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    Evaluating the McMahon score for predicting mortality in earthquake-induced rhabdomyolysis: a retrospective study
    (Oxford Univ Press, 2024) Yaman, Mahmut; Sen, Abdullah; Durgun, Hasan Mansur; Eynel, Eren; Belek, Sema; Ulgut, Silan Goger; Orak, Murat
    Background: In natural disasters like earthquakes, building collapses can trap individuals, causing crush syndrome and rhabdomyolysis. This life-threatening condition often leads to acute kidney injury. We aimed to determine the effectiveness of the McMahon score in predicting mortality due to rhabdomyolysis in patients affected by the earthquake. Methods: This is a retrospective observational study. In this study, the clinical and laboratory data of patients who presented to the emergency department due to the earthquake were analyzed. The McMahon score was calculated by evaluating factors such as creatine kinase, serum creatinine levels, age, and gender. Results: The study included 151 patients, of whom 74 (49.0%) were male and 77 (51.0%) were female. In the univariate model, significant (P < .05) effectiveness was observed in differentiating between patients with and without mortality for McMahon score and the risk of acute kidney injury. At a McMahon score cutoff of 6, significant effectiveness was also observed, with an area under the curve of 0.723. At this cutoff value, the sensitivity was 80.0% and the specificity was 64.5%. Conclusions: The use of the McMahon score in emergency medicine and disaster management plays a crucial role in rapid decision-making processes due to its effectiveness in predicting mortality. Key messages What is already known on this topic center dot Rhabdomyolysis, often associated with crush syndrome and acute renal failure, leads to elevated serum creatinine levels due to muscle breakdown, frequently seen in trauma and earthquake victims. What this study adds center dot The McMahon score helps predict mortality and acute kidney injury in rhabdomyolysis patients, particularly after earthquakes, by evaluating key clinical and demographic factors. How this study might affect research, practice, or policy center dot This study highlights the McMahon score's reliability in predicting mortality in rhabdomyolysis patients, potentially guiding future research on early intervention strategies and trauma management, informing clinical practices for rapid assessment and treatment.
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    The relationship between infection parameters and urine volume in acute kidney injury
    (2024) Oruç, İdris; Sarı, Hıdır; Eynel, Eren; İnce, Hasan; Yıldırım, Yaşar; Aydın, Emre; Aydın, Fatma Yılmaz
    Aim: Acute kidney injury (AKI) is a clinical syndrome that can cause disturbances in fluid-electrolyte and acid-base balance, resulting in the accumulation of nitrogen and uremic toxins along with the loss of kidney functions within hours or days. In this study, it was aimed to retrospectively examine patients with acute kidney injury to determine whether there is a relationship between infection parameters and urine volume. Materials and Methods: The study included a total of 144 patients with (n=74) and without infection (n=70) out of 294 patients with AKI who received treatment between 1 January 2020 and 31 December 2021 in the nephrology clinic of a tertiary university hospital. Results: The mean age was 66.4±15.7 (range:19-95) in patients with infection and 63.8±15.2 (range:36- 93) in non- infected patients. 51.4% (n=38) of those with infection and 52.9% (n=37) of those without infection were women. There was no difference between the individuals with and without infection in terms of age and gender (p>0.05). Infection was present in 51.4% (n=74) of the patients included in the study. Urinary tract (31.3%) and respiratory tract infections (13.2%) were the most common in those with infection. A moderate negative correlation was observed between admission CRP and discharge creatinine level in patients with infection. There was no correlation between PCT and sedimentation rate, urine volume and admission/discharge creatinine level. Moderate positive correlations were found between admission/ discharge PCT and admission/discharge urine volume in patients without infection. In addition, moderate negative correlations were found between admission/discharge sedimentation rate and admission urine volume. Conclusions: No correlation was found between PCT and sediment (incoming/exit) and outflow urine volume in patients with infection.
  • Küçük Resim
    Öğe
    The Role of monocyte to high-density lipoprotein cholesterol ratio in predicting the severity of proteinuria and renal dysfunction in primary nephrotic syndrome
    (Cureus Inc., 2021) Aydın, Fatma Yılmaz; Eynel, Eren; Oruç, İdris; İnce, Hasan; Yüksel, Enver; Aydın, Emre
    Introduction: Monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) has emerged as a novel marker of endothelial injury, inflammation, and oxidative stress. This study aimed to investigate the effect of MHR on primary nephrotic syndrome (NS) and its relationship with the severity of proteinuria. Methods: This study enrolled 161 patients newly diagnosed with primary NS and 100 healthy individuals. Demographic characteristics of the patients, primary NS diagnosis, basal laboratory parameters, the amount of 24-hour urinary protein excretion, and MHR were recorded. The groups were compared regarding these parameters. Results: MHR was significantly higher in patients with primary NS compared with the healthy group (12.89 +/- 4.86 and 9.71 +/- 2.30, respectively; p < 0.001). There was no difference between the groups in terms of age and sex. The amount of protein in the 24-hour urine in patients with a diagnosis of primary NS was 6.91 +/- 3.73 g/day. The correlation analysis showed a positive correlation between MHR and the amount of proteinuria (r = 0.519, p < 0.001) and creatinine level (r = 0.167, p = 0.034). The multivariate regression analysis found that the severity of proteinuria was independently correlated to MHR (p < 0.001). According to the receiver operating characteristic curve analysis, the optimal cut-off level for MHR in NS was 10.08 (area under the curve of 0.704, sensitivity of 68%, and a specificity of 62%). Conclusion: Our study is the first to compare the severity of proteinuria and renal functions with MHR in patients with primary NS. We believe that MHR can be used as a biomarker to determine inflammation, endothelial injury, and the level of oxidative stress, and may be useful to predict prognosis in patients with primary NS.
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    Yoğun bakım hastalarında mekanik ventilatörden ayırmaya akut böbrek hasarının etkisinin değerlendirilmesi
    (2017) Eynel, Eren; Yılmaz, Zülfükar
    Giriş ve Amaç: Akut böbrek hasarı (ABH) yoğun bakımdaki hasta populasyonunda %5-%30 oranında görülmekte ve yoğun bakımda ABH gelişen olgularda mortalite %40-90'a ulaşmaktadır. Yoğun bakımda ABH gelişimi mortaliteyi ciddi biçimde arttıran, yoğun bakımda kalış süresini uzatan, diyaliz ve diğer pahalı tedavi yöntemlerini gerekli kılarak maliyeti artıran önemli bir problemdir. Akciğer ve renal fonksiyon bozulması birlikteliği ile ilgili son zamanlarda birçok çalışma yapılmaktadır. Fakat mekanik ventilatöre bağlı hastalarda akut böbrek hastalığının mekanik ventilatörden ayırma üzerine etkisi üzerine yapılmış çok az çalışma bulunmaktadır. Biz yapacağımız bu çalışmayla dahiliye yoğun bakımda entübe şekilde takip edilen hastalarda akut böbrek hasarının mekanik ventilatörden ayırma üzerine olan etkisini ortaya koymaya çalışacağız. Materyal-metod: Bu çalışmaya 2010-2016 yılları arasında Dicle Üniversitesi Tıp Fakültesi dahiliye yoğun bakımda takibi yapılan hastalardan seçim yapılmıştır. Hastaların akut böbrek hasarı tanısı KDIGO kriterlerine bakılarak konulmuştur. Kronik böbrek yetmezliği ve kronik böbrek hastalığı, kronik akciğer hastalığı ve kalp yetmezliği tanısı olan hastalar çalışmaya dahil edilmedi. En az kırk sekiz saat takibi yapılan ve solunum yetmezliği nedeniyle entübe olan hastalar tasnif edildi. Bu kriterleri karşılayan 100 akut böbrek hasarı olan ve 100 akut böbrek hasarı olmayan hasta incelendi. Hastaların yaş, cinsiyet, kreatinin, albümin, SOFA skoru, APACHE II skoru, hemoglobin değeri, oksijen saturasyonu, parsiyel oksijen basıncı, parsiyel karbondioksit basıncı, PH değeri ve sepsis kriterlerini taşıyıp taşımadığına bakıldı. Bulgular: Hastalarımızın cinsiyet dağılımı % 58,5 erkek % 41,5 kadın (erkek; 117 ve kadın;83) olarak saptandı. Tüm hastalar içerisinde weaning yapılabilme oranı % 23 olarak bulundu. ABH olan hastalarda weaning yapılabilenlerin oranı ABH olmayan hastalardaki weaning yapılabilenlerin oranına göre daha düşük saptandı (%13 vs %43 - p < 0.001). Weaning yapılabilen hastalarda kreatinin düzeyi weaning yapılamayan hastalara göre daha düşük bulundu (Kreatinin; 1,35 + 1,39 vs 2,10 + 1.42, mg/dl; p = 0.001). Ek olarak weaning yapılabilen hastalarda APACHE II (21,7 + 4,6 vs. 26,6 + 5,7) ve SOFA (7,45 + 2,3 vs. 9,5 + 3,2) ölçümleri yapılamayan hastalara göre daha düşük bulundu (p < 0.001). Multipl lojistik regresyon analizine göre akut böbrek hasarına sahip olmamanın weaning yapılabilme oranını arttırdığı gösterildi.(Tahmini rölatif risk:4,95 - Güvenlik aralığı :2,41-10,16 - p<0,001). Sonuç: Sonuç olarak, çalışmamızda mekanik ventilasyon ile takip edilen yoğun bakım hastalarında böbrek fonksiyon bozukluğu ile solunum sistemi arasında yakın bir ilişki olduğu görülmektedir. ABH yoğun bakımda mekanik ventilatöre bağlı takip edilen hastalarda weaning üzerine olumsuz etkisi görülmektedir. Bu hasta populasyonunda ABH' ın erken tanınması, prognozun belirlenmesinde ve diğer klinik yaklaşımların tayin edilmesinde faydalı olabilir. Anahtar Kelimeler: Akut böbrek hastalığı, mekanik ventilatör, weaning, solunum yetmezliği