Sepsis ve ciddi sepsis-septik şokta miyokardiyal disfonksiyon ve inflamatuar biyomarker düzeyinin prognoza etkisi
Myocardial dysfunction and inflammatory biomarkers levels of impact on prognosis in sepsis and severe sepsis-septic shock
Yazar: ATIF HARMANKAYA
Danışman: DOÇ. DR. MEHMET GÜL
Necmettin Erbakan Üniversitesi / Meram Tıp Fakültesi / Acil Tıp Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2012
Konu: İlk ve Acil Yardım = Emergency and First Aid
Dizin: Biyobelirteçler = Biomarkers ; C reaktif protein = C reactive protein ; Ekokardiyografi = Echocardiography ; Kalsitonin = Calcitonin ; Kreatin kinaz = Creatine kinase ; Laktatlar = Lactates ; Miyokard = Myocardium ; Sepsis = Sepsis ; Troponin = Troponin ; Şok-septik = Shock-septic

Özet:
AmaçKritik yoğun bakım servisinde yatan, tanımlama kriterleri doğrultusunda sepsis, ciddisepsis ve septik şok tanısı alan hastalarda WBC, laktat, CK-MB, troponin-I (cTnI), CRP, prokalsitonin (PCT) düzeylerinin ekokardiyografide sağ ventrikül doku doppleri değerleri ile bakılan diyastolik fonksiyonla kıyaslanarak mortalite ve morbiditeyle ilişkisinin araştırılması amaçlanmaktadır.Gereç ve YöntemÇalışmada 24 sepsis, 31 ciddi sepsis ve septik şoklu iki grup ve 28 kişilik kontrol grubu olmak üzere calışmaya toplam 83 olgu dahil edildi. Ayrıca 27 tane 28 gün içinde ölen ve 28 tanede 28 günden fazla yaşayan alt grup oluşturuldu. Tüm hastaların demografik özellikleri, labaratuar değerleri ve ekokardiyografi bulguları kaydedildi. Tanı anındaki ölçülen WBC, laktat, CK-MB, cTnI, CRP ve PCT düzeyleri ile ekokardiyografi ve doku doppler görüntüleme (DDG) parametrelerinin hem sepsis ve ciddi sepsis septik şok grubunda hemde ölen ve hayatta kalan hasta grubunda karşılaştırma yapıldı.BulgularSepsisli hastaların CRP seviyesi 92,6±32,0 mg/L, PCT seviyesi 23,0±36,2 ng/mL,CKMB seviyesi 4,45±5,5 ng/mL,cTnI seviyesi 0,17±0,35 ng/mL, laktat düzeyi 1,81±0,85 mmol/L iken ciddi sepsis septik şoklu hastaların CRP seviyesi 93,5±24,5 mg/L, PCT seviyesi28,7±33,7 ng/mL, CK-MB seviyesi 6,99±7,1 ng/mL, cTnI seviyesi 0,36±0,85 ng/mL,Laktat düzeyi 3,08±2,0 mmol/L bulundu.DDG ile bakılan sağ ventrikülde Sm velositesi sepsis grubunda 14,05±3,06 cm/sn,Em velositesi 11,74±2,65 cm/sn,Am velositesi 15,06±4,48 cm/sn,Tei indeksi 0,59±0,16iken ciddi sepsis septik şok grubunda Sm velositesi 11,74±4,10 cm/sn, Em velositesi 10,41±3,99 cm/sn,

Abstract:
AimThe aim is; investigate the relationship between morbidity-mortality and comparision of WBC count, lactate, CK-MB, troponin-I (cTnI), CRP and procalcitonin (PCT) levels with diastolic function of echocardiographic right ventricular tissue doppler imaging levels in patients which are identificate that sepsis, severe sepsis-septic shock. Material - MethodThis study included 94 patients in total; 25 patients had sepsis, 39 patients had severe sepsis and septic shock and 30 patients was in control group. We recorded demographic characteristics, labratory tests, echocardiographic findings for all patients. The measured WBC count, lactate, CK-MB, cTnI, CRP, PCT levels and echocardiographic tissue doppler imaging parameters at the time of diagnosis, compared in groups of both sepsis, severe sepsis-septic shock and groups of dead and surviving patients.ResultsIn sepsis group, the mean CRP values 92,6±32,0 mg/L, PCT values 23,0±36,2 ng/mL, CK-MB values 4,45±5,5 ng/mL, cTnI values 0,17±0,35 ng/mL, lactate values 1,81±0,85 mmol/L while in severe sepsis-septic shock groups CRP values 93,5±24,5 mg/L, PCT values 28,7±33,7 ng/mL, CK-MB values 6,99±7,1 ng/mL, cTnI values 0,36±0,85 ng/mL, lactate values 3,08±2,0 mmol/L found. While the tissue doppler imaging right ventricular Sm velocity was 14,05±3,06 cm/s, Em velocity was 11,74±2,65 cm/s, Am velocity was 15,06±4,48 cm/s, Tei index was 0,59±0,16 in patients with sepsis, Sm velocity was 11,74±4,10 cm/s, Em velocity was 10,41±3,99 cm/s, Am velocity was 13,59±5,02 cm/s, Tei index was 0,58±0,17 in patients with 12severe sepsis-septic shock. Sm velocity 15,08±2,07 cm/s, Em velocity 11,89±2,45 cm/s, Am velocity 16,74±4,68 cm/s Tei index 0,49±0,06 were found control group.Also while the Sm velocity 11,84±4,22 cm/s, Em velocity 10,52±4,12 cm/s, Am velocity 11,96±4,49 cm/s, Tei index 0,63±0,16 were found in dead patients with sepsis, Sm velocity 13,62±3,26 cm/s, Em velocity 11,44±2,78 cm/s, Am velocity 16,52±4,01 cm/s, Tei index 0,53±0,16 were found in surviving patients While the 25 percentage of patients with sepsis dying the first 28 days 68 percentage of patients with severe sepsis-septic shock died in first 28 days. Totally 27 of 55 patients (%49) died in first 28 days.ConclusionThe WBC count, CRP and PCT levels are guide for diagnosis of sepsis. But they are not useful for prognosis. The lactate, CK-MB and cTnI values helpful for suppose of poor prognosis and mortality. The TDI and cardiac markers are usable alternative method for severty of patients with sepsis, diagnosis and follow-up of both right and left sistolic and diastolic dysfunction and relationship of this case and mortality.KeywordsWBC, CRP, PCT, lactate, CK-MB, cTnI, Echocardiography, Tissue Doppler Imaging