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Procalcitonin/Albumin Ratio: Could it be a Novel Marker Indicating Severity of Inflammation in Pneumonia? A Retrospective Study in Elderly Patients with Community-acquired Pneumonia

Yıl 2020, Cilt: 3 Sayı: 1, 11 - 17, 30.04.2020

Öz

Aim: Community-acquired pneumonia (CAP) in elderly patients is a major health problem causing morbidity and mortality. Markers for determining the severity of disease are still insufficient. With this study conducted on geriatric age group patients treated in intensive care unit (ICU) with CAP; it was aimed to evaluate the importance and usability of procalcitonin/albumin ratio for predicting progression of disease or mortality.

Material and Methods:
This retrospective study was conducted in a tertiary hospital, on geriatric age group patients who were hospitalized in ICU with diagnosis of community-acquired pneumonia, between January 1, 2016 and December 31, 2018. Total 490 patients were followed-up and 350 who met inclusion criteria were enrolled in the study. One hundred and sixty two patient (46%) were female and 188 (54%) were male, mean age was 73.5±10.9. On admission to ICU, blood tests, blood and sputum cultures has been obtained from all patients. Accompanying diseases, age, gender data has been recorded, complete blood count (leukocyte, platelet count, MPV), CRP, uric acid, procalcitonin and albumin has been studied.

Results: Age (p=0.005), procalcitonin (p=0.001), MPV (p=0.001), CRP (p=0.002) and procalcitonin/albumin ratio (p=0.001) were found to be significant between groups in survivors and fatalities. In 30-day follow up period, 166 patients survived, while 188 patients died. Area under curve (AUC) value for procalcitonin/albumin ratio was significant when compared to other parameters (p=0.001).

Conclusion: The relationship between thirty-day mortality in ICU and age, procalcitonin/albumin ratio, procalcitonin, CRP and MPV values were significant. 

Kaynakça

  • 1. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72 doi:10.1086/511159
  • 2. Cilloniz C, Rodriguez H, Ellsbury G. Characteristics and Management of Community Acquired Pneumonia in the Era of Global Aging. Med Sci (Basel). 2018 Jun; 6(2): 35 doi: 10.3390/medsci60200354
  • 3. Cilloniz C, Dominedo C, Ielpo A, et al. Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia. J Clin Med. 2019 Jul; 8(7): 961.doi: 10.3390/jcm8070961
  • 4. Guo S, Mao X, Liang M. The moderate predictive value of serial serum CRP and PCT levels for the prognosis of hospitalized community acquired pneumonia. Respir Res. 2018; 19: 193. doi: 10.1186/s12931-018-0877-x
  • 5. Vincent JL. Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol. 2009 Jun;23(2):183-91. doi:10.1016/j.bpa.2008.11.004
  • 6. Ho KM, Lee KY, Dobb GJ, Webb SA. C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study. Intensive Care Med. 2008 Mar;34(3):481-7.doi:10.1007/s00134-007-0928-0
  • 7. Ito A, Ishida T, Tokumasu H, et al. Prognostic factors in hospitalized community-acquired pneumonia: a retrospective study of a prospective observational cohort. BMC Pul Med. 2017;17:78. doi: 10.1186/s12890-017-0424-4
  • 8. Boussekey N, Leroy O, Georges H, Devos, P, d’ Escrivan, T, & Guery B. Diagnostic and Prognostic Values of Admission Procalcitonin Levels in Community Acquired Pneumonia in an Intensive Care Unit. Infection, 33(4), 257–263. doi:10.1007/s15010-005-4096-2
  • 9. Masia M, Gutierrez F, Shum C, et al. Usefulness of procalcitonin levels in community acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest. 2005;128:2223–2229. doi: 10.1378/chest.128.4.2223
  • 10. Parli SE, Trivedi G, Woodworth A, Chang PK. Procalcitonin: Usefulness in acute care surgery and trauma. Surg Infect 2018;19:131–136.doi: 10.1089/sur.2017.307
  • 11. Jensen JU, Hein L, Lundgren B, et al. Procalcitonin guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomi-zed trial. Crit Care Med 2011;39:2048-5.doi: 10.1097/CCM.0b013e31821e8791
  • 12. Akagi T, Nagata N, Miyazaki H, et al. Procalcitonin is not an independent predictor of 30-day mortality, albeit predicts pneumonia severity in patients with pneumonia acquired outside the hospital. BMC Geriatr. 2019 Jan 7;19(1):3. doi: 10.1186/s12877-018-1008-8
  • 13. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72.doi:: 10.1086/511159
  • 14. Bafadhel M, Clark TW, Reid C, et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest. 2011;139:1410–1418. doi: 10.1378/chest.10-1747
  • 15. Luo X, Yang X, Li J, et al. The procalcitonin/albumin ratio as an early diagnostic predictor in discriminating urosepsis from patients with febrile urinary tract infection. Medicine (Baltimore). 2018 Jul;97(28):e11078. doi: 10.1097/MD.0000000000011078
  • 16. Kim JH, Seo JW, Mok JH, et al. Usefulness of plasma procalcitonin to predict severity in elderly patients with community-acquired pneumonia. Tuberc Respir Dis (Seoul). 2013 May;74(5):207-14. doi: 10.4046/trd.2013.74.5.207
  • 17. Muller B, Peri G, Doni A, et al. High circulating levels of the IL-1 type II decoy receptor in critically ill patients with sepsis: association of high decoy receptor levels with glucocorticoid administration. J Leukoc Biol. 2002;72:643–649. PMID: 12377932
  • 18. Lee JH, Park M, Han S, Hwang JJ, Park SH, Park SY. An increase in mean platelet volume during admission can predict the prognoses of patients with pneumonia in the intensive care unit: A retrospective study. PLoS One. 2018 Dec 11;13(12):e0208715. doi: 10.1371/journal.pone.0208715
  • 19. Rafieian-Kopaie M, Nasri H. Platelet counts and mean platelet volume in association with serum magnesium in maintenance hemodialysis patients. J Renal Inj Prev. 2012;1(1):17-21. doi: 10.12861/jrip.2012.08
  • 20. Lee JH, Kim J, Kim K, et.al. Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia. J Crit Care. 2011 Jun;26(3):287-94. doi: 10.1016/j.jcrc.2010.10.007
  • 21. Viasus D, Garcia-Vidal C, Simonetti A, et al. Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia. J Infect. 2013 May;66(5):415-23. doi: 10.1016/j.jinf.2012.12.007
  • 22. Deng S, Gao J, Zhao Z, Tian M, Li Y, Gong Y. Albumin/Procalcitonin Ratio Is a Sensitive Early Marker of Nosocomial Blood Stream Infection in Patients with Intra-Cerebral Hemorrhage. Surg Infect (Larchmt). 2019 Dec;20(8):643-649. doi: 10.1089/sur.2018.260

Prokalsitonin/Albumin Oranı: Pnömoni Şiddetini Gösteren Yeni Bir Belirteç Olabilir mi? Toplum Kaynaklı Pnömonisi olan Hastalarda Yapılmış Retrospektif Bir Çalışma

Yıl 2020, Cilt: 3 Sayı: 1, 11 - 17, 30.04.2020

Öz

Amaç: Bu çalışmada; yoğun bakıma toplum kaynaklı pnömoni (TKP) nedeniyle yatırılan geriatrik yaş grubundaki hastalarda, prokalsitonin/albümin oranının pnömoni seyrini ve mortaliteyi göstermekteki etkinliği değerlendirilmiştir.

Gereç ve Yöntemler: Bu çalışma, geriatrik yaş grubundaki hastalarda, 1 Ocak 2016 - 31 Aralık 2018 tarihleri arasında TKP tanısı konularak, hastane yoğun bakım ünitesinde yatırılmış 490 hastadan çalışmaya dahil edilme kriterleri uyan 350'si ile tek merkezli ve retrospektif olarak yapılmıştır. Hastaların 162 (%46)'si kadın, 188 (%54)'i ise erkek idi. Hastaların yaş ortalaması 73,50±10,9 yıldı. Hastaların 30 günlük mortalite oranıyla; eşlik eden hastalıkları, yaş, cinsiyet, lenfosit, nötrofil ve trombosit sayısı, ortalama trombosit hacmi (MPV), C-reaktif protein (CRP), ürik asit, prokalsitonin ve albumin değerleri arasındaki ilişki değerlendirilmiştir. Hastaların biyokimya testleri, kan ve balgam kültürleri; yoğun bakıma yatırıldığı anda alınmıştır.

Bulgular: Yaşayan ve ölen hasta grupları arasında; yaş (p=0,005), prokalsitonin (p=0,001), MPV (p=0,001), CRP (p=0,002) ve prokalsitonin/albumin oranı (p=0,001) değerleri arasından anlamlı fark saptanmıştır. Otuz günlük takip sırasında; hastaların 166 tanesi yaşamını sürdürürken, 184 hasta yaşamını yitirmiştir. Prokalsitonin/albumin oranının eğri altında kalan alan (AUC) değeri, diğer parametrelerden anlamlı olarak fazla bulunmuştur (p=0,001).

Sonuç: Yoğun bakımda toplum kökenli pnömoni nedeniyle yatırılan hastalarda 30 günlük mortalite oranı ile yaş, CRP, MPV, prokalsitonin değerleri ve prokalsitonin/albumin oranının anlamlı olarak ilişkili olduğu saptanmıştır.

Kaynakça

  • 1. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72 doi:10.1086/511159
  • 2. Cilloniz C, Rodriguez H, Ellsbury G. Characteristics and Management of Community Acquired Pneumonia in the Era of Global Aging. Med Sci (Basel). 2018 Jun; 6(2): 35 doi: 10.3390/medsci60200354
  • 3. Cilloniz C, Dominedo C, Ielpo A, et al. Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia. J Clin Med. 2019 Jul; 8(7): 961.doi: 10.3390/jcm8070961
  • 4. Guo S, Mao X, Liang M. The moderate predictive value of serial serum CRP and PCT levels for the prognosis of hospitalized community acquired pneumonia. Respir Res. 2018; 19: 193. doi: 10.1186/s12931-018-0877-x
  • 5. Vincent JL. Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol. 2009 Jun;23(2):183-91. doi:10.1016/j.bpa.2008.11.004
  • 6. Ho KM, Lee KY, Dobb GJ, Webb SA. C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study. Intensive Care Med. 2008 Mar;34(3):481-7.doi:10.1007/s00134-007-0928-0
  • 7. Ito A, Ishida T, Tokumasu H, et al. Prognostic factors in hospitalized community-acquired pneumonia: a retrospective study of a prospective observational cohort. BMC Pul Med. 2017;17:78. doi: 10.1186/s12890-017-0424-4
  • 8. Boussekey N, Leroy O, Georges H, Devos, P, d’ Escrivan, T, & Guery B. Diagnostic and Prognostic Values of Admission Procalcitonin Levels in Community Acquired Pneumonia in an Intensive Care Unit. Infection, 33(4), 257–263. doi:10.1007/s15010-005-4096-2
  • 9. Masia M, Gutierrez F, Shum C, et al. Usefulness of procalcitonin levels in community acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest. 2005;128:2223–2229. doi: 10.1378/chest.128.4.2223
  • 10. Parli SE, Trivedi G, Woodworth A, Chang PK. Procalcitonin: Usefulness in acute care surgery and trauma. Surg Infect 2018;19:131–136.doi: 10.1089/sur.2017.307
  • 11. Jensen JU, Hein L, Lundgren B, et al. Procalcitonin guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomi-zed trial. Crit Care Med 2011;39:2048-5.doi: 10.1097/CCM.0b013e31821e8791
  • 12. Akagi T, Nagata N, Miyazaki H, et al. Procalcitonin is not an independent predictor of 30-day mortality, albeit predicts pneumonia severity in patients with pneumonia acquired outside the hospital. BMC Geriatr. 2019 Jan 7;19(1):3. doi: 10.1186/s12877-018-1008-8
  • 13. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72.doi:: 10.1086/511159
  • 14. Bafadhel M, Clark TW, Reid C, et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest. 2011;139:1410–1418. doi: 10.1378/chest.10-1747
  • 15. Luo X, Yang X, Li J, et al. The procalcitonin/albumin ratio as an early diagnostic predictor in discriminating urosepsis from patients with febrile urinary tract infection. Medicine (Baltimore). 2018 Jul;97(28):e11078. doi: 10.1097/MD.0000000000011078
  • 16. Kim JH, Seo JW, Mok JH, et al. Usefulness of plasma procalcitonin to predict severity in elderly patients with community-acquired pneumonia. Tuberc Respir Dis (Seoul). 2013 May;74(5):207-14. doi: 10.4046/trd.2013.74.5.207
  • 17. Muller B, Peri G, Doni A, et al. High circulating levels of the IL-1 type II decoy receptor in critically ill patients with sepsis: association of high decoy receptor levels with glucocorticoid administration. J Leukoc Biol. 2002;72:643–649. PMID: 12377932
  • 18. Lee JH, Park M, Han S, Hwang JJ, Park SH, Park SY. An increase in mean platelet volume during admission can predict the prognoses of patients with pneumonia in the intensive care unit: A retrospective study. PLoS One. 2018 Dec 11;13(12):e0208715. doi: 10.1371/journal.pone.0208715
  • 19. Rafieian-Kopaie M, Nasri H. Platelet counts and mean platelet volume in association with serum magnesium in maintenance hemodialysis patients. J Renal Inj Prev. 2012;1(1):17-21. doi: 10.12861/jrip.2012.08
  • 20. Lee JH, Kim J, Kim K, et.al. Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia. J Crit Care. 2011 Jun;26(3):287-94. doi: 10.1016/j.jcrc.2010.10.007
  • 21. Viasus D, Garcia-Vidal C, Simonetti A, et al. Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia. J Infect. 2013 May;66(5):415-23. doi: 10.1016/j.jinf.2012.12.007
  • 22. Deng S, Gao J, Zhao Z, Tian M, Li Y, Gong Y. Albumin/Procalcitonin Ratio Is a Sensitive Early Marker of Nosocomial Blood Stream Infection in Patients with Intra-Cerebral Hemorrhage. Surg Infect (Larchmt). 2019 Dec;20(8):643-649. doi: 10.1089/sur.2018.260
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Recep Alanlı 0000-0003-4663-1898

Murat Bülent Küçükay 0000-0003-3657-6565

Serkan Yalçın

Yayımlanma Tarihi 30 Nisan 2020
Gönderilme Tarihi 4 Aralık 2019
Kabul Tarihi 30 Nisan 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 3 Sayı: 1

Kaynak Göster

APA Alanlı, R., Küçükay, M. B., & Yalçın, S. (2020). Procalcitonin/Albumin Ratio: Could it be a Novel Marker Indicating Severity of Inflammation in Pneumonia? A Retrospective Study in Elderly Patients with Community-acquired Pneumonia. Geriatrik Bilimler Dergisi, 3(1), 11-17.
AMA Alanlı R, Küçükay MB, Yalçın S. Procalcitonin/Albumin Ratio: Could it be a Novel Marker Indicating Severity of Inflammation in Pneumonia? A Retrospective Study in Elderly Patients with Community-acquired Pneumonia. GBD. Nisan 2020;3(1):11-17.
Chicago Alanlı, Recep, Murat Bülent Küçükay, ve Serkan Yalçın. “Procalcitonin/Albumin Ratio: Could It Be a Novel Marker Indicating Severity of Inflammation in Pneumonia? A Retrospective Study in Elderly Patients With Community-Acquired Pneumonia”. Geriatrik Bilimler Dergisi 3, sy. 1 (Nisan 2020): 11-17.
EndNote Alanlı R, Küçükay MB, Yalçın S (01 Nisan 2020) Procalcitonin/Albumin Ratio: Could it be a Novel Marker Indicating Severity of Inflammation in Pneumonia? A Retrospective Study in Elderly Patients with Community-acquired Pneumonia. Geriatrik Bilimler Dergisi 3 1 11–17.
IEEE R. Alanlı, M. B. Küçükay, ve S. Yalçın, “Procalcitonin/Albumin Ratio: Could it be a Novel Marker Indicating Severity of Inflammation in Pneumonia? A Retrospective Study in Elderly Patients with Community-acquired Pneumonia”, GBD, c. 3, sy. 1, ss. 11–17, 2020.
ISNAD Alanlı, Recep vd. “Procalcitonin/Albumin Ratio: Could It Be a Novel Marker Indicating Severity of Inflammation in Pneumonia? A Retrospective Study in Elderly Patients With Community-Acquired Pneumonia”. Geriatrik Bilimler Dergisi 3/1 (Nisan 2020), 11-17.
JAMA Alanlı R, Küçükay MB, Yalçın S. Procalcitonin/Albumin Ratio: Could it be a Novel Marker Indicating Severity of Inflammation in Pneumonia? A Retrospective Study in Elderly Patients with Community-acquired Pneumonia. GBD. 2020;3:11–17.
MLA Alanlı, Recep vd. “Procalcitonin/Albumin Ratio: Could It Be a Novel Marker Indicating Severity of Inflammation in Pneumonia? A Retrospective Study in Elderly Patients With Community-Acquired Pneumonia”. Geriatrik Bilimler Dergisi, c. 3, sy. 1, 2020, ss. 11-17.
Vancouver Alanlı R, Küçükay MB, Yalçın S. Procalcitonin/Albumin Ratio: Could it be a Novel Marker Indicating Severity of Inflammation in Pneumonia? A Retrospective Study in Elderly Patients with Community-acquired Pneumonia. GBD. 2020;3(1):11-7.

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