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    Do high PaCO2 levels during discharge from the hospital predict medium-term mortality in chronic respiratory failure patients without domiciliary non-invasive mechanical ventilator?
    (2022) Çelik, Deniz; Yıldız, Murat; Kurt, Gızem; Saymaz, Zeynep Tilbe
    Aim: Long-term domiciliary use of a non-invasive mechanical ventilator (NIV) is a controversial form of therapy for patients with chronic obstructive pulmonary disease (COPD) and moderate hypercapnia. The present research attempted to examine hospital admissions, hospitalizations, and medium-term (6-8 months) mortality in a group of patients with compensated but moderate hypercapnia who were discharged from our clinic without a domiciliary NIV. Material and Method: The sample of this retrospective, observation-based cohort study consisted of compensated hypercapnic cases that were hospitalized in our Pulmonology Intensive Care Unit (ICU) between 01.01.2019 and 12.31.2020. Results: A total of 245 patients discharged with high partial pressure of carbon dioxide (PaCO2) levels between 01.01.2019 and 12.31.2020 were included in the study. While 58% of the cases were males (n=142), we found the mean age of the patients to be 71.89±12.63 years. The findings yielded no significant differences between the groups by sex, use of NIV during hospitalization, number of days of NIV use during hospitalization, use of LTOT or Oxygen tube at home, and intubation history before ICU admission (p>0.05). Similarly, we could not conclude significant differences between the groups by hospitalization, discharge, and follow-up arterial blood gas (ABG) parameters. Yet, the rates of congestive heart failure, coronary artery disease, and atrial fibrillation were significantly higher in the mortality group (p=0.017, p=0.032, and p=0.002, respectively). Besides, high PaCO2 levels versus mortality rates at 1, 3, 6, 8, and 12 months and in the entire follow-up period were subjected to the ROC analysis. Accordingly, when accepting 50.25 mmHg as the cut-off value for determining the 8-month mortality for discharge PaCO2 levels, we calculated the sensitivity to be 78.6% and the specificity to be 43%. Conclusion: Overall, it is highly convenient to consider the possible positive effects of NIV therapy on mortality among patients with heart-related diseases and with moderate hypercapnia (PaCO2>50 mmHg) at discharge.
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    Öğe
    The effects of D-dimer high rates on prognosis and mortality in chronic obstructive respiratory disease
    (2022) Saymaz, Zeynep Tilbe; Çelik, Deniz; Yıldız, Murat; Özdağ, Özlem
    Aim: We aim to answer the question of “Can D-dimer be an indicator of prognosis and mortality in COPD exacerbations?” by doing retrospective research on the prognosis and mortality of patients who had high D-dimer levels in COPD exacerbations with no thromboembolism detected. Material and Method: Our research is retrospective and cross-sectional. A total of 115 patients who had applied to our hospital between January 2018 and January 2019 with COPD acute exacerbations and who had higher D-dimer levels detected than the 0.44 mg/L upper limit of our hospital’s laboratory are included in this research. All patients have been previously diagnosed with COPD by a pulmonologist and have been undergoing treatment. Patients under the age of 18, patients whose information was not accessible through their files, pregnant patients, patients who have not been diagnosed with COPD by a pulmonologist, patients who had been diagnosed with lung malignancy through pathology, patients where pulmonary embolism was detected through pulmonary CT angiography, patients with renal function test disorder and patients with known renal failure are not included in this study. Results: A total of 115 patients were included in the study. Patients who developed mortality had statistically significant lower levels of OSAS, higher rates of pneumonia, anemia, and liver failure, higher numbers of applications to emergency services in 1 year, higher numbers of hospitalizations due to COPD acute exacerbations in 1 year, higher numbers of intensive care unit admissions due to COPD acute exacerbations in 1 year and lower survival time. In addition, patients who developed mortality had statistically significant lower rates of group B and C and higher rates of group D according to the classification of Global Initiative of Chronic Obstructive Lung Disease (GOLD). Although the D-dimer levels were higher in patients who developed mortality, there were no statistically significant differences between groups. No significant cut-off value for D-dimer was calculated. Conclusion: As a result, although our study has found higher D-dimer levels in patients who develop mortality, these results were not statistically significant.