Research Article
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Use of Inflammation Markers for Mortality Prediction in Intensive Care Patients

Year 2021, Volume: 23 Issue: 1, 75 - 82, 30.04.2021
https://doi.org/10.24938/kutfd.817743

Abstract

Objective: Calculating the expected mortality rates of intensive care patients is important, therefore some scores that can be used in mortality prediction have been developed. In this study, we aimed to investigate whether C-reactive protein, procalcitonin, albumin, which are inflammatory markers can be used as predictors of mortality.
Material and Methods: Patients who were admitted to intensive care unit between August 2017 and January 2018 were prospectively and observationally analyzed. Demographic, clinical and laboratory data of the patients were recorded. Acute Physiology and Chronic Health Evaluation II (APACHE-II) score was calculated. The relationship between the score results and the laboratory data at the time of hospitalization with the length of stay in the intensive care unit and the intensive care outcome were evaluated.
Results: While C-reactive protein was found to be correlated with length of stay in intensive care unit (p=0.044) and APACHE II score (p=0.02); procalcitonin was in correlation with APACHE II score (p=0.001). When surgery group patients were evaluated as emergency and elective surgery patients; the C-reactive protein (p=0.011) and procalcitonin (p=0.017) values were significantly higher in the patients who died in the elective surgery group. When the medical patient group was examined, C-reactive protein value (p=0.001) was significantly higher in the patient group who died, while the value of albumin (p<0.001) was significantly lower.
Conclusion: As a result of this study, it is thought that the elevation of CRP and procalcitonin values can be used as good markers in predicting early mortality. We think that mortality can be predicted with higher probability by evaluating C-reactive protein and procalcitonin values in patients admitted to intensive care after elective surgery and C-reactive protein, albumin and APACHE-II score together in the medical patient group.

References

  • 1. Cavalazzi R, Marik PE, Hirani A, Pachinburavan M, Vasu TS, Leiby BE. Association between time of admission to the ICU and mortality: a systematic review and metaanalysis. Chest. 2010;138(1):68-75.
  • 2. Kara İ, Altınsoy S, Gök U, Onur A, Sasıbabıccı R. Factors effecting the mortality of patients hospitalized with nontraumatic reasons in general intensive care unit of state hospital. Yogun Bakım Derg. 2015;68(3):70-7.
  • 3. Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):1266-71.
  • 4. Detsky AS, Stricker SC, Mulley AG, Thibault GE. Prognosis, survival, and the expenditure of hospital resources for patients in an intensive-care unit. NEJM. 1981;305(12):667-72.
  • 5. Bouch DC, Thompson JP. Severity scoring systems in the critical ill. Contin Educ Anaesth Crit Care Pain. 2008;8(5):181-5.
  • 6. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
  • 7. Brunkhorst FU, Heinz Z. Forycki. Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med. 1998;24(8):888-9.
  • 8. Meisner M. Procalcitonin (PCT), A New, Innovative Infection Parameter, Biochemical and Clinical Aspects. 3rd ed. New York. Thieme Medical Publishing Group, 2000.
  • 9. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Mélot C, Vincent JL. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. CHEST. 2003;123(6):2043-9.
  • 10. Moshage HJ, Janssen JA, Franssen JH, Hafkenscheid JC, Yap SH. Study of the molecular mechanism of decreased liver synthesis of albumin in inflammation. J Clin Invest. 1997;79(6):1635-41.
  • 11. Reny JL, Vuagnat A, Ract C, Benoit MO, Safar M, Fagon JY. Diagnosis and follow-up of infections in intensive care patients: value of C-reactive protein compared with other clinical and biological variables. Crit Care Med. 2002;30(3):529-35.
  • 12. Adıyaman E, Tokur ME, Bal ZM, Gökmen AN, Koca U. Anestezi yoğun bakım ünitesinde takip ve tedavi edilen travma hastaların retrospektif değerlendirilmesi. J Turc Soc Intens Care. 2019;17(3):146-53.
  • 13. Simon L, Gauvin F, Amre DK, Saint-Lous P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004;39(2):206-17.
  • 14. Goldhill DR, Sumner A. Outcome of intensive care patients in a group of British intensive care units. Crit Care Med. 1998;26(8):1337-45.
  • 15. Waheed U, Williams P, Brett S, Baldock G, Soni N. White cell count and intensive care unit outcome. Anaesthesia 2003;58(2):180-3.
  • 16. Uysal N, Gündoğdu N, Börekçi Ş, Dikensoy Ö, Bayram N, Uyar M et al. Prognosis of patients in a medical intensive care unit of a tertiary care centre. Yoğun Bakım Derg. 2010;1(1):1-5.
  • 17. Colpan A, Akıncı E, Erbay A, Balaban N, Bodur H. Evaluation of risk factors for mortality in intensive care units. A prospective study from a referral hospital in Turkey. Am J Infect Control. 2005;33(1):42-7.
  • 18. Naved SA, Siddiqui S, Khan FH. APACHE-II score correlation with mortality and length of stay in an intensive care unit. J Coll Physicians Surg Pak. 2011;21(1):4-8.
  • 19. Kruse JA, Thill-Baharozian MC, Carlson RW. Comparison of clinical assessment with APACHE II for predicting mortality risk in patients admitted to a medical intensive care unit. JAMA. 1998;260(12):1739-42.
  • 20. Appelgren P, Hellström I, Weitzberg E, Söderlund V, Bindslev L, Ransjö U. Risk factors for nosocomial intensive care infection: a long‐term prospective analysis. Acta Anaesthesiol Scand. 2001;45(6):710-9.
  • 21. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE et al. Characteristics and outcomes in adult patients receiving mechanical ventilation. A 28-day international study. JAMA 2002;287(3):345-55.
  • 22. Prieto MF, Kilstein J, Bagilet D, Pezzotto SM. C-reactive protein as a marker of mortality in intensive care unit. Med Intensiva. 2008;32(9):424-30.
  • 23. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Mélot C et al. C-reactive protein level scores relate with mortality and organ failure in critically ill patients. CHEST. 2003;123(6):2043-9.
  • 24. Pettilä V, Pentti J, Pettilä M, Takkunen O, Jousela I. Predictive value of antithrombin III and serum C-reactive protein concentration in critically ill patients with suspected sepsis. Crit Care Med. 2002;30(2):271-75.
  • 25. Seller-Pérez G, Herrera-Gutiérrez ME, Lebrón-Gallardo M, de Toro-Peinado I, Martín-Hita L, Porras-Ballesteros JA. Serum C-reactive protein as a marker of outcome and infection in critical care patients. Med Clin (Barc). 2005;125(20):761-65.
  • 26. Mäkelä JT, Klintrup K, Takala H, Rautio T. The role of C-reactive protein in prediction of theseverity of acute diverticulitis in an emergency unit. Scand J Gastroenterol. 2015;50(5):536-41.
  • 27. Suberviola B, Castellanos-Ortega A, González-Castro A, García-Astudillo LA, Fernández-Miret B. Prognostic value of procalcitonin, C-reactive protein and leukocytes in septic shock. Med Intensiva. 2012;36(3):177-84.
  • 28. Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med. 2006;34(10):2596-602.
  • 29. Waheed U, Williams P, Brett S, Baldock G, Soni N. White cell count and intensive care unit outcome. Anaesthesia 2003;58(2):180-2.
  • 30. Weitkamp JH, Stüber F, Bartmann P. Pilot study assessing TNF gene polymorphism as a prognostic marker for disease progression in neonates with sepsis. Infection. 2000;28(2):92-6.
  • 31. Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol. 1997;50(6):693-703.
  • 32. Uluöz HO, Sebe A, Ay MO, Topal Y, Açıkalın A, Gülen M, Acehan S. The relationship between inflammatory reagents and mortality in patients over the age of 55 hospitalised in the internal medicine intensive care unit from the emergency service. JAEM. 2013;12(1):13-8.

YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI

Year 2021, Volume: 23 Issue: 1, 75 - 82, 30.04.2021
https://doi.org/10.24938/kutfd.817743

Abstract

Amaç: Yoğun bakım hastalarının beklenilen ölüm oranlarının hesaplanması, mevcut tıbbi durumu acil teşhis ve tedavi gerektirecek hastaların hızlıca belirlenmesi, yoğun bakımların standardizasyonu, hizmet kalitesinin değerlendirilmesi ve sağlanması açısından önemlidir. Bu nedenle mortalite tahmininde geliştirilen ölçekler kullanılmaktadır. Bu çalışmada mortalite prediktörü olabilecek inflamasyon belirteçlerinden C-reaktif protein, prokalsitonin, albümin ve beyaz küre değerlerinin mortalite tahminindeki etkinliğinin araştırılması amaçlandı.
Gereç ve Yöntemler: Çukurova Üniversitesi Tıp Fakültesi Reanimasyon Yoğun Bakım ünitesine Ağustos 2017 ve Ocak 2018 arasında kabul edilen, 18 yaş üstü hastalar prospektif ve gözlemsel olarak incelendi. Hastaların demografik, klinik ve laboratuvar verileri kaydedildi. Acute Physiology and Chronic Health Evaluation-II (APACHE-II) skoru hesaplandı. Skor sonuçları ve yatış anındaki laboratuvar verilerinin yoğun bakım yatış süresi ve yoğun bakım tedavisi sonlanımı ile ilişkisi değerlendirildi.
Bulgular: C-reaktif protein, yoğun bakım yatış süresi (p=0.044) ve APACHE-II skoru (p=0.02) ile korelasyon gösterirken; prokalsitonin ise APACHE II skoru ile (p=0.001) korele bulundu. Tüm hastalar değerlendirildiğinde C-reaktif protein (p<0.001) ve prokalsitonin (p=0.004) düzeylerinin ölen hastalarda istatistiksel anlamlı daha yüksek olduğu görüldü. Cerrahi grubundaki hastalar acil ve elektif cerrahi hastaları olarak değerlendirildiğinde; acil cerrahi grubunda, ölen ve sağ kalan hastalardaki C-reaktif protein (p>0.05) ve prokalsitonin (p>0.05) düzeyleri arasında istatistiksel anlamlı fark bulunmazken, elektif cerrahi grubunda ölen hastalarda C-reaktif protein (p=0.011) ve prokalsitonin (p=0.017) değerleri istatistiksel anlamlı daha yüksek idi. Medikal hasta grubu incelendiğinde ise ölen hastalarda C-reaktif protein değeri (p=0.001) istatistiksel anlamlı daha yüksek iken, albümin (p<0.001) değeri istatistiksel anlamlı düşük idi.
Sonuç: Bu çalışmada elde edilen verilere göre C-reaktif protein ve prokalsitonin değerlerinin mortalite tahmininde iyi bir belirteç olarak kullanabileceği düşünülmektedir. Elektif cerrahi sonrasında yoğun bakıma kabul edilen hastalarda C-reaktif protein ve prokalsitonin değerlerinin; medikal hasta grubunda ise C-reaktif protein, albümin ve APACHE-II skorunun birlikte değerlendirilmesiyle, daha yüksek olasılıkla mortalite tahmini yapılabileceğini düşünmekteyiz.

References

  • 1. Cavalazzi R, Marik PE, Hirani A, Pachinburavan M, Vasu TS, Leiby BE. Association between time of admission to the ICU and mortality: a systematic review and metaanalysis. Chest. 2010;138(1):68-75.
  • 2. Kara İ, Altınsoy S, Gök U, Onur A, Sasıbabıccı R. Factors effecting the mortality of patients hospitalized with nontraumatic reasons in general intensive care unit of state hospital. Yogun Bakım Derg. 2015;68(3):70-7.
  • 3. Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):1266-71.
  • 4. Detsky AS, Stricker SC, Mulley AG, Thibault GE. Prognosis, survival, and the expenditure of hospital resources for patients in an intensive-care unit. NEJM. 1981;305(12):667-72.
  • 5. Bouch DC, Thompson JP. Severity scoring systems in the critical ill. Contin Educ Anaesth Crit Care Pain. 2008;8(5):181-5.
  • 6. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
  • 7. Brunkhorst FU, Heinz Z. Forycki. Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med. 1998;24(8):888-9.
  • 8. Meisner M. Procalcitonin (PCT), A New, Innovative Infection Parameter, Biochemical and Clinical Aspects. 3rd ed. New York. Thieme Medical Publishing Group, 2000.
  • 9. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Mélot C, Vincent JL. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. CHEST. 2003;123(6):2043-9.
  • 10. Moshage HJ, Janssen JA, Franssen JH, Hafkenscheid JC, Yap SH. Study of the molecular mechanism of decreased liver synthesis of albumin in inflammation. J Clin Invest. 1997;79(6):1635-41.
  • 11. Reny JL, Vuagnat A, Ract C, Benoit MO, Safar M, Fagon JY. Diagnosis and follow-up of infections in intensive care patients: value of C-reactive protein compared with other clinical and biological variables. Crit Care Med. 2002;30(3):529-35.
  • 12. Adıyaman E, Tokur ME, Bal ZM, Gökmen AN, Koca U. Anestezi yoğun bakım ünitesinde takip ve tedavi edilen travma hastaların retrospektif değerlendirilmesi. J Turc Soc Intens Care. 2019;17(3):146-53.
  • 13. Simon L, Gauvin F, Amre DK, Saint-Lous P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004;39(2):206-17.
  • 14. Goldhill DR, Sumner A. Outcome of intensive care patients in a group of British intensive care units. Crit Care Med. 1998;26(8):1337-45.
  • 15. Waheed U, Williams P, Brett S, Baldock G, Soni N. White cell count and intensive care unit outcome. Anaesthesia 2003;58(2):180-3.
  • 16. Uysal N, Gündoğdu N, Börekçi Ş, Dikensoy Ö, Bayram N, Uyar M et al. Prognosis of patients in a medical intensive care unit of a tertiary care centre. Yoğun Bakım Derg. 2010;1(1):1-5.
  • 17. Colpan A, Akıncı E, Erbay A, Balaban N, Bodur H. Evaluation of risk factors for mortality in intensive care units. A prospective study from a referral hospital in Turkey. Am J Infect Control. 2005;33(1):42-7.
  • 18. Naved SA, Siddiqui S, Khan FH. APACHE-II score correlation with mortality and length of stay in an intensive care unit. J Coll Physicians Surg Pak. 2011;21(1):4-8.
  • 19. Kruse JA, Thill-Baharozian MC, Carlson RW. Comparison of clinical assessment with APACHE II for predicting mortality risk in patients admitted to a medical intensive care unit. JAMA. 1998;260(12):1739-42.
  • 20. Appelgren P, Hellström I, Weitzberg E, Söderlund V, Bindslev L, Ransjö U. Risk factors for nosocomial intensive care infection: a long‐term prospective analysis. Acta Anaesthesiol Scand. 2001;45(6):710-9.
  • 21. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE et al. Characteristics and outcomes in adult patients receiving mechanical ventilation. A 28-day international study. JAMA 2002;287(3):345-55.
  • 22. Prieto MF, Kilstein J, Bagilet D, Pezzotto SM. C-reactive protein as a marker of mortality in intensive care unit. Med Intensiva. 2008;32(9):424-30.
  • 23. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Mélot C et al. C-reactive protein level scores relate with mortality and organ failure in critically ill patients. CHEST. 2003;123(6):2043-9.
  • 24. Pettilä V, Pentti J, Pettilä M, Takkunen O, Jousela I. Predictive value of antithrombin III and serum C-reactive protein concentration in critically ill patients with suspected sepsis. Crit Care Med. 2002;30(2):271-75.
  • 25. Seller-Pérez G, Herrera-Gutiérrez ME, Lebrón-Gallardo M, de Toro-Peinado I, Martín-Hita L, Porras-Ballesteros JA. Serum C-reactive protein as a marker of outcome and infection in critical care patients. Med Clin (Barc). 2005;125(20):761-65.
  • 26. Mäkelä JT, Klintrup K, Takala H, Rautio T. The role of C-reactive protein in prediction of theseverity of acute diverticulitis in an emergency unit. Scand J Gastroenterol. 2015;50(5):536-41.
  • 27. Suberviola B, Castellanos-Ortega A, González-Castro A, García-Astudillo LA, Fernández-Miret B. Prognostic value of procalcitonin, C-reactive protein and leukocytes in septic shock. Med Intensiva. 2012;36(3):177-84.
  • 28. Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med. 2006;34(10):2596-602.
  • 29. Waheed U, Williams P, Brett S, Baldock G, Soni N. White cell count and intensive care unit outcome. Anaesthesia 2003;58(2):180-2.
  • 30. Weitkamp JH, Stüber F, Bartmann P. Pilot study assessing TNF gene polymorphism as a prognostic marker for disease progression in neonates with sepsis. Infection. 2000;28(2):92-6.
  • 31. Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol. 1997;50(6):693-703.
  • 32. Uluöz HO, Sebe A, Ay MO, Topal Y, Açıkalın A, Gülen M, Acehan S. The relationship between inflammatory reagents and mortality in patients over the age of 55 hospitalised in the internal medicine intensive care unit from the emergency service. JAEM. 2013;12(1):13-8.
There are 32 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Özlem Özkan Kuşcu 0000-0003-2252-4289

Meltem Aktay 0000-0002-6295-6599

Dilek Destegül 0000-0003-4363-6239

Ferit Kuşcu 0000-0001-5662-8305

Dilek Özcengiz 0000-0003-4095-6712

Publication Date April 30, 2021
Submission Date October 28, 2020
Published in Issue Year 2021 Volume: 23 Issue: 1

Cite

APA Özkan Kuşcu, Ö., Aktay, M., Destegül, D., Kuşcu, F., et al. (2021). YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 23(1), 75-82. https://doi.org/10.24938/kutfd.817743
AMA Özkan Kuşcu Ö, Aktay M, Destegül D, Kuşcu F, Özcengiz D. YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI. Kırıkkale Uni Med J. April 2021;23(1):75-82. doi:10.24938/kutfd.817743
Chicago Özkan Kuşcu, Özlem, Meltem Aktay, Dilek Destegül, Ferit Kuşcu, and Dilek Özcengiz. “YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23, no. 1 (April 2021): 75-82. https://doi.org/10.24938/kutfd.817743.
EndNote Özkan Kuşcu Ö, Aktay M, Destegül D, Kuşcu F, Özcengiz D (April 1, 2021) YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23 1 75–82.
IEEE Ö. Özkan Kuşcu, M. Aktay, D. Destegül, F. Kuşcu, and D. Özcengiz, “YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI”, Kırıkkale Uni Med J, vol. 23, no. 1, pp. 75–82, 2021, doi: 10.24938/kutfd.817743.
ISNAD Özkan Kuşcu, Özlem et al. “YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 23/1 (April 2021), 75-82. https://doi.org/10.24938/kutfd.817743.
JAMA Özkan Kuşcu Ö, Aktay M, Destegül D, Kuşcu F, Özcengiz D. YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI. Kırıkkale Uni Med J. 2021;23:75–82.
MLA Özkan Kuşcu, Özlem et al. “YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 23, no. 1, 2021, pp. 75-82, doi:10.24938/kutfd.817743.
Vancouver Özkan Kuşcu Ö, Aktay M, Destegül D, Kuşcu F, Özcengiz D. YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI. Kırıkkale Uni Med J. 2021;23(1):75-82.

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