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    Atrial Fibrillation Among ICU Patients with Type 2 Respiratory Failure: Who Is at Risk and What Are the Outcomes?
    (Mdpi, 2025) Mentes, Oral; Celik, Deniz; Yildiz, Murat; Ozdemir, Tarkan; Ari, Maside; Aksoy Guney, Eda Nur; Ari, Emrah
    Background: Atrial fibrillation (AF) frequently occurs in individuals with hypercapnic type 2 respiratory failure and has the potential to adversely affect patient outcomes. This study sought to investigate the clinical features and prognostic significance of atrial fibrillation in patients admitted to the intensive care unit with hypercapnic type 2 respiratory failure. Methods: This retrospective, single-center study included 200 adult patients diagnosed with hypercapnic type 2 respiratory failure between May 2022 and May 2023. Patients were grouped according to whether atrial fibrillation was present or not. Demographic, laboratory, and echocardiographic findings, comorbidities, and outcomes were compared. Kaplan-Meier survival analysis and Cox regression were used to identify mortality predictors. Results: AF was present in 50.5% of patients. Those with AF were older, had higher Charlson Comorbidity Index scores, and a greater prevalence of heart failure (p < 0.001). No significant differences were found in arterial blood gas values. AF patients had higher urea, creatinine, and BNP levels, and lower hemoglobin, lymphocyte, eosinophil, and monocyte counts (p < 0.05). Echocardiography showed more severe tricuspid and mitral regurgitation, lower ejection fractions, and higher systolic pulmonary pressures in the AF group. About 20% of AF patients were not receiving anticoagulants at ICU admission. AF was associated with shorter survival (49.6 +/- 4.07 vs. 61.4 +/- 3.8 days, p = 0.031) and 1.6-fold higher mortality risk (HR: 1.60, 95% CI: 1.04-2.47). Advanced age and low hemoglobin were independent predictors of mortality. Conclusions: AF is frequent among patients with type 2 respiratory failure and is linked to increased mortality. Despite known complications, treatment remains underutilized. AF should be actively screened during ICU admissions for respiratory failure.
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    Culture Positivity and Antibiotic Resistance in Respiratory Intensive Care Patients: Evaluation of Readmission and Clinical Outcomes
    (Mdpi, 2025) Mentes, Oral; Celik, Deniz; Yildiz, Murat; Ensarioglu, Kerem; Ari, Maside; Cirik, Mustafa Ozgur; Kahraman, Abdullah
    Background: Multidrug-resistant bacteria (MDRB) represent a significant challenge in intensive care units (ICUs), as they limit treatment options, prolong hospital stays, and escalate healthcare costs. Respiratory ICUs are particularly affected due to the high prevalence of chronically ill patients with recurrent infections. Understanding the impact of culture positivity and MDRB on clinical outcomes and readmission rates is essential for enhancing patient care and addressing the growing burden of antimicrobial resistance. Methods: This retrospective study was conducted in a specialized respiratory ICU at a tertiary care hospital between 1 January 2019, and 1 January 2020. A total of 695 ICU admissions were analyzed, with patients grouped based on readmission status and culture results. Demographic, clinical, and laboratory data were reviewed. Statistical analyses were performed using appropriate tests, with p-values <= 0.05 considered statistically significant. Results: Among the 519 unique patients, 65 experienced ICU readmissions. Male patients were significantly more likely to be readmitted (p = 0.008). Culture positivity was predominantly observed in respiratory samples, with Klebsiella spp. identified as the most common pathogen. MDRB prevalence exceeded 60% in both groups, significantly prolonging ICU stays (p = 0.013). However, no significant differences in survival rates were observed between MDRB-positive and MDRB-negative groups. Notably, patients with readmissions had lower C-reactive protein (CRP) levels both during admission and at discharge compared to non-readmitted patients (p = 0.004). This paradox may reflect a subclinical inflammatory response associated with bacterial colonization rather than active infection, particularly in patients with chronic respiratory diseases. Conclusions: MDRB infections and culture positivity are key contributors to prolonged ICU stays, resulting in increased healthcare costs. Implementing effective strategies to manage MDRB infections is critical for improving outcomes in respiratory ICUs and reducing associated risks. This study underscores the growing burden of MDRB and highlights the importance of enhanced antimicrobial stewardship in respiratory ICUs.
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    Factors Affecting the Length of Hospital Stay in Hypercapnic Respiratory Failure
    (Multidisciplinary Digital Publishing Institute (MDPI), 2025) Ari, Maside; Özdemir, Tarkan; Yildiz, Murat; Çelik, Deniz; Usul, Eren; Ari, Emrah; Tuten, Omer Faruk
    Background/Objectives: Hypercapnic respiratory failure (HRF) is a primary cause of admittance to the intensive care unit (ICU). This study aimed to investigate the factors that affect the length of hospital stay in HRF patients. Methods: This study was designed as a retrospective, cross-sectional analysis of patients who were admitted to the ICU because of HRF between 2022 and 2024. The demographic and clinical characteristics of the patients and laboratory results were recorded. The Charlson Comorbidity Index (CCI) was calculated. The relationship between these parameters and the length of hospital stay was assessed. Results: A total of 138 patients were included in the study. The average length of hospital stay was 11.45 days, and 37% of the patients were included in the long-term hospitalization group. The degree of hypercapnia was not associated with the length of hospital stay. It was determined that the patients’ albumin levels and CCI were significant determinants of the length of hospital stay. The combined assessment of these two parameters was found to be superior compared to their separate evaluations. Conclusions: In our study, hypoalbuminemia and a higher CCI were identified as predictors of a prolonged ICU stay in HRF patients. Albumin levels of <3.25 g/dL and CCI scores of ?5 were linked to longer stays, with this combined evaluation offering greater predictive value. These factors can guide patient management. © 2024 by the authors.
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    Neutrophil Percentage-to-Albumin Ratio as a Prognostic Marker in Pneumonia Patients Aged 80 and Above in Intensive Care
    (Mdpi, 2025) Ari, Maside; Solay, Asli Haykir; Ozdemir, Tarkan; Yildiz, Murat; Mentes, Oral; Tuten, Omer Faruk; Manav, Husra Tetik
    Background/Objectives: In recent years, inflammatory markers have been increasingly utilized to predict disease prognosis. The neutrophil percentage-to-albumin ratio (NPAR) has emerged as a novel biomarker reflecting inflammation and systemic response. This study was conducted to evaluate the prognostic value of NPAR in pneumonia patients aged 80 years and older hospitalized in intensive care. Methods: Patients aged 80 years and older who were followed up in the intensive care unit with a diagnosis of pneumonia between 1 October 2022, and 31 May 2024, were retrospectively reviewed. Demographic characteristics, laboratory data, disease severity scores (APACHE II, SOFA), intensive care interventions, and variables associated with mortality were analyzed. NPAR was calculated by dividing the neutrophil percentage by the serum albumin level. The prognostic value of NPAR was assessed using Kaplan-Meier survival analysis, receiver operating characteristic (ROC) curve analysis, and Cox regression analysis. Results: A total of 135 patients were included in the study. Patients with NPAR > 0.286 had significantly higher SOFA (p = 0.002) and APACHE II (p = 0.007) scores. The high NPAR group was at significantly greater risk for requiring invasive mechanical ventilation (p = 0.003), vasopressor support (p = 0.042), and developing sepsis (p = 0.035). Elevated NPAR was strongly associated with mortality (p < 0.001) and was identified as an independent predictor of mortality in the Cox regression analysis (HR = 2.488, 95% CI: 1.167-5.302, p = 0.018). Conclusions: NPAR may serve as an effective biomarker for predicting disease severity and mortality risk in pneumonia patients aged 80 years and older. Due to its simplicity and accessibility, it can be considered a practical parameter for integration into clinical practice. However, large-scale, multicenter, and prospective studies are needed to validate these findings.
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    The importance of uric acid levels in geriatric patients with respiratory failure under noninvasive mechanical ventilation in the respiratory intensive care unit
    (Bmc, 2025) Yildiz, Murat; Celik, Deniz; Ozdemir, Tarkan; Doganay, Guler Eraslan; Doganci, Melek; Cirik, Mustafa Ozgur; Ari, Maside
    Introduction The respiratory system is critical for gas exchange, with respiratory failure resulting in insufficient oxygen and inadequate removal of carbon dioxide. Serum uric acid (SUA), a byproduct of purine metabolism, rises during hypoxemic conditions and has potential as a prognostic marker in respiratory failure. This study aimed to explore the relationship between SUA levels, mortality, duration of hospital stay, and ICU scores (APACHE II, and SOFA) in geriatric patients receiving non-invasive mechanical ventilation (NIV). Materials and methods We conducted a retrospective analysis of 1109 patients with respiratory failure admitted to the Respiratory Intensive Care Unit (RICU) from 2020 to 2022. We excluded minor patients (under 18 years old), patients with incomplete records, known gout, and dialysis-dependent or SRRT required renal failure. We collected demographics, comorbidities, laboratory findings, APACHE II, and SOFA scores. Patients were divided into two age groups (>= 65 and < 65). Statistical analysis, including chi-square, regression, and correlation tests, was performed to evaluate the association between SUA and clinical outcomes. Results Patients aged >= 65 had significantly higher SUA, creatinine, and BUN levels, as well as longer hospital stays and higher APACHE II and SOFA scores. Elevated SUA levels correlated with increased mortality and NIV requirements in the elderly. Regression analysis confirmed SUA as a predictor of NIV need. Discussion SUA levels are positively associated with worse outcomes in elderly patients with respiratory failure. This study supports previous research findings that hyperuricemia correlates with increased ICU admissions and mortality in respiratory conditions, particularly in older adults who need a noninvasive ventilation (NIV). Conclusion Elevated SUA levels are a valuable prognostic marker for predicting NIV needs and poor outcomes in geriatric patients with respiratory failure. Regular monitoring of SUA could enhance clinical management and improve prognosis in this population.