KOAH Alevlenmesi Nedeniyle Yoğun Bakımda Takip Edilen Hastalarda Akut Böbrek Hasarı ve Hastane İçi Mortaliteye Etki Eden Faktörlerin Değerlendirilmesi

Öz

Amaç: Kronik obstrüktif akciğer hastalığı (KOAH) akut alevlenmesi nedeniyle yoğun bakım ünitesinde izlenen hastalarda akut böbrek hasarı (ABH) sık görülen bir komplikasyondur. KOAH ve ABH hastalarında artmış sistemik inflamasyonun hastalık şiddeti ve mortaliteyle ilişkili olduğu bilinmektedir. Bu çalışmada, KOAH akut 
alevlenmesi nedeniyle yoğun bakım ünitesinde takip edilen hastalarda hastane içi mortaliteye etki eden faktörler ve ABH sıklığının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Haziran 2017 - Eylül 2023 tarihleri arasında KOAH akut alevlenmesi nedeniyle yoğun bakım ünitesine yatırılan 421 hasta retrospektif olarak değerlendirildi. Akut böbrek hasarı tanısı, serum kreatinin düzeyinde 48 saat içinde ≥0,3 mg/dL artış olması kriterine göre (KDIGO 2020) konuldu. Hastaların demografik, klinik ve laboratuvar verileri; beyaz küre, nötrofil, hemoglobin, albumin, prokalsitonin, üre (BUN), kreatinin, ürik asit ve fosfor düzeyleri dahil olmak üzere kaydedildi. Mortaliteyle ilişkili bağımsız belirteçler lojistik regresyon analizi ile değerlendirildi.
Bulgular: Hastaların yaş ortalaması 71,1±10,4 yıl olup %34,9’u kadındı. Toplam 421 hastanın 108’inde (%25,6) akut böbrek hasarı (ABH) saptandı. ABH gelişen hastalarda hastane içi mortalite oranı anlamlı olarak daha yüksekti (p<0,05). Hastane içi mortalite, hastaneye yatış süresince meydana gelen ölümleri kapsamaktadır ve 59 hastada (%14) gözlendi. Mortalite saptanan hastalarda beyaz küre (WBC), nötrofil, kan üre azotu (BUN), başlangıç ve 48. saat serum kreatinin, prokalsitonin (PCT), ürik asit ve fosfor düzeyleri istatistiksel olarak anlamlı şekilde daha yüksek; hemoglobin (HGB) ve albumin düzeyleri ise anlamlı olarak daha düşüktü (p<0,05). Lojistik regresyon analizinde ileri yaş, yüksek APACHE II skoru ve invaziv mekanik ventilasyon uygulaması mortaliteyle bağımsız olarak ilişkili bulundu (p<0,05).
Sonuç: KOAH akut alevlenmesi nedeniyle yoğun bakım üntesinde izlenen hastalarda ABH sık görülmekte ve mortaliteyle ilişkilidir. WBC, NE, HGB, albumin, PCT, kreatinin, BUN, fosfor ve ürik asit gibi biyobelirteçlerin izlenmesinin, mortalite tahmininde klinik olarak yararlı olabileceği düşünülmektedir. Bulgularımız, ileriye 
dönük ve çok merkezli çalışmalarla desteklenmelidir.
 

Anahtar Kelimeler

• Akut Böbrek Hasarı
• Kronik Obstrüktif Akciğer Hastalığı
• Hastane İçi Mortalite
• Yoğun Bakım Ünitesi
• Biyobelirteç

Destekleyen Kurum

Bu araştırma kamu, ticari veya kar amacı gütmeyen herhangi bir finansman kuruluşundan özel bir destek almamıştır.

Proje Numarası

Not applicable

Etik Beyan

After obtaining approval from the Fırat University Non-Invasive Ethics Committee (02 February 2024; No: 21851).

Teşekkür

Teşekkür edilecek kişi veya kurum bulunmamaktadır.

EVALUATION OF FACTORS AFFECTING ACUTE KIDNEY INJURY AND IN-HOSPITAL MORTALITY IN PATIENTS FOLLOWED UP IN INTENSIVE CARE UNIT DUE TO COPD EXACERBATION

Öz

Objective: Acute kidney injury (AKI) is a frequent complication among patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) who are admitted to intensive care units (ICUs). The presence of systemic inflammation in both COPD and AKI has been associated with increased disease severity and mortality. This study aimed to evaluate the incidence of AKI and identify factors associated with in-hospital mortality among ICU patients with acute COPD exacerbation.
Material and Methods: A total of 421 patients hospitalized in the ICU due to acute exacerbation of COPD between June 2017 and September 2023 were retrospectively analyzed. AKI was diagnosed according to KDIGO 2020 criteria (an increase in serum creatinine ≥0.3 mg/dL within 48 hours). Demographic, clinical, and laboratory parameters including white blood cell (WBC), neutrophil (NE), hemoglobin (HGB), albumin, procalcitonin (PCT), blood urea nitrogen (BUN), creatinine, uric acid, and phosphorus levels were recorded. Logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Results: The mean age of the patients was 71.1±10.4 years, and 34.9% were female. The incidence of AKI was 25.6% (n=108), and in-hospital mortality occurred in 14% (n=59) of patients. Those who died had significantly higher WBC, NE, BUN, creatinine, PCT, uric acid, and phosphorus levels, while HGB and albumin levels were significantly lower (p<0.05). Logistic regression analysis revealed that advanced age, higher APACHE-II score, and invasive mechanical ventilation were independent predictors of mortality. Conclusion: AKI is a common and clinically important complication in ICU patients with acute COPD exacerbation, contributing to higher mortality rates. Monitoring commonly used biomarkers such as WBC, NE, HGB, albumin, PCT, creatinine, BUN, phosphorus, and uric acid may provide useful insight into independent mortality prediction. Further large-scale, prospective, multicenter studies are warranted to confirm these findings.

Anahtar Kelimeler

• Acute Kidney Injury
• Chronic Obstructive Pulmonary Disease
• Mortality
• Intensive Care Unit
• Biomarkers

Destekleyen Kurum

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Proje Numarası

Not applicable

Etik Beyan

After obtaining approval from the Fırat University Non-Invasive Ethics Committee (02 February 2024; No: 21851).

Teşekkür

Not applicable

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