Rabia Sari

Background: Sepsis and septic shock are associated with high mortality in intensive care units (ICUs), with a substantial risk persisting after ICU discharge. However, it remains unclear whether inflammatory biomarkers retain their prognostic value at the time of ICU discharge. This study aimed to evaluate whether discharge inflammatory biomarkers—including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-mean platelet volume ratio (PLT/MPV), and C-reactive protein-to-albumin ratio (CAR)—remain predictive of short- and long-term mortality in patients with sepsis and septic shock. Methods: In this single-center, retrospective cohort study, adult patients with sepsis or septic shock discharged from a tertiary ICU specializing in chest diseases between January 2013 and January 2015 were included. Sepsis and septic shock were retrospectively re-classified according to Sepsis-3 criteria. Inflammatory biomarkers measured at ICU admission and discharge, along with clinical variables and disease severity scores (APACHE II and SOFA), were recorded. Patients were followed for 28-day, 6-month, and 2-year mortality. The prognostic performance of biomarkers was assessed using receiver operating characteristic (ROC) analysis, and optimal cut-off values were determined. Independent predictors of mortality were evaluated using Cox proportional hazards regression analysis. Results: A total of 461 patients were included. In total, 291 (63.1%) had sepsis without shock and 170 (36.9%) had septic shock. The overall male proportion was 62%, with a median age of 65 (IQR 54–74) years in the sepsis group and 70 (63–79) years in the septic shock group. Mortality rates were significantly higher in patients with septic shock compared to those with sepsis at 28 days (24% vs. 10%, p < 0.001), 6 months (44% vs. 27%, p < 0.001), and 2 years (71% vs. 57%, p = 0.003). In unadjusted survivor/non-survivor comparisons, elevated discharge NLR and CAR were associated with early post-ICU mortality. However, in multivariable Cox regression, discharge NLR, but not discharge CAR, remained independently associated with 28-day and 6-month mortality. On ROC analysis, discharge NLR showed moderate discriminative performance for 28-day mortality (AUC 0.67, 95% CI 0.60–0.74), as did discharge CAR (AUC 0.68, 95% CI 0.60–0.76), although CAR did not retain independent prognostic significance after adjustment. An NLR value ≥ 5 was identified as an independent predictor of 28-day mortality (HR 2.44; 95% CI 1.24–4.80; p = 0.010) and was also significantly associated with 6-month mortality (HR 2.02; 95% CI 1.18–3.45; p = 0.011), although its predictive value decreased over longer follow-up periods (HR 1.37; 95% CI 0.93–2.01; p = 0.11 at 2 years). Conclusions: Inflammatory biomarkers measured at ICU discharge, particularly NLR, remain predictive of short-term mortality in patients with sepsis and septic shock, but their prognostic value diminishes over time. Assessment of inflammatory status at ICU discharge may provide a practical tool for early post-ICU risk stratification and may support clinical decisions regarding intensified outpatient surveillance and follow-up scheduling in this vulnerable population.

OBJECTIVE: Epithelial damage together with endothelitis and microvascular thrombi are responsible for COVID-19 associat-ed acute respiratory distress syndrome (ARDS). Iloprost, improves endothelial damage and re -duces thrombotic complications with its vaso-dilator, anti-platelet, anti-inflammatory, and an-ti-fibrotic effects. In our study, we aimed to de-termine the effect of iloprost on oxygenation, hemodynamics, weaning, and mortality in se-vere COVID-19 ARDS.PATIENTS AND METHODS: This was a retro-spective study conducted in a pandemic hospi-tal in the city of Istanbul, Turkey. Patients, with severe COVID-19 ARDS, who were receiving ilo-prost for seven days were included in the study. The demographic data, APACHE II, and SOFA (Sequential Organ Failure Assessment score) scores (at admission and discharge), pH, PaO2, PCO2, SatO2, lactate, PaO2/FiO2 (inspiratory frac-tionated oxygen), respiratory rate-oxygenation (ROX) index (peripheral oxygen saturation/frac-tion of inhaled oxygen), systolic arterial pres -sure (SAP), diastolic arterial pressure (DAP), mean arterial pressures (MAP), heart rate (HR) values were recorded before starting iloprost (T0), and on days of iloprost administration (2.0 nanograms/kg/minute/6 hours/day) (T1, T2, T3, T4, T5, T6, T7), and the day after last day of ilo-prost administration (Tfinal). Also, mortality was recorded in a retrospective manner. Two groups were formed according to mortality (Group M) and discharge (Group D). RESULTS: A total of 22 patients (16 men, 6 women) were evaluated. Age, APACHE II, SO-FA scores were higher in Group M. The lactate value at T1-3-4-5-7 was lower than T0 in both groups. PaO2 value between T2-Tfinal was higher than T0. A statistically significant increase was found in PaO2/FiO2 levels in both groups. The PaO2/FiO2value between T5-Tfinal was significant -ly lower in Group M compared to Group D. ROX index was significantly higher between T4-Tfinal when compared with T0.CONCLUSIONS: Iloprost improves oxy-genati on but has no effect on mortality in COVID-19 ARDS.

While C-reactive protein (CRP) is a well-studied marker for predicting treatment response and mortality in sepsis, it was aimed to assess the efficacy of the neutrophil lymphocyte ratio (NLR) as a predictor of mortality and treatment response in sepsis patients in the intensive care unit (ICU). In this retrospective cross-sectional study, sepsis patients were divided according to the presence of septic shock on the 1st day of ICU stay, and then subgrouped according to mortality. Patient demographics, acute physiologic and chronic health evaluation II and sequential organ failure assessment scores, NLR and CRP (on the 1st, 3rd, and last day in the ICU), microbiology data, antibiotic responses, ICU data, and mortality were recorded. Receiver operating characteristic (ROC) curves for the area under curve (AUC) were calculated for the inflammatory markers and ICU severity scores for mortality. Of the 591 (65% male) enrolled patients, 111 (18.8%) were nonsurvivors with shock, 117 (19.8%) were survivors with shock, 330 (55.8%) were survivors without shock, and 33 (5.6%) were nonsurvivors without shock. On the 1st day of ICU stay, the NLR and CRP were similar in all of the groups. On the 3rd day of antibiotic response, the NLR was increased (11.8) in the nonresponsive patients when compared with the partially responsive (11.0) and responsive (8.5) patients. If the NLR was ≥15 on the 3rd day, the mortality odds ratio was 6.96 (CI: 1.4–34.1, P < 0.017). The NLR and CRP on the 1st, 3rd, and last day of ICU stay (0.52, 0.58, 0.78 and 0.56, 0.70, 0.78, respectively) showed a similar increasing trend for mortality. The NLR can predict mortality and antibiotic responsiveness in ICU patients with sepsis and septic shock. If the NLR is >15 on the 3rd day of postantibiotic initiation, the risk of mortality is high and treatment should be reviewed carefully.