Sepsis ve prokalsitonin

Year 2009, Volume: 31 Issue: 4, 502 - 512, 05.08.2009

Özgür Günal Hüseyin Barut

Abstract

Özet

Sepsis, bir çok sistemi etkileyen, hemodinamik değişikliklere yol açan, şok, organ fonksiyon bozukluğu ve organ yetmezliğine kadar giden ölümcül bir enfeksiyon hastalığıdır. Tedavideki yeni gelişmelere rağmen mortalitesi hala yüksektir. Enfeksiyon ile enfeksiyon dışı sistemik inflamatuar durumların ayrımının hızlı bir şekilde yapılarak uygun tedaviye başlanması hastaların morbidite, mortalite ve bakım maliyetlerinin azalmasını sağlayacaktır. Prokalsitonin son yıllarda enfeksiyon belirteçlerine eklenen yeni bir parametredir. Prokalsitonin (PCT); ciddi enfeksiyonların tanısında kullanılan daha hızlı ve daha iyi bir belirteç olarak karşımıza çıkmaktadır. Ayrıca PCT, bu hasta grubunda prognoz ve tedaviye yanıtın izleminde de kullanılabilmektedir. Bu yazıda prokalsitoninin sepsis tanısı ve prognozunu belirlemedeki öneminden bahsedilmiştir.

Anahtar kelimeler: Sepsis, prokalsitonin

 

Abstract

Sepsis is a fatal infection disease affecting many of the systems, causing hemodynamic changes, organ dysfunction and even organ failure. Despite the new developments in the treatment, its mortality is still high. Starting the suitable treatment rapidly after the separation between the infection and systemic inflammatory cases out of infection will provide to reduce morbidity, mortality and care costs of the patients. Procalcitonin (PCT) is a new parameter added to the infection markers recently. PCT is occurred to be more rapid and better marker used in diagnosis of serious infections. Besides, PCT can be used to follow the response to the treatment and the prognosis in this patient group. In this report, it is mentioned that PCT is important to diagnose sepsis, and to determine the prognosis of sepsis.

Keywords: Sepsis, procalcitonin

Keywords

-

SEPSIS AND PROCALCITONIN

Abstract

Sepsis is a fatal infection disease affecting many of the systems, causing hemodinamic changes, organ disfunction and even organ failure. Despite the new developments in the treatment, its mortality is stil high. Starting the suitable treatment rapidly after the seperation between the infection and systemic inflamatuar cases out of infection will provide to reduce morbidity, mortality and care costs of the patients. Procalcitonin (PCT) is a new parameter added to the infection markers recently. PCT is occured to be more rapid and better marker used in diagnosis of serious infections. Besides, PCT can be used to follow the response to the treatment and the prognosis in this patient group. In this report, it is mentioned that PCT is important to diagnose sepsis, and to determine the prognosis of sepsis.

Keywords

Sepsis, prokalsitonin

References

• Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29: 1303-10.
• Yorgancı K, Sayek İ : Sepsis ve ilgili tanımlamalar. Yoğun bakım dergisi 2005; 5: 75-79.
• Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RMH, Sibbald WJ. ACCP/SCCM Consensus Conference : Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992; 101: 1644-55.
• Levy MM, Fink MP, Marshall JC. 2001 SCC/ESICM/ACCP/ATS/SIS International sepsis definition conferance. Crit Care Med 2003; 31: 1250-56.
• Martin GS, Mannino DM, Eaton S, Moss M. The epidemiyoloji of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348: 1546-54.
• Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, Sicignano A, Plazzo M, Moreno R, Boulme R, Lepage E, Le Gall JR. Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 2002; 28: 108-121.
• Öncü S. Sepsisi tanıyormuyuz ? ANKEM Derg 2006; 20: 40.
• Doğanay M. Sepsis.. Enfeksiyon Hastalıkları ve Mikrobiyolojisi Cilt 1. Topçu AW, Söyletir G, Doğanay M. (editörler). Nobel Tıp Kitapevleri, İstanbul 2002, 621-36.
• Nee P.A. Emerg Med J 2006; 23: 713–17.
• Weinstein MP, Towns ML, Quartery SM. The clinical significance of positive blood cultures in the 1990s: A prospective comprehensive evaluation of microbiology, epidemiology and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997; 24: 584.
• Dimirdağ K, Özden M, Gödekmerdan A, Cihangiroğlu M. Sepsis olgularında prokalsitonin, TNF-α ve C-reaktif protein düzeylerinin değerlendirilmesi. Klimik Dergisi 2003; 16: 21-4.
• James K. Cellular and humoral mediators of infmamation. Clinical Laboratory Medicine. 2th ed. McClatchey KD (ed): Lippincott Williams& Wilkins, Philadelphia 2002, 1426-47.
• Llewelyn M, Cohen J. Diagnosis of infection in sepsis. Intensive Care Med 2001; 27: 10- 32.
• Lynn WA. Sepsis : Infectious Diseases: volume one, section 2. Armstrong D, Cohen J. (eds) Mosby: London; 1999, p: 613-27.
• Zeerleder S, Zwart B, Wuillemin WA, Aerden LA, Groeneveld ABJ, Caliezi C, Nieuwenhuijze AEM, Mierio GJ, Eerenberg AJM, Lammle B, Hack CE. Elevated nucleosome levels in systemic inflammation and sepsis. Crit Care Med 2003; 31: 1947- 51.
• Matot I, Sprung CL. Definition of sepsis. Intensive Care Med 2001; 27: 3-9.
• Çelikel T : Sepsis : Genel bakış. Yoğun Bakım Dergisi 2005; 5: 73-4.
• Ruokonen E, IIkka L, Niskanen M, Takala J. Procalcitonin and neopterin as indicators in critically ill patients. Acta Anaesthesiol Scan 2002; 46: 398-404.
• Maisner M. Procalcitonin-a new, innovative infection parameter biochemical and clinical aspects. 3. revised and expanded edition. (Thieme, Stuttgart, New York), 2000.
• Carrol ED, Thomson APJ, Hart CA. Procalcitonin as a marker of sepsis. Int J Antimicrob Agents 2002; 20:1-9.
• Gendrel D, Bohuon C. Procalcitonin as a marker of bacterial infection. Pediatr Infect Dic J 2000; 19: 679-88.
• Maruna P, Nedelnikova K, Gürlich R. Physiology and genetics of procalcitonin. Physiol Res 2000; 49: 57-61.
• Oczenski W, Fitzgerald R:D and Scwarz S. Procalcitonin: a new parameter for the diagnosis of bacterial infection in the peri-operative perion. European Journal of Anesthesiology 1998; 15: 202-09.
• Ortatatlı M, Özgüven V, Şengül A. Sepsis ve ağır enfeksiyonların tanı ve takibinde yeni bir belirteç: Prokalsitonin. Flora 1999; 4: 151-55.
• Monneret G, Laroche B, Bienvenu J. Procalcitonin is not produced by circulating blood cells. Infection 1999; 27: 34-5.
• Meisner M, Tschaikowsky K, Schnabel S, Schmidt J, Katalinic A, Schüttler J. Procalcitonin-influence of temperature, storage, anticoagulation and arterial or venous asservation of blood samples on procalcitonin concentrations. Eur J Clin Chem Clin Biochem 1997; 35: 597-601.
• Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaund J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341: 515- 18.
• Gandrel D, Raymond J, Coste J, Moulin F, Lorror M, Guerin S, Ravilly S, Lefevre H, Royer C, Lacombe C, Palmer P, Bohuon C. Comparison of procalcitonin with C-reactive protein, interleukin 6 and interferon-alpha for differentitation of bacterial vs. viral infections. Pediatr Infect Dis J 1999; 18: 875-81.
• Clec’h C, Ferriere F, Karoubi P, Fosse J.P, Cupa M, Hoang P, Cohen Y. Diagnostic and prognostic value of procalcitonin in patients with septic shock. Crit Care Med 2004; 32: 1166-9.
• Balcı C, Sungurtekin H, Gürses E. Usefulness of procalcitonin for diagnosis of sepsis. Critical Care 2003; 7: 85-90.
• Ghorbani G. Procalcitonin role in differential diagnosis of infection stages and non infection inflammation. Pak J Biol Sci 2009; 12: 393-6.
• Lee CC, Chen SY, Tsai CL, Wu SC, Chiang WC, Wang JL, Sun HY, Chen SC, Chen WJ, Hsueh PR. Procnostic value of mortality in emergency department sepsis score, procalcitonin and C-reactif protein in patients with sepsis at the emergency department. Shock 2008; 29: 322-7.
• Brunkhorst R, Ebenhard OK, Haubitz M, Brunkhorst EM. Procalcitonin for discirimination between activity of systemic autoimmune disease and systemic bacterial infection. Intensive Care Med 2000; 26: 199-201.
• Brunkhorst FM, Eberhard OK, Brunkhorst R. Discrimination of infectious and noninfectious causes of early acute respiratory distress syndrome by procalcitonin. Crit Care Med 1999; 27: 2172-6.
• Niederman MS. Biological markers to determine eligibility in trials for community- acquired pneumonia: a focus on procalcitonin. Clin Infect Dis. 2008; 47: 127-32.
• Brunkhorst FM, Wegscheider K, Forycki ZF, Brunkhorst R. Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis and septic shock. Intensive Care Med 2000; 26: 148-52.