Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study.

OBJECTIVE: A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. MATERIAL AND METHODS: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. RESULTS: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). CONCLUSION: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye.

Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear. Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19. Study Design: Multicenter prospective observational clinical study. Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated. Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004). Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

Comparison of nutritional risk status assessment tools in predicting 30-day survival in critically ill COVID-19 pneumonia patients.

BACKGROUND: Few clinical studies have addressed nutritional risk assessment in patients with COVID-19 pneumonia admitted to the intensive care unit (ICU). OBJECTIVES: Assess the nutritional risk status of the critically ill COVID-19 pneumonia patients admitted to the ICU, and compare the nutritional risk screening tools. DESIGN: Medical record review SETTING: Tertiary critical care unit PATIENTS AND METHODS: We included adult (age >18 years) PCR-confirmed critically ill COVID-19 pneumonia cases admitted to the ICU between August 2020 and September 2021. Scoring systems were used to assess COVID-19 severity and nutritional status (mNUTRIC: modified Nutrition Risk in Critically Ill, NRS2002: Nutritional Risk Screening 2002). The 30-day mortality prediction performance of nutritional scores and survival comparisons between clinical and demographic factors were assessed. MAIN OUTCOME MEASURES: Compare the nutrition risk tools SAMPLE SIZE: 281 patients with a mean (SD) age of 64.3 (13.3) years; 143 (50.8%) were 65 years and older. RESULTS: The mean mNUTRIC score of the cases was 3.81 (1.66) and the mean NRS-2002 score was 3.21 (0.84.), and 101 (35.9%) were at high risk of malnutrition according to the mNUTRIC score and 229 (81.4%) according to the NRS 2002 score. In cases at high risk of malnutrition by the mNUTRIC score there was a greater need for invasive mechanical ventilation, vasopressors, and renal replacement therapy (P<.001 for all comparisons). The mNUTRIC score was superior to the NRS-2002 score in estimating 30-day mortality. In patients who died within 30 days, the mNUTRIC score and NRS-2002 score on the day of hospitalization were significantly higher (P<.001), and the proportion of patients with NRS-2002 score ≥3 and mNUTRIC score ≥5 was significantly higher in the non-surviving group (P<.001). In addition, patients with a high risk of malnutrition had a shorter survival time. The mNUTRIC score was an independent and important prognostic factor for 30-day mortality, and patients with an mNUTRIC score ≥5 had a 6.26-fold risk for 30-day mortality in the multivariate Cox regression. CONCLUSION: One third of critical COVID-19 pneumonia cases hospitalized in the ICU due to acute respiratory failure have a high risk of malnutrition, and a high mNUTRIC score is associated with increased mortality. LIMITATIONS: Single center retrospective study. CONFLICT OF INTEREST: None.

EFFECTS OF HYDROXYCHLOROQUINE PLUS FAVIPIRAVIR TREATMENT ON THE CLINICAL COURSE AND BIOMARKERS IN HOSPITALIZED COVID-19 PATIENTS WITH PNEUMONIA.

Background: The novel coronavirus disease 2019 (COVID-19) has a broad spectrum of clinical manifestations, the most common serious clinical manifestation of the coronavirus infection being pneumonia. Unfortunately, the optimal treatment approach is still uncertain. However, many studies have been conducted on the effectiveness of several medications in the treatment of COVID-19 infection. The aim of this study was to evaluate the effectiveness of the hydroxychloroquine (HCQ) + favipiravir (FAV) treatment regimen and HCQ alone by comparing the patient's clinical response and laboratory results on the fifth day of treatment in patients hospitalized due to COVID-19 infection. Patients and methods: This retrospective cohort study was conducted in Malatya Training and Research Hospital between March 2020 and July 2020. The study included 69 patients with confirmed COVID-19 with pneumonia. The patients were divided into 2 groups, those receiving HCQ alone and those receiving the HCQ + FAV combination. Results: A total of 69 patients were included in the study, and the mean age was 60.09±15.56 years. A statistically significant decrease was observed in C-reactive protein (CRP) levels, at the end of the fifth day, in patients who received HCQ + FAV treatment (p=0.002), whereas there was no decrease in CRP levels in patients who received HCQ treatment alone. In addition, an increase in lymphocyte count and a better fever response was observed at the end of the fifth day in patients who received HCQ + FAV (p=0.008). However, there was no statistical difference between both treatment regimens in terms of hospital stay and treatment results (p=0.008, p=0.744, p=0.517). Conclusion: Although the combination of HCQ + FAV treatment was observed to be effective on CRP levels and fever response in patients with COVID-19 pneumonia, there was no difference in terms of hospital stay and discharge.

Prognostic factors for 30-days mortality in eighty years aged and older critically ill patients: a single center retrospective cohort study

Background/aim: Nowadays, with the rise in average life expectancy, the rate of hospitalization of the older population in intensive care unit (ICU) is gradually increasing. Unfortunately, there are no ideal combination of prognostic factors predicting the mortality in older patients admitted to the ICU. In the present study, we aim to determine the prognostic factors and their impacts on short-time mortality in older critically ill patients. Materials and methods: This retrospective cohort study was performed between January 2019 and February 2020. We included 133 patients aged ≥80 years and hospitalized ≥24 h in the ICU. Results: A total of 133 critically ill patients enrolled in the present study. And, the median age of the patients was 85 (80­106) years. 30-days and overall ICU mortality rates were found 30.1% and 34.6%, respectively. The patients were grouped as survivors (n = 94) and nonsurvivors (n = 39). Hospital length of stay before the ICU admission was found significantly longer in nonsurvivors (p = 0.001). Sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation-II (APACHE-II) score were significantly higher in nonsurvivors (p < 0.001, p < 0.001). Also, blood lactate level and glucose level were respectively significantly higher in nonsurvivors (p < 0.001, p = 0.006). We found that modified nutrition risk in critically ill (mNUTRIC) score and prehospital clinical frailty scale (CFS) were independent prognostic factors for the older critically ill patients (HR = 9.19, 95% CI=1.47­57.32, p = 0.018, HR = 20.16, 95% CI = 2.63­54.07, p =0.004). Conclusion: mNUTRIC score and prehospital CFS score were the most important prognostic factors in the admission of older patients to intensive care units.

Differential diagnosis of COVID-19 pneumonia from acute heart failure in pandemic: Importance of radiological and laboratory findings.

INTRODUCTION: COVID-19 pneumonia typically presents with high fever, cough, and shortness of breath and on thorax computed tomography (CT) peripheral ground glass opacities help the diagnosis. Although typical imaging findings for COVID-19 pneumonia are specified in thorax CT, these findings can be confused with other diseases. The aim of this study is to investigate the roles of radiological imaging and laboratory findings in the differential diagnosis of COVID-19 pneumonia and acute heart failure (AHF). MATERIALS AND METHODS: In the present study, 74 patients who admitted to the emergency department with respiratory distress during the pandemic period and received a diagnosis of COVID-19 pneumonia and AHF were included. Laboratory data and radiological findings of the patients, at the time of admission, were evaluated. RESULT: On admission, there was no difference in age, gender between two groups. However, COVID-19 exposure history was found significantly higher in COVID-19 pneumonia patients group (p<0.001). Fever, cough, and fatigue were found significantly higher in the COVID-19 pneumonia patients group (p<0.001). There was difference of lesions distribution between the two groups, centrally distributed lesions were found significantly higher in acute heart failure patients (p<0.001). Pleural effusion and cardiomegaly were found significantly higher in AHF patients (p<0.001, p<0.001). Counts of the white blood cells and lymphocytes were found significantly lower in COVID-19 pneumonia patients (p= 0.003, p= 0.009). COVID-19 pneumonia patients had significantly higher levels of CRP, ferritin, LDH and CK compared with AHF patients (p<0.001, p<0.001, p= 0.002, p= 0.013). However the level of NT-proBNP was found significantly higher in the AHF patients group (p<0.001). CONCLUSIONS: We believe that laboratory data and thorax CT findings can provide beneficial clinical information in differentiating COVID-19 pneumonia from AHF during the pandemic.

A new scoring system for early diagnosis of ventilator-associated pneumonia: LUPPIS.

INTRODUCTION: The Clinical Pulmonary Infection Score (CPIS) based on chest X-ray has been developed to facilitate clinical diagnosis of ventilator-associated pneumonia (VAP); however, this scoring system has a low diagnostic performance. We developed the Lung Ultrasound and Pentraxin-3 Pulmonary Infection Score (LUPPIS) for early diagnosis of VAP and evaluated the performance of this new scoring system. MATERIAL AND METHODS: In a prospective study of 78 patients with suspected VAP, we assessed the detection accuracy of LUPPIS for pneumonia in adult patients. We also evaluated the diagnostic performance of pentraxin-3 (PTX-3) findings of infection. On the day of the study, lung ultrasound was performed, PTX-3 levels were determined, and an endotracheal aspirate was obtained for Gram staining and culture. RESULTS: No significant differences were found between groups with respect to age, mechanical ventilation time, APACHE II score, or SOFA score (p > 0.05). Procalcitonin and PTX-3 levels were significantly higher in the VAP (+) group (p < 0.001 and p < 0.001, respectively). The threshold for LUPPIS in differentiating VAP (+) patients from VAP (-) patients was > 7. In predicting VAP, LUPPIS > 7 (sensitivity of 84%, specificity of 87.7%) was superior to CPIS > 6 (sensitivity of 40.1%, specificity of 84.5%). CONCLUSIONS: LUPPIS appears to provide better results in the prediction of VAP compared to CPIS, and the importance of lung ultrasound and PTX-3 is emphasized, which is a distinctive property of LUPPIS.

Comparison of neutrophil to lymphocyte ratio with other prognostic markers affecting 30 day mortality in acute pulmonary embolism.

Introduction: Identifying the prognostic factors for patients with acute pulmonary embolism (APE) play a critical role in determining of the treatment strategy and to reduce mortality. The aim of this study is to evaluate the prognostic value of Neutrophil to Lymphocyte Ratio (NLR) and compare NLR with other prognostic factors in APE. Materials and Methods: We retrospectively examined 550 cases of acute pulmonary embolism diagnosed by spiral computed tomographic angiography. A receiver operating characteristics (ROC) curve was used to determine the sensitivity and specificity of parameters and the optimal cut-off value for predicting mortality. Significance of each prognostic factors selected by univariate analysis confirmed using Cox regression model. Result: Baseline NLR, Platelet to Lymphocyte Ratio (PLR), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP), and D-dimer values respectively were found significantly high in patients who died within 30 days (p< 0.05). Patients with high-risk status and sPESI > 2 points had a significantly higher short-term mortality rate (p< 0.05). Short-time mortality was found significantly higher in patients with NLR > 7.3 (p< 0.05). Cox regression analysis indicated that patient risk status and sPESI score were independent prognostic factors (p< 0.05). However, NLR was not found as a predictor of mortality in APE (p> 0.05). After the subgroup analysis of the study, in patients without comorbid diseases NLR, patient's risk status, sPESI score were found the predictor of mortality in APE (p< 0.05). Conclusions: NLR maybe a useful prognostic factor for patients without comorbid diseases in short time of mortality in APE.

Abdominal perfusion pressure is superior from intra-abdominal pressure to detect deterioration of renal perfusion in critically Ill patients.

BACKGROUND: Intra-abdominal hypertension (IAH) is a frequent cause of acute kidney injury (AKI) among critically ill patients who have risk factors. This study aimed to determine the relation between Abdominal Perfusion Pressure (APP) and AKI showed by the Doppler-based renal resistive index (RRI). METHODS: In this study, 38 patients older than 18 years old who received mechanical ventilation and had risk factors for the development of IAH were prospectively studied. All measurements and parameters were divided into two groups according to renal dysfunction (Group I: RRI <0.72 vs Group II: RRI >0.72). RESULTS: The mean IAPs were not significant between the groups, 11.5±6.9 mm Hg in Group I (n=35) and 13.5±5.8 in Group II (n=33), respectively. APPs were statistically higher in Group I (81.2±13.6) than Group II (66.4±9.5) (p<0.001). The AUC for the association between APP at RRI >0.72 was 0.802 (p<0.001), with the APP ≤72 mmHg having a sensitivity of the 76% (95% CI 58-89%) and a specificity of 71% (95% CI 54-85%). CONCLUSION: Our findings suggest that an APP with a threshold of ≤72 mmHg is associated with a significant increase in renal RRI, which may be predictive of worsening of renal perfusion.

The Role of Transcranial Doppler Ultrasonography in the Diagnosis of Brain Death.

Ancillary tests can be used for the diagnosis of brain death in cases wherein uncertainty exists regarding the neurological examination and apnoea test cannot be performed. Transcranial Doppler ultrasonography (TCD) is a useful, valid, non-invasive, portable, and repeatable ancillary test for the confirmation of brain death. Despite its varying sensitivity and specificity rates with regard to the diagnosis of the brain death, its clinical use has steadily increased in the intensive care unit because of its numerous superior properties. The use of TCD as an ancillary test for the diagnosis of brain death and cerebral circulatory arrest is discussed in the current review.

Pleural effusion as an indicator of short term mortality in acute pulmonary embolism.

INTRODUCTION: Pulmonary embolism (PE) is known as one of the major causes of cardiovascular morbidity and mortality. Identification of high risk patients for short term and long-term mortality is crucial. The purpose of this study is to demonstrate the prognostic importance of simplified pulmonary embolism severity index (sPESI), radiological investigations and comorbidities in terms of short-term mortality by simultaneous assessment of sPESI score, pulmonary computed tomography (CT) angiography findings and underlying comorbidities in patients diagnosed with acute pulmonary embolism. MATERIALS AND METHODS: We retrospectively evaluated 570 patients diagnosed with acute PE confirmed by computer tomography pulmonary angiography (CTPA). Comorbidities were recorded, pulmonary embolism severity index scores were calculated and CTPA data were evaluated as predictors for short-term mortality. RESULT: The study population consisted of 570 patients, 292 (51.2%) patients were female and 74 patients (12.9%) died within 30 days due to PE diagnosis. In univariate analysis male gender (p= 0.031), congestive heart failure (CHF)(p< 0.029), main pulmonary artery involvement (p= 0.045), presence of pleural effusion (p= 0.001) and pericardial effusion (p= 0.004) at time of diagnosis and high risk sPESI group (p< 0.001) had a significant influence on mortality. In the multivariate analysis, pleural effusions (HR, 1.67; CI, 1.05-2.66; p< 0.030) and sPESI high risk group (HR, 9.56; CI, 4.71-19.43; p< 0.001) were remained significant and independent prognostic factors for survival. CONCLUSIONS: The present study underlined that presence of pleural effusion at the time of diagnosis in patients with massive pulmonary embolism and a high sPESI score in other patients were significant predictors of short-term mortality.

Diagnostic Accuracy of Procalcitonin for Differentiating Bacteraemic Gram-Negative Sepsis from Gram-Positive Sepsis.

OBJECTIVE: The identification of bacteraemia in patients with suspected sepsis is crucial for survival. A cheap, fast and reliable biomarker, which can predict the causative pathogen group, may be useful to confirm or exclude the presence of bacteraemia. This study aimed to evaluate the relationship between procalcitonin (PCT) and the causative pathogen in intensive care patients with sepsis and bacteraemia. METHODS: Patients with diagnosed sepsis, a positive blood culture and measured serum procalcitonin levels during their intensive care unit stay were included in the study. Demographic data, PCT level, leukocyte count, C-reactive protein level, creatinine level, lymphocyte count, leukocyte/lymphocyte ratio and the group of the pathogen that detected in the blood culture were retrospectively recorded. RESULTS: Overall, 136 sepsis patients who were diagnosed with bacteraemia were included in the study. The PCT level was 7.31 ng mL-1 in the gram-negative group and 0.46 ng mL-1 in the gram-positive group. For PCT, the sensitivity was 70.83% and the specificity was 84.21%, with the cut-off value being ≤1.3. The area under the receiver operating characteristics curve for PCT was 0.80. CONCLUSION: Patients with gram-negative sepsis had higher PCT values than those with gram-positive sepsis. Our results suggest that PCT value may be a useful tool for distinguishing between gram-negative and gram-positive bacteraemia.

[Lung carcinoma patients aged eighty years over and prognostic factors affecting survival]. / Seksen yas üzerindeki akciger kanseri olgulari ve sagkalimi etkileyen faktörler.

INTRODUCTION: Almost 50% of all cancers and 70% of cancer deaths occur in cases aged 65 years and more. Thus diagnosis, treatment and follow up in old cases gain importance. Since there a limited number of study that show age-mortality relation in lung cancer cases aged 80 years and over, issues may arise in diagnosis and treatment process of these cases. In this study, we aimed to evaluate general characteristics of lung cancer cases aged 80 years or over and factors that affect survey. MATERIALS AND METHODS: Between 2010 and 2013, the retrospective cohort study was done in Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital and 100 cases of lung carcinoma were examined. RESULT: In the study, 70% of the cases were male and 30% were female. Median age was 83 ± 2.91 (80-92) years. 71% of the cases were found to be suffering from a comorbid disease; 29% did not have any comorbid disease. Dyspnea (56%), cough (50%) and chest pain (41%) were the most frequent symptoms. Histopathologically, 41% of the patients diagnosed with adenocarcinoma and 40% were diagnosed with squamous cell carcinoma. Median survival time was 2.73 months (%95 CI 0.96-4.49) and 1-year survival rate was 17%. Length of time of the cases with smoking history was found shorter than of cases without smoking history (p= 0.013). Life expectancy of the cases with advanced disease and performance score of 3-4 was detected to be short (p= 0.006, p< 0.001). Compared to the cases who operated on and had chemoradiotherapy, length of life who had symptomatic treatment was shorter (p< 0.001). CONCLUSIONS: Despite the comorbidity in lung cancer cases aged 80 years and over, life expectancy of the cases who had surgical and/or chemoradiotherapy treatment is longer. While deciding on treatment methods on these cases, patient's performance must be taken into consideration.

The sensitivity and specifity of DR-70 immunoassay as a tumor marker for non-small cell lung cancer.

INTRODUCTION: Lung cancer is the most important causes of the cancer related mortality. Patients with lung cancer are usually diagnosed at advanced or locally advanced stage, for this reason early diagnosis of lung cancer is very important. For early detection of lung cancer some methods are emphasized such as low-dose computed tomography or tumor biomarkers. In this study we aimed to evaluate DR-70 sensitivity and specificity as a tumor marker in detection of non-small cell lung cancers. PATIENTS AND METHODS: Between May 2013 and April 2014, the serum samples from 88 non lung cancer patients, 86 patients with chronic obstructive pulmonary disesase were obtained. Blood samples from each participant were analyzed for DR-70 level. RESULT: Totally 174 patients were enrolled to the study (152 male, 22 female). Histopathologically 47(53.4%) patients were diagnosed with squamous cell lung cancer, 34 (38.6%) with adenocarcinoma, and 7 (8%) with non-small cell lung cancer. The mean serum DR-70 levels in lung cancer patients (2.43 ± 1.82 µg/mL) was significantly higher compared to the 86 non-cancerous subjects (1.15 ± 0.70 µg/mL) (p< 0.01). DR-70 exhibited clinical sensitivity and specificity of 54.5 and 83.7%, respectively, at an optimal cut off at 1.98 µg/mL. It could be said that the risk of the presence of the disease is 6.171 times higher in the cases where DR-70 level is 1.98 µg/mL and higher. CONCLUSION: DR-70, a marker used to measure fibrin degradation products, generated by all major cancers, may helps to find high risk lung cancer patients.

Prognostic factors affecting survival in non-small cell lung carcinoma patients with malignant pleural effusions.

BACKGROUND AND AIMS: Lung cancer is the most common cause of malignant pleural effusions (MPEs). For patients with lung cancer and MPE, median survival is only 3-4 months. The aim of this study was to evaluate lung cancer patients with MPE by clinical and laboratory findings on admission, and determine 2-year survival rate and prognostic factors. METHODS: Between 2008 and 2011, we examined 199 cases of non-small cell lung carcinoma with MPE. Demographic factors of patients, tumor characteristics, treatment delivered and laboratory parameters affecting prognosis were evaluated. Survival rates were estimated by Kaplan-Meier method. Significance of each prognostic factors selected by univariate analysis were confirmed using Cox regression model. RESULTS: The study included 139 (69.8%) male and 60 (30.2%) female patients with a median age of 64 (30-85) years. Median overall survival was 4.4 months. Adenocarcinoma was the leading cause of MPE with 80.4%. A univariate analysis showed that factors affecting mortality included gender (P < 0.001), MPE with distant metastasis (P = 0.025), lower serum albumin (P < 0.0001), lower pleural protein (P < 0.0001), increased serum lactate dehydrogenase (P = 0.003), increased serum C-reactive protein (CRP) (P < 0.0001), increased white blood cells (P < 0.0001), histopathological type (P = 0.004) and treatment decision (P < 0.0001). A multivariate analysis revealed that patients who had high level of serum CRP (P = 0.017), lower serum albumin (P = 0.009) and lower pleural protein (P = 0.003), MPE with distant metastasis (P = 0.003) and those who were chemotherapy naive (P < 0.0001) had shorter survival. CONCLUSION: High level of serum CRP, lower serum albumin and lower pleural protein, MPE with distant metastasis were most important prognostic factors for non-small cell lung carcinoma in patients with MPEs.

Hospital Treatment Costs and Factors Affecting These Costs in Community-Acquired Pneumonia.

OBJECTIVES: Community-acquired pneumonia (CAP) accounts for an important part of hospital admissions and health expenses worldwide. The cost increases when treated in a hospital, and reports on this issue are limited in Turkey. This study aimed to investigate direct hospital costs and factors affecting these costs for patients who were hospitalized in our clinic because of the diagnosis of CAP. MATERIAL AND METHODS: The records of patients who had been hospitalized for the diagnosis of CAP were retrospectively reviewed. Demographic features, radiological features, pneumonia severity index (PSI), CURB-65 scorings, duration of hospitalization, treatments, and the results of treatments were examined. Total hospitalization costs and the expenses for intervention, medication, examinations, and additional services were recorded. The effect of data on the cost was evaluated. RESULTS: The study was conducted with 87 patients with CAP. The mean duration of hospitalization was 15.6 days and nine patients (10.3%) were exitus. The median total hospital cost was 2062 (451-11690) TL [952 euros (€), 1305 dollars ($)], and the median hospitalization expense per day was 148 Turkish Lira (TL) (68.3 €, 93.7 $). Medication expenses and total cost were higher in male patients than in female patients. Abscess/necrotizing pneumonia increased the cost depending on the infiltration that occurred either alone or with parapneumonic pleurisy. Whereas an increase in the PSI stage increased the total cost and expenses for intervention and medication, medication expenses increased in patients with CURB-65 score of 3 and 4 (p<0.05). Age, smoking, and low oxygen saturation level did not affect the cost. No statistically significant difference was found between the expenses of exitus patients and the expenses of patients who recovered. CONCLUSION: CAP can lead to high costs and result in death. In our study, it was concluded that the cost increased in male patients, patients with abscess/necrotizing pneumonia, and patients with high PSI scores.