Acil servise başvuran sepsis hastalarında MPW, PDW ve Trombosit değerlerinin prognoz ve mortalite üzerindeki etkilerinin incelenmesi
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Tarih
2017
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info:eu-repo/semantics/embargoedAccess
Özet
Sepsis, bir çok sistemi tutan, özellikle hemodinamik değişikliklere yol açan, şok, organ fonksiyon bozukluğu ve organ yetmezliğine kadar giden öldürücü bir enfeksiyon hastalığıdır. Sepsis; acil servis, klinik ve yoğun bakım hastalarının en önemli morbidite ve mortalite nedenlerindendir. Destekleyici tedaviler ve etkili antibiyotiklere rağmen hastalarda %30-70 oranında ölüm ile sonuçlanmaktadır. Sepsis ,organların fonksiyon bozukluklarını tetikleyen ve tüm vücudun ,kan dolaşımı enfeksiyonuna verdiği iltihabi bir reaksiyon olup, sıklıkla öldürücü bir hastalıktır. Sepsis erişkin yaş grubunda önemli bir ölüm nedeni olarak ortaya çıkmakta olup, her yıl yüzlerce erişkin septik tablolar nedeniyle acil servislere başvurmaktadır. Dünyada yaklaşık 1 dakikada 14 kişi sepsis nedeniyle ölmektedir. Sepsis, hem bakteriler hem de mantarlar dahil olmak üzere, çeşitli enfeksiyon ajanlarına bağlı olarak ortaya çıkabilir. Enfeksiyonla savaşmak üzere harekete geçen bağışıklık sistemi, septik semptomlara sebep olan hasarı ortaya çıkarır. Nötrofil ve Trombositlerdeki aşırı derecede etkileşmenin yanı sıra mikrovasküler yapıdaki yaralanma, en sonunda organ yetmezliğine yol açar. Bu çalışmada 1 Ocak 2012 – 31 Aralık 2014 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Hastanesi Acil Servis birimine sepsis nedeniyle başvuran hastalar (yaş?18) retrospektif olarak değerlendirilecektir. Olguların başvuru özellikleri, klinik özellikleri, yapılan tetkikleri (laboratuvar, görüntüleme ve kültür), konsültasyonları ve sonuçları, yatış ve mortaliteleri retrospektif olarak incelendi. Öncelikle acil poliklinik defteri taranarak sepsis nedeniyle başvuran hastaların isimleri ve acil servis poliklinik protokolleri çıkarıldı. Bu isim ve protokol numaraları kullanılarak arşivden acil servis hasta muayene kartları çıkarıldı ve önceden belirlenen kriterlere uygun hastalar çalışmaya dahil edildi. Hasta muayene kartlarından yaş, cinsiyet, başvuru şikâyet şekli (ateş, bulantı, halsizlik, mental durum değişikliği, nefes darlığı), hastaların özgeçmişinde kronik hastalık (diyabet, hipertansiyon, böbrek yetmezliği… vs.) varlığı, hastaların başvuru vitalleri (ateş, sistolik ve diyastolik tansiyon değerleri, nabız ve solunum sayıları), hastaların başvuru laboratuvar sonuçları (wbc, platelet, pdw, mpw, glukoz, ast, alt. vs.) hastaların akciğer görüntüleme sonuçları (normal, infiltratif) , hastaların yatış durumu, kültür sonuçları, yatış sonrası hastanede kalış süreleri ve mortalite durumları incelenerek her hasta için ayrı ayrı oluşturulan formlara not edildi. Çalışmaya 24 aylık dönemde toplam 2390 hasta alınmıştır. Çalışmamızda a) yaş<18 b)aktif GİS kanaması c)İdıyopatik tromsitopenik purpura, trombotik tombositopenik purpura ve esansiyel trombositoz tanısı olanlar, sonuç ve bilgilere ulaşılamayan hastalar çalışmamız dışı bırakıldı. Kriterleri sağlamayan hastalar dışlanınca 330 hasta ile çalışma tamamlandı. Çalışmaya alınan hastaların yaş, cinsiyet, başvuru şikâyeti, eşlik eden komorbid durum, acil servise başvuru sırasındaki belirti ve bulgula¬r (bulantı-kusma, ateş, mental durum değişikliği)ve laboratuvar inceleme sonuçları, yatış gün sayıları ve mortaliteleri değerlendi¬rildi. Sonuç olarak sağlık kuruluşlarına başvuran sepsis hastalarında hemen hepsinde ucuz ve kolay ulaşılabilir olan mpv, pdv ve trombosit sayısı mortaliteyi öngörmede kullanılabilir. Bu nedenle erken dönem bakılacak hemogramlarda mpv, pdv ve trombosit sayılarının mortalite ve prognoz açısından etkinliğini incelemek istedik. Anahtar Kelimeler: Sepsis, mpw, pdw, trombosit
Sepsis is a fatal infectious disease that affects many systems, especially leading to haemodynamic changes, leading to shock, organ dysfunction and organ failure. Sepsis is the most important causes of morbidity and mortality in emergency services, clinics and intensive care patients. Despite supportive treatment and effective antibiotics mortality results in patients is 30-70%. Sepsis is an inflammatory reaction that triggers dysfunctions of the organs and gives the whole body blood circulation infection and is often a fatal disease. Sepsis appears one of the important causes of death in the adult age group, due to septic tables hundreds of adults are referred to the emergency services every year. Due to sepsis 14 people die in about a minute in the world . Sepsis may occur due to a variety of infectious agents, including both bacteria and fungi. The immune system that acts to fight the infection reveals damage that causes septic symptoms. In addition to excessive overactivity in neutrophils and platelets, injury to the microvascular structure ultimately leads to organ failure. In this study patients (age ? 18) admitted to the Emergency Department of Dicle University Medical Faculty Hospital between 1 January 2012 - 31 December 2014 due to sepsis will be evaluated retrospectively. The characteristics of the cases, clinical features, examinations (laboratory, imaging and culture), consultations and outcomes, admission and mortality were reviewed retrospectively. First of all, the emergency polyclinic book was scanned and the patients names and emergency services policlinic protocol numbers were taken who applied for sepsis .By using these names and protocol numbers Emergency Service patient examination cards removed from archive and patients according to predetermined criteria were included in the study. Patient's examination cards show age, gender, type of complaint (fever, nausea, weakness, mental state change, shortness of breath), the presence chronic illness in patients background (diabetes, hypertension, kidney failure, etc.), patients' referral vitals (body temperature, systolic and diastolic blood pressure values, pulse and respiratory counts), patient laboratory results at the time of application (wbc, platelet, pdw, mpv, glucose, ast, alt, etc.), chest x-ray results of patients (normal, infiltrative), patients' admission status, culture results, the length of stay in the hospital and the mortality cases after the hospitalization were examined and were noted in the forms created for each patient . 2390 patients were included in the 24-month study period. In this study a) age <18 b) active GIS bleeding c) Idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura and patientswho has essential thrombocytosis , patients whose results and information were not available were excluded from our study. When patients who do not meet the criteria are excluded study completed with 330 patients. In this study patients’ emergency department admission symptoms and signs (nausea-vomiting, fever, mental status change) and laboratory findings, days of hospitalization, and mortality were assessed for age, sex, admission complaints, comorbid conditions were evaluated. In conclusion, MPV, PDV and platelet counts which are cheap and easily accessible can be used for predicting mortality in almost all patients with sepsis patients who applied to health institutions. Keywords: Sepsis, mpw, pdw, thrombocyte
Sepsis is a fatal infectious disease that affects many systems, especially leading to haemodynamic changes, leading to shock, organ dysfunction and organ failure. Sepsis is the most important causes of morbidity and mortality in emergency services, clinics and intensive care patients. Despite supportive treatment and effective antibiotics mortality results in patients is 30-70%. Sepsis is an inflammatory reaction that triggers dysfunctions of the organs and gives the whole body blood circulation infection and is often a fatal disease. Sepsis appears one of the important causes of death in the adult age group, due to septic tables hundreds of adults are referred to the emergency services every year. Due to sepsis 14 people die in about a minute in the world . Sepsis may occur due to a variety of infectious agents, including both bacteria and fungi. The immune system that acts to fight the infection reveals damage that causes septic symptoms. In addition to excessive overactivity in neutrophils and platelets, injury to the microvascular structure ultimately leads to organ failure. In this study patients (age ? 18) admitted to the Emergency Department of Dicle University Medical Faculty Hospital between 1 January 2012 - 31 December 2014 due to sepsis will be evaluated retrospectively. The characteristics of the cases, clinical features, examinations (laboratory, imaging and culture), consultations and outcomes, admission and mortality were reviewed retrospectively. First of all, the emergency polyclinic book was scanned and the patients names and emergency services policlinic protocol numbers were taken who applied for sepsis .By using these names and protocol numbers Emergency Service patient examination cards removed from archive and patients according to predetermined criteria were included in the study. Patient's examination cards show age, gender, type of complaint (fever, nausea, weakness, mental state change, shortness of breath), the presence chronic illness in patients background (diabetes, hypertension, kidney failure, etc.), patients' referral vitals (body temperature, systolic and diastolic blood pressure values, pulse and respiratory counts), patient laboratory results at the time of application (wbc, platelet, pdw, mpv, glucose, ast, alt, etc.), chest x-ray results of patients (normal, infiltrative), patients' admission status, culture results, the length of stay in the hospital and the mortality cases after the hospitalization were examined and were noted in the forms created for each patient . 2390 patients were included in the 24-month study period. In this study a) age <18 b) active GIS bleeding c) Idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura and patientswho has essential thrombocytosis , patients whose results and information were not available were excluded from our study. When patients who do not meet the criteria are excluded study completed with 330 patients. In this study patients’ emergency department admission symptoms and signs (nausea-vomiting, fever, mental status change) and laboratory findings, days of hospitalization, and mortality were assessed for age, sex, admission complaints, comorbid conditions were evaluated. In conclusion, MPV, PDV and platelet counts which are cheap and easily accessible can be used for predicting mortality in almost all patients with sepsis patients who applied to health institutions. Keywords: Sepsis, mpw, pdw, thrombocyte
Açıklama
Anahtar Kelimeler
Sepsis, MPW, PDW, Trombosit, Sepsis, Thrombocyte
