TY - JOUR T1 - Prognostic significance of inflammatory biomarkers in predicting mortality among geriatric patients with sepsis in the intensive care unit TT - Geriatrik sepsis hastalarında mortaliteyi öngörmede inflamatuar biyobelirteçlerin prognostik önemi AU - Bulun Yediyıldız, Merve AU - Taşkın, Kübra AU - Durmuş, İrem AU - Fidan, Reyhan PY - 2025 DA - August Y2 - 2025 DO - 10.47582/jompac.1714806 JF - Journal of Medicine and Palliative Care JO - J Med Palliat Care / JOMPAC / Jompac PB - MediHealth Academy Yayıncılık WT - DergiPark SN - 2717-7505 SP - 371 EP - 376 VL - 6 IS - 4 LA - en AB - Aims: This study aims to investigate the prognostic significance of inflammatory biomarkers including the C-reactive protein (CRP)/albumin ratio, neutrophile-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and procalcitonin (PCT) in predicting mortality among geriatric patients with sepsis in the intensive care unit (ICU).Methods: This retrospective study analyzed the medical records of 239 patients aged 65 years and older who were hospitalized with sepsis in the ICU between May and October 2023. Demographic characteristics, APACHE II scores, laboratory biomarkers (CRP, PCT, complete blood count), length of ICU stay and mortality outcomes were collected. Univariate and multivariate logistic regression analyses were used to determine predictors of mortality.Results: The overall mortality rate was 66.9%. CRP, CRP/albumin ratio, mean platelet volume (MPV), red blood cell distribution width (RDW), lactate and APACHE II scores were significantly higher (p<0.05). In multivariate analysis only the CRP/albumin ratio and APACHE II score remained independent predictors of mortality. The CRP/albumin ratio showed moderate discriminatory power (AUC: 0.632) at a cutoff value of 6.20, with a sensitivity of 48.8% and a specificity of 73.4%. Conclusion: The CRP/albumin ratio and APACHE II score were independently associated with mortality in elderly septic patients. These accessible and cost-effective parameters may aid in early risk stratification and guide clinical decision-making in the ICU setting. KW - Sepsis KW - APACHE II KW - elderly KW - inflammatory KW - intensive care units KW - mortality N2 - Amaç:Bu çalışmanın amacı, yoğun bakım ünitesinde (YBÜ) sepsis tanısı almış geriatrik hastalarda C-Reaktif Protein (CRP)/albümin oranı, Nötrofil/Lenfosit Oranı (NLR), Trombosit/Lenfosit Oranı (PLR) ve prokalsitonin (PCT) gibi inflamatuar biyobelirteçlerin mortaliteyi öngörmedeki prognostik değerini araştırmaktır.Yöntemler:Bu retrospektif çalışmada, Mayıs–Ekim 2023 tarihleri arasında YBÜ’de sepsis nedeniyle yatan 65 yaş ve üzeri 239 hastanın tıbbi kayıtları incelenmiştir. Demografik veriler, APACHE II skorları, laboratuvar biyobelirteçleri (CRP, prokalsitonin, tam kan sayımı), YBÜ kalış süresi ve mortalite verileri toplanmıştır. Mortalite ile ilişkili değişkenleri belirlemek için univaryant ve multivaryant lojistik regresyon analizleri uygulanmıştır.Bulgular:Genel mortalite oranı %66,9 olarak bulunmuştur. CRP, CRP/albümin oranı, Ortalama Trombosit Hacmi (MPV), Eritrosit Dağılım Genişliği (RDW), laktat düzeyi ve APACHE II skorları mortalite grubunda anlamlı derecede yüksek bulunmuştur (p<0,05). Multivaryant analizde yalnızca CRP/albümin oranı ve APACHE II skoru mortalitenin bağımsız öngördürücüleri olarak kalmıştır. CRP/albümin oranı, 6,20 eşik değerinde orta düzeyde ayırt edici güce sahipti (AUC: 0,632) ve bu değerde duyarlılık %48,8, özgüllük ise %73,4 olarak hesaplanmıştır.Sonuç:CRP/albümin oranı ve APACHE II skoru, yaşlı sepsis hastalarında mortalite ile bağımsız olarak ilişkili bulunmuştur. Bu erişilebilir ve düşük maliyetli parametreler, erken risk sınıflandırmasında fayda sağlayabilir ve YBÜ ortamında klinik karar verme süreçlerine rehberlik edebilir. CR - Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016; 315(8):801-810. doi:10.1001/jama.2016.0287 CR - Pérez-González A, Almudí-Ceinos D, Del Moral, et al. Is mortality in elderly septic patients as high as expected? Long-term mortality in a surgical sample cohort. Med Intensiva (Engl Ed). 2019;43(8):464-473. doi:10.1016/j.medin.2018.05.003 CR - Demir İ, Yücel M. Investigation of relation between mortality of geriatric patients with sepsis and C-reactive protein, procalcitonin and neutrophil/lymphocyte ratio in admission to intensive care unit. Fam Pract Palliat Care. 2020;5(1):12-17. doi:10.22391/fppc.650570 CR - Velissaris D, Pantzaris ND, Bountouris P, Gogos C. Correlation between neutrophil-to-lymphocyte ratio and severity scores in septic patients upon hospital admission. A series of 50 patients. Rom J Intern Med. 2018;56(3):153-157. doi:10.2478/rjim-2018-0005 CR - Pepys MB, Hirschfeld GM. C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805-1812. doi:10.1172/JCI18921 CR - Gavazzi G, Drevet S, Debray M, et al. Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study. BMC Geriatr. 2022;22(1):965. doi: 10.1186/s12877-022-03658-4 CR - Gavazzi G, Meyrignac L, Zerhouni N, et al. Intrinsic values of procalcitonin in bacterial bloodstream infections in people aged 75 years and over: a retrospective study. Diagn Microbiol Infect Dis. 2023; 105(3):115887. doi:10.1016/j.diagmicrobio.2022.115887 CR - Mustafić S, Brkić S, Prnjavorac B, Sinanović A, Porobić Jahić H, Salkić S. Diagnostic and prognostic value of procalcitonin in patients with sepsis. Med Glas (Zenica). 2018;15(2):93-100. doi:10.17392/963-18 CR - Rajagopal P, Ramamoorthy S, Grace Jeslin A. Utility of haemogram parameters in mortality risk prediction of critically ill patients. J Evol Med Dent Sci. 2018;7(8):1024-1029. CR - Liu B, Lv D. Prognostic value of C-reactive protein to albumin ratio for mortality in acute kidney injury. BMC Nephrol. 2023;24(1):44. doi:10. 1186/s12882-023-03090-9 CR - Yeşilkaya A, Arıkan M, Taşdelen BN, et al. Variables affecting mortality in patients in palliative care units: or is it still just albumin? Turkish J Geriatr. 2024;27(2):168. doi:10.29400/tjgeri.2024.390 CR - Park JE, Chung KS, Song JH, et al. The C-reactive protein/albumin ratio as a predictor of mortality in critically ill patients. J Clin Med. 2018;7(10): 333. doi:10.3390/jcm7100333 CR - Çakin Ö, Karaveli, A, Aktepe MY, Gümüş, A, Yildirim ÖE. Comparison of inflammatory marker scoring systems and conventional inflammatory markers in patients over 65 years of age admitted to the intensive care unit: a multicenter, retrospective, cohort study. J Clin Med. 2024;13(14):4011. doi:10.3390/jcm13144011 CR - Kim MH, Ahn JY, Song JE, et al. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe sepsis or septic shock treated with early goal-directed therapy. PLoS One. 2015; 10(7):e0132109. doi:10.1371/journal.pone.0132109 CR - Sargın M, Demirel HF. Relationship between mortality and the laboratory values at admission to palliative care unit in geriatric patients with no diagnosis of malignancy. Turkish J Geriatr. 2019;22(4):434-442. doi:10.31086/tjgeri.2020.122 CR - Basile-Filho A, Lago AF, Menegueti MG, et al. The use of APACHE II, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients: a retrospective cohort study. Medicine (Baltimore). 2019;98(26):e16204. doi:10.1097/MD. 0000000000016204 CR - Oh J, Kim SH, Park KN, et al. High-sensitivity C-reactive protein/albumin ratio as a predictor of in-hospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med. 2017;4(1): 19-24. doi:10.15441/ceem.16.158 CR - Başgöz BB, Aykan MB, Acar R, Taşçı İ. Efficacy of prognostic scoring systems and neutrophil-to-lymphocyte ratio (NLR) among critically ill elder sepsis patients. J Ankara Fac Med. 2021;74(3):289-295. doi:10.4274/atfm.galenos.2021.31032 CR - Rout U, Malla A, Kumar SD, et al. Comparative study between CRP/albumin ratio and serum procalcitonin as a prognostic marker in sepsis. Int J Pharmaceutical Clin Res. 2023;15(12);662-668 CR - Schmidt de Oliveira-Netto AC, Morello LG, Dalla-Costa LM, et al. Procalcitonin, C-reactive protein, albumin and blood cultures as early markers of sepsis diagnosis or predictors of outcome: a prospective analysis. Clin Pathol. 2019;12:2632010X19847673. doi:10.1177/2632010X 19847673 CR - Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-829. UR - https://doi.org/10.47582/jompac.1714806 L1 - https://dergipark.org.tr/tr/download/article-file/4938173 ER -