Hasim Boyaci

Background/Objectives: Idiopathic pulmonary fibrosis (IPF) frequently coexists with comorbidities that may influence clinical outcomes. The Charlson Comorbidity Index (CCI) quantifies the weighted comorbidity burden, whereas the age-adjusted Charlson Comorbidity Index (ACCI) additionally incorporates age. We evaluated the associations of CCI and ACCI with pulmonary function, disease severity, clinical course, and mortality in IPF. Methods: This retrospective, single-center cohort study included 319 patients with IPF. Comorbidities present at diagnosis were scored using the CCI and ACCI. Associations with pulmonary function, GAP index, acute exacerbations, hospitalization, long-term oxygen therapy, echocardiographic findings suggestive of pulmonary hypertension, incident malignancy, antifibrotic treatment, and mortality were assessed. Correlation analyses were performed using Spearman’s rank correlation coefficient, and Bonferroni correction was applied to account for multiple testing. Multivariable Cox proportional hazards regression was used to evaluate whether the CCI or ACCI was independently associated with survival. Time-to-event analyses were performed using Kaplan–Meier survival analysis. Results: The mean age was 71 ± 8 years, 78.1% were male, and 75.5% had at least one comorbid condition among patients with available comorbidity data. The median CCI and ACCI scores were 2 (IQR, 0–4) and 5 (IQR, 4–7), respectively. Higher CCI and ACCI categories were associated with hospitalization (p = 0.006 and p = 0.011), echocardiographic findings suggestive of pulmonary hypertension (both p = 0.002), and incident malignancy (p < 0.001 and p = 0.005, respectively). After Bonferroni correction, higher CCI and ACCI categories remained significantly associated with echocardiographic findings suggestive of pulmonary hypertension (both p = 0.002) and incident malignancy (both p < 0.001), whereas the associations with hospitalization did not remain statistically significant. A nominal association between ACCI and mortality (p = 0.044) also did not remain significant after Bonferroni correction. In Spearman analyses, ACCI remained significantly correlated with current age, age at IPF diagnosis, and the GAP index after correction, whereas the correlations of CCI and ACCI with baseline DLCO did not. Neither CCI (HR = 1.029, 95% CI: 0.923–1.146; p = 0.610) nor ACCI (HR = 1.035, 95% CI: 0.936–1.144; p = 0.509) was independently associated with survival in multivariable Cox regression analyses. Lower baseline DLCO remained independently associated with survival in both Cox models (both p < 0.001).Kaplan–Meier survival curves were constructed according to the predefined CCI and ACCI score categories (0, 1–2, 3–4, and ≥5), and survival distributions across categories were compared using the log-rank test. Conclusions: CCI and ACCI were associated with selected clinical characteristics in IPF, particularly echocardiographic findings suggestive of pulmonary hypertension and incident malignancy. However, neither index independently predicted survival after multivariable adjustment. These indices may complement, rather than replace, disease-specific physiological assessments in patients with IPF.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Exacerbations significantly contribute to poor clinical outcomes and increased mortality. Biomarkers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and eosinophil-to-lymphocyte ratio are useful in predicting the prognosis of COPD exacerbations. This study aimed to evaluate the predictive value of the lactate dehydrogenase-to-albumin ratio (LAR), along with NLR, PLR, and eosinophil-to-lymphocyte ratio, for poor clinical outcomes and mortality in patients hospitalized due to COPD exacerbations. We retrospectively analyzed 216 patients hospitalized for COPD exacerbations between 2018 and 2023. Demographic data, comorbidities, laboratory findings, and clinical outcomes, including mortality, noninvasive mechanical ventilation (NIMV), intensive care unit (ICU) admission, and prolonged hospitalization, were evaluated. Multivariate logistic regression and receiver operating characteristic curve analyses were used to examine the relationships between biomarkers and clinical outcomes. Both NLR and PLR were significantly increased in patients admitted to the ICU ( P = .008 and P = .048) and in those who died ( P = .005 and P = .019). Deceased patients also had higher levels of urea and blood urea nitrogen ( P = .008 and P = .007) and lower lymphocyte counts ( P = .012). The risk of mortality was higher in patients with longer hospital stays (odds ratio [OR]: 1.326; P = .025), those requiring NIMV (OR: 20.62; P = .035), patients with elevated blood urea nitrogen levels (OR: 1.126; P = .015), and in those with lower lymphocyte counts (OR: 0.996; P = .039). Receiver operating characteristic analysis showed that NLR predicted mortality with an area under the curve of 0.794 (95% confidence interval: 0.682–0.905; cutoff: 11.84; sensitivity: 75%; specificity: 80.8%, P = .005) and PLR with an area under the curve of 0.745 (95% confidence interval: 0.635–0.855; cutoff: 256.53; sensitivity: 75%; specificity: 70.7%, P = .019). LAR levels were significantly higher in patients who required oxygen therapy ( P = .004) and NIMV ( P = .049). In this study, NLR and PLR were significantly associated with ICU admission and in-hospital mortality. Although LAR was higher in patients requiring oxygen therapy and NIMV, it was not significantly associated with mortality; therefore, its prognostic value remains uncertain. Future research should focus on prospective multicenter cohorts and incorporate dynamic or serial biomarker monitoring to improve prognostic accuracy and better characterize the temporal behavior of these markers.

Background/Objectives: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic interstitial lung disease with high mortality and limited treatment options. Despite recent therapeutic advances, predicting survival remains challenging. Given the challenge of predicting disease progression in IPF, identifying reliable prognostic markers may support individualized treatment strategies, guide follow-up intensity, and improve clinical decision making. This study aimed to evaluate mortality rates and factors associated with poor prognosis in patients with IPF over a 10-year period at a tertiary care center. Methods: Medical records of 268 patients diagnosed with IPF between 2015 and 2024 were retrospectively reviewed. Demographic characteristics, comorbidities, radiological findings, pulmonary function test results, frequency of exacerbations and hospitalizations, treatment details, and survival outcomes were analyzed. Univariate and multivariate logistic regression analyses were performed to identify predictors of mortality. Results: This study included 268 patients (77.2% male; median age, 72 years). During a median follow-up of 24 months, 44% (n = 118) of patients died. Deceased patients were older (p < 0.001) and had higher rates of coronary artery disease, pulmonary embolism, pulmonary hypertension, and malignancy (all p < 0.05). A definite UIP pattern was more common among deceased patients (71.2% vs. 52.4%, p = 0.02). Acute exacerbations (23.3% vs. 8.1%) and hospitalizations (61.9% vs. 23.3%) were significantly more frequent in this group (p < 0.001). In multivariate analysis, GAP score (OR 11.68, p = 0.001), pulmonary hypertension (OR 15.39, p = 0.02), history of exacerbation (OR 56.2, p = 0.04), baseline FVC (OR 1.10, p = 0.02), mean platelet volume (OR 0.29, p = 0.01), and AST level (OR 1.12, p = 0.04) were independent predictors of mortality. Conclusions: Despite advances in management, IPF continues to carry a high mortality risk. This study represents one of the largest single-center IPF cohorts from our region with long-term real-life follow-up and additionally evaluates laboratory biomarkers such as MPV and AST, which have not been widely investigated as prognostic indicators in IPF. Advanced age, reduced pulmonary function, comorbidities, and acute exacerbations are major prognostic factors. Early recognition and proactive management of these parameters may help improve survival outcomes.

This study examined the long-term transcriptomic reprogramming in peripheral blood mononuclear cells (PBMCs) of severe COVID-19 patients and its effects for cancer development. RNA sequencing was conducted on PBMCs obtained from healthy controls, COVID-19 patients without pneumonia, and COVID-19 patients exhibiting severe pneumonia one year post-infection. Differential gene expression analysis identified a sustained pro-oncogenic molecular signature, especially among severe COVID-19 patients. Functional enrichment analysis revealed a substantial enrichment of cancer-associated pathways, encompassing apoptosis, viral carcinogenesis, and transcriptional dysregulation. Notably, the autophagy-related gene SQSTM1/P62 was recognized as a distinctive hub gene within the severe COVID-19 patients, interacting with pivotal genes associated with inflammation, apoptosis, and cancer advancement. Survival analysis demonstrated that elevated expression of COVID-19-associated hub genes correlated with unfavorable prognosis in various cancer types, including adrenocortical carcinoma, bladder urothelial carcinoma, and brain lower-grade glioma. These findings indicate that severe COVID-19 infection may establish a systemic milieu favorable to cancer development or recurrence, highlighting the necessity of prolonged oncological monitoring in these patients. Finding specific molecular targets and pathways can help us understand how COVID-19 might be linked to a higher risk of cancer.

Background: Sarcoidosis is a systemic granulomatous disease with a highly variable clinical course, and distinguishing it from other diseases and predicting its prognosis can be challenging. In recent years, hematological and biochemical parameters have been investigated as potential biomarkers for assessing inflammation and predicting disease prognosis. This study aimed to evaluate the prognostic value of the lactate dehydrogenase-to-albumin ratio (LAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR). Methods: This retrospective, single-center study included 369 newly diagnosed patients with sarcoidosis who were admitted between January 2020 and October 2024. Sarcoidosis was diagnosed based on current ERS, ATS, and WASOG guidelines. At the 6-month follow-up, patients’ clinical courses were classified as regression, stable, or progression based on clinical, radiological, and pulmonary function tests. The predictive values of various hematological and biochemical parameters were analyzed using statistical methods, including binary logistic regression analysis and ROC analysis. Results: A total of 369 patients were included in the study. At the 6-month follow-up, 63.4% of patients showed regression, 21.4% had a stable course, and 15.2% showed progression. The progression group had a significantly higher LAR (5.26 [4.21–7.76]) compared to the stable/regression group (4.59 [3.82–5.86]) (p = 0.033). Additionally, baseline FVC% (OR, 0.97; p = 0.036) and the presence of dyspnea (OR, 3.08; p = 0.03) were identified as independent risk factors for disease progression. No significant associations were found between NLR, PLR, LMR, and serum ACE levels and the clinical course. The cutoff value of LAR for predicting disease progression was 4.87 (AUC: 0.605), with a sensitivity of 58.8% and specificity of 59.7%. Conclusions: Our study, which is the first to evaluate the prognostic value of LAR in sarcoidosis, identified this parameter as a significant indicator for the clinical course. The finding of significantly higher LAR levels in patients with disease progression suggests its potential as a prognostic biomarker. These results may help guide treatment and follow-up strategies, although further large-scale prospective studies are needed for validation.

An Important Question: Can Serum Chitotriosidase Enzyme Predict the Activity and Clinical Course of Sarcoidosis Disease? - Thoracic Research and Practice

The process of aging is characterized by a series of physiological, cellular, and immunological changes in tissues. Bempedoic acid is an antioxidant, anti-inflammatory, and cholesterol-lowering drug that does not belong to the statin class. The objective of this study was to assess the impact of bempedoic acid on age-related histopathological alterations in rat lungs. A total of 40 Wistar-Albino male rats (275–357 g) were included in the study, with 10 rats in each experimental group [Young control (YC), Young + Bempedoic acid (YD), Elderly control (EC), Elderly + Bempedoic acid (ED)]. Bempedoic acid (30 mg/kg/day) was administered orally for one month. The rats were housed under controlled conditions to minimize external stressors. The Geropathological Grading System (GGP) was used to standardize the evaluation of age-related findings in the lungs. Some lesions were classified as either present or absent, whereas others were evaluated on a scale of 0–4 according to their severity. Composite lesion scores were calculated for each rat. Additionally, the presence and severity of emphysema in the rat lungs were recorded. Although the median composite lesion score was higher in the elderly groups, the difference was not statistically significant (p = 0.7). The distribution of cells associated with passive congestion, heart failure, and atelectasis was higher in the elderly drug group (p = 0.024 and p = 0.015, respectively). The prevalence of perivascular inflammation was significantly higher in the elderly control group compared to the other groups. Moreover, no cases of moderate-to-severe perivascular inflammation were observed in the elderly drug group (p = 0.019). The prevalence of severe emphysema was higher in the elderly control group compared to the other groups, whereas no cases of severe emphysema were observed in the elderly drug group (p = 0.044). It is hypothesized that statins, a class of antihyperlipidemic drugs, exert a protective effect against aging due to their ability to correct oxidative damage. Similarly, bempedoic acid’s effect on fat oxidation and cholesterol metabolism may be associated with its protective role in the lungs.

There are studies evaluating the association of serum lactate dehydrogenase (LDH) and albumin levels with mortality in COVID-19 patients. The aim of our study was to evaluate the predictive effect of the LDH/albumin ratio (LAR) on mortality and poor clinical course in COVID-19 patients. A total of 2093 patients for whom LDH and albumin tests were available were included in the study. Demographic data, length of hospitalization, and signs of poor clinical course were recorded and compared with the LAR value at the time of hospitalization. The study included 1010 female (48.3%) and 1083 male (51.7%) patients. Notably, 1408 (67.3%) of the patients had at least 1 comorbidity. Oxygen was required in 860 patients (41.1%) and intensive care unit was required in 215 patients (10.3%). The mortality rate was 8.1% (n: 170). The median LAR value was 8.05. A positive correlation was observed between LAR and length of hospitalization. The LAR value was significantly higher in patients who died compared with those who survived, in patients who required intensive care compared with those who did not, and in patients who required oxygen compared to those who did not. The cutoff value for LAR in predicting mortality was calculated as 10.48. The sensitivity and specificity were determined as 73.5% and 73.7%. In conclusion, serum LAR at the time of admission is predictive of poor clinical course and mortality in COVID-19 patients. Patients with LAR values higher than the cutoff value should be closely monitored for poor clinical course.

Objective: Cough is one of the most frequent symptoms in patients with idiopathic pulmonary fibrosis (IPF). The aim of this study was to investigate whether there was any difference with respect to quality of life, depression, sleep disturbance and reflux symptoms between IPF patients with and without cough symptom. Study Design: Cross-sectional study Materials and Methods: Patients with IPF who were admitted to outpatient clinic were divided into two groups according to the Visual Analog Scale (VAS) scores as cough group and non- cough group. In each group, Leicester cough questionnaire, reflux questionnaire, Beck depression questionnaire, St George's quality of life questionnaire (SGRQ) and Sleep Quality index were evaluated to determine whether there were any differences between groups. Results: It was shown that the Leicester cough questionnaire score was lower in the cough group (86±24.9 vs 111±18.9) (p 0,02). Beck depression score revealed moderate level of depression in both groups (22±10.74 in cough group vs 18±11.86 in non-cough group) (p 0,4). SGRQ symptom score was significantly higher in the cough dominant group (p 0,04). Conclusion: It is found that presence of cough in patients with IPF negatively affected the quality of life and was associated with the sleep disorders and depression. Leicester cough questionnaire can be used to assess whether the cough symptom affects patients’ quality of life in routine clinical evaluation of patients with IPF. This evaluation is thought to improve quality of life and treatment compliance by increasing cough palliation in IPF patients.