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    Can red blood cell distribution width (RDW) level predict the severity of acute exacerbation of chronic obstructive pulmonary disease (AECOPD)?
    (Wiley-Hindawi, 2021) Alparslan Bekir, Sumeyye; Tuncay, Eylem; Gungor, Sinem; Yalcinsoy, Murat; Sogukpinar, Ozlem; Gundogus, Baran; Aksoy, Emine
    Background Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung pulmonary diseases (COPD). There are limited data about RDW levels in acute exacerbation of COPD (AECOPD). Aim/Objective The association of the RDW levels with the severity of AECOPD was evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU)). Methods Cross sectional retrospective study was designed in tertiary care hospital for chest diseases in 2015. Previously COPD diagnosed patients admitted to hospital outpatient-clinic, ward and ICU due to AECOPD were included in the study. Patients demographics, RDW, biomarkers (CRP, RDW, Neutrophil to lymphocyte ratio (NLR), platelet to mean platelet volume (PLT-MPV)) C-CRP, biochemistry values were recorded from hospital electronic system. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11%-0.15% (normal). Neutrophil to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Biomarker values were compared according to where AECOPD was treated. Results 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RDW values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (P < .001). In outpatient to ward and ICU, low RDW values were significantly increased (31%, 66%, 83%, respectively) and high RDW values significantly decreased (54%, 24%, 10%) (P < .001). According to attack severity, low RDW values were determined. Conclusion Patients with AECOPD, lower RDW values should be considered carefully. Lower RDW can be used for decision of COPD exacerbation severity and follow up treatment response
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    Delays in diagnosis in patients with pulmonary and extrapulmonary sarcoidosis
    (2019) Tuncay Acarturk, Eylem; Yalcinsoy, Murat; Gungor, Sinem; Selcuk, Engin Burak; Tokgoz Akyil, Fatma; Yavuz, Dilek; Sucu, Pakize; Alpaslan Bekir, Sumeyye; Ocaklı, Birsen; Aksoy, Emine
    Abstract: Aim: Sarcoidosis is a multisystemic disease with typical or atypical pulmonary and extra-pulmonary symptoms or frequently withoutsymptoms. Presence of typical clinical findings and symptoms contribute to rapid diagnosis, whereas asymptomatic progressionleads to delays in the diagnosis. The aim of this study was to investigate the delay in diagnosis in between patients with pulmonaryand/or extra-pulmonary involvement and related symptoms and those without symptoms.Material and Methods: Patients in the sarcoidosis clinics between 2010-2015, were retrospectively evaluated. The cases weregrouped according to the presence or absence of symptoms (pulmonary and/or extra-pulmonary). The groups were compared withregard to the delay in diagnosis.Results: Among the 300 patients, 209 (69%) were female. The mean age was 43±11.68. The disease was stage I in 67.3%, stage IIin 23.7%, stage III in 5.7% and stage 0 in 3.3% of the patients. No significant difference was observed between symptomatic andasymptomatic patients with regard to total duration until diagnosis (p=0.78). A statistically significant difference was observedbetween patients groups with regard to physician-related delayed diagnosis(p=0.026). The mean delay in physician-relateddiagnosis was observed to be longer in asymptomatic cases (21.44 days) compared to patients with pulmonary symptoms (13.66days)(p=0.036). In asymptomatic cases, the mean duration of physician-related delayed diagnosis (21.44 days) was observed to belonger in comparison with patients with extra-pulmonary symptoms (12.79 days)(p=0.016). In patient-related delayed diagnosis, nodifference was observed between groups with regard to the duration until diagnosis(p=0.78).Conclusion: Comparison of delayed diagnosis between patients with or without pulmonary and/or extra-pulmonary symptomsrevealed a longer duration of delay in asymptomatic cases compared to symptomatic cases. The timing of diagnosis is veryimportant in sarcoidosis in order to reduce morbidity and mortality; a suspicious approach to asymptomatic patients will increasethe possibility of diagnosis and prevent delayed diagnosis.
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    Delays in diagnosis in patients with pulmonary and extrapulmonary sarcoidosis
    (2019) Acarturk Tuncay, Eylem; Yalcinsoy, Murat; Gungor, Sinem; Selcuk, Engin Burak; Tokgoz Akyil, Fatma; Yavuz, Dilek; Sucu, Pakize; Alpaslan Bekir, Sumeyye; Ocakli, Birsen; Aksoy, Emine
    Aim: Sarcoidosis is a multisystemic disease with typical or atypical pulmonary and extra-pulmonary symptoms or frequently without symptoms. Presence of typical clinical findings and symptoms contribute to rapid diagnosis, whereas asymptomatic progression leads to delays in the diagnosis. The aim of this study was to investigate the delay in diagnosis in between patients with pulmonary and/or extra-pulmonary involvement and related symptoms and those without symptoms. Material and Methods: Patients in the sarcoidosis clinics between 2010-2015, were retrospectively evaluated. The cases were grouped according to the presence or absence of symptoms (pulmonary and/or extra-pulmonary). The groups were compared with regard to the delay in diagnosis. Results: Among the 300 patients, 209 (69%) were female. The mean age was 43±11.68. The disease was stage I in 67.3%, stage II in 23.7%, stage III in 5.7% and stage 0 in 3.3% of the patients. No significant difference was observed between symptomatic and asymptomatic patients with regard to total duration until diagnosis (p=0.78). A statistically significant difference was observed between patients groups with regard to physician-related delayed diagnosis(p=0.026). The mean delay in physician-related diagnosis was observed to be longer in asymptomatic cases (21.44 days) compared to patients with pulmonary symptoms (13.66 days)(p=0.036). In asymptomatic cases, the mean duration of physician-related delayed diagnosis (21.44 days) was observed to be longer in comparison with patients with extra-pulmonary symptoms (12.79 days)(p=0.016). In patient-related delayed diagnosis, no difference was observed between groups with regard to the duration until diagnosis(p=0.78). Conclusion: Comparison of delayed diagnosis between patients with or without pulmonary and/or extra-pulmonary symptoms revealed a longer duration of delay in asymptomatic cases compared to symptomatic cases. The timing of diagnosis is very important in sarcoidosis in order to reduce morbidity and mortality; a suspicious approach to asymptomatic patients will increase the possibility of diagnosis and prevent delayed diagnosis.Keywords: Sarcoidosis; diagnosis; delay; extrapulmonary symptoms.
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    A Revised Treatment Approach for Hospitalized Patients with Eosinophilic and Neutrophilic Exacerbations of Chronic Obstructive Pulmonary Disease
    (Bilimsel Tip Publishing House, 2018) Aksoy, Emine; Gungor, Sinem; Agca, Meltem Coban; Ozmen, Ipek; Duman, Dildar; Kocak, Nagihan Durmus; Akturk, Ulku Aka
    OBJECTIVES: The choice of treatment according to the inflammation type in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been of recent interest. This study investigated the role of novel biomarkers, hospital outcomes, and readmission rates in the first month in patients with eosinophilic or neutrophilic AECOPD. MATERIALS AND METHODS: We conducted a retrospective observational cohort study in a Chest Teaching Hospital with hospitalized AECOPD patients. Subjects' characteristics, hemogram results, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR), platelet/mean platelet volume (PLT/MPV), length of hospital stay, mortality, and steroid use were recorded. Eosinophilic AECOPD defined as peripheral blood eosinophilia (PBE) was >2% and neutrophilic AECOPD as PBE Q%. Readmission within 28 days of discharge was recorded. RESULTS: Of 2727(31.5% females) patients, eosinophilic AECOPD was found in 510 (18.7%) patients. Leucocytes, CRF,' NLR, and PLR were significantly higher in neutrophilic AECOPD than in eosinophilic AECOPD (p<0.001). Steroid use and mortality rate were 45% and 0.6% in eosinophilic AECOPD and 71%, and 1.4% in neutrophilic AECOPD, respectively (p=0.001, p=0.19). Age >75 years, albumin <2.5 g/dL, CRP >50 mg/dL, and PLT/MPV <20x103 were found to be risks factors for hospital mortality (p<0.05 each). Readmission rates within 28 days of discharge were 5% (n=136), and this rate was higher in eosinophilic AECOPD patients not taking steroids (p<0.001). CONCLUSION: NLR, PLR, and CRP levels were higher in neutrophilic AECOPD compared with eosinophilic AECOPD. These markers decreased with treatment in neutrophilic AECOPD. A PLT/MPV ratio of <20x103 resulted in an increased mortality rate. Thus, appropriate steroid therapy may reduce readmission rates in the first 28 days after discharge in eosinophilic AECOPD.
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    A revised treatment approach for hospitalized patients with eosinophilic and neutrophilicexacerbations of chronic obstructive pulmonary disease
    (Bılımsel tıp publıshıng house, bukres sokak no 3-20 kavaklıdere, ankara, 00000, turkey, 2018) Aksoy, Emine; Gungor, Sinem; Agca, Meltem Coban; Ozmen, Ipek; Duman, Dildar; Kocak, Nagihan Durmus; Akturk, Ulku Aka; Tuncay, Eylem; Salturk, Cuneyt; Yalcinsoy, Murat
    OBJECTIVES: The choice of treatment according to the inflammation type in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been of recent interest. This study investigated the role of novel biomarkers, hospital outcomes, and readmission rates in the first month in patients with eosinophilic or neutrophilic AECOPD. MATERIALS AND METHODS: We conducted a retrospective observational cohort study in a Chest Teaching Hospital with hospitalized AECOPD patients. Subjects' characteristics, hemogram results, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR), platelet/mean platelet volume (PLT/MPV), length of hospital stay, mortality, and steroid use were recorded. Eosinophilic AECOPD defined as peripheral blood eosinophilia (PBE) was >2% and neutrophilic AECOPD as PBE Q%. Readmission within 28 days of discharge was recorded. RESULTS: Of 2727(31.5% females) patients, eosinophilic AECOPD was found in 510 (18.7%) patients. Leucocytes, CRF,' NLR, and PLR were significantly higher in neutrophilic AECOPD than in eosinophilic AECOPD (p<0.001). Steroid use and mortality rate were 45% and 0.6% in eosinophilic AECOPD and 71%, and 1.4% in neutrophilic AECOPD, respectively (p=0.001, p=0.19). Age >75 years, albumin <2.5 g/dL, CRP >50 mg/dL, and PLT/MPV <20x103 were found to be risks factors for hospital mortality (p<0.05 each). Readmission rates within 28 days of discharge were 5% (n=136), and this rate was higher in eosinophilic AECOPD patients not taking steroids (p<0.001). CONCLUSION: NLR, PLR, and CRP levels were higher in neutrophilic AECOPD compared with eosinophilic AECOPD. These markers decreased with treatment in neutrophilic AECOPD. A PLT/MPV ratio of <20x103 resulted in an increased mortality rate. Thus, appropriate steroid therapy may reduce readmission rates in the first 28 days after discharge in eosinophilic AECOPD.