Acil servis yoğun bakım ünitesine kabul edilen hastalarda elektrolit imbalansının görülme sıklığı ve mortalite ile ilişkisi
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Tarih
2024
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Yoğun bakım ünitesindeki (YBÜ) çoğu hasta elektrolit bozukluğu açısından risk altındadır. Kritik hastalar suboptimal elektrolit seviyelerine karşı en hassas hasta grubunu oluşturmaktadır. Optimal tedavi ve bakım için, acil tıp uzmanları elektrolit bozukluğu patofizyolojilerine aşina olmalıdır. Çalışmamızın amacı, acil YBÜ hastalarında başlıca elektrolit bozukluklarının (sodyum, potasyum, magnezyum, klorür, kalsiyum ve bikarbonat) sıklığını araştırmak ve elektrolit bozuklukları ile klinik özellikler ve prognoz arasındaki ilişkiyi değerlendirmektir.
Gereç ve yöntem
Bu çalışmaya 01.01.2020 ile 31.12.2022 tarihleri arasında Necmettin Erbakan Üniversitesi Tıp Fakültesi Acil YBÜ'ye başvuran ve başvuru sırasında elektrolit bozukluğu olan 1072 hasta retrospektif olarak dahil edildi. Travma hastaları, gebeler ve 18 yaşından küçük hastalar çalışma dışı bırakıldı. Hastane veri tabanı ve hasta dosyalarından demografik özellikler, eşlik eden hastalıklar, Ulusal Erken Uyarı Skoru-2 (NEWS-2), Charlson Komorbidite Skoru (CCI) ve Acil YBÜ kabul tanıları elde edildi. Başvuru elektrolit düzeyleri arasından sodyum, potasyum, megnezyum, klorür ve kalsiyum düzeylerine göre hastalar gruplandırıldı (hipo-, normo-, hiper-). Hastane sonlanımı kaydedildi. Hastane sonlanımı üzerinde etkisi olan elektrolit bozuklukları analiz edildi.
Bulgular
Hastaların yaş ortalaması 70.0 ± 18.0 yıl (20-99 yıl) idi. Hastaların %50,5'i erkek, %49,5'i kadındı. En sık başvuru tanıları sırasıyla enfeksiyon (%20,6), solunum (%19,6), dolaşım (%12,8) ve sindirim sistemi (%11,5) hastalıklarıydı. Hastaların %32,3’ünde hiponatremi, %12’sinde hipernatremi, %6,6’sında hipopotasemi, %28,3’ünde hiperpotasemi, %12,2’sinde hipomagnezemi, %13,5’inde hipermagnezemi, %25’inde hipokloremi, %16,3’ünde hiperkloremi, %36,6’sında hipokalsemi ve %4,6’sında hiperkalsemi mevcuttu. HCO3 düzeyi hastaların %69,7'sinde düşük, %10,6'sında yüksekti. Olguların %94,3'ünde herhangi bir elektrolit bozukluğu mevcuttu. %15,8'inde bir, %23,3'ünde iki, %27,7'sinde üç,
IV
%17,4'ünde dört, %8,1'inde beş ve %2'sinde altı elektrolit bozukluğu aynı anda mevcuttu. Ortalama hastanede kalış süresi 3,0 ± 4,4 gündü. Hastaların %41'i kaybedilirken, %31,6'sı dış merkeze sevk edilmiş ve %27,4'ü taburcu edilmişti. Multivaryant analizlerde, düşük HCO3 (OR=5,51, p<0,001), hiperkalsemi (OR=4,76, p<0,001), hipernatremi (OR=2,74, p=0,008), hipokloremi (OR=2,05, p=0,005) ve hiperpotaseminin (OR=1,84, p=0,008) mortalitede belirleyici olduğu izlendi.
Sonuç
Acil YBÜ hastaları elektrolit bozukluğu açısından yüksek risklidir. Birden fazla elektrolit bozukluğu aynı anda ortaya çıkmaktadır. Elektrolit bozukluğu olan hastaların acil YBÜ'de erken tanı ve tedavisi ile prognoz geliştirilebilir.
Most patients are at risk of at least one electrolyte abnormality in the intensive care unit (ICU). Critically ill patients are the most vulnerable group of patients to the effects of sub-optimal electrolyte levels. To provide optimal care, emergency medicine experts should be familiar with the principles of physiology and pathophysiology of electrolyte imbalance. The aim of our study was to investigate the frequency of major electrolyte disturbances (sodium, potassium, magnesium, chloride, calcium, and bicarbonate) in emergency ICU patients and to evaluate the relationship between electrolyte disturbances and clinical features and prognosis. Material and methods In this study, 1072 patients who were admitted to Necmettin Erbakan University Faculty of Medicine Emergency ICU between 01.01.2020 and 31.12.2022 and who had electrolyte disturbance at admission were included, retrospectively. Trauma patients, pregnant patients and patients younger than 18 years were excluded from the study. Hospital database and patient files were evaluated for demographic features, comorbidities, National Early Warning Score-2 (NEWS-2), Charlson Comorbidity Score (CCI) scores, diagnosis at emergency ICU admission. Patients were grouped according to the levels of sodium, potassium, magnesium, chloride and calcium among the admission electrolyte levels (hypo-, normo-, hyper-). Hospital outcomes were recorded. Electrolyte disturbances that have an impact on hospital outcome were analysed. Results The mean age of the patients was 70.0 ± 18.0 years (20-99 years). 50.5% of the patients were male and 49.5% were female. The most common diagnoses were infectious (20.6%), respiratory (19.6%), circulatory (12.8%) and digestive (11.5%) diseases, respectively. Hyponatremia was present in 32.3%, hypernatremia in 12%, hypopotassemia in 6.6%, hyperpotassemia in 28.3%, hypomagnesaemia in 12.2%, hypermagnesaemia in 13.5%, hypochloraemia in 25%, hyperchloraemia in 16.3%, hypocalcaemia in 36.6% and hypercalcaemia in 4.6%. HCO3 level was low in 69.7% and high in 10.6% of the patients. Any electrolyte disorder was present in 94.3% of the patients. One electrolyte disorder was present in 15.8%, two in 23.3%, three in 27.7%, four in 17.4%, five in 8.1%, and six in 2%. The mean hospital stay was 3.0 ± 4.4 days. Forty-one percent of the patients died in the hospital, 31.6% were referred to an external centre and 27.4% were discharged. Multivariate analyses showed that low HCO3 (OR=5.51, p<0.001), hypercalcaemia (OR=4.76, p<0.001), hypernatraemia (OR=2.74, p=0.008), hypochloraemia (OR=2.05, p=0.005) and hyperpotassaemia (OR=1.84, p=0.008) were determinants of mortality. Conclusion Emergency ICU patients are at high risk for electrolyte disturbance. Multiple electrolyte disorders occur at the same time. Prognosis can be improved with early diagnosis and treatment of patients with electrolyte disorders in the emergency ICU.
Most patients are at risk of at least one electrolyte abnormality in the intensive care unit (ICU). Critically ill patients are the most vulnerable group of patients to the effects of sub-optimal electrolyte levels. To provide optimal care, emergency medicine experts should be familiar with the principles of physiology and pathophysiology of electrolyte imbalance. The aim of our study was to investigate the frequency of major electrolyte disturbances (sodium, potassium, magnesium, chloride, calcium, and bicarbonate) in emergency ICU patients and to evaluate the relationship between electrolyte disturbances and clinical features and prognosis. Material and methods In this study, 1072 patients who were admitted to Necmettin Erbakan University Faculty of Medicine Emergency ICU between 01.01.2020 and 31.12.2022 and who had electrolyte disturbance at admission were included, retrospectively. Trauma patients, pregnant patients and patients younger than 18 years were excluded from the study. Hospital database and patient files were evaluated for demographic features, comorbidities, National Early Warning Score-2 (NEWS-2), Charlson Comorbidity Score (CCI) scores, diagnosis at emergency ICU admission. Patients were grouped according to the levels of sodium, potassium, magnesium, chloride and calcium among the admission electrolyte levels (hypo-, normo-, hyper-). Hospital outcomes were recorded. Electrolyte disturbances that have an impact on hospital outcome were analysed. Results The mean age of the patients was 70.0 ± 18.0 years (20-99 years). 50.5% of the patients were male and 49.5% were female. The most common diagnoses were infectious (20.6%), respiratory (19.6%), circulatory (12.8%) and digestive (11.5%) diseases, respectively. Hyponatremia was present in 32.3%, hypernatremia in 12%, hypopotassemia in 6.6%, hyperpotassemia in 28.3%, hypomagnesaemia in 12.2%, hypermagnesaemia in 13.5%, hypochloraemia in 25%, hyperchloraemia in 16.3%, hypocalcaemia in 36.6% and hypercalcaemia in 4.6%. HCO3 level was low in 69.7% and high in 10.6% of the patients. Any electrolyte disorder was present in 94.3% of the patients. One electrolyte disorder was present in 15.8%, two in 23.3%, three in 27.7%, four in 17.4%, five in 8.1%, and six in 2%. The mean hospital stay was 3.0 ± 4.4 days. Forty-one percent of the patients died in the hospital, 31.6% were referred to an external centre and 27.4% were discharged. Multivariate analyses showed that low HCO3 (OR=5.51, p<0.001), hypercalcaemia (OR=4.76, p<0.001), hypernatraemia (OR=2.74, p=0.008), hypochloraemia (OR=2.05, p=0.005) and hyperpotassaemia (OR=1.84, p=0.008) were determinants of mortality. Conclusion Emergency ICU patients are at high risk for electrolyte disturbance. Multiple electrolyte disorders occur at the same time. Prognosis can be improved with early diagnosis and treatment of patients with electrolyte disorders in the emergency ICU.
Açıklama
Anahtar Kelimeler
Elektrolit bozukluğu, Electrolyte disturbance, Acil yoğun bakım ünitesi, Emergency intensive care unit, Mortalite, Mortality, Kritik hasta, Critically ill
Kaynak
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Scopus Q Değeri
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Künye
Acar, E. (2024). Acil servis yoğun bakım ünitesine kabul edilen hastalarda elektrolit imbalansının görülme sıklığı ve mortalite ile ilişkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
