Septik Şokta Pozitif Sıvı Dengesi ve Mortalite İlişkisi
Amaç: Septik şok resüsitasyonunda intravenöz sıvının uygulanması için hala en uygun yaklaşım bilinmemektedir. Septik şoku olan hastalarda pozitif sıvı dengesi ile kötüleşen sonuçların ilişkili olduğu bildirilmiştir. Çalışmamızda, bu ilişkinin değerlendirilmesi amaçlanmıştır. Yöntem: Çalışma 1 Ocak 2017 ile 31 Aralık 2017 tarihleri arasında Anestezi ve Reanimasyon Yoğun Bakım Ünitesinde yapıldı. Veriler retrospektif olarak hastaların dosyalarından elde edildi. Sepsis nedeniyle yatan tüm hastaların 0-24 saat, 0-72 saat ve 0-7 gün arası sıvı dengesi ile mor- talite ilişkisi değerlendirildi. Bulgular: Çalışmaya 164 sepsis hastası dahil edildi. Yirmi dördüncü saat sıvı dengesi için ROC eğrisi altındaki alan 0.794’tü. (%95 GA: 0.724-0.853 p=0.0001). Mortalite için 24. saatteki sıvı dengesi eşik değeri >1700 mL (duyarlılık: %73.61, %95 GA: 61.9-83.3, özgüllük: %76.09, %95 GA: 66.1-84.4) olarak bulundu. Yetmiş ikinci saat sıvı dengesi için ROC eğrisi altındaki alan 0.823’tü. (%95 GA: 0.753-0.880 p=0.0001). Mortalite için 72. saatteki sıvı dengesi eşik değeri >1600 mL (duyarlılık: %86.15, %95 GA: 75.3-93.5, özgüllük: %67.82, %95 GA: 56.9-77.4) olarak bulundu. Yedinci gün sıvı dengesi için ROC eğrisi altındaki alan 0.857’tü. (%95 GA: 0.780-0.916 p=0.0001). Mortalite için 7. gündeki sıvı dengesi eşik değeri >1910 mL (duyarlılık: %100, %95 GA: 92.7-100, özgüllük: %66.15, %95 GA: 53.4-77.4) olarak bulundu. Sonuç: Günlük pozitif sıvı dengesi ile mortalitenin ilişkili olduğunu ve pozitif sıvı dengesinin sepsis hastalarında mortalite göstergesi olarak takip edilmesi gerektiğini düşünüyoruz.
The Relationship Between Positive Fluid Balance and Mortality in Septic Shock
Objective: The most suitable approach for resuscitation of septic shock, is still not known yet. There are some reports mentioning some correlation between the worsening results and positive fluid balance of patients having septic shock. This study aimed to identify this relationship. Methods: This retrospective study was conducted in Intensive Care Unit of Anesthesia and Reanimation between January 1 st 2017 and December 31 st 2017. The data of the patients were obtained from the medical records. The relationship between fluid balance and mortality was evaluated in all hospitalized patients with sepsis at intervals of 0-24 hours, 0-72 hours and 0-7 days. Results: We included 164 patients with sepsis in the study.. The area under the Receiver Operating Characteristic (ROC) curve was 0.794 at 24 th hour (95% confidence interval (CI): 0.724-0.853 p=0.0001). The threshold value of fluid balance for mortality at 24 th hour was found out to be >1700 mL (sensitivity: 73.61%, 95% CI: 61.9-83.3, specificity: 76.09%, 95% CI: 66.1-84.4). The area under the ROC curve was 0.823 at 72 th hour (95% CI: 0.753-0.880 p=0.0001). The threshold value of fluid balance for mortality at 72 th hour was found out to be >1600 mL (sensitivity: 86.15%, 95% CI: 75.3-93.5, specificity: 67.82%, 95% CI: 56.9-77.4). The area under the ROC curve was 0.823 on the 7 th day (95% CI: 0.780-0.916 p=0.0001). The threshold value of fluid balance for mortality on the 7 th day was found out to be >1910 mL (sensitivity: 100%, 95% CI: 92.7-100, specificity: 66.15%, 95%CI: 53.4-77.4). Conclusions: Daily positive fluid balance is strictly correlated with mortality thus, we think that it should be monitored as a predictor for mortality.
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