65 yaş üstü toplum kökenli pnömoni ile interne edilen hastalarda osmolarite indeksinin prognoz ile ilişkisi
The relationship between osmolarity index and prognosis in patients over 65 years of age hospitalized with community-acquired pneumonia
Yazar: MEHMET KARA
Danışman: PROF. DR. SEMA BASAT
Sağlık Bilimleri Üniversitesi / İstanbul Ümraniye Eğitim ve Araştırma Hastanesi / İç Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2023
Konu: İç Hastalıkları = Internal diseases

Özet:
Amaç: Pnömoni yaşlılarda en sık görülen enfeksiyonlardan biridir. Yaşlı hastalarda pnömoni, gençlere göre daha yüksek mortalite ve morbidite ile ilişkilidir. Çalışmamızda 65 yaş üstü toplum kökenli pnömonili hastalarda osmolarite indeksi ile hesaplanan osmolarite ile prognoz arasındaki ilişkiyi irdeledik.

Gereç ve Yöntem: Bu çalışmaya Sağlık Bilimleri Üniversitesi Ümraniye Eğitim Araştırma Hastanesi İç Hastalıkları Kliniği' ne interne edilen 65 yaş üstü toplum kökenli pnömoni tanılı 140 hasta alındı. Hastalar osmolarite indeksine göre hiperosmolar hastalar ve hiperosmolar olmayan hastalar olarak 2 gruba ayrıldı. Her iki grupta yatış süresi, yoğun bakım ünitesi (YBÜ) ihtiyacı ve mortalite oranı karşılaştırıldı. Aynı şekilde klasik osmolarite denklemine göre de 2 gruba ayrılıp, her iki grup arasında yatış süresi, YBÜ ihtiyacı ve mortalite oranı arasında fark olup olmadığı irdelendi.

Bulgular: Bizim çalışmamızda olguların osmolarite indekslerine göre ortalama osmolaritesi 298,74±22,59 olarak saptanmış olup, olguların %49,3'ü (n=69) hiperosmolar gözlenmiştir. Olguların klasik osmolarite denklemine göre ortalama osmolaritesi 294,39±22,94 olarak saptanmış olup, olguların %35'i (n=49) hiperosmolar gözlenmiştir. Osmolarite indeksine göre hesaplanan osmolaritede hiperosmolar ve hiperosmolar olmayan hastalar karşılaştırıldığında hastane yatış süresi arasında anlamlı fark saptanmamıştır. Osmolarite indeksine göre hesaplanan hiperosmolar hastaların, hiperosmolar olmayanlara göre YBÜ sevk oranı istatiksel olarak anlamlı şekilde daha yüksek bulunmuştur.(p=0,039). Osmolarite indeksine göre hesaplanan osmolaritede hiperosmolar hastaların, hiperosmolar olmayanlara göre mortalite oranı istatiksel olarak yüksek bulunmuştur. (p=0,033). Klasik osmolarite denklemine göre hesaplanan osmolaritede hiperosmolar hastaların hiperosmolar olmayan hastalara göre hastanede yatış süresi, YBÜ sevk oranı ve mortalite oranı arasında anlamlı fark saptanmadı.

Sonuç: 65 yaş üstü toplum kökenli pnömoni tanısı ile interne edilen hastalarda, osmolarite indeksine göre hiperosmolar olmak prognozu kötü yönde etkiler. Bu hastalarda yoğun bakım ünitesi sevki ve mortalite oranı daha yüksektir. Klasik osmolarite denklemine göre hiperosmolar hastalar ile hiperosmolar olmayan hastalar arasında prognoz yönünden bir fark yoktur. Toplum kökenli pnömoniye sahip yaşlı bireylerde osmolarite indeksi prognozu değerlendirmede daha iyi bir göstergedir.

Anahtar Kelimeler: Osmolarite indeksi, Pnömoni, Yaşlılık

Abstract:
Purpose: Pneumonia is one of the most commonly diagosed infections in the elderly. Pneumonia in elderly patients is associated with higher mortality and morbidity than in younger patients. In our study, we examined the relationship between osmolarity calculated by the osmolarity index and disease prognosis in patients with community-acquired pneumonia over the age of 65. We also investigated the relationship between prognosis of pneumonia and osmolarity calculated by the classical osmolarity equation.

Methods: In our study, we included 140 patients over the age of 65, who were diagnosed and admitted with community-acquired pneumonia to the Internal Medicine Clinic of the University of Health Sciences Ümraniye Training and Research Hospital. The patients were divided into two groups according to the osmolarity index: hyperosmolar patients and non-hyperosmolar patients. Potential differences in duration of admission, intensive care unit(ICU) referral rate and mortality rate between the two groups were analyzed. Similarly, they were divided into two groups according to the classical osmolarity equation, and it was examined whether there was any difference in the duration of admission, ICU referral rate and mortality rate between the two groups.

Results: In our study, the mean osmolarity of the cases was found to be 298.74±22.59 according to their osmolarity index, and 49.3% (n=69) of the cases were observed to be hyperosmolar to the osmolarity index, the ICU referral rate of hyperosmolar patients was found to be. According to the classical osmolarity equation, the average osmolarity of the cases was determined as 294.39±22.94, and 35% (n=49) of the cases were observed to be hyperosmolar. There was no significant difference in the duration of admission between the groups by osmolarity calculated according to the osmolarity index, depending on whether the patient was hyperosmolar . In osmolarity calculated according statistically higher than that of non-hyperosmolar patients (p = 0.039). In osmolarity calculated according to the osmolarity index, the mortality rate of hyperosmolar patients was found to be statistically higher than that of non-hyperosmolar patients. (p=0.033). In osmolarity calculated according to the classical osmolarity equation, no significant difference was found between the hospital stay , ICU referral rate and mortality rate of hyperosmolar patients compared to non-hyperosmolar patients. There was no significant difference in the duration of admission between the groups and patient being hyperosmolar had no effect in the osmolarity calculated according to the osmolarity index. The ICU referral rate of hyperosmolar patients was found to be statistically higher than that of non-hyperosmolar patients (p = 0.039) in the osmolarity calculated according to the osmolarity index. The mortality rate of hyperosmolar patients was found to be statistically higher than that of non-hyperosmolar patients (p=0.033) in the osmolarity calculated according to the osmolarity index. In osmolarity calculated according to the classical osmolarity equation, no significant difference was found between the hospital stay , ICU referral rate and mortality rate of hyperosmolar patients compared and non-hyperosmolar patients.

Conclusion: In patients over the age of 65 who are interned with a diagnosis of community-acquired pneumonia, being hyperosmolar according to the osmolarity index negatively affects the prognosis. Intensive care unit referral and mortality rates are higher in these patients. According to the classical osmolarity equation, there is no difference in prognosis between hyperosmolar patients and non-hyperosmolar patients. Osmolarity index is a better indicator to evaluate prognosis in elderly individuals with community-acquired pneumonia.

Key Words: Osmolarity index, Pneumonia, Old Age