Dahiliye yoğun bakım ünitesine yatışı yapılan kritik kanser hastalarında morbidite ve mortalite nedenlerinin incelenmesi
Küçük Resim Yok
Tarih
2025
Yazarlar
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Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmanın amacı, dahiliye yoğun bakım ünitesine yatırılan kritik kanser hastalarında morbidite ve mortalite nedenlerini detaylı bir şekilde incelemektir. Bu retrospektif çalışma, 1 Ocak 2015-31 Ekim 2023 tarihleri arasında hastanemiz Dahiliye Yoğun Bakım Ünitesi'nde (DYBÜ) takip ve tedavi edilen hematolojik ve onkolojik tanılı hastalar üzerinde gerçekleştirilmiştir. Çalışmaya malignite tanısı almış toplam 205 hasta dahil edilmiştir. Hastaların yaşları 25-102 arasında değişmekte olup yaş ortalaması 70.58±13.40 idi. Çalışmaya dahil edilen hastaların %66,8'i erkek, %33,2'si kadındı. Hastaların 76'sı (%37,1) pnömoni, 42'si (%20,5) postoperatif takip, 33'ü (%16) septisemi, 12'si (%5,8) akut böbrek hasarı, 11'i (%5,4) febril nötropeni, 7'si (%3,4) gastrointestinal sistem kanaması, 6'sı (%2,9) serebrovasküler olay, 3'ü (%1,5) tümör lizis sendromu, 3'ü (1,5) miyokard enfarktüs, 2'si (%1,0) dekompanse kalp yetmezliği, 2'si (%1,0) status epileptikus ve 8'i (%3,9) diğer (birer hasta içeren; vena kava süperior sendromu, dissemine intravasküler koagülasyon, pulmoner emboli, hemoptizi, ARDS, kronik obstüriktif akciğer hastalığı atak, immün efektör hücreyle ilişkili nörotoksisite sendromu, diyabetik ketoasidoz) tanılar ile yatışı yapıldı. Çalışmamız sonucunda pnömoni yatış tanısı ile DYBÜ'ye yatışı yapılan hastaların ölüm oranın (%37,1) diğer yatış tanılarına kıyasla anlamlı şekilde daha yüksek olduğu saptandı (p<0,001). Çalışmamız sonucunda progresif onkolojik hastaların (%40,9) DYBÜ'de daha yüksek bir ölüm oranına sahip olduğu ve bu durumun istatistiksel olarak anlamlı olduğu görüldü (p<0,05). DYBÜ'ye kabul sırasında metastazı olan hastalarda ölüm oranının %55,3 olduğu ve metastaz olmayan hastalarda ise ölüm oranının (%44,7) daha az olduğu ve bu durumun istatistiksel olarak anlamlı olduğu belirlendi (p=0,033). DYBÜ'de ölen kanser hastalarında invaziv mekanik ventilasyon uygulanma oranının (%87,9), ölmeyenlere (%20,5) kıyasla anlamlı şekilde yüksek olduğu tespit edildi (p<0,001). Ölen onkolojik hastalarda giriş APACHE II skorunun (ölen 35,32±8,63, yaşayan 18,24±8,32 p<0,001) ile yatış günü hesaplanan SOFA (ölen 10,87±3,64, yaşayan 4,53±3,35, p<0,001) ve giriş GKS (ölen 7,72±3,96, yaşayan 13,21±2,84, p<0,001) skorlarının yaşayan hastalara kıyasla anlamlı şekilde daha yüksek olduğu görüldü. Çalışmamız sonucunda DYBÜ'den taburculuk durumu ile nötropeni varlığı arasında ve yatış G-CSF tedavisi alıp almama arasında anlamlı ilişki olmadığı bulundu (nötropeni için p=0,778; G-CSF için p:0,965). Ölen kritik kanser hastalarında vazopressör kullanım oranının (%88,6) yaşayan hastalardan (%20,5) anlamlı şekilde yüksek olduğu saptandı (p<0,001). ARDS gelişme durumu ile DYBÜ'den taburcu olma durumu arasında anlamlı bir ilişki saptanmadı (p=0,557). Akut böbrek hasarı gelişmeyen kritik kanser hastaları arasında taburculuk oranını (%80,8) akut böbrek hasarı gelişen hastalara kıyasla (%19,2) anlamlı şekilde yüksekti (p<0,001). DYBÜ'de ölen onkolojik hastalarda yatış günü bakılan lökosit, nötrofil, üre, kreatinin, aspartat aminotransferaz, c-reaktif protein, laktat dehidrogenaz ve laktat düzeyinin taburcu olanlara kıyasla anlamlı şekilde yüksek, hemoglobin, platelet, albumin, kan pH ve PaO2/FiO2 değerlerinin ise anlamlı şekilde düşük olduğu bulundu.
The aim of study was to examine in detail the causes of morbidity and mortality in critically ill cancer patients hospitalized in the internal intensive care unit. This retrospective study was conducted on patients with hematological and oncological diagnoses who were followed and treated in the Internal Medicine Intensive Care Unit (ICU) of our hospital between January 1, 2015 and October 31, 2023. A total of 205 patients diagnosed with malignancy were included in the study. The ages of the patients ranged between 25-102 years with a mean age of 70.58±13.40 years. Of the patients included in the study, 66.8% were male and 33.2% were female. 76 (37.1%) pneumonia, 42 (20.5%) postoperative follow-up, 33 (16%) septicemia, 12 (5.8%) acute kidney injury, 11 (5.4%) febrile neutropenia, 7 (3.4%) gastrointestinal bleeding, 6 (2.9%) cerebrovascular events, 3 (1.5%) tumor lysis syndrome, 3 (1.5%) myocardial infarction, 2 (1%) decompensated heart failure, 2 (1.0%) status epilepticus and 8 (3.9%) other diagnoses (containing one patient each: vena cava superior syndrome, disseminated intravascular coagulation, pulmonary embolism, hemoptysis, ARDS, chronic obstructive pulmonary disease attack, immune effector cell-related neurotoxicity syndrome, diabetic ketoacidosis). As a result of our study, it was found that the mortality rate (37.1%) of patients admitted to the ICU with the diagnosis of pneumonia hospitalization was significantly higher compared to other hospitalization diagnoses (p<0.001). As a result of our study, progressive oncologic patients (40.9%) had a higher mortality rate in the ICU and this was statistically significant (p<0.05). It was determined that the mortality rate in patients with metastasis at the time of admission to the ICU was 55.3%, and the mortality rate in patients without metastasis was lower (44.7%), and this was statistically significant (p = 0.033). The rate of invasive mechanical ventilation was significantly higher in cancer patients who died in the ICU (87.9%) compared to those who did not die (20.5%) (p<0.001). In deceased oncologic patients, the baseline APACHE II score (deceased 35.32±8.63, living 18.24±8.32 p<0.001) and SOFA calculated on the day of hospitalization (deceased 10.87±3, 64, living 4.53±3.35, p<0.001) and admission GCS (deceased 7.72±3.96, living 13.21±2.84, p<0.001) scores were significantly higher compared to living patients. As a result of our study, there was no significant correlation between discharge status from the ICU and the presence of neutropenia and whether or not G-CSF treatment was received during hospitalization (p=0.778 for neutropenia; p=0.965 for G-CSF). The rate of vasopressor use in deceased critically ill cancer patients (88.6%) was significantly higher than in living patients (20.5%) (p<0.001). There was no significant correlation between the development of ARDS and discharge from the ICU (p=0,557). The discharge rate was significantly higher among critically ill cancer patients who did not develop acute kidney injury (80.8%) compared to patients who developed acute kidney injury (19.2%) (p<0.001). Leukocyte, neutrophil, urea, creatinine, aspartate aminotransferase, c-reactive protein, lactate dehydrogenase and lactate levels on the day of hospitalization were significantly higher, while hemoglobin, platelet, albumin, blood pH and PaO2/FiO2 values were significantly lower in oncologic patients who died in the ICU compared to those who were discharged.
The aim of study was to examine in detail the causes of morbidity and mortality in critically ill cancer patients hospitalized in the internal intensive care unit. This retrospective study was conducted on patients with hematological and oncological diagnoses who were followed and treated in the Internal Medicine Intensive Care Unit (ICU) of our hospital between January 1, 2015 and October 31, 2023. A total of 205 patients diagnosed with malignancy were included in the study. The ages of the patients ranged between 25-102 years with a mean age of 70.58±13.40 years. Of the patients included in the study, 66.8% were male and 33.2% were female. 76 (37.1%) pneumonia, 42 (20.5%) postoperative follow-up, 33 (16%) septicemia, 12 (5.8%) acute kidney injury, 11 (5.4%) febrile neutropenia, 7 (3.4%) gastrointestinal bleeding, 6 (2.9%) cerebrovascular events, 3 (1.5%) tumor lysis syndrome, 3 (1.5%) myocardial infarction, 2 (1%) decompensated heart failure, 2 (1.0%) status epilepticus and 8 (3.9%) other diagnoses (containing one patient each: vena cava superior syndrome, disseminated intravascular coagulation, pulmonary embolism, hemoptysis, ARDS, chronic obstructive pulmonary disease attack, immune effector cell-related neurotoxicity syndrome, diabetic ketoacidosis). As a result of our study, it was found that the mortality rate (37.1%) of patients admitted to the ICU with the diagnosis of pneumonia hospitalization was significantly higher compared to other hospitalization diagnoses (p<0.001). As a result of our study, progressive oncologic patients (40.9%) had a higher mortality rate in the ICU and this was statistically significant (p<0.05). It was determined that the mortality rate in patients with metastasis at the time of admission to the ICU was 55.3%, and the mortality rate in patients without metastasis was lower (44.7%), and this was statistically significant (p = 0.033). The rate of invasive mechanical ventilation was significantly higher in cancer patients who died in the ICU (87.9%) compared to those who did not die (20.5%) (p<0.001). In deceased oncologic patients, the baseline APACHE II score (deceased 35.32±8.63, living 18.24±8.32 p<0.001) and SOFA calculated on the day of hospitalization (deceased 10.87±3, 64, living 4.53±3.35, p<0.001) and admission GCS (deceased 7.72±3.96, living 13.21±2.84, p<0.001) scores were significantly higher compared to living patients. As a result of our study, there was no significant correlation between discharge status from the ICU and the presence of neutropenia and whether or not G-CSF treatment was received during hospitalization (p=0.778 for neutropenia; p=0.965 for G-CSF). The rate of vasopressor use in deceased critically ill cancer patients (88.6%) was significantly higher than in living patients (20.5%) (p<0.001). There was no significant correlation between the development of ARDS and discharge from the ICU (p=0,557). The discharge rate was significantly higher among critically ill cancer patients who did not develop acute kidney injury (80.8%) compared to patients who developed acute kidney injury (19.2%) (p<0.001). Leukocyte, neutrophil, urea, creatinine, aspartate aminotransferase, c-reactive protein, lactate dehydrogenase and lactate levels on the day of hospitalization were significantly higher, while hemoglobin, platelet, albumin, blood pH and PaO2/FiO2 values were significantly lower in oncologic patients who died in the ICU compared to those who were discharged.
Açıklama
Anahtar Kelimeler
İç Hastalıkları, Internal diseases
