Yonsei Medical Journal最新文献

{"title":"Prospective Evaluation of Various Ultrasound Parameters for Assessing Renal Allograft Rejection Subtypes: Elasticity and Dispersion as Diagnostic Tools.","authors":"Yeji Kwon, Jongjin Yoon, Dae Chul Jung, Young Taik Oh, Kyunghwa Han, Minsun Jung, Byung Chul Kang","doi":"10.3349/ymj.2024.0082","DOIUrl":"10.3349/ymj.2024.0082","url":null,"abstract":"<p><strong>Purpose: </strong>Renal allograft rejection, either acute or chronic, is prevalent among many recipients. This study aimed to identify multiple Doppler ultrasound parameters for predicting renal allograft rejection.</p><p><strong>Materials and methods: </strong>Between November 2021 and April 2022, 61 renal allograft recipients were studied prospectively after excluding two patients with dual transplants and seven with hydronephrosis. The analysis excluded 11 cases (10 due to missing Doppler data or pathology reports and one due to a high interquartile range/median dispersion value), resulting in a final analysis of 50 patients. Clinical characteristics, color Doppler imaging, superb microvascular imaging, and shear-wave imaging parameters were assessed by three experienced genitourinary radiologists. The Banff classification of the biopsy tissue served as the reference standard. Univariable and multivariable logistic regression, contingency matrices, and multiple machine-learning models were employed to estimate the associations.</p><p><strong>Results: </strong>Fifty kidney transplant recipients (mean age, 53.26±8.86 years; 29 men) were evaluated. Elasticity (≤14.8 kPa) demonstrated significant associations for predicting the combination of (borderline) T cell-mediated rejection (TCMR) categories (Banff categories 3 and 4) (<i>p</i>=0.006) and yielded equal or higher area under the receiver operating characteristics curve (AUC) values compared to various classifiers. Dispersion (>15.0 m/s/kHz) was the only significant factor for predicting the combination of non-TCMR categories (Banff categories 2, 5, and 6) (<i>p</i>=0.026) and showed equal or higher AUC values than multiple machine learning classifiers.</p><p><strong>Conclusion: </strong>Elasticity (≤14.8 kPa) showed a significant association with the combination of (borderline) TCMR categories, whereas dispersion (>15.0 m/s/kHz) was significantly associated with the combination of non-TCMR categories in renal allografts.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 4","pages":"249-258"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Evaluation of Pre-Test Probability Models for Coronary Artery Disease with Assessment of a New Machine Learning-Based Model.","authors":"Kyung-A Kim, Min Soo Kang, Byoung Geol Choi, Ji Hun Ahn, Wonho Kim, Myung-Ae Chung","doi":"10.3349/ymj.2024.0067","DOIUrl":"10.3349/ymj.2024.0067","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to validate pivotal pre-test probability (PTP)-coronary artery disease (CAD) models (CAD consortium model and IJC-CAD model).</p><p><strong>Materials and methods: </strong>Traditional PTP models-CAD consortium models: two traditional PTP models were used under the CAD consortium framework, namely CAD1 and CAD2. Machine learning (ML)-based PTP models: two ML-based PTP models were derived from CAD1 and CAD2, and used to enhance predictive capabilities [ML-CAD2 and ML-IJC (IJC-CAD)]. The primary endpoint was obstructive CAD. The performance evaluation of these PTP models was conducted using receiver-operating characteristic analysis.</p><p><strong>Results: </strong>The study included 238 participants, among whom 157 individuals (65.9% of the total sample) had CAD. The IJC-CAD model demonstrated the highest performance with an area under the curve (AUC) of 0.860 [95% confidence interval (CI): 0.812-0.909]. Following this, the ML-CAD2 model exhibited an AUC of 0.814 (95% CI: 0.758-0.870), CAD1 showed an AUC of 0.767 (95% CI: 0.705-0.830), and CAD2 had an AUC of 0.785 (95% CI: 0.726-0.845). Each of the PTP models was adjusted to have a CAD score cutoff that classified cases with a sensitivity of over 95%. The respective cutoff values were as follows: CAD1 and CAD2 >12, ML-CAD2 >0.380, and IJC-CAD >0.367. All PTP models achieved a CAD sensitivity of over 95%. Similar to the AUC performance, the accuracy of the PTP models was highest for IJC-CAD, reaching 80.3%. The accuracy of ML-CAD2 was 77.7%, while that for CAD1 and CAD2 was 74.8% and 75.2%, respectively.</p><p><strong>Conclusion: </strong>ML-CAD2 and IJC-CAD showed superior performance compared to traditional existing models (CAD1 and CAD2).</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 4","pages":"211-217"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the Interconnected Web of Health: A Comprehensive Review of the One Health Paradigm and Its Implications for Disease Management.","authors":"Andrea Hernandez, Jaehyun Lee, Hojeong Kang","doi":"10.3349/ymj.2024.0108","DOIUrl":"10.3349/ymj.2024.0108","url":null,"abstract":"<p><p>Disease outbreaks pose serious threats to humans, as highlighted by the recent pandemic, underscoring the need for an institutionalized multi-sectoral approach like One Health, encompassing human, animal, and environmental health. One Health has demonstrated efficacy in addressing emerging issues such as antimicrobial resistance and zoonotic disease spillover. While integrating the human-animal sector has yielded positive outcomes, the majority of zoonotic spillovers originate from wildlife, emphasizing the crucial role of environmental surveillance within global One Health systems. Additionally, climate change intensifies the frequency and emergence of infectious diseases and spillover events. Tackling the complexity and interconnectedness of health challenges necessitates integrated solutions that incorporate broader structural factors, aiding in the prevention, detection, and mitigation of disease outbreaks. Embracing One Health through multi-sectoral preparedness can effectively confront the escalating threats of pandemics and other emerging diseases.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 4","pages":"203-210"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Inferiority Analysis of Electrocardiography Analysis Application vs. Point-of-Care Ultrasound for Screening Left Ventricular Dysfunction.","authors":"Jin Hee Kim, Jae Yun Jung, Joonghee Kim, Youngjin Cho, Eunkyoung Lee, Dahyeon Son","doi":"10.3349/ymj.2024.0148","DOIUrl":"10.3349/ymj.2024.0148","url":null,"abstract":"<p><strong>Purpose: </strong>Point-of-care ultrasound (POCUS) is widely used for heart function evaluation in emergency departments (EDs), but requires specific equipment and skilled operators. This study evaluates the diagnostic accuracy of a mobile application for estimating left ventricular (LV) systolic dysfunction [left ventricular ejection fraction (LVEF) <40%] using electrocardiography (ECG) and tests its non-inferiority to POCUS.</p><p><strong>Materials and methods: </strong>Patients (aged ≥20 years) were included if they had both a POCUS-based EF evaluation and an ECG within 24 hours of their ED visit between January and May 2022, along with formal echocardiography within 2 weeks before or after the visit. A mobile app (ECG Buddy, EB) estimated LVEF (EF from EB) and the risk of LV dysfunction (LV-Dysfunction score) from ECG waveforms, which were compared to NT-proBNP levels and POCUS-evaluated LVEF (EF from POCUS). A non-inferiority margin was set at an area under the curve (AUC) difference of 0.05.</p><p><strong>Results: </strong>Of the 181 patients included, 37 (20.4%) exhibited LV dysfunction. The AUCs for screening LV dysfunction using POCUS and NT-proBNP were 0.885 and 0.822, respectively. EF from EB and LV-Dysfunction score outperformed NT-proBNP, with AUCs of 0.893 and 0.884, respectively (<i>p</i>=0.017 and <i>p</i>=0.030, respectively). EF from EB was non-inferior to EF from POCUS, while LV-Dysfunction score narrowly missed the mark. A subgroup analysis of sinus-origin rhythm ECGs supported the non-inferiority of both EF from EB and LV-Dysfunction score to EF from POCUS.</p><p><strong>Conclusion: </strong>A smartphone application that analyzes ECG image can screen for LV dysfunction with a level of accuracy comparable to that of POCUS.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 3","pages":"172-178"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Phenotyping of Rare Endocrine Diseases Across International Data Networks and the Effect of Granularity of Original Vocabulary.","authors":"Seunghyun Lee, Namki Hong, Gyu Seop Kim, Jing Li, Xiaoyu Lin, Sarah Seager, Sungjae Shin, Kyoung Jin Kim, Jae Hyun Bae, Seng Chan You, Yumie Rhee, Sin Gon Kim","doi":"10.3349/ymj.2023.0628","DOIUrl":"10.3349/ymj.2023.0628","url":null,"abstract":"<p><strong>Purpose: </strong>Rare diseases occur in <50 per 100000 people and require lifelong management. However, essential epidemiological data on such diseases are lacking, and a consecutive monitoring system across time and regions remains to be established. Standardized digital phenotypes are required to leverage an international data network for research on rare endocrine diseases. We developed digital phenotypes for rare endocrine diseases using the observational medical outcome partnership common data model.</p><p><strong>Materials and methods: </strong>Digital phenotypes of three rare endocrine diseases (medullary thyroid cancer, hypoparathyroidism, pheochromocytoma/paraganglioma) were validated across three databases that use different vocabularies: Severance Hospital's electronic health record from South Korea; IQVIA's United Kingdom (UK) database for general practitioners; and IQVIA's United States (US) hospital database for general hospitals. We estimated the performance of different digital phenotyping methods based on International Classification of Diseases (ICD)-10 in the UK and the US or systematized nomenclature of medicine clinical terms (SNOMED CT) in Korea.</p><p><strong>Results: </strong>The positive predictive value of digital phenotyping was higher using SNOMED CT-based phenotyping than ICD-10-based phenotyping for all three diseases in Korea (e.g., pheochromocytoma/paraganglioma: ICD-10, 58%-62%; SNOMED CT, 89%). Estimated incidence rates by digital phenotyping were as follows: medullary thyroid cancer, 0.34-2.07 (Korea), 0.13-0.30 (US); hypoparathyroidism, 0.40-1.20 (Korea), 0.59-1.01 (US), 0.00-1.78 (UK); and pheochromocytoma/paraganglioma, 0.95-1.67 (Korea), 0.35-0.77 (US), 0.00-0.49 (UK).</p><p><strong>Conclusion: </strong>Our findings demonstrate the feasibility of developing digital phenotyping of rare endocrine diseases and highlight the importance of implementing SNOMED CT in routine clinical practice to provide granularity for research.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 3","pages":"187-194"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Approach to Epilepsy in Patients with Mitochondrial Diseases.","authors":"Ji-Hoon Na, Young-Mock Lee","doi":"10.3349/ymj.2024.0325","DOIUrl":"10.3349/ymj.2024.0325","url":null,"abstract":"<p><p>Mitochondrial diseases (MDs) are genetic disorders with diverse phenotypes that affect high-energy-demand organs, notably the central nervous system and muscles. Epilepsy is a common comorbidity, affecting 40%-60% of patients with MDs and significantly reducing their quality of life. This review discusses the different treatment modalities for epilepsy in patients with MDs. Advances in genetic sequencing have identified specific mutations in mitochondrial and nuclear DNA, enabling more precise diagnoses and tailored therapeutic strategies. Anti-seizure medications and dietary interventions, such as ketogenic diets and their variants, have been effective in reducing seizures and improving mitochondrial function. Emerging treatments include gene therapy, mitochondrial transplantation, and antioxidants such as EPI-743, which protect mitochondrial integrity and improve neurological function. Additionally, therapies that promote mitochondrial biogenesis, such as bezafibrate and epicatechin, are being explored for their potential to enhance mitochondrial proliferation and energy production. Gene therapy aims to correct genetic defects underlying MDs. Techniques like mitochondrial gene replacement and using viral vectors to deliver functional genes have shown promise in preclinical studies. Mitochondrial transplantation, an emerging experimental technique, involves transferring healthy mitochondria into cells with dysfunctional mitochondria. This technique has been demonstrated to restore mitochondrial function and energy metabolism in preclinical models. Patient-derived induced pluripotent stem cells can model specific mitochondrial dysfunctions in vitro, allowing for the testing of various treatments tailored to individual genetic and biochemical profiles. The future of mitochondrial medicine is promising, with the development of more targeted and personalized therapeutic strategies offering hope for improved management and prognosis of mitochondrial epilepsy.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 3","pages":"131-140"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated Soluble Suppressor of Tumorigenicity 2 Levels in Gout Patients and Its Association with Cardiovascular Disease Risk Indicators.","authors":"Jiyoung Agatha Kim, Ji Eun Lee, Kunhyung Bae, Sung Soo Ahn","doi":"10.3349/ymj.2024.0001","DOIUrl":"10.3349/ymj.2024.0001","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between soluble suppressor of tumorigenicity 2 (sST2) levels and cardiovascular disease predictors in patients with gout.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed the medical records of patients with gout who were tested for sST2 but did not receive uric acid-lowering therapy. These patients were classified into elevated and normal sST2 groups using a cut-off of >49.6 ng/mL and >35.4 ng/mL in males and females, respectively. Correlations between clinical and laboratory variables, sST2 levels, and elevated sST2 level predictors were assessed using linear and logistic regression analyses.</p><p><strong>Results: </strong>Notably, 27 (11.3%) and 211 (88.7%) of the 238 identified patients had elevated and normal sST2 levels, respectively. Linear regression analysis revealed that male sex (β=-0.190, <i>p</i>=0.002), body mass index (BMI) (β=-0.184, <i>p</i>=0.002), white blood cell count (β=0.231, <i>p</i><0.001), C-reactive protein (β=0.135, <i>p</i>=0.031), and fasting blood glucose (β=0.210, <i>p</i><0.001) were independently associated with sST2 levels. In multivariate logistic regression analysis, male sex [odds ratio (OR) 0.112, <i>p</i>=0.001], BMI (OR 0.836, <i>p</i>=0.008), creatinine (OR 5.730, <i>p</i>=0.024), and fasting blood glucose (OR 1.042, <i>p</i>=0.002) predicted elevated sST2 levels. Patients with increased sST2 levels had a significantly higher atherosclerotic cardiovascular disease risk score and a greater proportion of high-risk Framingham Risk Score compared to the normal sST2 group (<i>p</i>=0.002 and <i>p</i><0.001).</p><p><strong>Conclusion: </strong>Patients with gout and elevated sST2 levels have a higher risk of future cardiovascular disorders, which may provide insights into risk stratification and the implementation of intervention strategies.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 3","pages":"151-159"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Treatment Outcomes Depending on the Adjuvant Treatment Modality in Craniopharyngioma.","authors":"Byung Min Lee, Jaeho Cho, Dong-Seok Kim, Jong Hee Chang, Seok-Gu Kang, Eui-Hyun Kim, Ju Hyung Moon, Sung Soo Ahn, Yae Won Park, Chang-Ok Suh, Hong In Yoon","doi":"10.3349/ymj.2023.0566","DOIUrl":"10.3349/ymj.2023.0566","url":null,"abstract":"<p><strong>Purpose: </strong>Adjuvant treatment for craniopharyngioma after surgery is controversial. Adjuvant external beam radiation therapy (EBRT) can increase the risk of long-term sequelae. Stereotactic radiosurgery (SRS) is used to reduce treatment-related toxicity. In this study, we compared the treatment outcomes and toxicities of adjuvant therapies for craniopharyngioma.</p><p><strong>Materials and methods: </strong>We analyzed patients who underwent craniopharyngioma tumor removal between 2000 and 2017. Of the 153 patients, 27 and 20 received adjuvant fractionated EBRT and SRS, respectively. We compared the local control (LC), progression-free survival (PFS), and overall survival between groups that received adjuvant fractionated EBRT, SRS, and surveillance.</p><p><strong>Results: </strong>The median follow-up period was 77.7 months. For SRS and surveillance, the 10-year LC was 57.2% and 57.4%, respectively. No local progression was observed after adjuvant fractionated EBRT. One patient in the adjuvant fractionated EBRT group died owing to glioma 94 months after receiving radiotherapy (10-year PFS: 80%). The 10-year PFS was 43.6% and 50.7% in the SRS and surveillance groups, respectively. The treatment outcomes significantly differed according to adjuvant treatment in non-gross total resection (GTR) patients. Additional treatment-related toxicity was comparable in the adjuvant fractionated EBRT and other groups.</p><p><strong>Conclusion: </strong>Adjuvant fractionated EBRT could be effective in controlling local failure, especially in patients with non-GTR, while maintaining acceptable treatment-related toxicity.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 3","pages":"141-150"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Model for Projecting the Number of Doctors in South Korea.","authors":"Se-Jik Kim","doi":"10.3349/ymj.2024.0400","DOIUrl":"10.3349/ymj.2024.0400","url":null,"abstract":"<p><p>This paper develops a new model for forecasting potential shortfalls in the healthcare sector, providing an economically grounded framework for projections. The model is applied to assess potential doctor shortages in South Korea over the next decade under reasonable economic scenarios. Our analysis indicates that demand for healthcare, driven by aging-related factors, is projected to grow at an annual rate of 1.3% to 1.9%. In contrast, the supply of healthcare-bolstered by technological advancements, improved medical equipment, and natural growth in the doctor workforce-is expected to increase by 3.2% annually. These findings suggest that South Korea's healthcare system is likely to meet future demand without necessitating an expansion of medical school admissions.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 3","pages":"195-201"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Application of New Risk-Adjustment Models to Improve the Current Model for Hospital Standardized Mortality Ratio in South Korea.","authors":"Hyeki Park, Ji-Sook Choi, Min Sun Shin, Soomin Kim, Hyekyoung Kim, Nahyeong Im, Soon Joo Park, Donggyo Shin, Youngmi Song, Yunjung Cho, Hyunmi Joo, Hyeryeon Hong, Yong-Hwa Hwang, Choon-Seon Park","doi":"10.3349/ymj.2023.0545","DOIUrl":"10.3349/ymj.2023.0545","url":null,"abstract":"<p><strong>Purpose: </strong>This study assessed the validity of the hospital standardized mortality ratio (HSMR) risk-adjusted model by comparing models that include clinical information and the current model based on administrative information in South Korea.</p><p><strong>Materials and methods: </strong>The data of 53976 inpatients were analyzed. The current HSMR risk-adjusted model (Model 1) adjusts for sex, age, health coverage, emergency hospitalization status, main diagnosis, surgery status, and Charlson Comorbidity Index (CCI) using administrative data. As candidate variables, among clinical information, the American Society of Anesthesiologists score, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 3, present on admission CCI, and cancer stage were collected. Surgery status, intensive care in the intensive care unit, and CCI were selected as proxy variables among administrative data. In-hospital death was defined as the dependent variable, and a logistic regression analysis was performed. The statistical performance of each model was compared using C-index values.</p><p><strong>Results: </strong>There was a strong correlation between variables in the administrative data and those in the medical records. The C-index of the existing model (Model 1) was 0.785; Model 2, which included all clinical data, had a higher C-index of 0.857. In Model 4, in which APACHE II and SAPS 3 were replaced with variables recorded in the administrative data from Model 2, the C-index further increased to 0.863.</p><p><strong>Conclusion: </strong>The HSMR assessment model improved when clinical data were adjusted. Simultaneously, the validity of the evaluation method could be secured even if some of the clinical information was replaced with the information in the administrative data.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 3","pages":"179-186"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}