Acil Servise Başvuran Sepsis ve Septik Şok Tanili Hastaların Prognoz ve Mortalitelerinin Öngörülmesinde Laktat, Baz Defisiti ve Albuminin Beraber Değerlendirilmesi
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Gür A, Co-Evaluation of Lactate, Bas Excess and Albumin as Predictor of Prognosis and Mortality for Patients with Sepsis and Septic Shock Admitted to the Emergency Department, Hacettepe University Faculty of Medicine, Thesis of Emergency Medicine. Ankara, 2022. Purpose: Our aim in this study is to determine the benefits of serum lactate, albumin and base excess values in predicting prognosis and mortality in patients with sepsis or septic shock when evaluated together. Methods: Our study is a retrospective observational study. The study included 217 patients over the age of 18 and with a SOFA score of 2 and above, who applied to the Adult Emergency Service of Hacettepe University Hospital. Lactate, albumin and base excess values of patients at admission, 24th hour and 48th hour were examined. Hospital mortality and 90-day mortality were calculated according to lactate, albumin and base excess values, and its usability in predicting prognosis and mortality was investigated. Results: In 0-24-48th hour, low albumin values increases the mortality of sepsis patients in our study. While 0-48th hour lactate values do not affect the hospital mortality, high lactate value in the 24th hour increases the hospital mortality. High lactate values in 0-48th hours increases the 90-day mortality. Base excess values had no effect on hospital mortality and 90-day mortality. There was no effect of lactate, albumin and base excess values on mortality in patients with septic shock. When the mortality rates are analyzed according to the lactate clearance of patients with sepsis, hospital mortality increases only as 24-hours lactate clearance decreases. Alactic base excess has no effect on the mortality. While no significant AUC value was found for base excess in ROC analyzes; the AUC values of lactate and albumin are significant, but their sensivity is low since the AUC values found for lactate and albumin are below 0.70. In ROC analyzes for lactate clearance, the AUC value for 24-hour lactate clearance is significant, but the sensivity of the AUC value is low. The areas under the curve (AUC) were not statistically significant in the ROC analyzes for the alactic base excess. Conclusions: Contrary to the literature, lactate, albumin and base excess were found to have low sensitivity in determining prognosis and mortality in our study. When factors that may affect serum lactate, albumin and base excesss (such as chronic liver diseases, chronic kidney diseases, metformin use) are excluded, the values of these biomarkers in determining mortality in sepsis and septic shock decrease.