Esra ÇAKIR, Ahmet BİNDAL, Pakize ÖZÇİFTCİ YILMAZ, Nevzat Mehmet MUTLU, Cihangir DOĞU, Işıl ÖZKOÇAK TURAN

Yoğun Bakım Ünitesindeki Septik Şok Hastalarında Şok İndekslerinin Erken Dönem Sonuçları Öngörmede Kullanılabilirliği

Amaç: Yoğun Bakım Ünitesinde (YBÜ) mortaliteyi ön görmek için bazı parametreler kullanılmaktadır. Çalışmamızda YBÜ’ye yatan sepsis ve septik şoktaki hastalarda şok indeksi (SI), modifiye şok indeksi (MSI) ve yaş şok indeksinin (YSI) hastaların klinik sonuçlarını ve mortaliteyi ön görmede kullanılabilirliğinin araştırılması amaçlanmıştır. Çalışma Planı:Çalışmamız Anesteziyoloji ve Yoğun Bakım Ünitesi Kliniğinde 1 Ocak 2018 ile 31 Aralık 2018 tarihleri arasında retrospektif hasta verileri değerlendirilerek yapıldı. Hastalar ve Yöntemler:Sepsis hastalarınının yaşları, cinsiyetleri, eşlik eden hastalıkları, akut fizyoloji ve kronik sağlık değerlendirme II (APACHE II) skoru, mekanik ventilasyon süresi, yatış süresi, SI, MSI, YSI ve mortalite verileri kayıt edildi. Bulgular: Çalışmaya 172 sepsis hastası dahil edildi. Mortalite olan hastalarda SI, MSI ve YSI anlamlı yüksek bulundu (p<0,05). SI için ROC eğrisi altındaki alan 0,649'dur (% 95 güven aralığı (GA): 0,573 - 0,720 P = 0,0003). Mortalite için eşik değeri 1,06’dır (duyarlılık: %62, %95 GA: 51-72,3, özgüllük: %67,44, %95 GA: 56,5-77,2). MSI için ROC eğrisi altındaki alan 0,585’tir (% 95 GA: 0,508 – 0,659 P = 0,049). Mortalite için eşik değeri 1,69’dur (duyarlılık: %37,9 %95 GA: 27,7 – 49, özgüllük: %82,5, %95 GA: 72,9 – 89,9). YSI için ROC eğrisi altındaki alan 0,613'tür (% 95 GA: 0,536 - 0,686 P = 0,0078). Mortalite için eşik değeri 87,42’dir (duyarlılık: %40,2, %95 GA: 29,9-51,3, özgüllük: %82,56, %95 GA: 72,9-89,9). Sonuç: Sepsis hastalarında şok indeksleri mortaliteyi ön görmesi açısından anlamlı bulundu. Ancak duyarlılık üç şok indeksininde sınırlıyken, özgüllük açısından YSI ve MSI yüksek anlamlı, SI daha düşük anlamlı bulundu.

Utility of Shock Indexes in Predicting Early Results of Septic Shock Patients in Intensive Care Unit

Objectives: Some parameters are currently being used in Intensive Care Units (ICU) in order to predict the mortality. In our study, we aimed to determine the usability of shock index (SI), modified shock index (MSI) and age shock index (ASI) in order to predict the clinical outcomes and mortality of patients with sepsis and septic shock. Study Design: We retrospectively evaluated the results of patients who were hospitalized in ICU, between January 1, 2018 and December 31, 2018. Patients and Methods: Age, gender, co-morbidities, acute physiology and chronic health evaluation II (APACHE II) scores, length of mechanical ventilation, length of hospital stay, SI, MSI, ASI and mortalitywere recorded in patients with sepsis.. Results:We evaluated 172 patients with sepsis. SI, MSI, ASI levels were significantly higher in patients with mortality (p < 0.05). For SI, the area under the receiver operating characteristic (ROC) curve was 0.649 (95% CI = 0.573–0.720, p = 0.0003) and cutoff value for shock index was 1.06 (sensitivity: 62%, 95% CI: 51-72.3; specificity: 67.44%, 95% CI: 56.5-77.2). For MSI, the area under the ROC curve was 0.585 (95% CI = 0.508–0.659, p = 0.049) and cutoff value was 1.69 (sensitivity: 37.9%, 95% CI: 27.7-49; specificity: 82.5%, 95% CI: 72.9-89.9). For ASI, the area under the ROC curve was 0.613 (95% CI = 0.536–0.686, p = 0.0078) and cutoff value was 87.42 (sensitivity: 40.2%, 95% CI: 29.9–51.3; specificity: 82.56%, 95% CI: 72.9–89.9). Conclusion: The shock indexes were found out to be significant in predicting mortality in septic patients. While the sensitivity was limited in 3 shock indexes, specificity was determined significantly higher in ASI and MSI with significantly lower in SI.

Keywords:

Intensive Care Unit, Mortality, Shock Index, Modified Shock Index, Age Shock Index,

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