Kronik böbrek hastalığında inflamasyon belirteçleri ile enfeksiyon ilişkisi

Year 2021, Volume: 46 Issue: 1, 177 - 185, 31.03.2021

Sultan Sipahi , Seher Kır , Melda Dilek

Abstract

Amaç: Bu çalışmada kronik böbrek hastalığı (KBH) olan hastalarda gelişen enfeksiyonların tanı ve takibinde C-reaktif protein (CRP) ve prokalsitonin (PCT)’in önemini değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Bu çalışmada, Mart 2012 - Haziran 2014 tarihleri arasında Ondokuz Mayıs Üniversitesi nefroloji bölümünde yatarak tedavi gören 1538 hasta değerlendirildi. Çalışmaya herhangi bir bakteriyel enfeksiyon nedeniyle tedavi almış ve tüm verileri eksiksiz olan 72 KBH (Glomerüler filtrasyon hızı <60 ml/dak) hastası dahil edildi. Hastaların antibiyotik tedavisi öncesi ve sonrasındaki laboratuar değerleri karşılaştırıldı.
Bulgular: Çalışmaya dahil edilen 72 hastanın yaş ortancası 66 (20-90) yıl olup %52,8’i (n=38) erkekti. Hastaların %52,8’inin (n=38) primer yatış nedeni enfeksiyondu. Enfeksiyon tedavisi sonrasında CRP ve PCT’de anlamlı azalma saptandı. Tedavi sonrası CRP farkının kültürde üremesi olan hastalarda olmayanlara göre anlamlı olarak daha fazla olduğu görüldü. CRP, PCT ve PCT farkının kültürde üreme durumuna karar verdirici özelliğinin olmadığı saptanırken CRP’deki farkın kültürde üreme durumunu karar verdirici özelliğinin olduğu saptandı.
Sonuç: Çalışmada CRP ve PCT düzeylerinin KBH hastalarında enfeksiyon tedavisinden sonra anlamlı düzeyde azaldığını ve KBH hastalarında da diğer hasta gruplarında olduğu gibi bakteriyel enfeksiyonların tanı ve takibinde değerli bir belirteç olduğu saptanmıştır. CRP değerindeki değişimin kültürde üreme saptanmasıyla ilişkili iken PCT değerindeki değişimin kültürde üremeyi öngörmede etkin olmadığı tespit edildi. KBH hastalarında enfeksiyonun göstergesi olarak normalden daha yüksek bir CRP kesim değeri (12 mg/L) olduğu belirlenmiştir.

Keywords

C-reaktif protein, Kronik böbrek hastalığı, prokalsitonin, enfeksiyon

Relationship between inflammatory markers and infection in chronic kidney disease

Abstract

Purpose: The aim of this study was to evaluate the importance of C-reactive protein (CRP) and procalcitonin (PCT) in the diagnosis and monitoring of infections in chronic kidney disease (CKD) patients.
Materials and Methods: In this study, 1538 hospitalized patients in the nephrology division of Ondokuz Mayıs University between March 2012 and June 2014 were evaluated. A total of 72 patients with CKD (Glomerular filtration rate <60 ml/min), treated for any bacterial infection and complete data were included. The laboratory values before and after antibiotic treatments were compared.
Results: The median age of 72 patients was 66 (20-90) years, and 52.8% (n=38) were male. Primary reason for hospitalization was infection in 52.8% (n=38) of the patients. There was a significant decrease in CRP and PCT after infection treatment. CRP difference after treatment was significantly high in patients with positive culture. CRP, PCT and difference in PCT had no decision-making feature for the culture positivity, while the difference in CRP was determined to have a decision-making feature.
Conclusion: CRP and PCT levels decreased significantly in CKD patients after infection treatment, and we confirmed that they are valuable markers in the diagnosis and follow-up of bacterial infections in CKD patients as in other patient groups. We found that the difference in CRP was predictive for culture positivity while the difference in PCT was not. We found a higher than normal CRP cut-off value (12 mg/L) in CKD patients as an indicator of infection.

Keywords

Chronic kidney disease, C-reactive protein, procalcitonin, infection

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