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Acil Serviste Prokalsitonin Düzeyi ile Kısa Dönem Mortalite Arasındaki İlişki

Yıl 2023, Cilt: 6 Sayı: 3, 105 - 110, 30.09.2023
https://doi.org/10.54996/anatolianjem.1245961
Bu makale için 31 Mart 2024 tarihinde bir düzeltme yayımlandı. https://dergipark.org.tr/tr/pub/anatolianjem/issue/84043/1463330

Öz

Amaç: Prokalsitonin (PKT), enfeksiyonu gösteren biyobelirteçtir ve son yıllarda popülaritesi artmaktadır. Çalışmamızda acil serviste (AS) prokalsitonin düzeyi ölçülen hastalarda prokalsitonin düzeyleri ile yedi günlük mortalite arasında ilişki olup olmadığını araştırdık.

Gereç ve Yöntemler: Tek merkezli, kesitsel, analitik, retrospektif bu çalışmaya Dokuz Eylül Üniversitesi Hastanesi erişkin acil servisinde 01.01.2016-31.03.2016 tarihleri arasında PKT düzeyi ölçülen hastalar dahil edildi. Yaşayan ve ölen hasta gruplarında PKT düzeyi ve diğer parametreler değerlendirildi.

Bulgular: PKT düzeyi ölçülen 499 hastayı analiz ettik. Yaş ortalama 74 (ÇAA 63-82) ve % 54'ü erkekti. Prokalsitonin düzeyleri 499 hastanın 6'sında (%1,2) hafif yüksek (ortanca 0,03: ÇAA 0,02-0,04), 407'sinde (%81,6) orta yüksek (ortanca 0,26; ÇAA 0,16-0,54) ve 86'sında (%17,2) ciddi yüksek (ortanca 5,54; ÇAA 3,20-15,31) seviyelerde idi. PKT düzeyi yüksek olan grup diğer gruplarla karşılaştırıldığında; sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), trombosit sayısı, pCO2 daha düşük iken; nabız, beyaz küre, laktat, baz açığı değerleri daha yüksekti. Hastaların 249'unun (%49,9) acil servisten taburcu edildiği, 112'sinin (%22,4) servise yattığı, 66'sının (%13,2) yoğun bakımda yattığı ve 72'sinin (%14,4) öldüğü belirlendi. Ölen grubun PKT düzeyleri, yaşayan gruba göre daha yüksekti (0,29 ngr/mL'ye karşı 1,07 ngr/mL, p<0,001). Tek değişkenli analizde, ölen grubun yaş, nabız, solunum hızı, prokalsitonin seviyeleri, laktat ve baz açığı değerleri daha yüksek ve SKB, DKB, oksijen satürasyonu ve pH değerlerinin daha düşük olduğu gösterildi. ROC eğrisinde PKT için eğri altında kalan alan değeri 0,722 (%95 GA 0,660-0,784) idi. Çok değişkenli lojistik regresyon analizinde, yaş, SKB, oksijen satürasyonu ve laktat acil serviste mortalite için bağımsız risk faktörleri olarak tespit edildi.

Sonuç: Acil servise başvuran hastalarda yüksek PKT seviyeleri artmış mortalite ile ilişkilidir. PKT düzeyi yüksek olan hastalarda yoğun bakım ünitesine yatış ve ölüm daha fazladır. Acil servis başvurusunda ileri yaş, düşük sistolik kan basıncı, düşük oksijen satürasyonu ve yüksek laktat seviyeleri mortalite için bağımsız risk faktörleridir.

Kaynakça

  • Maruna P, Nedelníková K, Gürlich R. Physiology and genetics of procalcitonin. Physiol Res. 2000;49 Suppl 1:S57-S61.
  • Becker KL, Nylén ES, White JC, et al. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004 Apr;89(4):1512-25.
  • Cleland DA, Eranki AP. Procalcitonin. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 16, 2019.
  • So-Ngern A, Leelasupasri S, Chulavatnatol S, et al. Prognostic Value of Serum Procalcitonin level for the Diagnosis of Bacterial Infections in Critically-ill Patients. Infect Chemother. 2019 Sep;51(3):263-273
  • Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-1247.
  • AlRawahi AN, AlHinai FA, Doig CJ, et al. The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review. Crit Care. 2019 Dec 3;23(1):390.
  • Sandek A, Springer J, Habedank D, et al. Procalcitonin-guided antibiotic treatment in heart failure. Lancet. 2004;363(9420):1555-1556.
  • Rowland T, Hilliard H, Barlow G. Procalcitonin: potential role in diagnosis and management of sepsis. Adv Clin Chem. 2015;68:71-86.
  • Dai J, Xia B, Wu X. Elevated plasma procalcitonin level predicts poor prognosis of ST elevation myocardial infarction in Asian elderly. Scand J Clin Lab Invest. 2018 Feb-Apr;78(1-2):49-54.
  • Tan M, Lu Y, Jiang H, et al. The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: A systematic review and meta-analysis. J Cell Biochem. 2019 Apr;120(4):5852-5859.
  • Pedersen M, Brandt VS, Holler JG, et al. Lactate level, aetiology and mortality of adult patients in an emergency department: a cohort study. Emerg Med J. 2015;32(9):678-684.
  • Arora S, Singh P, Singh PM, et al. Procalcitonin Levels in Survivors and Nonsurvivors of Sepsis: Systematic Review and Meta-Analysis. Shock. 2015;43(3):212-221.
  • Gök RGY, Gök A, Bulut M. Assessing prognosis with modified early warning score, rapid emergency medicine score and worthing physiological scoring system in patients admitted to intensive care unit from emergency department. Int Emerg Nurs. 2019 Mar;43:9-14.
  • Nannan Panday RS, Minderhoud TC, Alam N, et al. Prognostic value of early warning scores in the emergency department (ED) and acute medical unit (AMU): A narrative review. Eur J Intern Med. 2017 Nov;45:20-31.
  • Fernandes L, Arora AS, Mesquita AM. Role of Semi-quantitative Serum Procalcitonin in Assessing Prognosis of Community Acquired Bacterial Pneumonia Compared to PORT PSI, CURB-65 and CRB-65. J Clin Diagn Res. 2015;9(7):OC01-OC4.

The Relationship Between Procalcitonin Level and Short Term Mortality in Emergency Department

Yıl 2023, Cilt: 6 Sayı: 3, 105 - 110, 30.09.2023
https://doi.org/10.54996/anatolianjem.1245961
Bu makale için 31 Mart 2024 tarihinde bir düzeltme yayımlandı. https://dergipark.org.tr/tr/pub/anatolianjem/issue/84043/1463330

Öz

Aim: Procalcitonin (PCT) is a biomarker for infection, which has grown in popularity in recent years. In our study, we investigated whether there was a relationship between procalcitonin levels and seven-day mortality in all patients whose procalcitonin levels were measured in the emergency department (ED).

Material and Methods: In this single-center, cross-sectional, analytic, retrospective study, the patients whose PCT levels were measured in Dokuz Eylül University Hospital adult emergency department between 01.01.2016 and 31.03.2016 were included. PCT level and other parameters were evaluated in the survived and non- survived groups,

Results: We analyzed 499 patients whose PCT levels were measured. The median age was 74 (IQR: 63-82) years, and 54% were male. Of the 499 patients, 6 (1.2%) had a low procalcitonin level (median 0.03: IQR 0.02-0.04), 407 (81.6%) had an intermediate procalcitonin level (median 0.26; IQR 0.16-0.54) and 86 (17.2%) had a high procalcitonin level (median 5.54; IQR 3.20-15.31). When the PCT level-high group was compared with the other groups; systolic blood pressure (SBP), diastolic blood pressure (DBP), platelet count, pCO2 were lower and pulse rate, WBC, lactate, base excess values were higher. It was found that 249 (49.9%) of the patients were discharged from the ED, 112 (22.4%) were hospitalized, 66 (13.2%) were hospitalized in the intensive care unit, and 72 (14.4%) died. The PCT level was higher in the non-survivor group than in the survivor group (0.29 ngr/mL vs 1.07 ngr/mL, p<0.001). Univariate analysis showed that the non-survivor group had higher age, pulse, respiratory rate, procalcitonin levels, lactate and base deficiency levels, and lower SBP, DBP, oxygen saturations, and pH. The AUC for PCT was 0.722 (CI% 0.660-0.784) in the ROC curve In the multivariate logistic regression analysis, age, SBP, oxygen saturation, and lactate were independent risk factors for mortality in ED.

Conclusion: High PCT levels are associated with increased mortality in patients admitted to the ED. Patients with high- PCT levels showed higher mortality and were hospitalized in the intensive care unit. Advanced age, low systolic blood pressure, low oxygen saturation and high lactate levels are independent risk factors for mortality in ED admissions.

Kaynakça

  • Maruna P, Nedelníková K, Gürlich R. Physiology and genetics of procalcitonin. Physiol Res. 2000;49 Suppl 1:S57-S61.
  • Becker KL, Nylén ES, White JC, et al. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004 Apr;89(4):1512-25.
  • Cleland DA, Eranki AP. Procalcitonin. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 16, 2019.
  • So-Ngern A, Leelasupasri S, Chulavatnatol S, et al. Prognostic Value of Serum Procalcitonin level for the Diagnosis of Bacterial Infections in Critically-ill Patients. Infect Chemother. 2019 Sep;51(3):263-273
  • Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-1247.
  • AlRawahi AN, AlHinai FA, Doig CJ, et al. The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review. Crit Care. 2019 Dec 3;23(1):390.
  • Sandek A, Springer J, Habedank D, et al. Procalcitonin-guided antibiotic treatment in heart failure. Lancet. 2004;363(9420):1555-1556.
  • Rowland T, Hilliard H, Barlow G. Procalcitonin: potential role in diagnosis and management of sepsis. Adv Clin Chem. 2015;68:71-86.
  • Dai J, Xia B, Wu X. Elevated plasma procalcitonin level predicts poor prognosis of ST elevation myocardial infarction in Asian elderly. Scand J Clin Lab Invest. 2018 Feb-Apr;78(1-2):49-54.
  • Tan M, Lu Y, Jiang H, et al. The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: A systematic review and meta-analysis. J Cell Biochem. 2019 Apr;120(4):5852-5859.
  • Pedersen M, Brandt VS, Holler JG, et al. Lactate level, aetiology and mortality of adult patients in an emergency department: a cohort study. Emerg Med J. 2015;32(9):678-684.
  • Arora S, Singh P, Singh PM, et al. Procalcitonin Levels in Survivors and Nonsurvivors of Sepsis: Systematic Review and Meta-Analysis. Shock. 2015;43(3):212-221.
  • Gök RGY, Gök A, Bulut M. Assessing prognosis with modified early warning score, rapid emergency medicine score and worthing physiological scoring system in patients admitted to intensive care unit from emergency department. Int Emerg Nurs. 2019 Mar;43:9-14.
  • Nannan Panday RS, Minderhoud TC, Alam N, et al. Prognostic value of early warning scores in the emergency department (ED) and acute medical unit (AMU): A narrative review. Eur J Intern Med. 2017 Nov;45:20-31.
  • Fernandes L, Arora AS, Mesquita AM. Role of Semi-quantitative Serum Procalcitonin in Assessing Prognosis of Community Acquired Bacterial Pneumonia Compared to PORT PSI, CURB-65 and CRB-65. J Clin Diagn Res. 2015;9(7):OC01-OC4.
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Orijinal Çalışma
Yazarlar

Onur Barıs Cehreli 0000-0003-1438-4108

Başak Bayram 0000-0003-2084-2646

Duygu Gürsoylu 0000-0002-2158-3642

Nese Colak 0000-0001-6821-9031

Yayımlanma Tarihi 30 Eylül 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 6 Sayı: 3

Kaynak Göster

AMA Cehreli OB, Bayram B, Gürsoylu D, Colak N. The Relationship Between Procalcitonin Level and Short Term Mortality in Emergency Department. Anatolian J Emerg Med. Eylül 2023;6(3):105-110. doi:10.54996/anatolianjem.1245961