Abstract

Giriş ve Amaç: Bu retrospektif çalışmanın amacı, prognozun ölümcül olabileceği perkütan dilatasyonel trakeostomi (PDT) uygulanan hastalarda mortaliteyi öngörmede biyokimyasal parametrelerin biyobelirteç olarak kullanılma olasılığını araştırmaktır.

Gereç ve Yöntem: Hastaların demografik özellikleri, erken komplikasyonları, yoğun bakımda gün sayısı ve mortalite oranları kaydedildi. Ek olarak, PDT prosedüründen 1 gün önce ve 1 gün sonra alınan venöz kan örneklerinden elde edilen veriler kaydedildi, nötrofil-lenfosit oranları (NLR) ve trombosit-lenfosit oranları (PLR) değerlendirildi. Hastalar 2 gruba ayrıldı: Hayatta Kalanlar grubu (PDT uygulanan ve tedaviden sonra hastaneden taburcu edilenler, n=20) ve Hayatta Kalamayanlar grubu (PDT uygulanan ancak tedaviden sonra hastanede ölen hastalar, n=67).

Bulgular: Yoğun bakımda gün sayısı (p=0.006), preoperatif nötrofil sayısı (p=0.041) ve postoperatif NLR (p=0.041) açısından gruplar arasında anlamlı bir fark bulundu. Hayatta Kalamayanlar grubundaki hastaların ameliyat öncesi ve sonrası kan parametrelerinde lenfosit sayısı (p<0.001), Ortalama Trombosit Hacmi (MPV) (p=0.002) ve PLR ​​(p<0.001) değerleri arasında fark saptandı . Korelasyon analizinin sonuçları prognoz ile nötrofil sayısı (p = 0.040) arasında ve prognoz ile PDT sonrası NLR (p=0.040) arasında pozitif bir korelasyon olduğunu, ancak hastanede kalış süresi ve prognozu ile negatif korelasyonunu ortaya koydu. (p=0.005). ROC eğrisi analizi, 6.91 kesme noktası üzerinde sadece% 68.7 hassasiyet ve 0 60.0 özgüllük gösteren PDT sonrası NLR değerinin, ölümle sonuçlanacak bir prognozun spesifik ve hassas bir biyomedikal belirleyicisi ve öngörücüsü olabileceğini göstermiştir.

Sonuç: Bu pilot çalışmanın bir sonucu olarak, PDT sonrası ölçülen NLR seviyesinin PDT uygulanan hastalar için mortalite riskini tahmin etmede prognostik bir biyobelirteç olabileceği söylenebilir.

Keywords

• Trakeostomi,mortalite,biyobelirteçler,Griggs tekniği

Can biochemical biomarkers predict mortality in percutaneous dilatational tracheostomies?

Abstract

Aim: The aim of this retrospective study was to explore the possibility of using biochemical parameters as biomarkers in predicting mortality in patients undergoing percutaneous dilatational tracheostomy (PDT) where the prognosis may be fatal.
Material and Method: The patients’ demographic features, early complications, days in the intensive care unit and mortality rates were recorded. Additionally, data obtained from venous blood samples taken 1 day prior to and 1 day following the PDT procedure were noted, neutrophil-to-lymphocyte ratios (NLR) and platelet-to-lymphocyte ratios (PLR) were assessed. Patients were divided into 2 groups: the survivor group (those who underwent PDT and were discharged from the hospital after treatment, n=20) and the non-survivor (patients who underwent PDT but died at the hospital after treatment, n=67).
Results: A significant difference was found between the groups in terms of a number of days in intensive care (p=0.006), preoperative neutrophil count (p=0.041) and postoperative NLR (p=0.041). Differences were seen in the pre- and postoperative blood parameters of the patients in the non-survivor group in terms of lymphocyte count (p<0.001), Mean Platelet Volume (MPV) (p=0.002) and PLR (p<0.001) values. The results of the correlation analysis revealed a positive correlation between the prognosis and the neutrophil count (p=0.040) and between the prognosis and post-PDT NLR (p=0.040), but a negative correlation between the prognosis and duration of the hospital stay (p=0.005). ROC curve analysis showed that only the post-PDT NLR value, indicating 68.7% sensitivity and 60.0% specificity over the 6.91 cut-off point, could be a specific and sensitive biomedical marker and predictor of a prognosis that would end in mortality.
Conclusion: As a result of this pilot study, it can be argued that the NLR level measured post-PDT can be a prognostic biomarker in predicting the risk of mortality for patients undergoing PDT. 

Keywords

• Tracheostomy,mortality,biomarkers,Griggs technique

References

1. 1. Singh J, Sing RF. Performance, long term management, and coding for percutaneous dilatational tracheostomy. Chest 2018.
2. 2. Al-Ansari MA, Hijazi MH. Clinical review: percutaneous dilatational tracheostomy. Crit Care 2006; 10: 202.
3. 3. Lerner AD, Yarmus L. Percutaneous dilatational tracheostomy. Clinics Chest Med 2018; 39: 211-22.
4. 4. Mehta C, Mehta Y. Percutaneous tracheostomy. Ann Card Anaesth. 2017; 20: 19-25.
5. 5. Batuwitage B, Webber S, Glossop A. Percutaneous tracheostomy. Continuing Education in Anaesthesia, Critical Care & Pain 2014; 14: 268-72.
6. 6. Karimpour HA, Mohammadi S. Percutaneous dilatational tracheostomy via Griggs technique. Archives Iran Med 2017; 20: 49.
7. 7. Ambesh S, Sinha P, Tripathi M, Matreja P. Laryngeal mask airway vs endotracheal tube to facilitate bedside percutaneous tracheostomy in critically ill patients: a prospective comparative study. J Postgraduate Med 2002; 48: 11.
8. 8. Şahiner İT, Şahiner Y. Bedside percutaneous dilatational tracheostomy by Griggs technique: A single-center experience. Medical science monitor: Int Medical J Experiment Clin Res 2017; 23: 4684.

9. 9. Klotz R, Probst P, Deininger M, et al. Percutaneous versus surgical strategy for tracheostomy: a systematic review and meta-analysis of perioperative and postoperative complications. Langenbecks Arch Surg 2018; 403: 137-49.
10. 10. Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care 2006; 10: R55.
11. 11. Bowen CP, Whitney LR, Truwit JD, et al. Comparison of safety and cost of percutaneous versus surgical tracheostomy. Am Surg 2001; 67: 54-60.
12. 12. McHenry CR, Raeburn CD, Lange RL, Priebe PP. Percutaneous tracheostomy: a cost-effective alternative to standard open tracheostomy. Am Surg 1997; 63: 646-51.
13. 13. Kornblith LZ, Burlew CC, Moore EE, et al. One thousand bedside percutaneous tracheostomies in the surgical intensive care unit: time to change the gold standard. J Am College Surgeons 2011; 212: 163-70.
14. 14. Goldenberg D, Golz A, Huri A, et al. Percutaneous dilation tracheotomy versus surgical tracheotomy: our experience. Otolaryngology–Head Neck Surg 2003; 128: 358-63.
15. 15. Rumbak MJ, Newton M, Truncale T, et al. A prospective, randomized, study comparing early percutaneous dilatational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 2004; 32: 1689-94.
16. 16. Taşkaldiran I, Omma T, Önder ÇE, et al. Neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, platelet to lymphocyte ratio in different etiological causes of thyrotoxicosis. Turk J Med Sci 2019; 49: 1687-92. doi: 10.3906/sag-1901-116.
17. 17. Ma L, Zeng A, Chen B, Chen Y, Zhou R. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with systemic lupus erythematosus and their correlation with activity: A meta-analysis. Int Immunopharmaco. 2019; 76: 105949. doi: 10.1016/j.intimp.
18. 18. Tekin YK. Are neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios associated with mortality in pediatric trauma patients? a retrospective study. Rambam Maimonides Med J 2019; 10: 4.