Sepsisli olgularda atriyal ve beyin natriüretik peptit, troponin ı, c_reaktif protein düzeylerinin prognostik değeri
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2007
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info:eu-repo/semantics/openAccess
Özet
Çalışmamızda, sepsis gelişmiş olgularda ANP, BNP, cTnI ve CRP düzeyleri ile bu belirteçlerin sepsisin şiddeti ve prognozu ile ilişkisini araştırmayı amaçladık. Bu çalışma Trakya Üniversitesi Hastanesi yoğun bakım ünitesinde yatan 18 yaş üstü sepsisli hastalar üzerinde gerçekleştirildi. Yaşayan (Grup I) ve yaşamayan (Grup II) hastalar her biri 20 kişiden oluşan iki gruba ayrıldı. Çalışma için sepsis tanısı konduğu gün, 2. gün ve hastaların taburcu olduğu veya öldüğü gün alınan kanları usulüne uygun olarak santrifüj edilip serumları -700C'de saklandı. Hedeflenen sayıya ulaşılınca oda sıcaklığına getirilen serumlar aynı gün içinde incelendi. Grup I'de ANP düzeyleri, Grup II'ye göre istatistiksel olarak anlamlı düşük bulundu (p<0,05). Grup I ve Grup II'de günler arasında ANP değerleri anlamlı farklı bulundu (p<0,001). Grup I'de BNP düzeyleri, Grup II'ye göre istatistiksel olarak anlamlı düşük bulundu (p<0,05). Grup I ve Grup II'de günler arasında BNP değerleri anlamlı farklı bulundu (p<0,001). Grup I'de cTnI düzeyleri, Grup II'ye göre sepsis tanısı konduğu gün için istatistiksel olarak anlamsız bulundu p>0,05). Grup I'de cTnI düzeyleri, Grup II'ye göre 2. ve son gün anlamlı olarak düşük bulundu (p<0,05). Grup I ve Grup II'de günler arasında cTnI düzeyleri anlamlı farklı bulundu (p<0,001). Grup I'de Grup II'ye göre sepsis tanısı konduğu gün CRP düzeyleri, istatistiksel olarak anlamsız bulundu (p>0,05). Grup I'de Grup II'ye göre 2. ve son gün değerleri anlamlı olarak düşük bulundu (p<0,05). Grup I ve Grup II'de günler arasında CRP düzeyleri anlamlı farklı bulundu (p<0,001). Çalışmamızdaki bulgulara göre sepsis tanısı konduğu gün ve 1. gün prognozu belirlemede en güçlü test BNP olarak bulundu (p<0,001). BNP'yi sırasıyla ANP, APACHE II, CRP ve cTnI izlemekteydi. Son gün prognozu belirlemede en güçlü değer yine BNP (p<0,001) ve APACHE II (p<0,001) olarak bulundu. Son gün BNP ve APACHE II'yi sırasıyla ANP, CRP ve cTnI izlemekteydi. Sonuç olarak; sepsisli hastalarda ANP, BNP ve APACHE II değerlerinin prognozu yansıttığını, cTnI, CRP başlangıç değerleriyle sonucun tahmin edilemeyeceğini, ancak takip sırasında düzeylerin prognozun seyrini gösterdiğini düşünmekteyiz. Her beş parametreyi etkileyen birçok faktör bulunduğundan ileri araştırmaların yapılması gerektiği kanısındayız. Anahtar kelimeler: sepsis, natriüretik peptitler, troponin I, C-reaktif protein, APACHE II
Our objective was to investigate the plasma levels of atrial and brain natriuretic peptides, troponin I, C- reactive protein and the prognostic value of these markers in patients with sepsis. This is a prospective study of 40 patients over 18 years old with sepsis at the intensive care unit in Trakya University Medical Faculty, Turkey. The patients were divided into two groups containing 20 patients as survivors (Group I) and non-survivors (Group II). The blood collection was performed on the day of diagnosis, 2nd day and the day of discarge or death. The samples were santrifuged methodical and plasma samples were preserved at - 700C. After reaching the target quantity, all plasma samples were studied at the room temperature in the same day. Statistically significant low ANP values were determined in Group I compared with Group II (p<0,005). In Group I and II, the ANP values were found significantly different in all days (p<0,001). Statistically significant low BNP values were determined in Group I compared with Group II (p<0,005). In Group I and II, the BNP values were found significantly different at all days (p<0,001). In group I the cTnI values were statistically insignificant on the day of diagnosis compared with Group II (p>0,05). Statistically significant low cTnI values were determined in Group I compared with Group II on the 2nd and last day. In Group I the CRP values were statistically insignificant on the day of diagnosis compared with Group II (p=0,579)(p>0,05). Statistically significant low CRP values were determined in Group I compared with Group II on the 2nd and last day. According to the results of our study, at the day of diagnosis and 2nd day the strongest test on predictimg the prognosis was BNP (p<0,001). ANP, APACHE II, CRP and cTnI were following BNP respectively. At the last day the strongest values on predicting the prognosis were BNP (p<0,001) and APACHE II (p<0,001). Last day ANP, CRP and cTnI were following BNP and APACHE II respectively. We conclude that ANP, BNP and APACHE II values reflects the prognosis in septic patients, and also with initial cTnI and CRP values, it is impossible to predict the prognosis but during the follow-up these values can demonstrate the status of prognosis. There are several factors affecting those five parameters thereby we suppose that further researchs should be performed. Key words: sepsis, natriuretic peptides, troponin I, C- reactive protein, APACHE II
Our objective was to investigate the plasma levels of atrial and brain natriuretic peptides, troponin I, C- reactive protein and the prognostic value of these markers in patients with sepsis. This is a prospective study of 40 patients over 18 years old with sepsis at the intensive care unit in Trakya University Medical Faculty, Turkey. The patients were divided into two groups containing 20 patients as survivors (Group I) and non-survivors (Group II). The blood collection was performed on the day of diagnosis, 2nd day and the day of discarge or death. The samples were santrifuged methodical and plasma samples were preserved at - 700C. After reaching the target quantity, all plasma samples were studied at the room temperature in the same day. Statistically significant low ANP values were determined in Group I compared with Group II (p<0,005). In Group I and II, the ANP values were found significantly different in all days (p<0,001). Statistically significant low BNP values were determined in Group I compared with Group II (p<0,005). In Group I and II, the BNP values were found significantly different at all days (p<0,001). In group I the cTnI values were statistically insignificant on the day of diagnosis compared with Group II (p>0,05). Statistically significant low cTnI values were determined in Group I compared with Group II on the 2nd and last day. In Group I the CRP values were statistically insignificant on the day of diagnosis compared with Group II (p=0,579)(p>0,05). Statistically significant low CRP values were determined in Group I compared with Group II on the 2nd and last day. According to the results of our study, at the day of diagnosis and 2nd day the strongest test on predictimg the prognosis was BNP (p<0,001). ANP, APACHE II, CRP and cTnI were following BNP respectively. At the last day the strongest values on predicting the prognosis were BNP (p<0,001) and APACHE II (p<0,001). Last day ANP, CRP and cTnI were following BNP and APACHE II respectively. We conclude that ANP, BNP and APACHE II values reflects the prognosis in septic patients, and also with initial cTnI and CRP values, it is impossible to predict the prognosis but during the follow-up these values can demonstrate the status of prognosis. There are several factors affecting those five parameters thereby we suppose that further researchs should be performed. Key words: sepsis, natriuretic peptides, troponin I, C- reactive protein, APACHE II
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
