İç hastalıkları yoğun bakım ünitesine hayati organ tutuluşu ile başvuran romatolojik hastalıkların retrospektif incelenmesi
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Romatolojik hastalıklar tarihsel süreç boyunca ciddi mortalite ve morbidite sebebidir. Güncel tedavi modaliteleri ile mortalite oranları azalma gösterse de yoğun bakım yatışı gerektiren hastalarda mortalite yaklaşık %38'ler düzeyindedir. Bu hastalıklara yaklaşırken, plazmaferez ve IVIg gibi yenilikçi tedavi modaliteleri ile mortaliteyi düşürmek amaçlanmaktadır. Ancak bu tedavilerin pahalı olması nedeniyle hasta seçiminin doğru yapılması önem arz etmektedir. Bu retrospektif kohort çalışması ile romatolojik hastalıklarda mortaliteyi ön görmek ve hasta seçiminde daha doğru tercihler yapmak amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada 2011-2021 tarihleri arasında İç Hastalıkları Anabilim Dalı Yoğun Bakım Ünitesinde Yatmış olan hayati organ tutuluşlu romatolojik hastalığa sahip 75 hastanın retrospektif incelenmesiyle yapıldı. Romatolojik hastalıkların tanısında Sistemik Lupus Eritematozus için ACR/EULAR 2019 sınıflama kriterleri, Granülamatöz Polianjitis için 1990 sınıflama kriterleri, EGPA için ACR sınıflama kriterleri, Microskobik Polianjitis için EUVAS kriterleri, Behçet Hastalığı için Uluslararası Behçet Çalışma Grubu sınıflama kriterleri, GBM hastalığı için antikor pozitifliği ve klinik bulgu olması kabul edildi. Bu hastalarda klinik ve demografik özellikler ile yatış ve takiplerindeki laboratuvar parametreleri ve bu değerlerdeki değişimler [Δ(Sonlanım-Yatış) /Yatış] kaydedildi. Bulgular: Çalışmaya 75 hasta dahil edildi. Bu hastalardan 29'u Granülamatöz Polianjitis, 28'i Sistemik Lupus Eritamatozus, 11'i Mikroskobik Polianjitis, 3'ü Anti Glomerüler Bazal Membran Hastalığı, 2'si Eozinofilik Granülamatöz Polianjitis ve 2'si Behçet Hastalığı tanısına sahipti. IVIg tedavisi uygulanan hasta sayısı 42, plazmaferez tedavisi uygulanan hasta sayısı ise 46'dır. Tüm subgruplarda bakıldığında mortalite açısından inotrop (p<0,001) ve entübasyon (p<0,001) ihtiyacı anlamlı olarak farklı bulundu. Vaskülit hastalarında univarite analizlerde ΔLenfosit, ΔNLR, ΔCRP, Plateletmin, Lenfositmin Albuminyatış, Albuminmin değerleri anlamlı olarak farklıdır (sırasıyla p=0,039, p=0,043, p<0,001, p=0,007, p=0,001, p=0,003, p=0,002). Lenfositte düşüşün fazlalığı, platetelet, lenfosit, takip ve yatış albümin değerlerinin daha düşük olması moralite ile ilişkilidir. Multivariate modele göre ΔNLR (p=0,008) ve ΔCRP (p=0,001) değişkenlerinin mortalite için risk faktörü olduğu görülmektedir. ΔNLR değişkenindeki bir birimlik artış mortalite görülme oranını 4,693 artırırken, ΔCRP bir birimlik artış mortalite görülme oranını 62,677 kat artırmaktadır. Vaskülit hastalarında bakılan ROC eğrisi analizinde %71 duyarlılık, %98 özgüllük ile ΔNLR değişkeninin kestirim değeri 1,3(AUC: %82), %78 duyarlılık, %78 özgüllük ile ΔCRP değişkeninin kestirim değeri -0,76(AUC: %86) olarak bulunmuştur. Sistemik Lupus Eritematozus hastalarında bakıldığında ise mortalite açısından univarite analizlerde ΔKreatinin, ΔLDH, ΔPlatelet, ΔAlbumin, Lenfositmin anlamlı olarak farklıdır (sırasıyla p=0,001, p=0,021, p<0,001, p=0,005, p=0,002). Kreatinin ve LDH'da artma platelette ve albüminde ise düşme mortalite ile ilişkilidir. Ancak multivarite analizlerde anlamlılık saptanamamıştır. Teröpatik plazma değişimi yapılan hastalarda mortalite açısından yapılan univarite analizlerde ΔLDH, ΔPlatelet, ΔCRP, Lenfositmin, Plateletmin değerlerinde anlamlı farklılık saptandı (sırasıyla p=0,003, p=0,010, p=0,006, p=0,004, p=0,001). IVIg tedavisi verilen hastalarda ΔLDH, ΔPlatelet, Lenfositmin, Plateletmin anlamlı olarak farklı bulundu (sırasıyla, p=0,014, p= 0,001, p=<0,001, p=<0,001). LDH ve CRP'de artma platelette ise düşme mortalite ile ilişkilidir. Lenfosit ve platelet minumun değerleri mortalite olan grupta daha düşüktür. Her iki grupta da multivarite analizlerde ise tek başına mortalite göstergesine erişilemedi. Sonuç: Vaskülit hastalarında NLR ve CRP'deki değişim mortaliteyi ön görmek için faydalıdır. Farklı romatolojik hastalıklara sahip, farklı modalitelerle tedavi edilen hastalarda platelet değerinindeki düşüşün mortalite olan grupta fazla olması romatolojik hastalıklarda ortak olarak mortalite göstergesi olarak kullanılabileceğini düşündürmüştür.
Introduction: Rheumatological diseases have been and are the cause of serious mortality and morbidity throughout the historical process. Although mortality rates have decreased with current treatment modalities, mortality in patients requiring intensive care hospitalization is approximately 38%. While approaching these diseases, it is aimed to reduce mortality with innovative treatment modalities such as plasmapheresis and IVIG, but since these treatments are expensive, it is important to choose the right patient. With this retrospective cohort study, it was aimed to predict mortality in rheumatological diseases and to make more accurate choices in patient selection. Methods: This study was carried out by retrospectively examining 75 patients with the rheumatological disease with vital organ involvement who were hospitalized in the Intensive Care Unit of the Internal Diseases Department between 2011-2021. ACR/EULAR 2019 classification criteria for Systemic Lupus Erythematosus, 1990 classification criteria for Granulomatous Polyangiitis, ACR classification criteria for EGPA, EUVAS criteria for Microscopic Polyangiitis, International Behçet's Study Group classification criteria for Behçet's Disease, antibody positivity and clinical findings for GBM disease, to diagnose the rheumatologic diseases. Clinical and demographic characteristics, biochemistry, hemogram parameters, and changes in these values [Δ(End-Admission) / Admission] were recorded in these patients. Findings: 75 patients were included in the study. Of these patients, 29 were diagnosed with Granulamatous Polyangitis, 28 with Systemic Lupus Erythematosus, 11 with Microscopic Polyangitis, 3 with Anti-Glomerular Basal Membrane Disease, 2 with Eosinophilic Granulamatous Polyangitis, and 2 with Behçet's Disease. The number of patients who received IVIG treatment was 42 and the number of patients who received plasmapheresis treatment was 46. In all subgroups, the need for inotrop (p<0.001) and intubation (p<0.001) were found to be significantly different in terms of mortality. ΔLymphocyte, ΔNLR, ΔCRP, Plateletmin, Lymphocyte Albuminadm, Albuminmin values were found to be significantly different in univariate analyzes in patients with vasculitis (respectively p=0.039, p=0.043, p<0.001, p=0.007, p=0.001, p=0.003, p = 0.002). The Increse CRP values and the decrease NLR is related to mortality. The decrease in lymphocyte, platelets and admission albumin values is also related to mortality. According to the multivariate model, ΔNLR (p=0.008) and ΔCRP (p=0.001) variables seem to be risk factors for mortality. A one-unit increase in the ΔNLR variable increases the death rate by 4.693 times, while a one-unit increase in ΔCRP increases the mortality rate by 62,677 times. In the ROC curve analysis of vasculitis patients, the cut-off value of the ΔNLR variable with 71% sensitivity, 98% specificity was 1.3(AUC: 82%), the cut-off value of the ΔCRP value 78% sensitivity, 78% specificity, was -0.76(AUC: 86%) ΔCreatinin, ΔLDH, ΔPlatelet, ΔAlbumin, and Lymphocytemin were significantly different in terms of mortality in patients with Systemic Lupus Erythematosus (p=0.001, p=0.021, p<0.001, p=0.005, p=0.002, respectively). The increase in creatinine and LDH and the decrease in platelet are associated with mortality. However, no significance was found in multivariate analyses. A significant difference was found in the values of ΔLDH, ΔPlatelet, ΔCRP, Lymphocythmin, and Plateletmin in patients who underwent therapeutic plasma exchange in terms of mortality (p=0.003, p=0.010, p=0.006, p=0.004, p=0.001). ΔPlatelet, Lymphocytemin, and Plateletmin were found to be significantly different (p= 0.014, p= 0.001, p=<0.001, p=<0.001, respectively). The increase in LDH and CRP and the decrease in platelet are associated with mortality. The lymphocyte and platelet minimum values were lower in the mortality group. In both groups, the mortality indicator alone could not be reached in multivariate analyzes. Conclusion: Changes in NLR and CRP may be useful for predicting mortality in patients with vasculitis. The low platelet and high LDH values in patients with different rheumatological diseases treated with different modalities in the mortality group suggested that they can be used as a common mortality indicator in rheumatological diseases.
Introduction: Rheumatological diseases have been and are the cause of serious mortality and morbidity throughout the historical process. Although mortality rates have decreased with current treatment modalities, mortality in patients requiring intensive care hospitalization is approximately 38%. While approaching these diseases, it is aimed to reduce mortality with innovative treatment modalities such as plasmapheresis and IVIG, but since these treatments are expensive, it is important to choose the right patient. With this retrospective cohort study, it was aimed to predict mortality in rheumatological diseases and to make more accurate choices in patient selection. Methods: This study was carried out by retrospectively examining 75 patients with the rheumatological disease with vital organ involvement who were hospitalized in the Intensive Care Unit of the Internal Diseases Department between 2011-2021. ACR/EULAR 2019 classification criteria for Systemic Lupus Erythematosus, 1990 classification criteria for Granulomatous Polyangiitis, ACR classification criteria for EGPA, EUVAS criteria for Microscopic Polyangiitis, International Behçet's Study Group classification criteria for Behçet's Disease, antibody positivity and clinical findings for GBM disease, to diagnose the rheumatologic diseases. Clinical and demographic characteristics, biochemistry, hemogram parameters, and changes in these values [Δ(End-Admission) / Admission] were recorded in these patients. Findings: 75 patients were included in the study. Of these patients, 29 were diagnosed with Granulamatous Polyangitis, 28 with Systemic Lupus Erythematosus, 11 with Microscopic Polyangitis, 3 with Anti-Glomerular Basal Membrane Disease, 2 with Eosinophilic Granulamatous Polyangitis, and 2 with Behçet's Disease. The number of patients who received IVIG treatment was 42 and the number of patients who received plasmapheresis treatment was 46. In all subgroups, the need for inotrop (p<0.001) and intubation (p<0.001) were found to be significantly different in terms of mortality. ΔLymphocyte, ΔNLR, ΔCRP, Plateletmin, Lymphocyte Albuminadm, Albuminmin values were found to be significantly different in univariate analyzes in patients with vasculitis (respectively p=0.039, p=0.043, p<0.001, p=0.007, p=0.001, p=0.003, p = 0.002). The Increse CRP values and the decrease NLR is related to mortality. The decrease in lymphocyte, platelets and admission albumin values is also related to mortality. According to the multivariate model, ΔNLR (p=0.008) and ΔCRP (p=0.001) variables seem to be risk factors for mortality. A one-unit increase in the ΔNLR variable increases the death rate by 4.693 times, while a one-unit increase in ΔCRP increases the mortality rate by 62,677 times. In the ROC curve analysis of vasculitis patients, the cut-off value of the ΔNLR variable with 71% sensitivity, 98% specificity was 1.3(AUC: 82%), the cut-off value of the ΔCRP value 78% sensitivity, 78% specificity, was -0.76(AUC: 86%) ΔCreatinin, ΔLDH, ΔPlatelet, ΔAlbumin, and Lymphocytemin were significantly different in terms of mortality in patients with Systemic Lupus Erythematosus (p=0.001, p=0.021, p<0.001, p=0.005, p=0.002, respectively). The increase in creatinine and LDH and the decrease in platelet are associated with mortality. However, no significance was found in multivariate analyses. A significant difference was found in the values of ΔLDH, ΔPlatelet, ΔCRP, Lymphocythmin, and Plateletmin in patients who underwent therapeutic plasma exchange in terms of mortality (p=0.003, p=0.010, p=0.006, p=0.004, p=0.001). ΔPlatelet, Lymphocytemin, and Plateletmin were found to be significantly different (p= 0.014, p= 0.001, p=<0.001, p=<0.001, respectively). The increase in LDH and CRP and the decrease in platelet are associated with mortality. The lymphocyte and platelet minimum values were lower in the mortality group. In both groups, the mortality indicator alone could not be reached in multivariate analyzes. Conclusion: Changes in NLR and CRP may be useful for predicting mortality in patients with vasculitis. The low platelet and high LDH values in patients with different rheumatological diseases treated with different modalities in the mortality group suggested that they can be used as a common mortality indicator in rheumatological diseases.
Açıklama
Anahtar Kelimeler
Vaskülit, Sistemik Lupus Eritematozus, Mortalite, Teröpatik Plazma Değişimi, İntravenöz İmmünglobulin, Vaskulitis, Sistemic Lupus Eritematozus, Mortality, Therapeutic Plasma Exchange, Intravenous Immunglobulin
