Procjena učinka terapijske hipotermije na ishod bolesnika s upalnim bolestima središnjega živčanoga sustava [Efficacy of therapeutic hypothermia in patients with inflammatory diseases of the central nervous system]

Kutleša, Marko (2013) Procjena učinka terapijske hipotermije na ishod bolesnika s upalnim bolestima središnjega živčanoga sustava [Efficacy of therapeutic hypothermia in patients with inflammatory diseases of the central nervous system]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

AIM AND A PURPOSE OF THE STUDY The main objective of the study was to evaluate the efficacy of therapeutic hypothermia (TH) in the treatment of the severe inflammatory diseases of the central nervous system (CNS). ----- PATIENTS AND METHODS Adult patients with severe inflammatory disease of the CNS will be included in this prospective study from January 2009 untill January of 2013. Indications for TH and variables of importance are included in the previously designed treatment protocol. After enrolment is finished the impact of TH on the outcome will be analyzed in comparison to the historic control group. ----- RESULTS 131 patients with community acquired bacterial meningitis (CABM) were included in the study. 41 were treated with TH and 90 were historic control patients. The patients with non-bacterial CNS inflammatory disease were excluded from the analysis due to the sample insufficiency. The results revealed that TH is a independent predictor variable of the favorable outcome. Logistic regression detected significant mortality reduction in the TH arm (OR 0.059, p<0.001). Unfavorable outcome (GOS 1-3) was also significantly reduced in the TH arm (OR 0.209, p=0.0011). Cox-regression revealed hazard ratio of 0.367 in the TH arm which was also statistically significant (p=0.0107). ----- CONCLUSIONS Our results confirm that implementation of TH is a significant predictor of a favorable outcome in patients with severe form of CABM. Reduction in mortality, as well as decrease in unfavorable neurological outcome were confirmed. These results justify the recommandation to implement this method in patients with CABM on a wider scale.

Abstract in Croatian

CILJ I SVRHA ISTRAŽIVANJA Glavni cilj istraživanja je procjena učinkovitosti terapijske hipotermije (TH) u bolesnika s upalnom bolesti CNS-a, reduciranom CO2 reaktivnosti i/ili teškim poremećajem svijesti (GCS≤9). ----- ISPITANICI I METODE Odrasli ispitanici liječeni TH zbog teške upalne bolesti središnjeg živčanog sustava (CNS) u Klinici za infektivne bolesti „Dr.F.Mihaljević“ su bili prospektivno uključivani u studiju od siječnja 2009. do siječnja 2013. godine. Postavljanje indikacije za TH i praćenje varijabli je određeno prema unaprijed utvrđenom protokolu. Nakon prestanka uključivanja ispitanika statističkom analizom će se utvrditi utjecaj TH na ishod bolesnika usporedbom sa kontrolnom historijskom skupinom koja nije liječena TH. ----- REZULTATI U analizu je uključen ukupno 131 bolesnik s domicilnim bakterijskim meningitisom (CABM). 41 bolesnik je liječen TH, a 90 bolesnika u historijskoj kontrolnoj skupini s kompatibilnom kliničkom težinom bolesti su liječeni bez TH. Bolesnici s nebakterijskom upalnom bolesti CNS-a nisu uključeni u ispitivanje zbog premalog broja ispitanika. Rezultatima je utvrđeno da je TH nezavisan prediktor povoljnog ishoda. Logističkom regresijskom analizom je dokazano da primjena TH smanjuje mogućnost letalnog ishoda 17 puta (OR 0.059, p<0.001) te nepovoljnog ishoda (GOS 1-3) 5 puta (OR 0.209, p=0.0011). Cox-regresijskom analizom preživljenja je utvrđen HR od 0.367 u bolesnika tretiranih TH, odnosno 2.8 veća šansa za 28-dnevno preživljenje. ----- ZAKLJUČAK Naši rezultati dokazuju da TH statistički signifikantno utječe na povoljan ishod u bolesnika sa teškom formom CABM. Osim što smanjuje smrtnost, poboljšava i konačan neurološki ishod bolesnika. Dobiveni rezultati omogućuju davanje preporuke za širu primjene ove terapijske metode u bolesnika s CABM.

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