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Ergün B, Esenkaya F, Küçük M, Yakar MN, Uzun Ö, Heybeli C, Hanci V, Ergan B, Cömert B, Gökmen AN. Amikacin-induced acute kidney injury in mechanically ventilated critically ill patients with sepsis. J Chemother 2023; 35:496-504. [PMID: 36469702 DOI: 10.1080/1120009x.2022.2153316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/04/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
In this retrospective cohort study, we aimed to evaluate the incidence, risk factors and outcomes of amikacin-induced acute kidney injury (AKI) in critically ill patients with sepsis. A total of 311 patients were included in the study. Of them, 83 (26.7%) had amikacin-induced AKI. In model 1, the multivariable analysis demonstrated concurrent use of colistin (OR 25.51, 95%CI 6.99-93.05, p< 0.001), presence of septic shock during amikacin treatment (OR 4.22, 95%CI 1.76-10.11, p=0.001), and Charlson Comorbidity Index (OR 1.14, 95%CI 1.02-1.28, p=0.025) as factors independently associated with an increased risk of amikacin-induced AKI. In model 2, the multivariable analysis demonstrated concurrent use of at least one nephrotoxic agent (OR 1.95, 95%CI 1.10-3.45; p=0.022), presence of septic shock during amikacin treatment (OR 3.48, 95%CI 1.61-7.53; p=0.002), and Charlson Comorbidity Index (OR 1.12, 95%CI 1.01-1.26; p=0.037) as factors independently associated with an increased risk of amikacin-induced AKI. In conclusion, before amikacin administration, the risk of AKI should be considered, especially in patients with multiple complicated comorbid diseases, septic shock, and those receiving colistin therapy.
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Affiliation(s)
- Bişar Ergün
- Department of Internal Medicine and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Fethiye Esenkaya
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Murat Küçük
- Department of Internal Medicine and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Mehmet Nuri Yakar
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Özcan Uzun
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Cihan Heybeli
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Volkan Hanci
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Begüm Ergan
- Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Bilgin Cömert
- Department of Internal Medicine and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ali Necati Gökmen
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Ergün B, Küçük M, Nuri Yakar M, Öztürk MC, Bayrak V, Emecen AN, Hancı V, Cömert B, Necati Gökmen A, Ergan B. Clinical Significance of Pleural Lactate Measurement in Critically Ill Patients with Parapneumonic Pleural Effusion. Thorac Res Pract 2023; 24:245-252. [PMID: 37581374 PMCID: PMC10543991 DOI: 10.5152/thoracrespract.2023.23021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/06/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE Pleural fluid pH measurement is recommended for tube thoracostomy decisions in complicated parapneumonic pleural effusions. However, pleural fluid pH may be affected by blood pH in critically ill patients with common systemic acid-base disorders. We aimed to investigate the use of pleural fluid lactate to distinguish culture-positive parapneumonic effusions from other pleural effusions. MATERIAL AND METHODS This prospective observational study included 121 eligible patients (51 female and 70 male). All patients with pleural effusion who underwent thoracentesis were assessed. Pleural fluid lactate was measured by a blood gas analyzer. RESULTS Of the 121 patients, 30 (24.8%) were transudate and 91 (75.2%) were exudate. Of the 91 patients with exudative pleural effusion, 61 were diagnosed as culture-negative parapneumonic, 13 as culture-positive parapneumonic, 9 as malignant, and 8 as other exudative effusion. There was a strong positive linear association between serum pH and pleural fluid pH (R = 0.77, P < .001). The post hoc tests for pleural fluid lactate revealed there was a significant difference between culture-positive parapneumonic versus culture-negative parapneumonic groups (P = .004), culture-positive parapneumonic versus transudative effusion groups (P < .001), culture-negative parapneumonic versus transudative effusion groups (P = .008) and lastly; malignant effusion versus transudative effusion groups (P = .001). Receiver operating characteristics curve analysis for culture-positive parapneumonic indicated a cutoff of 4.55 mmol/L for pleural fluid lactate to have a sensitivity of 76.9% and a specificity of 84.3% (positive predictive value: 37%, negative predictive value: 96.8%). CONCLUSION A cutoff of 4.55 mmol/L of pleural fluid lactate can be used as a useful tool to distinguish culture-positive parapneumonic effusions from other effusions in critically ill patients.
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Affiliation(s)
- Bişar Ergün
- Department of Internal Medicine and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Murat Küçük
- Department of Internal Medicine and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Nuri Yakar
- Department of Anesthesiology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Celal Öztürk
- Department of Anesthesiology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Vecihe Bayrak
- Department of Internal Medicine and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ahmet Naci Emecen
- Department of Public Health, Epidemiology Subsection, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Volkan Hancı
- Department of Anesthesiology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Bilgin Cömert
- Department of Internal Medicine and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ali Necati Gökmen
- Department of Anesthesiology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Begüm Ergan
- Department of Pulmonary and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Ergün B, Yakar MN, Küçük M, Baghiyeva N, Emecen AN, Yaka E, Ergan B, Gökmen AN. Combined Effects of Prone Positioning and Airway Pressure Release Ventilation on Oxygenation in Patients with COVID-19 ARDS. Turk J Anaesthesiol Reanim 2023; 51:188-198. [PMID: 37455436 DOI: 10.4274/tjar.2022.22783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS). Invasive mechanical ventilation (IMV) support and prone positioning are essential treatments for severe COVID-19 ARDS. We aimed to determine the combined effect of prone position and airway pressure release ventilation (APRV) modes on oxygen improvement in mechanically-ventilated patients with COVID-19. Methods This prospective observational study included 40 eligible patients (13 female, 27 male). Of 40 patients, 23 (57.5%) were ventilated with APRV and 17 (42.5%) were ventilated with controlled modes. A prone position was applied when the PaO2/FiO2 ratio <150 mmHg despite IMV in COVID-19 ARDS. The numbers of patients who completed the first, second, and third prone were 40, 25, and 15, respectively. Incident barotrauma events were diagnosed by both clinical findings and radiological images. Results After the second prone, the PaO2/FiO2 ratio of the APRV group was higher compared to the PaO2/FiO2 ratio of the control group [189 (150-237)] vs. 127 (100-146) mmHg, respectively, (P=0.025). Similarly, after the third prone, the PaO2/FiO2 ratio of the APRV group was higher compared to the PaO2/FiO2 ratio of the control group [194 (132-263)] vs. 83 (71-136) mmHg, respectively, (P=0.021). Barotrauma events were detected in 13.0% of the patients in the APRV group and 11.8% of the patients in the control group (P=1000). The 28-day mortality was not different in the APRV group than in the control group (73.9% vs. 70.6%, respectively, P=1000). Conclusion Using the APRV mode during prone positioning improves oxygenation, especially in the second and third prone positions, without increasing the risk of barotrauma. However, no benefit on mortality was detected.
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Affiliation(s)
- Bişar Ergün
- Department of Internal Medicine and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Nuri Yakar
- Department of Anaesthesiology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Murat Küçük
- Department of Internal Medicine and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Narmin Baghiyeva
- Department of Anaesthesiology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ahmet Naci Emecen
- Department of Public Health, Epidemiology Subsection, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Erdem Yaka
- Department of Neurology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Begüm Ergan
- Department of Pulmonary and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ali Necati Gökmen
- Department of Anaesthesiology and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Zhu S, Ergün B, Busch J, Rabien A. MMP-14 implication in immunoregulation of bladder cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00584-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Meriç Çoban M, Nuri Yakar M, Küçük M, Ergün B, Çelik M, Ergan B, Yaka E, Gökmen N. COVID-19 Pneumonia After SARS-CoV-2 Vaccination with CoronaVac: A Case Series from Turkey. Turk Thorac J 2022; 23:185-191. [PMID: 35404251 PMCID: PMC9450107 DOI: 10.5152/turkthoracj.2022.0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coronavirus disease 2019 is a novel viral infection that has caused a pandemic globally. Many kinds of vaccine development studies were conducted to prevent the spread and deaths. The CoronaVac is the most commonly used vaccine in Turkey. Phase 3 trials from various countries revealed that CoronaVac efficacy ranged from 50.7% to 91.25% but increased in moderate or severe cases to 100%. Additionally, it was remarkable owing to high seroconversion rates achieving up to 100%. After the vaccine campaign began in Turkey, critically ill patients continued to admit to our center’s intensive care unit though they had been vaccinated with 2 doses of CoronaVac. The clinical course of these patients revealed that they are still at high risk of severe disease and death. Therefore, we aimed to share these patients’ clinical characteristics and disease course, laboratory, and radiologic data.
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Affiliation(s)
- Mehmet Meriç Çoban
- Department of Internal Medicine, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Mehmet Nuri Yakar
- Division of Intensive Care, Department of Anaesthesiology and Reanimation, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Murat Küçük
- Division of Intensive Care, Department of Internal Medicine, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Bişar Ergün
- Division of Intensive Care, Department of Internal Medicine, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Muammer Çelik
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Begüm Ergan
- Division of Intensive Care, Department of Chest Diseases, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Erdem Yaka
- Division of Intensive Care, Department of Neurology, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Necati Gökmen
- Division of Intensive Care, Department of Anaesthesiology and Reanimation, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
- Corresponding author: Necati Gökmen, e-mail:
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Küçük M, Ergan B, Yakar MN, Ergün B, Akdoğan Y, Cantürk A, Gezer NS, Kalkan F, Yaka E, Cömert B, Gökmen NA. The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019. Balkan Med J 2022; 39:140-147. [PMID: 35330565 PMCID: PMC8941223 DOI: 10.4274/balkanmedj.galenos.2021.2021-7-32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: The prediction of high-flow nasal oxygen (HFNO) failure in patients with coronavirus disease-2019 (COVID-19) having acute respiratory failure (ARF) may prevent delayed intubation and decrease mortality. Aims: To define the related risk factors to HFNO failure and hospital mortality. Study Design: Retrospective cohort study. Methods: To this study, 85 critically ill patients (≥18 years) with COVID-19 related acute kidney injury who were treated with HFNO were enrolled. Treatment success was defined as the de-escalation of the oxygenation support to the conventional oxygen therapies. HFNO therapy failure was determined as the need for invasive mechanical ventilation or death. The patients were divided into HFNO-failure (HFNO-F) and HFNO-success (HFNO-S) groups. Electronic medical records and laboratory data were screened for all patients. Respiratory rate oxygenation (ROX) index on the first hour and chest computed tomography (CT) severity score were calculated. Factors related to HFNO therapy failure and mortality were defined. Results: This study assessed 85 patients (median age 67 years, 69.4% male) who were divided into two groups as HFNO success (n = 33) and HFNO failure (n = 52). The respiratory rate oxygenation (ROX) was measured at 1 hour and the computed tomography (CT) score indicated HFNO failure and intubation, with an area under the receiver operating characteristic of 0.695 for the ROX index and 0.628 for the CT score. A ROX index of <3.81 and a CT score of >15 in the first hour of therapy were the predictors of HFNO failure and intubation. Age, Acute Physiology and Chronic Health Evaluation II score, arterial blood gas findings “(i.e., partial pressure of oxygen [PaO2], PaO2 [fraction of inspired oxygen]/SO2 [oxygen saturation] ratio)”, and D-dimer levels were also associated with HFNO failure; however, based on logistic regression analysis, a calculated ROX on the first hour of therapy of <3.81 (odds ratio [OR] = 4.78, 95% confidence interval [CI] = 1.75–13.02, P = 0.001) and a chest CT score of >15 (OR = 2.83, 95% CI = 1.01–7.88, P = <0.001) were the only independent risk factors. In logistic regression analysis, a ROX calculated on the first hour of therapy of <3.81 (OR = 4.78, [95% CI = 1.75–13.02], P = 0.001) and a chest CT score of >15 (OR 2.83, 95% CI = 1.01–7.88, P = <0.001) were the independent risk factors for the HFNO failure. The intensive care unit and hospital mortality rates were 80.2% and 82.7%, respectively, in the HFNO failure group. Conclusion: The early prediction of HFNO therapy failure is essential considering the high mortality rate in patients with HFNO therapy failure. Using the ROX index and the chest CT severity score combined with the other clinical parameters may reduce mortality. Additionally, multi-centre observational studies are needed to define the predictive value of ROX and chest CT score not only for COVID-19 but also other causes of ARF.
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Ergün B, Ergan B, Yakar MN, Küçük M, Özçelik M, Yaka E, Gökmen AN. Incidence of and risk factors for postintubation hypotension in critically ill patients with COVID-19. Rev Bras Ter Intensiva 2022. [PMID: 35766662 PMCID: PMC9345582 DOI: 10.5935/0103-507x.20220007-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19. Methods: We conducted a retrospective study of 141 patients with COVID-19 who were intubated in the intensive care unit. Postintubation hypotension was defined as the need for any vasopressor dose at any time within the 60 minutes following intubation. Patients with intubation-related cardiac arrest and hypotension before intubation were excluded from the study. Results: Of the 141 included patients, 53 patients (37.5%) had postintubation hypotension, and 43.6% of the patients (n = 17) were female. The median age of the postintubation hypotension group was 75.0 (interquartile range: 67.0 - 84.0). In the multivariate analysis, shock index ≥ 0.90 (OR = 7.76; 95%CI 3.14 - 19.21; p < 0.001), albumin levels < 2.92g/dL (OR = 3.65; 95%CI 1.49 - 8.96; p = 0.005), and procalcitonin levels (OR = 1.07, 95%CI 1.01 - 1.15; p = 0.045) were independent risk factors for postintubation hypotension. Hospital mortality was similar in patients with postintubation hypotension and patients without postintubation hypotension (92.5% versus 85.2%; p = 0.29). Conclusion: The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels < 2.92g/dL were independently associated with postintubation hypotension. Furthermore, a shock index ≥ 0.90 may be a practical tool to predict the increased risk of postintubation hypotension in bedside scenarios before endotracheal intubation. In this study, postintubation hypotension was not associated with increased hospital mortality in COVID-19 patients.
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Affiliation(s)
- Bişar Ergün
- Department of Internal Medicine and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Begüm Ergan
- Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
- Corresponding author: Begüm Ergan Department of Pulmonary and Critical Care Faculty of Medicine, Dokuz Eylül University Cumhuriyet Bulvarı, 144 Alsancak/İzmir 35210 Turkey E-mail:
| | - Mehmet Nuri Yakar
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Murat Küçük
- Department of Internal Medicine and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Murat Özçelik
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Erdem Yaka
- Neurology and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Ali Necati Gökmen
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
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Ergün B, Ergan B, Yakar MN, Küçük M, Özçelik M, Yaka E, Gökmen AN. Incidence of and risk factors for postintubation hypotension in critically ill patients with COVID-19. Rev Bras Ter Intensiva 2022; 34:131-140. [PMID: 35766662 DOI: 10.5935/0103-507x.20220007-pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/04/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19. METHODS We conducted a retrospective study of 141 patients with COVID-19 who were intubated in the intensive care unit. Postintubation hypotension was defined as the need for any vasopressor dose at any time within the 60 minutes following intubation. Patients with intubation-related cardiac arrest and hypotension before intubation were excluded from the study. RESULTS Of the 141 included patients, 53 patients (37.5%) had postintubation hypotension, and 43.6% of the patients (n = 17) were female. The median age of the postintubation hypotension group was 75.0 (interquartile range: 67.0 - 84.0). In the multivariate analysis, shock index ≥ 0.90 (OR = 7.76; 95%CI 3.14 - 19.21; p < 0.001), albumin levels < 2.92g/dL (OR = 3.65; 95%CI 1.49 - 8.96; p = 0.005), and procalcitonin levels (OR = 1.07, 95%CI 1.01 - 1.15; p = 0.045) were independent risk factors for postintubation hypotension. Hospital mortality was similar in patients with postintubation hypotension and patients without postintubation hypotension (92.5% versus 85.2%; p = 0.29). CONCLUSION The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels < 2.92g/dL were independently associated with postintubation hypotension. Furthermore, a shock index ≥ 0.90 may be a practical tool to predict the increased risk of postintubation hypotension in bedside scenarios before endotracheal intubation. In this study, postintubation hypotension was not associated with increased hospital mortality in COVID-19 patients.
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Affiliation(s)
- Bişar Ergün
- Department of Internal Medicine and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Begüm Ergan
- Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Mehmet Nuri Yakar
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Murat Küçük
- Department of Internal Medicine and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Murat Özçelik
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Erdem Yaka
- Neurology and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
| | - Ali Necati Gökmen
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Dokuz Eylül University - Izmir, Turkey
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Yakar MN, Ergan B, Ergün B, Küçük M, Cantürk A, Ergon MC, Gezer NS, Yaka E, Cömert B, Gökmen AN. Clinical characteristics and risk factors for 28-day mortality in critically ill patients with COVID-19: a retrospective cohort study. Turk J Med Sci 2021; 51:2285-2295. [PMID: 34461684 PMCID: PMC8742492 DOI: 10.3906/sag-2104-356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background To date, the coronavirus disease 2019 (COVID-19) caused more than 2.6 million deaths all around the world. Risk factors for mortality remain unclear. The primary aim was to determine the independent risk factors for 28-day mortality. Materials and Methods In this retrospective cohort study, critically ill patients (≥ 18 years) who were admitted to the intensive care unit due to COVID-19 were included. Patient characteristics, laboratory data, radiologic findings, treatments, and complications were analyzed in the study. Results A total of 249 patients (median age 71, 69.1% male) were included in the study. 28-day mortality was 67.9% (n = 169). The median age of deceased patients was 75 (66–81). Of them, 68.6% were male. Cerebrovascular disease, dementia, chronic kidney disease, and malignancy were significantly higher in the deceased group. In the multivariate analysis, sepsis/septic shock (OR, 15.16, 95% CI, 3.96–58.11, p < 0.001), acute kidney injury (OR, 4.73, 95% CI, 1.55–14.46,p = 0.006), acute cardiac injury (OR, 9.76, 95% CI, 1.84–51.83, p = 0.007), and chest CT score higher than 15 (OR, 4.49, 95% CI, 1.51-13.38, p = 0.007) were independent risk factors for 28-day mortality. Conclusion Early detection of the risk factors and the use of chest CT score might improve the outcomes in patients with COVID-19.
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Affiliation(s)
- Mehmet Nuri Yakar
- Department of Anaesthesiology and Reanimation, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Begüm Ergan
- Department of Chest Diseases, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Bişar Ergün
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Murat Küçük
- Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ali Cantürk
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Mahmut Cem Ergon
- Department of Medical Microbiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Naciye Sinem Gezer
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Erdem Yaka
- Department of Neurology, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Bilgin Cömert
- Department of Internal Medicine and Critical Care, Medicana International Hospital, İzmir, Turkey
| | - Ali Necati Gökmen
- Department of Anaesthesiology and Reanimation, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Ergün B, Ergan B, Sözmen MK, Küçük M, Yakar MN, Cömert B, Gökmen AN, Yaka E. New-onset atrial fibrillation in critically ill patients with coronavirus disease 2019 (COVID-19). J Arrhythm 2021; 37:1196-1204. [PMID: 34518774 PMCID: PMC8427018 DOI: 10.1002/joa3.12619] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022] Open
Abstract
Background Mortality in critically ill patients with coronavirus disease 2019 (COVID-19) is high, therefore, it is essential to evaluate the independent effect of new-onset atrial fibrillation (NOAF) on mortality in patients with COVID-19. We aimed to determine the incidence, risk factors, and outcomes of NOAF in a cohort of critically ill patients with COVID-19. Methods We conducted a retrospective study on patients admitted to the intensive care unit (ICU) with a diagnosis of COVID-19. NOAF was defined as atrial fibrillation that was detected after diagnosis of COVID-19 without a prior history. The primary outcome of the study was the effect of NOAF on mortality in critically ill COVID-19 patients. Results NOAF incidence was 14.9% (n = 37), and 78% of patients (n = 29) were men in NOAF positive group. Median age of the NOAF group was 79.0 (interquartile range, 71.5-84.0). Hospital mortality was higher in the NOAF group (87% vs 67%, respectively, P = .019). However, in multivariate analysis, NOAF was not an independent risk factor for hospital mortality (OR 1.42, 95% CI 0.40-5.09, P = .582). Conclusions The incidence of NOAF was 14.9% in critically ill COVID-19 patients. Hospital mortality was higher in the NOAF group. However, NOAF was not an independent risk factor for hospital mortality in patients with COVID-19.
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Affiliation(s)
- Bişar Ergün
- Department of Internal Medicine and Critical CareFaculty of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Begüm Ergan
- Department of Pulmonary and Critical CareFaculty of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Melih Kaan Sözmen
- Department of Public HealthFaculty of MedicineIzmir Katip Celebi UniversityIzmirTurkey
| | - Murat Küçük
- Department of Internal Medicine and Critical CareFaculty of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Mehmet Nuri Yakar
- Department of Anesthesiology and Critical CareFaculty of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Bilgin Cömert
- Department of Internal Medicine and Critical CareFaculty of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Ali Necati Gökmen
- Department of Anesthesiology and Critical CareFaculty of MedicineDokuz Eylül UniversityIzmirTurkey
| | - Erdem Yaka
- Department of Neurology and Critical CareFaculty of MedicineDokuz Eylül UniversityIzmirTurkey
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11
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Abstract
Transplanting a germinal vesicle (GV) to another enucleated oocyte provides a possible way to avoid age-related aneuploidy in metaphase II (MII) oocytes from older women. This study was conducted to examine the efficiency of each step of nuclear transplantation as reflected in the survival and maturation capacity of immature mouse oocytes subjected to this procedure. GV stage oocytes were retrieved from unstimulated ovaries. A GV removed with a small amount of cytoplasm (karyoplast) was transferred subzonally into a previously enucleated oocyte, which was then exposed to direct current to promote fusion. Such reconstituted oocytes were placed in culture to allow maturation, and some that had extruded a first polar body were fixed and processed for chromosome analysis. Each step of nuclear transplantation - survival, enucleation, grafting, and reconstitution - was successful in >90%, with the overall efficiency of reconstitution being 80%. The observation of normal karyotypes confirmed that the procedure did not increase chromosomal aneuploidy. An electrolytic medium, revealed to be superior for the reconstitution procedure, also allowed haploidization of the transplanted nucleus. These findings suggest that this technique can be applied to study the effects of a 'younger' woman's ooplasm on the disjunction of an 'older' woman's chromosomes during meiosis I.
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Affiliation(s)
- T Takeuchi
- The Center for Reproductive Medicine and Infertility, The New York Hospital-Cornell Medical Center, 505 East 70th Street, HT-336, New York, NY 10021, USA
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12
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Wolny YM, Fissore RA, Wu H, Reis MM, Colombero LT, Ergün B, Rosenwaks Z, Palermo GD. Human glucosamine-6-phosphate isomerase, a homologue of hamster oscillin, does not appear to be involved in Ca2+ release in mammalian oocytes. Mol Reprod Dev 1999; 52:277-87. [PMID: 10206659 DOI: 10.1002/(sici)1098-2795(199903)52:3<277::aid-mrd5>3.0.co;2-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Injections of cytosolic preparations from mammalian sperm into oocytes have been shown to trigger calcium [Ca2+]i oscillations and initiate activation of development. Recently, a protein isolated from hamster sperm has been suggested to be involved in the generation of these oscillations and it was named "oscillin." The human homologue of hamster oscillin is glucosamine 6-phosphate isomerase (GPI, EC no. 5.3.1.10), an enzyme so far described to be involved in hexose phosphate metabolism. To assess the role of GPI on Ca2+ signaling, a human recombinant protein was generated in a prokaryotic system and injected into fura-2-dextran-loaded metaphase II (MII) mouse oocytes. Injection of recombinant GPI failed to induce Ca2+ responses in 12/12 injected MII oocytes despite the fact that the recombinant GPI was active as assessed by an enzymatic assay. Injection of buffer (0/6 oocytes) or fructose-6-phosphate, a product of GPI enzymatic reaction (0/5 oocytes), also failed to initiate Ca2+ responses. Conversely, injections of sperm cytosolic factor induced [Ca2+]i oscillations in all 17/17 oocytes. In addition, injection of recombinant GPI or GPI mRNA failed to induce parthenogenetic activation (0/30 oocytes). Immunofluorescence studies using an anti-GPI polyclonal antibody (GK) resulted in localization of GPI to the sperm's equatorial region. Incubation of the GK antibody with sperm extracts failed to block the [Ca2+]i responses induced by these extracts. Moreover, near complete depletion of GPI from sperm fractions by immunoprecipitation did not impair the ability of these fractions to induce [Ca2+]i oscillations. In summary, our results support the role of a sperm cytosolic component(s) in the generation of [Ca2+]i oscillations during mammalian fertilization, although a protein other than GPI/oscillin is likely to be the active calcium releasing factor.
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Affiliation(s)
- Y M Wolny
- The Center for Reproductive Medicine and Infertility, New York Hospital-Cornell Medical Center, New York 10021, USA
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13
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Palermo GD, Schlegel PN, Hariprashad JJ, Ergün B, Mielnik A, Zaninovic N, Veeck LL, Rosenwaks Z. Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod 1999; 14:741-8. [PMID: 10221707 DOI: 10.1093/humrep/14.3.741] [Citation(s) in RCA: 197] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The evident ability of the intracytoplasmic sperm injection (ICSI) procedure to achieve high fertilization and pregnancy rates regardless of semen characteristics has induced its application with spermatozoa surgically retrieved from azoospermic men. Here, ICSI outcome was analysed in 308 cases according to the cause of azoospermia; four additional cycles were with cases of necrozoospermia. All couples were genetically counselled and appropriately screened. Spermatozoa were retrieved by microsurgical epididymal aspiration or from testicular biopsies. Epididymal obstructions were considered congenital (n = 138) or acquired (n = 103), based on the aetiology. Testicular sperm cases were assessed according to the presence (n = 14) or absence (n = 53) of reproductive tract obstruction. The fertilization rate using fresh or cryopreserved epididymal spermatozoa was 72.4% of 911 eggs for acquired obstructions, and 73.1% of 1524 eggs for congenital cases; with clinical pregnancy rates of 48.5% (50/103) and 61.6% (85/138) respectively. Spermatozoa from testicular biopsies fertilized 57.0% of 533 eggs in non-obstructive cases compared to 80.5% of 118 eggs (P = 0.0001) in obstructive azoospermia. The clinical pregnancy rate was 49.1% (26/53) for non-obstructive cases and 57.1% (8/14) for testicular spermatozoa obtained in obstructive azoospermia, including three established with frozen-thawed testicular spermatozoa. In cases of obstructive azoospermia, fertilization and pregnancy rates with epididymal spermatozoa were higher than those achieved using spermatozoa obtained from the testes of men with non-obstructive azoospermia.
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Affiliation(s)
- G D Palermo
- The Center for Reproductive Medicine and Infertility, The New York Hospital-Cornell Medical Center, NY 10021, USA
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