ÖZET
Amaç:
Yoğun bakım hastalarında mortaliteyi tahmin eden birçok puanlama sistemi ve biyobelirteç mevcuttur. Ancak yaşlı sepsis hastalarında kullanılabilirlikleri konusunda netlik bulunmamaktadır. Bu çalışmada, yaşlı sepsis hastalarında sağkalımı öngörmede şu anda kullanılan prognostik skorlama ölçeklerini ve nötrofil lenfosit oranını (NLO) değerlendirmeyi amaçladık.
Gereç ve Yöntem:
Çalışmaya yoğun bakım ünitesine sepsis tanısı ile yatırılan yaşlı hastalar prospektif olarak dahil edildi. Başvuru anında Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi-II (APACHE), Sıralı (sepsisle ilişkili) Organ Yetmezliği Değerlendirmesi (SOFA) ve Glasgow koma skoru (GKS) puanı ve NLO hesaplandı. 28 günlük bir takip süresinin sonunda, hastalar “hayatta kalanlar” ve “hayatta kalmayanlar” olarak iki gruba ayrıldı ve çalışma parametreleri yönünden karşılaştırıldı.
Bulgular:
Otuz altı hastanın verileri analiz edildi (ortalama yaş: 80,00±6,37 yıl, kadın: %58,3). Ölüm oranı %47,3 (n=17) idi. Başvuru anındaki ortalama SOFA skoru ve medyan NLO, hayatta kalanlarda [SOFA: 10,37±2,91 ve NLR: 9,64 (11,25)], hayatta kalmayanlara [SOFA: 12,82±3,21 ve NLR: 14,95 (35,53)] (p<0,05) göre anlamlı olarak daha düşüktü, ancak ortalama APACHE-II ve medyan GKS skoru benzerdi. ROC eğrisi analizini kullanarak, sadece SOFA skorunun ve NLO’nun mortaliteyi tahmin edebileceğini belirledik.
Sonuç:
Bu çalışma, yoğun bakım ünitesine kabul edilen sepsisli yaşlı hastalar arasında, APACHE-II veya GKS skorunun değil, başlangıç SOFA skorunun ve NLO’nun mortaliteyi başarıyla tahmin edebileceğini gösterdi. Yaşlılarda mevcut prognoz ölçeklerinin faydasını değerlendirmek için daha ileri çalışmalara ihtiyaç vardır.
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