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    Prognostic role of the simplified pulmonary embolism severity index and shock index in pulmonary embolism
    (Medycyna Praktyczna, 2014) Kilic, Talat; Ermis, Hilal; Gulbas, Gazi; Kaya, Omar; Aytemur, Zeynep A.; Inceoglu, Feyza; Hacievliyagil, Suleyman S.
    INTRODUCTION The stratification of acute pulmonary embolism (PE) using the simplified pulmonary embolism severity index (sPESI) and shock index (SI) does not require any prognostic tools such as biomarkers or echocardiography. OBJECTIVES We compared the ability of the sPESI and SI to predict 30-day and 3-year mortality following PE. PATIENTS AND METHODS Prognostic models based on the sPESI and SI were used to predict the overall 30-day (short-term) and 3-year (long-term) mortality in a cohort of 194 patients with confirmed PE. RESULTS Overall, the mortality rate in this cohort was 9.2% in the first month and 29.9% at 3 years. The sPESI categorized fewer patients as low risk (41.7%; 81 of 194 patients) when compared with the SI lower than 1 (74.7%; 145 of 194 patients). Importantly, patients classified as low risk in the sPESI had no 30-day mortality compared with 2.1% of patients (3 of 145) classified as low-risk based on the SI. The 3-year mortality rate in low-risk patients according to the sPESI was lower than that in low-risk patients identified based on the SI (4.9% vs. 20.7%; P < 0.0001). While a multivariate Cox analysis showed that both the SI and sPESI were independent prognostic variables for 3-year mortality, it showed that only the SI was an independent prognostic variable for 30-day mortality. CONCLUSIONS Both prognostic models allow to stratify the risk of short-and long-term mortality in patients with PE, but the sPESI was better than SI at classifying low-risk patients.
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    Relationship between serum ?-glutamyltransferase levels and acute exacerbation of chronic obstructive pulmonary disease
    (Medycyna Praktyczna, 2013) Ermis, Hilal; Celik, Muhammet R.; Gulbas, Gazi; Tavli, Deniz; Aytemur, Zeynep A.
    INTRODUCTION gamma-glutamyltransferase (GGT) is a plasma membrane enzyme, which is involved in antioxidant glutathione resynthesis. OBJECTIVES The aim of the study was to compare the serum levels of GGT (which is considered a novel marker of oxidative stress) between patients with stable chronic obstructive pulmonary disease (COPD) and those with acute exacerbation of COPD, and the relationship of GGT with inflammation. PATIENTS AND METHODS The study involved 132 patients with exacerbated COPD and normal function of the liver and biliary tract (mean age, 66.6 +/- 10.1 years; men, 88.6%) and 147 patients with stable COPD (mean age, 65.4 +/- 8.8 years; men, 87.1%). Serum GGT and C-reactive protein (CRP) levels were measured and compared between the groups. RESULTS Serum GGT levels in patients with exacerbated COPD were significantly higher than in those with stable COPD (30 U/l; interquartile range [IQR], 18.8 vs. 25 U/l; IQR, 16; P < 0.001]. Serum CRP levels were significantly higher in patients with exacerbated COPD compared with those with stable COPD (34 mg/l; IQR, 58.3 vs. 16 mg/l; IQR, 24.6; P < 0.001). A significant positive correlation was observed between GGT activity and CRP levels (r = 0.27, P = 0.002). The GGT level of 29 U/l was set as a cutoff value of acute exacerbation with the specificity of 70.1% and sensitivity of 62.8% (95% confidence interval, 0.6-0.71; area under the curve, 0.66; standard error, 0.032; P < 0.001). CONCLUSIONS Our study indicates that serum GGT levels as the marker of oxidative stress increase during exacerbated COPD and correlate with CRP levels. The measurement of GGT activity may be useful in the evaluation of exacerbated COPD.