Hakan Tanrıverdi

Comparison of diagnostic values of procalcitonin, C-reactive protein and blood neutrophil/lymphocyte ratio levels in predicting bacterial infection in hospitalized patients with acute exacerbations of COPD

SummaryBackgroundViral or bacterial upper respiratory infections are the most common cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Based on available data, no reliable parameter has been presented to distinguish between bacterial and nonbacterial exacerbations. Therefore, we compared the diagnostic value of procalcitonin (PCT) level, which is a newer marker for predicting bacterial infections in patients with AECOPD, to routine parameters such as C-reactive protein (CRP) levels and the neutrophil/lymphocyte (N/L) ratio.MethodsThis study included all consecutive patients who were admitted for a diagnosis of AECOPD between January 1 and March 31, 2014. PCT, CRP, and the N/L ratio were assessed in addition to cultures from tracheal aspirates or sputum on the first day of admission. Patients with a pneumonic infiltration on chest radiographs, or an extrapulmonary infection focus, or whose blood samples were not obtained for PCT and/or CRP at the same time as sputum culture were excluded from the study.ResultsA total of 77 patients were included with a mean age of 71.7xa0±xa09.5 years. Bacteria were isolated in 37.4xa0% of the patients. Mean PCT levels were significantly higher in patients with positive sputum cultures than in patients with negative sputum cultures. The cut-off values for PCT, CRP, and the N/L ratio for predicting a bacterial infection were 0.40xa0ng/mL, 91.50xa0mg/L, and 11.5, respectively; sensitivity was 61, 54, and 61xa0% respectively; specificity was 67, 52, and 58xa0%, respectively; and the area under the curve (AUC) values were 0.64, 0.52, and 0.58, respectively. The AUC value of PCT was significantly better for predicting bacterial infection compared with the CRP level or the N/L ratio (pxa0=xa00.042).ConclusionPCT was better than CRP and the N/L ratio for predicting a bacterial infection in hospitalized patients with AECOPD. However, we find PCT not so reliable in predicting bacterial infection in AECOPD due to sensitivity and specificity of less than 80xa0% and a low AUC value.ZusammenfassungHintergrundVirale oder bakterielle Infektionen des oberen Respirationstraktes sind die häufigste Ursache einer akuten Exazerbation einer chronisch obstruktiven Lungenerkrankung (COPD). Bis jetzt ist kein verlässlicher Parameter bekannt, der in der Lage ist, zwischen bakteriellen und nicht-bakteriellen Exazerbationen zu unterscheiden. Wir haben daher den diagnostischen Wert der Konzentrationen von Procalcitonin (PCT), einem neueren Marker zur Vorhersage bakterieller Infektionen bei Patienten mit COPD, mit dem der herkömmlichen Routineparameter, wie dem C-reaktivem Protein (CRP) und dem Neutrophilen/Lymphozyten (N/L) Quotienten, verglichen.MethodenDiese Studie schloss alle konsekutiven Patienten ein, die mit der Diagnose einer COPD zwischen 1. Jänner und 31. März 2014 aufgenommen waren. PCT, CRP und die N/L Quotienten wurden zusätzlich zu Kulturen von Aspiraten aus der Trachea oder von Sputa am Aufnahmetag erhoben. Patienten mit einem Lungeninfiltrat oder einem extrapulmonalen Infektionsherd und/oder deren Blutproben nicht am selben Tag wie die Sputum Kulturen abgenommen waren, wurden aus der Studie ausgeschlossen.ErgebnisseSiebenundsiebzig Patienten mit einem mittlerem Alter von 71,7xa0±xa09,5 Jahren wurden in die Studie aufgenommen. Bei 37,4xa0% der Patienten konnten Bakterien isoliert werden. Die mittleren PCT Werte waren bei den Patienten mit positiven Sputum Kulturen signifikant höher als bei denen mit negativen Kulturen. Die Grenzwerte für die PCT, CRP und N/L Quotienten Werte zur Vorhersage eines bakteriellen Infektes lagen bei 0,40xa0ng/mL, 91,50xa0mg/L, und 11,5. Die Sensitivität war bei 61, 54, und 61xa0% – die Spezifität bei 67, 52, und 58xa0%, die Flächen unter der Kurve (AUC) 0,64, 0,52, and 0,58. Die AUC der PCT Werte war bei der Vorhersage von bakteriellen Infekten im Vergleich zu den CRP Werten und den N/L Quotienten signifikant besser (pxa0=xa00,042).SchlussfolgerungBei Patienten mit COPD war das PCT bei der Vorhersage von bakteriellen Infekten besser als das CRP beziehungsweise die N/L Quotienten. Wir sind allerdings der Meinung, dass PCT kein sehr verlässlicher Parameter in der Vorhersage von bakteriellen Infekten ist, da sowohl die Spezifität als auch die Sensitivität unter 80xa0% liegen, und da auch die AUC niedrig ist.

Prognostic value of serum procalcitonin and C-reactive protein levels in critically ill patients who developed ventilator-associated pneumonia.

INTRODUCTION: Ventilator-associated pneumonia (VAP) is an important cause of mortality and morbidity in critically ill patients. We sought to determine the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) kinetics in critically ill patients who developed VAP. METHODS: Patients who were admitted to the intensive care unit (ICU) and developed VAP were eligible. Patients were followed for 28 days after the pneumonia diagnosis and blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis (D0), and days 3 (D3) and 7 (D7) after the diagnosis. Patients were grouped as survivors and non-survivors, and the mean PCT and CRP values and their kinetics were assessed. RESULTS: In total, 45 patients were enrolled. Of them, 22 (48.8%) died before day 28 after the pneumonia diagnosis. There was no significant difference between the survivor and non-survivor groups in terms of PCT on the day of pneumonia diagnosis or CRP levels at any point. However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group. Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not. A PCT level above 1 ng/mL on day 3 was the strongest predictor of mortality, with an odds ratio of 22.6. CONCLUSION: Serum PCT was found to be a superior prognostic marker compared to CRP in terms of predicting mortality in critically ill patients who developed VAP. The PCT level on D3 was the strongest predictor of mortality in VAP.

Syncope as a presentation of acute pulmonary embolism.

Purpose Syncope is an atypical presentation for acute pulmonary embolism (APE). There are conflicting data concerning syncope and prognosis of APE. Patients and methods One hundred and seventy-nine consecutive patients aged 22–96 years (median, 68 years) with APE were retrospectively enrolled in the study. Results Prevalence of syncope was 13% (n=23) at the time of presentation. Compared to patients without syncope, those with syncope had a higher rate of central embolism (83% vs 43%, respectively, P=0.002), right ventricular dysfunction (91% vs 68%, P=0.021), and troponin positivity (80% vs 39%, P=0.001) but not 30-day mortality (13% vs 10%, P=0.716). Multivariate analysis showed that central localization (odds ratio: 9.08) and cardiac troponin positivity (odds ratio: 4.67) were the independent correlates of the presence of syncope in the patients with APE. Frequency of cardiopulmonary disease was lower, and duration from symptom onset to hospital admission was shorter in patients with syncope (P=0.138 and 0.118, respectively), although not significant. Conclusion Syncope most likely represents an intermediate condition between massive APE and hypotension. In APE patients with syncope, the prognosis seems to depend on the underlying pathology, the patient’s age, comorbidities and duration from symptom onset to hospital admission, and the use of thrombolytic therapy.

Association between continuous positive airway pressure and circulating omentin levels in patients with obstructive sleep apnoea.

PurposeInflammation and oxidative stress play important roles in the pathogenesis of obstructive sleep apnoea syndrome (OSAS). Omentin is expressed in visceral adipose tissue and is associated with the inflammatory response. The aim of this study was to assess the relationship between OSAS and omentin based on a comparison of its serum levels at baseline and after 3xa0months of continuous positive airway pressure (CPAP) therapy.MethodsNinety-six newly diagnosed OSAS patients and 31 non-apnoeic controls were enrolled in this study. Blood samples were obtained in the morning after polysomnography. Within the OSAS group, 30 patients were started on CPAP therapy and then reassessed clinically, including a blood test for serum omentin and other biochemical analysis, at 3xa0months.ResultsSerum omentin levels were significantly lower in the OSAS group than in the control group (27.7u2009±u20097.6 and 42.5u2009±u20095.2xa0ng/mL, Pu2009<u20090.001). In the subgroup analysis, omentin concentrations were significantly lower in patients with severe OSAS than in those with mild/moderate OSAS (Pu2009<u20090.001). Circulating omentin levels were significantly correlated with the apnoea–hypopnoea index (AHI), mean SaO2, oxygen desaturation index, and serum C-reactive protein levels. Treatment with CPAP resulted in a significant increase in circulating omentin levels after 3xa0months, from 22.7u2009±u20091.4 to 41.2u2009±u20093.3xa0ng/mL (Pu2009<u20090.001).ConclusionsOSAS is associated with low serum omentin levels, and these levels can be reversed by effective CPAP treatment.

The neutrophil-to-lymphocyte ratio in patients with obstructive sleep apnoea syndrome and its relationship with cardiovascular disease

OBJECTIVEnTo investigate the association between the neutrophil-to-lymphocyte ratio (NLR) and obstructive sleep apnoea syndrome (OSAS) severity and whether the NLR predicts cardiovascular disease (CVD) in patients with OSAS.nnnBACKGROUNDnOSAS is known as a risk factor for CVD. An increased NLR was strongly correlated with cardiovascular outcomes in several studies.nnnMETHODSnWe retrospectively examined the laboratory data for 289 patients with suspected OSAS evaluated using polysomnography.nnnRESULTSnThe study included 171 OSAS patients and 118 controls. The NLR was higher in OSAS group than control group. The NLR was significantly higher in patients with CVD than in those without (3.31 ± 1.1 vs. 1.93 ± 0.8, p = 0.002). There were also significant correlations between the NLR and apnoea-hypopnoea index, mean SaO2, and oxygen desaturation index.nnnCONCLUSIONSnThere was a significant correlation between the NLR and OSAS severity and the NLR was independently associated with CVD in patients with OSAS.

The Impact of Obstructive Sleep Apnoea and Nasal Continuous Positive Airway Pressure on Circulating Ischaemia-Modified Albumin Concentrations

The aim of the present study was to evaluate the impact of obstructive sleep apnoea syndrome (OSAS) and the effects of nasal continuous positive airway pressure (CPAP) on circulating ischaemia-modified albumin (IMA) concentrations. The study included 97 newly diagnosed OSAS patients and 30 nonapnoeic controls. Blood samples were obtained in the morning after polysomnography. After 3 months of CPAP treatment, 31 patients with moderate-severe OSAS were reassessed for serum IMA concentrations. Significantly higher serum IMA concentrations were measured in the OSAS group than in the control group [0.518 ± 0.091 absorbance units (ABSU), 0.415 ± 0.068 ABSU, P < 0.001]. Serum IMA concentrations correlated significantly with the apnoea-hypopnoea index, mean SaO2, desaturation index, and C-reactive protein concentrations. Multiple logistic regression analyses showed that OSAS increased the serum IMA concentration independent of age, sex, body mass index, smoking habit, and cardiovascular disease. After 3 months of treatment with CPAP, OSAS patients had significantly lower serum IMA concentrations (0.555 ± 0.062 ABSU to 0.431 ± 0.063 ABSU, P < 0.001). The results showed that OSAS is associated with elevated concentrations of IMA, which can be reversed by effective CPAP treatment.

BRONCHOALVEOLAR LAVAGE FLUID CHARACTERISTICS OF PATIENTS WITH SARCOIDOSIS AND NONSARCOIDOSIS INTERSTITIAL LUNG DISEASES: TEN-YEAR EXPERIENCE OF A SINGLE CENTER IN TURKEY

Background: Bronchoalveolar lavage (BAL) is a noninvasive and useful technique for evaluating interstitial lung diseases (ILDs). Flow cytometric analysis of BAL fluid reveals specific diagnostic information in some unusual ILDs, and helps to narrow down the possible causes of interstitial diseases in most patients with more common disorders. A high BAL CD4/CD8 ratio is highly specific for sarcoidosis but can also be seen in other ILDs. Objectives: In this retrospective, descriptive, cross-sectional study, we compared BAL fluid characteristics and clinical variables in patients with sarcoidosis and non-sarcoidosis ILDs in a large cohort. Patients and Methods: The study was conducted in a tertiary university hospital in Zonguldak, the biggest city of the western Black Sea region of Turkey. Between 2004 and 2014, all patients who underwent both fiberoptic bronchoscopy and BAL with a suspicion of ILD were included in the study, retrospectively. Patients were divided into two main groups: sarcoidosis and non-sarcoidosis ILDs. Non-sarcoidosis ILDs were further divided into subgroups: pneumoconiosis, tuberculosis (TB), collagen vascular diseases, idiopathic interstitial pneumonias, malignancies, and unclassified ILDs. The clinical data of patients, including age, gender, smoking status, pulmonary function tests, and BAL flow cytometric analysis results, were compared among groups. Results: In total, 261 patients (119 sarcoidosis and 142 non-sarcoidosis ILDs) were enrolled. The median (interquartile range) BAL CD4/CD8 ratio and lymphocyte fraction were significantly higher in sarcoidosis than in non-sarcoidosis ILDs: 3.88 (3.76) versus 0.88 (1.01), respectively, and 20.6 (28.3) versus 6.0 (13.7), respectively. T cell receptor γ delta, CD16+56+, CD103+, CD8+103+, and CD3+16+56+ cells were significantly lower in sarcoidosis than in non-sarcoidosis ILDs. The median BAL CD4/CD8 ratios were significantly higher in patients with TB (1.87, P = 0.01) and malignancies (1.69, P = 0.03) than in other non-sarcoidosis ILDs. Conclusions: Among BAL fluid flow cytometric parameters, CD4/CD8 and lymphocyte fraction may be helpful for distinguishing sarcoidosis from other ILDs, but they are neither specific nor diagnostic for any lung disease. Thus, a multidisciplinary diagnostic discussion is required to differentiate various ILDs.

Platelet Indices in Patients with Coal Workers' Pneumoconiosis.

PurposeCoal workers’ pneumoconiosis (CWP) is caused by an accumulation of coal particles in the lung parenchyma. Reactive oxygen species (ROS) play an important role in the pathogenesis of CWP. It is well documented that ROS stimulate platelet activation, adhesion, and aggregation. The aim of the present study was to investigate the relationship between platelet indices and CWP.MethodsThe demographic features, occupational and medical history, exposure time, and complete blood count of retired coal miners were retrospectively analysed. The control group comprised healthy subjects who had not worked underground. Chest radiographs were evaluated according to the CWP classification of the International Labour Office.ResultsThe study population was divided into following groups: 50 controls, 97 without CWP, 142 simple pneumoconiosis (SP), 157 progressive massive fibrosis (PMF). The platelet count, mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) were significantly higher in patients with CWP compared to those in patients without CWP and controls. The platelet count, MPV, and PCT were higher in patients with PMF compared to those in the SP group (pxa0<xa00.05). The results of multiple logistic regression analyses indicated that the platelet count, MPV, and PCT were independently associated with the development of CWP.ConclusionsPlatelet indices may be considered as disease markers for pneumoconiosis in coal miners and as a useful indicator of the progression of pneumoconiosis.

Disseminated tuberculosis in a non immun compromised patient with a complicated diagnosis

Tuberculosis (TB) has become a global emergency worldwide. The long time period between the exposure to TB bacillus and the onset of symptoms cause a delay in diagnosis. Herein, we report a case of 64-year-old female patient suffering from dyspepsia, anorexia, weight loss and abdominal pain for the last 8 months. Physical examination, ascites fluid evaluation, chest radiography, ultrasonographic and tomographic scans, histopathological analysis of the lymphadenopathy (LAP) and endometrial tissue revealed TB. A fourfold antituberculous treatment with isoniazid, pyrazinamide, rifampicin and ethambutol was prescribed for two months and for four months maintenance therapy with isoniazid and rifampicin was given. On the fourth month of the medical treatment the patient clinically recovered. Since the diagnosis of TB is difficult, high grade suspicion, combination of the radiologic, microbiologic and histopathological examinations are needed to achieve a diagnosis.

Prognostic Value of Renal Dysfunction Indicators in Normotensive Patients With Acute Pulmonary Embolism

Introduction: Glomerular filtration rate (GFR) and blood urea nitrogen (BUN) are important prognostic indicators for cardiovascular disease. However, data on the relationship between renal dysfunction (RD) and prognosis in patients with acute pulmonary embolism (APE) are limited. The estimated-GFR (eGFR), based on the Modification of Diet in Renal Disease (MDRD) equation, has been suggested as a possible prognostic marker in patients with APE; however, at present, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is thought to be more accurate than the MDRD equation for the estimation of RD. Objective: We investigated whether eGFRCKD-EPI or BUN could predict adverse outcomes (AOs) better than eGFRMDRD in normotensive patients with APE. Methods: Ninety-nine normotensive patients with APE (aged 22-96, 56% male) were enrolled in the study retrospectively. Adverse outcomes were defined as the occurrence of any of the following: death, cardiopulmonary resuscitation, use of vasopressors, thrombolysis, or mechanical ventilation. Results: In univariate analyses, age, gender (male), heart rate (>110 bpm), serum creatinine, BUN, cardiac troponin (cTn) positivity, right ventricle–left ventricle ratio, eGFRMDRD, and eGFRCKD-EPI were found to be significantly different between those with and without AOs. Comparing area under the curves for AO, we found statistically significant differences between eGFRCKD-EPI and eGFRMDRD (P = .01) but not between BUN and eGFRCKD-EPI or BUN and eGFRMDRD. Furthermore, 30-day mortality was 36% versus 11% in cTn-positive patients with an eGFRCKD-EPI < and ≥ 60 mL/min, respectively. Conclusion: There is a close relationship between RD and APE prognosis. We conclude eGFRCKD-EPI is a potential prognostic marker for risk stratification in normotensive patients with APE.