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Öğe Apoptosis and its relation with clinical course in patients with Crimean-Congo hemorrhagic fever(WILEY, 2019) Engin, Aynur; Aydin, Huseyin; Cinar, Ziynet; Buyuktuna, Seyit Ali; Bakir, MehmetCrimean-Congo hemorrhagic fever (CCHF) is a tick-mediated viral infection. Patients with CCHF may show various clinical presentations. The cause of this difference in the clinical course is not completely understood. Apoptosis is programmed cell death and plays an important role in regulating the immune system. Our knowledge of the role of apoptosis in CCHF disease is limited. We investigated the role of apoptosis and their relationship with the severity of the disease in CCHF. Thus, in 30 patients with CCHF and 30 healthy individuals, we analyzed the serum levels of cytochrome C, apoptotic protease activating factor-1 (Apaf 1), caspase 3, caspase 8, caspase 9, sFas, sFasL, perforin, granzyme B, and CK18 by enzyme-linked immunosorbent assay. This is the first study that research the serum levels of the mentioned apoptosis markers in adult patients with CCHF. We found that the serum levels of sFasL, cytochrome C, Apaf 1, caspase 3, caspase 8, caspase 9, perforin, granzyme B, and M30 were statistically significantly different in the acute phase of the disease compared with healthy individuals and patients in convalescent period. There was no association between the clinical severity of the disease and apoptosis markers. In conclusion, the results of our study suggested that the extrinsic and intrinsic apoptosis pathway play an important role in CCHF.Öğe Athlete Sleep Behavior Questionnaire - Turkish Version: Study of Validity and Reliability(GALENOS YAYINCILIK, 2019) Darendeli, Abdulkerim; Diker, Gurkan; Cinar, ZiynetObjective: Athlete sleep behavior questionnaire (ASBQ) is a new, valid and reliable questionnaire for evaluating the sleep behaviors of elite athletes. The main objective of the current study was to provide evidence for the validity and reliability of the Turkish version of the ASBQ (ASBQ-TR). Materials and Methods: Ninety-seven athletes and eighty-three non-athletes were included in the current study and asked to complete the 18-item ASBQ-TR. A sub-group of athletes (n=50) completed the ASBQ-TR twice, 7 days apart. The ASBQ was translated into English twice and then back-translated to Turkish after the permission of the author was received. Test-retest reliability and internal consistency were performed via intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. Results: There was a significant difference between the athlete and non-athlete groups in ASBQ-TR total score (38.4 and 36.2 respectively, p<0.05). Test-retest reliability of the questionnaire was acceptable (ICC=0.85). The factor loadings of ASBQ-TR were between 0.41 and 0.82. One of the 18-items of the questionnaire was removed due to the factor loading (below 0.40). Conclusion: The ASBQ-TR is a 17-item valid and reliable tool that can be used to identify sleep challenges that athletes face. The ASBQ-TR can be used as a practical tool for researchers and coaches evaluating the sleep behaviors of elite athletes. This tool may also be used to examine the sleep behavior differences among sports with different recovery needs and training loads.Öğe Atrial fibrillation is associated with increased mean platelet volume in patients with type 2 diabetes mellitus(TAYLOR & FRANCIS INC, 2013) Turgut, Okan; Zorlu, Ali; Kilicli, Fatih; Cinar, Ziynet; Yucel, Hasan; Tandogan, Izzet; Dokmetas, Hatice SebilaPlatelet abnormalities in diabetes mellitus (DM) and atrial fibrillation (AF) may underline the etiology of a prothrombotic state in these conditions. Increased mean platelet volume (MPV) is a marker of abnormal platelet function and activation. We aimed to investigate the possible association of chronic AF with MPV in patients who have type 2 DM. Patients who had type 2 DM with either chronic (>= 6 months) AF or normal sinus rhythm (NSR) were included in the study. A total of 162 patients (aged 38-89 years) were divided into 2 groups according to the presence of either AF or NSR. Group 1 consisted of 81 diabetic patients with AF, and group 2 consisted of 81 diabetic patients with NSR. The two groups were not significantly different in terms of age, and gender, as well as in hypertension, smoking, history of coronary artery disease, previous cerebrovascular accidents, microalbuminuria, retinopathy, duration of DM, body mass index, hemoglobin A(1c), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (p > 0.05 for all variables). Although no significant difference was present between groups concerning platelet count; for patients with AF, MPV was higher compared with patients with NSR (9.0 +/- 0.2 fl vs. 8.4 +/- 0.2 fl; p = 0.001). Furthermore, no significant difference was noted between groups regarding routine medications received by patients. In multivariate logistic regression analysis, MPV was the only variable independently related to AF (OR = 2.659; 95% CI, 1.286-5.498; p = 0.008). Consequently, it is concluded that AF is associated with increased MPV in patients with type 2 DM, suggesting the presence of tentatively related processes leading to reciprocal interaction.Öğe Central Diastolic Blood Pressure Is Associated With the Degree of Coronary Collateral Development(SAGE PUBLICATIONS INC, 2013) Ege, Meltem Refiker; Zorlu, Ali; Yilmaz, Mehmet Birhan; Acikgoz, Savas; Tandogan, Izzet; Cinar, ZiynetCoronary collaterals (CCs) serve as alternative conduits for blood flow in obstructive coronary artery disease. We investigated the association of various components of blood pressure (BP) parameters with the the degree of coronary collateralization. Patients (n = 245) who underwent coronary angiography were included. Intraarterial BP in the ascending aorta was determined using a standard fluid-filled system. Readings of the conventional peripheral pressure were measured using a manual sphygmomanometer. All blood samples were drawn at admission, before coronary angiography. A total of 65 patients were found to have adequate CC development. Central diastolic BP and peripheral diastolic BP were found to be lower in the group with adequate CC. In multivariate logistic regression model, central diastolic BP and Gensini score were found to be independent predictors of adequate CC. In conclusion, low central diastolic BP in the case of severe coronary stenosis may be an important stimulus for adequate CC development.Öğe The changing epidemiological trends for carcinoma of the lung in Turkey(SAUDI MED J, 2008) Gonlugur, Ugur; Gonlugur, Tanseli E.; Kaptanoglu, Melih; Nadir, Aydin; Cinar, ZiynetObjective: To compare epidemiological parameters for lung cancer in the last 2 decades (1986-1995 versus 1996-2005). Methods: Data on demographic characteristics, and histological subtype of lung cancer patients were retrospectively collected by a chart review in Cumhuriyet University Hospital, Sivas, Turkey for the period of 1993-2005. All other full-text papers that report epidemiological data for lung cancer in Turkey were also searched for meta-analysis. Results: A total of 25,604 patients were analyzed in the last 2 decades. The mean age at the time of diagnosis was 59.4 years, and 92.5% of the patients were males. In the last decade, the rate of squamous cell carcinoma decreased from 61-50%, however, the rate of small cell carcinoma increased from 19-24%, and the rate of adenocarcinoma. from 20-26%. Conclusion: There was a shift in the male/female ratio in Turkey. The rate of squamous cell carcinoma decreased, however, small cell carcinoma and adenocarcinorna increased progressively.Öğe Crimean-Congo Hemorrhagic Fever Virus in High-Risk Population, Turkey(CENTERS DISEASE CONTROL, 2009) Gunes, Turabi; Engin, Aynur; Poyraz, Omer; Elaldi, Nazif; Kaya, Safak; Dokmetas, Ilyas; Bakir, Mehmet; Cinar, ZiynetIn the Tokat and Sivas provinces of Turkey, the overall Crimean-Congo hemorrhagic fever virus (CCHFV) seroprevalence was 12.8% among 782 members of a high-risk population. CCHFV seroprevalence was associated with history of tick bite or tick removal from animals, employment in animal husbandry or farming, and being > 40 years of age.Öğe Delayed habituation in Behcet's disease(NEUROL SOC INDIA, 2008) Gulturk, Sefa; Akyol, Melih; Kececi, Hulusi; Ozcelik, Sedat; Cinar, Ziynet; Demirkazik, AyseBackground: The autonomic nervous system in Behcet's patients may be affected due to various reasons. This entity may be detected with the measurement of the electrodermal activities, heart rate variability and pupillometric methods. Habituation is one of the implicit forms of learning and memory and the loss of habituation can reveal pathological changes in the synaptic regions. Aim: To determine whether there is a functional decrease in the synaptic effectiveness (habituation) of the pathways to sympathetic neurons that had been repeatedly activated in Behcet's. Materials and Methods: Twelve patients with Behcet's disease and 12 healthy controls were included in the study. Sympathetic skin potential (SSP) records were taken at normal room temperature in a quiet place within a Faraday cage. Sixteen square wave single shock impulses (duration: 1200 mu s, strength: 5 mA) were applied on each case. Results: After the 1(st) stimulus, the SSP amplitudes were lower in the patients compared to the controls (P 0.001, t value = 7.69). There was no significant differences among the SSP amplitudes after the 13(th) impulse in the patients (P>0.05). Whereas there was no significant differences among the SSP amplitudes after the 9(th) impulse in the controls (P>0.05). The habituation rate of the SSP after consecutive impulses was slowest in the patients compared to controls (P<0.001, t value = 12.39). Conclusions: There is a delayed habituation in Behcet's disease and that may due to pathologic changes with vasculitis through their peripheral nerves.Öğe Determination of kidney stone prevalence in Sivas city center: A retrospective research(Bayrakol Medical Publisher, 2021) Saygin, Huseyin; Cinar, Ziynet; Ozturk, Abuzer; Kirac, Emre; Ergin, Ismail Emre; Velibeyoglu, Arslan Fatih; Korgali, EsatAim: In this study, it was aimed to determine the prevalence of urinary stone disease (USD) in the center of Sivas based on data from patients who were diagnosed with USD at the urology clinic of the hospitals in Sivas center. Material and Methods: This is a retrospective study. The records of the patients who applied to the Urology Department of the Faculty of Medicine of Sivas Cumhuriyet University and Sivas Numune Hospital i between 2014 and 2019 were examined in this research. Evaluations of statistics were made on the basis of data to determine the prevalence of USD in Sivas center. Results: The data of 30218 people (20114 mates and 10104 females) who applied to the Urology Policlinic of Sivas Central Hospitals in 2014 and 2019 were evaluated for USD. Also, 4739 patients who were operated in both hospitals were evaluated according to gender and age. Results significantly increased with age for both genders (p<0.05). On the other hand, the number of people treated with Extracorporeal Shock Wave Lithotripsy (ESWL) in both hospitals was 1543. They were evaluated by age and gender, and results were not statistically significant (p>0.05). The prevalence of USD in the Sivas Center was determined as 8%. Agglomeration was observed in 31-70 age groups in both sexes. The results showed that the risk of USD was twice as high among men in both Numune Hospital and C.U Hospital. Discussion: Our country is one of the regions where USD is common, but there are not enough prevalence studies on this subject. It is a known fact that processes of diseases and treatment put a great burden on the economy of the country. Knowing the frequency of the disease makes it easier to take precautions. More epidemiological studies in larger populations are needed to direct health policies.Öğe Evaluation of sleep quality in patients with psoriasis(TURKISH SOC DERMATOLOGY VENEROLOGY, 2015) Bicici, Fatma; Hayta, Sibel Berksoy; Akyol, Melih; Ozcelik, Sedat; Cinar, ZiynetBackground and Design: Psoriasis causes impairments in many daily activities, such as sleeping and occupational performance. One of the most important factors determining the quality of life of a person is sleeping. Studies about sleep quality in psoriasis are quite limited. In this study, we aimed to assess the quality of sleep and to examine the factors affecting the quality of sleep in patients with psoriasis. Materials and Methods: Seventy-three patients with psoriasis and 73 healthy subjects were included in the study. A sociodemographic data form was completed by all the participants and the Pittsburgh Sleep Quality Index (PSQI), 36-item Short-form Health Survey (SF-36), Hamilton Depression Rating Scale (HAM-D) and the Hamilton Anxiety Rating Scale (HAM-A) were administered to the patients and controls. Body Mass Index (BMI) was calculated in patient and control groups. The Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were administered and pruritus was assessed in patient group. Results: PSQI global scores in patient group were found to be higher than in control group. Quality of sleep was worse in patient group. Severity of disease and sociodemographic features were found to be factors not affecting the quality of sleep. In patient group, the patients with higher sleep disturbances had higher rates of depression and anxiety scores. In patient group, the patients with severe pruritus had worse sleep quality. Conclusion: Psoriasis and psoriatic symptoms including pruritus impair sleep quality. Assessment of sleep quality and new strategies to improve sleep quality in patients with psoriasis may help improve quality of life.Öğe An experimental model to study pneumothorax in Rats(ACADEMIC JOURNALS, 2010) Akkas, M. D. Yucel; Sahin, Ekber; Celik, Burcin; Nadir, Aydin; Karadayi, Sule; Gumus, Cesur; Cinar, Ziynet; Kaptanoglu, MelihResearchers have used various techniques to form pneumothorax in animals, but to date, no standard method or rate of pneumothorax has been defined. We tried to develop a standard and a safe method of pneumothorax model in this study. 12 female Wistar Albino rats weighing 200-220 g were used. Two groups (6 rats in each) were formed. Open pneumothorax was formed by 0.5 cm incision through the right, 5(th) intercostal space. The first group was held in open pneumothorax position for 1 min and the second group, for 2 min and the incisions were sutured. After 48 h, computed tomography of the rats were obtained and the pneumothorax rates were measured. The mean pneumothorax value was greater in Group II (13.89%) than in Group I and it was statistically significant (p < 0.05). The above mentioned method produces low rates of pneumothorax (10 - 15%), without injuring lung tissue. It should be useful for researchers, who plan to study lung physiology with low rates of pneumotohorax.Öğe Humic Acid, a Polyphenolic Substance, Decreases Alveolar Bone Loss in Experimental Periodontitis in Rats(Sage Publications Inc, 2019) Calisir, Metin; Akpinar, Aysun; Poyraz, Omer; Goze, Fahrettin; Cinar, ZiynetThe purpose of this study was to evaluate the biochemical, morphometric, and histopathological changes associated with experimental periodontitis in rats in response to local administration of humic acid. Thirty-eight Wistar rats were divided into 5 experimental groups: nonligated (NL) group, ligature-only (LO) group, and ligature + local administration of humic acid (20, 80, and 150 mg/kg body weight per day for 15 days, respectively; L-20, L-80, and L-150 groups). Changes in alveolar bone levels were clinically measured as the distance from the cementoenamel junction to the alveolar bone crest with a stereomicroscope. Tissues were histopathologically examined to assess the osteoclast numbers, osteoblastic activity, and inflammatory cell infiltration among the study groups. Enzyme-linked immunosorbent assay interleukin1 beta (IL-1 beta) and IL-10 levels in serum and gingival homogenates were evaluated. At the end of 15 days, the alveolar bone loss was significantly higher in the LO group compared to the NL, L-20, and L-150 groups (P < .05). The osteoclast number in the LO group was significantly higher than the NL, L-20, and L-150 groups (P < .05). Inflammatory cell infiltration was significantly higher in the LO and L-80 groups than the other groups (P < .05). The highest serum and gingival homogenate IL-10 levels were determined in the NL group (P < .05). The serum and gingival homogenate IL-1 beta levels in LO group were significantly higher than the NL, L-20, and L-150 groups (P < .05). Within the limits of this study, it can be suggested that humic acid, when administered locally at 20 and 80 mg/kg doses, may prevent alveolar bone loss in the rat model.Öğe Migraine prevalence, alexithymia, and post-traumatic stress disorder among medical students in Turkey(SPRINGEROPEN, 2012) Balaban, Hatice; Semiz, Murat; Senturk, Ilteris Ahmet; Kavakci, Onder; Cinar, Ziynet; Dikici, Ayfer; Topaktas, SuatThe aim of this study was to investigate the prevalence of migraine, alexithymia, and post-traumatic stress disorder among medical students at Cumhuriyet University of Sivas in Turkey. A total of 250 medical students participated in this study and answered the questionnaires. The study was conducted in three stages: the self-questionnaire, the neurological evaluation, and the psychiatric evaluation. In the first stage, the subjects completed a questionnaire to assess migraine symptoms and completed the three-item Identification of Migraine Questionnaire, the Toronto Alexithymia Scale, and the Post-Traumatic Stress Disorder Checklist-Civilian Version Scale. The subjects who reported having a migraine underwent a detailed neurological evaluation conducted by a neurologist to confirm the diagnosis. In the final stage, the subjects with a migraine completed a psychiatric examination using the structured clinical interview for DSM-IV-R Axis I. The actual prevalence of migraine among these medical students was 12.6 %. The students with a migraine were diagnosed with alexithymia and post-traumatic stress disorder more frequently than those without migraine. The Migraine Disability Assessment Scale scores correlated with the post-traumatic stress disorder scores. The results of this study indicate that migraine was highly prevalent among medical students in Turkey and was associated with the alexithymic personality trait and comorbid psychiatric disorders including post-traumatic stress disorder. Treatment strategies must be developed to manage these comorbidities.Öğe Moral distress in Turkish intensive care nurses(SAGE PUBLICATIONS LTD, 2017) Karagozoglu, Serife; Yildirim, Gulay; Ozden, Dilek; Cinar, ZiynetBackground: Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess moral distress suffered by nurses nor a study conducted on the issue. Aim/objective: The study aims to (a) validate the Turkish version of the Moral Distress Scale-Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses' moral distress level. Method: The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale-Revised. Ethical considerations: The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality. Results: In parallel with the original scale, Turkish version of Moral Distress Scale-Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 +/- 48.23 and 3.36 +/- 4.50, respectively. Conclusion: Turkish version of Moral Distress Scale-Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care.Öğe A new perspective to determine the severity of cases with Crimean-Congo hemorrhagic fever(MALARIA RESEARCH CENTRE, INDIAN COUNCIL MEDICAL RESEARCH-ICMR, 2012) Bakir, Mehmet; Engin, Aynur; Gozel, Mustafa Gokhan; Elaldi, Nazif; Kilickap, Saadettin; Cinar, ZiynetBackground & objectives: We have established a severity grading score (SOS) system for predicting the fatality :in Crimean-Congo hemorrhagic fever (CCHF) for the first time. Methods: This SOS has been set up by using several variables which were assumed to be associated with mortality according to the literature and also were considered to have clinical importance. Results: In all, 237 patients who had symptoms of CCHF for <= 5 days were included. The patients were grouped into three categories according to the mortality risk by using SOS as follows : low or no risk, intermediate and high risk groups. A SOS <= 5 showed no association with mortality (there were 158 cases in this group and all survived). This group constituted 66.7% of all the patients with CCHF. A SOS 6-10 showed moderate risk of mortality (10%) and seven out of 70 patients in this group died. SOS >= 11 means high risk for mortality (67%) and six out of 9 patients in this group died (p = 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for >= 11 points of SOS were 67, 100, 98, 100, and 98%, respectively. Conclusions: This scoring system may help the clinicians to decide which patient to refer to a tertiary step hospital which may also decrease the cost and improve the functionality of healthcare staff.Öğe Prevalence of common and atypical melanocytic nevi in Turkish children(JOHN LIBBEY EUROTEXT LTD, 2008) Akyol, Melih; Atli, Abuzer Gaffar; Oezcelik, Sedat; Cinar, Ziynet; Cig, Filiz Altioglu; Bircan, HuedaverdiThe incidence of malignant melanoma is increasing rapidly in the white population of the world. Therefore, it is necessary to know the etiological factors of malignant melanoma and to take preventive measures in high-risk groups in different populations. This study aimed to estimate the prevalence of common melanocytic nevi (CNIN) and atypical melanocytic nevi (AMN) and to identify some phenotypic factors (eye and hair color, skin type), gender, and age associated with CNIN and AMN presence in primary school children in a Turkish population. In this study, 1491 children aged from 7-15 were examined. Brown-black discrete lesions of two millimeters or larger, with the exceptions of solar lentigo and ephelides, were counted as CNIN. The CNIN prevalence was 73.85%, and the ANIN prevalence was 3.45%. The numbers of CNIN and AMN were found to be higher in boys than in girls. While more CNIN were present in the head and neck areas than in other anatomic regions, the number of AMN was higher on the ventral and dorsal trunk. Our study provides evidence for a significant relationship between specific characteristics, including skin type, age, gender and the number of CMN in our population. However, CMN is more frequent in children having a lighter skin type, and its number increases with age. The results of our study and further studies which take sun-exposure characteristics and pigmentary factors into account, may facilitate the determination of the other factors affecting nevus production and the development of further strategies for following and preventing cutaneous melanoma in our geographical area.Öğe The relationship between D-dimer level and the development of atrial fibrillation in patients with systolic heart failure(SPRINGER, 2012) Zorlu, Ali; Akkaya, Emre; Altay, Hakan; Bektasoglu, Gokhan; Turkdogan, Kenan Ahmet; Sincer, Isa; Vuruskan, Ertan; Cinar, Ziynet; Tandogan, Izzet; Yilmaz, Mehmet BirhanHeart failure (HF) is one of the most common and leading cause of death worldwide. Clinical trials provide evidence that the development of atrial fibrillation (AF) is a marker of poor prognosis in patients with HF. Furthermore, elevated D-dimer level is associated with increased cardiovascular mortality independent of AF in HF patients. We investigated whether plasma D-dimer levels in patients with hospitalized systolic HF could predict development of AF. A total of 150 consecutive patients with sinus rhythm who admitted to the emergency department with hospitalized systolic HF were evaluated. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission. Atrial fibrillation developed in 31 (20.7%) patients during follow-up period of 6.3 +/- A 5 months. Patients who developed atrial fibrillation had significantly increased levels of D-dimer [608 (339-1,022) ng/ml versus 1,100 (608-2,599) ng/ml, P = 0.001]. Optimal cut-off level of D-dimer to predict development of AF was found to be > 792 ng/ml. D-dimer > 792 ng/ml, right ventricular dilatation, age, systolic pulmonary pressure, left atrium size, moderate to severe tricuspid regurgitation, and beta blocker usage were found to have prognostic significance in univariate analysis. In multivariate Cox proportional-hazards model, D-dimer levels > 792 ng/ml (HR = 3.019, P = 0.006), and right ventricular dilatation (HR = 8.676, P = 0.003) were associated with an increased risk of new-onset AF. In conclusion, D-dimer could predict development of AF in patients with hospitalized systolic HF.Öğe A scale-development study: Exploration of intensive-care nurses' attitudes towards futile treatments(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2019) Yildirim, Gulay; Karagozoglu, Serife; Ozden, Dilek; Cinar, Ziynet; Ozveren, HusnaThe study was conducted to determine the validity and reliability of the tool used to assess nurses' attitudes towards futility, and to explore intensive-care nurses' attitudes towards futility. Principal components analysis revealed that 18item scale was made up of four subdimensions that assess Identifying(beliefs), Decision-Making, Ethical Principles and Law, and Dilemma and Responsibilities related to futile treatments. The internal consistency of the scale was in the acceptable range, with a total Cronbach's alpha value of 0.72. Overall the results of study suggest that scale can be used as a valid and reliable assessment tool to assess nurses' attitudes towards futility.Öğe Usefulness of Admission Red Cell Distribution Width as a Predictor of Early Mortality in Patients With Acute Pulmonary Embolism(EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, 2012) Zorlu, Ali; Bektasoglu, Gokhan; Guven, Fatma Mutlu Kukul; Dogan, Omer Tamer; Gucuk, Esra; Ege, Meltem Refiker; Altay, Hakan; Cinar, Ziynet; Tandogan, Izzet; Yilmaz, Mehmet BirhanRed cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 +/- 15 years. The mean follow-up duration was 11 +/- 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p <0.001). Increased RDW >14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p.= 0.012) and the presence of shock (hazard ratio 9.354, p <0.001) remained associated with increased risk for acute PE-related early mortality in a multivariate Cox proportional-hazards model. In conclusion, high RDW was associated with worse hemodynamic parameters, and RDW seems to aid in the risk stratification of patients with acute PE. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:128-134)
