Murat DURANAY, Sami KINIKLI, Ali Pekcan DEMİRÖZ, Reyhan ÖZTÜRK, Hülya PARPUCU, Gül R. YILMAZ, Cemal BULUT

Assessment of procalcitonin and other inflammatory markers in peritoneal dialysis-related peritonitis

Amaç: Kronik böbrek yetmezliği (KBY) tanılı hastalarda herhangi bir infeksiyöz patoloji olmadan da eritrosit sedimentasyon hızı, C-reaktif protein ve diğer akut faz proteinleri gibi sık kullanılan inflamatuar parametrelerde artış olduğu bildirilmiştir. Bu çalışmada peritoneal diyaliz ilişkili peritonit tanılı hastalarda prokalsitonin ile C-reaktif protein (CRP) ve eritrosit sedimentasyon hızı (ESR) gibi diğer inflamatuar parametrelerin durumu incelendi.Yöntem ve gereç: Çalışma 600 yataklı bir eğitim ve araştırma hastanesinde yapıldı. Şubat 2006 ile Temmuz 2006 tarihleri arasında süreli ayaktan periton diyalizi ile ilişkili peritonit tanısı alan 50 hasta çalışma grubu, sürekli ayaktan periton diyalizi uygulanan ve herhangi bir infeksiyon belirti ve bulgusu olmayan 50 olgu kontrol grubu olarak alındı. Tüm hastalarda serum beyaz küre sayısı, prokalsitonin, ESR ve CRP düzeyleri çalışıldı. Bulgular: Çalışma grubundaki 50 hastada 56 peritonit atağı tespit edildi. Çalışma grubunda yer alan hastaların ortalama ESR ve CRP düzeyleri kontrol grubuna göre yüksek bulundu (P < 0,001). PKT düzeyi çalışma grubundaki 50 hastanın 21’inde (% 42), kontrol grubundaki 50 hastanın 8’inde (% 16) 0,5 ng/mL’nin üzerinde bulundu. Peritonitli hastalarda 5mg/dL’den daha yüksek CRP ve 2 ng/mL’den daha yüksek PKT düzeylerinin her ikisi için pozitif prediktif değerler % 100 olarak saptandı. CRP ve PKT’nin aynı cut-off değerleri için duyarlılıkları % 40 ve % 14 olarak bulundu. Sonuç: CRP inflamasyonun tespitinde önemli ve yararlı bir parametredir. Peritoneal diyaliz uygulanan hastalarda CRP için 5 mg/dL değerinin cut-off olarak alınması, sürekli ayaktan periton diyalizine bağlı peritonitte bu parametrenin yararına katkı sağlayacaktır. Periton diyalizi hastalarında prokalsitoninin sensivite ve spesifitesinin CRP’ye bir üstünlüğü yoktur.

Peritoneal diyalizle ilişkili peritonitte prokalsitonin ve diğer inflamatuar parametrelerin değerlendirilmesi

Aim: It is demonstrated that in end-stage renal failure without an infectious pathology conventional laboratory parameters such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) or other acute-phase proteins increase non-specifically. We aimed to evaluate procalcitonin (PCT) and other inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in patients with continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis. Materials and methods: A case-control study was conducted in a 600-bed tertiary hospital. Fifty patients with CAPD- related peritonitis constituting the study group and 50 CAPD patients without infection as the control group were included in the study between February 2006 and July 2006. Baseline serum WBC count, PCT, ESR, and CRP levels were determined in all patients.Results: Fifty-six peritonitis episodes were detected in 50 patients. The mean ESR and CRP levels were significantly higher in the study group (P < 0.001). PCT levels were >0.5 ng/mL in 21 of the 50 patients (42%) in the study group and 8 of the 50 patients (16%) in the control group. The positive predictive value was 100% for CRP levels higher than 5 mg/dL and PCT levels higher than 2 ng/mL. The sensitivities were calculated as 40% and 14% by the same cut-off levels for CRP and PCT, respectively. Conclusion: Serum CRP level is a significant and valuable parameter for detecting inflammation, and determining a new cut-off point for CRP will increase its usefulness in patients with CAPD-related peritonitis. The sensitivity and specificity of PCT were not superior to CRP in peritoneal dialysis-related peritonitis.

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