Poređenje skora DECAF i skora DECAF+Laktat u predikciji mortaliteta kod bolesnika sa akutnim pogoršanjem HOBP
Sažetak
Uvod/Cilj. Hronična opstruktivna bolest pluća (HOBP) je hroničan proces koji napreduje sa egzacerbacijama. Da bi se predvidela smrtnost obolelih, sprovode se razne studije. Među rutinskim testovima koji se koriste za praćenje i lečenje bolesti u hitnoj pomoći, posebno se nastoji da se pronađu testovi koji su smisleni i dijagnostički. Cilj rada bio je da se uporedi skor DECAF i skor DECAF+Laktat i ispita značaj skora DECAF+Laktat u predikciji smrtnosti kritično obolelih bolesnika sa pogoršanjem HOBP. Metode. Prospektivnom multicentričnom studijom obuhvaćeno je 435 bolesnika iz dva centra. U studiju su uključeni bolesnici koji su se javili u odeljenje hitne pomoći sa akutnim pogoršanjem HOBP i koji su odgovarali definiciji kritično bolesnih prema skoru quick Sequential Organ Failure Assessment (qSOFA). Prognostičke vrednosti skorova upoređene su korišćenjem analize receiver operating characteristic (ROC) krive. Efikasnost bodovanja 28-dnevnog mortaliteta upoređena je korišćenjem logističke regresione analize. Rezultati. Za 435 bolesnika izračunati su osetljivost, specifičnost i area under the curve (AUC) za laktate, DECAF i DECAF+Laktat skorove, koji su bili statistički značajni u ROC analizi za predikciju mortaliteta: 50%, 90,2%, 0,711, odds ratio (OR): 0,622 [95% confidence interval – CI: 1,573–2,203]; 57,6%, 64,3%, 0,654, OR: 0,618 (95%CI: 1,501–2,291%); 60,1%, 75,4%, 0,744, OR: 0,790 (95%CI: 1,826–2,659), redom. Svako povećanje jedinice u skoru DECAF+Laktat povećavalo je rizik od smrtnosti za 2,203. Zaključak. Kao rezultat naše studije, verujemo da je skor DECAF+Laktat efikasniji sistem bodovanja od skora DECAF, kao prediktor mortaliteta kod kritično obolelih osoba sa pogoršanjem HOBP.
Reference
Roman-Rodriguez M, Kaplan A. GOLD 2021 Strategy Report: Implications for Asthma-COPD Overlap. Int J Chron Ob-struct Pulmon Dis 2021; 16: 1709–15.
Hillas G, Perlikos F, Tzanakis N. Acute exacerbation of COPD: is it the "stroke of the lungs"? Int J Chron Obstruct Pulmon Dis 2016; 11: 1579–86.
Nguyen HB. Lactate in the critically ill patients: an outcome marker with the times. Crit Care 2011; 15(6): 1016.
Vincent JL, Quintairos E Silva A, Couto L Jr, Taccone FS. The value of blood lactate kinetics in critically ill patients: a sys-tematic review. Crit Care 2016; 20(1): 257.
Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 2009; 37(5): 1670–7.
Echevarria C, Steer J, Bourke SC. Comparison of early warning scores in patients with COPD exacerbation: DECAF and NEWS score. Thorax 2019; 74(10): 941–6.
Huang Q, He C, Xiong H, Shuai T, Zhang C, Zhang M, et al. DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMJ Open 2020; 10(10): e037923.
Rusinowicz T, Zielonka TM, Zycinska K. Cardiac Arrhythmias in Patients with Exacerbation of COPD. Adv Exp Med Biol 2017; 1022: 53–62.
Gayaf M, Karadeniz G, Güldaval F, Polat G, Türk M. Which one is superior in predicting 30 and 90 days mortality after COPD exacerbation: DECAF, CURB-65, PSI, BAP-65, PLR, NLR. Expert Rev Respir Med 2021; 15(6): 845–51.
Steer J, Gibson J, Bourke SC. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax 2012; 67(11): 970–6.
Ahmed N, Jawad N, Jafri S, Raja W. DECAF versus CURB-65 to Foresee Mortality among Patients Presenting with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Cu-reus 2020; 12(1): e6613.
Hylands M, Moller MH, Asfar P, Toma A, Frenette AJ, Beaudoin N, et al. A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension. Can J Anaesth 2017; 64(7): 703–15.
Perner A, Hjortrup PB, Arabi Y. Focus on blood pressure tar-gets and vasopressors in critically ill patients. Intensive Care Med 2019; 45(9): 1295–7.
Kaufmann T, Cox EGM, Wiersema R, Hiemstra B, Eck RJ, Koster G, et al. Non-invasive oscillometric versus invasive arterial blood pressure measurements in critically ill patients: A post hoc analysis of a prospective observational study. J Crit Care 2020; 57: 118–23.
Malo de Molina R, Aguado S, Arellano C, Valle M, Ussetti P. Is-chemic Heart Disease during Acute Exacerbations of COPD. Med Sci (Basel) 2018; 6(4): 83.
Castañ-Abad MT, Montserrat-Capdevila J, Godoy P, Marsal JR, Ortega M, Alsedà M, et al. Diabetes as a risk factor for severe exacerbation and death in patients with COPD: a prospective cohort study. Eur J Public Health 2020; 30(4): 822–7.