Acil akut aort diseksiyonu cerrahisi sonrasý mortalite tahmininde sýralý organ yetmezliði deðerlendirme skoru (SOFA) ve kardiyak cerrahi skor (CASUS) sistemlerinin karþýlaþtýrýlmasý

AMAÇ: Akut tip A aort diseksiyonu (ATAAD) en ölümcül kardiyovasküler hastalýklardan biridir ve acil taný ve ameliyat gerektirir. Hastanýn klinik bulgularý, komplikasyonlarý ve hastalýðýn geçmiþi ölüm oranlarý ile yakýndan iliþkilidir. CASUS, kalp cerrahisi geçiren hastalarýn özel patofizyolojik durumlarý dikkate alýnarak hesaplanan ve ameliyat sonrasý sonuçlarý yüksek doðrulukla öngören bir skorlama sistemidir.
GEREÇ VE YÖNTEM: Kurumsal etik kurul (ID: 2021/7/496) onayý alýndýktan sonra 1 Ocak 2019–31 Aralýk 2020 tarihleri arasýnda hastanemizde acil cerrahi uygulanan 50 ATAAD hastasýnýn verileri deðerlendirildi. SOFA ve CASUS skorlarý hem acil servise baþvuru hem de YBÜ takibi süresince günlük laboratuvar ve nörolojik durumun en kötü deðerleri kullanýlarak hesaplandý. Bu skorlarýn ortalama ve toplam deðerleri ameliyat öncesi, ameliyat sonrasý ilk gün için kaydedildi ve kategorik veriler frekans ve yüzde olarak tanýmlandý. Baðýmsýz sürekli veri karþýlaþtýrmalarý için Mann-Whitney U testini ve kategorik veri karþýlaþtýrmasý için Pearson ki-kare veya Fisher kesin testini kullandýk. Sürekli veriler medyan ve çeyrekler arasý aralýklar (25–75) olarak sunuldu.
BULGULAR: Çalýþma 50 hastadan oluþuyordu, ölüm oraný %34 (n=17) idi. Toplam grupta hipertansiyon (HT) %72 (n=36), diabetes mellitus %24 (n=12), baþlangýç hemoglobin 12.5 g/dL (10.7–14.1, 25.–75.), kreatinin 1.09 mg/dL (0.85–1.33, 25.–75), bu hastalarýn %72’si (n=36) erkekti. CASUSortalama, SOFAortalama skoru hayatta kalan hastalara göre ölen hasta grubunda daha yüksekti (12.9 (9.5–13.8, 25.–75.), 3 (2–5, 25.–75.); 8 (6.1–9.2, 25.–75.), 2.6 (2–4.5, 25.–75.), p<0.001 sýrasýyla). CASUSortalama, model 1’de bir aylýk mortalite ile baðýmsýz olarak iliþkili bulundu (HR 1.25 (1.14–1.37) (p<0.001).
TARTIÞMA: Sonuç olarak, CASUSortalama’daki artýþ, bir aylýk mortalitenin temel prediktörüdür. CASUSortalama deðeri 8.3’ün üzerinde, hastalar ölüm dahil önemli istenmeyen olaylar açýsýndan daha dikkatli izlenmelidir.

Comparison of sequential organ failure assessment score and cardiac surgery score systems for mortality prediction after emergency acute aortic dissection surgery

BACKGROUND: Acute type A aortic dissection (ATAAD) is one of the most mortal cardiovascular diseases and requires urgent diagnosis and surgery. The patient’s clinical findings, complications, and patient’s history are closely related to mortality rates. Cardiac surgery score (CASUS) is a scoring system which is calculated by considering the special pathophysiological conditions of patients undergoing cardiac surgery and predicts post-operative results with high accuracy.
METHODS: Following the ethical approval from institutional ethics committee (ID: 2021/7/496), the data of consecutive 50 ATAAD patients who underwent emergent surgery in our hospital between January 1, 2019, and December 31, 2020, were evaluated. The Se-quential Organ Failure Assessment and CASUS scores were calculated using the worst values of the daily laboratory and neurological status for both in admission to emergency department and during intensive care unit (ICU) follow-up period. The average and the total values of these scores were recorded for pre-operative, post-operative 1st day, and for the categorical data were defined as frequency and percentage. We used the Mann–Whitney U test for the independent continuous data comparisons and Pearson Chi-Square or Fisher ex-act test for categorical data comparison whole ICU period. Continuous data were presented as median and interquartile ranges (25–75th).
RESULTS: The study comprised 50 patients, the rate of death was 34% (n=17). In total group, there were hypertension 72% (n=36), diabetes mellitus 24% (n=12), initial hemoglobin 12.5 g/dL (10.7–14.1, 25–75th), creatinine 1.09 mg/dL (0.85–1.33, 25–75th), and 72% (n=36) of these patients were male. The CASUSmean and SOFAmean scores were higher in the death-group when compared with the group who survived (12.9 [9.5–13.8, 25–75th], 3 [2–5, 25–75th]; 8 [6.1–9.2, 25–75th], 2.6 (2–4.5, 25–75th], p<0.001, respectively]. CASUSmean was independently associated with the 1-month mortality in model 1 (HR 1.25 [1.14–1.37] (p<0.001).
CONCLUSION: According to our results increase in CASUS mean was the main predictor of 1 month mortality. When CASUS mean exceeds 8.3 the patient should be followed up more carefully for major adverse events including death.