Abstract
Amaç: Çalışmanın amacı yoğun bakım ünitesinde takip edilen onkoloji hastalarının mortalitesine etki eden faktörlerin belirlenmesidir.
Gereç ve Yöntem: Bu çalışmada 2012-2014 yılları arasında Çukurova Üniversitesi Tıp Fakültesi İç Hastalıkları AB.D. yoğun bakım ünitesinde takip edilen ardışık 100 hasta prospektif olarak incelenmiştir. Mortaliteyi etkileyen faktörleri saptamak için Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE) II, Sıralı Organ Yetmezliği Değerlendirme Puanı (SOFA) 1. gün ve SOFA 3. gün skorları kullanılmıştır. Laktat magnezyum, fosfor, potasyum, kan üre azotu (BUN) ve beta 2 mikroglobülin düzeyleri belirlenmiştir. Hastaların yoğun bakımda takip edildiği süre boyunca vazopressör, renal, solunumsal destek ihtiyacı, nötropeni ve enfeksiyöz etkenler ile mortalite arasındaki ilişki belirlenmiştir. Yoğun bakım takibinden çıkarılıp servise devredilen hastalar (Grup 1: 40 hasta) ve yoğun bakım takibinde ölen hastalar (Grup 2: 60 hasta) olmak üzere iki grupta incelenmiştir.
Bulgular: Grup 1 ve Grup 2’deki hastaların APACHE II değeri, SOFA 1. Gün ve SOFA 3. Gün skoru, Prediktif mortalite oranı, yoğun bakıma kabul anındaki laktat değerleri, vazopressör destek ihtiyacı, solunumsal destek ihtiyacı, renal destek ihtiyacı, BUN düzeyi, potasyum düzeyi, magnezyum düzeyi, beta 2 mikroglobulin düzeyi ve Acinetobacter baumannii üremesi ile hastaların yoğun bakım takiplerinde kaybedilmesiyle istatistiksel olarak anlamlı bulunmuştur. Ayrıca yeni yoğun bakım ünitesinde izlenen hastalarda mortalite daha az bulunmuştur.
Sonuç: Beta 2 mikroglobülin düzeyi yoğun bakım mortalitesini tahmin etmekte kullanılabilir.
Keywords
Supporting Institution
Yok
References
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Abstract
Purpose: The aim of the study is to determine the factors affecting the mortality of oncology patients followed in the intensive care unit (ICU).
Materials and Methods: In this study 100 patients who were followed up in the ICU of Cukurova University Faculty of Medicine, Internal Medicine Department between 2012-2014 were prospectively included. Acute Physiology and Chronic Health Evaluation (APACHE) II, 1st and 3rd day Sequential Organ Failure Assessment Score (SOFA) scores were used to determine the factors that were affecting mortality. Lactate, magnesium, phosphorus, potassium, blood urea nitrogen (BUN) and beta 2 microglobulin levels were determined at the time of admission to ICU. The relationship between vasopressor, renal, respiratory support need, neutropenia, infectious agents and mortality was determined during the follow-up period in the ICU. The patients were divided into two groups as patients transferred from ICU to the inpatient clinics (Group 1: 40 patients) and patients who were died in the ICU follow-up (Group 2: 60 patients).
Results: APACHE II and 1st and 3rd day SOFA scores, predictive mortality rate, intensive care admission lactate levels, vasopressor and respiratory support needs, renal support needs, BUN, potassium and magnessium levels, beta 2 microglobulin levels, positive Acinetobacter baumannii culture mean was statistically significant with mortality during intensive care follow up between the Group 1 and 2 patients. In addition, mortality was found to be less in patients followed up in the new ICU.
Conclusion: Beta 2 microglobulin level can be used to predict intensive care mortality.
References
- 1. Bouch DC, Thompson JP. Severity scoring systems in the critical ill. Continuing Education in Anesthesia and Critical Care. 2008;8:181-85.
- 2. Sakarya M. Yoğun bakımda skorlama sistemleri. Anestezi Yoğun Bakım Ağrı (Ed F Tüzüner):1209-1220. Ankara, Nobel Tıp, 2010.
- 3. Holmes CL, Gregoire G, Russell JA. Assessment of severity of illness. Principal of Critical Care. (Eds Hall JB, Schmidt GA, Wood LDH):63-78. New York, The McGraw- Hill Company, 2005.
- 4. Higgins TL. Severity of illness indices and outcome prediction. Textbook of Critical Care. (Eds Fink MP, Abraham E, Vincent JL. Kochanek PM):2195-2206. Philadelphia, Elsevier Saunders, 2005.
- 5. Cédric A, Régis B, Nicolas F, Delphine D, Bruno F, Olivier B. Plasma beta-2 mıcroglobulın as a marker of fraılty ın older adults: a pılot study. Journal of Gerontology. 2011;66:1077-79.
- 6. Bataille R, Grenier J, Sany J. Beta-2-microglobulin in myeloma: optimal use for staging, prognosis, and treatment. A prospective study of 160 patients. Blood. 1984;63:468–76.
- 7. Shinkai S, Chaves PH, Fujiwara Y, et al. Beta2-microglobulin for risk stratification of total mortality in the elderly population: comparison with cystatin C and C-reactive protein. Arch Intern Med. 2008;168:200–6.
- 8. Cherif H, Martling CR, Hansen J, Klio M, Bjorkholm M. Predictors of short and long term outcome in patients with hematological disorders admitted to the intensive care unit for a life threatining complication. Support Care Cancer. 2007;15:1393-98.
- 9. Lamia B, Hellot MF, Girault C, Tamion F, Dachraoui F, Lenain P, Bonmarchand G. Changes in Severity and organ failure scores as prognostic factors in onco-hematological malignancy patients admitted to the ICU. Intensive Care Med. 2006;32:1560-68.
- 10. Nichol AD, Egi M, Pettila V, Bellomo R, French C, Hart G et al. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care. 2010;14-25.
- 11. Lieberman D, Nachshon L, Miloslavsky O, Dvorkin V, Shimoni A, Lieberman D. How do older ventilated patients fare? A survival/functional analysis of 641 ventilations. J Crit Care. 2009;24:340–46.
- 12. Dardaine V, Dequin PF, Ripault H, Constans T, Giniès G. Outcome of older patients requiring ventilatory support in intensive care: impact of nutritional status. J Am Geriatr Soc. 2001;49:564–70.
- 13. Goodfellow PN. The Beta 2 microglobulin gene is on chromosome 15 and not in the HLA-A region. Nature. 1975;254-57.
- 14. Chiorazzi N, Rai KR & Ferrarini M. Chronic lymphocytic leukemia. New England Journal of Medicine. 2005;352:804–8.
- 15. Rubeız GJ, Thıll-Baharozıan M, Hardıe D et al. Association of hypomagnesemia and mortality in acutely ill medical patients. Crit Care Med. 1993;21:203-9.
- 16. Guerin C, Cousin C, Mignot F et al. Serum and erythrocyte magnesium in critically ill patients. Intensive Care Med. 1996;22:724-27.
- 17. Beier K, Eppanapally S, Bazick HS et al. Elevation of blood urea nitrogen is predictive of long-term mortality in critically ill patients independent of “normal” creatinine. Crit Care Med. 2011;39:305–13.
- 18. Aronson D, Mittleman MA, Burger AJ. Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure. Am J Med. 2004;116:466–73.
- 19. Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med. 1999;341:577–85.
- 20. Pan SW, Kao HK, Yu WK. Synergistic impact of low serum albumin on intensive care unit admission and high blood urea nitrogen during intensive care unit stay on post-intensive care unit mortality in critically ill elderly patients requiring mechanical ventilation. Geriatr Gerontol Int. 2013;13:107–15.
- 21. Park SY, Choo JW, Kwon SH. Risk Factors for Mortality in Patients with Acinetobacter baumannii Bacteremia. Infect Chemother. 2013;45:325-30.
- 22. Al-Samsam RH, Cullen P. Sleep and adverse environmental factors in sedated mechanically ventilated pediatric intensive care patients. Pediatr Crit Care Med. 2005;5:562-7.
- 23. ShiloL, DaganY, SmorjikY, Weinberg U, Dolev S, Komptel B et al. Patients in the intensive care unit suffer fromsevere lack of sleep associated with loss of normal melatonin secretion pattern. Am J Med Sci. 1999;317:278-81.
- 24. Mistraletti G, Sabbatini G, Taverna M, Figini MA, Umbrello M, Magni P et al. Pharmacokinetics of orally administered melatonin in critically ill patients. J Pineal Res. 2010;48:142-7.
- 25. Vaughan GM, Pelham RW, Pang SF, Loughlin LL, Wilson KM, Sandock KL et al. Nocturnal elevation of plasma melatonin and urinary 5-hydroxyindoleacetic acid in young men: attempts at modification by brief changes in environmental lighting and sleep and by autonomic drugs. J Clin Endocrinol Metab. 1976;42:752-64.
Details
| Primary Language | English |
|---|---|
| Subjects | Oncology and Carcinogenesis |
| Journal Section | Research |
| Authors | |
| Publication Date | December 27, 2020 |
| Acceptance Date | September 29, 2020 |
| Published in Issue | Year 2020 Volume: 45 Issue: 4 |
