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  • Küçük Resim
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    Can the progression of COVID-19 pneumonia be predicted?
    (2022) Üçsular, Fatma Demirci; Ayrancı, Aysu; Polat, Gülru; Yalnız, Enver; Güldaval, Filiz; Karadeniz, Gülistan; Unat, Damla Serçe
    Background: Coronavirus disease-2019 (COVID-19) remains a major cause of morbidity and mortality. There are many parameters affecting the progression of the disease. The purpose of the present study was to evaluate and compare the initial data of patients hospitalized with the diagnosis of COVID-19 pneumonia, who progressed during the hospitalization period, with other patients who recovered or remained stable, and to investigate the risk factors that can be used to predict the disease progression. Materials and Methods: Patients, who received inpatient treatment with the diagnosis of COVID-19 pneumonia, were included in the study retrospectively. Two groups were created from all patients according to their progression in hospital follow-ups: Group 1: Progression group and group 2: Recovery/stabilization group. If patients had clinical, laboratory and/or radiological deterioration or died during follow-up, these patients were included in the progression group. If patients recovered or remained stable, these patients were also included in the recovery/stabilization group. The demographic data, initial hemogram, biochemical parameters and radiological data of the patients were recorded. Results: It was determined in the univariate analysis that the age, smoking status, comorbidity, heart disease, chronic obstructive pulmonary disease, cancer, dyspnea, fever, leukocytosis, lymphopenia, elevated neutrophil-lymphocyte ratio (NLR), C-reactive protein, albumin, lactate dehydrogenase, ferritin, D-dimer, troponin-T, pro-B-type natriuretic peptide (pro-BNP) were risk factors predicting disease progression all p-values<0.05. In the multivariate logistic regression analysis, it was found that fever, NLR, and D-dimer could be used to predict the disease progression (p<0.05). In the ROC analysis, the sensitivity of NLR was 83.3%, specificity 57.5%, and cut-off >3.545 [area under curve (AUC)=0.752; p<0.001]; the sensitivity of pro-BNP was 71.8%, specificity 73.8%, and cut-off >332.8 (AUC=0.752; p<0.001), the sensitivity of troponin-T was 81.2%, specificity was 60.6%, and cut-off was >4.58 (AUC=0.730; p<0.001) in predicting progression. Conclusion: The identification of risk factors predicting progression is important in reducing morbidity and mortality rates. Fever, NLR, D-dimer troponin-T and pro-BNP are important parameters that can be used to predict progression.
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    Do the Amount of Fluid, Histopathology, Radiology and Pleurodesis Status Affect the Survival in Malignant Pleural Effusions?
    (2021) Büyükşirin, Melih; Tatar, Dursun; Karadeniz, Gülistan; Polat, Gülru; Aksel, Nimet; Güldaval, Filiz; Üçsular, Fatma Demirci
    INTRODUCTION: The primary objective of this study was to identify the most common pleural malignancies leading to malign pleural effusion (MPE). The secondary objective was to evaluate the relationship between the amount of fluid and radiological findings, etiologies, treatment methods and survival. METHODS: We retrospectively included cases of MPE with a tissue diagnosis. RESULTS: The most common causes of MPE were lung cancer (73%), breast cancer (8.3%) and mesothelioma (7%). In patients who were offered chemical pleurodesis, pleurodesis was successful in nearly 31.1%. No relation wasfound between the amount of pleural fluid and cell type,survival, pulmonary, extrapulmonary malignancy and mesothelioma, Patients live longer if pleurodesis was successful (p = 0.005). Median survival of patients with MPE due to pulmonary, extrapulmonary and mesothelioma, ORCID: 0000-0002-8939-336X respectively were 77 ± 12.8, 150 ± 48.4 and 365 ± 0 days. The survival of the patients with mesothelioma was significantly longer than others (P: 0.000). DISCUSSION AND CONCLUSION: The main cause of MPE was lung cancer, followed by breast cancer, unknown primary and mesothelioma. Chemical pleurodesis was a viable palliative measure for MPE. Successful pleurodesis had a significant contribution to the survival.
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    Pulmoner emboli klinik, laboratuvar bulguları, prognoz ve mortalite açısından cinsiyetler arasında farklılık gösterir mi?
    (2020) Unat, Damla Serçe; Ayrancı, Aysu; Polat, Gülru; Karadeniz, Gülistan; Üçsular, Fatma Demirci; Unat, Ömer Selim; Yalnız, Enver
    Amaç: Pulmoner Tromboemboli (PTE) mortal ve tanı konulması zor bir hastalıktır. Bulgularınınnonspesifik olması nedeniyle zaman zaman tanıya ulaşmak oldukça zor olmaktadır. Malignite,immobilite, geçirilmiş cerrahi, trombofili, ilerlemiş yaş, genetik faktörler majör risk faktörleridir.PTE’de cinsiyetin prognoz ile ilişkisi hakkında yapılan çalışmalarda oldukça farklı sonuçlar bulunmaktadır. Biz bu çalışmada prognoz, yoğun bakım yatışı, laboratuvar ve radyolojik testler açısından cinsiyet farklılıklarını değerlendirmeyi amaçladık.Yöntem: Ocak 2012 ve Aralık 2015 tarihleri arasında Akut PTE tanılı toplam 348 hastanın verileri retrospektif olarak tarandı. Bu hastaların tümü 3. basamak bir göğüs hastalıkları hastanesiolan merkezimizin acil servisine başvurmuş hastalardı. Prognoz sınıflandırılmaları yapılırkenAvrupa Kardiyoloji Topluluğu (ESC) ve Avrupa Solunum Topluluğu (ERS) tarafından ortak tasarlanan PTE kılavuzu temel alındı.Bulgular: Hastaların yaş ortalaması 62,7 iken erkek hastalar daha genç olarak bulundu. Yaş ortalamasının kadınlarda daha yüksek olmasıyla uyumlu olarak kadınların basitleştirilmiş PulmonerEmboli Ciddiyet Endeksi (sPESI) skoru daha yüksek olarak gözlemlendi. Kadınların kötü prognostik faktörleri daha fazla olmasına rağmen her iki cinsiyet arasında erken mortalite açısındananlamlı bir fark bulunmadı.Sonuç: Yaş ortalamaları ve sPESI skorları arasında fark olmasına rağmen; kadınlarla erkekler arasında erken mortalite farkı bulunmadı. PTE’de cinsiyet çalışması farklı çalışmalarda farklı sonuçlarvermesi ve izlem protokollerini etkileyebilecek olmasından dolayı yeni çalışmalara açık bir alandır.