Browsing by Author "Karabay, Oguz"

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    Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome
    (2018) Erdogan, Haluk; Cag, Yasemin; Karabay, Oguz; Sipahi, Oguz Resat; Aksoy, Firdevs; Durmus, Gul; Batirel, Ayse; Ak, Oznur; Kocak-Tufan, Zeliha; Atilla, Aynur; Piskin, Nihal; Akbas, Turkay; Erol, Serpil; Ozturk-Engin, Derya; Caskurlu, Hulya; Onal, Ugur; Demirel, Aslihan; Dogru, Arzu; Harman, Rezan; Hamidi, Aziz Ahmad; Karasu, Derya; Korkmaz, Fatime; Korkmaz, Pinar; Eser, Fatma Civelek; Onem, Yalcin; Cesur, Sinem; Salmanogiu, Musa; Erdem, Ilknur; Diktas, Husrev; Vahabaroglu, Haluk; 30256855
    Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.
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    Treatment of ventilator-associated pneumonia (VAP) caused by Acinetobacter: results of prospective and multicenter ID-IRI study
    (2020) Erdem, Hakan; Cag, Yasemin; Gencer, Serap; Uysal, Serhat; Karakurt, Zuhal; Harman, Rezan; Aslan, Emel; Mutlu-Yilmaz, Esmeray; Karabay, Oguz; Uygun, Yesim; Ulug, Mehmet; Tosun, Selma; Dogru, Arzu; Sener, Alper; Dogan, Mustafa; Hasbun, Rodrigo; Durmus, Gul; Turan, Hale; Batirel, Ayse; Duygu, Fazilet; Inan, Asuman; Akkoyunlu, Yasemin; Celebi, Guven; Ersoz, Gulden; Guven, Tumer; Dagli, Ozgur; Guler, Selma; Meric-Koc, Meliha; Oncu, Serkan; Rello, Jordi; 31502120
    Ventilator-associated pneumonia (VAP) due to Acinetobacter spp. is one of the most common infections in the intensive care unit. Hence, we performed this prospective-observational multicenter study, and described the course and outcome of the disease. This study was performed in 24 centers between January 06, 2014, and December 02, 2016. The patients were evaluated at time of pneumonia diagnosis, when culture results were available, and at 72 h, at the 7th day, and finally at the 28th day of follow-up. Patients with coexistent infections were excluded and only those with a first VAP episode were enrolled. Logistic regression analysis was performed. A total of 177 patients were included; empiric antimicrobial therapy was appropriate (when the patient received at least one antibiotic that the infecting strain was ultimately shown to be susceptible) in only 69 (39%) patients. During the 28-day period, antibiotics were modified for side effects in 27 (15.2%) patients and renal dose adjustment was made in 38 (21.5%). Ultimately, 89 (50.3%) patients died. Predictors of mortality were creatinine level (OR, 1.84 (95% CI 1.279-2.657); p = 0.001), fever (OR, 0.663 (95% CI 0.454-0.967); p = 0.033), malignancy (OR, 7.095 (95% CI 2.142-23.500); p = 0.001), congestive heart failure (OR, 2.341 (95% CI 1.046-5.239); p = 0.038), appropriate empiric antimicrobial treatment (OR, 0.445 (95% CI 0.216-0.914); p = 0.027), and surgery in the last month (OR, 0.137 (95% CI 0.037-0.499); p = 0.003). Appropriate empiric antimicrobial treatment in VAP due to Acinetobacter spp. was associated with survival while renal injury and comorbid conditions increased mortality. Hence, early diagnosis and appropriate antibiotic therapy remain crucial to improve outcomes.