Handan ANKARALI, Fatih ERMİŞ, Yusuf AYDIN, Murat ERDOĞAN, Ali KUTLUCAN, Leyla KUTLUCAN, Hilmi DEMİRİN, Elif ŞENOCAK, Mücahit GÜR

Enfeksiyon Tanılı Yoğun Bakım Hastalarında Kısa ve Uzun Dönem Mortaliteye Etkili Faktörler

AMAÇ: Yoğun Bakım Ünitesindeki YBÜ enfeksiyöz hastalarda mortalite üzerinde etkili olabilecek risk faktörleri olan yaş, eşlik eden hastalıklar, prokalsitonin PCT , C-reaktif protein CRP , 25-OH vitamin D düzeyi ve APACHE II skoru ile; bu parametrelerin yoğun bakımda ve hastane sonrası otuz ile doksan günlük mortalite arasındaki ilişkisini değerlendirmeyi amaçladık. YÖNTEMLER: Düzce Üniversitesi Tıp Fakültesi İç Hastalıları YBÜ’ye 1 Eylül 2011–30 Ağustos 2012 tarihleri arasında enfeksiyon tanısı ile kabul edilen 52 hasta prospektif olarak değerlendirilmiştir. BULGULAR: Sepsis, YBÜ’de mortaliteyi belirgin artırmıştır. Eşlik eden hastalıklardan; hipertansiyon dışındakilerin taburculuk durumuna, 30 ve 90 günlük yaşam süresine ulaşmayla ilişkisi saptanmadı. Yatış laboratuar değerlerinde; CRP ve PCT yüksek, 25-OH vitamin D ise düşük saptanmıştır. YBÜ’den taburculukta; yaş, 25-OH vitamin D, PCT, APACHE II’nin etkili olmadıkları, CRP artışının ölüm riski ile ilişkili olduğu görüldü. APACHE II skoru, otuz günlük yaşamla; yaş ise, otuz ve doksan günlük yaşamla ilişkili bulunmuştur. YBÜ sonrası devredilen serviste yatış süresi uzun olanlarda, hastane sonrası yaşam süresinin yüksek olduğu saptanmıştırSONUÇ: Sepsis, YBÜ mortalitesini, sepsisle beraber ileri yaş ta taburculuk sonrası 30 ve 90 günlük mortaliteyi artırabilir. APACHE II skoru, taburculuk sonrası uzun dönem sağkalım tahmininde kullanılabilir. PCT, CRP ve 25-OH vitamin D’nin, YBÜ hastalarının takibi ve prognozunu belirlemede tek başlarına ideal yöntemler olarak kullanılmasının uygun olmadığı düşünülmektedir.

Anahtar Kelimeler:

Yoğun bakım, enfeksiyon, mortalite tahmini

Factors Affecting the Short and Long Term Mortality of Infected Patients in Intensive Care Unit

OBJECTIVE: We aimed to investigate the possible risk factors which could effect the mortality of infected patients in Intensive Care Unit ICU like age, concomitant diseases, Procalcitonin PCT , C-reactive protein CRP , vitamin D levels and APACHE II score. These parameters were also investigated for mortality during hospitalization period and thirty and ninety-day mortality after discharge from hospital.METHODS: Fifty-two infected patients who were admitted to ICU of Duzce University School of Medicine, Department of Internal Medicine between 01 September 2011 to 30 August 2012 were evaluated prospectively.RESULTS: Sepsis increased mortality rate in ICU significantly. Concomitant diseases except hypertension were not associated with discharge status, 30 and 90 daily life expectancy. In the first hospitalization day CRP and PCT were found to be high while 25-OH vitamin D was found to be low. 25-0H vitamin D and PCT levels and APACHE II score were not associated with discharge status from ICU. CRP has been associated with increased risk of death, while APACHE II score was associated with thirty and ninety days life expectancy. It was found that life expectancy is higher with longer duration of hospitalization after ICU.CONCLUSION: Sepsis may increase ICU mortality as well as advanced age with septicemia may increase 30th and 90th days mortality after discharge. APACHE II score can be used to predict long-term survival after discharge. PCT, CRP and 25-OH vitamin D were not considered as an ideal method alone for follow up and prognosis of ICU patients.

Keywords:

Intensive care unit, infection, mortality prediction,

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