Do Different TSH Suppression Levels Effect Heart Rate Variability and QT Dispersions in Patients with Differentiated Thyroid Cancer?

OBJECTIVE: The aim of this study was to investigate changes in heart rate variability (HRV) and QT dispersion (QTd) in patients with differentiated thyroid cancer at different TSH suppression levels. METHODS: The study included 125 DTC patients, who had been on TSH suppression treatment (TSHST) for at least 1 year. The patients were categorized into three groups: patients with TSH < 0.1 mIU/L (n:30), those with TSH 0.1 to 0.5 mIU/L (n:56), and those with TSH 0.5 to 2 mIU/L (n:39). The first two groups were classified as suppression groups, and the last as replacement (control) group. All patients underwent 12-lead electrocardiogram (ECG) recording and 24-hour rhythm holter echocardiography analysis. RESULTS: The HRV results derived from a 24-hour rhythm holter did not exhibit any significant difference (p < 0.05). In dispersion evaluations, the QTd was significantly longer in the suppression groups (groups 1 and 2), than in the replacement group (group 3) (p < 0.001 and p:0.002, respectively). The same was found for corrected QT dispersion (QTcd) (p < 0.001 and p: 0.008, respectively). In multivariate linear regression analysis, TSH was found to affect QTd (ß = -0.299; p = 0.002) and QTcd (ß = -0.300; p = 0.002) values independently. CONCLUSION: In this study, it was shown that in patients with DTC receiving TSHST, QT dispersion prolonged as the TSH suppression level increased. Especially in high-risk DTC patients, evaluation of QTd may be useful in terms of evaluating cardiovascular risk and regulating TSHST level.

Predictive value of prognostic nutritional index on postoperative intensive care requirement and mortality in geriatric hip fracture patients.

OBJECTIVE: The incidence of postoperative morbidity and mortality in hip fracture patients is high and is associated with nutritional deficiencies. This study investigated the predictive value of preoperative prognostic nutritional index (PNI) on postoperative intensive care unit (ICU) requirement and mortality in geriatric hip fracture patients. METHODS: Geriatric (≥65 years old) hip fracture patients who underwent surgery between January 2021 and September 2023 were evaluated retrospectively. Patients were classified according to the unit followed in the postoperative period (service group and ICU group) and 28-day mortality (mortality group and survivor group). The predictive value of PNI for ICU requirement and mortality and the factors affecting ICU requirement and mortality were investigated. RESULTS: The study included two hundred twenty-two patients, and 66.2% (n=147) were women. In the postoperative period, 47.7% (n=106) of the patients were followed in the ICU and 52.3% (n=116) in the inpatient service. The 28-day mortality of the patients was 6.8% (n=15). PNI was found to be significantly lower in patients followed in the ICU (group ICU) than in those followed in the service (group S) and in patients who died (group mortality) compared to those who lived (group survivor) (p<0.001 and p=0.029, respectively). In multivariate regression analysis, high American Society of Anesthesiologists (ASA) status and low PNI were determined to be independent risk factors for ICU requirement. Acute Physiology and Chronic Health Assessment II score was an independent predictor of mortality. In ROC curve analysis, the cut-off value of PNI in predicting mortality was 32.5, and the area under the curve was 0.660 (95% CI, 0.516-0.803). CONCLUSION: In geriatric hip fracture patients, preoperative PNI value can be used, like ASA status, in determining postoperative ICU requirements. Nutritional deficiencies are associated with adverse postoperative outcomes in this patient group, and low PNI values (<32.5) help predict in-hospital mortality.

Can The Systemic Immune-Inflammation Index (SII) and Charlson Comorbidity Index (CCI) be used to predict mortality in patients with necrotizing fasciitis?

PURPOSE: This study aimed to determine the impact of mortality and morbidity indices on the diagnosis and prognosis of patients suffering from necrotizing fasciitis. METHODS: A retrospective analysis was performed on 41 patients (26 females, 15 males) with necrotizing fasciitis (NF). The SII (Systemic Immune-Inflammation Index) was computed using the formula SII = (P × N)/L, where P, N, and L measure the counts of peripheral platelets, neutrophils, and lymphocytes, respectively. This study evaluated the clinicopathological characteristics and follow-up information to assess the comparative effectiveness of SII, CCI (Charlson Comorbidity Index), and LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) scores as mortality and morbidity indices for patients with NF. RESULTS: The optimal cut-off for SII was determined to be 455. The SII value in the group with mortality was significantly higher compared to the group without mortality (p < 0.05). The CCI value in the group with mortality was significantly higher than the group without mortality (p < 0.05). The SII and CCI values were found to be effective in distinguishing between patients who suffered mortality and those who did not. CONCLUSION: SII is a powerful tool for predicting mortality in patients with necrotizing fasciitis (NF). The SII index provides a novel, easily accessible, and inexpensive indicator for monitoring the progress and predicting the survival of patients with NF.

Neutrophil-to-lymphocyte and Platelet-to-lymphocyte Ratios in those with Pulmonary Embolism in the Course of Coronavirus Disease 2019.

BACKGROUND: To investigate the levels of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in those having a pulmonary embolism (PE) in the course of coronavirus disease 2019 (COVID-19). METHODS: The records of those having COVID-19 were retrospectively obtained from the hospital automation system. NLR and PLR were measured with the help of patients' blood cell counts. RESULTS: Of 1,452 COVID-19 patients, 17 (1.2%) were diagnosed with PE. Compared with the controls, while leukocyte (p = 0.001), neutrophil (p <0.001), and neutrophil percentages, (p = 0.001) and NLR (p <0.001) and PLR (p = 0.006) had higher values, lymphocyte count (p = 0.004) and lymphocyte percentage (p <0.001) showed lower values in the patients with PE.Compared to the survivors, the non-survivors were found to have increased leukocyte (p <0.001), neutrophil (p <0.001), and neutrophil percentages (p <0.001), NLR (p <0.001) and PLR (p <0.001), and decreased lymphocyte (p <0.001) counts and percentage (p <0.001), hemoglobin (p = 0.005), hematocrit (p = 0.012), and platelet counts (p <0.001).While NLR and PLR cutoffs were found as 4.338 and 187.83 in predicting PE, the cutoff values of NLR and PLR were, respectively, 4.301 and 172.5 in predicting mortality.The logistic regression analysis also revealed that all hematological parameters had no effects on the development of PE. CONCLUSION: Although NLR and PLR had higher scores in PE patients, no relationship was determined between the levels of NLR and PLR and PE development. Further prospective studies including larger populations are required to enlighten the increased NLR and PLR in PE patients having COVID-19. HOW TO CITE THIS ARTICLE: Akkus C, Yilmaz H, Duran R, Diker S, Celik S, Duran C. Neutrophil-to-lymphocyte and Platelet-to-lymphocyte Ratios in those with Pulmonary Embolism in the Course of Coronavirus Disease 2019. Indian J Crit Care Med 2021;25(10):1133-1136.