Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
권호 표지
DOI QR코드

DOI QR Code

The Effects of Agent Orange in Patient with Pneumonia

고엽제 노출이 폐렴의 치료 결과에 미치는 영향

  • Kim, Dong Sung (Department of Emergency Medicine, Veterans Health Service Medical Center) ;
  • Lee, Jungyoup (Department of Emergency Medicine, Veterans Health Service Medical Center) ;
  • Kye, Yu Chan (Department of Emergency Medicine, Veterans Health Service Medical Center) ;
  • Jung, Euigi (Department of Emergency Medicine, Veterans Health Service Medical Center) ;
  • Jeong, Ki Young (Department of Emergency Medicine, Kyung Hee University Medical Center)
  • 김동성 (중앙보훈병원 응급의학과) ;
  • 이정엽 (중앙보훈병원 응급의학과) ;
  • 계유찬 (중앙보훈병원 응급의학과) ;
  • 정의기 (중앙보훈병원 응급의학과) ;
  • 정기영 (경희대학교병원 응급의학과)
  • Received : 2020.02.10
  • Accepted : 2020.04.03
  • Published : 2020.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Agent Orange (AO) is a herbicide and defoliant used by the United States and its military allies during the Vietnam War. Pneumonia is a common cause of death among Vietnam veterans in our hospital. There have been no previous studies researching any association between AO exposure and the prognosis for pneumonia. The primary objective of this study was to investigate associations between AO exposure and 30-day mortality due to pneumonia. The secondary objective was to examine the clinical factors associated with therapeutic outcomes in veterans with pneumonia, and to assess the prevalence of combined diseases in AO-exposed veterans. Methods: This study retrospectively included veteran patients diagnosed with pneumonia in the emergency department and hospitalized between February 2014 and March 2018. The enrolled patients were grouped according to their defoliant exposure history, and the clinical information of defoliant-exposed and non-defoliant-exposed groups were compared. Patients were divided according to 30-day mortality, and significant factors influencing mortality were evaluated by using univariate analysis and multivariate analysis. The final multivariate model revealed the effect of AO exposure on therapeutic outcomes of pneumonia. Results: A total of 1006 patients were analyzed. Of these, 276 patients had a history of AO exposure, whereas 730 patients had not been exposed. Factors positively associated with 30-day mortality were malignancy, respiratory rate, blood urea nitrogen, and albumin which was negatively associated with mortality. Conclusion: Exposure to defoliant is not associated with 30-day mortality in patients with pneumonia. However, veterans with defoliant exposure are associated with a high prevalence of diabetes mellitus, hypertension, cerebrovascular accident, malignancy, and chronic kidney disease.

Keywords

References

  1. Kang HK, Dalager NA, Needham LL, et al. Health status of Army Chemical Corps Vietnam veterans who sprayed defoliant in Vietnam. Am J Ind Med 2006;49:875-84. https://doi.org/10.1002/ajim.20385
  2. Boehmer TK, Flanders WD, McGeehin MA, et al. Postservice mortality in Vietnam veterans: 30-year follow-up. Arch Intern Med 2004;164:1908-16. https://doi.org/10.1001/archinte.164.17.1908
  3. Cypel Y, Kang H. Mortality patterns of Army Chemical Corps veterans who were occupationally exposed to herbicides in Vietnam. Ann Epidemiol 2010;20:339-46. https://doi.org/10.1016/j.annepidem.2010.02.003
  4. Dalager NA, Kang HK. Mortality among Army Chemical Corps Vietnam veterans. Am J Ind Med 1997;31:719-26. https://doi.org/10.1002/(SICI)1097-0274(199706)31:6<719::AID-AJIM8>3.0.CO;2-L
  5. Ketchum NS, Michalek JE. Postservice mortality of Air Force veterans occupationally exposed to herbicides during the Vietnam War: 20-year follow-up results. Mil Med 2005;170:406-13. https://doi.org/10.7205/MILMED.170.5.406
  6. McBride D, Cox B, Broughton J, et al. The mortality and cancer experience of New Zealand Vietnam war veterans: a cohort study. BMJ Open 2013;3:e003379. https://doi.org/10.1136/bmjopen-2013-003379
  7. Michalek JE, Ketchum NS, Akhtar FZ. Postservice mortality of US Air Force veterans occupationally exposed to herbicides in Vietnam: 15-year follow-up. Am J Epidemiol 1998;148:786-92. https://doi.org/10.1093/oxfordjournals.aje.a009699
  8. Visintainer PF, Barone M, McGee H, et al. Proportionate mortality study of Vietnam-era veterans of Michigan. J Occup Environ Med 1995;37:423-8. https://doi.org/10.1097/00043764-199504000-00013
  9. Watanabe KK, Kang HK. Military service in Vietnam and the risk of death from trauma and selected cancers. Ann Epidemiol 1995;5:407-12. https://doi.org/10.1016/1047-2797(95)00039-A
  10. Yi SW, Ryu SY, Ohrr H, et al. Agent Orange exposure and risk of death in Korean Vietnam veterans: Korean Veterans Health Study. Int J Epidemiol 2014;43:1825-34. https://doi.org/10.1093/ije/dyu183
  11. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50. https://doi.org/10.1056/NEJM199701233360402
  12. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44:27-72.
  13. Jackson ML, Neuzil KM, Thompson WW, et al. The burden of community-acquired pneumonia in seniors: results of a population-based study. Clin Infect Dis 2004;39:1642-50. https://doi.org/10.1086/425615
  14. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50. https://doi.org/10.1056/NEJM199701233360402
  15. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377-82. https://doi.org/10.1136/thorax.58.5.377
  16. Tablan OC, Anderson LJ, Besser R, et al. Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004;53:1-36.
  17. Niederman MS. Guidelines for the management of respiratory infection: why do we need them, how should they be developed, and can they be useful? Curr Opin Pulm Med 1996;2:161-5. https://doi.org/10.1097/00063198-199605000-00001
  18. American Thoracic S, Infectious Diseases Society of A. Guidelines for the management of adults with hospitalacquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416. https://doi.org/10.1164/rccm.200405-644ST
  19. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017;43:304-77. https://doi.org/10.1007/s00134-017-4683-6
  20. Moses T, Holland PW. A comparison of statistical selection strategies for univariate and bivariate log-linear models. Br J Math Stat Psychol 2010;63:557-74. https://doi.org/10.1348/000711009X478580
  21. Bello S, Fandos S, Lasierra AB, et al. Red blood cell distribution width [RDW] and long-term mortality after community-acquired pneumonia. A comparison with proadrenomedullin. Respir Med 2015;109:1193-206. https://doi.org/10.1016/j.rmed.2015.07.003
  22. Lee J, Kim K, Jo YH, et al. Severe thinness is associated with mortality in patients with community-acquired pneumonia: a prospective observational study. Am J Emerg Med 2015;33:209-13. https://doi.org/10.1016/j.ajem.2014.11.019