Background/Aims: Acute kidney injury (AKI) is frequent in cirrhotic patients and is associated with a poor prognosis. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) organization recommended new criteria for the diagnosis and staging for AKI. The aim of this study was to evaluate the presence of AKI according to KDIGO criteria in cirrhotic patients admitted to the hospital and to determine its association with hospital mortality. Materials and Methods: This retrospective study included 277 cirrhotic patients admitted to the intensive care unit and gastroenterology service of a tertiary referral hospital from January 2008 to January 2012. AKI was diagnosed and classified according to the KDIGO criteria. Results: The overall incidence of AKI in cirrhotic patients was 39%, and the overall hospital mortality was 15.5%. Patients without AKI had a hospital mortality rate of 2.4%, whereas the mortality rate for patients with AKI was 36.1%. The peak AKI stage detected during hospitalization was stage 1 for 58 patients (53.7%), stage 2 for 20 patients (18.5%), and stage 3 for 30 patients (27.7%). Mortality was found to be associated with the presence, stage, and progression of AKI. Multivariate analysis showed that AKI was an independent factor significantly associated with mortality (odds ratio: 9.1; 95% confidence interval: 2.89–29.1; p<0.001). Conclusion: KDIGO criteria can be used to evaluate AKI in cirrhotic patients. The prevalence of AKI in patients with cirrhosis is high, and AKI is associated with mortality. If early preventive measures are taken, it may be possible to prevent AKI progression and thus mortality.

Red cell distribution width (RDW) and the systemic immune-inflammation index (SII) have been extensively studied as predictors of morbidity and mortality in several cardiovascular diseases. This pr...

It is well known that approximately 20% of patients who undergo cardiac surgery experience weight loss in postoperative period. However, there is a lack of data on postoperative consequences of malnutrition. This study aimed to investigate the relationship between nutritional status and long-term outcomes in patients undergoing isolated coronary artery bypass grafting (CABG). A total of 586 patients who underwent isolated CABG in our center between January 2015 and March 2016 were included in this study. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of all-cause death, non-fatal myocardial infarction (MI), and stroke. Patients were divided into two groups based on their MACCE outcomes. Prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and controlling nutritional status (CONUT) scores were used to show the nutritional status. The mean follow-up time of the whole study group was 38.08 ± 13.4 months. The follow-up time was 39 ± 13 months in patients with mortality, while it was 20 ± 15 months in those without mortality. The PNI and GNRI values were lower in patients with major adverse cardiac and cerebrovascular events (MACCE) compared to patients without MACCE. The median CONUT score was higher in patients with MACCE. Our study showed that nutritional indices including PNI, CONUT, and GNRI were associated with long-term MACCE and mortality in patients who underwent isolated CABG. The use of these scores in order to predict prognosis in patients treated with CABG seems to be an applicable method in clinical practice.

Malnutrition has been shown to be associated with survival in a variety of diseases. Our aim is to evaluate the prognostic value of objective nutritional indexes indicating malnutrition, in patients underwent endovascular aortic replacement. We retrospectively evaluated 149 consecutive patients who underwent technically successful endovascular aortic replacement operation between October 2010 and August 2019. Objective nutritional indexes, prognostic nutritional index, geriatric nutritional risk index and controlling nutritional status, scores were calculated using the preoperative data. Optimal cut-off values were obtained by receiver operating characteristic analysis. According to the cut-off values, we investigated the relationship between indexes and the long-term all-cause mortality. During mean 48.0 ± 30.3 months follow-up duration, in 47 of patients (31.5%), all-cause mortality were documented. In mortality group, prognostic nutritional index (42.8 ± 7.1 vs 51.3 ± 5.2, p < 0.001) and geriatric nutritional risk index (100.7 ± 10.1 vs 107.6 ± 9.2, p < 0.001) were significantly lower, controlling nutritional status score (2.0 (1.0–4.0) vs 1.0 (0.0–2.0), p < 0.001) was higher when compared to survivor group. Kaplan–Meier curves presented higher mortality incidence in malnutrition patients evaluated with objective nutritional indexes (Log-rang test, for all three indexes p < 0.001). Besides Cox-proportional hazard analysis showed all three nutritional indexes may be a predictive marker for all-cause mortality, prognostic nutritional index introduced more valuable data than other two indexes. Malnutrition is associated with significant increase in postoperative long-term mortality in endovascular aortic replacement patients. Preoperatively calculated objective nutritional indexes especially prognostic nutritional index can be used as an important prognostic tool.

BACKGROUND: Double-kissing (DK) crush and DK culotte are the recommended 2-stent strategies in true coronary bifurcation lesions. However, it is a matter of curiosity about which of the DK crush and DK culotte stenting techniques will have superior results. We aimed to compare the clinical outcomes of DK crush and DK culotte stenting in nonleft main coronary artery bifurcation. METHODS: Consecutive patients who received DK crush or DK culotte technique for de novo true nonleft main coronary artery bifurcation lesion were categorized according to which treatment they received. The primary end point of the study was target lesion failure as a composite end point of target lesion revascularization, target vessel myocardial infarction, and cardiac death. Secondary end points were all-cause death and definite stent thrombosis. RESULTS: A total of 202 patients were categorized as DK crush (101 patients) or DK culotte (101 patients) techniques. The target lesion failure had occurred frequently in the DK crush (10.9%) compared with the DK culotte (3.0%; P =0.028) that was mainly driven by increased target lesion revascularization (9.9% in the DK crush versus 3.0% in the DK culotte; P =0.045). The number of patients with target vessel myocardial infarction (3.0% in the DK crush versus 2.0% in the DK culotte; P =0.651) and cardiac death (1.0% in the DK crush versus 0.0% in the DK culotte; P =0.315) was higher in the DK crush. There were no differences in terms of definite stent thrombosis and all-cause death between groups. CONCLUSIONS: In the present analysis, DK culotte was associated with lower 1-year target lesion failure rates compared with DK crush in true nonleft main coronary artery bifurcations. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04789161.