KAN DOLAŞIMI ENFEKSİYONLARININ ERKEN TANISINDA İNFLAMATUVAR BELİRTEÇLERİN DEĞERLENDİRİLMESİ

Öz

Amaç Bu çalışmanın amacı, kan dolaşımı enfeksiyonu (KDE)'nun tanısında kan kültürüne alternatif olarak kullanılabilecek prokalsitonin (PCT), yüksek sensitif C-reaktif protein (hsCRP), hsCRP/albümin oranı (CAR) ve tam kan sayımı (TKS) parametrelerinin tanısal performansını araştırmaktır. Gereç ve Yöntem Mayıs 2019-Mayıs 2020 tarihleri arasında hastanemizde yatarak tedavi gören ve kan kültürü, PCT, hsCRP, TKS ve albümin tetkikleri eşzamanlı istenilen hastaların dosyaları retrospektif olarak incelendi. Hastalar kan kültüründe üremesi olanlar (n=95) ve kan kültüründe üremesi olmayanlar (n=157) olarak iki gruba ayrıldı. Kan kültürleri, BacT/ALERT 3D (bioMérieux, Fransa) otomatize kan kültürü sisteminde takip edildi. Prokalsitonin ve hsCRP düzeyleri, Roche Cobas 6000 modüler sisteminde (Roche Diagnostics, Almanya) ölçüldü. Tam kan sayımı analizi, UniCel DxH 800 hematoloji analizöründe (Beckman Coulter, ABD) gerçekleştirildi. Bulgular Hemokültür pozitif ve hemokültür negatif grup arasında, PCT, hsCRP, CAR, nötrofil, lenfosit, hemoglobin, eritrosit dağılım genişliği (RDW), ortalama trombosit hacmi (MPV), nötrofil/lenfosit oranı (NLR), lenfosit/ monosit oranı (LMR), trombosit/lenfosit oranı (PLR), MPV/trombosit oranı (MPV/PLT) ve albümin düzeyleri bakımından istatistiksel olarak anlamlı fark bulundu (p<0.05). Prokalsitonin ile hsCRP, CAR, MPV, NLR ve PLR arasında istatistiksel olarak anlamlı pozitif korelasyon saptandı (p<0.05). Lojistik regresyon modelinde, PCT (odds oranı: 10.930) ve CAR (odds oranı: 1.806) KDE için güçlü prediktif faktörler olarak saptandı (p<0.05). Sonuç Test edilen belirteçler arasında PCT ve CAR, KDE için en iyi tanısal performansa sahiptir. Yüksek sensitif CRP ile birlikte tam otomatik hemogram cihazlarında kolay, ucuz ve hızlı bir şekilde ölçülebilen NLR, LMR, PLR, MPV/PLT, RDW, MPV değerleri, KDE’nin öngörülmesinde yardımcı ek testler olarak kullanılabilir.

Anahtar Kelimeler

• Bakteriyemi
• sepsis
• prokalsitonin
• C-reaktif protein
• serum albümini
• tam kan sayımı

EVALUATION OF INFLAMMATORY MARKERS IN THE EARLY DIAGNOSIS OF BLOODSTREAM INFECTIONS

Öz

Objective The aim of this study was to investigate the diagnostic performance of procalcitonin (PCT), high sensitive C-reactive protein (hsCRP), hsCRP/albumin ratio (CAR) and complete blood count (CBC) parameters which can be used as an alternative to the blood culture in the diagnosis of bloodstream infection (BSI). Materials and Methods Medical records of the patients who received inpatient treatment in our hospital between May 2019-May 2020 and who were simultaneously requested for blood culture, PCT, hsCRP, CBC and albumin tests were retrospectively reviewed. The patients were divided into two groups as those with positive blood culture (n=95) and those with negative blood culture (n=157). Blood cultures were performed using the BacT/ALERT 3D (bioMérieux, France) automated blood culture system. The levels of PCT and hsCRP were measured by the Roche Cobas 6000 modular system (Roche Diagnostics, Germany). Complete blood count analysis was performed using the UniCel DxH 800 hematology analyzer (Beckman Coulter, USA). Results A statistically significant difference was found between the hemoculture positive and the hemoculture negative groups in terms of PCT, hsCRP, CAR, neutrophil, lymphocyte, hemoglobin, red blood cell distribution width (RDW), mean platelet volume (MPV), neutrophil/ lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR) platelet/lymphocyte ratio (PLR), MPV/platelet ratio (MPV/PLT) and albumin levels (p<0.05). There was a statistically significant positive correlation between PCT and hsCRP, CAR, MPV, NLR and PLR (p<0.05). In the logistic regression model, PCT (odds ratio: 10.930) and CAR (odds ratio: 1.806) were found to be the strong predictive factors for BSI (p<0.05). Discussion Among the tested markers, PCT and CAR had the best diagnostic performance for BSI. High sensitive CRP and NLR, LMR, PLR, MPV/PLT, RDW, MPV values that can be measured easily, cheaply and quickly by fully automated hemogram devices may be used as additional tests in predicting BSI.

Anahtar Kelimeler

• Bacteremia
• sepsis
• procalcitonin
• C-reactive protein
• serum albumin
• complete blood count.

Kaynakça

1. Kirn TJ, Weinstein MP. Update on blood cultures: how to obtain, process, report, and interpret. Clin Microbiol Infect 2013;19:513-20.
2. Ntusi N, Aubin L, Oliver S, Whitelaw A, Mendelson M. Guideline for the optimal use of blood cultures. S Afr Med J 2010;100:839-43.
3. Kan Dolaşımı Örnekleri, Tıbbi Mikrobiyoloji Uzmanları İçin Klinik Örnekten Sonuç Raporuna Uygulama Rehberi. KLİMUD, 2017.
4. Karakoç AE. Güncel rehberler ışığında sepsis, klasik ve hızlı tanı yöntemleri, ulusal hemokültür rehberi. ANKEM Derg 2014;28(Ek 2):46-51.
5. Reinhart K, Bauer M, Riedemann NC, Hartog CS. New Approaches to sepsis: Molecular diagnostics and biomarkers. Clin Microbiol Rev 2012;25(4):609-34.
6. Henriquez-Camacho C, Losa J. Biomarkers for sepsis. Biomed Res Int 2014;2014:547818.
7. Ranzani OT, Zampieri FG, Forte DN, Azevedo LCP, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE 2013;8(3):e59321.
8. Kim MH, Ahn JY, Song JE, Choi H, Ann HW, Kim JK, ve ark. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe sepsis or septic shock treated with early goal-directed therapy. PLoS ONE 2019;14:e0225620.

9. Oh TK, Song I, Lee JH. Clinical usefulness of C-reactive protein to albumin ratio in predicting 30-day mortality in critically ill patients: A retrospective analysis. Sci Rep 2018;8:14977.
10. Park JE, Chung KS, Song JH, Kim SY, Kim EY, Jung JY, ve ark. The C-reactive protein/albumin ratio as a predictor of mortality in critically ill patients. J Clin Med 2018;7:333.
11. Güneş H, Yurttutan S, Çobanuşağı M, Doğaner A. CRP/albumin ratio: A promising marker of gram-negative bacteremia in late-onset neonatal sepsis. Turk Arch Pediatr 2021;56: 32-6.
12. Yılmaz EM, Kandemir A. Significance of red blood cell distribution width and C-reactive protein/albumin levels in predicting prognosis of acute pancreatitis. Ulus Travma Acil Cerrahi Derg 2018;24:528-31.
13. Colak A, Zeytinli Aksit M, Toprak B, Yılmaz N. Diagnostic values of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and procalcitonin in early diagnosis of bacteremia. Turk J Biochem 2020;45:57-64.
14. Akkeçeci NS, Seğmen B, Yurttutan S, Acıpayam C, Dinçer Z, Öksüz G. Yenidoğan sepsisinde tam kan sayımı parametrelerinin tanısal değeri. Dicle Med J 2019;46:149-58.
15. Sirin MC, Korkmaz S, Erturan I, Filiz B, Cicioglu Aridogan B, Sesli Cetin E, Yildirim M. Evaluation of monocyte to HDL cholesterol ratio and other inflammatory markers in patients with psoriasis. An Bras Dermatol 2020;95:575-82.
16. Eraldemir FC. Prokalsitonin yerine nötrofil/lenfosit oranı: Bir seçenek olabilir mi? Türk Klinik Biyokimya Derg 2018;16:11-6.
17. Loonen AJM, de Jager CPC, Tosserams J, Kusters R, Hilbink M, Wever PC, van den Brule AJC. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PLoS ONE 2014;9:e87315.
18. Ljungstroöm L, Pernestig A-K, Jacobsson G, Andersson R, Usener B, Tilevik D. Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. PLoS ONE 2017;12:e0181704.
19. Zhang HB, Chen J, Lan QF, Ma XJ, Zhang SY. Diagnostic values of red cell distribution width, platelet distribution width and neutrophil-lymphocyte count ratio for sepsis. Exp Ther Med 2016;12:2215-19.
20. Sirin MC, Cicioglu Aridogan B, Sesli Cetin E, Sirin FB. Evaluation of biochemical, hematological, RIBA and PCR assays in predicting viremia in anti-HCV positive patients. J Infect Dev Ctries 2019;13(8):736-43.
21. Laukemann S, Kasper N, Kulkarni P, Steiner D, Rast AC, Kutz A, ve ark. Can we reduce negative blood cultures with clinical scores and blood markers? Results from an observational cohort study. Medicine 2015;94:e2264.
22. Sönmezer MÇ, Tülek N. Bakteriyel infeksiyonlarda ve sepsiste biyobelirteçler. Klimik Derg 2015;28: 96-102.
23. Hoeboer SH, van der Geest PJ, Nieboer D, Groeneveld ABJ. The diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis. Clin Microbiol Infect 2015;21:474-81.
24. Leli C, Ferranti M, Moretti A, Al Dhahab ZS, Cenci E, Mencacci A. Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections. Dis Markers 2015; 2015:701480.
25. Watanabe Y, Oikawa N, Hariu M, Fuke R, Seki M. Ability of procalcitonin to diagnose bacterial infection and bacteria types compared with blood culture findings. Int J Gen Med 2016;9:325-31.
26. Günal Ö, Ulutan F, Erkorkmaz Ü. Sepsisli hastalarda prokalsitoninin prognostik değeri. Klimik Derg 2011;24:31-5.
27. Liu HH, Zhang MW, Guo JB, Li J, Su L. Procalcitonin and C-reactive protein in early diagnosis of sepsis caused by either gram-negative or gram-positive bacteria. Ir J Med Sci 2017;186:207-12.
28. Li S, Rong H, Guo Q, Chen Y, Zhang G, Yang J. Serum procalcitonin levels distinguish gram-negative bacterial sepsis from gram-positive bacterial and fungal sepsis. J Res Med Sci 2016;21:39.
29. Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med 2006;34:1996-2003.