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Item Prognostic Significance of Medical Therapy in Patients with Heart Failure with Reduced Ejection Fraction(2023) Kocabas, Umut; Ergin, Isil; Kivrak, Tarik; Oztekin, Gulsum Meral Yilmaz; Tanik, Veysel Ozan; Ozdemir, Ibrahim; Demir, Fulya Avci; Dogdus, Mustafa; Sen, Taner; Altinsoy, Meltem; Ustundag, Songul; Urgun, Orsan Deniz; Sinan, Umit Yasar; Uygur, Begum; Yeni, Mehtap; Ozcalik, Emre; 0000-0001-6424-9399; 37804042; GXG-7709-2022Aims The use of guideline-directed medical therapy (GDMT) among patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains suboptimal. The SMYRNA study aims to identify the clinical factors for the non-use of GDMT and to determine the prognostic significance of GDMT in patients with HFrEF in a real-life setting.Methods and results The SMYRNA study is a prospective, multicentre, and observational study that included outpatients with HFrEF. Patients were divided into three groups according to the status of GDMT at the time of enrolment: (i) patients receiving all classes of HF medications including renin-angiotensin system (RAS) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRAs); (ii) patients receiving any two classes of HF medications (RAS inhibitors and beta-blockers, or RAS inhibitors and MRAs, or beta-blockers and MRAs); and (iii) either patients receiving class of HF medications (only one therapy) or patients not receiving any class of HF medications. The primary outcome was a composite of hospitalization for HF or cardiovascular death. The study population consisted of 1062 patients with HFrEF, predominantly men (69.1%), with a median age of 68 (range: 20-96) years. RAS inhibitors, beta-blockers, and MRAs were prescribed in 76.0%, 89.4%, and 55.1% of the patients, respectively. The proportions of patients receiving target doses of guideline-directed medications were 24.4% for RAS inhibitors, 11.0% for beta-blockers, and 11.1% for MRAs. Overall, 491 patients (46.2%) were treated with triple therapy, 353 patients (33.2%) were treated with any two classes of HF medications, and 218 patients (20.6%) were receiving only one class of HF medication or not receiving any HF medication. Patient-related factors comprising older age, New York Heart Association functional class, rural living, presence of hypertension, and history of myocardial infarction were independently associated with the use or non-use of GDMT. During the median 24-month period, the primary composite endpoint occurred in 362 patients (34.1%), and 177 of 1062 (16.7%) patients died. Patients treated with two or three classes of HF medications had a decreased risk of hospitalization for HF or cardiovascular death compared with those patients receiving <= 1 class of HF medication [hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.49-0.85; P = 0.002, and HR: 0.61; 95% CI: 0.47-0.79; P < 0.001, respectively].Conclusions The real-life SMYRNA study provided comprehensive data about the clinical factors associated with the non-use of GDMT and showed that suboptimal GDMT is associated with an increased risk of hospitalization for HF or cardiovascular death in patients with HFrEF.Item Investigation of the Factors Affecting the Mortality of Patients Over 80 Years of Age Diagnosed with Acute Pulmonary Thromboembolism(2023) Sen, Nazan; Yilmaz, Mustafa; 0000-0002-2557-9579; S-6973-2016Introduction: To investigate the factors affecting the 30-day mortality of patients over 80 years of age diagnosed with acute pulmonary thromboembolism.Materials and method: This descriptive, retrospective, and single-center study reviewed the medical records of patients over 80 years of age who were admitted to the hospital with a diagnosis of acute pulmonary thromboembolism between January 1, 2008, and April 30, 2023. The factors associated with mortality in patients who had died were examined. The recorded values of factors considered to be the determinants of 30-day mortality were also determined.Results: This study included 113 patients, with a mean age of 83.7 +/- 2.7 years, and comprised of 68 (60.2%) females. During the one-month follow-up period, 30 patients (26.5%) died of acute pulmonary thromboembolism or related complications. No statistically significant difference in age and gender was observed between the exitus and non-exitus groups (p > 0.05). Moreover, no significant difference was observed between the two groups in terms of hypertension and diabetes (p > 0.05), whereas other comorbidities were statistically significantly higher in the exitus group (p < 0.05). In the linear regression analysis, heart failure (p < 0.001), D-dimer level (p = 0.019), partial arterial oxygen pressure (p < 0.001), systolic pulmonary artery pressure (p < 0.001), and recent history of major surgery (p = 0.021) were found to be factors that affected the mortality.Conclusion: The presence of comorbidities, poor hemodynamic findings, poor oxygenation, high pulmonary artery pressure, and high D-dimer levels may be mortality indicators in acute pulmonary thromboembolism patients over 80 years of age.Item The Impact of COVID-19 Infection on Hemodialysis Patients vs Kidney Transplant Patients(2023) Tasci, Halil Ibrahim; 38131360AIM: AS in the whole world, there has been a decrease in the number of both cadaveric and living-donor kidney transplants in our country due to the COVID-19 pandemic. This study aimed at comparing the data of patients who previously underwent a kidney transplant in our clinic and patients on hemodialysis treatment and were diagnosed with COVID-19 during their follow-ups to find answer to the question "Should we postpone kidney transplants during the pandemic or perform transplants as soon as possible?". MATERIAL AND METHOD: Among those diagnosed with COVID-19 during follow-ups between March 2020 and March 2021 and treated on an inpatient or outpatient basis, the data of patients who previously underwent a kidney transplant in Baskent University Faculty of Medicine, Department of Transplantation, Konya Practice and Research Hospital and hemodialysis patients followed up by the Nephrology Clinic were retrospectively analyzed. RESULTS: In our study, intensive care stay (Group 1:48.8%, Group 2: 40.4%, P=.34), intubation requirement (Group 1: 35%, Group 2: 34.6%, P=.96) and mortality (Group 1: 36.3%, Group 2: 34%, P=.84) rate was higher in the hemodialysis group, although no statistically significant difference was found. CONCLUSION: All this literature information and our study suggests that mortality rates were statistically similar or lower for transplant group. So it is unnecessary to delay kidney transplantation in patients with appropriate indications.Item Acute Renal Injury in Liver Transplant Patients and Its Effect on Patient Survival(2014) Kirnap, Mahir; Colak, Turan; Baskin, Esra; Akdur, Aydincan; Moray, Gokhan; Arslan, Gulnaz; Haberal, Mehmet; https://orcid.org/0000-0002-8372-7840; https://orcid.org/0000-0003-4361-8508; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24635816; AAH-9198-2019; AAJ-8554-2021; B-5785-2018; AAA-3068-2021; AAE-1041-2021; AAJ-8097-2021Objectives: Acute renal injury is a common complication in liver transplant patients. Acute kidney injury is due to nephrotoxic drugs used after liver transplant, infections, and hemorrhage. Though it is generally reversible, it has effects on grafts and patients survival. In this retrospective observational study carried out at a single center, the effects of acute renal disease on liver recipient's survival were investigated. Materials and Methods: Liver transplant recipients of live-donor and deceased-donor transplants between January 2002 and May 2013 were included in this study; there were 310 liver transplant patients (mean age, 28 y; age range, 6 mo-62 y; 165 males, 145 females). The acute kidney disease diagnosis and staging was based on the nephrology department evaluation and daily serum creatinine levels. Patients with acute kidney injury before undergoing liver transplant and those undergoing a transplant for the second time were excluded. Kidney functions were evaluated by the nephrology department 1 week, 3 months, and 1 year after the liver transplant. Results: Acute kidney disease rates in these patients were 5%, 8%, and 12%. Four patients developed chronic kidney failure during follow-up. The mortality rate was higher (18%) in acute renal failure patients compared with those that did not have acute renal failure. The mortality rate was 11% in patients without acute renal failure. Conclusions: Acute renal injury is common after liver transplant and has an effect on mortality.Item SARS-Cov-2 Infection Might Be A Predictor of Mortality in Intracerebral Hemorrhage(2023) Mowla, Ashkan; Shakibajahromi, Banafsheh; Shahjouei, Shima; Baharvahdat, Humain; Harandi, Ali Amini; Rahmani, Farzad; Mondello, Stefania; Rahimian, Nasrin; Cernigliaro, Achille; Hokmabadij, Elyar Sadeghi; Ebrahimzadeh, Seyed Amir; Ramezani, Mahtab; Mehrvar, Kaveh; Farhoudi, Mehdi; Naderi, Soheil; Fenderi, Shahab Mahmoudnejad; Pishjoo, Masoud; Alizada, Orkhan; Purroy, Francisco; Requena, Manuel; Tsivgoulis, Georgios; Zand, Ramin; 36455388Background: SARS-CoV-2 infection may be associated with uncommon complications such as intracerebral hemorrhage (ICH), with a high mortality rate. We compared a series of hospitalized ICH cases infected with SARS-CoV-2 with a non-SARS-CoV-2 infected control group and evaluated if the SARS-CoV-2 infection is a predictor of mortality in ICH patients.Methods: In a multinational retrospective study, 63 cases of ICH in SARS-CoV-2 infected patients admitted to 13 tertiary centers from the beginning of the pandemic were collected. We compared the clinical and radiological characteristics and in-hospital mortality of these patients with a control group of non-SARS-CoV-2 infected ICH patients of a previous cohort from the country where the majority of cases were recruited.Results: Among 63 ICH patients with SARS-CoV-2 infection, 23 (36.5%) were women. Compared to the non-SARS-CoV-2 infected control group, in SARS-CoV-2 infected patients, ICH occurred at a younger age (61.4 +/- 18.1 years versus 66.8 +/- 16.2 years, P = 0.044). These patients had higher median ICH scores ([3 (IQR 2-4)] versus [2 (IQR 1-3)], P = 0.025), a more frequent history of diabetes (34% versus 16%, P = 0.007), and lower platelet counts (177.8 +/- 77.8 x 109/L versus 240.5 +/- 79.3 x 109/L, P < 0.001). The in-hospital mortality was not significantly different between cases and controls (65% versus 62%, P = 0.658) in univariate analysis; however, SARS-CoV-2 infection was significantly associated with in-hospital mortality (aOR = 4.3, 95% CI: 1.28-14.52) in multivariable analysis adjusting for potential confounders.Conclusion: Infection with SARS-CoV-2 may be associated with increased odds of in-hospital mortality in ICH patients.Item Morbidity and Mortality of Colorectal Cancer Surgery in Octogenarians(2016) Torer, NurkanObjectives The aim of this study was to determine common problems, preoperative assessment criteria, and postoperative morbidity and mortality of octogenarians with colorectal cancer. Materials and method We screened the medical records of patients aged 80 years or older (study group) and that of patients of 50-59 years of age (control group) who were operated for colon cancer. Demographic features, comorbidities, American Society of Anaesthesiologists (ASA) score, urgency of operation, tumor localization, presence of colostomy, duration of hospital stay, admission to and duration of stay in the intensive care unit (ICU), TNM (Tumor, Node, Metastasis) stage, postoperative morbidity, and mortality rates were recorded. Results The medical records of 23 patients aged above 80 years and 39 patients aged between 50-59 years were screened retrospectively. The two groups did not differ significantly with respect to the morbidity rate but the mortality rate was significantly higher in the study group (p = 0.583 and p = 0.016, respectively). The study group patients needed significantly more ostomy creation procedures. In the analysis of the octogenarian groups, the ASA score or the presence of comorbidities had no discernible effect on the morbidity and mortality rates. Conclusion Specific preoperative evaluations are needed for prediction of mortality risk in geriatric patients. Rational criteria for performing protective ostomy should also be determined in octogenarians.Item East Mediterranean Region Sickle Cell Disease Mortality Trial: Retrospective Multicenter Cohort Analysis of 735 Patients(2016) Karacaoglu, Pelin Kardas; Asma, Suheyl; Korur, Asli; Solmaz, Soner; Buyukkurt, Nurhilal Turgut; Gereklioglu, Cigdem; Kasar, Mutlu; Ozbalci, Demircan; Unal, Selma; Kaya, Hasan; Gurkan, Emel; Yeral, Mahmut; Sariturk, Cagla; Boga, Can; Ozdogu, Hakan; https://orcid.org/0000-0002-7459-7167; https://orcid.org/0000-0001-5335-7976; https://orcid.org/0000-0002-0895-4787; https://orcid.org/0000-0003-3856-7005; https://orcid.org/0000-0002-9580-628X; https://orcid.org/0000-0002-4130-1059; https://orcid.org/0000-0002-8902-1283; 27068408; HKF-1250-2023; AAI-7831-2021; AAL-6544-2020; AAE-1457-2021; AAL-3906-2021; ABC-4148-2020; AAS-7129-2021; AAD-6222-2021; AAD-5542-2021Sickle cell disease (SCD), one of the most common genetic disorders worldwide, is characterized by hemolytic anemia and tissue damage from the rigid red blood cells. Although hydroxyurea and transfusion therapy are administered to treat the accompanying tissue injury, whether either one prolongs the lifespan of patients with SCD is unknown. SCD-related mortality data are available, but there are few studies on mortality-related factors based on evaluations of surviving patients. In addition, ethnic variability in patient registries has complicated detailed analyses. The aim of this study was to investigate mortality and mortality-related factors among an ethnically homogeneous population of patients with SCD. The 735 patients (102 children and 633 adults) included in this retrospective cohort study were of Eti-Turk origin and selected from 1367 patients seen at 5 regional hospitals. A central population management system was used to control for records of patient mortality. Data reliability was checked by a data supervision group. Mortality-related factors and predictors were identified in univariate and multivariate analyses using a Cox regression model with stepwise forward selection. The study group included patients with homozygous hemoglobin S (Hgb S) disease (67 %), Hb S-beta(0) thalassemia (17 %), Hgb S-beta(+) thalassemia (15 %), and Hb S-alpha thalassemia (1 %). They were followed for a median of 66 +/- 44 (3-148) months. Overall mortality at 5 years was 6.1 %. Of the 45 patients who died, 44 (6 %) were adults and 1 (0.1 %) was a child. The mean age at death was 34.1 +/- 10 (18-54) years for males, 40.1 +/- 15 (17-64) years for females, and 36.6 +/- 13 (17-64) years overall. Hydroxyurea was found to have a notable positive effect on mortality (p = 0.009). Mortality was also significantly related to hypertension and renal damage in a univariate analysis (p = 0.015 and p = 0.000, respectively). Acute chest syndrome, splenic sequestration, and prolonged painful-crisis-related multiorgan failure were the most common causes of mortality. In a multivariate analysis of laboratory values, only an elevated white blood cell count was related to mortality (p = 0.009). These data show that despite recent progress in the treatment of SCD, disease-related factors continue to result in mortality in young adult patients. Our results highlight the importance of evaluating curative treatment options for patients who have an appropriate stem cell donor in addition to improving patient care and patient education.Item The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients(2017) Hur, Ender; Kose, Sennur Budak; Magden, Kemal; Yildiz, Gursel; Soyaltin, Utku; Toka, Bilal; Turan, Naki; Celikors, Saadet; Altundal, Bunyamin; Tunc, Ali; Yilmaz, Adil; Sivri, Ahmet; Sezer, Siren; Duman, SonerOBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials.Gov Identifier:NCT01468363). MATERIAL and METHODS: A total of 431 Prevalent HD patients were followed for 32.2+/-14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded. RESULTS: The mean age was 59.4+/-14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4+/-n 25.8 and diastolic BP 79.2+/-12.4 mm Hg. The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well. The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW. CONCLUSION: Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis.Item Clinical Characteristics of Acinetobacter baumannii Infection in Solid-Organ Transplant Recipients(2018) Serifoglu, Irem; Dedekarginoglu, Balam Er; Bozbas, Serife Savas; Akcay, Sule; Haberal, Mehmet; 0000-0002-7230-202X; 0000-0002-8360-6459; 0000-0002-7230-202X; 0000-0002-3462-7632; 29528021; AAS-6628-2021; AAI-8064-2021; AAB-5175-2021; AAJ-8097-2021Objectives: Acinetobacter baumannii, depending on the immune status of the host, may result in one of the most serious hospital infections. Infections involving A. baumannii infection have been recently rising. However, little is known about the clinical features of A. baumannii infection in solid-organ transplant recipients. We aimed to share our clinical experiences with A. baumannii infection in our transplant recipients. Materials and Methods: Between 2011 and 2017, 41 solid-organ transplant patients developed A. baumannii infection at Baskent University Hospital. Medical records were reviewed, and patient demographics, microbiology results, and overall outcome data were noted. Results: Of 41 solid-organ transplant patients with A. baumannii infection, 29 were male and 12 were female patients with mean age of 47.15 +/- 13.24 years. Our infection rate with A. baumannii infection was 6.1%. The most common sites of infection were deep tracheal aspirate (48.8%)and bloodstream (36.6%). Onset of infection 1 year post-transplant was identified in 58.5% of recipients. Risk factors included presence of invasive procedures (56.1%) and administration of high-dose corticosteroids for rejection 1 year before infection (68.3%). Thirty-day mortality rate was 41.5% (17/41 patients)and was not associated with the infection site, microbiological cure, clinical cure, and drug resistance in our study group. Conclusions: Acinetobacter baumannii is an important cause of hospital-acquired infection and mortality worldwide. A major problem with A. baumannii infection is delayed initiation of appropriate antibiotic treatment and the rising numbers of extensively drugresistant organisms. Predicting the potential risk factors, especially in the already at-risk solid-organ transplant population, has an important role in patient outcomes.Item Impact of COVID-19 on Outcomes of Patients with Hematologic Malignancies: A Multicenter, Retrospective Study(2022) Acar, Ibrahim Halil; Guner, Sebnem Izmir; Aslaner Ak, Muzeyyen; Gocer, Mesut; Ozturk, Erman; Atalay, Figen; Sincan, Gulden; Yikilmaz, Aysun Senturk; Ekinci, Omer; Ince, Idris; Gulturk, Emine; Demir, Nazli; Dogan, Ali; Ipek, Yildiz; Guvenc, Birol; https://orcid.org/0000-0003-4384-2913; 36425152Objectives: Patients with hematological malignancies have a high risk of mortality from coronavirus disease 2019 (COVID-19). This study aimed to investigate the impact of COVID-19 on mortality rates in patients with various hematological malignancies and to determine risk factors associated with all-cause mortality.Methods: A multicenter, observational retrospective analysis of patients with hematological malignancies infected with COVID-19 between July 2020 and December 2021 was performed. Demographic data, clinical characteristics, and laboratory parameters were recorded. Patients were grouped as non-survivors and survivors. All-cause mortality was the primary outcome of the study.Results: There were 569 patients with a median age of 59 years. Non-Hodgkin lymphoma (22.0%) and multiple myelomas (18.1%) were the two most frequent hematological malignancies. The all-cause mortality rate was 29.3%. The highest mortality rates were seen in patients with acute myeloid leukemia (44.3%), acute lymphoid leukemia (40.5%), and non-Hodgkin lymphoma (36.8%). The non-survivors were significantly older (p<0.001) and had more comorbidities (p<0.05). In addition, there were significantly more patients with low lymphocyte percentage (p<0.001), thrombocytopenia (p<0.001), and high CRP (p<0.001) in the non-survived patients. Age >= 65years (p=0.017), cardiac comorbidities (p=0.041), and continuation of ongoing active therapy for hematological cancer (p<0.001) were the independent risk factors for the prediction of mortality.Conclusions: In patients with hematological malignancies, coexistent COVID-19 leads to a higher mortality rate in elderly patients with more comorbidities. Acute myeloid and lymphoid leukemia and non-Hodgkin lymphoma have the highest mortality rates. Older age, cardiac diseases, and continuation of ongoing active therapy for hematological cancer are the independent risk factors for mortality in hematological malignancy patients with COVID-19.
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