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Öğe Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis(LIPPINCOTT WILLIAMS & WILKINS, 2013) Biyik, Murat; Ucar, Ramazan; Solak, Yalcin; Gungor, Gokhan; Polat, Ilker; Gaipov, Abduzhappar; Cakir, Ozlem O.Objectives Neutrophil-to-lymphocyte ratio (NLR) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. We aimed to evaluate the role of NLR in the prediction of long-term mortality in patients with stable liver cirrhosis. Materials and methods This is a retrospective observational cohort study in which 145 stable cirrhotic patients without infection, hepatocellular carcinoma, and ongoing steroid therapy were enrolled between January 2009 and December 2011. The primary end point was survival during follow-up. NLR along with Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) scores, and Charlson comorbidity index were assessed for the prediction of mortality. Results There were 86 men and 59 women, mean age 58.9 +/- 13.4 years. The etiologies of liver cirrhosis included viral hepatitis (n = 73), cryptogenic (50), alcoholic (12), and other (10). The mean follow-up duration was 27.8 +/- 6.8 months, during which 40 patients died. The mean NLRs were 2.08 +/- 0.99 and 4.39 +/- 3.0 in surviving and nonsurviving patients, respectively (P < 0.001). Kaplan-Meier survival analysis was carried out according to the median NLR above and below 2.72. Patients with NLR of at least 2.72 had a significantly lower survival (log rank, P < 0.001). NLR was found to be an independent predictor of mortality in all Cox Regression models (odds ratio 1.2; 95% confidence interval 1.2-1.3; P < 0.001). Receiver operating characteristic analysis showed that cut-off values of 4.22, 3.07, and 2.96 for NLR predicted 12, 24, and 36-month mortality, respectively (AUC: 0.806, P = 0.0029; 0.841, P < 0.0001 and 0.783, P < 0.0001, respectively). Conclusion NLR is a predictor of mortality independent of CTP and MELD scores in patients with liver cirrhosis. NLR could predict mortality in the subgroup of patients with low MELD scores as well. Eur J Gastroenterol Hepatol 25:435-441 (C) 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2013, 25:435-441Öğe A duodenal mass and acute pancreatitis(TURKISH SOC GASTROENTEROLOGY, 2013) Ozer Cakir, Ozlem; Biyik, Murat; Gungor, Gokhan; Ataseven, Huseyin; Demir, Ali; Tavli, Lema[Abstract not Available]Öğe Neutrophil gelatinase-associated lipocalin in prediction of mortality in patients with hepatorenal syndrome: a prospective observational study(WILEY, 2014) Gungor, Gokhan; Ataseven, Huseyin; Demir, Ali; Solak, Yalcin; Gaipov, Abduzhappar; Biyik, Murat; Ozturk, BahadirBackground & AimsHepatorenal syndrome (HRS) is a severe complication of cirrhosis which is characterized by renal dysfunction and associated with poor survival. Neutrophil gelatinase-associated lipocalin (NGAL) is a troponin-like biomarker for human acute kidney injury. We aimed to investigate levels of plasma and urine NGAL in HRS and predictive ability of these markers for all-cause mortality, in HRS, stable cirrhosis and control subjects. MethodsA total of 64 patients with cirrhosis (8 patients with type 1 HRS, 22 with type 2 HRS, and 34 without HRS) and 23 control subjects were included in the study. Blood and urine samples were measured with Human NGAL sandwich ELISA. Patients were followed up prospectively. ResultsPatients with type 1 and type 2 HRS had significantly higher plasma and urine NGAL levels compared with stable cirrhosis and control subjects. Cox regression analysis showed that plasma NGAL and MELD-Na scores were independent predictors of mortality. ROC-curve analysis showed that the plot of the plasma NGAL, urine NGAL, MELD-Na and Child-Turcot-Pugh score could predict all-cause mortality in cirrhotic patients' area under the curve (AUC 0.819, 0.686, 0.807 and 0.795 respectively). ConclusionsNGAL could predict mortality in patients with HRS independent of other commonly used risk factors.Öğe Routinely evaluated clinical assays and laboratory tests [real test] and fibrosis stages of chronic hepatitis B and C(AVES, 2014) Bugdaci, Mehmet Sait; Korkmaz, Huseyin; Demir, Ali; Biyik, Murat; Temel, Tuncer; Gokturk, Huseyin Savas; Ozakyol, AysegulBackground/Aims: To provide a new mathematical formula to predict liver fibrosis in patients with chronic viral hepatitis. Materials and Methods: Patients with chronic hepatitis B and C who underwent liver biopsy at different centers were included in this study. Chronic hepatitis B was defined as immunopositivity for the hepatitis B surface antigen for at least 6 months, and chronic hepatitis C was defined as positivity for HCV RNA for at least 3 months. The histological features were evaluated by the histological activity index and fibrosis. Results: In total, 1299 patients were included in the study. The distribution and the mean of the parameters of the patients were as follows: 1009 patients with chronic hepatitis B with a mean age of 45 +/- 13/years [emale/male (F/M)=47.5/52.5%] and 290 patients with hepatitis C with a mean age of 52 +/- 10.3/years [F/M=61/39%]. When the cut-off value of the REAL TEST formula"[(age x pT x AST)/(PLT/1000)]/100" in patients with hepatitis B was determined to be >= 1.37, it was found that it could predict fibrosis with 79% specificity, 78% sensitivity, 85% negative predictive value (NPV), and 70% positive predictive value (PPV) (area under the curve (AUC)=0.852, 95% CI: 0.82-0.87). When the cut-off value of the REAL TEST formula in patients with hepatitis C was determined to be >= 1.99, it was found that it could predict significant fibrosis with 87% specificity, 90% sensitivity, 94.4% NPV, and 79.4% PPV (AUC: 0.95, 95% CI: 0.93-0.98) Conclusion: The REAL TEST formula results correlated with the pathological findings and may be a useful method for the evaluation of patients with chronic hepatitis B and C.Öğe SERUM AND URINE NGAL LEVELS IN PATIENTS WITH CIRRHOSIS AND HEPATO-RENAL SYNDROME(OXFORD UNIV PRESS, 2012) Gungor, Gokhan; Ataseven, Huseyin; Demir, Ali; Solak, Yalcin; Biyik, Murat; Ozturk, Bahadir; Polat, Ilker[Abstract not Available]Öğe Sleep Quality and Depression in Peritoneal Dialysis Patients(TAYLOR & FRANCIS LTD, 2008) Gueney, Ibrahim; Biyik, Murat; Yeksan, Mehdi; Biyik, Zeynep; Atalay, Huseyin; Solak, Yalcin; Selcuk, N. YilmazBackground. Sleep quality (SQ) is a significant problem in peritoneal dialysis (PD) patients, yet the underlying factors are not well known. In addition, depression and impaired quality of life (QOL) are main problems in PD patients. We measured the SQ and investigated the effect of depression, QOL, and some other factors on SQ in PD patients. Methods. Data were collected from 124 PD patients (59 male, 65 female) in our center. Demographic data and laboratory values were analyzed. All patients were asked to complete the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Index (BDI), and SF-36. Results. Mean age of the patients was 52.6 14.3 year. The prevalence of poor SQ was 43.5%, defined as global PSQI score 5. The prevalence of depression was 25.8%, defined as BDI scores 17. The poor sleepers had higher BDI scores, poor QOL, older age, and lower duration of PD compared to the good sleepers. There was not a difference in hemoglobin, albumin, C-reactive protein, Kt/V, urea, creatinine, lipid parameters, gender, marital status, cigarette smoking, mode of PD, and comorbidity between poor and good sleepers. The global PSQI score was correlated negatively with both PCS and MCS (r = -0.414, r = -0.392, respectively; p 0.001) and correlated positively with BDI scores and age (r = 0.422, p 0.001 and r = 0.213, p = 0.018, respectively). In multivariate analysis, only BDI scores were found to be factors that could predict the patients being poor sleepers. Conclusion. Poor SQ is a significant problem in PD patients, and we found an association with depression, QOL, and age. Regular assessment and management of SQ may be important especially with PD patients who are depressive and elderly to increase QOL.Öğe Unintentional Weight Loss in a Renal Transplant Recipient: Do Not Overlook Coeliac Disease(BASKENT UNIV, 2013) Solak, Yalcin; Gaipov, Abduzhappar; Biyik, Zeynep; Ucar, Ramazan; Biyik, Murat; Esen, Hasan; Ataseven, HuseyinUnintentional weight loss in a renal transplant recipient is an important condition, requiring diagnostic search within the framework of malignancy and opportunistic infections. To the best of our knowledge, there are no data in the literature reporting underlying coeliac disease as the cause of significant weight loss after renal transplant. We report a 32-year-old woman, who complained of significant weight loss during the 3.5 years posttransplant. Diagnostic work-up revealed coeliac disease, and a gluten-free diet stabilized her weight loss. Considering the high frequency of coeliac disease, this should be kept in the differential diagnosis of renal transplant recipients presented with weight loss and other suggestive features.
