Derya HOŞGÜN, Esen SAYIN GÜLENSOY, Evrim AKPINAR, Nalan OGAN, Can ATEŞ, Semih AYDEMİR

Toplum kökenli pnömönide serum albümin ve CRP/albümin oranının hastalık seyrine etkisi

Amaç:Toplum kökenli pnömöni (TKP) solunum yolu enfeksiyonları içinde yüksek mortalite ve morbiditeye sahiptir.Tanı, tedavi, prognoz takibinde çeşitli biokimyasal markerlar kullanılmaktadır.CRP, albümin rutin uygulamada sıklıkla kullanılan biokimyasal markerlardır.İnflamasyon temellli CRP/albümin oranı çeşitli hastalıklarda prognoz tahmininde kullanılmaktadır.Postoperatif yoğun bakıma kabul edilen hastalarda yapılan çalışmalarda 30 günlük ve 1 yıllık mortalite tahmininde bağımsız risk faktörü olarak bulunmuştur.Çeşitli klinik durumlarda CRP/albümin oranı tek başına albümin ve CRP’den daha iyi inflamatuvar durumu yansıttığı düşünülmektedir.Bu çalışmanın amacı TKP nedeniyle hastaneye yatırılan CRP/albümin oranının 30 günlük mortalite tahminindeki rolünü belirlemekti.Çalışmanın ikincil sonlanım noktası ise yoğun bakım ihtiyacı idi. Gereç Ve Yöntem:Göğüs hastalıkları ve yoğun bakım servisine yatırılan TKP’li hastalar çalışmaya dahil edildi. Retrospektif olarak hasta dosyaları, radyolojik incelemeleri ve laboratuvar bulguları tarandı. Bulgular:Yüz(%55.9)’ü göğüs hastalıkları servisinde 79’u yoğun bakımda yatmakta olan 179 TKP’li hasta çalışmaya dahil edildi. Hastaların yaş ortalaması 72.027±12.88 yıldı, %61.5’i erkek, %38.5’i kadındı.CRP değeri ve CRP/albümin oranı 30 günlük mortalite ve yoğun bakım ihtiyacını tahmin etmede anlamlı bulunmazken (sırasıyla p:0.728, p:0.232, p:0.110), düşük albümin değerlerinin mortalite ve yoğun bakım ihtiyacı riskini anlamlı derecede artırdığı bulundu(p<0.001, p<0.001).CURB-65, PSI ve albümin 30 günlük mortalite ve yoğun bakım ihtiyacını tespit etmede anlamlı bulunan değişkenlerdir. Sonuç: Albumin değerinin yüksek olması TKP’de 30 günlük mortalite ve yoğun bakım ihtiyacı riskini azaltmaktadır. CRP , CRP/albümin oranının TKP’de kısa dönem mortalite ve morbiditeyi tahmin edememektedir. TKP’li hastalarda serum albümin, CRP düzeyleri ve CRP/albümin oranının uzun dönem prognozu tahmin gücünü ortaya koymak için geniş kohortlarda, çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Toplum kökenli pnömöni, biyomarkerlar, mortalite, prognoz

Serum albumin and C-reactive protein/albumin ratio in community-acquired pneumonia

Introduction: Community-acquired pneumonia (CAP) is a common type of respiratory tract infections with high morbidity and mortality. Prognostic role of CRP/Albumin ratio in CAP patients still is unknown. The aim of this study was to investigate the role the CRP/albumin ratio in predicting 30-day mortality and ICU requirement in hospitalized patients with CAP. Material and Method: The study included patients with CAP.Clinical records and plain radiographic images of the patients were retrieved from hospital database and were reviewed for each patient. Results: The 179 CAP patients who were hospitalized were included. CRP level and the CRP/albumin ratio were found to have no significant effect on mortality and ICU requirement (p=0.728, p=0.232, and p=0.110, respectively), whereas low albumin level was associated with high mortality and ICU requirement (p<0.001 for both). Conclusion: Increased albumin concentration was associated with a lower risk of 30-day mortality. The CRP/albumin ratio was found to have no significant role in predicting short-term mortality and morbidity in CAP patients. Further large-scale, multicenter studies are needed to investigate the prognostic value of the CRP/albumin ratio in predicting long-term prognosis in CAP patients

Keywords:

Community-acquired pneumonia, biomarkers, mortality, prognosis,

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Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200: e45-67.
Farah R, Mograbi J, Makhoul N.Impact of serum C-reactive protein measurements in the first 2 days on the 30-day mortality in hospitalized patients with severe community-acquired pneumonia: A cohort study. J Crit Care 2013; 28: 291-5.
Arnau-Barrés I, Güerri-Fernández R, Luque S, Sorli L, Vázquez O, Miralles R. Serum albumin is a strong predictor of sepsis outcome in elderly patients. Eur J Clin Microbiol Infect Dis 2019; 38: 743-6.
Eshwara VK, Mukhopadhyay C, Rello J. Community-acquired bacterial pneumonia in adults. An update. Indian J Med Res 2020; 151: 287-302.
Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. Plos One 2013; 8: e59321.
Kocatürk M, Kocatürk O. Assessment of relationship between C-reactive protein to albumin ratio and 90-day mortality in patients with acute ischaemic stroke. Neurol Neurochir Pol 2019; 53: 205-11.
Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA. 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: 1730-54.
British Thoracic Society Standarts of Care Committee BTS Guidelines for the management of community acquired pneumonia in adults. Thorax 2001; 56: iV1-64.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD. Infectious Diseases Society of America/America Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44: S27-72.
Bouch DC, Thompson JP. Severity scoring systems in the critical ill. Continuing Education in Anesthesia and Critical Care 2018; 8: 181-5.
Metersky ML, Waterer G, Nsa W, Bratzler DW. Predictors of in-hospital vs discharge mortality in pneumonia. Chest 2012; 142: 476-81
Lee JH, Kim J, Kim K. Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia. J Crit Care 2011; 26: 287-94.
Oh TK, Eunjeong J, Hyo-seok N, et al. C-reactive protein to albumin ratio predicts 30-day and 1-year mortality in postoperative patients after admission to the intensive care unit. J Clin Med 2018; 7: 39.
Kim MH, Ahn JY, Song JE, et al. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe or septic shock treated with early goal-directed therapy. Plos One 2015; 10: e0132109.
Oh J, Kim SH, Park KN. High-sensitivity C-reactive protein/albumin ratio as a predictor of in-hospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med 2017; 4: 19-24.
Charles PG, Wolfe R, Whitby M, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008; 47: 375-84.
Ventura JC, Hauschild DB, Moreire MDE.C-reactive protein/albumin ratio is associated with lung function among children/adolescents with cystic fıbrosis: a three years longitudinal study. Sao Paulo Med J 2018; 136: 29-36.
Mendez R, Aldas I, Menendez R. Biomarkers in community-acquired pneumonia (cardiac and non-cardiac). J Clin Med 2020; 9: 549.
Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacol Ther 2021; 217: 107663.
Sungurlu S, Balk RA. The role of biomarkers in the diagnosis and management of pneumonia. Clin Chest Med 2018; 39: 691-701.
Ugajin M, Yamaki K, Iwamura N, Yagi T, Asano T. Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community-acquired pneumonia. Int J Gen Med 2012; 5: 583-9.
Moncada DC, Rueda ZV, Macías A, Suárez T, Ortega H, Vélez LA. Reading and interpretation of chest X-ray in adults with community-acquired pneumonia. Braz J Infect Dis 2011; 15: 540-6.
Lanks CW, Musani A,Hsia DW. Community-acquired pneumonia and hospital acquied pneumonia. Med Clin N Am 2019; 103: 487-501.
Poetter-Lang S, Herold CJ.Community-acquired pneumonia. Radiologe 2017; 57: 6-12.
Sharma S, Maycher B, Eschun G. Radiological imaging in pneumonia: recent innovations. Curr Opion Pulm Med 2007; 13: 159-69.