Yoğun Bakım Ünitesinde Takip Edilen Pnömoni Hastalarında Mortaliteyi Öngören Risk Faktörleri ve Mortalite Skor Değerlerinin Tespiti

Öz

Amaç: Yoğun bakım ünitesinde pnömoni hastalarının mortalite riskinin öngörülmesi tedavi sürecinde önemli bir adımdır. Hastaların ciddiyetini değerlendirmek ve prognozu tahmin etmek için bir dizi skorlama sistemi geliştirilmiştir. Klinikte prognostik değerlendirmede yoğun bakımda pnömoni hastalarının mortaliteyi öngören risk faktörleri ve mortalite skor değerlerini tespit etmek amaçlanmıştır. Gereç ve Yöntemler: Tek merkezli ve retrospektif bir çalışmadır. Hastaların mekanik ventilasyon, hemodiyaliz ihtiyacı, inotrop desteği, göğüs tüpü takılması, yoğun bakımda yatış süresi, hastanede kalış süresi, 6 aylık mortalite oranları kaydedildi. SOFA, APACHE II ve PSI, CURB-65 ve I-ROAD skoru hesaplandı. Prokalsitonin, C-reaktif protein, albümin, kreatinin, üre ve laktat değeri skorlamalarla değerlendirildi. Bulgular: 143 hastanın 94’u (%65,7) taburcu olurken (Grup 1: yaşayanlar), 49’u (%34,2) hayatını kaybetti (Grup 2: Yaşamını kaybedenler). Üre ve laktat motalite ile daha güçlü korelasyon gösterirken (p<0,001), kreatinin daha zayıf korelasyon göstermiştir (p=0,011). CURB-65 ve PSI mortalite ile güçlü bir ilişki gösterirken (p<0,001), I-ROAD bu ilişkiyi zayıf desteklemiştir (p=0,046). SOFA (0,261) ve APACHE II (0,211) anlamlı ilişki tespit edilmedi (p>0,05). İnotrop desteği alan hastalarda mortalite riski anlamlı ölçüde yüksekti (p<0,001), ancak göğüs tüpü ve hemodiyaliz uygulamalarının mortalite üzerine etkisi istatistiksel olarak anlamlı bulunmadı (sırasıyla p=0,943 ve p=0,297). Sonuç: Yoğun bakım hastalarında pnömoni mortalitesini öngörmede belirleyici faktörler olarak inotropik destek almak, hastanede yatış sırasında üre, kreatinin ve laktat düzeylerinin yüksekliği risk faktörleri olarak bulunmuştur. PSI ve CURB-65 mortalitenin öngörülmesinde ve kritik hasta seçimlerinde yol gösterici olabilir

Anahtar Kelimeler

• Pnömoni
• yoğun bakım
• mortalite
• skorlama

Destekleyen Kurum

yok

Proje Numarası

yok

Etik Beyan

Alınmıştır

Identification of Risk Factors and Mortality Score Values Predicting Mortality in Pneumonia Patients Monitored in Intensive Care Units

Öz

Aim: Predicting the mortality risk of pneumonia patients in the intensive care unit is an important step in the treatment process. A number of scoring systems have been developed to assess the severity of patients and predict prognosis. The aim of this study was to determine the risk factors predicting mortality and mortality score values of pneumonia patients in intensive care unit in clinical prognostic evaluation. Material and Methods: It was a single-center and retrospective study. Mechanical ventilation, hemodialysis requirement, inotrope support, chest tube insertion, duration of intensive care unit stay, length of hospital stay, and 6-month mortality rates were recorded. SOFA, APACHE II and PSI, CURB-65 and I-ROAD scores were calculated. Procalcitonin, C-reactive protein, albumin, creatinine, urea and lactate values were evaluated by scoring. Results: Of the 143 patients, 94 (65.7%) were discharged (Group 1: survivors), while 49 (34.2%) died (Group 2: exitus). Urea and lactate showed a stronger correlation with mortality (p<0.001), while creatinine showed a weaker correlation (p=0.011). CURB-65 and PSI demonstrated a strong association with mortality (p<0.001), while I-ROAD supported this association more weakly (p=0.046). SOFA and APACHE II did not show a significant association with mortality (p>0.05). Patients receiving inotropic support had a significantly higher risk of mortality (p<0.001), however, chest tube placement and hemodialysis did not have a statistically significant impact on mortality (p=0.943 and p=0.297, respectively). Conclusion: Receiving inotropic support, high urea, creatinine and lactate levels during hospitalization were found to be risk factors for predicting pneumonia mortality in intensive care unit patients. PSI and CURB-65 may be guiding in the prediction of mortality and selection of critical patients.

Anahtar Kelimeler

• Pneumonia
• intensive care
• mortality
• scoring

Proje Numarası

yok

Kaynakça

1. 1. Dambrava PG, Torres A, Vallès X, Mensa J, Marcos MA, Peñarroja G, Camps M, Estruch R, Sánchez M, Menéndez R, Niederman MS. Adherence to guidelines’ empirical antibiotic recommendations and community-acquired pneumonia outcome. Eur Respir J 2008;32: 892-901.
2. 2. Özlü T, Bülbül Y, Alatas F, Arseven O, Coşkun AŞ, Çilli A, Ekim N , Erdem H , Gürsel G, Hatipoğlu N, Leblebicioğlu H, Mülazımoğlu L, Özden H, Özinel MA, Şahinöz S, Tabakoğlu E, Uçku R, Ünal S. Türk Toraks Derneği Erişkinlerde Toplumda Gelişen Pnömoni Tanı ve Tedavi Uzlaşı Raporu. Türk Toraks Dergisi 2009;10: 3-16.
3. 3. Brar NK, Niederman MS. Management of community-acquired pneumonia:a review and update. Ther Adv Respir Dis 2011;5: 61-78.
4. 4. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44: 27.
5. 5. Sayıner A, Azap A, Yalçı A, Şakar Coşkun A, Babayiğit C, Edis Çakır E, Evren E, Başara E, Demirdöğen E, Altay FA, Eyüboğlu FÖ, Özkan M, Çevik M, Ünal S. Erişkinlerde Toplumda Gelişen Pnömoniler Tanı ve Tedavi Uzlaşı Raporu 2021; 4-10.
6. 6. Modi AR, Kovacs CS. Community-acquired pneumonia: Strategies for triage and treatment. Cleve Clin J Med. 2020;87(3):145- 151.
7. 7. Ozlu T, Bulbul Y, Ozsu S. Ulusal Verilerle Toplumda gelişen pnomoniler. Tuberkuloz ve Toraks Dergisi 2007;55: 191-212.
8. 8. Van der Eerden MM, de Graaff CS, Bronsveld W, Jansen HM, Boersma WG. Prospective evaluation of pneumonia severity index in hospitalised patients with community-acquired pneumonia. Respir Med. 2004; 98: 872-8.

9. 9. Fukuyama H, Ishida T, Tachibana H, Nakagawa H, Iwasaku M, Saigusa M, Yoshioka H, Arita M, Hashimoto T. Validation of scoring systems for predicting severe community-acquired pneumonia. Intern Med. 2011; 50(18): 1917-22.
10. 10. Valencia M, Badia JR, Cavalcanti M, Ferrer M, Agustí C, Angrill J, García E, Mensa J, Niederman MS, Torres A. Pneumonia severity index class v patients with community-acquired pneumonia: characteristics, outcomes, and value of severity scores. Chest. 2007; 132(2): 515-22.
11. 11. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019, 200(7): 45-67.
12. 12. İlhan G, Karakaya Z, Akyol P, Topal F, Payza U. Acil serviste toplum kökenli pnömoni tanısı alan hastalarda PSI ve CURB- 65 pnömoni skorlama sistemlerinin değerlendirilmesi. Cumhuriyet Tıp Dergisi. 2017; 39: 586 - 596.
13. 13. Pakpahan FS, Bihar S, Syarani F, Eyanoer P. A-DROP Scoring System in Predicting Mortality within 30 Days of Hospitalization in Community-acquired Pneumonia Patients at H. Adam Malik General Hospital Medan. Maced J Med Sci. 2024;10: 954-8.
14. 14. Zhang W, Liu P, Yang Y, Tan WC, Ng SH, Fong KY. Prognostic value of Pneumonia Severity Index, CURB-65, CRB-65, and procalcitonin in community-acquired pneumonia in Singapore. Proceedings of Singapore Healthcare. 2016;25(3): 139-147.
15. 15. Kim HI, Kim SW, Chang HH, Cha SI, Lee JH, Ki HK, Cheong HS, Yoo KH, Ryu SY, Kwon KT, Lee BK, Choo EJ, Kim DJ, Kang CI, Chung DR, Peck KR, Song JH, Suh GY, Shim TS, Kim YK, Kim HY, Moon CS, Lee HK, Park SY, Oh JY, Jung SI, Park KH, Yun NR, Yoon SH, Sohn KM, Kim YS, Jung KS. Mortality of community-acquired pneumonia in Korea: assessed with the pneumonia severity index and the CURB-65 score. Journal of Korean medical science. 2013; 28: 1276-82.
16. 16. Chalmers JD, Taylor JK, Mandal P, Choudhury G, Singanayagam A, Akram AR, Hill AT. Validation of the Infectious Diseases Society of America/ American Thoracic Society minor criteria for intensive care unit admission in community-acquired pneumonia patients without major criteria or contraindications to intensive care unit care. Clin Infect Dis 2011;53: 503-511.
17. 17. Li HY, Guo Q, Song WD, Zhou YP, Li M, Chen XK, Liu H, Peng HL, Yu HQ, Chen X, Liu N, Lü ZD, Liang LH, Zhao QZ, Jiang M. Mortality among severe community-acquired pneumonia patients depends on combinations of 2007 IDSA/ATS minor criteria. Int J Infect Dis. 2015;38:141-5.
18. 18. Phua J, See KC, Chan YH, Widjaja LS, Aung NW, Ngerng WJ, Lim TK. Validation and clinical implications of the IDSA/ATS minor criteria for severe community-acquired pneumonia. Thorax. 2009;64: 598-603.
19. 19. Matsunuma R, Asai N, Ohkuni Y, Nakashima K, Iwasaki T, Misawa M, Norihiro K. I-ROAD could be efficient in predicting severity of community-acquired pneumonia or healthcare-associated pneumonia. Singapore Med J. 2014;55(6):318-24.
20. 20. Ito A, Ishida T, Tokumasu H, Yamazaki A, Washio Y. Evaluation of pneumonia severity scoring systems in nursing and healthcare-associated pneumonia for predicting prognosis: A prospective, cohort study Journal of Infection and Chemotherapy. 2020;4: Pages 372-378.
21. 21. Baek MS, Park S, Choi J-H, Kim C-H, Hyun IG. Mortality and Prognostic Prediction in Very Elderly Patients With Severe Pneumonia. Journal of Intensive Care Medicine. 2020;35(12):1405-1410.
22. 22. Kaymak Ç, Sencan I, Izdes S, Sari A,Yagmurdur H , Karadas D, Oztuna D. Mortality of adult intensive care units in Turkey using the APACHE II and SOFA systems (outcome assessment in Turkish intensive care units. Archives of Medical Science 14(3) May 2016DOI: 10.5114/aoms.2016.59709).
23. 23. Cilloniz C, Ward L, Mogensen ML, Pericàs JM, Méndez R, Gabarrús A, Ferrer M, Garcia-Vidal C, Menendez R, Torres A. Machine-Learning Model for Mortality Prediction in Patients With Community-Acquired Pneumonia: Development and Validation Study.” Chest 163,1 2023: 1:77-88.