Yoğun Bakım Ünitesinde Laktat ve Mortalite

Amaç: Çalışmamızda, yoğun bakım ünitesi (YBÜ)’nde sepsis nedeniyle yatan hastalarda yatış laktat düzeyleri ile mortalite ilişkisine bakılması amaçlanmıştır.Araçlar ve Yöntem: Çalışmamız sepsis nedeniyle Anesteziyoloji ve YBÜ kliniğine yatan hastalarda retrospektif olarak yapıldı. Hastaların demografik ve klinik özellikleri tıbbi dosya kayıtlarından elde edildi. Yatan tüm hastaların serum laktat düzeyleri alındı. Mortalite olan ve olmayan hastalarda demografik özellikler, klinik ve laktat düzeyleri karşılaştırıldı. Mortalite tahmininde eşik laktat değeri ve prediktif tanısal değerini belirlemek için ROC eğrisi istatistiksel analizleri yapıldı.Bulgular: Çalışma döneminde YBÜ’ye yatan 892 hastadan, 218 tanesi sepsis nedeniyle takip edilip çalışmaya dahil edildi. Laktatın mortaliteyi öngörmedeki ROC eğrisi altında kalan alan 0.862 idi (% 95 GA:0.809–0.905) (p=0.0001). Mortalite için eşik laktat değeri 2.7 mmol/L (duyarlılık: %90.3, %95 GA: 82.4–95.5, özgüllük: %72.8, GA: 64.1–80.4) olarak bulundu.Sonuç: Laktat, sepsis tanılı hastaların hastane ve YBÜ’lerin mortalitesini göstermede önemli bir belirteçtir. Hastanın yatışından itibaren laktatın yakın takibi tedavi yönetimini ve klinik sonuçları değiştirebilir.

Anahtar Kelimeler:

yoğun bakım ünitesi, mortalite, laktat, sepsis

Lactate and Mortality in the Intensive Care Unit

Purpose: In our study, we aimed to assess the relationship between the initial value of blood lactate levels and mortality rate in ICU patients with sepsis.Materials and Methods: Our study was conducted as a retrospective study, and patients admitted to the Anesthesiology Intensive Care Unit with sepsis diagnosis were included. Demographic and clinical characteristics of patients' data were collected and recorded from patients’ medical records. Blood lactate levels were obtained from all patients. Demographic and clinical characteristics and blood lactate levels compared between the mortality occurring and a non-mortality groups of patients. A receiver-operating characteristic (ROC) curve was constructed to assess the best blood lactate level cutoff to predict the mortality rate and diagnostic value of this cutoff level.Results: During the study period, 892 patients were admitted to ICU and 218 of those with sepsis were included in the study. The area under the ROC curve to predict the mortality rate of blood lactate level was 0.862 (95% CI: 0.809–0.905) (p= 0.0001). The blood lactate cutoff level related to mortality was found to be 2.7 mmol / L (sensitivity: 90.3%, 95% CI: 82.4–95.5, specificity: 72.8%, CI:64.1–80.4).Conclusion: Lactate levels are important indicator for predicting mortality in patients with sepsis in the hospitals and ICUs. Close follow-up for lactate levels may change the treatment modality and clinical outcome during hospitalization.

Keywords:

intensive care unit;, mortality, lactate, sepsis,

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