Pnömoni Hastalarında, CRP, Prokalsitonin ve Laktat Ölçümünün Prognostik Değerinin, Sık Kullanılan Skorlama Sistemleri ile Karşılaştırılması

Year 2019, Volume: 2 Issue: 2, 10 - 17, 31.07.2019

Nimet Gülen , Müge Günalp Eneyli

Abstract

Giriş:Pnömoni hastalarında hastalığın ciddiyetini ve prognozu belirlemek amacıyla oluşturulmuş, farklı skorlama sistemleri mevcuttur. Ancak hiçbir skorlama sisteminin sensitivite ve spesivitesi %100 değildir. Bu çalışmada amaçlanan, farklı demografik özellikler, etyolojiler ve ko- morbiditelere göre, CRP, laktat ve prokalsitonin değerlerinin, prognozu saptamada sık kullanılan skorlama sistemlerine göre etkinliklerini belirlemek ve hastaların tedavisini düzenlemedeki faydasını saptamaktır.

Metod: Ankara Üniversitesi Tıp Fakültesi Hastanesi Acil Servisi'ne 1 Aralık 2015 ile 31 Mayıs 2016 tarihleri arasında başvuran, pnömoni tanısı alan 144 hastanın vital bulguları, kan tetkikleri ve kan gazı analizinin sonuçları değerlendirmeye alınmıştır. Hastaların tedavileri kılavuzların önerdiği şekilde düzenlenmiştir. Çalışmanın sonlanım noktaları hastane ve yoğun bakım ünitesine yatış ihtiyacı ile 28 günlük mortalite olarak belirlenmiştir. Çalışma kapsamında, hastaların tanı ve tedavisini yönlendirilecek herhangi bir müdahalede bulunulmamıştır.

Bulgular: Çalışmaya dahil edilen, yaş ortalaması 71±20 olarak saptanan ve kadın-erkek dağılımı dengeli olan hastaların her birinin en az bir kronik hastalığı bulunmaktadır ancak bu hastalıkların mortalite ile direk ilişkisi saptanmamıştır. Hastaların başvuru anındaki vital bulguları açısından yaşayan ve ölen hastalar arasında anlamlı fark bulunmazken, konfüzyon mortalite ile ilişkili bulunmuştur. Hastaların CRP, prokalsitonin, laktat ve WBC değerleri arasında mortalite ile istatistiksel olarak anlamlı ilişki saptanmazken, hipoalbuminemi (p=0,092) ve üremi (0,018) değerlerinde korelasyon saptanmıştır. Skorlama sistemlerine bakıldığında; en sık kullanılan CURB-65’in ayaktan takip olacak hastaları ayırt etme gücü yetersiz kalırken (p=0,179); PSI’ın ayaktan takip edilecek hastaları saptamada (p=0,009), SMART-COP’un ise yoğun bakım ihtiyacı olabilecek hastaları saptamada (p=0,007) oldukça başarılı olduğu görülmüştür.

Sonuç: Araştırılan tüm parametreler ve skorlar arasında ayaktan takip edilecek hastaları belirlemede PSI’ın, yoğun bakıma yatışı öngörmede ise SMART-COP’un güvenle kullanılabileceği sonucuna varıldı.

Keywords

pnömoni, crp, prokalsitonin, laktat, PSI, CURB-65, SMART-COP, prognoz

The Prognostic Value of CRP, Procalcitonin and Lactate Measurement in Comparison With Frequently Used Scoring Systems in Prenumonia Patients

Abstract

Background: Several scoring systems have been used to predict severity and mortality in patients with community acquired pneumonia. However, no scoring system has the 100 % sensitivity and specificity. The aim of this study was to determine the prognosis and the benefits of the managing the treatment according to the different demographic features, etiology and co-morbidities by comparing the CRP, lactate and procalcitonin values with frequently used scoring systems.

Methods: One hundred and fourty four patients ,who admitted to Ankara University Emergency Department between 1 December 2015 and 31 May 2016, and diagnosed as pneumonia were included in this study. Vital signs, blood tests and blood gas analysis results were analyzed. The treatment of patients were arranged according to the international guidelines. The end points of this study were accepted as hospitalization to the wards, intensive care units and also 28-day mortality. In the scope of the study, no intervention was made to guide the diagnosis and treatment of the patients.

Results: The distribution of the male and female patients were equally and the mean age of patients was 71 (±20). All patients had at least one chronic disease, and there wasn’t determined direct relation between mortality and these diseases. No significant difference was found between the admission vital signs of survival and mortal patients; but confusion during the initial admittance was found associated with mortality. CRP, procalcitonin, lactate and WBC values weren’t represent statistically significant relationship between the mortality;however hypoalbuminemia (p = 0.092) and uremia (p=0,018) values had correlation. The comparison of the scoring systems showed that; CURB- 65, most commonly used system to distinguish outpatients was found as insufficient (p = 0.179) however PSI was successfull (p = 0.009). SMART- COP was found successfull to distinguish patients needed intensive care treatment (p = 0.007).

Conclusion: Among all the parameters and scores investigated, PSI was superior in detecting outpatients, whereas SMART-COP could be used safely in detecting patients in need of intensive care.

Keywords

Pneumonia, CRP, Procalcitonin, Lactate, PSI, CURB-65, SMART-COP, Prognosis

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