Kamal Quliyev

Synchronous bilateral Wilms tumor (BWT) demands oncologic control while protecting lifelong kidney function. In mesenchymal-predominant tumors, radiologic shrinkage after neoadjuvant therapy may be minimal and can mislead size-based surgical sequencing. In BWT with discordant radiologic response, split renal function can decisively guide sequencing and expand nephron preservation.

Objective The aim of this study was to evaluate the role of baseline oxygenation parameters, including PaO2/FiO2 and SpO2, as well as the inflammatory marker IL-6, in predicting in-hospital mortality among patients treated in the intensive care unit with a diagnosis of acute respiratory distress syndrome (ARDS). Methods This retrospective cohort study included 97 patients diagnosed with ARDS who were treated in the intensive care unit and had available baseline PaO2/FiO2, SpO2, and IL-6 measurements. Patients were divided into two groups according to clinical outcome: survivors and non-survivors. Baseline oxygenation and inflammatory parameters were compared between the groups. Factors associated with in-hospital mortality were evaluated using logistic regression analysis. The prognostic performance of individual parameters and the combined model was assessed using receiver operating characteristic (ROC) analysis. Results Among the 97 patients included in the study, 58 survived and 39 died during hospitalization, resulting in an overall in-hospital mortality rate of 40.2%. Non-survivors had significantly lower PaO2/FiO2 and SpO2 values compared with survivors, while IL-6 levels were significantly higher. In ROC analysis, PaO2/FiO2 showed the highest prognostic performance among individual parameters, with an area under the curve (AUC) of 0.944. The AUC values were 0.911 for SpO2 and 0.868 for IL-6. The combined model including PaO2/FiO2, SpO2, and IL-6 demonstrated the highest discrimination ability, with an AUC of 0.962. Conclusion Low baseline PaO2/FiO2 and SpO2 levels and elevated IL-6 values are strongly associated with in-hospital mortality in patients with ARDS. The combined use of oxygenation parameters and IL-6 may provide a simple, accessible, and clinically useful approach for early mortality risk stratification in intensive care settings.

Acute respiratory distress syndrome (ARDS) remains a severe clinical condition in intensive care practice, characterized by high morbidity and mortality. ARDS is not limited to respiratory failure alone but is also accompanied by a systemic inflammatory response, endothelial dysfunction, and activation of the coagulation system. Although intravenous immunoglobulin (IVIG) therapy has attracted attention as an immunomodulatory approach in critical illness, its relationship with coagulation dynamics in patients with ARDS has not been sufficiently investigated This retrospective, single-center cohort study was conducted in the intensive care unit of the Baku Medical Plaza Babek branch. Patients aged 18 years and older who were diagnosed with ARDS according to the Berlin criteria and treated between January 1, 2015 and December 31, 2020 were included in the study. Patients were divided into two groups: those receiving standard treatment alone and those receiving IVIG in addition to standard treatment. IVIG was administered at a dose of 0.4 g/kg/day for 5 days. Coagulation parameters, including the international normalized ratio (INR) and D-dimer levels, were assessed at treatment initiation and on days 3, 5, 7, and 10. Survival was analyzed as an exploratory clinical outcome. A total of 89 patients were included in the study (IVIG group n=26, control group n=63). At baseline, INR and D-dimer values were similar between the groups. From day 3 of treatment onward, the IVIG group demonstrated more stable and consistent changes in INR over time, with statistically significant differences observed at several consecutive time points. D-dimer levels showed a declining trend in both groups, but no statistically significant differences were recorded between the groups. Logistic regression analysis for survival showed a statistically non-significant association between IVIG therapy and an increased probability of survival. In patients with ARDS, intravenous immunoglobulin therapy was associated with the temporal dynamics of coagulation parameters, particularly INR. Although the findings regarding D-dimer and survival were not statistically conclusive, the observed trends do not rule out a potential effect of IVIG on coagulation balance. These findings provide a basis for evaluating IVIG as an additional immunomodulatory approach in the treatment of ARDS and highlight the importance of future prospective studies. Although the observed INR changes did not exceed clinically critical thresholds, they may reflect a more stable course of coagulation balance.