Serum prolidaz, palyatif bakım hastalarında bası ülserleri için prediktif bir biyobelirteç olabilir mi?

Year 2025, Volume: 6 Issue: 5, 487 - 490, 24.10.2025

Osman Başpınar , Deniz Avcı , Yasin Şimşek , Anıl Uçan , Derya Koçer , Oğuzhan Sıtkı Dizdar

Abstract

Giriş:
Prolidaz, inflamasyon, doku hasarı, yara iyileşmesi ve benzeri birçok durumda rol oynayan bir belirteçtir. Basınç ülserleri (BÜ), palyatif bakım servislerinde yatan hastalarda yaygın olarak görülen ve morbidite ile mortaliteyi artıran önemli durumlardır. Bası yaralarının şiddetinin öngörülmesi, izlem ve tedavi açısından oldukça önemlidir. Prolidazın bu tür yaralarla olan ilişkisinin klinik fayda sağlaması mümkündür.

Hastalar ve yöntemler:
Çalışmaya palyatif bakım ünitesinde yatan 76 hasta dahil edilmiştir. Hastalar, basınç ülserinin varlığına ya da yokluğuna göre iki gruba ayrılmıştır. Kontrol grubu, bası ülseri olmayan grup olarak tanımlanmıştır. Hafif ve şiddetli BÜ olan hastalar ise ayrı gruplarda değerlendirilmiştir. Tüm hastaların C-reaktif protein (CRP) ve Prolidaz düzeyleri ölçülmüştür. Yaraların enfekte olmadığını teyit etmek amacıyla prokalsitonin düzeyi de değerlendirilmiştir.

Bulgular:
Basınç ülseri olan grupta, olmayan gruba kıyasla prolidaz ve CRP düzeyleri anlamlı derecede yüksek bulunmuştur. Hafif ve şiddetli yaraları olan hastalar karşılaştırıldığında, şiddetli grup daha yüksek CRP ve prolidaz düzeylerine sahipti.

Sonuç:
Bu öncü çalışma, palyatif bakım servisinde yatan BÜ’lü hastalarda prolidazın bası yaralarının takibi ve ilerleyişinde bir belirteç olarak kullanılabileceğini göstermiştir.

Keywords

prolidaz , bası ülseri , C-reaktif protein , palyatif bakım , prokalsitonin

Potential role of serum prolidase as a biomarker in predicting pressure ulcers among palliative care patients

Abstract

Aims: Prolidase is a marker that plays a role in inflammation, collagen turnover, tissue damage, wound healing and many similar conditions. Pressure ulcers (PU) are common among palliative care patients and increase morbidity and mortality. Predicting the severity of PU is very important for follow-up and treatment. It is possible that the association of prolidase with such wounds will provide clinical benefit.
Methods: The prospective cross-sectional study included 76 hospitalized patients in a palliative care unit between 2019 and 2020. Patients were divided into two groups: with PU and without PU (controls). PU patients were classified into mild (stages I–II) and severe (stages III–IV). Serum prolidase level, C-reactive protein (CRP), and procalcitonin were measured.
Results: Patients with PU had significantly higher prolidase and CRP levels compared with controls. Severe PU patients had higher prolidase and CRP than mild PU patients. Procalcitonin levels were low and similar across groups. A positive correlation was found between prolidase, CRP, and PU severity.
Conclusion: Serum prolidase level may be a useful biomarker reflecting PU severity in palliative care patients. Further largescale prospective studies are needed.

Keywords

Prolidase , pressure ulcer , C-reactive protein , palliative care , procalcitonin

Ethical Statement

The study was initiated with the approval of the "Erciyes University Ethics Committee for Clinical Research" (Date: 2019, Decision No:424).

Supporting Institution

none

References

• Kitchener RL, Grunden AM. Prolidase function in proline metabolism and its medical and biotechnological applications. J Appl Microbiol. 2012;113(2):233-247. doi:10.1111/j.1365-2672.2012.05310.x
• Ramshaw JA, Shah NK, Brodsky B. Gly-X-Y tripeptide frequencies in collagen: a context for host-guest triple-helical peptides. J Struct Biol. 1998;122(1-2):86-91. doi:10.1006/jsbi.1998.3977
• Laurent GJ. Dynamic state of collagen: pathways of collagen degradation in vivo and their possible role in regulation of collagen mass. Am J Physiol. 1987;252(1 Pt 1):C1-9. doi:10.1152/ajpcell.1987.252.1.C1
• Duong HS, Zhang QZ, Le AD, Kelly AP, Kamdar R, Messadi DV. Elevated prolidase activity in keloids: correlation with type I collagen turnover. Br J Dermatol. 2006;154(5):820-828. doi:10.1111/j.1365-2133.2006.07167.x
• Surazynski A, Miltyk W, Palka J, Phang JM. Prolidase-dependent regulation of collagen biosynthesis. Amino Acids. 2008;35(4):731-738. doi:10.1007/s00726-008-0051-8
• Posthauer ME, Banks M, Dorner B, Schols JM. The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper. Adv Skin Wound Care. 2015;28(4):175-188. doi:10. 1097/01.ASW.0000461911.31139.62
• Jaul E, Calderon-Margalit R. Systemic factors and mortality in elderly patients with pressure ulcers. Int Wound J. 2015;12(3):254-259. doi:10. 1111/iwj.12086
• Degerli MS. Pressure ulcers in palliative care unit patients. Experimed. 2023;13(2):133-141. doi:10.26650/experimed.1322111
• Biçer EK, Güçlüel Y, Türker M, Kepiçoğlu NA, Şekerci YG, Say A. Pressure ulcer prevalence, incidence, risk, clinical features, and outcomes among patients in a Turkish hospital: a cross-sectional, retrospective study. Wound Manag Prev. 2019;65(2):20-28. doi:10.25270/wmp.2019.2.2028
• Gürlek F, Taşdemie E, Erol A, Coşkun F. Comparison of the incidence of pressure ulcers among patients admitted to the palliative care service from different providers. Fam Pract Palliat Care. 2025;10(1):5-10. doi:10. 22391/fppc.1528838
• National Pressure Injury Advisory Panel. NPIAP pressure injury. Stages. Last accessed August 19, 2020.
• Keller BP, Wille J, van Ramshorst B, van der Werken C. Pressure ulcers in intensive care patients: a review of risks and prevention. Intensive Care Med. 2002;28(10):1379-1388. doi:10.1007/s00134-002-1487-z
• Karakioulaki M, Stolz D. Biomarkers in pneumonia-beyond procalcitonin. Int J Mol Sci. 2019;20(8):2004. doi:10.3390/ijms20082004
• Eren MA, Torun AN, Tabur S, et al. Serum prolidasE activity in diabetic foot ulcers Acta Diabetol. 2013;50(3):423-427. doi:10.1007/s00592-012-0448-4
• Gonzalez AC, Costa TF, Andrade ZA, Medrado AR. Wound healing-a literature review. An Bras Dermatol. 2016;91(5):614-620. doi:10.1590/abd1806-4841.20164741
• Senboshi Y, Oono T, Arata J. Localization of prolidase gene expression in scar tissue using in situ hybridization. J Dermatol Sci. 1996;12(2):163-171. doi:10.1016/0923-1811(95)00505-6
• Ayas ZO, Kotan D, Akdogan M, Gunel ME. Serum prolidase enzyme activity level: not a predictive biomarker for epilepsy. Eurasian J Med. 2019;51(1):27-30. doi:10.5152/eurasianjmed.2018.18183
• Tarján D, Szalai E, Lipp M, et al. Persistently high procalcitonin and C-reactive protein are good predictors of infection in acute necrotizing pancreatitis: a systematic review and meta-analysis. Int J Mol Sci. 2024; 25(2):1273. doi:10.3390/ijms25021273