Objectives: To evaluate the effect of adjunct treatment with Octagam, an intravenous immunoglobulin (IVIG) product, on clinical outcomes and biomarkers in critically ill COVID-19 patients. Methods: Data from a single center was analyzed retrospectively. Patients had received preliminary standard of intensive care (SIC) according to a local treatment algorithm, either alone or along with Octagam 5% at 30 g/day for 5 days. Both groups were compared regarding baseline characteristics, survival, and changes in inflammation markers. Imbalance in baseline APACHE II scores was addressed by propensity score matching. Otherwise, Kaplan-Meier and multiple logistic regression models were used. Results: Out of 93 patients, 51 had received Octagam and 42 had not. About 75% of patients were male and both groups had comparable body mass index and AB0 blood type distribution. Octagam-treated patients were younger (mean 65 ± 15 versus 71 ± 15 years, p = 0.066) and had slightly lower baseline disease scores (APACHE II: 20.6 versus 22.4, p = 0.281; SOFA: 5.0 versus 7.0, p = 0.006). Overall survival was 61% in the SIC + Octagam and 38% in the SIC only group (odds ratio: 2.2, 95% confidence interval: 0.9-5.4, p = 0.091 after controlling for baseline imbalances). Octagam significantly prolonged median survival time (68 versus 18 days, p = 0.014) and significantly reduced plasma levels of C-reactive protein (median change from baseline -71.5 versus -0.3 mg/L, p = 0.049). Conclusion: Clinically relevant benefits through adjunct Octagam treatment in COVID-19 need to be confirmed in a randomized, controlled trial.

The defective interplay between coagulation and inflammation may be the leading cause of intravascular coagulation and organ dysfunction in COVID-19 patients. Abnormal coagulation profiles were reported to be associated with poor outcomes. In this study, we assessed the prognostic values of antithrombin (AT) activity levels and the impact of fresh frozen plasma (FFP) treatment on outcome. Conventional coagulation parameters as well as AT activity levels and outcomes of 104 consecutive critically ill acute respiratory distress syndrome (ARDS) patients with laboratory confirmed COVID-19 disease were retrospectively analyzed. Patients with AT activity below 75% were treated with FFP. Maximum AT activity levels achieved in those patients were recorded. Significantly low levels of admission AT activity were recorded in non-surviving patients (73%). The cutoff level for admission AT activity was 79% and 58% for the lowest AT for survival. The outcome in those patients who had AT activity levels above 75% after FFP treatment was better than the nonresponding group. As well as AT, admission values of d-dimer, C-reactive protein, and procalcitonin were coagulation and inflammatory parameters among the mortality risk factors. AT activity could be used as a prognostic marker for survival and organ failure in COVID-19 associated ARDS patients. Antithrombin supplementation therapy with FFP in patients with COVID-19 induced hypercoagulopathy may improve thrombosis prophylaxis and thus have an impact on survival.

Background and Aims: Sepsis-associated acute kidney injury (S-AKI) is common and is associated with poor outcomes. This prospective observational study aimed to assess the predictive value of four novel biomarkers—syndecan-1 (SDC1), neutrophil gelatinase-associated lipocalin (NGAL), proenkephalin (PENK), and presepsin (PSPN)—for renal outcomes and mortality in septic ICU patients. Methods: Serum biomarker levels were measured in serum samples collected at the time of sepsis diagnosis on the basis of the Sepsis-3 criteria. Acute kidney injury (AKI) was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, and patients were grouped by the presence of AKI, renal replacement therapy requirement (RRT), and intensive care unit (ICU) survival. Demographic, clinical, laboratory, and severity score data were compared between groups to evaluate the predictive performance of biomarkers and clinical parameters. Results: Of the 140 septic patients included, 55.0% developed AKI, 17.2% required RRT, and the ICU mortality rate was 50.0%. SDC1 was independently associated with both AKI (OR: 1.201; p = 0.024) and RRT initiation (OR: 1.260; p = 0.004). It also demonstrated the highest predictive performance for RRT (AUC: 0.715; p = 0.001) and a significant AUC for AKI evaluation (AUC: 0.659; p = 0.002). NGAL levels were significantly elevated in patients with AKI and higher SOFA scores but were not independently predictive. PENK and PSPN were not significantly associated with any renal outcome or mortality. The combined SOFA–SDC1 model improved discrimination for both AKI (AUC: 0.770) and RRT (AUC: 0.737), surpassing individual predictors. Conclusions: SDC1 emerged as the most reliable biomarker for assessing AKI and predicting the need for RRT, highlighting its potential role in early renal risk stratification among critically ill patients.

Amaç: Kasım 2012 tarihinde Çin’in Wuhan şehrinden yeni tip Koronavirüse bağlı (SARSCoV- 2), Koronavirüse hastalığı-2019 (COVID-19 ) olarak isimlendirilen salgın bildirilmiştir. Mortaliteyi etkileyen risk faktörleri halen net olarak tanımlanmamştır. Biz de çalışmamızda İstanbul Tıp Fakültesi Hastanesi’nde 18 Mart 2020 ile 30 Mayıs 2020 tarihleri arasında yoğun bakımda takip edilmiş olan laboratuvar ile onaylanmış 90 COVID-19 hastasıda cinsiyetin enflamatuvar belirteçler üzerine etkisini saptamayı planladık. Gereç ve Yöntem: İstanbul Tıp Fakültesi Hastanesi’nde 18 Mart 2020 ile 30 Mayıs 2020 tarihleri arasında yoğun bakımda takip edilmiş olan laboratuvar ile onaylanmış 90 COVID-19 hastası retrospektif olarak tarandı. elektronik medikal kayıtlardan hastaların demografik, klinik ve laboratuvar kayıtlarına ulaşılmış, erkek ve kadın cinsiyetler arası karşılaştırılmıştır. Bulgular: İstanbul Tıp Fakültesi Yoğun Bakım Ünitesi’nde (YBÜ) takip ettiğimiz 90 hasta da erkek hasta sayısı, kadın hasta sayısına oranla daha fazla olup (erkek hasta sayısı 66, kadın hasta sayısı 24), hastaların klinik verileri ve demografik verileri arasında anlamlı olarak fark bulunmamamıştır. YBÜ’ ye yatış sırasında erkek hastaların interlökin (İL)-6 ve ferritin düzeyleri kadın hastaların düzeylerine göre anlamlı olarak yüksek saptanmıştır. Cinsiyetler arasında mortalite açısından anlamlı fark saptanmamıştır. Sonuç: COVID-19 hastalığına bağlı yoğun bakımda takip edilen hasta sayısı olarak erkek cinsiyet halen kadın cinsiyete göre yüksek olup mortalite üzerinde cinsiyetin anlamlı etkisi saptanmamıştır. Ancak erkek hastalarda enflamatuvar belirteçler olan İL-6 ve ferritinin daha yüksek saptanması, hastalığın erkeklerde daha şiddetli geçmesine sebep olabilir.

ÖZ Amaç Aşırı enflamasyona bağlı hiperkoagülopati, koronavirüs hastalığı-2019 (COVİD-19) hastalarında mortalite ve organ yetmezliğinden sorumlu olabilir. Anormal pıhtılaşma profilleri, kötü sonlanımlarla ilişkilendirilmiştir. Bu çalışmada, yoğun bakım ünitesine (YBÜ) kabul edilen kritik COVİD-19 hastalarında antitrombin (AT) düzeylerinin prognostik değerini değerlendirmeyi amaçladık. Gereç ve Yöntem Dört yüz on kritik COVİD-19 hastası retrospektif olarak analiz edildi. YBÜ’ye yatışta enflamatuvar ve konvansiyonel pıhtılaşma parametreleri ile AT aktivite seviyeleri kaydedildi. Hastaların klinik sonuçları değerlendirildi. Bulgular YBÜ kabulündeki AT seviyeleri ölenlerde yaşayanlara göre anlamlı olarak daha düşüktü (%77,9 vs. %82,5; p=0,027). D-dimer değerleri ise ölenlerde yaşayanlara anlamlı olarak daha yüksekti (2775 vs. 1495 µg/L; p