Celil Alper USLUOĞULLARI, Sedat CANER, FEVZİ BALKAN, Vedat KILIÇ, Siren SEZER

Akut böbrek yetmezliği gelişen yoğun bakım hastalarında Rifle kriterlerinin uygulanması ve prognoza etki eden faktörlerin değerlendirilmesi

Amaç: Akut böbrek yetmezliği (ABY), yoğun bakım ünitelerinde yatmakta olan hastalarda %5-20 oranında görülmektedir. Metabolik ve hormonal fonksiyonlardaki bozulmalar ABY gelişen hastalarda mortalite ve morbiditenin artmasına da katkıda bulunabilirler. Çalışmamızda yoğun bakım ünitesinde ABY gelişen hastaları önce RIFLE sınıflamasına göre gruplara ayırıp klinik ve laboratuvar değerlerini karşılaştırdık, bunun yanında hastaların prognozuna etkili olabilecek faktörleri değerlendirdik. Yöntemler: Çalışmaya, Başkent Üniversitesi Tıp Fakültesi Hastanesi yoğun bakım ünitesinde ABY gelişen toplam 50 hasta dahil edildi. RIFLE sınıflamasına göre hastalar risk, injury ve failure olmak üzere 3 gruba ayrıldı. Hasta grupları klinik ve laboratuvar özellikleri ile karşılaştırıldı. Prospektif takiplerine göre hastalar eksitus ve sağ kalan olarak iki gruba ayrıldı, her iki grubun ABY tanısı aldığındaki vital bulguları ve laboratuvar değerleri kaydedildi. Bulgular: İnsülin direnci (HOMA-IR), RIFLE grupları arasında istatiksel olarak anlamlı farklılık gösteriyordu (p=0,034,p=0,004). Hastaların hemodiyaliz ihtiyacı olup olmaması, yoğun bakımda yatış süreleri ve mortalite oranları gruplar arasında karşılaştırıldığında istatiksel olarak anlamlı farklar saptandı (p =0,017, p =0,010, p=0,001). Glukoz, insülin düzeyleri ve HOMA-IR eksitus olan grupta istatiksel olarak anlamlı farklı bulundu (p=0,040, p=0.048, p =0,001). Sonuç: Hiperglisemi ve insülin direncinin de eşlik ettiği ABY hastalarındaki yüksek mortalite oranları göz önüne alınarak, bu hastalarda yakın kan glukoz düzeyi takibi, ılımlı ve kontrollü insülin tedavisinin de yararlı olabileceğini düşünmekteyiz.

Implementation of RIFLE criteria and assessment of factors that affect the prognosis in patients with acute renal failure in intensive care

Objective: Acute renal failure (ARF) was seen in 5-20% of patients in intensive care unit (ICU). The disturbances of metabolic and hormonal functions contribute to increase the rate of mortality and morbidity in the patients whose have ARF. In our study, firstly we separated the patients, have ARF, into the groups as RIFLE classification after that we compared the collected data from clinic and laboratory, at the same time we evaluated the factors may effects the prognosis of patients. Methods: The fifty patients that have ARF in the intensive care unit of Başkent Universty Hospital were included. The patients divided into three groups, which are called risk, injury and failure according to RIFLE classification. The grouped patients are compared as laboratory and clinical features. We planned that divide the patients into two groups as died and alive according to prospective follow up, when we put diagnosis, we record the vital signs and laboratory values. Results: There is a considerable difference as statistical between RIFLE groups about insulin resistance (HOMAIR). (p =0,034, p =0,004). When we compare the patient whether they needs hemodialysis or not, during the patient being at intensive care unit, and mortality rate, we saw considerable difference as statistical (p =0,017, p =0,010, p =0,001). Glucose, insulin level, and HOMA-IR observed meaningful as statistical in the exitus groups. (p =0,040, p=0.048, p =0,001). Conclusion: We think that the close monitoring of blood glucose and the controlled insulin treatment may be beneficial by taking into consideration of high mortality rate in the patient with ARF accompanying hyperglycemia and insulin resistance.

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