Yaşlı Sepsis Hastalarında Prognostik Puanlama Sistemlerinin ve Nötrofil-Lenfosit Oranının (NLO) Etkinliği

Year 2021, Volume: 74 Issue: 3, 289 - 295, 17.09.2021

Bilgin Bahadır Başgöz

Abstract

Amaç: Yoğun bakım hastalarında mortaliteyi tahmin eden birçok puanlama sistemi ve biyobelirteç mevcuttur. Ancak yaşlı sepsis hastalarında
kullanılabilirlikleri konusunda netlik bulunmamaktadır. Bu çalışmada, yaşlı sepsis hastalarında sağkalımı öngörmede şu anda kullanılan prognostik
skorlama ölçeklerini ve nötrofil lenfosit oranını (NLO) değerlendirmeyi amaçladık.

Gereç ve Yöntem: Çalışmaya yoğun bakım ünitesine sepsis tanısı ile yatırılan yaşlı hastalar prospektif olarak dahil edildi. Başvuru anında Akut
Fizyoloji ve Kronik Sağlık Değerlendirmesi-II (APACHE), Sıralı (sepsisle ilişkili) Organ Yetmezliği Değerlendirmesi (SOFA) ve Glasgow koma skoru (GKS)
puanı ve NLO hesaplandı. 28 günlük bir takip süresinin sonunda, hastalar “hayatta kalanlar” ve “hayatta kalmayanlar” olarak iki gruba ayrıldı ve
çalışma parametreleri yönünden karşılaştırıldı.

Bulgular: Otuz altı hastanın verileri analiz edildi (ortalama yaş: 80,00±6,37 yıl, kadın: %58,3). Ölüm oranı %47,3 (n=17) idi. Başvuru anındaki
ortalama SOFA skoru ve medyan NLO, hayatta kalanlarda [SOFA: 10,37±2,91 ve NLR: 9,64 (11,25)], hayatta kalmayanlara [SOFA: 12,82±3,21 ve NLR:
14,95 (35,53)] (p<0,05) göre anlamlı olarak daha düşüktü, ancak ortalama APACHE-II ve medyan GKS skoru benzerdi. ROC eğrisi analizini kullanarak,
sadece SOFA skorunun ve NLO’nun mortaliteyi tahmin edebileceğini belirledik

Sonuç: Bu çalışma, yoğun bakım ünitesine kabul edilen sepsisli yaşlı hastalar arasında, APACHE-II veya GKS skorunun değil, başlangıç SOFA skorunun
ve NLO’nun mortaliteyi başarıyla tahmin edebileceğini gösterdi. Yaşlılarda mevcut prognoz ölçeklerinin faydasını değerlendirmek için daha ileri
çalışmalara ihtiyaç vardır.

Keywords

Organ İşlev Bozukluğu Puanları, Sepsis, APACHE, Hayatta Kalma, Yoğun Bakım Üniteleri, Yaşlı

Ethical Statement

Ethics Committee Approval: The Health Sciences University Non-Invasive Research Ethics Committee approved the study protocol (code: 46418926-18/55). Informed Consent: Written informed consent was obtained for each participant. Peer-reviewed: Externally peer-reviewed.

Supporting Institution

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Project Number

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Thanks

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Efficacy of Prognostic Scoring Systems and Neutrophil-to- Lymphocyte Ratio (NLR) Among Critically Ill Elder Sepsis Patients

Abstract

Objectives: Several scoring models and biomarkers are available to predict survival among critically ill patients. However, their accuracy among
older adults with sepsis has been questioned. In this study, we aimed to evaluate the currently used prognostic scoring scales and neutrophil-tolymphocyte
ratio (NLR) in the prediction of survival among older adults with sepsis.

Materials and Methods: The study prospectively included older adults who were admitted to the intensive care unit (ICU) with sepsis. On admission,
Acute Physiology And Chronic Health Evaluation (APACHE)-II, Sequential (sepsis-related) Organ Failure Assessment (SOFA), Glasgow coma scale
(GCS) score, and NLR were calculated. By the end of a 28-day follow-up period, survivors and non-survivors were compared for the study parameters.

Results: Overall, the data of 36 patients were analyzed (mean age: 80.00±6.37 years, female: 58.3%). The rate of mortality was 47.3% (n=17). The
mean SOFA score and the median NLR on admission were significantly lower in survivors [SOFA: 10.37±2.91, and NLR: 9.64 (11.25)] vs non-survivors
[SOFA: 12.82±3.21 and NLR: 14.95 (35.53)] (p<0.05) but the mean APACHE-II and the median GCS score were comparable. Using ROC curve analysis,
we determined that only the SOFA score and NLR could predict mortality.

Conclusion: The present study showed that, among older adults with sepsis admitted to the ICU, baseline SOFA score and NLR but not APACHE-II
or GCS score could successfully predict mortality. Further studies are required to evaluate the utility of existing prognosis scales in older people.

Keywords

Organ Dysfunction Scores, Sepsis, APACHE, Survival, Intensive Care Units, Aged

Project Number

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