Yoğun Bakım Ünitesinde Takip Edilen Pnömoni Hastalarında Mortaliteyi Öngören Risk Faktörleri ve Mortalite Skor Değerlerinin Tespiti

Abstract

Amaç: Yoğun bakım ünitesinde pnömoni hastalarının mortalite riskinin öngörülmesi tedavi sürecinde önemli bir adımdır. Hastaların ciddiyetini değerlendirmek ve prognozu tahmin etmek için bir dizi skorlama sistemi geliştirilmiştir. Klinikte prognostik değerlendirmede yoğun bakımda pnömoni hastalarının mortaliteyi öngören risk faktörleri ve mortalite skor değerlerini tespit etmek amaçlanmıştır. Gereç ve Yöntemler: Tek merkezli ve retrospektif bir çalışmadır. Hastaların mekanik ventilasyon, hemodiyaliz ihtiyacı, inotrop desteği, göğüs tüpü takılması, yoğun bakımda yatış süresi, hastanede kalış süresi, 6 aylık mortalite oranları kaydedildi. SOFA, APACHE II ve PSI, CURB-65 ve I-ROAD skoru hesaplandı. Prokalsitonin, C-reaktif protein, albümin, kreatinin, üre ve laktat değeri skorlamalarla değerlendirildi. Bulgular: 143 hastanın 94’u (%65,7) taburcu olurken (Grup 1: yaşayanlar), 49’u (%34,2) hayatını kaybetti (Grup 2: Yaşamını kaybedenler). Üre ve laktat motalite ile daha güçlü korelasyon gösterirken (p<0,001), kreatinin daha zayıf korelasyon göstermiştir (p=0,011). CURB-65 ve PSI mortalite ile güçlü bir ilişki gösterirken (p<0,001), I-ROAD bu ilişkiyi zayıf desteklemiştir (p=0,046). SOFA (0,261) ve APACHE II (0,211) anlamlı ilişki tespit edilmedi (p>0,05). İnotrop desteği alan hastalarda mortalite riski anlamlı ölçüde yüksekti (p<0,001), ancak göğüs tüpü ve hemodiyaliz uygulamalarının mortalite üzerine etkisi istatistiksel olarak anlamlı bulunmadı (sırasıyla p=0,943 ve p=0,297). Sonuç: Yoğun bakım hastalarında pnömoni mortalitesini öngörmede belirleyici faktörler olarak inotropik destek almak, hastanede yatış sırasında üre, kreatinin ve laktat düzeylerinin yüksekliği risk faktörleri olarak bulunmuştur. PSI ve CURB-65 mortalitenin öngörülmesinde ve kritik hasta seçimlerinde yol gösterici olabilir

Keywords

• Pnömoni
• yoğun bakım
• mortalite
• skorlama

Supporting Institution

yok

Project Number

yok

Ethical Statement

Alınmıştır

Identification of Risk Factors and Mortality Score Values Predicting Mortality in Pneumonia Patients Monitored in Intensive Care Units

Abstract

Aim: Predicting the mortality risk of pneumonia patients in the intensive care unit is an important step in the treatment process. A number of scoring systems have been developed to assess the severity of patients and predict prognosis. The aim of this study was to determine the risk factors predicting mortality and mortality score values of pneumonia patients in intensive care unit in clinical prognostic evaluation. Material and Methods: It was a single-center and retrospective study. Mechanical ventilation, hemodialysis requirement, inotrope support, chest tube insertion, duration of intensive care unit stay, length of hospital stay, and 6-month mortality rates were recorded. SOFA, APACHE II and PSI, CURB-65 and I-ROAD scores were calculated. Procalcitonin, C-reactive protein, albumin, creatinine, urea and lactate values were evaluated by scoring. Results: Of the 143 patients, 94 (65.7%) were discharged (Group 1: survivors), while 49 (34.2%) died (Group 2: exitus). Urea and lactate showed a stronger correlation with mortality (p<0.001), while creatinine showed a weaker correlation (p=0.011). CURB-65 and PSI demonstrated a strong association with mortality (p<0.001), while I-ROAD supported this association more weakly (p=0.046). SOFA and APACHE II did not show a significant association with mortality (p>0.05). Patients receiving inotropic support had a significantly higher risk of mortality (p<0.001), however, chest tube placement and hemodialysis did not have a statistically significant impact on mortality (p=0.943 and p=0.297, respectively). Conclusion: Receiving inotropic support, high urea, creatinine and lactate levels during hospitalization were found to be risk factors for predicting pneumonia mortality in intensive care unit patients. PSI and CURB-65 may be guiding in the prediction of mortality and selection of critical patients.

Keywords

• Pneumonia
• intensive care
• mortality
• scoring

Project Number

yok

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