Hatice Eyiol

Bahar Oc and Ates Duman were inadvertently omitted from the author list in the original publication

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection (Sepsis-3 definition), associated with high mortality in intensive care unit (ICU) patients. Composite immune–nutritional indices derived from routine laboratory data have emerged as accessible prognostic tools; however, their comparative value in critically ill septic patients remains insufficiently characterised. This study aimed to compare the prognostic performance of the haemoglobin–albumin–lymphocyte–platelet (HALP) score, pan-immune-inflammation value (PIV), and Naples Prognostic Score (NPS) for predicting in-hospital mortality in ICU patients with sepsis as the primary outcome, and to assess their incremental predictive value as the secondary objective. Methods: In this retrospective, two-centre cohort study, 1020 consecutive eligible adult patients fulfilling Sepsis-3 criteria (suspected or confirmed infection with an acute increase in SOFA score ≥ 2 points) admitted to the ICUs of Necmettin Erbakan University Hospital and Beyhekim Training and Research Hospital between January 2016 and June 2025 were included. HALP was calculated as haemoglobin (g/L) × albumin (g/L) × lymphocyte count (×10⁹/L) ÷ platelet count (×10⁹/L); PIV as (neutrophil × platelet × monocyte) ÷ lymphocyte (all ×10⁹/L). NPS was computed from serum albumin, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio, with the total-cholesterol component imputed due to availability in only 31.7% of patients. Discriminative performance was evaluated by receiver operating characteristic (ROC) analysis, pairwise DeLong tests, bootstrap resampling (1000 iterations), Hosmer–Lemeshow calibration, and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analyses. Five pre-specified nested multivariable logistic regression models were constructed. Results: Of 1020 patients (median age 76 years, IQR 67–83; 59.8% male), 521 (51.1%) died during hospitalisation. HALP showed the highest discriminative ability among individual indices (AUC 0.626, 95% CI 0.594–0.658), while PIV was non-discriminatory (AUC 0.504, p = 0.78) and NPS showed limited performance (AUC 0.563, 95% CI 0.531–0.595). HALP remained an independent predictor of mortality after multivariable adjustment (OR 0.98, 95% CI 0.97–0.99, p = 0.002). NRI and IDI analyses showed no incremental value with NPS addition. Conclusions: HALP demonstrated modest but independently consistent discrimination for in-hospital mortality in ICU patients with sepsis, outperforming PIV and NPS. However, an AUC of 0.626 does not support standalone clinical use; external validation and comparison with established severity models are required before integration into risk stratification frameworks.

Background: Opioid dependence treated with buprenorphine/naloxone is associated with increased cardiovascular risk; however, data regarding aortic elasticity and cardiac electrophysiological balance during long-term maintenance therapy remain limited. This study investigated aortic stiffness and distensibility in individuals receiving buprenorphine/naloxone (Suboxone), and examined their associations with echocardiographic and electrocardiographic parameters, including the index of cardiac electrophysiological balance (iCEB and iCEBc). Methods: A retrospective cohort analysis was conducted, including 130 intravenous opioid users receiving Suboxone and 150 age- and sex-matched healthy controls. All participants underwent clinical evaluation, transthoracic echocardiography, resting 12-lead electrocardiography, and 24-h ambulatory blood pressure monitoring. Results: Compared to controls, opioid users demonstrated significantly higher aortic distensibility (median 0.019 vs. 0.015, p < 0.001) and lower aortic stiffness (median 52.31 vs. 64.66, p < 0.001). Patients receiving Suboxone for more than 18 months exhibited higher diastolic blood pressure (p = 0.044), mean arterial pressure (p = 0.046), and pulmonary artery pressure (p = 0.022). Aortic elasticity indices showed strong correlations with blood pressure and echocardiographic parameters. In the overall cohort, Suboxone use duration was not significantly correlated with aortic stiffness or distensibility parameters, while a weak negative correlation was observed with ferritin levels (r = −0.231, p = 0.008). In subgroup analysis of long-term users (>18 months), a moderate positive correlation was observed between therapy duration and iCEB values (r = 0.367, p = 0.001). Conclusions: Chronic buprenorphine/naloxone therapy appears to be associated with changes in aortic elasticity, blood pressure, and mild electrophysiological alterations. These results support the use of non-invasive vascular and electrocardiographic evaluations for cardiovascular risk monitoring and stratification among patients receiving opioid maintenance therapy.

Background: Continuous non-invasive hemoglobin monitoring (SpHb) may provide real-time information during surgery, but its accuracy in neurosurgery remains uncertain. We evaluated the agreement, trending ability, and diagnostic performance of SpHb compared with arterial blood gas hemoglobin during elective intracranial neurosurgery. Methods: In this prospective observational study, 60 adults undergoing elective neurosurgery with invasive arterial monitoring were included. SpHb (Masimo Radical-7) was compared with paired arterial hemoglobin values. Agreement was assessed using repeated-measures Bland–Altman analysis and mixed-effects modeling. Trending ability was evaluated using four-quadrant concordance with an exclusion zone of ±0.5 g/dL. Discrimination for severe anemia (Hb < 8 g/dL) was assessed using ROC analysis with patient-level cluster bootstrapping. Results: A total of 190 paired measurements were analyzed. Mean bias was +0.23 g/dL, with wide limits of agreement (−3.26 to +3.72 g/dL). Agreement was worse under low-perfusion-index conditions. Trending performance was preserved, with an overall concordance rate of 85.5%. SpHb showed moderate discrimination for severe anemia (AUC 0.78; 95% CI 0.61–0.93), although severe anemia events were infrequent. Conclusions: SpHb showed limited reliability for absolute hemoglobin quantification during neurosurgery but provided useful trend information. SpHb should not replace invasive hemoglobin measurements for clinical decision-making.

Background: Dyspnea is a frequent complaint during pregnancy and is often considered a benign physiological finding; however, it may also reflect underlying subclinical cardiovascular alterations. Pregnancy-related vascular remodeling and low-grade systemic inflammation may contribute to changes in aortic elastic properties and inflammatory biomarkers, particularly in symptomatic women. Objective: This study aimed to compare aortic elastic properties and albumin-based inflammatory indices between dyspneic and asymptomatic third-trimester pregnant women. A secondary aim was to establish reference values for echocardiographic and biomarker parameters in dyspneic pregnancy. Methods: In this prospective observational study, third-trimester pregnant women (≥27 gestational weeks) presenting to the emergency department (ED) with dyspnea were consecutively enrolled and compared with age-matched asymptomatic pregnant controls. Demographic, laboratory, and echocardiographic data were recorded. Aortic strain, aortic distensibility, and aortic stiffness were calculated using transthoracic echocardiography. Albumin-based inflammatory indices, including the hemoglobin–albumin–lymphocyte–platelet (HALP) score, prognostic nutritional index (PNI), C-reactive protein-to-albumin ratio (CAR), and RDW-to-albumin ratio (RAR), were analyzed. Receiver operating characteristic (ROC) and correlation analyses were performed. Results: A total of 241 pregnant women were included (121 dyspneic, 120 controls). Demographic characteristics were comparable between groups. Dyspneic pregnant women exhibited significantly lower aortic strain and aortic distensibility and higher aortic stiffness compared with controls (for all p < 0.05). Among laboratory parameters, CAR levels were significantly elevated in the dyspneic group (p < 0.001), whereas HALP, PNI, and RAR did not differ significantly. After adjustment for potential confounders, differences in aortic elastic properties remained significant. CAR demonstrated moderate discriminative ability for dyspnea (AUC = 0.692), while aortic elastic parameters showed modest predictive performance. In combined prediction models incorporating CAR with echocardiographic parameters, discriminatory performance improved, with area under the curve values exceeding 0.70. Weak positive correlations were observed between PNI and aortic strain and distensibility. Conclusions: Dyspneic third-trimester pregnant women exhibit impaired aortic elastic properties and increased CAR levels, suggesting the presence of subclinical vascular and inflammatory alterations. Assessment of aortic elasticity and CAR may provide a simple and practical approach for early cardiovascular risk stratification in symptomatic pregnancy, particularly in ED settings. Further multicenter studies with longitudinal follow-up are warranted to clarify their prognostic significance.

Introduction: Acute coronary syndrome (ACS), encompassing unstable angina, NSTEMI, and STEMI, is a major cause of morbidity and mortality worldwide. Novel inflammatory and nutritional biomarkers may provide incremental value for risk stratification beyond conventional predictors. This work sought to determine whether the Pan-Immune-Inflammatory Value (PIV) and the Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score could serve as independent prognostic indicators in individuals presenting with acute coronary syndrome. Methods: A retrospective multicenter study included ACS patients hospitalized between January 2020 and May 2024. Demographics, clinical data, and laboratory results were collected. PIV was calculated as follows: neutrophils × platelets × monocytes/lymphocytes. HALP score was calculated as follows: hemoglobin × albumin × lymphocytes/platelets. Correlations with clinical parameters and mortality prediction were analyzed. Results: A total of 1134 patients (mean age 62 ± 12 years) were included. PIV showed positive correlations with WBC (Rho = 0.574), troponin (Rho = 0.381), and CRP (Rho = 0.295), and negative correlations with HDL (Rho = –0.101) and ejection fraction (Rho = –0.316) (all p < 0.01). PIV independently predicted mortality with a cut-off ≥1074.2 (AUC = 0.619, sensitivity 45%, specificity 79.9%). HALP score negatively correlated with age, troponin, CRP, and ICU stay, and predicted mortality with a cut-off ≤3.58 (AUC = 0.722, sensitivity 53.8%, specificity 82%). Comparative ROC analysis showed that HALP demonstrated superior discriminative ability for mortality prediction compared with PIV. Conclusions: PIV and HALP score are independent prognostic markers in ACS, reflecting inflammatory burden and nutritional status. Their integration into clinical workflows may enhance risk stratification and support individualized management strategies. Given their simplicity and universal availability, PIV and HALP may serve as practical adjunctive tools to established risk scores, enabling early identification of high-risk ACS patients at the time of admission.

Amaç: Bu çalışma, akut koroner sendrom (AKS) tanısı alan hastalarda eritrosit da%ılım genişli%i/albümin oranının (RAR) prognostik de%erini araştırmayı amaçlamıştır.Gereç ve Yöntemler: Bu retrospektif, iki merkezli çalışmaya, 1 Ocak 2020 ile 1 Haziran 2025 tarihleri arasında Necmettin Erbakan Üniversitesi Tıp Fakültesi ve Konya Beyhekim E%itim ve Araştırma Hastanesi kardiyoloji kliniklerinde AKS tanısı ile izlenen 677 hasta dahil edildi. Çalışma popülasyonunun %63,5'i (n = 430) STEMI, %27,5'i (n = 186) NSTEMI ve %9,0'ı (n = 61) instabil angina pektoris (UAP) olarak sınıflandırıldı. Demografik, klinik ve laboratuvar parametreleri retrospektif olarak kaydedildi. RAR de%erleri şu formül kullanılarak hesaplandı: RDW (%) / Albümin (g/dL). Hastalar hastane içi mortaliteye göre iki gruba ayrıldı ve karşılaştırıldı.Bulgular: Genel ortalama RAR 4,03 ± 0,92 idi. Eksitus olan hastalarda RAR, hayatta kalanlara göre anlamlı derecede yüksekti (4,76 ± 1,01'e karşı 3,95 ± 0,84; p < 0,001). Lojistik regresyon analizinde yaş (OR 1,05; p = 0,001), ejeksiyon fraksiyonu (OR 0,93; p < 0,001) ve RAR (OR 2,87; p < 0,001) hastane içi mortalitenin ba%ımsız öngördürücüleri olarak belirlendi. ROC e%risi analizi, RAR için 0,864'lük bir AUC (%95 GA: 0,810–0,917) gösterdi; ≥ 0,373 kestirim de%erinde duyarlılık %93,2 ve özgüllük %71,2 olarak saptandı.Sonuçlar: RAR, AKS'li hastalarda mortaliteyi ve advers klinik sonuçları öngörmek için güçlü bir biyobelirteçtir. Rutin kan testlerinden kolayca elde edilen pratik ve düşük maliyetli bir parametre olarak RAR, klinisyenlere erken risk sınıflandırmasında yardımcı olabilir. Bu bulgular, kardiyovasküler prognozun belirlenmesinde inflamasyonun ve beslenme durumunun önemini desteklemektedir.

Aim Uric acid/albumin ratio (UAR) has recently emerged as a potential marker for oxidative stress and inflammation, which are key components in the pathophysiology of myocarditis. Therefore, high UAR may reflect increased disease activity and severity in myocarditis patients. In this study, we aimed to evaluate the usability of uric acid/albumin ratio as a biomarker in determining disease severity in patients with acute myocarditis. Methods The study population was evaluated retrospectively. Laboratory parameters of the patients were examined. We classified the condition as severe myocarditis based on the presence of refractory chest pain, hypotension, detection of pericardial effusion with subsequent increase, a decrease in ejection fraction (EF), and lack of response to medical and symptomatic treatment. The primary outcome was the association between UAR and disease severity. Results The median age was 43.5 years. The UAR was significantly higher in females (0.10 vs. 0.10, p=0.003). Patients with pericardial effusion had significantly higher UARs (0.137 vs. 0.100, p

Acute pericarditis is a sudden, typically noninfectious inflammation of the membrane surrounding the heart. It can arise from various causes, including viral infections, autoimmune diseases, cancer, trauma, or medications. This study aimed to evaluate the prognostic significance of the Pan-Immune-Inflammatory Value (PIV) and the hemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting disease severity, recurrence, and prognosis in patients with acute pericarditis. A retrospective cohort study was conducted, including 281 patients diagnosed with acute pericarditis between 2014 and 2023. Data on hemoglobin, albumin, neutrophil, monocyte, lymphocyte, and platelet levels, as well as clinical characteristics, treatment outcomes, and recurrence status, were extracted from hospital records. The PIV was calculated using the formula: neutrophil count (10³/mL) × monocyte percentage (%) × platelet count (10⁹/L)/lymphocyte count (10³/mL). The HALP score was determined as hemoglobin (g/L) × albumin (g/L) × lymphocyte count (10³/mL)/platelet count (10⁹/L). Statistical analyses were performed to evaluate the associations between these biomarkers and clinical outcomes. PIV was significantly higher in patients with pericardial effusion, pericardial friction rub, and persistent chest pain at 15-day follow-up ( P = .003). Patients with hypertension, hyperlipidemia, and recent infections showed elevated PIV values, indicating more severe disease and a higher likelihood of recurrence. HALP score was significantly lower in patients with pericardial effusion and in nonsmokers. HALP score was significantly higher in patients with electrocardiography changes. PIV emerged as a stronger predictor of pericarditis severity, prognosis, and recurrence compared to the HALP score. The combined use of both markers may enhance the assessment of disease severity and prognosis, offering valuable insights for clinical decision-making in pericarditis management. Further studies are needed to validate these findings.