Scoring Pulmonary Fibrosis Following COVID-19 Pneumonia with Quantitative HRCT: Relationship with Clinical Parameters, Mean Platelet Volume and Lymphocyte/Monocyte Ratio - Thoracic Research and Practice

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is heterogeneous, and phenotype-based classification may better capture differences in clinical burden and healthcare needs beyond standard GOLD categories. We aimed to describe the distribution of GesEPOC COPD phenotypes in Turkey and compare their demographic, clinical, functional, radiological, treatment, and healthcare utilization profiles. Materials and Methods: DIPTUR was a multicenter, observational, cross-sectional study conducted prospectively in 26 centers across 17 Turkish cities (October 2019–June 2021). Stable COPD patients (≥40 years; post-bronchodilator FEV1/FVC < 0.7) without exacerbation or major treatment modification within the previous four weeks were enrolled consecutively. Phenotypes were assigned per GesEPOC: exacerbator with emphysema (EE), exacerbator with chronic bronchitis (ECB), asthma–COPD overlap (ACO), and non-exacerbator (NE). Frequent exacerbators were defined as patients who experienced two or more exacerbations during the 12 months preceding enrollment, based on medical records and patient reports. Results: Among 894 patients, phenotype distribution was NE 44.1%, ECB 26.2%, EE 20.5%, and ACO 9.3%. Male predominance was observed across groups (80–89%; p = 0.006). Active smoking was most frequent in ECB (37.6%; p < 0.001), and BMI was lowest in EE (p < 0.001). Comorbidity patterns differed, with hypertension (p < 0.001), diabetes mellitus (p = 0.029), and heart failure (p < 0.001) most prevalent in ECB. Pulmonary function (FEV1 and FVC) was lowest in EE (both p < 0.001), and severe airflow limitation (GOLD III–IV) was most common in EE and ECB (p < 0.001). Dyspnea (mMRC ≥ 2) was more frequent in EE/ECB than in ACO/NE (p < 0.001). Emphysematous changes on thoracic CT predominated in EE (91.7%; p < 0.001). Long-term oxygen therapy was most common in EE (32.4%; p < 0.001). Emergency admissions, hospitalizations, and total length of stay were markedly higher in EE and ECB than in ACO and NE (all p < 0.001). Conclusions: COPD phenotypes in Turkey show substantial heterogeneity in clinical, functional, radiological, and utilization domains. Exacerbator phenotypes—particularly EE and ECB—represent higher-burden groups, supporting phenotype-oriented management and closer monitoring beyond GOLD classification.

Objective: There is no existing scoring system to predict postoperative risks, such as the Canet scoring system, for patients referred to pulmonology clinics.The aim of this study was to develop a scoring system to predict postoperative pulmonary complications (PPCs) in patients referred to the pulmonology clinics for preoperative evaluation. Patients ans Methods: This prospective, single-center study included patients referred for preoperative evaluation by surgical departments to the pulmonary medicine clinic at a tertiary care center. Preoperative demographic data and pulmonary evaluation results were recorded. Patients were followed postoperatively until discharge, with follow-up phone calls at the first month to assess pulmonary symptoms. Mortality data was recorded at the third month. Results: A total of 203 patients were included between January 2018 and February 2020. Of these, 55.7% were female, with a mean age of 60.59 years. PPC rate at the first month was 36.4%, and 22.7% had ongoing symptoms or new complications. The most common complication was bronchospasm (23.2%). Significant preoperative risk factors included surgery type, preoperative cough/dyspnea, and the season of surgery (p<0.05). Pulmonary complications were three times more frequent in patients undergoing upper abdominal or thoracic surgery. Conclusion: Avoiding surgery during symptomatic periods and making optimal preoperative preparations may reduce the PPC rates.

Objective: Acute exacerbations (AECOPD) are primary determinants of clinical instability in chronic obstructive pulmonary disease (COPD), and the “frequent exacerbator” (≥2/year) phenotype markedly increases morbidity and healthcare utilization. In this study, we evaluated the association between the Systemic Immune-Inflammation Index (SII), calculated from routine hemogram parameters during the stable period, and the occurrence of frequent exacerbations within the subsequent 1 year, and aimed to define a clinically applicable SII threshold (cut-off). Materials and Methods: In this retrospective observational cohort study conducted at a tertiary care center, patients who attended the outpatient clinic between January 2020 and February 2025 and had COPD confirmed by post-bronchodilator spirometric criteria (FEV₁/FVC < 70%) were identified through electronic medical records. The index date was defined as a routine outpatient visit during stable COPD; patients were followed for AECOPD for 365 days after the index date. The stable period was defined as a visit occurring ≥4 weeks after the last exacerbation and without signs of acute infection. Patients with positive COVID-19 PCR results were excluded due to the uncertainty in distinguishing exacerbation from COVID-19. The primary endpoint was the development of frequent exacerbations (≥2 AECOPD) within 365 days. AECOPD was defined as an acute worsening of dyspnea, cough, and/or sputum requiring additional pharmacotherapy (systemic corticosteroids and/or antibiotics). SII, NLR, PLR, LMR, and PPN were calculated using hemogram parameters. Groups ( 1082.79 (OR = 3.028, 95% CI: 1.522–6.027; p = 0.002) was associated with frequent exacerbations. In a multivariable logistic regression adjusted for cardiovascular disease and overall comorbidity status, SII > 1082.79 remained independently associated (OR = 3.029, 95% CI: 1.485–6.179; p = 0.002). Other hemogram-derived indices did not retain independent prognostic significance in this outpatient cohort. Conclusion: SII measured during stable COPD was independently associated with frequent exacerbations over the subsequent 1 year. The SII > 1082.79 threshold may offer a practical risk stratification approach to flag “high-risk” patients in outpatient care. However, given the modest discriminative performance and the single-cohort derivation, this cut-off should be considered exploratory despite the use of bootstrap internal validation. Because this was a single-center study with a predominantly male cohort, the generalizability—particularly to female patients and other settings—requires prospective external validation.

Background and Objectives: Nutritional impairment and systemic inflammation contribute to disease progression and poor outcomes in Chronic Obstructive Pulmonary Disease (COPD). The geriatric-nutritional-risk-index (GNRI) and prognostic-nutritional-index (PNI) are practical markers reflecting both nutritional and immune status. In elderly COPD patients, malnutrition-related exacerbations often worsen quality of life and increase hospitalization. Identifying reliable predictors of exacerbation risk is therefore important for improving disease management. This study evaluated the association between GNRI, PNI and exacerbation frequency across different age groups in COPD. Materials and Methods: This multicenter retrospective study included 302 patients with COPD from 10 medical centers. All patients were classified as GOLD Group-E according to exacerbation history. Demographic characteristics, pulmonary function tests, Charlson-Comorbidity-Index (CCI), pharmacological treatments, dyspnea scores, and annual exacerbation frequency were obtained from hospital databases. Laboratory parameters including complete blood count, C-reactive protein, albumin, and total protein were recorded. GNRI, PNI, and neutrophil-to-lymphocyte ratio (NLR) were calculated to evaluate nutritional and inflammatory status. Results: The mean age of participants was 67.9 ± 9.6 years and 26.5% were female. Elderly patients had significantly higher CCI scores, longer disease duration, greater cumulative smoking exposure, and more frequent exacerbations than younger patients (p < 0.001). Pulmonary function parameters were significantly lower in the elderly group, while long-term oxygen therapy and nebulizer use were more common (p < 0.001). Baseline and exacerbation NLR levels were higher in elderly patients, whereas GNRI and PNI values were lower during both stable disease and exacerbation periods. Patients with more than four exacerbations per year had significantly higher NLR and lower GNRI values. Conclusions: Elderly COPD patients in GOLD Group-E demonstrate marked inflammatory and nutritional burden. Lower PNI values were independently associated with increased annual exacerbation frequency, while lower GNRI values were observed in patients with greater inflammatory and nutritional burden. Routine immune-nutritional assessment may improve risk stratification and help identify patients who could benefit from early multidisciplinary management.

Purpose: Structured risk scores are recommended to identify patients at risk of postoperative pulmonary complications (PPCs), yet their uptake among the specialists who deliver preoperative respiratory consultation is poorly characterised. We examined reported score use, associated factors, and the barriers reported by non-users. Methods: We conducted a cross-sectional online survey using voluntary convenience sampling of pulmonologists and pulmonary medicine residents in Türkiye, recruited through professional channels (September 2025–March 2026). The primary outcome was self-reported use of scoring systems in preoperative assessment; naming at least one validated PPC prediction model (ARISCAT/Canet, Gupta, or Arozullah) was analysed as a post hoc secondary outcome. Associated factors were explored using multivariable logistic regression with categorical coding of institution and professional position, collinearity diagnostics, and sensitivity analyses. Reporting followed STROBE and CHERRIES. Results: Of 202 respondents, 154 (76.2%; 95% CI 69.8– 81.9) reported using scores and 142 (70.3%; 95% CI 63.5– 76.5) named a validated PPC model; 135 of these 142 (95.1%) named ARISCAT/Canet, whereas the Gupta and Arozullah models were each named by ≤ 8.9% of respondents. University-hospital practice was associated with higher odds of score use than state/private-hospital practice (adjusted OR 5.93; 95% CI 1.77– 19.94), and this association persisted in all sensitivity analyses. Residents and specialists did not differ after adjustment (OR 0.80; 95% CI 0.29– 2.21). Academic-rank physicians reported lower use than residents (OR 0.21; 95% CI 0.06– 0.78), but this exploratory finding was not robust to exclusion of internally inconsistent responses. Among the 38 consistent non-users, the most frequently reported barriers were limited assessment time (57.9%) and insufficient knowledge (26.3%). Conclusion: In this convenience sample, reported structured PPC risk assessment relied almost entirely on a single instrument and differed chiefly by institutional setting. These cross-sectional, self-reported findings suggest that education, workflow integration, and local comparative evaluation of candidate models merit prospective study.