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Objective: This study investigates the effect of convalescent plasma (CP) addition to the standard treatment on mortality in critical coronavirus disease-2019 (COVID-19) patients. Materials and Methods: This retrospective cohort study was conducted by evaluating the data of 255 critical COVID-19 patients in Marmara University Medical Faculty Hospital, Pandemic Intensive Care Unit (ICU), between April and November 2020. Results: The patients were divided into two groups, a control group that received standard treatment (153; 60.0%) versus a second group that received CP in addition to standard treatment (102; 40.0%). The ICU mortality rate was found to be lower (p<0.05) in patients receiving CP (38; 37.3%) compared to patients not receiving CP (79; 51.6%). The use of CP was found to reduce the probability of ICU mortality in patients with Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score ≤10 [odds ratio (OR): 0.251; confidence interval (CI) 95%: 0.063-0.994, p=0.049) and APACHE-II score 11-14 (OR: 0.237; CI 95%: 0.066-0.844, p=0.026). CP transfusion, however, did not reduce the mortality in patients with an APACHE-II score of 15 and above. Furthermore, each day of delay in CP transfusion was found to increase the probability of mortality by 1.3 times (OR: 1.369; CI 95%: 1.155-1.622, p<0.001). Conclusion: The addition of CP to standard treatment in COVID-19 patients followed in ICU reduces mortality. [ABSTRACT FROM AUTHOR]

Background: The number of geriatric patients in the intensive care unit (ICU) is increasing day by day in line with the increase in the population. The present study evaluated the relationship between the presence of acute kidney injury (AKI) and mortality in geriatric patients, who are increasingly seen in the ICU. Methods: This retrospective study was conducted in a tertiary-level ICU of a public hospital in Istanbul, Turkey. The data of 2154 patients aged 65 and over, who were followed up in the ICU between January 2013 and January 2020, were collected and digitally analyzed using Structured Query Language. Results: The patients were divided into two groups as 1286 (59.7%) who developed AKI and 868 (40.3%) who did not develop AKI. Patients with AKI stay in the ICU longer than patients who did not develop AKI (median 5.91 vs. 3.44 days, p < 0.05). ICU mortality was 46.2% in patients with AKI and 25.8% in patients without AKI (p < 0.001). All stages of AKI were found to increase mortality (p < 0.05). The probability of mortality in patients above 85 years of age who developed AKI was 1.7 times higher compared to that of geriatric patients who developed AKI younger than 75 years (OR: 1.749; 95% CI: 1.099–2.785). While the increase in sequential organ failure assessment score, ventilator workload and lactate level, need for dialysis, and development of pressure sores was associated with increased mortality in geriatric patients with AKI, an increase in body mass index was associated with a decrease in mortality (OR: 0.961; 95% CI: 0.929–0.995). Conclusion: AKI is associated with ICU mortality in geriatric patients and it increases morbidity. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of perioperative goal-directed fluid therapy (GDFT) on intraoperative fluid balance, postoperative morbidity, and mortality. Methods: This is a prospective randomized study, and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included. Patients were randomized into 2 groups that received liberal fluid therapy (the LFT group, n=45) and goal-directed fluid therapy (the GDFT group, n=45). Patients' Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) physiological score, Charlson Comorbidity Index (CCI), perioperative vasopressor and inotrope use, postoperative AKIN classification, postoperative intensive care unit (ICU) hospitalization, hospital stay, and 30-day mortality were recorded. Results: The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group (P<0.05). CR-POSSUM physiological score and CCI were significantly higher in the GDFT group (P<0.05). Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group (P<0.05), postoperative acute kidney injury development was not affected. Postoperative mortality was determined to be similar in both groups (P>0.05). Conclusion: Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery, and it can prevent perioperative fluid overload, and the postoperative results are comparable in the two groups. [ABSTRACT FROM AUTHOR]

The conflicting results of studies on intensive care unit (ICU) mortality of obese patients and obese patients with acute kidney injury (AKI) reveal a paradox within a paradox. The aim of this study was to determine the effects of body mass index and obesity on AKI development and ICU mortality. The 4,459 patients treated between January 2015 and December 2019 in the ICU at a Tertiary Care Center in Turkey were analyzed retrospectively. AKI developed more in obese patients with 69.8% (620). AKI development rates were similar in normal-weight (65.1%; 1172) and overweight patients (64.9%; 1149). The development of AKI in patients who presented with cerebrovascular diseases was higher in obese patients (81; 76.4%) than in normal-weight (158; 62.7%) and overweight (174; 60.8%) patients (p < 0.05). The risk of developing AKI was approximately 1.4 times (CI 95% = 1.177–1.662) higher in obese patients than in normal-weight patients. Dialysis was used more frequently in obese patients (24.3%, p < 0.001), who stayed longer in the ICU (p < 0.05). It was determined that the development of AKI in normal-weight and overweight patients increased mortality (p < 0.001) and that there was not a difference in mortality rates between obese patients with and without AKI. The risk of AKI development was higher in obese patients but not in those who were in serious conditions. Another paradox was that the development of AKI was associated with a higher mortality rate in normal-weight and overweight patients, but not in obese patients. Cerebrovascular diseases as a cause of admission pose additional risks for AKI. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the factors associated with prolonged intensive care unit length of stay (ICU-LOS), which is increasingly common in ICU, and to evaluate its effect on patient outcomes. Methods: This retrospective study was evaluated by obtaining data of 5,022 patients who were followed in the ICU of a tertiary education and research hospital between January 2014 and January 2021 and met the research criteria in electronic environment. Results: Patients were divided into two groups as patients with ICU-LOS <14 days (n=4,083, 81.3%) and patients with ICU-LOS ≥14 days (n=939, 18.7%). Sepsis and pulmonary diseases were more common in the prolonged ICU-LOS group than in the non-prolonged ICU-LOS group (p<0.05). While 61.8% (2,525) in the non-prolonged ICU-LOS group needed mechanical ventilator support, this rate increased to 97.4% (915) in the prolonged ICU-LOS group (p<0.001). The duration of MV was higher in the prolonged ICU-LOS group [20.3 (14.9-29.2)] than in the non-prolonged ICU-LOS group [3.4 (1.7-6.2)] (p>0.001). Although 18.7% of the patients had prolonged ICU-LOS, they consumed 66.3% and 59.7% of all mechanical ventilator days and ICU hospitalization days, respectively. ICU mortality was higher in the prolonged ICU-LOS group (n=376; 40%) than in the non-prolonged ICU-LOS group (n=1219; 29.9%). The development of acute kidney injury (odds ratio (OR): 1,807; 95% confidence interval (CI) 1,434-2,277), development of pressure sores (OR: 3,572; 95% CI: 2,663-4,792), total parenteral nutrition use (OR: 2,014; 95% CI: 1,639-2,475), increase in body mass index (OR: 1,015; 95% CI: 1.001-1.031), and mechanical power increase (OR: 1.041; 95% CI: 1.002-1.082) were associated with prolonged ICU-LOS (OR: 1.015; 95% CI: 1.001-1.031). Conclusion: Prolonged ICU-LOS is associated with increased costs, use of resources, and morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective: Risk factors affecting mortality in the coronavirus disease-2019 (COVID-19) pandemic, which emerged in Wuhan, China and affected the whole world, are yet to be clearly determined. Assessment of Charlson comorbidity index (CCI) and pneumonia severity index (PSI) can assist clinicians in identifying patients at high risk of mortality. This study aimed to determine the relation between CCI, indicating comorbidity burden in COVID-19 infection, and PSI, indicating disease severity, and their relationship with mortality. Materials and Methods: This was a retrospective cohort study conducted by accessing demographic, clinical and laboratory data from the electronic medical records of 214 patients diagnosed with COVID-19. The patients were followed up in the intensive care unit of University of Health Sciences Turkey, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital between March 10, 2020 and June 1, 2020. Results: Patients were divided into two groups i.e., survivors (n=109; 50.9%) and those with mortality (n=105; 49.1%). A one point increase in CCI was determined to increase the mortality probability by 32% [odds ratio (OR): 1,324, 95% confidence interval (CI): 1,178-1,488]. On the other hand, a one-point increase in PSI increased the mortality possibility by 2% (OR: 1,020, 95% CI: 1,012-1,0,27). In the correlation analysis performed to determine the relationship between CCI and PSI, a bidirectional and strong correlation was found between CCI and PSI (p<0.001, r=0.667). Conclusion: As a model for summarizing the sum of age and comorbidities, CCI can help identify patients at high mortality risk in the COVID-19 pandemic. Moreover, PSI may be useful in patients with low CCI scores for predicting mortality in COVID-19 patients; however, has not been found reliable in patients with high CCI scores. [ABSTRACT FROM AUTHOR]

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