KAN DOLAŞIMI ENFEKSİYONLARININ ERKEN TANISINDA İNFLAMATUVAR BELİRTEÇLERİN DEĞERLENDİRİLMESİ

Amaç Bu çalışmanın amacı, kan dolaşımı enfeksiyonu (KDE)'nun tanısında kan kültürüne alternatif olarak kullanılabilecek prokalsitonin (PCT), yüksek sensitif C-reaktif protein (hsCRP), hsCRP/albümin oranı (CAR) ve tam kan sayımı (TKS) parametrelerinin tanısal performansını araştırmaktır. Gereç ve Yöntem Mayıs 2019-Mayıs 2020 tarihleri arasında hastanemizde yatarak tedavi gören ve kan kültürü, PCT, hsCRP, TKS ve albümin tetkikleri eşzamanlı istenilen hastaların dosyaları retrospektif olarak incelendi. Hastalar kan kültüründe üremesi olanlar (n=95) ve kan kültüründe üremesi olmayanlar (n=157) olarak iki gruba ayrıldı. Kan kültürleri, BacT/ALERT 3D (bioMérieux, Fransa) otomatize kan kültürü sisteminde takip edildi. Prokalsitonin ve hsCRP düzeyleri, Roche Cobas 6000 modüler sisteminde (Roche Diagnostics, Almanya) ölçüldü. Tam kan sayımı analizi, UniCel DxH 800 hematoloji analizöründe (Beckman Coulter, ABD) gerçekleştirildi. Bulgular Hemokültür pozitif ve hemokültür negatif grup arasında, PCT, hsCRP, CAR, nötrofil, lenfosit, hemoglobin, eritrosit dağılım genişliği (RDW), ortalama trombosit hacmi (MPV), nötrofil/lenfosit oranı (NLR), lenfosit/ monosit oranı (LMR), trombosit/lenfosit oranı (PLR), MPV/trombosit oranı (MPV/PLT) ve albümin düzeyleri bakımından istatistiksel olarak anlamlı fark bulundu (p<0.05). Prokalsitonin ile hsCRP, CAR, MPV, NLR ve PLR arasında istatistiksel olarak anlamlı pozitif korelasyon saptandı (p<0.05). Lojistik regresyon modelinde, PCT (odds oranı: 10.930) ve CAR (odds oranı: 1.806) KDE için güçlü prediktif faktörler olarak saptandı (p<0.05). Sonuç Test edilen belirteçler arasında PCT ve CAR, KDE için en iyi tanısal performansa sahiptir. Yüksek sensitif CRP ile birlikte tam otomatik hemogram cihazlarında kolay, ucuz ve hızlı bir şekilde ölçülebilen NLR, LMR, PLR, MPV/PLT, RDW, MPV değerleri, KDE’nin öngörülmesinde yardımcı ek testler olarak kullanılabilir.

Anahtar Kelimeler:

Bakteriyemi, sepsis, prokalsitonin, C-reaktif protein, serum albümini, tam kan sayımı

EVALUATION OF INFLAMMATORY MARKERS IN THE EARLY DIAGNOSIS OF BLOODSTREAM INFECTIONS

Objective The aim of this study was to investigate the diagnostic performance of procalcitonin (PCT), high sensitive C-reactive protein (hsCRP), hsCRP/albumin ratio (CAR) and complete blood count (CBC) parameters which can be used as an alternative to the blood culture in the diagnosis of bloodstream infection (BSI). Materials and Methods Medical records of the patients who received inpatient treatment in our hospital between May 2019-May 2020 and who were simultaneously requested for blood culture, PCT, hsCRP, CBC and albumin tests were retrospectively reviewed. The patients were divided into two groups as those with positive blood culture (n=95) and those with negative blood culture (n=157). Blood cultures were performed using the BacT/ALERT 3D (bioMérieux, France) automated blood culture system. The levels of PCT and hsCRP were measured by the Roche Cobas 6000 modular system (Roche Diagnostics, Germany). Complete blood count analysis was performed using the UniCel DxH 800 hematology analyzer (Beckman Coulter, USA). Results A statistically significant difference was found between the hemoculture positive and the hemoculture negative groups in terms of PCT, hsCRP, CAR, neutrophil, lymphocyte, hemoglobin, red blood cell distribution width (RDW), mean platelet volume (MPV), neutrophil/ lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR) platelet/lymphocyte ratio (PLR), MPV/platelet ratio (MPV/PLT) and albumin levels (p<0.05). There was a statistically significant positive correlation between PCT and hsCRP, CAR, MPV, NLR and PLR (p<0.05). In the logistic regression model, PCT (odds ratio: 10.930) and CAR (odds ratio: 1.806) were found to be the strong predictive factors for BSI (p<0.05). Discussion Among the tested markers, PCT and CAR had the best diagnostic performance for BSI. High sensitive CRP and NLR, LMR, PLR, MPV/PLT, RDW, MPV values that can be measured easily, cheaply and quickly by fully automated hemogram devices may be used as additional tests in predicting BSI.

Keywords:

Bacteremia, sepsis, procalcitonin, C-reactive protein, serum albumin, complete blood count.,

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