Şiddetli Toplum Kökenli Pnömonili Hastalarda Pan-İmmün-İnflamasyon Değerinin 30 Günlük Mortaliteyi Öngörmedeki Rolü

Öz

Toplum kökenli pnömoni (TKP), özellikle yoğun bakım ünitelerine (YBÜ) yatırılan kritik hastalarda önemli morbidite ve mortalite nedenidir. Prognostik sınıflamada yaygın olarak kullanılan çeşitli klinik skorlama sistemleri bulunsa da, bu sistemlerin sınırlılıkları yeni biyobelirteçlere olan ilgiyi artırmıştır. Pan-immün-inflamasyon değeri (PIIV), sistemik inflamasyon ve bağışıklık durumunu değerlendirmede yeni tanımlanmış bir biyobelirteçtir. Bu çalışmada, YBÜ’ye yatırılan TKP hastalarında PIIV ile diğer geleneksel inflamatuar belirteçler ve mortalite arasındaki ilişki araştırılmıştır. Çalışmaya retrospektif olarak toplam 248 TKP hastası dahil edilmiştir. Elektronik arşivlerden elde edilen demografik, klinik ve laboratuvar verileri ile 30 günlük mortalite arasındaki ilişki değerlendirilmiştir. Bağımsız mortalite belirleyicilerini tanımlamak amacıyla univaryant ve multivaryant lojistik regresyon analizleri yapılmış, ROC analizi ile tanısal performans değerlendirilmiştir. Çalışmadaki 248 hastanın 156’sı (%62,9) hayatını kaybetmiştir. PIIV, prokalsitonin, laktat ve nötrofil-lenfosit oranı (NLO), sağ kalamayan hastalarda anlamlı düzeyde yüksek bulunmuştur. Çok değişkenli analizde, PIIV (düzeltilmiş OR: 1,227; %95 CI: 1,097–1,372; p < 0,001), laktat (düzeltilmiş OR: 1,637; %95 CI: 1,290–2,077; p < 0,001) ve prokalsitonin (düzeltilmiş OR: 1,017; %95 CI: 1,002–1,033; p = 0,022) 30 günlük mortalitenin bağımsız belirleyicileri olarak tanımlandı. ROC analizinde PIIV için 1928,3 kesim değerinde %54,5 duyarlılık ve %70,7 özgüllük elde edilmiştir. Laktat en yüksek duyarlılığı (%75,6) gösterirken, prokalsitonin %73,7 duyarlılık ve %61,9 özgüllüğe sahiptir. PIIV, TKP hastalarında mortaliteyi öngörmede bağımsız ve değerli bir biyobelirteçtir. Çok sayıda hematolojik parametreyi entegre ederek bağışıklık-inflamasyon dengesini yansıtabilir ve mevcut belirteçlerle birlikte kullanıldığında klinik karar süreçlerine katkı sağlayabilir.

Anahtar Kelimeler

• Toplum Kökenli Pnömoni
• Prognoz
• mortalite
• pan-immun-inflamasyon değeri

Assessing the Prognostic Performance of Pan Immune-Inflammation Value and Inflammatory Biomarkers in Critically Ill Patients with Community-Acquired Pneumonia

Öz

Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality, particularly among critically ill patients in intensive care units (ICUs). Although various clinical scoring systems are used for prognostic stratification, their limitations have prompted interest in novel biomarkers. The pan-immune-inflammation value (PIIV) is a recently proposed index assessing systemic inflammation and immune status. This study investigates the relationship between PIIV, traditional inflammatory markers, and mortality outcomes in ICU-admitted CAP patients. A total of 248 CAP patients were retrospectively analyzed. Demographic, clinical, and laboratory data were obtained from electronic medical records. Associations between these variables and 30-day mortality were evaluated. Univariate and multivariate logistic regression analyses identified independent mortality predictors, and Receiver Operating Characteristic (ROC) analysis assessed diagnostic performance. Among 248 patients, 156 (62.9%) died. PIIV, procalcitonin, lactate, and neutrophil-lymphocyte ratio (NLR) levels were significantly higher in non-survivors. Multivariable analysis identified PIIV (adjusted OR: 1.227; 95% CI: 1.097–1.372; p < 0.001), lactate (adjusted OR: 1.637; 95% CI: 1.290–2.077; p < 0.001), and procalcitonin (adjusted OR: 1.017; 95% CI: 1.002–1.033; p = 0.022), as independent predictors of 30-day mortality. ROC analysis showed optimal cut-off values: PIIV ≥1928.3 (54.5% sensitivity, 70.7% specificity), lactate ≥1.6 mmol/L (75.6% sensitivity), and procalcitonin ≥1.26 ng/mL (73.7% sensitivity, 61.9% specificity). PIIV is an independent prognostic indicator of mortality in CAP patients, reflecting systemic inflammation through multiple hematological parameters. It may capture complex immune-inflammatory dynamics and serve as a useful adjunctive biomarker alongside established markers.

Anahtar Kelimeler

• Community acquired pneumonia
• prognosis
• mortality
• pan-immune-inflammation value

Kaynakça

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