Handan AKSOY, Ezgi ÖZYILMAZ, Müge AYDOĞDU, Handan GÜRSEL, Numan EKİM

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Mortality prediction in community-acquired pneumonia requiring mechanical ventilation; values of pneumonia and intensive care unit severity scores

Ağır toplum kökenli pnömoni (TKP), yoğun bakım ünitesi (YBÜ) yatışlarının önemli bir nedenini oluşturur. YBÜ’ye yatış gerekliliğinin ve mortalite riskinin belirlenmesi amacıyla pek çok skorlama sistemi geliştirilmiştir. Ama bu skorlama sistemlerinin yararı ve doğruluğu konusunda tartışmalar halen devam etmektedir. Öte yandan bu skorlar mekanik ventilasyon ihtiyacı olan hastalarda YBÜ mortalitesini tahmin etme açısından değerlendirilmemiştir. Bunun için çeşitli YBÜ skorlama sistemleri kullanılmaktadır. Bu çalışmanın amacı; mekanik ventilasyon ihtiyacı olan ağır TKP’li hastalarda pnömoni ve YBÜ skorlama sistemlerinin etkinliğini karşılaştırmaktır. Retrospektif gözlemsel kohort çalışmasıdır. Mekanik ventilasyon uygulanan TKP’li hastaların dosyaları ve kayıtları değerlendirilmiş; demografik, laboratuvar ve klinik özellikleri kaydedilmiştir. Pnömoni skorlama sistemleri [modifiye “American Thoracic Society (ATS)” kriterleri, CURB-65, pneumonia severity index (PSI)] ve YBÜ skorlama sistemleri [Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA)] mortalite tahmini açısından karşılaştırılmıştır. Yaş ortalamaları 68 ± 16 yıl olan 38’i kadın, 63’ü erkek toplam 101 TKP’li hasta çalışmaya dahil edildi. Çalışmaya katılan hastaların YBÜ mortalitesi %55 olarak değerlendirildi. Hastaların %90’ı YBÜ yatışı açısından modifiye ATS kriterlerini sağlarken, %92’si PSI skorunu sağlıyordu. Pnömoni skorlama sistemleri; CURB-65, PSI, modifiye ATS kriterleri YBÜ mortalitesini tahmin etmede değerli bulunmazken, YBÜ’lerde sıklıkla kullanılan APACHE II skorunun artmış değerleri mortalite ile ilişkili bulundu (APACHE II > 20 odds ratio: 3, %95 CI: 1.2-7, p= 0.024). Bu sonuçlar göstermiştir ki, YBÜ mortalitesini tahmin etmede pnömoni skorları değil, YBÜ’lerde sıklıkla kullanılan APACHE II skoru daha değerlidir. APACHE II skoru > 20 olan TKP’li hastaların tedavisinde ve takibinde daha dikkatli olunmalıdır.

Mekanik ventilasyon ihtiyacı olan toplum kökenli pnömoni hastalarının mortalite tahmininde pnömoni ve yoğun bakım skorlarının değeri

Severe community-acquired pneumonia (CAP) is an important cause of intensive care unit (ICU) admissions. Many different pneumonia scoring systems have been developed in order to assess the severity of pneumonia and to decide the ICU follow-up and treatment. But still debate is going on about their performances and also they have not been tested yet if they can predict ICU mortality in severe CAP patients requiring mechanical ventilation. The aim of this study is to evaluate the performances of pneumonia and ICU scores in predicting mortality in CAP patients requiring mechanical ventilation. A retrospective observational cohort study. The files of mechanically ventilated CAP patients were reviewed and demographic, clinic and laboratory characteristics were recorded. Scoring systems of pneumonia [revised American Thoracic Society (ATS) criteria, CURB-65, pneumonia severity index (PSI)] and ICU [Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment] were compared for mortality prediction. Thirty eight female and 63 male, a total of 101 severe CAP patients, with the mean age of 68 ± 16 years, were included in the study. ICU mortality rate was assessed as 55%. Ninety percent of all patients met the revised ATS criteria and 92% of them met the PSI scoring system for ICU admissions. Although the CURB-65, PSI, revised ATS criteria were not found valuable to predict mortality, the increased APACHE II score was found to be related with increased mortality rate (for APACHE II > 20 odds ratio: 3, 95% CI: 1.2-7, p= 0.024). These results suggest that instead of the pneumonia scoring systems the APACHE II score can best predict the ICU mortality. So, more attention should be paid for severe CAP patients with APACHE II score > 20.
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Tüberküloz ve Toraks-Cover
  • ISSN: 0494-1373
  • Yayın Aralığı: 4
  • Başlangıç: 1951
  • Yayıncı: Tuba Yıldırım
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