Publication: Sepsis ve ağır sepsiste proBNP’ni n prognostik değeri
Abstract
Sepsis ve Ağır Sepsiste proBNP’ nin Prognostik Değeri Amaç: Sepsis ve ağır sepsis hastalarında proBNP düzeylerinin septik sok gelisecek hastaları ayırt edebilme kabiliyetini ve prognostik özelliğini değerlendirmeyi amaçladık. Gereç ve Yöntem: Marmara Üniversitesi Tıp Fakültesi Etik Kurulu onayı alınarak, çalısmamız, Marmara Üniversitesi Pendik Eğitim ve Arastırma Hastanesi Anesteziyoloji ve Reanimasyon Yoğun Bakım Ünitesinde yatan hastalarda, retrospektif olarak gerçeklestirildi. Çalısmamıza, sepsis, ağır sepsis ve septik sok tanısı almıs (American College of Chest Physicians/ Society of Critical Care Medicine Consensus Conference Committe) 18 yas üstü son iki yıl içinde yoğun bakım ünitesinde yatmıs hastalar dahil edildi. Takip formlarında konjestif kalp yetersizliği, kronik böbrek yetersizliği olan, tıkayıcı / hemorajik serebrovasküler olay geçirmis hastalar çalısma dısı bırakıldı. Hastaların demografik verileri, yatıs APACHE II skorları, SOFA skorları, yoğun bakım yatıs süreleri kayıt altına alındı. Yatıs süresince renal replasman tedavisi gereksinimi ve süresi, sok gelisimi ve vazopresör kullanımı, mekanik ventilasyon ihtiyacı ve süreleri çalısmamız kapsamında değerlendirildi. Yatısları süresince yatıs günü, sok gelisiminden önceki gün,sok günü ve taburcu ya da eksitus günü kandan analiz edilmis proBNP, CRP, laktat, lökosit, santral venöz oksijen satürasyonu, prokalsitonin değerleri kaydedildi. Hastalar çıkıs durumları saptanarak, ölen ve yasayan olmak üzere iki gruba ayrıldı. Bulgular: Ölen hastalarda yasayanlara göre proBNP düzeyleri tüm günlerde istatistiksel olarak anlamlı yüksek bulundu(sırası ile p=0,001, p=0,006, p<0,001, p<0,001). Ölen hastalarda proBNP değeri sok günü yatıs gününe ve soktan önceki güne göre istatistiksel olarak anlamlı yüksek saptandı (sırası ile p<0,001 ve p=0,008). Lökosit, C reaktif protein, laktat, prokalsitonin, ScvO2 düzeyleri ve SOFA skorları açısından gruplar arasında istatistiksel olarak anlamlı fark saptanmadı. iii Mekanik ventilatör gereksinimi, renal replasman tedavisi gereksinimi ve vazopressör gereksinimi açısından gruplar arası istatistiksel olarak anlamlı fark saptanmadı. Sonuç: Bulgularımız proBNP’nin sepsiste sok günü değeri sağ kalım açısından prognostik bir belirteç olarak değerlendirilebileceği yönündedir. Ne var ki, yatıs günü ve soktan bir önceki gün bakılan proBNP’ nin sok gelisimi açısından prediktör bir test olmaması, sağ kalım açısından da prognostik değere sahip olmaması söz konusudur. natriüretik peptitler, proBNP, sepsis, sok, prognoz,
The prognostic value of proBNP in sepsis and severe sepsis Purpose : We aimed to evaluate the proBNP level’s prognostic value and differantiation ability of patient will develop septic shock, in sepsis and severve sepsis. Materials and Methods: With the approval of the Marmara University School of Medicine Ethic Committee, our study was performed retrospectively in patient hospitalized in Marmara University Pendik Education and Research Hospital Anesthesiolgy and Reanimation Đntensive Care Unit. In our study, patient with diagnosis of sepsis, severve sepsis and septic shock (American College of Chest Physicians/ Society of Critical Care Medicine Consensus Conference Committe), 18 years and older, admitted over the two years in intensive care unit were included. Patient with congestive heart failure, chronic renal failure, occlusive/ haemorrhagic cerebrovascular event in the observation form, were excluded. Patients demographic data, APACHE II score at admission, SOFA scores, length of stay in intensive care unit were recorded. Renal replacement requirement and duration, the shock development, use of vasopressor and duration, mechanical ventilation requirement and duration during hospitalization were evaluated in our study. proBNP, C reactive protein, lactate, leukocyte, central venous oxygen saturation, procalcitonin values analyzed from blood were recorded at the admission day, the day before shock, the shock day and the day patient discharged od died. Patients were divided into two grpups according to unit discharge status: non-survivor and survivors. Results: proBNP levels in non-survivor patien were significantly higher than survivor group at all days (in order of p=0,001, p=0,006, p<0,001, p<0,001). In non-survivors, the shock day proBNP value were significantly higher than the value of the admission and the day before shock (p<0,001 and p=0,008). Significantly differences were not detected in Leukocyte, C reaktive protein, lactate, ScvO2 levels and SOFA score between two groups. v There was no significantly difference between two groups in mechanical ventilation, renal replacement threapy and vasopressor reqirement. Results: In sepsis, the shock day’s proBNP level can be considered as a prognostic marker in the terms of survival. However, at the admission day and the day before shock, proBNP value was not a predictor in terms of development of shock and also survival too. Key words: natriuretic peptides, proBNP, sepsis, shock, prognosis,
The prognostic value of proBNP in sepsis and severe sepsis Purpose : We aimed to evaluate the proBNP level’s prognostic value and differantiation ability of patient will develop septic shock, in sepsis and severve sepsis. Materials and Methods: With the approval of the Marmara University School of Medicine Ethic Committee, our study was performed retrospectively in patient hospitalized in Marmara University Pendik Education and Research Hospital Anesthesiolgy and Reanimation Đntensive Care Unit. In our study, patient with diagnosis of sepsis, severve sepsis and septic shock (American College of Chest Physicians/ Society of Critical Care Medicine Consensus Conference Committe), 18 years and older, admitted over the two years in intensive care unit were included. Patient with congestive heart failure, chronic renal failure, occlusive/ haemorrhagic cerebrovascular event in the observation form, were excluded. Patients demographic data, APACHE II score at admission, SOFA scores, length of stay in intensive care unit were recorded. Renal replacement requirement and duration, the shock development, use of vasopressor and duration, mechanical ventilation requirement and duration during hospitalization were evaluated in our study. proBNP, C reactive protein, lactate, leukocyte, central venous oxygen saturation, procalcitonin values analyzed from blood were recorded at the admission day, the day before shock, the shock day and the day patient discharged od died. Patients were divided into two grpups according to unit discharge status: non-survivor and survivors. Results: proBNP levels in non-survivor patien were significantly higher than survivor group at all days (in order of p=0,001, p=0,006, p<0,001, p<0,001). In non-survivors, the shock day proBNP value were significantly higher than the value of the admission and the day before shock (p<0,001 and p=0,008). Significantly differences were not detected in Leukocyte, C reaktive protein, lactate, ScvO2 levels and SOFA score between two groups. v There was no significantly difference between two groups in mechanical ventilation, renal replacement threapy and vasopressor reqirement. Results: In sepsis, the shock day’s proBNP level can be considered as a prognostic marker in the terms of survival. However, at the admission day and the day before shock, proBNP value was not a predictor in terms of development of shock and also survival too. Key words: natriuretic peptides, proBNP, sepsis, shock, prognosis,