Acil Serviste Prokalsitonin Düzeyi ile Kısa Dönem Mortalite Arasındaki İlişki

Year 2023, Volume: 6 Issue: 3, 105 - 110, 30.09.2023

Onur Barıs Cehreli , Başak Bayram , Duygu Gürsoylu , Nese Colak

https://doi.org/10.54996/anatolianjem.1245961

Cited By: 1

An Erratum to this article was published on March 31, 2024. https://dergipark.org.tr/en/pub/anatolianjem/issue/84043/1463330

Abstract

Amaç: Prokalsitonin (PKT), enfeksiyonu gösteren biyobelirteçtir ve son yıllarda popülaritesi artmaktadır. Çalışmamızda acil serviste (AS) prokalsitonin düzeyi ölçülen hastalarda prokalsitonin düzeyleri ile yedi günlük mortalite arasında ilişki olup olmadığını araştırdık.

Gereç ve Yöntemler: Tek merkezli, kesitsel, analitik, retrospektif bu çalışmaya Dokuz Eylül Üniversitesi Hastanesi erişkin acil servisinde 01.01.2016-31.03.2016 tarihleri arasında PKT düzeyi ölçülen hastalar dahil edildi. Yaşayan ve ölen hasta gruplarında PKT düzeyi ve diğer parametreler değerlendirildi.

Bulgular: PKT düzeyi ölçülen 499 hastayı analiz ettik. Yaş ortalama 74 (ÇAA 63-82) ve % 54'ü erkekti. Prokalsitonin düzeyleri 499 hastanın 6'sında (%1,2) hafif yüksek (ortanca 0,03: ÇAA 0,02-0,04), 407'sinde (%81,6) orta yüksek (ortanca 0,26; ÇAA 0,16-0,54) ve 86'sında (%17,2) ciddi yüksek (ortanca 5,54; ÇAA 3,20-15,31) seviyelerde idi. PKT düzeyi yüksek olan grup diğer gruplarla karşılaştırıldığında; sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), trombosit sayısı, pCO2 daha düşük iken; nabız, beyaz küre, laktat, baz açığı değerleri daha yüksekti. Hastaların 249'unun (%49,9) acil servisten taburcu edildiği, 112'sinin (%22,4) servise yattığı, 66'sının (%13,2) yoğun bakımda yattığı ve 72'sinin (%14,4) öldüğü belirlendi. Ölen grubun PKT düzeyleri, yaşayan gruba göre daha yüksekti (0,29 ngr/mL'ye karşı 1,07 ngr/mL, p<0,001). Tek değişkenli analizde, ölen grubun yaş, nabız, solunum hızı, prokalsitonin seviyeleri, laktat ve baz açığı değerleri daha yüksek ve SKB, DKB, oksijen satürasyonu ve pH değerlerinin daha düşük olduğu gösterildi. ROC eğrisinde PKT için eğri altında kalan alan değeri 0,722 (%95 GA 0,660-0,784) idi. Çok değişkenli lojistik regresyon analizinde, yaş, SKB, oksijen satürasyonu ve laktat acil serviste mortalite için bağımsız risk faktörleri olarak tespit edildi.

Sonuç: Acil servise başvuran hastalarda yüksek PKT seviyeleri artmış mortalite ile ilişkilidir. PKT düzeyi yüksek olan hastalarda yoğun bakım ünitesine yatış ve ölüm daha fazladır. Acil servis başvurusunda ileri yaş, düşük sistolik kan basıncı, düşük oksijen satürasyonu ve yüksek laktat seviyeleri mortalite için bağımsız risk faktörleridir.

Keywords

Prokalsitonin, mortalite, acil servis, hastaneye yatış

The Relationship Between Procalcitonin Level and Short Term Mortality in Emergency Department

An Erratum to this article was published on March 31, 2024. https://dergipark.org.tr/en/pub/anatolianjem/issue/84043/1463330

Abstract

Aim: Procalcitonin (PCT) is a biomarker for infection, which has grown in popularity in recent years. In our study, we investigated whether there was a relationship between procalcitonin levels and seven-day mortality in all patients whose procalcitonin levels were measured in the emergency department (ED).

Material and Methods: In this single-center, cross-sectional, analytic, retrospective study, the patients whose PCT levels were measured in Dokuz Eylül University Hospital adult emergency department between 01.01.2016 and 31.03.2016 were included. PCT level and other parameters were evaluated in the survived and non- survived groups,

Results: We analyzed 499 patients whose PCT levels were measured. The median age was 74 (IQR: 63-82) years, and 54% were male. Of the 499 patients, 6 (1.2%) had a low procalcitonin level (median 0.03: IQR 0.02-0.04), 407 (81.6%) had an intermediate procalcitonin level (median 0.26; IQR 0.16-0.54) and 86 (17.2%) had a high procalcitonin level (median 5.54; IQR 3.20-15.31). When the PCT level-high group was compared with the other groups; systolic blood pressure (SBP), diastolic blood pressure (DBP), platelet count, pCO2 were lower and pulse rate, WBC, lactate, base excess values were higher. It was found that 249 (49.9%) of the patients were discharged from the ED, 112 (22.4%) were hospitalized, 66 (13.2%) were hospitalized in the intensive care unit, and 72 (14.4%) died. The PCT level was higher in the non-survivor group than in the survivor group (0.29 ngr/mL vs 1.07 ngr/mL, p<0.001). Univariate analysis showed that the non-survivor group had higher age, pulse, respiratory rate, procalcitonin levels, lactate and base deficiency levels, and lower SBP, DBP, oxygen saturations, and pH. The AUC for PCT was 0.722 (CI% 0.660-0.784) in the ROC curve In the multivariate logistic regression analysis, age, SBP, oxygen saturation, and lactate were independent risk factors for mortality in ED.

Conclusion: High PCT levels are associated with increased mortality in patients admitted to the ED. Patients with high- PCT levels showed higher mortality and were hospitalized in the intensive care unit. Advanced age, low systolic blood pressure, low oxygen saturation and high lactate levels are independent risk factors for mortality in ED admissions.

Keywords

Procalcitonin, mortality, emergency department, hospitalization

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