The Glasgow Prognostic Score and fibrinogen to albumin ratio as prognostic factors in hospitalized patients with COVID-19.

Aim: This study aims to determine the prognostic value of the Glasgow Prognostic Score (GPS) and fibrinogen to albumin ratio (FAR) in patients with COVID-19.Methods: Electronic database records of 400 patients with COVID-19 were retrospectively analyzed and the initial levels of CRP, albumin, fibrinogen values were recorded. The ground-glass opacities (GGO) and consolidations were evaluated on thorax CT. Hospital mortality and the need for intensive care unit (ICU) transfer were determined as adverse outcomes.Results: It was determined that 345 patients (86.25%) were discharged while 31 patients (7.75%) were transferred to ICU in addition to 24 patients who died (6%). The rates of deaths and transfers to ICU were significantly increased in GPS 2 group compared to both GPS 0 and 1 groups. Additionally, increased FAR was observed in patients who died and transferred to ICU compared to the discharged patients. The FAR was significantly increased in patients with diffuse GGO. Logistic regression analysis indicated that FAR ≥144.59 and the presence of GPS 2 were independent predictors of the adverse outcomes in COVID-19 patients.Conclusion: Our results demonstrated that the GPS and FAR could possess a predictive value for adverse outcomes in patients with COVID-19.

MR-proADM and MR-proANP levels in patients with acute pulmonary embolism.

BACKGROUND: The aim of this study was to determine levels of Mid-regional Pro-adrenomedullin (MR-proADM) and Mid-regional Pro-atrial Natriuretic Peptide (MR-proANP) in patients with acute pulmonary embolism (PE), the relationship between these parameters and the risk classification in addition to determining the relationship between 1and 3month mortality. METHODS: 82 PE patients and 50 healthy control subjects were included in the study. Blood samples for Mr-proANP and Mr-proADM were obtained from the subjects prior to the treatment. Risk stratification was determined according to sPESI (Simplified Pulmonary Embolism Severity Index). Following these initial measurements, cases with PE were assessed in terms of all causative and PE related mortalities. RESULTS: The mean serum Mr-proANP and Mr-proADM levels in acute PE patients were found to be statistically higher compared to the control group (p < 0.001, p < 0.01; respectively) and statistically significantly higher in high-risk patients than low-risk patients (p < 0.01, p < 0.05; respectively). No statistical difference was determined in high-risk patients in case of sPESI compared to low-risk patients while hospital mortality rates were higher. It was determined that the hospital mortality rate in cases with Mr-proANP ≥ 123.30 pmol/L and the total 3-month mortality rate in cases with Mr-proADM ≥ 152.2 pg/mL showed a statistically significant increase. CONCLUSIONS: This study showed that Mr-proANP and MRproADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies.

Prognostic value of copeptin in patients with acute pulmonary thromboembolism.

BACKGROUND AND AIMS: The aim of this study was to determine the level of copeptin, which is one of the new cardiac markers in acute pulmonary thromboembolism (PE) cases, and to determine the relationship between the severity of the disease, risk classification and hospital, first month, third month and 3-month total mortality. METHODS: The study included 100 cases with PE and 60 healthy control subjects. Copeptin was measured in control group. The risk grade of the cases was determined according to the sPESI index. Patients survival data at the first and third months were determined. This study was performed in patients with strict exclusion criteria for comorbidities known to be associated with increased risk of PE. RESULTS: sPESI was ≥1 in 68 (68%) of patients with acute PE. Mean serum copeptin levels were found statistically higher in patients with high risk compared to low-risk cases and controls (9.18 ± 3.29, 6.47 ± 2.29, and 5.26 ± 2.15, P < 0.0001, respectively). When the cut-off value of copeptin was taken as ≥7.87 with ROC analysis for predicting high sPESI score, the sensitivity of the copeptin was 78% and the specificity was 62% (AUC = 0.74, 95% CI = 0.63-0.85, P < <0.0001). When cases divided in the groups according to the cut-off value as 7.87, first month hospital mortality and 3-month total mortality rate was found statistically higher in patients with copeptin ≥7.87 (χ2 = 5.33 P < 0.05, χ2 = 3.88, P < 0.05 and χ2 = 4.26, P < 0.05 respectively). CONCLUSIONS: The results of our study showed that increased serum copeptin levels might predict the severity of PE as well as a promising marker of early mortality in high-risk cases according to sPESI.

Serum Cystatin C Levels in COPD: Potential Diagnostic Value and Relation between Respiratory Functions.

BACKGROUND: The aim of this study was to determine the level of serum cystatin C (CysC) in patients with Chronic Obstructive Pulmonary Disease (COPD) during exacerbation and stable periods and to investigate its potential diagnostic value and the relationship between CysC levels and the pulmonary function test (PFT). METHODS: One hundred twenty-six patients with COPD (68 in stable periods, 58 during exacerbation periods) and 50 healthy subjects were included in the study. PFT, body mass index (BMI), white blood cell counts, C-reactive protein (CRP), serum urea and creatinine levels were evaluated in both groups of patients. CysC levels were measured in all participants. RESULTS: Serum CysC levels were statistically higher in both COPD groups than the control group (p<0.001 for both) although there was no statistically significant difference between COPD groups (p>0.05). CysC levels showed negative correlation with forced expiratory volume in 1 second (FEV1) and a positive correlation with C-reactive protein (CRP) levels in patients with stable COPD. There was a positive correlation between serum CysC levels and serum urea, creatinine, CRP levels in patients with COPD exacerbation (r=0.333, p=0.011; r=0.260, p=0.049; r=0.414, p<0.01 respectively). When stable COPD and control groups were evaluated, serum CysC had an area under the curve (AUC) in the receiver operating characteristic (ROC) curve of 0.951 (0.909-0.994 95% CI: p<0.001). CONCLUSIONS: Our results showed that CysC levels increased in both COPD groups. Increased CysC levels may be related with lung function decline and inflammation in COPD patients. In addition, CysC levels may be a potential indicator for the diagnosis of COPD.

The Importance of Neutrophil-to-Lymphocyte Ratio in Chronic Obstructive Pulmonary Disease.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow limitation and systemic inflammation. Recently, neutrophil-to-lymphocyte ratio (NLR) has gathered increasing interest in the detection of inflammation in inflammatory diseases. This study aimed to investigate the role of NLR in COPD for identifying the detection of inflammation and recognition of acute exacerbation. MATERIAL AND METHODS: The laboratory results of 103 COPD patients were included into the study, of which 47 patients were in acute exacerbation and 56 patients were at stable period, and there were 40 gender and age-matched healthy controls. Complete blood count (CBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were evaluated. NLR was calculated from CBC. RESULTS: NLR values of patients with COPD (both acutely exacerbated and stable) were found significantly higher than those of the controls (p< 0.001, p< 0.05; respectively). In all patients with COPD, NLR values positively correlated with serum CRP (r= 0.641, p< 0.001) and ESR (r= 0.276, p= 0.005) levels and negatively correlated with forced vital capacity (r= -0.20, p= 0.043) and forced expiratory volume in the 1st second (r= -0.288, p= 0.003). For an NLR cutoff of 3.34, sensitivity for detecting exacerbation of COPD was 78.7% and specificity was 73.2% (AUC 0.863, p< 0.001). CONCLUSION: Our results suggest that NLR may be considered as a reliable and simple indicator in the determination of increased inflammation in patients with COPD. Furthermore, NLR could be useful for the early detection of possible acute exacerbations in patients with COPD.