SARS-CoV-2 İlişkili Yoğun Bakım Hastalarında Septik Şoka Neden Olan Sekonder Enfeksiyonların Prokalsitonin, CRP, Lökosit ve COVİD-19 Aşılanma İle İlişkisi

Öz

AMAÇ Şiddetli ve kritik COVID-19 hastalarda sekonder enfeksiyonların daha yüksek bir mortalite oranına yol açtığı görülmüştür. Bununla birlikte, aşıların geliştirilmesiyle COVID-19 ilişkili mortalite oranı azalmıştır. Bu çalışmada COVID-19 tanılı yoğun bakım hastalarında, sekonder enfeksiyona bağlı septik şok gelişimi ile COVID-19 aşılama arasında nasıl bir ilişki olduğunun araştırılması ve sekonder enfeksiyon etkenleri ve dağılım oranlarının değerlendirilmesi amaçlandı. Aynı zamanda bu hasta grubunda uygulanan ampirik antimikrobiyal tedavi öncesi ve sonrası CRP, prokalsitonin ve lökosit değerlerinin klinik kötüleşme ile korelasyonu değerlendirildi. GEREÇ VE YÖNTEM Çalışma COVID-19 enfeksiyon tanısı alan (nazofarengeal sürüntü örneği RT-PCR ile doğrulanan), yoğun bakım yatışı sırasında sekonder enfeksiyona bağlı septik şok gelişen, 18 yaş üstü hastalarda retrospektif, kesitsel ve tek merkezli olarak yapıldı. BULGULAR Hastaların medyan yaşı 69 (23-95) olup %54,6’sının erkek olduğu görülmüştür. 28 günlük mortalite oranı %80,4 (n=225) olarak bulunmuştur. Hastaların yoğun bakım medyan yatış süresi 18 (3-106) gün olarak hesaplandı. Hastaların %77,1'inde (n=216) ek hastalık mevcuttu. Hastaların %76,1'inde (n=213) sekonder enfeksiyon gelişmişti. Erkekler arasında mortalite oranı anlamlı derecede yüksek bulundu (p=0,006). Aşılanmamış hasta grubunda mortalite oranı (n=143, %85,1) aşılanmış gruba göre anlamlı derecede yüksek saptanmıştır (p=0,014). Ölen hasta grubunda ampirik antimikrobiyal tedavi öncesi ve sonrası ortalama prokalsitonin ve lökosit değerleri, sağ kalanlara göre anlamlı derecede yüksekti (p<0,05). Aşılanmamış hasta grubunda toplam sekonder enfeksiyon görülme oranı %83,3 (n=140) olup, aşı yapılan hasta grubuna göre anlamlı derecede yüksekti (p<0,01). SONUÇ COVID-19 yoğun bakım ünitesine kabul edilen aşılanmamış hasta grubunda sekonder enfeksiyon oranı önemli ölçüde yüksektir. Bu durum mortalite açısından bir risk teşkil etmektedir. Prokalsitonin ve lökosit değerleri ampirik antimikrobiyal tedavi öncesi ve sonrası mortaliteyi göstermesine rağmen CRP gösterememiştir. Anahtar kelimeler SARS-CoV-2, sekonder enfeksiyon, COVID-19 aşı, prokalsitonin, lökosit

Anahtar Kelimeler

• SARS-CoV-2
• sekonder enfeksiyon
• COVID-19 aşı
• prokalsitonin
• lökosit

The Relationship between Secondary Infections Causing Septic Shock and Procalcitonin, CRP, and Leukocyte Values and COVID-19 Vaccination in SARS-CoV-2-Related Intensive Care Patients

Öz

AIM Secondary infections in patients with severe and critical COVID-19 have been seen to entail a higher mortality rate. However, COVID-19-related mortality declined with the development of vaccines. The purpose of this study was to examine the relationship between septic shock development associated with secondary infection and COVID-19 vaccination in patients with COVID-19 and to evaluate the agents of secondary infection and their distribution patterns. This research also evaluated the correlation between pre- and post-empiric antimicrobial therapy CRP, leukocyte, and procalcitonin values and clinical worsening. MATERIAL AND METHOD This retrospective, cross-sectional, single-center study was conducted with patients aged over 18, diagnosed with COVID-19 (confirmed by nasopharyngeal swab RT-PCR), and developing septic shock in association with secondary infection during their ICU stays. RESULTS The patients’ median age was 69 years (23-95), and 54.60% were men. The 28-day mortality rate was 80.4% (n=225), and the median length of stay in the ICU was 18 days (3-106). Additional disease was present in 77.1% (n=216) of patients. Secondary infection developed in 76.10% (n=213) of the patients. The exitus rate was significantly higher among men (p=0.006). The exitus rate among the unvaccinated individuals, 85.1% (n=143), was significantly higher than in the vaccinated group (p=0.014). Mean pre- and post-empiric antimicrobial therapy procalcitonin and leukocyte values were significantly higher in the exitus cases than in the survivors (p<0.05). The total incidence of secondary infections, 83.3% (n=140), was significantly higher in the unvaccinated patient group than in the vaccinated patients (p<0.01). CONCLUSION The secondary infection rate were significantly high in the unvaccinated patient group admitted to the COVID-19 ICU. This represents a risk in terms of mortality. Although procalcitonin and leukocyte values indicated pre- and post-empiric antimicrobial therapy mortality, CRP was unable to do so. Key words SARS-CoV-2, secondary infection, COVID‐19 vaccine, procalcitonin, leukocyte

Anahtar Kelimeler

• SARS-CoV-2
• secondary infection
• COVID‐19 vaccine
• procalcitonin
• leukocyte

Kaynakça

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