Abstract
Objectives
This study aimed to evaluate the relationship between C-reactive protein/albumin (CRP/Alb), neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR) ratios and the Acute Physiology ...And Chronic Health Evaluation II (APACHE II) score and 28-day mortality among 400 patients admitted to internal medicine and anesthesia reanimation intensive care unit (ICU).
Methods
This prospective study included a total of 400 patients who were admitted to hospital internal medicine and anesthesia reanimation ICUs.
Results
The most common reasons for ICU admission were pneumonia (29.3%), gastrointestinal bleeding (10.3%), acute exacerbation of chronic kidney disease (CKD) (10.3%), and acute kidney injury (7.5%). The comparison of the laboratory findings with survival outcomes revealed that among the patients with acute exacerbation of CKD, the median NLR (p=0.043) and median CRP/Alb (p=0.021) were significantly higher in patients who died. For all of the patients, the APACHE II score was positively correlated with CRP (p<0.001) and CRP/Alb (p<0.001), negatively correlated with Alb (p<0.001), positively correlated with the NLR (p<0.001), and positively correlated with the PLR.
Conclusions
The APACHE II score was significantly correlated with the CRP/Alb ratio, NLR, and PLR. The NLR and CRP/Alb ratio were statistically associated with mortality in patients hospitalized for acute exacerbation of CKD.
Mean platelet volume (MPV) is an indicator of thrombocyte volume and tendency to thrombosis can be mentioned in case of MPV elevation. Cancers are one of the important groups of thrombotic diseases. ...In the present study, MPV value was scrutinized in patients with cancer that developed thrombosis. Totally 43 patients followed in Kayseri Training and Research Hospital, in who thromboembolus has been developed, were prospectively recruited in the study. Thrombocyte, MPV, and platicrit (PCT) values were recorded at the time of cancer diagnosis and thrombosis development. Frequency analysis, crosstabs, and paired samples t test were used. Analyses showed that MPV values at the time of thrombosis development were significantly low as compared to those at the time of cancer diagnosis (P = .041). Thrombocyte count and PCT values were also low but not significant. The result of the present study is likely to show that thrombocytes have ignorable effect on thrombosis development in patients with cancer.
Deep vein thrombosis (DVT) of the lower extremities is the most common form of vascular involvement in Behçet disease (BD), frequently leading to post-thrombotic syndrome (PTS) as a disabling ...complication. We have described the clinical characteristics and predictors of PTS presence among patients with BD and lower extremity DVT. We also used venous Doppler ultrasound (US) examinations in our assessment.
Patients with BD (n = 205; 166 men, 39 women; age 39 ± 9.5 years) and a history of DVT were investigated. The Villalta scale was used to assess the presence and severity of PTS. Doppler US examinations were performed within 1 week of the clinical evaluation. The total number of vessels with reflux, thrombi, recanalization, and collateral vessels were calculated.
Of the 205 patients with BD, 62% had had PTS and 18% had had severe PTS. Patients with PTS had had greater reflux (P = .054) and thrombosis (P = .02) scores compared with patients without PTS. Treatment with anticoagulation (AC), immunosuppressive (IS) therapy, or AC combined with IS drugs did not affect the occurrence of PTS. However, patients treated with IS therapy, with or without AC drugs, had a decreased incidence of severe PTS compared with the AC-only group (P = .017). Patients treated with AC plus IS agents also had increased collateral scores compared with patients treated with only IS drugs. Interferon-α use seemed to provide better recanalization scores compared with azathioprine only (1.0 range, 0-14 vs 2.5 range, 0-10; P = .010).
Patients with BD and DVT have a high risk of developing severe PTS. IS treatment decreases the development of severe PTS. AC therapy might influence the course of PTS by increasing the collateral scores, and the use of interferon-α also increased recanalization scores. Routine assessment with Doppler US examinations could be helpful in the prediction of severe PTS.
This study aimed to compare Tuberculin Skin Test (TST) and QuantiFERON®-TB Gold In-Tube (QFT–GIT) test in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients scheduled for biological and ...targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) in a Bacillus Calmette-Guérin-vaccinated population. Adult RA (
n
= 206) and SpA (
n
= 392) patients from the TReasure database who had both TST and QFT–GIT prior to initiation of biological and targeted synthetic DMARDs were included in the study. Demographic and disease characteristics along with pre-biologic DMARD and steroid use were recorded. The distribution of TST and performance with respect to QFT–GIT were compared between RA and SpA groups. Pre-biologic conventional DMARD and steroid use was higher in the RA group. TST positivity rates were 44.2% in RA and 69.1% in SpA for a 5 mm cutoff (
p
< 0.001). Only 8.9% and 15% of the patients with RA and SpA, respectively, tested positive by QFT–GIT. The two tests poorly agreed in both groups at a TST cutoff of 5 mm and increasing the TST cutoff only slightly increased the agreement. Among age, sex, education and smoking status, pre-biologic steroid and conventional DMARD use, disease group, and QFT–GIT positivity, which were associated with a 5 mm or higher TST, only disease group (SpA) and QFT–GIT positivity remained significant in multiple logistic regression. TST positivity was more pronounced in SpA compared to that in RA and this was not explainable by pre-biologic DMARD and steroid use. The agreement of TST with QFT–GIT was poor in both groups. Using a 5 mm TST cutoff for both diseases could result in overestimating LTBI in SpA.
The risk of thromboemboli is increased in patients with cancer, and this is precipitated by the chemotherapeutic agents. Bevacizumab is an anti-vascular endothelial growth factor monoclonal antibody ...and has an importance in the treatment of metastatic colon cancer. The association between bevacizumab, which is demonstrated to increase the risk of thromboemboli, and mean platelet volume (MPV), which is a marker of thrombocyte function, has been investigated within study. A total of 74 patients with metastatic colon cancer were included in the study and the levels of platelets (PLTs), MPV, and platecrit (PCT) values were recorded in SPSS 16.0 program both at baseline and at the >third month. There were significant decreases in 3 parameters (PLT, MPV, and PCT) during the treatment period with bevacizumab (P = .009, P = .001, and P = .000, respectively). Unlike cases with thrombosis, there is a significant decrease in MPV in combination treatments with bevacizumab.
Cardiovascular disease (CVD) is more prevalent in almost all patients with chronic inflammatory musculoskeletal diseases than in their healthy counterparts. The aim of this study was to assess the ...presence of subclinical atherosclerosis in patients with psoriatic arthritis (PsA) in comparison with patients with rheumatoid arthritis (RA) and healthy controls.
A total of 30 patients with PsA, 30 patients with RA, and 30 healthy controls were enrolled in this parallel group study. Demographic, clinical, and laboratory data of the groups were recorded. The Disease Activity Score-28 tool was used for joint assessment. The erythrocyte sedimentation rate and C-reactive protein level were measured as acute phase reactants. Flow-mediated dilatation (FMD) and carotid intima media thickness (CIMT) were also measured in all participants.
The median duration of disease in patients with PsA was 60 months (range: 8-216 months). A total of 22 of 30 (73.3%) PsA patients had a diagnosis of psoriasis and 13 (48.1%) had active disease. The study groups were similar with regard to age, gender, and body mass index data. In all, 23 (76.7%) of the PsA patients and 5 (16.7%) of the RA patients were using an anti-tumor necrosis factor alpha therapy (p<0.001). The FMD percentage was significantly smaller in both the PsA and the RA patients than in the healthy controls (p<0.001). The median CIMT was greater in the RA patients compared with the PsA patients and the healthy controls (p=0.008). There was no significant difference in FMD or CIMT between patients with and without an active joint lesion.
Endothelial functions were impaired in PsA, as in RA, in the absence of conventional risk factors or overt CVD. This finding may show a potential association between PsA, atherosclerosis, and CVD.
Amaç: Psoriatik artrit (PsA), entezit ve/veya yumuşak doku şişliği tüm psoriazisli hastaların yaklaşık %6-30’unda birlikte görülmektedir. Geri
dönüşü olmayan komplikasyonlar ile giden sakatlayıcı ...ciddi bir komorbidite olması nedeniyle PsA’nın erken tanısı önemlidir.
Gereç ve Yöntem: Mart 2014-Mart 2015 tarihleri arasında Hacettepe Üniversitesi Tıp Fakültesi Dermatoloji Anabilim Dalı Polikliniği’ne başvuran
öncesinde PsA tanısı olmayan plak psoriazisli hastalar çalışmaya dahil edildi. Demografik bilgiler, daha önce alınan tedaviler, laboratuvar parametreler
ve muayene bulguları toplandı. Tüm hastalara aynı hekim tarafından eşlik edebilecek romatolojik şikayetler ile ilgili hazırlanmış beş sorudan oluşan
romatolojik anket uygulandı. En az bir soruya pozitif yanıt veren hastalar aynı merkezin romatoloji bölümüne konsülte edilerek değerlendirildi.
Bulgular: İki yüz yirmi üç hasta çalışmaya dahil edildi, %58’i (n=129) erkek ve %42’si (n=94) kadındı. Hastaların ortalama yaşı 43,46±14,31
yıldı. Ortalama Psoriazis Alan ve Şiddet İndeks skoru 12,66±9,89 idi. Ankette en sık saptanan şikayet istirahatte miyalji/artralji varlığı olarak
hastaların %28’inde (n=62) saptandı. Hastalardan ankette en az bir pozitif yanıtı olan %30’u (n=69) romatoloji bölümüne konsülte edildi, bu
hastaların %24’ü (n=53) romatoloji tarafından değerlendirildi. Bu hastaların %40’ında (n=21) PsA, %6’sında (n=3) sakroiliit, %4’ünde (n=2)
ankilozan spondilit ve bir hastada tanımlanamayan bağ doku hastalığı olmak üzere hastaların %51’i (n=27) hasta romatolojik hastalık tanısı aldı
Sonuç: Dermatoloji hekimlerinin PsA semptomlarından şüphelenme, bu belirtileri sorgulama ve muayene yetilerinin geliştirilmesi erken tanının
sağlanabilmesi için önemlidir. Bu çalışmada psoriazisli hastalarda standart bir romatolojik anket uygulaması ile verimli biçimde PsA tanısının
tahmin edilebileceği sonucuna varılmıştır.
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