Gülseda DEDE, Leyla ŞAHAN, Bahadır DEDE, Semra DEMİRBİLEK

Kan Laktat Seviyesi Yoğun Bakım Hastalarında Mortaliteyi Tahmin Etmede Ne Kadar Etkilidir?

Amaç: Bu çalışma ile Yoğun Bakım Ünitesinde yatan hastalarının mortalite tahmininde, kan laktat değerlerinin ne kadar etkili olduğunu göstermek amaçlanmıştır. Materyal ve Metod: Muğla Sıtkı Koçman Üniversitesi Anestezi Yoğun Bakım Ünitesinde 2015 yılında yatan 114 hastanın dosyaları etik kurul onayı alındıktan sonra retrospektif olarak incelenmiştir. Hastaların kayıtlı APACHE II, SOFA, giriş ve çıkış kan gazı analizleri değerlendirmeye alınmıştır. Bulgular: Çalışmaya alınan 114 olgunun yaş ortalaması 62.78±20.43 olup; %59,6’sı erkek, %40,4’ü kadındır. Araştırma grubunun %75,4’ünde eşlik eden bir yandaş hastalığı vardır. Hastaların ortalama yatış süresi ortalama 10.85±13.17 gün olup, %31,6’sı exitus ile sonuçlanmıştır. Araştırma grubunun yaş ortalaması, APACHE II skoru, SOFA skoru, laktat değeri ve çıkış pH değeri ile mortalite arasında istatiksel olarak anlamlı derecede yüksek ilişki bulunmuştur (P<0.05). Araştırma grubunda exitus olan olguların giriş ve çıkış kan değerleri arasındaki ilişkiye bakıldığında pH, laktat, HC03 değerleri ve APACHE II, SOFA skor ortalamalarıyla mortalite arasında istatiksel olarak anlamlı bir ilişki bulunmuştur (P<0.05). Tek değişkenli analizlerde anlamlı bulunan değişkenler logistik regresyon modeline alınmış ve mortalite ile ilişkisine göre etkisi incelendi. APACHE II skorunun (≥23.50) [OR=37.00 (5.35 – 255.75)], SOFA skorunun (≥5.50) [OR=12.50 (4.21 – 37.04)], çıkış laktat seviyesinin (≥1.75mmol) [OR=7.59 (3.34 – 17.22)] ve yaşın (≥65.00) [OR=5.36 (2.09 – 13.71)] mortalite riskini artırdığı bulunmuştur. Sonuç: Hastanın prognozunu belirlemede kan laktat değeri, yoğun bakımda kullanılan skorlama sistemleri kadar önemlidir. Laktat mortalite tahmininde kullanılabilecek iyi bir parametredir.

Anahtar Kelimeler:

Mortalite, Laktat, Skorlamalar

Blood Lactate Levels Intensive Care Patients Mortality Estimating, How much?

Background: This study’s aim was to show the blood lactate levels how effective mortality prediction of the patients hospitalized in the Intensive Care Unit. Materials and Methods: After obtaining the approval of the relevant ethics committee files of 114 patients hospitalized in Muğla Sıtkı Koçman University Intensive Care Unit in 2015 were analyzed retrospectively. Results: The mean age of the 114 patients was 62.78±20.43 ; %59.6 was male and %40.4 was female. The research group has an associated co-morbid disease in %75.4. The average length of stay of patients was 10.85±13.17 per day and %31.6 patients were died. The mean age of study group, APACHE II score, SOFA score, a statistically significant relationship between mortality and high lactate levels and pH were found out ( P<0.05). In univariate analysis multivariate logistic regression models were found to significantly influence and examined by association with mortality. . APACHE II score (≥23.50) [OR=37.00 (5.35 – 255.75)], SOFA score (≥5.50) [OR=12.50 (4.21 – 37.04)], lactate output value (≥1.75mmol) [OR=7.59 (3.34 – 17.22)] and ages (≥65.00) [OR=5.36 (2.09 – 13.71)] have been found to increased the risk of mortality. Conclusion: The blood lactate value in determining the prognosis of patients is as important as scoring systems used in intensive care. Lactate is a good parameter that can be used to estimate mortality.

Keywords:

Lactate, Mortality, Scoring system,

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