Belkız ÖNGEN İPEK, Mustafa Erinç SİTAR, Aslı KARADENİZ

Yoğun bakım hastalarında sepsis ve prokalsitonin ilişkisi

ÖZET Sepsis, enfeksiyona karşı oluşan konakçı tepkisi nedeniyle hayatı tehdit eden organ fonksiyon bozukluğu olarak tanımlanır. Hastane ve yoğun bakımdaki ölüm nedenlerinin en önemli sebeplerinden birini oluşturur. Sepsis teşhisi ve prognozu için rutinde altın standart bir test bulunmamaktadır ancak CRP ve prokalsitonin sepsis teşhisi ve prognozu için rutinde en çok kullanılan testlerden ikisidir. Birçok çalışma ile prokalsitonin rehberli tedavinin antibiyotik kullanımını azalttığı gösterilmiştir. Prokalsitonin ve/veya CRP, klinisyenlere rehber olma açısından büyük yararlar sağlasa da, tek başına bu testlerin ideal test özelliklerini eksiksiz yerine getirebilmesi zordur. Bu nedenle bilim dünyası translasyonel tıp temelinde yeni belirteçler arayışına girmiştir. SUMMARY

Anahtar Kelimeler:

Sepsis, prokalsitonin

PDF

___

1. BalcI C, Sungurtekin H, Gürses E, Sungurtekin U, Kaptanoğlu B. Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Critical Care. 2002;7(1):85.
2. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama. 2016;315(8):801-10.
3. Zanon F, Caovilla JJ, Michel RS, Cabeda EV, Ceretta DF, Luckemeyer GD, et al. Sepsis in the intensive care unit: etiologies, prognostic factors and mortality. Revista Brasileira de terapia intensiva. 2008;20(2):128- 34.
4. Marshall JC, Vincent J-L, Guyatt G, Angus DC, Abraham E, Bernard G, et al. Outcome measures for clinical research in sepsis: a report of the 2nd Cambridge Colloquium of the International Sepsis Forum. Critical care medicine. 2005;33(8):1708-16.
5. Orucu M, Geyik MF. Yoğun bakım ünitesinde sık görülen enfeksiyonlar. Düzce Tıp Fakültesi Dergisi. 2008;1(1):40-3.
6. Marik PE, Taeb AM. SIRS, qSOFA and new sepsis definition. Journal of thoracic disease. 2017;9(4):943. 7. Charles PE, Ladoire S, Aho S, Quenot J-P, Doise J-M, Prin S, et al. Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria. BMC infectious diseases. 2008;8(1):38.
8. Tan M, Lu Y, Jiang H, Zhang L. The diagnostic accuracy of procalcitonin and Creactive protein for sepsis: A systematic review and meta-analysis. Journal of cellular biochemistry. 2019;120(4):5852-9.
9. Rojas-Moreno C, Regunath H. Procalcitonin in Sepsis. 2016.
10. Schuetz P, Chiappa V, Briel M, Greenwald JL. Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Archives of internal medicine. 2011;171(15):1322-31. 11. Brodská H, Malíčková K, Adámková V, Benáková H, Šastná MM, Zima T. Significantly higher procalcitonin levels could differentiate Gram-negative sepsis from Gram-positive and fungal sepsis. Clinical and experimental medicine. 2013;13(3):165-70.
12. Branche A, Neeser O, Mueller B, Schuetz P. Procalcitonin to guide antibiotic decision making. Current opinion in infectious diseases. 2019;32(2):130- 5.
13. Nunnally ME, Patel A. Sepsis-What’s new in 2019? Current Opinion in Anesthesiology. 2019;32(2):163-8.
14. Merker M, Bolliger R, Schuetz P. Procalcitonin- guided decision-making results in a significant reduction of antibiotic therapy and hospital stay in neonates with suspected early-onset sepsis. BMJ evidence-based medicine. 2018;23(4):154-5. 15. Wirz Y, Meier MA, Bouadma L, Luyt CE, Wolff M, Chastre J, et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Critical care. 2018;22(1):191.
16. Prkno A, Wacker C, Brunkhorst FM, Schlattmann P. Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock–a systematic review and meta-analysis. Critical Care. 2013;17(6):R291.
17. Schuetz P, Birkhahn R, Sherwin R, Jones AE, Singer A, Kline JA, et al. Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Critical care medicine. 2017;45(5):781-9.
18. Morley JJ, Kushner I. Serum Creactive protein levels in disease. Annals of the New York Academy of Sciences. 1982;389(1):406-18.
19. Garnacho-Montero J, Huici-Moreno MJ, Gutiérrez-Pizarraya A, López I, Márquez-Vácaro JA, Macher H, et al. Prognostic and diagnostic value of eosinopenia, C-reactive protein, procalcitonin, and circulating cell-free DNA in critically ill patients admitted with suspicion of sepsis. Critical care. 2014;18(3):R116. 20. Zhang H, Wang X, Zhang Q, Xia Y, Liu D. Comparison of procalcitonin and high-sensitivity C-reactive protein for the diagnosis of sepsis and septic shock in the oldest old patients. BMC geriatrics. 2017;17(1):173.
21. Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med. 2006;34(10):2596-602.
22. Lippi G. Sepsis biomarkers: past, present and future. Clinical Chemistry and Laboratory Medicine (CCLM). 2019.