Publication: Acil Servise Sepsis Öntanısı İle Başvuran Hastaların Geliş VitalParametreleri Ve Prokalsitonin Değerlerinin Kan KültürüÜremeleriyle Olan İlişkisinin Araştırılması
Abstract
Amaç: Çalışmamızda Marmara Üniversitesi Acil Tıp Anabilim DalınaBaşvuran ve sepsis ön tanısı ile takip ettiğimiz hastaların kan kültürpozitifliklerini hastaların geliş vital parametreleri ve serum prokalsitonin(PCT) düzeyleri ile önceden tahmin etmek amaçlandı.Yöntem: Marmara Üniversitesi acil servisinde, 05.10.2018 ile 31.03.2019tarihleri arasında, tek merkezli, prospektif ve gözlemsel olarakyürüttüğümüz bu çalışmaya qSOFA kriterlerinden an az 3 ‘te 2 sinin pozitifolduğu ve dışlama kriterlerine sahip olmayan 131 sepsis hastası dahil edildi.Çalışma hastalarının geliş vital parametreleri kaydedilip, bu hastalardan PCTdahil olmak üzere kan tetkikleri, kan kültürleri ve gerekli diğer kültürlerialınarak laboratuvara gönderildi.Bulgular: Çalışmaya dahil edilen 131 sepsis hastası kan kültür sonuçlarınagöre üreme olan, üreme olmayan ve kan kültürü kontamine olaraksonuçlanan olarak üç gruba ayrıldı. Bu üç grubun geliş vital parametreleriarasında istatiksel olarak anlamlı fark yoktu. Bu üç grubun PCT değerlerinikarşılaştırıldığında ise istatiksel olarak anlamlı bir fark bulundu. Üremeolmayan grupta PCT medyan değeri 2,2 μg/L (İKA 0,5-13), üreme olangrupta 5,2 μg/L (İKA 1,6-24,8) ve kontaminasyonun olduğu grupta 0,8 μg/L(İKA 0,3-4,3) olarak tespit edildi. Dwass-Steel-Critchlow-Fligner ikilikarşılaştırmasına göre bu farkın üreme olan ve kontaminasyon grubundankaynaklandığı saptandı (p=0.01).Sonuç: Çalışmamızın sonucunda ise herhangi bir vital parametrenin ya daserum PCT düzeyinin kan kültür sonucunu önceden tahmin etmekonusunda başarılı olmadığı ama üreme olmayan grup ile gram (-) üremeolan grup karşılaştırıldığında serum PCT değeri gram (-) bakteremiyi tahminetmede kullanılabileceği tespit edildi.
Aim: In this study, we aimed to predict blood culture positivity of patients admitted to Marmara University Department of Emergency Medicine with the preliminary diagnosis of sepsis with their vital parameters and serum Geliş procalcitonin(PCT) levels. Method: This single center, prospective study involved 131 hospitalized patients who met two or more criteria for Quick Sofa (qSOFA) during the period between October 2018 and April 2019 in the Marmara University Emergency Department. The vital parameters of the study patients were recorded and blood tests including PCT, blood cultures and other necessary cultures were taken from the patients and sent to the laboratory. Results: We seperated 131 septic patients into three groups according to their blood culture results. There was no statistically significant difference between the vital parameters of these three groups. When we compared the PCT values of these three groups, we found a statistically significant difference. The median value of PCT in the gram-negative bacterial reproduction in blood culture was 2.2 μg / L (ICA 0.5-13), in the gram-positive bacterial reproduction in blood culture was 5.2 μg / L (ICA 1.6- 24.8) and in the contamination group 0.8 μg / L (ICA 0.3-4.3). According to the Dwass-Steel Critchlow-Fligner method, we found that this difference was due to positive blood culture and contamination group (p = 0.01). Conclusions: As a result of our study, we determined that any vital parameter or serum PCT level was not successful in predicting blood culture results, but serum PCT value could be used to estimate gram (-) bacteremia when the nonreproductive group and the group with gram (-) reproduction were compared.
Aim: In this study, we aimed to predict blood culture positivity of patients admitted to Marmara University Department of Emergency Medicine with the preliminary diagnosis of sepsis with their vital parameters and serum Geliş procalcitonin(PCT) levels. Method: This single center, prospective study involved 131 hospitalized patients who met two or more criteria for Quick Sofa (qSOFA) during the period between October 2018 and April 2019 in the Marmara University Emergency Department. The vital parameters of the study patients were recorded and blood tests including PCT, blood cultures and other necessary cultures were taken from the patients and sent to the laboratory. Results: We seperated 131 septic patients into three groups according to their blood culture results. There was no statistically significant difference between the vital parameters of these three groups. When we compared the PCT values of these three groups, we found a statistically significant difference. The median value of PCT in the gram-negative bacterial reproduction in blood culture was 2.2 μg / L (ICA 0.5-13), in the gram-positive bacterial reproduction in blood culture was 5.2 μg / L (ICA 1.6- 24.8) and in the contamination group 0.8 μg / L (ICA 0.3-4.3). According to the Dwass-Steel Critchlow-Fligner method, we found that this difference was due to positive blood culture and contamination group (p = 0.01). Conclusions: As a result of our study, we determined that any vital parameter or serum PCT level was not successful in predicting blood culture results, but serum PCT value could be used to estimate gram (-) bacteremia when the nonreproductive group and the group with gram (-) reproduction were compared.