KOAH atak ile acil servise başvuran hastalarda akut solunum yolu enfeksiyonlarını belirlemede ve antibiyotik başlamada prokalsitoninin önemi

Year 2024, , 343 - 350, 30.09.2024

Gülsüm Çalışkan Günay , Fevzi Yılmaz , Adem Çakır

https://doi.org/10.18663/tjcl.1455819

Abstract

Amaç: KOAH, hava yollarının ve alveollerin hasarı sonucu kalıcı hava akımı kısıtlılığı ve solunum zorluğu ile karakterize; dünya çapında mortalite ve morbidite ile ilişkili bir hastalıktır. Bakteriyel patojenlerin KOAH alevlenmesinde ana nedenlerden biri olduğu kabul edilse de birçok hastada kesin neden tespit edilemediği için asıl nedene yönelik tedavi oldukça zor olabilmektedir. Prokalsitonin kılavuzluğunda, antibiyotik tedavisinin KOAH alevlenme hastalarının tedavisinde güvenilir bir klinik fayda sağlayıp sağlanmadığı belirsizliği devam etmektedir. Bu çalışmamızda, acil servise başvuran KOAH alevlenme hastalarında hem tanı hem de antibiyotik tedavisini belirlemede PCT’nin öngörü başarısını tespit etmeyi amaçladık.
Gereç ve Yöntemler: Çalışmamız tek merkezli ve prospektif olarak planlandı. Çalışma, hastanemiz acil servisine KOAH alevlenme ile başvuran ve çalışmaya dahil edilme kriterlerini karşılayan ve geliş sırasına göre randomize olarak seçilen 100 hasta ile yapıldı.
Bulgular: Çalışmamıza dahil edilen 100 hastanın %87’si erkek ve yaş ortalaması 70,4±10,5 yıl idi. PCT ve CRP düzeylerine göre verilen tedavi ve sonlanım değerlendirildiğinde; antibiyotik başlanan olgular ile başlanmayan olgular arasında CRP ve PCT ortanca değerleri arasında anlamlı fark olduğu tespit edildi (sırasıyla p=0.017 ve p<0.001). Taburculuktan servis yatışına ve servis yatışından yoğum bakım ünitesine yatışa doğru gidildiğinde (hastanın kritikliği arttığında) PCT’nin de anlamlı olarak yüksek olduğu görüldü (p<0.001). Fakat sonlanım ile CRP arasındaki bu ilişki anlamlı farklı değildi.
Sonuç: KOAH atak nedeniyle acil servise başvuran hastalarda prokalsitonin; hastalığın şiddeti, antibiyotik başlanma kararı, NIMV ve IMV tedavisine, hastaların Acil Servis’ten taburculuk veya hastaneye kabulünü belirleyen önemli bir belirteç olduğu düşünüyoruz.

Keywords

Kronik Obstrüktif Akciğer Hastalığı, Akut Atak, Antibiyotik Yönetimi, İnflamatuar Biyobelirteçler

Ethical Statement

Etik kurul izni alınmıştır ve dosyalar içine yüklenmiştir.

Supporting Institution

Herhangi bir finansal destek alınmamıştır.

Thanks

Antalya Eğitim ve Araştırma Hastanesi Acil Tıp Kliniği çalışanlarına, çalışmaya olan desteklerinden dolayı minnettarız.

The importance of procalcitonin in determining acute respiratory tract infections and initiating antibiotics in patients admitting to the emergency department with a COPD attack

Abstract

Aim: COPD is characterized by permanent airflow limitation and difficulty breathing as a result of damage to the airways and alveoli; It is a disease associated with mortality and morbidity worldwide. Although it is accepted that bacterial pathogens are one of the main causes of COPD exacerbation, treatment for the main cause can be quite difficult since the exact cause cannot be determined in many patients. It remains unclear whether procalcitonin-guided antibiotic therapy provides a reliable clinical benefit in the treatment of patients with COPD exacerbations. In this study, we aimed to determine the predictive success of PCT in determining both diagnosis and antibiotic treatment in COPD exacerbation patients presenting to the emergency department.
Material and Methods: Our study was planned single-center and prospectively. The study was conducted with 100 patients who presented to our hospital's emergency department with COPD exacerbation and met the inclusion criteria and were randomly selected according to the order of arrival.
Results: 87% of the 100 patients included in our study were male and the average age was 70.4±10.5 years. When the treatment and outcome are evaluated according to PCT and CRP levels; It was determined that there was a significant difference in the median values of CRP and PCT between the cases in which antibiotics were started and those in which antibiotics were not started (p=0.017 and p<0.001, respectively). It was observed that PCT was significantly higher as the patient moved from discharge to ward admission and from ward admission to intensive care unit admission (when the criticality of the patient increased) (p<0.001). However, this relationship between outcome and CRP was not significantly different.
Conclusions: Procalcitonin in patients admitted to the emergency department due to COPD attack; We think that the severity of the disease, the decision to start antibiotics, NIMV and IMV treatment are important indicators that determine the discharge of patients from the Emergency Department or admission to the hospital.

Keywords

Chronic Obstructive Pulmonary Disease, Acute Attact, Antibiotic Stewardship, Inflammatory Biomarkers

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