Faktori rizika i mere prevencije poremećaja krvnog pritiska tokom hemodijafiltracije kod bolesnika sa sepsom
Sažetak
Uvod/Cilj. Hemodijafiltracija (HDF) ima izuzetno važnu ulogu u lečenju bolesnika sa sepsom i posledičnom akutnom bubrežnom slabošću. Međutim, poremećaj krvnog pritiska (PKP) tokom HDF loše utiče na prognozu i povećava smrtnost od svih uzroka kod bolesnika sa sepsom. Cilj rada bio je da se ispitaju faktori rizika i mere prevencije PKP tokom HDF kod bolesnika sa sepsom. Metode. U ovu studiju je ukupno bilo uključeno 145 bolesnika sa sepsom koji su bili podvrgnuti HDF, i bili su podeljeni u dve grupe: grupu sa normalnim krvnim pritiskom (NKP) (n = 89) i grupu sa PKP (n = 56). Prikupljeni su njihovi klinički podaci, a nezavisni faktori uticaja na PKP tokom HDF procenjeni su univarijantnom i multivarijantnom logističkom regresionom analizom. Na osnovu rezultata multivarijantne analize konstruisan je model nomograma za predviđanje i njegova diskriminacija i konzistencija bile su procenjene korišćenjem receiver operating characteristic i cacalibration krive. Da bi se procenila prognoza 28 dana posle HDF, za crtanje krive preživljavanja korišćen je Kaplan-Majerov metod. Rezultati. Multivarijantnom logističkom regresionom analizom otkriveno je da su životno doba, kalcijum u krvi, glukoza u plazmi natašte, intaktni paratireoidni hormon, volumen ultrafiltracije i brzina ultrafiltracije bili nezavisni faktori rizika, dok je albumin bio faktor protekcije od PKP tokom HDF (p < 0,05). Model nomograma pokazao je dobar efekat uklapanja, sa visokom diskriminacijom i tačnošću. Kaplan-Majerova analiza preživljavanja pokazala je da je grupa sa NKP imala statistički značajno višu 28-dnevnu stopu preživljavanja u odnosu na grupu sa PKP (88,76% vs. 73,21%) (p < 0,05).
Zaključak. Konstruisani model rizika je pogodan za identifikaciju visokorizičnih grupa i pruža preporuku za efikasnu prevenciju i lečenje, u cilju snižavanja stope incidencije PKP i poboljšanja prognoze.
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