KOAH alevlenme ile gelen hastalarda hiponatreminin prognoza etkisi
Yükleniyor...
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: KOAH alevlenme tanısı ile servisimizde takip edilen ve beraberinde hiponatremisi olan hastalarda, hiponatreminin hastalığın prognozuna etkisini incelemektir.
Gereç ve Yöntem: Çalışma retrospektif bir çalışma olarak yapılmıştır. Çalışmaya Necmettin Erbakan Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı Servisinde Ocak 2009 – şubat 2024 tarihleri arasında yatan Koah Alevlenme Hastaları dahil edildi. Örneklem büyüklüğü G power programıyla Mann Whitney U Testi baz alınarak %5 hata payı %80 güç ve orta etki büyüklüğü (0,65), grupların oranı 1 olacak şekilde minimum 80 kişi olarak hesaplandı. Çalışmaya KOAH alevlenmesi olan beraberinde hiponatremisi olan 40 hasta ve hiponatremisi olmayan 46 hasta dahil edildi. Çalışmaya dahil edilen hastaların dosyaları retrospektif olarak incelendi. Çalışmaya dahil edilen hastaların demografik verileri (yaş, cinsiyet, ek hastalık) veriler, labaratuar verileri, Solunum Fonksiyon Testi Sonuçları kaydedilmiştir. Verilerin bilgisayar ortamına aktarılıp analiz edilmesinde SPSS paket programı kullanıldı. Analizler sırasında tanımlayıcı istatistikler olarak aritmetik ortalama±standart sapma, ortanca (Interquantile Range), sayı ve yüzdeliklerin kullanılması planlanmıştır. Kategorik veriler arası ilişkilerin belirlenmesinde Ki-kare testi ve Fisher’ın kesin ki-kare testi kullanıldı. Bağımsız iki grupta sayısal veriler arası ilişkilerin belirlenmesinde verilerin dağılımına göre parametrik testlerden; Student T testi, non-parametrik testlerden; Mann Whitney U testi kullanıldı. Normal dağılıma uygun olan sayısal veriler arasında Pearson korelasyon analizi, normal dağılıma uymayan sayısal veriler arası ilişki Spearman korelasyon analizi ile değerlendirildi. İstatistiksel anlamlılık için p’nin 0,05’ten küçük olduğu durumlar kabul edilmiştir.
Bulgular: Çalışmamıza Necmettin Erbakan Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı Servisinde Ocak 2009 – şubat 2024 tarihleri arasında takip edilen Koah Alevlenme Hastaları incelendi. KOAH alevlenmesi olan beraberinde hiponatremisi olan 40 hasta ve hiponatremisi olmayan 46 hasta dahil edildi. Dahil edilen hastaların yaş ortalaması 67,71±10,01 idi. Hiponatremisi olan hastaların 37’si erkek 3’ü kadın (%7,5), hiponatremisi
olmayan hastaların tamamı erkekti. Çalışmaya dahil edilen hastaların demografik verileri (yaş, cinsiyet, ek hastalık) veriler, labaratuar verileri, Solunum Fonksiyon Testi Sonuçları kayıt edildi. Hastaların hiponatremi değerlerinin gerçek hiponatremi olup olmadığını göstermek için kan Glukoz düzeyi kayıt edilerek “Hillier, 1999” modeline göre düzeltilmiş sodyum değeri hesaplandı.Hiponatremi grubuna dahil edilen hastalarda sınır sodyum değeri 135 olarak belirlendi ve alt değere sahip olan hastalar hiponatremi grubuna alındı. Hastaların hiponatremi derecesini sınıflandırmak için düzeltilmiş sodyum değeri; 134-130 hafif dereceli, 129-120 orta dereceli, <120 ise ağır dereceli hiponatremi olarak kayıt edildi. Kötü prognoz kriteri ise uzun süreli yatış, yoğun bakımda takip ve ölüm olarak belirlendi. Hipertansiyon (HT) ve konjestif kalp yetmezliği (KKY) görülme oranının hiponatremi ile takip edilen hastalarda anlamlı düzeyde yüksek olduğu görüldü (p değerleri sırasıyla; p=0,037; p=0,048). Diğer komorbidite oranlarının hasta gruplarında dağılımında istatistiki olarak fark belirlenmedi (p>0,05). Hiponatremi ile takip edilen hastaların yatış süresi medyan değeri 15 (5-62) gün ile hiponatremi olmayan hastalara göre anlamlı düzeyde yüksek kaydedildi (p<0,001). Yatış süresi ile paralel olarak YBÜ yatış oranının da hiponatremi olan hastalarda diğer hastalara kıyasla yüksek oranda olduğu belirlendi. Yatış süresi ile düzeltilmiş sodyum düzeyi arasında negatif yönde orta düzeyde korelasyon bulundu (r=-0,446; p<0,001) . YBÜ yatışı olan hastalarda sodyum seviyesi anlamlı düzeyde düşük tespit edildi (p=0,006).
Sonuç: Çalışmamızda hiponatremi hastalarında Hipertansiyon (HT) ve konjestif kalp yetmezliği (KKY)’nin daha sık görüldüğünü gözlemledik. Hiponatremi hasta grubunun hiponatremi olmayan gruba göre daha uzun yatış süresine, daha fazla yoğun bakımda takip edildiğine ve daha fazla ölüm sayısına sahip olduğunu gözlemledik. Koah alevlenme hastalarında elektrolit bozukluğu görülüyorsa ve özellikle hiponatremi izleniyorsa hasta prognozunu iyileştirme açısından daha dikkatli olunmalı, hiponatreminin sebebi ve düzeltilmesi açısından gerekli önlemler, tetkik ve tedaviler öncelikli olarak değerlendirilmelidir.
Objective:. The aim is to investigate the impact of hyponatremia on the prognosis of patients with COPD exacerbation who were followed up in our department and had concurrent hyponatremia. Method: This is a retrospective study conducted as a research. The study included patients with COPD exacerbation who were hospitalized in the Department of Chest Diseases at Necmettin Erbakan University Faculty of Medicine between January 2009 and February 2024. Sample size was calculated using G Power program based on Mann Whitney U Test with a 5% error rate, 80% power, and medium effect size (0.65), assuming a ratio of 1 for the groups, resulting in a minimum of 80 patients. The study included 40 patients with COPD exacerbation accompanied by hyponatremia and 46 patients without hyponatremia. The medical records of the included patients were retrospectively reviewed. Demographic data (age, gender, comorbidities), laboratory data, and Pulmonary Function Test results of the patients were recorded. SPSS package program was used for data entry and analysis. Descriptive statistics such as arithmetic mean ± standard deviation, median (Interquartile Range), number, and percentages were planned to be used during analysis. Chi-square test and Fisher's exact chi-square test were used to determine relationships between categorical variables. Parametric tests such as Student's t-test and non-parametric tests such as Mann Whitney U test were used to determine relationships between numerical variables in independent two groups based on the distribution of the data. Pearson correlation analysis was conducted for numerical variables that were normally distributed, while Spearman correlation analysis was used for numerical variables that did not follow a normal distribution. A p-value less than 0.05 was considered statistically significant. Results: Our study included patients with COPD exacerbation who were followed up in the Department of Chest Diseases, Faculty of Medicine, Necmettin Erbakan University, between January 2009 and February 2024. The study included 40 patients with COPD exacerbation with hyponatremia and 46 patients without hyponatremia. The average age of the included patients was 67.71±10.01 years. Of the patients with hyponatremia, 37 were male and 3 were female (7.5%), while all of the patients without hyponatremia were male. The demographic data (age, gender, comorbidities), laboratory data, and Pulmonary Function Test results of the included patients were recorded. To determine whether the hyponatremia values of the patients were true hyponatremia, the corrected sodium value was calculated using the blood glucose level according to the "Hillier, 1999" model. The threshold sodium value for the hyponatremia group was set at 135, and patients with values below this were included in the hyponatremia group. To classify the degree of hyponatremia, the corrected sodium value was recorded as follows: 134-130 for mild hyponatremia, 129-120 for moderate hyponatremia, and <120 for severe hyponatremia. Poor prognosis criteria were defined as long-term hospitalization, intensive care follow-up, and death. It was observed that the incidence of hypertension (HT) and congestive heart failure (CHF) was significantly higher in patients followed up with hyponatremia (p values: p=0.037; p=0.048, respectively). There was no statistically significant difference in the distribution of other comorbidity rates between the patient groups (p>0.05). The median length of hospital stay for patients followed up with hyponatremia was significantly higher at 15 (5-62) days compared to those without hyponatremia (p<0.001). In parallel with the length of stay, the rate of ICU admission was also found to be higher in patients with hyponatremia compared to other patients. There was a moderate negative correlation between the length of stay and the corrected sodium level (r=-0.446; p<0.001). Sodium levels were found to be significantly lower in patients admitted to the ICU (p=0.006). Conclusion: In our study, we observed that hypertension (HT) and congestive heart failure (CHF) were more frequently seen in patients with hyponatremia. We observed that the hyponatremia patient group had a longer hospital stay, more intensive care follow-up, and a higher number of deaths compared to the non-hyponatremia group. If an electrolyte imbalance, particularly hyponatremia, is observed in patients with COPD exacerbation, more attention should be paid to improving the patient's prognosis. Necessary precautions, investigations, and treatments should be prioritized to determine and correct the cause of hyponatremia.
Objective:. The aim is to investigate the impact of hyponatremia on the prognosis of patients with COPD exacerbation who were followed up in our department and had concurrent hyponatremia. Method: This is a retrospective study conducted as a research. The study included patients with COPD exacerbation who were hospitalized in the Department of Chest Diseases at Necmettin Erbakan University Faculty of Medicine between January 2009 and February 2024. Sample size was calculated using G Power program based on Mann Whitney U Test with a 5% error rate, 80% power, and medium effect size (0.65), assuming a ratio of 1 for the groups, resulting in a minimum of 80 patients. The study included 40 patients with COPD exacerbation accompanied by hyponatremia and 46 patients without hyponatremia. The medical records of the included patients were retrospectively reviewed. Demographic data (age, gender, comorbidities), laboratory data, and Pulmonary Function Test results of the patients were recorded. SPSS package program was used for data entry and analysis. Descriptive statistics such as arithmetic mean ± standard deviation, median (Interquartile Range), number, and percentages were planned to be used during analysis. Chi-square test and Fisher's exact chi-square test were used to determine relationships between categorical variables. Parametric tests such as Student's t-test and non-parametric tests such as Mann Whitney U test were used to determine relationships between numerical variables in independent two groups based on the distribution of the data. Pearson correlation analysis was conducted for numerical variables that were normally distributed, while Spearman correlation analysis was used for numerical variables that did not follow a normal distribution. A p-value less than 0.05 was considered statistically significant. Results: Our study included patients with COPD exacerbation who were followed up in the Department of Chest Diseases, Faculty of Medicine, Necmettin Erbakan University, between January 2009 and February 2024. The study included 40 patients with COPD exacerbation with hyponatremia and 46 patients without hyponatremia. The average age of the included patients was 67.71±10.01 years. Of the patients with hyponatremia, 37 were male and 3 were female (7.5%), while all of the patients without hyponatremia were male. The demographic data (age, gender, comorbidities), laboratory data, and Pulmonary Function Test results of the included patients were recorded. To determine whether the hyponatremia values of the patients were true hyponatremia, the corrected sodium value was calculated using the blood glucose level according to the "Hillier, 1999" model. The threshold sodium value for the hyponatremia group was set at 135, and patients with values below this were included in the hyponatremia group. To classify the degree of hyponatremia, the corrected sodium value was recorded as follows: 134-130 for mild hyponatremia, 129-120 for moderate hyponatremia, and <120 for severe hyponatremia. Poor prognosis criteria were defined as long-term hospitalization, intensive care follow-up, and death. It was observed that the incidence of hypertension (HT) and congestive heart failure (CHF) was significantly higher in patients followed up with hyponatremia (p values: p=0.037; p=0.048, respectively). There was no statistically significant difference in the distribution of other comorbidity rates between the patient groups (p>0.05). The median length of hospital stay for patients followed up with hyponatremia was significantly higher at 15 (5-62) days compared to those without hyponatremia (p<0.001). In parallel with the length of stay, the rate of ICU admission was also found to be higher in patients with hyponatremia compared to other patients. There was a moderate negative correlation between the length of stay and the corrected sodium level (r=-0.446; p<0.001). Sodium levels were found to be significantly lower in patients admitted to the ICU (p=0.006). Conclusion: In our study, we observed that hypertension (HT) and congestive heart failure (CHF) were more frequently seen in patients with hyponatremia. We observed that the hyponatremia patient group had a longer hospital stay, more intensive care follow-up, and a higher number of deaths compared to the non-hyponatremia group. If an electrolyte imbalance, particularly hyponatremia, is observed in patients with COPD exacerbation, more attention should be paid to improving the patient's prognosis. Necessary precautions, investigations, and treatments should be prioritized to determine and correct the cause of hyponatremia.
Açıklama
Anahtar Kelimeler
KOAH, COPD, hiponatremi, hyponatremia, prognoz, prognosis, alevlenme, exacerbation
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Avcil, S. (2024). KOAH alevlenme ile gelen hastalarda hiponatreminin prognoza etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Göğüs Hastalıkları Anabilim Dalı, Konya.
