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    Are Pattern Recognition Receptors Associated with Hepatocellular Carcinoma?
    (Aves, 2021) Dertli, Ramazan; Asil, Mehmet; Biyik, Murat; Karakarcayildiz, Ahmet; Keskin, Muharrem; Kayar, Yusuf; Basdemirci, Muserref
    Background: Hepatocellular carcinoma (HCC) is one of the important causes of mortality due to malignancy. Toll-like receptors (TLRs) are very important in liver pathophysiology in terms of their roles in the innate immune system, such as the regulation of inflammation, wound healing, stimulation of adaptive immune responses, promotion of epithelial regeneration, and carcinogenesis. In this study, we planned to examine the role of TLR1 (rs4833095, rs5743551) and nucleotide-binding oligomerization domain (NOD2) (rs2066844, rs2066845, rs2066847) polymorphisms in the development of HCC and their effects on the clinical presentation of HCC patients. Methods: Our study was designed prospectively. Cirrhotic and HCC patients who were followed up in our clinic between January 2015 and September 2018 were included in the study. Sex, age, cirrhosis etiology, Child-Pugh class, and MELD scores were recorded. TLR1 and NOD2 polymorphisms were studied by the PCR method. Results: HCC developed in 88 (31.4%) of the 280 patients who were followed up, either during the recruitment phase of our study or during the follow-up. The mean follow-up time of our patient group was 17.04 +/- 11.72 months, and the mean follow-up time of HCC patients was 12.09 +/- 10.26 months. TLR1 (rs5743551) polymorphism was associated with HCC development (P =.003). TLR1 (rs5743551) and NOD2 (rs2066844) polymorphisms were associated with the development of spontaneous bacterial peritonitis (SBP) in the HCC patient group (P =.013 and P =.021, respectively). Conclusion: We think that increased bacterial translocation in cirrhotic patients may contribute to HCC development by causing chronic inflammation, especially in patients with TLR 1 (rs5743551) polymorphism.
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    Can Hematological Inflammatory Parameters Predict Mortality in Hepatocellular Carcinoma?
    (Springer, 2021) Dertli, Ramazan; Asil, Mehmet; Biyik, Murat; Karakarcayildiz, Ahmet; Keskin, Muharrem; Goktepe, Hakan Mevlut; Kayar, Yusuf
    Purpose Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Inflammatory and hematological parameters such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) provided useful information especially in the diagnosis, treatment, and follow-up of malignancies. In this study, we planned to demonstrate the efficacy of NLR and PLR levels in the evaluation of the prognosis of patients with HCC in our clinic. Material and Methods This study was planned as a prospective observational cohort study. The study included 105 patients with HCC on the base of cirrhosis. Our study group was classified according to Barcelona Clinic Liver Cancer (BCLC), Okuda staging system, and Milan criteria at the time of admission. Results The mean age of all cases was 60.6 +/- 12.4 years, and 77 (73.3%) of the patients were male. The mean life expectancy of all patients was 7.7 +/- 4.3 months. During 1-year follow-up, 61 (58.1%) HCC patients died. The mean survival of the patients who died was 4.6 +/- 3.0 months. In our study, patients with NLR > 2.7, patients with PLR > 100.29, BCLC advanced stage, and Okuda advanced stage, and patients who did not meet the Milan criteria had shorter survival duration. NLR > 2.7, BCLC advanced stage, and Child C were determined as independent risk factors affecting mortality. Conclusion There was a strong correlation between NLR-PLR levels and mortality. PLR and NLR levels can be used in conjunction with other staging systems to regulate, monitor, and predict the survival of HCC patients.
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    Can neutrophil-lymphocyte ratio predict mortality in acute non-variceal upper gastrointestinal bleeding?
    (Turkish Assoc Trauma Emergency Surgery, 2022) Dertli, Ramazan; Toka, Bilal; Asil, Mehmet; Kayar, Yusuf; Karakarcayildiz, Ahmet; Goktepe, Mevlut Hakan; Biyik, Murat
    BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is one of the common gastrointestinal problems and has a high mortality, especially in patients with poor hemodynamics. Therefore, treatment and follow-up should be managed dynamically. Neutrophil-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are fast workable, cheap, and easy to calculate hematological parameters. We need easily accessible parameters as well as routine classifications such as Rockall score in the treatment and follow-up of NVUGIB patients, whose hemodynamics are unstable and progress with high mortality. In this study, we planned to evaluate NLR and PLR levels in patients with NVUGIB in the treatment follow-up with other scoring systems and their relationship with mortality in these patients. METHODS: Two hundred and forty-nine patients who were admitted to our clinic between January 2015 and January 2017 diagnosed with NVUGIB, and who underwent necessary examinations and follow-ups, were included in the study. The patients' Glasgow Blacthford, Rockall Score, NLR, and PLR levels were calculated at the first admission. RESULTS: One hundred and fifty-six of the patients were male (70.6%) and the mean age of all patients was 64.5 +/- 18.0 years. After follow-up and treatment, 28 (11.2%) patients died due to bleeding. High NLR and tachycardia at the time of admission and high patient age were found to be independent risk factors affecting the long of hospital stay. High Rockall score, high NLR at admission, and hypotension at admission were shown to be independent risk factors affecting mortality. CONCLUSION: Besides the use of various scoring systems in patients with NVUGIB, we think that the use of simple hematological parameters may be appropriate and the use of these hematological parameters may be useful in the management of patients with unstable hemodynamics.
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    Can neutrophil-lymphocyte ratio predict mortality in acute non-variceal upper gastrointestinal bleeding?
    (Turkish Assoc Trauma Emergency Surgery, 2022) Dertli, Ramazan; Toka, Bilal; Asil, Mehmet; Kayar, Yusuf; Karakarcayildiz, Ahmet; Goktepe, Mevlut Hakan; Biyik, Murat
    BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is one of the common gastrointestinal problems and has a high mortality, especially in patients with poor hemodynamics. Therefore, treatment and follow-up should be managed dynamically. Neutrophil-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are fast workable, cheap, and easy to calculate hematological parameters. We need easily accessible parameters as well as routine classifications such as Rockall score in the treatment and follow-up of NVUGIB patients, whose hemodynamics are unstable and progress with high mortality. In this study, we planned to evaluate NLR and PLR levels in patients with NVUGIB in the treatment follow-up with other scoring systems and their relationship with mortality in these patients. METHODS: Two hundred and forty-nine patients who were admitted to our clinic between January 2015 and January 2017 diagnosed with NVUGIB, and who underwent necessary examinations and follow-ups, were included in the study. The patients' Glasgow Blacthford, Rockall Score, NLR, and PLR levels were calculated at the first admission. RESULTS: One hundred and fifty-six of the patients were male (70.6%) and the mean age of all patients was 64.5 +/- 18.0 years. After follow-up and treatment, 28 (11.2%) patients died due to bleeding. High NLR and tachycardia at the time of admission and high patient age were found to be independent risk factors affecting the long of hospital stay. High Rockall score, high NLR at admission, and hypotension at admission were shown to be independent risk factors affecting mortality. CONCLUSION: Besides the use of various scoring systems in patients with NVUGIB, we think that the use of simple hematological parameters may be appropriate and the use of these hematological parameters may be useful in the management of patients with unstable hemodynamics.
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    May Neutrophil Gelatinase-Associated Lipocalin (NGAL) Level Predict Mortality in Patients with Hepatocellular Carcinoma (HCC)?
    (Springer, 2020) Dertli, Ramazan; Biyik, Murat; Yolacan, Ramazan; Karakarcayildiz, Ahmet; Keskin, Muharrem; Kayar, Yusuf; Asil, Mehmet
    Purpose Hepatocellular carcinoma (HCC) ranks fifth among the common cancers worldwide. Hepatocarcinogenesis is a multiple-phases process, which involves changes in cellular genomes including high cell proliferation.In this study, we aimed to evaluate the relationship of NGAL level at the time of diagnosis with mortality in patients diagnosed with HCC. Material and Methods A total of 35 patients who developed HCC on the ground of HBV(+) and 30 healthy subjects were included in the study. Barcelona Clinic Liver Cancer (BCLC), Okuda staging system, and Milan criteria were used for staging of the patients with HCC. Results The mean age of all patients was 59.54 +/- 11.57 years. Seventeen (48.6%) HCC patients died during 1-year follow-up. Survival of the patients who met the Milan criteria was longer (log-rank (Mantel-Cox) test, chi 2 = 5.353,p= 0.021). Kaplan-Meier curve was drawn for NGAL cut-off value, mortality was found to be higher in patients with a NGAL level higher than 217.50 (log-rank (Mantel-Cox) test, chi 2 = 15.540,p< 0.001). Conclusion In this study, we found that high levels of NGAL at the time of diagnosis were associated with poor prognosis in HCC patients.
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    A Novel Marker Affecting Survival in Acute Non-variceal Upper Gastrointestinal Bleeding: Cardiac Troponin I
    (Galenos Publ House, 2021) Dertli, Ramazan; Biyik, Murat; Yolacan, Ramazan; Keskin, Muharrem; Karakarcayildiz, Ahmet; Kayar, Yusuf; Ataseven, Huseyin
    Introduction: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is an important public health problem with high rates of morbidity and mortality. ANVUGIB results in hypovolemia, hypotension, and shock, increasing cardiac oxygen use and may cause elevated serum levels of cardiac troponin (cTn). In this study, we aimed to evaluate whether elevated cTnI has clinical significance in patients with ANVUGIB. Methods: A total of 62 patients diagnosed with ANVUGIB whose serum cTnI levels were studied at the time of admission and follow-up in our clinic from January 2015 to January 2016 were included in the study. Patients with acute cardiac diseases that may cause elevated cTn were excluded from the study. Results: Forty-three of the patients were male (69.4%), and the mean age of all patients was 71.52 +/- 13.30 years. The mean cTnI level was 0.042 +/- 0.097 in all patients, with cTnI levels higher than the reference value in nine (14.5%) patients. In logistic regression analysis, the factors found to contribute to cTnI were tachycardia, chronic kidney disease, and coronary artery disease. In receiver operating characteristic analysis, cutoff values of 0.025 and 6.5 were found for cTnI and the Rockall score, respectively. In addition, cTnI and the Rockall score were shown to affect survival [log-rank (Mantel-Cox) test: p=0.011; log-rank (Mantel-Cox) test: p=0.014; respectively]. Conclusion: We believe that serum cTnI levels studied during the first admission will be found useful as a biomarker in addition to the other existing risk determination systems, in order to identify patients at risk, even if findings of acute coronary syndrome are not observed in patients presenting with ANVUGIB.
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    Serum soluble TWEAK levels in non-alcoholic fatty liver disease
    (2019) Dertli, Ramazan; Yolaçan, Ramazan; Keskin, Muharrem; Kayar, Yusuf; Ataseven, Hüseyin; Polat, Hakkı; Ünver, Nurcan; Demir, Ali; Asıl, Mehmet; Bıyık, Murat; Uysal, Saliha
    Aim: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. The exact pathogenesis of NAFLD has not been fully elucidated. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is a member of TNF superfamily and it hasbeen implicated in the pathogenesis of several diseases including liver inflammation and fibrosis. Current study was conducted to evaluate serum sTWEAK levels in patients with NAFLD. Material and Methods: Seventeen patients with biopsy proven non-alcoholic steatohepatitis (NASH), 22 patients with simple hepatosteatosis and 30 healthy controls were included in the study and serum sTWEAK concentrations were measured using commercial ELISA kits. Results: Mean serum sTWEAK concentration was significantly lower in the NASH group when compared to the simple hepatosteatosis group and healthy controls (199.6101.2 pg/mL, 246.165.7 pg/mL and 277.6117.6 pg/mL respectively, p0.029). ROC analysesfor sTWEAK to differentiate NASH patients from healthy controls and from simple hepatosteatosis revealed that AUC for sTWEAK was 0.712 (%95 CI, 0.543-0.880). For the specified cut off value, 171.1 pg/mL positive and negative predictive values calculated were 64.3% and 85.5% respectively. Conclusion: Serum sTWEAK concentration is decreased in patients with NASH when compared to patients with simple hepatosteatosis and healthy controls.