YOĞUN BAKIM HASTALARINDA PLAZMA D-DİMER DÜZEYİNİN MORTALİTE İLE İLİŞKİSİ

Giriş: D-dimer fibrin pıhtısının plazmin tarafından yıkılması sonucu oluşur. D-dimer bazı fizyolojik durumlarda artış gösterse de en sık tromboembolik olaylarda artmaktadır. D-dimer yüksekliğinin özellikle tromboembolik olaylarda artmış mortalite göstergesi olduğunu belirten birçok çalışma ve yayın bulunmaktadır. Aynı zamanda sağlıklı popülasyonda da artmış mortalite oranları ile ilişkilendirilmiştir. Biz de çalışmamızda dahiliye yoğun bakım ünitesinde takip ettiğimiz hastalarımızda d-dimer yüksekliği ile mortalite arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmaya SBÜ Bozyaka Eğitim ve Araştırma Hastanesi 1. basamak iç hastalıkları yoğun bakım ünitesinde 2018-2019 yılları arasında takip edilen 259 hasta dahil edildi. Hastaların sonuçları retrospektif olarak değerlendirildi. Çalışmaya kronik hastalık ve enfeksyöz tablo nedeni ile interne edilen hastalar alırken; 18 yaş altı hastalar ,gebeliği ,hematolojik malignitesi ve akut tromboembolik durumu olan hastalar çalışma dışında bırakıldı.Taburcu edilen ve eksitus olan hastaların demografik verileri, d-dimer düzeyleri, yatış tanıları , SOFA ve Apache II skorları ve mortalite oranları kaydedildi. Bulgular: Hastalardan 94’ü eksitus , 165’i taburcu idi. Her iki grubun yaş, cinsiyet, geriatrik yaş dağılımı ve yatış süreleri benzerdi. Eksitus olan hastaların d-dimer ortalaması (1742,6±1945,2), taburcu olan hastaların d dimer ortamasına (881,2±673) göre istatistiksel olarak anlamlı yüksekti (p: 0,005). Hastalık alt analizinde enfeksiyöz hastalığı olan grubun d-dimer düzeyleri enfeksiyöz hastalığı olmayanlara göre anlamlı yüksek saptandı (p:0.045) Sonuç: Sonuç olarak d-dimer bir mortalite ölçeği olarak da değerlendirilebilir. D- dimer yüksekliği olan hastaların ölüm riskinin daha yüksek olabileceği göz önünde bulundurulmalıdır.

ASSOCIATION BETWEEN PLASMA D-DIMER LEVEL AND MORTALITY IN INTENSIVE CARE UNIT PATIENTS

Introduction: D-dimer is formed by the destruction of the fibrin clot by plasmin. Although d-dimer can inscreases physiologically, it is most frequently elevated in thromboembolic events and its association with mortality has been shown in literature. İn addition a positive correlation between mortality and d-dimer levels has been shown in healty population. We aimed to evaluate relationship between d-dimer and mortality. Material and Method: The study included 259 patients who were followed-up in SBU Bozyaka Training and Research Hospital intensive care unit between 2018-2019. The patients who were hospitalized due to chronic and infectious diseases were included in the study; patients under 18 years of age and who had pregnancy, hametological malignancy and acute thrombo embolic event were excluded from the study syndrome were excluded from the study. The results of the patients were evaluated retrospectively. Demographic data, d-dimer levels, hospitalization diagnoses, SOFA and Apache II scores, and mortality rates of patients were recorded. Results: 94 of the patients were exitus and 165 were discharged. Age, gender, geriatric age distribution and length of stay were similar for both groups. The d-dimer mean (1742,6±1945,2) of the exitus group was statistically significantly higher than the d dimer mean (881,2±673) of the patients discharged (p: 0.005). In the disease sub-analysis, the group who had infectious diseases were significantly higher d-dimer levels than the patients without infections disease (p: 0.045). Conclusion: As a result, d-dimer can be evaluated as a mortality scale. It should be taken into consideration that patients with higher d-dimer levels may have an increased mortality risk.

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