Kronik böbrek hastalığında inflamasyon belirteçleri ile enfeksiyon ilişkisi

Yıl 2021, Cilt: 46 Sayı: 1, 177 - 185, 31.03.2021

Sultan Sipahi , Seher Kır , Melda Dilek

Öz

Amaç: Bu çalışmada kronik böbrek hastalığı (KBH) olan hastalarda gelişen enfeksiyonların tanı ve takibinde C-reaktif protein (CRP) ve prokalsitonin (PCT)’in önemini değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Bu çalışmada, Mart 2012 - Haziran 2014 tarihleri arasında Ondokuz Mayıs Üniversitesi nefroloji bölümünde yatarak tedavi gören 1538 hasta değerlendirildi. Çalışmaya herhangi bir bakteriyel enfeksiyon nedeniyle tedavi almış ve tüm verileri eksiksiz olan 72 KBH (Glomerüler filtrasyon hızı <60 ml/dak) hastası dahil edildi. Hastaların antibiyotik tedavisi öncesi ve sonrasındaki laboratuar değerleri karşılaştırıldı.
Bulgular: Çalışmaya dahil edilen 72 hastanın yaş ortancası 66 (20-90) yıl olup %52,8’i (n=38) erkekti. Hastaların %52,8’inin (n=38) primer yatış nedeni enfeksiyondu. Enfeksiyon tedavisi sonrasında CRP ve PCT’de anlamlı azalma saptandı. Tedavi sonrası CRP farkının kültürde üremesi olan hastalarda olmayanlara göre anlamlı olarak daha fazla olduğu görüldü. CRP, PCT ve PCT farkının kültürde üreme durumuna karar verdirici özelliğinin olmadığı saptanırken CRP’deki farkın kültürde üreme durumunu karar verdirici özelliğinin olduğu saptandı.
Sonuç: Çalışmada CRP ve PCT düzeylerinin KBH hastalarında enfeksiyon tedavisinden sonra anlamlı düzeyde azaldığını ve KBH hastalarında da diğer hasta gruplarında olduğu gibi bakteriyel enfeksiyonların tanı ve takibinde değerli bir belirteç olduğu saptanmıştır. CRP değerindeki değişimin kültürde üreme saptanmasıyla ilişkili iken PCT değerindeki değişimin kültürde üremeyi öngörmede etkin olmadığı tespit edildi. KBH hastalarında enfeksiyonun göstergesi olarak normalden daha yüksek bir CRP kesim değeri (12 mg/L) olduğu belirlenmiştir.

Anahtar Kelimeler

C-reaktif protein, Kronik böbrek hastalığı, prokalsitonin, enfeksiyon

Relationship between inflammatory markers and infection in chronic kidney disease

Öz

Purpose: The aim of this study was to evaluate the importance of C-reactive protein (CRP) and procalcitonin (PCT) in the diagnosis and monitoring of infections in chronic kidney disease (CKD) patients.
Materials and Methods: In this study, 1538 hospitalized patients in the nephrology division of Ondokuz Mayıs University between March 2012 and June 2014 were evaluated. A total of 72 patients with CKD (Glomerular filtration rate <60 ml/min), treated for any bacterial infection and complete data were included. The laboratory values before and after antibiotic treatments were compared.
Results: The median age of 72 patients was 66 (20-90) years, and 52.8% (n=38) were male. Primary reason for hospitalization was infection in 52.8% (n=38) of the patients. There was a significant decrease in CRP and PCT after infection treatment. CRP difference after treatment was significantly high in patients with positive culture. CRP, PCT and difference in PCT had no decision-making feature for the culture positivity, while the difference in CRP was determined to have a decision-making feature.
Conclusion: CRP and PCT levels decreased significantly in CKD patients after infection treatment, and we confirmed that they are valuable markers in the diagnosis and follow-up of bacterial infections in CKD patients as in other patient groups. We found that the difference in CRP was predictive for culture positivity while the difference in PCT was not. We found a higher than normal CRP cut-off value (12 mg/L) in CKD patients as an indicator of infection.

Anahtar Kelimeler

Chronic kidney disease, C-reactive protein, procalcitonin, infection

Kaynakça

• 1. Ishigami J, Matsushita K. Clinical epidemiology of infectious disease among patients with chronic kidney disease. Clin Exp Nephrol. 2019; 23:437–47.
• 2. Filiopoulos V, Vlassopoulos D. Inflammatory syndrome in chronic kidney disease: pathogenesis and influence on outcomes. Inflamm Allergy Drug Targets. 2009; 8:369-82
• 3. Rojas L, Muñoz P, Kestler M, Arroyo D, Guembe M, Rodríguez-Créixems M, et al. Bloodstream infections in patients with kidney disease: risk factors for poor outcome and mortality. J Hosp Infect. 2013; 85:196–205.
• 4. Hildebrand A. Komenda P, Miller L, Rigatto C, Verrelli M, Sood AR, et al. Peritonitis and exit site infections in first nations patients on peritoneal dialysis. Clin J Am Soc Nephrol. 2010; 5:1988-95.
• 5. Panichi V, Migliori M, De Pietro S, Taccola D, Bianchi AM, Norpoth M, et al. C reactive protein in patients with chronic renal diseases. Ren Fail. 2001;23(3-4):551-62.
• 6. Kalantar-Zadeh K. Inflammatory marker mania in chronic kidney disease: pentraxins at the crossroad of universal soldiers of inflammation. Clin J Am Soc Nephrol. 2007; 2(5):872-5.
• 7. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004; 39:206-17.
• 8. Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA. Procalcitonin test in the diagnosis of bacteremia: a meta-analysis. Ann Emerg Med. 2007; 50(1):34–41.
• 9. Guz G, Colak B, Hizel K, Reis KA, Erten Y, Bali M, et al. Procalcitonin and conventional markers of inflammation in peritoneal dialysis patients and peritonitis. Perit Dial Int. 2006; 26(2):240-8.
• 10. Tang H, Huang T, Jing J, Shen H, Cui W. Effect of procalcitoninguided treatment in patients with infections: a systematic review and meta-analysis. Infection. 2009; 37(6):497–507.
• 11. Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab. 1994; 79(6):1605-8.
• 12. Pepys MB, Hirschfield GM. C-rective protein: a critical update. J Clin Invest. 2003; 111:1805-12.
• 13. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2013; 39(2):165-228.
• 14. Paolucci M, Landini MP, Sambri V. Conventional and molecular techniques for the early diagnosis of bacteraemia. Int J Antimicrob Agents. 2010; 36S:S6-S16.
• 15. Lu X-L, Xiao ZH, Yang MY, Zhu YM. Diagnostic value of serum procalcitonin in patients with chronic renal insufficiency: a systematic review and meta-analysis. Nephrol Dial Transplant. 2012; 28:122-9.
• 16. Meisner M. Procalcitonin: a new innovative infection parameter. 3rd ed. Stuttgart: Brahms Diagnostica; 2000.
• 17. van Rossum AMC, Wulkan RW, Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children. Lancet Inf Dis. 2004; 4:620-30.
• 18. Oczenski W, Fitzgerald RD, Schwarz S. Procalcitonin: a new parameter for the diagnosis of bacterial infection in the peri-operative period. Eur J Anaesthesiol. 1998; 15(2): 202-9.
• 19. Schindler R, Boenisch O, Fischer C, Frei U. Effect of the hemodialysis membrane on the inflammatory reaction in vivo. Clin Nephrol. 2000; 53(6):452-9.
• 20. Steinbach G, Bölke E, Grünert A, Orth K, Störck M. Procalcitonin in patients with acute and chronic renal insufficiency. Wien Klin Wochenschr. 2004; 116: 849-53.
• 21. Park JH, Kim DH, Jang HR, Kim MJ, Jung SH, Lee JE, et al. Clinical relevance of procalcitonin and C-reactive protein as infection markers in renal impairment: a cross-sectional study. Critical Care. 2014;18(6):640.
• 22. Yeun JY, Levine RA, Mantadilok V, Kaysen GA. C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis. 2000; 35(3):469-76.
• 23. Ducloux D, Bresson-Vautrin C, Kribs M, Abdelfatah A, Chalopin JM. C-reactive protein and cardiovascular disease in peritoneal dialysis patients. Kidney Int. 2002; 62:1417-22.
• 24. Herget-Rosental S, Marggraf G, Pietruck F, Hüsing J, Strupat M, Philipp T, et al. Procalcitonin for accurate of infection in haemodialysis. Nephrol Dial Transplant. 2001;16;975-9.
• 25. Lavin Gomez et al. Palomar-Fontanet R, Gago-Fraile M, Quintanar-Lartundo JA, Gómez-Palomo E, González-Lamuño D. Inflammation markers, chronic kidney disease, and renal replacement therapy Adv Perit Dial. 2011;27:33-7.
• 26. Lee J, Hwang SS, Kim K, Jo YH, Lee JH, Kim J, et al. Bacteremia prediction model using a common clinical test in patients with community-acquired pneumonia. Am J Emerg Med. 2014; 32(7):700-4.
• 27. Dumea R, Siriopol D, Hogas S, Mititiuc I, Covic A. Procalcitonin: diagnostic value in systemic infections in chronic kidney disease or renal transplant patients Int Urol Nephrol. 2014; 46:461-8.
• 28. Oksuz L, Somer A, Salman N, Erk O, Gurler N. Procalcitonin and C-reactive protein in differantiating to contamination from bacteremia. Brazilian Journal of Microbiology. 2014; 45(4):1415-21.
• 29. Schuetz P, Mueller B, Trampuz A. Serum procalcitonin for discrimination of blood contamination from bloodstream infection due to coagulase-negative staphylococci. Infection. 2007; 35:352-5.
• 30. Jeong S, Park Y, Cho Y, Kim HS. Diagnostic utilities of procalcitonin and C-reactive protein for the prediction of bacteremia determined by blood culture. Clin Chim Acta. 2012; 413:1731-6.