Ateş yüksekliği şikâyeti ile başvuran immunsuprese hastaların prospektif olarak incelenmesi
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2021
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İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ VE AMAÇ: İmmunsuprese hastaların yeterli immun cevabı oluşturamaması ve atipik şikâyetlerle acil servise başvurmaları sebebi ile tanıları ve tedavileri gecikmektedir. İmmunsuprese hastaların hasta yoğunluğu fazla olan acil servislerde hızlı ve uygun yönetimlerinin yapılması oldukça önemlidir. Bizim çalışmamızdaki temel amaç; bu hasta grubunun acil servise başvuru anında yapılan tetkikler ile hastaların erken tanı, prognoz, mortalite ve hastaneye yatış durumları arasındaki ilişkiyi ortaya koymaktır. GEREÇ VE YÖNTEM: Mayıs 2019 ve Mayıs 2020 tarihleri arasında erişkin acil servise ateş yüksekliği şikâyeti ile başvuran 80 immunsuprese hasta prospektif olarak incelendi. 18 yaşından büyük hastalar çalışmaya dâhil edilirken, ateş yüksekliği şikâyeti olmayan, immünsuprese olmayan ve sağlıklı bireyler çalışmadan çıkarıldı. Ateş yüksekliği ile başvuran immussuprese hastaların inceleme formu oluşturuldu ve her hasta için dolduruldu. BULGULAR: Çalışmaya alınan 80 hastanın cinsiyet analizinde; 44'ü (%55) kadın, 36'sı (%45) erkek olarak saptandı ve yaş ortalaması 58.50±14.72 yıl olarak bulundu. Hastaların yatış süreleri ile CRP ve TİT WBC değerleri arasında anlamlı ilişki olduğunu saptadık. Hastalarımızda albümin, O2 saturasyonu, PLT, total protein değerlerinin düşük olması ve lipaz, PCT değerlerinin yüksek olmasının mortalite ile ilişkili olduğunu bulduk. Hastalarımızda albümin, total protein ve sistolik kan basıncının düşük olması, kan üre azotu, laktat dehidrojenaz, nötrofil ve prokalsitonin düzeylerinin yüksek olması ile yoğun bakım yatışı ilişkili olduğu saptadık. Hastalarımızın immunsupresyon durumuna göre son tanılarını incelediğimizde; karaciğer nakli olan hastaların büyük kısmının kolanjit, malignitesi olan hastaların büyük kısmının solunum sistemi enfeksiyonu, böbrek nakli olan hastaların büyük kısmı üriner sistem enfeksiyonu tanısını aldığını bulduk. SONUÇ: Ateş yüksekliği şikâyeti ile acil servise başvuran immunsuprese hastaların ölçülen ateş yükseklikleri olmasa dahi ciddiye alınmalıdır. Ayrıca bu hastalara başvuru anında yapılacak uygun tetkikler, klinik seyir açısından hayati önem taşımaktadır. ANAHTAR KELİMELER: Ateş, İmmunsupresyon, Transplantasyon
INTRODUCTION AND AIM: The diagnosis and treatment of immunosuppressed patients are delayed because of the inability to create an adequate immune response and their admission to the emergency department with atypical complaints. Rapid and appropriate management of immunosuppressed patients in emergency services with high patient density is very important. The main purpose of our study; to reveal the relationship between the examinations performed at the time of admission to the emergency department of this patient group and the patients' early diagnosis, prognosis, mortality and hospitalization status. MATERIALS AND METHODS: Eighty immunosuppressed patients who were admitted to the adult emergency department with high fever between May 2019 and May 2020 were prospectively studied. While patients older than 18 years of age were included in the study, healthy individuals without fever complaints, who were not immunosuppressed and were excluded from the study. An examination form was created for immunosuppressed patients who presented with high fever and filled out for each patient. RESULTS: In the gender analysis of 80 patients included in the study; 44 (55%) were female, 36 (45%) were male and the mean age was 58.50 ± 14.72 years. We found that there was a significant relationship between the length of stay of the patients and the CRP and TIT WBC values. We found that low albumin, O2 saturation, PLT, total protein values and high lipase, PCT values were associated with mortality in our patients. We found that low albumin, total protein, systolic blood pressure and high blood urea nitrogen, lactate dehydrogenase, neutrophil, procalcitonin levels were associated with intensive care admission in our patients. When we examine the last diagnoses of our patients according to their immunosuppression status; we found that most of the patients with liver transplantation were diagnosed with cholangitis, most of the patients with malignancy had respiratory system infection, and most of the patients with kidney transplantation had urinary tract infection. CONCLUSION: Immunosuppressed patients admitted to the emergency department with high fever should be taken seriously, even if they do not have high fever. In addition, appropriate examinations to be made at the time of admission to these patients are of vital importance in terms of clinical course. KEYWORDS: Fever, Immunosuppression, Transplantation
INTRODUCTION AND AIM: The diagnosis and treatment of immunosuppressed patients are delayed because of the inability to create an adequate immune response and their admission to the emergency department with atypical complaints. Rapid and appropriate management of immunosuppressed patients in emergency services with high patient density is very important. The main purpose of our study; to reveal the relationship between the examinations performed at the time of admission to the emergency department of this patient group and the patients' early diagnosis, prognosis, mortality and hospitalization status. MATERIALS AND METHODS: Eighty immunosuppressed patients who were admitted to the adult emergency department with high fever between May 2019 and May 2020 were prospectively studied. While patients older than 18 years of age were included in the study, healthy individuals without fever complaints, who were not immunosuppressed and were excluded from the study. An examination form was created for immunosuppressed patients who presented with high fever and filled out for each patient. RESULTS: In the gender analysis of 80 patients included in the study; 44 (55%) were female, 36 (45%) were male and the mean age was 58.50 ± 14.72 years. We found that there was a significant relationship between the length of stay of the patients and the CRP and TIT WBC values. We found that low albumin, O2 saturation, PLT, total protein values and high lipase, PCT values were associated with mortality in our patients. We found that low albumin, total protein, systolic blood pressure and high blood urea nitrogen, lactate dehydrogenase, neutrophil, procalcitonin levels were associated with intensive care admission in our patients. When we examine the last diagnoses of our patients according to their immunosuppression status; we found that most of the patients with liver transplantation were diagnosed with cholangitis, most of the patients with malignancy had respiratory system infection, and most of the patients with kidney transplantation had urinary tract infection. CONCLUSION: Immunosuppressed patients admitted to the emergency department with high fever should be taken seriously, even if they do not have high fever. In addition, appropriate examinations to be made at the time of admission to these patients are of vital importance in terms of clinical course. KEYWORDS: Fever, Immunosuppression, Transplantation
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TOPAL, T. (2021). Ateş yüksekliği şikâyeti ile başvuran immunsuprese hastaların prospektif olarak incelenmesi, İnönü Üniversitesi / Tıp Fakültesi / Acil Tıp Ana Bilim Dalı.
