Acil Servise Başvuran Malignite Hastalarının Morbidite ve Mortalitelerini Etkileyen Faktörler

Abstract

Amaç: Çalışmada acil servis başvuran malignite hastalarının klinik karakteristik özelliklerini, morbidite ve mortalitelerine etki eden faktörleri inceleyerek hastaların bakım kalitesini ve hedefe yönelik hızlı tedavi bilincini artırmayı amaçladık. Gereç ve Yöntem: Üniversite Hastanesi Acil Tıp Kliniğine 06.11.2014-06.05.2015 tarihleri arasında başvuran, 18 yaş ve üzeri kanser hastaları prospektif olarak incelendi. Hastaların demografik özellikleri, vital bulguları, maligniteleri ile ilgili özellikler, yapılan tetkikler ve sonuçları, tedaviler ve acil serviste yatış süreleri değerlendirildi. Bulgular: Toplam 1283 hastanın, 1522 başvuru yaptığı tespit edildi. Hastaların %51,99'u erkek (ortalama yaş: 57,52±13,12), %48,01'i kadın (ortalama yaş: 69,05±15,15), genel yaş ortalaması 63,05±14,08 idi. Nefes darlığı (%17,94) en sık başvuru şikayeti olup, en sık rastlanan kanser türü akciğer kanseri (%16,23) idi. Erkeklerde en sık başvuru nedeni ateş, en sık kanser türü akciğer kanseri (%34,63); kadınlarda en sık başvuru şikayeti nefes darlığı, en sık kanser tipi meme kanseri olarak saptandı (%35,25). Hastaların %64'ünde uzak metastaz mevcuttu. Ortalama arteriyal basıncının, nabız dakika sayısının, hemoglobin düzeyinin, üremi ve hipoalbümineminin, mortalite ve yoğun bakım yatışı oranları üzerinde anlamlı etkisi saptandı. Hastaların %41,46'sı herhangi bir servise yatırılırken, %1,05'i kaybedildi. Hastaneye yatışı yapılan hastaların ortalama yatış süreleri 4,64±6,73 gün idi. Sonuç: Malignite hastaları acil servise başvuran hastaların önemli bir kısmını oluşturmaktadır. Acil servis hekimlerinin onkolojik aciller konusunda yeterli bilgi, deneyim ve tecrübe edinmeleri, bu hastaların mortalite ve morbidite oranlarını azaltacaktır. 

Keywords

• Acil tıp,Malignite,Mortalite,Morbidite,Komplikasyon

Factors Affecting the Morbidity and Mortality of Malignancy Patients Admitted to the Emergency Department

Abstract

Objectives: The objective of this study is to identify the clinical characteristics and the factors affecting the morbidity and mortality of the patients with malignancy and to increase the quality of care and raise awareness of rapid targeted-therapy in the emergency department. Materials and Methods: In our study, cancer patients 18 years of age and older who presented to the emergency department of a university hospital were evaluated prospectively. Patients' demographics, vital signs, characteristics associated with malignancy, examinations performed, and their results, treatments, and length of stay were evaluated. Results: A total of 1283 patients and 1522 presentations were recorded. 51.99% of the patients were male, and 48.01% were female. The overall mean age was 63.05±14.08. The most prevalent symptom was dyspnea (17.94%), and the most common type of cancer was lung cancer (16.23%). In male patients, the most prevalent complaint was fever, and the most common type of cancer was lung cancer (34.63%). In female patients, the most prevalent complaint was dyspnea, and the most common type of cancer was breast cancer (35.25%). The influence of MAP, pulse, Hb levels, uremia, and hypoalbuminemia on mortality and ICU admission was significant. Overall, 41.46% of the patients were hospitalized, and 1.05% of the patients died. The average length of stay was 4.64±6.73 days.  Conclusion: Patients with malignancy constitute a significant portion of emergency department admissions. Promoting the emergency physicians' insight into and experience on oncological emergencies would contribute to decreasing the mortality and morbidity of these patients. 

Keywords

• Emergency Medicine,Malignancy,Mortality,Morbidity,Complication

References

1. 1. Başara BB, Güler C, Eryılmaz Z, Yentür GK, Pulgat E. TC Sağlık Bakanlığı Sağlık İstatistikleri Yıllığı 2013. Sağlık Araştırmaları Genel Müdürlüğü, Sağlık Bakanlığı. Ankara: Sentez Matbaacılık ve Yayıncılık; 2014.
2. 2. Katabathina VS, Restrepo CS, Betancourt Cuellar SL, Riascos RF, Menias CO. Imaging of oncologic emergencies: what every radiologist should know. Radiographics. 2013 Oct;33(6):1533-53.
3. 3. Lewis MA, Hendrickson AW, Moynihan TJ. Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin. 2011 Sep-Oct;61(5):287-314.
4. 4. McCarthy EP, Phillips RS, Zhong Z, Drews RE, Lynn J. Dying with cancer: patients' function, symptoms, and care preferences as death approaches. J Am Geriatr Soc. 2000;48(5 Suppl):S110-21.
5. 5. Suvannasankha A, Chirgwin JM. Role of bone-anabolic agents in the treatment of breast cancer bone metastases. Breast Cancer Res. 2014;16(6):484.
6. 6. Rosner MH, Dalkin AC. Electrolyte disorders associated with cancer. Adv Chronic Kidney Dis. 2014 Jan;21(1):7-17.
7. 7. Pi J, Kang Y, Smith M, Earl M, Norigian Z, McBride A. A review in the treatment of oncologic emergencies. J Oncol Pharm Pract. 2015 Oct 6. DOI: 1078155215605661.
8. 8. Flowers CR, Seidenfeld J, Bow EJ, Karten C, Gleason C, Hawley DK, Kuderer NM, Langston AA, Marr KA, Rolston KV, Ramsey SD. Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2013; 31:794.

9. 9. Mak KS, Lee LK, Mak RH, Wang S, Pile-Spellman J, Abrahm JL, Prigerson HG, Balboni TA.. Incidence and treatment patterns in hospitalizations for malignant spinal cord compression in the United States, 1998-2006. Int J Radiat Oncol Biol Phys 2011; 80:824.
10. 10. Swenson KK, Rosa MA, Ritz L, Murray CL, Adlis SA. Recognation and Evaluations of Oncology-Related Symptoms in the Emergency Department. Ann Emerg Med. 1995 Jul;26(1):12-7.
11. 11. Bozdemir N, Eray O, Eken C, Şenol Y, Artaç M, Samur M. Demographics, Clinical Presentation an Outcome of Cancer Patients Admitting to Emergency Department. Turk J Med Sci. 2009;39: 235-40.
12. 12. Can N, Yolcu Ş, Çetin Beceren NG, Tomruk Ö. Acil Servisimize Başvuran Kanser Hastalarının Sosyodemografik Özelliklerinin ve Acil Başvuları Arasındaki İlişkinin Belirlenmesi. Bozok Tıp Dergisi. 2013;2: 6-11.
13. 13. Yaylacı S, Topuzoğlu A, Karcıoğlu Ö. [Acil Servise Başvuran Kanser Hastalarının Klinik Karakteristikleri ve Bir Yıllık Sağ Kalımları]. Int J Hematol Oncol, 2009;19(4): 213-22.
14. 14. Kerrouault E, Denis N, Le Conte P, Dabouis G. [Improving Organization of Care Could Reduce Referrals of Cancer Patients to the Emergency Department]. Presse Med Presse Medicale. 2007;36: 1557-62.
15. 15. Liaw SJ, Bullard MJ, Hu PM, Chen JC, Liao HC. Rates and Causes of Emergency Department Revisitis Within 72 Hours. J Formos Med Assoc 1999;98(6): 422-5.
16. 16. Kılıçarslan İ, Bozan H, Oktay C, Göksu E. Türkiye’de Acil Servise Başvuran Hastaların Demografik Özellikleri. Türkiye Acil Tıp Dergisi,2005;5(1): 5-13.
17. 17. Koçak S, Ertekin B, Polat M, Girişgin S, Kara H. Onkolojik Hastaların Acile Başvuru Nedenleri. Sakarya Medical Journal, 2012;2(1): 16-20.
18. 18. Abi Aad S, Pierce M, Barmaimon G, Farhat FS, Benjo A, Mouhayar E. Hypertension induced by chemotherapeutic and immunosuppresive agents: a new challenge. Crit Rev Oncol Hematol. 2015 Jan;93(1):28-35.
19. 19. Moussaid Y, Bertaux M, Chargari C, Helissey C, Le Moulec S, Errihani H, Vedrine L. [Fever and cancer: components of diagnosis for optimal management]. Rev Med Interne. 2013 Sep;34(9):545-52.
20. 20. Escalante CP, Manzullo EF, Lam TP, Ensor JE, Valdres RU, Wang XS. Fatigue and its risk factors in cancer patients who seek emergency care. J Pain Symptom Manage. 2008 Oct;36(4):358-66.
21. 21. Anderson EJ. Respiratory infections. Cancer Treat Res. 2014;161:203-36.
22. 22. Evans SE, Ost DE. Pneumonia in the neutropenic cancer patient. Curr Opin Pulm Med. 2015 May;21(3):260-71.
23. 23. Wada K, Kumon H. [Managements of urinary catheterization and urinary tract infection in cancer patients]. Gan To Kagaku Ryoho. 2012 Feb;39(2):169-73.
24. 24. Endicott M. Oncologic emergencies. Clin Tech Small Anim Pract. 2003 May;18(2):127-30. Review.
25. 25. Aydin Y, Turkyilmaz A, Intepe YS, Eroglu A. Malignant pleural effusions: appropriate treatment approaches. Eurasian J Med. 2009 Dec;41(3):186-93. Review.
26. 26. Walji N, Chan AK, Peake DR. Common acute oncological emergencies: diagnosis, investigation and management. Postgrad Med J. 2008 Aug;84(994):418-27. Review.