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    Comparison of tocilizumab and intravenous immunoglobulin treatment in intensive care unit patients with COVID-19 who developed cytokine storm: A single-center retrospective study
    (Bayrakol Medical Publisher, 2024) Kalkan, Serkan; Demircan, Selcuk; Disli, Zeliha Korkmaz; Duzenci, Deccane; Memisoglu, Funda; Yalcinsoy, Murat; Bicakcioglu, Murat
    Aim: Coronavirus disease 2019 (COVID-19) may trigger a severe inflammatory response. In the present study, the effects of tocilizumab and intravenous immunoglobulin (IVIG) on mortality in COVID-19 patients with cytokine storms were examined and compared. Material and Methods: This retrospective study included all COVID-19 patients who were diagnosed and followed in the intensive care unit between April 2020 and May 2022. The patients were divided into two groups depending on whether they were receiving IVIG or tocilizumab treatment. In addition to the patients' demographic information, the 28-day mortality was recorded. Their PaO2/FiO2 ratio, CRP, procalcitonin, lymphocyte, ferritin, and D-dimer levels were also recorded before drug administration and on the first day, third day, and first week following the drug administration. Results: Of the 73 patients included in this study, 43 (59%) received tocilizumab (Group T), while 30 (41%) received IVIG treatment (Group IVIG). No significant statistical differences were detected between the groups in terms of demographic data, pre-drug inflammatory parameters, improvement in PaO2/FiO2 ratios, and 28-day mortality. The rate of change in CRP levels was significantly higher in Group T than in Group IVIG on day 3 (p=0.010) and in the first week (p=0.001). The improvement in ferritin levels in the first week was significantly higher in Group T (p=0.018). Discussion: No significant difference was detected between the effects of IVIG and tocilizumab on mortality in COVID-19 patients with cytokine storm. However, tocilizumab suppressed inflammation more strongly than IVIG.
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    Does COVID-19-related viral sepsis stimulate angiotensin II levels more than bacterial sepsis?
    (Bayrakol Medical Publisher, 2023) Demircan, Selcuk; Bulut, Niluefer; Kalkan, Serkan; Duzenci, Deccane; Bicakcioglu, Murat; Ozden, Mehmet; Dogan, Zafer
    Aim: Angiotensin II and its receptors play a role in both COVID and bacterial sepsis. The aim of this study was to compare the levels of serum angiotensin II and its receptors in viral sepsis due to COVID-19 with the levels in bacterial sepsis.Material and Methods: The study included 62 sepsis patients (n=31 COVID and n=31 non-COVID) with similar disease severity in the tertiary ICU. The serum angiotensin II, angiotensin II receptors 1 and 2 (ATR1, ATR2) and other inflammatory parameters were measured. Demographic data and 28-day mortality were recorded.Results: Angiotensin II level was significantly higher in COVID patients than in non-COVID patients (p<0.05). ATR1 and ATR2 did not differ between the two groups. There was a negative correlation between angiotensin II and procalcitonin levels in all patients, and a positive correlation between ATR1 and procalcitonin, APACHE II score, and SOFA score in COVID patients (p<0.05).Discussion: Observation showed that angiotensin II levels were higher in patients with COVID-19 compared to those with bacterial sepsis, and ATR1 level was higher in COVID-19 patients who died. It was thought that the renin-angiotensin cascade could be stimulated differently in bacterial sepsis compared to viral sepsis due to COVID.
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    The effect of plasmapheresis therapy on management of patients with snakebite
    (2023) Bıcakcıoğlu, Murat; Kalkan, Serkan; Doğan, Zafer; Togal, Turkan; Yucel, Neslihan; Demircan, Selcuk; Duzenci, Deccane
    Aim: The aim of the study was to evaluate the effectiveness of plasmapheresis therapy in patients with snakebite who were admitted to intensive care unit in the setting of tertiary referral hospital. Materials and Methods: The retrospective study involved 114 adult patients with snakebite who were admitted to a referral hospital’s intensive care unit between January 2012 and December 2022. The patients were divided into four groups according to the treatments. Group AV performed antivenom (Group AV) alone. Group PP performed plasmapheresis alone. Group AV+PP performed antivenom and plasmapheresis. Group GST performed only general supportive therapy. Results: Fifty two of 114 were included in Group GST, 31 in Group AV, 18 in Group PP and 13 in Group AV+PP. APACHE score, SOFA score, GCS, stage of the bite, length of stay in the intensive care unit, acute kidney injury, and hematological disorders were higher while the platelet count at admission was lower in Group PP and Group AV+PP compared to Group AV and Group GST (p< 0.05). Conclusion: Antivenom and plasmapheresis are not alternatives to each other, antivenom should be performed to patients according to the severity of the bite, and plasmapheresis should be performed without delay in those with severe hematological effects.