AKUT KARIN PATOLOJİLERİ İLE ACİL SERVİSE BAŞVURAN GERİATRİK HASTALARDA PROGNOZU ÖNGÖRMEDE KLİNİK KIRILGANLIK ÖLÇEĞİ'NİN ETKİNLİĞİNİN DEĞERLENDİRİLMESİ: PROSPEKTİF ÇALIŞMA

Öz

AMAÇ: Klinik kırılganlık indeksi, 1 (çok iyi) ile 9 (ölümcül hasta) arasında değişen bir kırılganlık puanı oluşturmak amacı ile işlev, komorbidite ve biliş dahil olmak üzere belirli alanları değerlendirir. Bu çalışmanın amacı, akut abdominal patolojileri olan geriatrik hastalarda mortaliteyi öngörmede klinik kırılganlık indeksinin etkinliğini araştırmaktır.
GEREÇ VE YÖNTEM: 01.10.2020 - 31.03.2021 tarihleri arasında acil servise akut abdomen patolojisi ile başvuran 65 yaş üstü hastalar çalışmaya alındı. Klinik kırılganlık indeksi hesaplanıp kaydedildi ve 1’den 9’a kadar gruplara ayrıldı. İstatistiksel analiz SPSS 22.0 ile gerçekleştirildi.
BULGULAR: Çalışmamıza 151 hasta dahil edildi ve hastaların %53’ü kadın hasta idi. Yaş ortalaması 75,57±8,078 olup; 22(14,56%) hasta ex oldu. Hastalarımızın klinik kırılganlık indeksi incelemesinde mortal olan grupta CFS istatistiksel anlamlı olarak daha yüksek düzeyde tespit edildi (p<0,001). Hastalarımızın 83 (%55)’ü opere edildi. Opere olan ve opere olmayan grupta klinik kırılganlık indeksinin mortalite ile ilişkisi bakımından istatistiksel olarak anlamlı fark gözlenmemiştir (p=0,613). Yaşın 75 ve üzeri olmasını kriter olarak eklediğimizde mortaliteyi predikte etmede klinik kırılganlık indeksi ile mortalite arasında istatistiksel fark olup olmadığı da araştırıldı. Eğri altında kalan alanlar (EAA) karşılaştırıldığında ise, kırılganlık indeksi ile 75 yaş üstü kriteri ile birlikte olan kırılganlık indeksinde istatistiksel olarak anlamlı fark görülmedi. (Eğri altında kalan alan kırılganlık indeksi ve kırılganlık indeksi-yaş p=0.597, de Longe quality test).
SONUÇ: Klinik kırılganlık indeksi yüksekliği ve klinik kırılganlık indeksi-yaş, mortalite ile genellikle ilişkilidir fakat opere edilmeme, medikal tedavinin yeterli olacağı düşüncesi ya da komorbiditeler nedeni ile risk bilgilendirilmesi nedenli olarak bu durum ortaya çıkabilmektedir. Geriatrik hastalarda kırılganlık indeksi yüksekliği operasyon kararında tek başına yeterli olmayabilir.

Anahtar Kelimeler

• Geriatrik hastalar
• Kırılganlık indeksi
• Cerrahi
• Geriatrics
• Fraility index
• Surgery

EVALUATION OF THE EFFICACY OF THE CLINICAL FRAILTY SCALE IN THE PREDICTION OF PROGNOSIS IN GERIATRIC PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ACUTE ABDOMINAL PATHOLOGIES: A PROSPECTIVE STUDY

Öz

OBJECTIVE: The CFS (Clinical Frailty Score) evaluates specific domains including function, comorbidity, and cognition to generate a frailty score ranging from 1 (very fit) to 9 (terminally ill). The aim of this study was to investigate the efficacy of CFS in the prediction of mortality in geriatric patients with acute abdominal pathologies.
MATERIAL AND METHODS: Patients over 65 years who presented to the emergency department with acute abdominal pathologies between October 1, 2020 and March 31, 2021 were included in the study. Clinical Frailty Score was calculated and categorized into groups from 1 to 9. Statistical analyses were performed using SPSS version 22.0.
RESULTS: The study included 151 patients, of whom 53% were female. The mean age was 75.57±8.078 years. Twenty-two (14.56%) patients died. Clinical Frailty Score was found to be statistically significantly higher in the non-survivor group (p<0.001). Eighty-three (55%) of the patients underwent surgery. There was no statistically significant relationship between Clinical Frailty Score and mortality in the operated and non-operated groups (p=0.613). We added an age of 75 and over as a criterion (Clinical Frailty Score -age) and compared its predictive ability for mortality with CFS. There was no statistically significant difference between Clinical Frailty Score and Clinical Frailty Score-age in terms of the area under the curve values in the prediction of mortality (the area under the curve Clinical Frailty Score and Clinical Frailty Score-age p=0.597, DeLong quality test).
CONCLUSIONS: High Clinical Frailty Score and Clinical Frailty Score-age are generally associated with mortality, but this may occur due to non-operation, the thought that medical treatment will be sufficient, or risk information due to comorbidities. In geriatric patients, an increased Clinical Frailty Score may not be sufficient alone in making a surgery decision.

Anahtar Kelimeler

• Geriatrics
• Fraility index
• Surgery

Kaynakça

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