Dong-Gyu Kim

Hallym University Medical Center, Sŏul, Seoul, South Korea

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Publications (40)36.59 Total impact

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    ABSTRACT: Data on the clinical outcomes and role of brain natriuretic peptide (BNP) levels in patients with chronic cor pulmonale are limited. A total of 69 patients with chronic cor pulmonale, admitted for dyspnea (January 2007 to September 2011) to three university hospitals, were retrospectively reviewed. All of the patients had right ventricular (RV) dysfunction on echocardiography. The median age was 70.0 yr, and chronic obstructive pulmonary disease (40.6%) and tuberculosis-destroyed lung (TDL, 27.5%) were the leading causes of chronic cor pulmonale. At the 1-yr follow-up, the mortality rate was 15.9%, and the readmission rate was 53.7%; patients with TDL had higher mortality (31.6% vs. 10.0%; P=0.059) and readmission rates (78.9% vs. 43.8%; P=0.009) than those with non-TDL diseases. The area under the receiver operating characteristic curve for admission BNP levels to predict readmission was 0.788 (95% confidence interval [CI], 0.673-0.904), and the sensitivity and specificity of the cut-off value were 80.6% and 77.4%, respectively. In multivariate analysis, high admission BNP levels were a significant risk factor for subsequent readmission (hazard ratio, 1.049; 95% CI, 1.005-1.094). Additionally, admission BNP levels were well correlated with cardiac troponin I (r=0.558), and delta BNP also correlated with delta RV systolic pressure (n=25; r=0.562). In conclusion, among hospitalized patients with chronic cor pulmonale, admission high BNP levels are a significant risk factor for subsequent readmission. Therefore, more intensive monitoring and treatment are needed in patients with higher BNP levels.
    Journal of Korean medical science 04/2015; 30(4):442-9. DOI:10.3346/jkms.2015.30.4.442 · 1.25 Impact Factor
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    ABSTRACT: The Xpert MTB/RIF assay is a novel real-time polymerase chain reaction technique for the detection of the Mycobacterium tuberculosis (MTB) complex and rifampin (RIF) resistance. We evaluated the performance of this assay in identifying MTB and resistance to RIF in clinical specimens. We analyzed clinical specimens from 383 patients with suspected TB who were hospitalized at a secondary hospital in Korea. Specimens were processed using the Xpert MTB/RIF assay, acid-fast bacilli smear and culture, and drug susceptibility test (DST). Among the 444 clinical samples analyzed, the Xpert MTB/RIF assay identified MTB in 56 (13.8%) of 405 respiratory specimens, but did not detect MTB in the remaining 39 non-respiratory specimens. Of the 65 pulmonary TB patients, 52 (80.0%) were confirmed by using mycobacterial culture as a reference standard. The sensitivity, specificity, PPV, and NPV of the Xpert MTB/RIF assay were 73.85%, 99.03%, 94.12%, and 94.72%, respectively. Among five patients with RIF resistance determined by the Xpert MTB/RIF assay, four (80%) were confirmed as suffering from multidrug-resistant (MDR) TB by DST. The Xpert MTB/RIF assay appears to be an accurate, simple, and useful technique for detecting MTB, especially in respiratory specimens. However, RIF resistance, if detected, should be verified with DST. © 2015 by the Association of Clinical Scientists, Inc.
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    ABSTRACT: Fire smoke contains toxic gases and numerous chemical compounds produced by incomplete combustion, and may cause injury to the airways. Increased airway reactivity, as well as a decrease in lung function, has been reported as a sequela of smoke inhalation injury. This study was undertaken to assess lung functions in the early phase of patients with smoke inhalation damage from fires.
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    ABSTRACT: Polymerase chain reaction (PCR) for the detection of Mycobacterium tuberculosis (MTB) is more sensitive, specific, and rapid than the conventional methods of acid-fast bacilli (AFB) smear and culture. The aim of this study was to determine if the Xpert MTB/rifampicin (RIF) assay had additional advantages over nested PCR for the detection of MTB in a geographical area with intermediate tuberculosis (TB) incidence.
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    ABSTRACT: Cigarette smoking is the most commonly encountered risk factor for chronic obstructive pulmonary disease (COPD). However, it is not the only one and there is consistent evidence from epidemiologic studies that nonsmokers may develop chronic airflow limitation. A history of tuberculosis has recently been found to be associated with airflow obstruction in adults older than 40 years. The aim of this study was to evaluate the association between the radiologic changes by tuberculosis and airflow obstruction in a population based sample. A nationwide COPD prevalence survey was conducted. We compared the prevalence of airflow obstruction according to the presence of the radiologic change by the tuberculosis. We analyzed 1,384 subjects who participated in the nationwide Korean COPD survey. All subjects were older than 40 years and took the spirometry and simple chest radiography. We defined the airflow obstruction as FEV1/FVC <0.7. A total of 149 (10.8%) subjects showed airflow obstruction. A total of 167 (12.1%) subjects showed radiologic change by tuberculosis. Among these 167 subjects, 44 (26.3%) had airflow obstruction. For the subjects without radiologic change by tuberculosis, the prevalence of airflow obstruction was only 8.6%. The unadjusted odds ratio for airflow obstruction according to the radiologic change was 3.788 (95% CI: 2.544-5.642). The radiologic change by tuberculosis was associated with airflow obstruction.
    05/2014; 6(5):471-6. DOI:10.3978/j.issn.2072-1439.2014.04.02
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    ABSTRACT: A recent study demonstrated that exertional desaturation is a predictor of rapid decline in lung function in patients with chronic obstructive pulmonary disease (COPD); however, the study was limited by its method used to detect exertional desaturation. The main purpose of this study was to explore whether exertional desaturation assessed using nadir oxygen saturation (SpO₂) during the 6-minute walk test (6MWT) can predict rapid lung function decline in patients with COPD. A retrospective analysis was performed on 57 patients with moderate to very severe COPD who underwent the 6MWT. Exertional desaturation was defined as a nadir SpO₂ of <90% during the 6MWT. Rapid decline was defined as an annual rate of decline in forced expiratory volume in 1 second (FEV₁)≥50 mL. Patients were divided into rapid decliner (n=26) and non-rapid decliner (n=31) groups. A statistically significant difference in exertional desaturation was observed between rapid decliners and non-rapid decliners (17 vs. 8, p=0.003). No differences were found between the groups for age, smoking status, BODE index, and FEV₁. Multivariate analysis showed that exertional desaturation was a significant independent predictor of rapid decline in patients with COPD (relative risk, 6.8; 95% CI, 1.8 to 25.4; p=0.004). This study supports that exertional desaturation is a predictor of rapid lung function decline in male patients with COPD.
    Yonsei medical journal 05/2014; 55(3):732-8. DOI:10.3349/ymj.2014.55.3.732 · 1.26 Impact Factor
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    ABSTRACT: Interferon-γ assays based on tuberculosis (TB)-specific antigens have been utilized for diagnosing and ruling out latent TB and active TB, but their utility is still limited for TB incidence countries. The aim of this study is to understand the clinical utility of enzyme-linked immunospot (ELISpot) assays among patients with clinically suspected TB and healthy adults in clinical practices and community-based settings. The ELISpot assays (T SPOT.TB, Oxford Immunotec, UK) were prospectively performed in 202 patients. After excluding those with indeterminate results, 196 were included for analysis: 41 were TB patients, 93 were non-TB patients, and 62 were healthy adults. The sensitivity and negative predictive values of the T SPOT.TB assays for the diagnosis of TB were 87.8% and 89.1%, respectively, among patients with suspected TB. The agreement between the tuberculin skin test (10-mm cutoff) and the T SPOT.TB assay was 66.1% (kappa=0.335) in all participants and 80.0% (kappa=0.412) in TB patients. Among those without TB (n=155), a past history of TB and fibrotic TB scar on chest X-rays were significant factors that yielded positive T SPOT.TB results. There was a significant difference in the magnitude of T SPOT.TB spot counts between TB patients and non-TB patients or healthy adults. The T SPOT.TB assay appeared to be a useful test for the diagnostic exclusion of TB. A positive result, however, should be cautiously interpreted for potential positives among those without active TB in intermediate TB incidence areas.
    Tuberculosis and Respiratory Diseases 01/2014; 76(1):23-9. DOI:10.4046/trd.2014.76.1.23
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    ABSTRACT: Cystic Fibrosis/ Bronchiectasis PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PMPURPOSE: The characteristic features of bronchiectasis are abnormal dilated thick-walled bronchi that are inflamed and chronically infected by bacteria. It is a chronic condition, which can result in significant physical and social morbidity. Adults with bronchiectasis often have chronic cough and sputum production and frequently develop pulmonary exacerbation driven by infection. The purpose of current study was to evaluate the long-term consequence of bronchiectsis patients.METHODS: We enrolled 79 bronchiectasis patients who visited our institution and were followed up at least 1 year. There were 52 women and 27 men included in our study. The mean age was 60.1 years of age (range 35-86 years). All of the subjects were confirmed to have bronchiectasis by the chest CT scans.RESULTS: The mean follow-up duration was 66.1±24.0 months. During the follow-up period, a total 46.8% of the patients admitted hospital and the total number of admission was 114. Among the patients who admitted hospital, the mean frequency of hospital admission was 3.08±2.08. Pneumonia was the most common cause of hospital admission (54.4% of the total admission). A total 37.7% of the admissions were due to acute exacerbation. The mean age of the patients who admitted hospital was older than patients who did not (65.0±12.1 vs. 55.8±12, p=0.001). The mean number of hospital admission according to the baseline pulmonary function was significantly different (0.33±0.76 in patients with normal pulmonary function; 1.57±2.51 in patients with restrictive defect; 0.60±0.89 in GOLD 1 patients; 1.22±1.86 in GOLD 2 patients; 3.87±4.03 in GOLD 3&4 patients , p<0.001). We cultured sputum samples for microbiology during the follow-up period. A total 55.7% of patients showed microbes in the sputum samples. Pseudomonas aeruginosa was the most frequently cultured pathogen (21.5%). Non tuberculosis mycobacterium was cultured in 13.9% of the patients. Patients with positive culture for P.aeruginosa admitted more frequently (3.41±3.91 vs.0.90±1.60, p<0.001).CONCLUSIONS: A total 46.8% of bronchiectasis patients admitted hospital during the long-term follow-up period. Older patients with poor lung function and positive culture for P.aeruginosa experienced more hospital admission.CLINICAL IMPLICATIONS: A more specific management strategy is needed for older non-cystic fibrosis bronchiectasis patients with poor lung function and positive culture for P.aeruginosaDISCLOSURE: The following authors have nothing to disclose: Yong Il Hwang, Jee Hee Kim, Sunghoon Park, Seung Hun Jang, Yong Bum Park, Dong-Gyu Kim, In-Gyu Hyun, Myung-Goo Lee, Ji-Suck JungNo Product/Research Disclosure Information.
    Chest 10/2013; 144(4_MeetingAbstracts):585A. DOI:10.1378/chest.1704180 · 7.13 Impact Factor
  • Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 02/2013; 110(2):118-9. DOI:10.1016/j.anai.2012.11.008 · 2.75 Impact Factor
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    ABSTRACT: PURPOSE: Chemotherapy-induced neutropenia (CIN) has been associated with better therapeutic results in studies of various tumors. Herein, we explored the relationship between timing (onset) of CIN and clinical outcomes of patients with metastatic non-small-cell lung cancer (NSCLC). METHODS: Patients with stage IV NSCLC receiving at least two cycles of first-line doublet chemotherapy (gemcitabine plus platinum) were reviewed retrospectively. Subjects were stratified by onset of CIN into two groups: early-onset (lowest neutrophil count of cycles 1-2 <2.0 × 10(9)/L) and non-early-onset. The non-early-onset group was further subdivided into late-onset (lowest neutrophil count of cycles 3-6 <2.0 × 10(9)/L) and absence of neutropenia. RESULTS: A total of 123 patients were studied. Significantly better disease control rate, progression-free survival (PFS), and overall survival (OS) were observed in early-onset versus non-early-onset patients. Median PFS of 5.1 and 3.8 months (p = 0.0016) and median OS of 16.7 and 11.2 months (p = 0.0004) were achieved for these groups, respectively. Patient subsets with late-onset and absence of neutropenia showed similarly poor clinical outcomes, with 4.8 and 3.8 months median PFS (p = 0.5067) and 13.0 and 11.2 months median OS (p = 0.6304), respectively. CONCLUSIONS: Timing of CIN is predictive of prognosis in patients with metastatic NSCLC receiving gemcitabine/platinum doublet chemotherapy. Better clinical outcomes were achieved when onset of neutropenia was early versus late or absent altogether. Further research is warranted to determine whether above findings are applicable to other chemotherapeutic regimens.
    Journal of Cancer Research and Clinical Oncology 11/2012; 139(3). DOI:10.1007/s00432-012-1341-9 · 3.01 Impact Factor
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    Changhwan Kim, Dong-Gyu Kim
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    ABSTRACT: The frequency of diagnosing bronchiectasis is increasing around the world. Cystic fibrosis is the most common inherited cause of bronchiectasis, but there is increasing recognition of significant numbers of patients with bronchiectasis from various causes. With increasing awareness of bronchiectasis, a significant number of research, concerning the causes and treatments, were published over the past few years. Investigation of the underlying cause of bronchiectasis is the most important key to effective management. The purpose of this report is to review the immunological abnormalities that cause bronchiectasis in those that the cystic fibrosis has been excluded, identify the available evidences of current management, and discuss several controversies in the treatment of this disorder.
    Tuberculosis and Respiratory Diseases 11/2012; 73(5):249-57. DOI:10.4046/trd.2012.73.5.249
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    ABSTRACT: Introduction Mild hypoglycemia is associated with increased mortality in critically ill patients. However, data regarding the association between mild hypoglycemia and patient outcomes among patients with sepsis are limited. Methods Patients admitted to a medical ICU for sepsis, as defined by the Surviving Sepsis Campaign guidelines, during a 3-year period were enrolled retrospectively. Data on blood glucose (BG) control parameters and patient outcomes were collected. The primary outcome was the relationship of mild hypoglycemia (defined as minimum BG of 40 to 69 mg/dl during ICU stay) to hospital mortality, and the secondary outcomes were ICU-acquired complication rates, ICU and 1-year mortality rates. A relationship between glucose variability and hypoglycemic events was also investigated. Results Three-hundred and thirteen consecutive patients with sepsis were enrolled (mean age, 71.8 ± 11.3 years; male, n = 166; diabetics, n = 102). A total of 14,249 (5.6/day/patient) BG tests were performed, and 175 hypoglycemic events (spontaneous, n = 71; iatrogenic, n = 104) occurred in 80 (25.6%) patients during the ICU stay; severe hypoglycemia (minimum BG level < 40 mg/dl) occurred in 24 (7.7%) patients, and mild hypoglycemia (minimum BG level 40 to 69 mg/dl) was found in 56 (17.9%) patients. The frequency of hypoglycemic events increased with higher glucose variability, and patients with mild hypoglycemia had higher rates of ICU-acquired complications than did those with no hypoglycemia (renal, 36.2% vs. 15.6%, P = 0.003; cardiac, 31.9% vs. 14.3%, P = 0.008; hepatic, 34.0% vs. 18.2%, P = 0.024; bacteremia, 14.9% vs. 4.5%, P = 0.021). Multivariate analysis revealed that mild hypoglycemia was independently associated with increased hospital mortality (odds ratio, 3.43; 95% confidence interval, 1.51 to 7.82), and even a single event was an independent risk factor (odds ratio, 2.98; 95% confidence interval, 1.10 to 8.09). Kaplan-Meier analysis demonstrated that mild hypoglycemia was significantly associated with a lower 1-year cumulative survival rate among patients with sepsis (P < 0.001). Conclusion Mild hypoglycemia was associated with increased risk of hospital and 1-year mortality, as well as the occurrence of ICU-acquired complications. Physicians thus need to recognize the importance of mild hypoglycemia in patients with sepsis.
    Critical care (London, England) 10/2012; 16(5):R189. DOI:10.1186/cc11674
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    ABSTRACT: The purpose of this study was to investigate the clinical aspects of patients satisfying the Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor severity criteria, focusing on their treatment response to empirical antibiotics. In total, 381 community-acquired pneumonia (CAP) patients who did not require mechanical ventilation or vasopressors at admission were enrolled, and 50 (13.1%) satisfied the minor severity criteria (i.e. , minor severe CAP [minor-SCAP]). The rates of new complication events and clinical treatment failure were significantly higher in the minor-SCAP group than in the control group (30.0% vs 2.1%, P < 0.001, and 42.0% vs 10.6%, P < 0.001, respectively), and the time to reach clinical stability was longer in the minor-SCAP group (8 days vs 3 days, P < 0.001). In a multivariate model, minor severity criteria (≥ 3) were significantly associated with treatment failure (odds ratio, 2.838; 95% confidence interval, 1.216 to 6.626), and for predicting treatment failure the value of the area under the receiver operating characteristic curve for minor criteria was 0.731, similar to other established scoring methods. The IDSA/ATS minor severity criteria can predict delayed treatment response and clinical treatment failure.
    Journal of Korean medical science 08/2012; 27(8):907-13. DOI:10.3346/jkms.2012.27.8.907 · 1.25 Impact Factor
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    ABSTRACT: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.
    05/2012; 72(5):441-7. DOI:10.4046/trd.2012.72.5.441
  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012
  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012
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    ABSTRACT: A new spirometric reference equation was recently developed from the first national chronic obstructive pulmonary disease (COPD) survey in Korea. However, Morris' equation has been preferred for evaluating spirometric values instead. The objective of this study was to evaluate changes in severity staging in Korean COPD patients by adopting the newly developed Korean equation. We evaluated the spirometric data of 441 COPD patients. The presence of airflow limitation was defined as an observed post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) less than 0.7, and the severity of airflow limitation was assessed according to GOLD stages. Spirometric values were reassessed using the new Korean equation, Morris' equation and other reference equations. The severity of airflow limitation was differently graded in 143 (32.4%) patients after application of the new Korean equation when compared with Morris' equation. All 143 patients were reallocated into more severe stages (49 at mild stage, 65 at moderate stage, and 29 at severe stage were changed to moderate, severe and very severe stages, respectively). Stages according to other reference equations were changed in 18.6-49.4% of the patients. These results indicate that equations from different ethnic groups do not sufficiently reflect the airflow limitation of Korean COPD patients. The Korean reference equation should be used for Korean COPD patients in order to administer proper treatment.
    Yonsei medical journal 03/2012; 53(2):363-8. DOI:10.3349/ymj.2012.53.2.363 · 1.26 Impact Factor
  • American Thoracic Society 2011 International Conference, May 13-18, 2011 • Denver Colorado; 05/2011
  • American Thoracic Society 2011 International Conference, May 13-18, 2011 • Denver Colorado; 05/2011
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    ABSTRACT: Few data are available on sinus tachycardia among medical intensive care unit (ICU) patients. We investigated new critical illnesses related to new-onset prolonged sinus tachycardia (NOPST) and the relationship of NOPST with ICU mortality. The heart rate (HR) of all enrolled patients was monitored hourly over a 12-month period, and NOPST was defined as sinus tachycardia (>100 beats/min) with an increase in HR of more than 20% from the baseline value lasting longer than 6 hours. Among the 522 patients enrolled, the average mean HR was 96.1 ± 18.4 beats/min. Fifty-two (10.0%) patients met the criteria for NOPST; pneumonia, delirium, septic shock, acute respiratory distress syndrome, catheter-related infections, and mechanical ventilator-related problems were related to the occurrence of NOPST. The ICU mortality rate in patients with a NOPST duration of more than 72 hours was higher compared with other patients with NOPST (60.0% vs 18.5%; P = .002). A high daily mean HR rather than NOPST was a significant predictor of ICU mortality (odds ratio, 1.415; 95% confidence interval, 1.177-1.700). Although NOPST was not associated with ICU mortality, it indicates the presence of new critical events in the medical ICU setting.
    Journal of critical care 03/2011; 26(5):534.e1-8. DOI:10.1016/j.jcrc.2011.01.001 · 2.19 Impact Factor