Acil servis hastalarında laktat/albümin oranınn prognostik değeri
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Tarih
2022
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Acil Servis Hastalarında Laktat/Albumin Oranının Prognostik Değeri Kartal ALUMERT, Prof Dr Zerrin Defne DÜNDAR, Tıpta Uzmanlık Tezi, 2022 Giriş ve Amaç: Çalışmamızda acil servise başvuran genel hasta popülasyonunda laktat/albümin oranının (LAR) hastane içi mortalite ve acil servisten yatış – taburculuk için prognostik değerini araştırdık. Yöntem: Çalışmamıza 01 Temmuz 2020 ile 31 Aralık 2020 tarihleri arasında başvurmuş yaş >18 yıl olan ve dahil edilme kriterlerini karşılayan 2244 hasta dahil edildi. İlk sonlanım noktamızı acil servis sonucu, ikinci sonlanım noktamızı hastane içi mortalite olarak belirledik. Hastaların yaş, cinsiyet, eşlik eden hastalık, üre, kreatinin, albümin, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), C-reaktif protein (CRP), beyaz küre sayısı (BK), nötrofil sayısı (#NE), lenfosit sayısı (#LY), pH, laktat, baz açığı (cBase(B)c), acil sonlanımı, hastane içi mortalite, yoğun bakım yatış süresi, hastanede kalış süresi, acil servis tanısı bilgileri kaydedildi. Verilerin analizi SPSS 20.0 programı kullanılarak yapıldı. Verilerin normallik analizleri yapıldı. Kategorik değişkenler n (%), normal dağılıma uyan numerik değişkenler ortalama±SD ve normal dağılıma uymayan numerik değişkenler medyan (%25-%75 çeyreklikler) olarak ifade edildi. Hastalar taburcu olan, yoğun bakım ünitesine yatan, servise yatan ve eksitus olarak dört gruba ayrıldı. Yine hastalar sağ kalanlar ve eksitus olanlar olarak iki gruba ayrıldı. Parametrelerin hasta grupları arasındaki farklılığı uygun istatistiksel testler kullanılarak araştırıldı. Bulgular: Çalışmamızda eksitus olan hasta grubunda yaş anlamlı şekilde daha büyüktü ve eksitus olan hastaların çoğu erkekti. Hastane içi sonlanıma göre nötrofil değeri eksitus olan grupta daha yüksek iken lenfosit sağ kalan grupta daha yüksekti ve ikisi de istatistiksel olarak anlamlıydı (p<0,001). Albümin eksitus olan hasta grubunda anlamlı şekilde daha düşüktü (p<0,001). Laktat eksitus olan hasta grubunda belirgin daha yüksekti (p<0,001). Nötrofil/lenfosit oranı (NLR) ve LAR her ikisi de eksitus olan hasta grubunda daha yüksekti ve anlam teşkil ediyorlardı (sırasıyla p<0,001; p<0,001). LAR üzerine hastane içi mortalite için eğri altındaki alan 0,794±0,016 (%95 güven aralığı (GA) 0,762-0,826) (p<0,001) olarak bulundu, kesim değeri 0,63 üzeri için %70,8 sensitivite, %75,1 spesifisite ölçüldü. Diğer sonlanım noktamız olan acil servis sonucuna göre; yatış alan hastaların yaşı daha yüksekti ve yatış alan hastaların çoğunluğu erkekti (sırasıyla p<0,001; p<0,001). Albümin değeri yatış alan hasta grubunda anlamlı daha düşüktü (p<0,001). Laktat hospitalize edilen hasta grubunda belirgin daha yüksekti (p<0,001). Hem NLR hem LAR değerleri yatış alan hasta grubunda taburcu olanlara göre anlamlı yükseklik gösterdiler (sırasıyla p<0,001; p<0,001). Acil sonlanımı üzerine LAR için eğri altındaki alan 0,676±0,011 (%95 GA 0,654-0,699) (p<0,001) olarak tespit edildi, kesim değeri 0,53 üzeri için %54,6 sensitivite, %72,1 spesifisite gösterdi. NLR değeri acil sonlanımı için eğri altındaki alan 0,718±0,011 (%95 GA 0,696-0,739) (p<0,001) olarak tespit edildi, kesim değeri 3,6 üzeri için %67,7 sensitivite, %67,4 spesifisite gösterdi. Sonuç: Çalışmamızda LAR değerinin hastane içi mortalite üzerine güçlü bir prediktör olduğunu, kesim noktası 0,63 üzeri olarak alındığında bu görevi yüksek bir sensitivite ve spesifite ile ifa ettiğini bulduk. Acil servisten hasta taburcu – yatış kararı için güçlü bir yol gösterici olduğunu, kesim değeri 0,53 üzeri alındığında yüksek bir spesifisite ile bu görevi de yerine getirebileceğini gösterdik. Sonuçlarımız arasında LAR hastane içi mortalite için daha güçlü bir gösterge iken NLR acil servis sonlanımı üzerine daha etkin tespit edildi. Bu iki parametrenin birlikte kullanılması daha faydalı olacaktır. Anahtar Kelimeler: Acil sonucu, genel hasta popülasyonu, laktat/albümin oranı, mortalite, nötrofil/lenfosit oranı
Prognostic Value of Lactate/Albumin Ratio in Emergency Department Kartal ALUMERT, Prof Dr Zerrin Defne DÜNDAR, Specialization Thesis in Medicine, 2022 Introduction and Purpose: In our study, we investigated the prognostic value of lactate/albumin ratio (LAR) for in-hospital mortality and hospitalization – discharge from the general patient population admitted to the emergency department. Method: Our study included 2244 patients aged >18 years who applied between 01 July 2020 and 31 December 2020 and met the inclusion criteria. We determined our first endpoint as emergency room outcome and our second endpoint as in-hospital mortality. Patients' age, gender, comorbidity, urea, creatinine, albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), C-reactive protein (CRP), white blood cell count (BK), neutrophil count (#NE), lymphocyte count (#LY), pH, lactate, base deficit (cBase(B)c), emergency outcome, in-hospital mortality, intensive care unit length of stay, hospital stay, emergency room diagnosis information were recorded. Data analysis was done using SPSS 20.0 program. Normality analyzes of the data were performed. Categorical variables were expressed as n (%), normally distributed numerical variables were expressed as mean±SD, and non-normally distributed numerical variables were expressed as median (25%-75% quartiles). The patients were divided into four groups as discharged, hospitalized in the intensive care unit, hospitalized and deceased. Again, the patients were divided into two groups as those who survived and those who died. Differences in parameters between patient groups were investigated using appropriate statistical tests. Results: In our study, the age of the deceased patient group was significantly older, and most of the deceased patients were male. According to the in-hospital outcome, the neutrophil value was higher in the deceased group, while the lymphocyte level was higher in the surviving group, both of which were statistically significant (p<0.001). Albumin was significantly lower in the group of patients who died (p<0.001). Lactate was significantly higher in the deceased patient group (p<0.001). The neutrophil/lymphocyte ratio (NLR) and LAR were higher in the patient group who died and both were statistically significant (p<0.001; p<0.001, respectively). Area under the curve for in-hospital mortality on LAR was found to be 0.794±0.016 (95% confidence interval (CI) 0.762-0.826) (p<0.001), 70.8% sensitivity, 75.1% specificity measured for cut-off value above 0.63. According to the emergency service outcome, which is our other endpoint; Hospitalized patients were older and the majority of hospitalized patients were male (p<0.001; p<0.001, respectively). Albumin value was significantly lower in the hospitalized patient group (p<0.001). Lactate was significantly higher in the hospitalized patient group (p<0.001). Both NLR and LAR values were significantly higher in the hospitalized patient group than in the discharged group (p<0.001; p<0.001, respectively). The area under the curve for LAR on the emergency room outcome was 0.676±0.011 (95% CI 0.654-0.699) (p<0.001), with 54.6% sensitivity and 72.1% specificity for cut-off value above 0.53. The area under the curve for the NLR value for emergency room outcome was determined as 0.718±0.011 (95% CI 0.696-0.739) (p<0.001), showing 67.7% sensitivity and 67.4% specificity for the cut-off value above 3.6. Conclusion: In our study, we found that LAR value is a strong predictor of in-hospital mortality, and when the cut-off point is above 0.63, it performs this task with high sensitivity and specificity. We have shown that it is a strong guide for the decision of discharge-admission from the emergency department, and that it can fulfill this task with a high specificity when the cut-off value is above 0.53. Among our results, LAR was a stronger indicator for in-hospital mortality, while NLR was more effective on emergency room outcome. It would be more beneficial to use these two parameters together. Keywords: Emergency outcome, general patient population, lactate/albumin ratio, mortality, neutrophil/lymphocyte ratio
Prognostic Value of Lactate/Albumin Ratio in Emergency Department Kartal ALUMERT, Prof Dr Zerrin Defne DÜNDAR, Specialization Thesis in Medicine, 2022 Introduction and Purpose: In our study, we investigated the prognostic value of lactate/albumin ratio (LAR) for in-hospital mortality and hospitalization – discharge from the general patient population admitted to the emergency department. Method: Our study included 2244 patients aged >18 years who applied between 01 July 2020 and 31 December 2020 and met the inclusion criteria. We determined our first endpoint as emergency room outcome and our second endpoint as in-hospital mortality. Patients' age, gender, comorbidity, urea, creatinine, albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), C-reactive protein (CRP), white blood cell count (BK), neutrophil count (#NE), lymphocyte count (#LY), pH, lactate, base deficit (cBase(B)c), emergency outcome, in-hospital mortality, intensive care unit length of stay, hospital stay, emergency room diagnosis information were recorded. Data analysis was done using SPSS 20.0 program. Normality analyzes of the data were performed. Categorical variables were expressed as n (%), normally distributed numerical variables were expressed as mean±SD, and non-normally distributed numerical variables were expressed as median (25%-75% quartiles). The patients were divided into four groups as discharged, hospitalized in the intensive care unit, hospitalized and deceased. Again, the patients were divided into two groups as those who survived and those who died. Differences in parameters between patient groups were investigated using appropriate statistical tests. Results: In our study, the age of the deceased patient group was significantly older, and most of the deceased patients were male. According to the in-hospital outcome, the neutrophil value was higher in the deceased group, while the lymphocyte level was higher in the surviving group, both of which were statistically significant (p<0.001). Albumin was significantly lower in the group of patients who died (p<0.001). Lactate was significantly higher in the deceased patient group (p<0.001). The neutrophil/lymphocyte ratio (NLR) and LAR were higher in the patient group who died and both were statistically significant (p<0.001; p<0.001, respectively). Area under the curve for in-hospital mortality on LAR was found to be 0.794±0.016 (95% confidence interval (CI) 0.762-0.826) (p<0.001), 70.8% sensitivity, 75.1% specificity measured for cut-off value above 0.63. According to the emergency service outcome, which is our other endpoint; Hospitalized patients were older and the majority of hospitalized patients were male (p<0.001; p<0.001, respectively). Albumin value was significantly lower in the hospitalized patient group (p<0.001). Lactate was significantly higher in the hospitalized patient group (p<0.001). Both NLR and LAR values were significantly higher in the hospitalized patient group than in the discharged group (p<0.001; p<0.001, respectively). The area under the curve for LAR on the emergency room outcome was 0.676±0.011 (95% CI 0.654-0.699) (p<0.001), with 54.6% sensitivity and 72.1% specificity for cut-off value above 0.53. The area under the curve for the NLR value for emergency room outcome was determined as 0.718±0.011 (95% CI 0.696-0.739) (p<0.001), showing 67.7% sensitivity and 67.4% specificity for the cut-off value above 3.6. Conclusion: In our study, we found that LAR value is a strong predictor of in-hospital mortality, and when the cut-off point is above 0.63, it performs this task with high sensitivity and specificity. We have shown that it is a strong guide for the decision of discharge-admission from the emergency department, and that it can fulfill this task with a high specificity when the cut-off value is above 0.53. Among our results, LAR was a stronger indicator for in-hospital mortality, while NLR was more effective on emergency room outcome. It would be more beneficial to use these two parameters together. Keywords: Emergency outcome, general patient population, lactate/albumin ratio, mortality, neutrophil/lymphocyte ratio
Açıklama
Anahtar Kelimeler
Laktat, Albümin, Prognostik değer, Lactate, Albumin, Prognostic value
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Alumert, K. (2022). Acil servis hastalarında laktat/albümin oranınn prognostik değeri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
