Ahmet Nalbant

Background and aim. The controlling nutritional status (CONUT) score and prognostic nutritional index (PNI) are albumin-based composite indices widely used as prognostic markers whose interpretation in patients with ascites remains uncertain. We examined their associations with ascites etiology and cirrhosis severity. Materials and methods. We retrospectively studied 91 adults hospitalized for evaluation of newly detected ascites between January 2021 and June 2023. Both indices were calculated from laboratory values. Exploratory receiver operating characteristic (ROC) thresholds underwent bootstrap internal validation. Logistic regression models adjusted for age, sex, and C-reactive protein for cirrhotic ascites and for age and sex for malignant ascites. Results. Ascites was cirrhotic in 57 patients (62.6%), malignant in 20 (22.0%), cardiac in 8 (8.8%), and other in 6 (6.6%). The CONUT score differed across etiologies (global p = 0.017) and was higher in cirrhotic than malignant ascites (7.0 ± 2.8 vs. 4.8 ± 2.4; pairwise p = 0.002). Serum albumin (p = 0.021) and total cholesterol (p < 0.001) showed parallel differences, whereas total lymphocyte count did not (p = 0.363). The PNI did not differ significantly across groups (p = 0.099). For cirrhotic ascites, the CONUT score ≥6 and PNI ≤33.2 had AUCs of 0.68 and 0.65 and adjusted odds ratios of 3.77 and 10.25, respectively. The indices correlated with Child–Pugh and MELD-Na scores and were strongly inversely correlated (r = −0.88). Conclusion. Both indices were associated with cirrhotic etiology and measures of cirrhosis severity, but showed only modest, internally derived discrimination. Their associations cannot distinguish hepatic dysfunction from nutritional impairment without objective nutritional assessment. External validation is needed.

Background/Objectives: Contrast agents can damage renal tissue through multiple mechanisms, particularly by increasing reactive oxygen species (ROS), which contribute to DNA oxidation, lipid peroxidation, and endothelial injury. This prospective, comparative study aimed to evaluate the changes in ROS-related gene expressions—NFKB1, SIRT1, NFE2L2, and FOXO1—in patients who developed contrast-induced nephropathy (CIN) following coronary angiography versus those who did not. Methods: A total of 48 patients undergoing primary percutaneous coronary intervention were enrolled. Twenty-three patients who developed CIN (Group 1) were compared to 25 matched controls without CIN (Group 2) based on age, gender, and comorbidities. Blood and serum samples were collected 72 h post-contrast exposure to assess biochemical markers and mRNA expression levels of the target genes. Results: The mean age was similar between the groups (63 ± 7 vs. 62 ± 6 years; p > 0.05), as was gender distribution. Group 1 showed significant increases in serum creatinine and reductions in e-GFR post-procedure. Importantly, NFKB1, NFE2L2, and FOXO1 mRNA expression levels were significantly upregulated in CIN patients—by 5.7-, 5.8-, and 4.97-fold, respectively, while SIRT1 expression was downregulated by 0.76-fold (p < 0.05). Conclusions: These findings indicate enhanced activation of inflammatory and oxidative stress pathways in CIN patients, particularly through the NF-κB signaling axis. Conversely, reduced SIRT1 expression suggests diminished antioxidant protection. The study highlights that ROS-related gene expression changes may serve as potential biomarkers for CIN progression. Further studies at the protein level are needed to clarify cytokine roles in these pathways.

Background/Objectives: Contrast agents can damage renal tissue through multiple mechanisms, particularly by increasing reactive oxygen species (ROS), which contribute to DNA oxidation, lipid peroxidation, and endothelial injury. This prospective, comparative study aimed to evaluate the changes in ROS-related gene expressions—NFKB1, SIRT1, NFE2L2, and FOXO1—in patients who developed contrast-induced nephropathy (CIN) following coronary angiography versus those who did not. Methods: A total of 48 patients undergoing primary percutaneous coronary intervention were enrolled. Twenty-three patients who developed CIN (Group 1) were compared to 25 matched controls without CIN (Group 2) based on age, gender, and comorbidities. Blood and serum samples were collected 72 hours post-contrast exposure to assess biochemical markers and mRNA expression levels of the target genes. Results: The mean age was similar between the groups (63 ± 7 vs. 62 ± 6 years; p > 0.05), as was gender distribution. Group 1 showed significant increases in serum creatinine and reductions in e-GFR post-procedure. Importantly, NFKB1, NFE2L2, and FOXO1 mRNA expression levels were significantly upregulated in CIN patients—by 5.7-, 5.8-, and 4.97-fold, respectively—while SIRT1 expression was downregulated by 0.76-fold (p < 0.05). Conclusions: These findings indicate enhanced activation of inflammatory and oxidative stress pathways in CIN patients, particularly through the Nf-κB signaling axis. Conversely, reduced SIRT1 expression suggests diminished antioxidant protection. The study highlights that ROS-related gene expression changes may serve as potential biomarkers for CIN progression. Further studies at the protein level are needed to clarify cytokine roles in these pathways.

Objective: The Fibrosis-4 (FIB-4) index is a noninvasive marker of liver fibrosis in various patient populations. We examined whether there is a relationship between the severity and prognosis of COVID-19 disease and the FIB-4 index. Materials and Methods: This stuy is a cross-sectional and retrospective. The patients were divided into two groups as those hospitalized in the intensive care unit (ICU) and those hospitalized in the clinic (non- ICU). Results: Of the total 158 cases,86(54%) were male. Age, total bilirubin, AST levels and FIB-4 index were higher in ICU patients compared to non-ICUs (p<0.001,p=0.002, p=0.003, p<0.001 respectively). FIB-4 index non-survivors were also higher (p=0.002). When the effect of the FIB-4 index on the severity of COVID-19 disease and mortality was evaluated by ROC analysis, both ICU and non-survivors were found to be significant (respectively FIB-4 score;AUC=0.705,95%CI:0.624-785,p<0.001;AUC=0.654,95%CI:0.566-742,p=0.002). When the FIB-4 index cut-off value for disease severity was taken as 2.19, 70.0% sensitivity and 60% specificity were found in predicting disease severity. Moreover, when the FIB-4 index cut-off value for mortality was taken as 2.19, 71.2% sensitivity and 53% specificity were found in predicting mortality. Conclusion: The FIB-4 index is an independent predictor of severity and mortality in COVID-19 patients requiring ICU.

Objective: This research aims to analyze the HALP. (hemoglobin, albumin, lymphocyte. platelet) score of.survivor-deceased Covid-19 patients. Material and methods: 590 patients with. Covid-19 were. included. in. this. study. Patients. were. divided. into two groups as survivor (n:296) and deceased (n:294). Patient information was collected from the hospital online system. The Study was conducted retrospectively, and it aims to.investigate.the association.between HALP score and.mortality.in Covid-19.patients. Results: In.the deceased group.the.mean.age was 71.32±10.9 (n:294) while in the survivor.group, it.was 59.97±16.2 (n:296) (p:0.000). 65,6% of the deceased group were.male, while 55% of survivor group were male (p<0.001). The median HALP score was 11,45 (1,00-1594,00) in the deceased group, while it was 23,58 (1,73-231,75) (p<0.001) in survivor group. Through our analysis,.we have found.that.the.HALP score.was associated with mortality, thus the.relationship.between 1/HALP.score.and.mortality was examined. While the median 1/HALP was 0.08 (0.01-1.00) in deceased group, it was 0.04 (0.01-0.58) in the survivor group. ROC (receiver.operating.characteristic) analysis was executed for determining the cut off value of 1/HALP. The cut.off.value of 1/HALP for mortality was 0,064 ((AUC: 0,724 (0,682-0,767); 67,3% Sensitivity, 67,0% Specificity; p<0.001)). Conclusion: There is a meaningful correlation established between low HALP score and.mortality. in.Covid-19.patients. We.have reached the.conclusion that using HALP score.to. predict.mortality.in.Covid-19.patients might be useful.

The primary objective of this study was to explore the impact of metformin and metformin/gliptin combination therapy on the serum concentrations of vitamin B12, ferritin, and folic acid in individuals diagnosed with type 2 diabetes.

There are limited data about the significance of erythrocyte sedimentation rate as a single prognostic parameter for the prognosis and mortality of COVID-19. This study aimed to investigate the diagnostic utility of erythrocyte sedimentation rate as a prognostic factor for the disease severity and mortality in patients with COVID-19. A total of 148 consecutive patients with a confirmed diagnosis of COVID-19 and hospitalized at the intensive care unit or non-the intensive care unit were included in the study. The patients were allocated to groups as severe/critical disease versus nonsevere disease and survivors and nonsurvivors. The prognostic role and predictable values of erythrocyte sedimentation rate were analyzed. Erythrocyte sedimentation rate was found to be higher among patients with severe/critical disease compared to those with nonsevere disease (p<0.001) and among nonsurvivors compared to survivors (p<0.001). The logistic regression analysis showed that erythrocyte sedimentation rate was an independent parameter for predicting disease severity and mortality. The role of erythrocyte sedimentation rate in the assessment of severity and mortality in patients with COVID-19 was analyzed using the receiver operating characteristic curve and was found to be significant in both. The analyses suggested that the optimum erythrocyte sedimentation rate cutoff point for disease severity and mortality were 52.5 mm/h with 65.5% sensitivity and 76.3% specificity and 56.5 mm/h with 66.7% sensitivity and 72.5% specificity. Our results suggest that erythrocyte sedimentation rate was an independent prognostic factor for severity and mortality in patients with COVID-19.

Background Prognostic nutritional index (PNI) and systemic immune-inflammatory index (SII) are inflammation-based novel markers that predict the prognosis in various patient populations. We have investigated the relationship between the disease severity in COVID-19, and the PNI and SII scores in the present study. Materials and Methods This cross-sectional retrospective study included 118 consecutive hospitalized patients with a confirmed diagnosis of COVID-19. The patients were divided into two groups as those who were hospitalized at the intensive care unit (ICU) and those who had been internalized at the clinic (non-ICU). Results Of the 118 patients, 50.8% were male. The mean age was 57.7±17.5 years in non-ICU patients and 70.3±11.7 years in ICU patients and the difference was statistically significant (p<0.001). The lymphocyte count and the albumin levels were significantly lower in ICU patients (p< 0.001, p< 0.001, respectively). The PNI score was significantly lower in ICU patients compared to non-ICU patients (p<0.001). The SII score was found to be significantly higher in ICU patients compared to non-ICU patients (p<0.001). The value of PNI and SII scores in prediction of the disease severity in COVID-19 was evaluated with the ROC analysis ([PNI; AUC=0.796,95%CI:0.715-0.877, p<0.001], SII; AUC=0.689,95% CI:0.559-0.819, p=0.004]). When the cut-off value was taken as ≤36.7 for the PNI score, it was found to have 73.4% sensitivity and 70.8% specificity for predicting of the disease severity and ICU admission probability was 4.4 times higher. When the cut-off value was taken as ≥813.6 for SII score, it was found to have 70.8% sensitivity and 66.0% specificity for predicting of the disease severity and ICU admission probability was 6 times higher. Conclusion The PNI and the SII scores are independent predictors of the prognosis and the disease severity in COVID-19 patients who require hospitalization at the ICU.

Background Some biomarkers have been reported to be related to the prognosis of the coronavirus disease 2019 (COVID-19). There are sparse data regarding the prognostic value of serum calprotectin in COVID-19 patients. Aims This study aimed to investigate the relationship between serum calprotectin level and clinical severity of COVID-19 disease in hospitalized patients. Methods This retrospective cross-sectional cohort study included 80 consecutive hospitalized patients with confirmed diagnosis of COVID-19. The study population was divided into two groups as patients hospitalized in the intensive care unit (ICU) and patients hospitalized but not in the ICU. The serum calprotectin levels, other laboratory, and clinical parameters were compared between groups. Results The mean age of the patients was 66.5 ± 15.7 years. Of the patients, 42 were in the ICU and 38 were not. Serum calprotectin level and acute-phase reactants such as C-reactive protein, procalcitonin, ferritin, fibrinogen, and white blood cell were significantly higher in ICU patients than in non-ICU patients. ROC curve analysis identified that serum calprotectin level was a predictor for ICU requirement with an area under the curve of 0.641 (p = 0.031). Logistic regression analysis revealed that serum calprotectin was a significant determinant for whether or not patient required the ICU. Conclusions These findings demonstrate that serum calprotectin level seems to be a useful biomarker that can predict the severity of COVID-19 disease. Serum calprotectin is a significant predictor of ICU requirement in patients with COVID-19.