Işıl KÖSE, Çiler ZİNCİRCİOĞLU, Gürsel ERSAN, Lütfiye KUZUCU, ŞÜKRAN KÖSE

VENTİLATÖR İLİŞKİLİ PNÖMONİNİN MORTALİTE TAHMİNİNDE SKORLAMA SİSTEMLERİ VE BİYOBELİRTEÇLERİN DEĞERLENDİRİLMESİ

Amaç: Ventilatör ilişkili pnömoni (VİP) gelişen hastalardan ölüm riskinin yüksek olanların erken tanınması, tedavi yaklaşımlarını hasta prognozunu etkileyecek şekilde değiﬂtirmeye yardımcı olabilir. Çalışmamızın amacı; VİP gelişen hastalarda CRP, PCT, SOFA ve MODS’un mortaliteyi erken dönemde belirlemedeki yararını ortaya koymaktır. Yöntem: Çalışmamız prospektif kohort çalışma olarak bir yıl boyunca bir Eğitim ve Araştırma Hastanesi Yoğun Bakım ünitesinde yatan ve VİP gelişen 65 hastada gerçekleştirilmiştir. VİP tanısı mekanik ventilasyon başlangıcından 48 saat sonra pnömoni gelişen hastalarda klinik pulmoner enfeksiyon skorlaması (CPIS) hesaplanarak konmuştur. Tan› bu hastalarda trakeal aspirasyon örneğinin bakteriyolojik analizi ile doğrulanmıştır. Hastalarda rekürrens ve süperenfeksiyon hızları saptanmıştır. 30 günlük mortalite belirleyicisi olarak 0., 3. ve 7. günlerde SOFA ve MODS skorlar› ve PCT ve CRP düzeyleri karşılaştırılmıştır. Veriler SPSS 20.0 program› kullanılarak analiz edilmiştir. Bulgular: Etken mikroorganizmalar açısından en sık etken Acinetobacter spp. iken, ölüm en sık E. coli ile görülmüştür. Etken mikroorganizmanın mortalite ile ilişkisi istatistiksel olarak anlamlı bulunmamıştır. SOFA ve MODS skorları ölen hasta grubunda istatistiksel olarak anlamlı yüksek bulunmuştur. CRP ve PCT düzeyleri ise her iki grup arasında istatistiksel fark göstermemiştir. MODS ve SOFA arasında güçlü korelasyon saptanırken, PCTile SOFAve MODS arasında zayıf korelasyon saptanmıştır. Sonuç: Sonuç olarak VİP’de PCT ve CRP düzeylerinin SOFA ve MODS skorlarına göre kötü birer mortalite belirleyicisi olduğu saptanmıştır.

ASSESSMENT OF SCORING SYSTEMS AND BIOMARKERS IN PREDICTION OF THE MORTALITY IN VENTILATORY ASSOCIATED PNEUMONIA

Objective: Early identification of the patients with ventilator associated pneumonia (VAP) at high risk of death may help in determining therapeutic interventions that could have an impact on patient’s outcome. The aim of our study was to assess the utility of identifying CRP, PCT, SOFAand MODS as useful predictors of mortality early in the patients with VAP. Method: Our study was carried out as a prospective cohort study on 65 patients who developed VAP in Intensive Care Unit of an Education and Research Hospital in one year. Diagnosis of VAP was made according to CPIS (clinical pulmonary infection score) when suspicion of pneumonia was occurred after 48 hours of mechanical ventilation. Diagnosis was confirmed with bacteriologic analysis of tracheal aspirate samples. Recurrence and super infection rates of the patients were determined. The compared mortality predictors were CRP and PCT levels, and SOFA and MODS scores at 0., 3. and 7. days. Data were analyzed using SPSS Version 20.0 software. Results: While Acinetobacter spp. was the most frequently found microorganism, death was seen most with Escherichia coli. The relationship between causing microorganism and mortality was found not statistically significant. The SOFA and MODS scores were found significantly higher in nonsurvivor group. But CRP and PCT levels were not significantly different between two groups. We found strong correlation between SOFAand MODS, and weak correlation between PCTand SOFA/MODS. Conclusion: In conclusion, we found out that PCT and CRP levels are poorer mortality predictors for VAP compared to SOFA and MODS scores.

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