Septik şok nedeniyle yoğun bakım ünitesine yatırılan kronik obstrüktif akciğer hastalığı olan hastalarda hastane içi ölüm ile ilişkili faktörler

Year 2025, Volume: 16 Issue: 1, 186 - 194, 25.03.2025

Korhan Kollu , Selma Özlem Çelikdelen

https://doi.org/10.18663/tjcl.1651695

Abstract

Amaç: Bu çalışma, septik şok nedeniyle yoğun bakım ünitesine (YBÜ) kabul edilen kronik obstrüktif akciğer hastalığı (KOAH) olan hastalarda hastane içi ölüm ile ilişkili faktörleri değerlendirmeyi amaçladı.
Gereç ve Yöntemler: Bu retrospektif çalışmaya, bir üçüncü basamak yoğun bakım ünitesinde septik şok tanısı almış 62 KOAH hastası dahil edildi. Sepsis-3 kriterleri, septik şok tanısını koymada kullanıldı. Elektronik tıbbi kayıtlar aracılığıyla demografik ve klinik veriler, komorbid durumlar, laboratuvar parametreleri, inflamatuar belirteçler, Akut Fizyoloji ve Kronik Sağlık Değerlendirme II (APACHE II) skoru, Sekansiyel Organ Yetmezliği Değerlendirme (SOFA) skoru ve klinik sonuçlar toplandı. Modifiye Charlson Komorbidite İndeksi (mCCI), hastaların hastane öncesi dönemde sahip olduğu komorbid durumlar kullanılarak hesaplandı.
Bulgular: Çalışma popülasyonunun ortalama yaşı 70.6 ± 11.0 yıl olup, %67.7'si erkekti. Daha yüksek mCCI skorları [Hazard oranı (HR):1.23, p = 0.002], yüksek APACHE II (HR: 1.15, p < 0.001) ve SOFA skorları (HR: 1.35, p < 0.001) ile birlikte hastane içi ölümün bağımsız öngörücüleriydi. Laboratuvar parametreleri arasında, yüksek prokalsitonin (HR: 1.04, p < 0.001) ve C-reaktif protein (HR: 1.03, p < 0.001) seviyeleri tek değişkenli analizde mortalite ile ilişkili bulundu, ancak çok değişkenli regresyon analizinde anlamlılığını korumadı. Mortaliteyi öngörmede mCCI eşik değeri ≥7 olarak belirlendi ve bu değer, %72.5 duyarlılık ve %94.7 özgüllük gösterdi.
Sonuç: Septik şoklu KOAH hastalarında, mCCI, APACHE II ve SOFA skorlarıyla mortalitenin önemli bir bağımsız öngörücüsü olarak belirlendi. Bu yüksek riskli popülasyonda, mCCI risk sınıflandırması için yararlı bir araç olabilir.

Keywords

Eşlik eden hastalık, kronik obstrüktif akciğer hastalığı, inflamasyon, septik şok, sağkalım

Ethical Statement

The study was conducted with the permission of the XXX University Hospital Ethics Committee (Date: 26.09.2024, Decision No: 2024/005).

Factors associated with in-hospital mortality in patients with chronic obstructive pulmonary disease hospitalized to the intensive care unit due to septic shock

Abstract

Aim: This study aimed to evaluate in-hospital mortality-related factors in patients with chronic obstructive pulmonary
disease (COPD) who were admitted to the intensive care unit (ICU) due to septic shock.
Material and Methods: This retrospective study included 62 COPD patients diagnosed with septic shock in a tertiary ICU. The Sepsis-3 criteria were used to establish the diagnosis of sepsis shock. Demographic and clinical data, including comorbid conditions, laboratory parameters, inflammatory markers, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Sequential Organ Failure Assessment (SOFA) scores, and clinical outcomes were collected from electronic medical records. The modified Charlson Comorbidity Index (mCCI) calculation was based on the available comorbid conditions collected in the prehospital setting.
Results: The mean age of the study population was 70.6 ± 11.0 years, and 67.7% were male. Higher mCCI scores [Hazard ratio (HR): 1.23, p = 0.002], along with elevated APACHE II (HR: 1.15, p < 0.001) and SOFA scores (HR: 1.35, p < 0.001), were independent predictors of in-hospital mortality. Among laboratory parameters, higher procalcitonin (HR: 1.04, p < 0.001), and C-reactive protein (HR: 1.03, p< 0.001) were associated with mortality in univariate analysis but did not remain significant in multivariate regression. The optimal mCCI cut-off for predicting mortality was ≥7, yielding a sensitivity of 72.5% and specificity of 94.7%.
Conclusion: The mCCI, along with APACHE II and SOFA scores, serves as a significant independent predictor of mortality in COPD patients with septic shock. The mCCI may be a useful tool for risk stratification in this high-risk population.

Keywords

Comorbidity, chronic obstructive pulmonary disease, inflammation, septic shock, survival

Ethical Statement

The study was conducted with the permission of the XXX University Hospital Ethics Committee (Date: 26.09.2024, Decision No: 2024/005).

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