Spontan bakteriyel peritonit tanısı alan hastaların klinik ve laboratuvar özellikleri
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Date
2017
Authors
Ocak, Tuğba
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Spontan Bakteriyel Peritonit (SBP), dekompanse karaciğer sirozunun sık görülen ve yüksek mortalite oranlarına sahip bir komplikasyonudur. Bu çalışma SBP'si olan siroz hastalarında mortalite ile ilişkili faktörlerin tespiti amacıyla yapılmıştır. Uludağ Üniversitesi Tıp Fakültesi Hastanesi Gastroenteroloji Kliniğinde Ocak 2013 - Mart 2016 tarihleri arasında yatan 69 sirotik hasta ve bu hastalarda gelişen 74 SBP epizodu değerlendirildi. Bu hastaların demografik bilgileri, başvuru semptomları, ek hastalıkları, laboratuvar değerleri (asit sıvı hücre sayımı, asit sıvı total protein, asit sıvı albümin, asit sıvı laktat dehidrogenaz (LDH), asit sıvısında üreyen mikroorganizmalar, serum lökosit, polimorfnüveli lökosit, hemoglobin (Hb), hematokrit (Hct), trombosit, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), alkalen fosfataz (ALP), total bilirubin, direkt bilirubin, LDH, gama glutamil transferaz (GGT), total protein, albümin, sodyum (Na), potasyum (K), kalsiyum (Ca), uluslararası normalizasyon oranı (international normalized ratio:INR), üre, kreatinin, sedimentasyon, c-reaktif protein (CRP), prokalsitonin), tedavi protokolleri, siroz nedenleri, model for end-stage liver disease (MELD) Na-MELD, child turcotte pugh (CTP) skorları, hepatik ensefalopati, hepatorenal sendrom, özafagus varis kanaması, hepatosellüler karsinom gibi diğer siroz komplikasyonlarının görülme oranları ve bunların mortalite ile ilişkisi analiz edildi. SBP epizodu geçiren tüm vakaların tanı anında kaydedilen laboratuvar değerlerinden Hb, Hct, serum lökosit, serum polimorfnüveli lökosit, INR, üre, kreatinin, LDH, total bilirubin, direkt bilirubin, asit lökosit, asit polimorfnüveli lökosit, asit LDH, CRP'nin mortalite ile ilişkili olduğu izlendi. SBP epizodu geçiren vakalarda tanı anında hesaplanan CTP, MELD ve Na-MELD skorlarının ortalama değerlerinin mortalite ile ilişkili olduğu izlenmiştir. Siroza eşlik eden diğer komplikasyonların varlığı ile mortalite riski arasında istatistiksel açıdan anlamlı fark bulundu. Siroz komplikasyonları ayrı ayrı ele alındığında özafagus varis kanaması ve hepatorenal sendrom ile mortalite arasında istatistiksel açıdan anlamlı fark saptanmıştır. Sonuç olarak SBP yüksek mortalite oranlarına sahiptir. Erken tanı konulmalıdır. Mortalite ile ilişkili faktörler de göz önünde bulundurularak erken tedavi uygulanmalıdır.
Spontaneous bacterial peritonitis (SBP) is a complication with common and high mortality rate in decompensated liver cirrhosis. Therefore, this study was conducted to determine the factors associated with mortality in cirrhosis patients with SBP. Sixty nine cirrhotic patients who were hospitalized at Uludağ University, Faculty of Medicine Gastroenterology Clinic between January 2013 - March 2016 and 151 SBP episodes in these patients were evaluated. Demographic characteristics, symptoms of referral, additional diseases, laboratory values (acid liquid cell count, acid liquid total protein, acid liquid albumin, acid liquid lactate dehydrogenaze (LDH), microorganisms breeding in acid liquid, serum leukocyte, serum polimorf nüveli leukocyte (PMNL), hemoglobin (Hb), hematocrit (Hct), platelets, aspratate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin, direct bilirubin, LDH, gama glutamyl transferase (GGT), total protein, albumin, sodium (Na), potassium (K), calcium (Ca), international normalized ratio (INR), urea, creatinine, sedimentation, c reactive protein (CRP), procalcitonin), treatment protocols, causes of cirrhosis, model for end-stage liver disease (MELD), Na-MELD and child turcotte pugh (CTP), scores, rate of other cirrhosis complications such as hepatic ensefalopaty, hepatorenal syndrome, esophageal variceal hemorrhage and their association with mortality was analyzed. It was observed that Hb, Hct serum leukocyte, PMNL, INR, urea, creatinine, LDH, total bilirubin, direct bilirubin, acid liquid leucocyte, acid liquid PMNL, acid liquid LDH, CRP were associated with mortality in all the cases with SBP epizodes recorded at the time of diagnosis. It was observed that the mean values of CTP, MELD, Na- MELD scores calculated at the time of diagnosis in cases SBP episodes were related to mortality. There was a statistically siginifcant difference betweeen the presence of other complications accompanied by cirrhosis and mortality. When the complications of cirrhosis were considered separately, a statistically significant difference was found between the esophageal variceal hemorrhage and hepatorenal syndrome and mortality. As a result SBP has a high mortality rate and should be diagnosed early. Early treatment should be performed considering mortality-related factors.
Spontaneous bacterial peritonitis (SBP) is a complication with common and high mortality rate in decompensated liver cirrhosis. Therefore, this study was conducted to determine the factors associated with mortality in cirrhosis patients with SBP. Sixty nine cirrhotic patients who were hospitalized at Uludağ University, Faculty of Medicine Gastroenterology Clinic between January 2013 - March 2016 and 151 SBP episodes in these patients were evaluated. Demographic characteristics, symptoms of referral, additional diseases, laboratory values (acid liquid cell count, acid liquid total protein, acid liquid albumin, acid liquid lactate dehydrogenaze (LDH), microorganisms breeding in acid liquid, serum leukocyte, serum polimorf nüveli leukocyte (PMNL), hemoglobin (Hb), hematocrit (Hct), platelets, aspratate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin, direct bilirubin, LDH, gama glutamyl transferase (GGT), total protein, albumin, sodium (Na), potassium (K), calcium (Ca), international normalized ratio (INR), urea, creatinine, sedimentation, c reactive protein (CRP), procalcitonin), treatment protocols, causes of cirrhosis, model for end-stage liver disease (MELD), Na-MELD and child turcotte pugh (CTP), scores, rate of other cirrhosis complications such as hepatic ensefalopaty, hepatorenal syndrome, esophageal variceal hemorrhage and their association with mortality was analyzed. It was observed that Hb, Hct serum leukocyte, PMNL, INR, urea, creatinine, LDH, total bilirubin, direct bilirubin, acid liquid leucocyte, acid liquid PMNL, acid liquid LDH, CRP were associated with mortality in all the cases with SBP epizodes recorded at the time of diagnosis. It was observed that the mean values of CTP, MELD, Na- MELD scores calculated at the time of diagnosis in cases SBP episodes were related to mortality. There was a statistically siginifcant difference betweeen the presence of other complications accompanied by cirrhosis and mortality. When the complications of cirrhosis were considered separately, a statistically significant difference was found between the esophageal variceal hemorrhage and hepatorenal syndrome and mortality. As a result SBP has a high mortality rate and should be diagnosed early. Early treatment should be performed considering mortality-related factors.
Description
Keywords
Spontan bakteriyel peritonit, Mortalite, Siroz, Spontaneous bacterial peritonitis, Cirrhosis, Mortality
Citation
Ocak, T. (2017). Spontan bakteriyel peritonit tanısı alan hastaların klinik ve laboratuvar özellikleri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.