Evaluation of systemic immune-inflammation index for predicting severity of lower extremity arterial disease

OBJECTIVE

Predictive value of systemic immune-inflammation index (SII) has been shown in clinical outcomes and complexity of coronary artery disease, acute coronary syndrome, and heart failure. We sight to evaluate value of SII in patients with lower extremity arterial disease (LEAD).

METHODS

A total of 271 patients diagnosed with LEAD were included to our study. Blood samples of the patients were collected and analyzed for biochemical variables and complete blood count parameters. SII value of each patient was calculated. The complexity of atherosclerotic disease was classified according to Trans-Atlantic Inter-Society Consensus (TASC II) classification.

RESULTS

Patients with TASC C-D were older than patients in TASC A-B group (63.06 ± 9.24 years and 60.85 ± 8.75 years, respectively). Other co-morbidities were comparable in both groups. Hemoglobin level and lymphocyte count were significantly lower, neutrophil, platelet counts, and SII values were significantly higher in patients with TASC C-D disease compared to that of patients with TASC A-B disease. SII showed significant correlation with the severity of LEAD (r = 0.363, p < .001). SII value of 664.24 predicted TASC C-D disease with a sensitivity and specificity of 60.8% and 73.3%, respectively. Results of multivariate logistic regression analysis showed that SII had higher odds ratio compared to platelet, neutrophil, and lymphocyte counts.

CONCLUSION

Higher SII may indicate probability of more complex LEAD. This relationship seems plausible in terms of similar pathophysiology of coronary artery disease and peripheral artery disease.

Enhanced Stent Imaging System Guided Percutaneous Coronary Intervention Is Linked to Optimize Stent Placement

Stent under-expansion is a predictor of restenosis and stent thrombosis. It remains uncertain whether enhanced stent imaging (ESI) (CLEARstent) guidance can improve stent under-expansion. Our aim was to assess the effect of using ESI on stent under-expansion, after percutaneous coronary intervention (PCI) in a single center, cross-sectional observational study. Participants attending our cardiology clinic with stable angina or acute coronary syndrome, from March to September 2020 were recruited. A total of 164 patients who underwent post-PCI ESI (CLEARstent) were compared with 77 age- and sex-matched control patients. Post-procedural minimal lumen diameter (MLD) was calculated. The patients in the ESI-guided PCI group, had a median age of 61 (54-69 IQR 25-75) years and 76.8% (n = 126) were males. The patients in ESI-guided PCI group had a greater minimal lumen diameter compared with the X-ray guided PCI group (βeta coefficient:2.88 (95% CI:2.58-2.99) vs βeta coefficient 2.55 (95% CI 2.34-2.63), P < .001). Our finding supports the use of the ESI system to optimize stent placement as expressed by the MLD.

Adrenocortical System Hormones in Non-Critically Ill COVID-19 Patients

Context

The effects of COVID-19 on the adrenocortical system and its hormones are not well known.

Objectives

We studied serum cortisol, serum adrenocorticotropic hormone (ACTH), and their ratio in hospitalized non-critically ill COVID-19 patients.

Design

A prospective case-control study.

Methods

The study participants were divided into 2 groups. Group 1 consisted of 74 COVID-19 patients. The second group consisted of 33 healthy persons. Early admission above hormones levels was determined and compared between the study groups. Besides that, COVID-19 patients were grouped according to their Glasgow Coma Score (GCS), CURB-65 score, and intensive care unit (ICU) requirement, and further sub-analyses were performed.

Results

There were no significant differences in the mean age or gender distribution in both groups. In the patients' group, the serum ACTH concentration was lower than in the healthy group (p<0.05). On the other hand, the serum cortisol levels and cortisol/ACTH ratio of the patients' group were significantly higher than of the healthy controls (p<0.05, all). Further analyses showed that, although serum cortisol and ACTH levels were not high, the cortisol/ACTH ratio was higher in COVID-19 patients with low GCS (<15) than patients with normal GCS (=15) (p<0.05). In COVID-19 in patients with different CURB-65 scores, the cortisol/ACTH ratio was significantly different (p<0.05), while serum cortisol and ACTH were not different in groups (p>0.05). Serum cortisol levels and cortisol/ACTH ratio were higher but ACTH level was lower in the ICU needed COVID-19 patients than in patients who do not need ICU (p<0.05).

Conclusion

Our pilot study results showed that the cortisol/ACTH ratio would be more useful than serum cortisol and/or ACTH levels alone in evaluating the adrenocortical system of COVID-19 patients. Still, further detailed studies are needed to confirm these.

Estimated Glomerular Filtration Rate as a Predictor of Restenosis After Carotid Stenting Using First-Generation Stents

This study evaluated the impact of the baseline estimated glomerular filtration rate (eGFR) on clinical and angiographic outcomes and long-term in-stent restenosis (ISR) rates in patients undergoing elective carotid artery stenting (CAS) procedures. Consecutive patients who underwent CAS were retrospectively enrolled (n = 456). At the end of 3 years of follow-up, patients who had died or were lost follow-up were excluded from the study and a final analysis was performed using data from the remaining 405 patients. The study population (n = 405) was divided into 3 tertiles based on the tertile values of the eGFR level (T1, T2, and T3); then, clinical and procedural characteristics and 3-year ISR rates were compared between the groups. An ISR of 50% was detected in 49 (12%) surviving patients. The 3-year ISR was higher among patients with the lowest eGFR values (T1) by 3.7 times (95% CI: 2.01-11.38) than that among patients with the highest eGFR values (T3). These significant relationships persisted following adjustment for confounders. A lower baseline eGFR level was significantly associated with an increased ISR rate. Decreased renal function may be a predictor of ISR after CAS using first-generation stents.

The association between neutrophil-to-lymphocyte ratio and contrast-induced acute kidney injury in patients with carotid artery stenting

OBJECTIVES

Contrast-induced acute kidney injury (CI-AKI) is a life-threatening complication that leads to comorbidities and prolonged hospital stay lengths in the setting of peripheral interventions. The presence of some CI-AKI risk factors has already been investigated. In this study, we evaluated the predictors of CI-AKI after carotid artery stenting.

METHODS

A total of 389 patients with 50% to 99% carotid artery stenosis who underwent carotid artery stenting were included in this study. Patients were grouped according to CI-AKI status.

RESULTS

CI-AKI developed in 26 (6.6%) patients. Age, baseline creatinine level, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were higher and estimated glomerular filtration rate, haemoglobin and lymphocyte count were lower in CI-AKI patients. In the multivariate regression analysis, the neutrophil-to-lymphocyte ratio triggered a 1.39- to 2.63-fold increase in the risk of CI-AKI onset (p < 0.001).

CONCLUSIONS

The neutrophil-to-lymphocyte ratio may be a significant predictor of CI-AKI in patients with carotid artery stenting and higher neutrophil-to-lymphocyte ratio values may be independently associated with CI-AKI.

The association of preprocedural C-reactive protein/albumin ratio with in-stent restenosis in patients undergoing iliac artery stenting

Introduction: In-stent restenosis (ISR) still constitutes a major problem after percutaneous vascular interventions and the inflammation has a pivotal role in the pathogenesis of such event. The C-reactive protein/albumin ratio (CAR) is a newly identified inflammatory biomarker, and it may be used as an indicator to predict ISR in subjects with coronary artery stenting. In light of these data, our main objective was to investigate the relationship between the preprocedural CAR and ISR in patients undergoing successful iliac artery stent implantation.

Methods: In total, 138 consecutive patients who had successful iliac artery stent implantation in a tertiary heart center between 2015 and 2018 were enrolled in the study. The study population was categorized into two groups; patients with ISR and those without ISR during follow-up. The CAR was determined by dividing CRP by serum albumin.

Results: In the multivariable regression analysis; the CAR (HR: 2.66, 95% CI: 1.66-4.25, P < 0.01), stent length (HR: 1.01, 95% CI: 0.99-1.02, P = 0.04), and HbA1c levels (HR: 1.22, 95% CI: 0.99-1.51, P = 0.04) were independently related with ISR. A receiver operating curve analysis displayed that the CAR value of >0.29 predicted ISR with sensitivity of 97.5% and specificity of 88.8% (AUC 0.94, P < 0.01).

Conclusion: Our findings provide evidence that the CAR may be an applicable inflammatory biomarker in predicting ISR in subjects undergoing iliac artery stenting for the treatment of peripheral artery disease (PAD). Also, the stent length and poor glycemic control were found to be associated with ISR.

Could hematologic parameters be useful biomarkers for the diagnosis of endometriosis?

OBJECTIVES

The objective of this study was to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte‑to‑monocyte ratio (LMR), and mean platelet volume (MPV) in patients with endometriosis as compared with healthy controls.

BACKGROUND

Currently, no non-invasive diagnostic test of endometriosis has been implemented in clinical practice.

METHODS

A total of 121 women with endometriosis and 136 controls participated in this retrospective study. The extent of the disease in the patients with endometriosis was determined using the American Society of Reproductive Medicine revised classification. Sensitivities and specificities of NLR, LMR and MPV were evaluated by receiver-operating characteristic (ROC) analysis.

RESULTS

Patients with endometriosis had higher neutrophil counts, white blood cell (WBC) levels, NLR, MPV, and lower lymphocyte count and LMR than the control group. The cut-off values were found to be 1.6 for NLR at 87.6 % sensitivity and 44.8 % specificity and 8 for MPV at 75.2 % sensitivity and 68.4 % specficity. For LMR, the cut-off value was 5.6 with 66.1 % sensitivity, 50 % specificity. Patients with stages III or IV had significantly lower MPV (p = 0.039) and LMR levels (p = 0.016) than patients with stages I or II.

CONCLUSION

NLR, LMR, and MPV may be used to distinguish patients with endometriosis from controls (Tab. 4, Fig. 4, Ref. 37).

A Rare Cause of Angina After Coronary Bypass Grafting; Left İnternal Mammary Artery to Pulmonary Artery Fistula and Successful Treatment with Transcatheter Coil Embolization

Fistula from left internal mammary artery (LIMA) to pulmonary artery (PA) is rarely encountered in daily practice. In recent years, endovascular therapy options have emerged for the treatment of fistula formations and replaced with surgery. A 53-year-old man admitted to our outpatient clinic with symptoms of typical angina and shortness of breath despite optimal medical therapy. In his relevant history, he had a coronary artery bypass graft (CABG) operation in 2009 in which his LIMA was anastomosed to left anterior descending (LAD) and ramus artery sequentially. Coronary angiography including selective imaging of LIMA demonstrated a fistula formation originating from the proximal portion of the LIMA and draining to PA. After successful closure of fistula with transcatheter coil embolization, the patient was discharged without any complication and symptom. In conclusion, although LIMA to PA fistula is an infrequent clinical condition, it should be considered as a potential cause of persistent angina after CABG operation. Treatment options include conservative medical therapy, surgical ligation and endovascular interventions. The best therapy should be individualised for each patient in respect to patient's symptoms, surgical compatibility and anatomy of fistula.

Outcomes of survivors of ST-segment elevation myocardial infarction complicated by out-of-hospital cardiac arrest: a single-center surveillance study

OBJECTIVE

The aim of the present study was to evaluate in-hospital and long-term outcomes of ST-segment elevation myocardial infarction (STEMI) survivors who experienced out-of-hospital cardiac arrest (OHCA) and underwent primary percutaneous coronary intervention (PCI) at a high-volume center within the STEMI network.

METHODS

The records of 2681 consecutive STEMI patients who underwent primary PCI between January 2009 and December 2014 at a single center in the STEMI network were retrospectively analyzed. Patients with STEMI complicated by OHCA were compared with a reference group of STEMI patients who did not experience OHCA.

RESULTS

Compared with STEMI survivors without OHCA (n=2587, 96.5%), the frequency of anterior myocardial infarction, duration of hospitalization, rate of in-hospital major adverse cardiovascular and cerebrovascular events, and the incidence of ischemic cerebrovascular disease and major bleeding during in-hospital follow-up were significantly greater in those with OHCA (n=94, 3.5%). The distribution of age and gender was similar between the 2 groups. The primary PCI success rate was high and was similar in both groups. In-hospital mortality was significantly higher (18.1% vs. 1.5%; p<0.001) and survival at the 12th and 60th months was lower (74.5% vs. 96.5%; p<0.001 and 71.3% vs. 93.7%; p<0.001) in STEMI survivors with OHCA. OHCA was an independent predictor for in-hospital mortality (Odds ratio [OR]: 3.413; 95% confidence interval [CI]: 1.534-7.597; p=0.003) and all-cause mortality at 60 months (OR: 3.285; 95% CI: 2.020-5.340; p<0.001).

CONCLUSION

Mortality was high in patients with STEMI complicated by OHCA, even though PCI was performed with the same success rate seen in patients without OHCA.

Renal function in patients with mechanical prosthetic valves : Long-term effects of anticoagulation and over-anticoagulation with warfarin

BACKGROUND

Warfarin-related nephropathy (WRN) is a complication of warfarin over-anticoagulation that is associated with acute and/or chronic renal dysfunction and increased mortality. The long-term effects of warfarin on renal function has not been adequately studied in patients with a mechanical prosthetic valve (MPV).

AIM

To study the time-dependent effects of over-anticoagulation on renal function in patients with a MPV.

METHODS

A total of 193 patients who underwent MPV implantation and were followed up in this study were eligible for inclusion. Time above therapeutic international normalized ratio (INR) range (TATR) was calculated by dividing the number of INR measurements above target in a year by the total number of INR measurements within a year. Patients were divided into quartiles according to average TATR at 60 months.

RESULTS

At 60 months more patients within the 4th quartile had a ≥20% reduction in the estimated glomerular filtration rate (eGFR, 25.0%, p = 0.04) and chronic kidney disease (CKD, 33.0%, p = 0.07) compared to patients within the 1st quartile. High TATR remained a significant determinant for reduction in eGFR (odds ratio OR: 7.50, 95% confidence interval CI:1.55-36.32) and CKD (OR:5.15, 95% CI: 1.26-20.62) after adjusting for other variables. Longitudinal analysis revealed that the change in eGFR was related to the duration of warfarin use (p < 0.001) and the interaction between the duration of warfarin use and TATR (p = 0.03). Similar findings were observed in patients without CKD at baseline, but not in those with CKD before the index operation.

CONCLUSION

Anticoagulation over targeted INR values is associated with a steeper decline in eGFR and an increased frequency of CKD in patients with a MPV.

Ureterorenoscopy with stenting and its effect on male sexual function: A controlled randomised prospective study

Seventy-two male patients, who were included in this study, underwent ureteroscopic stone surgery (study group). Forty-two healthy males were enrolled as control group. Changes in sexual function were evaluated using International Index of Erectile Function questionnaire in pre-operative, first and third postoperative terms. Overall satisfaction in relation to the age, operation time, presence of stents, body mass index, educational status, previous operations, International Index of Erectile Function score, International Prostate Symptom Score, Quality of Life, income status, Male Sexual Health Questionnaire, stone-free rates and Beck's depression scale were evaluated. Erectile and ejaculatory functions, quality of life and lower urinary tract symptoms were negatively affected due to ureteroscopic stone surgery, while educational status, psychogenic aspect and income status remained stable. In conclusion, ureteroscopic stone surgery with JJ catheterisation seems to have a progressively decreasing negative effect on male sexual function and whenever possible, stenting should be avoided. If JJ stenting is necessary, patients should be informed that they may experience sexual dysfunction at least for 3 months and if stenting proves necessary the indwelling should be kept as short as possible.

Platelet-to-Lymphocyte Ratio Predicts Contrast-Induced Acute Kidney Injury in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

We aimed to investigate the relationship between platelet-to-lymphocyte ratio (PLR) and contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). A total of 2563 patients diagnosed with STEMI and underwent primary pPCI were retrospectively included in the study. Levels of PLR and creatinine were measured before and at 72 hours after pPCI. Patients were divided into 2 groups: non-CI-AKI group and CI-AKI group. Contrast-induced acute kidney injury occurred in 6.4% of the overall study population. Patients in the CI-AKI group had significantly higher PLR than those in the non-CI-AKI group (169.18 ± 81.01 vs 149.49 ± 74.54, P < .001). In logistic regression analysis, PLR was an independent predictor of CI-AKI (odds ratio [OR]: 1.774, 95% CI: 1.243-2.532, P = .002), along with age, use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prior to the procedure, preprocedural creatinine level, amount of contrast material used during the procedure, and hypertension. Increased PLR levels are independently associated with a greater risk of CI-AKI in patients undergoing primary PCI for STEMI.

[Primitive neuroendocrine/ectodermal kidney tumor]

PNET of the kidney are rare, aggressive tumors that occur mainly in adolescents. The diagnosis of PNET is difficult, but is possible with pathognomonic radiological findings. Since a radical nephrectomy is generally not sufficient for PNET of the kidney, early diagnosis and treatment is essential for successful recovery.

Assessment of Short-term Blood Pressure Variability in Patients With Ascending Aortic Dilatation

BACKGROUND

Blood pressure variability (BPV) is a novel parameter related to adverse cardiovascular findings and events, especially in hypertensive patients. The aim of the present study was to investigate the relationship between short-term BPV and ascending aortic dilatation (AAD).

HYPOTHESIS

Hypertensive patients with AAD may exhibit higher short-term BPV compared to hypertensive patients with normal diameter ascending aorta and BPV may be correlated with aortic sizes.

METHODS

Seventy-six hypertensive patients with AAD and 181 hypertensive patients with a normal-diameter ascending aorta were retrospectively enrolled in the study. Clinical data, echocardiographic characteristics, and 24-hour ambulatory blood pressure monitoring characteristics were compared between the 2 groups. Standard deviation (SD) and Δ of BP were used as parameters of BPV.

RESULTS

Although 24-hour mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were similar between the 2 groups, the SD of SBP and SD of DBP values were significantly higher in AAD patients (17.2 ± 6.8 vs 13.8 ± 3.5, P < 0.01; and 12.1 ± 5.1 vs 10.7 ± 3.1, P = 0.02, respectively). Daytime SD of SBP values were higher in AAD patients, whereas nighttime SD of SBP values did not differ between groups. In multivariate linear regression analysis, 24-hour SD of SBP, 24-hour Δ SBP, daytime SD of SBP, daytime Δ SBP, and left ventricular mass index were independently correlated with aortic size index.

CONCLUSIONS

Our study revealed higher levels of short-term BPV in hypertensive patients with AAD. This conclusion warrants further study.