Emrah BOZBEYOĞLU, Özlem YILDIRIMTÜRK, Yiğit ÇANGA, Mert İlker HAYIROĞLU, Ayça GÜMÜŞDAĞ, Koray KALENDEROĞLU, Ahmet Okan UZUN, Seçkin PEHLİVANOĞLU

Acute Renal Failure in Patients with Massive Pericardial Effusion or Cardiac Tamponade

INTRODUCTION: Acute kidney injury (AKI) is an important complication in intensive care unit especially in critically ill patients. Prevalence of AKI is ranged from 3 to 25% in different intensive care unit series. Knowledge about incidence of AKI in intensive cardiac care units (ICCU) is limited especially in patients with massive pericardial effusion and cardiac tamponad (PEoT). Our aim was to clarify the prevalence and predictors of AKI in these patients. METHODS: Between October 2014-January 2016, 4,829 patients were hospitalized in our ICCU. Eigthy one of these patients (%1.67) were diagnosed with PEoT during their hospitalization. All patients' relevant data gathered retrospectively from hospital ICCU database. Patients were evaluated for AKI, its prevalence and predictors. Patients were divided into two groups according to development of AKI. RESULTS: Acute kidney injury was seen in 23 (%28.4) patients. Patients with AKI were significantly older, had higher chronic renal disease and congestive heart failure history and lower hypertension history. Left ventricular systolic functions were similar in both patient groups. Baseline serum creatinine and blood urea nitrogen (BUN) levels were higher in patients with AKI. Logistic regression analysis revealed that hypertension history and creatinine levels on admission were only predictors of AKI in these patients. In-hospital mortality was similar in both groups. DISCUSSION and CONCLUSION: Massive pericardial effusion or cardiac tamponade is an important cause of AKI especially in patients with hypertension history and high creatinine levels on admission in ICCU.

Kardiyak Tamponad Gelişen ya da Masif Perikardiyal Effüzyonu Olan Hastalarda Akut Böbrek Yetmezliği

GİRİŞ ve AMAÇ: Akut böbrek yetmezliği (ABY) yoğun bakım ünitelerinde özellikle kritik hastalarda sık karşılaşılan bir durumdur. Akut böbrek yetmezliği prevalansı 3-25% arasında değişmektedir. Koroner yoğun bakım ünitelerindeki (KYBÜ) hastalarda gelişen ABY ile ilgili literatürde yeterli very bulunmamaktadır. Özelllikle massif perikardiyal effüzyon ve kardiyak tamponad bulunan hastalardaki ABY gelişimi için prediktörler bilinmemektedir. Bu çalışmadaki amaç bu hasta grubunda ABY prevalansını ve prediktörlerini belirlemektir. YÖNTEM ve GEREÇLER: Ekim 2014 ile Ocak 2016 arasında KYBÜ'ne 4829 hasta interne edilmiştir. Bu hastalardan 81'inde (1.67%) internasyon süresince masif perikardiyal effüzyon ya da kardiyak tamponad gelişmiştir. Bütün hasta verilerine KYBÜ elektronik veri sisteminden retrospektif olarak ulaşılmıştır. Hastalar ABY prevalansı ve prediktörleri açısından değerlendirilmişlerdir. Hastalar ABY gelişip gelişmediğine gore iki gruba ayrlmışlardır. BULGULAR: Akut böbrek yetmezliği 23 (28.4%) hastada görülmüştür. ABY görülen hastalar daha yaşlı olmakla beraber bu hastalarda kronik böbrek yetmezliği ve konjestif kalp yetmezliği öyküsü daha sık bulunmuştur. Ayrıca bu hastaların arteryel kan basınçları daha düşük saptanmıştır. İki hasta grubunun sol ventrikül ejeksiyon fraksiyonları benzerdir. Bazal kreatinin ve kan üre nitrojen değerleri ABY gelişen hastalarda daha yüksektir. Lojistik regresyon analizinde hipertansiyon öyküsü ve bazal kretainin değeri ABY gelişimini predikte eden parametreler olarak saptanmıştır. Hastane içi mortalite iki hasta grubunda da benzer saptanmıştır. TARTIŞMA ve SONUÇ: Masif perikardiyal effüzyon veya kardiyak tamponad KYBÜ hastalarında önemli bir ABY nedenidir. Hipertansiyon öyküsü ve bazal kreatinin değerleri ABY gelişimini predikte eden parametrelerdir.

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