Vücut kitle indeksi ve komorbiditelerin yoğun bakım ünitesinde nozokomiyal pnömoni olan hastaların prognozuna etkisi

Abstract

Amaç: Bu çalışmanın amacı, Akdeniz Üniversitesi Anestezi Yoğun Bakım Ünitelerinde (YBÜ) ventilatör ilişkili pnömoni (VAP) hastalarında prognoz ile ilişkili olabilecek hasta ve diğer ilgili özellikleri, örneğin vücut kitle indeksi (VKİ) ve komorbiditeleri belirlemektir. Yöntemler: Bu çalışma, yoğun bakım ünitesinde VAP tanısı alan hastaları içeren retrospektif bir kohort çalışması olarak tasarlanmıştır. Elde edilen ve analiz edilen demografik ve klinik veriler yaş, cinsiyet, komorbiditeler, BMI, Charlson komorbidite indeksi (CCI) ve yoğun bakım ünitesine yatış nedeniydi. Hastaların klinik ciddiyeti Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi-II (APACHE II) skoru ve Sıralı Organ Yetmezliği Değerlendirmesi (SOFA) skoru ile belirlendi. Sonuçlar: Çalışma, VAP tanısı alan 111 hastayı kapsamaktadır. VAP hastalarında genel yoğun bakım ünitesi mortalitesi %64, 28 günlük yoğun bakım ünitesi mortalitesi ise %55 olarak saptanmıştır. Çalışmada, mortalite ile bağımsız olarak ilişkili olduğu belirlenen bir dizi faktör saptanmıştır. Bu faktörler arasında yaşın artması, yüksek CCI, APACHE II, SOFA skorları, diabetes mellitus, solid organ malignitesi ve immünosupresyonun varlığı (kronik kortikosteroid kullanımı ve immünosupresif tedavi) yer almaktadır. Sonuç: VAP, yoğun bakım ünitelerinde önemli bir sorun olmaya devam etmekte ve bu hastalarda mortalite önemli bir sorun teşkil etmektedir. Daha etkili kontrol önlemlerinin uygulanması büyük önem taşımaktadır. Tek bir parametre seti yerine kombine bir modelin kullanılması, bu hastalarda mortalitenin daha kesin bir şekilde tahmin edilmesini kolaylaştırabilir.

Keywords

• Yoğun bakım Ünitesi
• Mortalite
• Ventilatör ilişkili pnömoni

Prognostic factors in intensive care unit patients with ventilator associated pneumonia: the role of comorbidity and clinical severity scores

Abstract

Aims: The objective of this study is to ascertain patient and other related characteristics, such as body-mass index (BMI) and comorbidities, that may be associated with prognosis in patients with ventilator-associated pneumonia (VAP) in the Anaesthesia Intensive Care Units (ICU) of Akdeniz University. Methods: It was designed as a retrospective cohort study in which patients with a diagnosis of VAP in the ICU was included. The demographic and clinical data obtained and analysed were age, gender, comorbidities, BMI, Charlson Comorbidity Index (CCI) and the reason for admission to the ICU. The clinical severity of patients was determined by the Acute Physiology and Chronic Health Evaluation-II (APACHE II) score and the Sequential Organ Failure Assessment (SOFA) score. Results: The study comprised of 111 patients diagnosed with VAP. The overall ICU mortality in VAP patients was 64%, and the 28-day ICU mortality was 55%. A number of factors have been identified as being independently associated with mortality in the studied cohort. These factors include increasing age, SOFA score on the day of VAP and the presence of chronic corticosteroid use. Conclusion: VAP remains a significant problem in ICUs, and mortality is a major issue in these patients. The implementation of more effective control measures is of great importance. Among all the variables studied, age and SOFA score demonstrated the most consistent and statistically significant discriminatory power.

Keywords

• Intensive care unit
• mortality
• ventilator associated pneumonia

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