Risk Factors of Prolonged Hospitalization in Patients with Hyperemesis Gravidarum

Purpose: To evaluate the risk factors of prolonged hospitalization in patients with hyperemesis gravidarum (HEG). Material and Methods: The medical records of 114 patients who were admitted to the Zekai Tahir Burak Womens Health Education and Research Hospital with a diagnosis of HEG in the period January 2013 to June 2014 were analyzed retrospectively. Hospital stay of more than 4 days was considered as prolonged hospitalization. Ninety -three patients with HEG who needed hospitalization less than four days formed the control group and 21 patients with HEG who needed hospitalization equal to or longer than four days formed the study group. The variables regarding age, body mass index, week of pregnancy, number of parity, daily vomiting number, number of days in hospital, need of combined antiemetic use, complete blood count, biochemistry markers, hormone tests, urine analysis were evaluated to assess their relationship with the risk factors for prolonged hospitalization in patients with HEG. Results: Twenty-one of 114 patients diagnosed with HEG had a prolonged hospital stay, with a mean stay of 5.1 days. Age, body mass index, week of pregnancy, need of using combined antiemetics, complete blood count parameters, liver and kidney function tests were not associated with the duration of hospitalization. Daily vomiting, maternal serum TSH levels and blood urea nitrogen levels were 2.4 +/- 1.3 vs 4.2 +/- 1.9; p= 0.01, 1.19 +/- 0.71 vs 0.82 +/- 0.67; p= 0.04, 21.2 +/- 6.4 vs 18.1 +/- 5.3; p= 0.03; respectively, and these differences were found to be statistically significant among groups. The serum maternal TSH < 0.1 and micro;IU/mL and vomiting and #8805; 5 per day were found to be significant indicators for longer hospitalization (OR = 4.05, 95%CI = 1.07-15.3; P <0.05, OR=9.55, 95%CI = 1.81-50.4 P <0.05; respectively). Conclusion: Number of vomiting per day and maternal serum TSH levels could help physicians to estimate the risk of prolonged hospitalization; however further investigations are needed in large population studies. Identifying the high risk patients is important both for prevention of HEG and beginning appropriate antiemetic treatment to avoid complications to reduce the economic costs. [Cukurova Med J 2015; 40(1.000): 113-118

Efficacy of blood parameters in predicting the severity of gestational hypertension and preeclampsia

The aim of this retrospective study was to demonstrate the effectiveness of APRI, DNI, NLR, PLR, and PDW in predicting the severity of gestational hypertension (GHT) and PE and to determine whether these factors can be used as screening tools. Normotensive pregnant women (n = 792) served as the control group. 1,213 single pregnant women who met the following criteria for a GHT diagnosis were included in the study group. We found a significantly higher mean PLR and NLR value. The mean PDW value was significantly lower in the control group than in the other groups. The SPE group had a significantly higher mean APRI score. The groups did not differ by their DNI. We determined PDW and APRI as independent parameters that predicted SPE by multiple logistic regression analysis. In retrospective analysis of blood samples taken from these participants below week 20, we found that the APRI value differed significantly between the control and SPE groups. NLR, PLR, DNI, and PDW had no clinical significance. We further suggested that APRI may provide a clinical indication of progression from hypertensive pregnancy disorders to SPE, which seems to be a promising implication that should be verified by further studies.IMPACT STATEMENT What is already known on this subject? Hypertensive disorders in pregnancy are a major cause of maternal and perinatal morbidity and mortality. Screening pregnant women for risk factors for developing hypertensive disorders and identifying women at high risk in early pregnancy and initiating prophylactic treatment are important for pregnancy monitoring and planning in experienced centres. Because only 30% of women who will develop preeclampsia can be predicted by risk factors, the combined use of laboratory tests and imaging with risk factors to calculate a woman’s risk of developing preeclampsia is currently being investigated. However, no proven marker has yet been found. What do the results of this study add? In our study, we found that NLR, PLR, DNI, and PDW have no clinical significance in assessing the risk of developing gestational hypertension and preeclampsia and in predicting the severity of preeclampsia. However, in our study, we found that APRI can provide a clinical indication of the progression of hypertensive pregnancy to SPE. What are the implications of these findings for clinical practice and/or further research? This study represents an important contribution to the literature because it is the first study to examine the association between APRI and HT in pregnancy

Evaluation of the Diagnostic Accuracy of Serum D-Dimer Levels in Pregnant Women with Adnexal Torsion

We aimed to evaluate the diagnostic accuracy of serum D-dimer levels in pregnant women with adnexal torsion (AT). The pregnant women with ovarian cysts who suffered from pelvic pain were divided into two groups; the first group consisted of the cases with surgically proven as AT (n = 17) and the second group consisted of the cases whose pain were resolved in the course of follow-up period without required surgery (n = 34). The clinical characteristics and serum D-dimer levels were compared between the groups. Patients with AT had a higher rate of elevated serum white blood cell (WBC) count (57% vs. 16%, p = 0.04) and serum D-dimer levels (77% vs. 21%, p &lt; 0.01) on admission in the study group than in the control group. Elevated D-dimer and cyst diameter larger than 5 cm yielded highest sensitivity (82% for each); whereas the presence of nausea and vomiting and elevated CRP had the highest specificity (85% and 88%, respectively). This is the first study that evaluates the serum D-dimer levels in humans in the diagnosis of AT, and our findings supported the use of D-dimer for the early diagnosis of AT in pregnant women

Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV mortality prediction score (IMPRES)

KUCUK, Ahmet Oguzhan/0000-0002-6993-0519; Kirakli, Cenk/0000-0001-6013-7330; KUCUK, Mehtap PEHLIVANLAR/0000-0003-2247-4074; Aksoy, Iskender/0000-0002-4426-3342WOS: 000504051300010PubMed: 31655511Background/aim: The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients. Materials and methods: The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed. Results: The following cut-off scores were used to indicate mortality risk: 8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was 93.3% for patients with total 1M PRES scores of greater than 8 (P < 0.001). Conclusion: The present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data