Background and Objectives: Procalcitonin (PCT) kinetics are increasingly used as prognostic markers in sepsis, but their interpretation is confounded by dynamic changes in renal function during acute illness. This study evaluated the prognostic value of ΔPCT for 30-day mortality in critically ill patients with either sepsis or septic shock by incorporating serial kinetic eGFR measurements and renal function-adjusted ΔPCT cut-off values based on the mean kinetic eGFR during the first 48–72 h of ICU admission. Materials and Methods: This retrospective cohort study included 106 adult ICU patients with either sepsis or septic shock. Serial procalcitonin measurements were used to calculate ΔPCT as a ratio of follow-up to baseline values, while renal function was assessed using mean kinetic eGFR over the first 72 h of ICU admission. Results: Thirty-day mortality was 43.4%. ΔPCT was a strong independent predictor of mortality across all models. At 48 h, ΔPCT2 was independently associated with 30-day mortality in the overall cohort (AUC 0.793) and demonstrated independent prognostic significance only in patients with preserved renal function (GFR ≥ 30 mL/min/1.73 m²). The optimal ΔPCT2 cut-off corresponded to a 56% reduction in procalcitonin levels. At 72 h, ΔPCT3 emerged as an independent predictor of mortality regardless of renal function. ROC analysis identified an optimal ΔPCT3 cut-off corresponding to 62% procalcitonin reduction in the overall cohort, with renal function-specific thresholds of ~50% for patients with GFR < 30 mL/min/1.73 m² and ~73% for those with preserved renal function. The combination of APACHE II score and ΔPCT3 demonstrated the highest discriminative performance for mortality prediction (AUC 0.948). Conclusions: Procalcitonin kinetics provide clinically meaningful prognostic information in sepsis when interpreted alongside dynamic renal function. While 48 h procalcitonin kinetics offer prognostic value primarily in patients with preserved renal function, 72 h ΔPCT provides renal function-independent and superior mortality discrimination. Integrating serial kinetic eGFR measurements enables renal function-adapted ΔPCT threshold determination and may improve risk stratification in critically ill septic patients.

Yoğun Bakımda Akciğer Tüberkülozu: Tanı, Tedavi ve İzolasyon İmren TAŞKIRAN Erişkin Yoğun Bakım Hasta Popülasyonunun Özellikleri ve Yoğun Bakımda Güncel Sorunlar Ömer EMGİN Yaşam Sonu Bakımı: Etik, Klinik ve Kişisel Perspektifler Yakup ÖZGÜNGÖR Yoğun Bakımda Enteral ve Parenteral Beslenme Engin HAFTACI Yoğun Bakımda Hasta ve Hasta Yakını İletişimi Murat GÜNEŞ Beyin Ölümü Tanısı-Güncel Konular Mehmet YAVUZ Yoğun Bakımda Tiroid Fonksiyon Bozuklukları Uğur AYDOĞAN Yoğun Bakımda Adrenal Yetmezlik Ebru AYDOĞAN Yoğun Bakımda Obstrüktif Uyku Apne Sendromu Engin KIRMIZIGÜL Donör Bakımı Ayşe ÇAPAR Yoğun Bakımda İnflamatuar Barsak Hastalıkları Adnan ATA Yoğun Bakımda Plevral Efüzyon ve Ultrasonografi Ömer KEKLİCEK Yoğun Bakım Hastalarında Venöz Tromboembolizm Turgay ATAY

Background : Non-thyroidal illness syndrome is frequent in critically ill patients, but the prognostic value of dynamic changes in thyroid function tests remains unclear. This study evaluated whether serial measurements of thyroid-stimulating hormone (TSH) and free triiodothyronine (FT3) provide additional predictive value for 30-day mortality beyond conventional severity scores in ICU patients. Methods : This single-center retrospective observational study included 74 adult patients treated for ≥72 hours in a general ICU who had TSH and FT3 measured within 24 hours of admission and again at 48–72 hours. Demographic characteristics, comorbidities, APACHE II, SOFA, modified NUTRIC (mNUTRIC) scores, and routine laboratory data (including albumin, CRP, and lactate) were recorded. The primary outcome was 30-day mortality. Between-group comparisons were performed using t-tests, Mann–Whitney U, and Chi-square tests. Variables significant in univariate analyses were entered into binary logistic regression models, and predictive performance was assessed using receiver operating characteristic (ROC) curves and the Youden index. Results: The mean age was 68.7 ± 14.7 years, and 41.9% (n = 31) of patients died within 30 days. Non-survivors had higher APACHE II, SOFA, and mNUTRIC scores and lower albumin, lymphocyte count, and second FT3 levels compared with survivors (all p ≤ 0.003). Baseline FT3 and TSH were not associated with mortality, whereas both the second FT3 measurement and the ΔT3 (second–first FT3) were strongly predictive. Second FT3 <1.63 pg/mL yielded an AUC of 0.835 (sensitivity 77%, specificity 74%), and a ΔT3 log ratio threshold of –0.09 (≈20% early FT3 decline) produced an AUC of 0.835 (sensitivity 71%, specificity 81%). The APACHE II + ΔT3 (numeric) model showed the best discrimination (AUC 0.921; sensitivity 87.1%, specificity 81.4%), outperforming APACHE II alone (AUC 0.861). Conclusions : In critically ill adults, dynamic T3 kinetics—particularly early decline in FT3 within the first 72 hours—provide substantial incremental prognostic value for 30-day mortality beyond APACHE II. Serial FT3 monitoring may help identify high-risk patients whose endocrine adaptation to critical illness is failing.

Background: Non-thyroidal illness syndrome is frequent in critically ill patients, but the prognostic value of dynamic changes in thyroid function tests remains unclear. This study evaluated whether serial measurements of thyroid-stimulating hormone (TSH) and free triiodothyronine (FT3) provide additional predictive value for 30-day mortality beyond conventional severity scores in ICU patients. Methods: This single-center retrospective observational study included 74 adult patients treated for ≥72 h in a general ICU who had TSH and FT3 measured within 24 h of admission and repeated at 48–72 h. Patients aged 18 years or above admitted to the intensive care unit were included in the study. Demographic characteristics, comorbidities, APACHE II, SOFA, modified NUTRIC (mNUTRIC) scores, and routine laboratory data (including albumin, CRP, and lactate) were recorded. The primary outcome was 30-day mortality. Between-group comparisons were performed using t-tests, Mann–Whitney U, and Chi-square tests. Variables significant in univariate analyses were entered into binary logistic regression models, and predictive performance was assessed using receiver operating characteristic (ROC) curves and the Youden index. Results: The mean age was 68.7 ± 14.7 years, and 41.9% (n = 31) of the patients died within 30 days. Non-survivors had higher APACHE II, SOFA, and mNUTRIC scores and lower albumin, lymphocyte count, and second FT3 levels compared with survivors (all p ≤ 0.003). Baseline FT3 and TSH were not associated with mortality, whereas both the subsequent FT3 measurements and the ΔT3 (variance in former to latter FT3) were remarkably predictive. The latter FT3 < 1.63 pg/mL produced an AUC of 0.835 (sensitivity: 77%, specificity: 74%), and a ΔT3 log ratio threshold of −0.09 (≈20% early FT3 decline) produced an AUC of 0.835 (sensitivity: 71%, specificity: 81%). The APACHE II + ΔT3 (numeric) model showed the best discrimination (AUC: 0.921; sensitivity: 87.1%, specificity: 81.4%), outperforming APACHE II alone (AUC: 0.861). Conclusions: In critically ill adult patients, dynamic T3 kinetics—particularly premature decline in FT3 within the first 72 h—provide incremental prognostic value for 30-day mortality beyond APACHE II. Serial FT3 monitoring may help identify high-risk patients whose endocrine adaptation to critical illness is failing.

Background and Objectives: Tracheostomy is frequently performed in critically ill patients requiring prolonged invasive mechanical ventilation; however, factors associated with intermediate-term mortality after tracheostomy remain poorly characterized. This study aimed to identify clinical and procedural factors associated with 90-day all-cause mortality after tracheostomy in ICU patients. Materials and Methods: This retrospective multicenter cohort study included 292 adult patients who underwent tracheostomy in two tertiary ICUs between 1 October 2023 and 1 June 2025. Demographic characteristics, admission diagnoses, comorbidities, clinical severity scores, procedural variables, microbiological culture results, and survival data were collected. Univariate analyses, multivariable binary logistic regression, Cox proportional hazards regression, receiver operating characteristic (ROC) analysis, and Kaplan–Meier survival analysis were performed. Results: The overall 90-day all-cause mortality rate was 74.7%. Age, Charlson Comorbidity Index, and APACHE II score were significantly associated with 90-day mortality in univariate analyses, whereas tracheostomy timing and technique were not. In multivariable logistic regression analysis, the Charlson Comorbidity Index and APACHE II score were independently associated with mortality. Cox proportional hazards regression confirmed that both APACHE II score and Charlson Comorbidity Index were independently associated with mortality over time. ROC analysis demonstrated moderate discriminative performance for age, Charlson Comorbidity Index, and APACHE II score. Conclusions: In critically ill patients undergoing tracheostomy, 90-day mortality was high and was driven primarily by acute illness severity and comorbidity burden rather than procedural characteristics. These findings support incorporating biological vulnerability, expected recovery potential, and goals-of-care discussions into tracheostomy decision-making.

Yaşam sonu bakımı, modern tıbbın sunduğu olanaklara rağmen, ölümü onurlu ve insancıl bir şekilde karşılamayı hedefleyen bir disiplindir. Etik, klinik ve kültürel boyutların birleştiği bu alan, hasta özerkliği ve insan onurunu merkeze alarak fiziksel, psikososyal ve manevi ihtiyaçlara bütüncül bir yaklaşım sunar. Bilgilendirilmiş onam gibi etik ilkeler, hasta bakımında kritik önem taşırken, bilinç kaybı yaşayan hastalar için karar verme süreçleri karmaşık etik ve hukuki sorunlara yol açabilir. Manevi destek, hastaların ölüm sürecini anlamlandırmalarına yardımcı olurken, dini ve kültürel hassasiyetler onurlu bir ölüm deneyimi sağlamak açısından hayati rol oynar. Terminal dönem yönetiminde multidisipliner ekiplerin koordinasyonu ve etik değerlendirmeler, hastaların konforunu artırırken, gelecekte hukuki düzenlemeler ve toplumsal farkındalık bu alanın gelişimini destekleyecektir.