Kronik karaciğer hastalarında spontan asit infeksiyonlarının retrospektif değerlendirilmesi
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Dosyalar
Tarih
2021
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Spontan bakteriyel peritonit sirozun yüksek morbidite ve mortaliteye sahip en önemli komplikasyonlarından biridir. Hastaların erken tespiti ve risk faktörlerinin ortaya konulmasının prognoza olumlu etkileri olacaktır. Bu araştırmada sirotik ve spontan asit infeksiyonlu hastaların klinik, mikrobiyolojik ve laboratuvar bulgularını retrospektif olarak değerlendirerek yaşamsüresi ve erken mortaliteye etki eden faktörleri saptamayı amaçladık. Çalışmada Trakya Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı’nda 20122019 yılları arasında karaciğer sirozu ve spontan asit infeksiyonu tanısıyla yatırılan 125 hasta ve 136 spontan bakteriyel peritonit epizodu retrospektif olarak değerlendirildi. Spontan asit infeksiyonu tanısı asit sıvısı kültüründe üreme ve/veya asit sıvısındaki nötrofil sayısının >250/mm 3 olması ile konuldu. Hastaların klinik ve laboratuvar parametreleri kaydedildi. Child Turcot Pugh ve MELD puanları hesaplandı. İstatistiksel analizde Mann Whitney U testi, lojistik regresyon analizi, Kaplan Meier yaşam analizi ve ROC analizleri kullanıldı. 125 hastanın %71,2’si erkek, %28,8’u kadındı, yaş ortalaması 64,8 ± 11,4 (30-89) yıldı. Sirotik hastaların etyolojik değerlendirmesinde Hepatit B infeksiyonu (%33,6) ve alkol kullanımı (%27,2) en sık nedenlerdi. Asit kültüründe en sık izole edilen etken E. Coli idi. Hastaların %32’si Child Turcot evre B, %68’si evre C olarak değerlendirildi. Hastalarda 4 haftalık erken mortalite oranı %36,8 olarak saptandı. Tek değişkenli analizde kreatinin, sodyum, AST, ALT ve bilirubin düzeyleri ile Child Turcot ve MELD skorlarının erken mortalite ile ilişkili olduğu gözlendi. Çok değişkenli analizde MELD skorunun erken mortaliteyi göstermede önemli bir faktör olduğu gözlendi. MELD skorunun 24,5 sınır değerinde erken mortaliteyi göstermede duyarlılığı %76,1, özgüllüğü % 73,4 (eğri altında kalan alan 0,81, p<0,001) olarak hesaplandı Çalışmamıza alına125 hastanın ortalama takip süresi 13,9 ay, ortanca 4 (1-72) ay idi. 125 hastanın ortalama yaşam süresi 18,9 ay (14,2-23,6) ay idi. Yaş, cinsiyet, diyabetik olma durumu ile yaşam süresi arasında ilişki saptanmadı. Child- Pugh skoru ve başvuru sırasında hepatik ensefalopati olması ile yaşam süresi arasında ilişki saptandı. Sonuç olarak; sirotik hastalarda spontan asit infeksiyonu önemli bir mortalite nedeni olmaya devam etmektedir. MELD skoru ve renal fonksiyonlar erken mortaliteye etki eden en önemli faktörlerdir. İnfeksiyonun erken tanısı ve tedavisinin mortaliteyi azaltmada önemli olacağı düşünülmektedir.
Spontaneous bacterial peritonitis is one of the most important complications of cirrhosis with high morbidity and mortality. Early detection of patients and revealing risk factors will have positive effects on prognosis. In this study, we aimed to determine the factors affecting the life span and early mortality by retrospectively evaluating the clinical, microbiological and laboratory findings of patients with cirrhotic and spontaneous acid infection. In the study, 125 patients and 136 spontaneous episodes of bacterial peritonitis who were hospitalized with the diagnosis of liver cirrhosis and spontaneous acid infection between 2012-2019 in the Gastroenterology Department of Trakya University Faculty of Medicine were evaluated retrospectively. Spontaneous acid infection was diagnosed with growth in the acidic fluid culture and / or the neutrophil count> 250 /mm3 in the ascitic fluid. Clinical and laboratory parameters of the patients were recorded. Child Turcot Pugh and MELD scores were calculated. Mann Whitney U test, logistic regression analysis, Kaplan Meier survival analysis and ROC analysis were used for statistical analysis. 71,2% of 125 patients were male and 28.8% were female, the mean age was 64,8 ± 11,4 (30-89) years. Hepatitis B infection (%33,6) and alcohol use (%27,2) were the most common causes in the etiological evaluation of cirrhotic patients. E. Coli was the most frequently isolated agent in acid culture. %32 of the patients were evaluated as Child Turcot stage B and %68 as stage C. 4 week early mortality rate in patients was found to be %36,8. In univariate analysis, it was observed that creatinine, sodium, AST, ALT and bilirubin levels and Child Turcot and MELD scores were associated with early mortality. In multivariate analysis, it was observed that the MELD score was an important factor in showing early mortality. The sensitivity of the MELD score to show early mortality at the cut-off value of 24,5 was %76,1, and the specificity was %73,4 (area under the curve 0,81, p <0,001). The mean follow-up period of the 125 patients included in our study was 13.9 months and the median was 4 (1-72) months. The mean life span of 125 patients was 18,9 months (14,223,6) months. No relationship was found between age, gender, being diabetic and life expectancy. A relationship was found between the Child-Pugh score and hepatic encephalopathy at presentation and survival. As a result; Spontaneous ascites infection continues to be an important cause of mortality in cirrhotic patients. MELD score and renal functions are the most important factors affecting early mortality. It is thought that early diagnosis and treatment of infection will be important in reducing mortality.
Spontaneous bacterial peritonitis is one of the most important complications of cirrhosis with high morbidity and mortality. Early detection of patients and revealing risk factors will have positive effects on prognosis. In this study, we aimed to determine the factors affecting the life span and early mortality by retrospectively evaluating the clinical, microbiological and laboratory findings of patients with cirrhotic and spontaneous acid infection. In the study, 125 patients and 136 spontaneous episodes of bacterial peritonitis who were hospitalized with the diagnosis of liver cirrhosis and spontaneous acid infection between 2012-2019 in the Gastroenterology Department of Trakya University Faculty of Medicine were evaluated retrospectively. Spontaneous acid infection was diagnosed with growth in the acidic fluid culture and / or the neutrophil count> 250 /mm3 in the ascitic fluid. Clinical and laboratory parameters of the patients were recorded. Child Turcot Pugh and MELD scores were calculated. Mann Whitney U test, logistic regression analysis, Kaplan Meier survival analysis and ROC analysis were used for statistical analysis. 71,2% of 125 patients were male and 28.8% were female, the mean age was 64,8 ± 11,4 (30-89) years. Hepatitis B infection (%33,6) and alcohol use (%27,2) were the most common causes in the etiological evaluation of cirrhotic patients. E. Coli was the most frequently isolated agent in acid culture. %32 of the patients were evaluated as Child Turcot stage B and %68 as stage C. 4 week early mortality rate in patients was found to be %36,8. In univariate analysis, it was observed that creatinine, sodium, AST, ALT and bilirubin levels and Child Turcot and MELD scores were associated with early mortality. In multivariate analysis, it was observed that the MELD score was an important factor in showing early mortality. The sensitivity of the MELD score to show early mortality at the cut-off value of 24,5 was %76,1, and the specificity was %73,4 (area under the curve 0,81, p <0,001). The mean follow-up period of the 125 patients included in our study was 13.9 months and the median was 4 (1-72) months. The mean life span of 125 patients was 18,9 months (14,223,6) months. No relationship was found between age, gender, being diabetic and life expectancy. A relationship was found between the Child-Pugh score and hepatic encephalopathy at presentation and survival. As a result; Spontaneous ascites infection continues to be an important cause of mortality in cirrhotic patients. MELD score and renal functions are the most important factors affecting early mortality. It is thought that early diagnosis and treatment of infection will be important in reducing mortality.
Açıklama
Anahtar Kelimeler
Kronik karaciğer hastalığı, Spontan asit infeksiyonu, Sağkalım, Chronic liver disease, Spontaneous acid infection, Survival
