INFLAMMATORY MARKERS AND MORTALITY IN PATIENTS WITH GRAM NEGATIVE BACTEREMIA

Öz

Background/aim:In our study, we aimed to determine the relationship between C-reactive protein (CRP), neutrophils, lymphocytes, platelets, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), length of hospitalization and mortality in patients with gram negative bacteremia in blood cultures. Materials and methods :The files of patients who were hospitalized in our hospital between January 2022 and May 2022 and for whom CRP and CBC (complete blood count) tests were requested simultaneously with blood culture were retrospectively analyzed. The study included 50 patients between the ages of 31 and 88 who were diagnosed with gram (-) sepsis. Results :There was no significant difference between the groups in terms of age, CRP, neutrophil, lymphocyte, platelet and NLR levels. The length of hospitalization in the ex group was higher than the length of hospitalization in the discharge group. In addition, the PLR rate in the ex group was lower than the PLR rate in the discharge group. CRP levels were positively correlated with NLR levels in patients with gram negative bacterial sepsis. Conclusion :In this study, it was found that NLR and CRP values were not statistically significant in determining the prognosis of patients diagnosed with Gram negative bacteremia. However, due to the high mortality rate and hospitalization duration of these patients, it was concluded that follow-up and treatment of these patients is important together with some markers. These findings emphasize that the correct approach in the treatment of patients diagnosed with Gram-negative bacteremia should be planned by considering the symptoms.

Anahtar Kelimeler

• Bacteremia
• sepsis
• C-reactive protein
• NLR
• PLR
• Mortality

Kaynakça

1. Abe, R., Oda, S., Sadahiro, T., Nakamura, M., Hirayama, Y., Tateishi, Y., Shinozaki, K., & Hirasawa, H. (2010). Gram-negative bacteremia induces greater magnitude of inflammatory response than Gram-positive bacteremia. Critical Care, 14(2), 1–7.
2. Artero, A., Zaragoza, R., Camarena, J. J., Sancho, S., González, R., & Nogueira, J. M. (2010). Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock. Journal of Critical Care, 25(2), 276–281.
3. Brodská, H., Malíčková, K., Adámková, V., Benáková, H., Šťastná, M. M., & Zima, T. (2013). Significantly higher procalcitonin levels could differentiate Gram-negative sepsis from Gram-positive and fungal sepsis. Clinical and Experimental Medicine, 13, 165–170.
4. Cabral, L., Afreixo, V., Meireles, R., Vaz, M., Frade, J.-G., Chaves, C., Caetano, M., Almeida, L., & Paiva, J.-A. (2019). Evaluation of procalcitonin accuracy for the distinction between Gram-negative and Gram-positive bacterial sepsis in burn patients. Journal of Burn Care & Research, 40(1), 112–119.
5. Chen, L., Wu, X., Qin, H., & Zhu, H. (2021). The PCT to albumin ratio predicts mortality in patients with acute kidney injury caused by abdominal infection-evoked sepsis. Frontiers in Nutrition, 8, 584461.
6. Demir-Çuha, M., & Hazırolan, G. (2020). Hacettepe Üniversitesi Tıp Fakültesi Hastanesi’nde 2017-2019 Yılları Arasında Kan Kültürlerinden İzole Edilen Anaerop Bakteriler: Üç Yıllık Bir Değerlendirme. Klimik Journal/Klimik Dergisi, 33(3).
7. Djordjevic, D., Rondovic, G., Surbatovic, M., Stanojevic, I., Udovicic, I., Andjelic, T., Zeba, S., Milosavljevic, S., Stankovic, N., & Abazovic, D. (2018). Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically ill and injured patients: which ratio to choose to predict outcome and nature of bacte. Mediators of Inflammation, 2018.
8. Grumaz, S., Stevens, P., Grumaz, C., Decker, S. O., Weigand, M. A., Hofer, S., Brenner, T., von Haeseler, A., & Sohn, K. (2016). Next-generation sequencing diagnostics of bacteremia in septic patients. Genome Medicine, 8(1), 1–13.

9. Hattori, T., Nishiyama, H., Kato, H., Ikegami, S., Nagayama, M., Asami, S., Usami, M., Suzuki, M., Murakami, I., & Minoshima, M. (2014). Clinical value of procalcitonin for patients with suspected bloodstream infection. American Journal of Clinical Pathology, 141(1), 43–51.
10. Huang, Z., Fu, Z., Huang, W., & Huang, K. (2020). Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. The American Journal of Emergency Medicine, 38(3), 641–647.
11. Hwang, S. Y., Shin, T. G., Jo, I. J., Jeon, K., Suh, G. Y., Lee, T. R., Yoon, H., Cha, W. C., & Sim, M. S. (2017). Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. The American Journal of Emergency Medicine, 35(2), 234–239.
12. Kocazeybek, B., Küçükoğlu, S., & Öner, Y. A. (2003). Procalcitonin and C-reactive protein in infective endocarditis: correlation with etiology and prognosis. Chemotherapy, 49(1–2), 76–84.
13. Leli, C., Ferranti, M., Moretti, A., Dhahab, A., Salim, Z., Cenci, E., & Mencacci, A. (2015). Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections. Disease Markers, 2015.
14. Li, S., Rong, H., Guo, Q., Chen, Y., Zhang, G., & Yang, J. (2016). Serum procalcitonin levels distinguish Gram-negative bacterial sepsis from Gram-positive bacterial and fungal sepsis. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 21.
15. Liu, H. H., Zhang, M. W., Guo, J. B., Li, J., & Su, L. (2017). Procalcitonin and C-reactive protein in early diagnosis of sepsis caused by either Gram-negative or Gram-positive bacteria. Irish Journal of Medical Science (1971-), 186, 207–212.
16. Pathak, A., & Agrawal, A. (2019). Evolution of C-reactive protein. Frontiers in Immunology, 10, 943.
17. Prieto, M. F., Kilstein, J., Bagilet, D., & Pezzotto, S. M. (2008). C-reactive protein as a marker of mortality in intensive care unit. Medicina Intensiva, 32(9), 424–430.
18. Salciccioli, J. D., Marshall, D. C., Pimentel, M. A. F., Santos, M. D., Pollard, T., Celi, L. A., & Shalhoub, J. (2015). The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Critical Care, 19(1), 1–8.
19. Silvestre, J., Povoa, P., Coelho, L., Almeida, E., Moreira, P., Fernandes, A., Mealha, R., & Sabino, H. (2009). Is C-reactive protein a good prognostic marker in septic patients? Intensive Care Medicine, 35, 909–913.
20. Simon, L., Gauvin, F., Amre, D. K., Saint-Louis, P., & Lacroix, J. (2004). Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clinical Infectious Diseases, 39(2), 206–217.
21. Sligl, W., Taylor, G., & Brindley, P. G. (2006). Five years of nosocomial Gram-negative bacteremia in a general intensive care unit: epidemiology, antimicrobial susceptibility patterns, and outcomes. International Journal of Infectious Diseases, 10(4), 320–325.
22. Wakabayashi, T., & Iwata, H. (2021). Outcome, diagnosis, and microbiological profile comparison of community‐and hospital‐acquired bacteremia: A retrospective cohort study. Journal of General and Family Medicine, 22(6), 327–333.
23. Wyllie, D. H., Bowler, I., & Peto, T. E. A. al. (2004). Relation between lymphopenia and bacteraemia in UK adults with medical emergencies. Journal of Clinical Pathology, 57(9), 950–955.
24. Zahorec, R. (2001). Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratislavske Lekarske Listy, 102(1), 5–14.