Sepsis Hastalarında Laktat, Laktat Klirensi, CRP, Prokalsitonin ve Klinik Skorlama Sistemlerinin Prognostik Değeri: Retrospektif Gözlemsel Bir Çalışma

Abstract

Sepsis, yüksek ölüm oranları ve önemli sağlık yükleriyle ilişkili, dünya çapında kritik bir sağlık sorunudur. Sepsis hastalarının erken teşhisi ve prognoz değerlendirmesi, optimum yönetim için esastır. Laktat, prokalsitonin (PCT) ve C-reaktif protein (CRP) dahil olmak üzere çeşitli biyobelirteçler ve Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II (APACHE II) ve Sıralı Organ Yetmezliği Değerlendirmesi (SOFA) gibi klinik puanlama sistemleri, sepsis hastalarında sonuçları tahmin etmek için kullanılmıştır. Bu çalışma, laktat, laktat klirensi, CRP, PCT, APACHE II ve SOFA puanlarının sepsis hastalarında mortaliteyi tahmin etmedeki prognostik etkinliğini değerlendirmeyi amaçlamıştır. Ocak 2016 ile Ocak 2019 arasında sepsis tanısı konulan ve yoğun bakım ünitesine (YBÜ) yatırılan 118 yetişkin hasta üzerinde retrospektif bir gözlemsel çalışma yürütüldü. Hasta demografisi, eşlik eden hastalıklar, yatış laktat, CRP ve PCT düzeyleri, 6, 12 ve 24. saatlerde seri laktat ölçümleri ve karşılık gelen laktat klirensleri kaydedildi. APACHE II ve SOFA skorları yatışta hesaplandı. Bu değişkenlerin 28 günlük mortaliteyi tahmin etmedeki prognostik önemini belirlemek için ROC eğrisi analizi ve lojistik regresyon dahil istatistiksel analizler yapıldı. Genel 28 günlük mortalite oranı %48,3 idi. Daha yüksek başlangıç laktat düzeyleri mortalite ile önemli ölçüde ilişkiliydi (p<0,001), optimum kesme değeri ≥2,2 mmol/L idi ve %82,5 duyarlılık ve %85,2 özgüllük sağladı. 6 saatlik laktat seviyesi de mortalitenin güçlü bir öngörücüsüydü (AUC 0,839, p<0,001). 6, 12 ve 24. saatlerdeki laktat klirensi, başlangıç laktatına kıyasla daha zayıf prognostik değer gösterdi. Daha yüksek APACHE II (≥22) ve SOFA (≥8) skorları mortalite ile önemli ölçüde ilişkiliydi (p<0,001). Lojistik regresyon analizi, erkek cinsiyetinin (OR: 6,53, p=0,018), kabul sırasında hipotansiyonun (OR: 29,78, p=0,011), başlangıç laktatının (OR: 11,95, p=0,004) ve vazopressör gereksiniminin (OR: 114,98, p=0,007) mortalitenin bağımsız öngörücüleri olduğunu ortaya koydu. Sonuç olarak; laktat ve seri ölçümlerinin sepsis hastalarında mortaliteyi tahmin etmede en güvenilir biyobelirteçler olduğu, laktat klirensi, CRP ve PCT ile karşılaştırıldığında üstün duyarlılık ve özgüllüğe sahip olduğu bulundu. APACHE II ve SOFA skorları da önemli prognostik göstergelerdi. Sepsis yönetiminde optimum risk sınıflandırması için birden fazla biyobelirteç ve klinik puanlama sistemini entegre eden kapsamlı bir yaklaşım önerilir.

Keywords

• Sepsis
• Laktat
• Biyobelirteçler
• APACHE II
• SOFA

Prognostic Value of Lactate, Lactate Clearance, CRP, Procalcitonin, and Clinical Scoring Systems in Sepsis Patients: A Retrospective Observational Study

Abstract

Sepsis is a critical health issue worldwide, associated with high mortality rates and significant healthcare burdens. Early identification and prognosis assessment of sepsis patients are essential for optimal management. Various biomarkers, including lactate, procalcitonin (PCT), and C-reactive protein (CRP), as well as clinical scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA), have been used to predict outcomes in sepsis patients. This study aimed to evaluate the prognostic effectiveness of lactate, lactate clearance, CRP, PCT, APACHE II, and SOFA scores in predicting mortality in sepsis patients. A retrospective observational study was conducted on 118 adult patients diagnosed with sepsis and admitted to the intensive care unit (ICU) between January 2016 and January 2019. Patient demographics, comorbidities, admission lactate, CRP, and PCT levels, serial lactate measurements at 6, 12, and 24 hours, and corresponding lactate clearances were recorded. APACHE II and SOFA scores were calculated at admission. Statistical analyses, including ROC curve analysis and logistic regression, were performed to determine the prognostic significance of these variables in predicting 28-day mortality. The overall 28-day mortality rate was 48.3%. Higher initial lactate levels were significantly associated with mortality (p<0.001), with an optimal cut-off value of ≥2.2 mmol/L, yielding a sensitivity of 82.5% and specificity of 85.2%. The 6-hour lactate level was also a strong predictor of mortality (AUC 0.839, p<0.001). Lactate clearance at 6, 12, and 24 hours demonstrated weaker prognostic value compared to initial lactate. Higher APACHE II (≥22) and SOFA (≥8) scores were significantly correlated with mortality (p<0.001). Logistic regression analysis revealed that male gender (OR: 6.53, p=0.018), hypotension at admission (OR: 29.78, p=0.011), initial lactate (OR: 11.95, p=0.004), and vasopressor requirement (OR: 114.98, p=0.007) were independent predictors of mortality. In conclusion; lactate and its serial measurements were found to be the most reliable biomarkers for predicting mortality in sepsis patients, with superior sensitivity and specificity compared to lactate clearance, CRP, and PCT. APACHE II and SOFA scores were also significant prognostic indicators. A comprehensive approach integrating multiple biomarkers and clinical scoring systems is recommended for optimal risk stratification in sepsis management.

Keywords

• Sepsis
• Lactate
• Biomarkers
• APACHE II
• SOFA

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