Soner Yeşilyurt

Background and Objectives: Hematological and immune-inflammation indices (e.g., neutrophil-to-lymphocyte ratio [NLR], systemic immune-inflammation index [SII] and pan-immune-inflammation value [PIV]) and albumin-based indices (e.g., prognostic nutritional index [PNI] and red cell distribution width [RDW]-to-albumin ratio [RAR]) have each been studied extensively as prognostic markers in pneumonia but are rarely compared head-to-head or benchmarked against serum albumin and their own components. We compared 16 indices, with particular attention to whether composite ratios add value over serum albumin alone. Materials and Methods: In this single-centre retrospective cohort of 957 adults hospitalized with pneumonia, indices were recomputed from raw laboratory values with explicit units. The primary outcome was a composite of in-hospital death or ICU-level care, defined as admission to the institutional intensive care unit (ICU) or verified transfer to an ICU at another hospital when no institutional bed was available (118 events, 12.3%); sensitivity analyses restricted to death or institutional ICU admission (94 events) and excluding the transferred patients (n = 933) are reported. Discrimination used the area under the receiver operating characteristic curve (AUC) with DeLong tests and Holm correction; incremental value used multivariable logistic regression with bootstrap internal validation (including index selection), calibration, category-free net reclassification improvement/integrated discrimination improvement (NRI/IDI), restricted cubic splines, multiple imputation and decision-curve analysis. Results: The RDW-to-albumin ratio (RAR; AUC 0.722, 95% confidence interval [CI] 0.675–0.769), the prognostic nutritional index (PNI; 0.721) and serum albumin (0.710) were the best discriminators. After Holm correction, RAR and PNI had significantly higher AUCs than all inflammatory comparators; albumin had significantly higher AUCs than most, but its differences from the lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI) and NLR were not significant after adjustment (adjusted p = 0.053–0.074). RAR did not significantly outperform albumin alone (ΔAUC +0.012, 95% CI −0.020 to +0.044, p = 0.46) and PNI did not significantly differ from albumin (p = 0.40). Added to a base model (apparent AUC 0.599), albumin gave 0.728 and RAR 0.731 (optimism-corrected 0.720 and 0.722), versus 0.651 for SII (0.634). No significant difference was detected between base + RAR and base + albumin + RDW (ΔAUC −0.009, 95% CI −0.031 to +0.006). At the cohort-derived Youden threshold of RAR ≥ 5.03, sensitivity was 0.73 and specificity 0.65 (positive likelihood ratio [LR+] 2.1, negative likelihood ratio [LR−] 0.42); this cut-off is exploratory and requires external validation. Results were materially unchanged in both sensitivity analyses. Component variables had no missing values, so a multiple-imputation analysis returned identical estimates; procalcitonin discrimination was low (AUC 0.63). Conclusions: In this exploratory analysis of a verified composite of death or ICU-level care, RAR and PNI showed the highest univariable discrimination but did not significantly outperform serum albumin, and component modelling found no evidence that RAR added discrimination beyond albumin and RDW modelled separately. Albumin-based risk markers require prospective external validation alongside established pneumonia severity scores before clinical use.

Aim: Malnutrition and inflammation are critical factors affecting the duration of hospitalization. Although the Nutritional Risk Screening 2002 (NRS-2002) is widely recommended for nutritional assessment, its predictive value for length of stay (LOS) remains controversial. The C-reactive protein to albumin ratio (CAR) has emerged as an objective inflammatory-nutritional marker. This study aimed to compare the prognostic performance of NRS-2002 and CAR in predicting prolonged hospitalization in an internal medicine cohort.Methods: This retrospective cohort study included 375 adult patients hospitalized in the internal medicine ward of a tertiary care hospital between April and October 2023. Prolonged LOS was defined as a hospitalization duration exceeding the median value (>9 days). The predictive performance of NRS-2002, albumin, CRP, and CAR was analyzed using univariate and multivariate binary logistic regression and receiver operating characteristic (ROC) curve analysis.Results: The median LOS was 9 days, and 48.8% of patients experienced prolonged hospitalization. In univariate analysis, CAR (8.5 [24.3] vs. 15 [36.9], p=0.004), albumin (3.3 [0.9] vs. 3.0 [0.8] g/dL, p=0.001) and CRP (25.9 [72.5] vs. 46.0 [104.8] mg/L, p=0.008) differed significantly between the normal and prolonged LOS groups. NRS-2002 scores did not differ between groups (3 [2] vs. 3 [2], p=0.617), and nutritional risk prevalence (NRS-2002 ≥3) was identical in both groups (68.3%). ROC analysis showed that CAR (area under the curve [AUC]=0.585) and albumin (AUC=0.604) had superior discriminative ability compared with NRS-2002 (AUC=0.515). In multivariate analysis, CAR remained an independent predictor (odds ratio [OR]=1.01, p=0.038), whereas NRS-2002 was not (p=0.598).Conclusion: CAR index outperforms the NRS-2002 screening tool in predicting prolonged hospital stay in internal medicine inpatients. While NRS-2002 remains essential for identifying patients in need of nutritional intervention, the integration of objective inflammatory-nutritional biomarkers such as CAR may improve risk stratification for hospitalization outcomes.

Background/Objectives: Simple admission laboratory indices have been proposed for early risk stratification in acute pancreatitis (AP), but their relative performance and their value beyond established severity assessment are rarely examined directly. We performed an exploratory head-to-head comparison of eight admission inflammatory and immunonutritional indices, including the Global Immune-Nutrition-Inflammation Index (GINI), for a composite adverse in-hospital outcome. Methods: This single-center retrospective study (2020 to 2026) analyzed the index admission of each adult hospitalized with AP (one observation per patient). Eight indices were evaluated (NLR, CAR, PIV, PNI, HALP, CALLY, CCR, GINI). The primary endpoint was a composite of in-hospital death, intensive care unit (ICU) admission, or prolonged hospitalization (a length of stay of at least 7 days). We assessed discrimination (area under the curve, AUC, with DeLong intervals and Holm-corrected comparison), age-adjusted logistic regression, calibration, bootstrap validation, and incremental value over the Bedside Index for Severity in Acute Pancreatitis (BISAP), with a patient-clustered robustness analysis. Results: Of 238 patients, 73 (30.7%) met the composite outcome (prolonged stay 63, ICU 15, death 2). After age adjustment, all eight indices were associated with the outcome (all p < 0.001). The three numerically highest were NLR (age-adjusted AUC 0.737, 95% CI 0.667 to 0.808), CALLY (0.735), and GINI (0.734), with no significant pairwise difference after correction. Each added discrimination beyond BISAP (BISAP alone AUC 0.631 vs. BISAP plus CALLY 0.752; likelihood ratio p < 0.001). GINI was numerically higher but not significantly better than its components (CAR 0.710, PIV 0.708). Models were well calibrated (calibration slope 0.97 to 1.00). Conclusions: In AP, several admission indices, led by NLR, CALLY, and GINI, gave modest, broadly comparable discrimination for a composite adverse in-hospital outcome and added information beyond BISAP. No index was superior, and the composite was driven largely by prolonged hospitalization. These exploratory findings require prospective external validation before any clinical use.

Background/Objectives: Depression and anxiety are common among individuals with type 2 diabetes mellitus (T2DM) and are associated with poorer clinical outcomes. Although diabetes stigma and perceived social support have been linked to psychological distress in T2DM, they have largely been investigated separately and with limited adjustment for potential confounders. This study aimed to examine whether diabetes stigma and perceived social support are independently associated with depression and anxiety after adjustment for sociodemographic and clinical confounders and, secondarily, to evaluate the association of insulin use with these psychological outcomes. Methods: In this single-center, cross-sectional study, 209 adults with T2DM attending a tertiary internal medicine outpatient clinic were enrolled. Diabetes stigma was assessed using the Type 2 Diabetes Stigma Assessment Scale (DSAS-2), depression using the Beck Depression Inventory (BDI), anxiety using the Beck Anxiety Inventory (BAI), and perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). Mann–Whitney U tests, Spearman correlation analyses, and two-step hierarchical linear regression models were performed. Results: Diabetes stigma was positively correlated with depression (ρ = 0.351) and anxiety (ρ = 0.432), whereas perceived social support was negatively correlated with both depression (ρ = −0.394) and anxiety (ρ = −0.275) (all p < 0.001). After adjustment for sociodemographic and clinical covariates, the addition of diabetes stigma and perceived social support explained an additional 21.4% of the variance in depression (ΔR² = 0.214) and 17.9% of the variance in anxiety (ΔR² = 0.179) (both p < 0.001). Both diabetes stigma and perceived social support remained independently associated with depression and anxiety, whereas insulin use was not independently associated with either outcome. Conclusions: Diabetes stigma and perceived social support exhibit independent and additive associations with depression and anxiety among individuals with T2DM. Integrating psychosocial assessment, stigma-reduction strategies, and interventions aimed at strengthening social support into routine diabetes care may contribute to improved psychological well-being in this population.

Background/Objectives: Metabolic dysregulation has emerged as a potential modifier of disease activity and disability in multiple sclerosis (MS). However, the relationship between glycemic status and clinical outcomes in patients with MS remains incompletely understood. This study aimed to investigate the associations of glycemic regulation with disease severity, relapse activity, inflammatory markers, and metabolic characteristics in patients with MS. Methods: In this retrospective single-center observational study, 455 patients with MS aged 18–65 years were included. Patients were categorized into normoglycemia (n = 241), prediabetes (n = 98), and diabetes (n = 116) according to American Diabetes Association criteria and documented diabetes diagnosis. Demographic characteristics, Expanded Disability Status Scale (EDSS) scores, annualized relapse rate (ARR), disease-modifying therapy (DMT), hematological indices, inflammatory markers, and metabolic parameters were retrieved from electronic medical records. Associations between glycemic status and clinical outcomes were evaluated using group comparisons, Spearman correlation analyses, and multivariable linear regression models. Results: Significant differences were observed among glycemic groups for age, disease duration, EDSS score, ARR, MS phenotype, platelet count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), lipid parameters, estimated glomerular filtration rate, alanine aminotransferase, gamma-glutamyl transferase, triglyceride–glucose (TyG) index, and atherogenic index of plasma (all p < 0.05). HbA1c, FPG, TyG index, lipid parameters, CRP, and ESR were positively correlated with EDSS scores (all p < 0.05). In contrast, these markers showed inverse correlations with ARR. However, after adjustment for demographic and clinical variables, including age, sex, disease duration, MS phenotype, and disease-modifying therapy (DMT), neither prediabetes nor diabetes remained independently associated with disability, as measured by the EDSS score, or with ARR. Progressive MS phenotype, older age, and longer disease duration were independently associated with higher disability, whereas age, disease duration, and progressive phenotype were independently associated with lower ARR. Conclusions: Impaired glycemic status is associated with greater disability, unfavorable metabolic profiles, and increased systemic inflammation in patients with MS. Nevertheless, glycemic status was not independently associated with disability or relapse activity after adjustment for major clinical confounders. These findings suggest that metabolic dysregulation accompanies more severe clinical characteristics but may not independently drive disease progression in MS.

Objective: This study is a retrospective investigation of the relationship among vitamin D levels, neutrophil-to-lymphocyte ratio (NLR), and routine inflammatory markers. Material and Methods: A total of 3,859 individuals were included in this retrospective cross-sectional study. Participants were evaluated for age, sex, vitamin D level, C-reactive protein (CRP), erythrocyte sedimentation rate, lymphocyte, neutrophil, white blood cell (WBC), ferritin, and alanine aminotransferase (ALT) levels. Vitamin D levels were categorized as >30 ng/mL (normal), 20–30 ng/mL (insufficient), <20 ng/mL (deficient), and <10 ng/mL (severe deficiency). Differences and correlations between the groups were analyzed using SPSS v26 software. Results: The participants' average age was 46.9±16.0 years, and 73.1% of them were female. The average vitamin D level was 19.7±12.0 ng/mL. CRP and WBC levels were significantly higher in the severe deficiency group (p<0.01). Vitamin D levels showed a negative correlation with CRP (r = –0.52, p = 0.002) and WBC (r = –0.079, p = 0.000). A borderline negative correlation was observed between vitamin D and NLR (r = –0.32, p = 0.051). Ferritin, eGFR, and hemoglobin levels also showed significant differences across vitamin D categories. Inflammatory markers were higher in men, whereas vitamin D levels were significantly lower in women. Conclusion: Vitamin D deficiency is associated with elevated inflammatory markers. These findings indicate that vitamin D levels should be considered in the clinical evaluation of systemic inflammation and related health conditions.

The Global Emergency and Critical Care is a peer-reviewed, open-access scientific journal of the Turkish Emergency Medicine Foundation, publishing high-quality research in emergency medicine and related fields. The journal is published quarterly in March, June, September, and December. Objective: The aim of this study was to evaluate the post-treatment change in base excess (ΔBE) in diabetic ketoacidosis (DKA) and to assess how both the magnitude of correction an...

Objectives: Thiol-disulfide measurements will assess obesity-related oxidative stress. Methods: A prospective observational study was done at two tertiary care centers. The participants were divided into three distinct categories based on their body mass index (BMI): The control group (Group 1) consisted of 116 individuals with a BMI ranging from 18 to 25 kg/m², while the overweight group (Group 2, n = 89) included those with a BMI between 25 and 30 kg/m². The obese group (Group 3, n = 39) comprised individuals with a BMI of 30 kg/m² or greater. This approach primarily utilizes the disulfide/native thiol ratio, disulfide/total thiol ratio, and native thiol/total thiol ratio as key metrics. All patients' demographics, waist circumference, hip circumference, height, weight, hemoglobin, hematocrit, white blood cell count, glucose, C-reactive protein, disulfide, native-thiol (NT), total-thiol (TT), lipid hydroperoxide radical (LOOH), and absolute ischemia-modified-albumin (ABSO) levels were recorded on calculations and records were made for disulfide to native and total thiol ratios. Results: Thiol-disulfide equilibrium differed between the three groups. NT concentrations averaged 368.87 mmol/L across all individuals and were significantly higher in the normal-weight cohort (BMI 18-25 kg/m2) at 380.60 mmol/L, compared to overweight and obese populations (p<0.001). TT concentrations were higher in normal-weight individuals, with an average of 426.36±54.48 mmol/L, compared to 405.41±52.14 and 391.07±46.45 in overweight and obese individuals, respectively (p<0.001). Conclusions: Reduced native and total thiol levels, along with altered disulfide concentrations in obese individuals, serve as indicators of oxidative stress.

Objective Thyroid hormones are known to affect the biosynthesis and degradation of antioxidant compounds, suggesting a possible link between hypothyroidism and oxidative stress. However, there is no clear consensus in the literature regarding this association. The aim of this study was to evaluate oxidative stress markers (extracellular thiol-disulfide homeostasis and intracellular glutathione homeostasis) in patients with hypothyroidism due to autoimmune (Hashimoto’s thyroiditis) or nonautoimmune thyroid disease rendered euthyroid after levothyroxine replacement. Subjects and methods The study included 116 patients [...] ABSTRACT Objective Thyroid hormones are known to affect the biosynthesis and degradation of antioxidant compounds, suggesting a possible link between hypothyroidism and oxidative stress. However, there is no clear consensus in the literature regarding this association. The aim of this study was to evaluate oxidative stress markers (extracellular thiol-disulfide homeostasis and intracellular glutathione homeostasis) in patients with hypothyroidism due to autoimmune (Hashimoto’s thyroiditis) or nonautoimmune thyroid disease rendered euthyroid after levothyroxine replacement. Subjects and methods The study included 116 patients