Özgür Batum

Background: Epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and ROS-1 mutations are critical for targeted therapy in lung adenocarcinoma. This study evaluated whether CT features can predict mutation positivity in stage IV lung adenocarcinoma. Material and Methods: We retrospectively analyzed 810 patients. CT images were reviewed for tumor size, ground-glass opacity (GGO), convergence, cavitation, and other features. Multivariate logistic regression identified independent predictors, and ROC analysis determined optimal cut-offs. Results: Mutation positivity was identified in 96 of the 810 patients (11.9%), most commonly EGFR (n=76), followed by ALK (n=14) and ROS-1 (n=6). Independent predictors included age ≤50 years (OR: 1.95; p=0.038), never-smoking (OR: 12.11; p<0.001), tumor short diameter <3 cm (OR: 2.44; p=0.001), presence of GGO (OR: 3.41; p<0.001), convergence (OR: 1.72; p=0.042), and cavity formation (OR: 9.86; p=0.040). ROC analysis demonstrated moderate discriminatory power for age, tumor diameter, and GGO. erj;68/suppl_70/PA1019/F1 F1 F1 Conclusion: Alongside clinical predictors, thoracic CT features—particularly GGO, small tumor size, cavitation, and convergence—were independently associated with mutation positivity in stage IV lung adenocarcinoma. These non-invasive markers may guide molecular testing and early treatment decisions when tissue sampling is limited.

Background: Intermediate-high and high-risk pulmonary embolism (PE) are associated with substantial mortality despite anticoagulation. While reperfusion therapies may improve outcomes, real-world evidence comparing treatment strategies and identifying predictors of mid-term mortality remains limited. We aimed to evaluate predictors of 90-day mortality and the impact of reperfusion therapy in patients with intermediate-high and high-risk PE managed within a multidisciplinary Pulmonary Embolism Response Team (PERT). Methods: This retrospective cohort study included 114 consecutive patients with intermediate-high or high-risk acute PE admitted to a tertiary referral center between October 2023 and December 2024. Risk stratification was performed according to ESC guidelines, and simplified Pulmonary Embolism Severity Index (sPESI) scores were calculated. Treatment strategies included anticoagulation alone or reperfusion therapy (systemic thrombolysis or catheter-directed therapy). The primary endpoint was all-cause 90-day mortality. Multivariate logistic regression was performed to identify independent predictors of mortality. Results: The mean age was 68 ± 16 years, and 88% had at least one comorbidity. Reperfusion therapy was administered to 27% of patients. Mortality rates were 1% at 24 h, 6% at 7 days, 17% at 30 days, and 25% at 90 days. In multivariate analysis, hemoglobin ≤ 11.7 g/dL (OR 5.06, 95% CI 1.58–16.17, p = 0.006), sPESI > 2 (OR 4.86, 95% CI 1.49–15.84, p = 0.009), prior stroke (OR 11.59, 95% CI 2.08–64.51, p = 0.005), and high 30-day mortality risk classification (OR 14.14, 95% CI 1.19–167.89, p = 0.036) were independent predictors of mortality. Reperfusion therapy was independently associated with a significant reduction in 90-day mortality (OR 0.05, 95% CI 0.003–0.65, p = 0.022). The regression model demonstrated good explanatory power (Nagelkerke R² = 0.487). Conclusions: In this real-world cohort of intermediate-high and high-risk PE, reperfusion therapy was independently associated with lower 90-day mortality and low bleeding risk. In addition to established predictors, sPESI retained strong prognostic value beyond its traditional 30-day timeframe. These findings support risk-adapted reperfusion strategies guided by multidisciplinary teams and reinforce the role of integrated clinical risk assessment in optimizing outcomes.

Chronic thromboembolic pulmonary disease (CTEPD) is a severe long-term complication of acute pulmonary thromboembolism (PTE). Its pathogenesis is multifactorial, involving incomplete thrombus resolution, hemodynamic burden, comorbidities, and genetic factors. However, the contribution of inherited thrombophilic mutations to CTEPD development remains controversial. This retrospective cohort study included 204 patients diagnosed with acute PTE at a tertiary referral center between December 2023 and December 2024. Baseline demographic, clinical, laboratory, and echocardiographic data were collected. Genetic analysis assessed Factor II, Factor V Leiden, MTHFR C677T, MTHFR A1298C, Factor XIII V34L, and PAI-1 4G/5G polymorphisms. Patients were followed for at least 12 months for the development of CTEPD, defined according to guideline-based hemodynamic and imaging criteria. During follow-up, 17 patients (8.3%) developed CTEPD. Patients with CTEPD were significantly older and had higher baseline and follow-up systolic pulmonary artery pressure (sPAP) (p < 0.001), elevated NT-proBNP and troponin levels (both p < 0.001), and more frequent comorbidities, including cardiac and renal disease. Multivariate logistic regression identified comorbid diseases (HR: 0.17, 95% CI: 0.039–0.80, p = 0.025) and genetic thrombophilic factors (HR: 0.30, 95% CI: 0.10–0.91, p = 0.034) as independent predictors. Among genetic variants, only the PAI-1 4G/5G polymorphism was significantly associated with CTEPD (p = 0.001). Our study demonstrates that advanced age, comorbid diseases, elevated cardiac biomarkers, and genetic predisposition are associated with the development of CTEPD after acute PTE, while the PAI-1 4G/5G polymorphism may contribute to CTEPD susceptibility within a multifactorial context.

Amaç: Suda boğulma, ölümle sonuçlanabilen ciddi bir halk sağlığı sorunudur. Boğulayazma ise bireyin suda boğulma tehlikesini atlatmasıdır. Bu çalışmada, yoğun bakım sonrası serviste izlenen 17 boğulayazma olgusu sunulmuş; özellikle nadir pulmoner nedenli iki vaka detaylı olarak incelenmiştir. Gereç ve yöntem: Mayıs 2024 – Eylül 2024 tarihleri arasında İzmir Şehir Hastanesi’nde izlenen 17 boğulayazma vakasının tümü yoğun bakım sonrası şifa ile taburcu edilmiştir. Olguların %64.7’si erkekti ve ortalama yaş 52.6 olarak bulundu. Vakaların %64.7’si entübe edilmeden, geri kalanlar ortalama 4.5 gün entübe şekilde izlenmiştir. Ortalama yoğun bakım süresi 4.8 gün, servis süresi 5.1 gündür. Hastaların %70’inde en az bir kronik hastalık, %11.7’sinde pulmoner hastalık öyküsü mevcuttu. Görüntülemelerde tüm olgularda bilateral infiltrasyon, %82.3’ünde sağ akciğerde belirgin tutulum saptandı. Pulmoner nedenler saptanan iki olgu detaylıca sunulmuştur. Sonuç: Suda boğulayazma olgularında yalnızca resüsitasyon değil, etiyolojik değerlendirme de hayat kurtarıcı olabilir. Pulmoner nedenler, özellikle genç hastalarda tanı konulamayan boğulma olaylarının nedeni olabilmektedir. Bu nedenle, kapsamlı klinik ve radyolojik değerlendirme büyük önem taşımaktadır. Anahtar kelimeler: Suda boğulma, Boğulayazma, Pulmoner emboli, Uyku apne sendromu, Yoğun bakım.

Aim: The effect of outpatient pulmonary rehabilitation (OPR) on mortality in COPD patients is little understood. The aim of this study was to evaluate the effect of completing an OPR program on 3-year mortality in patients with COPD. Materials and methods: The study included 447 COPD patients who were eligible for the OPR between January 2012 and December 2015. While 288 COPD patients finished the program (8 weeks, 2 times a week), 159 individuals did not begin the program or dropped out. The findings were classified into three groups: those who completed the program, those who dropped out, and those who did not begin the program. Conclusion: After 3-years follow up, the mortality of the patients who completed the program were statistically significantly lower than those who did not. As a result of the cox regression, multivariate analysis to measure the effect of PR, the mortality of patients who dropped out the PR was 1.93 times higher than those who completed it (p=0.012, HR:1.1-3.2). The mortality of patients who did not start PR was 2.08 times higher than those who completed it (p=0.014, HR:1.1-3.7). The mortality rate of patients with COPD who completed the PR program was found to be lower. Keywords: COPD, pulmonary rehabilitation, mortality, health status, exercise capacity

Aim:The purpose of this study was to determine the host risk factors associated with mortality in COVID-19 patients who are hospitalized for pneumonia, and also, to find a COVID-19 mortality score based on these. Methods:All patients diagnosed as confirmed or probable COVID-19 pneumonia whom hospitalised in our Chest Diseases Education and Research Hospital between March 11, 2020 and October 1,2020 were enrolled. The optimal cut-off values, sensitivity and specificity values and odds ratios to be used in mortality prediction of the novel scoring system created from these parameters were calculated by ROC analysis according to the area under the curve and Youden index. Results:Over 422 patients (n: 51 mortal, n: 371 survivors) univariate regression analysis showed that age, male gender, smoking, comorbidity, and using ACE inhibitor were prognostic host risk factors for COVID-19-related mortality. Using this analysis, a novel scoring model Co-AMSCA (Age, Male, Smoking history, Comorbidity, ACE inh)was established. The cut-off value of this scoring system (including only host risk factors), which determines the mortality risk in patients, was 3.5 points with 88.4% sensitivity and 65.5 % specificity (AUC = 0.761, 95% CI 0.697-0.826, P < .001) (Figure 1). The mortality risk in patients with a Co-AMSCA mortality score above 3.5 points was 7.8 times higher than patients with lower than 3.5 (OR= 7.8; P < .001).In multivariate logistic regression analysis, older age and smoking (smoker/ex-smoker) were found to be important risk factors for mortality (OR = 12.09; 95% CI 2,564-57,054 P =0.004 and OR = 3.1; 95% CI 1,381-7,295; P = 0.007,respectively). Counclusion:We created a simple mortality score, which is easily calculated and does not require laboratory and time.This study showed that by using Co-AMSCA mortality score that has only host risk factors achieved a prediction of mortality in COVID-19 patients who are hospitalized for pneumonia.

Objective: Epilepsy, pneumonia, gastritis, esophagitis, malnutrition, dehydration, fractures, and non-pneumonic lung disorders (asthma, pleural fluid, respiratory failure) are the leading causes of hospitalization among cerebral palsy (CP) patients. This study aimed to determine respiratory tract diseases and mortality rates in patients with CP admitted to the chest diseases hospital. Materials and Methods: Patients diagnosed with CP and hospitalized in Chest Diseases Hospital between January 2010 and December 2017 were included in the study and analyzed retrospectively. As the endpoint, hospitalized patients' respiratory tract infection-related 30-days mortality were examined. Results: Forty-three hospitalizations of 23 patients were evaluated. The mean length of hospital stay was 15.5 (1-62) days. The reasons for hospitalization in patients with CP were mainly composed of respiratory tract infections (pneumonia %88,4, lung abscess %7). The most frequently isolated pathogenic microorganisms were gram-negative bacteria. Wheezing, bacterial culture growth, vasopressor and invasive mechanical ventilation were all factors that increased 30-day mortality (respectively p=0,016; p=0,024; p=0,003; p=0,003). The 30-day mortality rate was %21,7. While 2 patients died at first hospitalization, 4 patients died on recurrent hospitalizations. Conclusion: Patients with CP are often hospitalized due to respiratory tract infections. Recurrent hospitalizations may increase mortality. This study emphasizes the importance of close follow-up with these patients considering the high mortality rate among CP patients hospitalized for respiratory tract infections.

Background: The COVID‐19 pandemic, which first appeared in Wuhan, China, in December 2019 and spread rapidly around the globe, continues to be a serious threat today. Rapid and accurate diagnostic methods are needed to identify, isolate and treat patients as soon as possible because of the rapid contagion of COVID‐19. In the present study, the relation of the semi‐quantitative scoring method with computed tomography in the diagnosis of COVID‐19 in determining the severity of the disease with clinical and laboratory parameters and survival of the patients were investigated along with its value in prognostic prediction.Material and method: A total of 277 adult patients who were followed up in the chest diseases clinic because of COVID‐19 pneumonia between 11.03.2020 and 31.05.2020 were evaluated retrospectively in the present study. Both lungs were divided into five regions in line with their anatomical structures, and semiquantitative radiological scoring was made between 0 and 25 points according to the distribution of lesions in each region. The relations between semiquantitative radiological score and age, gender, comorbidity, and clinical and laboratory parameters were examined.Results: A significant correlation was detected between advanced age, lymphopenia, low oxygen saturation, high ferritin, D‐dimer, and radiological score in the univariate analysis performed in the present study. The cut‐off value of the semiquantitative radiology score was found to be 15 (AUC: 0.615, 95% CI: 0.554–0.617,p = 0.106) in ROC analysis. The survival was found to be better in cases with a radiology score below 15, in Kaplan–Meier analysis (HR: 4.71, 95% CI: 1.43–15.46,p < 0.01). In the radiological score and nonparametric correlation analyses, positive correlations were detected between CRP, D‐dimer, AST, LDH, ferritin, and pro‐BNP, and a negative correlation was found between partial oxygen pressure and oxygen saturation (p = 0.01,r = 0.321/0.313/0.362/0.343/0.313/0.333/−0.235/−0.231, respectively)Conclusion: It was found that the scoring system that was calculated quantitatively in thorax HRCTs in Covid‐19 patients is a predictive actor in determining the severity and prognosis of the disease in correlation with clinical and laboratory parameters. Considering patients who have a score of 15 and above with semiquantitative scoring risky in terms of poor prognosis and short survival and close follow‐up and early treatment may be effective to reduce mortality rates.

Amaç: Plevral sıvıların tanısında, transüda (T)–eksüda (E) ayrımının yapılması önemlidir. Bu çalışmanın amacı, Light kriterleri ile plevral sıvı kolesterol düzeyini içeren tekli, ikili ve üçlü testlerin, T-E ayırımındaki duyarlılık ve özgüllüğünü belirlemektir. Gereç ve Yöntem: Çalışmaya plevral sıvı nedeniyle başvuran 145 hasta dâhil edildi. Plevral sıvı kolesterol düzeyi (PSKD) ≥45 mg/dL (tekli test); PSKD ≥45 mg/dL veya plevral sıvı LDH düzeyi >kan normal LDH’sının %45 (ikili test); plevral sıvı protein >2,9 g/dL, PSKD ≥45 mg/dL, plevral sıvı LDH düzeyi >kan normal LDH’sının %45 (üçlü test) olarak tanımlandı. Kesin tanıya uygun beklenen plevral sıvı tipi altın standart olarak değerlendirmeye alındı. Bulgular: Çalışmaya alınan 139 hastada, kesin tanıya uygun beklenen plevral sıvı tipi olguların %81’inde eksüda; %19’unda transüda olarak belirlendi. Eksüdatif plevral sıvıyı saptamada, tekli testin kesin tanıya uygun beklenen plevral sıvı tipi ile karşılaştırılmasında iki grup arasında sınırda anlamlılık saptandı (p=0.05). İkili ve üçlü test değerlendirmelerinde ise iki grup arasında istatistiki anlamlı fark saptandı (p