Yoğun Bakıma Kabul Edilen Sepsisli Geriatrik Hastalarda Polifarmasinin Prokalsitonin Değerlerine Olan Etkisi

Abstract

Amaç: Yoğun bakım (YB) hastalarının önemli kısmı sepsisli ve kronik hastalıkları nedeniyle polifarmasi maruziyeti olan yaşlılardır. Prokalsitonin (PCT) klinikte sepsis ön tanısında kullanılan, değeri gittikçe artan bir biyobelirteçtir. Çalışmamızla sepsis ön tanılı 65 yaş üstü hastaların yoğun bakıma kabulünde polifarmasinin PCT düzeylerine olan etkisi incelenmiştir. Gereç ve Yöntem: Sepsis nedeniyle yoğun bakım kabulü yapılan yaşlı hastaların demografik özellikleri, sepsisle ilişkili laboratuvar sonuçları, SOFA ve APACHE skorları, kullandıkları ilaçlar kaydedildi. Bulgular: Toplam 227 hastanın olduğu çalışmada medyan yaş 77(70-84)’dir. Hastaların %41’i genç-yaşlı, %35.7’si orta-yaşlı, %23.3’ü ileri-yaşlıdır. %49.8 hastada polifarmasi varken, %50.2’sinde yoktur. Genç-yaşlıların %39.8’i polifarmasi(+), %60.2’si ise polifarmasi(-)’dir. Orta-yaşlılarda oranlar sırasıyla %56.8 ve %43.2 iken ileri yaşlılarda %58.5 ve %41.5’dir. Yaş gruplarına göre polifarmasi görülme açısından genç-yaşlılarla diğer gruplar arasında anlamlı fark vardır (p<0.05). Ortalama 5.7±2.4 farklı ilaç kullanan hastalarda sıkça kullanılan ilaçlar sırasıyla antihipertansifler, proton pompası inhibitörleri, steroid olmayan antiinflamatuarlardır. Polifarmasi(+) grupta, polifarmasi(-) gruba göre PCT değerlerinde anlamlı azalma vardır. YB’a alınacak ciddi enfeksiyonlu ve sepsis riski taşıyan polifarmasili yaşlılarda, 5 ng/mL’nin üzerindeki PCT değerleri polifarmasi gözlenmeyenlere göre anlamlı düşüktür (p<0.05). 5 ng/mL’nin altındaki lokal enfeksiyonlu ve olası sepsis riski taşımayan yaşlı hastalardaysa gruplar arasında PCT düzeyleri açısından anlamlılık yoktur. Sonuç: Yoğun bakıma kabul edilen sepsisli yaşlılarda yaş ilerledikçe polifarmasi görülme oranları artmaktadır. Yoğun bakıma kabul edilen özellikle ciddi enfeksiyonlu ve sepsis riski taşıyan polifarmasili yaşlılarda PCT değerleri polifarmasi gözlenmeyenlere göre anlamlı şekilde düşüktür. Polifarmasili yaşlılarda sepsisin tanı ve takibinde dikkatli olunmalı, PCT değerleri mutlaka klinik bulgularla birlikte değerlendirilmelidir.

Keywords

• Geriatri,Yoğun Bakım Ünitesi,Polifarmasi,Sepsis,Prokalsitonin

The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients with Sepsis

Abstract

Objective: Procalcitonin(PCT) is a biomarker used in early diagnosis of sepsis and gaining more value day by day. This study aimed to research the effect of polypharmacy on PCT levels in admission to intensive care unit(ICU) of elderly patients pre-diagnosed with sepsis. Methods: Data of the elderly patients who admitted to intensive care due to sepsis were recorded, such as demographic features like age and gender, sepsis-related laboratory results, SOFA and APACHE II scores, medications they used, were recorded. Results: The percentage of young-old, middle-old, and very-old patients was %41%, 35.7%, and 23.3%, respectively. In young-old patients those who are polypharmacy form 39.8% and non-polypharmacy form 60.2%. In middle-old patients, the rates are 56.8%-43.2%, and in very-old patients are 58.5%-41.5%, respectively. According to age groups, there is a significant difference in the polypharmacy in terms of prevalence in the young-old groups and the other groups(p<0.05). In the polypharmacy group, there is a significant decrease in PCT values compared to the non-polypharmacy group. In old patients with polypharmacy, that has serious infection, at the risk of sepsis and will be admitted to the ICU, PCT values above 5 ng/mL, found significantly lower than patients without polypharmacy(p<0.05). Conclusions: PCT levels are significantly lower in the elderly who are admitted to ICU, especially those with severe infection and polypharmacy who have sepsis risk, compared to those without polypharmacy. Care should be taken in the diagnosis and follow-up of sepsis in elderly patients with polypharmacy, PCT levels should be evaluated together with clinical findings.

Keywords

• Geriatrics,Intensive Care Units,Polypharmacy,Sepsis,Procalcitonin

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