Use of Inflammation Markers for Mortality Prediction in Intensive Care Patients

Öz

Objective: Calculating the expected mortality rates of intensive care patients is important, therefore some scores that can be used in mortality prediction have been developed. In this study, we aimed to investigate whether C-reactive protein, procalcitonin, albumin, which are inflammatory markers can be used as predictors of mortality.

Material and Methods: Patients who were admitted to intensive care unit between August 2017 and January 2018 were prospectively and observationally analyzed. Demographic, clinical and laboratory data of the patients were recorded. Acute Physiology and Chronic Health Evaluation II (APACHE-II) score was calculated. The relationship between the score results and the laboratory data at the time of hospitalization with the length of stay in the intensive care unit and the intensive care outcome were evaluated.

Results: While C-reactive protein was found to be correlated with length of stay in intensive care unit (p=0.044) and APACHE II score (p=0.02); procalcitonin was in correlation with APACHE II score (p=0.001). When surgery group patients were evaluated as emergency and elective surgery patients; the C-reactive protein (p=0.011) and procalcitonin (p=0.017) values were significantly higher in the patients who died in the elective surgery group. When the medical patient group was examined, C-reactive protein value (p=0.001) was significantly higher in the patient group who died, while the value of albumin (p<0.001) was significantly lower.

Conclusion: As a result of this study, it is thought that the elevation of CRP and procalcitonin values can be used as good markers in predicting early mortality. We think that mortality can be predicted with higher probability by evaluating C-reactive protein and procalcitonin values in patients admitted to intensive care after elective surgery and C-reactive protein, albumin and APACHE-II score together in the medical patient group.

Anahtar Kelimeler

• Intensive Care
• Mortality
• Procalcitonin
• Albumin
• C-reactive protein

YOĞUN BAKIM HASTALARINDA İNFLAMASYON BELİRTEÇLERİNİN MORTALİTE TAHMİNİNDE KULLANIMI

Öz

Amaç: Yoğun bakım hastalarının beklenilen ölüm oranlarının hesaplanması, mevcut tıbbi durumu acil teşhis ve tedavi gerektirecek hastaların hızlıca belirlenmesi, yoğun bakımların standardizasyonu, hizmet kalitesinin değerlendirilmesi ve sağlanması açısından önemlidir. Bu nedenle mortalite tahmininde geliştirilen ölçekler kullanılmaktadır. Bu çalışmada mortalite prediktörü olabilecek inflamasyon belirteçlerinden C-reaktif protein, prokalsitonin, albümin ve beyaz küre değerlerinin mortalite tahminindeki etkinliğinin araştırılması amaçlandı.

Gereç ve Yöntemler: Çukurova Üniversitesi Tıp Fakültesi Reanimasyon Yoğun Bakım ünitesine Ağustos 2017 ve Ocak 2018 arasında kabul edilen, 18 yaş üstü hastalar prospektif ve gözlemsel olarak incelendi. Hastaların demografik, klinik ve laboratuvar verileri kaydedildi. Acute Physiology and Chronic Health Evaluation-II (APACHE-II) skoru hesaplandı. Skor sonuçları ve yatış anındaki laboratuvar verilerinin yoğun bakım yatış süresi ve yoğun bakım tedavisi sonlanımı ile ilişkisi değerlendirildi.

Bulgular: C-reaktif protein, yoğun bakım yatış süresi (p=0.044) ve APACHE-II skoru (p=0.02) ile korelasyon gösterirken; prokalsitonin ise APACHE II skoru ile (p=0.001) korele bulundu. Tüm hastalar değerlendirildiğinde C-reaktif protein (p<0.001) ve prokalsitonin (p=0.004) düzeylerinin ölen hastalarda istatistiksel anlamlı daha yüksek olduğu görüldü. Cerrahi grubundaki hastalar acil ve elektif cerrahi hastaları olarak değerlendirildiğinde; acil cerrahi grubunda, ölen ve sağ kalan hastalardaki C-reaktif protein (p>0.05) ve prokalsitonin (p>0.05) düzeyleri arasında istatistiksel anlamlı fark bulunmazken, elektif cerrahi grubunda ölen hastalarda C-reaktif protein (p=0.011) ve prokalsitonin (p=0.017) değerleri istatistiksel anlamlı daha yüksek idi. Medikal hasta grubu incelendiğinde ise ölen hastalarda C-reaktif protein değeri (p=0.001) istatistiksel anlamlı daha yüksek iken, albümin (p<0.001) değeri istatistiksel anlamlı düşük idi.

Sonuç: Bu çalışmada elde edilen verilere göre C-reaktif protein ve prokalsitonin değerlerinin mortalite tahmininde iyi bir belirteç olarak kullanabileceği düşünülmektedir. Elektif cerrahi sonrasında yoğun bakıma kabul edilen hastalarda C-reaktif protein ve prokalsitonin değerlerinin; medikal hasta grubunda ise C-reaktif protein, albümin ve APACHE-II skorunun birlikte değerlendirilmesiyle, daha yüksek olasılıkla mortalite tahmini yapılabileceğini düşünmekteyiz.

Anahtar Kelimeler

• Yoğun Bakım
• Mortalite
• Prokalsitonin
• Albumin
• C-reaktif protein

Kaynakça

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