The Importance of D-Dimer, Ferritin, CRP and Lymphocyte Values in Determining Mortality in COVID-19 Disease in Turkey.

BACKGROUND: It is critical to determine the importance of laboratory tests on the mortality of Covid-19 disease. Our aim is to search the effect of D-dimer, C-reactive protein (CRP), ferritin, and lymphocyte count in the algorithm organized by our Ministry of Health in the diagnosis and treatment of Covid-19 on mortality. METHODS: Two hundred forty-five patients admitted to the emergency department (ED) with a diagnosis of Covid-19 pneumonia between March 15, 2020, and May 15, 2020. CRP, D-dimer, ferritin, and lymphocyte count included in the algorithm of the Ministry of Health. The relationship between demographic, clinical, and laboratory characteristics of the patients and their thirty-day mortality was examined. RESULTS: A statistically significant difference was only found in coronary artery disease between the mortality rates and underlying diseases of the patients included in the study. When the diagnostic contribution of laboratory values to the mortality estimation was evaluated, the areas under the curve were the highest for CRP 0.782 (95% Cl 0.68 - 0.88), ferritin 0.740 (95% Cl 0.60 - 0.88), and D-dimer 0.738 (95% Cl 0.58 - 0.89). CONCLUSIONS: An increased serum CRP, D-dimer, ferritin levels, and low lymphocyte count as shown by Turkish Ministry of Health in Turkey are significant predictors of COVID-19 mortality.

Prognosis and therapy of tumor-related versus non-tumor-related status epilepticus: a systematic review and meta-analysis.

BACKGROUND: Status epilepticus (SE) is a medical emergency with high mortality rates. Of all SE's, 7% are caused by a brain tumor. Clinical guidelines on the management of SE do not make a distinction between tumor-related SE and SE due to other causes. However, pathophysiological research points towards specific mechanisms of epilepsy in brain tumors. We investigated whether clinical features support a distinct profile of tumor-related SE by looking at measures of severity and response to treatment. METHODS: Systematic review of the literature and meta-analysis of studies on adult SE that report separate data for tumor-related SE and non-tumor-related SE on the following outcomes: short-term mortality, long-term morbidity, duration of SE, and efficacy of anticonvulsant intervention. RESULTS: Fourteen studies on outcome of SE were included. Tumor-related SE was associated with higher mortality than non-tumor-related SE (17.2% versus 11.2%, RR 1.53, 95%-CI 1.24-1.90). After exclusion of patients with hypoxic-ischemic encephalopathy (a group with a known poor prognosis) from the non-tumor-group, the difference in mortality increased (17.2% versus 6.6%; RR 2.78, 95%-CI 2.21 - 3.47). Regarding long-term morbidity and duration of SE there were insufficient data. We did not find studies that systematically compared effects of therapy for SE between tumor- and non-tumor-related SE. CONCLUSIONS: Based on - mostly retrospective - available studies, short-term mortality seems higher in tumor-related SE than in SE due to other causes. Further studies on the outcome and efficacy of different therapeutic regimens in tumor-related SE are needed, to clarify whether tumor-related SE should be regarded as a distinct clinical entity.

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.