The efficacy of blood procalcitonin levels in discrimination of systemic inflammatory response syndrome and burn sepsis

Yıl 2014, Cilt: 22 Sayı: 2, 54 - 58, 01.08.2014

Harun Analay Nazım Gümüş Ahmet Erkılıç Mehmet Sait Yıldırım

Öz

Introduction: Systemic response syndrome may arise in the presence of infection alone or from some causes except for infection. Discrimination of these two clinical entities is very important in planning the treatment of disease and in the evaluation of the efficacy of the treatment. In this study, blood procalcitonin (PTC) levels of severe burn patients were determined and efficacy of them in the diagnosis of sepsis was investigated. Effect of PCT on the follow up of treatment and determination of patient prognosis was also evaluated. Materials and methods: This study enrolled 37 burn patients who had second degree of 25%or more total burned surface area and third degree of 10 %or more total burned surface area. Besides their PCT levels, white blood cell count, platelet count, blood culture and clinically fever, pulse and breath count were determined. All findings were compared statistically between patients with normal PCT levels and those with higher PCT levels, by using Chi-Square test with Yates correction test. Results: Blood PCT level was determined as normal in 23 patients (62.2%) and as high in 14 patients (37.8%). While in 20 (86.9 %) patients with high PCT levels, blood culture grew up, in 3 (13.1 %) patients with high PCT levels it was negative. According to these findings, sensitivity and specificity of PCT in the diagnosis of sepsis were calculated as 86,9 %and 78,5 %respectively. Statistically significant difference was found between the patients with high PCT levels and those with normal PCT levels in the occurrence of sepsis (p<0.001). Conclusion: We consider that determination of blood procalcitonin levels during the treatment of patients with large burns, is a valuable indicator to discriminate SIRS from bacterial sepsis and may be a tool to use in decision on beginning antibiotic therapy and following its effectiveness and ending it. In addition, measurement of blood procalcitonin levels may help to avoid the bacterial resistance to antibiotics in burn units which is a severe problem for burn treatment, and to reduce overall treatment costs.

Anahtar Kelimeler

Systemic inflammatory response, burn, procalcitonin, sepsis

Sistemik inflamatuar yanıt ile yanık sepsisi ayrımında kan prokalsitonin düzeyinin etkinliği

Öz

Giriş: Sistemik inflamatuar yanıt sendromu enfeksiyon varlığında veya enfeksiyon dışı nedenlerle gelişebilir. İki klinik durumun ayırt edilmesi, tedavinin planlanması ve etkinliğinin değerlendirilmesinde önemlidir. Burada, ciddi yanığı olan hastaların kan prokalsitonin (PCT) düzeyi belirlenerek sepsis tanısındaki etkinliği araştırıldı. PCT’nin ayrıca sepsis tedavisinin takibine ve hasta prognozunu belirlemeye etkisi incelendi. Gereç ve yöntem: Bu çalışma, vücut yüzey alanı %25 ve üzeri 2. derece ve %10 ve üzeri 3. derece yanıklı 37 hastada yapıldı. Hastaların kan PCT düzeyleri ile birlikte, beyaz küre (WBC) sayıları, trombosit (PLT) sayıları, kan kültürleri ve klinik olarak da ateş, nabız ve solunum sayıları incelendi. PCT düzeyi yüksek olan ve olmayan hastalar arasında sonuçlar, istatistiksel olarak Yates düzeltmeli ki-kare testi ile kıyaslandı. Bulgular: Hastaların 23 (%62,2)’ünde kan PCT seviyeleri yüksek, 14 (%37,8)’ünde normal olarak belirlendi. Kan PCT değeri yüksek olan hastaların 20 (%86,9)’sinde kan kültüründe üreme varken, 3 (%13,1)’ünde kültür negatifti. PCT değeri normal olan hastaların ise 11 (%78,5)’inde üreme yokken, 3 (%21,5)’ünde kan kültüründe üreme oldu. Buna göre sepsis tanısında, PCT’in sensivitesi ve spesifitesi sıra ile %86,9 ve %78,5 olarak hesaplandı. Kan PCT değeri yüksek ve normal olan hastalar arasında sepsis görülmesi bakımından istatistiksel olarak anlamlı fark saptandı (p

Anahtar Kelimeler

sistemik inflamatuar yanıt, yanık, prokalsitonin, sepsis

Kaynakça

• Mann EA, Wood GL, Wade CE. Use of procalcitonin for the detec- 1.
• tion of sepsis in the critically ill burn patient: a systematic review
• of literature. Burns 2011;37(4):549-58.
• Carrol ED, Thomson APJ, Hart CA. Procalcitonin as a marker of 2.
• sepsis. Int J Antimicrob Agents 2002;20: 1-9.
• Gendrel D, Bohuon C. Procalcitonin as a marker of bacterial in- 3.
• fection. Pediatr Infect Dic J 2000;19: 679-88.
• Levy MM, Fink MP, Marshall JC et al. 2001 SCCM/ESICM/ACCP/ 4.
• ATS/SIS International Sepsis Definition Conference. Crit care
• Med 2003;31(4): 1250-6.
• Dornbusch HJ, Strenger V, Kerbl R, Lackner H, Schwinger W, So- 5.
• vinz P. Procalcitonin –a marker of invasive fungal infection? Sup
• port Care Cancer 2005;13: 343-6.
• Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon 6.
• C. High serum procalcitonin concentrations in patients with
• sepsis and infection. Lancet 1993;341: 515–8.
• ve spesifiteyi %42,4 ve %88,8 olarak bulmuştur.15 Ne- 12. Kim HS, Yang HT, Hur J, Chun W, Ju YS, Shin SH, Kang HJ, Lee KM.
• Procalcitonin levels within 48 hours after burn injury as a prog
• nostic factor. Ann Clin Lab Sci. 2012;42(1): 57-64. 13. Lavrentieva A, Papadopoulou S, Kioumis J, Kaimakamis E, Bit
• zani M. PCT as a diagnostic and prognostic tool in burn patients.
• Whether time course has a role in monitoring sepsis treatment.
• Burns. 2012;38(3): 356-63. 14. Barati M, Alinejad F, Bahar MA, Tabrisi MS, Shamshiri AR, Bodouhi
• NO, Karimi H. Comparison of WBC, ESR, CRP and PCT serum levels
• in septic and non-septic burn cases. Burns. 2008;34(6): 770-4. 15. Bargues, Chancerelle Y, Catineau J, Jault P, Carsin H. Evaluation of
• serum procalcitonin concentration in the ICU following severe
• burn. Burns. 2007;33(7):860-4. 16. Neely AN, Fowler LA, Kagan RJ, Warden GD. Procalcitonin in pe
• diatric burn patients: an early indicator of sepsis? J Burn Care
• Rehabil. 2004;25(1):76-80. 148-52.