Anevrizmal subaraknoid kanama, kafa travmas� ve sepsis hastalar�n�n yo�un bak�m tedavileri s�ras�nda akut b�brek hasar� geli�imi ve etkileyen risk fakt�rlerinin incelenmesi

Kamar, Ceren; Ali, Achmet; Altun, Demet; Orhun, Gunseli; Sabanci, Akin; Sencer, Altay; Akinci, Ibrahim Ozkan

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Anevrizmal subaraknoid kanama, kafa travmas� ve sepsis hastalar�n�n yo�un bak�m tedavileri s�ras�nda akut b�brek hasar� geli�imi ve etkileyen risk fakt�rlerinin incelenmesi [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2017; 23(1): 39-45 | DOI: 10.5505/tjtes.2016.83451

Anevrizmal subaraknoid kanama, kafa travmas� ve sepsis hastalar�n�n yo�un bak�m tedavileri s�ras�nda akut b�brek hasar� geli�imi ve etkileyen risk fakt�rlerinin incelenmesi

Ceren Kamar¹, Achmet Ali¹, Demet Altun¹, Gunseli Orhun¹, Akin Sabanci², Altay Sencer¹, Ibrahim Ozkan Akinci¹
¹�stanbul �niversitesi, �stanbul T�p Fak�ltesi, Anesteziyoloji Ana Bilim Dal�, �stanbul, T�rkiye
²�stanbul �niversitesi, �stanbul T�p Fak�ltesi, Beyin Cerrahisi Ana Bilim Dal�, �stanbul, T�rkiye

AMA�: Yo�un bak�m �nitelerinde (YB�) takip edilen farkl� hasta gruplar�nda akut b�brek hasar� (ABH) geli�imini inceleyen az �al��ma bulunmaktad�r. �al��mam�zda farkl� yo�un bak�m hasta gruplar�nda ABH geli�mesini ve bunda etkili risk fakt�rlerini incelemeyi ama�lad�k.
GERE� VE Y�NTEM: Bu �al��ma �� farkl� YBܒde ger�ekle�tirildi ve AKI network (AKIN) s�n�fland�rmas�na g�re ABH olu�umu kar��la�t�r�ld�. Travma, beyin cerrahi ve genel YBܒlerde yatan s�ras� ile kafa travmas�, anevrizmal subaraknoid kanama (aSAK) ve septik �ok nedeniyle takip edilen 300 hasta ABH insidans� ve risk fakt�rleri a��s�ndan incelendi.
BULGULAR: Anevrizmal subaraknoid kanama grubunda serum kreatin de�erine g�re ABH geli�en hasta saptanmad� fakat vol�m d�zeltilmi� kreatinin de�erine g�re (VACr) hastalar�n %5�inde ABH geli�ti�i g�r�ld�. AKI network s�n�fland�rmas� baz al�nd��nda sepsis grubunda %76, kafa travmas� grubunda hastalar�n %20�sinde hem serum kreatin hemde VACr de�erine g�re ABH geli�ti�i g�r�ld� ve sepsis grubunda ABH insidans� anlaml� oranda y�ksek bulundu (p<0.001). Sadece vazopres�r kullan�m� sepsis ve kafa travmas� grubunda ABH geli�imi i�in risk fakt�r� olarak saptand�. Hastalar�n mortalite oranlar� aSAK, kafa travmas� ve sepsis grubu i�in s�ras� ile %8, %22 ve %42 saptand�. Vazopress�r kullan�m� ve ABH geli�mesi sepsis grubunda mortalite i�in risk fakt�r� olarak saptand�.
TARTI�MA: Benzer �zellikler ve risk fakt�rlerine ra�men aSAK hastalar�nda ABH daha nadir g�r�lmektedir. Vazospazm tedavisi i�in uygulanan hipertansiyon, hipervolemi ve tuz kaybettirici sendrom sonucu olu�an poli�ri aSAK hastalar�nda ABH geli�imden koruyan fakt�rler olabilir.

Anahtar Kelimeler: B�brek yetmezli�i, kafa travmas�, sepsis, subaraknoid kanama.

Evaluation of risk factors and development of acute kidney injury in aneurysmal subarachnoid hemorrhage, head injury, and severe sepsis/septic shock patients during ICU treatment

Ceren Kamar¹, Achmet Ali¹, Demet Altun¹, Gunseli Orhun¹, Akin Sabanci², Altay Sencer¹, Ibrahim Ozkan Akinci¹
¹Istanbul University, Istanbul Medical Faculty, Anesthesiology Department, Istanbul,Turkey
²Istanbul University, Istanbul Medical Faculty, Neurosurgery Department, Istanbul, Turkey

BACKGROUND: There are few studies examining development of acute kidney injury (AKI) in the various types of patients in intensive care units (ICUs). Presently described is evaluation of risk factors and development of AKI in different groups of ICU patients.
METHODS: Present study was performed in 3 different ICUs. Development of AKI was measured using Acute Kidney Injury Network (AKIN) classification system. Total of 300 patients who were treated in trauma, neurosurgery, or general ICU departments (due to head injury, aneurysmal subarachnoid hemorrhage [aSAH], or severe sepsis/septic shock, respectively) were assessed for incidence, risk factors, and development of AKI.
RESULTS: AKI did not develop in aSAH patients when evaluated based on serum creatinine level; however, it was observed in 5% of aSAH patients according to volume adjusted creatinine (VACr) level. AKI developed in 76% of sepsis group, and in 20% of head injury group, based on AKIN classification, according to both serum and VACr levels. Incidence of AKI was significantly higher in sepsis group (p<0.001). Only use of vasopressor was significantly related to AKI development in sepsis and head injury groups. Mortality rate was 8%, 22%, and 42% in aSAH, head injury, and sepsis groups, respectively. AKI development and vasopressor use were significantly related to mortality in sepsis group.
CONCLUSION: Despite similar characteristics and risk factors, there were fewer instances of AKI in aSAH group. Hypertension or hydration therapy used to treat vasospasm and polyuria due to cerebral salt-wasting syndrome may prevent aSAH patients from developing AKI.

Keywords: Head trauma, renal insufficiency, sepsis, subarachnoid hemorrhage.

Ceren Kamar, Achmet Ali, Demet Altun, Gunseli Orhun, Akin Sabanci, Altay Sencer, Ibrahim Ozkan Akinci. Evaluation of risk factors and development of acute kidney injury in aneurysmal subarachnoid hemorrhage, head injury, and severe sepsis/septic shock patients during ICU treatment. Ulus Travma Acil Cerrahi Derg. 2017; 23(1): 39-45

Sorumlu Yazar: Ibrahim Ozkan Akinci, T�rkiye
Makale Dili: �ngilizce

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