Solunumsal yoğun bakım hastalarında mortaliteyi etkileyen faktörler
[ X ]
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Yoğun Bakım Ünitesi’ne (YBÜ) kabul edilen hastalarda mortalite oranı yüksektir. Hastalık şiddetinin belirlenmesi ve mortaliteye etkili risk faktörlerinin tanınması, hastanın prognozunun saptanmasında büyük önem taşımaktadır. Ayrıca tedavi yönetim stratejilerinin belirlenmesi ve kaynakların kullanımını da etkiler. Bu çalışma; YBÜ’ye kabul edilen hastaların prognoz tayininde, yatış esnasındaki skorlama sistemleri ile beraber yatış ve üçüncü günkü laboratuvar parametrelerini karşılaştırmak amacıyla planlandı. Kasım 2013 ve Nisan 2014 tarihleri arasında Dicle Üniversitesi Hastanesi Solunumsal Yoğun Bakım Kliniğinde yaşları 22-93 arasında değişen 86 hasta, retrospektif olarak çalışmaya dahil edildi. Hastalar ölenler ve yaşayanlar olmak üzere iki gruba ayrıldı. . Hastaların demografik verileri, tanıları, klinik ve laboratuar bulguları, YBÜ’de kaldığı süre, mekanik ventilasyonda kaldığı süre kaydedildi. YBÜ’ye kabulün ilk günü içerisindeki APACHE II (Acute Pysiology And Chronic Health Evaluation), SOFA (SequentialOrgan Failure Assesment), SAPS II (Simplified Acute Physilogy Score) ve GKS(Glaskow Koma Skoru) skorları hesaplandı. Tüm hastalardan YBÜ’ne giriş anında ve 72 saat sonunda hemogram, CRP (C-Reaktif Protein), biyokimyasal parametreler ve hormon düzeyleri çalışıldı. Sonuçlar ölenler ve yaşayanlar arasında karşılaştırıldı. Ölen hastalarla yaşayan hastalar arasında yaş, cinsiyet ve yoğun bakımda yatış süresi bakımından anlamlı bir fark olmadığı görüldü. Ölen hastaların mekanik ventilasyonda kalma süresi yaşayanlara göre anlamlı ölçüde daha uzundu (p<0,05). Ölenlerde bakılan ateş, nabız ve ağırlık yaşayanlara göre istatistiksel olarak anlamlı farklılık saptandı(p<0,05). Yatış esnasında bakılan sistolik ve diastolik tansiyonlar da ölenlerde yaşayanlara göre istatistiksel olarak anlamlı farklılık bulundu (p<0,05). Ayrıca hastanın inotropik destek ihtiyacı ölenlerde taburcu olanlara göre istatistiksel olarak anlamlı farklılık saptandı (p<0,05). Yatış esnasındaki hastanın solunum desteği türü gruplar arasında istatistiksel olarak mortalite için anlamlı farklılık gözlenmedi. Ölen hastalarda, APACHE II, SOFA ve SAPS II skoru yaşayan olgulara göre istatistiksel olarak anlamlı ölçüde daha yüksekti. GKS ise istatistiksel olarak daha düşüktü (p<0.001). Yaşayan grup ile karşılaştırıldığında ölen grupta yatış esnasında bakılan WBC ( Beyaz Kan Hücresi) ve CRP düzeyleri daha yüksek, hemoglobinve hematokrit düzeyleri daha düşük bulundu, ancak bu farklılık istatiksel olarak anlamlı değildi. Ölen olgularda trombosit sayısı yaşayanlara göre belirgin düşük bulundu (p<0,05). Yoğun bakıma kabul edilen hastalar arasında bakılan biyokimyasal parametrelerden albümin, üre, kreatinin seviyelerindeki düşüklük, HDL (High Dansity Lipoprotein) , LDL (Low Dansity Lipoprotein), kolesterol, direkt bilirubin, CK(Keratin Kinaz) değerlerindeki yükseklik ölenlerde yaşayanlara göre istatistiksel olarak anlamlı farlıklık gösterdi (p<0,05). Sodyum, potasyum, glukoz, AST, ALT değerleri mortalite açısından gruplar arasında anlamlı farklılık gözlenmedi. Yatış esnasında bakılan hormon düzeylerinden T4 (Tiroksin) düşüklüğü, kortizol, ACTH (Adrenokortikotropik Hormon) ve BH (Büyüme Hormonu ) yüksekliği ölenlerde taburcu olanlara göre istatistiksel olarak anlamlı faklılık saptandı (p<0,05). Ancak T3 (Triiyodotironin), DEAH (Dehidroepiandrosteron) ve TSH (Tiroid Stimulan Hormon) mortalite için gruplar arasında anlamlı farklıklık saptanmadı. Hastaların yatışta ve üçüncü günde bakılan laboratuvar parametrelerinde ölenler ve yaşayanlar arasında sadece fosfor düzeyinde anlamlı farklılık saptandı (p<0,05). Bakılan diğer parametrelerde mortalite için belirgin farklılık gözlenmedi. Sonuç olarak, YBÜ’ye kabul edilen kritik hastalarda, skorlama sistemleri prognoz değerlendirmesinde önemli bir etkinliğe sahiptir. Bununla beraber yatışta bakılan trombosit sayısı, albümin, kortizol, ACTH, üre, kreatinin, HDL, kolesterol ve CK düzeyleri mortalite tahmini için ek bilgiler sağlamaktadır. Bununla beraber üçüncü günde bakılan bu parametrelerdeki değişiminde fosfor düzeyindeki düşüşler istatistiksel olarak mortalite için anlamlıydı. Anahtar Sözcükler: Yoğun Bakım, Mortalite, Skorlama Sistemleri, Labortauvar parametreleri, Göğüs Hastalıkları
Rate of mortality is high in patients admitted to Intensive Care Unit (ICU). Assessment of disease severity and recognition of mortality risk factors are of great importance in determining the patient's prognosis. Also, determination of management strategies and effect the use of resources. This study in determining the prognosis of patients admitted to ICU admission with scoring systems during hospitalization. Furthermore, weaim to exchange of values on the third day of the laboratory parameters examined. Eighty six patients (aged between 22 and 93) who were treated in Dicle University Hospital, Respiratory Intensive Care Clinic between November 2013 and April 2014 were included in the study. Patients were divided into two groups, namely the dead and the living. APACHE II, SOFA, SAPS II and GCS scores were calculatedin the first day of admission to the ICU. Demographic data of the patients, diagnosis, clinical and laboratory findings, length of stay in the ICU, length his stay in mechanical ventilation were recorded. WBC, CRP, biochemical parameters and hormone levels were studied from the ICU to the time of entry and at the end of 72 hours in all patients. Results were compared between the dead and the living. The age of patients, gender and in length of stay in intensive care showed no significant difference between dead patients and living patients. Length of mechanical ventilation were significantly higher than those living to dead patients(p <0.05). Measured fewer, pulse and weight in dead group were statistically significantly different when compared to those living group (p<0.05). Systolic and diastolic blood pressure was found to be statistically significantly lower than those living to dead patients(p<0.05). In addition there was a statistically significantly difference compared to patients who were discharged in dying need of inotropic support (p <0.05). Patient's respiratory support during hospitalization observed no statistically significantly differences for mortality among groups. APACHE II, SOFA and SAPS II score were statistically higher significantly than the living patients to those dead patients. GCS was statistically lower significantly than the living patients to those dead patients. (p <0.001). During hospitalization studied for WBC, hemoglobin, hematocrit and CRP levels statistically was observed significantly increase according to the time of discharge in dead patients. Lower platelet count statistically was observed significant according to the living in dead patients (p <0.05). Lower albumin, urea, creatinine and higher HDL, LDL cholesterol, direct bilirubin, and CK levels examined from biochemical parameters among patients admitted to the intensive care unit, was statistically significant compared to than those living in the dead (p <0.05). Sodium, potassium, glucose, AST, ALT values were no significant differences between the groups in terms of mortality. Looking at the hormone levels during hospitalization; lower T4 and higher cortisol, ACTH, GH were statistically significant differences than those living in the dead (p <0.05). However, T3, and TSH, DEAH detected no significant differed between the groups for mortality. In addition in our study, we aim to exchange of values on the third day of the laboratory parameters examined. Lower phosphorus levels were found significant differences among the dead and the living patients (p <0.05). Looking at the other parameters, no significant differences between the groups for mortality. Finally, scoring systems may be an indicator for mortality, Laboratory parameters examined in lower platelet count, albumin, üre creatinin and higher cortisol, ACTH, BH, cholesterol, direct bilirubin levels that admitted during hospitalization in critically ill patients may be indicative of mortality. However, lower phosphorus levels when in the change of the third day investigated laboratory parameters were statistically found to be significantly. Keywords: İntensive Care Unit, Mortality, Scoring Systems, Laboratory Parameters, Chest Disease
Rate of mortality is high in patients admitted to Intensive Care Unit (ICU). Assessment of disease severity and recognition of mortality risk factors are of great importance in determining the patient's prognosis. Also, determination of management strategies and effect the use of resources. This study in determining the prognosis of patients admitted to ICU admission with scoring systems during hospitalization. Furthermore, weaim to exchange of values on the third day of the laboratory parameters examined. Eighty six patients (aged between 22 and 93) who were treated in Dicle University Hospital, Respiratory Intensive Care Clinic between November 2013 and April 2014 were included in the study. Patients were divided into two groups, namely the dead and the living. APACHE II, SOFA, SAPS II and GCS scores were calculatedin the first day of admission to the ICU. Demographic data of the patients, diagnosis, clinical and laboratory findings, length of stay in the ICU, length his stay in mechanical ventilation were recorded. WBC, CRP, biochemical parameters and hormone levels were studied from the ICU to the time of entry and at the end of 72 hours in all patients. Results were compared between the dead and the living. The age of patients, gender and in length of stay in intensive care showed no significant difference between dead patients and living patients. Length of mechanical ventilation were significantly higher than those living to dead patients(p <0.05). Measured fewer, pulse and weight in dead group were statistically significantly different when compared to those living group (p<0.05). Systolic and diastolic blood pressure was found to be statistically significantly lower than those living to dead patients(p<0.05). In addition there was a statistically significantly difference compared to patients who were discharged in dying need of inotropic support (p <0.05). Patient's respiratory support during hospitalization observed no statistically significantly differences for mortality among groups. APACHE II, SOFA and SAPS II score were statistically higher significantly than the living patients to those dead patients. GCS was statistically lower significantly than the living patients to those dead patients. (p <0.001). During hospitalization studied for WBC, hemoglobin, hematocrit and CRP levels statistically was observed significantly increase according to the time of discharge in dead patients. Lower platelet count statistically was observed significant according to the living in dead patients (p <0.05). Lower albumin, urea, creatinine and higher HDL, LDL cholesterol, direct bilirubin, and CK levels examined from biochemical parameters among patients admitted to the intensive care unit, was statistically significant compared to than those living in the dead (p <0.05). Sodium, potassium, glucose, AST, ALT values were no significant differences between the groups in terms of mortality. Looking at the hormone levels during hospitalization; lower T4 and higher cortisol, ACTH, GH were statistically significant differences than those living in the dead (p <0.05). However, T3, and TSH, DEAH detected no significant differed between the groups for mortality. In addition in our study, we aim to exchange of values on the third day of the laboratory parameters examined. Lower phosphorus levels were found significant differences among the dead and the living patients (p <0.05). Looking at the other parameters, no significant differences between the groups for mortality. Finally, scoring systems may be an indicator for mortality, Laboratory parameters examined in lower platelet count, albumin, üre creatinin and higher cortisol, ACTH, BH, cholesterol, direct bilirubin levels that admitted during hospitalization in critically ill patients may be indicative of mortality. However, lower phosphorus levels when in the change of the third day investigated laboratory parameters were statistically found to be significantly. Keywords: İntensive Care Unit, Mortality, Scoring Systems, Laboratory Parameters, Chest Disease
Açıklama
Anahtar Kelimeler
Yoğun bakım, Intensive care unit, Mortalite, Mortality, Skorlama sistemleri, Scoring systems, Labortauvar parametreleri, Laboratory parameters, Göğüs hastalıkları, Chest disease
