[Show abstract][Hide abstract] ABSTRACT: Sepsis, including severe sepsis and septic shock, is a major cause of morbidity and mortality. Albumin and C-reactive protein (CRP) are considered as good diagnostic markers for sepsis. Thus, initial CRP and albumin levels were combined to ascertain their value as an independent predictor of 180-day mortality in patients with severe sepsis and septic shock.
We conducted a retrospective cohort study involving 670 patients (>18 years old) who were admitted to the emergency department and who had received a standardized resuscitation algorithm (early goal-directed therapy) for severe sepsis and septic shock, from November 2007 to February 2013, at a tertiary hospital in Seoul, Korea. The outcome measured was 180-day all-cause mortality. A multivariate Cox proportional hazard model was used to identify the independent risk factors for mortality. A receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive accuracy of the CRP/albumin ratio at admission.
The 180-day mortality was 28.35% (190/670). Based on the multivariate Cox proportional hazard analysis, age, the CRP/albumin ratio at admission (adjusted HR 1.06, 95% CI 1.03-1.10, p<0.001), lactate level at admission (adjusted HR 1.10, 95% CI 1.05-1.14, p<0.001), and the Sequential Organ Failure Assessment (SOFA) score at admission (adjusted HR 1.12, 95% CI 1.07-1.18, p<0.001) were independent predictors of 180-day mortality. The area under the curve of CRP alone and the CRP/albumin ratio at admission for 180-day mortality were 0.5620 (P<0.001) and 0.6211 (P<0.001), respectively.
The CRP/albumin ratio was an independent predictor of mortality in patients with severe sepsis or septic shock.
PLoS ONE 07/2015; 10(7):e0132109. DOI:10.1371/journal.pone.0132109 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose
Over the last 30 years, Serratia marcescens (S. marcescens) has emerged as an important pathogen, and a common cause of nosocomial infections. The aim of this study was to identify risk factors associated with mortality in patients with S. marcescens bacteremia.
Materials and Methods
We performed a retrospective cohort study of 98 patients who had one or more blood cultures positive for S. marcescens between January 2006 and December 2012 in a tertiary care hospital in Seoul, South Korea. Multiple risk factors were compared with association with 28-day all-cause mortality.
The 28-day mortality was 22.4% (22/98 episodes). In a univariate analysis, the onset of bacteremia during the intensive care unit stay (p=0.020), serum albumin level (p=0.011), serum C-reactive protein level (p=0.041), presence of indwelling urinary catheter (p=0.023), and Sequential Oran Failure Assessment (SOFA) score at the onset of bacteremia (p<0.001) were significantly different between patients in the fatal and non-fatal groups. In a multivariate analysis, lower serum albumin level and an elevated SOFA score were independently associated with 28-day mortality [adjusted odds ratio (OR) 0.206, 95% confidential interval (CI) 0.044-0.960, p=0.040, and adjusted OR 1.474, 95% CI 1.200-1.810, p<0.001, respectively].
Lower serum albumin level and an elevated SOFA score were significantly associated with adverse outcomes in patients with S. marcescens bacteremia.
Yonsei Medical Journal 02/2015; 56(2):348-354. DOI:10.3349/ymj.2015.56.2.348 · 1.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimTo evaluate the relationship between human cytomegalovirus (HCMV) antibody status, and hypertension and functional status among elderly Koreans.Methods
Patients aged ≥65 years were prospectively enrolled from March 2011 to February 2012 at a 2000-bed university hospital. We collected data including CD4+ and CD8+ T-lymphocyte count, and functional status by measuring basic activities of daily living and instrumental activities of daily living for all patients. In addition, HCMV immunoglobulin G levels were analyzed using enzyme-linked fluorescent assay.ResultsDuring the study period, 103 patients (51 men), who were admitted for treatment of infections or other diseases, were enrolled. Multivariate analysis showed that body mass index and HCMV immunoglobulin G antibody titers were independent factors associated with hypertension in elderly patients (OR 1.347, 95% CI 1.113–1.630, P = 0.002; OR 1.023, 95% CI 1.001–1.047, P = 0.042, respectively). In univariate linear correlations, HCMV antibody levels were positively correlated with systolic blood pressure levels (r = 0.303, P = 0.002), CD8+ T-lymphocyte count (r = 0.313, P = 0.001) and instrumental activities of daily living scores (r = 0.217, P = 0.028). In addition, HCMV immunoglobulin G titers were inversely associated with estimated glomerular filtration rate (r = −0.268, P = 0.006). These four variables remained independently significant in multivariate correlation analysis.Conclusion
These findings could provide insight into the important role of HCMV in the pathogenesis of essential hypertension and decreased functional status in the elderly. Geriatr Gerontol Int 2014; ●●: ●●–●●.
Geriatrics & Gerontology International 01/2015; DOI:10.1111/ggi.12428 · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although the proteasome inhibitor known as bortezomib can modulate the inflammatory process through the nuclear factor-kappa B signaling pathway, the immunomodulatory effect of pre-incubated bortezomib has not been fully evaluated for inflammation by infectious agents. Therefore, we evaluated the effect of bortezomib on the expression of inflammatory cytokines and mediators in macrophage cell lines and on survival in a murine peritonitis sepsis model.
Bortezomib was applied 1 hr before lipopolysaccharide (LPS) stimulation in RAW 264.7 cells. The cecal ligation and puncture (CLP) experiments were performed in C57BL/6J mice.
Pre-incubation with bortezomib (25 nM or 50 nM) prior to LPS (50 ng/mL or 100 ng/mL) stimulation significantly recovered the number of viable RAW 264.7 cells compared to those samples without pre-incubation. Bortezomib decreased various inflammatory cytokines as well as nitric oxide production in LPS-stimulated cells. The 7-day survival rate in mice that had received bortezomib at 0.01 mg/kg concentration 1 hr prior to CLP was significantly higher than in the mice that had only received a normal saline solution of 1 mL 1 hr prior to CLP. In addition, the administration of bortezomib at 0.01 mg/kg concentration 1 hr before CLP resulted in a significant decrease in inflammation of the lung parenchyma. Collectively, pretreatment with bortezomib showed an increase in the survival rate and changes in the levels of inflammatory mediators.
These results support the possibility of pretreatment with bortezomib as a new therapeutic target for the treatment of overwhelming inflammation, which is a characteristic of severe sepsis.
Yonsei Medical Journal 01/2015; 56(1):112-23. DOI:10.3349/ymj.2015.56.1.112 · 1.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Invasive mucormycosis is an uncommon but increasing, life-threatening fungal infection. Effective therapy is represented by the combination of surgery and antifungal agent administration and early initiation of the therapy is necessary for favorable outcome. However, the disease is difficult to diagnose and mortality reaches 40% even if treated adequately, and clinical data on clinical course are limited.
Methods: We retrospectively reviewed histologically proven cases of invasive mucormycosis in two tertiary care referral hospitals from 2004 to 2013. The clinical and laboratory data were analyzed for all patients.
Results: We reviewed total of 28 patients who were histologically diagnosed as invasive mucormycosis. Overall survival was 60% (n = 17). The time from onset of symptom to diagnostic procedure proved to be associated with mortality (P <0.001). In addition, time from onset of symptom to initiation of antifungal therapy was associated with a poor outcome in our study (P = 0.032). On multivariate regression analysis, delayed diagnostic procedure (more than 10 days after onset of symptom) was an independently significant predictor of mortality (odds ratio = 13.28, 95% confidence interval, 1.07-164.62; P= 0.044).
Conclusion: Mucormycosis is a destructive fungal infection that is associated with a high mortality, ranging from 40 to 100 % depending on disease form. When a clinician suspects an invasive mucormycosis infection, early diagnostic procedure done within 10 days from the onset of symptom and early initiation of antifungal therapy will lead to successful management of the disease.
IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
[Show abstract][Hide abstract] ABSTRACT: The incidence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) bacteraemia has increased in recent years, and infections caused by CRPA result in higher mortality than those caused by susceptible strains. This study was performed to evaluate the risk factors for mortality, and to study the impact of virulence factors and bacterial strains on clinical outcomes in patients with CRPA bacteraemia. Data on 63 episodes of CRPA bacteraemia that have occurred between January 1, 2007 and December 31, 2009 in a teaching hospital (2000 beds) in Seoul, Korea were analyzed. The APACHE II score at the time of CRPA bacteraemia and the capacity of CRPA to form biofilm were independent predictive factors for mortality in patients with CRPA bacteraemia. In addition, the biofilm-forming ability and elastase activity of strains were correlated with APACHE II scores to measure the severity of disease and estimate predicted mortality in the patients.
[Show abstract][Hide abstract] ABSTRACT: The hypervirulent Clostridium difficile strains, most notably the BI/NAP1/027, have been increasingly emerging in Western countries as local epidemics. We performed a prospective multicenter observational study from December 2011 to May 2012 to identify recent incidences of toxigenic culture-confirmed hospital-onset CDI and their associated clinical characteristics in South Korea. The patients, suspected to have been suffering from CDI more than 48 hours after admission and aged ≥20 years, were prospectively enrolled and provided loose stool specimens. The toxigenic C. difficile culture (anaerobic culture + toxin A/B/binary gene PCR) and PCR ribotyping were performed in one central laboratory. We enrolled 98 toxigenic culture-confirmed CDI-infected patients and 250 toxigenic culture-negative participants from three hospitals. The incidence of toxigenic culture-confirmed hospital-onset CDI cases was 2.7 cases/10,000 patient-days. The percentage of severe CDI cases was relatively low at only 3.1%. UK ribotype 018 was the predominant type (48.1%). There were no hypervirulent BI/NAP1/027 isolates identified. The independent risk factors of toxigenic culture-confirmed hospital-onset CDI were the invasive procedure (OR 7.3, P=0.003) and past CDI history within three months (OR 28.5, P=0.003). In conclusion, the incidence and severity of CDI in our study were not higher than reported in Western countries.
Journal of Medical Microbiology 09/2014; 63(Pt_11). DOI:10.1099/jmm.0.070672-0 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose
Fluoroquinolones, rapidly gaining prominence in treatment of Stenotrophomonas maltophilia (SMP), are noted for their potency and tolerability. However, SMP may rapidly acquire resistance to fluoroquinolones. We evaluated associations of clinical factors with acquisition of levofloxacin resistance (LFr) in SMP.
Materials and Methods
Our retrospective cohort study was based on patient data collected between January 2008 and June 2010. Through screening of 1275 patients, we identified 122 patients with data for SMP antibiotic susceptibility testing in ≥3 serial SMP isolates.
We assigned the 122 patients to either the SS group (n=54) in which levofloxacin susceptibility was maintained or the SR group (n=31) in which susceptible SMP acquired resistance. In multivariate regression analysis, exposure to levofloxacin for more than 3 weeks [odds ratio (OR) 15.39, 95% confidential interval (CI) 3.08-76.93, p=0.001] and co-infection or co-colonization with Klebsiella pneumoniae resistant to levofloxacin (OR 4.85, 95% CI 1.16-20.24, p=0.030) were independently associated with LFr acquisition in SMP.
Acquisition of LFr during serial sampling of SMP was related to the levofloxacin exposure.
Yonsei Medical Journal 07/2014; 55(4):987-93. DOI:10.3349/ymj.2014.55.4.987 · 1.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Carbapenem resistance among gram-negative bacilli is an emerging threat worldwide. The objective of this study was to identify risk factors for the acquisition of carbapenem-resistant Escherichia coli (CRE). Methods: We conducted a matched case-control study comprising 57 cases of acquisition of CRE and 114 controls (1:2 matched) selected from patients with a culture of carbapenem-susceptible E coli between January 2006 and December 2010 at a 2000-bed tertiary care center in South Korea. Results: On univariate analysis, previous use of carbapenem (P < .01), fluoroquinolone (P < .01), and glycopeptide (P < .01), as well as length of hospital stay (P < .05), were significantly associated with CRE acquisition. On multivariate analysis, previous use of carbapenem (odds ratio [OR], 4.56; 95% confidence interval [CI] 1.44-14.46; P = .01) and previous use of fluoroquinolone (OR, 2.81; 95% CI, 1.14-6.99; P = .03) were independent risk factors. Conclusions: At this institute, the antibiotic selective pressure of carbapenems and fluoroquinolones was shown to be an important risk factor for the acquisition of CRE. Copyright
American Journal of Infection Control 06/2014; 42(6):621-5. DOI:10.1016/j.ajic.2014.02.024 · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Sepsis is a syndrome that results in high morbidity and mortality. We investigated the delta neutrophil index (DN) as a predictive marker of early mortality in patients with gram-negative bacteremia.
Materials and Methods
We conducted a retrospective study at a tertiary referral hospital in South Korea from November 2010 to March 2011. The DN was measured at onset of bacteremia and 24 hours and 72 hours later. The DN was calculated using an automatic hematology analyzer. Factors associated with 10-day mortality were assessed using logistic regression.
A total of 172 patients with gram-negative bacteremia were included in the analysis; of these, 17 patients died within 10 days of bacteremia onset. In multivariate analysis, Sequental organ failure assessment scores (odds ratio [OR]: 2.24, 95% confidence interval [CI]: 1.31 to 3.84; P = 0.003), DN-day 1 ≥ 7.6% (OR: 305.18, 95% CI: 1.73 to 53983.52; P = 0.030) and DN-day 3 ≥ DN-day 1 (OR: 77.77, 95% CI: 1.90 to 3188.05; P = 0.022) were independent factors associated with early mortality in gram-negative bacteremia. Of four multivariate models developed and tested using various factors, the model using both DN-day 1 ≥ 7.6% and DN-day 3 ≥ DN-day 1 was most predictive early mortality.
DN may be a useful marker of early mortality in patients with gram-negative bacteremia. We found both DN-day 1 and DN trend to be significantly associated with early mortality.
[Show abstract][Hide abstract] ABSTRACT: Less costly but still accurate methods for monitoring HIV treatment response are needed. We prospectively evaluated if a qualitative polymerase chain reaction (PCR) amplification assay for virologic monitoring could maintain accuracy while reducing costs in Seoul, South Korea. We conducted the first prospective study comparing a qualitative PCR amplification of HIV-1 reverse transcriptase (RT) versus a commercial real time PCR assay (i.e. viral load) for virologic monitoring of 150 patients receiving antiretroviral therapy (ART) between November 2011 and August 2012 at an urban hospital in Seoul, South Korea. A total of 215 blood plasma samples from 150 patients receiving ART for more than 6 months were evaluated. Using the individual viral load assay, 12 of 215 (5.6%) plasma samples had more than 500 HIV RNAcopies/mL. The qualitative PCR amplification assay detected individual samples with ≥ 500 HIV RNA copies/mL with 100% sensitivity. The specificities of the qualitative PCR amplification of HIV-1 RT assay were 94.1%, 93.6%, and 93.2% compared to the real time PCR at 500, 1000, and 5000 threshold of HIV RNA copies/mL, respectively, and $24,940 USD would have been saved for 150 patients during 10 months. The qualitative PCR amplification of HIV-1 RT assay might be a useful approach to effectively monitor patients receiving ART and save resources.
AIDS research and human retroviruses 04/2014; 30(8). DOI:10.1089/AID.2013.0227 · 2.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Multiple prevention measures have the possibility of impacting HIV incidence in South Korea, including early diagnosis, early treatment, and pre-exposure prophylaxis (PrEP). We investigated how each of these interventions could impact the local HIV epidemic, especially among men who have sex with men (MSM), who have become the major risk group in South Korea. A mathematical model was used to estimate the effects of each these interventions on the HIV epidemic in South Korea over the next 40 years, as compared to the current situation.
We constructed a mathematical model of HIV infection among MSM in South Korea, dividing the MSM population into seven groups, and simulated the effects of early antiretroviral therapy (ART), early diagnosis, PrEP, and combination interventions on the incidence and prevalence of HIV infection, as compared to the current situation that would be expected without any new prevention measures.
Overall, the model suggested that the most effective prevention measure would be PrEP. Even though PrEP effectiveness could be lessened by increased unsafe sex behavior, PrEP use was still more beneficial than the current situation. In the model, early diagnosis of HIV infection was also effectively decreased HIV incidence. However, early ART did not show considerable effectiveness. As expected, it would be most effective if all interventions (PrEP, early diagnosis and early treatment) were implemented together.
This model suggests that PrEP and early diagnosis could be a very effective way to reduce HIV incidence in South Korea among MSM.
PLoS ONE 03/2014; 9(3):e90080. DOI:10.1371/journal.pone.0090080 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Bacteremia with multidrug-resistant (MDR) Acinetobacter baumannii with carbapenem resistance is an important healthcare-associated infection that increases morbidity and mortality in immunocompromised patients. The aim of this study was to assess the annual incidence and clinical characteristics of such bacteremia and to identify the risk factors for infection in hematopoietic stem cell transplantation (HSCT) recipients. Methods: A retrospective cohort and case-control study was conducted in 483 HSCT recipients between January 2005 and December 2011 at a single tertiary center. Thirty-eight control HSCT patients without evidence of post-transplant infection were matched with 19 patients with bacteremia due to MDR A. baumannii in a 2:1 ratio. Results: The total incidence of carbapenem-resistant-MDR A. baumannii bacteremia was 0.52 cases/10,000 patient-days. In most cases (17 of 19, 89.5%), bacteremia developed after engraftment. Pneumonia was the origin of bacteremia in all patients. Eighteen (94.7%) patients with bacteremia and 3 (8.3%) without bacteremia died. In multivariate regression analyses, the duration between admission and HSCT (odds ratio (OR) 2.19 per 1-day increase, p = 0.030) and a history of care in an intensive care unit after HSCT (OR 32.2, p = 0.021) were independent risk factors for the development of carbapenem-resistant-MDR A. baumannii bacteremia. Conclusions: We report that carbapenem-resistant-MDR A. baumannii bacteremia in HSCT recipients is a fatal infectious complication and mainly develops after engraftment.
[Show abstract][Hide abstract] ABSTRACT: The generation of highly efficient electricity and the production of massive hydrogen are possible using a very high temperature reactor (VHTR) among generation IV nuclear power plants. The structural material for an intermediate heat exchanger (IHX) among numerous components should be endurable at high temperature of up to 950 °C during long-term operation. Impurities inevitably introduced in helium as a coolant facilitate the material degradation by corrosion at high temperature. In the present work, the surface reactions available under controlled impure helium at 950 °C were investigated based on the thermodynamics and the corrosion tests were performed in a temperature range of 850–950 °C during 10–250 h for commercial Alloy 617 as a candidate material for an IHX. Moreover, the mechanical property and microstructure for nickel-based alloys fabricated in laboratory were evaluated as a function of the processing parameters such as hot rolling and heat treatment conditions. From the reaction rate constant obtained from an impure helium control system for a material evaluation, it was predicted that the outer oxide layer thickness, internal oxide depth, and carbide-depleted zone depth reach about 116, 600 and 1000 μm, respectively when Alloy 617 is exposed to an impure helium environment at 950 °C for 20 years. For Ni–Cr–Co–Mo alloy, subsequent annealing and a combination of cold working and subsequent annealing following solution annealing caused increases in the grain boundary carbide coverage and size. The angular distribution of the grain boundary as well as the carbide distribution was also changed leading to a consequent improvement of the mechanical property at 950 °C in air.
Journal of Materials Science and Technology -Shenyang- 12/2013; 29(12):1184–1190. DOI:10.1016/j.jmst.2013.09.022 · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. While gastrointestinal surgery is relatively common in Korea, few studies have evaluated SSI in the context of gastric surgery. Thus, we performed a prospective cohort study to determine the incidence and risk factors of SSI in Korean patients undergoing gastric surgery.
A prospective cohort study of 2,091 patients who underwent gastric surgery was performed in 10 hospitals with more than 500 beds (nine tertiary hospitals and one secondary hospital). Patients were recruited from an SSI surveillance program between June 1, 2010, and August 31, 2011 and followed up for 1 month after the operation. The criteria used to define SSI and a patient's risk index category were established according to the Centers for Disease Control and Prevention and the National Nosocomial Infection Surveillance System. We collected demographic data and potential perioperative risk factors including type and duration of the operation and physical status score in patients who developed SSIs based on a previous study protocol.
A total of 71 SSIs (3.3%) were identified, with hospital rates varying from 0.0 - 15.7%. The results of multivariate analyses indicated that prolonged operation time (P = 0.002), use of a razor for preoperative hair removal (P = 0.010), and absence of laminar flow in the operating room (P = 0.024) were independent risk factors for SSI after gastric surgery.
Longer operation times, razor use, and absence of laminar flow in operating rooms were independently associated with significant increased SSI risk after gastric surgery.
[Show abstract][Hide abstract] ABSTRACT: Background: There have been various efforts to identify less costly but still accurate methods for monitoring the response to HIV treatment. We evaluated a pooling method to determine if this could improve screening efficiency and reduce costs while maintaining accuracy in Seoul, South Korea. Methods: We conducted the first prospective study of pooled nucleic acid testing (NAT) using a 5 minipool + algorithm strategy versus individual viral load testing for patients receiving antiretroviral therapy (ART) between November 2011 and August 2012 at an urban hospital in Seoul, South Korea. The viral load assay used has a lower level of detection of 20 HIV RNA copies/ml, and the cost per assay is US$ 136. The 5 minipool +algorithm strategy was applied and 43 pooled samples were evaluated. The relative efficiency and accuracy of the pooled NAT were compared with those of individual testing. Results: Using the individual viral load assay, 15 of 215 (7%) plasma samples had more than 200 HIV RNA copies/ml. The pooled NAT using the 5 minipool + algorithm strategy was applied to 43 pooled samples; 111 tests were needed to test all samples when virologic failure was defined at HIV RNA ≥ 200 copies/ml. Therefore, 104 tests were saved over individual testing, with a relative efficiency of 0.48. When evaluating costs, a total of US$ 14,144 was saved for 215 individual samples during 10 months. The negative predictive value was 99.5% for all samples with HIV RNA ≥ 200 copies/ml. Conclusions: The pooled NAT with 5 minipool + algorithm strategy seems to be a very promising approach to effectively monitor patients receiving ART and to save resources.
[Show abstract][Hide abstract] ABSTRACT: Background:
A novel therapeutic human cytomegalovirus (HCMV) DNA vaccine that includes glycoprotein B (gB) has recently undergone a successful phase 2 trial in allogenic hematopoietic stem cell transplantation recipients. However, a few studies have analyzed gB genotypes and their association with clinical outcome in patients with various underlying diseases. The aim of this study was to analyze the gB genotype distribution and its association with clinically significant factors such as survival rate and occurrence of tissue-invasive disease.
This study was performed on 52 HCMV strains obtained from blood samples of immunocompromised patients presenting at a single tertiary center between January and April 2013. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and sequencing analysis were used to confirm the gB genotypes. Patients' clinical data were obtained from medical records.
Among the 52 patients, 26 (50%) had hematologic diseases including malignancy, 6 (12%) had solid organ cancers, 5 (10%) had autoimmune diseases, and the rest (28%) had infectious diseases. The prevalent genotypes of HCMV gB were type 1 (26, 50%) and 3 (24, 46%). No statistically significant difference was found between gB1 and gB3 distributions by disease among patients with and without hematologic disease (p=0.482). No statistically significant difference was noted between genotypes and all causes of in-hospital mortality (p=0.452). Among the 52 patients, 15 patients had HCMV disease, with HCMV pneumonitis being the most commonly identified (13/15, 86%). No statistically significant difference was found between the occurrence of HCMV disease and genotypes (p=0.879).
In South Korea, HCMV gB1 and gB3 were both identified at similar levels. No significant difference was noted between gB1 and gB3 distributions with respect to underlying illness, survival, or occurrence of HCMV disease.
IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
[Show abstract][Hide abstract] ABSTRACT: Background: HIV-associated neurocognitive disorder (HAND) is an independent predictor of early mortality, and strongly predictive of a wide variety of difficulties in activities of daily living. We conducted a study to determine the prevalence and risk factors of HAND in HIV-infected Koreans. In addition, we investigated the performance of screening tools and components of neuropsychological (NP) tests for diagnosing HAND.
Methods: Two hundred HIV-infected patients were recruited consecutively from two different urban teaching hospitals in Seoul, South Korea between Mar 2012 and Sep 2012. Six subjects were excluded due to confounding comorbidity and withdrawing their agreement. Subjects completed a detailed neuropsychological assessment measuring their functioning in 6 cognitive domains known to be commonly affected by HIV. The Frascati criteria were used for diagnosing HAND. Four key questionnaires, international dementia scale (IDS) and MOCA-K were assessed as a screening tool.
Results: Among the 194 enrolled participants, the prevalence of HAND was 26.3%. Asymptomatic HAND and mild HAND accounted for 52.9% and 47.1% of the patients with HAND, respectively. In multivariate analysis, hemoglobin levels ≤13g/dL (p=0.046) and current use of PI-based regimen (p=0.031) were independent risk factors for HAND. The area under curves of key questionnaires, IDS and MOCA-K for diagnosing HAND were 0.584 (p=0.051), 0.678 (p<0.001) and 0.666 (p<0.001), respectively. Among NP tests, the Grooved Pegboard Test had the highest sensitivity and modest specificity (90.2% and 72.0%, respectively), and that of Wisconsin Card Sorting Test were 61.2% and 84.4%, respectively.
Conclusion: The prevalence of HAND in HIV-infected Koreans was similar with those of western countries. IDS and MOKA-K as a screening tool for HAND had insufficiently better performance than key questionnaires. The Grooved Pegboard Test might be used as a screening tool for HAND in HIV infected Koreans.
IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013