Acil servise başvuran karaciğer sirozu hastalarında spontan bakteriyel peritonit tanı prediktörlerinin retrospektif olarak değerlendirilmesi
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Acil servise başvuran karaciğer sirozu tanılı hastalardan parasentez ve asit örneklemesi yapılanları spontan bakteriyel peritonit tanısı alanlara ve almayanlara göre retrospektif olarak değerlendirerek tanıyı öngörmede etkili olan verileri belirlemeyi hedefledik. Gereç ve Yöntem: Çalışmamız retrospektif olarak 01.01.2016 ile 31.12.2020 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Hastanesi Acil Servisi’ne başvuran hastaların arşiv taraması yapılarak gerçekleşti. Karaciğer sirozu tanılı hastalardan batın içi sıvı (asit) örneklemesi yapılmış 18 yaş üstü olanlar geriye dönük olarak incelendi. Olguların demografik özellikleri ile acil servise başvuru nedenleri, vital bulguları, kronik hastalıkları, geçirilmiş spontan bakteriyel peritonit (SBP) öyküsü, karaciğer sirozunun etiyolojisi, hepatik ensefalopati varlığı, fizik muayene bulguları, serum ve asit sıvısı biyokimyası, asit sıvısı hücre sayımı ve kültürü, Child-Pugh sınıfı, olası SBP tanısı, acil servis sonlanımı ve 30 günlük mortalitesi ile ilgili elde edilen veriler çalışma formuna kaydedildi. Pozitif asit sıvısı kültürü ve/veya asit sıvısı polimorfonükleer lökosit sayısı 250 hücre/mm3 veya daha fazla olup sekonder peritonit bulgusu olmayan hastalar spontan bakteriyel peritonit olarak kabul edildi. Geçmişinde karaciğer sirozu tanısı olan veya acil serviste tanı alan hastalardan acil tıp hekimlerince parasentez işlemi yapılan 18 yaş üstü hastalar çalışmaya dahil edildi. Karaciğer sirozu dışındaki asit nedenleri ile başvuran hastalar çalışmaya dahil edilmedi. SBP tanısının tahminlenmesinde önce tek değişkenli lojistik regresyon modelleri kuruldu, sonra anlamlı çıkan değişkenlerle çoklu model oluşturuldu. Bulgular: Çalışmaya alınan 253 olgunun verileri incelendiğinde; olgu popülasyonunun 35-87 yaş aralığında olduğu, olguların %60,1’ini erkek cinsiyetin oluşturduğu, olgulardaki karaciğer sirozunun en sık nedeninin alkol (%28,8) olduğu saptandı. Tek değişkenli analizle; kalp hızı, karın ağrısı, karında şişlik, bilinç bulanıklığı, ateş, üşüme-titreme, lökosit sayısı, nötrofil sayısı, hemoglobin, nötrofil/lenfosit oranı (NLR), trombosit sayısı, sodyum, C-reaktif protein (CRP), asit lökosit sayısı, asit mononükleer lökosit sayısı, asit polimorfonükleer lökosit sayısı, asit total protein, asit albümin, asit laktat dehidrogenaz, kriptojenik etiyoloji, batında hassasiyet, bilinç değişikliği, hepatik ensefalopati ve acil serviste kalış süresi spontan bakteriyel peritonit (SBP) varlığı açısından anlamlı bulundu. Çok değişkenli analizle; karın ağrısı , batında hassasiyet, asteriksis (flapping tremor), kriptojenik etiyoloji, NLR ve trombosit sayısından oluşan ve SBP tanısını öngördürmede tahmin amaçlı kullanılabilecek bir model önerildi (AUC: 0,84, p<0,001). Model doğruluğu %70 saptandı. Bu modelden SBP tanısına yönelik eşik değer belirlenerek gerçek SBP değerleri ile modelden tahminlenen değerler çapraz tabloda kıyaslandığında kappa katsayısı 0,58 olarak hesaplandı. Sonuç: Karın ağrısı, batında hassasiyet, asteriksis (flapping tremor), kriptojenik etiyoloji, NLR ve trombosit sayısından oluşan bir skorlama sistemi SBP tanısını öngördürmede tahmin amaçlı olarak kullanılabilir.
Objective: We aimed to determine the data that are effective in predicting the diagnosis by retrospectively evaluating the patients with liver cirrhosis who admitted to the emergency department, who underwent paracentesis and ascites sampling, compared to those who were diagnosed with spontaneous bacterial peritonitis and those who did not. Material and Method: Our study was carried out retrospectively by searching the archives of patients who admitted to the Emergency Department of Ege University Medical Faculty Hospital between 01.01.2016 and 31.12.2020. Patients with liver cirrhosis who were older than 18 years of age, whose intra-abdominal fluid (ascites) sampling was performed, were retrospectively analyzed. Demographic features of the cases and reasons for admission to the emergency department, vital signs, chronic diseases, history of previous spontaneous bacterial peritonitis (SBP), etiology of liver cirrhosis, presence of hepatic encephalopathy, physical examination findings, serum and ascitic fluid biochemistry, ascitic fluid cell count and culture, Child -Pugh class, possible diagnosis of SBP, emergency room outcome and 30-day mortality data were recorded in the study form. Patients with a positive ascitic fluid culture and/or ascitic fluid polymorphonuclear leukocyte count of 250 cells/mm3 or more and no evidence of secondary peritonitis were considered as spontaneous bacterial peritonitis. Patients over the age of 18 who underwent paracentesis by emergency medicine physicians from patients with a history of liver cirrhosis or diagnosed in the emergency room were included in the study. Patients presenting with ascites other than liver cirrhosis were not included in the study. In estimating the diagnosis of SBP, univariate logistic regression models were first established, and then a multivariate model was created with the variables found to be significant. Results: When the data of 253 cases included in the study were examined; It was determined that the case population was between the ages of 35-87, 60.1% of the cases were male, and the most common cause of liver cirrhosis in the cases was alcohol (28.8%). With univariate analysis; heart rate, abdominal pain, abdominal swelling, confusion, fever, chills, leukocyte count, neutrophil count, hemoglobin, neutrophil/lymphocyte ratio (NLR), platelet count, sodium, C-reactive protein (CRP), acid leukocyte count , acid mononuclear leukocyte count, acid polymorphonuclear leukocyte count, acid total protein, acid albumin, acid lactate dehydrogenase, cryptogenic etiology, abdominal tenderness, altered consciousness, hepatic encephalopathy and duration of stay in the emergency room were found to be significant in terms of the presence of spontaneous bacterial peritonitis (SBP). With multivariate analysis; A model consisting of abdominal pain, abdominal tenderness, asterixis (flapping tremor), cryptogenic etiology, NLR and platelet count, which can be used to predict the diagnosis of SBP, was proposed (AUC: 0.84, p<0.001). Model accuracy was found to be 70%. The cut-off value for the diagnosis of SBP was determined from this model, and the kappa coefficient was calculated as 0.58 when the actual SBP values and the values estimated from the model were compared in the cross table. Conclusion: A scoring system consisting of abdominal pain, abdominal tenderness, asterixis (flapping tremor), cryptogenic etiology, NLR and platelet count can be used to predict the diagnosis of SBP.
Objective: We aimed to determine the data that are effective in predicting the diagnosis by retrospectively evaluating the patients with liver cirrhosis who admitted to the emergency department, who underwent paracentesis and ascites sampling, compared to those who were diagnosed with spontaneous bacterial peritonitis and those who did not. Material and Method: Our study was carried out retrospectively by searching the archives of patients who admitted to the Emergency Department of Ege University Medical Faculty Hospital between 01.01.2016 and 31.12.2020. Patients with liver cirrhosis who were older than 18 years of age, whose intra-abdominal fluid (ascites) sampling was performed, were retrospectively analyzed. Demographic features of the cases and reasons for admission to the emergency department, vital signs, chronic diseases, history of previous spontaneous bacterial peritonitis (SBP), etiology of liver cirrhosis, presence of hepatic encephalopathy, physical examination findings, serum and ascitic fluid biochemistry, ascitic fluid cell count and culture, Child -Pugh class, possible diagnosis of SBP, emergency room outcome and 30-day mortality data were recorded in the study form. Patients with a positive ascitic fluid culture and/or ascitic fluid polymorphonuclear leukocyte count of 250 cells/mm3 or more and no evidence of secondary peritonitis were considered as spontaneous bacterial peritonitis. Patients over the age of 18 who underwent paracentesis by emergency medicine physicians from patients with a history of liver cirrhosis or diagnosed in the emergency room were included in the study. Patients presenting with ascites other than liver cirrhosis were not included in the study. In estimating the diagnosis of SBP, univariate logistic regression models were first established, and then a multivariate model was created with the variables found to be significant. Results: When the data of 253 cases included in the study were examined; It was determined that the case population was between the ages of 35-87, 60.1% of the cases were male, and the most common cause of liver cirrhosis in the cases was alcohol (28.8%). With univariate analysis; heart rate, abdominal pain, abdominal swelling, confusion, fever, chills, leukocyte count, neutrophil count, hemoglobin, neutrophil/lymphocyte ratio (NLR), platelet count, sodium, C-reactive protein (CRP), acid leukocyte count , acid mononuclear leukocyte count, acid polymorphonuclear leukocyte count, acid total protein, acid albumin, acid lactate dehydrogenase, cryptogenic etiology, abdominal tenderness, altered consciousness, hepatic encephalopathy and duration of stay in the emergency room were found to be significant in terms of the presence of spontaneous bacterial peritonitis (SBP). With multivariate analysis; A model consisting of abdominal pain, abdominal tenderness, asterixis (flapping tremor), cryptogenic etiology, NLR and platelet count, which can be used to predict the diagnosis of SBP, was proposed (AUC: 0.84, p<0.001). Model accuracy was found to be 70%. The cut-off value for the diagnosis of SBP was determined from this model, and the kappa coefficient was calculated as 0.58 when the actual SBP values and the values estimated from the model were compared in the cross table. Conclusion: A scoring system consisting of abdominal pain, abdominal tenderness, asterixis (flapping tremor), cryptogenic etiology, NLR and platelet count can be used to predict the diagnosis of SBP.
Açıklama
Anahtar Kelimeler
Karaciğer Sirozu, Spontan Bakteriyel Peritonit, Parasentez, Asit, Liver Cirrhosis, Spontaneous Bacterial Peritonitis, Paracentesis, Ascites
