Showing papers by "Ilker Tasci published in 2021"

Clinical characteristics and outcomes of COVID-19 in patients with type 2 diabetes in Turkey: A nationwide study (TurCoviDia).

Abstract: BACKGROUND: Coronavirus disease 2019 (COVID-19) has been reported to be associated with a more severe course in patients with type 2 diabetes mellitus (T2DM). However, severe adverse outcomes are not recorded in all patients. In this study, we assessed disease outcomes in patients with and without T2DM hospitalized for COVID-19. METHODS: A nationwide retrospective cohort of patients with T2DM hospitalized with confirmed COVID-19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. Multivariate modeling was used to assess the independent predictors of demographic and clinical characteristics with mortality, length of hospital stay, and intensive care unit (ICU) admission and/or mechanical ventilation. RESULTS: A total of 18 426 inpatients (median age [interquartile range, IQR]: 61 [17] years; males: 43.3%) were investigated. Patients with T2DM (n = 9213) were compared with a group without diabetes (n = 9213) that were matched using the propensity scores for age and gender. Compared with the group without T2DM, 30-day mortality following hospitalization was higher in patients with T2DM (13.6% vs 8.7%; hazard ratio 1.75; 95% CI, 1.58-1.93; P < .001). The independent associates of mortality were older age, male gender, obesity, insulin treatment, low lymphocyte count, and pulmonary involvement on admission. Older age, low lymphocyte values, and pulmonary involvement at baseline were independently associated with longer hospital stay and/or ICU admission. CONCLUSIONS: The current study from the Turkish national health care database showed that patients with T2DM hospitalized for COVID-19 are at increased risk of mortality, longer hospital stay, and ICU admission.

No association of anti-osteoporosis drugs with COVID-19-related outcomes in women: a nationwide cohort study.

Abstract: This study was performed to evaluate whether the use of drugs in the treatment of osteoporosis in women is associated with COVID-19 outcomes. The results showed that the risk of hospitalization, intensive care unit admission, and mortality was not altered in individuals taking anti-osteoporosis drugs, suggesting no safety issues during a COVID-19 infection. Whether patients with COVID-19 receiving anti-osteoporosis drugs have lower risk of worse outcomes has not been reported yet. The aim of this study was to evaluate the association of anti-osteoporosis drug use with COVID-19 outcomes in women. Data obtained from a nationwide, multicenter, retrospective cohort of patients diagnosed with COVID-19 from March 11th to May 30th, 2020 was retrieved from the Turkish Ministry of Health Database. Women 50 years or older with confirmed COVID-19 who were receiving anti-osteoporosis drugs were compared with a 1:1 propensity score-matched COVID-19 positive women who were not receiving these drugs. The primary outcomes were hospitalization, ICU (intensive care unit) admission, and mortality. A total of 1997 women on anti-osteoporosis drugs and 1997 control patients were analyzed. In the treatment group, 1787 (89.5%) women were receiving bisphosphonates, 197 (9.9%) denosumab, and 17 (0.9%) teriparatide for the last 12 months. Hospitalization and mortality rates were similar between the treatment and control groups. ICU admission rate was lower in the treatment group (23.0% vs 27.0%, p = 0.013). However, multivariate analysis showed that anti-osteoporosis drug use was not an independent associate of any outcome. Hospitalization, ICU admission, and mortality rates were similar among bisphosphonate, denosumab, or teriparatide users. Results of this nationwide study showed that preexisting use of anti-osteoporosis drugs in women did not alter the COVID-19-related risk of hospitalization, ICU admission, and mortality. These results do not suggest discontinuation of these drugs during a COVID-19 infection.

Lower COVID-19 Mortality in Patients with Type 2 Diabetes Mellitus Taking Dipeptidyl Peptidase-4 Inhibitors: Results from a Turkish Nationwide Study.

Abstract: To investigate the effect of preexisting treatment with dipeptidyl peptidase-4 inhibitors (DPP-4is) on COVID-19-related hospitalization and mortality in patients with type 2 diabetes mellitus (T2DM). A multicenter, retrospective cohort study was conducted using patient data extracted from the Turkish National Electronic Database. All patients who tested positive for COVID-19 (PCR test) between 11 March through to 30 May 2020 were screened for eligibility (n = 149,671). Following exclusion of patients based on pre-determined inclusion criteria, patients with T2DM using a DPP-4i or glucose-lowering medications other than a DPP-4i were compared for mortality and hospitalization. The propensity score method was used to match age, gender, micro- and macrovascular complications, and medications in the two groups. Independent associates of mortality were analyzed using multivariable analysis on the whole T2DM population. A total of 33,478 patients with T2DM who tested postive for COVID-19 who met the inclusion criteria were included in the analysis. Median (interquartile range) age was 54 (22) years and 42.4% were male. Of these, 9100 patients using DPP-4is (n = 4550) or other glucose-lowering drugs (n = 4550) were matched in two groups. After matching, analysis revealed a lower mortality in the DPP-4i group (9.5 vs. 11.8%; p < 0.001). In the multivariable model, the use of DPP-4is (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.35–0.91; p = 0.02) was associated with lower mortality in the whole sample, while age, male gender, computed tomography finding of COVID-19, obesity, low glomerular filtration rate, and an insulin-based regimen also predicted increased risk of death. There was no association between the preexisting treatment with DPP-4is and COVID-19-related hospitalization in the matched analysis or multivariate model. The rate of admission to the intensive care unit and/or mechanical ventilation favored the DPP-4i group (21.7 vs. 25.2%; p = 0.001), although this association became saturated in the multivariate analysis (OR 0.65, 95% CI 0.39–1.08; p = 0.099). The results of this study demonstrate an association between DDP-4i use and reduced mortality in people with T2DM who tested PCR positive for COVID-19.

Clinical Characteristics and Outcomes of COVID-19 Patients with Overweight and Obesity: Turkish Nationwide Cohort Study (TurCObesity).

Abstract: Purpose While obesity is related to more severe outcomes of coronavirus disease 2019 (COVID-19), factors leading to poor prognosis still remain unclear. The present study evaluated the outcomes of COVID-19 patients who were overweight or obese and variables associated with severe disease in a large group of consecutive cases. Methods A nationwide retrospective cohort study was performed using the Turkish National Healthcare Database. Demographic characteristics, laboratory tests, comorbidities, and medications of patients registered between March 11 and May 30, 2020, were recorded. Results A total of 14, 625 patients (median age:42, IQR:26 years; female 57.4%) with normal weight (34.7%), overweight (35.6%), and obesity (29.7%) were included. Hospitalization, ICU admission, intubation/mechanical ventilation, pulmonary involvement, and mortality were significantly higher in patients who were overweight or obese. In adjusted analyses, both overweight (OR, 95% CI: 1.82, 1.04–3.21; p=0.037) and obesity (OR, 95% CI: 2.69, 1.02–1.05; p Conclusions COVID-19 patients who were overweight or obese were more likely to have adverse outcomes but only obesity was a predictor of mortality. Such patients should receive urgent medical attention and active management, especially the elderly, men, and people with chronic kidney disease.

Clinical outcomes of non-diabetic COVID-19 patients with different blood glucose levels: a nationwide Turkish study (TurCoGlycemia).

Abstract: New coronavirus disease 2019 (COVID-19) has a worse prognosis in patients with diabetes. However, there are insufficient data about the effect of hyperglycemia on COVID-19 prognosis in non-diabetic patients. This study aimed to investigate the relationship between random blood glucose levels measured at the time of diagnosis and prognosis of COVID-19 disease in non-diabetic patients. A nationwide retrospective cohort of non-diabetic patients with confirmed COVID-19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. The patients were stratified into three groups according to blood glucose levels which were <100 mg/dL in group-1, in the range of 100–139 mg/dl in group-2, and the range of 140–199 mg/dl in group-3. Clinical characteristics and outcomes were compared among the groups. The primary outcome was mortality. A total of 12,817 non-diabetic patients (median age [IQR]: 44 [25] years, females: 50.9%) were included. Patients in group-2 (5%) and group-3 (14%) had higher mortality rates than patients in group-1 (2.1%). The rates of hospitalization, hospital stays longer than 8 days, intensive care unit (ICU) admission, ICU stay more than 6 days, and mechanical ventilation were also significantly higher in group-3 patients. Likewise, glucose levels in the range of 140–199 mg/dL were an independent associate of mortality and composite of ICU admission and/or mechanical ventilation. Hyperglycemia at the time of COVID-19 diagnosis is associated with poor prognosis in non-diabetic patients. Clinicians should be more careful in the treatment of non-diabetic COVID-19 patients with hyperglycemia.

Gait Speed is independently associated with Depression Symptoms in Mild Cognitive Impairment.

Abstract: Depression symptoms are known to influence gait speed in cognitively healthy adults. In this study, we aimed to examine the relationship between gait speed and depression symptoms in older patients with mild cognitive impairment. The participants were classified as slow and normal gait speed based on the Fried criteria. A total of 152 subjects with mild cognitive impairment were included. Of these, 39.5% (n=60) had slow gait speed. Compared to normal speed group (n=92), patients with slow speed had more clinically significant depression (geriatric depression scale score ≥ 6) (p=0.004), cardiovascular disease (p=0.007), recent falls (p<0.001), and anticholinergic burden (p=0.005). Multivariable logistic regression analysis yielded statistically significant associations between slow gait speed and depression in age and gender adjusted [OR:3.30 (1.46-7.46), p=0.004] and fully adjusted [OR: 2.80 (1.10-7.08), p=0.030] models. This study showed an independent association between slow gait speed and depression symptoms in older people with mild cognitive impairment.

Higher rate of covid-19 mortality in patients with type 1 than type 2 diabetes: a nationwide study

Abstract: PurposeCOVID-19 disease has a worse prognosis in patients with diabetes, but the comparative data about the course of COVID-19 in patients with type 1 (T1DM) and type 2 diabetes (T2DM) are lacking. The purpose of this study was to find out the relative clinical severity and mortality of COVID-19 patients with T1DM and T2DM.MethodsA nationwide retrospective cohort of patients with confirmed (PCR positive) COVID-19 infection (n=149,671) was investigated. After exclusion of individuals with unspecified diabetes status, the adverse outcomes between patients with T1DM (n=163), T2DM (n=33,478) and the non-diabetics (n=115,108) were compared by using the propensity score matching method. The outcomes were hospitalization, the composite of intensive care unit (ICU) admission and/or mechanical ventilation and mortality.ResultsThe patients with T1DM had higher mortality than the age and gender matched patients with T2DM (n=489) and the non-diabetics (n=489) (p<0.001). After further adjustment for the A1c, microvascular and macrovascular complications, the odds of mortality (OR:3.35, 95% CI:1.41–7.96, p=0.006) and ICU admission and/or mechanical ventilation (OR: 2.95, 95% CI:1.28–6.77, p=0.011) were significantly higher in patients with T1DM compared to those with T2DM. Older age (OR:1.06, 95% CI:1.01–1.12, p=0.028) and lymphopenia (OR:5.13, 95% CI:1.04–25.5, p=0.045) were independently associated with mortality in patients with T1DM.ConclusionAccording to the results, patients with T1DM had poorer COVID-19 prognosis than those with T2DM or the non-diabetics. These patients should be cared diligently until more data will be available about the causes of increased COVID-19 mortality in T1DM.

Psychological Burden among Community-dwelling Older Adults with and without a History of a Recent Covid-19 Infection.

Abstract: Objectives: The outbreak of Covid-19's psychological burden to recovered vs. non-infected older individuals has not been compared yet. We aimed to perform a comparative analysis of psychological symptoms in community-dwelling older adults with and without a history of a Covid-19 infection.Methods: In this study, we utilized a geriatric care unit's outpatient registry to prospectively enroll older adults with and without a history of Covid-19. An interviewer administered generalized anxiety disorder-2 (GAD-2), patient health questionnaire-2 (PHQ-2), six-item cognitive impairment (6-CIT), and post-traumatic stress disorder-5 (PTSD-5) tests over the phone. Correlation and multivariate logistic regression analyses were used to examine associations.Results: The study included 120 older subjects, 46 (38.3%) reported past Covid-19 infection. Anxiety and depression were both significantly more prevalent among subjects without a history of Covid-19. Having no history of Covid-19, female gender, and psychoactive medication use showed independent associations with the risk of depression symptoms among all subjects, and female gender was additionally associated with anxiety symptoms.Conclusion: This study showed that the risk of depression symptoms was higher in a sample of older adults who were not infected with Covid-19 compared to those recovering from the disease.Clinical implications: The impact of "fear of transmission" on the mental health of the elderly may be a significant issue to deal with. Older women are more prone to mental health risks by Covid-19.

The clinical outcomes of COVID-19 infection in patients with a history of thyroid cancer: A nationwide study.

Abstract: BACKGROUND: There are scarce published data in differentiated thyroid cancer patients about new coronavirus disease 2019 (COVID-19) disease outcomes and mortality. Here, we evaluated COVID-19 infection outcomes and mortality in thyroid cancer patients with COVID-19 infection. DESIGN AND METHODS: We included a cohort of patients with thyroid cancer with PCR-confirmed COVID-19 disease from 11 March to 30 May 2020 from the Turkish Ministry of Health database in our nationwide, retrospective study. We compared the mortality and morbidity of COVID patients with or without thyroid cancer. Univariate and multivariate analyses were used to assess the independent factors for mortality, length of hospital stay and intensive care unit (ICU) admission and mechanical ventilation. We also analysed the effect of radioiodine treatment on severity and death rate of COVID-19 disease. RESULTS: We evaluated 388 COVID-19 patients with thyroid cancer [median age: 54 years, interquartile range (IQR) 18 years, males: 23%] and age and gender-matched 388 COVID-19 patients without thyroid cancer. Patients with thyroid cancer had a similar mortality ratio compared with the non-cancer group. Among patients with thyroid cancer, age, presence of diabetes mellitus, asthma/COPD, heart failure, chronic kidney disease, prior coronary artery disease, RAS blocker usage and low lymphocyte count were associated with mortality. Radioactive iodine (RAI) treatment and cumulative radioactive iodine dosage did not negatively affect the severity and mortality of COVID-19 disease in our patient group. CONCLUSIONS: Our study indicated that history of thyroid cancer did not have an increased risk of mortality or morbidity in COVID-19 disease. Besides, RAI therapy history and doses of radioactive iodine did not affect mortality or outcome.

Comment on "The psoas muscle index as a predictor of mortality and morbidity of geriatric trauma patients: experience of a major trauma center in Kobe."

Abstract: For more than a decade, considerable attention has been focused on muscle mass, muscle function, or both, and their relationship with adverse health consequences in older people. Initially, muscle mass was given much importance [1]. However, there is accumulating evidence, that the “strength’’ of the muscle is more meaningful [2]. The most recent update from the European consensus group suggests the simultaneous use of muscle strength and muscle mass, with specific recommendations for clinical practice [3]. A recent article by Nishimura et al. published in Surgery Today concluded with findings of an association between sarcopenia and mortality in geriatric patients who suffered severe trauma [4]. Research on the association of adverse outcomes in such heterogeneous groups is very important and relevant to the care of an aging population worldwide. In elective surgery, sarcopenia was reported as a reliable indicator of postoperative complications and long-term mortality; however, limited data are available for geriatric trauma patients in the emergency setting [5]. Moreover, we would like to comment on some technical aspects of classifying an older adult with sarcopenia. The most recent European Working Group on Sarcopenia report recommends the assessment of handgrip strength in the first order [3]. When there is no reduction in adjusted grip strength, sarcopenia is considered unlikely [3]. This is in accordance with the understanding of the North American approach published several years ago [2]. Hence, muscle mass measurement, either through bioelectrical impedance analysis or psoas muscle area on computerized tomography (CT)/magnetic resonance imaging, is unlikely to be a single reliable indicator of deprived muscle dynamics according to current guidelines. Finally, the method used by Nishimura et al. to estimate the muscle mass using a single-slice CT of the L3 vertebra is not recommended in the recent Asian Working Group for Sarcopenia consensus update [6]. In addition to the above concerns that can cause misclassification of older adults with sarcopenia, other issues with the CT-guided muscle mass measurement need to be acknowledged. Tissue analysis via CT requires the calculation of tissue Hounsfield unit (HU) attenuations [7], which is not uniform in all scanners and can be challenging when working on contrast-enhanced images. [7, 8]. Thus, to control for such potential errors in research works, all measurements need to be done by the same CT scanner, and only non-contrast-enhanced images should be evaluated to maintain consistency in the classification of patients for sarcopenia. * Umut Safer umut.safer@sbu.edu.tr