Klinik Araştırma
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Toplum kökenli pnömönide serum albümin ve CRP/albümin oranının hastalık seyrine etkisi

Yıl 2022, , 111 - 116, 28.06.2022
https://doi.org/10.47582/jompac.1128249

Öz

Amaç:Toplum kökenli pnömöni (TKP) solunum yolu enfeksiyonları içinde yüksek mortalite ve morbiditeye sahiptir.Tanı, tedavi, prognoz takibinde çeşitli biokimyasal markerlar kullanılmaktadır.CRP, albümin rutin uygulamada sıklıkla kullanılan biokimyasal markerlardır.İnflamasyon temellli CRP/albümin oranı çeşitli hastalıklarda prognoz tahmininde kullanılmaktadır.Postoperatif yoğun bakıma kabul edilen hastalarda yapılan çalışmalarda 30 günlük ve 1 yıllık mortalite tahmininde bağımsız risk faktörü olarak bulunmuştur.Çeşitli klinik durumlarda CRP/albümin oranı tek başına albümin ve CRP’den daha iyi inflamatuvar durumu yansıttığı düşünülmektedir.Bu çalışmanın amacı TKP nedeniyle hastaneye yatırılan CRP/albümin oranının 30 günlük mortalite tahminindeki rolünü belirlemekti.Çalışmanın ikincil sonlanım noktası ise yoğun bakım ihtiyacı idi.
Gereç Ve Yöntem:Göğüs hastalıkları ve yoğun bakım servisine yatırılan TKP’li hastalar çalışmaya dahil edildi. Retrospektif olarak hasta dosyaları, radyolojik incelemeleri ve laboratuvar bulguları tarandı.
Bulgular:Yüz(%55.9)’ü göğüs hastalıkları servisinde 79’u yoğun bakımda yatmakta olan 179 TKP’li hasta çalışmaya dahil edildi. Hastaların yaş ortalaması 72.027±12.88 yıldı, %61.5’i erkek, %38.5’i kadındı.CRP değeri ve CRP/albümin oranı 30 günlük mortalite ve yoğun bakım ihtiyacını tahmin etmede anlamlı bulunmazken (sırasıyla p:0.728, p:0.232, p:0.110), düşük albümin değerlerinin mortalite ve yoğun bakım ihtiyacı riskini anlamlı derecede artırdığı bulundu(p<0.001, p<0.001).CURB-65, PSI ve albümin 30 günlük mortalite ve yoğun bakım ihtiyacını tespit etmede anlamlı bulunan değişkenlerdir.
Sonuç:
Albumin değerinin yüksek olması TKP’de 30 günlük mortalite ve yoğun bakım ihtiyacı riskini azaltmaktadır. CRP , CRP/albümin oranının TKP’de kısa dönem mortalite ve morbiditeyi tahmin edememektedir. TKP’li hastalarda serum albümin, CRP düzeyleri ve CRP/albümin oranının uzun dönem prognozu tahmin gücünü ortaya koymak için geniş kohortlarda, çok merkezli çalışmalara ihtiyaç vardır.

Destekleyen Kurum

yok

Proje Numarası

yok

Kaynakça

  • Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200: e45-67.
  • Farah R, Mograbi J, Makhoul N.Impact of serum C-reactive protein measurements in the first 2 days on the 30-day mortality in hospitalized patients with severe community-acquired pneumonia: A cohort study. J Crit Care 2013; 28: 291-5.
  • Arnau-Barrés I, Güerri-Fernández R, Luque S, Sorli L, Vázquez O, Miralles R. Serum albumin is a strong predictor of sepsis outcome in elderly patients. Eur J Clin Microbiol Infect Dis 2019; 38: 743-6.
  • Eshwara VK, Mukhopadhyay C, Rello J. Community-acquired bacterial pneumonia in adults. An update. Indian J Med Res 2020; 151: 287-302.
  • Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. Plos One 2013; 8: e59321.
  • Kocatürk M, Kocatürk O. Assessment of relationship between C-reactive protein to albumin ratio and 90-day mortality in patients with acute ischaemic stroke. Neurol Neurochir Pol 2019; 53: 205-11.
  • Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163: 1730-54.
  • British Thoracic Society Standarts of Care Committee BTS Guidelines for the management of community acquired pneumonia in adults. Thorax 2001; 56: iV1-64.
  • Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD. Infectious Diseases Society of America/America Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44: S27-72.
  • Bouch DC, Thompson JP. Severity scoring systems in the critical ill. Continuing Education in Anesthesia and Critical Care 2018; 8: 181-5.
  • Metersky ML, Waterer G, Nsa W, Bratzler DW. Predictors of in-hospital vs discharge mortality in pneumonia. Chest 2012; 142: 476-81
  • Lee JH, Kim J, Kim K. Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia. J Crit Care 2011; 26: 287-94.
  • Oh TK, Eunjeong J, Hyo-seok N, et al. C-reactive protein to albumin ratio predicts 30-day and 1-year mortality in postoperative patients after admission to the intensive care unit. J Clin Med 2018; 7: 39.
  • Kim MH, Ahn JY, Song JE, et al. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe or septic shock treated with early goal-directed therapy. Plos One 2015; 10: e0132109.
  • Oh J, Kim SH, Park KN. 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: 19-24.
  • Charles PG, Wolfe R, Whitby M, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008; 47: 375-84.
  • Ventura JC, Hauschild DB, Moreire MDE.C-reactive protein/albumin ratio is associated with lung function among children/adolescents with cystic fıbrosis: a three years longitudinal study. Sao Paulo Med J 2018; 136: 29-36.
  • Mendez R, Aldas I, Menendez R. Biomarkers in community-acquired pneumonia (cardiac and non-cardiac). J Clin Med 2020; 9: 549.
  • Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacol Ther 2021; 217: 107663.
  • Sungurlu S, Balk RA. The role of biomarkers in the diagnosis and management of pneumonia. Clin Chest Med 2018; 39: 691-701.
  • Ugajin M, Yamaki K, Iwamura N, Yagi T, Asano T. Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community-acquired pneumonia. Int J Gen Med 2012; 5: 583-9.
  • Moncada DC, Rueda ZV, Macías A, Suárez T, Ortega H, Vélez LA. Reading and interpretation of chest X-ray in adults with community-acquired pneumonia. Braz J Infect Dis 2011; 15: 540-6.
  • Lanks CW, Musani A,Hsia DW. Community-acquired pneumonia and hospital acquied pneumonia. Med Clin N Am 2019; 103: 487-501.
  • Poetter-Lang S, Herold CJ.Community-acquired pneumonia. Radiologe 2017; 57: 6-12.
  • Sharma S, Maycher B, Eschun G. Radiological imaging in pneumonia: recent innovations. Curr Opion Pulm Med 2007; 13: 159-69.

Serum albumin and C-reactive protein/albumin ratio in community-acquired pneumonia

Yıl 2022, , 111 - 116, 28.06.2022
https://doi.org/10.47582/jompac.1128249

Öz

Introduction: Community-acquired pneumonia (CAP) is a common type of respiratory tract infections with high morbidity and mortality. Prognostic role of CRP/Albumin ratio in CAP patients still is unknown. The aim of this study was to investigate the role the CRP/albumin ratio in predicting 30-day mortality and ICU requirement in hospitalized patients with CAP.
Material and Method: The study included patients with CAP.Clinical records and plain radiographic images of the patients were retrieved from hospital database and were reviewed for each patient.
Results: The 179 CAP patients who were hospitalized were included. CRP level and the CRP/albumin ratio were found to have no significant effect on mortality and ICU requirement (p=0.728, p=0.232, and p=0.110, respectively), whereas low albumin level was associated with high mortality and ICU requirement (p<0.001 for both).
Conclusion: Increased albumin concentration was associated with a lower risk of 30-day mortality. The CRP/albumin ratio was found to have no significant role in predicting short-term mortality and morbidity in CAP patients. Further large-scale, multicenter studies are needed to investigate the prognostic value of the CRP/albumin ratio in predicting long-term prognosis in CAP patients

Proje Numarası

yok

Kaynakça

  • Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200: e45-67.
  • Farah R, Mograbi J, Makhoul N.Impact of serum C-reactive protein measurements in the first 2 days on the 30-day mortality in hospitalized patients with severe community-acquired pneumonia: A cohort study. J Crit Care 2013; 28: 291-5.
  • Arnau-Barrés I, Güerri-Fernández R, Luque S, Sorli L, Vázquez O, Miralles R. Serum albumin is a strong predictor of sepsis outcome in elderly patients. Eur J Clin Microbiol Infect Dis 2019; 38: 743-6.
  • Eshwara VK, Mukhopadhyay C, Rello J. Community-acquired bacterial pneumonia in adults. An update. Indian J Med Res 2020; 151: 287-302.
  • Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. Plos One 2013; 8: e59321.
  • Kocatürk M, Kocatürk O. Assessment of relationship between C-reactive protein to albumin ratio and 90-day mortality in patients with acute ischaemic stroke. Neurol Neurochir Pol 2019; 53: 205-11.
  • Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163: 1730-54.
  • British Thoracic Society Standarts of Care Committee BTS Guidelines for the management of community acquired pneumonia in adults. Thorax 2001; 56: iV1-64.
  • Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD. Infectious Diseases Society of America/America Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44: S27-72.
  • Bouch DC, Thompson JP. Severity scoring systems in the critical ill. Continuing Education in Anesthesia and Critical Care 2018; 8: 181-5.
  • Metersky ML, Waterer G, Nsa W, Bratzler DW. Predictors of in-hospital vs discharge mortality in pneumonia. Chest 2012; 142: 476-81
  • Lee JH, Kim J, Kim K. Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia. J Crit Care 2011; 26: 287-94.
  • Oh TK, Eunjeong J, Hyo-seok N, et al. C-reactive protein to albumin ratio predicts 30-day and 1-year mortality in postoperative patients after admission to the intensive care unit. J Clin Med 2018; 7: 39.
  • Kim MH, Ahn JY, Song JE, et al. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe or septic shock treated with early goal-directed therapy. Plos One 2015; 10: e0132109.
  • Oh J, Kim SH, Park KN. 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: 19-24.
  • Charles PG, Wolfe R, Whitby M, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008; 47: 375-84.
  • Ventura JC, Hauschild DB, Moreire MDE.C-reactive protein/albumin ratio is associated with lung function among children/adolescents with cystic fıbrosis: a three years longitudinal study. Sao Paulo Med J 2018; 136: 29-36.
  • Mendez R, Aldas I, Menendez R. Biomarkers in community-acquired pneumonia (cardiac and non-cardiac). J Clin Med 2020; 9: 549.
  • Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacol Ther 2021; 217: 107663.
  • Sungurlu S, Balk RA. The role of biomarkers in the diagnosis and management of pneumonia. Clin Chest Med 2018; 39: 691-701.
  • Ugajin M, Yamaki K, Iwamura N, Yagi T, Asano T. Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community-acquired pneumonia. Int J Gen Med 2012; 5: 583-9.
  • Moncada DC, Rueda ZV, Macías A, Suárez T, Ortega H, Vélez LA. Reading and interpretation of chest X-ray in adults with community-acquired pneumonia. Braz J Infect Dis 2011; 15: 540-6.
  • Lanks CW, Musani A,Hsia DW. Community-acquired pneumonia and hospital acquied pneumonia. Med Clin N Am 2019; 103: 487-501.
  • Poetter-Lang S, Herold CJ.Community-acquired pneumonia. Radiologe 2017; 57: 6-12.
  • Sharma S, Maycher B, Eschun G. Radiological imaging in pneumonia: recent innovations. Curr Opion Pulm Med 2007; 13: 159-69.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Research Articles [en] Araştırma Makaleleri [tr]
Yazarlar

Derya Hoşgün

Esen Sayın Gülensoy 0000-0002-0154-7775

Evrim Akpınar

Nalan Ogan 0000-0001-5232-3803

Can Ateş 0000-0003-2286-4398

Semih Aydemir

Proje Numarası yok
Yayımlanma Tarihi 28 Haziran 2022
Yayımlandığı Sayı Yıl 2022

Kaynak Göster

AMA Hoşgün D, Sayın Gülensoy E, Akpınar E, Ogan N, Ateş C, Aydemir S. Serum albumin and C-reactive protein/albumin ratio in community-acquired pneumonia. J Med Palliat Care / JOMPAC / Jompac. Haziran 2022;3(2):111-116. doi:10.47582/jompac.1128249

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