Metabolic Dysfunction-Associated Fatty Liver Disease and Fibrosis Status in Patients with Type 2 Diabetes Treated at Internal Medicine Clinics: Türkiye DAHUDER Awareness of Fatty Liver Disease (TR-DAFLD) Study.

This awareness study aimed to determine the ultrasound (US) examination rates in relation to US-confirmed metabolic dysfunction-associated fatty liver disease (MAFLD) diagnosis in internal medicine outpatients with type 2 diabetes (T2D) across Türkiye. A total of 6283 T2D patients were included in this multicenter retrospective cohort study conducted at 17 internal medicine clinics across Türkiye. The presence and indications for US performed within the last 3 years were recorded along with US-confirmed MAFLD rates, laboratory findings on the day of US, and referral rates. Fibrosis-4 (FIB-4) index was calculated to estimate the risk of advanced liver fibrosis (FIB-4 index ≥ 1.3). Overall, 1731 (27.6%) of 6283 patients had US examination, which revealed MAFLD diagnosis in 69.9% of cases. In addition, 24.4% of patients with US-confirmed MAFLD were at risk of advanced fibrosis (FIB-4 index ≥ 1.3), and the referral rate was 15.5%. In conclusion, our findings emphasize an insufficient MAFLD awareness among clinicians and the likelihood of most of T2D patients to be at risk of living with an unknown status regarding their MAFLD and advanced fibrosis risk.

Should new organ involvement be included in Response Evaluation Criteria in PSMA Imaging?

PURPOSE: The current study is intended to investigate the effect of new organ involvement on overall survival (OS) and modify the Response Evaluation Criteria in PSMA Imaging (RECIP) by including new organ involvement to RECIP 1.0. MATERIALS AND METHODS: This retrospective study includes 114 patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC) between September 2017 and June 2022 who had received docetaxel treatment and had baseline and post-treatment prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) images. The inclusion criteria were patients with pre- and post-treatment [18F]FDG PET/CT images and whose [18F]FDG PET images were negative. Those whose data were unavailable, who had additional malignancy, or who received abiraterone, enzalutamide, or Lutetium (Lu)-177 treatment were excluded. Age, Gleason score (GS), TPSA (total prostate-specific antigen) levels, surgical history, and OS information were recorded for each patient. RESULTS: The 114 patients herein had a median age of 72.5 (51-91) years and a median GS of 8 (7-10). New lesions were observed in 59 patients (51.7%) and new organ PSMA uptake was observed in 14 patients (12.2%). In the multivariate Cox regression analysis, volume-based treatment response (vTR)-total lesion PSMA (TLP), RECIP PSMA-VOL, modified RECIP (mRECIP) PSMA-VOL, and mRECIP TLP were independent prognostic factors for mortality (p < 0.001, p = 0.006, p = 0.003, and p = 0.003, respectively). The median OS of patients with new organ involvement and new lesion with PSMA uptake was 9.3 months (95% CI 2.1-16.5 months) and 11.8 months (95% CI 7.4-16.2 months), respectively. CONCLUSION: The study concluded that new organ involvement had a shorter OS than new lesion involvement. In the mRECIP that we developed, unlike RECIP, we demonstrated that both PSMA-VOL and TLP value were independent prognostic factors for mortality.

The Comparison of scoring systems: SOFA, APACHE-II, LODS, MODS, and SAPS-II in critically ill elderly sepsis patients.

INTRODUCTION: The elderly population is unique and the prognostic scoring systems developed for the adult population need to be validated. We evaluated the predictive value of frequently used scoring systems on mortality in critically ill elderly sepsis patients. METHODOLOGY: In this single-center, observational, prospective study, critically ill elderly sepsis patients were evaluated. Sequential organ failure evaluation score (SOFA), acute physiology and chronic health evaluation score-II (APACHE-II), logistic organ dysfunction score (LODS), multiple organ dysfunction score (MODS), and simplified acute physiology score-II (SAPS-II) were calculated. The participants were followed up for 28 days for in-hospital mortality. Prognostic scoring systems, demographic characteristics, comorbid conditions, and baseline laboratory findings were compared between "survivor" and "non-survivor" groups. RESULTS: 202 patients with a mean age of 79 (interquartile range, IQR: 11) years were included, and 51% (n = 103) were female. The overall mortality was 41% (n = 83). SOFA, APACHE-II, LODS, MODS, and SAPS-II scores were significantly higher in the non-survivor group (p < 0.001), and higher scores were correlated with higher mortality. The receiver operator characteristics (ROC) - area under curve (AUC) values were 0.802, 0.784, 0.735, 0.702 and 0.780 for SOFA, APACHE-II, LODS, MODS, and SAPS-II, respectively. All prognostic scoring models had a significant discriminative ability on the prediction of mortality among critically ill elderly sepsis patients (p < 0.001). CONCLUSIONS: This study showed that SOFA, APACHE-II, LODS, MODS, and SAPS-II scores are significantly associated with 28-day mortality in critically ill elderly sepsis patients, and can be successfully used for predicting mortality.

Assessment of Risk Factors for Mortality in Patients in Medical Intensive Care Unit of a Tertiary Hospital.

BACKGROUND: Knowing the risk factors for patients in intensive care units (ICUs) facilitates patient's management. The goal of this study was to determine the risk agents that influence our medical ICU mortality. PATIENTS AND METHODS: This 11-month retrospective trial was managed in the medical ICU. In this study, 340 patients who were followed up for at least 24 hours in ICUs were accepted. The clinical data on patients were recorded retrospectively, and the mortality-related factors were analyzed. A regression analysis was also performed to determine the independent risk factors for ICU mortality. RESULTS: The median age was 73 (53-82) years. The death rate was 23.8%. Length of stay (LOS) in ICU was 3 (2-5) days, and APACHE-II (acute physiologic and chronic health evaluation) score was 19 (13-25). The prevalence of chronic diseases was not dissimilar except acute and chronic renal failures among survivors and deceased patients (p >0.05). Acute and chronic renal failures were higher in deceased patients than in survivors and were statistically important [107 (41.3%) vs 47 (58%), p = 0.008] and 38 (14.7%) vs 22 (27.2%), p = 0.01], respectively. In the binary logistic regression analysis, age, APACHE II score, need for invasive mechanical ventilation (IMV), decreased serum albumin levels, and increased creatinine levels were established to be independent risk factors for death [(OR (odds ratio): 1.045 (1.009-1.081), p = 0.013, OR: 1.076 (21.008-1.150), p = 0.029, OR: 19.655 (6.337-60.963), p = 0.001), OR: 2.673 (1.191-6.024), p = 0.017, OR: 1.422 (1.106-1.831), p = 0.006)], respectively. CONCLUSION: The most significant risk agents of death were determined through high APACHE II score, decreased serum albumin levels, and increased creatinine levels. HOW TO CITE THIS ARTICLE: Kalin BS, Özçaylak S, Solmaz I, Kiliç J. Assessment of Risk Factors for Mortality in Patients in Medical Intensive Care Unit of a Tertiary Hospital. Indian J Crit Care Med 2022;26(1):49-52.

Vitamin D deficiency in patients with chronic hepatitis D viral infection.

AIM OF THE STUDY: Vitamin D deficiency is known to be associated with disease severity, unresponsiveness to treatment, and morbidity among patients with chronic viral hepatitis B and C, autoimmune hepatitis, and alcoholic hepatitis. This study aims to research vitamin D levels in patients suffering from cirrhotic and non-cirrhotic phases of hepatitis D. MATERIAL AND METHODS: 170 individuals in total were included in the study in the form of two groups: the first group of 100 patients with chronic hepatitis D (CHD), 30 of whom had cirrhosis, and the second control group of 70 individuals with similar characteristics to those of the first group in terms of age, type, and seasonal sampling. Levels of 25-hydroxy vitamin D [25(OH)D] were measured in the serum collected from patients and the control group. RESULTS: The lowest 25(OH)D levels were identified in patients with cirrhotic CHD. When these levels were compared with those of the control group, they were found to be significant (15.30 ±6.92 and 18.90 ±8.30 ng/ml, respectively, p = 0.04). 25(OH)D deficiency (< 10 ng/ml) was detected at significantly higher rates in patients with both cirrhotic and non-cirrhotic CHD compared to the healthy controls (30%, 25%, and 8.5%, respectively, p = 0.01). A significant correlation was established between 25(OH)D levels and bilirubin in patients with CHD (r = 0.252, p = 0.012). Multivariate analysis showed that chronic hepatitis D (odds ratio [OR] = 3.608, 95% confidence interval [CI]: 1.31-9.89, p = 0.013) and age (OR = 1.04, 95% CI: 1.00-1.08, p = 0.033) were associated with vitamin D deficiency. CONCLUSIONS: Frequency of 25(OH)D vitamin deficiency is higher in patients with CHD. The identification of vitamin D levels and the replacement of any deficiency may create a positive effect on disease progression, morbidity, and mortality levels.

ABO blood groups in COVID-19 patients; Cross-sectional study.

AIM: The aim of this study was to investigate the ABO and Rh blood group distribution and clinical characteristics in patients with COVID-19. MATERIALS AND METHODS: The clinical characteristics and blood groups of 1667 patients who were hospitalised because of COVID-19 (with a positive PCR test) between 16 March and 10 July were reviewed cross-sectionally. RESULTS: When blood groups of patients diagnosed with COVID-19 and control group were compared, it was observed that there was an increase in the number of COVID-19 patients with blood groups A and AB, decrease in the number of COVID-19 patients with blood group O, a statistically significant increase in the number of individuals with blood group A in COVID-19 patients compared with healthy individuals, and almost significant increase in the number of COVID-19 patients with blood group AB and a very significant decrease in the number of COVID-19 patients with blood group O. CONCLUSION: Our study has found that having blood group O may be protective, that blood group A may have greater susceptibility to the disease, but this does not affect the course of the disease and is not associated with mortality.

Risk factors affecting ICU admission in COVID-19 patients; Could air temperature be an effective factor?

AIM: As the COVID-19 pandemic has been spreading rapidly all over the world, there are plenty of ongoing works to shed on light to unknown factors related to disease. One of the factors questioned is also to be the factors affecting the disease course. In this study, our aim is to determine the factors that affect the course of the disease in the hospitalised patients because of COVID-19 infection and to reveal whether the seasonal change has an effect on the disease course. METHODS: Our study was conducted on 1950 PCR test positive patients who were hospitalised for COVID-19 disease between March 16 and July 15. RESULTS: As the seasonal temperature increases, decrease in WBC, PLT and albumin levels and increase in LDH and AST levels were observed. Risk of need for ICU has been found statistically significant (P < .05) with the increase in the age, LDH levels and CRP levels and with the decrease in the Ca and Albumin levels. CONCLUSIONS: It is predicted with these results that, seasonal change might have affects on the clinical course of the disease, although it has no affect on the spread of the disease. And it might beneficial to check biochemical parameters such as LDH, CRP, Ca and Albumin to predict the course of the disease.

Assessment of antibiotic resistance of infectious agents in patients with pneumonia in tertiary critical care unit and effect on clinical outcomes.

OBJECTIVE: The aim of this study was to determine the prevalence of the causative agents of multi-drug resistant bacteria in pneumonia and also evaluate their mortality rates in the intensive care unit (ICU). METHODS: This study included all the cases of hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP) in the ICU between the period of January 2018 and December 2019. RESULTS: Seventy-four patients in pneumonia were included. Mortality rate was 45.9%. In patients with HAP had higher length of stay days in hospital and ICU, the use of sedative agents, sepsis rate and mortality rate as compared in patients with CAP (for all P < .05). Microorganism was identified in 27 (36.6%) of the patients. Respiratory samples were positive in 25.4% of patients with CAP and 60.8% of patients with HAP. Acinetobacter baumannii and Klebsiella pneumoniae were the most frequent aetiologic agents (40.7% and 22.2%, respectively). Acinetobacter baumannii was not susceptible to the third generation cephalosporin, piperacillin-tazobactam, carbapenem, fluoroquinolone and trimethoprim/sulfamethoxazole. Amongst gram-positive bacteria, the most common isolate was Staphylococcus aureus. The frequency of methicillin-resistant Staphylococcus aureus was 75% but these isolates were susceptible to vancomycin and tigecycline. CONCLUSION: The predominance of gram-negative agents was observed in pneumonia patients and because of the high resistance to antibiotics, treatment strategies need to be reconsidered in order to improve the poor prognosis.