Factors Affecting the Short and Long Term Mortality of Infected Patients in Intensive Care Unit

Year 2015, , 117 - 124, 01.05.2015

Ali Kutlucan Murat Erdoğan , Leyla Kutlucan Handan Ankaralı Fatih Ermiş Mücahit Gür Elif Şenocak Hilmi Demirin Yusuf Aydın

https://doi.org/10.5505/abantmedj.2015.19870

Abstract

OBJECTIVE: We aimed to investigate the possible risk factors which could effect the mortality of infected patients in Intensive Care Unit ICU like age, concomitant diseases, Procalcitonin PCT , C-reactive protein CRP , vitamin D levels and APACHE II score. These parameters were also investigated for mortality during hospitalization period and thirty and ninety-day mortality after discharge from hospital.METHODS: Fifty-two infected patients who were admitted to ICU of Duzce University School of Medicine, Department of Internal Medicine between 01 September 2011 to 30 August 2012 were evaluated prospectively.RESULTS: Sepsis increased mortality rate in ICU significantly. Concomitant diseases except hypertension were not associated with discharge status, 30 and 90 daily life expectancy. In the first hospitalization day CRP and PCT were found to be high while 25-OH vitamin D was found to be low. 25-0H vitamin D and PCT levels and APACHE II score were not associated with discharge status from ICU. CRP has been associated with increased risk of death, while APACHE II score was associated with thirty and ninety days life expectancy. It was found that life expectancy is higher with longer duration of hospitalization after ICU.CONCLUSION: Sepsis may increase ICU mortality as well as advanced age with septicemia may increase 30th and 90th days mortality after discharge. APACHE II score can be used to predict long-term survival after discharge. PCT, CRP and 25-OH vitamin D were not considered as an ideal method alone for follow up and prognosis of ICU patients.

Keywords

Intensive care unit, infection, mortality prediction

Enfeksiyon Tanılı Yoğun Bakım Hastalarında Kısa ve Uzun Dönem Mortaliteye Etkili Faktörler

Abstract

AMAÇ: Yoğun Bakım Ünitesindeki YBÜ enfeksiyöz hastalarda mortalite üzerinde etkili olabilecek risk faktörleri olan yaş, eşlik eden hastalıklar, prokalsitonin PCT , C-reaktif protein CRP , 25-OH vitamin D düzeyi ve APACHE II skoru ile; bu parametrelerin yoğun bakımda ve hastane sonrası otuz ile doksan günlük mortalite arasındaki ilişkisini değerlendirmeyi amaçladık. YÖNTEMLER: Düzce Üniversitesi Tıp Fakültesi İç Hastalıları YBÜ’ye 1 Eylül 2011–30 Ağustos 2012 tarihleri arasında enfeksiyon tanısı ile kabul edilen 52 hasta prospektif olarak değerlendirilmiştir. BULGULAR: Sepsis, YBÜ’de mortaliteyi belirgin artırmıştır. Eşlik eden hastalıklardan; hipertansiyon dışındakilerin taburculuk durumuna, 30 ve 90 günlük yaşam süresine ulaşmayla ilişkisi saptanmadı. Yatış laboratuar değerlerinde; CRP ve PCT yüksek, 25-OH vitamin D ise düşük saptanmıştır. YBÜ’den taburculukta; yaş, 25-OH vitamin D, PCT, APACHE II’nin etkili olmadıkları, CRP artışının ölüm riski ile ilişkili olduğu görüldü. APACHE II skoru, otuz günlük yaşamla; yaş ise, otuz ve doksan günlük yaşamla ilişkili bulunmuştur. YBÜ sonrası devredilen serviste yatış süresi uzun olanlarda, hastane sonrası yaşam süresinin yüksek olduğu saptanmıştırSONUÇ: Sepsis, YBÜ mortalitesini, sepsisle beraber ileri yaş ta taburculuk sonrası 30 ve 90 günlük mortaliteyi artırabilir. APACHE II skoru, taburculuk sonrası uzun dönem sağkalım tahmininde kullanılabilir. PCT, CRP ve 25-OH vitamin D’nin, YBÜ hastalarının takibi ve prognozunu belirlemede tek başlarına ideal yöntemler olarak kullanılmasının uygun olmadığı düşünülmektedir.

Keywords

Yoğun bakım, enfeksiyon, mortalite tahmini

References

• Akalın H. Sepsis: Tanımlar, Tanı, Etyoloji veEpidemiyolojide Yeni Gelişmeler. Türk Yoğun Bakım Derneği Dergisi, Cilt:5, Özel Sayı 2007.
• Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348(16): 1546-54.
• Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Facing the challenge: decreasing case fatality rates in severe sepsis despite increasing hospitalizations. Crit Care Med 2005; 33(11): 2555- 62.
• Winters BD, Eberlein M, Leung J, Needham DM, Pronovost PJ, Sevransky JE. Long-term mortality and quality of life in sepsis: a systematic review. Crit Care Med 2010; 38(5): 1276-83.
• Perl TM, Dvorak L, Hwang T, Wenzel RP. Long- term survival and function after suspected gram- negative sepsis. JAMA 1995; 274(4): 338-45.
• Sasse KC, Nauenberg E, Long A, Anton B, Tucker HJ, Hu TW.. Long-term survival after intensive care unit admission with sepsis. Crit Care Med 1995; 23:1040-47.
• Bouch DC, Thompson JP. Severity scoring systems in the critical ill. Continuing Education in Anesthesia and Critical Care 2008; 8: 181-5
• Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: A systematic review. Crit Care 2008; 12: R161.
• Kuzniewicz MW, Vasilevskis EE, Lane R, Dean ML, Trivedi NG, Rennie DJ, et al. Variation in ICU risk-adjusted mortality: impact of methods of assessment and potential confounders. Chest 2008; 133: 1319-27.
• Bouillon R. Vitamin D: from photosynthesis, metabolism and action to clinical applications. In: Endocrinology, Jameson JL, De Groot LJ (Eds), Saunders; 2001. p.1010-28.
• Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, et al. Toll-like receptor triggering of a vitamin D- mediated human antimicrobial response. Science 2006; 311: 1770-73.
• McKinney JD, Bailey BA, Garrett LH, Peiris P, Manning T, Peiris AN: Relationship between vitamin D status and ICU outcomes in veterans. J Am Med Dir Assoc 2011; 12: 208-11.
• Schrİder MA, Poulsen JB, Perner A. Acceptable long-term outcome in elderly intensive care unit patients. Dan Med Bul 2011; 58(7): A4297.
• Hartl WH, Wolf H, Schneider CP, Küchenhoff H, Jauch KW.. Acute and long-term survival in chronically critically ill surgical patients: a retrospective observational study. Crit Care. 2007; 11(3): R55.
• Venker J, Miedema M, Strack van Schijndel RJ, Girbes AR, Groeneveld AB. Long-term outcome after 60 days of intensive care. Anaesthesia, 2005, 60, pages 541–46.
• Suberviola B, Castellanos-Ortega A, González- Castro A, García-Astudillo LA, Fernández-Miret B. Prognostic value of procalcitonin, C-reactive protein and leukocytes in septic shock. Med Intensiva. 2012; 36(3): 177-84.
• Azevedo JR, Torres OJ, Czeczko NG, Tuon FF, Nassif PA, Souza GD. Procalcitonin as a prognostic biomarker of severe sepsis and septic shock. Rev Col Bras Cir. 2012 Dec; 39(6): 456-61.
• Neuenschwander LC, Bittencourt H, Ribeiro AF, Teixeira AL, Teixeira MM, Teixeira JC, et al. Plasma levels of procalcitonin and eight additional inflammatory molecules in febrile neutropenic patients. Clinics 2011; 66(10): 1699-705.
• Sudhir U, Venkatachalaiah RK, Kumar TA, Rao MY, Kempegowda P. Significance of serum procalcitonin in sepsis. Indian J Crit Care Med. 2011 Jan-Mar; 15(1): 1–5.
• Kenzaka T, Okayama M, Kuroki S, Fukui M, Yahata S, Hayashi H. et al. Use of a semiquantitative procalcitonin kit for evaluating severity and
• predicting mortality in patients with sepsis. Int J Gen Med. 2012; 5: 483–88.
• Pettilä V, Hynninen M, Takkunen O, Kuusela P, Valtonen M. Predictive value of procalcitonin and interleukin-6 in critically ill patients with suspected sepsis. Intensive Care Med 2002; 28: 1220-25.
• Seligman R, Seligman BG, Teixeira PJ. Comparing the accuracy of predictors of mortality in ventilator- associated pneumonia. J Bras Pneumol. 2011; 37(4): 495-503.
• Prieto MF, Kilstein J, Bagilet D, Pezzotto SM. C- reactive protein as a marker of mortality in intensive care unit. Med Intensiva. 2008; 32: 424- 30.
• Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Mélot C, et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest. 2003 Jun;123(6): 2043- 49.
• Pettilä V, Pentti J, Pettilä M, Takkunen O, Jousela I. Predictive value of antithrombin III and serum C- reactive protein concentration in critically ill patients with suspected sepsis. Crit Care Med. 2002; 30(2): 271-75.
• Seller-Pérez G, Herrera-Gutiérrez ME, Lebrón- Gallardo M, de Toro-Peinado I, Martín-Hita L, Porras-Ballesteros JA. Serum C-reactive protein as a marker of outcome and infection in critical care patients. Med Clin (Barc). 2005 Dec 3; 125(20): 761- 65.
• Devran Ö, Karakurt Z, Adıgüzel N, Güngör G, Yazıcıoğlu Moçin Ö, Kalamanoğlu Balcı M, et al. C- reactive protein as a predictor of mortality in patients affected with severe sepsis in intensive care unit. Multidiscip Respir Med. 2012; 7(1): 47.
• Ho KM, Lee KY, Dobb GJ, Webb SA. C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study. Intensive Care Med. 2008; 34(3): 481-87.
• Litton E, Ho KM, Chamberlain J, Dobb GJ, Webb SA. C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a nested case-control study. Crit Care Resusc. 2007; 9(1): 19- 25
• Arnson Y, Gringauz I, Itzhaky D, Amital H. Vitamin D deficiency is associated with poor outcomes and increased mortality in severely ill patients. QJM. 2012; 105(7): 633-39.
• Amrein K, Schnedl C, Berghold A, Pieber TR, Dobnig H. Correction of vitamin D deficiency in critically ill patients - VITdAL@ICU study protocol of a double-blind, placebo-controlled randomized clinical trial. BMC Endocr Disord. 2012; 12(1): 27.
• Cecchi A, Bonizzoli M, Douar S, Mangini M, Paladini S, Gazzini B, Degl'Innocenti S, Linden M, Zagli G, Peris A. Vitamin D deficiency in septic patients at ICU admission is not a mortality predictor. Minerva Anestesiol. 2011 Dec; 77(12): 1184-89
• Del Bufalo C, Morelli A, Bassein L, Fasano L, Quarta CC, Pacilli AM, Gunella G. Severity scores in respiratory intensive care: APACHE II predicted mortality better than SAPS II. Respir Care. 1995 Oct; 40(10): 1042-47.
• Naved SA, Siddiqui S, Khan FH. APACHE-II score correlation with mortality and length of stay in an intensive care unit. J Coll Physicians Surg Pak. 2011 Jan; 21(1): 4-8.
• Oh TE, Hutchinson R, Short S, Buckley T, Lin E, Leung D. Verification of the Acute Physiology and Chronic Health Evaluation scoring system in a Hong Kong intensive care unit. Crit Care Med. 1993 May; 21(5): 698-705.
• Fadaizadeh L, Tamadon R, Saeedfar K, Jamaati HR. Performance assessment of Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II in a referral respiratory intensive care unit in Iran. Acta Anaesthesiol Taiwan. 2012 Jun;50(2): 59-62.
• Escarce JJ, Kelley MA. Admission source to the medical intensive care unit predicts hospital death independent of APACHE II score. JAMA. 1990; 264(18): 2389-94.
• Capuzzo M, Valpondi V, Sgarbi A, Bortolazzi S, Pavoni V, Gilli G, Candini G, Gritti G, Alvisi R. Validation of severity scoring systems SAPS II and APACHE II in a single-center population. Intensive Care Med. 2000; 26(12): 1779-85.