A Cross-Sectional Study for Determining the Role of High-Sensitivity Cardiac Troponin T in Predicting 4-Month Mortality during the First Wave of the COVID-19 Pandemic.

Background: Positivity of cardiac troponins is common in hospitalized COVID-19 patients and may serve as an additional risk stratification tool in everyday clinical settings. Since patients with elevated troponins have a higher risk of in-hospital mortality, troponins have prognostic importance. As well as in-hospital mortality, high-sensitive troponin T may reflect 4-month mortality. We analyzed the relationship between cardiac troponin T levels and 4-month mortality of COVID-19. Materials and Methods: It was conducted as a retrospective cross-sectional study in Health Sciences University Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, Turkey, with COVID-19 pneumonia patients during the first wave of the pandemic. We analyzed their comorbidities, C-reactive protein, ferritin, aspartate transaminase, alanine transaminase, cardiac troponin T, N-terminal-prohormone B-type-natriuretic peptide, international normalized ratio; duration of hospital stay, and survival status. Results: Factors associated with mortality were cardiac troponin T > 0.53 pg/dl (p = 0.009) and aspartate transaminase > 26.5 U/l (p = 0.012). The threshold for cardiac troponin T to predict 4-month mortality was 5.83pg/ml. Its sensitivity was 82.8% and its specificity was 66.4%. Conclusion: Cardiac troponin T and AST are indicators that can be used to predict 4-month mortality in addition to showing in-hospital mortality. The threshold for cardiac troponin T to predict 4-month all-cause mortality is 5.83pg/ml. The mortality difference persists at the beginning, middle, and end of the 4 months. Reference thresholds likely underestimate the true prognostic extent of cardiac injury and lower cutoff values may show mortality.

Comparison of Brock University, Mayo Clinic and Herder models for pretest probability of cancer in solid pulmonary nodules.

OBJECTIVE: Risk analysis models, which are used in the diagnostic algorithm of incidental pulmonary nodules, are based on patient data from developed countries. Mayo Clinic, Brock University and Herder are among the most known models. We aim to compare the reliability of these models in patients with indeterminate solid nodules and to investigate the contribution of the predictors used to the model. METHODS: We analysed 305 patients who performed transthoracic needle biopsy and positron emission tomography/computed tomography for solid nodules, retrospectively. For all three models, the malignancy risk probabilities of patients were calculated, and patients were classified as low (<5%), moderate (60%) and high (<60%) risk groups. Later, the malignancy rates of each model in three different risk groups were compared within each other and among the models. RESULTS: The malignancy rate is 73% in 305 patients. In the Mayo Clinic and Herder models, the difference in the low-, medium- and high-risk groups is significant (p < 0.001). In the medium-risk group, the rate of malignancy is 96.8% in the Brock model. In the high-risk group, the rate of malignancy in Herder is 88.3% and the rate of malignancy in Mayo Clinic is 28.8%. The optimal cutoff values for the Mayo Clinic, Brock University, and Herder were 29.6, 13.4 and 70 (AUC, respectively; 0.71, 0.67 and 0.73). Age, smoking, gender, size, emphysema and spiculation increase the likelihood of malignancy. CONCLUSION: Close results were obtained in all three models. In the high-risk group, the Herder model has the highest reliability rate (odds ratio 3.3, confidence interval [1.1, 10.2]). Upper lobe predilection is not a reliable predictor.

The impact of anemia on the mortality of COPD patients hospitalized for acute exacerbation resulting in respiratory failure.

Anemia increases mortality in patients with chronic obstructive pulmonary disease (COPD), but its effects on mortality and survival time for different levels of airflow limitation severity are unclear. Our goal was to investigate the effects of anemia on survival time and mortality in COPD patients with varying degrees of airflow limitation. We looked at 300 consecutive COPD patients in the past. Their demographic information, Charlson comorbidity index, previous early (30 days) and late (>30 days) hospitalizations, blood counts, and post-bronchodilator spirometric values were all recorded. They were contacted by phone to check on their vital status, and their mortality rates were calculated. Anemic patients had a mean overall survival time of 31.9 2.8 months and normal patients had a mean overall survival time of 41.7 2.1 months (p=0.001). Their 1-year and 2-year mortality rates are higher. Age, Charlson comorbidity index, BMI, FEV1%, anemia, MCV, hemoglobin, serum creatinin, and early and late hospitalizations all had an impact on mortality. BMI, anemia, and FEV1% remained risk factors for death. Anemic group 2 patients had a higher mortality rate than groups 3 and 4. Anemic patients in groups 2 and 4 had shorter survival times. Anemic COPD patients have higher 1-year and 2-year mortality rates. Mortality is affected by age, Charlson comorbidity index, BMI, FEV1%, anemia, MCV, hemoglobin, serum creatinin, and early and late hospitalizations. BMI, anemia, and FEV1% remained risk factors for death. Anemic group 2 patients have a higher mortality rate than groups 3 and 4. Anemic patients in groups 2 and 4 have shorter survival times.

Correlation of preoperative PET/computer tomography 18F-fluorodeoxyglucose uptake (maximum standardized uptake value) with prognosis in patients with operated lung cancer.

PURPOSE: The aim of this study was to investigate the correlation of preoperative 18F-fluorodeoxyglucose PET/computed tomography maximum standardized uptake value (SUVmax) in operated non-small cell lung cancer (NSCLC) cases with other prognostic parameters and survival. PATIENTS AND METHODS: NSCLC patients treated by surgical resection were imaged with PET within 60 days before surgery. RESULTS: Overall, 525 cases consecutive patients were retrospectively reviewed. The median value of SUVmax in a total of 525 cases was 12.1, and the mean was 13.3 ± 7.13. Logistic regression analysis performed to identify the variables that have an impact on SUVmax revealed that histology [hazard ratio (HR: 1.893; 95% CI; P = 0.001) and T status (HR: 8.991; 95% CI; P = 0.000) are correlated with SUVmax. Kaplan-Meier analysis revealed a mean survival of 73.7 ± 1.95 months and a median survival of 85.6 ± 6.03 months. In the group with an SUVmax value of less than 10, the mean survival was 81.9 ± 3.02 months (76.0-87.8), and in the group with SUVmax greater than 10.1, the mean survival was 68.6 ± 2.4 months (63.9-73.3) (P = 0.000). In the multivariate analysis, SUVmax, age, tumor histology, lymph node metastasis, comorbid diseases and complete/incomplete status of the resection were identified as the factors predictive of prognosis. CONCLUSION: It is seen that preoperative SUVmax is a parameter with prognostic significance at least as much as histopathology, age, complete/incomplete status of resection and lymph node involvement.

How does chronic obstructive pulmonary disease affect the survival of patients with stage 4 lung cancer?

BACKGROUND: Lung cancer risk is increased in COPD. However, it is not clear how COPD affects the course of lung cancer. AIM: To determine whether the overall survival of stage 4 lung cancer patients differ in various COPD stages. STUDY DESIGN: A cross-sectional retrospective study. METHODS: We screened lung cancer patients with ICD code: C34 and included stage 4 lung cancer patients with histological diagnosis and pulmonary function tests at admission in the study. Demographic data, stages, metastasis sites and number of metastases, performance status, pulmonary function tests, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, arterial blood gasses and treatment methods were recorded on a standardised database. We checked their dates of death from national database. Data were evaluated with SPSS programme version 18. RESULTS: Out of 900 patients, 146 patients had stage 4 disease at the time of diagnosis and, 127 patients had COPD. There was a significant difference between survivals of stage 4 cancer patients with different COPD stages. As COPD stage increased, overall survival worsened (P = 0.037). Factors affecting survival were bone metastasis (P = 0.01, OR = 1.72), liver metastasis (P = 0.04, OR = 1.87), brain metastasis (P = 0.001, OR = 2.6), having N 2-3 disease (P = 0.01, OR = 1.79) and GOLD 4 COPD (P = 0.01, OR = 2.28). CONCLUSION: As COPD becomes more severe, overall survival rates of stage 4 patients worsen. Bone metastasis, liver metastasis, brain metastasis, having N2-3 disease and GOLD 4 COPD worsen the overall survival.

Characteristics of Patients with Large-Cell Neuroendocrine Carcinoma of the Lung.

OBJECTIVES: Neuroendocrine tumors of the lungs are a clearly different group of tumors with definite ultrastructural, immunohistochemical, and molecular features. We reported and analyzed the incidence, clinicopathological features, surgery rates, responses to first-line therapy, and survival outcomes of this rare condition according to our lung cancer patient database. MATERIALS AND METHODS: We retrospectively collected the data of 62 patients who were histopathologically diagnosed with large cell neuroendocrine carcinoma of lung (LCNEC) between January 2010 and January 2016. RESULTS: The patients were predominantly (95%) men (male:female=59:3) with their average age being 60.3±8.6 years. Diagnosis was made by the fine-needle aspiration biopsy (NAB) in 7 patients, bronchoscopic transbronchial biopsy in 13, and surgery in 42. Nearly 43.5% of the patients presented with the tumor in the right upper lobe. Additionally, tumors of 46.8% patients could be observed in peripheral locations. Sixteen patients presented with stage 1, 17 with stage 2, 15 with stage 3, and 14 with stage 4. Median progression-free survival (PFS) was 29 months (SE: 12.2) (95% CI, 5.2-52.8 months). Progression-free survival (PFS) was significantly better in patients with low N, M0, early stage, p63 positive, and TTF-1 positive across the entire cohort. Overall survival (OS) was significantly better in patients with comparatively lower N, M0, low stage, and peripheral location. CONCLUSION: This study demonstrated a single-center experience with clinicopathologic factors and survival outcomes of LCNEC patients.

Metabolic activity of primary tumour on PET/CT has a relationship with survival in stages I-III small-cell lung carcinoma.

INTRODUCTION: There is limited evidence about the prognostic value of FDG-PET/CT metrics in small cell lung cancer (SCLC) patients staged with TNM staging system. OBJECTIVES: The aim of this study is to examine the prognostic value of pretreatment FDG-SUVmax in patients with SCLC staged with 8th TNM staging system. METHODS: A total of 344 (292 male) SCLC patients with pretreatment FDG- PET/CT were included. One hundred fifty-three of cases were stages I-III, 191 were stage IV. SUVmax values were obtained for primary tumour, lymph nodes and metastases. Univariate and multivariate analysis were performed to determine the effect of pretreatment SUVmax, with cut-off value of median, on progression-free and overall survival (PFS and OS). RESULTS: Median OS and PFS for patients with stages I-III were 16.50 and 11.00 months, respectively. Median OS and PFS for patients with stage IV were 10.00 and 7.00 months, respectively. SUVmax of the primary tumour (PT), lymph nodes or metastasis were not associated with OS and PFS on univariate analysis. On multivariate analysis, SUVmax -PT with cut-off value of 11.60 was found to be an independent prognostic factor for OS in patients with stages I-III (HR;1.88, 95% CI:1.15-3.08, P = .012). But the SUVmax -PT (HR; 1.60, 95% CI: 0.99-2.60; P = .057) for PFS was found to be a prognostic factor with marginal significance. SUVmax were not significantly associated with OS and PFS in patients with stage IV disease. CONCLUSION: Pretreatment SUVmax -PT (median cut-off 11.6) may have a prognostic value of OS and PFS in patients with TNM staged I-III SCLC.

Diagnostic success of transthoracic needle biopsy and PET-CT for 1 to 2 cm solid indeterminate pulmonary nodules.

OBJECTIVES: Among the nodule types, the most controversial group are indeterminate solid nodules from 1 to 2 cm in size with the first choice being transthoracic needle biopsy (TTNB) or positron emission tomography (PET-CT) or both methods together. However, no single diagnostic algorithm could be applied to all cases. This research discusses the diagnostic success of PET-CT and TTNB. MATERIALS AND METHODS: 407 Patients who referred to our hospital for any reason, with solid nodules with the size from 1 to 2 cmincidentally identified on the thoracic CT tests were investigated. Among the patients who underwent biopsy, 312 cases had PET-CT, and maximum SUV (SUVmax) values of the nodules were examined. Values of ≥2.5 were accepted as hypermetabolic. RESULTS: The mean age of the patients was 61 ± 10.8 years. 84 patients were female (20.6%) and 323 were male (79.4%). For TTNB; sensitivity, specificity and accuracy rates of all cases, who were correctly diagnosed, were 76.9%, 83.3% and 78.9%, respectively (P < .001). The 2.5 SUVmax cutoff value had sensitivity of 91%, specificity of 35.6%, accuracy of 75% (P = .034). The cutoff value of 49 years of age, nodule size of 16.4 mm, gender and 2.5 SUVmax value had high accuracy for benign-malignant differentiation. No statistically significant difference was found in the upper lobe localization of nodule. CONCLUSION: A positive result from TTNB is a reliable finding; however, a negative result is not definitive. The high negative predictive value of PET-CT is effective in preventing the unnecessary biopsies and surgical procedures.

Duration of Stay of Patients with Community-Acquired Pneumonia in Influenza Season.

OBJECTIVES: There is a seasonal variation in the incidence of some infectious diseases. We analyzed the impact of influenza season (IS) on duration of stay (DOS) and some other characteristics of patients with community-acquired pneumonia (CAP). MATERIALS AND METHODS: In our retrospective cohort study, we analyzed data of 369 patients with CAP. RESULTS: The mean patient age was 65.5±16.69 years, and 267 (72.4%) patients were male. There was no difference between patients with CAP admitted to hospital and intensive care unit during IS and non-influenza season (NIS) with respect to age, mortality, and DOS. There was no difference in leukocyte and neutrophil counts, C-reactive protein level, and erythrocyte sedimentation rate in different seasons. Although most comorbid disease rates were similar, only cancer, especially lung cancer, was more prevalent in NIS. Bilateral CAP confirmed using thorax computed tomography was more frequent in IS. CONCLUSION: Although more patients with bilateral pneumonias were hospitalized in IS, DOS was not different between IS and NIS.

Pulmonary tuberculosis due to Mycobacterium bovis revealed by skin lesion in slaughterhouse worker.

A 46-year-old male patient who has worked as a butcher was admitted to the hospital with an unhealing wound on the dorsal side of his hand. Incisional biopsy was performed from the lesion and histopathological diagnosis revealed a granulomatous inflammatory process, compatible with tuberculosis. The patient was directed to the department of chest diseases for further investigation in terms of pulmonary Tuberculosis (TB) infection. On the chest X-ray and thoracic CT scan, a minimal infiltration was observed in the left upper lobe. In two respiratory samples obtained by fiberoptic bronchoscopy, Mycobacterium tuberculosis complex was isolated and identified as M. bovis in subspecies level. After overall clinical evaluation, anti-TB treatment was initialized and a radiologic/clinical regression was observed during the follow-up procedure. This case has been reported as a rare and noteworthy pulmonary TB disease due to M. bovis in a slaughterhouse worker with a cutaneous granulomatous inflammatory reaction.

Multiple endobronchial hamartoma.

BACKGROUND AND AIMS: Pulmonary hamartomas appear as parenchymal or endobronchial lesions, the latter representing '1.4 to 11%' of the total number of pulmonary hamartomas. Endobronchial hamartomas usually emerge as a single mass. As they are accepted as benign tumors, endobronchial treatments are recommended today. 45 year-old male patient admitted with cough, phlegm and fever. A lesion totally obstructing the right main bronchus was found in CT. METHODS: In his brochoscopy, a mobile, smooth-surfaced lesion obstructing right main bronchus was seen. Its histopathology was reported as 'hamartoma.' RESULTS: The lesion was removed by using argon plasma coagulation and electrocotery. After the removal of the lesion in right main bronchus, another lesion with similar characteristics was seen in the intermedius bronchus and this lesion which histopathology was reported as 'hamartoma' was excised by using electrocauter snare. There was no recurrence in the 24 month follow-up. CONCLUSION: Reports of multiple endobronchial hamartomas are rare in the literature, and the awareness of this form of benign disease is important in the differential diagnosis of pulmonary diseases.