OBJECTIVE: The aim of this study is to investigate the relationship between risk scores and immune-inflammatory indices with prognosis and mortality in community-acquired pneumonia. Additionally, we aim to examine the association between mortality and the Acute Phase Reactant Index, which we developed using C-reactive protein, procalcitonin, and albumin levels.

Objective: Pulmonary embolism is a cardiopulmonary emergency commonly encountered in emergency departments with a high mortality rate. In cases of pulmonary embolism, the prompt and effortless implementation of echocardiography in the emergency department for the identification of right ventricular dysfunction, a significant predictor of mortality, is not always feasible. The aim of this study is to demonstrate the role of the readily available blood pressure index in determining right ventricular dysfunction and mortality in patients with pulmonary embolism. Material and Methods: A total of 180 patients (90 females and 90 males) who were diagnosed with pulmonary embolism based on computed tomography pulmonary angiography in the emergency department between 2013 and 2019 and subsequently underwent echocardiography were included in the study. The blood pressure index was obtained by dividing the systolic blood pressure by the diastolic blood pressure. Results: The average blood pressure index of the patients was calculated as 1.7±0.2. There was no statistically significant difference in terms of BPI between the two groups, one with right ventricular dysfunction and the other without right ventricular dysfunction, based on echocardiography (p=0.529). A total of 22.2% of the patients experienced 30-day mortality. There was no significant difference in terms of blood pressure index between the group with observed mortality and the group without observed mortality (p=0.438). Conclusion: No significant relationship was identified between blood pressure index and right ventricular dysfunction or mortality in patients with pulmonary embolism. However, considering the ease of accessibility and applicability of blood pressure index in emergency departments, we believe it can be considered as a useful parameter. We anticipate that blood pressure index would yield more accurate results in determining right ventricular dysfunction and mortality, especially in patients with pulmonary embolism who have reduced systolic blood pressure.

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are among the most common reasons for emergency department visits. In patients who develop hypercapnic respiratory failure, non-invasive mechanical ventilation (NIV) is generally the preferred treatment. However, in overcrowded emergency departments, the number of mechanical ventilation devices may be insufficient. In such situations, positive expiratory pressure (PEP) devices can be utilized. This study aims to evaluate the clinical efficacy of the PEP device (EzPAP®) compared to NIV for the management of exacerbations of COPD in the emergency department. This prospective, randomized controlled study was conducted on 103 patients who presented to the emergency department with exacerbations of COPD and acute hypercapnic respiratory failure between November 2023 and April 2024. Patients were divided into two groups: EzPAP® (E) and NIV (N). Spirometric parameters, arterial blood gas values, hospital admission rates, and 30-day mortality rates were compared before and after treatment in both groups. A total of 103 patients were included in the study (N: 49, E: 54). In Group N, no statistically significant increase was observed in FEV₁ and FVC after treatment (p = 0.120). A statistically significant increase in FEV₁ and FVC was detected in the EzPAP group (p < 0.001). An increase in oxygen saturation and an improvement in PaCO₂ and lactate levels were observed in both groups (p < 0.001). The difference in blood gas values before and after treatment (delta = Δ) was not statistically significant between the two groups. However, ΔFEV₁ and ΔFVC were significantly higher in the EzPAP group compared to the NIV group (p = 0.007, p = 0.022). The hospital admission rate was higher in the NIV group than in the EzPAP® group (p = 0.04). EzPAP® may be a suitable option for use in overcrowded emergency departments, as it demonstrates efficacy comparable to NIV in the management of exacerbations in COPD. Additionally, it can also be considered as a treatment alternative in situations where the number of mechanical ventilation devices for NIV is insufficient, such as during a pandemic. ClinicalTrials Number: NCT06561464 Registration Date: 07/08/2024.

Acute cholecystitis is a common inflammatory condition encountered in emergency departments (EDs), with severity varying widely among patients. Rapid risk stratification and appropriate management are critical in preventing complications and mortality. This study aimed to evaluate the association between the acute-phase reactant index (APhRI) and disease severity, and to investigate the potential prognostic value of APhRI in clinical decision-making. We conducted a single-center, retrospective observational study of adult patients diagnosed with acute cholecystitis in a tertiary ED between January 2024 and January 2025. APhRI was calculated as (C-reactive protein [CRP] × procalcitonin [PCT])/ albumin. Patients were stratified according to the Tokyo Guidelines 2018 (TG18). Statistical analyses included chi-square/Fisher exact tests, t -test/Mann–Whitney U test, receiver operating characteristic curve analysis, and DeLong test. A total of 547 patients were included. According to TG18, 28.7% were classified as moderate-to-severe acute cholecystitis. APhRI levels were significantly higher in these patients. The area under the curve of APhRI for predicting severity was 0.687, superior to CRP (0.673), PCT (0.567), and albumin (0.618) ( P < .05 for all). Higher APhRI values were also observed in patients requiring surgery ( P = .008) or interventional radiology ( P < .001), and positively correlated with hospital stay (ρ = 0.327, P < .001). APhRI appears to be a practical and useful biomarker not only for predicting severity in acute cholecystitis but also for supporting early triage and treatment decisions in the ED.

OBJECTIVES: In acute pancreatitis (AP), the variable clinical course and high mortality have led to the use of complex and time-consuming scoring systems. This study aimed to evaluate the diagnostic performance of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting mortality and intensive care unit (ICU) admission in patients with AP, and to compare it with the Atlanta classification and the Bedside Index for Severity in AP (BISAP). METHODS: This single-center retrospective study included 455 patients diagnosed with AP. Demographic data, laboratory findings, and clinical course of the patients were recorded, and HALP, BISAP, and Atlanta classification scores were calculated. RESULTS: The Atlanta classification showed the highest predictive accuracy for both mortality and ICU admission (mortality: sensitivity 91%, specificity 96%; ICU admission: sensitivity 77%, specificity 99%). The HALP score demonstrated a moderate predictive ability for both mortality (sensitivity = 0.64; specificity = 0.79) and ICU admission (sensitivity = 0.74; specificity = 0.67). The sensitivity of the HALP score was significantly higher than that of the BISAP score for both outcomes (P < 0.001). CONCLUSION: Although the HALP score has a lower overall predictive power compared to the Atlanta and BISAP scores, its higher sensitivity and easily calculable structure compared to the BISAP score suggest that it may serve as a supportive tool for early prognostic assessment of AP patients in emergency department settings.