Sepsis hastalarında inflamasyon ilişkili prognostik skorlar CRP/albumin, LDH/albumin ve laktat/albumin oranlarının değerlendirilmesi

Abstract

Amaç: Septik hastalarda C-reaktif protein (CRP), laktat dehidrogenaz (LDH) ve laktat gibi inflamasyona dayalı parametrelerin klinik yararlılığı ve tahmin doğruluğuna ilişkin sonuçlar çelişkilidir. Çalışmamızda bu inflamatuvar parametrelerin albumin ile kombinasyonunun, hastalık şiddeti ve prognoz ile ilişkilerini değerlendirmeyi amaçladık. Gereç ve yöntem: Sepsis tanısı konulan 98 hasta, yoğun bakım ünitesi (YBÜ) mortalitelerine göre yaşayanlar (n=68) ve ölenler (n=30) olarak sınıflandırıldı. Prognostik faktörler receiver operating characteristic curve ve Cox proportional hazard regression model ile değerlendirildi. Sağ kalım Kaplan-Meier methodu ile analiz edildi. Bulgular: Yaşayan hastalarla karşılaştırıldığında, ölen hastalarda CRP ve laktat düzeyleri artmıştı (sırasıyla 13,5'e karşı 10,0, p=0,044; 2,2'ye karşı 1,7, p=0,006), ancak LDH ve albumin düzeyleri anlamlı derecede farklı değildi (sırasıyla 246,0'ya karşı 245,0, p=0,624; 2,9'a karşı 3,0, p=0,061). Kombine faktörler değerlendirildiğinde, CRP/albumin ve laktat/albumin ölen hastalarda anlamlı derecede yüksek iken (sırasıyla 4,9'a karşı 3,0, p=0,018; 0,8'e karşı 0,5, p=0,001), LDH/albumin ise her iki grupta benzerdi (93,1'e karşı 78,9, p=0,148). Laktat/albumin 0,709 ile en yüksek AUC'ye sahipken (p=0,001), CRP 0,628 ile en düşük AUC'ye sahipti (p=0,044). YBÜ mortalitesinin olası belirleyicilerinin çok değişkenli analizinde, yalnızca laktat kötü sonucun bağımsız bir belirleyicisi olabilirken (HR:1,998; p=0,020), diğer değişkenler bağımsız olarak ilişkili değildi. Sonuç: Septik hastalarda CRP, laktat, CRP/albumin ve laktat/albumin düzeylerindeki artış kötü sonuçlarla ilişkilidir. Laktat düzeyi mortalitenin bağımsız bir belirleyicisidir.

Keywords

• Albumin
• C-reaktif protein
• laktat
• prognoz
• sepsis

Evaluation of inflammation-related prognostic scores, CRP/albumin, LDH/albumin and lactate/albumin ratios in patients with sepsis

Abstract

Purpose: Results regarding the clinical usefulness and predictive accuracy of inflammation-based parameters, including C-reactive protein (CRP), lactate dehydrogenase (LDH), and lactate in septic patients are conflicting. In our study, we aimed to evaluate the relationships of the combination of these inflammatory parameters with albumin, disease severity and prognosis. Materials and methods: 98 patients diagnosed with sepsis were categorised as survivors (n=68) and nonsurvivors (n=30) according to their intensive care unit (ICU) mortality. Prognostic factors were evaluated with the receiver operating characteristic curve and Cox proportional hazard regression model. Survival was analyzed with the Kaplan-Meier method. Results: Compared to survivors, nonsurvivors had increased CRP and lactate (13.5 vs 10.0, p=0.044; 2.2 vs 1.7, p=0.006, respectively), while LDH and albumin levels were not significantly different (246.0 vs 245.0, p=0.624; 2.9 vs 3.0, p=0.061, respectively). When combined factors were evaluated, CRP/albumin and lactate/albumin were significantly higher in nonsurvivors (4.9 vs 3.0, p=0.018; 0.8 vs 0.5, p=0.001, respectively), while LDH/albumin was similar in both groups (93.1 vs 78.9, p=0.148). Lactate/albumin had the highest AUC of 0.709 (p=0.001), while CRP had the lowest AUC of 0.628 (p=0.044). In a multivariate analysis of possible predictors of ICU mortality, only lactate could be an independent predictor of poor outcome (HR:1.998; p=0.020), while other variables were not independently associated. Conclusion: Increased CRP, lactate, CRP/albumin and lactate/albumin levels in septic patients were associated with poor outcomes. Lactate level was an independent predictor of mortality.

Keywords

• Albumin
• C-reactive protein
• lactate
• prognosis
• sepsis

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