Comparison of Controlling Nutritional Status Score with Bedside Index for Severity in Acute Pancreatitis Score and Atlanta Classification for Mortality in Patients with Acute Pancreatitis.

Background/Objectives: Acute pancreatitis (AP) is characterized by pancreatic gland inflammation, and its clinical course ranges from mild to severe. Predicting the severity of AP early and reliably is important. In this study, we investigate the potential use of the Controlling Nutritional Status (CONUT) score as a prognostic marker in acute pancreatitis. Methods: We examined 336 patients who had been hospitalized with an AP diagnosis in the internal medicine clinic. The patients included in the study were followed up for 5 years. The study analyzed the specific variables of age, gender, and AP etiology as recorded biochemical parameters for all study participants and calculated the effects of age, sex, Bedside Index of Severity in AP (BISAP), the revised Atlanta classification, and the CONUT score on mortality. Results: When compared with surviving patients, non-surviving patients had higher scores for BISAP, CONUT, and the Atlanta Classification (p ˂ 0.001). In the non-surviving group, hemoglobin, lymphocyte, and albumin levels were significantly lower and creatinine, uric acid, and procalcitonin levels were significantly higher compared to the surviving group (p ˂ 0.001, 0.003, ˂0.001, ˂0.001, 0.005, ˂0.001, respectively). The multivariate analysis showed a significant association of mortality with age, CONUT, and BISAP scores (p ˂ 0.003, 0.001, 0.012 respectively). The CONUT score was separated into two groups based on the median value. The predicted survival time in the group with a CONUT score > 2 (53.8 months) was significantly lower than in the group with a CONUT score ≤ 2 (63.8 months). The cumulative incidence of all-cause mortality was significantly higher in the patients with higher CONUT scores. Conclusions: This study has assigned the CONUT score as an independent risk factor for mortality in AP.

Hypermagnesemia is associated with poor outcomes during hospitalization.

BACKGROUND: Hypermagnesemia is one of the vital electrolyte disturbances and is associated with such chronic conditions as cardiovascular, endocrinologic, renal diseases, and malignancy. AIM: This study evaluates the association between hypermagnesemia and clinical course in hospitalized patients. METHODS: This study was conducted at the University of Health Sciences Haseki Training and Research Hospital Internal Medicine Clinic. We evaluated a total of 3850 patients. 2130 patients have met the inclusion criteria were included in the study. Those who were discharged with healing were evaluated as having a good prognosis. Patients who died or were transferred to the intensive care unit (ICU) were defined as having a poor prognosis. We divided the patients' serum magnesium levels into four quartiles and examined the clinical course/conditions of the patients. RESULTS: Of 2130 patients, 1013 (51.9%) were female. The mean age of patients with poor prognoses (69.2 ± 14.9) was higher than those with good prognoses (59.7 ± 19.1). Hypermagnesemia (4th quartile) was detected in 61 (33.9%), and hypomagnesemia (1st quartile) was found in 42 (23.3%) patients out of 180 patients with poor clinical outcomes. It was statistically significant that hypermagnesemia was more common in patients with poor prognoses (p: 0.002). Chronic kidney disease (CKD) was diagnosed in 258 (53.3%) of 484 hypermagnesemia patients. Hypermagnesemia was found to be more common in patients with CKD, which was statistically significant (p: 0.003). CONCLUSIONS: Hypermagnesemia is associated with poor prognosis independent of comorbidities. Besides hypomagnesemia, hypermagnesemia should be considered a critical electrolyte imbalance.

Systemic Immune-Inflammation and Systemic Inflammation Response Indices are Predictive Markers of Mortality in Inpatients Internal Medicine Services.

Purpose: Internal medicine services serve the patient population with many chronic diseases. Therefore, it is high mortality rates compared to other departments of the hospital. Estimating the prognostic risk of hospitalized patients may be useful in mortality for patients. In this study, we evaluated the level of Systemic Immune Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) and its association with mortality in inpatients. Patients and methods: This study was performed in 2218 patients who were hospitalized between January 1st-December 31th of 2019. Patients were followed up for three years about primary endpoint as all-cause (except for unnatural deaths) mortality. Participants were divided into 4 equal groups according to their increasing levels of SII and SIRI. (Quartile 1-4) Age, gender, diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, malignancies (solid), white blood cell, neutrophil, lymphocyte, monocytes, hemoglobin, hematocrit, platelet, CRP, albumin, Systemic Inflammation Response Index (Quartile 1-4), Systemic Immune Inflammation Index (Quartile 1-4) were compared between survival and non-survival groups. Results: There were 1153 female and 1065 male participants enrolled. Compared with surviving patients, patients who died were older and had a higher prevalence of diabetes mellitus, hypertension, malignancy, chronic kidney disease and coronary artery disease (p < 0.001). There was a lower proportion of female patients among the patients who died. Compared to the survivor group, group who died exhibited a significant increase in CRP level, neutrophil, white blood cell and monocyte counts, but had a lower lymphocyte count, albumin level and hemoglobin count (P < 0.001). Results of Cox regression analysis showed that age, chronic kidney disease, malignancy, SIRI quartile 3, 4 and SII quartile 3, 4 pointed out a close relationship with mortality risk. (P < 0.001). Conclusion: The SIRI and SII have indicated the clinical importance of as novel markers for predicting mortality in inpatients.

Evaluation of the Charlson Comorbidity Index and Laboratory Parameters as Independent Early Mortality Predictors in Covid 19 Patients.

Purpose: Various parameters have been proposed to predict the outcome of patients with coronavirus disease. The aim of this study was to evaluate the utility of the age-adjusted CCI score and biochemical parameters for predicting outcomes for COVID-19 patients on admission. Patients and methods: A total of 511 patients were included in the study. Only swab or serological tests positive patients were included. The clinical characteristics of the patients were compared between survival and non-survival COVID-19 inpatients. Hemoglobin, platelet, sedimentation, creatinine, AST, ALT, LDH, CK, albumin, ferritin, lymphocyte, neutrophil, CRP (1-5;5-10;10-20 × upper limit), procalcitonin (5-10;10-20; > 20 × upper limit), D Dimer (> 2 × upper limit), age, gender, chronic diseases and CCI scores were compared between the two groups. Results: 68 patients died and 443 patients survived. Mean age was 74.3±7.3 years in survival group and 76.7±8.0 in nonsurvival group. Age, male sex, ischemic heart disease (CHD), chronic kidney disease and active malignancy was statistically higher in non-survivor group. The biochemical parameters was compared in survival and nonsurvival group. CCI score, AST, LDH, CK, Ferritin, CRP are significantly higher and albumin, lymphocyte levels are significantly lower in nonsurvival group. D-dimer and procalcitonin levels are significantly higher in nonsurvival group. CCI score and neutrophil, creatinine, ALT, AST, d-dimer and procalcitonin elevations were correlated. Low albumin and lymphocyte levels were correlated with the CCI score. There was no significant correlation between ferritin, sedimentation, CRP levels and CCI score. A multivariate logistic regression analysis indicated that anaemia, elevated CRP (> 10-20 × upper limit), procalcitonin (> 5-10 × upper limit), ALT, AST levels and higher CCI score were independent risk factors for mortality in COVID-19 patients. Conclusion: Anaemia, elevated CRP, procalcitonin levels, ALT, AST levels and higher CCI score were found independent risk factors for mortality in COVID-19 patients.

Serum albumin and FT3/FT4 ratio as additional co-morbidity parameters to predict mortality as a new approach: The Haseki Scoring Index (updated Charlson Comorbidity Index).

BACKGROUND: Charlson Comorbidity Index (CCI) is the common and valid method to predict mortality by classifying comorbidities such as cardiovascular, metabolic, renal, hepatic, pulmonary diseases, and malignancy. Novel risk factors are not included in the Charlson Comorbidity Index, such as thyroid hormone index (FT3/FT4 ratio) and serum albumin levels. In the present study, we aimed to assess whether the thyroid hormone index and albumin are useful clinical parameters in short and long-term mortality. METHODS: In the retrospective cohort study with a 5 year follow up, the data of 1292 patients who were hospitalized between January 1st-June 30th of 2014 were examined. Three months mortality as short term and 5-year mortality as long term were evaluated. RESULTS: Three months and 5 years mortality rates for 1064 patients were analyzed. We showed that hypoalbuminemia and thyroid hormone index had statistically significant effects on short and long-term mortality. According to ROC analysis it was demonstrated that the scoring system including biochemical parameters such as thyroid hormone index and serum albumin level was more significant for 3-month mortality. In addition, both scoring systems are equal in demonstrating long-term mortality. CONCLUSION: Thyroid hormone index and albumin could improve the prognostic performance of the original Charlson Comorbidity Index in short term mortality. The combined score may offer improvements in comorbidity summarization over existing scores.

Does the FT3-to-FT4 ratio easily predict the progression of NAFLD and NASH cirrhosis?

BACKGROUND: Factors causing progression from nonalcoholic fatty liver to nonalcoholic steatohepatitis (NASH) and liver cirrhosis remain relatively unknown. We aimed to evaluate the power and effectiveness of the free triiodothyronine (FT3)-to-free thyroxine (FT4) ratio to predict non-alcoholic fatty liver disease (NAFLD)/liver fibrosis and NASH cirrhosis severity. METHODS: Patients (n = 436) with NASH-associated liver cirrhosis (n = 68), patients with liver biopsy-proven NAFLD (n = 226), or healthy participants (n = 142) were enrolled between January 2010 and January 2020. The aspartate aminotransferase-to-thrombocyte ratio (APRI), NAFLD fibrosis score, albumin-bilirubin score (ALBI), aspartate aminotransferase (AST)-to-alanine aminotransferase (ALT) ratio, FT3-to-FT4 ratio, and Fibrosis-4 (FIB-4) were calculated and evaluated. RESULTS: All parameters were significantly higher in NASH cirrhosis than in the healthy group. Body mass index, ALT, fasting insulin, homeostatic model assessment for insulin resistance, and triglyceride levels were significantly higher in liver biopsy-proven NAFLD than in the healthy group. The APRI, NAFLD fibrosis score, ALBI, AST-to-ALT ratio, FT3-to-FT4 ratio, and FIB-4 were significantly higher in the NASH cirrhosis group than in the healthy group. In patients with biopsy-proven NAFLD, the FT3-to-FT4 ratio was significantly lower than in the healthy group. CONCLUSION: The FT3-to-FT4 ratio is an effective and useful indicator to predict NAFLD/liver fibrosis and NASH cirrhosis severity.

Prediabetes and Type 2 Diabetes are Independent Risk Factors for Computed Tomography-Estimated Nonalcoholic Fatty Pancreas Disease.

OBJECTIVES: Nonalcoholic fatty pancreas disease (NAFPD) is characterized by excessive fat deposition in the pancreas in the absence of alcohol consumption. In this study, we aimed to detect a possible relationship between adipose tissue accumulation, prediabetes and diabetes. METHODS: This cross-sectional and retrospective study included 110 patients. Three groups were classified as controls, patients with prediabetes and patients with type 2 diabetes. The abdominal computed tomography (CT) attenuation measurement results of the pancreas were evaluated independently by two experienced radiologists. CT measurements and biochemical parameters were compared between study groups. The relationship between continuous variables was assessed by using one-way ANOVA. To determine the changes in the dependent variable for the effects on study groups, the independent variable was adjusted using ANCOVA. A p-value less than 0.05 was considered statistically significant. RESULTS: The presence of prediabetes and type 2 diabetes was correlated with a decrease in the mean Hounsfield Unit (HU) value of the pancreas (p=0.002). Age was determined to be an independent risk factor and was correlated with NAFPD (p=0.0001). When compared to the controls (p=0.041), 71% of patients with prediabetes and 67% of patients with type 2 diabetes were observed to have an increased incidence of NAFPD. Decreased serum amylase was found to be correlated with the mean HU value of the pancreas (p=0.043). CONCLUSION: NAFPD was independently correlated with both prediabetes and type 2 diabetes adjusted for age (p=0.0001) in this study. Additionally, age was determined to be an independent risk factor and was correlated with NAFPD.

Prediabetes and type 2 diabetes are independent risk factors for computed tomography-estimated nonalcoholic fatty pancreas disease

OBJECTIVES: Nonalcoholic fatty pancreas disease (NAFPD) is characterized by excessive fat deposition in the pancreas in the absence of alcohol consumption. In this study, we aimed to detect a possible relationship between adipose tissue accumulation, prediabetes and diabetes. METHODS: This cross-sectional and retrospective study included 110 patients. Three groups were classified as controls, patients with prediabetes and patients with type 2 diabetes. The abdominal computed tomography (CT) attenuation measurement results of the pancreas were evaluated independently by two experienced radiologists. CT measurements and biochemical parameters were compared between study groups. The relationship between continuous variables was assessed by using one-way ANOVA. To determine the changes in the dependent variable for the effects on study groups, the independent variable was adjusted using ANCOVA. A p-value less than 0.05 was considered statistically significant. RESULTS: The presence of prediabetes and type 2 diabetes was correlated with a decrease in the mean Hounsfield Unit (HU) value of the pancreas (p=0.002). Age was determined to be an independent risk factor and was correlated with NAFPD (p=0.0001). When compared to the controls (p=0.041), 71% of patients with prediabetes and 67% of patients with type 2 diabetes were observed to have an increased incidence of NAFPD. Decreased serum amylase was found to be correlated with the mean HU value of the pancreas (p=0.043). CONCLUSION: NAFPD was independently correlated with both prediabetes and type 2 diabetes adjusted for age (p=0.0001) in this study. Additionally, age was determined to be an independent risk factor and was correlated with NAFPD.

Prognostic significance of high free T4 and low free T3 levels in non-thyroidal illness syndrome.

BACKGROUND: Non-thyroidal illness syndrome is characterized by decreased serum free T3 (FT3) level and associates with long term mortality. Serum free T4 (FT4) may affect on mortality with FT3 in course of chronic illness. This study performed to evaluate the association between both decreased FT3 with elevated FT4 levels and mortality risk. METHODS: This study is a retrospective cohort analysis and consisted up 1164 (571 male, 593 female) patients with a 36 months follow up period. Patients divided into four groups according to thyroid functions. Patients with euthyroidism were in Group A, elevated FT3 in group B, decreased FT3 in group C and both decreased FT3 and elevated FT4 levels in group D. The levels of thyroid hormones and all cause mortality were compared between four groups. RESULTS: Mortality rate was elevated between Groups A and B, A and C, A and D, B and C, B and D, C and D, (p < .001, p < .001, p < .001, p < .001, p < .001, p:0.019, respectively). A multivariate Cox proportional hazards model was performed to evaluate the mortality risk between groups. A close relationship was observed in Group C and D patients for the mortality risk (OR:1.561, 95% CI:1.165-2.090, p:0.003 and OR:2.224, 95% CI:1.645-3.006, p:0.0001, respectively). CONCLUSION: Both decreased FT3 and elevated FT4 levels are independent predictor for long term mortality risk in hospitalized chronic patients with non-thyroidal illness syndrome.

FT3/FT4 ratio predicts non-alcoholic fatty liver disease independent of metabolic parameters in patients with euthyroidism and hypothyroidism.

OBJECTIVE: This study was performed to evaluate the effects of metabolic parameters and thyroid dysfunction on the development of non-alcoholic fatty liver disease (NAFLD). METHODS: The current study evaluated a total of 115 patients, 75 female and 40 male. Physical examination and anthropometric measurements were applied to all participants. Hypothyroidism was considered at a thyroid stimulating hormone level ≥ 4.1 mIU/L. Patients with euthyroidism and patients with hypothyroidism were compared. Abdominal ultrasonography was used to diagnose non-alcoholic fatty liver disease. The participants were further compared with regard to the presence of non-alcoholic fatty liver disease. Logistic regression modeling was performed to identify the relationship between non-alcoholic fatty liver disease and independent variables, such as metabolic parameters and insulin resistance. RESULTS: Non-alcoholic fatty liver disease was identified in 69 patients. The mean waist circumference, body mass index, fasting plasma insulin, HOMA-IR (p<0.001) and FT3/FT4 ratio (p=0.01) values were significantly higher in the patients with NAFLD compared to those without it. Multivariate regression analysis revealed that FT3/FT4 ratio, waist circumference and insulin resistance were independent risk factors for non-alcoholic fatty liver disease. CONCLUSION: Insulin resistance, enlarged waist circumference, elevated body mass index, higher FT3/FT4 ratio and hypertriglyceridemia are independent risk factors for NADLF, whereas hypothyroidism is not directly related to the condition.

The prevalence of metabolic syndrome in different ethnic groups in Turkey.

OBJECTIVE: To determine the prevalence of metabolic syndrome and its risk factors in various ethnic groups in Istanbul, Turkey. METHODS: Study participants were aged ≥ 20 years. Risk factor components for metabolic syndrome were measured and its presence was determined in study participants. RESULTS: The study included 254 Greeks, 273 West Thracians, 275 East Turkistanis and 304 Armenians. The prevalence of metabolic syndrome was significantly different between groups (Greeks, 19.3%; West Thracians, 24.9%; East Turkistanis, 15.3%; Armenians, 20.4%), and increased with age in all groups. Low levels of high-density lipoprotein cholesterol (HDL-C) were found mainly in Greeks (females, 64.5%; males, 61.6%) and West Thracians (females, 75.8%; males, 73.1%). Among East Turkistanis, HDL-C and triglyceride levels were significantly higher compared with the other ethnic groups. Hypertension was the most frequently encountered component of metabolic syndrome in East Turkistanis. CONCLUSIONS: The prevalence of metabolic syndrome varied between ethnic groups living in the same geographical location. In Turkey, metabolic syndrome is common. It is important to determine differences between ethnic groups, as this will assist in identifying those at higher risk of developing coronary heart disease.

Neck circumference, metabolic syndrome and obstructive sleep apnea syndrome; evaluation of possible linkage.

BACKGROUND: This study was performed to evaluate neck circumference (NC) and metabolic syndrome (MS) parameters in severe and non-severe (mild-moderate) obstructive sleep apnea syndrome (OSAS) patients according to apnea-hypopnea index (AHI). MATERIAL AND METHODS: We enrolled 44 patients diagnosed with OSAS based on overnight polysomnography. The diagnosis of OSAS was based on AHI. Apnea is a pause of airflow for more than 10 seconds. and hypopnea is a decrease of airflow for more than 10 seconds and oxygen desaturation of 4% or greater. AHI score. per hour; below 5 normal. 5-29 mild-moderate. 30 and above were grouped as severe OSAS. Height. weight. neck circumference (NC). waist circumference (WC) and body mass index (BMI) of the patients were measured. MS was diagnosed by the Adult Treatment Panel (ATP) III criteria (≥3 of the following abnormalities): 1) WC ≥94 cm for males, ≥80 cm for females; 2) arterial blood pressure ≥130/85 mmHg; 3) fasting blood glucose ≥100 mg/dl; 4) high density lipoprotein (HDL) cholesterol <40 mg/dl in man, <50 mg/dl in women; 5) triglycerides ≥150 mg/dl. RESULTS: Mean BMI and NC were higher in severe OSAS patients compared to non-severe patients (p=0.021. p<0.001). According to ATP III criteria. 64% of severe and 61.1% of non-severe OSAS patients were MS (p=0.847). A logistic regression model displayed an association with NC as a risk factor for severe OSAS (p=0.01). but not with MS. CONCLUSIONS: In this study. NC in severe OSAS patients was significantly higher than in non-severe OSAS patients. The prevalence of metabolic syndrome was not correlated with OSAS severity. NC is an independent risk factor for severe OSAS.

Additional value of carotid artery intima-media thickness in cardiovascular risk assessment by Framingham risk-score in Type 2 diabetes: a retrospective cohort study.

BACKGROUND: The intima-media thickness (IMT) of the carotid artery is highly correlated with cardiovascular events in Type 2 diabetes mellitus (T2DM). The aim of the present study was to undertake a cardiovascular risk assessment in a group of patients (n = 102) who had been followed-up for 10 years. METHODS: Framingham risk score (FRS), IMT, and various other clinical parameters were evaluated retrospectively using Student's t-test, regression analysis, and χ² tests. Primary endpoints were defined as cardiovascular death, non-fatal myocardial infarction, angina, and ischemic stroke. RESULTS: The IMT (1.09 ± 0.32 vs 0.89 ± 0.25; P < 0.001) and percentage coronary risk as determined by the FRS (24.33 ± 11.07 vs 16.54 ± 8.35; P = 0.001) were significantly higher in patients presenting with any of the primary endpoints compared with patients in whom no cardiovascular morbidity or mortality was recorded. Other factors that significantly predicted cardiovascular mortality and morbidity included diastolic blood pressure and urinary albumin excretion (UAE; P < 0.001). The likelihood of primary endpoints could be predicted by UAE >30 mg/day, carotid artery IMT ≥0.9 mm, and FRS ≥20 (odds ratios 8.800, 3.377, and 2.807, respectively). CONCLUSION: Although FRS predicts 10-year risk for cardiovascular mortality and morbidity in T2DM, we suggest that UAE and carotid artery IMT should also be considered in risk assessments.