Öz

Amaç: İlaç kaynaklı karaciğer hasarı (DILI), yoğun bakım ünitesi (YBÜ) hastalarında polifarmasi ve kritik hastalık nedeniyle önemli bir komplikasyondur. Bu çalışma, YBÜ hastalarında DILI insidansı, klinik özellikleri, etkilenen ilaçlar ve sonuçlarını araştırmayı amaçladı.

Yöntem: Retrospektif, kesitsel olarak tasarlanan çalışmaya, Ekim 2023–Ekim 2024 arasında YBÜ’ye yatışı yapılan ve anormal karaciğer fonksiyon testleri görülen hastalar dahil edildi. Viral, alkolik, otoimmün, tümör ilişkili veya diğer ilaç dışı karaciğer hastalıkları olanlar çalışma dışı bırakıldı. Demografik veriler, klinik skorlar, kullanılan ilaçlar ve sonuçlar analiz edildi. Nedensellik değerlendirmesi RUCAM skalası ile yapıldı.

Bulgular: 475 YBÜ hastası arasında 16 (%9,89) DILI vakası tespit edildi. Ortalama yaş 47,1±23,6 yıl; ve hastaların %43,8’i kadın idi. Hasara en sık yol açan ilaç grubu antibiyotikler (%62,5) olup, bunu antikoagülanlar ve antipsikotikler izledi. Karaciğer hasarı çoğunlukla hepatosellüler (%81,3) idi ve DILI yatıştan ortalama 9,5±5,2 gün sonra gelişti. DILI hastalarında mortalite %56,3 olarak gözlendi.

Sonuç: Yoğun bakım hastalarında görülen ilaç kaynaklı karaciğer hasarı (DILI), özellikle β-laktam antibiyotikler olmak üzere anti-infektiflerle güçlü bir ilişki göstermekte ve çoğunlukla hepatoselüler hasar şeklinde ortaya çıkmaktadır. Yüksek mortalite nedeni ile, karaciğer fonksiyonlarının dikkatle izlenmesi, şüpheli ilaçların zamanında kesilmesi ve klinik eczacıların kilit destek rolü üstlendiği çok disiplinli bir yaklaşım gereklidir. DILI, kritik hastalarda morbidite ve mortaliteyi arttırabilir; bu da erken tanı ve proaktif yönetimin önemini ortaya koymaktadır.

Anahtar Kelimeler: İlaç kaynaklı hepatotoksisite, Kritik hastalar, Hepatosellüler hasar, Polifarmasi

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Gül F, Ünder D. Yoğun bakım ünitesindeki kritik hastalarda ilaç kaynaklı hepatotoksisite. Turk J Intensive Care. 2025;23(4):315-325. https://doi.org/10.63729/TJIC.2025.676