Yogun bakımda yatan hastalarda bakılan skorlama sistemlerinin prognoz ile ilişkisinin degerlendirilmesi
Küçük Resim Yok
Tarih
2013
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmamızda Yoğun Bakım Ünitesinde yatan hastaların prognozunun değerlendirmesinde farklı skorlama sistemlerinin (APACHE II, APACHE III, APACHE IV, MPM II, SOFA, SAPS II ve LODS) etkinliğini karşılaştırmayı amaçladık Çalışma Trakya Üniversitesi Tıp Fakültesi Hastanesi Cerrahi ve Reanimasyon yoğun bakım ünitelerine yatan 18 yaş üzeri 24 saat veya daha fazla yatan 110 olgu dahil edildi. Olgular hastaların prognozlarına göre 2 gruba ayrıldı; Grup I (n=63): yoğun bakımda eksitus olan hastalardan, Grup II (n=47): sağlıklı olarak yoğun bakımdan taburcu olan hastalardan oluşturuldu. Hastalıkların prognozunu önceden belirlemek için çeşitli skorlama sistemleri geliştirilmiştir. Bu sistemlerde hastalığın tipi, hastanın fizyolojik rezervi ve tedaviye yanıtı gibi etkenler göz önüne alınarak prognoz belirlenmeye çalışıldı. Bu skorlama sistemleri APACHE (Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi), SAPS (Basitleştirilmiş Akut Fizyoloji Skoru), LODS (Lojistik Organ Disfonksiyon Sistemi), MPM (Mortalite İhtimal Modelleri) ve SOFA (Ardışık Organ Yetersizliği Değerlendirmesi) olarak belirlendi. Bu skorlama sistemlerinde günlük bakılan ve kayıt edilen hastanın laboratuvar değerleri (lökosit, kretinin, bun, sodium, bilirubin, glukoz, trombosit, protrombin zamanı) vital bulguları (FiO2, tansiyon, ısı, solunum sayısı, nabız sayısı, arteriyel kan gazı) ve fizik muayene bulguları (glaskow koma skalası, ek hastalıkları, enfeksiyon varlığı, yaş, kilo) baz alınarak bilgisayar programı eşliğinde her bulguya ait verilen puan değerlerinin girilmesi ile hesaplanması sonucu çıkan sayısal puan, skor puanı olarak kayıt edildi. Bu skorlama puanları regresyon analizi yöntemi ile mortalite üzerine etkisi değerlendirildi. Verilerin analizinde; Student?s t testi ve Mann Whitney U testi kullanıldı. Grupların kendi içlerinde karşılaştırılmaları için t testi ve Wilkinson testi kullanıldı. Fiziksel veriler (örn: cinsiyet vb.) için tablolar yapılarak Pearson x² analizi uygulandı. Nicel veriler için tanımlayıcı istatistik olarak aritmetik ortalama ve standart sapma verildi. p<0.05 istatistiksel olarak anlamlı kabul edildi. Gruplar arasında yaş, yoğun bakım öncesi hastanede kalış süresi, yoğun bakım kalış süresi, ek hastalıkları, SOFA skoru bakımından anlamlı bir farkın olmadığı, Grup I?deki olgularda mekanik ventilatöre bağlanma ve ilk 24 saatte mekanik ventilatöre bağlanmaoranları Grup II?ye göre daha yüksek olduğu, Grup I?deki olgularda APACHE II, III, IV, MPM, SAPS II ve LODS skoru ortalamaları Grup II?ye göre anlamlı derecede yüksek olduğu, Yoğun bakım öncesi hastanede kalış süresi ile APACHE II, APACHE III, MPM, SOFA ve SAPS II skorları arasında anlamlı bir ilişki bulunmaz iken, yoğun bakım öncesi hastanede kalış süresi ile APACHE IV ve LODS skorları arasında pozitif bir ilişki olduğu, Yoğun bakımda kalış süresi ile APACHE III, APACHE IV, MPM, SOFA, SAPS II, ve LODS skorları arasında anlamlı bir ilişki bulunmaz iken, yoğun bakım öncesi hastanede kalış süresi ile APACHE II arasında pozitif yönde bir ilişki olduğu, Prognoza göre mortaliteyi tespit etme duyarlılığı en yüksek %81 oranında APACHE III ile tespit edilirken, 6 ay sonraki duruma göre mortaliteyi tespit etme duyarlılığı en yüksek %76,2 oranında SAPS II ile tespit edildiği bulundu. Sonuç olarak; bu skorlama sistemlerinin performanslarının değişik popülasyonlara uygulandığı zaman ciddi farklılıklar gösterebileceği düşünülebilir. Bunun sebepleri arasında skorlama sistemlerinin uygulanmasındaki hatalar ve henüz bilinmeyen faktörlerin sonuçlar üzerinde etkisinin olabileceği düşüncesindeyiz. Anahtar kelimeler; Yoğun bakım, skorlama sistemleri, mortalite
İn this study we aimed to compare the effectiveness of different scoring systems for the evaluation of the prognosis of the patients hospitalized in the Intensive Care Unit (APACHE II, APACHE III, APACHE IV, MPM II, SOFA, SAPS II and LODS) The study was conducted on 110 cases over the age of 18 and hospitalized 24 hours or more lying in Trakya üniversity medical faculty hospital surgery and reanimation intensive care units. The patients were divided into 2 groups according to prognosis of patients; Group I (n = 63): patients who died in the intensive care unit, Group II (n=47): In healthy patients who were discharged from the intensive care unit was created. Various scoring systems have been developed to predict the prognosis. In these systems, to determine the prognosis taking into consideration factors such as the type of disease, the patient's physiological reserve and response to treatment were examined. These scoring systems was determined as APACHE (Acute Physiology and Chronic Health Evaluation), SAPS (Simplified Acute Physiology Score), LODS (Logistic Organ Dysfunction System), MPM (Mortality Probability Models) and SOFA (Sequential Organ Failure Assessment). These scoring sysytems was evaluated based on the daily viewed and recorded laboratory values (WBC, kretinin, bun, sodium, bilirubin, glucose, platelets, prothrombin time), vital parameters (FiO2, blood pressure, temperature, respiratory rate, pulse rate, and arterial blood gas analysis) and physical examination findings (Glasgow coma scale, additional diseases, presence of infection, age, weight). Scoring system points was calculated with computer software by using these values, parameters and findings. The effects of these scoring system points on the mortality was evaluated by using regression analysis. Student?s t test and Mann Whitney U test was used to Analysis of the datas. T test and Wilkinson test was used to compare of the groups themselves. Physical data (eg, gender, etc.). Pearson chi-square analysis was performed for the statements made . For quantitative data, descriptive statistics were given as mean and standard deviation. p <0.05 was considered statistically significant. Between the groups in age, duration of hospital stay before ICU, intensive care unit length of stay, additional diseases, there is no a significant difference in terms of the SOFA score. In Group I Connecting mechanical ventilation and connecting mechanical ventilation in the first 24 hour rates were higher than Group II but were not statistically significant. Group I patients with APACHE II, III, IV, MPM, SAPS II and LODS mean score was significantly higher than in Group II patients. There was not a significant relationship between length of hospital stay before ICU with APACHE II, APACHE III, MPM, SOFA and SAPS II scores although there was a significant correlation between lenght of hospital stay before ICU with APACHE IV and LODS scores. There was not a significant relationship between length of ICU stay with APACHE III, APACHE IV, MPM, SOFA, SAPS II, and LODS scores although there was a significant correlation between lenght of stay ICU with APACHE II score. APACHE III has the highest sensitivity to detect the prognostic mortality by rate of 81%. SAPS II has the highest sensitivity to detect at the sixth month prognostic mortality by rate of 76.2%. Consequently; these scoring systems may show significant differences in performance when applied to different populations may be considered. Among the reasons for the implementation of this scoring system errors and unknown factors that may be considered when the effect on the results. Key words: intensive care, severity, and mortality
İn this study we aimed to compare the effectiveness of different scoring systems for the evaluation of the prognosis of the patients hospitalized in the Intensive Care Unit (APACHE II, APACHE III, APACHE IV, MPM II, SOFA, SAPS II and LODS) The study was conducted on 110 cases over the age of 18 and hospitalized 24 hours or more lying in Trakya üniversity medical faculty hospital surgery and reanimation intensive care units. The patients were divided into 2 groups according to prognosis of patients; Group I (n = 63): patients who died in the intensive care unit, Group II (n=47): In healthy patients who were discharged from the intensive care unit was created. Various scoring systems have been developed to predict the prognosis. In these systems, to determine the prognosis taking into consideration factors such as the type of disease, the patient's physiological reserve and response to treatment were examined. These scoring systems was determined as APACHE (Acute Physiology and Chronic Health Evaluation), SAPS (Simplified Acute Physiology Score), LODS (Logistic Organ Dysfunction System), MPM (Mortality Probability Models) and SOFA (Sequential Organ Failure Assessment). These scoring sysytems was evaluated based on the daily viewed and recorded laboratory values (WBC, kretinin, bun, sodium, bilirubin, glucose, platelets, prothrombin time), vital parameters (FiO2, blood pressure, temperature, respiratory rate, pulse rate, and arterial blood gas analysis) and physical examination findings (Glasgow coma scale, additional diseases, presence of infection, age, weight). Scoring system points was calculated with computer software by using these values, parameters and findings. The effects of these scoring system points on the mortality was evaluated by using regression analysis. Student?s t test and Mann Whitney U test was used to Analysis of the datas. T test and Wilkinson test was used to compare of the groups themselves. Physical data (eg, gender, etc.). Pearson chi-square analysis was performed for the statements made . For quantitative data, descriptive statistics were given as mean and standard deviation. p <0.05 was considered statistically significant. Between the groups in age, duration of hospital stay before ICU, intensive care unit length of stay, additional diseases, there is no a significant difference in terms of the SOFA score. In Group I Connecting mechanical ventilation and connecting mechanical ventilation in the first 24 hour rates were higher than Group II but were not statistically significant. Group I patients with APACHE II, III, IV, MPM, SAPS II and LODS mean score was significantly higher than in Group II patients. There was not a significant relationship between length of hospital stay before ICU with APACHE II, APACHE III, MPM, SOFA and SAPS II scores although there was a significant correlation between lenght of hospital stay before ICU with APACHE IV and LODS scores. There was not a significant relationship between length of ICU stay with APACHE III, APACHE IV, MPM, SOFA, SAPS II, and LODS scores although there was a significant correlation between lenght of stay ICU with APACHE II score. APACHE III has the highest sensitivity to detect the prognostic mortality by rate of 81%. SAPS II has the highest sensitivity to detect at the sixth month prognostic mortality by rate of 76.2%. Consequently; these scoring systems may show significant differences in performance when applied to different populations may be considered. Among the reasons for the implementation of this scoring system errors and unknown factors that may be considered when the effect on the results. Key words: intensive care, severity, and mortality
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
