İç hastalıkları yoğun bakım ünitesi'nde yatan hastalarda serum ferritin düzeyinin mortalite belirteci olarak incelenmesi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Ferritin, inflamasyon başta olmak üzere birçok klinik durumla ilişkisi saptanmıştır bir moleküldür. Serum ferritini hemofagositik lenfohistiyositoz (HLH) gibi inflamasyon ilişkili hastalıkların tanısında kullanılabilmektedir. Artmış ferritin düzeylerinin yoğun bakım ünitesi (YBÜ) hastalarında, HLH ve sepsis gibi hiperinflamasyon tablolarında mortaliteyle ilişkisi olduğu birçok çalışmada kanıtlanmıştır. Biz de kendi çalışmamızda yoğun bakımda yatan hastalarda serum ferritin düzeyinin HLH hastalarında prognoz ve mortalite üzerine etkilerini incelemeyi amaçladık. Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıkları YBÜ'de Ocak 2013- Haziran 2022 tarihlerinde yatmakta olan HLH-2004 tanı kriterlerini karşılayan 143 hastanın verileri retsospektif olarak incelendi. Hastaların demografik bilgileri, yoğun bakıma giriş ve çıkış verileri, kemik iliği biyopsileri, aldıkları tedaviler ve H-skorları kayıt altına alındı. Ölen ve yaşayan hastalar kıyaslandı. Yoğun bakıma yatış ve çıkış değerleri arasında fark delta (?) olarak hesaplanmıştır. ? değeri, sonlanım noktası değeri-başlangıç noktası değeri olarak hesaplanmıştır. Bulgular: Çalışmamızda tek değikenli lojistik regresyon analizinde ? Ferritin [Odds Ratio (OR):1.00 p 0.005], maksimum (Max) H-skorunun (OR: 1.012, p 0.001) ve maksimum ferritin düzeyinin (OR: 1.00 p 0.006) mortalite prediktörleri olduğu saptanmıştır. Bunlara ek olarak ? kardiyotorasik oran (KTO), ? NT-proBNP, ? kreatinin, ? albumin, ? NLR, ? MVP, ? lenfosit sayısı, ? crp ve yaş ile yatışı esnasında gelişen kalp yetmezliği (KY) de mortaliteyle ilişkili saptanmıştır. Yaş ve kreatinin sabitlediğinde ? NT-proBNP hala mortaliteyle ilişkili çıkmıştır. Çok değikenli lojistik regresyon analizinde ise KY gelişimi (OR: 3,726, p 0,031), ? KTO, Max H-skoru, ? albumin, ? NLR mortaliteyle ilişkili saptanmıştır. Max ferritin-mortalite ilişkisi açısından ROC eğrisi yapıldığında ise 3000 µg/L kesim noktası için sensitivite 89%, spesifite 52%, AUC: 74.3% olarak saptanmıştır. Sonuç: HLH, sepsis gibi hiperinflamasyonla seyreden klinik tablolarda hastaların bazal ferritin düzeyi, maksimum ferritin düzeyi ve ferritinin zamansal değişimi mortaliteyi öngörmektedir. Hiperinflamasyon durumunda hastalar yeni gelişen KY açısından yakın takip edilmelidirler. NT-proBNP takibi, kalp yetmezliği gelişmese dahi hiperinflamasyon durumunda prognozu öngörmede başarılı bir belirteçtir. Mortalitesi yüksek bu klinik tablolalarda bahsedilen bu belirteçler yakın takip edilmeli, hızlıca etkin tedavi yöntemleri uygulanmalıdır. Anahtar kelimeler: ferritin ; hemofagositik sendrom; NT-proBNP ; H-skoru
INTRODUCTION: Ferritin is a molecule that has been associated with many clinical conditions, especially inflammation. Serum ferritin can be used in the diagnosis of inflammation -related diseases such as hemophagocytic lymphohistyocytosis (HLH). In the intensive care unit (ICU) patients, increased levels of ferritin have been proved in many studies that they have a relationship with increased mortality in hyperinflamation conditions such as HLH and sepsis. In our own study, we aimed to examine the effects of serum ferritin levels on prognosis and mortality in patients with intensive care. AIMS AND METHOD: Between January 2013 and June 2022, we evaluate 143 patients who are diagnosed as HLH due to HLH-2004 diagnostic criteria and followed in the Ege University Hospital Internal Medicine ICU. The demographic informations of the patients, intensive care unit input and output data, bone marrow biopsies, the treatments they received and H-score were recorded. Survivor and non-survivor patients were compared. The difference between the intensive care input and the output values were calculated as delta (?). The ? value is calculated as the output value-input value. RESULTS: In our study, in univariate logistic regression analysis, it was found that ? ferritin [Odds Ratio (OR):1.00 p 0.005], maximum (max) H-score (OR: 1.012, p 0.001) and maximum ferritin levels (OR: 1.00 p 0.006) were mortality predictors. In addition, ? cardiotoracic ratio (CTR), ? NT-proBNP, ? creatinine, ? albumin, ? NLR, ? MVP, ? lymphocytes, ? CRP and age and newly developed heart failure (HF) during hospitalization were associated with mortality. When age and creatinine adjusted, ? NT-proBNP was still associated with mortality. In the multivariate logistic regression analysis, HF development (OR: 3,726, P 0.031), ? CTR, Max H-score, ? albumin, ? NLR were associated with mortality. In the Receiver Operating Characteristics (ROC) analysis, the cutoff value of max ferritin for mortality was determined as 3000 µg/L with 89% sensitivity, 52% specificity and AUC: 74.3% . CONCLUSION: In clinical conditions with hyperinflamation such as HLH and sepsis, levels of basal ferritin, levels of maximum ferritin and the temporal changes of ferritin predict mortality. In case of hyperinflamation, patients should be followed closely in terms of newly developing KY. NT-proBNP tracking is a successful marker in predicting prognosis in case of hyperinflamation even if heart failure does not develop. These markers mentioned in these clinical paintings with high mortality should be followed closely and quickly effective treatment methods should be applied. Key words: ferritin ; hemophagocytic syndrome ; NT-proBNP ; H-score
INTRODUCTION: Ferritin is a molecule that has been associated with many clinical conditions, especially inflammation. Serum ferritin can be used in the diagnosis of inflammation -related diseases such as hemophagocytic lymphohistyocytosis (HLH). In the intensive care unit (ICU) patients, increased levels of ferritin have been proved in many studies that they have a relationship with increased mortality in hyperinflamation conditions such as HLH and sepsis. In our own study, we aimed to examine the effects of serum ferritin levels on prognosis and mortality in patients with intensive care. AIMS AND METHOD: Between January 2013 and June 2022, we evaluate 143 patients who are diagnosed as HLH due to HLH-2004 diagnostic criteria and followed in the Ege University Hospital Internal Medicine ICU. The demographic informations of the patients, intensive care unit input and output data, bone marrow biopsies, the treatments they received and H-score were recorded. Survivor and non-survivor patients were compared. The difference between the intensive care input and the output values were calculated as delta (?). The ? value is calculated as the output value-input value. RESULTS: In our study, in univariate logistic regression analysis, it was found that ? ferritin [Odds Ratio (OR):1.00 p 0.005], maximum (max) H-score (OR: 1.012, p 0.001) and maximum ferritin levels (OR: 1.00 p 0.006) were mortality predictors. In addition, ? cardiotoracic ratio (CTR), ? NT-proBNP, ? creatinine, ? albumin, ? NLR, ? MVP, ? lymphocytes, ? CRP and age and newly developed heart failure (HF) during hospitalization were associated with mortality. When age and creatinine adjusted, ? NT-proBNP was still associated with mortality. In the multivariate logistic regression analysis, HF development (OR: 3,726, P 0.031), ? CTR, Max H-score, ? albumin, ? NLR were associated with mortality. In the Receiver Operating Characteristics (ROC) analysis, the cutoff value of max ferritin for mortality was determined as 3000 µg/L with 89% sensitivity, 52% specificity and AUC: 74.3% . CONCLUSION: In clinical conditions with hyperinflamation such as HLH and sepsis, levels of basal ferritin, levels of maximum ferritin and the temporal changes of ferritin predict mortality. In case of hyperinflamation, patients should be followed closely in terms of newly developing KY. NT-proBNP tracking is a successful marker in predicting prognosis in case of hyperinflamation even if heart failure does not develop. These markers mentioned in these clinical paintings with high mortality should be followed closely and quickly effective treatment methods should be applied. Key words: ferritin ; hemophagocytic syndrome ; NT-proBNP ; H-score
Açıklama
Anahtar Kelimeler
Hematoloji, Hematology ; Romatoloji, ferritin, hemofagositik sendrom, NT-proBNP, H-skoru
