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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.
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    The Prevalence of Previous Coronavirus Disease-19 in Patients with Pulmonary Thromboembolism and Its Effect on Embolism Severity
    (Mdpi, 2025) Kocak, Nagihan Durmus; Tutar, Nuri; Cil, Gizem; Afsin, Emine; Senturk, Aysegul; Aydin, Derya; Mermit, Buket
    Background/Objectives: The association between past coronavirus disease-19 (COVID-19) infection and pulmonary thromboembolism (PTE) is a potential research topic. We aimed to research the prevalence of previous COVID-19 infection in patients with PTE and to determine whether there is a difference in embolism severity in these cases. Methods: Study design: Multicenter, observational, cross-sectional. Patients diagnosed with PTE between 11 March 2022 and 11 March 2023 were prospectively included in this study, excluding cases with PTE along with active COVID-19, patients under the age of 18, and pregnant patients. Group 1 consisted of PTE cases with previous COVID-19, and Group 2 consisted of PTE cases without previous COVID-19. Key variables are D-Dimer level, right ventricle/left ventricle (RV/LV) ratio, simplified pulmonary embolism severity score, and treatment type. Results: A total of 1185 patients (Group 1; n = 360, Group 2; n = 825) were included in this study. The proportion of patients with RV/LV ratio > 1 on computed tomography pulmonary angiography (CTPA) was significantly high in Group 2 compared to Group 1 (27.9% vs. 19.7%, p = 0.003). In multivariate logistic regression analysis, the absence of any identifiable risk factor for PTE was found to be a 0.46-fold protective factor in the presence of previous COVID-19 (OR: 0.456 95% CI: 0.274-0.760, Wald = 9.070, df = 1, p = 0.003) and an RV/LV ratio > 1 on CTPA was found to be a 0.60-fold protective factor (OR: 0.603, 95% CI: 0.365-0.998, Wald = 3.874, df = 1, p = 0.049). Conclusions: The prevalence of previous COVID-19 infection in PTE cases was 30.4%, and 26.3% of idiopathic cases had previous COVID-19 infection. Although the parameters related to embolism severity were higher in the non-COVID-19 group, multivariate analyses revealed a 2.2-fold increased risk for idiopathic PTE and a 1.7-fold increased risk for RV/LV ratio > 1 on CTPA in patients without COVID-19 compared to those with prior COVID-19.