Acute and Critical Care

Original Articles

Pulmonary
Association between nutritional risk scores and timing of endotracheal intubation in COVID-19-associated acute respiratory distress syndrome: a single-center cohort study in South Korea: Hyojin Jang, Wanho Yoo, Kwangha Lee; Acute Crit Care. 2025;40(4):538-547. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.003900

1,422 View
124 Download

Abstract PDF: Background
The optimal timing of endotracheal intubation in patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) remains uncertain, and delayed intubation is associated with worse outcomes. Nutritional status, known to affect respiratory function and immune response, may help identify patients at risk of rapid deterioration. This study aimed to evaluate whether nutritional risk scores can predict early intubation in COVID-19-associated ARDS.
Methods
We retrospectively analyzed 247 patients with COVID-19-associated ARDS admitted to a tertiary hospital intensive care unit. Nutritional status at admission was assessed using the modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the Prognostic Nutritional Index (PNI). Early intubation was defined as occurring within 24 hours of hospital admission. Receiver operating characteristic curves and multivariate logistic regression were used to evaluate predictive performance
Results
Of 247 patients, 193 (78.1%) required mechanical ventilation, and 133 (68.9%) underwent early intubation. The mNUTRIC score showed moderate discriminatory performance (area under the curve [AUC], 0.705), while PNI performed poorly (AUC, 0.401). In a multivariate analysis adjusted for illness severity, only Acute Physiology and Chronic Health Evaluation II (OR, 1.206, P<0.001) and SOFA scores (OR, 1.270, P=0.028) were independent predictors of early intubation. The mNUTRIC score was not independently associated (P>0.05), suggesting its value is derived from component severity.
Conclusions
The predictive power of the mNUTRIC score for early intubation in COVID-19 ARDS was primarily driven by its embedded illness severity components. Nevertheless, the score demonstrated practical utility as a single, composite marker for rapid, holistic evaluation of patient risk.

Pulmonary/Policy
Association between the National Health Insurance coverage benefit extension policy and clinical outcomes of ventilated patients: a retrospective study: Wanho Yoo, Saerom Kim, Soohan Kim, Eunsuk Jeong, Kwangha Lee; Acute Crit Care. 2022;37(1):53-60. Published online February 22, 2022; DOI: https://doi.org/10.4266/acc.2021.01389

8,262 View
188 Download
2 Web of Science
2 Crossref

Background
This study aimed to investigate the association between the Korean National Health Insurance coverage benefit extension policy and clinical outcomes of patients who were ventilated owing to various respiratory diseases.
Methods
Data from 515 patients (male, 69.7%; mean age, 69.8±12.1 years; in-hospital mortality rate, 28.3%) who were hospitalized in a respiratory intensive care unit were retrospectively analyzed over 5 years.
Results
Of total enrolled patients, 356 (69.1%) had one benefit items under this policy during their hospital stay. They had significantly higher medical expenditure (total: median, 23,683 vs. 12,742 U.S. dollars [USD], P<0.001), out-of-pocket (median, 5,932 vs. 4,081 USD; P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (median, 26.0% vs. 32.2%; P<0.001). Patients without benefit items associated with higher in-hospital mortality (hazard ratio [HR], 2.794; 95% confidence interval [CI], 1.980–3.941; P<0.001). In analysis of patients with benefit items, patients with three items (“cancer,” “tuberculosis,” and “disability”) had significantly lower out-of-pocket medical expenditure (3,441 vs. 6,517 USD, P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (17.2% vs. 27.7%, P<0.001). They were associated with higher in-hospital mortality (HR, 3.904; 95% CI, 2.533–6.039; P<0.001).
Conclusions
Our study showed patients with benefit items had more medical resources and associated improved in-hospital survival. Patients with the aforementioned three benefit items had lower out-of-pocket medical expenditure due to the implementation of this policy, but higher in-hospital mortality.

Citations

Citations to this article as recorded by

Association between health insurance benefit extension policy and long-term outcomes in ventilated pneumonia patients: Analysis of a nationwide dataset
Wanho Yoo, Hyojin Jang, Min Ki Lee, Yeongdae Kim, Son Jungmin, Kim Jinmi, Kwangha Lee
Medicine.2025; 104(38): e44687. CrossRef
The effect of socioeconomic status, insurance status, and insurance coverage benefits on mortality in critically ill patients admitted to the intensive care unit
Moo Suk Park
Acute and Critical Care.2022; 37(1): 118. CrossRef

First
Prev
Page of 1
Next
Last

Search