Kardiyotorasik dışı cerrahilerde postoperatif pulmoner komplikasyonlar

Purpose: Postoperative pulmonary complications (PPCs) are a major cause of mortality and morbidity. The aim of this study is to evaluate frequencies and determine risk factors of PPCs which developed subsequent to general surgery and orthopedic surgery in a tertiary university hospital.Materials-methods: Patients who were operated in Departments of General Surgery and Orthopedics and Traumatology were retrospectively included to the study.Results: 683 patients with a mean age of 59.43±18.77 years were included in the study. The ratio of PPC was 10.3%. Most frequent PPC was found to be pneumonia (6.3%). The prevelance of PPC was significantly higher in patients ?65 years than who were 4 h) were respectively as follows 2.8%, 9.5%, 25%, 75% and 100% (p<0.001). Multivariable logistic regression analysis showed that being ?65 years, having ASA?3 and hypoalbuminemia (<3g/dl) were independent risk factors for development of PPC (OR:2.45, 95% CI (1.14-5.25) p<0.05; OR: 44.5, 95% CI (5.13-386.1) p<0.05; OR:6.4, 95% CI (3.14-13.1) p<0.05).Conclusion: The clinicians should be aware of PPCs especially in patients who were ?65 years, had ASA?3 and hypoalbuminemia (<3g/dl)Amaç: Postoperatif pulmoner komplikasyonlar (PPK) önemli mortalite ve morbidite sebebidir. Çalışmamızın amacı ortopedi ve genel cerrahi operasyonlarından sonra gelişen PPK sıklığını ve risk faktörlerini belirlemektir. Gereç ve yöntem: Genel cerrahi, ortopedi ve travmatoloji kliniklerinde opere edilen hastalar retrospektif olarak değerlendirildi. Bulgular: Ortalama yaşı 59,43±18,77 yıl olan 683 hasta çalışmaya alındı.PPK %10,3 idi. Pnömöni (%6,3) en sık görülen PPK olarak tespit edildi. PPK sıklığı 65 yaş ve üstünde altında göre belirgin olarak yüksek saptandı. (%18,2 vs %4,4) (p<0,001). Acil cerrahi operasyonlarda elektif operasyonlara göre daha sık tespit edildi (%24,1 vs %8) (p4st) PPK gelişim oranı sırasıyla %2,8, %9,5, %25, %75 ve %100 olarak bulundu (p<0,001). Çok değişkenli logiistik regresyon analizine göre ASA≥3, hipoalbunemi (<3g/dl) ve 65 yaş üstü PPK gelişiminde bağımsız risk faktörü olarak saptandı (OR: 2,45, %95 CI (1,14-5,25) p<0,05; OR: 44,5, %95 CI (5,13-386,1) p<0,05; OR: 6,4, %95 CI (3,14-13,1) p<0,05). Sonuç: Klinisyenler preoperative değerlendirmede ASA≥3, hipoalbunemi (<3g/dl) ve 65 yaş üzerindeki hastalarda PPK açısından dikkatli olmalıdır

Should the cut-off value of D-dimer be elevated to exclude pulmonary embolism in acute exacerbation of COPD?

Objective: The aim of this study was to evaluate the D-dimer levels in patients with chronic obstructive pulmonary disease (COPD) exacerbation with and without pulmonary embolism (PE) and to attempt to define a new cut-off value for D-dimer to exclude the diagnosis of PE in patients with COPD exacerbation. Methods: This cross-sectional study was performed between the June 2012 and January 2013. The COPD patients who were admitted to the emergency department with acute exacerbation were consecutively included. D-dimer levels were measured upon admission. All patients underwent computed tomography angiography (CTA) and Doppler ultrasonography (US) of the lower extremities. Results: A total of 148 patients were enrolled. Fifty-three patients (36%) who did not have PE had higher than normal (>0.5 pg/mL) D-dimer levels. The D-dimer levels of the COPD patients with PE were significantly higher than those of the patients without PE (2.38±2.80 vs. 1.06±1.51 pg/mL) (P<0.001). The cut-off value for D-dimer in diagnosing PE in the COPD patients was 0.95 pg/mL. The area under the receiver operating characteristic (ROC) curve was 0.752±0.040 (95% CI: 0.672-0.831) (P<0.001). Conclusions: This study showed that the D-dimer concentrations of COPD patients who are in the exacerbation period may be higher than normal, even without PE. The cut-off level for D-dimer was 0.95 pg/mL (sensitivity 70%, spesificity 71%) for the exclusion of PE in the patients with COPD exacerbation. The D-dimer cut-off value that is used to exclude PE in patients with acute exacerbation of COPD should be reevaluated to prevent the excessive use of further diagnostic procedures

Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia?

Objective: Pneumonia is a leading cause of mortality worldwide, especially in theelderly. The use of clinical risk scores to determine prognosis is complex and thereforeleads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiacbiomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognosticrole of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear.The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patientswith CAP, as well as its correlation with clinical risk scores. Methods: Consecutiveinpatients with CAP were enrolled in the study. At hospital admission, venous bloodsamples were collected for the evaluation of NT-proBNP levels. The Pneumonia SeverityIndex (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ? 65years (CURB-65) score were calculated. The primary outcome of interest was all-causemortality within the first 30 days after hospital admission, and a secondary outcomewas ICU admission. Results: The NT-proBNP level was one of the best predictors of30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p< 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001),whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006).The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL. Conclusions: The NT-proBNP level appears to be agood predictor of ICU admission and 30-day mortality among inpatients with CAP, witha predictive value for mortality comparable to that of the PSI and better than that of theCURB-65 score

Impairment in heart functions and prognostic role of N‑terminal pro‑brain natriuretic peptide in patients with chronic obstructive pulmonary disease exacerbation

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) with comorbidities andcardiovascular disease is the most frequent one. The role of natriuretic peptides in determiningprognosis of COPD exacerbations is not yet clear. The frequency of pathologic findings of transthoracicechocardiography (TTE) during COPD exacerbation showed wide variability. This study aims toevaluate the predictive role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in determiningthe short-term prognosis of patients hospitalized with COPD exacerbation. As a secondary outcome,we aimed to investigate the frequency of TTE findings in these patients.MATERIALS AND METHODS: Eighty-six consecutive patients with COPD exacerbationwere included. NT-proBNP levels were measured and TTE was carried out to whole of theparticipants at administration. The primary outcome was development of “event” (readmissionor rehospitalization or mortality) within 30 days. The predictive role of NT-proBNP level for thedevelopment of “event” was evaluated. As a secondary outcome of the study, the frequency ofTTE findings was recorded.RESULTS: NT-proBNP level of the patients who developed event within 30 days had significantlyhigher than who did not (2343.16 ± 4107.17 pg/mL vs. 843.22 ± 2349.96 pg/mL, P = 0.001).A high negative correlation was found between NT-proBNP level and “time to event” (r =-0.992, P < 0.001). Multivariable logistic regression analysis showed that NT-proBNP levelwas an independent predictor for the development of “event” (P < 0.001) and the cutoff pointof it was found to be 303.5 pg/mL (0.639 sensitivity and 0.720 specificity). The most frequentechocardiographic findings were pulmonary hypertension (54.7%) and left ventricle diastolicdysfunction (39.5%).CONCLUSION: NT-proBNP level is a strong predictor for short-term prognosis of patients hospitalizedwith COPD exacerbation. Further and larger studies are needed to determine exact role of NT-proBNPin long-term prognosis of these patient