Geriatrik Hasta Grubunun Yoğun Bakımdan Çıkışı ve Mortalitesinin Retrospektif Olarak Değerlendirilmesi

Abstract

Giriş:Yoğun bakım ünitesinde (YBÜ) takip edilen geriatrik hastalar yüksek mortaliteye sahip olsalar da, morbidite ve mortalite oranları yaşa bağlı olmayıp altta yatan hastalığın şiddetiyle bağlantılıdır. Çalışmamın amacı, YBÜ’de yatan 65 yaş ve üzeri hastaların yoğun bakımdan taburculuk ve mortalite oranlarını karşılaştırmaktır. Gereç ve Yöntemler:YBÜ’de geritarik hastalara ait veriler,yaş, cinsiyet, yatış tanısı, altta yatan hastalıklar, kalış süreleri, mekanik ventilator gereksinimi ve Simplified Acute Physiology Score II (SAPS II) ile hastaların mortalite durumları değerlendirilmiştir. Çalışmaya 174 hasta dahil edilmiştir. Çalışmada Grup I; 65-77 yaş arası hastalardan, Grup II ise; 78 yaş ve üzeri hastalardan oluşmuştur. Bulgular:Gruplar arasında demografik veriler arasında istatistiksel açıdan anlamlı farklılık tespit edilmedi. SAPS II değerine bakıldığında grup I’de ortalama değer 42.05±19 iken Grup II’de 44.92±20.09 olarak saptandı. SAPS II skorlarına göre gruplar arasında mortalite ilişkisi incelendiğinde istatistiksel açıdan anlamlı bir ilişki olduğu saptanmıştır. Sonuç:Çalışma bulguları YBÜ’deki geriatrik hastalarda mortalite oranlarının değerlendirilmesinde SAPS II skorunun kullanılabileceğini göstermektedir.

Keywords

• geriatri
• yoğun bakım yatışı
• SAPS II

Retrospective evaluation of geriatric patient group discharge from Intensive Care Unit and mortality

Abstract

Aim:Although geriatric patients hospitalized in intensive care units (ICUs) have high mortality, morbidity and mortality rates are not related to age but are related to the severity of the underlying disease. The aim of our study is to compare the ICU discharge and mortality rates of 65 years and over aged patients hospitalized in the ICU. Material and Methods:Data belonging to geriatric patients in the ICU were evaluated with age, gender, hospitalization diagnosis, underlying diseases, duration of stay, mechanical ventilator requirement and the mortality status of the patients with Simplified Acute PhysiologyScore II (SAPS II). 174 patients were included in the study. In the study, patients were divided into two groups according to age group. Group I; among the patients between 65-77 years old, Group II; it consisted of patients 78 years and older. Results:There was no statistically significant difference between the demographic data between the groups. Looking at the SAPS II variable, the mean value was 42.05 ± 19 in group I, while it was 44.92 ± 20.09 in group II. When the relationship between mortality determined accordingto SAPS II scores and actual mortality was examined, istatistically significant relationship was found. Conclusion:The study findings show that SAPS II score can be used to evaluate mortality rates in geriatric patients in ICU.

Keywords

• geriatrics
• intensive care admission
• SAPSII

References

1. 1. https://www.brandingturkiye.com/tuikten-istatistiklerle-yaslilar-raporu-2018/(Erişilme tarihi: 28 Ağustos 2020)
2. 2. Clegg A, Young J, Iliffe S, Rikkert OM, Rockwood K.Frailty in elderlypeople. Lancet. 2013;381:756-762.
3. 3. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J. Committee on Man power for Pulmonary and Critical Care Societies (COMPACCS). Caring for the critically ill patient. Current and projected work force requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284(21):2762-2770.
4. 4. Teno JM, Gozalo P, Trivedi AN, Bunker J, Lima J, Ogarek J. Site of death, place of care, and health care transitions among US Medicare Beneficiaries, 2000-2015. JAMA. 2018;320(3):264-271. doi: 10.1001/jama.2018.8981.
5. 5. WHO, 2007: WHO Global Age Friendly Cities-guide (2007) (internet) https://apps.who.int/iris/bitstream/handle/10665/43755/9789241547307_eng.pdf?sequence=1 (Erişilme tarihi: 28 Ağustos 2020)
6. 6. Silva DJN, Casimiro LGG, Oliveira MIS, Ferreira LBDC, Abelha FJPA. A população cirúrgica muito idosa em cuidados intensivos: características clínicas e desfechos [The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes]. Rev Bras Anestesiol. 2020;70(1):3-8.
7. 7. Ihra GC, Lehberger J, Hochrieser H, et al. Development of demographics and outcome of very old critically ill patients admitted to intensive care units. Intensive Care Med. 2012;38(4):620-6. doi: 10.1007/s00134-012-2474-2477.
8. 8. Boumendil A, Aegerter P, Guidet B. CUB-Rea Network. Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study. J Am Geriatr Soc. 2005;53(1):88-93. doi: 10.1111/j.1532-5415.2005.53016.x.

9. 9. Köş M, Titiz H, Öneç B, et al. Comparison of clinical characteristics of the elderly and very elderly patients in the medical intensive care unit. JCEI. 2015;6(2):144-149. doi: 10.5799/ahinjs.01.2015.02.0506
10. 10. Fowler RA, Sabur N, Li P, et al. Sex- and age-based differences in the delivery and outcomes of critical care. CMAJ. 2007;177(12):1513–1519. 10.1503/cmaj.071112
11. 11. Bagshaw SM, Webb SA, Delaney A, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care. 2009;13(2):R45. doi:10.1186/cc7768
12. 12. Ulus F, Kokulu S, Savkilioglu E. Survival analysis of the elderly patients treated in the repiratory intensive care unit. Turk J Geriatr.2010;13:231-238.
13. 13. Tran HT, Leonard SD. Geriatric assessment for primary care providers. Primary Care. 2017;44(3):399-411. doi: 10.1016/j.pop.2017.05.001.
14. 14. Durmaz H. İç Hastalıkları Yoğun Bakımına Yatan Yaşlı Hastalarda Kırılganlığın Ve Etkilerinin Değerlendirilmesi [uzmanlık tezi] Hacettepe Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı. Ankara. 2018.
15. 15. Karakus A, Haas LEM, Brinkman S, de Lange DW, de Keizer NF. Trends in short-term and 1-year mortality in very elderly intensive care patients in the Netherlands: a retrospective study from 2008 to 2014. Intensive Care Med. 2017;43(10):1476-1484. doi: 10.1007/s00134-017-4879-9.
16. 16. Behrendt CE. Acute respiratory failure in the United States: incidence and 31-day survival.Chest. 2000;118:1100-1105. doi: 10.1378/chest.118.4.1100.
17. 17. Tannaou T, Koeberle S, Manckoundia P, Aubry R. Multifactorial immunodeficiency in frail elderly patients: Contributing factors and management. Med Mal Infect. 2019;49:167-172.
18. 18. Heyland D, Cook D, Bagshaw SM, et al. Canadian critical care trials group, canadian researchers at the end of life network. the very elderly admitted to ıcu: a quality finish?Crit Care Med. 2015;43:1352–1360. doi:10.1097/CCM.0000000000001024
19. 19. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system.Crit Care Med. 1985:13;818-829.
20. 20. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957-63. doi: 10.1001/jama.270.24.2957.
21. 21. McNelis J, Marini C, Kalimi R, Jurkiewicz A, Ritter G, Nathan I. A comparison of predictive outcomes of APACHE II and SAPS II in a surgical intensive care unit. Am J Med Qual. 2001;16(5):161-5. doi: 10.1177/106286060101600503.
22. 22. https://www.uptodate.com/contents/predictive-scoring-systems-in-the-intensive-care-unit(Erişilme tarihi: 28 Ağustos 2020)
23. 23. Suarez-de-la-Rica A, Castro-Arias C, Latorre J, Gilsanz F, Maseda E. Prognosis and predictors of mortality in critically ill elderly patients. Rev Esp Anestesiol Reanim. 2018;65(3):143-148. doi: 10.1016/j.redar.2017.11.004.
24. 24. Glance LG, Osler TM, Dick AW. Identifying quality outliers in a large, multiple-institution database by using customized versions of the Simplified Acute Physiology Score II and the Mortality Probability Model II0. Crit Care Med. 2002;30(9):1995-2002. doi: 10.1097/00003246-200209000-00008.
25. 25. Erden İA, Akıncı SB, Pamuk AG, Aycan İÖ, Çelebioğlu B, Aypar Ü. Yoğun bakımda yatan hastaların retrospektif olarak değerlendirilmesi. Turk J Geriatr.2009;12(4):171-176.
26. 26. Vosylius S, Sipylaste J, Ivaskevicius J. Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing. 2005;34:157-162.
27. 27. de Rooij SE, Abu-Hanna A, Levi M, de Jonge E. Identification of high-risk subgroups in very elderly intensive care unit patients.Crit Care. 2007;11(2):R33. doi: 10.1186/cc5716.
28. 28. Sánchez-Hurtado LA, Ángeles-Veléz A, Tejeda-Huezo BC, García-Cruz JC, Juárez-Cedillo T. Validation of a prognostic score for mortality in elderly patients admitted to intensive care unit. Indian J Crit Care Med. 2016;20(12):695-700. doi:10.4103/0972-5229.195702
29. 29. Korhan EA, Hakverdioglu G, Ozlem M, et al. Geriatric patient profile in the cardiovascular surgery intensive care unit. J Pak Med Assoc. 2013;63(11):1338-1341.