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Yuan H, Tian J, Wen L. Meta-analysis of the systemic immune-inflammatory index and in-hospital mortality of COVID-19 patients. Heliyon 2024; 10:e23441. [PMID: 38223728 PMCID: PMC10784146 DOI: 10.1016/j.heliyon.2023.e23441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024] Open
Abstract
Background The potential significance of immunoinflammatory factors in the prognosis of individuals afflicted with coronavirus disease 2019 (COVID-19) is worthy of examination. The systemic immune-inflammatory index (SII), a recently developed immunoinflammatory metric based on the enumeration of neutrophils, platelets, and lymphocytes in blood samples, holds promise for elucidating this relationship. Consequently, in order to explore any possible correlation between the SII levels at admission and the in-hospital mortality of patients with COVID-19, we undertook a thorough systematic review and meta-analysis. Methods In pursuit of accomplishing the aim of this meta-analysis, an extensive search was conducted to seek out pertinent observational studies featuring longitudinal follow-up across PubMed, Cochrane Library, Embase and the Web of Science databases. The I2 statistic was utilized to estimate the extent of heterogeneity and the Cochrane Q test was employed to evaluate heterogeneity between studies. The synthesis of outcomes involved the use of random-effects models, accounting for the possible influence of heterogeneity. Results Our analysis included sixteen studies, encompassing 10,007 hospitalized COVID-19 patients. Among them, 1801 patients (18.0 %) succumbed during hospitalization. The pooled results indicated that a high SII at admission was substantially linked to a higher risk of all-cause mortality (risk ratio [RR]: 2.41, 95 % confidence interval: 1.78 to 3.24, p < 0.001; I2 = 86 %). Meta-regression analysis demonstrated a negative correlation between mean SII at baseline and patient mortality in individual studies (coefficients = -0.00023 and -0.030, p < 0.05), effectively explaining the observed heterogeneity. Furthermore, in patients with lower baseline SII (<1300) and a lower risk of mortality (<20 %), we observed a more pronounced association between high SII levels and the risk of all-cause mortality. Conclusion The results of our study indicate that a high SII upon admission could potentially function as a prognostic indicator for mortality during hospitalization in patients diagnosed with COVID-19, particularly in individuals categorized as low risk.
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Affiliation(s)
- Hao Yuan
- Department of Respiratory and Critical Care Medicine, The Fourth Hospital of Changsha, Changsha, China
| | - Jing Tian
- Department of Respiratory and Critical Care Medicine, The Fourth Hospital of Changsha, Changsha, China
| | - Lu Wen
- Department of Hospital Infection Management, The Fourth Hospital of Changsha, Changsha, China
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Sasak Kuzgun G, Alisir Ecder S, Karaaslan T, Turkel G, Ayalaoglu Z. Predicting Mortality of COVID-19 in Kidney Transplant Recipients With Developed Scores. EXP CLIN TRANSPLANT 2024; 22:148-152. [PMID: 38385388 DOI: 10.6002/ect.mesot2023.o35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES COVID-19 is a recently discovered β-subtype coronavirus infection due to SARS-CoV-2. Approximately 20% of COVID-19 patients have moderate to severe clinical manifestations and 5% progress to critical illness. Kidney transplant patients form a special group. In our study, we aimed to evaluate the success of the COVID-gram score and systemic immuno-inflammation index score in predicting the risk of mortality during hospitalization among kidney transplant patients. MATERIALS AND METHODS Our study included 50 kidney transplant patients with positive real-time reverse transcription polymerase chain reaction COVID-19 tests between March 2020 and March 2021. Risk scores were calculated using baseline clinical data collected retrospectively from the patient cohort. RESULTS The mean age was 54.3 ± 10.2. The mortality rate was 12%. When we compared the COVID-gram and systemic immuno-inflammation index scores between survivors and nonsurvivors, we did not find any difference. CONCLUSIONS Kidney and other solid-organ transplant patients are at greater risk of infection and mortality than other groups. Accurate risk-predicting tools are imperative for managing the COVID-19 pandemic with limited health resources.
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Affiliation(s)
- Gulsah Sasak Kuzgun
- From the Department of Nephrology, Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
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Mangoni AA, Zinellu A. Systemic inflammation index, disease severity, and mortality in patients with COVID-19: a systematic review and meta-analysis. Front Immunol 2023; 14:1212998. [PMID: 37415980 PMCID: PMC10320859 DOI: 10.3389/fimmu.2023.1212998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction An excessive systemic pro-inflammatory state increases the risk of severe disease and mortality in patients with coronavirus disease 2019 (COVID-19). However, there is uncertainty regarding whether specific biomarkers of inflammation can enhance risk stratification in this group. We conducted a systematic review and meta-analysis to investigate an emerging biomarker of systemic inflammation derived from routine hematological parameters, the systemic inflammation index (SII), in COVID-19 patients with different disease severity and survival status. Methods A systematic literature search was conducted in PubMed, Web of Science, and Scopus, between the 1st of December 2019 and the 15th of March 2023. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Grades of Recommendation, Assessment, Development and Evaluation, respectively (PROSPERO registration number: CRD42023420517). Results In 39 studies, patients with a severe disease or non-survivor status had significantly higher SII values on admission compared to patients with a non-severe disease or survivor status (standard mean difference (SMD)=0.91, 95% CI 0.75 to 1.06, p<0.001; moderate certainty of evidence). The SII was also significantly associated with the risk of severe disease or death in 10 studies reporting odds ratios (1.007, 95% CI 1.001 to 1.014, p=0.032; very low certainty of evidence) and in six studies reporting hazard ratios (1.99, 95% CI 1.01 to 3.92, p=0.047; very low certainty of evidence). Pooled sensitivity, specificity, and area under the curve for severe disease or mortality were 0.71 (95% CI 0.67 to 0.75), 0.71 (95% CI 0.64 to 0.77), and 0.77 (95% CI 0.73 to 0.80), respectively. In meta-regression, significant correlations were observed between the SMD and albumin, lactate dehydrogenase, creatinine, and D-dimer. Discussion Our systematic review and meta-analysis has shown that the SII on admission is significantly associated with severe disease and mortality in patients with COVID-19. Therefore, this inflammatory biomarker derived from routine haematological parameters can be helpful for early risk stratification in this group. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023420517.
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Affiliation(s)
- Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Kaya Y, Gülcü O, Aksakal E, Kalkan K, Aydın SŞ, Kaya A, Bostan S. A significant predictor of in-hospital and long-term mortality and progression in COVID-19 patients: The end-stage liver disease (MELD) score model. J Med Virol 2022; 95:e28109. [PMID: 36043339 PMCID: PMC9539042 DOI: 10.1002/jmv.28109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/13/2022] [Accepted: 08/27/2022] [Indexed: 01/11/2023]
Abstract
The aim of this study is to investigate the relationship between the model for end-stage liver disease (MELD) score and disease progression and mortality in COVID-19 patients. The files of 4213 patients over the age of 18 who were hospitalized with the diagnosis of COVID-19 between March 20, 2020 and May 1, 2021 were retrospectively scanned. Sociodemographic characteristics, chronic diseases, hemogram and biochemical parameters at the time they were diagnosed with COVID-19 of the patients, duration of hospitalization, duration of intensive care unit (ICU), duration of intubation, in-hospital mortality from COVID-19 and outside-hospital mortality for another reason (within the last 1 year) and recurrent hospitalization (within the last 1 year) were recorded. The MELD scores of the patients were calculated. Two groups were formed as MELD score < 10 and MELD score ≥ 10. The rate of ICU, in-hospital mortality from COVID-19 and outside-hospital mortality from other causes, intubation rate, and recurrent hospitalization were significantly higher in the MELD ≥ 10 group. The duration of ICU, hospitalization, intubation were significantly higher in the MELD ≥ 10 group (p < 0.001). As a result of Univariate and Multivariate analysis, MELD score was found to be the independent predictors of ICU, in-hospital mortality, intubation, and recurrent hospitalization (p < 0.001). MELD score 18.5 predicted ICU with 99% sensitivity and 100% specificity (area under curve [AUC]: 0.740, 95% confidence interval [CI]: 0.717-0.763, p < 0.001) also MELD score 18.5 predicted in-hospital mortality with 99% sensitivity and 100% specificity (AUC: 0.797, 95% CI: 0.775-0.818, p < 0.001). The MELD score was found to be the independent predictors of in-hospital mortality, ICU admission, and intubation in COVID-19 patients.
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Affiliation(s)
- Yasemin Kaya
- Department of Internal MedicineOrdu University Medical FacultyOrduTurkey
| | - Oktay Gülcü
- Erzurum Regional Training and Research HospitalErzurumTurkey
| | - Emrah Aksakal
- Erzurum Regional Training and Research HospitalErzurumTurkey
| | - Kamuran Kalkan
- Erzurum Regional Training and Research HospitalErzurumTurkey
| | - Sidar Ş. Aydın
- Erzurum Regional Training and Research HospitalErzurumTurkey
| | - Ahmet Kaya
- Department of CardiologyOrdu University Medical FacultyOrduTurkey
| | - Sedat Bostan
- Health Care Management Department, Faculty of Health ScienceKaradeniz Techinical UniversityTrabzonTurkey
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Mosconi G, Fantini M, Righini M, Flachi M, Semprini S, Hu L, Chiappo F, Veterani B, Ambri K, Ferrini F, Milanesi C, Giudicissi A, La Manna G, Rigotti A, Buscaroli A, Sambri V, Cappuccilli M. Efficacy of SARS-CoV-2 Vaccination in Dialysis Patients: Epidemiological Analysis and Evaluation of the Clinical Progress. J Clin Med 2022; 11:jcm11164723. [PMID: 36012962 PMCID: PMC9410204 DOI: 10.3390/jcm11164723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/24/2022] [Accepted: 08/01/2022] [Indexed: 12/16/2022] Open
Abstract
This study investigated the impact of the fourth COVID-19 pandemic wave on dialysis patients of Romagna territory, assessing the associations of vaccination status with infection risk, clinical severity and mortality. From November 2021 to February 2022, an epidemiological search was conducted on 829 patients under dialysis treatment for at least one month. The data were then analyzed with reference to the general population of the same area. A temporal comparison was also carried out with the previous pandemic waves (from March 2020 to October 2021). The epidemiological evolution over time in the dialysis population and in Romagna citizens replicated the global trend, as the peak of the fourth wave corresponded to the time of maximum diffusion of omicron variant (B.1.1.529). Of 771 prevalent dialysis patients at the beginning of the study, 109 (14.1%) contracted SARS-CoV-2 infection during the 4-month observation period. Vaccine adherence in the dialysis population of the reference area was above 95%. Compared to fully or partially vaccinated subjects, the unvaccinated ones showed a significantly higher proportion of infections (12.5% vs. 27.0% p = 0.0341), a more frequent need for hospitalization (22.2% vs. 50.0%) and a 3.3-fold increased mortality risk. These findings confirm the effectiveness of COVID-19 vaccines in keeping infectious risk under control and ameliorating clinical outcomes in immunocompromised patients.
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Affiliation(s)
- Giovanni Mosconi
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
- Correspondence: (G.M.); (F.C.); Tel.: +39-0543-735-312 (G.M.)
| | - Michela Fantini
- Local Healthcare Authority of Romagna (AUSL Romagna), 48121 Ravenna, RA, Italy
| | - Matteo Righini
- Nephrology and Dialysis Unit, AUSL Romagna S. Maria delle Croci Hospital, 48121 Ravenna, RA, Italy
| | - Marta Flachi
- Nephrology and Dialysis Unit, AUSL Romagna Infermi Hospital, 47923 Rimini, RN, Italy
| | - Simona Semprini
- Unit of Microbiology, AUSL Romagna Laboratory, 47023 Pievesestina, FC, Italy
| | - Lilio Hu
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Francesca Chiappo
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
- Correspondence: (G.M.); (F.C.); Tel.: +39-0543-735-312 (G.M.)
| | - Barbara Veterani
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Katia Ambri
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Franca Ferrini
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Catia Milanesi
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Antonio Giudicissi
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40138 Bologna, BO, Italy
| | - Angelo Rigotti
- Nephrology and Dialysis Unit, AUSL Romagna Infermi Hospital, 47923 Rimini, RN, Italy
| | - Andrea Buscaroli
- Nephrology and Dialysis Unit, AUSL Romagna S. Maria delle Croci Hospital, 48121 Ravenna, RA, Italy
| | - Vittorio Sambri
- Unit of Microbiology, AUSL Romagna Laboratory, 47023 Pievesestina, FC, Italy
| | - Maria Cappuccilli
- Nephrology Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40138 Bologna, BO, Italy
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Güneylioğlu MM, Güngör A, Göktuğ A, Üner Ç, Bodur İ, Yaradılmış RM, Öztürk B, Şen ZS, Tuygun N. Evaluation of the efficiency of the systemic immune-inflammation index in differentiating parapneumonic effusion from empyema. Pediatr Pulmonol 2022; 57:1625-1630. [PMID: 35420252 DOI: 10.1002/ppul.25926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/10/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
AIM To evaluate the effectiveness of the systemic immune-inflammation index (SII) and other biomarkers in distinguishing parapneumonic effusion (PPE) and empyema. METHODS Patients who were thought to have pleural effusion secondary to pneumonia in the pediatric emergency department (PED) between 2004 and 2021 were retrospectively evaluated. The patients were divided into two groups as empyema and PPE. The efficacy of infection markers in predicting empyema was compared. RESULTS Fifty-nine patients (59.3% male) were included in the study. Forty-three (72.9%) patients were in the PPE and 16 (27.1%) were in the empyema group. Length of hospital stay and pleural fluid thickness measured with thoracic ultrasonography were significantly higher in the empyema group (p = 0.018 and p = 0.002, respectively). The mean SII was 1902.73 ± 1588.87 in PPE patients, while it was 6899.98 ± 6678 in empyema patients (p = 0.009). C-reactive protein (CRP), white blood cell (WBC) count, absolute neutrophil count (ANC), and neutrophil-lymphocyte ratio (NLR) were significantly higher in the empyema group; absolute lymphocyte count (ALC) and lymphocyte-monocytes ratio (LMR) were significantly lower than the PPE group. When the best cut-off values of inflammation markers are determined according to the area under the curve, the highest odds ratios suggesting empyema were found in SII, LMR, CRP, and ANC, respectively. CONCLUSION Inflammation markers can be useful in predicting empyema. The best markers were found to be SII, LMR, CRP, and ANC. High SII is one of the practical diagnostic markers that can be used differentiate empyema from PPE in PED.
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Affiliation(s)
- Muhammed M Güneylioğlu
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ali Güngör
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aytaç Göktuğ
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Çiğdem Üner
- Department of Pediatric Radiology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - İlknur Bodur
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Raziye M Yaradılmış
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Betül Öztürk
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Zeynep S Şen
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nilden Tuygun
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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Oguz EG, Yeter HH, Akcay OF, Besli S, Selen T, Derici U, Sencan I, Ayli MD. Predictive value of neutrophil-to-lymphocyte ratio in terms of need for intensive care unit and mortality in maintenance hemodialysis patients with COVID-19. Hemodial Int 2022; 26:377-385. [PMID: 35001488 DOI: 10.1111/hdi.13001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The transmission risk of Severe Acute Respiratory Syndrome Coronavirus-2 virus infection is increased in maintenance hemodialysis (MHD) patients, and also the disease causes much higher mortality than the normal population. The aim of this study is to define the predictive value of neutrophil-to-lymphocyte ratio (NLR) in terms of worse outcomes in MHD patients. METHODS A total of 123 MHD patients who had received inpatient care due to COVID-19 infection were included in this multicentered retrospective study. Receiver operating curve analysis were plotted to illustrate C reactive protein (C-rp), systemic inflammatory index (SII) and NLR best cut-off values for estimation of need for intensive care unit (ICU) and mortality. Multivariate regression analysis and Cox proportional hazard models were constructed to determine the association between C-rp, SII and NLR and mortality. RESULTS Twenty-eight (23%) patients with MHD were dead due to COVID-19. Nonsurvivor patients was significantly older than the survivors (p < 0.001) and also had higher rates of diabetes mellitus (p = 0.01) and coronary artery disease (p = 0.02). Cox regression analysis revealed that NLR >5.17 significantly associated with mortality [HR: 6.508, p < 0.001]. Similarly, SII > 726 [HR: 3.124, p = 0.006] and C-rp > 88 [HR: 4.590, p = 0.002] were significantly associated with mortality due to COVID-19 in hospitalized MHD patients. Multivarite logistic regression analysis showed that age older than 60 years, higher ferritin, and NLR > 5.17 were independent factors associated with mortality. CONCLUSION NLR had favorable predictive value than the C-rp and SII in terms of need for ICU and mortality in MHD patients. Determining the poor prognosis with simple and easily applicable markers may reduce mortality in these patients with early supportive treatments.
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Affiliation(s)
- Ebru Gok Oguz
- Department of Nephrology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Haci Hasan Yeter
- Department of Nephrology, Sivas Numune State Hospital, Sivas, Turkey
| | - Omer Faruk Akcay
- Faculty of Medicine, Department of Nephrology, Gazi University, Ankara, Turkey
| | - Sevval Besli
- Department of Nephrology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tamer Selen
- Department of Nephrology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ulver Derici
- Faculty of Medicine, Department of Nephrology, Gazi University, Ankara, Turkey
| | - Irfan Sencan
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Deniz Ayli
- Department of Nephrology, Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
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