Yoğun Bakımda Vitamin D Düzeyi ile Sepsis-Mortalite İlişkisi

Abstract

Amaç: Bu çalışmanın amacı vitamin D düzeyi ile sepsis, prognoz ve mortalite arasındaki ilişkiyi belirlemektir. Gereç ve Yöntemler: Bu çalışma 01.01.2018-31.12.2018 tarihleri arasında yoğun bakım ünitesine kabul edilen hastalarda retrospektif olarak yapılmıştır. Hastaların yaşı, cinsiyeti, kilo ve boyu, yatış tanıları, komorbiditeleri, mekanik ventilatörde kalış süresi, yoğun bakım ünitesinde ve hastanede kalış süresi, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE II) ve Sepsis İlişkili Organ Yetmezliği Değerlendirmesi (SOFA) skorları, vitamin D düzeyi ve sepsis göstergeleri (beyaz küre, C-reaktif protein (CRP) ve prokalsitonin düzeyleri) değerlendirildi. Bulgular: Çalışmaya dahil edilen 241 hastanın yaş ortalaması 69,9±13,7 yıldır. Vakaların %65,6’sı erkek (n=158), %34,4’ü kadın (n=83), %19,5’i obezdi (n=47). Hastaların %83,8’inde (n=202) ciddi düzeyde D vitamini eksikliği mevcuttu. Çalışmada APACHE II ve SOFA değerleri arasında pozitif, güçlü istatistiksel olarak anlamlı bir ilişki bulunmuştur. D vitamini ciddi düzeyde eksik olan grup ile normal grup arasında APACHE II, SOFA, Charlson Komorbidite İndeksi (CCI), Vücut Kitle İndeksi (VKİ), mekanik ventilasyon süresi, yoğun bakım ve hastane yatış süresi, inotropik ilaç kullanımı arasında istatistiksel anlamlı ilişki olmadığı gibi sepsis göstergeçleri (beyaz küre, CRP, prokalsitonin) ve 28 günlük mortalite yönünden de istatistiksel olarak anlamlı fark bulunamamıştır. Çalışmada Kronik Obstrüktif Akciğer Hastalığı (KOAH) olan hastalarda, malign ya da interstisyel akciğer hastalığı olanlara göre D vitamini eksikliği istatistiksel olarak anlamlı düzeyde yüksek bulunmuştur. Sonuç: Yoğun bakımda yatan KOAH hastalarının yetersiz beslenme ve azalmış fiziki aktivite nedeniyle vitamin D rezervleri oldukça düşüktü ancak vitamin D ile sepsis, prognoz ve mortalite arasında istatistiksel olarak anlamlı bir ilişki bulunamamıştır.

Keywords

• Mortalite
• sepsis
• vitamin D

The Relationship of Vitamin D Level and Sepsis-Mortality in Intensive Care

Abstract

Aim: The aim of this study is to determine the relationship between vitamin D level and sepsis, prognosis and mortality. Material and Methods: This study was conducted retrospectively with patients admitted to the intensive care unit between 01.01.2018-31.12.2018. Age, gender, weight and height of the patients, hospitalization diagnoses, comorbidities, mechanical ventilation duration, length of stay in intensive care unit and hospital, Acute Physiology and Chronic Health Assessment (APACHE II) and Sepsis-Related Organ Failure Assessment (SOFA) scores, vitamin D, the indicators of sepsis (white blood cell, C-reactive protein (CRP) and procalcitonin levels) were evaluated. Results: The average age of 241 patients included in the study is 69.9 ± 13.7 years. The 65.6% of the cases were male (n = 158), 34.4% were female (n = 83), 19.5% (n = 47) were obese. Severe vitamin D deficiency was present in 83.8% (n = 202) of the patients. In the study, a positive, strong and statistically significant relationship was found between APACHE II and SOFA values. There was no statistically significant relation between the group with severely vitamin D deficiency and the normal group, in terms of APACHE II, SOFA, Charlson Comorbidity Index (CCI), Body Mass Index (BMI), mechanical ventilation duration, length of stay in intensive care unit, length of stay in hospital, and inotrope use, as well as sepsis indicators (white blood cell, CRP, procalcitonin), and 28-day mortality. In the study, vitamin D deficiency was found to be statistically significantly higher in patients with chronic obstructive pulmonary disease (COPD). Conclusion: Vitamin D reserves of COPD patients in intensive care were very low due to malnutrition and lack of physical activity but no statistically significant relationship was found with sepsis, prognosis and mortality.

Keywords

• mortality
• sepsis
• vitamin D

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