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Başvuru sırasında toplum kökenli pnömoninin ciddiyetini tahmin etmek için herhangi bir prediktif belirtecimiz olmalı mı?

Year 2022, , 221 - 227, 26.09.2022
https://doi.org/10.47582/jompac.1159549

Abstract

Amaç: Toplum kökenli pnömoni (TKP), çocukları etkileyen önemli bir hastalıktır. Her yıl beş yaş altı yüz elli beş milyon çocuğa zatürre teşhisi konmakta, 20 milyonu hastaneye kaldırılmakta ve 2 milyonu ölmektedir. Erken tanı ve şiddet değerlendirmesi mortalite ve morbiditeyi azaltır. Bu çalışmada temel hemogram parametreleri, nötrofil-lenfosit oranı, immatür granülosit, immatür granülosit yüzdesi, CRP ve oksijen satürasyonunun hastalık şiddetine etkisinin belirlenmesi amaçlanmıştır.
Gereç ve Yöntem: Bu vaka-kontrol çalışması, Kasım 2018-Mayıs 2019 tarihleri arasında Erciyes Üniversitesi Tıp Fakültesi Çocuk Göğüs Hastalıkları Anabilim Dalı’nda yürütülmüştür. Klinik ve radyolojik bulgulara göre TKP tanısı konan altmış dokuz hasta çalışmaya dahil edildi. Hastalar hafif-orta pnömoni ve şiddetli pnömoni olmak üzere iki alt gruba ayrıldı.
Bulgular: Hafif-orta pnömonisi (%32/46,3) ve şiddetli pnömonisi (%37/53,6) olan hastaların lökosit, nötrofil, IGn, IG% ve satürasyonu karşılaştırıldı. İki grup arasında istatistiksel olarak anlamlı fark vardı (p 0,05). Ancak lenfosit sayısı, nötrofil lenfosit oranı (NLO) veya CRP’de istatistiksel olarak anlamlı bir fark yoktu (p>0,05). Pnömoninin şiddetini etkileyen bağımsız faktörleri belirlemek için tek değişkenli analiz kullanıldı. Lökositler, nötrofiller, immatür granülosit, immatür granülosit yüzdesi ve saturasyon, pnömoninin şiddetini öngörmede önemli bir etkiye sahipti (p<0,05).
Sonuç: Çalışmamız, artan immatür granülosit, immatür granülosit yüzdesi % ve azalmış oksijen satürasyonunun pnömonili çocuklarda ciddi sonuçlarla ilişkili olduğunu göstermektedir. Pnömoninin şiddetini belirlemede hastaneye başvuruda bu parametreler etkili olabilirler.

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References

  • Harris M, Clark J, Coote N, et al. British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for managing community-acquired pneumonia in children: update 2011. Thorax 2011; 66: 1-23.
  • Wardlaw T, Salama P, Johansson EW, Mason E. Pneumonia: the leading killer of children. Lancet 2006; 368: 1048-50.
  • Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008; 86: 408-16.
  • Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008; 121: 219-25.
  • Krüger S, Ewig S, Marre R, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008; 31: 349-35.
  • Hangul M, Ozturk D, Keti DB, Demirkan FG, Kose M. Plasma kallistatin levels in children with community-acquired pneumonia. Pediatr Allergy Immunol Pulmonol 2018; 31: 146-50.
  • Florin TA, Ambroggio L, Brokamp C, et al. Proadrenomedullin predicts severe disease in children with suspected community-acquired pneumonia. Clin Infect Dis 2021; 73: 524-30
  • Esposito S, Di Gangi M, Cardinale F, et al. Sensitivity and Specificity of soluble triggering receptor expressed on myeloid cells-1, midregional proatrial natriuretic peptide and midregional proadrenomedullin for distinguishing etiology and to assess severity in community-acquired pneumonia. PLoS One 2016; 1: 0163262.
  • Hangül M, Öztürk D, Keti DB, Köse M. Relationship between serum endocan levels and childhood community-acquired pneumonia. Turk Thorac J 2020; 21: 3-7.
  • Fernandes B, Hamaguchi Y. Automated enumeration of immature granulocytes. Am J Clin Pathol 2007; 128: 454-63.
  • Senthilnayagam B, Kumar T, Sukumaran J, M J, Rao K R. Automated measurement of immature granulocytes: performance characteristics and utility in routine clinical practice. Pathology Res Int 2012; 2012: 483670.
  • Ha SO, Park SH, Park SH, et al. Fraction of immature granulocytes reflects severity but not mortality in sepsis. Scand J Clin Lab Invest 2015; 75: 36-43.
  • Zeng L, Wang S, Lin M, et al. Evaluation of time to positivity for blood culture combined with immature granulocytes, neutrophil-to-lymphocyte ratio, and CRP in identifying bloodstream coagulase-negative Staphylococci infection in pediatric patients. J Clin Lab Anal 2020; 34; 23473
  • 14.Lee H, Kim I, Kang BH, Um SJ. Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia. PLoS One 2021; 16: 0250067
  • Cherian T, Mulholland EK, Carlin JB, et al. Standardized interpretation of pediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ 2005; 83: 353-9.
  • Ansari-Lari MA, Kickler TS, Borowitz MJ. Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol 2003; 120: 795-9.
  • Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than three months: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society America. Clin Infect Dis 2011; 53: 25-76.
  • Yang Z, Zhang Z, Lin F, et al. Comparisons of neutrophil-, monocyte-, eosinophil-, and basophil- lymphocyte ratios among various systemic autoimmune rheumatic diseases. APMIS 2017; 125: 863-71.
  • Dogan M, Öztürk MA. The importance of immature granulocyte and immature reticulocyte fraction for the severity of acute bronchiolitis. JPA 2022; 3: 11-5.
  • Agnello L, Giglio RV, Bivona G, et al. The value of a complete blood count (CBC) for sepsis diagnosis and prognosis. Diagnostics (Basel) 2021; 11: 1881.
  • Rey C, Los Arcos M, Concha A, et al. Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children. Intensive Care Med 2007; 33: 477-84.
  • Agnello L, Bellia C, Di Gangi M, et al. Utility of serum procalcitonin and C-reactive protein in severity assessment of community-acquired pneumonia in children. Clin Biochem 2016; 49: 47-50.
  • Dean P, Florin TA. Factors associated with pneumonia severity in children: a systematic review. J Pediatric Infect Dis Soc 2018; 7: 323-34.
  • Güngör A, Göktuğ A, Tekeli A, et al. Evaluation of the accuracy of immature granulocyte percentage in predicting pediatric serious bacterial infection. Int J Lab Hematol 2021; 43: 632-7.
  • Pimentel AM, Vilas-Boas CC, Vilar TS, Nascimento-Carvalho CM. The negative predictive ability of immature neutrophils for bacteremia in children with community-acquired infections. Front Pediatr 2020; 8: 208.
  • Huang Y, Xiao J, Cai T, et al. Immature granulocytes: A novel biomarker of acute respiratory distress syndrome in patients with acute pancreatitis. J Crit Care 2019; 50: 303-8.
  • Dean P, Schumacher D, Florin TA. Defining pneumonia severity in children: a Delphi study. Pediatr Emerg Care 2021; 37: 1482490.
  • Awasthi S, Rastogi T, Pandey AK, et al. Epidemiology of hypoxic community-acquired pneumonia in children under 5 years of age: an observational study in Northern India. Front Pediatr 2022; 9: 790109.
  • Modi P, Munyaneza RB, Goldberg E, et al Oxygen saturation can predict pediatric pneumonia in a resource-limited setting. J Emerg Med 2013; 45: 752-60.

Should we have any predictive marker for estimating the severity of community-acquired pneumonia at admission?

Year 2022, , 221 - 227, 26.09.2022
https://doi.org/10.47582/jompac.1159549

Abstract

Aim: Community-acquired pneumonia (CAP) is a disease that affects children. One hundred fifty-five million children under five years are diagnosed with pneumonia yearly, 20 million are hospitalized, and 2 million die. Early diagnosis and severity assessment reduce mortality and morbidity. This study aimed to determine the effect of basic hemogram parameters, neutrophil-lymphocyte ratio (NLR), immature (IG) granulocyte, immature granulocyte percentage (IG%), C-reactive protein (CRP), and oxygen saturation.
Material and Method: This case-control study was conducted between November 2018 and May 2019 at Erciyes University School of Medicine in the Department of Paediatric Pulmonology. Sixty-nine patients diagnosed with CAP had enrolled in the study by clinical and radiological findings. The patients were classified into two subgroups: mild-to-moderate pneumonia and severe pneumonia. The CAP severity of the disease was determined using the criteria indicated for children by the British Thoracic Society. Univariate analysis was used to identify independent factors that affect the severity of pneumonia.
Results: Pneumonia was mild-moderate in 46.3% (n=32/69) patients. Pneumonia was severe in 63% (n=37/69) of patients. Leukocytes, neutrophils, IGn, IG%, and saturations of these two groups were compared. There was a statistically significant difference between the two groups (p 0.05). However, there was no statistically significant difference in lymphocyte count, NLR, or CRP (p>0.05). Leukocytes, neutrophils, IGn, IG%, and saturation significantly predicted pneumonia severity (p<0.05).
Conclusion: Our studies show that increased IGn, IG%, and decreased oxygen saturation are related to severe outcomes in children with pneumonia. They may be effective parameters in determining the severity of pneumonia.

References

  • Harris M, Clark J, Coote N, et al. British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for managing community-acquired pneumonia in children: update 2011. Thorax 2011; 66: 1-23.
  • Wardlaw T, Salama P, Johansson EW, Mason E. Pneumonia: the leading killer of children. Lancet 2006; 368: 1048-50.
  • Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008; 86: 408-16.
  • Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008; 121: 219-25.
  • Krüger S, Ewig S, Marre R, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008; 31: 349-35.
  • Hangul M, Ozturk D, Keti DB, Demirkan FG, Kose M. Plasma kallistatin levels in children with community-acquired pneumonia. Pediatr Allergy Immunol Pulmonol 2018; 31: 146-50.
  • Florin TA, Ambroggio L, Brokamp C, et al. Proadrenomedullin predicts severe disease in children with suspected community-acquired pneumonia. Clin Infect Dis 2021; 73: 524-30
  • Esposito S, Di Gangi M, Cardinale F, et al. Sensitivity and Specificity of soluble triggering receptor expressed on myeloid cells-1, midregional proatrial natriuretic peptide and midregional proadrenomedullin for distinguishing etiology and to assess severity in community-acquired pneumonia. PLoS One 2016; 1: 0163262.
  • Hangül M, Öztürk D, Keti DB, Köse M. Relationship between serum endocan levels and childhood community-acquired pneumonia. Turk Thorac J 2020; 21: 3-7.
  • Fernandes B, Hamaguchi Y. Automated enumeration of immature granulocytes. Am J Clin Pathol 2007; 128: 454-63.
  • Senthilnayagam B, Kumar T, Sukumaran J, M J, Rao K R. Automated measurement of immature granulocytes: performance characteristics and utility in routine clinical practice. Pathology Res Int 2012; 2012: 483670.
  • Ha SO, Park SH, Park SH, et al. Fraction of immature granulocytes reflects severity but not mortality in sepsis. Scand J Clin Lab Invest 2015; 75: 36-43.
  • Zeng L, Wang S, Lin M, et al. Evaluation of time to positivity for blood culture combined with immature granulocytes, neutrophil-to-lymphocyte ratio, and CRP in identifying bloodstream coagulase-negative Staphylococci infection in pediatric patients. J Clin Lab Anal 2020; 34; 23473
  • 14.Lee H, Kim I, Kang BH, Um SJ. Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia. PLoS One 2021; 16: 0250067
  • Cherian T, Mulholland EK, Carlin JB, et al. Standardized interpretation of pediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ 2005; 83: 353-9.
  • Ansari-Lari MA, Kickler TS, Borowitz MJ. Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol 2003; 120: 795-9.
  • Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than three months: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society America. Clin Infect Dis 2011; 53: 25-76.
  • Yang Z, Zhang Z, Lin F, et al. Comparisons of neutrophil-, monocyte-, eosinophil-, and basophil- lymphocyte ratios among various systemic autoimmune rheumatic diseases. APMIS 2017; 125: 863-71.
  • Dogan M, Öztürk MA. The importance of immature granulocyte and immature reticulocyte fraction for the severity of acute bronchiolitis. JPA 2022; 3: 11-5.
  • Agnello L, Giglio RV, Bivona G, et al. The value of a complete blood count (CBC) for sepsis diagnosis and prognosis. Diagnostics (Basel) 2021; 11: 1881.
  • Rey C, Los Arcos M, Concha A, et al. Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children. Intensive Care Med 2007; 33: 477-84.
  • Agnello L, Bellia C, Di Gangi M, et al. Utility of serum procalcitonin and C-reactive protein in severity assessment of community-acquired pneumonia in children. Clin Biochem 2016; 49: 47-50.
  • Dean P, Florin TA. Factors associated with pneumonia severity in children: a systematic review. J Pediatric Infect Dis Soc 2018; 7: 323-34.
  • Güngör A, Göktuğ A, Tekeli A, et al. Evaluation of the accuracy of immature granulocyte percentage in predicting pediatric serious bacterial infection. Int J Lab Hematol 2021; 43: 632-7.
  • Pimentel AM, Vilas-Boas CC, Vilar TS, Nascimento-Carvalho CM. The negative predictive ability of immature neutrophils for bacteremia in children with community-acquired infections. Front Pediatr 2020; 8: 208.
  • Huang Y, Xiao J, Cai T, et al. Immature granulocytes: A novel biomarker of acute respiratory distress syndrome in patients with acute pancreatitis. J Crit Care 2019; 50: 303-8.
  • Dean P, Schumacher D, Florin TA. Defining pneumonia severity in children: a Delphi study. Pediatr Emerg Care 2021; 37: 1482490.
  • Awasthi S, Rastogi T, Pandey AK, et al. Epidemiology of hypoxic community-acquired pneumonia in children under 5 years of age: an observational study in Northern India. Front Pediatr 2022; 9: 790109.
  • Modi P, Munyaneza RB, Goldberg E, et al Oxygen saturation can predict pediatric pneumonia in a resource-limited setting. J Emerg Med 2013; 45: 752-60.
There are 29 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Melih Hangül

Mehmet Köse

Hüseyin Pür

Murat Doğan

Emrah Türk

Ali Ersoy

Mehmet Adnan Öztürk

Publication Date September 26, 2022
Published in Issue Year 2022

Cite

AMA Hangül M, Köse M, Pür H, Doğan M, Türk E, Ersoy A, Öztürk MA. Should we have any predictive marker for estimating the severity of community-acquired pneumonia at admission?. J Med Palliat Care / JOMPAC / Jompac. September 2022;3(3):221-227. doi:10.47582/jompac.1159549

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