The Predictors of Early Mortality in Geriatric Patients who Hospitalized to the Intensive Care Unit with Aspiration Pneumonia

Öz

Aim In the geriatric group, aspiration pneumonia is one of the most common causes of Intensive Care Unit admission. Multiple comorbidities related with systemic diseases, as well as dementia, fraility and difficulty in swallowing or protecting the airway may all contribute the development of the AP in the geriatric age. Furthermore, many other variables may influence the outcome of this patient group. In this study, it is aimed to determine the parameters that may have an effect on the intensive care mortality. Materials and Methods 221 patients aged ≥ 80 years who were admitted to the third level ICU with the diagnosis of aspiration pneumonia were retrospectively analyzed. They were divided into two groups according to the 28-day outcome (survived-nonsurvived). The admission levels of arterial blood Ph and pCO2 and lactate , blood urea, creatinine, potassium (K) and sodium (Na) levels, APACHE II, Glaskow Coma Scale (GCS), modified shock index (MSI) and the aspiration pneumonia's source ( community-acquired aspiration pneumonia (CA-AP) or healthcare-associated aspiration pneumonia (HCA-AP) )were recorded.The effects of these variables on 28-day mortality were analyzed. Results The presence of HCA-AP, GCS and APACHEII scores were found to be significantly correlated between the two groups. ROC analysis were done for those variables and cutoff points werecalculated. Logistic regression analysis indicated that APACHEII (>22.5,AUC:0.812,P=0.00) and GCS (<9, AUC:0.730, P=0.00) as the most prominentin dependent predictors of mortality (p<0,05, odds ratio 7.68, 3.23 respectively) with the presence of HCA-AP. Conclusion Although many variables are significant in predicting the first 28 days of mortality in ICU admission of geriatric patients with aspiration pneumonia, the presence of HCA-AP, high hospitalization APACHE II score and low GCS score were significant independent variables.

Anahtar Kelimeler

• aspiration pneumonia
• geriatrics
• mortality predictors
• intensive care units
• healthcare-associated aspiration pneumonia

Aspirasyon Pnömonisi ile Yoğun Bakım Ünitesine Yatan Geriatrik Hastalarda Erken Mortalite Belirteçleri

Öz

Amaç Geriatrik grupta aspirasyon pnömonisi en sık Yoğun Bakıma yatış nedenlerinden biridir. Sistemik hastalıklarla ilişkili çoklu komorbiditelerin yanı sıra demans, kırılganlık ve yutma veya hava yolunu koruma güçlüğü geriatrik yaşta aspirasyon pnömonisinin oluşumuna katkıda bulunabilir. Ayrıca, diğer birçok değişken bu hasta grubunun sonucunu etkileyebilir. Bu çalışmada yoğun bakım mortalitesine etkisi olabilecek parametrelerin belirlenmesi amaçlanmıştır. Materyal ve Metod Aspirasyon pnömonisi tanısı ile üçüncü basamak yoğun bakım ünitesine yatırılan 80 yaş ve üzeri 221 hasta retrospektif olarak incelendi. 28 günlük sonuçlara göre iki gruba ayrıldılar (hayatta kalanlar ve hayatta kalmayanlar). Arteriyel kan Ph ve pCO2 ve laktat, kan üre, kreatinin, potasyum (K) ve sodyum (Na) seviyeleri, APACHE II, Glaskow Koma Ölçeği (GCS), modifiye şok indeksi (MSI) ve aspirasyon pnömonisinin kaynağı ( toplum kökenli aspirasyon pnömonisi (CA-AP) veya sağlık hizmeti ile ilişkili aspirasyon pnömonisi (HCA-AP)) kaydedildi. Bu değişkenlerin 28 günlük mortalite üzerindeki etkileri analiz edildi. Bulgular HCA-AP, GCS ve APACHEII skorlarının varlığı iki grup arasında anlamlı olarak ilişkili bulundu. Bu değişkenler için ROC analizi yapıldı ve kesme noktaları hesaplandı. Lojistik regresyon analizi, APACHEII(>22.5, AUC:0.812,P=0.00) ve GCS'nin (<9, AUC:0.730, P=0.00) HCA-AP varlığı ilebirlikte mortalitenin en belirgin bağımlı belirleyicileri olduğunu gösterdi (p<0.05, olasılık oranı 7.68 , 3,23 sırasıyla). Sonuç Aspirasyon pnömonisi olan geriatrik hastaların yoğun bakım ünitesine yatışlarında ilk 28 günlük mortaliteyi öngörmede birçok değişken anlamlı olmakla birlikte, HCA-AP varlığı, yüksek yatış APACHE II skoru ve düşük GCS skoru anlamlı bağımsız değişkenlerdi.

Anahtar Kelimeler

• aspirasyon pnömonisi
• geriatri
• mortalite öngörücüleri
• yoğun bakım üniteleri
• sağlık hizmeti ilişkili aspirasyon pnömonisi

Kaynakça

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