Ali Cetinkaya

Introduction: Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality in elderly patients. Early identification of high-risk individuals is crucial for improving outcomes. Biomarkers derived from routine laboratory tests, such as the lactate / albumin (L/A) ratio, may provide valuable prognostic information. Methodology: This retrospective, two-center observational study included patients aged ≥ 65 years who were hospitalized with CAP between January 2021 and December 2024. Demographic characteristics, comorbidities, clinical severity scores, and laboratory parameters obtained at hospital admission were analyzed. Laboratory-derived ratios, including L/A, C-reactive protein/albumin (CRP/A), procalcitonin/albumin (PCT/A), and lactate dehydrogenase/albumin (LDH/A), were calculated. Receiver operating characteristic (ROC) analysis and logistic regression were performed to assess predictors of in-hospital mortality. Results: A total of 150 patients were included, of whom 24% died during hospitalization. Non-survivors had significantly higher comorbidity burden, quick sepsis-related organ failure assessment (qSOFA) scores, lactate levels, and biomarker-based ratios. The L/A ratio was significantly associated with mortality (p < 0.001) and demonstrated moderate diagnostic performance (area under ROC, AUC = 0.263), with relatively favorable sensitivity and negative predictive value. Among the evaluated clinical scores, qSOFA showed the most balanced discriminatory performance. Multivariate analysis identified baseline oxygen saturation, Glasgow coma scale, albumin, and lactate levels as independent predictors of mortality. Conclusions: The L/A ratio is a readily available biomarker associated with mortality in elderly patients with CAP. Although not a standalone predictor, it may serve as a complementary prognostic tool alongside established clinical severity scores, particularly during early patient assessment.

Cardiac involvement is increasingly recognized in patients with community-acquired pneumonia (CAP). This study aimed to investigate the association between baseline troponin I levels and clinical outcomes, including overall survival, among hospitalized patients with CAP who underwent clinician-directed cardiac evaluation. In this retrospective cohort study, 491 patients were stratified according to baseline cardiac troponin I level (P < .05). These patients also had lower left ventricular ejection fraction, higher rates of intensive care unit admission, and in-hospital mortality. During a median follow-up of 439 days, 167 patients (34%) died. Kaplan–Meier analysis showed significantly reduced overall survival in patients with elevated troponin I levels (log-rank P < .001). In multivariate Cox regression analysis, male gender, elevated troponin I (hazard ratio [HR] = 2.016), higher CCI (HR = 1.275), increased blood urea nitrogen to albumin ratio (HR = 2.876), lower hemoglobin levels (HR = 0.841), and reduced ejection fraction (HR = 0.964) were independently associated with mortality. Elevated baseline troponin I was associated with increased mortality and reduced overall survival in this selected high-risk patient population. However, its discriminative performance for mortality was modest (area under the curve [AUC] = 0.64) and lower than that of CCI (AUC = 0.73). The addition of troponin I to a model including age and CCI resulted in only minimal improvement in discrimination (AUC 0.721 vs 0.724), indicating limited incremental prognostic value beyond established risk indices.

Introduction: Lower respiratory tract infections (LTRI) are important hospitalization cause in pulmonary wards. The hospitalization time directly affects hospitalization costs. We aimed to find out whether the blood neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP) and procalcitonin (PCT) values predict the hospitalization time in patients with LTRI.Material and methods: We evaluated patients retrospectively between January 2016 and December 2018 in a cross-sectional study. 1297 patients with the diagnosis of pneumonia, chronic obstructive pulmonary disease (COPD) exacerbation, bronchiectasis exacerbation, parapneumonic effusions, and empyema were included in the study according to ICD-10 and hospitalization criteria guidelines.Results: Of 1297 patients, 762 (58.75%) were male and median age was 63 (interquartile range (IQR): 55–75). Median hospitalization time was 7 (IQR: 5–10) days. Median NLR was 6.28 (3.78–10.92), median CRP was 79.2 (IQR: 26.7–171.5) mg/l and median PCT was 0.23 (IQR: 0.08–0.51) ng/ml. Over 7 days’ hospitalization time was accepted as long-term hospitalization time. Median NLR was 5.73 (IQR: 5.51–10.16) in < 7 days, 6.94 (IQR: 4.22–11.77) in > 7 days. The difference was statistically significant between the groups (p = 0.000). Median CRP value was 61.5 (IQR: 21.75–139.70) mg/l in ≤ 7 days, and 109.4 (IQR: 22.4–199.5) mg/l in > 7 days. The difference was significant between the groups (p < 0.001). Median PCT value was 0.20 (IQR: 0.07–0.45) mg/l ≤ 7 in days and 0.28 (IQR: 0.10–0.55) mg/l in > 7 days. The difference was not significant between the groups (p = 0.055). For the multivariate analysis, the possible factors identified with univariate analyses were further entered into a logistic regression analysis to determine independent predictors of long-term hospitalization. The odds ratio for CRP was OR = 0.004 (p < 0.001), but NLR and PCT was not significant (p = 0.777, p = 0.784, respectively). Sputum culture positivity and radiological infiltration were associated with the long-term hospitalization (p = 0.003 and p = 0.027, respectively).Conclusions: CRP value was associated with the long-term hospitalization in patients with LTRI, but not with NLR and PCT. Sputum culture positivity and radiological infiltration might affect the long-term hospitalization.

To compare patients with COVID-19 in intensive care units (ICUs) to healthy controls using nailfold videocapillaroscopy (NVC), offering standardised findings about micro-circulation. A descriptive, cross-sectional study. Medical Intensive Care Unit, Kayseri City Education and Research Hospital, Kayseri, Turkey between January and May 2021. The NVC parameters-capillary morphology, loop diameter, capillary density, dilated capillaries, giant capillaries, avascular areas, microaneurysms, and micro-hemorrhages of 32 patients with COVID-19 and 29 controls were recorded. The most common capillary morphology in the COVID-19 group (18/32, 56.2%) was serpentine, which also characterised some (6/29, 20.7%) patients in the non-COVID-19 group (p <0.001). The median capillary loop diameter was 77.78 ± 3.63 µm in the COVID-19 group and 71.67 ± 2.19 µm in the non-COVID-19 group (p=0.030). Mean capillary density was 6.41 ± 1.21/1 mm in the COVID-19 group and 8.55 ± 1.12/1 mm in the non-COVID-19 group (p <0.001). The COVID-19 group had significantly more enlarged capillaries (p = 0.001), giant capillaries (p = 0.025), avascular areas (p = 0.028), micro-aneurysms (p <0.001), and micro-hemorrhages (p = 0.011). Mean capillary density was 5.50 ± 0.19/1 mm among deceased patients with COVID-19, but 6.71 ± 0.25/1 mm among survivors (p = 0.011). NVC findings differed between patients with COVID-19 and controls, and capillary density was less among deceased patients with COVID-19 than survivors. Capillaries, COVID-19, İntensive care unit, Micro-circulation, Nailfold videocapillaroscopy.