Arteryel-venöz karbondioksit farkı ve end-tidal karbondioksit'in sepsis mortalitesini öngörmedeki rolü
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Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmanın amacı, acil servise başvuran sepsis hastalarında Pv-aCO₂ ve ETCO₂ düzeylerinin
mortaliteyi öngörmedeki prognostik değerini araştırmaktır.
Yöntem:Sunulan çalışma, 3. basamak bir acil serviste prospektif ve kesitsel olarak gerçekleştirilmiştir. Sepsis
tanısı almış hastaların 0. ve 6. saatlerinde Pv-aCO₂, ETCO₂ ve laktat düzeyleri ölçüldü. Hastaların 0. ve 6. Saatte
SIRS ve NEWS skorları kaydedildi. Hastaların demografik verileri, vital bulguları, klinik özellikleri, laboratuvar
bulguları, mekanik ventilatör ihtiyacı, renal replasman ihtiyacı, kan ürünü replasman ihtiyacı, yoğun bakım kalış
süresi ve mortalite sonuçları kaydedilmiştir. Elde edilen veriler, mortalite ile karşılaştırılıp, ilişkili faktörlerin
belirlenmesinde kullanılmıştır. ROC analizi ile parametrelerin prognostik performansı değerlendirilmiştir.
Bulgular: Çalışmada, 0. ve 6. saatte Pv-aCO₂ ≥6 mmHg olan hastalarda mortalite oranlarının anlamlı derecede
yüksek olduğu saptanmıştır (p<0,001). 0. saatte bakılan ETCO₂ değeri <25 mmHg olan hastalarda mortalite
oranlarının anlamlı derecede yüksek olduğu belirlenmiştir (p<0,001). Yapılan çalışmalar, Pv-aCO₂ değeri ≥6
mmHg olan hastalarda mekanik ventilatör ihtiyacının yanı sıra vazopressör ve inotrop kullanımında artış olduğunu
göstermiştir. Bu bulgular, istatistiksel olarak anlamlı bulunmuştur (p<0,001). Pv-aCO₂ ve ETCO₂ değerleri
arasında negatif korelasyon, Pv-aCO₂ ile laktat düzeyleri arasında ise pozitif korelasyon gözlemlenmiştir. ROC
analizi ile Pv-aCO₂ ve ETCO₂ mortaliteyi öngörmedeki prognostik değerinin yüksek olduğu saptanmıştır. Ayrıca,
ETCO₂ ve laktat parametrelerinin de mortaliteyi tahmin etmede anlamlı katkı sağlayabileceği belirlenmiştir.
Sonuç: Çalışmamız, sepsis hastalarında Pv-aCO₂, ETCO₂ ve laktat düzeylerinin mortaliteyi öngörmede anlamlı
prognostik belirteçler olduğunu açıkça ortaya koymaktadır. Bu parametrelerin klinik pratiğe entegre edilmesi,
tedavi kararlarını yönlendirme açısından faydalı olabilir. Bununla birlikte, bu bulguların daha geniş ve farklı hasta
gruplarında doğrulanmasının önemi vurgulanmaktadır.
Objective: The aim of this study is to investigate the prognostic value of Pv-aCO₂ and ETCO₂ levels in predicting mortality among sepsis patients presenting to the emergency department. Methods: This prospective and cross-sectional study was conducted in a tertiary emergency department. Pv-aCO₂, ETCO₂, and lactate levels were measured at the 0th and 6th hours in patients diagnosed with sepsis. SIRS and NEWS scores were recorded at the time of sepsis diagnosis and at the 6th hour. Patients' demographic data, vital signs, clinical features, laboratory findings, mechanical ventilation requirements, need for renal replacement therapy, blood product replacement, intensive care unit length of stay, and mortality outcomes were documented. The collected data were compared with mortality to identify associated factors. The prognostic performance of the parameters was evaluated using ROC analysis. Results: In the study, patients with Pv-aCO₂ ≥6 mmHg at the 0th and 6th hours had significantly higher mortality rates (p<0.001). Patients with ETCO₂ levels <25 mmHg at the 0th hour were also found to have significantly higher mortality rates (p<0.001). Previous studies demonstrated that patients with Pv-aCO₂ ≥6 mmHg experienced increased requirements for mechanical ventilation as well as higher usage of vasopressors and inotropes. These findings were statistically significant (p<0.001). A negative correlation was observed between Pv-aCO₂ and ETCO₂ levels, while a positive correlation was noted between Pv-aCO₂ and lactate levels. ROC analysis showed that Pv-aCO₂ and ETCO₂ had a high prognostic value for predicting mortality . Furthermore, ETCO₂ and lactate parameters were also determined to be valuable in predicting mortality. Conclusion: Our study clearly demonstrates that Pv-aCO₂, ETCO₂, and lactate levels are significant prognostic markers for predicting mortality in sepsis patients. Integrating these parameters into clinical practice may assist in guiding treatment decisions. However, the importance of validating these findings in larger and more diverse patient populations is emphasized.
Objective: The aim of this study is to investigate the prognostic value of Pv-aCO₂ and ETCO₂ levels in predicting mortality among sepsis patients presenting to the emergency department. Methods: This prospective and cross-sectional study was conducted in a tertiary emergency department. Pv-aCO₂, ETCO₂, and lactate levels were measured at the 0th and 6th hours in patients diagnosed with sepsis. SIRS and NEWS scores were recorded at the time of sepsis diagnosis and at the 6th hour. Patients' demographic data, vital signs, clinical features, laboratory findings, mechanical ventilation requirements, need for renal replacement therapy, blood product replacement, intensive care unit length of stay, and mortality outcomes were documented. The collected data were compared with mortality to identify associated factors. The prognostic performance of the parameters was evaluated using ROC analysis. Results: In the study, patients with Pv-aCO₂ ≥6 mmHg at the 0th and 6th hours had significantly higher mortality rates (p<0.001). Patients with ETCO₂ levels <25 mmHg at the 0th hour were also found to have significantly higher mortality rates (p<0.001). Previous studies demonstrated that patients with Pv-aCO₂ ≥6 mmHg experienced increased requirements for mechanical ventilation as well as higher usage of vasopressors and inotropes. These findings were statistically significant (p<0.001). A negative correlation was observed between Pv-aCO₂ and ETCO₂ levels, while a positive correlation was noted between Pv-aCO₂ and lactate levels. ROC analysis showed that Pv-aCO₂ and ETCO₂ had a high prognostic value for predicting mortality . Furthermore, ETCO₂ and lactate parameters were also determined to be valuable in predicting mortality. Conclusion: Our study clearly demonstrates that Pv-aCO₂, ETCO₂, and lactate levels are significant prognostic markers for predicting mortality in sepsis patients. Integrating these parameters into clinical practice may assist in guiding treatment decisions. However, the importance of validating these findings in larger and more diverse patient populations is emphasized.
Açıklama
Anahtar Kelimeler
Sepsis, Septik Şok, Septic Shock, Pv-aCO₂, ETCO₂, Mortalite, Mortality
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Bilen, İ. B. (2025). Arteryel-venöz karbondioksit farkı ve end-tidal karbondioksit'in sepsis mortalitesini öngörmedeki rolü. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
