Browsing by Author "Kupeli, Elif"

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A 10-Year Experience of Tuberculosis in Solid-Organ Transplant Recipients
(2015) Ulubay, Gaye; Kupeli, Elif; Birben, Ozlem Duvenci; Seyfettin, Emine Pinar; Dogrul, Mustafa Ilgaz; Ugurlu, Aylin Ozsancak; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0002-5525-8207; 0000-0002-3462-7632; 0000-0003-2478-9985; 0000-0003-3598-3986; 0000-0002-5826-1997; 25894157; AAR-4338-2020; AAJ-8097-2021; AAB-5064-2021; AAA-2925-2020; AAB-5345-2021
Objectives: Tuberculosis remains an important problem in solid-organ transplant patients due to their immunocompromised state. The objective of the present study was to report the incidence, demographic characteristics, and various presentations of tuberculosis in solid-organ transplant recipients. Materials and Methods: We evaluated a total of 999 patients (male/female = 665/334, 661 renal and 338 liver transplants) who underwent solid-organ transplant between 2003 and 2013. The medical records of all patients were retrospectively reviewed. Patients' demographics, transplant type, primary site of tuberculosis specimen culture and pathology results, chest radiograph, and thoracic computed tomography findings, total blood count and chemistry were all recorded. Results: Among the 999 subjects, 19 patients (1.9%) (male/female: 15/4, mean +/- SD age, 42 +/- 18.5 y) were diagnosed with tuberculosis. The majority of patients (85%) were diagnosed with tuberculosis within 6 months after transplant, and 15% were diagnosed within 3 months. Most diagnoses of tuberculosis were based on histopathologic examination of biopsy material. Of these patients, 9 were diagnosed with pulmonary tuberculosis, 8 had extrapulmonary tuberculosis, and 2 had both. Nontuberculosis mycobacteria infections were detected in 3 patients. Conclusions: Even with a negative exposure history, tuberculosis can manifest as different clinic presentations in solid-organ transplant patients on immunosuppressive drugs, particularly in the first 6 months after transplant. Therefore, clinicians should always consider tuberculosis as the potential cause of an infectious disease with unknown cause to successfully diagnose and manage solid-organ transplant recipients.
American Society of Anesthesiologists Classification Versus ARISCAT Risk Index: Predicting Pulmonary Complications Following Renal Transplant
(2017) Kupeli, Elif; Dedekarginoglu, Balam Er; Ulubay, Gaye; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0002-5525-8207; 0000-0003-2478-9985; 0000-0002-3462-7632; 0000-0002-5826-1997; 28260470; AAR-4338-2020; AAB-5064-2021; AAJ-8097-2021; AAB-5345-2021
Objectives: Patients with chronic renal failure are prone to pulmonary complications. Renal transplant recipients should undergo complete preoperative evaluation to determine risk of postoperative pulmonary complications. The American Society of Anesthesiologists classification and the Assess Respiratory Risk in Surgical Patients in Catalonia risk index correlate well with incidence of postoperative pulmonary complications. Here, we compared their accuracy in predicting pulmonary complications following renal transplant. Materials and Methods: We retrospectively reviewed medical records of renal transplant recipients between years 2004 and 2015. We collected patient data on Assess Respiratory Risk in Surgical Patients in Catalonia risk index, including demographics, smoking history, comorbidities, preoperative pulmonary risk score, laboratory results, surgery information, history of lower respiratory tract infection 1 month pretransplant, urgency of surgery, American Society of Anesthesiologists classification, and pulmonary complications within 1 month post transplant. Results: Of 172 patients (123 males; mean age 38.82 y), 22 (12.8%) developed pulmonary complication during the first month posttransplant, including effusion (9 patients), pneumonia (10 patients), respiratory inefficiency (2 patients), and pulmonary embolism (1 patient). Atelectasis was observed in 95.4% of patients with complications. A positive correlation was observed between age and development of complications (r = 0.171; P = .025). Regarding risk score, 75% of patients at high risk and 19.5% at intermediate risk developed pulmonary complications. Patients with low-risk scores had significantly lower complications than intermediate-and high-risk groups (P < .001). A positive correlation was observed between preoperative risk score and complications (r = 0.34; P < .001). There was no association between the American Society of Anesthesiologists scores and postoperative complications (P = .7). Conclusions: The American Society of Anesthesiologists classification was found to be a weaker modality to predict pulmonary complications after renal trans plant; as it relates to the general health status, than the Assess Respiratory Risk in Surgical Patients in Catalonia risk index.
Are Inhaled Corticosteroids Safe for Large Airways? A New Paradigm?
(2015) Kupeli, Elif; Bandyopadhyay, Debabrata; 0000-0002-5826-1997; 26492602; AAB-5345-2021
Association Between Preoperative Pulmonary Risk Scores and Postoperative Complications in Renal Transplant Recipients
(2016) Kupeli, Elif; Dedekarginoglu, Balam Er; Ulubay, Gaye; Haberal, Mehmet; 0000-0002-5826-1997; 0000-0003-2478-9985; 0000-0002-3462-7632; 27805520; AAB-5345-2021; AAB-5064-2021; AAJ-8097-2021
Objectives: Patients who are being considered for renal transplant must undergo thorough preoperative pulmonary evaluation to determine risk of post operative pulmonary complications. The aim of this study was to determine the relation between the preoperative pulmonary risk factor score and pulmonary complications in patients undergoing renal transplant. Materials and Methods: Medical records of patients who underwent renal transplant at our institution between 2004 and 2015 were retrospectively reviewed. Patient demographics, smoking history, comorbidities, and preoperative pulmonary risk factors (age, oxygen saturation, hemoglobin level, type of incision, duration of surgery, history of lower respiratory tract infection 1 month before surgery, urgency of surgery), and type of pulmonary complications within 1 month after transplant were recorded. Results: Our study included 131 patients (94 male patients; mean age of 38.25 +/- 12.96 y). Of total patients, 21(16%) developed complications during the first month after transplant, with 10 of the 21 (7.6% overall) developing pulmonary complications. These complications were pleural effusion (2 patients), pneumonia (3 patients), respiratory failure (2 patients), and pulmonary embolism (1 patient). There were no deaths directly attributed to the pulmonary complications. A significant correlation was observed between the preoperative pulmonary risk factor score and postoperative pulmonary complications in renal transplant recipients (P =.003). A positive correlation between the preoperative pulmonary scores and postoperative pulmonary complications existed among life-long nonsmokers (r = 0.371; P =.003). Conclusions: Renal transplant is an established modality in treatment of chronic renal failure. Prevention of pulmonary complications is essential for successful outcomes following transplant. Health care professionals involved with renal transplant and transplant centers should be aware of preoperative pulmonary risk factors. Patients should be observed so that these risk factors can be reduced before planned transplant. Moreover, we also suggest that smoking history should be considered as a preoperative pulmonary risk factor as it was found to be a factor leading to postoperative pulmonary complications in our study.
Awareness of Respiratory Failure Can Predict Early Postoperative Pulmonary Complications in Liver Transplant Recipients
(2015) Ulubay, Gaye; Kirnap, Mahir; Dedekarginoglu, Balam Er; Kupeli, Elif; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-5826-1997; 0000-0003-2478-9985; 0000-0002-5525-8207; 26640928; AAJ-8097-2021; AAH-9198-2019; AAB-5345-2021; AAB-5064-2021; AAR-4338-2020
Objectives: Cardiovascular and respiratory system complications are the most common causes of early mortality after liver transplant. We evaluated the causes of respiratory failure as an early postoperative pulmonary complication in liver transplant recipients. Materials and Methods: Patients who underwent orthotropic liver transplant between 2001 and 2014 were retrospectively evaluated. Clinical and demographic variables and pulmonary complications at the first and second visit after transplant were noted. The first visit was within the first week and the second was between 1 and 4 weeks after transplant. An arterial oxygen saturation value below 90% in room air for at least 1 day was considered a medically significant respiratory failure. Results: Our study included 204 (148 men and 56 women; mean age 43.0.4 +/- 13.06 y) adult liver transplant recipients (46 from deceased and 158 from living donors). At the first visit after transplant, 161 patients (79%) had postoperative pulmonary complications, including pleural effusion accompanied by atelectasis (47.1%), only atelectasis (17.2%), and only pleural effusion (10.3%). At the second visit, complications included atelectasis associated with pleural effusion (12.3%) and pneumonia (12.3%). All patients had documented respiratory failure at the first visit, and 92 patients (45.1%) had respiratory failure at the second visit. Causes of respiratory failure at the first visit included atelectasis in 35 patients (17.2%) and atelectasis accompanied by pleural effusion in 96 patients (47.1%). At the second visit, 25 of 161 patients (25.3%) had respiratory failure due to pneumonia. Other causes included atelectasis accompanied by pleural effusion (24.2%) and pleural effusion (23.2%). Ninety-seven patients had no pulmonary complications. The mortality rate was 6.4% within the first visit and 8.7% within the second visit. Conclusions: Pneumonia, atelectasis, and pleural effusion can cause respiratory failure within the first month after liver transplant. Early pulmonary examination, diagnosis, and treatment can improve patient survival.
The Clinical Outcomes of Covid-19 Disease in Patients with Solid Organ Transplantation
(2021) Yuce, Gulbahar Darilmaz; Ulubay, Gaye; Karakaya, Emre; Tek, Korhan; Akdur, Aydincan; Bozbas, Serife Savas; Gedik, Ender; Kupeli, Elif; Erol, Cigdem; Arslan, Hande; Akcay, Sule; Haberal, Mehmet; https://orcid.org/0000-0002-4879-7974; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-2535-2534; https://orcid.org/0000-0002-5708-7915; https://orcid.org/0000-0002-3462-7632; JBS-4193-2023; AAD-5466-2021; AAA-3068-2021; AAJ-1219-2021; ABG-7034-2021; AAJ-8097-2021
The Clinical Outcomes Of Covid-19 Disease In Patients With Solıid Organ Transplantation
(2021) Yuce, Gulbahar Darilmaz; Ulubay, Gaye; Karakaya, Emre; Tek, Korhan; Akdur, Aydincan; Bozbas, Serife Savas; Gedik, Ender; Kupeli, Elif; Erol, Cigdem; Arslan, Hande; Akcay, Sule; Haberal, Mehmet; 0000-0002-8726-3369; 0000-0002-2535-2534; 0000-0002-5708-7915; 0000-0002-3462-7632; AAA-3068-2021; AAJ-1219-2021; ABG-7034-2021; AAJ-8097-2021
Conventional Transbronchial Needle Aspiration in Community Practice
(2015) Kupeli, Elif; 0000-0002-5826-1997; 26807272; AAB-5345-2021
Conventional transbronchial needle aspiration (C-TBNA) provides an opportunity to diagnose mediastinal lesions and stage bronchogenic carcinoma in a minimally invasive fashion. The procedure is easy to learn and requires zero upfront cost. Any community pulmonologist can acquire and maintain the skills of C-TBNA without undergoing formal interventional pulmonary fellowship training. Besides being used for the diagnosis and staging of lung cancer, C-TBNA can be used in patients suspected to have benign conditions such as sarcoidosis and tuberculosis. It also contributes in improving the diagnostic yield of flexible bronchoscopy while dealing with endobronchial, submucosal, peribronchial, or peripheral lesions. C-TBNA may be the only diagnostic modality that can be performed in patients in whom mediastinoscopy is contraindicated due to a bleeding diathesis. The procedure is safe and has great potential to augment the welfare of patients with pulmonary ailments. The learning curve of the procedure is short and steep. Every community pulmonologist should be able to perform C-TBNA.
Conventional Transbronchial Needle Aspiration: from Acquisition to Precision
(2015) Kupeli, Elif; Seyfettin, Pinar; Tepeoglu, Merih Demirel; 0000-0002-9894-8005; 0000-0002-5826-1997; 25593608; AAK-5222-2021; AAB-5345-2021
INTRODUCTION: Conventional transbronchial needle aspiration (C-TBNA) is a minimally invasive, safe, and cost-effective technique in evaluating mediastinal lymphadenopathy. Previously we reported that the skills for C-TBNA can be acquired from the books. We studied the learning curve for C-TBNA for a single bronchoscopist at a tertiary-care center where ultrasound technology remains difficult to acquire. METHODS: We prospectively collected results of the first 99 consecutively performed C-TBNA between December 2009 and 2013. Patients were divided into 3 groups: (I): First 33, (II): Next 33 and (III): Last 33. Results were categorized as malignant, non-malignant or non-diagnostic. Diagnostic yield (DY), sensitivity (SEN), specificity (SPE), positive and negative predictive values (PPV, NPV), and accuracy (ACC) were calculated to learn the learning curve for C-TBNA. RESULTS: Total 99 patients (M:F = 62:37), mean age 58.2 +/- 11.5 years, mean LN diameter 26.9 +/- 9.8 mm underwent C-TBNA. Sixty-nine patients had lymph nodes (LNs) >20 mm in diameter. Final diagnoses were established by C-TBNA in 44 (yield 44.4%), mediastinoscopy 47, transthoracic needle aspiration 5, endobronchial biopsy 2 and peripheral LN biopsy 1. C-TBNA was exclusively diagnostic in 35.4%. Group I: DY: 42.4%, 64.7% in malignancies, 19% in benign conditions (P = 0.008). SEN, SPE, PPV, NPV, ACC = 70%, 100%, 100%, 66.6%, 78.7%, respectively. Group II: DY: 54.5% (36.4% exclusive), 88.2% in malignancies and 19% benign conditions (P = 0.000). SEN, SPE, PPV, NPV, ACC=72%, 100%, 100%, 53.3%, 78.7%, respectively. Group III: DY: 36.3% (27% exclusive), 100% in malignancies and 16% in benign conditions. SEN, SPE, PPV, NPV, ACC = 92.3%, 100%, 100%, 95.2%, 97%, respectively. No difference was found in relation to LN size or location and TBNA yield. CONCLUSION: C-TBNA can be easily learned and the proficiency can be attained with <66 procedures. In selected patients, its exclusivity could exceed 35%.
A Curious Case of Pill Aspiration Response
(2015) Kupeli, Elif; Khemasuwan, Danai; 0000-0002-5826-1997; 26033145; AAB-5345-2021
EBUS-TBNA: Popular But Not Universal
(2014) Ulasli, Sevinc Sarinc; Kupeli, Elif; https://orcid.org/0000-0002-5826-1997; 24372957; AAB-5345-2021
In recent years, the number of publications concerning interventional bronchoscopy has increased dramatically. The present paper focused on publications related to endobronchial ultrasound technique. Its aim was to provide an overview of the nature of publications about endobronchial ultrasound technique, especially with regard to the countries of origin of publications and the categories of journals in which these papers are published. Overall, the review demonstrates a limited use of endobronchial ultrasound technique in many countries.
Effect of CPAP Therapy on Mean Platelet Volume and Hematocrit in Obstructive Sleep Apnea Syndrome (OSAS)
(2014) Cetin, Gulcan; Kupeli, Elif; Bozbas, Serife Savas; Eyuboglu, Fusun Oner; https://orcid.org/0000-0002-5826-1997; https://orcid.org/0000-0002-7230-202X; https://orcid.org/0000-0002-5525-8207; AAB-5345-2021; AAI-8064-2021; AAR-4338-2020
Invasive Pulmonary Aspergillosis in Heart Transplant Recipients
(2015) Kupeli, Elif; Ulubay, Gaye; Akkurt, Sevil Bayram; Eyulboglu, Fusun Oner; Sezgin, Atilla; 0000-0003-2478-9985; 0000-0002-5826-1997; 0000-0002-5525-8207; 25894189; AAB-5064-2021; AAB-5345-2021; AAR-4338-2020
Objectives: Invasive pulmonary aspergillosis is the most common invasive mycosis in heart transplant recipients. Early clinical recognition of this complication is difficult and laboratory data is not specific. Our aim was to study the characteristics of invasive pulmonary aspergillosis infections in heart transplant recipients. Materials and Methods: Between 2007 and 2013, there were 82 patients who underwent heart transplant at our institution, including 6 patients who were diagnosed with invasive pulmonary aspergillosis. Medical records of these patients were reviewed for demographic, clinical, and radiographic features, microbiology data, serum galactomannan levels, antifungal treatment, and overall outcomes. Results: The most common species causing the infection was Aspergillus fumigatus. The infection was encountered irrespective of the duration since the transplant. Bronchoalveolar lavage with positive culture for Aspergillus species and/or abnormal serum galactomannan level was suggestive of invasive pulmonary aspergillosis. Conclusions: In our opinion, empiric antifungal therapy should be commenced as soon as invasive pulmonary aspergillosis is suspected in heart transplant recipients to reduce mortality. Although the duration of antifungal therapy for invasive pulmonary aspergillosis is debatable, heart transplant recipients may require long-term therapy to avoid recurrence.
Lack of Association of Matrix Metalloproteinase-9 Promoter Gene Polymorphism in Obstructive Sleep Apnea Syndrome
(2015) Yalcinkaya, Mustafa; Erbek, Selim S.; Babakurban, Seda Turkoglu; Kupeli, Elif; Bozbas, Serife; Terzi, Yunus K.; Sahin, Feride Iffet; 0000-0001-5612-9696; 0000-0001-5067-4044; 0000-0003-4825-3499; 0000-0002-5826-1997; 0000-0001-7308-9673; 0000-0002-7230-202X; 26169999; B-4372-2018; AAI-8856-2021; B-7604-2019; AAB-5345-2021; AAC-7232-2020; AAI-8064-2021
Purpose: Obstructive sleep apnea syndrome (OSAS) is a public health problem. There is an effort to establish the genetic contributions to the development of OSAS. One is matrix metalloproteinases, extracellular matrix degrading enzymes related to systemic inflammation. However, the impact of matrix metalloproteinase-9 (MMP-9) genotypes on the development of OSAS is unknown. Our aim was to determine whether MMP-9 single nucleotide polymorphism (SNP) (MMP-9 -1562C > T) is related to susceptibility to OSAS. Material and methods: A total of 106 patients with a history of sleep apnea and 88 controls without a history of sleep apnea were enrolled in this study. Genotypes were determined by restriction fragment length polymorphism analyses after polymerase chain reaction. Results: Genotypes and allele frequencies of the MMP-9 -1562C > T SNP was not statistically different between the patient and control groups (p > 0.05). There was a statistical association between apnea -hypopnea index (AHI) and body mass index (BMI), and also between AHI and neck circumference (p < 0.001). There was no association among the genotypes and AHI, neck circumference, or BMI (p > 0.05). Conclusions: We found no association between MMP-9 -1562C > T SNP and OSAS. Studies to investigate the role of other polymorphisms and expression of MMP-9 gene will provide more information. (C) 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Long-Term Pulmonary Infections in Heart Transplant Recipients
(2015) Kupeli, Elif; Ulubay, Gaye; Akkure, Esma Sevil; Eyuboglu, Fusun Oner; Sezgin, Atilla; 0000-0002-5525-8207; 0000-0002-5826-1997; 0000-0003-2478-9985; 25894190; AAR-4338-2020; AAB-5345-2021; AAB-5064-2021
Objectives: Pulmonary infections are life-threatening complications in heart transplant recipients. Our aim was to evaluate long-term pulmonary infections and the effect of prophylactic antimicrobial strategies on time of occurrence of pulmonary infections in heart transplant recipients. Materials and Methods: Patients who underwent heart transplantation between 2003 and 2013 at Baskent University were reviewed. Demographic information and data about immunosuppression and infectious episodes were collected. Results: In 82 heart transplant recipients (mean age, 33.85 y; 58 male and 24 female), 13 recipients (15.8%) developed pulmonary infections (mean age, 44.3 y; 9 male and 4 female). There were 12 patients who had dilated cardiomyopathy and 1 patient who had myocarditis before heart transplantation; 12 patients received immunosuppressive therapy in single or combination form. Pulmonary infections developed in the first month (1 patient), from first to third month (6 patients), from third to sixth month (1 patient), and > 6 months after transplantation (5 patients). Chest computed tomography showed consolidation (unilateral, 9 patients; bilateral, 4 patients). Multiple nodular consolidations were observed in 2 patients and a cavitary lesion was detected in 1 patient. Bronchoscopy was performed in 6 patients; 3 patients had Aspergillus fumigatus growth in bronchoalveolar lavage fluid, and 2 patients had Acinetobacter baumannii growth in sputum. Treatment was empiric antibiotics (6 patients), antifungal drugs (5 patients), and both antibiotics and antifungal drugs (2 patients); treatment period was 1-12 months in patients with invasive pulmonary aspergillosis. Conclusions: Pulmonary infections are the most common cause of mortality in heart transplant recipients. A. fumigatus is the most common opportunistic pathogen. Heart transplant recipients with fever and cough should be evaluated for pulmonary infections, and invasive pulmonary aspergillosis should be suspected if these symptoms occur within the first 3 months. Immediately starting an empiric antibiotic is important in treating pulmonary infections in heart transplant recipients.
Long-Term Risk of Pulmonary Embolism in Solid-Organ Transplant Recipients
(2015) Kupeli, Elif; Ulubay, Gaye; Dogrul, Ilgaz; Birben, Ozlem; Seyfettin, Pinar; Ugurlu, Aylin Ozsancak; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0003-3598-3986; 0000-0002-5525-8207; 0000-0003-2478-9985; 0000-0002-5826-1997; 25894159; AAJ-8097-2021; AAA-2925-2020; AAR-4338-2020; AAB-5064-2021; AAB-5345-2021
Objectives: Solid-organ transplant recipients can develop chronic hypercoagulation that increases the incidence of pulmonary embolism. Here, we evaluate the frequency of pulmonary embolism in solid-organ transplant recipients during the first 10 years after transplantation and evaluate the risk factors for its development. Materials and Methods: The medical records of solid-organ transplant recipients who were treated between 2003 and 2013 were retrospectively reviewed. The reviewed data included demographics, type of transplant, comorbidities, procoagulation factors, thromboembolism prophylaxis, and the timing and extent of pulmonary embolism. Results: In total, 999 solid-organ transplant recipients are included in this study (661 renal and 338 liver transplant recipients) (male: female ratio = 665:334). Twelve renal (1.2%) and 1 liver transplant recipient (0.3%) were diagnosed with pulmonary embolism. Pulmonary embolism developed 1 year after transplantation in 10 patients: 1 patient developed pulmonary embolism < 3 months after transplantation, and the other 9 patients developed pulmonary embolism within 3 to 6 months. No patients had a prior history of deep venous thrombosis or pulmonary embolism. Five patients received tacrolimus, 7 patients received sirolimus, and 1 patient received cyclosporine. Ten patients received prednisolone, and 8 patients received mycophenolate mofetil. All patients were homozygous normal for factor V Leiden and prothrombin genes. One patient was homozygous abnormal, and 1 patient had a heterozygous mutation in the methylenetetrahydrofolate reductase gene. Two patients were treated with low-molecular-weight heparin, while the remaining patients received warfarin. Eight patients were treated for 6 months, and the remainder received longer treatments. Conclusions: Here, the incidence of pulmonary embolism in solid-organ transplant recipients is 1.2%. Renal transplant recipients are at higher risk of developing pulmonary embolism than liver transplant recipients. The factors that increase the risk of pulmonary embolism in solid-organ transplant recipients appear to be multifactorial and include genetic predisposition.
Lung Malignancy in Solid Organ Transplant Recipients: ACase Series
(2018) Esendagli, Donna; Kupeli, Elif; Bozbas, Serife Savas; Tepeoglu, Merih; Ozdemir, B. Handan; Akcay, Sule; Haberal, Mehmet; 0000-0002-5826-1997; 0000-0002-7230-202X; 0000-0002-9894-8005; 0000-0002-7528-3557; 0000-0002-8360-6459; 0000-0002-3462-7632; AAB-5345-2021; AAI-8064-2021; AAK-5222-2021; X-8540-2019; AAB-5175-2021; AAJ-8097-2021
Lung Related Complications in Heart Transplant Recipients: Results of a Single Center Experience
(2018) Esendagli, Donna; Kupeli, Elif; Akcay, Sule; Ulubay, Gaye; Sezgin, Atilla; Haberal, Mehmet; 0000-0002-5826-1997; 0000-0002-8360-6459; 0000-0003-2478-9985; 0000-0002-3462-7632; AAB-5345-2021; AAB-5175-2021; AAB-5064-2021; AAJ-8097-2021
MELD-XI score predicts in-hospital mortality independent of simplified pulmonary embolism severity index among patients with intermediate-to-high risk acute pulmonary thromboembolism
(2019) Ciftci, Orcun; Celik, Casit Olgun; Uzar, Guldeniz; Kupeli, Elif; Muderrisoglu, Ibrahim Haldun; 31709948
Introduction: Acute pulmonary thromboembolism (PTE) is a highly morbid and fatal condition. Although several risk stratification models exist for prediction of mortality risk in PTE, no study has yet focused on the effect of impaired vital organ function, such as renal or hepatic impairment, on mortality in PTE. MELD-XI (Model for end-stage liver disease excluding INR) score predicts mortality among patients with end-stage hepatic and cardiovascular disorders. Herein, we aimed to test MELD-XI score for predicting in-hospital prognosis of patients with intermediate-to-high risk acute PTE. Materials and Methods: We reviewed the medical records patients older than 18 years hospitalized with intermediate-to-high risk PTE between 01.06.2011 and 01.01.2019. Simplified pulmonary embolism severity index (sPESI) score and MELD-XI score were calculated, and in-hospital mortality determined. MELD-XI score was compared between patients with and without in-hospital mortality and was correlated to sPESI score. The predictive power of MELD-XI score for in-hospital mortality was sought and an in-hospital survival analysis with Kaplan Meier curve and log-rank test was done for MELD-XI score. Results: A total of 104 patients [mean age of 70.8 +/- 15.9 years; 68 (65.4%) females]. Fourteen (13.5%) patients died at hospital. MELD-XI and sPESI scores were significantly correlated to each other and were higher in deceased patients than the survivors [17.3 (IQR 14.3) vs. 10.12 (IQR 2.99); p < 0.05 and 2 (IQR 1) vs. 1 (IQR 1); p < 0.05, respectively]. MELD-XI score and sPESI score were significant predictor of in-hospital mortality in multivariate analysis. A MELD-XI score >= 10.25 had a sensitivity of 78.6% and a specificity of 70.0% for in-hospital mortality. A survival analysis revealed that a high MELD-XI category (MELD-XI score >= 10.2) significantly worsened in-hospital survival (p < 0.01; log rank test). Conclusion: MELD-XI score performs well for mortality prediction among patients with intermediate-to-high risk PTE. This subject needs to be further studied by large, randomized controlled studies.
Peripheral Muscle Strength Indicates Respiratory Function Testing in Renal Recipients
(2017) Ulubay, Gaye; Uyanik, Saliha; Dedekarginoglu, Balam Er; Serifoglu, Irem; Kupeli, Elif; Bozbas, Serife Savas; Sezer, Siren; Haberal, Mehmet; 0000-0002-5826-1997; 0000-0002-7230-202X; 0000-0002-3462-7632; 0000-0003-2478-9985; 28260479; AAB-5345-2021; AAI-8064-2021; AAJ-8097-2021; AAB-5064-2021; AAS-6628-2021
Objectives: Muscle wasting occurs in renal recipients due to decreased physical performance, and de creased respiratory muscle strength may occur due to changes in structure and function. Data are scarce regarding the roles of sarcopenia and nutritional status on respiratory muscle function in these patients. Here, we evaluated interactions among peripheral muscle strength, sarcopenia, nutritional parameters, and respiratory muscle function in renal transplant recipients. Materials and Methods: Ninety-nine patients were prospectively enrolled between September and April 2016 at Baskent University. Forced vital capacity values (via pulmonary function tests), respiratory muscle strength (via maximal static inspiratory and expiratory pressures), and peripheral muscle strength (via hand grip strength test) were recorded. Nutritional para meters, fat weight, arm circumference, waist circumference, and C-reactive protein levels were also recorded. Results: Of 99 patients, 68 were renal transplant recipients (43 men, mean age: 39.09 +/- 10.70 y) and 31 were healthy participants (14 men, mean age: 34.94 +/- 10.95 y). Forced vital capacity (P < .001, r = 0.65), maximal inspiratory (P = .002, r = 0.39) and expiratory (P < .001, r = 0.4) pressure, and hand grip strength showed significant relations in transplant recipients. Positive correlations were found between serum albumin levels and both hand grip strength (P = .16, r = 0.347) and forced vital capacity (P = .03, r = 0.436). Forced vital capacity was statistically different between renal recipients and healthy participants (P = .013), whereas maximal inspiratory and expiratory pressures were not (P > .05). No statistically significant relation was observed between biochemical para meters and maximal inspiratory and expiratory pressures (P > .05). Conclusions: Respiratory function and peripheral muscle strength were significantly related in renal transplant recipients, with significantly lower peripheral muscle strength suggesting the presence of inadequate respiratory function. Peripheral and respiratory muscle training and nutritional replacement strategies could help to improve postoperative respiratory function.