Ali OĞUL, Semra PAYDAŞ, Emre KARAKOÇ, Gülşah SEYDAOĞLU, Mahmut BÜYÜKŞİMŞEK

Yoğun bakım ünitesinde izlenen onkoloji hastalarının prognozunu belirleyen faktörler

Amaç: Çalışmanın amacı yoğun bakım ünitesinde takip edilen onkoloji hastalarının mortalitesine etki eden faktörlerin belirlenmesidir. Gereç ve Yöntem: Bu çalışmada 2012-2014 yılları arasında Çukurova Üniversitesi Tıp Fakültesi İç Hastalıkları AB.D. yoğun bakım ünitesinde takip edilen ardışık 100 hasta prospektif olarak incelenmiştir. Mortaliteyi etkileyen faktörleri saptamak için Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE) II, Sıralı Organ Yetmezliği Değerlendirme Puanı (SOFA) 1. gün ve SOFA 3. gün skorları kullanılmıştır. Laktat magnezyum, fosfor, potasyum, kan üre azotu (BUN) ve beta 2 mikroglobülin düzeyleri belirlenmiştir. Hastaların yoğun bakımda takip edildiği süre boyunca vazopressör, renal, solunumsal destek ihtiyacı, nötropeni ve enfeksiyöz etkenler ile mortalite arasındaki ilişki belirlenmiştir. Yoğun bakım takibinden çıkarılıp servise devredilen hastalar (Grup 1: 40 hasta) ve yoğun bakım takibinde ölen hastalar (Grup 2: 60 hasta) olmak üzere iki grupta incelenmiştir. Bulgular: Grup 1 ve Grup 2’deki hastaların APACHE II değeri, SOFA 1. Gün ve SOFA 3. Gün skoru, Prediktif mortalite oranı, yoğun bakıma kabul anındaki laktat değerleri, vazopressör destek ihtiyacı, solunumsal destek ihtiyacı, renal destek ihtiyacı, BUN düzeyi, potasyum düzeyi, magnezyum düzeyi, beta 2 mikroglobulin düzeyi ve Acinetobacter baumannii üremesi ile hastaların yoğun bakım takiplerinde kaybedilmesiyle istatistiksel olarak anlamlı bulunmuştur. Ayrıca yeni yoğun bakım ünitesinde izlenen hastalarda mortalite daha az bulunmuştur. Sonuç: Beta 2 mikroglobülin düzeyi yoğun bakım mortalitesini tahmin etmekte kullanılabilir.

Factors predicting prognosis of oncology patients followed in the intensive care unit

Purpose: The aim of the study is to determine the factors affecting the mortality of oncology patients followed in the intensive care unit (ICU). Materials and Methods: In this study 100 patients who were followed up in the ICU of Cukurova University Faculty of Medicine, Internal Medicine Department between 2012-2014 were prospectively included. Acute Physiology and Chronic Health Evaluation (APACHE) II, 1st and 3rd day Sequential Organ Failure Assessment Score (SOFA) scores were used to determine the factors that were affecting mortality. Lactate, magnesium, phosphorus, potassium, blood urea nitrogen (BUN) and beta 2 microglobulin levels were determined at the time of admission to ICU. The relationship between vasopressor, renal, respiratory support need, neutropenia, infectious agents and mortality was determined during the follow-up period in the ICU. The patients were divided into two groups as patients transferred from ICU to the inpatient clinics (Group 1: 40 patients) and patients who were died in the ICU follow-up (Group 2: 60 patients). Results: APACHE II and 1st and 3rd day SOFA scores, predictive mortality rate, intensive care admission lactate levels, vasopressor and respiratory support needs, renal support needs, BUN, potassium and magnessium levels, beta 2 microglobulin levels, positive Acinetobacter baumannii culture mean was statistically significant with mortality during intensive care follow up between the Group 1 and 2 patients. In addition, mortality was found to be less in patients followed up in the new ICU. Conclusion: Beta 2 microglobulin level can be used to predict intensive care mortality.

Keywords:

Intensive care unit, oncology patients, mortality,

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