Plazma Elektrolit Düzeylerinin Nöbet Tanısında Prediktif Değerleri

Abstract

Amaç: Bu çalışmanın amacı, acil servise bilinç kaybı ile başvuran erişkin hastalarda plazma elektrolit düzeyleri ve biyokimyasal parametrelerin nöbet tanısındaki prediktif değerini araştırmaktır.

Gereç ve Yöntemler: Retrospektif ve tek merkezli bu çalışma, 01 Ocak 2021 – 01 Ocak 2024 tarihleri arasında üçüncü basamak bir üniversite hastanesinin acil servisine başvuran ve senkop/bayılma, konvulsiyon, inme veya serebrovasküler hastalık tanısı alan 1816 erişkin hastayı kapsamaktadır. Hastalar nöbet geçiren (n=418) ve geçirmeyen (n=1398) olarak iki grupta değerlendirildi. Demografik veriler, elektrolit düzeyleri, laktat, kreatin kinaz ve ürik asit düzeyleri karşılaştırıldı. Elektrolit bozuklukları için risk analizi, sonlanım değişkeni “nöbet geçirme” olan lojistik regresyon ve ROC eğrisi analizleri uygulandı.

Bulgular: Nöbet geçiren hastalar, daha gençti (56 [35–71] - 68 [53–78], p<0,001). Nöbet grubunda laktat düzeyi (3,30 [1,90–6,50] - 2,00 [1,50–2,70], p<0,001) ve kreatin kinaz değerleri anlamlı olarak daha yüksek bulundu. Hipokalsemi, hiperkalsemi, hipofosfatemi, hiperfosfatemi ve hiperürisemi nöbetle ilişkili saptanırken, hiperkloremi nöbet gelişimine karşı koruyucu bir faktör olarak belirlendi. Çok değişkenli lojistik regresyon analizinde yalnızca laktat, nöbet gelişimi için bağımsız prediktör olarak kaldı (OR: 1,383; %95 GA: 1,280–1,494; p<0,001). ROC analizinde laktat, en yüksek ayırt edici güce sahip parametreydi (AUC=0,705); oluşturulan çok değişkenli modelin AUC değeri 0,720 idi.

Sonuç: Acil serviste bilinç kaybı ile başvuran hastalarda laktat düzeyi, nöbet tanısında güçlü bir biyobelirteç olarak öne çıkmaktadır. Elektrolit bozuklukları bazı alt gruplarda nöbetle ilişkili olmakla birlikte, çok değişkenli analizlerde bağımsız prediktör değildir. Bulgular, klinik pratikte laktat ölçümünün nöbet–senkop ve nöbet–diğer transient bilinç kaybı tablolarının ayırımında değerli bir tanısal destek aracı olabileceğini düşündürmektedir.

Keywords

• Nöbet
• elektrolit dengesizlikleri
• laktat
• acil servis
• biyobelirteç

Predictive Value of Plasma Electrolyte Levels in the Diagnosis of Seizures

Abstract

Aim: To evaluate the predictive value of plasma electrolyte levels and biochemical parameters in diagnosing seizures among adult patients presenting to the emergency department (ED) with loss of consciousness.

Material and Methods: This retrospective, single-center study included 1816 adult patients admitted to the ED of a tertiary university hospital between January 1, 2021, and January 1, 2024, with diagnoses of syncope, convulsion, stroke, or cerebrovascular disease. Patients were divided into seizure (n=418) and non-seizure (n=1398) groups. Demographic characteristics, electrolyte levels, lactate, creatine kinase, and uric acid values were compared. Risk analyses for electrolyte disturbances, logistic regression with seizure as the outcome, and ROC curve analyses were performed.

Results: Seizure patients were younger than non-seizure patients (56 [35–71] vs. 68 [53–78], p<0.001). Lactate (3.30 [1.90–6.50] vs. 2.00 [1.50–2.70], p<0.001) and creatine kinase levels were significantly higher in the seizure group. Hypocalcemia, hypercalcemia, hypophosphatemia, hyperphosphatemia, and hyperuricemia were associated with seizures, whereas hyperchloremia appeared protective. In multivariate logistic regression, only lactate was identified as an independent predictor of seizure (OR: 1.383, 95% CI: 1.280–1.494; p<0.001). Lactate had the highest discriminatory power in ROC analysis (AUC=0.705), while the overall multivariate model achieved an AUC of 0.720.

Conclusion: Elevated lactate levels serve as a strong biomarker for seizure diagnosis in ED patients presenting with loss of consciousness. Although several electrolyte disturbances were associated with seizures in univariate analyses, none remained independent predictors. These findings suggest that lactate measurement may provide valuable diagnostic support in distinguishing seizures from other causes of transient loss of consciousness.

Keywords

• Seizure
• electrolyte disturbances
• lactate
• emergency department
• biomarker

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