Ahmet Can ŞENEL, Nesrin ERCİYES, Ahmet EROĞLU

Revize edilmiş travma skoru ve serum C-reaktif protein arasındaki ilişki

Travma ve enfeksiyon sistemik inflamatuar yanıta yol açarak sitokinler ve akut faz reaktanlarının artışına neden olur. Bu çalışmada, karaciğerde üretilen bir akut faz reaktanı olan C-Reaktif Protein (CRP) ve travma ciddiyeti arasında ilişki araştırmayı amaçladık. Yoğun Bakım Ünitesinde bir yıllık bir süre boyunca (Temmuz 2000- Haziran 2001) izole kafa travması veya kafa travmasıyla beraber politravma ile yatan 146 olgu retrospektif olarak incelendi. Travmayı takiben ilk 24 saatteki Injury Severity Score (ISS), Glasgow Koma Skoru (GKS), Revize edilmiş Travma Skoru (RTS) ve serum CRP değerleri belirlendi. 72 saat sonra klinik belirtiler ve mikrobiyolojik kültür sonuçlarına göre enfeksiyon görülen ve görülmeyen olgular araştırıldı. Enfeksiyon görülmeyen 43 olgudaki serum CRP değerleri ve travma skorları arasında bir ilişki olup olmadığı araştırıldı. Travmayla gelen 146 olguda, travmayı takiben ilk 24 saatte ISS 23.2±9.8, GKS 7.9±3.2, RTS 4.5885±2.1516 ve serum CRP 9.77±4.31 mg/dL olarak tespit edildi. 72 saat sonra enfeksiyon görülen 103 olgunun serum CRP değerleri yükseldi (9.62±4.66'dan 16.83+3.92 mg/dL'ye, P

The relation between the revised trauma score and serum C-reactive protein

Systemic inflammatory response as a result of trauma and infection causes an increase in acute phase reactants. In this study, we aimed to study the relation between trauma and an acute phase reactant; C-reactive Protein (CRP). 146 ICU patients with an isolated craniocerebral trauma or polytrauma with craniocerebral trauma were included in this retrospective study between July 2000 and June 2001. The Injury Severity Score (ISS), Glas-gow Coma Score (GCS), the Revised Trauma Score (RTS) and serum CRP levels were recorded in 24 hours after the trauma. Patients were separated into two groups as infected and non-infected according to their clinical signs and microbiological culture results after 72 hours. A correlation between serum CRP and the RTS in non-infected 43 patients was also investigated. In the evaluation of 146 patients; the ISS, GCS, the RTS and serum CRP were 23.2±9.8, 7.9±3.2, 4.5885±2.1516 and 9.77±4,31 mg/dL respectively. After 72 hours, serum CRP levels of 103 infected patients were elevated from 9.62±4.66 to 16.83±3.92 mg/dL, (p

PDF

___

1. Miller PR, Munn DD, Meredith JW, Chang MC: Systemic inflammatory response syndrome in the trauma intensive care unit: who is infected? J Trauma 1999; 47:1004-8.
2. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME: A revision of the Trauma Score. J Trauma 1989; 29:623-9.
3. Garmer JS, Jarvis WR, Emori G, Horan TC, Hughes JM: CDC definitions for nosocomial infections,1988. Am J Infect Control 1988; 16:128-40.
4. Eggimann P, Pittet D: Infection control in the ICU. Chest 2001; 6:2059-93.
5. Yentis SM, Soni N, Sheldon J: C-reactive protein as an indicator of resolution of sepsis in the intensive care unit. Intens Care Med 1995; 21:602-5.
6. Povoa P, Almeida E, Moreira P, Fernandes A, Mealha R, aragoa A, Sabino H: C-reaktif protein as an indicator of sepsis. Intens Care Med 1998; 24:1052-6.
7. Oberhoffer M, Vogelsang H, Russwurm S, Hartung T, Reinhart K: Outcome prediction by traditional and new markers of inflammation in patients with sepsis. Clin Chem Lab Med 1999; 37:363-8.
8. Meisner M, Tschaikowsky K, Palmaers T, Schmidt J: Comparison of procalcitonin (PCT) and C-reaktif protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care 1999; 3:45-55.
9. Mimoz O, Benoist JF, Edouard AR, Assicot M, Bohuon C, Samii K: Procalcitonin and C-reactive protein during the early posttraumatic systemic inflammatory response syndrome. Intens Care Med 1998; 24:185-8.
10. Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW, et al: The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma 1990; 30:1356-65.
11. Mamelak AN, Pitts LH, Damron S: Predicting survival from head trauma 24 hours after injury: A practical method with therapeutic implications. J Trauma 1996; 41:91-9.
12. Hamano K, Gohra H, Noda H, Katoh T, Fujimura Y, Zempo N, Esato K: Increased serum interleukin-8: correlation with poor prognosis in patients with postoperative multipl organ failure. World J Surg 1998; 22:1077-81.
13. Gosling P, Dickson GR: Serum c-reactive protein in patients with serious trauma. Injury 1992; 23:483-6.
14. Presterl E, Staudinger T, Pettermann M, Lassnigg A, Burgmann H, Winkler S, et al: Cytokine profile and correlation to the APACHE III and MPM II scores in patients with sepsis. Am J Respir Crit Care Med 1997; 156:825-32.