Sepsisli Hastalarda Transfüzyonu Belirlemede Şok İndekslerinin Rolü

Yıl 2021, Cilt 31, Sayı 2, 125 - 129, 30.06.2021

Esra ÇAKIR Ahmet BİNDAL Pakize ÖZÇİFTCİ YILMAZ Mehmet MUTLU Cihangir DOĞU Işıl ÖZKOÇAK TURAN

https://doi.org/10.15321/GenelTipDer.2021.298

Öz

Amaç: Şok indeksleri özellikle hemorajik şok durumunda transfüzyonu ön görmede kullanılmaktadır. Ancak sepsis hastalarında transfüzyonu belirlemek için şok indekslerinin kullanımı konusunda yeterli çalışma yoktur. Çalışmamızda Yoğun bakım ünitesine (YBÜ) yatan sepsis ve septik şoktaki hastalarda şok indeksi (SI), modifiye şok indeksi (MSI) ve yaş şok indeksinin (YSI) hastaların eritrosit transfüzyonunu ön görmede kullanılabilirliğinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmamız Anesteziyoloji ve Yoğun Bakım Ünitesi Kliniğinde 1 Kasım 2017 ile 31 Aralık 2018 tarihleri arasında retrospektif hasta verileri değerlendirilerek yapıldı. Hastaların yaşları, cinsiyetleri, eşlik eden hastalıkları, akut fizyoloji ve kronik sağlık değerlendirme (APACHE II) skoru, mekanik ventilasyon süresi, yatış süresi, hemoglobulin değerleri, SI, MSI, YSI, eritrosit transfüzyon verileri kayıt edildi. Bulgular: Çalışmaya 225 hasta dahil edildi. Şok indeksi, MSI, YSI düzeyleri eritrosit transfüzyonu gerektiren hastalarda gerektirmeyen hastalara göre istatistiksel olarak anlamlı yüksekti (p<0,05). Şok indeksi için ROC (receiver operating characteristic) eğrisi altındaki alan 0,691'dir (% 95 güven aralığı (GA): 0,626 - 0,751 P = 0,0002). Transfüzyon için SI eşik değeri 0,98’dir (duyarlılık: %86,8, %95 GA: 71,9-95,5, özgüllük: %46,52, %95 GA: 39,2-53,9). MSI için ROC eğrisi altındaki alan 0,666’dır (% 95 GA: 0,601-0,728 P = 0,0012). Transfüzyon için MSI eşik değeri 1,67’dir (duyarlılık: %57,9 %95 GA: 40,8-73,7, özgüllük: %72,7, %95 GA: 65,7-79). Yaş SI için ROC eğrisi altındaki alan 0,639’'dur (% 95 GA: 0,572-0,702 P = 0,0076). Transfüzyon için YSI eşik değeri 102,85’tir (duyarlılık: %39,5, %95 GA: 21,4-56,6, özgüllük: %89,8, %95 GA: 84,6-93,8). Sonuç: Sepsis hastalarında şok indeksleri transfüzyon ihtiyacını belirlenmede kullanılabilir. Ancak şok indeksleri ile beraber ek parametrelerin kullanılması gerekmektedir.

Anahtar Kelimeler

Eritrosit Transfüzyonu, Yoğun Bakım Ünitesi, Şok İndeksi, Modifiye Şok İndeksi, Yaş Şok İndeksi

The Role of Shock Indices in Determining Transfusion in Patients with Sepsis

Öz

Objective: Shock indices are especially used in hemorragic shocks in order to predict if transfusion is needed or not. But there is not sufficient data for the usage of shock indices in order to predict transfusion needs for septic patients. In this study, we aimed to determine the availibility of shock index (SI), modified shock index (MSI) and age shock index (ASI) for the predicition of transfusion needs in septic and septic shock pateints Material and Methods: We retrospectively evaluated the results of patients who were hospitalized in ICU, between November 1, 2017 and December 31, 2018. We recorded age, gender, co-morbidities, acute physiology and chronic health evaluation II (APACHE II) scores, length of mechanical ventilation, length of hospital stay, hemoglobin levels, SI, MSI and ASI, erythrocyte transfusion requirement. Results : We evaluated 225 patients. SI, MSI and ASI levels were significantly higher in patients requiring erythrocyte transfusion compared with patients not receiving transfusion (p < 0.05). For SI, the area under the receiver operating characteristic (ROC) curve was 0.691 (95% confidence interval (CI): 0.626–0.751, p = 0.0002) and cutoff value for transfusion was 0.98 (sensitivity: 86.8%, 95% CI: 71.9-95.5; specificity: 46.52%, 95% CI: 39..2-53.9). For MSI, the area under the ROC curve was 0.666 (95% CI: 0.601–0.728, p = 0.0012) and cutoff value for transfusion was 1.67 (sensitivity: 57.9%, 95% CI: 40.8-73.7; specificity: 72.7%, 95% CI: 65.7-79). For ASI, the area under the ROC curve was 0.639 (95% CI: 0.572–0.702, p = 0.0076) and cutoff value for transfusion was 102.85 (sensitivity: 39.5%, 95% CI: 21.4–56.6; specificity: 89.8%, 95% CI: 84.6–93.8). Discussion: Shock indices can be used in septic pateints in order to predict their erytocyte transfusion needs. Additional parameters are needed to be used together with septic indices.

Anahtar Kelimeler

Erythrocyte Transfusion, Intensive Care Unit, Shock Index, Modified Shock Index, Age Shock Index

Kaynakça

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