Lower Albumin Values Research Articles

Factors Predicting Major Complications and Mortality in Percutaneous Endoscopic Gastrostomy: 8 Years of Experience of a Tertiary Surgery Center.

Percutaneous endoscopic gastrostomy (PEG) is a safe method of choice for patients who need long-term nutritional support. However, complications and high mortality rates have been reported. Based on 8 years of experience in tertiary care hospitals, we aimed to identify risk factors associated with major complications and 30-day mortality after PEG. Patients who underwent PEG in the General Surgery clinic of Tokat Gaziosmanpaşa University, Faculty of Medicine between January 2014 and March 2022 were included in the study. Data regarding patient demographics, comorbidities, laboratory data, drugs used together, and indications for PEG tube placement were collected. There were 429 patients. The mean age of the patients was 66.9±16.75 years, and 180 (44%) patients were female. The mean follow-up period was 8.84±6.75 months. Twenty patients (4.9%) had major complications. Female sex [Odds Ratio (OR) 0.33, 95% CI, CI=1.23-8.87, P=0.02] and diabetes mellitus (DM) (OR=0.23, 95% CI=1.93-6, P=0.002) were the independent variables associated with major complications. The all-cause 30-day mortality rate was 5.9% (n=24). Malignancy, DM, corticosteroid use, low albumin, and platelet values were associated with increased mortality in multivariate analysis as indications for PEG. Female sex and patients with DM may potentially face major complications. The patients with cancer, diabetes, and corticosteroid use were associated with higher mortality. In addition, low serum albumin and platelet levels were an effective factor for survival in patients undergoing PEG, and this should be taken into account in decision-making.

The relationship between the collagen score at the anastomotic site of esophageal squamous cell carcinoma and anastomotic leakage.

Anastomotic leakage (AL) has always been one of the most serious complications of esophagectomy with gastric conduit reconstruction. There are many strong risk factors for AL in clinical practice. Notably, the tension at the esophagogastric anastomosis and the blood supply to the gastric conduit directly affect the integrity of the anastomosis. However, there has been a lack of quantitative research on the tension and blood supply of the gastric conduit. Changes in extracellular matrix collagen reflect tension and blood supply, which affect the quality of the anastomosis. This study aimed to establish a quantitative collagen score to describe changes in the collagen structure in the extracellular matrix and to identify patients at high risk of postoperative AL. A retrospective study of 213 patients was conducted. Clinical and pathological data were collected at baseline. Optical imaging of the "donut" specimen at the anastomotic gastric end and collagen feature extraction were performed. Least absolute shrinkage and selection operator (LASSO) regression models were used to select the significant collagen features, compute collagen scores, and validate the predictive efficacy of the collagen scores for ALs. LASSO regression analysis revealed three collagen-related parameters in the gastric donuts: histogram mean, histogram variance, and histogram energy. Based on this analysis, we established a formula to calculate the collagen score. The results of the univariate analysis revealed significant differences in the preoperative low albumin values (P=0.002) and collagen scores between the AL and non-AL groups (P=0.001), while the results of the multivariate analysis revealed significant differences in the collagen scores between the AL and non-AL groups (P=0.002). The areas under the curve (AUCs) of the experimental and validation cohorts were 0.978 [95% confidence interval (CI): 0.931-0.996] and 0.900 (95% CI: 0.824-0.951), respectively. The collagen score established herein was shown to be related to AL and can be used to predict AL in patients who underwent esophagectomy.

#2154 Rituximab in the treatment of PLA2R-associated membranous nephropathy: insights from a hospital centre experience

Abstract Background and Aims Rituximab (RTX) is recommended as the first-line therapy for PLA2R-associated Membranous Nephropathy in patients with a moderate to high risk of progressive loss of kidney function, according to the KDIGO 2021 guidelines. This recommendation is based on the superior long-term efficacy and improved safety profile of RTX. This study aims to assess the use of RTX for the treatment of for PLA2R-associated Membranous Nephropathy at a hospital centre. Method A retrospective study was conducted on patients diagnosed with PLA2R-associated Membranous Nephropathy who underwent their first RTX administration between 2017 and 2022 at a tertiary hospital centre. Exclusion criteria involved patients with less than 6 months of follow-up post-RTX. The study evaluated the occurrence of immune remission, clinical remission, as well as instances of immune and proteinuria relapse, and recorded any adverse events. Results A total of 11 patients were included, with 54.5% being male. The mean age was 60.4 ± 14.7 years, and the median disease duration 69.0 [8.0-87.0] months. The mean follow-up time post-RTX was 36.7 ± 23.3 months. Regarding the risk of progressive loss of kidney function, 8 patients were classified as high risk, 1 as moderate risk, and 2 as low risk. RTX served as the initial immunosuppressive therapy for only 3 patients. Additional immunosuppressive therapies post-RTX, including further RTX doses, were administrated in 63.6% (n = 7) of patients. No response was observed in 18.2% (n = 2). Immune remission was achieved in 81.8% (n = 9), mean time of 3.8 ± 1.4 months. Within this group 55.5% (n = 5) patients achieved complete remission, 22.2% (n = 2) experienced partial remission, and 22.2% (n = 2) maintained nephrotic proteinuria, with immune remission consistently preceding clinical remission. Relapses occurred in 45.5% (n = 5), at a mean time of 20.8 ± 13.5 months. Patients with lower serum albumin at time of RTX administration were more likely to experience non-response or relapse (T (9) = 2.51, p = 0.03), with a Youden Index cut-off of 3.2 g/dL, demonstrating a sensitivity of 100% and a specificity of 85.7%. Patients with anti-PLA2R exceeding 150 RU/mL exhibited no response or relapsed. Four patients (36.4%) remained free of relapses throughout the entire follow-up period, mean time of 22.8 ± 10.0 months, with 1 keeping RTX maintenance therapy. During the 6 months post-RTX, 36.4% (n = 4) of patients experienced adverse events. Conclusion Rituximab demonstrated both efficacy and safety in treating PLA2R-associated Membranous Nephropathy. However, lower serum albumin levels and anti-PLA2R > 150 RU/mL at time of RTX administration were associated with worse response. Given the substantial need for additional immunosuppression, and considering lower albumin values and higher anti-PLA2R titres as risk markers, it is recommended to closely monitor these patients. Anti-PLA2R titres showed a meaningful association with disease activity, preceding changes in proteinuria levels. Therefore, tracking disease progression through the measurement of anti-PLA2R titres not only guides clinical decisions but also enables a judicious approach to subsequent RTX administrations.

A low albumin value is associated with adverse outcomes in elderly patients with Parkinson’s disease hospitalized due to COVID 19 associated pneumonia

A low albumin value is associated with adverse outcomes in elderly patients with Parkinson’s disease hospitalized due to COVID 19 associated pneumonia

Are precautions actually a risk factor in the development of bronchopleural fistula after pneumonectomy? A retrospective analysis of 299 cases.

Bronchopleural fistula most commonly occurs after pneumonectomies, with high morbidity and mortality. A preventive approach is essential. Risk factors can be classified depending on the patient, anatomy, surgical technique, and other causes. Patients (n = 370) who underwent pneumonectomy between 2010 and 2020 were evaluated. The digital media and archive files of the patients (n = 299) were reviewed retrospectively. While 271 patients (90.6%) were male, 28 (9.4%) were female. The mean age was 56.63years. The bronchopleural fistula rate was 14.7% (44/299). Serum protein deficiency, right pneumonectomy, completion pneumonectomy, bronchial manual suturing, advanced stage, prolongation of time after neoadjuvant therapy, length of drain and hospital stay, tissue support for the stump, and short bronchial stump were significant for bronchopleural fistula. Smoking in patients operated on for malignancy and low serum albumin value in benign and chronic infectious diseases were significant in terms of fistula. In patients who developed bronchopleural fistula, the 5-year survival rate was 18.4%. The most important risk factors in bronchopleural fistula depend on the surgical technique and so are completely preventable. Contrary to the literature, short stump and tissue support to the stump were found to be risk factors for fistula. In addition, the effect of the time between neoadjuvant therapy and operation should be examined in further studies.

The relationship between albumin level and the development of acute kidney injury and mortality in critically COVID-19 patients

Aims: The impact of the Coronavirus Pandemic, which began in 2019, has considerably diminished; however, its effects still persist. While respiratory symptoms have been prominent during the pandemic, acute kidney disease has emerged as a significant contributor to morbidity and mortality. This study aims to demonstrate that serum albumin levels can serve as a predictor for acute kidney injury (AKI) and mortality, owing to their cost- effectiveness and feasibility for use across various healthcare centers. The goal is to contribute to the reduction of AKI development and mortality rates. Methods: The study was conducted by analyzing data from a total of 350 patients admitted to intensive care units of a training and research hospital due to COVID-19 between March 1, 2020, and April 30, 2021. Of these patients, 179 (51%) were male, and 171 (49%) were female. The data were examined retrospectively. Patients were categorized into two groups based on serum albumin levels: ?2.5 mg/dl (severe hypoalbuminemia) and 2.5-3.5 mg/dl (mild hypoalbuminemia). Subsequently, the patients were further categorized into groups based on the presence or absence of AKI, and these groups were statistically compared. Demographic data, clinical information, and laboratory values of the patients were assessed. The diagnosis of acute kidney injury (AKI) was made according to KDIGO criteria. Data were compared using the SPSS version 24 software. Results: Among the 350 patients included in the study, 115 had serum albumin levels ?2.5 mg/dl (severe hypoalbuminemia), and 235 had levels in the range of 2.5-3.5 mg/dl (mild hypoalbuminemia). Among those who developed AKI, the average albumin level was found to be 2.68 mg/dl, whereas in the group without AKI, the average albumin level was 2.76 mg/dl. Out of the total, 201 (57%) patients developed AKI, and 82% of them experienced mortality. In contrast, among the 149 (43%) patients who did not develop AKI, the mortality rate was 42%. Further subgroup analysis revealed the highest mortality rate of 88% among patients with severe hypoalbuminemia and AKI development. Conversely, the lowest mortality rate of 40% was observed in patients with mild hypoalbuminemia and no AKI. Conclusion: This study aims to establish that low serum albumin levels should be regarded not only as a negative acute-phase reactant but also as a predictive factor for complications including acute kidney disease development and mortality. Lower albumin values are correlated with higher complication rates and increased mortality. Additionally, due to its widespread availability and low cost, serum albumin is a cost-effective diagnostic tool that can be utilized in almost any healthcare setting.

Factors Affecting Drain Output in Oral Carcinoma.

Advanced oral carcinoma surgery results in large denuded areas leading to seroma and hematoma. Closed suction drains obliterate dead space and create negative pressure on wound bed. Non-placement or early removal of drain can lead to various complications, while placement for long duration can cause surgical site infection. The study aims to evaluate factors affecting postoperative neck drain volume, guiding surgeons for decision making for time of drain removal. The study comprised of 222 patients with oral squamous cell carcinoma who underwent primary tumor resection and neck dissection. Demographical, clinical, and surgical details were retrospectively analyzed. The mean age of patients was 49.1 years. Majority of patients had advanced disease requiring extensive surgery. Patients with radical neck dissection and those reconstructed with pedicled flap had statistically significant drain volume as compared to those with selective neck dissection and free flaps, respectively. Patients with longer duration of surgery, higher blood loss, low postoperative albumin value, and complications showed increased drain volume. Mean duration of drain removal was 7 days, and all drains were removed by day 10. Advanced stage primary disease, radical and modified neck dissections, PMMC flap reconstruction, longer duration of surgery, and higher blood loss had higher drain output. Thus, patient parameters, tumor factors, and surgery factors influence drain output and hospitalization. Diligent preoperative and perioperative assessment of various factors can aid trainee surgeons to make decisions for appropriate time for drain removal.

The Relationship Between Platelet to Lymphocyte Ratio (PLR), Monocyte to Lymphocyte Ratio (MLR), Neutrophil to Lymphocyte Ratio (NLR), and Albumin Levels with The Severity of Community-acquired pneumonia (CAP) in Hospitalized Elderly Patients

Background: Community-acquired pneumonia (CAP) is a lung infection that often affects elderly patients and can be severe. Laboratory parameters, including platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio (NLR), and albumin, have been linked to the prognosis of various infectious diseases. However, the relationship between these parameters and the severity of CAP in elderly patients is not yet fully understood. Methods: This is an analytic observational study with a cross-sectional design that involved 125 elderly patients (≥60 years old) with CAP who were hospitalized at Prof. Dr. I.G.N.G. Ngoerah Hospital between January and December 2023. The study collected demographic data, nutritional status, smoking status, and laboratory parameters (PLR, MLR, NLR, and albumin) from electronic medical records. The severity of CAP was assessed based on the 2019 IDSA/ATS criteria. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off point of laboratory parameters. Proportion comparison analysis and multivariate logistic regression were used to evaluate the association between laboratory parameters and the severity level of CAP. Results: Of a total of 125 study subjects, 48 (38.4%) had severe CAP. NLR values ≥9.84 with RR 15.242 (95% CI 4.999-46.475; p<0.001) and albumin values <3.295 g/dL with RR 5.407 (95% CI 2.630-11.115; p<0.001) were significantly associated with the severity of CAP in hospitalized elderly patients. Multivariate analysis showed that NLR had HR 37.426; (95% CI 9.295-150.694; p<0.0001) and albumin had an HR value of 3.747 (95% CI 1.149-12.221; P=0.029) which was significantly associated with the severity of CAP in hospitalized elderly patients after adjusting for confounding factors. Conclusions: High NLR values and low albumin values may be potential predictors for identifying elderly patients with CAP who are at risk for severity. These findings emphasize the importance of assessing laboratory parameters in managing CAP in the elderly population.

Systematic oxidative stress indices predicts prognosis in patients with urothelial carcinoma of the upper urinary tract after radical nephroureterectomy

BackgroundOxidative stress plays an important role in the occurrence and development of malignancy. However, the relationship between oxidative stress and upper urinary tract urothelial carcinoma (UTUC) prognosis remains elusive. This study aimed to evaluate the prognostic value of systematic oxidative stress indices as a predictor of patient outcomes in UTUC after radical nephroureterectomy.MethodsClinical data for 483 patients with UTUC who underwent radical nephroureterectomy were analyzed. Patients were categorized according to an optimal value of systematic oxidative stress indices (SOSIs), including fibrinogen (Fib), gamma-glutamyl transpeptidase (γ-GGT), creatinine (CRE), lactate dehydrogenase (LDH) and albumin (ALB). Kaplan–Meier analyses were used to investigate associations of SOSIs with overall survival (OS) and progression-free survival (PFS). Moreover, associations between SOSIs and OS and PFS were assessed with univariate and multivariate analyses.ResultsHigh values of Fib, γ-GGT, CRE, and LDH, and low values of ALB were associated with reduced OS. SOSIs status correlated with age, tumor site, surgical approach, hydronephrosis, tumor size, T stage, and lymph node status. The Kaplan–Meier survival analysis showed a significant discriminatory ability for death and progression risks in the two groups based on SOSIs. Multivariate Cox proportional hazards models showed that SOSIs were an independent prognostic indicator for OS (p = 0.007) and PFS (p = 0.021). SOSIs and clinical variables were selected to establish a nomogram for OS. The 1-, 3-, and 5-year AUC values were 0.77, 0.78, and 0.81, respectively. Calibration curves of the nomogram showed high consistencies between the predicted and observed survival probability. Decision curve analysis curves showed that the nomogram could well predict the 1‐year, 3-year, and 5‐year OS.ConclusionsSOSIs are an independent unfavorable predictor of OS and PFS in patients diagnosed with UTUC undergoing RNU. Therefore, incorporating SOSIs into currently available clinical parameters may improve clinical decision-making.

Radiological characteristics of coronavirus patients.

The present study aimed to evaluate the radiological findings of coronavirus patients who had positive computed tomography of the lung following real-time reverse transcriptase-polymerase chain reaction testing. The data of 1727 patients who had reverse-transcriptase-polymerase chain reaction (RT-PCR) testing between May 2020 and August 2021 and had thoracic computed tomography (CT) on Days 7th to 8th were analyzed retrospectively. The Radiological Society of North America's recommended reporting system was used to categorize CT findings. Of the 1727 patients who underwent RT-PCR testing, there were 1417 patients with positive CT results. Of these 1417 patients, 679 (47.9%) were female. When patients with high blood values were evaluated, the number of CT-positive patients was significantly higher than CT-negative patients (P < .05). The number of patients with low lymphocyte and albumin values was significantly higher (P < .05). In 75.7% of those who had positive CT results, the PCR result was positive. Thoracic CT is a critical diagnostic tool in Coronavirus Disease 2019 patients with RT-PCR negative. It also depicts the progression of lung involvement in RT-PCR-positive patients. Performing it late in the disease's progression may increase the risk of contracting the disease.

Characteristics and outcomes of elderly patients with Parkinson's disease hospitalized due to COVID‑19‑associated pneumonia.

Patients with Parkinson's disease (PD) and coronavirus disease 2019 (COVID-19)-associated pneumonia present, according to the literature, high mortality rates due to the nature of the disease, advanced age, and underlying diseases. Most available studies, however, refer to the first waves of the pandemic. The aim of the present study was to investigate the clinical characteristics and outcomes of elderly patients (≥65 years old) with PD hospitalized with COVID-19-associated pneumonia during the period of prevalence of various severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, as well as to determine possible prognostic factors for poor outcomes. During the period from February 15, 2021, to July 15, 2022, 1,144 elderly patients with COVID-19 pneumonia were hospitalized. Age, sex, Charlson comorbidity index, vaccination status against SARS-CoV-2, and admission laboratory parameters were recorded for all patients. A total of 36 (3.1%) patients with PD were hospitalized due to COVID-19-associated pneumonia (18 males, 50%). The mean age of the patients was 82.72±8.18 years. In total, 8 patients (22.2%) were hospitalized during the period of alpha variant predominance, 3 patients (8.3%) during the period of delta variant predominance, and 25 patients (69.4%) during the omicron variant predominance period. Of note, 16 patients (44.4%) were vaccinated with at least two doses. In addition, 17 (47.2%) patients succumbed to the disease. Between the patients who survived and those who succumbed, a statistically significant difference was only found in the mean value of albumin (37.48±6.02 vs. 31.97±5.34 g/l, P=0.019). In particular, as shown by receiver operating characteristic curve analysis, albumin exhibited a satisfactory predictive ability for mortality (area under the curve, 0.780; P=0.013) with an albumin value ≤37.7 g/l being able to predict mortality with 85.7% sensitivity and 54.8% specificity. Overall, the findings of the present study indicate that mortality among elderly patients with PD hospitalized with COVID-19-associated pneumonia was high in all phases of the pandemic. A low albumin value, not only as an indicator of the immune status, but also of the nutritional status, is a predictor of adverse outcomes.

Cytomegalovirus reactivation in ulcerative colitis patients: Early indicators.

The association of. ytomegalovirus (CMV) infection with ulcerative colitis (UC) still remains a controversial topic for the clinicians. Aim: In this study, we aimed to elucidate the CMV infection related parameters in the exacerbation of UC. In this study, 812 UC patients who have admitted to our institution between June 2008 and November 2020 were analyzed retrospectively. CMV infection was diagnosed by the detection of CMV DNA with polymerase chain reaction (PCR) in tissue biopsies with presence of clinical colitis symptoms. CMV negative UC patient group was defined as UC activation group with negative PCR results. A total of 153 patients met the inclusion criteria during the study period, with a median age of 41.8 years. CMV PCR positivity had been detected in tissue biopsy in 43 (28.1%) UC patients. CMV-positive patients had a statistically significant higher frequency of steroid resistance, treatment with azathioprine, longer disease duration, longer remission, and hospitalization day. The mean C-reactive protein (CRP) level, platelet to lymphocyte ratio (PLR) were higher, and mean albumin level was lower in CMV positive patients, with statistically significance. Also, colectomy and anti-tumor necrosis factor-α (TNF-α) therapy were more frequent in CMV-reactivated group in long-term follow-up. In a multivariable model, steroid resistance, treatment with azathioprine, long disease duration, low albumin value was independently associated with colonic CMV infection. Steroid resistance, treatment with azathioprine, long disease duration, low albumin levels were significant risk factors for CMV colitis, among patients with UC activation.

Predicting Factors of Brucella melitensis Bacteremia in Children Admitted with Brucellosis

Abstract Objective Brucellosis is the most common zoonotic disease. Isolation of Brucella melitensis in blood culture is accepted as the gold standard for diagnosis. This study aims to determine the predictive factors of B. melitensis bacteremia in pediatric patients followed up with brucellosis. Methods Two-hundred twenty pediatric brucellosis patients were included in the study. The epidemiological, clinical, and laboratory data were recorded. Results The patients comprised 63.2% males and 36.8% females with a mean age of 10.45 ± 4.36 years (range, 1–18 years), and 70.5% were younger than 14 years old. B. melitensis was isolated in the blood culture in 33.6% of patients. In the epidemiological history of pediatric patients with bacteremic brucellosis, there was a history of dealing with, owning, or working with livestock. In patients with brucellosis, fever and weight loss, hepatomegaly, and arthritis were more common in patients with bacteremia than in those without bacteremia. Among laboratory findings, leukopenia, low albumin value, and high C-reactive protein were calculated as predictors of Brucella bacteremia in patients with brucellosis. Conclusion In regions where brucellosis is endemic, serum agglutination tests may be positive without clinical findings. Brucellosis can mimic many other diseases, so the definitive diagnosis is demonstrated by bacteremia. Blood cultures should be taken in patients with predictive factors suggestive of brucellosis.

Evaluation of coagulopathy frequency and risk factors in trauma patients in intensive care unit

Background: Post traumatic coagulopathy is a frequently encountered problem. However, risk factors related to coagulopathy are not exactly known. Objectives: In this study it is targeted to determine the frequency of coagulopathy related to trauma, risk factors and its affect to prognosis on patients admitted to Intensive Care Unit(ICU) after trauma retrospectively. Methods: 184 patients admitted to mixed type adult ICU, which is having 20 beds, in the years between 2011 and 2017 due to trauma have been studied. Patients have been separated into two groups as patients having coagulopathy and not having coagulopathy by examining their laboratory results. Patients having; thrombocyte count &lt;100 000/μL on the first and third days, Prothrombin Time(PT)&gt;16s, activated Partial Thromboplastine Time(aPTT)&gt;40s, International Normalized Ratio(INR)&gt;1.6 are being accepted as having coagulopathy. Medical records of patients have been recorded retrospectively. Results: The average age of 184 patients that are included in the study is 41.77; 19% of them are Female and 81% of them are Male. Coagulopathy detected on 78 patients (42.4%) (on the first day 32.6%, on the third day 9.8%). It has been detected that, patients developed coagulopathy were having more accompanying diseases(p&lt;0.05), lower Glasgow Coma Score (GCS)(p&lt;0.05), lower albumin values(p&lt;0.05) and higher 28-day mortality rates(p&lt;0.001) compared to patients that have not developed coagulopathy. Revised Trauma Score(RTS) of two groups are not significant(p&gt;0.05). Having accompanying diseases, having low GCS and albumin values are being determined as independent risk factors in coagulopathy development. Conclusion: As a conclusion; since it is not possible to change GCS and risk factors belong to critical trauma patients, we think that it is possible to decrease the frequency of coagulopathy development as well as mortality rate by preventing risk factors such as hypoalbuminemia by means of suitable approaches.

Analgesic Patterns and Opioid Administration in Children Hospitalized With Acute Pancreatitis.

Pain is the most common symptom of acute pancreatitis (AP), and opioids have been utilized as the cornerstone of treatment. Despite the adverse effects of opioids, data on effective analgesia in children with AP is lacking. We aimed to evaluate analgesia prescribing patterns in pediatric AP, identify factors associated with opioid administration, and test the associations between opioid administration and hospital length of stay (LOS). This is a retrospective cohort study of pediatric AP hospitalizations in a single institution from 2010 to 2020. Opioid administration was calculated for the first 48 hours of admission (morphine milligram equivalent; MME48). Data on multimodal analgesia [defined as the administration of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)] during hospitalization was captured. The sample included 224 patients, mean age 12.0 years (standard deviation = 4.9) and 58.9% female. Median LOS was 4 days (interquartile range 2-9). Most patients (71.4%) were prescribed opioids, 77.7% acetaminophen, 40.2% NSAIDs, and 37.5% multimodal analgesia. Opioid administration decreased over the study period; in contrast, there was an increase in multimodal analgesia administration. Opioid administration did not differ by sex, age, biliary versus non-biliary etiology, or race/ethnicity. In a multivariate regression model, lower albumin values ( P < 0.01) and younger age ( P < 0.05) were significant predictors of increased LOS, while MME48 was not associated with increased LOS. Opioids were commonly administered; only 37.5% of children were administered multimodal analgesia during their hospitalization for AP. Opioid administration was not associated with increased LOS. Prospective studies are needed to determine optimal pain management for pediatric AP.

Comparison of below-knee and above-knee amputations with demographic, comorbidity, and haematological parameters in patients who died

BackgroundThis study aimed to establish mortality predictive parameters with a higher contribution to mortality by comparing the demographic data, comorbid factors, and haematological values of patients who underwent below-knee and above-knee amputation and had died during the follow-up period.Materials and methodsBetween March 2014 and January 2022, 122 patients in a single centre who developed foot gangrene due to chronic diabetes and underwent below-knee or above-knee amputation were evaluated retrospectively. Patients who died of natural causes during the post-operative period were included in the study. Those who were amputated below the knee were assigned to Group 1, and those who were amputated above the knee were assigned to Group 2. The patients’ age, gender, side of amputation, comorbid diseases, American Society of Anaesthesiologists (ASA) score, Charlson comorbidity index (CCI), death time, and haematological values at the time of first admission were compared between the two groups and statistical analyses were performed.ResultsGroup 1 (n = 50) and Group 2 (n = 37) had similar distributions in terms of age, gender, side of operation, number of comorbidities, and CCI (p > 0.05). Group 2’s mean ASA score and c-reactive protein (CRP) levels were statistically higher than those of Group 1 (p < 0.05). Death time, albumin value, and HbA1c levels were statistically lower in Group 2 than in Group 1 (p < 0.05). There were no significant differences between the groups in haemogram, white blood cells (WBC), lymphocytes, neutrophils, creatinine, and Na values at the time of first admission (p > 0.05).ConclusionA high ASA score, low albumin value, and high CRP value were significant predictors of high mortality. Creatinine levels and HbA1c values were quite ineffective in predicting mortality.Level of evidenceLevel 3, retrospective comparative study.

Utility of Ranson score, computed tomography severity index, and CRP criteria in risk stratification on the day of hospital admission in patients with acute pancreatitis: A cross-sectional analysis.

The early identification of severe acute pancreatitis (AP) remains a great challenge in clinical practice and novel predictors are needed to complement available scoring systems. This study aimed to investigate utility of Ranson score, and computed tomography severity index (CTSI) and C-reactive protein (CRP) criteria in determination of risk prognostic status in AP. A total of 104 patients with AP (median age: 71.5 (range, 21-102) years, (59.6% were males) were included in this cross-sectional study. Patients were divided into two groups according to risk prognostic status including good prognosis (n=67) and poor prognosis (n=37) groups, based on presence of at least one of the poor prognostic criteria including Ranson score ≥3, presence of pseudocyst and necrotizing fluid collection on ultrasonography or computed tomography imaging and CRP levels >15 mg/L. Data on patient demographics, etiology of AP, smoking, blood biochemistry and hemogram findings and inflammatory markers including CRP (mg/L), mean platelet volume (fL), neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio were recorded. Overall, 37 (35.6) patients with at least one these criteria comprised the poor prognosis group. Most of patients were considered to be in the poor prognosis group based on CTSI only (35.1%), CTSI + CRP (18.9%), and CTSI + Ranson (16.2%). Overall, 6 (5.8%) patients died, and all of them were in the poor prognosis group (p=0.002). Patients with poor versus good prognosis had significantly higher median (min-max) values for creatinine (1 [0.57-10.0] vs. 0.76 [0.5-8.4] mg/dL, p=0.004) and urea (48.0 [9.0-247.0] vs. 27.0 [10.0-111.0] mg/dL, p<0.001), and lower albumin values (3.5 [2.4-4.3] vs. 3.6 [2.7-4.6] g/L, p=0.021). Kappa values indicated presence of a moderate agreement between CTSI and CRP (kappa: 0.408), a fair agreement between CTSI and Ranson (kappa: 0.312), and a none to slight agreement between Ranson and CRP (kappa: 0.175). CTSI was able to discriminate all 6 patients (100.0%) with mortality, whereas Ranson and CRP each discriminated only 2 (33.3%) of 6 patients with mortality. Our findings suggest a stronger individual prognostic value of CTSI alone, rather than CRP or Ranson score alone, in risk stratification of AP patients for severity of disease and related mortality risk on the day of admission, whereas emphasize the likelihood of using CRP or Ranson score complementary to CTSI to enable further identification of poor prognostic status.

AN OBSERVATIONAL CLINICAL STUDY OF 40 CASES OF INTESTINAL STOMA CLOSURE AND ITS COMPLICATIONS AT TERTIARY CARE HOSPITAL SOUTH GUJARAT

Background: Intestinal stoma whether temporary or permanent as its own complication which increase the morbidity of the patient and hospital stay .In this article we have tried to analyze the various complications faced in 40 cases of stoma closure in a tertiary care hospital and factors affecting the outcome of patient undergoing stoma closure which determine morbidity and decrease hospital stay. To Observe certain complications of intestinal stoma c Aims And Objectives: losure that are common in certain age group with ileoileal, ileo colonic &amp;colo-colonic types of intestinal stoma and its Outcome in Certain Age groups. Data was collected from case METHODS: reviews of patients admitted and operated in the hospital during the period of May 2018 to April 2020 and different parameters have been taken into consideration regarding the stoma closure and its related complications. Results &amp; Conclusion :Among 40 patients anastomotic leak is most common complication followed by obstruction due to stenosis or stricture and wound site complications.Abdominal tuberculosis is the commonest comorbidity associated with the overall post- operative complications, anastamotic leak and mortality.There is higher probability of anastamotic leak with the lower values of albumin and protein, with bowel lumen disparity and lower if early stoma closure was done(&lt;90days)

The Influence of Malnutrition Measured by Hypalbuminemia and Body Mass Index on the Outcome of Geriatric Patients with a Fracture of the Proximal Femur.

Background and Objectives: Fractures of the proximal femur are a life-changing and life-threatening event for older people. Concomitant malnutrition has been described as an independent risk factor for complications and mortality. Therefore, we examined the influence of albumin and body mass index (BMI) as parameters for the nutritional state on the outcome after geriatric hip fracture surgery. Materials and Methods: Data were retrospectively collected from hospital information systems, and complications and all other parameters were obtained from patient charts. We included patients aged 70 years or above with a fracture of the proximal femur. We excluded periprosthetic and peri-implant fractures and patients with a missing BMI or albumin value. Results: Patients with a BMI below 20 kg/m2 were more likely to be female but did not differ from the normal BMI group in terms of baseline parameters. Patients with hypoalbuminemia had a higher ASA grade and Charlson Comorbidity Index, as well as a lower hemoglobin value and prothrombin time compared to those with normal albumin values and low BMI. Hypoalbuminemia was associated with significantly increased rates of complications (57.9% vs. 46.7%, p = 0.04) and mortality (10.3% vs. 4.1%, p = 0.02). Blood loss and transfusion rates were higher in the hypoalbuminemia group. Patients with a BMI below 20 kg/m2 had a higher risk of intraoperative cardiac arrest (2.6% vs. 0.4%, p = 0.05) but did not show higher mortality rates than patients with a BMI above 20 kg/m2. However, the outcome parameter could not be confirmed in the regression analysis. Conclusions: Hypoalbuminemia might be an indicator for more vulnerable patients with a compromised hemoglobin value, prothrombin time, and ASA grade. Therefore, it is also associated with higher mortality and postoperative complications. However, hypoalbuminemia was not an independent predictor for mortality or postoperative complications, but low albumin values were associated with a higher CCI and ASA grade than in patients with a BMI below 20 kg/m2.

Relationship between lipid profile and monocyte to highdensity lipoprotein ratio with disease severity in chronic obstructive pulmonary disease patients

Aim: To examine lipid profile and monocyte to high density lipoprotein ratio ratio (MHR) values in stable chronic obstructive pulmonary disease patients. &#x0D; Material and Method: Patients admitted to our hospital with the diagnosis of chronic obstructive pulmonary disease (COPD) between 01.01.2014 - 01.01.2020 were included in the study and evaluated retrospectively. According to the COPD guideline, two main groups were formed as A+B and C+D. Demographic characteristics, hemogram, C-Reaktif protein (CRP), albumin, lipid profile values were analyzed. &#x0D; Result: In our study, there were 360 cases, 293 (81.4%) of which were male. The mean age was 67.61±8.7 years. There were 162 cases (45%) in the A+B group and 198 (55%) in the C+D group.White blood cell (WBC) , neutrophil, lymphocyte, neutrophil/lymphocyte ratio (NLR), monocytes, hemoglobin, CRP, Albumin, high density lipoprotein (HDL), monocyte to HDL ratio (MHR) were found to be different at the level of statistical significance, while cholesterol, triglyceride and low density lipoprotein (LDL) were not at this level of significance. When evaluated with multivariate regression analysis afterwards, it was observed that the statistical significance levels of MHR, CRP and albumin values continued. &#x0D; Conclusion: We think that high MHR rate, high CRP, and low albumin values in stable COPD patients may be a stimulant for increased disease severity.