute respiratory failure.

Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; therapy ; Prognosis ; Retrospective Studies ; Shock, Cardiogenic ; etiology ; mortality ; therapy ; Treatment Outcome

OBJECTIVETo explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS).

METHODSWe analyzed data from Chinese patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the CREATE trial. Predictors of 30-day mortality were identified by univariate and multivariate logistic regression analysis using baseline and procedural variables.

RESULTSThe overall 30-day mortality of STEMI complicated by CS among the 517 patients [(68.5 ± 10.3) years and 57.6% male] was 62.3%. Logistic regression analysis showed that the independent risk factors of death included age (OR = 1.46, 95%CI: 1.18 - 1.81), anterior infarction (OR = 2.01, 95%CI 1.29 - 3.11), admission glucose level > 7.8 mmol/L (OR = 2.17, 95%CI: 1.26 - 3.73), serum sodium concentration < 130 mmol/L (OR = 2.21, 95%CI: 1.21 - 4.04), left ventricular ejection fraction (LVEF) < 40% or sever left ventricular dysfunction (LVD) (OR = 3.78, 95%CI: 2.28 - 6.27), no emergency revascularization (OR = 3.53, 95%CI: 1.20 - 10.41) and diuretics use (OR = 1.90, 95%CI: 1.21 - 2.97). Analysis using baseline clinical variables showed that the first five risk factors mentioned above were also the baseline risk factors fro death. The receiver operating characteristic curve for predicting the death of the two models was 0.81 (95%CI: 0.77 - 0.86) and 0.80 (95%CI: 0.75 - 0.84), respectively.

CONCLUSIONThe 30-day mortality of patients with STEMI complicated by CS was over 60%. Age, anterior infarction, admission glucose level >7.8 mmol/L, serum sodium concentration < 130 mmol/L, left ventricular ejection fraction (LVEF) < 40% and no emergency revascularization were independent risk factors associated with 30-day mortality.

Aged ; China ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Myocardial Infarction ; complications ; mortality ; therapy ; Prognosis ; Risk Factors ; Shock, Cardiogenic ; etiology ; mortality ; therapy ; Survival Rate ; Treatment Outcome

OBJECTIVETo analyze the clinical features of inhalation injury in children, with the aim of improving its management.

METHODSThe incidence of inhalation injury in 333 cases of burned children was analyzed in terms of burn area, shock, infection and prognosis.

RESULTSThe incidences of shock and bacteremia were 41.14% and 18.92%, and those of moderate and severe inhalation injury were 58.76% and 31.96% respectively in burned children with inhalation injury. Bacteremia developed in 24.82% of the patients with shock. Among 67 patients who ultimately died, 58.21% of them were complicated with bacteremia ending in 34.33% of mortality. Early tracheostomy was beneficial in that less fluids were required for resuscitation.

CONCLUSIONBurn infection was an important factor affecting the prognosis of inhalation injury. And inhalation injury and shock were major inducers of burn infection. Early application of wide spectrum antibiotics and shock management were helpful in lowering of burn infection rate. Early tracheostomy might be beneficial to burn shock management.

Anti-Bacterial Agents ; therapeutic use ; Bacteremia ; epidemiology ; etiology ; prevention & control ; Burns ; physiopathology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Shock ; epidemiology ; etiology ; Smoke Inhalation Injury ; mortality ; physiopathology

Mushroom exposures are increasing worldwide. The incidence and fatality of mushroom poisoning are reported to be increasing. Several new syndromes in mushroom poisoning have been described. Rhabdomyolytic mushroom poisoning is one of new syndromes. Russula subnigricans mushroom can cause delayed-onset rhabdomyolysis with acute kidney injury in the severely poisoned patient. There are few reports on the toxicity of R. subnigricans. This report represents the first record of R. subnigricans poisoning with rhabdomyolysis in Korea, describing a 51-year-old man who suffered from rhabdomyolysis, acute kidney injury, severe hypocalcemia, respiratory failure, ventricular tachycardia, cardiogenic shock, and death. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown cause. Furthermore, R. subnigricans should be considered in the mushroom poisoning with rhabdomyolysis.
Acute Kidney Injury/*etiology ; Basidiomycota/isolation & purification/*pathogenicity ; Electrocardiography ; Heart Ventricles/physiopathology ; Humans ; Male ; Middle Aged ; Mushroom Poisoning/*diagnosis/microbiology/mortality ; Rhabdomyolysis/*etiology ; Shock, Cardiogenic/*etiology ; Tachycardia, Ventricular/etiology

OBJECTIVETo investigate the characteristics of circulatory disturbance and treatment of severe hand-foot-and-mouth disease (HFMD).

METHODThe clinical characteristics, laboratory findings, therapy and outcome of 22 severe HFMD patients were retrospectively analyzed.

RESULTAll the 22 severe HFMD patients came from the countryside. All these patients had encephalitis. Fifteen cases had myocardial injury. All had symptoms of sympathetic excitation and 17 cases had hypertension [(128 ± 16)/(81 ± 14) mm Hg (1 mm Hg = 0.133 kPa)]. Fourteen cases had exacerbation with rapid decline of blood pressure [(61 ± 12)/(33 ± 12) mm Hg]. In cardiorespiratory failure stage, 13 patients had neurogenic pulmonary edema accompanied by circulatory failure and 12 cases had a lower glasgow scores (less than 7). Myocardial injury and ECG change were found in some cases. Inotropic and pressor drugs were given in patients with circulatory collapse. Five cases received fluid resuscitation due to refractoriness to inotropic drugs. Nine patients received blood purification. Seventeen survived and 5 cases died due to circulatory failure.

CONCLUSIONCirculation failure of severe HFMD is the main cause of death. Early and appropriate circulation support is very important to reduce mortality.

Child, Preschool ; China ; epidemiology ; Combined Modality Therapy ; Female ; Hand, Foot and Mouth Disease ; complications ; mortality ; therapy ; Humans ; Immunoglobulins, Intravenous ; administration & dosage ; therapeutic use ; Infant ; Intensive Care Units, Pediatric ; Male ; Milrinone ; administration & dosage ; therapeutic use ; Multiple Organ Failure ; etiology ; mortality ; Pulmonary Edema ; etiology ; mortality ; Respiration, Artificial ; Retrospective Studies ; Shock ; etiology ; mortality ; Treatment Outcome

Limited data are available on inappropriate shocks in Korean patients implanted with an implantable cardioverter-defibrillator (ICD). We investigated the impact of inappropriate shocks on clinical outcomes. This retrospective, single-center study included 148 patients treated between October 1999 and June 2011. The primary outcome was a composite event of all-cause mortality or hospitalization for any cardiac reason. The median follow-up duration was 29 months (interquartile range: 8 to 53). One or more inappropriate shocks occurred in 34 (23.0%) patients. A history of atrial fibrillation was the only independent predictor of inappropriate shock (hazard ratio [HR]: 4.16, 95% confidence interval [CI]: 1.89-9.15, P < 0.001). Atrial fibrillation was the most common cause of inappropriate shock (67.7%), followed by supraventricular tachycardia (23.5%), and abnormal sensing (8.8%). A composite event of all-cause mortality or hospitalizations for any cardiac reason during follow-up was not significantly different between patients with or without inappropriate shock (inappropriate shock vs no inappropriate shock: 35.3% vs 35.4%, adjusted HR: 1.06, 95% CI: 0.49-2.29, P = 0.877). Inappropriate shocks do not affect clinical outcomes in patients implanted with an ICD, although the incidence of inappropriate shocks is high.
Adult ; Aged ; Atrial Fibrillation/complications ; Defibrillators, Implantable/*adverse effects ; Equipment Failure ; Female ; Hospitalization ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; *Predictive Value of Tests ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Shock/*etiology/mortality ; Tachycardia, Supraventricular/complications

BACKGROUNDMethylprednisolone (MP), a synthetic glucocorticosteroid, has been broadly studied in experiments on endotoxin-induced shock and septic shock. This study was designed to ascertain whether glycine and MP can protect against organ injury and death caused by hemorrhagic shock, and to elucidate the underlying mechanisms of these protective effects in rats.

METHODTo establish a shock model, Wistar rats were bled to maintain mean arterial pressure at 30-50 mmHg for 1 hour and subsequently resuscitated with the shed blood and normal saline. Just prior to resuscitation, the rats were randomly assigned to four groups: sham group (operation performed without inducing shock), shock group, shock + glycine group (glycine injected at the beginning of resuscitation) and shock + MP group (MP injected at the beginning of resuscitation).

RESULTS(1) Seventy-two hours after resuscitation, the survival rate of rats from the shock group had decreased to 20%, while the survival rates of rats from the shock + glycine and shock + MP groups were 77.8% and 80%, respectively. The difference was significant (P <0.05). (2) Eighteen hours after resuscitation, pathological alterations in the organs of the rats were apparent. In rats from the shock group, edema, interstitial leukocyte infiltration, and cellular degeneration occurred in the liver, lungs, kidneys, and heart. Glycine and MP reduced these pathological changes significantly. (3) Eighteen hours after resuscitation, the levels of creatine phosphokinase, transaminases, and creatine were elevated significantly in rats from the shock group, indicating injury to the heart, liver, and kidneys, while these levels were elevated only slightly in the shock + glycine and shock + MP groups. The differences were significant (P <0.01). (4) There were significant increases in intracellular calcium and production of tumor necrosis factor (TNF-alpha) by isolated Kupffer cells stimulated by endotoxin after hemorrhagic shock. These changes were completely prevented by glycine and MP (P <0.01).

CONCLUSIONGlycine and MP reduce organ injury and mortality caused by hemorrhagic shock by preventing increase of intracellular calcium levels in Kupffer cell, suppressing Kupffer cell activation, decreasing the production of TNF-alpha by Kupffer cells, and blocking systemic inflammatory responses.

Animals ; Calcium ; metabolism ; Glycine ; pharmacology ; therapeutic use ; Methylprednisolone ; pharmacology ; therapeutic use ; Multiple Organ Failure ; etiology ; Rats ; Rats, Wistar ; Shock, Hemorrhagic ; drug therapy ; mortality ; pathology ; Tumor Necrosis Factor-alpha ; biosynthesis

Spontaneous bacterial peritonitis (SBP) is an ascitic fluid infection as a complication of end stage liver disease. The outcome is related to the severity of hepatorenal function, gastrointestinal bleeding, and many others; however it is not well known whether the infection acquisition sites have an effect on the prognosis of SBP. In order to identify the prognostic significance of the acquisition sites, we studied 106 patients who were diagnosed as culture positive SBP between October 1998 and August 2003. Thirty-two episodes were nosocomial and 74 were community acquired. Gramnegative bacilli such as Escherichia coli were dominant in both of the nosocomial and community-acquired SBPs. Despite significantly higher resistance to cefotaxime in nosocomial isolates compared to community-acquired isolates (77.8% vs. 13.6%, p=0.001), no difference was found regarding short or long term prognosis. Infection acquisition sites were not related to short or long term prognosis either. Shock, gastrointestinal bleeding and renal dysfunction were related to short term prognosis. Only Child-Pugh class C was identified as an independent prognostic factor of long-term survival.
Time Factors ; Survival Rate ; Shock/etiology/mortality ; Prognosis ; Peritonitis/complications/microbiology/*pathology ; Multivariate Analysis ; Middle Aged ; Male ; Klebsiella pneumoniae/drug effects/growth & development ; Kidney Diseases/etiology/mortality ; Humans ; Gastrointestinal Hemorrhage/etiology/mortality ; Female ; Escherichia coli/drug effects/growth & development ; Drug Resistance, Bacterial ; Cross Infection/complications/microbiology/pathology ; Community-Acquired Infections/complications/microbiology/pathology ; Ciprofloxacin/pharmacology ; Cefotaxime/pharmacology ; Bacterial Infections/complications/microbiology/*pathology ; Anti-Bacterial Agents/pharmacology ; Aged

OBJECTIVE: To investigate the possible risk factors for death among liver or kidney recipients with bloodstream infections (BSIs). METHODS: A retrospective study of 138 episodes of bloodstream infections documented in 103 patients was conducted to assess potential risk factors for mortality. The risk factors were identified by logistic regression analysis. RESULTS: The mean age of the patients was 12-66 (42.3±12.7) years. The majority of infections were nosocomial (78.6%). The BSIs-related mortality rate was 39.8% (41/103). The following variables were identified as risk factors for BSIs-related mortality by univariate analysis: intraabdominal/ biliary focus (P=0.003), polymicrobial infection (P<0.001), liver transplant (P<0.001), platelet count <50000/mm3 (P<0.001), and septic shock (P<0.001). Platelet count < 50000/mm3 (P=0.002) and septic shock (P<0.001) showed significantly difference between the mortality group and the survival groups in the multivariate logistic regression analysis. CONCLUSION Decreased platelet count and septic shock are risk factors for increased
Adolescent ; Adult ; Aged ; Bacteremia ; epidemiology ; etiology ; mortality ; Cause of Death ; Child ; China ; epidemiology ; Female ; Gram-Negative Bacterial Infections ; epidemiology ; etiology ; mortality ; Humans ; Kidney Transplantation ; adverse effects ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Shock, Septic ; epidemiology ; Thrombocytopenia ; epidemiology ; Young Adult