Background: The development of frailty at hospital discharge affects the clinical outcomes in severe coronavirus disease 2019 (COVID-19) survivors who had no frailty before hospitalization. We aimed to describe the prevalence of new frailty using the clinical frailty scale (CFS) and evaluate its associated factors in patients with severe COVID-19 without pre-existing frailty before hospitalization. Methods: We performed a secondary analysis of clinical data from a nationwide retrospective cohort collected from 22 hospitals between January 1, 2020 and August 31, 2021. The patients were at least 19 years old and survived until discharge after admission to the intensive care unit (ICU) because of severe COVID-19. Development of new frailty was defined as a CFS score ≥5 at hospital discharge. Results: Among 669 severe COVID-19 survivors without pre-existing frailty admitted to the ICU, the mean age was 65.2±12.8 years, 62.5% were male, and 50.2% received mechanical ventilation (MV). The mean CFS score at admission was 2.4±0.9, and new frailty developed in 27.8% (186/483). In multivariate analysis, older age, cardiovascular disease, CFS score of 3–4 before hospitalization, increased C-reactive protein level, longer duration of corticosteroid treatment, and use of MV and extracorporeal membrane oxygenation were identified as factors associated with new-onset frailty. Conclusion Our study suggests that new frailty is not uncommon and is associated with diverse factors in survivors of severe COVID-19 without pre-existing frailty.

Background: The development of frailty at hospital discharge affects the clinical outcomes in severe coronavirus disease 2019 (COVID-19) survivors who had no frailty before hospitalization. We aimed to describe the prevalence of new frailty using the clinical frailty scale (CFS) and evaluate its associated factors in patients with severe COVID-19 without pre-existing frailty before hospitalization. Methods: We performed a secondary analysis of clinical data from a nationwide retrospective cohort collected from 22 hospitals between January 1, 2020 and August 31, 2021. The patients were at least 19 years old and survived until discharge after admission to the intensive care unit (ICU) because of severe COVID-19. Development of new frailty was defined as a CFS score ≥5 at hospital discharge. Results: Among 669 severe COVID-19 survivors without pre-existing frailty admitted to the ICU, the mean age was 65.2±12.8 years, 62.5% were male, and 50.2% received mechanical ventilation (MV). The mean CFS score at admission was 2.4±0.9, and new frailty developed in 27.8% (186/483). In multivariate analysis, older age, cardiovascular disease, CFS score of 3–4 before hospitalization, increased C-reactive protein level, longer duration of corticosteroid treatment, and use of MV and extracorporeal membrane oxygenation were identified as factors associated with new-onset frailty. Conclusion Our study suggests that new frailty is not uncommon and is associated with diverse factors in survivors of severe COVID-19 without pre-existing frailty.

Background: The development of frailty at hospital discharge affects the clinical outcomes in severe coronavirus disease 2019 (COVID-19) survivors who had no frailty before hospitalization. We aimed to describe the prevalence of new frailty using the clinical frailty scale (CFS) and evaluate its associated factors in patients with severe COVID-19 without pre-existing frailty before hospitalization. Methods: We performed a secondary analysis of clinical data from a nationwide retrospective cohort collected from 22 hospitals between January 1, 2020 and August 31, 2021. The patients were at least 19 years old and survived until discharge after admission to the intensive care unit (ICU) because of severe COVID-19. Development of new frailty was defined as a CFS score ≥5 at hospital discharge. Results: Among 669 severe COVID-19 survivors without pre-existing frailty admitted to the ICU, the mean age was 65.2±12.8 years, 62.5% were male, and 50.2% received mechanical ventilation (MV). The mean CFS score at admission was 2.4±0.9, and new frailty developed in 27.8% (186/483). In multivariate analysis, older age, cardiovascular disease, CFS score of 3–4 before hospitalization, increased C-reactive protein level, longer duration of corticosteroid treatment, and use of MV and extracorporeal membrane oxygenation were identified as factors associated with new-onset frailty. Conclusion Our study suggests that new frailty is not uncommon and is associated with diverse factors in survivors of severe COVID-19 without pre-existing frailty.

Background: The development of frailty at hospital discharge affects the clinical outcomes in severe coronavirus disease 2019 (COVID-19) survivors who had no frailty before hospitalization. We aimed to describe the prevalence of new frailty using the clinical frailty scale (CFS) and evaluate its associated factors in patients with severe COVID-19 without pre-existing frailty before hospitalization. Methods: We performed a secondary analysis of clinical data from a nationwide retrospective cohort collected from 22 hospitals between January 1, 2020 and August 31, 2021. The patients were at least 19 years old and survived until discharge after admission to the intensive care unit (ICU) because of severe COVID-19. Development of new frailty was defined as a CFS score ≥5 at hospital discharge. Results: Among 669 severe COVID-19 survivors without pre-existing frailty admitted to the ICU, the mean age was 65.2±12.8 years, 62.5% were male, and 50.2% received mechanical ventilation (MV). The mean CFS score at admission was 2.4±0.9, and new frailty developed in 27.8% (186/483). In multivariate analysis, older age, cardiovascular disease, CFS score of 3–4 before hospitalization, increased C-reactive protein level, longer duration of corticosteroid treatment, and use of MV and extracorporeal membrane oxygenation were identified as factors associated with new-onset frailty. Conclusion Our study suggests that new frailty is not uncommon and is associated with diverse factors in survivors of severe COVID-19 without pre-existing frailty.

Background: The development of frailty at hospital discharge affects the clinical outcomes in severe coronavirus disease 2019 (COVID-19) survivors who had no frailty before hospitalization. We aimed to describe the prevalence of new frailty using the clinical frailty scale (CFS) and evaluate its associated factors in patients with severe COVID-19 without pre-existing frailty before hospitalization. Methods: We performed a secondary analysis of clinical data from a nationwide retrospective cohort collected from 22 hospitals between January 1, 2020 and August 31, 2021. The patients were at least 19 years old and survived until discharge after admission to the intensive care unit (ICU) because of severe COVID-19. Development of new frailty was defined as a CFS score ≥5 at hospital discharge. Results: Among 669 severe COVID-19 survivors without pre-existing frailty admitted to the ICU, the mean age was 65.2±12.8 years, 62.5% were male, and 50.2% received mechanical ventilation (MV). The mean CFS score at admission was 2.4±0.9, and new frailty developed in 27.8% (186/483). In multivariate analysis, older age, cardiovascular disease, CFS score of 3–4 before hospitalization, increased C-reactive protein level, longer duration of corticosteroid treatment, and use of MV and extracorporeal membrane oxygenation were identified as factors associated with new-onset frailty. Conclusion Our study suggests that new frailty is not uncommon and is associated with diverse factors in survivors of severe COVID-19 without pre-existing frailty.

Anti-glomerular basement membrane (GBM) antibody disease is a rare autoimmune disorder characterized by autoantibodies directed against antigens within the GBM, primarily affecting the kidneys and lungs. This severe form of glomerulonephritis has an incidence of less than two cases per million individuals with crescentic glomerulonephritis. The coexistence of immunoglobulin A (IgA) nephropathy and anti-GBM disease is rare. Here, we present a case of concurrent anti-GBM antibody disease and IgA nephropathy. A 49-year-old male presented with fever, azotemia, proteinuria, and hematuria. Biopsy of the kidney revealed crescentic glomerulonephritis with linear IgG deposition along the GBM and IgA deposition in the mesangium. Elevated serum levels of anti-GBM antibody (311 U/mL) confirmed the diagnosis of concurrent anti-GBM antibody disease and IgA nephropathy. Despite treatment with methylprednisolone, cyclophosphamide, and plasma exchange, renal function deteriorated, necessitating hemodialysis.

OBJECTIVES: Observational studies have reported that diabetes is a risk factor that increases the risk of atherosclerotic cardiovascular disease (ASCVD). However, the causal relationship remains a matter of debate. This study aimed to analyze the relationship between fasting serum glucose (FSG) and ASCVD. METHODS: This study used data from the Korean Cancer Prevention Study-II (KCPS-II) Biobank, consisting of 159,844 people recruited with consent from 18 health examination centers from 2004 to 2013. Outcomes were confirmed based on diagnoses on hospital discharge summaries from National Health Insurance System. We used linear and non-linear Mendelian randomization (MR) methods. The outcome data were obtained from KCPS-II, and the exposure data were derived from the Korean Genome Epidemiology Study. RESULTS: First, a prospective cohort study estimated that for each 10 mg/dL increase in FSG level, the risk of ASCVD increased by 4% (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03 to 1.05). Second, the 2-sample MR study showed that every 10 mg/dL increase in FSG influenced the risk of ASCVD (odds ratio [OR], 1.11; 95% CI, 1.04 to 1.18). Third, the multivariable MR study showed that the OR per 10 mg/dL increase in FSG on ASCVD was 1.14 (p<0.001). Similar results were found for a 10 mg/dL increase in FSG and ischemic heart disease (IHD), but a significant relationship with stroke was not found. When performing non-linear MR, a linear relationship was observed between fasting blood sugar and ASCVD, including IHD and stroke. CONCLUSIONS FSG showed a linear and causal association with IHD, but not with stroke.

Purpose: This study aimed to evaluate the long-term clinical outcomes based on the ligation level of the inferior mesenteric artery (IMA) in patients with rectal cancer. Methods: This was a retrospective analysis of a prospectively collected database that included all patients who underwent elective low anterior resection for rectal cancer between January 2013 and December 2019. The clinical outcomes included oncological outcomes, postoperative complications, and functional outcomes. The oncological outcomes included overall survival (OS) and relapse-free survival (RFS). The functional outcomes, including defecatory and urogenital functions, were analyzed using the Fecal Incontinence Severity Index, International Prostate Symptom Score, and International Index of Erectile Function questionnaires. Results: In total, 545 patients were included in the analysis. Of these, 244 patients underwent high ligation (HL), whereas 301 underwent low ligation (LL). The tumor size was larger in the HL group than in the LL group. The number of harvested lymph nodes (LNs) was higher in the HL group than in the LL group. There were no significant differences in complication rates and recurrence patterns between the groups. There were no significant differences in 5-year RFS and OS between the groups. Cox regression analysis revealed that the ligation level (HL vs. LL) was not a significant risk factor for oncological outcomes. Regarding functional outcomes, the LL group showed a significant recovery in defecatory function 1 year postoperatively compared with the HL group. Conclusion LL with LNs dissection around the root of the IMA might not affect the oncologic outcomes comparing to HL; however, it has minimal benefit for defecatory function.

OBJECTIVES: Observational studies have reported that diabetes is a risk factor that increases the risk of atherosclerotic cardiovascular disease (ASCVD). However, the causal relationship remains a matter of debate. This study aimed to analyze the relationship between fasting serum glucose (FSG) and ASCVD. METHODS: This study used data from the Korean Cancer Prevention Study-II (KCPS-II) Biobank, consisting of 159,844 people recruited with consent from 18 health examination centers from 2004 to 2013. Outcomes were confirmed based on diagnoses on hospital discharge summaries from National Health Insurance System. We used linear and non-linear Mendelian randomization (MR) methods. The outcome data were obtained from KCPS-II, and the exposure data were derived from the Korean Genome Epidemiology Study. RESULTS: First, a prospective cohort study estimated that for each 10 mg/dL increase in FSG level, the risk of ASCVD increased by 4% (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03 to 1.05). Second, the 2-sample MR study showed that every 10 mg/dL increase in FSG influenced the risk of ASCVD (odds ratio [OR], 1.11; 95% CI, 1.04 to 1.18). Third, the multivariable MR study showed that the OR per 10 mg/dL increase in FSG on ASCVD was 1.14 (p<0.001). Similar results were found for a 10 mg/dL increase in FSG and ischemic heart disease (IHD), but a significant relationship with stroke was not found. When performing non-linear MR, a linear relationship was observed between fasting blood sugar and ASCVD, including IHD and stroke. CONCLUSIONS FSG showed a linear and causal association with IHD, but not with stroke.

Background/Aims: Renal relapse has known to be a poor prognostic factor in patients with lupus nephritis (LN), but there were few studies that identified the risk factors of renal relapse in real world. We conducted this study based on 35-years of experience at a single center to find out predictors of renal relapse in Korean patients with LN after achieving complete response (CR). Methods: We retrospectively analyzed the clinical, laboratory, pathologic and therapeutic parameters in 296 patients of LN who reached CR. The cumulative risk and the independent risk factors for renal relapse were examined by Kaplan-Meier methods and Cox proportional hazards regression analyses, respectively. Results: The median follow-up period from CR was 123 months. Renal relapse had occurred in 157 patients. Renal relapse occurred in 38.2%, 57.6% and 67.9% of patients within 5-, 10-, and 20-year, respectively. The age at diagnosis of SLE and LN were significantly younger, and the proportions of severe proteinuria and serum hypoalbuminemia were higher in patients with renal relapse. Interestingly, the proportion of receiving cytotoxic maintenance treatment was higher in patients with renal relapse. In Cox proportional hazards regression analyses, only young-age onset of LN (by 10 years, HR = 0.779, p = 0.007) was identified to independent predictor of renal relapse. Conclusions Young-age onset of LN was only independent predictor and the patients with severe proteinuria and serum hypoalbuminemia also tended to relapse more, despite of sufficient maintenance treatment. Studies on more effective maintenance treatment regimens and duration are needed to reduce renal relapse.