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Febril Nötropenide C-Reaktif Protein ve Prokalsitoninin Yeri

Yıl 2009, Cilt: 7 Sayı: 2, 7 - 12, 01.09.2009

Öz

Amaç: Febril nötropeni kanser hastalarında en önemli mortalite ve morbidite nedenidir. Bu nedenle tanının erken konması ve uygun antibiyoterapinin başlanması oldukça önemlidir. Bu çalışmada febril nötropenik hastalarda C-reaktif protein CRP ve prokalsitonin arasında sepsisin şiddeti ve tanımlanmasında bir farklılıkolup olmadığını göstermek amaçlanmıştır. Gereç ve Yöntem: Bu prospektif çalışmaya Uludağ Üniversitesi Tıp Fakültesi Çocuk Hematoloji ve Onkoloji Ünitesinde febril nötropeni tanısıyla izlenen 30 olgu 35 atak dahil edildi. Serum CRP ve prokalsitonin değerleri 0-5. günlerde alındı.Kültür üremesi, uzamış ateş, mukozitin varlığı ve mutlak nötrofil sayısı MNS ilekarşılaştırma yapıldı. Bulgular: Akut lösemi tanısı alan 16 %54 ve solid tümörlü olan 14 %46 olgu incelendi. CRP ve prokalsitonin değerleri karşılaştırıldığında her iki parametrenin depik değerine 1. günde ulaştığı ve benzer zamanlarda azaldığı görüldü, ancak aralarında istatistiksel olarak anlamlı korelasyon saptanmadı r=0,2, p>0,05 . Mukoziti ve kültür üremesi olan hastalarda parametreler açısından anlamlı bir fark yoktu.Ancak CRP, MNS

Kaynakça

  • Südhoff T, Giagounidis A, Karthaus M. Evaluation of neutro- penic fever: value of serum and plasma parameters in clini- cal practice. Chemotherapy 2000;46:77-85.
  • Feld R. Multinational cooperation in trials and guidelines dealing with febrile neutropenia. Int J Antimicrob Agents 2000;16:185-7.
  • Fleischhack G, Kambeck I, Cipic D, Hasan C, Bode U. Procal- citonin in paediatric cancer patients: its diagnostic relevan- ce is superior to that of C-reactive protein, interleukin 6, in- terleukin 8, soluble interleukin 2 receptor and soluble tumo- ur necrosis factor receptor II. Br J Haematol 2001;114:489-91.
  • Karin SR Massaro, Silvia F Costa, Claudio Leone et al. Pro- calcitonin (PCT) and C-reactive protein (CRP) as severe systemic infection markers in febrile neutropenic adults. BMC Infectious Diseases 2007;7:137-45.
  • Schuttrumpf S, Binder L, Hagemann T, Berkovic D, Trumper L, Binder C. Utility of procalcitonin concentration in the eva- luation of patients with malignant diseases and elevated C- reactive protein plasma concentrations. Clin Infect Dis 2006:15;43:468-73.
  • Ruokonen E, Nousiainen T, Pulkki K, Takala J. Procalcitonin concentrations in patients with neutropenic fever. Eur J Clin Microbiol Infect Dis 1999;18:283-5.
  • Katz JA, Mustafa MM, Bash RO, Cash JV, Buchanan GR. Va- lue of C-reactive protein determination in the initial diagnos- tic evaluation of the febrile, neutropenic child with cancer. Pediatr Infect Dis J 1992;11:708-12.
  • Jaye DL, Waites KB. Clinical applications of C-reactive pro- tein in pediatrics. Pediatr Infect Dis J 1997;16:735-46. 9. Becker KL, Neylen ES, Cohen R, Snider RH. Calcitonin: Struc- ture, Molecular Biology, and Actions in Principles of Bone Biology. Acad Pres 1996;34:471-94.
  • Karzai W, Oberhoffer M, Meier-Hellmann A, Reinhart K. Pro- calcitonin-a new indicator of the systemic response to seve- re infections. Infection 1997;25:329-34.
  • Secmeer G, Devrim I, Kara A, Ceyhan M et al. Role of procal- citonin and CRP in differentiating a stable from a deteriora- ting clinical course in pediatric febrile neutropenia. J Pediatr Hematol Oncol 2007;29:107-11.
  • Küpeli S, Turul T, Cüzdancı C ve ark. Kemik iliği transplantas- yonu yapılan çocuklarda prokalsitonin, kantitatif C-reaktif protein ve eritrosit sedimentasyon hızı değerleri. Çocuk Sağ- lığı ve Hastalıkları Dergisi 2007; 50:1-5.
  • Christofilopoulou S, Charvalos E, Petrikkos G. Could procalci- tonin be a predictive biological marker in systemic fungal in- fections? Study of 14 cases. Eur J Intern Med 2002;13:493-5.
  • Ortega M, Rovira M, Filella X, Almela M et al. Prospective evaluation of procalcitonin in adults with febrile neutro- penia after haematopoietic stem cell transplantation. Br J Haematol 2004;126:372-6.
  • Giamarellou H, Giamarellos-Bourboulis EJ, Repoussis P et al. Potential use of procalcitonin as a diagnostic criterion in febrile neutropenia: experience from a multicentre study. Clin Microbiol Infect 2004;10:628-33.
  • Young B, Gleeson M, Cripps AW. C-reactive protein: a criti- cal review. Pathology 1991;23:118-24.
  • Ciaccio M, Fugardi G, Titone L, Romano A et al. Procalci- tonin levels in plasma in oncohaematologic patients with and without bacterial infections. Clin Chim Acta 2004;340:149-52.
  • Svaldi M, Hirber J, Lanthaler AI, Mayr O et al. Procalcito- nin-reduced sensitivity and specificity in heavily leucope- nic and immunosuppressed patients. Br J Haematol 2001;115:53-7.

The Value of C-Reactive Protein and Procalcitonin in Febrile Neutropenia

Yıl 2009, Cilt: 7 Sayı: 2, 7 - 12, 01.09.2009

Öz

Aim: Febrile neutropenia is the major cause of mortality and morbidity in cancerpatients. For this reason, early diagnosis of severe infections and appropriate antimicrobial therapy are very important. The aim of this study was to investigatethe difference between C-reactive protein CRP and procalcitonin in determiningthe sepsis and its severity. Materials and Method: A total of 30 children 35 episodes with febrile neutropeniawho were hospitalized in the Uludag University, Pediatric Hematology and Oncology Unit were included in this prospective study. The blood samples for CRP andprocalcitonin were collected daily between 0 to 5thdays. Serum CRP and procalcitonin levels were compared with culture positivity, prolonged fever, mucositisand absolute granulosit count AGC . Results: A total of 16 patients 56% diagnosed with acute leukemia and, 14 patients 46% having solid tumours were evaluated. In sequential analysis of febrileepisodes, both the median of procalcitonin and the CRP concentrations showedthe same tendency and there was no significant correlation between them r=0.2,p>0.05 . There was no significant association between CRP and procalcitoninamong those having positive culture and mucositis. However, CRP values at the3rd, 4thand 5thdays were significantly higher in the patients with AGC100/mm3. Similarly,CRP values were significantly higher at the 1st, 2nd, 3rdand 4thdays among the patients having prolonged fever. Conclusion: Our study suggests that there is no difference between CRP and procalcitonin in determining sepsis andits severity. Although procalcitonin is a valuable acute phase reactant in non-neutropenic patients, larger prospective

Kaynakça

  • Südhoff T, Giagounidis A, Karthaus M. Evaluation of neutro- penic fever: value of serum and plasma parameters in clini- cal practice. Chemotherapy 2000;46:77-85.
  • Feld R. Multinational cooperation in trials and guidelines dealing with febrile neutropenia. Int J Antimicrob Agents 2000;16:185-7.
  • Fleischhack G, Kambeck I, Cipic D, Hasan C, Bode U. Procal- citonin in paediatric cancer patients: its diagnostic relevan- ce is superior to that of C-reactive protein, interleukin 6, in- terleukin 8, soluble interleukin 2 receptor and soluble tumo- ur necrosis factor receptor II. Br J Haematol 2001;114:489-91.
  • Karin SR Massaro, Silvia F Costa, Claudio Leone et al. Pro- calcitonin (PCT) and C-reactive protein (CRP) as severe systemic infection markers in febrile neutropenic adults. BMC Infectious Diseases 2007;7:137-45.
  • Schuttrumpf S, Binder L, Hagemann T, Berkovic D, Trumper L, Binder C. Utility of procalcitonin concentration in the eva- luation of patients with malignant diseases and elevated C- reactive protein plasma concentrations. Clin Infect Dis 2006:15;43:468-73.
  • Ruokonen E, Nousiainen T, Pulkki K, Takala J. Procalcitonin concentrations in patients with neutropenic fever. Eur J Clin Microbiol Infect Dis 1999;18:283-5.
  • Katz JA, Mustafa MM, Bash RO, Cash JV, Buchanan GR. Va- lue of C-reactive protein determination in the initial diagnos- tic evaluation of the febrile, neutropenic child with cancer. Pediatr Infect Dis J 1992;11:708-12.
  • Jaye DL, Waites KB. Clinical applications of C-reactive pro- tein in pediatrics. Pediatr Infect Dis J 1997;16:735-46. 9. Becker KL, Neylen ES, Cohen R, Snider RH. Calcitonin: Struc- ture, Molecular Biology, and Actions in Principles of Bone Biology. Acad Pres 1996;34:471-94.
  • Karzai W, Oberhoffer M, Meier-Hellmann A, Reinhart K. Pro- calcitonin-a new indicator of the systemic response to seve- re infections. Infection 1997;25:329-34.
  • Secmeer G, Devrim I, Kara A, Ceyhan M et al. Role of procal- citonin and CRP in differentiating a stable from a deteriora- ting clinical course in pediatric febrile neutropenia. J Pediatr Hematol Oncol 2007;29:107-11.
  • Küpeli S, Turul T, Cüzdancı C ve ark. Kemik iliği transplantas- yonu yapılan çocuklarda prokalsitonin, kantitatif C-reaktif protein ve eritrosit sedimentasyon hızı değerleri. Çocuk Sağ- lığı ve Hastalıkları Dergisi 2007; 50:1-5.
  • Christofilopoulou S, Charvalos E, Petrikkos G. Could procalci- tonin be a predictive biological marker in systemic fungal in- fections? Study of 14 cases. Eur J Intern Med 2002;13:493-5.
  • Ortega M, Rovira M, Filella X, Almela M et al. Prospective evaluation of procalcitonin in adults with febrile neutro- penia after haematopoietic stem cell transplantation. Br J Haematol 2004;126:372-6.
  • Giamarellou H, Giamarellos-Bourboulis EJ, Repoussis P et al. Potential use of procalcitonin as a diagnostic criterion in febrile neutropenia: experience from a multicentre study. Clin Microbiol Infect 2004;10:628-33.
  • Young B, Gleeson M, Cripps AW. C-reactive protein: a criti- cal review. Pathology 1991;23:118-24.
  • Ciaccio M, Fugardi G, Titone L, Romano A et al. Procalci- tonin levels in plasma in oncohaematologic patients with and without bacterial infections. Clin Chim Acta 2004;340:149-52.
  • Svaldi M, Hirber J, Lanthaler AI, Mayr O et al. Procalcito- nin-reduced sensitivity and specificity in heavily leucope- nic and immunosuppressed patients. Br J Haematol 2001;115:53-7.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Research Article
Yazarlar

Özlem Özdemir Bu kişi benim

Birol Baytan Bu kişi benim

Metin Demirkaya Bu kişi benim

Solmaz Çelebi Bu kişi benim

Yayımlanma Tarihi 1 Eylül 2009
Yayımlandığı Sayı Yıl 2009 Cilt: 7 Sayı: 2

Kaynak Göster

APA Özdemir, Ö., Baytan, B., Demirkaya, M., Çelebi, S. (2009). Febril Nötropenide C-Reaktif Protein ve Prokalsitoninin Yeri. Güncel Pediatri, 7(2), 7-12.
AMA Özdemir Ö, Baytan B, Demirkaya M, Çelebi S. Febril Nötropenide C-Reaktif Protein ve Prokalsitoninin Yeri. Güncel Pediatri. Eylül 2009;7(2):7-12.
Chicago Özdemir, Özlem, Birol Baytan, Metin Demirkaya, ve Solmaz Çelebi. “Febril Nötropenide C-Reaktif Protein Ve Prokalsitoninin Yeri”. Güncel Pediatri 7, sy. 2 (Eylül 2009): 7-12.
EndNote Özdemir Ö, Baytan B, Demirkaya M, Çelebi S (01 Eylül 2009) Febril Nötropenide C-Reaktif Protein ve Prokalsitoninin Yeri. Güncel Pediatri 7 2 7–12.
IEEE Ö. Özdemir, B. Baytan, M. Demirkaya, ve S. Çelebi, “Febril Nötropenide C-Reaktif Protein ve Prokalsitoninin Yeri”, Güncel Pediatri, c. 7, sy. 2, ss. 7–12, 2009.
ISNAD Özdemir, Özlem vd. “Febril Nötropenide C-Reaktif Protein Ve Prokalsitoninin Yeri”. Güncel Pediatri 7/2 (Eylül 2009), 7-12.
JAMA Özdemir Ö, Baytan B, Demirkaya M, Çelebi S. Febril Nötropenide C-Reaktif Protein ve Prokalsitoninin Yeri. Güncel Pediatri. 2009;7:7–12.
MLA Özdemir, Özlem vd. “Febril Nötropenide C-Reaktif Protein Ve Prokalsitoninin Yeri”. Güncel Pediatri, c. 7, sy. 2, 2009, ss. 7-12.
Vancouver Özdemir Ö, Baytan B, Demirkaya M, Çelebi S. Febril Nötropenide C-Reaktif Protein ve Prokalsitoninin Yeri. Güncel Pediatri. 2009;7(2):7-12.