Üçüncü Basamak Bir Yoğun Bakım Ünitesinde Bir Yıl Içinde Ölen Hastaların Klinik Özellikleri

Öz

Amaç: Amaç: Bu çalışmada Yoğun Bakım Ünitesinde (YBÜ) bir yıl içinde mortalite gözlenen hastaların klinik özelliklerinin saptanması ve YBÜ’ye kabul esnasında albümin, laktat seviyelerinin ve Acute Physiology and Chronic Health Evaluation II (APACHE II) skorlarının YBÜ yatış süresi ile ilişkisinin belirlenmesi amaçlandı.
Materyal ve Metot: Çalışmada Ocak 2018 ve Aralık 2018 tarihleri arasında YBÜ’de mortalite gözlenen (n:350) hastaların dosyaları retrospektif olarak incelendi. Hastaların demografik verileriyle birlikte klinik özellikleri, YBÜ’ye kabul tipi (cerrahi veya dahili), kabul edildiği üniteleri, kabul nedenleri, komorbiditeleri, kabul albümin ve laktat seviyeleri, APACHE II skorları ve YBÜ yatış süreleri kayıt edildi. Hastaların klinik özelliklerinin YBÜ yatış süresi ve laboratuvar değerleri ile ilişkisi değerlendirildi.
Bulgular: Hastaların yaş ortalaması 72.68±12.98 yıl, ortalama APACHE II skoru 27.0±10.0, albümin değeri 3.1±0.7 g/dL ve laktat değeri 4.1±3.3 mmol/L olarak belirlendi. Mekanik ventilatör (MV) ihtiyacı nedeniyle YBÜ’ye kabul edilen hastalarda albümin değerinin daha düşük olduğu (p<0.001), laktat değerinin ve APACHE II skorunun post–kardiyopulmoner resusitasyon hastalarda anlamlı olarak daha yüksek olduğu saptandı (p<0.001). YBÜ yatış süresi ortalaması 28.24 ± 37.53 gündü. Hastaların yatış süresi ile albümin arasında zayıf pozitif korelasyon (r = 0.172, p = 0.001), laktat (r = 0.121, p = 0.023) ve APACHE II skorları ile zayıf negatif korelasyon bulundu (r = 0,151, p = 0,001). Hastaların albümin ile laktat (r = 0.152, p = 0.004) arasında ve APACHE II skoru (r = 0.179, p = 0.001) arasında zayıf negatif korelasyon ve laktat ile APACHE II skoru arasında (r =0,401, p<0.001) orta derecede pozitif korelasyon bulundu.
Sonuç: Bu çalışmada, YBÜ’de mortalite gözlenen hastalarda hipoalbuminemi, hiperlaktatemi ve yüksek APACHE II skorları ile YBÜ yatış süresi arasında anlamlı bir ilişki gözlendi. Bu ilişkinin YBÜ’lerin etkin kullanımına etkilerini göstermek için daha kapsamlı araştırmalar gereklidir.

Clinical Characteristics of Patients who Died Within a Year in a Tertiary Intensive Care Unit

Abstract

Aim: The aim of this study was to find out the clinical characteristics of patients who died within a year in the intensive care unit (ICU) and to find out the association of ICU admission albumin, lactate levels and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of these patients who died with ICU length of stay.
Material and Method: The files of patients who died in the ICU (n:350) between January 2018 and December 2018 were examined retrospectively. The patients’ demographic data and their clinical characteristics, ICU admission types (surgery or medical medicine), the units they were admitted in, reasons for admission, comorbidities, admission albumin and lactate levels, APACHE II scores and ICU length of stay were recorded. The association of patients’ clinical characteristics with ICU length of stay and laboratory values was evaluated.
Result: The patients’ mean age was 72.68±12.98 years, mean APACHE II score was 27.0±10.0, mean albumin value was 3.1±0.7 g/dL and mean lactate value was 4.1±3.3 mmol/L. It was found that albumin value was lower in patients admitted to ICU with mechanical ventilator (MV) need (p<0.001), and lactate value and APACHE II score were significantly higher in patients with post-cardiopulmonary resuscitation (p<0.001). Mean ICU length of stay was 28.24 ± 37.53 days. A weak positive correlation (r =0.172, p=0.001) was found between the patients’ length of stay and albumin, and a weak negative correlation was found with the lactat (r = 0.121, p=0.023) and APACHE II scores (r = 0.151, p=0.001). A weak negative correlation was found between the patients’ albumin and lactate (r =0.152, p=0.004), and APACHE II score (r =0.179, p=0.001), as well as a moderate positive correlation between lactate and APACHE II score.
Conclusion: Significant association was found between hypoalbuminemia, hyperlactatemia and high APACHE II scores and ICU length of stay in patients who died in ICU. More comprehensive studies are needed to show the effects of this association on effective use of ICUs. 

Keywords

• Intensive care
• mortality
• length of stay
• hypoalbuminemia
• hyperlactatemia

Kaynakça

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