Plazma elektrolit düzeylerinin nöbet tanısında prediktif değerleri
Küçük Resim Yok
Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
ÖZET Amaç: Bu çalışmanın amacı, acil servise bilinç kaybı ile başvuran erişkin hastalarda plazma elektrolit düzeyleri ve biyokimyasal parametrelerin nöbet tanısındaki prediktif değerini araştırmaktır. Yöntem: Retrospektif ve tek merkezli bu çalışma, 01 Ocak 2021 – 01 Ocak 2024 tarihleri arasında üçüncü basamak bir üniversite hastanesinin acil servisine başvuran ve senkop/bayılma (R55), konvulsiyon (R56), inme (I61) veya serebrovasküler hastalık (I67) tanısı alan 1816 erişkin hastayı kapsamaktadır. Hastalar nöbet geçiren (n=418) ve geçirmeyen (n=1398) olarak iki grupta değerlendirildi. Demografik veriler, elektrolit düzeyleri, laktat, kreatin kinaz ve ürik asit değerleri karşılaştırıldı. Risk analizi, lojistik regresyon ve ROC eğrisi analizleri uygulandı. Bulgular: Nöbet geçiren hastalar, nöbet geçirmeyenlere kıyasla daha gençti (56 [35–71] vs. 68 [53–78], p<0,001). Laktat düzeyi (3,30 [1,90–6,50] vs. 2,00 [1,50–2,70], p<0,001) ve kreatin kinaz nöbet grubunda daha yüksekti. Elektrolit bozuklukları açısından hipokalsemi, hiperkalsemi, hipofosfatemi, hiperfosfatemi ve hiperürisemi nöbetlerle ilişkili bulunurken, hiperkloremi nöbet geçirme ile ters orantılı olarak saptandı. Çok değişkenli regresyon analizinde yalnızca laktat bağımsız prediktör olarak öne çıktı (OR: 1,383, %95 CI: 1,280–1,494; p<0,001). ROC analizinde laktat en yüksek ayırt edici güce sahip parametreydi (AUC=0,705). Regresyon modelinin genel AUC değeri 0,720 idi. Sonuç: Acil serviste bilinç kaybı ile başvuran hastalarda laktat düzeyleri, nöbet tanısında güçlü bir biyobelirteç olarak öne çıkmaktadır. Elektrolit bozuklukları bazı alt gruplarda nöbetle ilişkili olmakla birlikte, çok değişkenli analizlerde bağımsız prediktör değillerdir. Bulgular, klinik pratikte laktat ölçümünün nöbet tanısında değerli bir destek aracı olabileceğini göstermektedir. Anahtar Kelimeler: Nöbet, Elektrolit Dengesizlikleri, Laktat, Acil Servis, Biyobelirteç
ABSTRACT Aim: To evaluate the predictive value of plasma electrolyte levels and biochemical parameters in diagnosing seizures among adult patients presenting to the emergency department (ED) with loss of consciousness. Methods: This retrospective, single-center study included 1816 adult patients admitted to the ED of a tertiary university hospital between January 1, 2021, and January 1, 2024, with diagnoses of syncope (R55), convulsion (R56), stroke (I61), or cerebrovascular disease (I67). Patients were divided into seizure (n=418) and non-seizure (n=1398) groups. Demographic features, electrolyte levels, lactate, creatine kinase, and uric acid values were compared. Risk analysis, logistic regression, and ROC curve analyses were performed. Results: Seizure patients were younger than non-seizure patients (56 [35–71] vs. 68 [53–78], p<0.001). Lactate (3.30 [1.90–6.50] vs. 2.00 [1.50–2.70], p<0.001) and creatine kinase levels were significantly higher in the seizure group. With respect to electrolyte disorders, hypocalcemia, hypercalcemia, hypophosphatemia, hyperphosphatemia, and hyperuricemia were found to be associated with seizures, whereas hyperchloremia was identified as inversely related to seizure occurrence (OR: 1.383, 95% CI: 1.280–1.494; p<0.001). Lactate had the highest discriminatory power in ROC analysis (AUC=0.705). The overall regression model achieved an AUC of 0.720. Conclusion: Elevated lactate levels serve as a strong biomarker for seizure diagnosis in ED patients presenting with loss of consciousness. Although several electrolyte disturbances were associated with seizures in univariate analysis, none remained independent predictors. These findings suggest that lactate measurement may provide valuable diagnostic support in clinical practice. Keywords: Seizure, Electrolyte Disturbances, Lactate, Emergency Department, Biomarker
ABSTRACT Aim: To evaluate the predictive value of plasma electrolyte levels and biochemical parameters in diagnosing seizures among adult patients presenting to the emergency department (ED) with loss of consciousness. Methods: This retrospective, single-center study included 1816 adult patients admitted to the ED of a tertiary university hospital between January 1, 2021, and January 1, 2024, with diagnoses of syncope (R55), convulsion (R56), stroke (I61), or cerebrovascular disease (I67). Patients were divided into seizure (n=418) and non-seizure (n=1398) groups. Demographic features, electrolyte levels, lactate, creatine kinase, and uric acid values were compared. Risk analysis, logistic regression, and ROC curve analyses were performed. Results: Seizure patients were younger than non-seizure patients (56 [35–71] vs. 68 [53–78], p<0.001). Lactate (3.30 [1.90–6.50] vs. 2.00 [1.50–2.70], p<0.001) and creatine kinase levels were significantly higher in the seizure group. With respect to electrolyte disorders, hypocalcemia, hypercalcemia, hypophosphatemia, hyperphosphatemia, and hyperuricemia were found to be associated with seizures, whereas hyperchloremia was identified as inversely related to seizure occurrence (OR: 1.383, 95% CI: 1.280–1.494; p<0.001). Lactate had the highest discriminatory power in ROC analysis (AUC=0.705). The overall regression model achieved an AUC of 0.720. Conclusion: Elevated lactate levels serve as a strong biomarker for seizure diagnosis in ED patients presenting with loss of consciousness. Although several electrolyte disturbances were associated with seizures in univariate analysis, none remained independent predictors. These findings suggest that lactate measurement may provide valuable diagnostic support in clinical practice. Keywords: Seizure, Electrolyte Disturbances, Lactate, Emergency Department, Biomarker
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Künye
Akbaba, A. (2025). Plazma Elektrolit Düzeylerinin Nöbet Tanısında Prediktif Değerleri (Tez No. 959304) [Tıpta Uzmanlık Tezi, Düzce Üniversitesi].
