Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit

Year 2020, Volume: 5 Issue: 1, 12 - 17, 19.03.2020

İsmail Demir Muammer Yücel

https://doi.org/10.22391/fppc.650570

Cited By: 2

Abstract

Introduction: Sepsis is defined as life-threatening organ dysfunction caused by the body's irregular response to infection. Sepsis is the most common cause of death in intensive care units in elderly patients. The effect of CRP, procalcitonin levels and neutrophil/lymphocyte ratio at the time of admission on mortality of internal diseases patients in ICU over 65 years of age are investigated in this study.
Methods: The medical records of 207 patients with sepsis hospitalized between June 2018 and May 2019 in the Internal Medicine ICU of Bozyaka Training and Research Hospital were evaluated retrospectively in this cross-sectional study. Demographic data, APACHE II score, SOFA score, presence of systemic disease, CRP, procalcitonin, complete blood count, ICU stay and mortality status were recorded.
Results: The mean age of the geriatric patients with 207 sepsis hospitalized in the ICU over a 12-month period was 77.6±8.4 years. The study group consisted of 100 (48.3%) males and 107 (51.7%) females. In the study, 73(35.3%) of the patients died due to sepsis, 134(64.7%) were the surviving group. There was no difference between surviving and deceased patient groups in terms of length of stay (p=0.880). APACHE-II and SOFA scores were found to be statistically different between surviving and deceased patients (p<0.001). The mean procalcitonin level was 3.54±4.77µg/L among the surviving group and 20.83±12.18µg/L among the deceased patient group (p<0.001). The mean CRP was 97.7±77.4mg/L by the surviving group and 136.9±100.8 mg/L by the deceased patient group (p=0.002). The neutrophil/lymphocyte ratio was 7.49±6.83 in the surviving group and 12.73±15.09 in the deceased patient group (p=0.006).
Conclusion: Mortality rates of inpatients in ICU were higher than inpatients in other wards. Systematic evaluation of neutrophil/lymphocyte ratio, CRP and procalcitonin results, as well as complete blood count parameters during hospitalization, may be valuable in predicting intensive care outcomes of patients.

Keywords

Sepsis, intensive care unit, procalcitonin, neutrophil/lymphocyte ratio, C-Reactive Protein, neutrophil/lymphocyte ratio

Sepsisli geriatrik hastaların mortalitesi ile yoğun bakım ünitesine kabulündeki C-Reaktif Protein, Prokalsitonin ve Nötrofil/Lenfosit oranının ilişkisi

Abstract

Giriş: Sepsis, vücudun enfeksiyona karşı verdiği düzensiz yanıt nedeniyle oluşan, yaşamı tehdit eden organ fonksiyon bozukluğudur. Yaşlı hastalarda yoğun bakım ünitelerindeki (YBÜ) ölümlerin en sık sebebi sepsistir. Çalışmada Dahiliye YBÜ’de tedavi gören, sepsis tanılı 65 yaş ve üzeri hastalarda yatış esnasında CRP, prokalsitonin ve nötrofil/lenfosit oranının mortalite ile ilişkisi araştırılmıştır.
Yöntem: Kesitsel nitelikteki araştırmada SBÜ Bozyaka Eğitim Araştırma Hastanesi Dahiliye YBÜ’de Haziran 2018 ve Mayıs 2019 tarihleri arasında (12 ay) yatan sepsis tanılı 207 olgunun kayıtları geriye dönük olarak incelendi. Hastaların demografik verileri ile birlikte APACHE II skoru, SOFA skoru, sistemik hastalık varlığı, ilk alınan kan örneklerinden CRP, prokalsitonin, tam kan sayımı, yoğun bakım kalış süresi ve mortalite durumu kaydedildi.
Bulgular: Yoğun Bakım Ünitesinde 12 aylık süreçte izlenen sepsis tanılı 207 geriatrik hastanın yaş ortalaması 77,6±8,4 yıl olup %51.7’si (n=107) kadındı. Olguların 73’ü (%35,3) sepsis nedeniyle yaşamını yitirirken, 134’ü (%64,7) sağ kalan grubu oluşturdu. Sağkalan ve ölen hasta grupları arasında yatış süresi açısından fark saptanmadı (p=0,880). APACHE-II ve SOFA skorları, sağ kalan ve ölen hastalar arasında istatistiksel olarak farklı bulundu (p<0,001). Sağ kalan hasta grubunda prokalsitonin ortalaması 3,54±4,77 µg/L iken ölen hasta grubunda 20,83±12,18 µg/L olarak saptandı (p<0,001). Sağ kalan hasta grubunda CRP ortalaması 97,7±77,4 mg/L iken ölen hasta grubunda 136,9±100,8 mg/L idi (p=0,002). Sağ kalan ve ölen hasta gruplarının tam kan sayımı parametrelerinden lökosit, nötrofil, lenfosit sonuçlarında anlamlı fark yoktu. Nötrofil/lenfositoranı sağ kalan grupta 7,49±6,83 iken, ölen hasta grubunda 12,73±15,09 idi (p=0,006).
Sonuç: YBÜ’nde yatan hastaların mortalite oranları diğer servislerde yatan hastalara gore daha yüksektir. Yatış esnasındaki tam kan sayımı parametrelerinin yanında nötrofil/lenfositoranı, CRP ve prokalsitonin sonuçlarının sistematik bulgularla değerlendirilmesi hastaların yoğun bakım akıbetlerinin öngörülmesinde değerli olabilir. 

Keywords

Sepsis, yoğun bakım ünitesi, nötrofil/lenfosit oranı, prokalsitonin, C-Reaktif Protein, nötrofil/lenfosit oranı

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