Hilal AKAY ÇİZMECİOGLU, Mevlüt Hakan GÖKTEPE, Ahmet CİZMECİOGLU

Geriatrik Pnömoni Ciddiyeti ve Mortalite Sonuçlarında İmmatür Granülositler ve Çekirdekli Eritrositlerin Prognostik Önemi

Amaç: Yaşlı nüfusta pnömoninin seyri katastrofik olabilir. Pnömoninin ciddiyetini değerlendirebilen biyobelirteçler, prognozda önemli rol oynamaktadırlar. Bu çalışmada, geriatrik pnömoninin ciddiyetinin potansiyel göstergeleri olarak, immatür granülositlerin (İG) ve çekirdekli eritrositlerin (ÇE) kinetikleri değerlendirilmiştir. Gereç ve yöntem: Bu retrospektif ve kesitsel çalışmada, pnömoni tanısı konan hastalar, CURB-65 (Konfüzyon, Üre, Solunum sayısı, Kan basıncı, yaş >65) ve PSI (Pnömoni ciddiyet endeksi) olmak üzere iki önde gelen ciddiyet skorlama sistemine göre kategorize edilmiştir. Ayrıca, hastaların taburculuk durumu ve enfeksiyon süreci belirteçleri kaydedilmiştir. Bulgular: Toplamda 80 hasta değerlendirmeye dahil edilmiştir ve yaş ortalamaları 72.23 ± 7.26'dır. Onkoloji hastaları dahil edildiğinde %49 olan mortalite oranı, hariç tutulduklarında %26 idi. Ölen hastaların hastanede yatış süreleri daha uzundu, CURB-65 ve PSI kategori dereceleri daha yüksek sınıftaydı ve NRBC seviyeleri yükselmişti. CURB-65 tabanlı kategorizasyonda, hastalık şiddeti ile sadece NRBC düzeyinde artış gözlenirken, PSI tabanlı kategorizasyonda hem NRBC hem de IG düzeylerinde artış mevcuttu. Onkoloji hastaları analizden çıkarıldığında NRBC ve IG düzeylerinde istatistiksel fark gözlenmedi. Sonuç: Geriatrik pnömoni vakalarında, NRBC'nin dinamiklerinin, IG'ye kıyasla hastalık şiddetini belirtmede daha hayati olduğu görünmektedir. Ancak, onkolojik komorbiditesi olan hastalarda bu fırsatın zayıfladığı ya da kaybolduğu görülmektedir.

Anahtar Kelimeler:

CURB-65, Çekirdekli eritrosit, İmmatür granülosit, Pnömoni ciddiyet endeksi

Unveiling the Prognostic Significance of Immature Granulocytes and Nucleated Red Blood Cells in Geriatric Pneumonia Severity and Mortality Outcomes

Aim: The progression of pneumonia in the senior-age population can be catastrophic. Biomarkers capable of assessing the severity of pneumonia play a pivotal role in prognosis. We conducted an evaluation of the kinetics of immature granulocytes (IG) and nucleated red blood cells (NRBC) as potential indicators of the severity of geriatric pneumonia. Materials & Methods: In this retrospective cross-sectional study, patients diagnosed with pneumonia were categorized using two prominent severity scoring systems, CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, age >65) and PSI (Pneumonia severity index). Additionally, the patients' discharge status and infection process markers were noted. Results: A total of 80 patients were included in the evaluation, with a mean age of 72.23 ± 7.26. Excluding the mortality rate of 49% when including oncology patients, the overall mortality rate was 26%. The deceased patients had longer hospitalization durations, higher CURB-65 and PSI category classifications, and elevated NRBC results. In CURB-65-based categorization, there was an increase only in NRBC levels associated with disease severity, whereas, in PSI-based categorization, there was an increase in both NRBC and IG levels. No statistical difference was observed in NRBC and IG levels when excluding oncology patients from the analysis. Conclusion: In geriatric pneumonia cases, the dynamics of NRBC appear to be more crucial in indicating disease severity compared to IG. However, this opportunity seems to be missed or compromised in patients with oncological comorbidities.

Keywords:

CURB-65, Immature granulocyte, Nucleated red blood cell, Pneumonia severity index.,

PDF

___

1. Torres A, Cilloniz C, Blasi F, et al. Burden of pneumococcal community-acquired pneumonia in adults across Europe: A literature review. Respir Med 2018;137:6-13.
2. Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001;163(7):1730-54.
3. Sezgi C, Abakay A, Tanrikulu AC, et al. The Causes of Mortality in the Department of Pulmonary Diseases. Selcuk Med J 2010;26(2):42-45.
4. Eravci FC, Poyraz N, Korkmaz C, et al. The Relationship Between Pneumonia Severity and The Presence of Anosmia and Ageusia in Hospitalized Patients with Covid-19. Selcuk Med J 2021;37(4): 339-344.
5. Chalmers JD, Taylor JK, Mandal P, et al. Validation of the Infectious Diseases Society of America/American Thoratic Society minor criteria for intensive care unit admission in community-acquired pneumonia patients without major criteria or contraindications to intensive care unit care. Clin Infect Dis 2011;53(6):503-11.
6. Bradley J, Sbaih N, Chandler TR, et al. Pneumonia Severity Index and CURB-65 Score Are Good Predictors of Mortality in Hospitalized Patients With SARS-CoV-2 Community-Acquired Pneumonia. Chest 2022;161(4):927-36.
7. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58(5):377-82.
8. Satici C, Demirkol MA, Sargin Altunok E, et al. Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19. Int J Infect Dis 2020;98:84-9.
9. Cizmecioglu A, Göktepe MH, Akay Çizmecioglu H, et al. Administering Geriatric Pneumonia Cases without Waiting for CRP Results, is It Practicable?. J Contemp Med 2022; 12(2): 211-216.
10. Nikolich-Zugich J. The twilight of immunity: emerging concepts in aging of the immune system. Nat Immunol 2018;19(1):10-9.
11. Fulop T, Larbi A, Dupuis G, et al. Immunosenescence and Inflamm-Aging As Two Sides of the Same Coin: Friends or Foes? Front Immunol 2017;8:1960.
12. Liu C, Zhao Y, Okwan-Duodu D, et al. COVID-19 in cancer patients: risk, clinical features, and management. Cancer Biol Med 2020;17(3):519-27.
13. Eravci FC, Poyraz N, Korkmaz C, et al. The Relationship Between Pneumonia Severity and The Presence of Anosmia and Ageusia in Hospitalized Patients with Covid-19. Selcuk Med J 2021;37(4): 339-344.
14. Sezgi C, Abakay A, Tanrıkulu AC, et al. The Causes of Mortality in the Department of Pulmonary Diseases. Selcuk Med J 2010;26(2): 42-45.
15. Park JH, Byeon HJ, Lee KH, et al. Delta neutrophil index (DNI) as a novel diagnostic and prognostic marker of infection: a systematic review and meta-analysis. Inflamm Res 2017;66(10):863-70.
16. Park SH, Ha SO, Cho YU, et al. Immature platelet fraction in septic patients: clinical relevance of immature platelet fraction is limited to the sensitive and accurate discrimination of septic patients from non-septic patients, not to the discrimination of sepsis severity. Ann Lab Med 2016;36(1):1-8.
17. Cornet E, Boubaya M, Troussard X. Contribution of the new XN-1000 parameters NEUT-RI and NEUT-WY for managing patients with immature granulocytes. Int J Lab Hematol 2015;37(5):e123-6.
18. Duz ME, Arslan M, Menek EE, et al. Impact of the seventh day nucleated red blood cell count on mortality in COVID-19 intensive care unit patients: A retrospective case-control study. J Med Biochem 2023;42(1):138-44.
19. Desai S, Jones SL, Turner KL, et al. Nucleated red blood cells are associated with a higher mortality rate in patients with surgical sepsis. Surg Infect (Larchmt) 2012;13(6):360-5.