Effectiveness of Lactate Clearance to Predict In-Hospital Mortality in Patients with Upper Gastrointestinal Bleeding.

OBJECTIVE: To determine the performance of lactate clearance to predict prognosis in patients with upper gastrointestinal bleeding (UGIB). STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Emergency Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey, from January 2018 to 2022. METHODOLOGY: This study was conducted with 141 patients with UGIB. Lactate clearance was calculated based on the lactate levels at the time of admission and 6th hour. The primary outcome was survival. The secondary outcomes were the need for intensive care unit, endoscopic intervention, blood transfusion, and length of hospital stay. RESULTS: The median age of the patients was 71 years and 65.2% were males. In the non-survivor group; systolic blood pressure, diastolic blood pressure, base deficit, delta lactate, and lactate clearance were significantly lower; however, heart rate, baseline lactate and final lactate were significantly higher. The median lactate clearance of survivors and non-survivors were 23.61 and -0.51, respectively (p = 0.002). A unit decrease in lactate clearance increased mortality 1.011-fold. The performance of lactate clearance in predicting mortality was followed as; sensitivity 76.4, specificity 51.4 (AUC = 0.673, p = 0.002), and the cut-off value was 21.51. Lactate clearance was not statistically significant in determining the need for intensive care (p = 0.110), endoscopic intervention (p = 0.152) and blood transfusion (p = 0.266) in UGIB. CONCLUSION: Lactate clearance was an independent predictor of in-hospital mortality in UGIB. It is thought that the study will guide clinicians in the differentiation of critically-ill patients and an effective treatment planning. KEY WORDS: Upper gastrointestinal haemorrhage, Lactate, Lactate clearance, Mortality, endoscopy, Blood transfusion, Intensive care.

Comparison of the Effectiveness of Shock Index, Modified Shock Index, and Age Shock Index in COPD Exacerbations.

OBJECTIVE: To evaluate the effectiveness and practicality of shock index (SI), modified shock index (MSI), and age-shock index (Age-SI) in predicting the prognosis, mortality, ICU and service admission, and the need for intermittent mandatory ventilation (IMV) and nasal intermittent mandatory ventilation) (NIMV in the ED patients with chronic obstructive pulmonary disease (COPD) exacerbation. STUDY DESIGN: Retrospective study. PLACE AND DURATION OF STUDY: Balikesir University Faculty of Medicine, Emergency Service, Balikesir, Turkey, from January 2019 to May 2020. METHODOLOGY: Adult patients, who were admitted to the Emergency Department with diagnosis of COPD exacerbation, were included. Patients with missing data were excluded. SI, MSI, and age-SI values were calculated by using the vital signs. ROC curve analysis was used to evaluate the diagnostic performances of SI, MSI, and age-SI. RESULTS: The study consisted of 201 patients, 152 (75.6%) were males. Six (3%) patients died, 26 (12%) were admitted to ICU, 112 (55.7%) were admitted to the service, 11 (5.5%) needed IMV, and 48 (23.9%) needed NIMV in ED. SI was superior to the MSI and age-SI in predicting mortality, and AUC values of 0.802, 0.727, and 0.704, respectively. SI was also superior to the MSI and age-SI in predicting hospital admissions (SI AUC=0.591, p=0.029; MSI AUC=0.572, p=0.059; and age-SI AUC=0.580, p=0.089). CONCLUSION: Respectively none of the three indices was independently sufficient in predicting IMV, NIMV, and the need for ICU. SI is a valuable parameter in discriminating the COPD exacerbation. It is superior to the MSI and age-SI in predicting mortality and hospital admissions. It will be useful to evaluate SI for the severity classification, follow-up, and management of the patients with COPD. KEY WORDS: Age shock index, Chronic obstructive pulmonary disease, Modified shock index, mortality, Shock index.

The Efficiency of the HALP Score and the Modified HALP Score in Predicting Mortality in Patients with Acute Heart Failure Presenting to the Emergency Department.

OBJECTIVE: To investigate the relationship between the HALP score (haemoglobin, albumin, lymphocyte, and platelet), the modified HALP (m-HALP) score, and prognosis in patients presenting to the emergency department (ED) with acute heart failure (AHF). STUDY DESIGN: A Descriptive study. PLACE AND DURATION OF STUDY: The Emergency Department of Balikesir University Hospital, Turkey, between January 2019 and September 2021. METHODOLOGY: Patients diagnosed with AHF were divided into two groups, namely survivors and non-survivors. Both groups were compared in terms of HALP, m-HALP, PLT, NLR and PLR values ROC curve analysis was performed to evaluate their diagnostic performances in discriminating between one-week and three-month mortality. Youden J index was used to obtain the optimal cut-off value. RESULTS: The mean age of 101 patients included in the study was 73.15±10.19 years, with 51.5% (n=52) females, and 48.5% (n=49) males. The 1-week and 3-month mortality rates were 11.9% and 38.6%, respectively. For 1-week (p=0.018) and 3-month (p=0.006) mortality, platelet was significantly higher in the survivor group than in the non-survivor group. The m-HALP score and the NLR were found to be good predictors for 3-month mortality (p=0.002 and 0.016 respectively). The optimal cut-off values of m-HALP score, the platelet, and the NLR in predicting 3-month mortality were found as ≤1081723.5, ≤217, and >8.4. The area under curve (AUC) values were found as 0.687, 0.663, and 0.643, respectively. The sensitivity of the m-HALP score, the platelet, and the NLR were 76.92, 66.67, and 46.15, and the specificity values were 56.45, 67.74, and 79.03, respectively. CONCLUSION: The m-HALP score was found to be a potential independent prognostic index for patients with AHF. The classical HALP score was not adequate to predict early and late prognosis. In addition, thrombocytopenia and increased NLR were associated with increased mortality in patients with AHF. KEY WORDS: Acute heart failure (AHF), HALP score, m-HALP score, Neutrophil lymphocyte ratio (NLR), Platelet lymphocyte ratio (PLR), Platelet (PLT).

The Relationship of LDH and Hematological Parameters with Ischemic Volume and Prognosis in Cerebrovascular Disease.

OBJECTIVE: To determine whether lactate dehydrogenase (LDH), platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR) values can be used as a prediction for their relationship with stroke volume (SV) and for in-hospital mortality in stroke patients in Emergency Department (ED). STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Balikesir University, Turkey from 24/03/2021 to 30/06/2021. METHODOLOGY: Patients aged 18 years or older, diagnosed with stroke in ED, were included in the study. Stroke volumes were calculated from diffusion-weighted images (DWi) with 3D slicer software using image-based semi-automatic and manual segmentation methods. RESULTS: Of the 265 patients, 128 (48.3%) were males. SV was significantly higher in the non-survivor group than in the survivor group (p=0.007). NLR was significantly higher in the non-survivor group than in the survivor group (p=0.018). CONCLUSION: The ratios of NLR and SV stand out as practical parameters for the estimation of mortality, prognosis, and management of patients diagnosed with acute stroke. Taking into account, these parameters in the diagnosis process and prognosis management in EDs will provide convenience. Key Words: Ischemia, NLR, Stroke volume, Cerebrovasular accident, Prognosis.

Use of age shock index in determining severity of illness in patients presenting to the emergency department with gastrointestinal bleeding.

OBJECTIVES: This study aimed to make a comparison between classical shock index (SI), modified shock index (MSI), and age shock index (age SI) for predicting critical patients presenting to the emergency department (ED) with gastrointestinal bleeding (GIS). METHODS: The study, which was planned retrospectively, consisted of patients diagnosed with GIS bleeding at the ED admission. Triage time vital signs were used to calculate SI, MSI, and age SI. These results were compared with intensive care admission, endoscopic/colonoscopic (E/C) intervention, blood transfusion, and mortality criteria, which we define as adverse outcomes. RESULTS: The study included 151 patients. Seventy-nine (52.32%) of the patients had at least one adverse outcome. Of the 151 patients, 19 (12.58%) had ICU admission, 27 (17.88%) underwent endoscopic/colonoscopic (E/C) intervention, 68 (45.03%) received a blood transfusion, and 6 (3.97%) died. There was a significant difference between patients who had no adverse outcome and those who had at least one adverse outcome in terms of SI, age SI, and MSI. We performed ROC curve analyses to evaluate the diagnostic performances of all indices for predicting adverse outcomes. AUC (area under the curve) values for age SI was the highest (age SI AUC = 0.711, p < 0.001; SI AUC = 0.616; MSI AUC = 0.617). The performance of the age SI was significantly higher than the SI (p = 0.013) and the MSI (p = 0.024) for predicting adverse outcomes. The cut-off value for the age shock index was 45.12. CONCLUSIONS: In patients with GIS bleeding, age SI, which can be easily calculated in triage, is more significant than SI and MSI for predicting the critical patient.

The role of ultrasonography in the diagnosis of metacarpal fractures.

INTRODUCTION: The aim of this study was to evaluate the efficiency of ultrasonography (USG) in identifying metacarpal bone fractures in patients admitted to the emergency department (ED) with hand injury. MATERIALS AND METHODS: Patients who were admitted to a training and research hospital's ED during the study period with hand trauma and had suspected metacarpal fractures were included in the study. They were examined for metacarpal fracture by USG and x-ray. Hand radiographs reviewed by an emergency physician were considered to be the criterion standard diagnostic tool. Ultrasonography results were compared to x-ray results. RESULTS: Ninety-eight ultrasound examinations were performed on 96 adult patients who were enrolled in the study. The mean age of the patients was 30.1±11.8 years; 79.2% of the patients were male. Right hand injury was observed in 69.4% of the cases. Forty metacarpal fractures were detected in 38 patients on x-ray. We found a sensitivity of 92.5% (95% confidence interval [CI], 78.5-98), a specificity of 98.28% (95% CI, 89.5-99.9), a positive predictive value of 97.37% (95% CI, 84.5-99.8), and a negative predictive value of 95% (95% CI, 85-98) for USG to detect metacarpal fractures when compared to x-ray imaging. CONCLUSIONS: Under the light of these results, we suggest that USG may be an option for detecting metacarpal fractures and prevent unnecessary x-ray imaging examinations in patients presenting to the ED with hand trauma.