Akut solunum sıkıntısı sendromlu yoğun bakım hastalarında akut böbrek hasarı ile ilişkili faktörler: Retrospektif çalışma
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Tarih
2024
Kurum Yazarları
Özoğlu, Şeyda Demir
Süreli Yayın başlığı
Süreli Yayın ISSN
Cilt Başlığı
Yayınevi
Bursa Uludağ Üniversitesi
Özet
Amaç: Çalışmamızda, yoğun bakıma kabulünde Akut Solunum Sıkıntısı Sendromu (ARDS) tanısı alan hastalarda, Akut Böbrek Hasarı (ABH) gelişme insidansını ve risk faktörlerini; prognoz ve mortaliteyi etkileyen faktörleri değerlendirmeyi amaçladık. Metod: Etik kurul onayı alındıktan sonra Ocak 2016 - Ocak 2023 tarihleri arasında Reanimasyon ünitesine kabul edilen ve ARDS tanı kriterlerini karşılayan hastalar retrospektif olarak incelendi. ABH tanısı için Böbrek Hastalıkları: Küresel Sonuçların İyileştirilmesi (KDIGO) tanı kriterleri kullanıldı. ABH ile ilgili risk faktörleri tek değişkenli analiz kullanılarak belirlendi. Çok değişkenli Cox-regresyon analiziyle sağkalıma etkili faktörler saptandı. Bulgular: Yoğun bakıma kabul edilen 2136 hastanın 122'sine ARDS tanısı konuldu. Bu hastaların 89'unda ABH gelişti. İleri yaş, hipertansiyon ve Kronik Obstrüktif Akciğer Hastalığı, akut fizyoloji ve kronik sağlık değerlendirmesi (APACHE-II) ve ardışık organ yetmezliği skorlarının (SOFA) yüksek olması, vazoaktif ajan kullanımı ve sayısı ABH gelişimi ile ilişkili bulundu (p=0,024, p=0,014, p=0,034, p<0,001, p=0,001, p=0,020, p=0,001). ABH gelişenlerde mortalite yüksek olarak saptandı (HR=3.16, %95 CI: [1.50- 6.66]; p= 0.002). ARDS hastalarında ileri yaş, koroner arter hastalığı ve malignite varlığı mortalite artışına neden olduğu saptandı. Hafif ARDS tanısı alanların ve hipertansiyon öyküsü olanların mortalitesi daha düşük olduğu belirlendi. Sonuç: ARDS hastalarında mortaliteye etkili en önemli faktörler ABH gelişimi ve koroner arter hastalığı olarak tespit edilmiştir. ARDS tanılı hastalarda ileri yaş, komorbiditeler, yüksek yoğun bakım risk skorları ve vazoaktif ajan kullanımında ABH gelişimi açısından dikkatli olunması önerilir.
Objective: In our study, we examined the incidence and risk factors for the development of Acute Kidney Injury (AKI) in Acute Respiratory Distress Syndrome (ARDS) in critical care patients; We aimed to evaluate the factors affecting the prognosis and mortality of ARDS. Methods: After ethics committee approval was obtained, patients who were admitted to the Reanimation unit between January 2016 and January 2023 and met the ARDS diagnostic criteria were retrospectively examined. KDIGO diagnostic criteria were used to diagnose AKI. Risk factors associated with AKI were identified using univariate analysis. Factors affecting survival were determined by multivariate Cox-regression analysis. Results: ARDS was diagnosed in 122 of 2136 patients admitted to intensive care. AKI developed in 89 of these patients. Advanced age, hypertension and COPD, high APACHE-II and SOFA scores, use and number of vasoactive agents were found to be associated with the development of AKI (p=0.024, p=0.014, p=0.034, p<0.001, p=0.001, p=0.020, p=0.001). Mortality was found to be high in those who developed AKI (HR = 3.16, 95% CI: [1.50- 6.66]; p = 0.002). It was determined that advanced age, coronary artery disease and the presence of malignancy caused an increase in mortality in ARDS patients. It was determined that those diagnosed with mild ARDS and those with a history of hypertension had lower mortality. Conclusion: The most important factors affecting mortality in ARDS patients have been determined to be the development of AKI and coronary artery disease. It is recommended to be careful in terms of AKI development in patients with advanced age diagnosed with ARDS, comorbidities, high intensive care risk scores and use of vasoactive agents.
Objective: In our study, we examined the incidence and risk factors for the development of Acute Kidney Injury (AKI) in Acute Respiratory Distress Syndrome (ARDS) in critical care patients; We aimed to evaluate the factors affecting the prognosis and mortality of ARDS. Methods: After ethics committee approval was obtained, patients who were admitted to the Reanimation unit between January 2016 and January 2023 and met the ARDS diagnostic criteria were retrospectively examined. KDIGO diagnostic criteria were used to diagnose AKI. Risk factors associated with AKI were identified using univariate analysis. Factors affecting survival were determined by multivariate Cox-regression analysis. Results: ARDS was diagnosed in 122 of 2136 patients admitted to intensive care. AKI developed in 89 of these patients. Advanced age, hypertension and COPD, high APACHE-II and SOFA scores, use and number of vasoactive agents were found to be associated with the development of AKI (p=0.024, p=0.014, p=0.034, p<0.001, p=0.001, p=0.020, p=0.001). Mortality was found to be high in those who developed AKI (HR = 3.16, 95% CI: [1.50- 6.66]; p = 0.002). It was determined that advanced age, coronary artery disease and the presence of malignancy caused an increase in mortality in ARDS patients. It was determined that those diagnosed with mild ARDS and those with a history of hypertension had lower mortality. Conclusion: The most important factors affecting mortality in ARDS patients have been determined to be the development of AKI and coronary artery disease. It is recommended to be careful in terms of AKI development in patients with advanced age diagnosed with ARDS, comorbidities, high intensive care risk scores and use of vasoactive agents.
Açıklama
Anahtar kelimeler
Akut solunum sıkıntısı sendromu (ARDS), Akut böbrek hasarı (ABH), Mortalite, Acute respiratory distress syndrome (ARDS), Acute kidney injury (AKI), Mortality
Alıntı
Özoğlu, Ş. D. (2024). Akut solunum sıkıntısı sendromlu yoğun bakım hastalarında akut böbrek hasarı ile ilişkili faktörler: Retrospektif çalışma. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.