Emre Karakoç

Objective: Hyperglycemia is associated with adverse outcomes in patients with COVID-19. However, the prognostic significance of chronic glycemic status, reflected by glycated hemoglobin (HbA1c), and relative hyperglycemia, assessed by the stress hyperglycemia ratio (SHR), remains unclear. This study aimed to evaluate the association of HbA1c and SHR with in-hospital mortality in critically ill patients with COVID-19. Methods: In this retrospective observational study, 324 adult patients with confirmed COVID-19 admitted to the intensive care unit were evaluated. Admission blood glucose and HbA1c levels were obtained from laboratory records. The SHR was calculated to assess relative hyperglycemia. Factors associated with in-hospital mortality were analyzed using multivariable logistic regression. Results: Of the 324 patients included in the study, 125 (38.6%) died during hospitalization. Non-survivors had a significantly higher SHR compared with survivors (median [IQR], 1.30 [0.65] vs 1.15 [0.43]; P = .003). Admission glucose levels were also higher in non-survivors (178 versus 147 mg/dL; P = .01), as was the glycemic gap (34.3 and 20.2 mg/dL, respectively; P = .008). In contrast, HbA1c levels were similar between non-survivors and survivors (median [IQR], 5.9% [2.2%] vs 5.8% [2.5%]; P = .589). In multivariable logistic regression analysis, SHR remained independently associated with mortality across all adjusted models. Receiver operating characteristic (ROC) analysis showed that SHR had the highest predictive performance for the outcome (area under the curve [AUC] = 0.611) compared with glycemic gap, admission glucose, and HbA1c. Conclusions: Relative hyperglycemia assessed by the SHR may be a more informative prognostic marker of mortality in critically ill patients with COVID-19 than chronic glycemic status reflected by HbA1c.

Objectives: In this study, we aimed to investigate whether quality of life (QoL) before intensive care unit (ICU) admission could predict ICU mortality in critically ill patients. Patients and methods: Between January 2019 and April 2019, a total of 105 ICU patients (54 males, 51 females; mean age: 58 years; range, 18 to 91 years) from two ICUs of a tertiary care hospital were included in this cross-sectional, prospective study. Pre-admission QoL was measured by the Short Form (SF)-12- Physical Component Scores (PCS) and Mental Component Scores (MCS) and EuroQoL five-dimension, five-level scale (EQ-5D-5L) within 24 h of ICU admission and mortality rates were estimated. Results: The overall mortality rate was 28.5%. Pre-admission QoL was worse in the non-survivors independent from age, sex, socioeconomic and education status, and comorbidities. During the hospitalization, the rate of sepsis and ventilator/hospital-acquired pneumonia were similar among the two groups (p>0.05). Logistic regression analysis adjusted for sex, age, education status, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores showed that pre-admission functional status as assessed by the SF-12 MCS (odds ratio [OR]: 14,2; 95% confidence interval [CI]: 2.5-79.0), SF-12 PCS (OR: 10.6; 95% CI: 1.8-62.7), and EQ-5D-5L (OR: 8.0; 95% CI: 1.5-44.5) were found to be independently associated with mortality. Conclusion: Worse pre-admission QoL is a strong predictor of mortality in critically ill patients. The SF-12 and EQ-5D-5L scores are both valuable tools for this assessment. Not only the physical status, but also the mental status before ICU admission should be evaluated in terms of QoL to better utilize ICU resources.

Background/aim: Data on intoxication patients with shock and acute organ failure is valuable for the prediction of the tailored scale prognosis of the patients in the emergency department. Materials and methods: Our study was designed prospectively as a cross-sectional and observational over the course of four years. The patients over 18 years of age were included and the epidemiological data related to development of shock and acute organ failure, the treatments, and the outcome were recorded. The organic phosphate severity score was also calculated for all patients. Results: A total of 89 patients with shock and/or acute organ failure 72 (80.9%) of the patients were males. Methanol (51 patients, 57.3%) was the most common cause of intoxications followed by cardiovascular agents. Thirty (33.7%) patients died despite all treatments and mortality was found to be higher in patients with hypotension (p = 0.031) at the time of admission to the emergency department and in those with a high organic phosphate poisoning severity index (p = 0.001). High levels of WBC, creatine, lactate, base excess and low bicarbonate and blood pH were associated with mortality. The discharge rates of patients who received extracorporeal treatment were statistically higher than those who did not receive this treatment (p = 0.001). Conclusion: The organic phosphate poisoning severity score can partially help us to predict the prognosis in all poisoning patients at the time of the first presentation. Emergency physicians may consider the development of hypotension, high creatine, lactate, base excess, low bicarbonate, and blood pH to be associated with a poor prognosis in the first hours of admission in acute poisoning patients. In these patients, it was predicted that the addition of selected extracorporeal methods without delay, in addition to the treatments that should be applied, may increase the survival rate.

There are limited data on the long-term outcomes of COVID-19 from different parts of the world. To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Retrospective, observational cohort. Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO₂/FiO₂ ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

Purpose: The aim of this study was to determine parameters affecting the energy consumption in intensive care patients, and the most reliable formulas for calculation of energy consumption. Materials and Methods: This prospective study was carried out in the intensive care unit of the Internal Medicine Department of Çukurova University Hospital. Total 71 patients above 18 years of age, with hemodynamical and respirational stability, and being followed up on a mechanical ventilator for more than 24 hours, were included to this study. We analyzed the correlation of calculated energy consumption values obtained from formulas, with the energy consumption values measured by indirect calorimeter. Results: The study was executed on 71 patients. The mean energy consumption of the patients was 2078±794 kcal and the mean energy need per kilogram was found as 31.64±13.82 kcal. Indirect calorimeter measurements showed the strongest correlation with Swinamer formula. Conclusion: Indirect calorimetry has become not only a "gold standard" but an "achievable gold standard" in determining energy consumption. We recommend that the indirect calorimeter method should be used in intensive care patients to maintain nutrition properly. Under conditions where indirect calorimeter cannot be used, or it is not desirable to wait for 24 hours; feeding can be started according to the results of a 2-hour measurement, or reliable predictive equations.

Purpose: The aim of the study is to determine the factors affecting the mortality of oncology patients followed in the intensive care unit (ICU). Materials and Methods: In this study 100 patients who were followed up in the ICU of Cukurova University Faculty of Medicine, Internal Medicine Department between 2012-2014 were prospectively included. Acute Physiology and Chronic Health Evaluation (APACHE) II, 1st and 3rd day Sequential Organ Failure Assessment Score (SOFA) scores were used to determine the factors that were affecting mortality. Lactate, magnesium, phosphorus, potassium, blood urea nitrogen (BUN) and beta 2 microglobulin levels were determined at the time of admission to ICU. The relationship between vasopressor, renal, respiratory support need, neutropenia, infectious agents and mortality was determined during the follow-up period in the ICU. The patients were divided into two groups as patients transferred from ICU to the inpatient clinics (Group 1: 40 patients) and patients who were died in the ICU follow-up (Group 2: 60 patients). Results: APACHE II and 1st and 3rd day SOFA scores, predictive mortality rate, intensive care admission lactate levels, vasopressor and respiratory support needs, renal support needs, BUN, potassium and magnessium levels, beta 2 microglobulin levels, positive Acinetobacter baumannii culture mean was statistically significant with mortality during intensive care follow up between the Group 1 and 2 patients. In addition, mortality was found to be less in patients followed up in the new ICU. Conclusion: Beta 2 microglobulin level can be used to predict intensive care mortality.

Critically ill patients are at risk of developing gastrointestinal (GI) bleeding due to stress causing mucosal damage. Aim of the study was to determine the effect of oral/ enteral nutrition with or without concomitant pantoprazole on upper GI bleeding in low risk critically ill patients. This was a prospective, randomized, open-label, multicenter study conducted with intensive care unit (ICU) patients receiving oral/enteral nutritional support. Patients were randomly assigned into two groups including intervention group (received oral/EN plus pantoprazole) and control group (received only oral/EN). A total of 300 patients (intervention group: 152, control group: 148) participated in the study. Overall, 226 (75 %) patients were fed by oral and 74 (25%) patients fed by enteral tube. Median duration of nutritional support 4 (range: 2-33) days. Overt upper GI bleeding was noted only in one patient (0.65%) who was in the intervention group. The overall length of ICU stay of 4 (2-105) days, while ICU stay was significantly longer in the intervention group than in the control group (p=0.006). Our findings seems to indicate that in patients who are at low risk for GI bleeding and under oral/enteral nutritional support, the use of PPIs may not reduce the risk of bleeding, however these results are imprecise because of low event (GI bleeding) rate and limited power.

Amaç: Bu çalışmada bir Üniversite Dahiliye Yoğun Bakım Ünitesinde (DYBÜ) trombositopeni sıklığı, nedenleri, klinik sonuçları ile mortalite ve morbiditeye olan katkısını saptamayı amaçladık.Gereç ve Yöntemler: Temmuz 2011-Ağustos 2012 tarihleri arasında yoğun bakımda takip edilen vetrombosit sayısı 150.000/uL’nin altında olan 165 hasta çalışmaya dahil edildi. Trombositopeni nedenleri araştırıldı. Trombositopenisi olan ve trombositopenisi olmayan hastaların mortalite ve yoğun bakım yatış sürelerikarşılaştırıldı.Bulgular: Çalışma döneminde DYBÜ’de hastaların %30,1’inde trombositopeni gelişti (165/548). Hastaların 30 (%18)’unda trombositopeni nedeni sepsis, 18 (%10,9)’inde dissemine intravasküler koagülasyon (DİK) idi. Çalışma süresince 165 trombositopenik hastanın 115’i (%69,7), trombositopenik olmayan 383 hastanın 173’ü (%45,1) kaybedildi. Trombositopenisi olan hastalarda mortalite daha fazlaydı. Hastalarda trombosit düzeyi düştükçe mortalitenin istatistiksel olarak anlamlı düzeyde arttığı gözlendi. Aynı APACHE II skoruna sahip hasta gruplarında trombosit sayısı düştükçe mortalitenin istatistiksel olarak anlamlı olarak arttığı saptandı.Sonuç: Trombositopeninin en sık sebepleri sepsis ve DİK olup trombositopeni yoğun bakımda mortaliteyi arttıran bir etkendir.