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    Neutrophil Gelatinase-Related Lipocalin and Renal Resistive Index in the Diagnosis and Prognosis of Sepsis-Associated Acute Kidney Injury: A Cross-Sectional Study from Türkiye
    (Wolters Kluwer Medknow Publications, 2025) Teker, A. B.; Duzenci, D.; Teker, N.; Senturk, H.; Bicakcioglu, M.; Dogan, Z.; Ozer, A. B.
    Background:Acute kidney injury (AKI) is common in intensive care unit (ICU) and sepsis-induced AKI (SI-AKI) is a cause of the high mortality and morbidity.Aim:To determine the use of neutrophil gelatinase-related lipocalin (NGAL) and Renal Resistive Index (RRI) in the predicting the development of AKI and mortality in patients with sepsis in the ICU.Methods:Patients with sepsis who were admitted into the ICU were divided into the AKI and non-AKI groups. On the first and fifth days after sepsis diagnosis, blood samples were taken for NGAL levels while RRIs were measured via doppler ultrasound. Simultaneously, fluid responsiveness and perfusion status were evaluated with pleth variability index (PVI) and pulsatility index (PI). Twenty-eight day mortality was recorded.Results:The mean age of 101 patients was 63 years and 69% were male. On the first day, the NGAL (P = 0.002), RRI (P = 0.001) and PVI (P = 0.001) were significantly higher while the PI (P = 0.018) was lower in the AKI group. On the fifth day, the RRI and PVI were significantly higher in the AKI group. (P = 0.001). The RRI and PVI on the first and 5th days were significantly higher, while the PI was lower in non-surviving group (P = 0.001). The parameter that best predicted the development of AKI was RRI (area under curve [AUC] = 0.898, P = 0.001). The RRI, PI and PVI values were significantly associated with mortality (respectively AUC value 0.722, 0.714, 0.700, P = 0.001).Conclusions:The RRI is an important marker for predicting AKI in the early phase of sepsis and mortality in acutely ill patients, while NGAL is a biomarker that can predict AKI.
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    The Effect of Sevoflurane and Desflurane on Clara Cell Protein in the Lung in Liver Transplant Donors
    (Wolters Kluwer Medknow Publications, 2026) Teker, N.; Ucar, M.; Bulut, N.; Teker, A. B.; Colak, Y. Z.; Demiroz, D.; Erdogan, M. A.
    Background:Inhalation anesthetics are known to have different effects on the respiratory system than anesthesia. Clara cells in the respiratory epithelium, which protect the lungs, play a role in the detoxification of xenobiotics and oxidant gases, control of inflammation, mucociliary clearance of environmental agents, and proliferation and differentiation of ciliated cells. Serum concentrations of Clara Cell Protein (CC16) have been used as indicators of lung injury in various acute and chronic lung diseases.Aim:In this study, we aimed to investigate the effects of sevoflurane and desflurane inhalation anesthetics on CC16 in liver transplant donors scheduled for hepatectomy.Methods:A total of 75 patients aged 18-65 years, ASA I-II, and liver transplant donors undergoing right lobe hepatectomy were enrolled in this prospective, randomized clinical trial. Patients were evaluated in three groups: Group sevoflurane (Group S), group desflurane(Group D), and group control(Group K). Anesthesia was induced with 2 mg/kg propofol and 1 mu g/kg remifentanil in all groups and muscle relaxation was achieved with 0.6 mg/kg rocuronium. In addition to the FiO2:0.4 air/O2 mixture, Group S was ventilated with 1-2% sevoflurane and Group D was ventilated with 6-8% desflurane. Group K: Anesthesia maintenance was adjusted to 10 mg/kg/h for the first 10 min, 8 mg/kg/h for the next 10 min, 6 mg/kg/h propofol infusion, and 3 mu g/kg/h remifantanil. Patients in this group were ventilated with an air/O2 mixture with an FiO2 of 0.4, and inhalation anesthetics were not used. Blood samples for CC16 were obtained from all patients preoperatively, intraoperatively at 1 hour and immediately after the surgical procedure was completed.Results:There was a significant difference between the groups in terms of preoperative, 1st hour and pre-extubation CC16 values. CC16, 1st hour and pre-extubation CC16 values were significantly lower in Group S than in Group K.Conclusion:When used at clinical doses, sevoflurane and desflurane had no adverse effects on CC16, an important marker of acute airway injury, in healthy lungs. We found that sevoflurane decreased the CC16' level more than desflurane.