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    The Association of Macrophage Activation-Like Syndrome with Mortality in Elderly Patients with Sepsis
    (Bilimsel Tip Yayinevi, 2023) Bozgul, Sukriye Miray Kilincer; Acar, Caner; Kurtulmus, Ilkce Akgun; Aydin, Ozgur; Koca, Didem; Ak, Gunes; Cilli, Fatma Feriha
    Introduction: Among the geriatric population, when compared to younger individuals, mortality is high. Macrophage activation-like syndrome (MALS) has been reported to be an independent immunological entity associated with mortality among sepsis patients in adults which represents the increased inflammation state. This study aimed to investigate the frequency of MALS in elderly sepsis patients and its association with intensive care unit (ICU) mortality. Materials and Methods: This retrospective study included patients aged 65 years or older with sepsis between January 2013 and January 2022 in the ICU of the Internal Medicine Department of Ege University Hospital. MALS was diagnosed with a hemophagocytic syndrome score (H-score) of =151 and/or co-presence of hepatobiliary dysfunction (HBD) and disseminated intravascular coagulation (DIC). Clinical, demographic, and laboratory results were retrieved from the medical records. Factors affecting ICU mortality were investigated with binary logistic regression analysis. Results: In our study of 194 patients, mortality was 46.4% and MALS frequency was 23.7%. Among non-survivors, MALS frequency was significantly higher than survivors; 32.2% and 16.3%, p= 0.010. The median H-score was 117 in non-survivors and 78.5 in survivors, p= 0.002. ICU mortality of elderly sepsis patients increased by approximately 25 times when MALS was present. Age was not identified as a risk factor for ICU mortality. Conclusion: Among elderly sepsis patients, the frequency of MALS was found to be remarkably high in our single-center study. MALS may be one of the reasons for increased mortality in elderly sepsis patients.
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    Biomarker diversity in increased inflammation: Secondary hemophagocytic syndrome vs. systemic inflammatory response syndrome
    (Wiley, 2023) Kılınçer Bozgül, Şükriye Miray; Ak, Gunes; Soyer, Nur Akad; Barutçuoğlu, Burcu; Mercan, Erman; Acar, Caner; Yetişken, Merve
    IntroductionSecondary hemophagocytic syndrome (HPS) and systemic inflammatory response syndrome (SIRS) share similar clinical findings as a result of hyperinflammation. Due to high mortality rates in HPS; it is critical to diagnose promptly. Thus, this study aimed to evaluate the diagnostic and prognostic significance of inflammatory markers in these two increased inflammatory states. MethodsWe conducted a prospective observational study including patients hospitalized in the intensive care unit of the Internal Medicine Department of Ege University Hospital. ResultsThirty-three patients with HPS and 46 patients with SIRS were evaluated. Serum ferritin and sIL-2r levels were significantly higher in the HPS group than in the SIRS group, as expected. Receiver operating curve (ROC) analysis showed that the optimal cutoff for ferritin to distinguish HPS from SIRS was 1703 mu g/L (sensitivity: 75%, specificity: 94.1%, area under the curve (AUC): 0.871, p < 0.001), and that for sIL-2r was 5888 U/ml (sensitivity: 45.5%, specificity: 89.1%, AUC: 0.698, and p = 0.001). Temporal changes (Delta) in ferritin were determined as a mortality predictor. When evaluated in terms of prognostic significance in ROC analysis, a decrease in ferritin of less than 38% was the cutoff value (sensitivity: 92.3%, specificity: 76.9%, AUC: 0.888, and p < 0.001), in mortality. Contrarily, neither baseline nor temporal change in sIL-2r did not achieve prognostic significance as a mortality predictor. ConclusionIn this single-center study, serum ferritin level was found to be a particularly more valuable diagnostic and prognostic marker than sIL-2r in patients with HPS.
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    Clinical and Laboratory Findings of SARS-CoV-2 Infection in Children Younger than 6 Months Old: Neutropenia is More Common Not Lymphopenia
    (Oxford Univ Press, 2022) Ozenen, Gizem Guner; Bal, Zumrut Sahbudak; Bilen, Nimet Melis; Arslan, Sema Yildirim; Ak, Gunes; Koc, Gonca; Cicek, Candan
    Background Studies on age-related differences in clinical and laboratory features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. We aimed to evaluate the demographic, clinical, laboratory findings of SARS-CoV-2 infection in children younger than 6 months old and compare them with older children. Methods A single-center retrospective study, including 209 confirmed SARS-CoV-2 infection cases, was conducted between 11 March 2020 and 1 September 2021. The case group consisted of 47 patients younger than 6 months old, whereas the control group consisted of 162 patients older than 6 months old. Results The mean age of the case group was 2.77 +/- 1.52 months, and the control group was 101.89 +/- 65.77 months. Cough was statistically higher in the control group, and poor feeding was higher in the case group (p = 0.043, 0.010). The underlying disease rate was statistically higher in the control group; however, the hospitalization rate was higher in the case group (p = 0.036, 0.001). The case group had significantly lower median values of the absolute neutrophil count, hemoglobin and higher median values of white blood cell, absolute lymphocyte count and platelet than the control group (p < 0.05). C-reactive protein, fibrinogen values were significantly lower, and procalcitonin, D-dimer, troponin T, N-terminal pro-B-type natriuretic peptide significantly higher in the case group (p < 0.05). Lymphopenia was more common in the control group, whereas neutropenia was more common in the case group (p = 0.001, 0.011). Conclusions We showed that most children younger than 6 months old had mild and asymptomatic SARS-CoV-2 infection; however, the hospitalization rate was higher, and neutropenia was more common in older children. Lay summary Studies on age-related differences in clinical and laboratory features on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric patients are limited. We aimed to evaluate the demographic, clinical and laboratory findings of SARS-CoV-2 infection in children younger than 6 months old and compare them with older children. A single-center retrospective study was conducted, including 209 SARS-CoV-2 infection cases. The case group consisted of 47 patients younger than 6 months old, and the control group consisted of 162 patients older than 6 months old. Most children younger than 6 months old had mild and asymptomatic SARS-CoV-2 infection; however, the hospitalization rate was higher than older children. Neutropenia was more common in patients younger than 6 months than older children with SARS-CoV-2 infection, even if underlying diseases were excluded.
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    Co-analysis of pancreatic cyst fluid carcinoembryonic antigen and glucose with novel cut-off levels better distinguishes between mucinous and non-mucinous neoplastic pancreatic cystic lesions
    (Sage Publications Inc, 2022) Barutcuoglu, Burcu; Oruc, Nevin; Ak, Gunes; Kucukokudan, Serdar; Aydin, Ahmet; Nart, Deniz; Harman, Mustafa
    Background Pancreatic cyst fluid analysis plays an important role in distinguishing between mucinous and non-mucinous cyst lesions. We aimed to compare the diagnostic performances of cyst fluid carcinoembryonic antigen (CEA), CA 19-9, and glucose in differentiating mucinous from non-mucinous neoplastic pancreatic cystic lesions (PCLs) and determine the best cut-off levels. Methods Patients' data were evaluated retrospectively. 102 patients' PCLs were grouped as non-neoplastic (n = 25), non-mucinous neoplastic (n = 20), mucinous neoplastic (n = 47) and pancreatic adenocarcinomas with cystic degeneration (n = 10); and CEA, CA 19-9, and glucose levels were compared. Receiver-operating characteristic analysis was performed, and the ideal cut-off values were determined. Results Cyst fluid CEA and CA 19-9, levels were significantly higher (P < 0.001, P < 0.001, respectively) and glucose levels were significantly lower (P = 0.001) in mucinous than in non-mucinous neoplastic PCLs. Area under curve with 95% confidence interval of CEA, glucose and CEA and glucose test combination was 0.939 (95% CI = 0.885-0.993, P = 0.001), 0.809 (95% CI = 0.695-0.924, P < 0.001) and 0.937 (95% CI = 0.879-0.995), respectively. CEA cut-offs to rule-in and rule-out mucinous neoplastic were 135.1 ng/mL (sensitivity = 62%, specificity = 94.7%) and 6.12 ng/mL (sensitivity = 94.1%, specificity = 80.4%), respectively. Glucose cut-off of 2.8 mmol/L was chosen both to rule-in and rule-out mucinous neoplastic PCLs (sensitivity = 78%, specificity = 80%). Co-analysis of CEA and glucose to distinguish mucinous from non-mucinous neoplastic PCLs had sensitivity = 87.8%, specificity = 93.3%, and diagnostic accuracy = 89.3%. Conclusions We concluded that co-analysis of cyst fluid CEA (cut-off = 135.1 ng/mL) and glucose (cut-off = 2.8 mmol/L) at novel cut-offs had the best testing performance to rule-in mucinous neoplastic PCLs. To rule-out mucinous PCLs co-analysis of CEA (cut-off = 6.12 ng/mL) and glucose (cut-off = 2.8 mmol/L) added value to prediction.
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    Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in pregnant women with systemic lupus erythematosus
    (Taylor & Francis Inc, 2022) Ekici, Huseyin; Imamoglu, Metehan; Okmen, Firat; Gencosman, Gizem; Ak, Gunes; Ergenoglu, Mete
    Systemic lupus erythematosus (SLE) is associated with a higher risk of complications in pregnancy. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been evaluated in numerous inflammatory diseases. We evaluated the possible role of these markers in SLE pregnancies. Forty-six pregnant patients with an already established diagnosis of SLE were included in the study. Complete blood counts were obtained upon admission for delivery. Seven patients were diagnosed with a flare and managed with multiple medications, whereas rest of the patients were not on any treatment or managed with monotherapy. NLR and PLR values were also evaluated between two groups and no statistically significant difference was found (p=.44 and p=.80, respectively). This study is the first to evaluate the possible role of NLR and PLR in pregnant SLE patients in the literature. Further studies are warranted for an elaborate evaluation of NLR and PLR in lupus pregnancies.Impact Statement What is already known on this subject? Pregnancy in the setting of SLE is associated with a higher risk of complications. Active disease increases the risk of adverse outcomes further. What the results of this study add? This study is the first to evaluate NLR and PLR in pregnancies complicated by SLE. No significant association between the course of the disease in pregnancy and NLR/PLR was documented. What the implications are of these findings for clinical practice and/or further research? Further studies on the markers to predict prognosis of SLE in pregnancy are required to improve the maternal and neonatal outcomes in this exclusive group of high-risk patients.
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    The Follow-Up of Biomarkers Better Predicts the Poor Outcome in COVID-19 Patients
    (Assoc Clinical Scientists, 2020) Basoglu, Ozen K.; Ozhan, Mustafa Hikmet; Ekren, Pervin Korkmaz; Ak, Gunes; Tasbakan, Mehmet Sezai; Sayiner, Abdullah
    Objective. To investigate the course of biomarkers on admission and follow-up in order to identify early predictors for poor outcome in COVID-19 patients. Methods. in this study, 132 COVID-19 patients were classified as good outcome (n=62) and poor outcome (n=70) groups. Laboratory parameters were evaluated on admission and within 5-7 days after hospitalization. Results. Baseline levels of neutrophil-lymphocyte ratio, CRP, procalcitonin, ferritin, D-dimer and LDH were higher (p<0.01); lymphocyte count was lower in the poor outcome patients. During follow-up there was a larger decrease in lymphocyte count and more prominent increases in other biomarkers (p<0.001). in ROC analysis, the AUCs strongly indicated the poor outcome on days 5-7 of the hospitalization. Conclusions. This study suggests that the follow-up measurements of the biomarkers better predict the poor outcome in COVID-19 pneumonia.
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    Plasma steroid panel with liquid chromotographymass spectrometry (LC/MS-MS) method: utilization in differential diagnosis of hyperandrogenism
    (Karger, 2021) Ucar, Mert; Ata, Aysun; Barutcuoglu, Burcu; Ak, Gunes; Habif, Sara; Parildar, Zuhal; Goksen, Damla
    [No Abstract Available]
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    The relationship between nutritional status and Fetuin-A in Inflammatory Bowel Disease patients
    (Kuwait Medical Assoc, 2021) Barutcuoglu, Burcu; Unal, Nalan Gulsen; Ak, Gunes; Parildar, Zuhal; Oruc, Nevin; Ozutemiz, Ahmet Omer
    Objective: To investigate the relationship between fetuin-A and nutritional index parameters body mass index (BMI), fat mass (FM), fat free mass (FFM) and mini nutritional assessment (MNA (R)) in inflammatory bowel disease (IBD) patients. Design: Randomized, prospective study Setting: Department of Clinical Biochemistry and Gastroenterolgy, Medical School, Ege University, Izmir, Turkey Subjects: Seventy-six consecutive IBD out-patients and 24 healthy volunteers were enrolled in this study. IBD patients were grouped into: 1. BMI<18.5 kg/m(2); 2. BMI=18.5-24.9 kg/m(2); and 3. BMI >= 25 kg/m(2) and according to MNA (R) score as: 1. MNA (R) <17, 2. MNA (R)=17.5-23.5 and 3. MNA (R)>= 24. Interventions: Demographical data and nutritional index parameters (BMI, FM, FFM) were evaluated. MNA was assessed by a questionnaire. Main outcome measures: Fasting serum levels of albumin, glucose, total cholesterol, triglyceride, C-reactive protein (CRP), vitamin B12, folic acid, ferritin, fetuin-A, hemoglobin and white blood cell count were measured. Results: The level of CRP was significantly higher and fetuin-A was significantly lower (both P<.001) in IBD patients than in healthy subjects. Age (P<.001), MNA (R) total score (P=.001), FM (P<.001), FFM (P=.003) and fetuin-A (P=.012) were significantly different between the BMI groups. There was a significant difference in BMI (P<.001), FM (P<.001), FFM (P<.001), levels of Fetuin-A (P=.030) and CRP (P=.030) between MNA (R) groups. There was a weak correlation between fetuin-A and BMI (r=0.249,P=.030). Conclusion: in this study, fetuin-A, a negative acute phase protein is shown to be related to BMI in IBD patients. Serum fetuin-A levels were the lowest both in MNA<17 and BMI<18.5 kg/m(2), which showed us that it can predict nutritional status in IBD patients.