Miraç Öz

Introduction: To evaluate the value of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of enlarged intrathoracic lymph nodes in patients with extrathoracic malignancies (ETM). We aimed to investigate the rate of mediastinal metastasis in patients with ETM and increased F-18 Fluorodeoxyglucose (FDG)uptake. Methods: Patients with ETM and increased FDG uptake were evaluated from November 2020 to November 2025 for EBUS-TBNA due to mediastinal lymphadenopathy detected by Positron Emission Tomography- Computed Tomography (PET-CT). Results: Of the 1720 EBUS procedures, 203 were included in the analysis (Figure 1). Patient’ mean age was 65.2±12.2 years; there were 114 men. Primary malignancies were gastrointestinal malignancies in 81(39.7%)(Table 1). According to EBUS-TBNA smear and cell block histopathologic evaluations, 63 patients’ results (30.9%) were malignant compatible with metastasis of ETM. Conclusion: EBUS-TBNA sampling should be the first step method to be used in the diagnosis of mediastinal and hilar lymphadenopathies seen in extrathoracic malignancies. EBUS-TBNA reduces the need for surgical intervention. erj;68/suppl_70/PA2064/F1 F1 F1 erj;68/suppl_70/PA2064/F2 F2 F2

Introduction: The aim of this study was to evaluate the incidence of latent tuberculosis infection(LTBI) and active tuberculosis after liver transplantation(LT). Methods: Adult LT candidates evaluated between 2016 and 2022 were retrospectively assessed.Patients who underwent LT and had pretransplant tuberculin skin test(TST) and/or interferon-gamma release assay(IGRA) results were included in the study. Results: A total of 111 LT recipients with available IGRA and/or TST results were included; 70 were men (63.1%), with a mean age of 53.5 ± 11.3 years.The most common indication for LT was viral hepatitis (33.3%).Group 1 included patients with a positive IGRA and/or TST≥5 mm, whereas Group 2 comprised patients with TST<5 mm and negative IGRA results(Table 1).No patient received LTBI treatment before transplantation, whereas LTBI treatment was initiated in four patients after transplantation. None of these patients were able to continue prophylaxis due to treatment-related adverse effects.During a median follow-up period of 49[27–64] months after transplantation, no cases of active tuberculosis were observed among patients with positive TST and/or IGRA results. Conclusions: Prophylaxis with hepatotoxic agents poses a substantial risk in LT candidates.Because LTBI treatment may need to be discontinued due to elevations in liver enzymes, the risk–benefit balance of posttransplant LTBI therapy should be carefully assessed.In situations where LTBI treatment is deferred, close clinical monitoring is strongly recommended. erj;68/suppl_70/PA2934/F1 F1 F1

Background/Objectives: Cardiopulmonary exercise testing (CPET) provides an integrated assessment of cardiovascular, respiratory, and metabolic responses during exercise. Although CPET is increasingly used in older adults for preoperative physiological evaluation and assessment of exercise limitation, evidence regarding its safety and clinical feasibility in elderly patients with mixed cardiopulmonary comorbidities remains limited. Methods: In this retrospective observational study, we evaluated 235 consecutive patients who underwent CPET at a tertiary referral center. Patients were categorized into two groups according to age: ≥65 years and p = 0.02, OR (95% CI): 0.90 (0.84–0.96), p = 0.001, respectively]. Conclusions: CPET was feasible in the majority of elderly patients with cardiopulmonary comorbidities, with most individuals successfully completing testing and providing clinically interpretable physiological data. No major complications were observed in this cohort. These findings suggest that, when performed under appropriate supervision and careful patient selection, CPET may represent a practical tool for functional assessment and preoperative physiological evaluation in older adults. Larger prospective multicenter studies are warranted to further define its safety and feasibility in this population.

Background/Objectives: Tuberculosis remains one of the preventable causes of mortality among liver transplant recipients. The prevalence of tuberculosis in solid organ transplant recipients is higher than in the general population. The aim of this study was to evaluate the incidence of latent tuberculosis infection (LTBI) and active tuberculosis after liver transplantation. Methods: This is a retrospective, single-center, case–control study. Adult liver transplant candidates who were evaluated between 1 January 2016 and 31 December 2022 were retrospectively assessed. Patients with pre-transplant tuberculin skin test (TST) and/or interferon-gamma release assay (IGRA) results who underwent transplantation were included in this study. Results: A total of 111 liver transplant recipients with available IGRA and/or TST results were included; 70 were men (63.1%) and 41 were women (36.9%), with a mean age of 53.5 ± 11.3 years. Demographic, clinical, and laboratory characteristics were evaluated. The most common indication for liver transplantation was viral hepatitis (33.3%), followed by cryptogenic cirrhosis (19.8%) and hepatocellular carcinoma (10.8%). All patients had a Bacillus Calmette–Guérin (BCG) vaccination scar. Ten patients received grafts from deceased donors, while 101 underwent living-donor liver transplantation. No patient received LTBI treatment before transplantation, whereas LTBI treatment was initiated in four patients after transplantation. None of the patients had a diagnosis of active tuberculosis prior to transplantation. Thoracic computed tomography revealed findings compatible with tuberculosis sequelae in 11 patients (9.9%). During a median follow-up period of 49 [27–64] months after transplantation, no cases of active tuberculosis were observed among patients with positive TST and/or IGRA results. Patients were divided into two groups according to their TST and IGRA results. Group 1 consisted of patients with IGRA positivity and/or a TST ≥ 5 mm, while Group 2 included patients with a TST < 5 mm and negative IGRA results. The only statistically significant difference between the groups was the administration of LTBI treatment (p = 0.027); four patients in Group 1 received LTBI therapy. None of these patients were able to continue prophylaxis due to treatment-related adverse effects. Conclusions: Prophylaxis with hepatotoxic agents poses a substantial risk in liver transplant candidates. Since the hepatotoxicity may cause early cessation of LTBI treatment, the risk–benefit ratio of post-transplant LTBI therapy should be carefully assessed. In situations where LTBI treatment is deferred, close clinical monitoring is strongly recommended.

Temporal Trends in the Use of Pulmonary Function Tests Before, During, and After the COVID-19 Pandemic: Experience from a University Hospital in Türkiye - Thoracic Research and Practice

Health literacy encompasses patients' abilities to access healthcare, comprehend health information, and make decisions based on that knowledge. We aimed to examine the relationship between dyspnea levels, acute exacerbations, hospitalizations, disease severity and comorbidities of chronic obstructive pulmonary disease (COPD) patients according to their health literacy levels. A total of 106 COPD patients were prospectively enrolled in our study. Demographic data, history, pulmonary function tests, COPD severity, comorbidities, health status, quality of life and the factors determining the course of the disease in the last year were collected. We also measured patients' health literacy using the Turkish version of the European Health Literacy scale. Our findings revealed that elderly COPD patients (p= 0.04) with advanced disease stages (p< 0.001), higher Charlson Comorbidity Index and Saint George Hospital Respiratory Questionnaire scores (p< 0.001), and lowincome (p= 0.02) had lower levels of health literacy. Moreover, patients with lower health literacy experienced more frequent exacerbations (p= 0.01), more severe exacerbations (p< 0.001), and higher rates of hospitalization (p< 0.001). Logistic regression analysis unveiled that GOLD stages (OR: 11.62, 95% CI: 3.36-26.25), and recent severe exacerbations within the last year (OR: 14.24, 95% CI: 5.41-38.13) stood out as the most strongly associated risk factors for poor health literacy. COPD patients with low health literacy have a higher risk of severe disease. Recognizing the concept of health literacy and identifying risk factors associated with low health literacy are crucial steps in enhancing education, care, and social support for COPD patients. It emphasizes the need for tailored interventions and support for COPD patients, especially those with lower health literacy.

Purpose: The aim is to develop a learning model based on clinical and survey data to assess sleep quality and identify determining factors affecting sleep quality in chronic obstructive pulmonary disease (COPD) patients. Methods: The Pittsburgh Sleep Quality Index (PSQI) was administered to stable COPD patients to assess sleep quality. Patients were categorized into two groups: good sleep quality and poor sleep quality. Parameters for the best model were selected from a total of 61 clinical and laboratory parameters using recursive feature elimination (RFE) and the Bayesian Information Criterion (BIC). A logistic regression (LR) model was created. The model was evaluated using nested cross-validation with 5 inner and 5 outer folds, and this process was repeated with 1000 bootstrap iterations. Results were obtained with a 95% CI. Results: The mean age of the 132 patients was 66.68 ± 8.16 years, with a predominance of males (117, or 88.6%). Of the 132 patients, 68 were in the poor sleep quality group. In this group, the prevalence of dyspnea, snoring, witnessed apneas, and excessive daytime sleepiness (EDS) was higher. The parameters included in the model and occurrence rates in the poor sleep quality group are as follows: annual exacerbation and hospitalization (71.9%), presence of EDS (35.9%), cough (64.1%), active smoking (95.4%), short-acting beta agonist (SABA) requirement (59.4%), pH level, and coronary artery disease (CAD) (20.3%). In our final model, the test set demonstrated a sensitivity, specificity, accuracy, and AUC of 70.21%, 71.76%, 70.99%, and 0.757, respectively. Conclusion: Our machine learning model, developed using clinical data of COPD patients, can predict their sleep quality. We found that high annual exacerbation and hospitalization rates, the presence of EDS and cough symptoms, active smoking, and regular use of SABA as well as high pH levels, negatively affect sleep quality. Conversely, the presence of CAD under treatment in patients positively affects sleep quality.

This study aimed to investigate whether coronavirus disease-2019 (COVID-19) leads to impaired pulmonary function, fibrotic-like abnormalities or psychological symptoms six months after discharge. This study involves 162 laboratory-confirmed patients with COVID-19 who were diagnosed in Ankara University Faculty of Medicine, Department of Chest Diseases from February 1, 2021 to July 1, 2023. All patients were diagnosed with COVID-19 pneumonia by thorax computed tomography (CT). Patients who applied to the outpatient clinic six months after COVID-19 treatment were included in the study. A total of 133 patients underwent thorax CT scan, pulmonary function tests, six minutes walking test simultaneously. Radiographic patterns were categorized into two groups (normal/non-fibrotic and fibrotic-like). Group A had 66 patients who either had no fibrotic or non-fibrotic changes, and 67 patients who had fibrotic-like changes were categorized as group B. Mean age of the study subjects was 55.95 ± 12.42 years, and 75 (56.4%) patients were male. Overall, median diffusing capacity of the lungs for carbon monoxide (DLCO) % predicted measured as 73.5% [IQR 61-88]. DLCO and six-minute walking distance were significantly lower in the fibroticlike pattern group (p< 0.001, p= 0.014, respectively). Reduced DLCO in patients with fibrotic-like pattern after six months was common. Presence of ground-glass opacities, reticulations and traction bronchiectasis correlated strongly with reduced diffusing capacity (r= -0.190 p= 0.043, r -0.305 p= 0.001, r -0.404 p< 0.001, respectively). We demonstrated that smoking history and intensive care unit (ICU) admisson during COVID-19 pneumonia were independent risk factors for fibrotic-like radiographic abnormalities. Residual abnormalities resembling fibrosis were notably prevalent, particularly among severely ill patients, and impaired lung diffusion persisted in some individuals even six months post-discharge. Post-COVID-19 lung sequelae can persist and progress after hospital discharge, suggesting airways involvement and formation of new fibrotic-like lesions, mainly in patients who had been in the ICU and had smoking history.

Composite Model for End-Stage Liver Disease (MELD), an adapted version of the model score excluding international normalised ratio (MELD-XI), was reported to predict outcomes in patients with organ failure. Aim of study was to evaluate the prognostic significance of the MELD-XI score and compare it with the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation 2 (APACHE 2) scores in patients admitted to the intensive care unit (ICU) for respiratory failure. Out of 822 patients with respiratory failure between September 2020 and June 2023, a total of 727 patients with etiologies of chronic obstructive pulmonary disease exacerbation, cardiogenic pulmonary edema, pulmonary thromboembolism, pneumonia, bronchiectasis, kyphoscoliosis, neuromuscular diseases, obesity hypoventilation syndrome, and diffuse parenchymal lung disease were included. A statistically significant correlation was found between MELD-XI, SOFA, and APACHE 2 scores. The cutoff value of the MELD-XI score was 11 on receiver operating characteristic analysis, indicating a higher risk of mortality in patients with a score of 11 or above. The APACHE 2 and SOFA scores of the MELD-XI ≥11 group were found to be higher and the Glasgow Coma Scale were lower than the MELD-XI P < 0.001] and subgroups with different etiologies in Cox regression analysis. In the multivariate analysis, MELD-XI was the most important independent variable indicating an increased risk of mortality, regardless of etiology (HR: 2.4, 95% CI: 2.0-2.5, P < 0.001). MELD-XI is an important marker of ICU mortality in patients with respiratory failure due to different etiologies and is as effective as the SOFA and APACHE 2 in predicting mortality.