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Öğe Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV Mortality Prediction Score (IMPRES)(Tubitak Scientific & Technical Research Council Turkey, 2019) Ozlu, Tevfik; Pehlivanlar Kucuk, Mehtap; Kaya, Akin; Yarar, Esra; Kirakli, Cenk; Sengoren Dikis, Ozlem; Ozdemir, EsraBackground/aim: the present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients. Materials and methods: the study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed. Results: the following cut-off scores were used to indicate mortality risk: <2, low risk; 2-5, moderate risk; 5.1-8, high risk; >8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. the mortality rate was 93.3% for patients with total 1M PRES scores of greater than 8 (P < 0.001). Conclusion: the present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data.Öğe Combination and comparison of two models in prognosis of pulmonary embolism: Results from TUrkey Pulmonary Embolism Group (TUPEG) study(Pergamon-Elsevier Science Ltd, 2014) Ozsu, Savas; Ozlu, Tevfik; Senturk, Aysegul; Ucar, Elif Yilmazel; Kirkil, Gamze; Kadioglu, Esra Ekbic; Altinsoy, Bulent; Saylan, Bengu; Selimoglu, Hatice Sen; Dabak, Gul; Tutar, Nuri; Uysal, AhmetBackground: Clinical parameters, biomarkers and imaging-based risk stratification are widely accepted in pulmonary embolism(PE). The present study has investigated the prognostic role of simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model. Methods: This prospective cohort study included a total of 1078 patients from a multi-center registry, with objectively confirmed acute symptomatic PE. The primary endpoint was all-cause mortality during the first 30 days, and the secondary endpoint included all-cause mortality, nonfatal symptomatic recurrent PE, or nonfatal major bleeding. Results: Of the 1078 study patients, 95 (8.8%) diedwithin 30 days of diagnosis. There was no significant difference between non-low-risk patients ESC [12.2% (103 of 754;)] and high-risk patients as per the sPESI [11.6% (103 of 796)] for 30-day mortality. The nonfatal secondary endpoint occurred in 2.8% of patients in the the sPESI low-risk and 1.9% in the ESC low-risk group. Thirty-day mortality occurred in 2.2% of patients the sPESI low-risk and in 2.2% the ESC low-risk group (P = NS). In the present study, in the combination of the sPESI low-risk and ESC model low-risk mortality rate was 0%. Conclusions: The sPESI andthe ESCmodel showed a similar performance regarding 30-daymortality and secondary outcomes in the present study. However, the combination of these two models appears to be particularly valuable in PE. (C) 2014 Elsevier Ltd. All rights reserved.Öğe General Characteristics and Prognostic Factors of Pneumonia Cases Developed During Pandemic (H1N1) Influenza-A Virus Infection in Turkey(Aves Yayincilik, 2013) Ozlu, Tevfik; Bulbul, Yilmaz; Tasbakan, Sezai; Kilic, Hatice; Kuyucu, Tulin; Yildiz, Tekin; Ozdemir, Tarkan; Duru, Serap; Oztuna, Funda; Adiguzel, Nalan; Saglam, Leyla; Coskun, Aysin Sakar; Ornek, Tacettin; Gunduz, Gazi; Filiz, Ayten; Ozdemir, Levent; Okumus, GulferObjective: Unlike seasonal influenza, seen in previous years, the strain identified in the 2009 influenza-A pandemic involved high mortality. In this study, prognostic factors and general characteristics of pneumonia cases developed in Turkey during the H1N1 pandemic between October 2009 and January 2010 were analyzed. Study Design: Multicenter retrospective study. Material and Methods: This multicentric retrospective study was conducted between August and October 2010 and patients' data were collected by means of standard forms. Results: The study included 264 pneumonia cases, collected from 14 different centers. Mean age was 47.5 +/- 18.6 years. Nineteen patients (7.2%) were pregnant or had a new birth and comorbid diseases were detected in 52.3% of all patients. On admission, 35 (13.8%) cases had altered mental status. Overall, 32.6% were treated in intensive care units (ICU) and invasive/non-invasive mechanical ventilation was performed in 29.7%. The mean duration of ICU stay was 2.9 +/- 6.2 and total hospital stay was 12.0 +/- 9.4 days. Mortality rate was 16.8% (43-cases). The length of ICU treatment, total hospital stay, and mortality were significantly higher in H1N1-confirmed patients. Mortality was significantly higher in patients with dyspnea, cyanosis, and those who had altered mental status on admission. Patients who died had significantly higher rate of peripheral blood neutrophils, lower platelet counts, higher BUN, and lower SaO(2) levels. Conclusion: This study showed that pneumonia developed during H1N1 pandemic in our country had resulted in a high mortality. Mortality was especially high among patients with cyanosis, altered mental state and those with lower SaO(2).Öğe General Characteristics and Prognostic Factors of Pneumonia Cases Developed During Pandemic (H1N1) Influenza-A Virus Infection in Turkey(Aves Yayincilik, 2013) Ozlu, Tevfik; Bulbul, Yilmaz; Tasbakan, Sezai; Kilic, Hatice; Kuyucu, Tulin; Yildiz, Tekin; Ozdemir, Tarkan; Duru, Serap; Oztuna, Funda; Adiguzel, Nalan; Saglam, Leyla; Coskun, Aysin Sakar; Ornek, Tacettin; Gunduz, Gazi; Filiz, Ayten; Ozdemir, Levent; Okumus, GulferObjective: Unlike seasonal influenza, seen in previous years, the strain identified in the 2009 influenza-A pandemic involved high mortality. In this study, prognostic factors and general characteristics of pneumonia cases developed in Turkey during the H1N1 pandemic between October 2009 and January 2010 were analyzed. Study Design: Multicenter retrospective study. Material and Methods: This multicentric retrospective study was conducted between August and October 2010 and patients' data were collected by means of standard forms. Results: The study included 264 pneumonia cases, collected from 14 different centers. Mean age was 47.5 +/- 18.6 years. Nineteen patients (7.2%) were pregnant or had a new birth and comorbid diseases were detected in 52.3% of all patients. On admission, 35 (13.8%) cases had altered mental status. Overall, 32.6% were treated in intensive care units (ICU) and invasive/non-invasive mechanical ventilation was performed in 29.7%. The mean duration of ICU stay was 2.9 +/- 6.2 and total hospital stay was 12.0 +/- 9.4 days. Mortality rate was 16.8% (43-cases). The length of ICU treatment, total hospital stay, and mortality were significantly higher in H1N1-confirmed patients. Mortality was significantly higher in patients with dyspnea, cyanosis, and those who had altered mental status on admission. Patients who died had significantly higher rate of peripheral blood neutrophils, lower platelet counts, higher BUN, and lower SaO(2) levels. Conclusion: This study showed that pneumonia developed during H1N1 pandemic in our country had resulted in a high mortality. Mortality was especially high among patients with cyanosis, altered mental state and those with lower SaO(2).Öğe Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)(Turkish Assoc Tuberculosis & Thorax, 2020) Pehlivanlar Kucuk, Mehtap; Ozlu, Tevfik; Kucuk, Ahmet Oguzhan; Kaya, Akin; Kirakli, Cenk; Sengoren Dikis, Ozlem; Cortuk, MustafaIntroduction: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. Materials and Methods: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017. The clinical research was planned as observational, multicenter, cross-sectional. Results: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p< 0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% Cl: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. Conclusion: in this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.Öğe Pneumococcal infections and protection with vaccination in adult chronic lung diseases(Turkish Assoc Tuberculosis & Thorax, 2020) Karadeniz, Gulistan; Kilinc, Oguz; Olmez, Ayse; Ozhan, Mustafa Hikmet; Ozlu, Tevfik; Ozyurek, Berna Akinci; Sayiner, AbdullahPneumococcal infections are an important cause of mortality and morbidity in Chronic Lung Diseases. However, exacerbations, which make the treatment of diseases very difficult, and corticosteroids used during treatment carry a great risk of pneumococcal infection and adversely affect the treatment. The most rational way to reduce the negative impact of pneumococcal infections on the clinical and economic burden of Chronic Lung Diseases is vaccination of the risky population. Although, vaccination recommendations are well defined, recommended by national and international guidelines and are paid by health authorities, in Turkey, vaccination rates in adults with chronic lung disease is far below the expected. Since physicians are considered to be the most important and reliable resource that can guide their patients in vaccination, applying pneumococcal vaccination routinely in all patients with chronic lung diagnosis and making it a part of daily practice will greatly contribute to reducing the clinical and economic burden of pneumococcal infections in these patients. in this review, the effects of pneumococcal diseases on chronic lung diseases, the risk and clinical burden of pneumococcal diseases in chronic lung diseases are discussed in the light of guidelines and current literature, and the importance of protection from pneumonia in these patients is emphasized. in addition to general information and efficacy data about pneumococcal vaccines available in our country, application methods and access routes to vaccines are also described.
