Bir tıbbi yoğun bakım ünitesinde üst gastrointestinal kanamalı hastalarda mortalite risk faktörleri

Amaç: Bu çalışmada yoğun bakım ünitesinde (YBÜ) izlenen akut gastrointestinal sistem (GİS) kanamalı hastaların genel klinik özelliklerini ve mortalite için risk faktörlerini değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ekim 2016-Mart 2019 tarihleri arasında medikal YBÜ’de izlenen akut GİS kanamalı hastalar çalışmaya dahil edildi. Hastalar demografik, klinik ve laboratuvar verileri (kabul sırasında ve 24 saat sonra) açısından değerlendirildi ve mortalite durumuna (sağ kalan ve ölen) göre karşılaştırıldı. Bulgular: Medyan yaşı 73,5 (31-93) yıl olan toplam 64 hasta (37 erkek/27 kadın) değerlendirildi. Tüm hastaların üst GİS kanaması vardı ve ölüm oranı %29,7 olarak saptandı. Sağ kalan ve ölen gruplar arasında cinsiyet, yaş ve kronik yandaş hastalıklar açısından malignite dışında fark yoktu. Takipte 24 saat sonra bakılan BUN, kreatinin, INR ve laktat düzeylerinin yüksek seviyeleri mortalite ile ilişkili bulundu. Lojistik regresyon analizinde akut solunum yetmezliği varlığı, YBÜ'den önce hastanede kalma süresinin uzun olması, yüksek SOFA skoru ve 24 saat sonra bakılan yüksek laktat seviyeleri YBÜ mortalitesinin bağımsız belirleyicileri olarak saptandı Sonuç: Bu çalışmada hastaların YBÜ'ye yatıştaki değerlerinden ziyade 24 saat sonra bakılan ve yüksek seyreden BUN, kreatinin, INR ve laktat düzeyleri artmış mortalite ile ilişkili olduğunu saptadık. Bu nedenle bu değerlerin yakın takibi ve uygun tedaviler ile hızlıca normalleştirilmesinin önemli olduğunu düşünmekteyiz.

Anahtar Kelimeler:

Gastrointestinal kanama, yoğun bakım ünitesi, risk faktörleri, mortalite

Mortality risk factors in patients with upper gastrointestinal bleeding in a medical intensive care unit

Purpose: The aim of this study was to evaluate the general clinical characteristics of acute gastrointestinal system (GIS) bleeding patients who were followed-up in the intensive care unit (ICU) and the risk factors for mortality. Materials and Methods: The GIS bleeding patients followed up in a medical ICU between October 2016 and March 2019 were included. Patients were evaluated for demographic, clinical and laboratory data (on admission and after 24-hours) and compared according to the mortality status (surviving vs. non-surviving). Results: A total of 64 patients (37 males and 27 females) with a median age of 73.5 (31-93) years were evaluated. All patients had upper GIS bleeding and the mortality rate was 29.7%. There was no difference between the mortality groups for gender, age and chronic co-morbid diseases except malignancy. High BUN, creatinine, INR, and lactate levels after 24 hours were significantly associated with mortality. All patients had a diagnosis of upper GIS bleeding. In the logistic regression analysis, the presence of acute respiratory insufficiency, long hospital stays before ICU, high SOFA score and high lactate levels after 24 hours were the independent predictors of ICU mortality). Conclusion: In this study, we found that high levels of BUN, creatinine, INR, and lactate levels in the first 24 hours of follow-up, rather than the values on admission to ICU, were associated with increased mortality. Therefore, we suggest that close monitoring and rapid normalization of these values with appropriate treatments is important.

Keywords:

Gastrointestinal bleeding, intensive care unit, risk factors, mortality,

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