Abstract
Aim: The inflammatory response that occurs in sepsis causes the release of biomarkers which may be prognostic indicators. In our study, it was aimed to evaluate the CRP, PCT, Lactate levels and SOFA score change and their effect on prognosis estimation of patients that were hospitalized 30 days or less.
Materials and Methods: 485 patients who were hospitalized in the Anesthesiology and Reanimation ICU for 30 days or less were included in the study randomly and patient records were evaluated retrospectively. Age, gender, length of hospitalization in intensive care unit, sepsis diagnostic criteria on admission and intensive care unit days, serum CRP, PCT, lactate levels, SOFA and APACHE II scores were recorded. The diagnosis of sepsis (no sepsis / sepsis / severe sepsis / septic shock) was made according to the 2001 consensus and 2008 Surviving Sepsis Campaign guideline for all days in the intensive care unit.
Results: The mean age was 51.1 ± 20.6 years and the mean APACHE II score was 23.2 ± 8.9 years. 35 patients were discharged from intensive care unit (7.21%), 164 patients were referred to other in-hospital clinic (33.82%) while 286 patients (58.97%) died. 178 patients were never diagnosed as sepsis during intensive care stay. 307 of them were diagnosed as sepsis, severe sepsis or septic shock. In our study, the median CRP values of the patients with sepsis, severe sepsis and septic shock were 9.33, 13.76 and 16.77 mg/dl, respectively; PCT median values were found to be 1.66, 5.23 and 12.42 ng/ml. Thirty-five of the patients (7.21%) were dismissed from the ICU, 164 (33.82%) were transferred to other departments and 286 (58.97%) were exitus. The ratio of the last CRP value measured to the first measured one in the exitus group was statistically significant compared to patients dismissed or transferred to other departments
Conclusion: It was concluded that CRP level increases with increasing severity of sepsis and it is a reliable prognostic parameter in sepsis.
Keywords
References
- Singer M, Deutschman CS, Seymour CW et al The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (8): 801–10.
- Shankar-Hari M, Phillips GS, Levy ML et al. Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (8): 775–87.
- Seymour CW, Liu VX, Lwashyna TJ et al Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (8): 762–74.
- Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017; 45 (3): 486-552.
- Dupuy AM, Philippart F, Péan Y, et al. Role of biomarkers in the management of antibiotic therapy: an expert panel review: I- currently available biomarkers for clinical use in acute infections.Ann Intensive Care. 2013; 3 (1): 22.
- Sümer Ş, Erayman İ, Arıbaş Türk E. Sepsisin erken tanısı ve takibinde prokalsitonin, CRP, IL-6, IL-8 ve endotoksinin rolü.Türk Mikrobiyol Cem Derg.2010; 40 (1): 27-36.
- Arslan A. at al. Sepsisli yaşlı hastalarda mortaliteyi belirlemede sistatin-C ve pro-BNP’nin etkisi Gaziantep Med J 2014; 20 (1): 47-51.
- Aks M, Mehta AA, James P. Predictors of mortality of severe sepsis among adult patients in the medical Intensive Care Unit. Lung India 2017; 34 (4): 330-35.
- Shukeri WFWM, Ralib AM, Abdulah NZ, Mat-Nor MB. Sepsis mortality score for the prediction of mortality in septic patients. J Crit Care. 2018 Feb; 43: 163-68.
- Müller B, Becker KL, Schachinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000; 28 (4): 977-83.
- Suprin E, Camus C, Gacovin A, et al. Procalcitonin: a valuable indicator of infection in a medical ICU Intensive Care Med 2000; 26 (9) 1232-8.
- Kraut JA, Madias NE. Lactic acidosis. N Engl J Med. 2014; 371 (24): 2309-19.
- Casserly B, Phillips GS, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med. 2015; 43 (3): 567- 73.
Abstract
Amaç: Sepsiste meydana gelen inflamatuar yanıt, prognoz göstergesi olabilen biyobelirteçlerin salınımına neden olmaktadır. Çalışmamızda yoğun bakım kliniğinde 30 gün ve daha az süre yatan hastalarda CRP, PCT, Laktat düzeyleri ve SOFA Skoru değişimleri ile bunların prognoz tahminindeki yerinin değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Anesteziyoloji ve Reanimasyon Anabilim Dalı Yoğun Bakım Kliniğinde yatarak tedavi gören 485 hasta randomize olarak çalışmaya dahil edildi ve dosya bilgileri retrospektif olarak incelendi. Hastaların yaş, cinsiyet, yoğun bakımda yatış süreleri, yoğun bakıma yatışta ve yoğun bakımda izlendikleri günlerdeki sepsis tanı kriterleri, serum CRP, PCT, laktat düzeyleri, SOFA ve APACHE II skorları kaydedildi. Hastaların yoğun bakımda yattıkları tüm günler için sepsis tanıları (sepsisin olmadığı dönem / sepsis / ağır sepsis / septik şok) 2001 konsensus ve 2008 Surviving Sepsis Campaign rehberine göre kondu.
Bulgular: Ortalama yaş 51,1 ± 20,6, ortalama APACHE II skoru ise 23,2 ± 8,9 olarak belirlendi. Hastaların 35’i yoğun bakımdan taburcu (%7,21), 164’ü hastane içi diğer kliniğe sevk edilirken (%33,82) 286 hastada (%58,97) eksitus gerçekleştiği görüldü. Hastaların 178’i yoğun bakım yatış süresince sepsis tanısı almadı. Hastaların 307’sinin ise sepsis, ağır sepsis ya da septik şok tanılarından biri ya da fazlasını aldığı saptandı.
Sepsis, ağır sepsis ve septik şok tanısı alan hastaların ortalama CRP değerleri sırasıyla 9,33, 13,76 ve 16,77 mg/dl olarak; PCT ortalama değerleri ise 1,66, 5,23 ve 12,42 ng/ml olarak bulundu.
Hastaların 35’i yoğun bakımdan taburcu (%7,21), 164’ü diğer kliniğe sevk edilirken (%33,82), 286 hastada (%58,97) eksitus gerçekleştiği görüldü. Eksitus olan grupta son CRP değerinin ilk ölçülen CRP değerine oranı; taburcu ve diğer kliniklere nakil olan gruba göre istatistiksel olarak yüksek bulundu.
Sonuç: Serum CRP düzeyinin sepsisin ciddiyetine paralel olarak arttığı ve sepsiste güvenilir bir prognostik faktör olduğu kanısına varıldı.
Keywords
References
- Singer M, Deutschman CS, Seymour CW et al The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (8): 801–10.
- Shankar-Hari M, Phillips GS, Levy ML et al. Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (8): 775–87.
- Seymour CW, Liu VX, Lwashyna TJ et al Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (8): 762–74.
- Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017; 45 (3): 486-552.
- Dupuy AM, Philippart F, Péan Y, et al. Role of biomarkers in the management of antibiotic therapy: an expert panel review: I- currently available biomarkers for clinical use in acute infections.Ann Intensive Care. 2013; 3 (1): 22.
- Sümer Ş, Erayman İ, Arıbaş Türk E. Sepsisin erken tanısı ve takibinde prokalsitonin, CRP, IL-6, IL-8 ve endotoksinin rolü.Türk Mikrobiyol Cem Derg.2010; 40 (1): 27-36.
- Arslan A. at al. Sepsisli yaşlı hastalarda mortaliteyi belirlemede sistatin-C ve pro-BNP’nin etkisi Gaziantep Med J 2014; 20 (1): 47-51.
- Aks M, Mehta AA, James P. Predictors of mortality of severe sepsis among adult patients in the medical Intensive Care Unit. Lung India 2017; 34 (4): 330-35.
- Shukeri WFWM, Ralib AM, Abdulah NZ, Mat-Nor MB. Sepsis mortality score for the prediction of mortality in septic patients. J Crit Care. 2018 Feb; 43: 163-68.
- Müller B, Becker KL, Schachinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000; 28 (4): 977-83.
- Suprin E, Camus C, Gacovin A, et al. Procalcitonin: a valuable indicator of infection in a medical ICU Intensive Care Med 2000; 26 (9) 1232-8.
- Kraut JA, Madias NE. Lactic acidosis. N Engl J Med. 2014; 371 (24): 2309-19.
- Casserly B, Phillips GS, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med. 2015; 43 (3): 567- 73.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 30, 2020 |
| Submission Date | August 16, 2019 |
| Published in Issue | Year 2020 |