Cemil CİVELEK, İLHAN KORKMAZ, ŞEVKİ HAKAN EREN, FATMA MUTLU KUKUL GÜVEN, Şule KARADAYI, Ömer Tamer DOĞAN, Ziynet ÇINAR, İnan BEYDİLLİ

Kronik obstruktif akciğer hastalığı akut alevlenmeli hastalarda prokalsitonin ve diğer akut faz belirteçleri

Amaç: Çalışmanın amacı kronik obstruktif akciğer hastalığı (KOAH) akut alevlenmeli hastaların serum prokalsitonin (PCT) ölçümü ile diğer akut faz belirteçlerini karşılaştırmak ve klinikle ilişkisini araştırmaktır. Gereç ve yöntem: Çalışma acil servise başvuran 122 KOAH akut alevlenmeli hasta ile yapıldı. Prokalsitonin (PCT) değeri 0.05). Hastaların PCT ve CRP değerleri ile hastanede kalış süreleri arasında aynı yönlü ilişki saptandı (sırasıyla p=0.034, p=0.022). Eksitus olan hastalardaki PCT ortalama değeri 28.3 ± 27.5 ng/ml olup taburcu olanlara oranla anlamlı olarak yüksek bulundu (p= 0.012). Sonuç: Elde ettiğimiz verilere dayanarak PCT’nin KOAH akut alevlenmeli hastalarda morbidite ve prognozunun belirlenmesinde yararlı bir gösterge olarak kullanılabileceği sonucuna varıldı.

Procalcitonin and other acute phase reactants in patients with chronic obstructive pulmonary disease exacerbation

Objectives: The aim of this study was to investigate the correlation between procalcitonin and other acute phase reactants, and also analyze their relationship with clinical situation in chronic obstructive pulmonary disease (COPD) acute exacerbations. Materials and methods: The study was made with 122 acute COPD exacerbated patients, who were admitted to emergency service. Patients with below 0.25 ng/ml PCT value included Group 1, and the patients with PCT values ≥ 0.25 ng/ml Group 2. Serum procalcitonin levels, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) values and white blood cell (WBC) counts were measured. Also, patients hospitalization time and mortality rates were recorded and compared with PCT. Results: Patients were divided in 3 groups according to their clinical diagnosis; Pneumonia (n=27), Mycoplasma-Chlamydia pneumonia (n=11) and the patients with only COPD exacerbation(n=84). Mean PCT values according to the groups were 9.47 ± 8.1 ng/ml, 0.41 ± 0.2 ng/ml, and 0.21 ± 0.05 ng/ml respectively. The relationship between PCT with CRP and white blood cell has been found between significiant (p=0.001, p=0.005 respectively), whereas the relationship between PCT and ESR was nonsignificant (p=0.55). Procalcitonin and CRP had a positive correlation with the hospitalization time (p=0.034, p=0.022 respectively). The mean ± standard error of PCT for the patients who died was 28.3 ± 27.5 ng/ml, and the difference between patients who died or were discharged was statistically significant (p= 0.012). Conclusion: PCT can be a useful indicator for morbidity and prognosis in COPD patients.

PDF

___

1. Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest 2000;117(5):398-401.
2. Burge S, Wedzicha JA. COPD exacerbations: definitions and classifications. Eur Respir J Suppl 2003;41 (1):46-53.
3. Lacoma A, Prat C, Andreo F et al. Biomarkers in the management of COPD Eur Respir Rev 2009; 18(1): 96–104.
4. Genç H. Çocukluk çağı infeksiyonlarının tanı ve takibinde prokalsitonin, neopterin ve CRP’ nin yeri. Uzmanlık Tezi. Isparta 2003.
5. C.Bohuon. A brief history of procalcitonin. Intensive Care Med 2000; 26(2):146-7.
6. Stucker F, Herrmann F, Graf JD et al. Procalcitonin and infection in elderly patients. J Am Geriatr Soc (JAGS) 2005;53(10):1392–5.
7. Andreola B, Bressan S, Callegaro S et al. Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department. Pediatr Infect Dis J 2007;26(8):672-7.
8. Taşçı C, Balkan A, Karadurmuş N et al. The importance of serum procalcitonin levels in patients with chronic obstructive pulmonary disease exacerbations. Turk J Med Sci 2008; 38(2):139-44.
9. Sin Don D, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? Circulation 2000;107(11):1511-9.
10. Gan WQ, Man SF, Senthilselvan A et al. Association between chronic obstructive pulmonary disease and systemic inflamation: A systematic review and a metaanalysis. Thorax 2004;59(7):574-80.
11. Sapey E, Stockley RA. COPD exacerbations. 2: aetiology. Thorax 2006;61(3):250–8.
12. Müller B, Prat C. Markers of acute inflammation in assessing and managing lower respiratory tract infections: focus on procalcitonin. Clin Microbiol Infect 2006; 12 (Suppl 9): 8-16.
13. Toikka P, Irjala K, Juven T et al. Serum procalcitonin, C-reactive protein and interleukin 6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J 2000;19(7): 598-602.
14. Hedlund J, Hansson LO. Procalcitonin and C-Reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 2000;28(2):68-73.
15. Taşçı C, Deniz Ö, Tozkoparan E et al. Toplum kökenli pnomonilerde serum prokalsitonin değerleri ile diğer akut faz belirteçleri ve hastalığın radyolojik yaygınlığı arasındaki ilişki. Toraks Dergisi 2007;8(3):156-62.
16. Simon L, Gauvin F, Amre DK et al. Serum procalcitonin and C-Reactive protein levels as markers of bacterial infection: A systematic review and meta-analysis. CID 2004; 39(2):206–17.
17. Poyrazoğlu MH, Per H, Öztürk M et al. Çocukluk çağı pnomonilerinde serum prokalsitonin düzeyleri. Çocuk Sağlığı ve Hastalıkları Dergisi 2002; 46(2): 169-76.
18. Chang C, Yao WZ, Chen YH et al. The changes and clinical implications of serum procalcitonin in acute exacerbations of chronic obstructive pulmonary disease. Zhonghua Jie He He Hu Xi Za Zhi 2006; 29(7): 444-7.
19. Chang C, Yao WZ, Chen YH et al. Value of serum procalcitonin in diagnosing bacterial lower respiratory tract infections in people with exacerbation of chronic obstructive pulmonary disease. Beijing Da Xue Xue Bao 2006; 38(4):389-92.
20. Daubin C, Parienti JJ, Vabret A et al. Procalcitonin levels in acute exacerbation of COPD admitted in ICU: a prospective cohort study. BMC Infect Dis 2008, 8:145-8.
21. Ece F, Kılıçkan L, Aytaç J et al. Solunum yetmezliği ile yoğun bakıma yatırılan KOAH hastalarında infeksiyonu değerlendirmede CRP ve prokalsitoninin etkisi. Akciğer Arşivi 2009;10(1):13-7.
22. Stolz D, Christ-Crain M, Morgenthaler NG, et al. Copeptin, C-Reactive protein, and procalcitonin as prognostic biomarkers in acute exacerbation of COPD. Chest 2007;131(4):1058-67.
23. Gavazzi G, Stucker F, Herrmann F, Graf JD, Michel JP. Procalcitonin, predictor of early mortality in very old patients. Ann Gerontol 2009;2(3):75-8.
24. Rammaert B, Verdier N, Cavestri B et al. Procalcitonin as a prognostic factor in severe acute exacerbation of chronic obstructive pulmonary disease. Respirology 2009;14(7):969-74.
25. Taşdelen NF, Bayram N, Portakal OA et al. Yoğun bakım ünitesinde sepsis ve SIRS olgularında prokalsitoninin tanıdaki rolü. Yoğun Bakım Dergisi 2003;3(1):43-7.