Klinik Araştırma
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Kraniotomi Sonrası Gelişen Enfeksiyon Tanısında Prokalsitoninin C-Reaktif Proteinle Karşılaştırılması

Yıl 2022, Cilt: 5 Sayı: 2, 128 - 136, 31.08.2022
https://doi.org/10.36516/jocass.1101283

Öz

Prokalsitonin (PKT) 116 aminoasitlik bir glikopeptit olup kalsitonin hormonunun prekürsörüdür. Son yıllarda prokalsitonin bakteriyel enfeksiyonlara spesifik, viral enfeksiyonlar ve sistemik inflamatuar cevap sendromundan etkilenmeyen yeni bir enfeksiyon göstergesi olma özelliği ile daha çok dikkat çekmektedir. Biz çalışmamızda beyin cerrahisinin prokalsitonin düzeylerine etkisini ve prokalsitoninin beyin cerrahisinin yaratmış olduğu inflamatuar reaksiyonla, postoperatif gelişen enfeksiyonu ayırt etmesini araştırdık. Çalışmamız Mayıs 2007-Aralık 2007 tarihleri arasında, Çukurova Üniversitesi Tıp Fakültesi Beyin Cerrahisinde intrakranial tümörü olan 44 hastada yapılmıştır. Preoperatif 1 ve postoperatif 4 gün boyunca prokalsitonin, beyaz küre sayısı, C-reaktif protein (CRP) ve ateş değerlerindeki değişimler incelenmiştir. Veriler SPSS 15,0 programında analiz edilmiştir. Çalışmaya alınan enfeksiyon gelişen hastaların tümünde PKT değerleri 0,1 ng/ml’nin üzerinde bulunmuştur. Elde ettiğimiz sonuçlar ışığında postoperatif 2. ve 3. günde 0,1 ng/ml üzerinde PKT değeri olan hastaların postoperatif enfeksiyon açısından daha dikkatli monitorize edilmesi gerektiğini söyleyebiliriz. Çalışmamızda CRP enfeksiyon gelişen hastaların büyük kısmında, enfeksiyon gelişmeyen hastalardakine benzer bir kinetik izlemiştir. Enfeksiyon gelişen ve gelişmeyen tüm hastalarda CRP değerleri normalin üstündedir (CRP>5 ng/ml). Bu da CRP’nin postop enfeksiyonları takip açısından önemli bir parametre olarak kullanılmayacağını gösterir. Prokalsitoninin cerrahinin yaratmış olduğu inflamatuar yanıttan etkilenmemesi, rutinde kullanılan diğer parametrelere göre enfeksiyona çok daha hızlı cevap vermesi ile mevcut enfeksiyon parametrelerinden üstün olduğu söylenebilir. Gelecekte daha fazla hasta sayısı ve farklı operasyon türlerini de içeren gruplarla yapılacak çalışmaların sonuçlarıyla prokalsitoninin beyin cerrahi sonrası sistemik komplikasyonları takipte ciddi ve güvenli bir parametre olacağını düşünmekteyiz.

Kaynakça

  • 1. Çetinus E, Akgümüş M, Cever i, Atay ÖF, Bakariş S. Kınk iyileşmesi üzerine kalsitonin hormonunun etkisi. J Arthroplasty Arthroscopic Surg 2000; 11(2): 179-83.
  • 2. Saez-Lorens X, Lagrutta F. The acute phase reaction during bacterial infection and its clinical impact in children. Pediatr Infect Dis J 1993; 12(1): 83-7.
  • 3. Steel DM, Whitehead AS. The major acute phase reactants: C-reactive protein, serum amyloid P component and serum amyloid A protein. Immunology Today 1994; 15(2):818.
  • 4. Baumann H, Gauldie J. The acute phase response. Immunology Today 1994; 15(2): 74-80.
  • 5. Boeken U, Feindt P. The influence of extracorporeal circulation and inflammatory responses such as SIRS and sepsis on secretion of procalcitonin. J Clin Basic Cardiol 1999; 2: 225.
  • 6. Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, Moutardier V, Blache JL. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth. 2005;94(6):767-73.
  • 7. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J 1997; 16: 735-47.
  • 8. Moss A, Hamburger S, Moore R. Use of Selected Medical Device Implants in the United States, 1988. Vital and Health Statistics no. 191. Hyattsville, Md, National Center for Health Statistics,1990.
  • 9. Covey DC, Albright JA. Clinical significance of the erytrocyte sedimentation rate in orthopaedic surgery. J Bone Joint Surg 1994; 76-A (6): 848-53.
  • 10. Müler B, Kenneth LB. Procalcitonin: how a hormone became a marker and mediator of sepsis. Swiss Med Wkly 2001; 131: 595-602.
  • 11. Assicot M, Gendrel D Carsin H et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341: 515-518.
  • 12. Federico G. Tumbarello M ,. Risk factors and prognostic indicators of bacterial meningitis in a cohort of 3580 postneurosurgical patients. Scand Infect Dis 2001.;33(7):533-7.
  • 13. Shimetani N, Shimetani K, Mori M. Levels of three inflammation markers, C-reactive protein, serum amyloid A protein and procalcitonin, in the serum and cerebrospinal fluid of patients with meningitis. Scand J Clin Lab Invest.2001;61(7):567-74.
  • 14. D. Gendrel, C Bohuon. Procalcitonin in pediatrics for differentiation of bacterial and viral infections. Intensive Care Med (2000) 26:S 178-S 181.
  • 15. Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, Moutardier V, Blache JL. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth. 2005;94(6):767-73.
  • 16. Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schüttler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intens Care Med 1998; 24: 680-4.
  • 17. Jensen CK, Brandslund I, Sogaard I. Lumbar disc surgery and variations in C-reactive protein, erythrocyte sedimentation rate and the complement split product C3d. Acta Neurochir 1988; 90: 42-4.
  • 18. Scherer MA, Neumaier M. C-reactive protein in patients who had operative fracture treatment. Clin Orthop Rel Res 2001; 393: 287-93.
  • 19. Markus Neumaier and Michael A Scherer. C-reactive protein levels for early detection of postoperative infection after fracture surgery in 787 patients Acta Orthopaedica 2008; 79 (3): 428–432
  • 20. Sanzen L, Carlsson A S. The diagnostic value of C-reactive protein in infected total hip arthroplasies. J Bone Joint Surg (Br) 1989; 71: 638-41.
  • 21. Foglar C, Lindsey R W. C-reactive protein in orthopedics. Orthopedics 19

Comparing Procalcitonin to C-Reactive protein in Diagnosis of Craniotomi Associated Infection.

Yıl 2022, Cilt: 5 Sayı: 2, 128 - 136, 31.08.2022
https://doi.org/10.36516/jocass.1101283

Öz

Procalcitonin (PCT) is a glicopeptide of 116 amino acid and precursor of calcitonin hormone. At the present day procalcitonin take attention because of being specific to bacterial infection and also is a new indicator for infection which do not affected from viral infection and Systemic Inflamatuar Response Syndrome. The objective of this study was to show the effect of neurosurgical procedures to procalcitonin levels and to distinguish neurosurgical procedure inflammatory reaction from postsurgical associated infection. We carried out our study in Çukurova University Neurosurgery department between May 2007- December 2007. Total number of 44 intracranial tumor existing patients carried out in the study. One day preoperative and four days postoperative values of procalcitonin, white blood cell, C-reactive protein (CRP) and fever were investigated. Results were analyzed in SPSS 15.0 program. In all infection developing patients of the study procalsitonin levels found over 0.1 ng/ml. According to our results patients with a higher of 0.1 ng/ml procalsitonin values in postoperative second and third need attention to followed carefully for postoperative infection. In our study crp exposed a similar kinetic activity in infection developing and infection free patients. We exposed high levels of crp (CRP>5 ng/ml) in both groups. This predicate that crp can not be used in the following of postoperative infection. We may suggest procalcitonin is superior to other existing infection parameters because of not effecting from surgical associated inflamatuar response and a quicker response to routine used other parameters. We suggest that procalcitonin will be a safe and serious parameter in following neurosurgical associated systemic complications by results of new studies which includes more patients and different surgical procedures.

Kaynakça

  • 1. Çetinus E, Akgümüş M, Cever i, Atay ÖF, Bakariş S. Kınk iyileşmesi üzerine kalsitonin hormonunun etkisi. J Arthroplasty Arthroscopic Surg 2000; 11(2): 179-83.
  • 2. Saez-Lorens X, Lagrutta F. The acute phase reaction during bacterial infection and its clinical impact in children. Pediatr Infect Dis J 1993; 12(1): 83-7.
  • 3. Steel DM, Whitehead AS. The major acute phase reactants: C-reactive protein, serum amyloid P component and serum amyloid A protein. Immunology Today 1994; 15(2):818.
  • 4. Baumann H, Gauldie J. The acute phase response. Immunology Today 1994; 15(2): 74-80.
  • 5. Boeken U, Feindt P. The influence of extracorporeal circulation and inflammatory responses such as SIRS and sepsis on secretion of procalcitonin. J Clin Basic Cardiol 1999; 2: 225.
  • 6. Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, Moutardier V, Blache JL. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth. 2005;94(6):767-73.
  • 7. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J 1997; 16: 735-47.
  • 8. Moss A, Hamburger S, Moore R. Use of Selected Medical Device Implants in the United States, 1988. Vital and Health Statistics no. 191. Hyattsville, Md, National Center for Health Statistics,1990.
  • 9. Covey DC, Albright JA. Clinical significance of the erytrocyte sedimentation rate in orthopaedic surgery. J Bone Joint Surg 1994; 76-A (6): 848-53.
  • 10. Müler B, Kenneth LB. Procalcitonin: how a hormone became a marker and mediator of sepsis. Swiss Med Wkly 2001; 131: 595-602.
  • 11. Assicot M, Gendrel D Carsin H et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 341: 515-518.
  • 12. Federico G. Tumbarello M ,. Risk factors and prognostic indicators of bacterial meningitis in a cohort of 3580 postneurosurgical patients. Scand Infect Dis 2001.;33(7):533-7.
  • 13. Shimetani N, Shimetani K, Mori M. Levels of three inflammation markers, C-reactive protein, serum amyloid A protein and procalcitonin, in the serum and cerebrospinal fluid of patients with meningitis. Scand J Clin Lab Invest.2001;61(7):567-74.
  • 14. D. Gendrel, C Bohuon. Procalcitonin in pediatrics for differentiation of bacterial and viral infections. Intensive Care Med (2000) 26:S 178-S 181.
  • 15. Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, Moutardier V, Blache JL. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth. 2005;94(6):767-73.
  • 16. Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schüttler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intens Care Med 1998; 24: 680-4.
  • 17. Jensen CK, Brandslund I, Sogaard I. Lumbar disc surgery and variations in C-reactive protein, erythrocyte sedimentation rate and the complement split product C3d. Acta Neurochir 1988; 90: 42-4.
  • 18. Scherer MA, Neumaier M. C-reactive protein in patients who had operative fracture treatment. Clin Orthop Rel Res 2001; 393: 287-93.
  • 19. Markus Neumaier and Michael A Scherer. C-reactive protein levels for early detection of postoperative infection after fracture surgery in 787 patients Acta Orthopaedica 2008; 79 (3): 428–432
  • 20. Sanzen L, Carlsson A S. The diagnostic value of C-reactive protein in infected total hip arthroplasies. J Bone Joint Surg (Br) 1989; 71: 638-41.
  • 21. Foglar C, Lindsey R W. C-reactive protein in orthopedics. Orthopedics 19
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Makaleler
Yazarlar

Rıdvan Açıkalın 0000-0002-3484-1276

Can Sezer 0000-0002-4840-6769

Metin Tuna 0000-0003-4125-6574

Erken Görünüm Tarihi 18 Ağustos 2022
Yayımlanma Tarihi 31 Ağustos 2022
Kabul Tarihi 30 Temmuz 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 5 Sayı: 2

Kaynak Göster

APA Açıkalın, R., Sezer, C., & Tuna, M. (2022). Comparing Procalcitonin to C-Reactive protein in Diagnosis of Craniotomi Associated Infection. Journal of Cukurova Anesthesia and Surgical Sciences, 5(2), 128-136. https://doi.org/10.36516/jocass.1101283
https://dergipark.org.tr/tr/download/journal-file/11303