Özkan Kızkın

Factors affecting survival of hospitalised patients with COPD

Factors determining in-hospital mortality and long-term survival of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are not precisely understood. The aim of the present study was to assess the parameters related to in-hospital mortality and long-term survival after hospitalisation of patients with AECOPD. Clinical and epidemiological parameters on admission in 205 consecutive patients hospitalised with AECOPD were prospectively assessed. Patients were followed-up for 3 yrs. Factors determining short- and long-term mortality were analysed. In total, 17 patients (8.3%) died in hospital. In-hospital mortality was significantly associated with lower arterial oxygen tension (Pa,O2), higher carbon dioxide arterial tension, lower arterial oxygen saturation and longer hospital stay. The overall 6-month mortality rate was 24%, with 1-, 2- and 3-yr mortality rates of 33%, 39% and 49%, respectively. Cox regression analysis revealed that long-term mortality was associated with longer disease duration (relative risk (RR) = 1.158), lower albumin (RR = 0.411), lower Pa,O2 (RR = 0.871) and lower body mass index (RR = 0.830). When the model was run for the time elapsed since first hospitalisation, it also appeared as statistically significant (RR = 1.195). These findings show that patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease have poor short- and long-term survival. Prediction of survival status may be enhanced by considering arterial oxygen tension, albumin, body mass index, disease duration and time elapsed since the first hospitalisation.

Thoracic Involvement in Behçet's Disease and Its Correlation with Multiple Parameters

Abstract. In Behçets disease (BD), controversy has existed over the incidence of thoracic involvement, which may be a direct threat to the patients life. The aim of this study is to evaluate the incidence of thoracic involvement in BD and its correlation with the number of diagnostic BD criteria of The International Study Group (ISG), gender, disease duration, and the presence of symptoms. Forty-two BD patients, who had consecutively applied to different clinics in Turgut Özal Medical Center Research Hospital, were included in the study. They were either newly diagnosed or already under treatment. All patients were examined by standard chest roentgenogram, spirometry, and thorax CT. Perfusion scintigraphies were obtained in patients with thoracic involvement. Thoracic pathologic conditions were found in five patients (11.9%). All thoracic pathologic conditions appeared in patients with at least four diagnostic criteria (26 patients) of the ISG for BD. In this subgroup, the rate of thoracic involvement was 19.2%. Also, 25% of the patients with pulmonary symptoms (12 patients) had thoracic lesions. Gender and the duration of the disease did not correlate with thoracic involvement. Our findings suggest that the rate of thoracic involvement in BD is greater than is generally believed. An increased number of diagnostic BD criteria of the ISG may indicate other organ system involvement and an increased risk of thoracic pathosis. All BD patients with at least four diagnostic criteria or any pulmonary symptoms should be evaluated for thoracic involvement, which is a major menace to life and necessitates early intervention.

Asthma, Age, and Early Reversibility Testing

The aim of this study was to assess the effect of age on early reversibility testing (ERT) in patients with asthma. Forty-nine nonsmokers with asthma were investigated. In all cases, disease duration was less than 15 years; the absolute change (absolute variability, AV) in forced expiratory volume in 1 second (FEV1) on ERT was greater than 100 mL; and the increase in FEV1 on ERT was greater than 10%. Patients were categorized as group I (younger than 50 years; n = 24) and group II (50 years or older; n = 25). There were no significant differences between the groups regarding disease duration and severity. The mean patient ages in groups I and II were 40.3 ± 7.9 years and 59.2 ± 7.1 years, respectively, and the corresponding mean baseline FEV1 values were 62.2 ± 23.7% and 67.4 ± 21.1% of predicted value (p>0.05). Pulmonary function tests were performed at baseline, and then repeated for ERT 20 minutes after inhalation of 200 µg salbutamol. After ERT, the respective findings for groups I and II were as follows: AV 412 ± 184 mL and 247 ± 138 mL; percentage change (PC) in FEV1 21.5 ± 9.3% and 16.9 ± 7.5%; and percent of predicted change (PPC) in FEV113.6 ± 6.5% and 9.9 ± 4.9%. The AV, PC, and PPC values for group I all were higher than the corresponding findings for group II, and the differences in AV and PPC were statistically significant (p = 0.001, p<0.05). The study showed that elderly asthma patients exhibit significantly lower AV and PPC after ERT. To improve the accuracy of asthma diagnosis in elderly patients, limits of ERT should be redefined.