Ezgi Ozyilmaz

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.

Background and Objectives: Alarmins and Th2-driven inflammatory pathways may contribute to disease severity, exacerbation frequency, and mortality; however, their role in non-cystic fibrosis bronchiectasis remains insufficiently defined. This study aimed to investigate the association between alarmins, Th2 inflammation, disease severity, exacerbations, and mortality in patients with non-cystic fibrosis bronchiectasis. Materials and Methods: A total of 79 adult patients with stable state non-cystic fibrosis bronchiectasis were prospectively enrolled. Demographic characteristics, comorbidities, pulmonary function tests, radiological findings, and disease severity scores (Bronchiectasis Severity Index [BSI] and FACED score [FEV1, age, chronic colonization, extension, dyspnea]) were recorded. Serum levels of IL-25, IL-33, thymic stromal lymphopoietin (TSLP), IL-4, IL-5, IL-13, and IL-17A were measured using enzyme-linked immunosorbent assay. Associations between cytokine levels, disease severity, exacerbations, hospitalizations, and mortality were analyzed using correlation and logistic regression analyses. Results: The mean age of the patients was 50.19 years (range: 19–80). Etiological analysis revealed that 40.5% of cases were post-infectious, 22.8% were related to COPD, and 34.2% were associated with asthma. Pulmonary function tests showed obstructive patterns in 38% of patients, while 32.9% had normal findings. Increased IL-25 and IL-5 levels were associated with higher exacerbation frequency, emergency department visits, and hospitalizations. IL-25 levels showed significant correlations with IL-33 and TSLP. According to FACED classification, disease severity increased in parallel with IL-25 and IL-5 levels, whereas no significant association was observed between BSI scores and cytokine levels. Logistic regression analysis identified elevated IL-25 levels, recent hospitalizations, and emergency department admissions as independent risk factors for mortality and morbidity at 1-year follow-up. Agreement between FACED and BSI scores was modest (κ = 0.273). Conclusions: Alarmins, particularly IL-25, and Th2-driven inflammation may have a significant association with disease severity and clinical outcomes in non-cystic fibrosis bronchiectasis. Elevated IL-25 and IL-5 levels may serve as clinically relevant biomarkers. Combined use of FACED and BSI scores may improve risk stratification, and targeting alarmin-mediated inflammatory pathways could offer novel therapeutic opportunities.

Introduction: Glycosylated hemoglobin (HbA1c) levels are routinely used in secondary and tertiary care centers for monitoring diabetes patients. However, since it is an expensive test, it is not routinely tested in primary care or used as a screening test. This study aimed to examine the relationship between HbA1c levels and in-hospital costs in hospitalized patients during the pandemic period to draw attention to the issue and to be prepared for future pandemics. Methodology: The design of the study was retrospective and cross-sectional. The study was conducted in a tertiary hospital between March and December 2020. Independent variables, including HbA1c levels, comorbidities, age, and gender; and dependent variables including in-hospital costs, prolonged hospital stay ( 14 days), and 30-day mortality; were statistically analyzed. Results: Overall, 517 patients were included in the study, and 96 of them had high HbA1c levels (HbA1c  7). The in-hospital costs were significantly correlated with HbA1c  7 as continuous variables, and HbA1c  7 was a better indicator of in-hospital costs compared to the diagnosis of diabetes. Patients with HbA1c  7 also had prolonged hospital stays and higher mortality rates, in addition to high in-hospital costs. Conclusions: Routine testing of HbA1c levels might be cost-effective and should be performed at primary healthcare facilities.

The utility of lung ultrasound (LUS) in evaluation of coronavirus disease (COVID-19) with pneumonia has not yet been elucidated. The main objective of study is to determine whether LUS can effectively predict the prognosis in intensive care unit (ICU), including mortality and disease severity. It’s also aimed to determine whether LUS will provide a threshold value to predict mortality in COVID-19 cases. In this prospective observational study, 90 patients admitted to the ICU with COVID-19 pneumonia and respiratory failure were included. A LUS cutoff score of 21 on admission demonstrated sensitivity of 97% and specificity of 68% for predicting mortality. Baseline LUS scores were found to be significantly higher in nonsurvivor group(P < .001) whereas APACHE II, sequential organ failure assessment (SOFA), charlson comorbidity index (CCI), nutrition risk in critically ill (NUTRIC) scores, serum lactate, procalcitonin, ferritin, D-dimer levels and heart rate were also significantly found to be higher in nonsurvivor group(P < .05). Overall mean progression-free-survival (PFS) rate was significantly longer in patients with LUS scores < 21, (mean-survival 23.8 days) compared to those with LUS scores ≥ 21 (mean-survival 12.5 days) (P < .05). Multivariate Cox-regression analysis identified a LUS score ≥ 21 was an independent risk factor for mortality during ICU stay (P = .002). LUS performed at ICU admission can serve as a prognostic indicator for patients with COVID-19 pneumonia. By identifying high-risk groups and monitoring these patients closely using LUS, healthcare providers may enhance resource utilization and potentially improve patient outcomes.

Purpose: Although the Pulmonary Embolism Severity Index (PESI) is frequently used, assessing the severity of pulmonary thromboembolism in cancer patients is not sufficient for prognostic evaluation. In this study, we aimed to designate a scoring system to determine the prognosis of newly diagnosed pulmonary thromboembolism in adult cancer patients. Materials and Methods: This prospective, cross-sectional, and descriptive study was held in an emergency department of a university hospital. Patients were classified according to their PESI scores. The echocardiography results, blood gas analyses, lactate, d-dimer, and N-terminus pro-Brain natriuretic peptide levels of the patients were evaluated to prognosticate mortality. Results: Among 53 patients included, 13 mortalities occurred. The mortality was 38.8% (5/23) in PESI Class 3, 7.7% (1/12) in PESI Class 4, and 53.8% (7/10) in PESI Class 5 while none in the 8 patients in PESI Class 2. The mortality in the first 24 hours was 23%, 53.9% in the first month, and 23.1% in 1-3 months. According to the cut-off values determined, a scoring called ‘mPESI’ was developed by giving one point each for d-dimer >24.28 µg/mL, N-terminus pro-Brain natriuretic peptide >1340 pg/mL, blood pH

Purpose: Blood-derived biomarkers have been extensively considered as possible prognostic indicators in idiopathic pulmonary fibrosis (IPF) recently. In order to assess the value of circulating biomarkers in common IPF clinical practice, the study intends to draw conclusions regarding the link between disease severity, prognostic indicators, and serum matrix metalloproteinase in patients with stable idiopathic pulmonary fibrosis. Materials and Methods: The study comprised 22 people with an IPF diagnosis that had been verified by a multidisciplinary approach. The sociodemographic details, clinical and radiologic symptoms, pulmonary function tests and the Gender-Age-Physiology (GAP) score were noted. ELISA has been used to research serum MMP concentrations. Results: There is no statistically significant correlation between the Matrix Metalloproteinase (MMP) 2, MMP 7, MMP 9, and MMP13 and the GAP index and, pulmonary function tests, or disease severity. GAP score was found to be higher in stage 3 in patients with severe disease, in stage 2 in patients with moderate disease, and in stage 1 in patients with mild disease. Conclusion: There are consistent findings in the literature, despite the fact that the association between MMP and IPF prognostic markers, pulmonary function tests, and disease severity could not be seen in this investigation. However, because they could open the door to a cutting-edge treatment strategy, these indicators should be investigated prospectively in larger series.

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.

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.