Murat Sungur

Introduction and aimTo determine the association between whole blood thiamine pyrophosphate (TPP) concentrations in critically ill patients and plasma metabolites and linked metabolic pathways using high resolution metabolomics.Patients and methodsThis cross-sectional study was performed at Erciyes University Hospital, Medical Intensive Care Unit (ICU), Kayseri, Turkiye and Emory University Department of Medicine Clinical Biomarkers Laboratory, Atlanta, GA, USA. Participants were enrolled as follows;≥18 years of age, with an expected length of ICU stay longer than 48 h and receiving furosemide therapy for at least 6 months or longer before ICU admission.ResultsBlood for TPP and metabolomics was obtained on the first day of ICU admission. Whole blood TPP concentrations were measured using high-performance liquid chromatography (HPLC). Liquid chromatography/mass spectrometry for high …

Introduction and aimTracheotomy is a frequently performed procedure to facilitate weaning in critically ill patients who require mechanical ventilation. Two methods are applied, percutaneous and surgical. It was aimed to determine the effects of percutaneous dilatational tracheotomy (PDT) method on patient outcomes according to surgical technique (ST).Patients and methodsPatients who underwent tracheotomy in intensive care units (ICU) between 2013 and 2021 were retrospectively analyzed. Patients over the age of 18 were included in the study. Complications developed in the patients, need for vasopressors, number of days of mechanical ventilation (MV), number of days of intensive care stay, and mortality were recorded.Results119 patients were analyzed in this study. PDT method was used in 55 of the patients. The mean age of the patients was 59 (40–74). The female gender ratio was 36%. The most …

Methods: This study was conducted using a cross-sectional retrospective design in the ICU in Turkey. The patients included in the study were those who were affected by the February 6 earthquake, required ICU treatment, and had crush syndrome. All the data were recorded in the patients’ charts and the hospital’s electronic medical system.Results: A total of 62 patients were included in the study. The average age was 41±19 years and 47% were male. The median APACHE II score for the patients was 14 (IQR: 7-23). The most common reason for admission to the ICU was multitrauma and crush injury, which accounted for 82% of cases. The median values for creatinine, creatinine kinase (CK), and myoglobulin levels upon admission were 1.8 mg/dl (with an interquartile range of 0.8-4.1), 15470.0 U/L (IQR: 2832.5-56638.0), and 3000.0 ng/ml (IQR: 1242.5-15438.8), respectively. Upon admission to the ICU, 92% of …

Introduction and aimThiamine (vitamin B1) is a vitamin that plays a cofactor role in energy metabolism which provide energy from macronutrients in the human body. Plasma thiamine values indicate recent intake while erythrocyte thiamine pyrophosphate (eTPP) level shows actual thiamine status. To determine thiamine level, while the analysis of plasma thiamine is affected by inflammation, eTPP is not. This study aimed to determine effect of nutrition and inflammation on plasma thiamine and eTPP in acute phase of critical illness.Patients and methodsThis prospective observational study performed in medical intensive care unit (ICU). Acute phase determined first 7 days after ICU admission. The study period consisted of two study time points that first is within 24 h in ICU and second is discharge day in participants with ICU stay <7 days or on the 7th ICU day in participants with ICU stay>7 days. Plasma …

Introduction and aimThiamine plays a crucial role on energy metabolism. In critically ill patients, the provision of adequate nutritional support may lead thiamine deficiency. Thiamine deficiency may prevent to use of energy in metabolism in critical illness. This condition may create vicious circle, lead to severe thiamine depletion. Therefore, the determine of thiamine status is important. The analysis of plasma thiamine analysis to determine thiamine level is affected by inflammation related to critical illness. Erythrocyte thiamine pyrophosphate (eTPP) concentration, which is another method for assessing thiamine status, is not affected by inflammation. However, it is a relatively more difficult technical method. The aim of study was to determine the effect of inflammation on plasma thiamine level by accepting the eTPP level as the gold standard in critically ill patients.Patients and methodsThis study performed …

Introduction and aimOne of the most common causes of trauma is traffic accidents. Although the death rate is decreasing day by day as a result of trauma-related injuries, the incidence of injury is still very high (1). Morbidity is decreasing due to the development of pre-hospital emergency interventions and the increase of authorized personnel. Likewise, intensive care support is of great importance (2). The aim of the study is to sequentially determine serum adipokine levels in critically ill adult patients followed in the intensive care unit due to trauma.Patients and methodsThe study was carried out in Erciyes University Medical Faculty Hospital Internal Diseases Intensive Care Unit. Thirty patients aged 18 years and older and 30 healthy volunteers were included in the study. The patients consisted of patients who were admitted to the intensive care unit due to trauma, stayed for at least 7 days, and did not have any …

Introduction and aimTwo consecutive earthquakes that razed the southeast part of Turkiye on February 06, 2023, were one of the strongest earthquakes ever recorded in the last century. Unfortunately, over 13 million people were affected in 11 provinces, and around 50,000 patients passed away, based on the official reports of the Turkish Government (1). Data from previous earthquakes demonstrated that 80% of patients who suffered from earthquakes stuck under the rubble suddenly died, and 10% survived with minor injuries. The remaining 10% of patients had severe injuries and needed hospitalization, including intensive care unit (ICU) admission (2). Presenting the issues encountered in earthquakes and sharing experiences and the results of the medical interventions can enable more accurate treatments to be applied after future earthquakes. Therefore, this study aims to provide information regarding the …

Introduction and aimIntensive care unit patients with hematological malignancies have a higher mortality than other patients because this group often have acute respiratory distress, acute kidney (AKI) and liver injury (ALI) which reasons require these patients to be hospitalized in the intensive care unit (ICU). We aimed to evaluate the factors affecting mortality in patients with hematological malignancies hospitalized in the ICU.Patients and methodsPatients diagnosed with hematological malignancy and admitted to the intensive care unit between 2017 and 2022 were retrospectively analyzed. 363 patient records in the hospital database were analyzed. Data of the first 75 enrollable patients were recorded as preliminary results. Patients' kidney and liver function tests, vasopressor requirement, mechanical ventilation (MV) days, ICU stay, complications and mortality were recorded.ResultsThe mean age of patients …

Introduction and aimNutrition plays a major role in the treatment of patients hospitalized in the intensive care unit (ICU). Micronutrients have important functions in carbohydrate, protein, and lipid metabolism, which are necessary for energy production (1). In critically ill patients, micronutrient deficiencies occur as a result of inadequate intake, inadequate absorption, increased requirement, or increased catabolism. There is a risk of micronutrient loss in critically ill patients receiving burns, trauma, or continuous renal replacement therapy (2). Early detection and prevention of micronutrient deficiencies is important for the life expectancy of patients (3). The aim of our study is to evaluate the changes in vitamin B1, B6, B9 and E levels on consecutive days in critically ill patients hospitalized in the intensive care unit.Patients and methodsThirty patients aged 18 years and older and hospitalized in the ICU for 48 h or more …

Background/ObjectivesThiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations.Subjects/MethodsThis observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission.ResultsA total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with …

Background and Aim The new type of Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus 2019-COVID-19) infection is the largest pandemic in the last decade. Acute respiratory distress syndrome is the complication with the highest mortality rate of this infection and there is no adequate treatment with proven efficacy to reduce mortality. This multi-center, retrospective study aimed to determine the effect of high-dose vitamin C on survival and other endpoints in invasively ventilated ARDS patients. Methods This multi-center, observational retrospective cohort study was performed at five ICU centers between March 2020 and July 2020. Patients with ARDS due to COVID-19 who required IMV were included. High-dose vitamin C group was defined as patients who were treated with vitamin C over 200 mg/kg for four days. Patients who were not given vitamin C treatment were defined as the control group by using propensity score match analysis, as well. The groups were compared about the effects of high-dose vitamin C treatment on ICU mortality. Result A total of 86 patients with a mean age of 67.85 ± 10.38 were included in the study. 72.1% of the patients were male. Forty-two (49%) patients were in the high dose vitamin C group, and 44 (51%) were in the control group. The mean PaO2/FiO2 at the time of admission to the ICU was 128.27±58.69 mmHg (133.63±56.51 mmHg in the control group, 122.36±61.18 mmHg in the study group, p=0.389). The mortality rate of high dose vitamin C group was lower than the control group (73.8% vs. 90.9%, p = 0.037,respectively). Conclusion As an adjunctive therapy in invasively ventilated patients …

PurposeIn an effort to better manage critically ill patients hospitalised in the intensive care unit (ICU) after experiencing multiple traumas, the present study aimed to assess whether plasma levels of intestinal epithelial cell barrier proteins, including occludin, claudin-1, junctional adhesion molecule (JAM-1), tricellulin and zonulin, could be used as novel biomarkers. Additional potential markers such as intestinal fatty acid-binding protein (I-FABP), d-lactate, lipopolysaccharide (LPS) and citrulline were also evaluated. We also aimed to determine the possible relationships between the clinical, laboratory, and nutritional status of patients and the measured marker levels.MethodsPlasma samples from 29 patients (first, second, fifth and tenth days in the ICU and on days 7, 30 and 60 after hospital discharge) and 23 controls were subjected to commercial enzyme-linked immunosorbent assay (ELISA) testing.ResultsOn first …

Methods: This prospective observational study was performed in 15 adult medical ICUs in Turkey. Serial plasma thiamine concentrations were measured by high-performance liquid chromatography (HPLC).Results: A total of 221 participants were included. The median age of was 71 years and 49% were male. The mean (SD) APACHE II score on ICU admission was 17.7±7.4. Reasons for ICU admissions included respiratory failure (54%) and metabolic diseases (31%). Heart failure and chronic obstructive pulmonary disease were the most frequent underlying diseases requiring chronic diuretics. Median plasma thiamine levels ranged from 42.1 to 46.5 μg/L from baseline to day 10 after admission (normal range= 28–85 μg/L). A total of 18% of participants were thiamine deficient upon admission to the ICU, while 26% of participants were deficient at some point during the 10-day study period. At baseline, 47% of …

Methods: This cross-sectional study was performed in the Erciyes University Hospital Medical Intensive Care Unit, Kayseri, Turkey, with plasma HRM measured at the Emory University Clinical Biomarkers Laboratory, Atlanta, GA, USA. Participants were 18 years of age or older with expected length of ICU stay greater than 48 hours. HRM was performed with liquid chromatography/mass spectrometry analysis of plasma obtained on the first day of ICU admission, with mNUTRIC score calculated on the same day. Participants at high risk of malnutrition (mNUTRIC score 5-9) were compared to those with low risk (mNUTRIC score 0-4).Results: Of the 77 participants enrolled, 33 (43%) had a mNUTRIC score> 4 and thus were classified as high malnutrition risk. Pathway analysis of significant (p< 0.05) differentially expressed metabolites between the high and low malnutrition risk patients showed significant differences in …

Aim Therapeutic plasma exchange (TPD) is the separation of the patient's plasma for treatment purposes and the replacement of another fluid. Therapeutic plasma exchange, the use of which has expanded in recent years, is a treatment method that cleans the blood extra-corporeally and is used in many immunological and toxicological diseases. The aim of this study is to prospectively examine critical patients who are followed up in the intensive care unit and undergo therapeutic plasma exchange. Material and Method Patients who were hospitalized in the Intensive Care Unit of Erciyes University, Faculty of Medicine, older than 18, and whose therapeutic plasma exchange (TPD) indication were included in the study. Demographic information of the patients, indication for admission to intensive care unit, and TPD indication were recorded before the procedure. Patients who were indicated for plasmapheresis were observed for side effects during the procedure. Results A total of 31 patients were included in the study. The mean age of the patients was 46 ± 18 years. 52% of the patients were female and 48% were male. The hospitalization medyan APACHE II score (min-max: 5-40) of the patients was 20. When the patients were evaluated in terms of TPD indications in intensive care, the most common causes were 56% microangiopathic hemolytic anemia (MAHA), 13% Crimean Congo Hemorrhagic Fever (KKKA) and 10% Guillen Barre Syndrome. The patients were divided into two groups: living and dying. When these two groups were analyzed in terms of APACHE II Score, the mean APACHE II score of living patients was 17±7, and the mean …

Introduction: Blood purification therapy is a method used to enable cytokine removal and to improve disturbed immune homeostasis in patients with sepsis or septic shock. This study aimed to evaluate the impact of HA 330 treatment on biochemical and hemodynamic parameters and cytokine levels in adult patients with septic shock. Methods: Critically ill patients with septic shock who received continuous veno-venous hemodiafiltration and HA 330 treatment were included in this prospective observational study. Biochemical and hemodynamic parameters were followed throughout HA 330 treatment. Serum interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor (TNF)-α, high-mobility group box1 (HMGB-1) protein, IL-10 levels were analyzed by ELISA method, before and after each HA 330 session. Results: A total of 18 critically ill patients were included in this study. The median APACHE 2 score …

Objective: Genistein has an anti-inflammatory effect that may be beneficial in many inflammatory diseases. The aim of this study was to determine the effects of supplementation of oral/enteral nutrition (EN) with genistein on the level of inflammatory cytokines in septic patients.Materials and Methods: This prospective, randomized controlled study included critically ill adult patients with sepsis receiving EN or oral/EN. The patients were randomly divided into a genistein or a control group. Genistein (60 mg/day) was administered as a supplement to EN in the genistein group and the control group received only EN or oral/EN. Serum interleukin 1 beta (IL-1β), interleukin 6 (IL-6), high mobility group box 1 protein (HMGB-1), tumor necrosis factor alfa (TNF-α), procalcitonin (PCT), and C-reactive protein (CRP) concentrations were serially measured at the baseline, 24th hour, and 72nd hour after admission.Results: Thirty-two participants (genistein group: 16 patients, control group: 16 patients) were included. The mean age was 56±17 years. The serum IL-1β concentration in the genistein group was significantly higher than that of the control group in follow-up (p= 0.001). The control group had a significantly lower serum IL-6 value at the 72nd hour compared with the baseline and 24th-hour values (p= 0.001). The TNF-α concentration was significantly greater (p< 0.001, both groups), while the PCT values were lower in follow-up measurements (genistein group: p= 0.031; control group: p= 0.004). The CRP level was higher in the genistein group than in the control group at the baseline (p= 0.019) and significantly lower in follow-up measurements (p= 0.028 …

Objective Organophosphates are the insecticides commonly used worldwide. Inadequate treatment in organophosphates poisoning increases morbidity, and mortality. Purpose of the work was to determine the effect of standard treatment alone versus standard treatment plus plasmapheresis on the levels of serum pseudo-cholinesterase, and erythrocyte acetyl cholinesterase in severe patients with organophosphates poisoning. Material and Method This research is a prospective study. Patients diagnosed with organophosphates poisoning were included in the work. The patients were divided into two groups as the intervention group, and the standard group. The intervention group, plasmapheresis was performed in addition to the standard treatment. Results The research was conducted with forty cases. (Intervention group n:21, standard group n:19). Serum pseudo-cholinesterase values were 482.5 u/L at baseline, 3723 u/L after plasmapheresis. Erythrocyte acetyl cholinesterase values were 1.91 u/mL on admission, 2.53 u/mL after plasmapheresis. Erythrocyte acetyl cholinesterase and serum pseudo-cholinesterase values were compared between the two groups daily from the admission of patients to intensive care units during the first 5 days, and on the last day in the intensive care units. There was no statistical difference between two groups (p> 0.05), except for the second day. It was observed that there was a statistically significant difference between the pseudo-cholinesterase values in the second day comparison of both groups (p=0.028). Conclusion In conclusion, plasmapheresis treatment may contribute positively to pseudo …

Objective: Sepsis is a clinical condition that requires urgent treatment. Most patients with sepsis require intensive care. There is a high mortality rate. The primary aim of the present study was to examine risk factors for mortality in patients with sepsis or septic shock in a medical intensive care unit (ICU). The secondary objective was to analyze the demographic and clinical characteristics of these patients.Materials and Methods: This prospective study was conducted in a medical ICU. Patients diagnosed with sepsis according to the international consensus definition (Sepsis-3) and requiring ICU treatment were included in the study. Demographic and clinical characteristics were recorded and analyzed.Results: A total of 134 patients with sepsis were enrolled in the study. The mean age was 60±18 years and 49% were male. The most frequent reasons for admission to the ICU were respiratory failure (45.5%) and shock (44%). Gram-negative bacteria were present in 48%, Gram-positive bacteria in 15%, fungus in 8%, and there was no culture positivity in 29% of the patients. The in-hospital mortality rate was 51%. The need for vasopressor drugs (odds ratio [OR]: 4.612, 95% confidence interval [CI]: 1.273–16.781) or mechanical ventilation (OR: 25.312, 95% CI: 4.225–151.852) was an independent risk factor for mortality. Conclusion: Patients treated in the ICU for sepsis or septic shock had a high mortality rate. The need for vasopressor drugs or mechanical ventilation was an independent risk factor for mortality.

Background & aimsEnteral Nutrition (EN) may be interrupted due to various reasons in the setting of intensive care unit (ICU) care. This study aimed to investigate the reasons, frequency, and duration of EN interruptions in critically ill patients within the first 7 days of ICU stay.MethodsA total of 122 critically ill patients (median age: 63 years, 57% were males) initiating EN within the first 72 h of ICU admission and continued EN for at least 48 h during ICU stay were included in this observational prospective study conducted at a Medical ICU. Patients were followed for hourly energy intake as well as the frequency, reason, and duration of EN interruptions, for the first seven nutrition days of ICU stay or until death/discharge from ICU.ResultsThe median APACHE II score was 22 (IQR, 17–27). The per patient EN interruption frequency was 2.74 and the median total EN interruption duration was 960 (IQR, 105–1950) minutes …