KAN DOLAŞIMI ENFEKSİYONLARININ ERKEN TANISINDA İNFLAMATUVAR BELİRTEÇLERİN DEĞERLENDİRİLMESİ

Year 2021, Volume: 28 Issue: 2, 291 - 299, 15.06.2021

Fevziye Burcu Şirin , Mümtaz Cem Şirin

https://doi.org/10.17343/sdutfd.891528

Abstract

Amaç
Bu çalışmanın amacı, kan dolaşımı enfeksiyonu
(KDE)'nun tanısında kan kültürüne alternatif olarak
kullanılabilecek prokalsitonin (PCT), yüksek sensitif
C-reaktif protein (hsCRP), hsCRP/albümin oranı
(CAR) ve tam kan sayımı (TKS) parametrelerinin tanısal
performansını araştırmaktır.
Gereç ve Yöntem
Mayıs 2019-Mayıs 2020 tarihleri arasında hastanemizde
yatarak tedavi gören ve kan kültürü, PCT,
hsCRP, TKS ve albümin tetkikleri eşzamanlı istenilen
hastaların dosyaları retrospektif olarak incelendi.
Hastalar kan kültüründe üremesi olanlar (n=95) ve
kan kültüründe üremesi olmayanlar (n=157) olarak iki
gruba ayrıldı. Kan kültürleri, BacT/ALERT 3D (bioMérieux,
Fransa) otomatize kan kültürü sisteminde takip
edildi. Prokalsitonin ve hsCRP düzeyleri, Roche Cobas
6000 modüler sisteminde (Roche Diagnostics, Almanya)
ölçüldü. Tam kan sayımı analizi, UniCel DxH
800 hematoloji analizöründe (Beckman Coulter, ABD)
gerçekleştirildi.
Bulgular
Hemokültür pozitif ve hemokültür negatif grup arasında,
PCT, hsCRP, CAR, nötrofil, lenfosit, hemoglobin,
eritrosit dağılım genişliği (RDW), ortalama trombosit
hacmi (MPV), nötrofil/lenfosit oranı (NLR), lenfosit/
monosit oranı (LMR), trombosit/lenfosit oranı (PLR),
MPV/trombosit oranı (MPV/PLT) ve albümin düzeyleri
bakımından istatistiksel olarak anlamlı fark bulundu
(p<0.05). Prokalsitonin ile hsCRP, CAR, MPV, NLR ve
PLR arasında istatistiksel olarak anlamlı pozitif korelasyon
saptandı (p<0.05). Lojistik regresyon modelinde,
PCT (odds oranı: 10.930) ve CAR (odds oranı:
1.806) KDE için güçlü prediktif faktörler olarak saptandı
(p<0.05).
Sonuç
Test edilen belirteçler arasında PCT ve CAR, KDE
için en iyi tanısal performansa sahiptir. Yüksek sensitif
CRP ile birlikte tam otomatik hemogram cihazlarında
kolay, ucuz ve hızlı bir şekilde ölçülebilen NLR, LMR,
PLR, MPV/PLT, RDW, MPV değerleri, KDE’nin öngörülmesinde
yardımcı ek testler olarak kullanılabilir.

Keywords

Bakteriyemi, sepsis, prokalsitonin, C-reaktif protein, serum albümini, tam kan sayımı

EVALUATION OF INFLAMMATORY MARKERS IN THE EARLY DIAGNOSIS OF BLOODSTREAM INFECTIONS

Abstract

Objective
The aim of this study was to investigate the diagnostic
performance of procalcitonin (PCT), high sensitive C-reactive protein (hsCRP), hsCRP/albumin ratio
(CAR) and complete blood count (CBC) parameters
which can be used as an alternative to the blood culture
in the diagnosis of bloodstream infection (BSI).
Materials and Methods
Medical records of the patients who received inpatient
treatment in our hospital between May 2019-May 2020
and who were simultaneously requested for blood culture,
PCT, hsCRP, CBC and albumin tests were retrospectively
reviewed. The patients were divided into
two groups as those with positive blood culture (n=95)
and those with negative blood culture (n=157). Blood
cultures were performed using the BacT/ALERT 3D
(bioMérieux, France) automated blood culture system.
The levels of PCT and hsCRP were measured
by the Roche Cobas 6000 modular system (Roche Diagnostics,
Germany). Complete blood count analysis
was performed using the UniCel DxH 800 hematology
analyzer (Beckman Coulter, USA).
Results
A statistically significant difference was found between
the hemoculture positive and the hemoculture negative
groups in terms of PCT, hsCRP, CAR, neutrophil,
lymphocyte, hemoglobin, red blood cell distribution width
(RDW), mean platelet volume (MPV), neutrophil/
lymphocyte ratio (NLR), lymphocyte/monocyte ratio
(LMR) platelet/lymphocyte ratio (PLR), MPV/platelet
ratio (MPV/PLT) and albumin levels (p<0.05). There
was a statistically significant positive correlation
between PCT and hsCRP, CAR, MPV, NLR and PLR
(p<0.05). In the logistic regression model, PCT (odds
ratio: 10.930) and CAR (odds ratio: 1.806) were found
to be the strong predictive factors for BSI (p<0.05).
Discussion
Among the tested markers, PCT and CAR had the
best diagnostic performance for BSI. High sensitive
CRP and NLR, LMR, PLR, MPV/PLT, RDW, MPV values
that can be measured easily, cheaply and quickly
by fully automated hemogram devices may be used
as additional tests in predicting BSI.

Keywords

Bacteremia, sepsis, procalcitonin, C-reactive protein, serum albumin, complete blood count.

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