Investigation of the Effects of Blood Product Replacement and Type on Mortality in Patients with Sepsis and Septic Shock/ Sepsis ve Septik Sok Tanisi ile Takip Edilen Hastalarda Kan Urunu Replasman Sikligi ve Turunun Mortalite Uzerine Etkisinin Incelenmesi

• Published in: Yogu︣n bakim dergisi Vol. 9; no. 2; p. 40
• Main Authors: Yildiz, Seyma, Temel, Sahin, Mendil, Nilgun Ozlem Alptekinoglu, Karaca, Zahide, Simsek, Zuhal, Dirik, Hasan, Onuk, Sevda, Yuksel, Recep Civan, Savas, Nilgun, Bulut, Kadir, Yucesoy, Faruk Seckin, Gundogan, Kursat, Sungur, Murat
• Format: Journal Article
• Language: English
• Published: AVES 01-08-2018
• ISSN: 1309-1689
• DOI: 10.5152/dcbybd.2018.1619

Objective: Anaemia, thrombocytopenia, leucopenia, disseminated intravascular coagulation (DIC) and functional deficiencies of coagulation factors are all common in patients with severe sepsis or septic shock. There is no standard protocol for blood and blood product transfusion for this disease. The aim of this study is to evaluate prospectively the blood and blood products transfusion in patients who are diagnosed with sepsis and septic shock. Material and Methods: This prospective descriptive study was performed on patients who are 18 years of age and over, with septic/septic shock who stay for 48 hours or more in the intensive care unit. Results: One hundred three patients were enrolled in this study. Fifty six percent of the patients were male and fourty four percent were female. The mean age was 60.9 [+ or -] 17.2 years. APACHE II score of the patients was 23.2 [+ or -] 4.1. Patients were included in study in 6 (1-22) hours after being diagnosed with sepsis or septic shock in the intensive care unit. Patients were monitored for 6 (3-26) days as sepsis or septic shock. Blood and blood products was transfused to the 67 patients (65%). The most frequent transfused blood product was red blood cell suspension and the second most frequent transfused blood product was platelet suspension. Red blood cell suspension was transfused to 56% of the patients. The pre-transfusion Hb values of patients transfused erythrocyte suspension was 8.6 [+ or -] 1.5 g/dL. A total of 167 units of red blood cell suspension were transfused. Hemoglobin decrease was the most common cause of red blood cell transfusion. A part of 94.8% patients who received red blood cell transfusion died. The mortality rate was statistically higher in the group of red blood cell transfusion compared to the group without transfusion (p=0.005). Platelet suspension was transfused to 30% of the patients. The pre-transfusion platelet values of patients transfused platelet suspension was 23000 (6000-191000) 103/[micro]L. A total of 163 units of platelet suspension were transfused. Thrombocytopenia was the most common cause of platelet transfusion. All of patients who received platelet transfusion died. Patients mortality rate was 86% in intensive care unit. Conclusion: Patients with sepsis and septic shock who are followed up in intensive care unit are transfused high percent blood and blood products. The most transfused blood products were red blood cell and platelet suspensions. The mortality was higher in patients transfused blood and blood products. Keywords: Blood transfusion, intensive care, platelet, red blood cell, sepsis, septic shock Amac: Anemi, trombositopeni, lokopeni, yaygin intravaskuler koagulasyon (DIC), koagulasyon faktorlerinin fonksiyonel eksiklikleri septik sok ve ciddi sepsisde siklikla gorulmektedir. Bu hastalara kan ve kan urunu verilmesi ile ilgili standart bir protokol bulunmamaktadir. Bu calismanin amaci sepsis ve septik sok tanilari ile takip edilen hastalara verilen kan ve kan urunlerinin prospektif olarak degerlendirilmesidir. Gerec ve Yontemler: Bu prospektif tanimlayici calismaya 15.08.2016- 15.04.2017 tarihleri arasinda medikal yogun bakim unitesinde takip edilen, 18 yas ve uzeri, YBU'nde 48 saat ve daha uzun sure tetkik ve tedavi edilmis, sepsis/septik soktaki hastalar, kendilerinin veya birinci derece yakinlarinin onami alindiktan sonra dahil edildi. Bulgular: Calismaya 103 hasta alindi. Hastalarin %56' si erkek, %44' u kadindi. Hastalarin yas ortalamasi 60,9 [+ or -] 17,2 yil idi. Ortalama APACHE II (Acute Physiology and Chronic Health Evaluation II) skoru 23,2[+ or -]4,1 idi. Hastalar, YBU' nde yatip sepsis veya septik sok tanisi aldiktan medyan 6 (range:1-22) saat icinde calismaya alindi. Hastalar medyan 6 (range:3-26) gun boyunca sepsis veya septik sok tanilariyla takip edildi. Calismaya alinan hastalarin 67'sine (%65) kan ve kan urunu transfuzyonu yapildi. En sik verilen kan urunu eritrosit suspansiyonu (ES), ikinci sik verilen kan urunu ise trombosit suspansiyonu (TS) idi. Transfuzyon yapilan hastalarin % 56' sina ES verildi. Transfuzyon oncesi ortalama Hb degeri 8,6 [+ or -] 1,5 g/dL idi. Toplam 167 unite ES transfuzyonu yapildi. En sik ES replasmani nedeni hemoglobin dusuklugu idi. ES transfuzyonu alan hastalarin %94,8' i kaybedildi. ES transfuzyonu yapilan grupta mortalite yapilmayan gruba gore daha yuksekti (p=0.005). Transfuzyon yapilan hastalarin %30' una TS transfuzyonu yapildi. TS transfuzyonu yapilan hastalarin transfuzyon oncesi bakilan trombosit degerleri medyan 23000 [10.sup.3]/[micro]L (range: 6000-191000 [10.sup.3]/[micro]L) idi. Toplam 163 unite TS verildi. Hastalara en sik trombositopeni (163 kez) nedeni ile TS transfuzyonu yapildi. TS transfuzyonu yapilan hastalarin tumu kaybedildi. Calismaya alinan hastalarin yogun bakim mortalitesi %86 idi. Sonuc: Yogun bakim unitesinde takip edilen sepsis ve septik sok hastalarina yuksek oranda kan ve kan urunu verilmektedir. Kan ve kan urunu verilen hastalarda mortalite daha yuksek olarak tespit edildi. Anahtar Kelimeler: Eritrosit, kan transfuzyonu, sepsis, septik sok, trombosit, yogun bakim