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    Does c-reactive protein to serum albumin ratio correlate with diabetic nephropathy in patients with type 2 diabetes mellitus? The care time study
    (ELSEVIER SCI LTD, 2021) Bilgin, Satılmış; Kurtkulağı, Özge; Tel, Burcin Meryem Atak; Duman, Tuba Taslamacıoğlu; Kahveci, Gizem; Khalid, Atiqa; Aktaş, Gülali
    Aims: Diabetic Nephropathy (DN) is a complication of Diabetes Mellitus and is associated with chronic and low-grade inflammatory burden. Novel inflammatory predictors, such as, C-reactive protein to serum albumin ratio (CAR) has been studied various inflammatory conditions, recently. Increased inflammatory burden accompany to both type 2 Diabetes Mellitus (T2DM) and DN, hence we aimed to compare CAR levels of the T2DM subjects with DN to those of without DN. Methods: Patients with T2DM were enrolled to the study. Study population grouped into two according to the presence (group A) or absence (group B) of DN. Characteristics and laboratory data, as well as CAR levels; of the study groups were compared. Results: Median CAR levels of the groups A and B were 2.17% (0.02-13.2) and 0.39% (0.02-4.39), respectively (p < 0.001). CAR was found to be an independent risk factor for diabetic nephropathy (adjusted to age, BMI, fasting glucose, HbA1c, and body weight). One unit (0.1%) elevation in CAR increased the risk of nephropathy by 3.5 folds (p < 0.001, 95%CI: 2.24-5.45). CAR levels greater than 0.82% have 79% sensitivity and 78% specificity in predicting DN (AUC: 0.86 [95% CI: 0.80-0.92]; p < 0.001). Conclusions: In conclusion, elevated CAR levels are higher in type 2 diabetic patients with diabetic nephropathy. According to the ROC curve, a level higher than 0.82% presents the best sensitivity and specificity in the association with the presence of DN. (c) 2021 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
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    Hematological and biochemical parameters as diagnostic and prognosticmarkers in SARS-COV-2 infected patients of Pakistan: A retrospective comparative analysis
    (Taylor & Francis Ltd, 2021) Khalid, Atiqa; Jaffar, Muhammad Ali; Khan, Tabinda; Lail, Raees Abbas; Ali, Sana; Aktaş, Gülali
    Objectives:This study was conducted to investigate alteration in blood parameters and theirassociation with the presence, severity, and mortality of COVID-19 patients as the data onhematological abnormalities associated with the Pakistani COVID-19 patients is limited.Methodology:A double-centered, hospital-based comparative retrospective case study wasconducted, to include all the admitted patients (n= 317) having COVID-19 Polymerase chainreaction (PCR) positive. The control group (n= 157) tested negative for COVID-19.Results:Of 317 admitted cases, the majority were malesn= 198 (62.5%). Associatedcomorbidities, lower lymphocytes, platelets, and higher White blood cells, neutrophil,neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were found inCOVID-19 cases as compared to healthy controls (p< 0.001 for all). The biochemicalparameters of cases including Ferritin, D-Dimer, CRP, IL-6, LDH, ALT, AST, and APTT alsoshowed a statistically significant difference compared with standard values (p< 0.001 forall). However, their comparison with a severity level of the severe and non-severe groupsshowed significance for WBCs, neutrophils, NLR (p< 0.001 for all), and PLR (p= 0.06) only.Receiver operating characteristic curve analysis showed that NLR had the highest area undercurve (0.84) followed by 1/lymphocyte (0.82), neutrophils (0.74), PLR (0.67),1/platelets (0.68)and WBC’s (0.65). Comparison of cases and controls with recommended cut-offvaluesderived from sensitivity and 1-specificity was also done (p< 0.001).Conclusion:Monitoring all the hematological and biochemical parameters including novelhemograms NLR, PLR can aid clinicians to identify potentially severe cases at early stagesand initiate effective management in time which may reduce the overall mortality of COVID-19 patients.Abbreviations: ALT, Alanine Aminotransferase; APTT, Activated Partial Thromboplastin Time;AST, Aspartate Aminotransferase; CBCs, complete blood counts; COVID-19, coronavirusdisease 2019; CRP, C-Reactive Protein; GRA, granulocytes; HGB, hemoglobin; LDH, Lactatedehydrogenase; Lymph, lymphocyte; MLR, Monocyte to Lymphocyte ratio.; NLR, Neutrophilto Lymphocyte ratio; PLR, Platelet to lymphocyte ratio; PLTs, platelets count; PT,Prothrombin time; RBCs, red blood cells; SARS-CoV-2, Severe acute respiratory syndromecoronavirus 2; WBCs, white blood cells
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    ‘Immune-inflammatory markers & clinical characteristics for outcomes in hospitalized SARS-CoV-2 infected patients of Pakistan: a retrospective analysis'
    (Taylor& Francis, 2023) Khalid, Atiqa; Aqeel, Rao Faheem; Ahmad, Jehangir; Fatima, Syeda Tatheer; Rao, Aqsa Aqeel; Aktaş, Gülali
    Objective: Accumulating evidence suggests the role of immune-inflammatory markers in early risk stratification and prognostication of COVID-19 patients. We aimed to evaluate their association with severity and the development of diagnostic scores with optimal thresholds in critical patients. Setting and participants: This retrospective case study includes hospitalized COVID-19 patients from March 2019 to March, 2022, in the developing area teaching hospital in Pakistan. Polymerase chain reaction (PCR) positive patients, n = 467 were investigated for clinical outcomes, comorbidities and disease prognosis. The plasma levels of Interleukin-6 (IL-6), Lactate dehydrogenase (LDH), C-reactive protein (CRP), Procalcitonin (PCT), ferritin and Complete blood count markers were measured. Results: Majority were males (58.8%) and patients with comorbidities had more severe disease. Hypertension and diabetes mellitus were the commonest comorbidities. Shortness of breath, myalgia and cough were the main symptoms. The hematological markers NLR, as well as the plasma levels of immune-inflammatory variables, IL-6, LDH, Procalcitonin, Erythrocyte sedimentation rate, Ferritin were markedly raised in severe and critical patients (p < 0.0001 for these markers). ROC analysis supports IL-6 as the most accurate marker with high prognostic relevance with proposed cut-off threshold (43 pg/ml), determining >90% of patients in terms of COVID-19 severity (AUC = 0.93, 91.7%, se; 90.3%sp). Furthermore, positive correlation with all other markers including NLR with cut-off = 2.99 (AUC = 0.87, se = 89.8%, sp = 88.4%), CRP with cut-offs at 42.9 mg/l, (AUC = 0.883, se = 89.3% and sp = 78.6%), LDH cut-off at 267μg/L, evidenced in >80% patients (AUC = 0.834 se = 84% and sp = 80%). Additionally, ESR and ferritin have the corresponding AUC 0.81 and 0.813 with cut-off at 55 mm/hr and 370, respectively. Conclusion: Investigating the immune-inflammatory markers can assist physicians in providing prompt treatment and ICU admission in terms of COVID-19 severity. As a result, which may reduce the overall mortality of COVID-19 patients. Abbreviations: CBCs: complete blood counts; PCTs: Procalcitonin; CRP: C-reactive protein; LDH: Lactate dehydrogenase; ESR: Erythrocyte sedimentation rate; LDH: Lactate dehydrogenase; CRP: C-reactive Protein; NLR: Neutrophil to Lymphocyte ratio; se: sensitivity; sp: specificity
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    Poorly controlled hypertension is associated with elevated serum uric acid to HDL-cholesterol ratio: A cross-sectional cohort study
    (Taylor & Francis Ltd, 2022) Aktaş, Gülali; Khalid, Atiqa; Kurtkulağı, Özge; Duman, Tuba Taslamacıoğlu; Bilgin, Satılmış; Kahveci, Gizem; Tel, Burçin Meryem Atak; Sincer, İsa; Güneş, Yılmaz
    Objectives The diagnosis and follow-up of hypertension (HT) depend on the blood pressure measurements, which can be affected by several factors. In the present work, we aimed to explore the role of uric acid/HDL-cholesterol ratio (UHR) in HT and whether/or not it was associated with poor blood pressure control. Methods In this retrospective cross-sectional cohort study, all the participants treated for hypertension and then followed up in the internal medicine clinics of our institution were enrolled. Hypertensive patients were grouped as either poorly or well-controlled hypertension groups, according to the suggestions of Joint National Committee VIII criteria and healthy volunteers were enrolled as control group. UHR of the study groups was compared. Results Our study cohort consisted of 535 subjects; 258 in the well-controlled HT group, 186 in the poorly controlled HT group, and 91 in the control group. Median UHR levels of the poorly controlled HT group (13 (4-43) %) were significantly higher than well-controlled HT group 11 (4-22) %) and control group (8 (4-19) %) (p < 0.001). UHR was correlated with systolic (r = 0.33, p < 0.001) and diastolic (r = 0.28, p < 0.001) BP. UHR level greater than 11% has 70% sensitivity and 60% specificity in predicting poor BP control (AUC: 0.73, p < 0.001, 95%CI: 0.68-0.77). UHR was an independent risk factor for poor BP control in HT subjects and a unit elevation in UHR increased the risk of poorer BP control by 7.3 times (p < 0.001, 95%CI: 3.9-13.63). Conclusion Assessment of UHR may be useful in HT patients since elevated UHR levels could be associated with poor blood pressure control in this population.