Medikal yoğun bakım ünitesinde takip edilen sistemik romatolojik hastalığı olan hastaların klinik özellikleri, sonuçları ve prognostik faktörleri: Retrospektif tek merkezli çalışma

Yıl 2025, Cilt: 30 Sayı: 1, 40 - 47, 29.01.2025

Tuba Demirci Yıldırım , Süleyman Yıldırım , Cenk Kıraklı

https://doi.org/10.21673/anadoluklin.1446032

Öz

Amaç: Sistemik romatolojik hastalıklar, birçok organı etkileyebilen ve sıklıkla hastalığın şiddeti veya komplikasyonları nedeni ile yoğun bakım yatışı gereken bir grup hastalıktır. Bu çalışmada, medikal yoğun bakım ünitesinde (YBÜ) takip edilen sistemik romatolojik hastalık tanılı hastaların klinik özellikleri ve mortalite ile ilişkili faktörlerin değerlendirilmesini amaçladık.

Yöntemler: Bu retrospektif çalışma 1 Ocak 2018 ve 31 Aralık 2022 tarihleri arasında medikal YBÜ’ de yapılmıştır. On sekiz yaş ve üzerinde bilinen veya yeni tanı almış sistemik romatolojik hastalığı olan ve YBÜ’de 48 saatten daha uzun süre takip edilen hastalar çalışmaya dahil edildi. Hastaların YBÜ’ye yatış nedenleri, klinik özellikleri ve mortalite ile ilişkili faktörleri değerlendirildi.

Bulgular: Çalışmaya dahil edilen 76 hastanın ortalama yaşı 60.8±15.0 yıldı ve en sık sistemik romatolojik hastalık romatoid artrit (%39) olarak tespit edildi. Yoğun bakıma en sık kabul edilme nedeni akut solunum yetmezliği (%64) ve septik şoktu (%16). Toplam 41 (%54) hasta YBÜ takipleri esnasında vefat etti. Vefat eden hastalar yaşayan hastalar ile karşılaştırıldığında daha ileri yaşta (ortalama yaş, 66.1 vs. 54.8 yıl, p=0.005) ve daha yüksek APACHE-2 skoruna (ortanca, 24 vs. 14, p<0.001) sahipti. APACHE-2 skorunun 19 ve üzeri olmasının %82 sensitivite ve %80 spesifite ile sistemik romatolojik hastalığı olanlarda mortaliteyi gösterdiği tespit edildi.

Sonuç: Sistemik romatolojik hastalığı olan hastalarda yoğun bakım mortalitesi yüksektir. APACHE-2 skoru YBÜ’ de takip edilen sistemik romatolojik hastalığı olanlarda prognostik bir göstergedir.

Anahtar Kelimeler

APACHE II, ölüm oranı, romatizmal hastalıklar, yoğun bakım üniteleri

Clinical characteristics, outcomes, and prognostic factors of patients with systemic rheumatic diseases in medical intensive care unit: A retrospective single center study

Öz

Aim: Systemic rheumatic diseases are a group of diseases that can affect several organs and occasionally need intensive care unit (ICU) admission due to the severity of diseases or complications. In this study, we aimed to investigate clinical features and factors associated with mortality in patients with systemic rheumatic diseases who were followed up in the medical ICU

Methods: This retrospective cohort study was conducted at a medical ICU, between January 1, 2018, and December 31, 2022. Patients who were 18 years older and with known or newly diagnosed systemic rheumatic diseases who were followed up in the ICU for more than 48 hours were included in the study. The cause of admission, clinical characteristics, and factors associated with mortality were evaluated.

Results: A total of 76 patients were included in the final analysis; the mean age was 60,8±15.0 years and rheumatoid arthritis (RA) (39%) was the most common systemic rheumatic disease. Acute respiratory failure (64%) was the most common reason for ICU admission, followed by septic shock (16%). A total of 41 (54%) patients died during their ICU stay. Non-survivor patients were older (mean age, 66.1 vs. 54.8 years, p=0.005) and had a higher APACHE-2 score than survivors (median, 24 vs. 14, p<0.001). APACHE-2 score ≥19 predicted mortality with 82% sensitivity and 80% specificity in patients with systemic rheumatic diseases.

Conclusions: ICU mortality was higher in patients with systemic rheumatic diseases. APACHE-2 score is a prognostic factor for ICU mortality in patients with systemic rheumatic diseases.

Anahtar Kelimeler

APACHE II, intensive care units, mortality, rheumatic diseases

Kaynakça

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