Sistemik inflamatuar yanıt ile yanık sepsisi ayrımında kan prokalsitonin düzeyinin etkinliği

Giriş: Sistemik inflamatuar yanıt sendromu enfeksiyon varlığında veya enfeksiyon dışı nedenlerle gelişebilir. İki klinik durumun ayırt edilmesi, tedavinin planlanması ve etkinliğinin değerlendirilmesinde önemlidir. Burada, ciddi yanığı olan hastaların kan prokalsitonin (PCT) düzeyi belirlenerek sepsis tanısındaki etkinliği araştırıldı. PCT’nin ayrıca sepsis tedavisinin takibine ve hasta prognozunu belirlemeye etkisi incelendi. Gereç ve yöntem: Bu çalışma, vücut yüzey alanı %25 ve üzeri 2. derece ve %10 ve üzeri 3. derece yanıklı 37 hastada yapıldı. Hastaların kan PCT düzeyleri ile birlikte, beyaz küre (WBC) sayıları, trombosit (PLT) sayıları, kan kültürleri ve klinik olarak da ateş, nabız ve solunum sayıları incelendi. PCT düzeyi yüksek olan ve olmayan hastalar arasında sonuçlar, istatistiksel olarak Yates düzeltmeli ki-kare testi ile kıyaslandı. Bulgular: Hastaların 23 (%62,2)’ünde kan PCT seviyeleri yüksek, 14 (%37,8)’ünde normal olarak belirlendi. Kan PCT değeri yüksek olan hastaların 20 (%86,9)’sinde kan kültüründe üreme varken, 3 (%13,1)’ünde kültür negatifti. PCT değeri normal olan hastaların ise 11 (%78,5)’inde üreme yokken, 3 (%21,5)’ünde kan kültüründe üreme oldu. Buna göre sepsis tanısında, PCT’in sensivitesi ve spesifitesi sıra ile %86,9 ve %78,5 olarak hesaplandı. Kan PCT değeri yüksek ve normal olan hastalar arasında sepsis görülmesi bakımından istatistiksel olarak anlamlı fark saptandı (p

The efficacy of blood procalcitonin levels in discrimination of systemic inflammatory response syndrome and burn sepsis

Introduction: Systemic response syndrome may arise in the presence of infection alone or from some causes except for infection. Discrimination of these two clinical entities is very important in planning the treatment of disease and in the evaluation of the efficacy of the treatment. In this study, blood procalcitonin (PTC) levels of severe burn patients were determined and efficacy of them in the diagnosis of sepsis was investigated. Effect of PCT on the follow up of treatment and determination of patient prognosis was also evaluated. Materials and methods: This study enrolled 37 burn patients who had second degree of 25%or more total burned surface area and third degree of 10 %or more total burned surface area. Besides their PCT levels, white blood cell count, platelet count, blood culture and clinically fever, pulse and breath count were determined. All findings were compared statistically between patients with normal PCT levels and those with higher PCT levels, by using Chi-Square test with Yates correction test. Results: Blood PCT level was determined as normal in 23 patients (62.2%) and as high in 14 patients (37.8%). While in 20 (86.9 %) patients with high PCT levels, blood culture grew up, in 3 (13.1 %) patients with high PCT levels it was negative. According to these findings, sensitivity and specificity of PCT in the diagnosis of sepsis were calculated as 86,9 %and 78,5 %respectively. Statistically significant difference was found between the patients with high PCT levels and those with normal PCT levels in the occurrence of sepsis (p<0.001). Conclusion: We consider that determination of blood procalcitonin levels during the treatment of patients with large burns, is a valuable indicator to discriminate SIRS from bacterial sepsis and may be a tool to use in decision on beginning antibiotic therapy and following its effectiveness and ending it. In addition, measurement of blood procalcitonin levels may help to avoid the bacterial resistance to antibiotics in burn units which is a severe problem for burn treatment, and to reduce overall treatment costs.

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Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi-Cover
  • ISSN: 1300-6878
  • Başlangıç: 1978
  • Yayıncı: Türk Plastik Rekonstrüktif ve Estetik Cerrahi Derneği