Dahiliye yoğun bakım hastalarında sistemik immun inflamatuar indeksinin mortalite ve morbidite ile ilişkisi
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2023
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info:eu-repo/semantics/openAccess
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Amaç: Yoğun bakım tüm dünya çapında sağlık alanının en stresli, yönetimi zor, maliyetli ve yaşam beklentilerin ve aynı zamanda mortalite ve morbiditenin yüksek olduğu üniteleridir. Bu kapsamda ülkeler bu parametreleri değerlendirerek yoğun bakım ünitelerinde hastanın mortalitesi, yoğun bakımda kalış süresi, uygulanacak tedaviler, stres faktörlerinin yönetimi ve bu faktörlerin en az seviyeye indirilmesi gibi durumları göz ününe alarak skorlama sistemleri geliştirilmiştir. Çalışmamızın bir parametresi olan SII (Sistemik İmmün İnflamasyon İndex) ilk ortaya atıldığı 2014 yılından beri birçok konu (malignite, otoimmun hastalıklar, bazı enfektif hastalıklar, kalp ve karaciğer ve serobrovasküler hastalıklar) üzerinde çalışılmış olup etkisi araştırılmıştır. Literatüre baktığımızda konumuzun direkt olarak çalışılmadığı saptanmıştır. Dolayısıyla bu çalışmamızda SII’nin yoğun bakım skorlamaları ve skor parametreleri arasında herhangi bir korelasyon, servis ve yoğun bakım yatış süreleri arasında ilişkinin olup olmadığı araştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışmamıza Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi dahiliye yoğun bakım ünitesine 13/05/2022 ve 20/04/2023 tarihleri arasında 18 yaş üstü ve 100 yaş altı olan 223 yatan hasta dâhil edilmiştir. Hastaların verileri yoğun bakıma geldiği ilk 24 saat içindeki değerleri not edildi. Bu veriler hastaların demografik özellikleri, kronik hastalıkları, renal replesman tedavisi, idrar volumu, uzun süreli steroid veya immun supresif durumu, inotropik ajan kullanımı, mekanik ventilasyon desteği ve biyokimyasal laboratuvar değerleri not edilerek SII ve diğer skorlama sistem puanları hesaplandı. İstatiksel veriler SPSS (Statistical Package for Social Sciences) 18.0 paket programı kullanılarak analiz edildi.
Bulgular: Çalışmaya dahil edilen 223 hastanın yaş ortalaması 66,88 ± 14,44 yıl idi. Hastaların %53,4’ü (n=119) erkekti. En sık bulunan tanılar; %34,5 (n=77) ile hipertansiyon, %33,6 (n=75) ile diyabetes mellitus, %20,6 (n=46) ile akut böbrek yetmezliğiydi. En sık hastaneye yatış nedenleri ise %20,2 (n=45) ile akut böbrek yetmezliği, %19,7 (n=44) ile sepsis, %18,8 (n=42) ve Gastrointestinal sistem (GİS) kanaması olarak kaydedildi. Hastaların servis yatış süresi ortalaması 8,02±11,30 gün, YBÜ yatış süresi ortalaması 10,09±11,42 gün olarak belirlendi. Akut böbrek yetmezliği hastaların %38,6’sında (n=86), malignite %49,3’ünde (n=110), karaciğer hastalığı %24,2’sinde (n=54) bulunmaktaydı. Hastalara uygulanan tedaviler değerlendirildiğinde % 26,5’ine (n=59) renal replasman tedavisi verildiği, %31,4’üne (n=70) uzun süreli steroid veya immünsupresyon durumu olduğu, %31,8’ine (n=71) vazopressor kullanıldığı tespit edildi. Hastaların %29,1’inin (n=65) entübe olarak takip edildiği, son durumda hastaların %63,2’sinin (n=141) exitus olduğu belirlendi. SII’nin diğer skorlamalar ile mortalite arasındaki ilişkisinde sağ olanlarda 1084,05, exitus olanlarda 1621,8 p<0,017 gelmiştir. Mekanik ventilasyon durumuna göre incelendiğinde SII’nin p=0,078, NLR (Nötrofil Lenfosit Oranı) ise p=0,010 olup SII’den daha anlamlı olarak bulunmuştur. ABY (Akut Böbrek Yetmezliği) varlığına göre değerlendirildiğinde SII ABY olmayanlarda 1299, olanlarda 1563 p= 0,085, NLR ise olmayanlarda 8,3, olanlarda 13,4 p= 0,011 olarak bulunmuştur. Malignite ile karşılaştırıldığında malignite olmayanlarda 1101, olanlarda 1831 olup p= 0,001 gelmiştir. Karaciğer hastalık varlığına göre değerlendirildiğinde kc hastalığı olmayanlarda 1733, kc hastalığı olanlarda 846 p= 0,001 olup negatif korelasyon izlenmiştir. Servis, yoğun bakım, toplam hastane yatış süreleri arasında ilişki p değerleri sırasıyla (p=0,59-p=0,70-p=0,74) olup anlamlı bulunmamıştır. SII ve enfektif parametre olan crp, prokalsitonin ile arasındaki ilişki p değerleri sırası ile (p<0,001-p=0,020), NLR ile p değerleri sırası ile (p<0,001-p<0,001) olup istatistiksel olarak anlamlı çıkmıştır.
Sonuç: SII, NLR gibi inflamasyon parametreleri yoğun bakım da mortalite, mekanik ventilasyon ihtiyacı, akut böbrek yetmezliği ve prognoz ön görmede APACHE II, SAPS II, SOFA, GKS gibi skorlamalar kullanılabileceği ve aynı zamanda birlikte kullanımının daha fazla yarar sağlayacağı saptanmıştır.
Objective: Intensive care is one of the most stressful, difficult to manage, costly and life expectancy as well as mortality and morbidity units in the health field worldwide. In this context, countries have developed scoring systems by evaluating these parameters, taking into account the mortality of the patient in intensive care units, the duration of stay in intensive care, the treatments to be applied and the management of stress factors and minimization of these factors. SII (Systemic Immune Inflammation Index), which is a parameter of our study, has been studied on many subjects (malignancy, autoimmune diseases, some infective diseases, heart and liver and serobrovascular diseases...) since 2014 when it was first introduced and its effect has been investigated. When we looked at the literature, we realized that our subject has not been directly studied. In this study, we aimed to investigate whether there is any correlation between intensive care scoring and score parameters of SII and whether there is any correlation between the length of stay in the ward and intensive care unit. Materials and Methods: In our study, 223 inpatients over 18 years of age and under 100 years of age were included in the Necmettin Erbakan University Meram Medical Faculty internal medicine intensive care unit between 13/05/2022 and 20/04/2023. Data of the patients were recorded within the first 24 hours of admission to the intensive care unit. These data included demographic characteristics, chronic diseases, renal replacement therapy, urine volume, long-term steroid or immunosuppressive status, use of inotropic agents, mechanical ventilation support and biochemical laboratory values and SII and other scoring system scores were calculated. Statistical data were analyzed using SPSS (Statistical Package for Social Sciences) 18.0 package program. Results: The study included 223 patients hospitalized in the internal medicine intensive care unit. The mean age of the patients was 66.88 ± 14.44 years. 53.4% (n=119) of the patients were male. The most common diagnoses were hypertension with 34.5% (n=77), diabetes mellitus with 33.6% (n=75), and acute renal failure with 20.6% (n=46). The most common reasons for hospitalization were acute renal failure with 20.2% (n=45), sepsis with 19.7% (n=44), and gastrointestinal bleeding with 18.8% (n=42). The mean length of hospitalization was 8.02±11.30 days in the ward and 10.09±11.42 days in the ICU. Acute renal failure was present in 38.6% (n=86), malignancy in 49.3% (n=110), and liver disease in 24.2% (n=54). When the treatments administered to the patients were evaluated, it was determined that 26.5% (n=59) received renal replacement therapy, 31.4% (n=70) had long-term steroid or immunosuppression status, and 31.8% (n=71) used vasopressor. It was determined that 29.1% (n=65) of the patients were intubated and 63.2% (n=141) of the patients were exited in the final outcome. The correlation of SII with mortality was 1084.05 in survivors and 1621.8 in exitus patients, p<0.017. When analyzed according to mechanical ventilation status, SII was p=0.078 and NLR (Neutrophil Lymphocyte Ratio) was p=0.010 which was more significant than SII. When evaluated according to the presence of AKI (Acute Renal Failure), SII was 1299 in those without AKI and 1563 in those with AKI p= 0.085, NLR was 8.3 in those without AKI and 13.4 in those with AKI p= 0.011. When compared with malignancy, it was 1101 in those without malignancy and 1831 in those with malignancy, p= 0.001. When evaluated according to the presence of liver disease, 1733 in those without liver disease and 846 in those with liver disease, p= 0.001 and a negative correlation was observed. The p-values of the correlation between ward, intensive care unit, and total hospitalization durations were (p=0.59-p=0.70-p=0.74) respectively and were not found to be significant. The p-values of the correlation between SII and the infective parameters crp and procalcitonin were (p<0.001-p=0.020) and with NLR were (p<0.001-p<0.001) and statistically significant, respectively. Conclusion: Inflammation parameters such as SII, NLR can be used like APACHE II, SAPS II, SOFA, GCS in predicting mortality, mechanical ventilation requirement and acute renal failure and prognosis in intensive care unit and at the same time, it was found that their combined use would provide more benefit.
Objective: Intensive care is one of the most stressful, difficult to manage, costly and life expectancy as well as mortality and morbidity units in the health field worldwide. In this context, countries have developed scoring systems by evaluating these parameters, taking into account the mortality of the patient in intensive care units, the duration of stay in intensive care, the treatments to be applied and the management of stress factors and minimization of these factors. SII (Systemic Immune Inflammation Index), which is a parameter of our study, has been studied on many subjects (malignancy, autoimmune diseases, some infective diseases, heart and liver and serobrovascular diseases...) since 2014 when it was first introduced and its effect has been investigated. When we looked at the literature, we realized that our subject has not been directly studied. In this study, we aimed to investigate whether there is any correlation between intensive care scoring and score parameters of SII and whether there is any correlation between the length of stay in the ward and intensive care unit. Materials and Methods: In our study, 223 inpatients over 18 years of age and under 100 years of age were included in the Necmettin Erbakan University Meram Medical Faculty internal medicine intensive care unit between 13/05/2022 and 20/04/2023. Data of the patients were recorded within the first 24 hours of admission to the intensive care unit. These data included demographic characteristics, chronic diseases, renal replacement therapy, urine volume, long-term steroid or immunosuppressive status, use of inotropic agents, mechanical ventilation support and biochemical laboratory values and SII and other scoring system scores were calculated. Statistical data were analyzed using SPSS (Statistical Package for Social Sciences) 18.0 package program. Results: The study included 223 patients hospitalized in the internal medicine intensive care unit. The mean age of the patients was 66.88 ± 14.44 years. 53.4% (n=119) of the patients were male. The most common diagnoses were hypertension with 34.5% (n=77), diabetes mellitus with 33.6% (n=75), and acute renal failure with 20.6% (n=46). The most common reasons for hospitalization were acute renal failure with 20.2% (n=45), sepsis with 19.7% (n=44), and gastrointestinal bleeding with 18.8% (n=42). The mean length of hospitalization was 8.02±11.30 days in the ward and 10.09±11.42 days in the ICU. Acute renal failure was present in 38.6% (n=86), malignancy in 49.3% (n=110), and liver disease in 24.2% (n=54). When the treatments administered to the patients were evaluated, it was determined that 26.5% (n=59) received renal replacement therapy, 31.4% (n=70) had long-term steroid or immunosuppression status, and 31.8% (n=71) used vasopressor. It was determined that 29.1% (n=65) of the patients were intubated and 63.2% (n=141) of the patients were exited in the final outcome. The correlation of SII with mortality was 1084.05 in survivors and 1621.8 in exitus patients, p<0.017. When analyzed according to mechanical ventilation status, SII was p=0.078 and NLR (Neutrophil Lymphocyte Ratio) was p=0.010 which was more significant than SII. When evaluated according to the presence of AKI (Acute Renal Failure), SII was 1299 in those without AKI and 1563 in those with AKI p= 0.085, NLR was 8.3 in those without AKI and 13.4 in those with AKI p= 0.011. When compared with malignancy, it was 1101 in those without malignancy and 1831 in those with malignancy, p= 0.001. When evaluated according to the presence of liver disease, 1733 in those without liver disease and 846 in those with liver disease, p= 0.001 and a negative correlation was observed. The p-values of the correlation between ward, intensive care unit, and total hospitalization durations were (p=0.59-p=0.70-p=0.74) respectively and were not found to be significant. The p-values of the correlation between SII and the infective parameters crp and procalcitonin were (p<0.001-p=0.020) and with NLR were (p<0.001-p<0.001) and statistically significant, respectively. Conclusion: Inflammation parameters such as SII, NLR can be used like APACHE II, SAPS II, SOFA, GCS in predicting mortality, mechanical ventilation requirement and acute renal failure and prognosis in intensive care unit and at the same time, it was found that their combined use would provide more benefit.
Açıklama
Anahtar Kelimeler
SII, APACHE II, SAPS II, SOFA, GKS, GKS.
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Güdek, M. (2023). Dahiliye yoğun bakım hastalarında sistemik immun inflamatuar indeksinin mortalite ve morbidite ile ilişkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
