Savaş ALTINSOY, Sibel ÇATALCA, MEHMET MURAT SAYIN, Jülide ERGİL

YOĞUN BAKIM KALÇA KIRIĞI HASTALARINDA NÖTROFİL LENFOSİT ORANININ POSTOPERATİF ERKEN DÖNEM MORTALİTE VE MORBİDİTEYE ETKİSİ

Amaç: Bu çal›flmada anestezi yo¤un bak›m›n›na postoperatif dönemde kabul edilen kalça k›r›¤› (KK) hastalar›nda nötrofil lenfosit oran› (NLO)’nun mortalite ve morbidite üzerine etkisi de¤erlendirildi. Yöntem: Ocak 2015-Haziran 2016 tarihleri aras›nda, kalça k›r›¤› (KK) nedeniyle opere olan ve yo¤un bak›ma kabul edilen hastalar çal›flmaya dahil edildi. Grup Y (n=184)’de yaflayan hastalar, Grup K ( n=15)’da eksitus kabul edilen hastalar retrospektif olarak de¤erlendirildi. Çal›flmaya dahil edilen hastalarda; yafl, cinsiyet, koroner arter hastal›¤› varl›¤›, genel veya spinal anestezi alt›nda opere edilmifl olmalar›, preoperatif dönem ve postoperatif 1. gün nötrofil ve lenfosit say›lar› ve oranlar› (NLO1 ve NLO2) ile erken dönemde eksitus olanlar kay›t edildi. Bulgular: Çal›flmam›za 199 hasta dahil edildi. Gruplar aras›nda demografik veriler benzerdi. Preoperatif ve postoperatif ortalama NLR de¤erleri aç›s›ndan Grup Y ve Grup K aras›nda fark yoktu. NLO1 ve NLO2 de¤erleri gruplar aras›nda anlaml› farkl› de¤ildi. NLO1/NLO2 ile mortalite ve morbidite aras›nda hem grup Y’de hem de grup K’da anlaml› fark yoktu. Sonuç: Bu çal›flmada NLO ile kalça k›r›¤› olan hastalarda mortalite ve morbidite aç›s›ndan bir iliflki oldu¤unu gösterilememifltir.

THE EFFECT OF NEUTROPHIL TO LYMPHOCYTE RATIO ON POSTOPERATIVE EARLY MORTALITY AND MORBIDITY IN HIP FRACTURE INTENSIVE CARE PATIENTS

Objective: In this study the relation between the neutrophil and lymphocyte ratio (NLR) and mortality in patients with hip fracture accepted in ICU in the postoperative period was investigated. Method: The patients who were operated for hip fractures and accepted to ICU postoperatively between Jan 2015-Jun 2016 were included in the study. In Group Y (n=184) the patients who were survived and in Group K (n=15) the patients who did not survive were analysed retrospectively. Age, sex, coronary artery disease, general or regioal anesthesia technique for the surgery, NLR counts preoperatively and in the first postoperative day in the ICU and exitus at the early period were obtained. Results: One-hundred and ninety nine patients were included in the study. The demographic variables were similar between groups. There was no significant difference between preoperative and postoperative mean NLR between groups. The correlation between NLRpr/NLRpo and mortality was similar in Group Y and in Group K. Conclusion: In this study a correlation between NLR and morbidity and mortality of the patients with hip fracture was not demonstrated.

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Şenol Y, Akdeniz M. Yafll›l›k ve Koruyucu T›p. GeroFam 2010; 1: 49-68.
Rodop O, Kiral A, Kaplan H, et al. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop 2002; 26: 233-237.
Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 1997; 337: 1279-1284.
Stone ME Jr, Barbaro C, Bhamidipati C, et al. Elderly hip fracture patients admitted to the trauma service: does it impact patient outcome? J Trauma 2007; 63: 1348-1352.
Uygur E, Söylemez S, Aktafl B, Çarkç› E. Proksimal femoral çivileme ile tedavi edilen intertrokanterik femur k›r›¤› olan yafll› hastalar›n ameliyat sonras› sa¤ kal›m sonuçlar›. Medeniyet Medical Journal 2015; 30: 63-66.
Petersen MB, Jorgensen HL, Hansen K, Duus BR. Factors affecting postoperative mortality of patients with displaced femoral neck fracture. Injury 2006; 37: 705-711.
Abrahamsen, B, van Staa T, Ariely, R, Olson, M, Cooper, C. Excess mortality following hip fracture: A systematic epidemiological review. Osteoporosis International 2009; 20: 1633-1650.
Marottoli RA, Berkman LF, Cooney LM Jr. Decline in physical function following hip fracture. J Ann Geriatr Soc 1992; 40: 861-866.
Huddleston JM, Whitford KJ. Medical care of elderly patients with hip fractures. Mayo Clin Proc 2001; 76: 295-298.
Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014; 43: 464-471.
Talsnes O, Hjelmstedt F, Dahl OE, Pripp AH, Reikeras O. Clinical and biochemical prediction of early fatal outcome following hip fracture in the elderly. Int Orthop 2011; 35: 903-907.
Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 2012; 43: 676-685.
Mosfeldt M, Pedersen OB, Riis T, et al. Value of routine blood tests for prediction of mortality risk in hip fracture patients. Acta Orthop 2012; 83: 31-35.
Kovar FM, Endler G, Wagner OF, Jaindl M. Basal haemoglobin levels as prognostic factor for early death in elderly patients with a hip fracture. A twenty year observation study. Injury 2015; 46: 1018-1022.
Toson B, Harvey LA, Close JC. The ICD-10 Charlson Comorbidity Index predicted mortality but not resource utilization following hip fracture. J Clin Epidemiol 2015; 68: 44-51.
Koval KJ, Maurer SG, Su ET, Aharonoff GB, Zuckerman JD. The effects of nutritional status on outcome after hip fracture. J OrthopTrauma 1999; 13: 164-169.
Fisher A, Srikusalanukul W, Fisher L, Smith P. The neutrophil to lymphocyte ratio on admission and short-term outcomes in orthogeriatric patients. Int J Med Sci 2016; 13: 588-602.
Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther 2013; 11: 55-59.
Celikbilek A, Ismailogullari S, Zararsiz G. Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease. J Clin Lab Anal 2014; 28: 27-31.
Malietzis G, Giacometti M, Kennedy RH, Athanasiou T, Aziz O, Jenkins JT. The emerging role of neutrophil to lymphocyte ratio in determining colorectal cancer treatment outcomes: a systematic review and meta-analysis. Ann Surg Oncol 2014; 21: 3938-3946.
Carter ND, Kannus P, Khan KM. Exercise in the prevention of falls in older people: a systematic literature review examining the rationale and the evidence. Sports Med 2001; 31: 427-438.
Koval KJ, Maurer SG, Su ET, Aharonoff GB, Zuckerman JD. The effects of nutritional status on outcome after hip fracture. J Orthop Trauma 1999; 13: 164-169.
Atay T, Ceylan BG, Özmeriç A, et al. The effects of related factors on one- and two-year mortality after a hip fracture in elderly Turkish patients. Trakya Univ Tip Fak Derg 2010; 27: 127-131.
Çopuroglu C, Ünver V.K, Özcan M, Çiftdemir M, Turan N. F, Çopuro¤lu E. Kalças› k›r›k hastalarda tespit edilen risk faktörlerinin incelenmesi. Bak›rköy T›p Dergisi 2011; 7: 136-141.
Shebubakar L, Hutagalung E, Sapardan S, Sutrisna B. Effects of older age and multiple comorbidities on functional outcome after partial hip replacement surgery for hip fractures. Acta Med Indones 2009; 41: 195-199.
Franzo A, Francescutti C, Simon G. Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: A population based approach. Eur J Epidemiol 2005; 20: 985-991.
Forget P, Dillien P, Engel H, Cornu O, Kock MD, Yombi JC. Use of the neutrophil-to-lymphocyte ratio as a component of a score to predict postoperative mortality after surgery for hip fracture in elderly subjects. BMC Res Notes 2016; 9: 284.
Cook EJ, Walsh SR, Faroog N, Alberts JC, Justin TA, Keeling NJ. Postoperative neutrophil-lymphocyte ratio predicts complications following colorectal surgery. International Journal of Surgery 2007; 5: 27-30.