Kritik Hastalarda Trombositopeni Varlığı Hastalık Ciddiyetinin Bir Göstergesidir

Abstract

Amaç: Kritik hastalarda trombositopeni sık görülmektedir. Çalışmamızda üçüncü basamak medikal yoğun bakım ünitesine (YBÜ) yatırılan hastalarda, yatış esnasındaki trombositopeni sıklığı ve trombositopeni varlığının morbidite ve mortalite ile olan ilişkisinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Mart 2018 ve Şubat 2020 tarihleri arasında YBÜ’ye yatırılan 681 hasta geriye dönük incelendi. Vakaların yatış tanıları, komorbiditeleri, yatış günü bakılan laboratuvar tetkikleri, APACHE II (acute physiology and chronic health evaluation II) ve SOFA (sequential organ failure assessment) skorları, uygulanan organ destek tedavileri ve mortalite oranları kaydedildi. Trombositopeni kriteri için trombosit sayısı <150 x 103/μl alındı. Bulgular: Hastaların 167’sinde (%24,5) yatış günü trombositopeni tespit edildi. Trombositopenik hastalarda YBÜ yatış günü bakılan beyaz kan hücre, C-reaktif protein, kreatinin ve laktat değerleri istatiksel olarak anlamlı düzeyde yüksek saptanırken, albümin ve hemoglobin değerleri istatiksel olarak anlamlı düzeyde düşük bulundu (sırasıyla p<0,001, p=0,030, p=0004, p=0,037, p<0,001, p<0,001). Trombositopenik hastaların APACHE II ve SOFA skorları istatiksel olarak anlamlı düzeyde yüksek olduğu görüldü (sırasıyla p=0,002, p < 0,001). Eritrosit, taze donmuş plazma ve trombosit transfüzyon oranlarının trombositopenik hastalarda daha fazla olduğu belirlendi (sırasıyla p=0,030, p<0,001, p<0,001). Trombositopenik hastalara YBÜ yatış süresince daha fazla vazopresör desteği verildiği ve yoğun bakım ile hastane mortalite oranlarının istatiksel olarak anlamlı düzeyde yüksek olduğu görüldü (sırasıyla p=0,006, p=0,017, p=0,024,). Bu verilere rağmen lojistik regresyon analizinde trombositopeni mortalite prediktörü olarak saptanmadı. Yaş, APACHE II skoru, SOFA skoru ve yatış laktat düzeyi birer mortalite prediktörü olarak bulundu. Sonuç: Kritik hastalarda trombositopeni varlığı hastalık ciddiyetini göstermektedir. Trombositopenik hastalara uygulan organ destek tedavi oranları trombositopenik olmayanlara kıyasla daha fazladır ve bu hastaların mortalite oranları yüksektir.

Keywords

• trombositopeni
• mortalite
• APACHE II skoru
• vazopresör

Thrombocytopenia was an Indicator of Severity of Disease in Critically Ill Patients

Abstract

Aim: Thrombocytopenia is frequently encountered in critically ill patients. The study aimed to determine the frequency of thrombocytopenia, and the relationship between thrombocytopenia and morbidity and mortality in patients admitted to the tertiary medical intensive care unit (ICU). Material and Methods: This retrospective study included 681 patients admitted to the ICU between March 2018 and February 2020. Hospitalization diagnosis, comorbidities, admission laboratory tests, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores, organ support therapies and mortality were recorded. Thrombocytopenia was defined as a platelet count of <150x103/μl. Results: Thrombocytopenia was diagnosed in 167 (24.5%) patients on admission to the ICU. Thrombocytopenic patients had higher leucocyte counts, and C-reactive protein, creatinine and lactate levels, but lower albumin and hemoglobin levels (p<0,001, p=0,030, p=0004, p=0,037, p<0,001, p<0,001, respectively). Thrombocytopenic patients had significantly elevated APACHE II and SOFA scores compared to nonthrombocytopenic patients (p=0.002, p<0.001, respectively). It was determined that erythrocyte, thrombocyte and fresh frozen plasma transfusion rates were significantly higher in thrombocytopenic patients (p=0,030, p<0,001, p<0,001, respectively). Vasopressor infusion was significantly more required by thrombocytopenic patients during ICU stay (p=0.006). ICU and hospital mortality rates were significantly higher in thrombocytopenic patients (p=0.017, p=0.024, respectively). The presence of thrombocytopenia was not found to be a mortality predictor in the logistic regression analysis. Age, APACHE II score, SOFA score and lactate level were determined to be mortality predictors. Conclusion: The presence of thrombocytopenia represents the severity of disease in critically ill patients. Thrombocytopenic patients requires more organ support therapies and have high mortality rates.

Keywords

• thrombocytopenia
• mortality
• APACHE II score
• vasopressor

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