Ürosepsis nedeniyle hastaneye yatırılan hastalarda Sistemik İmmün-Enflamasyon İndeksi'nin (SII) prognostik değeri

Öz

Giriş: Ürosepsis, idrar yolu enfeksiyonlarından kaynaklanan ciddi ve yaşamı tehdit eden bir durumdur. Doğru ve erken prognostik göstergeler, klinik yönetimi yönlendirmek ve hasta sonuçlarını iyileştirmek için gereklidir. Periferik kan parametrelerinden elde edilen bir belirteç olan Sistemik Bağışıklık-Enflamasyon İndeksi (SII), son zamanlarda çeşitli hastalıklarda potansiyel bir prognostik araç olarak ortaya çıkmıştır. Bu çalışma, ürosepsis tanısı konulan hastalarda hastane içi mortaliteyi öngörmede SII'nin prognostik değerini değerlendirmeyi amaçlamaktadır. Yöntemler: Ocak 2023 ile Ocak 2025 tarihleri arasında üçüncü basamak bir hastanenin acil servisine ürosepsis tanısı ile yatırılan 312 yetişkin hasta üzerinde retrospektif bir kohort çalışması gerçekleştirdik. Demografik bilgiler, komorbiditeler, laboratuvar değerleri ve klinik sonuçlara ilişkin veriler toplandı. SII, trombosit sayısı × nötrofil sayısı / lenfosit sayısı olarak hesaplandı. Mortalitenin bağımsız belirleyicilerini tanımlamak için tek değişkenli ve çok değişkenli lojistik regresyon analizleri kullanıldı. SII'nin ayırt edici gücünü belirlemek için alıcı işletim karakteristiği (ROC) analizi kullanıldı. Sonuçlar: Çalışma popülasyonunda 64 hasta (%20,5) hastanede yatış sırasında hayatını kaybetti. Hayatta kalamayanların medyan SII değerleri, hayatta kalanlara kıyasla anlamlı olarak daha yüksekti (2328'e karşı 1392, p<0,001). Çok değişkenli lojistik regresyon, SII'nin hastane içi mortalitenin bağımsız bir belirleyicisi olduğunu ortaya koydu (OR: 2,13; %95 CI: 1,47–3,08; p=0,001). ROC analizi, SII için 0,782 AUC değeri gösterdi; optimal kesme değeri 2010 olup, %76,5 duyarlılık ve %71,8 özgüllük sağladı. Sonuç: SII, rutin laboratuvar parametreleri kullanılarak hesaplanabilen basit, maliyet etkin ve bağımsız bir prognostik biyomarkerdir. Yüksek SII, ürosepsis hastalarında hastane içi mortalite riskinin artmasıyla anlamlı bir şekilde ilişkilidir. Erken risk sınıflandırma modellerine dahil edilmesi, klinik karar vermeyi kolaylaştırabilir ve hasta sonuçlarını iyileştirebilir.

Anahtar Kelimeler

• ürosepsis
• Sistemik İmmün-Enflamasyon İndeksi
• prognoz

The Prognostic Value of Systemic Immune-Inflammation Index (SII) in Patients Hospitalized with Urosepsis

Öz

Background: Urosepsis is a severe and life-threatening condition originating from urinary tract infections. Accurate and early prognostic indicators are essential for guiding clinical management and improving patient outcomes. The Systemic Immune-Inflammation Index (SII), a marker derived from peripheral blood parameters, has recently emerged as a potential prognostic tool in various diseases. This study aims to evaluate the prognostic value of SII in predicting in-hospital mortality among patients diagnosed with urosepsis. Methods: We conducted a retrospective cohort study of 312 adult patients admitted to the emergency department of a tertiary care hospital with a diagnosis of urosepsis between January 2023 and January 2025. Data on demographics, comorbidities, laboratory values, and clinical outcomes were collected. SII was calculated as platelet count × neutrophil count/lymphocyte count. Univariate and multivariate logistic regression analyses were used to identify independent predictors of mortality. Receiver operating characteristic (ROC) analysis was employed to determine the discriminatory power of SII. Results: Among the study population, 64 patients (20.5%) died during hospitalization. Non-survivors had significantly higher median SII values compared to survivors (2328 vs. 1392, p<0.001). Multivariate logistic regression revealed that SII was an independent predictor of in-hospital mortality (OR: 2.13; 95% CI: 1.47–3.08; p=0.001). ROC analysis demonstrated an AUC of 0.782 for SII, with an optimal cutoff value of 2010 yielding a sensitivity of 76.5% and specificity of 71.8%. Conclusion: SII is a simple, cost-effective, and independent prognostic biomarker that can be calculated using routine laboratory parameters. Elevated SII is significantly associated with increased risk of in-hospital mortality in urosepsis patients. Its incorporation into early risk stratification models may enhance clinical decision-making and improve patient outcomes.

Anahtar Kelimeler

• Urosepsis
• Systemic Immune-Inflammation Index
• prognosis

Kaynakça

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