Yoğun Bakımdaki COVID-19 Hastalarında Kan Transfüzyonu ve İlişkili Faktörlerin Analizi: Tek Merkez Örneği

Öz

Amaç: Bu çalışmada COVID-19 Yoğun Bakım Ünitesi’nde (YBÜ) takip edilen hastalarda kan transfüzyonu karakteristiklerini, ilişkili faktörleri ve sonuçlarını tespit etmeyi amaçladık. Gereç ve Yöntemler: COVID-19 tanısıyla 21 Mart 2020 ve 01 Haziran 2020 tarihleri arasında COVID-19 YBÜ’nde takip edilen, 48 saatten uzun süre YBÜ’de kalan hastaların dosyaları retrospektif olarak incelendi. Hastaların demografik verileri, laboratuvar verileri (hemogram, koagülasyon parametreleri, inflamatuvar markerlar, arteriyel kan gazı parametreleri), kalp hızı, arteriyel kan basıncı, kanama bulguları, yaygın intravasküler koagülasyon (DIC) gelişimi, vazopressor ihtiyacı ve kan transfüzyonu ihtiyacı kaydedildi. Bulgular: Kan transfüzyonu uygulanan hastaların yoğun bakımda kalış süreleri [27 (4-65) gün], uygulanmayanlara göre [5 (0-30) gün] anlamlı şekilde yüksekti (p<0.001). Gruplar arasında yaş, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II (APACHE II) ve Glaskow koma skalası (GKS) skoru ortalamaları ile cinsiyet, Diabetes mellitus (DM), hipertansiyon, koroner arter hastalığı (KAH), kronik böbrek hastalığı (KBH) ve astım oranları açısından anlamlı bir fark saptanmadı (p>0.05). Kronik obstrüktif akciğer hastalığı (KOAH) oranlarının kan transfüzyonu uygulananlarda anlamlı şekilde yüksek olduğu (%33,3 vs %0,0) tespit edildi (p=0.026). Kan transfüzyonu uygulanan grupta fatalite hızı %44,4, transfüzyon uygulanmayan grupta fatalite hızı %21,1 saptandı (p=0.371). Sonuç: Çalışmamız sonucunda COVID-19 YBÜ’de KOAH tanısı olan, ağır kliniğe sahip olup entübasyon, mekanik ventilasyon gereken, uzun süre yoğun bakımda yatan hastalarda daha çok anemi geliştiği ve kan transfüzyonu yapıldığı, transfüzyon yapılan hastalarda ise mortalitenin yüksek olduğu tespit edilmiştir

Anahtar Kelimeler

• COVID-19
• KAN TRANSFÜZYONU
• YOĞUN BAKIM ÜNİTESİ

Analysis of Blood Transfusion and Related Factors in COVID-19 Critical Care Patients: Single Center Example

Öz

Aim: In this study, we aimed to determine the blood transfusion characteristics, related factors and results in patients followed in the COVID-19 Intensive Care Unit(ICU).Material and Methods: The files of patients who were followed up in the COVID-19 ICU between March 21, 2020 and June 01, 2020 with the diagnosis of COVID-19 and stayed in the ICU for more than 48 hours were retrospectively reviewed. Demographic data of the patients, laboratory data (hemogram, coagulation parameters, inflammatory markers, arterial blood gas parameters), heart rate, arterial blood pressure, bleeding findings, development of disseminated intravascular coagulation (DIC), vasopressor requirement and blood transfusion need were recorded. Results: The length of stay in the intensive care unit [27 (4-65) days] of the patients who received blood transfusion was significantly higher than those who did not [5 (0-30) days] (p<0.001). No significant difference was found between the groups in terms of age, Acute Physiology and Chronic Health Evaluation II(APACHE II) and Glasgow Coma Score (GCS) score averages, and gender, Diabetes mellitus (DM), hypertension, Coronary artery disease (CAD), chronic kidney disease (CKD) and asthma rates (p> 0.05). Chronic obstructive pulmonary disease (COPD) rates were significantly higher in those who received blood transfusion (33.3% vs 0.0%) (p=0.026). The fatality rate was 44.4% in the blood transfused group, and 21.1% in the non-transfused group (p=0.371). Conclusion: As a result of our study, it was determined that patients with a diagnosis of COPD in the COVID-19 ICU, who had a severe clinic and intubation need, mechanical ventilation, and who were hospitalized in the intensive care unit for a long time developed more anemia and blood transfusion, and mortality was higher in patients who underwent transfusion.

Anahtar Kelimeler

• COVID-19
• intensive care unite
• blood transfusion

Kaynakça

1. 1.https://covid19.saglik.gov.tr/Eklenti/39297/0/Covid-19rehberiagirpnomoniardssepsisveseptiksokyontemipdf.pdf. ( Erişim tarihi: 21.02.2021).
2. 2. Keddissi JI, Youness HA, Jones KR, et al. Fluid management in AcuteRespiratoryDistressSyndrome: A narrativereview. Can J RespirTher 2019;55:1-8.
3. 3. Cinel I, Kasapoglu US, Gul F, et al. The initial resuscitation of septic shock. J Crit Care 2020;57:108-17.
4. 4. Alhazzani W, Møller HM, Arabi YM et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVİD-19).
5. 5. https://www.yogunbakim.org.tr/haberler/7670/COVİD-19-%C4%B0li%C5%9Fkili-Septik-%C5%9Eok-Tedavisi---TYBD-Bilimsel-G%C3%B6r (Erişim tarihi:21.02.2021).
6. 6. Byrne L, Haren FV. Fluid resuscitation in human sepsis: Time to rewrite history? Ann. Intensive Care2017;7:4.
7. 7. The ProCESS Investigators. A Randomized Trial of Protocol-Based Care for Early Septic Shock.N Engl J Med 2014; 370:1683-1693.
8. 8. Holst LB, Haase N, Wetterslev J,et al. Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock.N Engl J Med 2014;371:1381-1391

9. 9. The ARISE Investigators and the ANZICS Clinical Trials Grou. Goal-Directed Resuscitation for Patients with Early Septic Shock. N Engl J Med 2014;371:1496-1506.
10. 10. Rhodes A, Evans LE, Alhazzani W. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Critical CareMedicine 2017;45(3):486-552.
11. 11. Corwin HL, Krantz SB. Anemia of thecriticallyill: acuteanemia of chronicdisease. CritCareMed. 2000;28:3098-3099.
12. 12. Horwitz SMC, Kelleher K,Thomas Boyce PMT, et al.Anemia and blood transfusion in critically ill patients. J Am Med Assoc. 2002;288:1499-1507.
13. 13. Groeger JS, Guntupalli KK, Strosberg M, et al. Descriptive analysis of critical care units in the United States, patient characteristics and intensive care unit utilization. Crit Care Med 1993;21:279-91.
14. 14. Vincent JL, Baron JF, Reinhart K, et al. Anemia and blood transfusion in critically ill patients. JAMA 2002; 288:1499–507. 15. Smoller BR, Kruskall MS. Phlebotomy for diagnostic laboratory tests in adults. Pattern of use and effect on transfusion requirements. N. Engl. J. Med. 1986;314(19):1233-1235.
15. 16. Von Ahsen N, Muller C, Serke S, et al. Important role of non-diagnostic blood loss and blunted erythropoietic response in the anemia of medical intensive care patients. CritCareMed. 1999;27:2630-2639.
16. 17. Lelubre C, Piagnerelli M, Vincent JL. Association between duration of storage of transfused red blood cells and morbidity and mortality in adult patients: myth or reality? Transfusion. 2009; 49:1384-1394
17. 18. Grimshaw K, Sahler J, Spinelli SL, et al. New frontiers in transfusion biology: identification and significance of mediator of morbidity and mortality in stored red blood cells. Transfusion. 2011;51:874-880.
18. 19. Blumberg N. Deleterious clinical effects of transfusion immunomodulation: proven beyond a reasonable doubt. Transfusion. 2005;45:33S-39S.
19. 20. Tinmouth A, Fergusson D, Yee IC, et al.; ABLE Investigators; Canadian Critical Care Trials Group. Clinical consequences of red cell storage in the critically ill. Transfusion. 2006;46:2014-2027.
20. 21. Watkins TC, Clark CT. Critically ill and septic patient: is red blood cell transfusion adding to the Domino Effect?J Infus Nurs2013;36(2):116-21.
21. 22. Retter A, Wyncoll D, Pearse R, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol 2013;160:445-464.