Yoğun bakım hastalarında mortaliteyi tahmin etmede albumin-bilirubin skorunun etkinliği

Öz

Amaç: Hepatoselüler karsinomlu hastalarda karaciğer fonksiyonunu değerlendirmek için geliştirilen Albümin-Bilirubin (ALBI) skoru, yakın dönemde kritik hastalarda prognostik belirteç olarak ilgi görmüştür. Bu çalışmada, yoğun bakım ünitesi (YBÜ) hastalarında ALBI skorunun mortaliteyi öngörmedeki etkinliğinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu retrospektif gözlemsel çalışmaya, Kasım 2023 ve Kasım 2024 tarihleri arasında, sepsis, solunum yetmezliği, travma, akut nörolojik olaylar ve kardiyak arrest sonrası gibi çeşitli klinik nedenlerle YBÜ'ye kabul edilen 157 erişkin hasta dahil edildi. Klinik veriler, laboratuvar parametreleri ile ALBI, SOFA ve APACHE II skorları YBÜ’ye kabulde değerlendirildi. ALBI skoru, (log10 bilirubin [μmol/L] × 0,66) + (albumin [g/L] × -0,085) formülü ile hesaplandı. Bulgular: Hastaların yaş ortalaması 71,7 ± 18,6 yıl olup, %55,4’ü erkekti. Hastaların %42,7’sinde diabetes mellitus, %21,7’sinde kronik böbrek hastalığı (KBH), %38,9’unda kronik obstrüktif akciğer hastalığı, %73,9’unda kardiyovasküler hastalık ve %19,7’sinde malignite mevcuttu. Genel mortalite oranı %42,7 bulundu. Çok değişkenli Cox regresyon analizinde KBH varlığı (HR: 1,90; %95 GA: 1,07–3,39; p = 0,029), yüksek ALBI skoru (HR: 1,65; %95 GA: 1,03–2,65; p = 0,038) ve yüksek APACHE II skoru (HR: 1,04; %95 GA: 1,00–1,08; p = 0,031) mortalitenin bağımsız prediktörleri olarak saptandı. Sonuç: ALBI skoru, farklı klinik nedenlerle yoğun bakıma yatırılan hastalarda mortalitenin bağımsız bir belirleyicisidir. ALBI skoru, karaciğer fonksiyonu, beslenme durumu ve sistemik inflamasyonu birlikte yansıtarak geleneksel prognostik araçları tamamlamakta ve klinik karar verme süreçlerini destekleyici bir araç olarak kullanılabilir.

Anahtar Kelimeler

• ALBI skoru
• yoğun bakım
• mortalite
• prognostik skor
• APACHE II
• SOFA
• albumin
• bilirubin

Etik Beyan

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Ordu University Non-Interventional Clinical Research Ethics Committee (Date: 20.12.2024, Approval No: 2024/207).

Effectiveness of albumin-bilirubin score in predicting mortality in intensive care patients

Öz

Aim: The Albumin-Bilirubin (ALBI) score, originally developed to assess liver function in patients with hepatocellular carcinoma, has recently gained attention as a prognostic marker in critically ill patients. This study aimed to evaluate the effectiveness of the ALBI score in predicting mortality among intensive care unit (ICU) patients. Material and Methods: This retrospective study included 157 adult patients admitted to the ICU diverse clinical conditions, including sepsis, respiratory failure, trauma, acute neurological events, and post-cardiac arrest, between November 2023 and November 2024. Clinical data, laboratory parameters, ALBI, SOFA, and APACHE II scores were assessed at ICU admission. The ALBI score is calculated as follows: (log10 bilirubin [μmol/L] × 0.66) + (albumin [g/L] × −0.085). Results: Among the study participants (mean age: 71.7 ± 18.6 years; 55.4% male), 42.7% had diabetes mellitus, 21.7% chronic kidney disease (CKD), 38.9% chronic obstructive pulmonary disease, 73.9% cardiovascular disease, and 19.7% malignancies. The overall mortality rate was 42.7%. Multivariable Cox regression analysis revealed that CKD (HR: 1.90; 95% CI: 1.07–3.39; p = 0.029), higher ALBI scores (HR: 1.65; 95% CI: 1.03–2.65; p = 0.038) and higher APACHE II scores (HR: 1.04; 95% CI: 1.00–1.08; p = 0.031) were independent predictors of mortality. Conclusion: The ALBI score is an independent predictor of mortality among critically ill patients with heterogeneous clinical conditions in general ICU settings. By integrating hepatic dysfunction, nutritional status, and systemic inflammation, ALBI complements traditional prognostic tools and may enhance clinical decision-making and risk stratification.

Anahtar Kelimeler

• ALBI score
• intensive care
• mortality
• prognostic score
• APACHE II
• SOFA
• albumin
• bilirubin

Kaynakça

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