Acil Servise başvuran febril nötropenik hastalarda prokalsitonin/albumin ve CRP/albumin değerlerinin prognoz açısından önemi
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Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Grş
Etkl stotoksk kemoterap rejmlernn gelştrlmes son yıllarda öneml br araştırma alanı
olmuştur. Ancak, bu tür tedavler genellkle kemk lğnde dern br baskılanma ve ardından febrl
nötropen (FEN) le sonuçlanmaktadır. FEN'l hastalar hastaneye yatırılmadan önce sıklıkla acl
servslerde değerlendrlmekte ve yönetlmektedr. FEN'n prognozu erken tanı ve tedavye bağlıdır.
FEN hastaları komplkasyonlar ve mortalte açısından heterojen br grup olduğu çn, yüksek rskl
hastalar acl servste hızlı br şeklde belrlenmeldr. FEN hastalarında prokalstonn, C-reaktf proten
ve albümn düzeylernn önem blnmektedr. Bununla brlkte, görece daha yen belrteçler olan
prokalstonn/albümn (PAR) ve C-reaktf proten/albümn (CAR) düzeylernn prognostk önem henüz
tam olarak aydınlatılamamıştır. Bu çalışmanın amacı, acl servse başvuran FEN hastalarında PAR ve
CAR sevyeler le prognoz arasındak lşky değerlendrmektr.
Gereç ve yöntem
Çalışmaya acl servse başvuran 344 yetşkn FEN hastası retrospektf olarak dahl edld.
Hastaların demografk özellkler, prmer malgnteler, başvuru anındak ve 24. saattek PAR ve CAR
sevyeler kaydedld. Acl servs sonlanımı, hastanede kalış süres, yoğun bakım üntesne kabul edlme
ve hastane ç ölüm oranları gb prognoz özellkler değerlendrld.
Bulgular
Hastaların yaş ortalaması 62,2 ± 12,8 yıl (18-86 yıl) d. Erkek/kadın oranı 1.4/1 d. En sık
görülen prmer malgnteler hematolojk (%40,4), gastrontestnal (%19,5) ve akcğer (%18,6)
malgnteler d. Acl servste hastaların %80,5' servslere, %15,1' YBÜ'ye kabul edld, %3,5' taburcu
edlrken, 1 hasta kend steğyle taburcu edlmşt, sadece 2 hasta acl servste kaybedld. Hastane
sonlanımına göre %20,1’ kaybedlrken, %78,5’ taburcu edlmşt, %1,5' se kend steğyle taburcu
edlmşt. Hastaların %22,4'ü yoğun bakım üntesne kabul edlmştr. Hastanede kalış süres medan 8
gündü (1-62 gün). Mortal seyreden hastaların başvuru CAR (p<0.001) ve PAR (p<0.001) ve 24. saat
CAR (p<0.001) ve PAR (p<0.001) düzeyler sağ kalanlardan daha yüksekt. ROC analzler, hastane ç
mortaltede başvuru CAR düzeynn (AUC=0,771) %69,5 senstvte ve %74,7 spesfteye sahp
olduğunu, 24. saat CAR düzeynn (AUC=0,785) se %74,6 senstvte ve %67,7 spesfteye sahp
olduğunu gösterd. Benzer şeklde, başvuru PAR düzey (AUC=0,829) hastane ç mortaltede %81,1
senstvte ve %75 spesfteye sahpken, 24. saat PAR düzey (AUC=0,840) %87,3 senstvte ve %71,6
spesfteye sahpt. Başvuru ve 24. saat PAR (sırasıyla AUC=0,823, %83,1 senstvte, %73 spesfte,
AUC=0,858, %87,8 senstvte, %73,2 spesfte) ve CAR düzeylernn (sırasıyla AUC=0,747, %66,2
senstvte, %71,9 spesfte, AUC=0,756, %71,6 senstvte, %67,6 spesfte) YBÜ'ye kabul çn y
belrleyc olduğu görüldü.
Sonuç
Acl servse başvuran FEN hastalarında hem başvuru sırasında hem de 24. saatte
değerlendrlen PAR ve CAR düzeyler, hastane ç mortalte ve YBÜ'ye kabul çn öneml br
prognostk potansyele sahptr.
Introduction The development of effective cytotoxic chemotherapy regimens has been a major area of research in recent decades. However, such treatment often results in profound bone marrow suppression and subsequent febrile neutropenia (FEN). Patients suffering from FEN are frequently evaluated and managed in emergency departments before being admitted to hospital. The prognosis of FEN depends on early diagnosis and treatment. As FEN patients exhibit a high degree of heterogeneity with regard to complications and mortality, it is imperative that rapid identification of high-risk patients is undertaken in the emergency department. The importance of procalcitonin, C-reactive protein and albumin levels in patients with FEN is known. Nonetheless, the prognostic significance of the relatively newer markers procalcitonin/albumin (PAR) and C-reactive protein/albumin (CAR) levels remains to be fully elucidated. The objective of the present study was to evaluate the relationship between PAR and CAR ratios and the prognosis of patients with FEN who presented to the emergency department. Material and methods The present study comprised 344 adult FEN patients who were admitted to the emergency department, retrospectively. The demographic characteristics, primary malignancies, PAR and CAR levels at admission and 24th hour were recorded. A range of prognosis indicators were analysed, including emergency department outcomes, lengths of hospital stays, intensive care unit admission rates, and rates of in-hospital mortality. Results The mean age of the patients was 62.2 ± 12.8 years (18-86 years). The male/female ratio was 1.4/1. The most common primary malignancies were haematological (40.4%), gastrointestinal (19.5%) and lung (18.6%). In the emergency department, 80.5% of the patients were transferred to inpatient services, 15.1% were transferred to ICU, 3.5% were discharged, 1 patient was discharged voluntarily and only 2 patients died in the emergency department. The hospital outcome data revealed that 78.5% of patients were discharged, 20.1% of patients died, and 1.5% of patients were discharged voluntarily. 22.4% of the patients were admitted to the ICU. The median length of hospital stay was 8 days (1-62 days). The admission CAR (p<0.001) and PAR (p<0.001) and 24th hour CAR (p<0.001) and PAR (p<0.001) levels of the lost patients were higher than those of the survivors. ROC analyses revealed that the admission CAR level (AUC=0.771) had 69.5% sensitivity and 74.7% specificity, whereas the 24th hour CAR level (AUC=0.785) had 74.6% sensitivity and 67.7% specificity in in-hospital mortality. Similarly, admission PAR level (AUC=0.829) had 81.1% sensitivity and 75% specificity, whereas the 24th hour PAR level (AUC=0.840) had 87.3% sensitivity and 71.6% specificity in in-hospital mortality. Admission and 24th hour PAR (AUC=0.823, 83.1% sensitivity, 73% specificity, AUC=0.858, 87.8% sensitivity, 73.2% specificity, respectively) and CAR levels (AUC=0.747, 66.2% sensitivity, 71.9% specificity, AUC=0.756, 71.6% sensitivity, 67.6% specificity, respectively) had good predictive value for ICU admission. Conclusion The PAR and CAR levels evaluated both on admission and at 24 hours have an important prognostic potential for in-hospital mortality and ICU admission in FEN patients admitted to the emergency department
Introduction The development of effective cytotoxic chemotherapy regimens has been a major area of research in recent decades. However, such treatment often results in profound bone marrow suppression and subsequent febrile neutropenia (FEN). Patients suffering from FEN are frequently evaluated and managed in emergency departments before being admitted to hospital. The prognosis of FEN depends on early diagnosis and treatment. As FEN patients exhibit a high degree of heterogeneity with regard to complications and mortality, it is imperative that rapid identification of high-risk patients is undertaken in the emergency department. The importance of procalcitonin, C-reactive protein and albumin levels in patients with FEN is known. Nonetheless, the prognostic significance of the relatively newer markers procalcitonin/albumin (PAR) and C-reactive protein/albumin (CAR) levels remains to be fully elucidated. The objective of the present study was to evaluate the relationship between PAR and CAR ratios and the prognosis of patients with FEN who presented to the emergency department. Material and methods The present study comprised 344 adult FEN patients who were admitted to the emergency department, retrospectively. The demographic characteristics, primary malignancies, PAR and CAR levels at admission and 24th hour were recorded. A range of prognosis indicators were analysed, including emergency department outcomes, lengths of hospital stays, intensive care unit admission rates, and rates of in-hospital mortality. Results The mean age of the patients was 62.2 ± 12.8 years (18-86 years). The male/female ratio was 1.4/1. The most common primary malignancies were haematological (40.4%), gastrointestinal (19.5%) and lung (18.6%). In the emergency department, 80.5% of the patients were transferred to inpatient services, 15.1% were transferred to ICU, 3.5% were discharged, 1 patient was discharged voluntarily and only 2 patients died in the emergency department. The hospital outcome data revealed that 78.5% of patients were discharged, 20.1% of patients died, and 1.5% of patients were discharged voluntarily. 22.4% of the patients were admitted to the ICU. The median length of hospital stay was 8 days (1-62 days). The admission CAR (p<0.001) and PAR (p<0.001) and 24th hour CAR (p<0.001) and PAR (p<0.001) levels of the lost patients were higher than those of the survivors. ROC analyses revealed that the admission CAR level (AUC=0.771) had 69.5% sensitivity and 74.7% specificity, whereas the 24th hour CAR level (AUC=0.785) had 74.6% sensitivity and 67.7% specificity in in-hospital mortality. Similarly, admission PAR level (AUC=0.829) had 81.1% sensitivity and 75% specificity, whereas the 24th hour PAR level (AUC=0.840) had 87.3% sensitivity and 71.6% specificity in in-hospital mortality. Admission and 24th hour PAR (AUC=0.823, 83.1% sensitivity, 73% specificity, AUC=0.858, 87.8% sensitivity, 73.2% specificity, respectively) and CAR levels (AUC=0.747, 66.2% sensitivity, 71.9% specificity, AUC=0.756, 71.6% sensitivity, 67.6% specificity, respectively) had good predictive value for ICU admission. Conclusion The PAR and CAR levels evaluated both on admission and at 24 hours have an important prognostic potential for in-hospital mortality and ICU admission in FEN patients admitted to the emergency department
Açıklama
Anahtar Kelimeler
Febrl nötropen, Febrile neutropenia, Prokalstonn/albümn oranı, Procalcitonin/albumin ratio, C-reaktf proten/albümn oranı, C-reactive protein/albumin ratio, Prognoz, Prognosis
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çimen, M. A. (2025). Acil Servise başvuran febril nötropenik hastalarda prokalsitonin/albumin ve CRP/albumin değerlerinin prognoz açısından önemi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
