Esra ÇAKIR, Ahmet BİNDAL, Pakize ÖZÇİFTCİ YILMAZ, Cihangir DOĞU, Işıl ÖZKOÇAK TURAN

Sepsisli Hastaların Hemodinamik Destek İhtiyacı

Amaç: Septik hastalar septik şok nedeniyle inotropik desteğe ihtiyaç duyabilir. Septik hastalarda inotropların ihtiyacını tahmin etmek için yeterli ve yüksek duyarlı parametre yoktur. Bu çalışmada yoğun bakım ünitesindeki (YBÜ) septik hastalarda inotrop kullanım ihtiyacının öngörülmesi için şok indeksi (SI), modifiye şok indeksi (MSI) ve yaş şok indeksinin (YSI) kullanılabilirliğini belirlemeyi amaçladık.Materyal ve metod: 1 Eylül 2017 ile 31 Aralık 2018 tarihleri arasında YBÜ'de yatan sepsisli hastaların sonuçlarını retrospektif olarak değerlendirdik. Yaş, cinsiyet, eşlik eden hastalıklar, akut fizyoloji ve kronik sağlık değerlendirme II (APACHE II) skorları, mekanik ventilasyon süresi, hastanede yatış süresi, inotrop desteği, SI, MSI ve YSI kayıt edildi.Bulgular: Çalışmamıza 233 sepsisli hasta dahil edildi. Şok indeksi, MSI ve YSI düzeyleri inotrop desteği alan sepsis hastalarında inotrop desteği almayan sepsis hastalarına göre istatistiksel olarak yüksek bulundu (p<0,05). Şok indeksi için ROC (receiver operating characteristic) eğrisi altındaki alan 0,765’tir (% 95 güven aralığı (GA): 0,706-0,818 P = 0,0001). İnotrop destek için SI eşik değeri 1,06’dır (duyarlılık: %77,2, %95 GA: 67,1-85,5, özgüllük: %70,3, %95 GA: 62,2-77,6). MSI için ROC eğrisi altındaki alan 0,753’tür (% 95 GA: 0,692-0,807 P = 0,0001). İnotrop destek için MSI eşik değeri 1,56’dır (duyarlılık: %68,2 %95 GA: 57,4-77,7, özgüllük: %70,3, %95 GA: 62,2-77,6). Yaş SI için ROC eğrisi altındaki alan 0,707’dir (% 95 GA: 0,644-0,764 P = 0,0001). İnotrop destek için YSI eşik değeri 82,4’tür (duyarlılık: %64,7, %95 GA: 53,9-74,7, özgüllük: %70,3, %95 GA: 62,2-77,6).Sonuç: Sonuçlarımız, tüm şok indekslerinin inotrop ihtiyacı için orta seviye tahmin gücüne sahip olduğunu gösterdi.

Anahtar Kelimeler:

İnotrop, Yoğun Bakım Ünitesi, Şok İndeksi, Modifiye Şok İndeksi, Yaş Şok İndeksi, Sepsis

The Need for Hemodynamic Support of Patients with Sepsis

Background: Septic patients may need inotropic support due to septic shock. There is no sufficient high-sensitive parameters in order to predict the need of inotropes, in septic patients. In this study, we aimed to determine the availability of shock index (SI), modified shock index (MSI) and age shock index (ASI) for the prediction of the need for inotrope usage in septic patients in intensive care units (ICU).Materials and Methods: We retrospectively evaluated the results of patients with sepsis who were hospitalized in ICU, between September 1, 2017 and December 31, 2018. We recorded age, gender, co-morbidities, acute physiology and chronic health evaluation II (APACHE II) scores, length of mechanical ventilation, length of hospital stay, inotropic support, SI, MSI and ASI.Results: Our study included 233 patients with sepsis. SI, MSI, ASI levels were found out to be statistically significantly higher in patients who did require inotropic support, compared with patients who did not receive inotropic support (p < 0.05). For SI, the area beneath the receiver operating characteristic (ROC) curve was 0.765 (95% confidence interval (CI): 0.706–0.818, p = 0.0001) and cut-off value for inotropic support was 1.06 (sensitivity: 77.2 %, 95% CI: 67.1-85.5; specificity: 70.3%, 95% CI: 62.2-77.6). For MSI, the area beneath the ROC curve was 0.753 (95% CI: 0.692–0.807, p = 0.0001) and cut-off value for inotropic support was 1.56 (sensitivity: 68.2%, 95% CI: 57.4-77.7; specificity: 70.3%, 95% CI: 62.2-77.6). For ASI, the area beneath the ROC curve was 0.707 (95% CI: 0.644–0.764, p = 0.0001) and cut-off value for inotropic support was 82.4 (sensitivity: 64.7%, 95% CI: 539–74.7; specificity: 70.3%, 95% CI: 6.22–77.6).Conclusion: Our data showed all the shock indices had mid-level prediction power for the need of inotropes.

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