Yetişkin Tuzlu Su Boğulması Hastalarında Mortalite Belirleyicileri: Arteriyel Kan Gazı, Enflamatuar İndeksler ve Radyolojik Bulguların Retrospektif Analizi

Öz

Bu çalışma, tuzlu su boğulması olan hastalarda mortalitenin bağımsız belirleyicilerini belirlemeyi ve arteriyel kan gazı parametreleri ile inflamatuar indekslerin prognostik performansını alıcı işletim karakteristik (ROC) eğrisi analizi kullanarak değerlendirmeyi amaçlamıştır.Toplam 51 boğulma vakasının (34 erkek, 17 kadın; ortalama yaş 48,8 yıl) tıbbi kayıtları retrospektif olarak incelendi. Yaş, cinsiyet, etanol seviyesi, tam kan sayımı, biyokimyasal parametreler, arteriyel kan gazı parametreleri, akciğer görüntüleme bulguları ve klinik sonuçlar analiz edildi. Ölüm için prediktif değerlere sahip parametrelerin kesim değerleri, alıcı işletim karakteristik (ROC) eğrisi analizi kullanılarak belirlendi. Genel ölüm oranı %45'ti (23/51). Ölüme önemli ölçüde bağlı olan ana faktörler ileri yaş, kalp durması, yoğun bakım ihtiyacı, yüksek troponin seviyeleri (>11 ng/L) ve şiddetli metabolik asidozdu. Bikarbonat <20,1 mmol/L (AUC: 0,95), baz defisiti <−8.15 mmol/L (AUC: 0,87), laktat >5.9 mmol/L (AUC: 0,90) ve arteriyel pH <7,22 (AUC: 0,97) ölüm oranı için en yüksek öngörü değerini gösterdi.Boğulma sonrası ölüm, basit ve yaygın olarak bulunan laboratuvar testleri ve klinik değerlendirmeler kullanılarak erken aşamada yüksek doğrulukla tahmin edilebilir. Lenfosit sayısı, troponin seviyeleri ve arteriyel kan gazı analizleri, acil triajda ve agresif tedavi stratejilerinin belirlenmesinde kritik bir rol oynar.

Anahtar Kelimeler

• Tuzlu su boğulma
• mortalite
• etanol
• ARDS

Predictors of Mortality in Adult Seawater Drowning Patients: A Retrospective Analysis of Arterial Blood Gas, Inflammatory Indices, and Radiological Findings

Öz

This study sought to identify independent predictors of mortality in patients with seawater drowning and to evaluate the prognostic performance of arterial blood gas parameters and inflammatory indices using receiver operating characteristic (ROC) curve analysis. Medical records of a total of 51 drowning cases (34 males, 17 females; mean age 48.8 years) were retrospectively reviewed. Age, sex, ethanol level, complete blood count, biochemical parameters, arterial blood gas parameters, lung imaging findings, and clinical outcomes were analyzed. The cut-off values of parameters with predictive values for mortality were determined using receiver operating characteristic (ROC) curve analysis. The overall mortality rate was 45% (23/51). The main factors significantly associated with mortality were advanced age, cardiac arrest, need for intensive care, elevated troponin levels (>11 ng/L), and severe metabolic acidosis. Bicarbonate <20.1 mmol/L (AUC: 0.95), base deficit <−8.15 mmol/L (AUC: 0.87), lactate >5.9 mmol/L (AUC: 0.90), and arterial pH <7.22 (AUC: 0.97) demonstrated the highest predictive value for mortality. Mortality following drowning can be predicted with high accuracy at an early stage using simple and widely available laboratory tests and clinical assessments. Lymphocyte count, troponin levels, and arterial blood gas analyses play a critical role in triage and in determining aggressive treatment strategies.

Anahtar Kelimeler

• Seawater drowning
• ethanol
• ARDS
• mortality

Kaynakça

1. 1.Van Beeck EF, Branche CM, Szpilman D, Modell JH, BierensJJLM. A new definition of drowning: towards documentationand prevention of a global public health problem The globalburden of drowning [Internet]. Vol. 83, Bulletin of the WorldHealth Organization. 2005. Available from: www.drowning.nl
2. 2.Idris AH, Berg RA, Bierens J, Bossaert L, Branche CM,Gabrielli A, et al. Recommended Guidelines for UniformReporting of Data from Drowning the “Utstein Style.” Vol.108, Circulation. 2003. p. 2565–74.
3. 3.Org G, Moore A. The power of U.S. investments in globalhealth. Lancet Glob Health. 2018;6(6):e620–e621.
4. 4.Leavy JE, Gray C, Della Bona M, D’Orazio N, Crawford G. AReview of Interventions for Drowning Prevention AmongAdults. Vol. 48, Journal of Community Health. Springer; 2023.p. 539–56.
5. 5.Lakadamyalı H., Doğan T. İnvestigation of Drowning Case in a Tourism Region of Türkiye. Turkiye Klinikleri J Med Sci 2008, 28:143-148.
6. 6.Soyuncu S, Isık S, Bektas F, Yigit O. The validity of GlasgowComa Scale and Rapid Emergency Medicine Score in evaluating patients admitted to the emergency department withdrowning or near-drowning. Turk J Emerg Med 2008;8:67-72.
7. 7.World Health Organization. Global status report on drowningprevention 2024. Geneva: World HealthOrganization.2024.https://www.who.int/teams/social-determinants-of-health/safety-and-mobility/global-report-on-drowning-prevention. Accessed 9 March 2025.
8. 8.Giamello JD, D’Agnano S, Paglietta G, Bertone C, Bruno A,Martini G, et al. Characteristics, Outcome and PrognosticFactors of Patients with Emergency Department Cardiac Arrest:A 14-Year Retrospective Study. J Clin Med. 2024 Aug1;13(16).

9. 9.Szpilman D, Bierens JJLM, Handley AJ, Orlowski JP.Drowning. New England Journal of Medicine [Internet]. 2012May 31;366(22):2102–10. Available from:http://www.nejm.org/doi/abs/10.1056/NEJMra1013317
10. 10.Orlowski JP, Abulleil MM, Phillips JM. The hemodynamic andcardiovascular effects of near-drowning in hypotonic, isotonic,or hypertonic solutions. Ann Emerg Med 1989;18:1044-9
11. 11.Lin CY, Wang YF, Lu TH, Kawach I. Unintentional drowning mortality, by age and body of water: an analysis of 60 countries. Inj Prev. 2015;21:e43–50.
12. 12.Lunetta P, Haikonen K. Hospital admissions for non-fatal drowning in Finland, 2002–2023: a nationwide population-based register study. Inj Epidemiol. 2025 Dec 1;12(1).
13. 13.World Health Organization. Cause-specific mortality, 2000–2019 (2020). [cited 2022 14 Oct]; Available from:https://www.who. int/data/gho/data/themes/mortality-and-global-health-estimates/ ghe-leading-causes-of-death.
14. 14.Leavy JE, Bona M Della, Abercromby M, Crawford G.Drinking and swimming around waterways: The role ofalcohol, sensation-seeking, peer influence and risk in youngpeople. PLoS One. 2022 Nov 1;17(11 November).
15. 15.Salomez F, Vincent JL. Drowning: A review of epidemiology,pathophysiology, treatment and prevention. Vol. 63,Resuscitation. 2004. p. 261–8.
16. 16.Mosayebi Z, Movahedian AH, Mousavi GA. Drowning inchildren in Iran: outcomes and prognostic factors. Med JMalaysia. 2011;66(3):187-190.
17. 17.Guthrie GJK, Charles KA, Roxburgh CSD, Horgan PG,McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: Experience in patients withcancer. Vol. 88, Critical Reviews in Oncology/Hematology.2013. p. 218–30.
18. 18.Wang JL, Lu XY, Xu XH, et al. Predictive value oflymphocyte-to-monocyte ratio for mortality in septic patients:A systematic review and meta-analysis. Medicine (Baltimore).2021;100(50):e28373. doi:10.1097/MD.0000000000028373
19. 19.Liu J, Liu Y, Xiang P, et al. Neutrophil-to-lymphocyte ratiopredicts critical illness patients with 2019 coronavirus diseasein the early stage. J Transl Med. 2020;18(1):206. Published2020 May 20. doi:10.1186/s12967-020-02374-0
20. 20.Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic andpredictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504.doi:10.1016/j.intimp.2020.106504
21. 21.Ender PT, Dolan MJ. Pneumonia associated with near-drowning. Clin Infect Dis. 1997 Oct;25(4):896-907. doi:10.1086/515532. PMID: 9356805.
22. 22.Kuo DC, Chang WH, Huang CH, Chen HW, Hsu CC, Hsu YH,Wu KH, Cheng TJ. Chest Radiographic Findings and Prognosisfor Near-Drowning Patients in the Emergency Department. JAcute Med. 2017 Dec 1;7(4):141-146. doi:10.6705/j.jacme.2017.0704.002. PMID: 32995191; PMCID:PMC7517808.
23. 23.Thom O, Roberts K, Devine S, Leggat PA, Franklin RC.Treatment of the lung injury of drowning: a systematic review.Crit Care. 2021;25(1):253. Published 2021 Jul 19.doi:10.1186/s13054-021-03687-2
24. 24.Mathew, Jan Rexie; Krishnamoorthy, K. Acute RespiratoryDistress Syndrome Following Near Drowning: A Case Reportand Review of Literature. Journal of Association ofPulmonologist of Tamil Nadu 4(1):p 43-45, Jan–Apr 2021.doi: 10.4103/japt.japt_26_21
25. 25.Wu Y, Zhai R, Wang B, Zhao P, Zhao L, Cui H, Chen C, HuM.ECMO combined with sequential oxygen therapy indrowning-induced ARDS: a case report. Front Med (Lausanne).2025; (doi:10.3389/fmed.2025.1609610).
26. 26.Kim KI, Lee KN, Tomiyama N, et al. Near drowning: thin-section CT findings in six patients. J Comput Assist Tomogr.2000;24(4):562-566. doi:10.1097/00004728-200007000-00009.
27. 27.Sarnaik AP, Preston G, Lieh-Lai M, Eisenbrey AB. Intracranialpressure and cerebral perfusion pressure in near-drowning. CritCare Med. 1985 Apr;13(4):224-7. doi: 10.1097/00003246-198504000-00003. PMID: 3979068.