Nonalkolik Steatohepatit Hastalarında Noninvaziv Fibrozis Testlerinin Değerlendirilmesi

Koylu B. Evaluation of the Noninvasive Fibrosis Tests in Nonalcoholic Steatohepatitis Patients, Hacettepe University Faculty of Medicine, Thesis in Internal Medicine, Ankara, 2021. The parameter that has the strongest relationship with liver-related complications and liver-related mortality in nonalcoholic steatohepatitis(NASH) patients is the fibrosis stage. The current gold standard test for the diagnosis of NASH is liver biopsy. However, because of the limitations of liver biopsy, there is an ongoing need for noninvasive methods that can accurately detect the fibrosis stage. The main aim of this study is to develop a new noninvasive scoring system that can predict hepatic fibrosis by using the most relevant variables among the demographic, clinical, laboratory, imaging data and 7 serum fibrosis biomarkers. 56 patients diagnosed as NASH by liver biopsy were prospectively enrolled in the study. Participants were divided into four groups according to fibrosis stage and a comparison was made for a total of 59 variables. Among the variables with statistically significant differences between the groups, total metabolic syndrome score(p=0.001), AST/ALT ratio(p<0.001) and MMP-1(p=0.009) variables were used in binary logistic regression analysis to develop a new scoring system. The diagnostic accuracy of this new score in detecting patients with fibrosis stage ≥ 2(at-risk NASH patients) and also patients with fibrosis stage ≥ 3(advanced fibrosis) was compared with the diagnostic performance of the FIB-4 score, NAFLD fibrosis score, BARD score, APRI score and kPa measurements obtained from MRE by using ROC analysis. The new score can detect patients with fibrosis stage ≥ 2 with a higher diagnostic accuracy (AUROC 0.88, %95 CI 0.79 – 0.97) than other noninvasive tests and MRE, and also can detect advanced fibrosis with a strong diagnostic accuracy(AUROC 0.95, %95 CI 0.90 – 1.00) that is similar to other noninvasive tests and higher than MRE.Köylü B. Nonalkolik Steatohepatit Hastalarında Noninvaziv Fibrozis Testlerinin Değerlendirilmesi, Hacettepe Üniversitesi, İç Hastalıkları Ana Bilim Dalı, Uzmanlık Tezi, Ankara, 2021. Nonalkolik steatohepatitte(NASH) karaciğer ilişkili komplikasyonlar ve karaciğer ilişkili mortalite ile en kuvvetli ilişkisi olan parametre fibrozis evresidir. NASH tanısında ise altın standart test karaciğer biyopsisidir. Ancak karaciğer biyopsisinin uygulamadaki bazı kısıtlılıkları nedeniyle her hastaya biyopsi yapılamamaktadır. Bu durumda fibrozis evresini doğru bir şekilde öngörebilecek noninvaziv yöntemlere ihtiyaç duyulmaktadır. Bu çalışmada; NASH hastalarına ait demografik, klinik, laboratuvar, görüntüleme verileri ve çeşitli serum fibrozis biyobelirteçleri kullanılarak elde edilen yeni bir noninvaziv skorlama sistemi ile NASH hastalarının değerlendirilmesi ve fibrozis prediksiyonu yapılması amaçlanmıştır. Biyopsi tanılı 56 hasta prospektif olarak çalışmaya dahil edilmiştir. Hastalar patolojik değerlendirme sonucunda fibrozis evrelerine göre dört gruba ayrılmış ve toplam 59 değişken açısından karşılaştırma yapılmıştır. Gruplar arasında istatistiksel açıdan anlamlı farklılık saptanan değişkenler içinden toplam metabolik sendrom puanı(p=0.001), AST/ALT oranı(p<0.001) ve MMP-1(p=0.009) değişkenleri kullanılarak iki durumlu lojistik regresyon analiziyle fibrozis evresi ≥ 2 olan hastaları saptayabilecek yeni bir skorlama elde edilmiştir. Yeni skorun fibrozis evresi ≥ 2 olan risk altındaki NASH hastalarını ve fibrozis evresi ≥ 3 olan ileri fibrozis hastalarını saptamadaki tanısal performansı, ROC analizi yapılarak FIB-4 skoru, NAYKH fibrozis skoru, BARD skoru, APRI skoru ve MRE’den elde edilen kPa ölçümlerinin tanısal performansı ile karşılaştırılmıştır. Yeni skor, hem fibrozis evresi ≥ 2 olan hastaları diğer noninvaziv testler ve MRE’ye göre daha yüksek bir tanısal doğruluk oranıyla saptayabilmekte(AUROC 0.88, %95 GA 0.79 – 0.97), hem de ileri fibrozisi olan hastaları bu testlere yakın ve MRE’den yüksek bir tanısal doğruluk oranıyla(AUROC 0.95, %95 GA 0.90 – 1.00) tespit edebilmektedir

Epidemiology and risk factors of 28-day mortality of hospital-acquired bloodstream infection in Turkish intensive care units: A prospective observational cohort study

OBJECTIVES: To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. METHODS: The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. RESULTS: Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55-78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14-1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58-3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12-3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25-6.95) and not achieving source control (aHR 2.02, 95% CI 1.15-3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06-0.90) and source control (aHR 0.46, 95% CI 0.28-0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17-1.43) and age (aHR 1.05, 95% CI 1.03-1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20-0.87) was associated with survival. CONCLUSIONS: Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.European Society of Intensive Care Medicine (ESICM) (ESICM Trials Group Awards 2018) ; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) (ESCMID Study Group Research Grants 2018) study Group for Infections in Critically Ill Patients (ESGCIP) ; Norva Dahlia (2018 Norva Dahlia study grant) foundation ; Redcliffe Hospital Private Practice Trust Fun

Epidemiology and risk factors of 28-day mortality of hospital-acquired bloodstream infection in Turkish intensive care units : a prospective observational cohort study

Objectives To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. Methods The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. Results Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55–78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14–1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58–3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12–3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25–6.95) and not achieving source control (aHR 2.02, 95% CI 1.15–3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06–0.90) and source control (aHR 0.46, 95% CI 0.28–0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17–1.43) and age (aHR 1.05, 95% CI 1.03–1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20–0.87) was associated with survival. Conclusions Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.</p