Huseyin Kaya

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: 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.

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.

Background: CABG is a commonly performed procedure to improve survival and quality of life in patients with coronary artery disease. Despite advances in surgical techniques and perioperative care, postoperative pneumonia remains a serious complication contributing to increased morbidity, mortality and healthcare costs. This study aims to evaluate the incidence of postoperative pneumonia (POP) and identify its risk factors in patients undergoing isolated CABG. Methods: This retrospective study analyzed 430 patients who underwent CABG between 2019 and 2024. Patient demographics, clinical characteristics, surgical details and laboratory data were collected. Statistical analysis included univariate and multivariate logistic regression to identify significant predictors of pneumonia. Results: The incidence of POP after CABG was 10% (43/430). In patients with POP, diabetes mellitus (p = 0.03) and chronic kidney disease (p = 0.048) prevalence was higher, cardiopulmonary bypass (CPB) (p = 0.01) and cross-clamp time (p = 0.003) was longer, LDH levels (p = 0.017) were higher, hemoglobin (p = 0.012) and albumin (p = 0.015) levels were lower, and lymphocyte % (p = 0.04) was lower; prevalence of COPD and length of stay (LOS) in hospital tended to be higher (both p < 0.06). Multivariate binary logistic regression identified COPD (OR 4.383, 95% CI: 1.106–17.363, p = 0.035), CPB time (OR 1.013, 95% CI: 1.001–1.025, p = 0.030) and LOS (OR 1.052, 95% CI: 1.004–1.103, p = 0.035) as independent predictors of POP. Conclusions: Postoperative pneumonia is a common complication after CABG and is strongly associated with preoperative COPD, CPB time and length of stay in hospital. These findings underline the importance of preoperative risk assessment and optimization. Early identification of high-risk patients may allow targeted strategies such as enhanced respiratory support and prophylactic antibiotics to reduce the incidence of pneumonia and improve clinical outcomes.

BACKGROUND AND AIM: Coronavirus Disease 2019 (COVID-19) infection is associated with an increased incidence of thromboembolic events. This study aimed to evaluate the frequency of in-hospital thromboembolic events in patients with COVID-19 and investigate the impact of blood parameters, measured at the time of diagnosis, on the development of thromboembolic events. METHODS: Demographic data, the frequency of thromboembolic events, and blood parameters at the time of diagnosis were recorded for all patients. RESULTS: A total of 2,323 patients, including 1,136 women (48.9%) and 1,187 men (51.1%) were included in the study. Thromboembolic events occurred in 103 (4.4%) patients during hospitalization. Deep vein thrombosis (DVT) was observed in four patients (0.2%), pulmonary thromboembolism (PTE) in three patients (0.15%), peripheral arterial disease in four patients (0.2%), cerebrovascular events in 17 patients (0.7%), mesenteric ischemia in one patient (0.05%), and myocardial infarction (MI) in 74 patients (3.2%). The frequency of thromboembolic events was significantly higher in patients with hypertension (HT) (p=0.03), heart failure (p=0.023), chronic kidney disease (p=0.017), and chronic obstructive pulmonary disease (COPD) (p=0.035) compared to those without these conditions. Patients with thromboembolic events were significantly older than those without such events (p=0.003). Among laboratory parameters, hemoglobin levels were significantly lower (p=0.002), and mean platelet volume (MPV) was significantly higher (p=0.009) in patients with thromboembolic events. Multiple regression analysis identified age (odds ratio [OR]: 1.014, 95% confidence interval [CI]: 1.001–1.027; p=0.032), hemoglobin levels (OR: 0.906, 95% CI: 0.824–0.997; p=0.043), and MPV (OR: 1.197, 95% CI: 1.030–1.391; p=0.019) as risk factors for thromboembolic events. CONCLUSIONS: Advanced age is a risk factor for thromboembolic events in patients with COVID-19. It is believed that hemoglobin levels and MPV at the time of hospital admission may also contribute to predicting thromboembolic events.