Ortopedik Cerrahi Sonrası Seviye 3 Yoğun Bakım Ünitesinde Takip Edilen Hastalarda SOFA, qSOFA, SIRS Kriter Puanlama Sistemleri ile 1 Yıllık Mortalite İlişkisi

Year 2021, , 303 - 309, 24.05.2021

Mehmet Burtaç Eren , Tahir Öztürk Erkal Bilgiç , Orhan Balta

https://doi.org/10.16899/jcm.821510

Abstract

Mortalite skolarmaları; taburcu durumu, hasta mortalitesi, Yoğun Bakım Ünitesi (YBÜ) mortalitesini ve hastanede kalış süresini tahmin etmek için tasarlanmıştır. Hastanın genel sağlık durumunun değerlendirilmesi açısından standardize edilmesi ve ortak bir dil oluşturması amaçlanan bu puanlama sistemleri, birçok YBÜ'de hastaların değerlendirilmesinde kullanılmaktadır. Bu çalışmayla, puanlama sistemlerinin spesifik bir hasta grubunda kullanılabilirliği değerlendirilmesi amaçlanmıştır.

Ortopedik cerrahi sonrası YBÜ'de nispeten kısa süreli hastaneye yatışlar meydana geldiğinden, mortalitenin bir göstergesi olarak kullanılabilecek tahmin edici puanlama sistemlerinin tahmin gücü arasında hiçbir fark olmayacağı hipotezimizi oluşturduk.

Çalışmamız tek merkez retrospektif olarak tasarlandı.
Ocak 2017 ile Ağustos 2018 arasında 3. seviye yoğun bakım takibi yapılan tüm hastalar otomasyon sisteminde belirlendi. 146 hasta dosyası ve otomasyon sistemi verilerinin değerlendirilmesinin ardından dahil etme ve dışlama kriterlerine uyan hastalar belirlendi.
Çalışmaya toplam 40 hasta dahil edildi. Ortalama yaş 75.69 (SD = 8.66 yıl),% 50 erkek ve% 50 kadındı. On beş hastanın (% 37,5) ilk yıl içerisinde vefat ettikleri görüldü.

Hastalar ilk yıl hayatta kalan ve kalamayanlar olarak değerlendirildiğinde, gruplar arasında kantitatif değişkenler açısından postoperatif erken GKS ve erken postoperatif oksijen satürasyonu açısından anlamlı farklılık olduğu görüldü. (P< 0,005)
Diğer hiçbir skorlama sistemi açısından anlamlı fark görülmedi(P> 0,005).

Yoğun bakım ünitesinde takibi standartlaştırmak için uygun bir mortalite prediktör skoru seçilmelidir.
Çalışmamız sonucunda SOFA, qSOFA ve SIRS kriterleri arasında anlamlı bir ilişki bulunmaması, bu skorlama sistemlerinin hasta grubumuzda 1 yıllık mortaliteyi öngörmek için uygun olmadığını düşündürdü.
Daha geniş seriler ve daha fazla kriter içeren çalışmalarla ortopedik yoğun bakım hastalarına özgü spesifik kriterlerin oluşturulması gerekmektedir.

Keywords

SOFA skoru, qSOFA skoru, SIRS kriterleri, yoğun bakım mortalitesi, ortopedik cerrahi

The Relationship Between SOFA, qSOFA, SIRS Criteria Scoring Systems and 1-Year Mortality in Patients Followed Up in Level 3 Intensive Care Unit after Orthopedic Surgery

Abstract

Predictive scoring systems are designed to predict patients' discharge status, patient mortality, Intensive Care Unit(ICU) mortality and lenght of hospital stay. These scoring systems, which are aimed to standardize and form a common language in terms of evaluating patient general health situation, are used in the evaluation of patients in many ICU.In this study, we aimed to evaluate the ability of the scoring systems that can be used to predict the mortality of the patients who will be followed up in the ICU after orthopedic surgery and predict the mortality that occurs in the first year outside the hospital.

We established our hypothesis that there will be no difference between the predictive power of predictive scoring systems, which can be used as a marker of mortality, since relatively short-term hospitalizations occur in the ICU after orthopedic surgery.

Our study was designed as a single center retrospective.
Between January 2017 and August 2018, all patients undergoing level 3 intensive care follow-up were identified in the automation system. After the evaluation of 146 patients' files and automation system data, patients who were in compliance with the inclusion and exclusion criteria were identified.
A total of 40 patients were included in the study. The mean age was 75.69 (SD = 8.66 years), 50% male and 50% female. Fifteen patients (37.5%) died during their first year follow-up.
When the patients were evaluated as survivors and non-survivors in the first year, it was observed that there was a significant difference between the groups in terms of quantitative variables in terms of early postoperative GCS and in terms of early postoperative oxygen saturationThere was no significant difference between the two groups in terms of qualitative variables. (P> 0.005)

An appropriate mortality predictor score should be selected to standardize follow-up in intensive care unit.
As a result of our study, there was no significant relationship between gropus SOFA, qSOFA scores and SIRS critera met suggested that these scoring systems were not suitable for predicting 1-year mortality in our patient group.
We believe that specific criteria should be established with studies with larger series and more criteria.

Keywords

SOFA score, qSOFA score, SIRS criteria, ICU mortality, orthopedic surgery

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