Çalışmamızı değerlendirdiğimizde bazı kısıtlayıcı yanlar olduğu düşünülmüştür. İlk olarak, böbrek fonksiyonları açısından ülke çapında eksik detaylandırılmış veriler vardır (örneğin bazal eGFR hesaplaması için serum kreatinin değerleri ölçümü). Bu nedenle bazı hastalarda önceden var olan kronik böbrek hastalıklarının evrelemesi ve tanımlanması yapılamamıştır. Ayrıca ileriki dönem takiplerinde SDBY’den daha az ciddi böbrek disfonksiyonu olan hastaların verilerine erişimim problemimiz de mevcuttur. Ancak D-ABH öyküsü olan hastalardan daha çok serum kreatinin ölçümü yapıldığından ve bunlara ulaşılabilir olduğundan muhtemelen istemsiz taraf tutmaya meyil olmaktadır.
Bu çalışma retrospektif kohort üzerinde uygulanan NLO’nun ABH hastalarındaki mortalite üzerindeki etkisini değerlendiren bir pilot çalışmadır. Tek merkezli çalışma olması nedeniyle seçim yanlılığı ile sonuçlanabilecek olması bir diğer durumdur. Hastanemizde Anesteziyoloji ve Reanimasyon, Göğüs Hastalıkları, Kardiyoloji, Kardiyovasküler Cerrahi, Genel Cerrahi ve Acil Servis departmanlarıyla birlikte olmak üzere toplam 7 yoğun bakım ünitesi bulunmaktadır. Çalışmamızın popülasyonu sadece dahili yoğun bakıma kabul edilen hastaları içermektedir. Bu nedenle, bulgularımızın başka nedenlerle ortaya çıkmış ABH
şikayeti olan yoğun bakım hastalarında uygulanmasının uygun olmayabileceğinin farkında
olunması önemlidir. Hastane takibinden sonra ABH gelişen hastalardan ziyade, sadece yatış sırasında ABH gelişen hastalar değerlendirmeye alınmıştır. Hastalar yoğun bakım yatışları ve taburculuklarından sonraki 6 ay süresince takip edilmişlerdir. Bu senaryo ABH gidişatının prediktörlerini analiz etmede sınırlı bir hasta grubu ve zaman aralığını temsil ediyor olabilir.
YBÜ’lerdeki diyalize alınma tipi ve yoğunluğu verileri açısından da sınırlı erişimimiz mevcuttur. Bu nedenle diyaliz modalitelerinin etkilerini değerlendirme imkanımız olmamıştır. Sonuç olarak, ABH yönetimi sırasında bir takip yöntemi olarak NLO’yu kullanmak,
başvurudaki değere kıyasla NLO’da yeterli azalma olmaması durumunda klinisyen koruyucu önlemler almaya odaklanmalıdır, aksi halde mortalite kaçınılmazdır. NLO, generalize sistemik inflamasyonu takip etmeye yarayan, kolay hesaplanabilir, ucuz ve güvenilir bir göstergedir. Diğer yoğun bakım departmanlarından da gelen daha fazla sayıdaki hastada NLO’nun değerlendirildiği randomize kontrollü çalışmalara ihtiyaç duyuluyor olsa da, ABH nedeniyle izlenen hastalarda NLO bir alarm göstergesi olabilir.
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