Yoğun Bakımda Eritrosit Transfüzyonunun Klinik Sonlanımlar Üzerine Etkisi

Bu araştırma ile yoğun bakım hastalarında eritrosit süspansiyonu (ES) transfüzyona ait potansiyel riskler ve transfüzyonun klinik sonuçlar üzerine etkilerinin araştırılması amaçlanmıştır. Yoğun Bakım Ünitesinde (YBÜ) 24 saatten uzun süre yatarak tedavi gören 259 hasta araştırmaya dâhil edilmiştir. Bu hastalara ait demografik veriler, APACHE II skorları, yoğun bakım yatış süreleri, mortalite, kültür üreme sonuçları, transfüzyon uygulanan hastaların anemi nedenleri ve Hemoglobin (Hgb) ve Hematokrit (Hct) düzeyleri ile transfüzyon sonrası Hgb ve Hct düzeyleri ve transfüzyona ait komplikasyonlar değerlendirildi. Araştırmaya dahil edilen 259 olgudan 78 (%30.1)’ne transfüzyon yapıldığı ve ortalama transfüzyon eşik hemoglobin değerinin 7.35±1.00 gr/dL olduğu saptandı. Transfüzyon grubunda kronik böbrek yetmezliği (p=0.007), sepsis (p=0.001) anlamlı oranda sık ve APACHE II skoru daha yüksek saptandı (p=0.001). YBÜ yatış süresi de transfüzyon grubunda (23.84±21.89 karşın 9.68±12.70 gün) anlamlı derecede uzundu (p<0.001). Nazokomiyal enfeksiyonlar transfüzyon grubunda %28.2 ile anlamlı derecede daha sıktı (p=0.043). Diğer yandan transfüzyonunun kendisi de mortalite (%37.2 karşın %22.7, p=0.016) ile yakın ilişkiye sahipti. Transfüzyon ile ilişkili komplikasyon izlenenlerde (p=0.048), eşlik eden malignite varlığında (p=0.020) ve nazokomiyal enfeksiyon gelişenlerde (p=0.048) mortalite oranı anlamlı düzeyde sık saptandı. ES transfüzyonunun hayat kurtarıcı olmasının yanı sıra potansiyel risklerin göz önünde bulundurularak hastaların ihtiyaçlarının titizlikle seçilmesi gerekmektedir. Kısıtlı transfüzyon stratejisinin daha düşük mortalite oranlarına sahip olması ise en dikkat çekici sonuçlarımızdan biridir.

Anahtar Kelimeler:

Eritrosit Süspansiyonu, Hemoglobin, Mortalite, Transfüzyon, Yoğun Bakım

The Impact of Erythrocyte Suspension Transfusion on Clinical Outcomes in Critical Care Settings

In this study, potential risks related to erythrocyte suspension (ES) transfusion in intensive care patients and the impacts on clinical results of the transfusion are aimed to be investigated. 259 patients who were hospitalized for more than 24 hours in intensive care unit (ICU) were included in the study. Demographic findings related to the patients, APACHE II scores, length of ICU stay, overall ICU mortality, culture results, causes of anemia in patients who are applied transfusion and levels of Hemoglobin (Hgb) and Hematocrit (Hct) with Hgb and Hct levels of post-transfusion and complications related to transfusion were recorded. Of the 259 cases included in the study, 78 (30.1%) were received transfusion and the mean Hgb threshold for transfusion was 7.35±1.00 gr/dL. In the transfusion group; chronic renal failure (p=0.007) and sepsis (p=0.001) were found significantly frequent and APACHE II score was higher (p=0.001). ICU length of stay (23.84±21.89 vs. 12.70±9.68) was also significantly longer in the transfusion group (p<0.001). Nosocomial pathogen-related infections were also significantly more frequent in the transfusion group (28.2%, p=0.043). Transfusion itself had a close relationship with mortality (37.2% vs. 22.7%, p=0.016). Mortality rates were found to be significantly higher in patients with transfusion-related complications (p=0.048), concomitant malignancy (p=0.020) and nasocomial pathogen-related infections (p=0.048). In addition to ES transfusion that is life saving, patients’ needs should be carefully assessed considering its potential risks. Strategy of restrictive transfusion that has lower mortality rates is one of the most attention grabbing results.

Keywords:

Erythrocyte Suspension, Hemoglobin, Intensive Care, Mortality, Transfusion,

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