Pobol i smrtnost bolesnika liječenih u internističkoj jedinici intenzivne medicine

master's thesis

• Title (english): Medical intensive care unit patients morbidity and mortality: single centre follow up
• Author: Đivo Čučević
• Mentor: Vesna Degoricija (mentor)
• Committee member: Marija Santini (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Vesna Degoricija (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

CILJ: Analiza pobola i smrtnosti bolesnika liječenih u Jedinici intenzivnog liječenja (JIL) Zavoda za intenzivnu medicinu Klinike za unutarnje bolesti Kliničkog bolničkog centra Sestre Milosrdnice (KBC SM) i Medicinskog fakulteta Sveučilišta u Zagrebu (MEF) periodu od 1. siječnja do 31. prosinca 2018. godine. ----- ISPITANICI I METODE: Retrospektivno prikupljeni podaci iz bolničke baze podataka KBC SM u navedenom razdoblju. Analizirani su svi bolesnici primljeni u JIL u navedenom periodu, te su prikupljeni podatci od kuda i kada su bolesnici primljeni u JIL, duljina njihovog liječenja u JIL-u, glavna i popratne dijagnoze, podatci o komorbiditetima i jesu li za vrijeme liječenja bili hemodijalizirani, mehanički ventilirani i/ili podvrgnuti vazoaktivnoj i/ili inotropnoj potpori. Za sve bolesnike prikupljeni su SAPS II i GCS zbrojevi ocjenskih ljestvica. ----- REZULTATI: U istraživanje je uključen 761 bolesnik. Medijan dobi iznosio je 71 godinu s rasponom od 19 do 96 godina. Podjednako su bili zastupljeni muškarci (51.8%) i žene (48.2%). Sepsa je bila najčešći razlog prijema u JIL, zabilježena je u 212 (27.9%) bolesnika. Medijan SAPS II zbroja iznosio je 37.0, a prediktivna smrtnost temeljem SAPS II zbroja bila je 19.6%. Stvarna smrtnost bila je nešto veća od prediktivne i iznosila je 23.4%. Najveći udio bolesnika, 79.1% primljen je u JIL iz Objedinjenog hitnog bolničkog prijema (OHBP) KBC SM. Mehanička ventilacija (MV) provedena je u 118 (15.5%), liječenje šoka u 92 (12.1%) i akutna hemodijaliza u 41 (5.4%) bolesnika. Statistički značajna povećana smrtnost zabilježena je u bolesnika u šoku (P<0.001), mehanički ventiliranih (P<0.001) i akutno hemodijaliziranih (P=0.044) bolesnika. ----- ZAKLJUČAK: U istraživanju je registrirana viša smrtnost bolesnika liječenih u JIL-u u usporedbi s drugim europskim istraživanjima. Ispitanici su bili starije životne dobi od ispitanika u spomenutim
istraživanjima. Visoka incidencija sepse bolesnika liječenih u JIL-u prati trend porasta incidencije sepse u drugim znanstvenim izvorima. Osnovnoj bolesti pridruženo akutno zatajenje rada organa bilo je povezano s povećanom smrtnosti bolesnika.

Abstract (english)

OBJECTIVES: Aim of the study was to determine mortality and morbidity of the patients admitted to medical intensive care unit (MICU), Sisters of Mercy University Hospital in Zagreb within one-year period. ----- PARTICIPANTS AND METHODS: In this retrospective study conducted from Januaryn 1st to December 31st 2018, hospital records of patients who were admitted in medical ICU were reviewed. Analyses included all patients regardless of the reason for admission to the MICU.
Demographic data, most common reasons for MICU admission, LOS, comorbidity presence and MICU outcome were analysed. Data regarding advance life support methods such as: haemodialysis, mechanical ventilation and shock management were collected as well as SAPS II and GCS scores. ----- RESULTS: Study included 761 patients. Age median was 71 years ranging from 19 to 96. Sepsis was primary admission reason and was present in 212 (27.9%) patients. SAPS II score median was 37.0. Predicted mortality rate based on SAPS II score was 19.6%. Real mortality rate was higher compared to predicted mortality rate and was 23.4%. There were 602 (79.1%) patients admitted directly from Emergency department, Clinical Hospital Sisters of Mercy. 118 (15.5%) patients received mechanical ventilation (MV), 92 (12.1%) patients required shock management and 41 (5.4%) patients received acute hemodialysis. Significant higher mortality rates were observed in patients requiring shock management (P<0.001), MV (P<0.001) and acute hemodialysis (P=0.044).
----- CONCLUSION: In our study mortality rate is higher compared to other similar European studies. However, participants in our study are older compared to participants in mentioned studies. Based on severity score scales patients were not critically ill. High sepsis incidence observed in our study correlates with upward trend of sepsis incidence in other institutions. Patientes who developed acute organ failure associated with main condition had higher mortality.

• Keywords: jedinica intenzivnog liječenja; pobol; smrtnost; intenzivno liječenje
• Keywords (english): intensive care unit; morbidity; mortality; intensive care
• Language: croatian
• URN:NBN: urn:nbn:hr:105:711735
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-05-03 08:56:11