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Comoglu M, Özdemir G, Sarıkaya B, Acehan F, Bingöl O, Kilic E, Bahadır B, Oruc M, Demir BF, Yılmaz Y, Sahiner ES. Sepsis predictors in earthquake survivors: A comparative analysis of amputation and fasciotomy patients. Jt Dis Relat Surg 2025; 36:155-163. [PMID: 39719913 DOI: 10.52312/jdrs.2025.1971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 11/21/2024] [Indexed: 12/26/2024] Open
Abstract
OBJECTIVES This study aimed to identify predictors of sepsis in earthquake survivors who underwent either amputation or fasciotomy and to compare these two patient groups across many clinical outcomes, including sepsis. PATIENTS AND METHODS In this retrospective study, a total of 1,608 patients who presented to our hospital following the February 6, 2023, Kahramanmaraş earthquakes were evaluated between February 2023 and March 2023. Of these, 138 patients (65 males, 73 females; median age: 35 years; range, 18 to 74 years) who underwent either fasciotomy or amputation were included in the study. Patients managed solely with fasciotomy were included in the fasciotomy group, while those who underwent amputation in at least one area were included in the amputation group. Sepsis predictors were investigated in this population. Additionally, the two groups were compared in terms of clinical outcomes, including bacteremia, sepsis, septic shock and mortality. RESULTS Of the 138 earthquake survivors, 59 (42.8%) were in the amputation group, and 79 (57.2%) were in the fasciotomy group. There were no significant differences between the groups in terms of the development of crush syndrome or the need for renal replacement therapy (p=0.781 and p=0.411, respectively). The duration of entrapment under rubble was higher in the amputation group (p=0.030). While bacteremia was more common in the amputation group, there was no significant difference in relation to sepsis (p=0.002 and p=0.106, respectively). Septic shock and mortality rates were higher in the amputation group (p=0.001 and p=0.009, respectively). Multivariate analysis revealed that the number of traumatized sites (odds ratio [OR]=3.68, 95% confidence interval [CI]: 2.13-6.33, p<0.001), amputation at more than two sites (OR=4.27, 95% CI: 1.15-15.9, p=0.022), and fasciotomy at more than two sites (OR=2.71, 95% CI: 1.10-6.69, p=0.021) were significant predictors of sepsis. CONCLUSION Patients undergoing fasciotomy and amputation should be comprehensively evaluated for potential benefits and risks. Close monitoring for sepsis is particularly recommended for patients who have amputation or fasciotomy procedures at more than two sites.
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Comoglu M, Acehan F, Inan O, Demir BF, Yılmaz Y, Sahiner ES. A new score predicting renal replacement therapy in patients with crush injuries: Analysis of a major earthquake. Am J Emerg Med 2025; 87:1-7. [PMID: 39447493 DOI: 10.1016/j.ajem.2024.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/10/2024] [Accepted: 10/15/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND It is important to predict which patients may require renal replacement therapy (RRT) at the time of initial presentation after crush injuries. There is limited data in the literature examining the predictors of RRT. METHODS This study was conducted by evaluating 2232 patients who presented to our hospital following two major earthquakes of magnitudes 7.6 and 7.7 Mw that occurred in Kahramanmaras, Turkey, on February 6, 2023. A total of 314 patients who were hospitalized upon being rescued from the rubble and had a creatine kinase (CK) level above 1000 U/L were included in the final analysis. Factors predicting the need for RRT were investigated, and a dialysis score was developed for this prediction. RESULTS Of the 314 patients included in the study, 95 (30.2 %) developed acute kidney injury (AKI). RRT was performed on 68 (21.6 %) patients. The optimal cut-off value of CK for the prediction of AKI was 23,000 U/L. Multivariate analysis revealed that factors predicting RRT were the number of traumatized sides (odds ratio [OR]: 2.2, 95 % confidence interval [CI]: 1.09-4.39, p = 0.026), albumin (OR:0.11, 95 % CI: 0.04-0.32, p < 0.001), and CK (OR: 1.00, 95 % CI 1.00-1.00, p < 0.001). A dialysis score was developed ranging from 0 to 7 based on the number of traumatized sides, albumin, and CK. The area under the curve (AUC) of the dialysis score in receiver operating characteristic analysis was 0.974. A dialysis score of 4 or higher had a sensitivity of 97.1 % and a specificity of 89.4 % for predicting the need for RRT. CONCLUSIONS The dialysis score predicts the need for RRT quite well. The simplicity of use and high sensitivity and specificity of this score in earthquake-related crush injuries will greatly facilitate clinicians in patient triage and follow-up.
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Zengin O, Gore B, Sahiner ES, Ates I. CAID syndrome and a two year clinical outcome. A case report. JOURNAL OF GASTROINTESTINAL AND LIVER DISEASES : JGLD 2024; 33:571-572. [PMID: 39733308 DOI: 10.15403/jgld-5772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/10/2024] [Indexed: 12/31/2024]
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Acehan F, Karsavuranoğlu B, Aslan M, Kalkan C, Sahiner ES, Inan O, Comoglu M, Yilmaz Y, Ates I. Improved outcomes in patients with non-variceal upper gastrointestinal bleeding while undergoing antithrombotic therapy: A propensity score matching analysis. Dig Liver Dis 2024; 56:1854-1862. [PMID: 38755023 DOI: 10.1016/j.dld.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/22/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND This study sought to examine the effect of antithrombotic use on clinical outcomes in non-variceal upper gastrointestinal bleeding (UGIB). METHODS Patients consecutively diagnosed with non-variceal UGIB between February 2019 and September 2020 were divided into two groups based on their antithrombotic use: users and non-users. Using propensity score matching (PSM) and multivariable regression analyses, the impact of antithrombotic use prior to UGIB presentation on clinical outcomes was examined. RESULTS In the entire cohort, there were 210 and 260 patients in the antithrombotic user and non-user groups, respectively. Using PSM analysis with seven covariates, two matched groups of 157 patients were created at a 1:1 ratio. In the matched cohort, despite their longer hospital stays and a higher rate of intensive care unit admissions, the patients in the user group had lower 30- and 90-day mortality rates (4.5% vs. 14.0 %; p = 0.003 and 8.9% vs. 18.5 %; p = 0.014, respectively). In the entire cohort, multivariable analyses adjusted for confounding factors revealed that antithrombotic use was associated with lower risks of in-hospital (adjusted OR: 0.437; 95 % CI: 0.191-0.999), 30-day (adjusted OR: 0.261; 95 % CI: 0.099-0.689), and 90-day (adjusted OR: 0.386; 95 % CI: 0.182-0.821) mortality. CONCLUSION Antithrombotic use prior to UGIB presentation was found to be an independent protective factor for all-cause mortality.
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Comoglu M, Acehan F, Sahiner ES, Kalkan C, Comoglu E, Yılmaz Y, Canlı T, Ates I. Clinical Features and Prognosis of Acute Cholangitis in Octogenarians: A Prospective Comparative Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1759. [PMID: 39596944 PMCID: PMC11596043 DOI: 10.3390/medicina60111759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 10/12/2024] [Accepted: 10/24/2024] [Indexed: 11/29/2024]
Abstract
Background: The data on acute cholangitis in the octogenarian population are very limited. This study aimed to examine the clinical characteristics of acute cholangitis and complications related to endoscopic retrograde cholangiopancreatography (ERCP) in octogenarians. Materials and Methods: This study was conducted prospectively between July 2022 and December 2023 and included 250 patients aged 65 years and older. Patients eligible for the study were divided into two groups: those aged ≥80 years (octogenarian) and those aged 65-79 years (non-octogenarian). These two groups were compared in terms of the clinical characteristics of cholangitis and ERCP-related complications. In addition, factors associated with in-hospital mortality were evaluated. Results: Out of 250 patients, 87 (34.8%) were octogenarians and 163 (65.2%) were non-octogenarians. The median age was 76 (69-82) years. Although the octogenarian group had higher rates of severe illness and intensive care unit admissions (p < 0.001 and p = 0.002, respectively), there were no significant differences in in-hospital mortality (p = 0.359) or ERCP-related complications (p = 0.417). Malignant etiology (odds ratio [OR]: 5.68, 95% confidence interval [CI]: 2.11-15.3), hypoalbuminemia (OR 0.18, 95% CI 0.07-0.45), and qSOFA score ≥ 2 (OR: 6.5, 95% CI: 1.7-24.5) were independent risk factors for in-hospital mortality. Conclusions: Being over 80 years old is not an indicator of poor outcomes, and ERCP can be safely performed on these patients. However, elderly patients with hypoalbuminemia, malignant etiology, or a qSOFA score of ≥2 should be closely monitored, regardless of their age.
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Ates I, Batirel A, Aydin M, Karadag FY, Erden A, Kucuksahin O, Armagan B, Guven SC, Karakas O, Gokdemir S, Altunal LN, Buber AA, Gemcioglu E, Zengin O, Inan O, Sahiner ES, Korukluoglu G, Sezer Z, Ozdarendeli A, Omma A, Kara A. Long-Term Results of Immunogenicity of Booster Vaccination against SARS-CoV-2 (Hybrid COV-RAPEL TR Study) in Turkiye: A Double-Blind, Randomized, Controlled, Multicenter Phase 2 Clinical Study. Vaccines (Basel) 2023; 11:1234. [PMID: 37515050 PMCID: PMC10416156 DOI: 10.3390/vaccines11071234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
The immunogenicity of vaccines decreases over time, causing a need for booster doses. This study aimed to present the long-term (Day 84) immunogenicity results of the double-blind, randomized, controlled, phase II Hybrid COV-RAPEL TR Study (NCT04979949), in which the TURKOVAC or CoronaVac vaccines were used as a booster after the second dose of primary vaccination with CoronaVac. A total of 190 participants from the Hybrid COV-RAPEL TR Study, who had both Day 28 and Day 84 immunogenicity results, were included. The immunogenicity on Day 84, regarding the neutralizing antibody positivity (Wuhan and Delta variants) and anti-spike immunoglobulin (Ig) G (IgG) antibody positivity, was compared between TURKOVAC and CoronaVac vaccine arms according to sex and age groups. Overall, antibody positivity showed a slight decrease on Day 84 vs. Day 28, but was not different between TURKOVAC and CoronaVac arms either for sexes or for age groups. However, TURKOVAC produced better antibody response against the Delta variant than CoronaVac, while CoronaVac was superior over TURKOVAC regarding neutralizing antibody positivity in the 50-60 years age group, regardless of the variant. A single booster dose, after the completion of the primary vaccination, increases antibody positivity on Day 28 which persists until Day 84 with a slight decrease. However, an additional booster dose may be required thereafter, since the decrease in antibody titer may be faster over time.
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Inan O, Sahiner ES, Ates I. Factors associated with clinical outcome in geriatric acute cholangitis patients. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2023; 27:3313-3321. [PMID: 37140281 DOI: 10.26355/eurrev_202304_32102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE We aimed to determine the risk factors associated with the clinical outcome in cases of acute cholangitis among the geriatric age group. PATIENTS AND METHODS Patients aged >65 years hospitalized with the diagnosis of acute cholangitis in an emergency internal medicine clinic were included in this study. RESULTS The study population comprised 300 patients. In the oldest-old group, the rates of severe acute cholangitis and intensive care unit hospitalization (39.1% vs. 23.2%, p<0.001) were higher. The mortality rate was also higher in the oldest-old group (10.4% vs. 5.9%, p=0.045). The presence of malignancy, ICU hospitalization, decreased platelet levels, decreased hemoglobin levels, and decreased albumin levels were associated with mortality. In the multivariable regression model in which variables associated with Tokyo severity were included, the associated factors for membership in the severe risk group compared to the moderate risk group were decreased platelet count (OR: 0.96; p=0.040) and decreased albumin level (OR: 0.93; p=0.027). Increasing age (OR: 1.07; p=0.001), malignancy etiology (OR: 5.03; p<0.001), increasing Tokyo severity (OR: 7.61; p<0.001), and decreasing lymphocyte count (OR: 0.49; p=0.032) were determined to be associated with ICU admission. Decreasing albumin levels (OR: 0.86; p=0.021) and ICU admission (OR: 16.43; p=0.008) were determined to be factors associated with mortality. CONCLUSIONS Worse clinical outcomes occur among geriatric patients with increasing age.
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Ertuna GN, Sahiner ES, Yilmaz FM, Ates I. The role of irisin and asprosin level in the pathophysiology of prediabetes. Diabetes Res Clin Pract 2023; 199:110642. [PMID: 36966974 DOI: 10.1016/j.diabres.2023.110642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE We aimed to examine whether irisin and asprosin have a role in the physiopathology of prediabetes. METHODS Hundred people were selected between the age of 18-65 years for the study population (60 prediabetes, 40 healthy). For the follow-up study, the patients with prediabetes were offered a 3-month program for lifestyle change and then reevaluated. Our research is a single-center, prospective observational study. RESULTS Among the healthy group and patients with prediabetes, irisin levels were lower and asprosin levels were higher (p < 0.001) in patients. In the follow-up part, the patients' insulin levels, HOMA index scores, and asprosin levels were decreased while irisin levels were elevated (p < 0.001). Sensitivity was 98.3% and specificity was 65% for asprosin of > 56.3 ng/mL, while they were 93.3% and 65% for irisin of ≤ 120.2 pg/mL, respectively. It was found that irisin had diagnostic performance similar to insulin and the HOMA index, while asprosin performed similarly to glucose, insulin, and the HOMA index. CONCLUSION Both irisin and asprosin have been found to be related to the prediabetes pathway and it has been shown that these molecules may be useful in daily clinical practice with diagnostic performances similar to those of the HOMA index and insulin.
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Omma A, Batirel A, Aydin M, Yilmaz Karadag F, Erden A, Kucuksahin O, Armagan B, Güven SC, Karakas O, Gokdemir S, Altunal LN, Buber AA, Gemcioglu E, Zengin O, Inan O, Sahiner ES, Korukluoglu G, Sezer Z, Ozdarendeli A, Kara A, Ates I. Safety and immunogenicity of inactive vaccines as booster doses for COVID-19 in Türkiye: A randomized trial. Hum Vaccin Immunother 2022; 18:2122503. [PMID: 36315843 PMCID: PMC9746394 DOI: 10.1080/21645515.2022.2122503] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Protective neutralizing antibody titers reduce in time after COVID-19 vaccinations, as in individuals who have had COVID-19. This study aimed to evaluate the safety and immunogenicity of CoronaVac and TURKOVAC vaccines used as a booster dose after CoronaVac primary vaccination. This double-blind, randomized, controlled, phase II, multicenter study included healthy male and female adults (18-60 years) who were vaccinated with two doses of CoronaVac vaccine and did not exceed the duration of at least 90 days and a maximum of 270 days from the second dose of vaccination. Among 236 eligible volunteers, 222 were recruited for randomization between July 12, 2021 and September 10, 2021; 108 and 114 were randomized to the TURKOVAC and CoronaVac arms, respectively. The primary endpoint was adverse events (AEs) (ClinicalTrials.gov; Identifier: NCT04979949). On day 28, at the neutralizing antibody threshold of 1/6, the positivity rate reached 100% from 46.2% to 98.2% from 52.6% in the TURKOVAC and CoronaVac arms, respectively, against the Wuhan variant and the positivity rate reached 80.6% from 8.7% in the TURKOVAC arm vs. 71.9% from 14.0% in the CoronaVac arm against the Delta variant. IgG spike antibody positivity rate increased from 57.3% to 98.1% and from 57.9% to 97.4% in the TURKOVAC and CoronaVac arms, respectively. The TURKOVAC and CoronaVac arms were comparable regarding the frequency of overall AEs. Both vaccines administered as booster yielded higher antibody titers with acceptable safety profiles.
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Inan O, Sahiner ES, Ates I. The role of triglyceride-glucose index in determining subclinical atherosclerosis in patients with primary hypertension. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2022; 26:7125-7134. [PMID: 36263560 DOI: 10.26355/eurrev_202210_29898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE With the current study, we aimed at examining the relationship between the triglyceride-glucose (TyG) index and subclinical atherosclerosis in patients with primary hypertension. PATIENTS AND METHODS 185 patients with primary hypertension were included in this study. The following findings were considered to be associated with target organ damage (TOD): urinary protein excretion > 150 mg/dL and microalbumin excretion > 30 mg/dL, carotid intima-media thickness (CIMT) ≥ 0.9 mm or carotid plaque and/or left ventricular mass index (LVMI) > 95 g/m2 in women, > 115 g/m2 in men. RESULTS TyG index values were positively correlated with levels of CIMT (r=0.434; p<0.001), LVMI (r=0.351; p<0.001), microalbuminuria (r=0.347; p<0.001), and proteinuria (r=0.355; p<0.001). In the multivariable regression model, in which the variables associated with the presence of TOD were included, increased age (OR: 1.04, p=0.025), increased body mass index (OR: 1.10, p=0.042), and increased TyG index value (OR: 1.05, p<0.001) had independent associations with TOD. The threshold value of the TyG index for the presence of TOD was determined as > 8.85 with 79.0% sensitivity and 77.1% specificity (AUC±SE: 0.859±0.03, +PV: 70.6%, -PV: 84.0%, p<0.001). The TyG index had a superior diagnostic discrimination compared to its components in predicting the presence of TOD. CONCLUSIONS Increased TyG index values in patients with primary hypertension are associated with damage to target organs, not merely subclinical atherosclerosis.
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Karakaş Ö, Erden A, Güven SC, Armağan B, Sahiner ES, Kurtipek AC, Inan O, Gemcioglu E, Ateş İ, Omma A, Küçüksahin O. Reducing length of hospital stay with colchicine. J Infect Dev Ctries 2022; 16:57-62. [PMID: 35192522 DOI: 10.3855/jidc.14924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/14/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Colchicine is an ancient agent with well-known anti-inflammatory effects and commonly used in treatment of hyperinflammatory conditions. It has been argued that colchicine could be an appropriate treatment option in COVID-19 to control hyperinflammatory response. Here in this study, we aimed to investigate the impact of colchicine on outcomes of COVID-19 in our inpatient cohort. METHODOLOGY In this retrospective cohort study, hospitalized COVID-19 patients were investigated. Demographics, comorbidities, COVID-19 symptoms, laboratory findings on admission and discharge, baseline and seventh day oxygenation status, rates of mortality, intensive care unit admission, administration of other anti-inflammatory treatments and length of hospital stay were compared between patients who received standard of care medications and who received colchicine additionally. RESULTS Three hundred and thirty-six patients were included in the study (171 standard of care, 165 standard of care plus colchicine). The median length of hospital stay in colchicine group was significantly shorter. Rates of admission to intensive care unit, anti-inflammatory treatment administration and mortality did not differentiate between standard of care and colchicine groups. However, reduced rates of mortality and ICU admission were observed in patients who received colchicine with a dose of 1 mg/day when compared to patients who received 0.5 mg/day. CONCLUSIONS Our study demonstrated that COVID-19 patients who received colchicine in addition to standard of care had shorter hospital stay. Our results further support the use of colchicine in treatment of COVID-19, particularly with a dose of 1 mg/day.
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Zengin O, Sahiner ES, Inan O, Topcuoglu C, Turhan T, Altiparmak E, Yilmaz N, Ates I. Endothelial Dysfunction and Endocan Levels in Patients with Gilbert Syndrome and Moderate Hyperbilirubinemia. Angiology 2021; 73:920-926. [PMID: 34933608 DOI: 10.1177/00033197211057692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we aim to evaluate the presence of endothelial dysfunction in Gilbert syndrome patients with left ventricular mass index (LVMI) and endocan levels. The study included 60 patients who diagnosed with Gilbert syndrome and 60 healthy controls who did not have any known diseases. Human endocan levels were measured using a sandwich ELISA method. The endocan and LVMI levels were lower in the Gilbert syndrome group than in the healthy controls. In the Gilbert syndrome group, total bilirubin level was negatively correlated with LVMI (r = -0246; P = .007) and endocan levels (r = -.270; P = .046). In the Gilbert syndrome group, increasing age (β ± SE = 20.78 ± 7.47; P = .006), was a positive independent predictor of LVMI, and increasing high-density lipoprotein cholesterol (HDL-C) (β ± SE = -.27 ± .09; P = .007), and total bilirubin levels (β ± SE = -6.09 ± 3.02; P = .046) were found to be a negative independent predictor. These results support that endothelial dysfunction is decreased in Gilbert Syndrome patients with mild hyperbilirubinemia compared with the healthy control group.
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Comoglu M, Dede F, Yenigun EC, Topcuoglu C, Inan O, Sahiner ES, Ates I. Effects of Medium Cutoff Membranes on Pro-Inflammatory Cytokine and Oxidative Marker Levels in Patients with Sepsis Who Developed Acute Kidney Injury. Blood Purif 2021; 51:772-779. [PMID: 34814149 DOI: 10.1159/000519881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is insufficient data on the role of the medium cutoff (MCO) membranes in the clearance of pro-inflammatory cytokines and oxidant radicals in patients with sepsis requiring hemodialysis. METHODS The study consisted of 38 septic patients who developed acute kidney injury (AKI) and who were scheduled to undergo 2 sessions of hemodialysis. Nineteen patients underwent their first dialysis session with the MCO membrane and 19 patients with the high-flux (HF) membrane. In the second session, the membranes were switched. Pro-inflammatory cytokine and oxidative marker levels were measured in blood samples obtained before and after both dialysis sessions. Reduction ratios were compared for the 2 types of hemodialysis membranes. RESULTS After the first session, there was a greater reduction in tumor necrosis factor (TNF)-α with the MCO membrane (28.2 ± 21.1 vs. 8.0 ± 6.6, p = 0.001). After the second session, there was a greater reduction in interleukin (IL)-6 (27.8 ± 26.5 vs. 5.9 ± 13.3, p = 0.003) and IL-1β (20.5 ± 21.1 vs. 4.0 ± 6.5, p = 0.004) with the MCO membrane. When the first and second sessions of all 38 patients were compared, the reductions in TNF-α, IL-6, and IL-1β were consistently greater for MCO than HF (p = 0.001, p = 0.006, p < 0.001, respectively). The reductions in total antioxidant status, total oxidant status, and myeloperoxidase were not statistically different for the 2 types of dialysis membranes. CONCLUSIONS MCO membrane was superior to HF membrane in the removal of cytokines in septic patients with AKI. However, a similar effect was not observed for oxidative stress markers.
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