Research Article
BibTex RIS Cite

Yoğun Bakıma Kabul Edilen Sepsisli Geriatrik Hastalarda Polifarmasinin Prokalsitonin Değerlerine Olan Etkisi

Year 2020, Issue: 2, 216 - 222, 04.06.2020
https://doi.org/10.18521/ktd.715702

Abstract

Amaç: Yoğun bakım (YB) hastalarının önemli kısmı sepsisli ve kronik hastalıkları nedeniyle polifarmasi maruziyeti olan yaşlılardır. Prokalsitonin (PCT) klinikte sepsis ön tanısında kullanılan, değeri gittikçe artan bir biyobelirteçtir. Çalışmamızla sepsis ön tanılı 65 yaş üstü hastaların yoğun bakıma kabulünde polifarmasinin PCT düzeylerine olan etkisi incelenmiştir.
Gereç ve Yöntem: Sepsis nedeniyle yoğun bakım kabulü yapılan yaşlı hastaların demografik özellikleri, sepsisle ilişkili laboratuvar sonuçları, SOFA ve APACHE skorları, kullandıkları ilaçlar kaydedildi.
Bulgular: Toplam 227 hastanın olduğu çalışmada medyan yaş 77(70-84)’dir. Hastaların %41’i genç-yaşlı, %35.7’si orta-yaşlı, %23.3’ü ileri-yaşlıdır. %49.8 hastada polifarmasi varken, %50.2’sinde yoktur. Genç-yaşlıların %39.8’i polifarmasi(+), %60.2’si ise polifarmasi(-)’dir. Orta-yaşlılarda oranlar sırasıyla %56.8 ve %43.2 iken ileri yaşlılarda %58.5 ve %41.5’dir. Yaş gruplarına göre polifarmasi görülme açısından genç-yaşlılarla diğer gruplar arasında anlamlı fark vardır (p<0.05). Ortalama 5.7±2.4 farklı ilaç kullanan hastalarda sıkça kullanılan ilaçlar sırasıyla antihipertansifler, proton pompası inhibitörleri, steroid olmayan antiinflamatuarlardır. Polifarmasi(+) grupta, polifarmasi(-) gruba göre PCT değerlerinde anlamlı azalma vardır. YB’a alınacak ciddi enfeksiyonlu ve sepsis riski taşıyan polifarmasili yaşlılarda, 5 ng/mL’nin üzerindeki PCT değerleri polifarmasi gözlenmeyenlere göre anlamlı düşüktür (p<0.05). 5 ng/mL’nin altındaki lokal enfeksiyonlu ve olası sepsis riski taşımayan yaşlı hastalardaysa gruplar arasında PCT düzeyleri açısından anlamlılık yoktur.
Sonuç: Yoğun bakıma kabul edilen sepsisli yaşlılarda yaş ilerledikçe polifarmasi görülme oranları artmaktadır. Yoğun bakıma kabul edilen özellikle ciddi enfeksiyonlu ve sepsis riski taşıyan polifarmasili yaşlılarda PCT değerleri polifarmasi gözlenmeyenlere göre anlamlı şekilde düşüktür. Polifarmasili yaşlılarda sepsisin tanı ve takibinde dikkatli olunmalı, PCT değerleri mutlaka klinik bulgularla birlikte değerlendirilmelidir.

References

  • Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002; 55(8): 809-17.
  • Fuchs L, Chronaki CE, Park S, Novack V, Baumfeld Y, Scott D, et al. ICU admission characteristics and mortality rates among elderly and very elderly patients. Intensive Care Med. 2012; 38(10): 1654-61.
  • Ozturk GZ, Ardic C, Toprak D. Frequency of polypharmacy and use of potentially inappropriate medications in the elderly. Turk J Geriatr. 2017; 20(4): 296-305.
  • Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018; 10: 289-98.
  • Biswal S, Mishra P, Malhotra S, Puri GD, Pandhi P. Drug utilization pattern in the intensive care unit of a tertiary care hospital. J Clin Pharmacol. 2006; 46(8): 945-51.
  • Yesil Y, Cankurtaran M, Kuyumcu ME. Polifarmasi. Klinik Gelisim Dergisi. 2012; 25: 18-23.
  • Garpestad E, Devlin JW. Polypharmacy and Delirium in Critically Ill Older Adults: Recognition and Prevention. Clin Geriatr Med. 2017; 33(2): 189-203.
  • Yao H, Rayburn ER, Shi Q, Gao L, Hu W, Li H. FDA-approved drugs that interfere with laboratory tests: A systematic search of US drug labels. Crit Rev Clin Lab Sci. 2017; 54(1): 1-17.
  • Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29(7): 1303-10.
  • Genga KR, Russell JA. Update of Sepsis in the Intensive Care Unit. J Innate Immun. 2017; 9(5): 441-5.
  • Sakr Y, Sponholz C, Tuche F, Brunkhorst F, Reinhart K. The role of procalcitonin in febrile neutropenic patients: review of the literature. Infection. 2008; 36(5): 396-407.
  • Hatzistilianou M. Diagnostic and Prognostic Role of Procalcitonin in Infections. Scientific World Journal. 2010; 10: 1941-6.
  • Matwiyoff GN, Prahl JD, Miller RJ, Carmichael JJ, Amundson DE, Seda G, et al. Immune regulation of procalcitonin: a biomarker and mediator of infection. Inflamm Res. 2012; 61(5): 401-9.
  • Schuetz P, Bretscher C, Bernasconi L, Mueller B. Overview of procalcitonin assays and procalcitonin-guided protocols for the management of patients with infections and sepsis. Expert Rev Mol Diagn. 2017; 17(6): 593-601.
  • Dupuy AM, Chevrier Q, Olejnik Y, Bargnoux AS, Badiou S, Cristol JP. Analytical evaluation of point-of-care procalcitonin (PCT) and clinical performances in an unselected population as compared with central lab PCT assay. Clin Chem Lab Med. 2017; 55(8): e167-e171.
  • Wolf TA, Wimalawansa SJ, Razzaque MS. Procalcitonin as a biomarker for critically ill patients with sepsis: Effects of vitamin D supplementation. J Steroid Biochem Mol Biol. 2019; 193: 105428.
  • Foushee JA, Hope NH, Grace EE. Applying biomarkers to clinical practice: a guide for utilizing procalcitonin assays. J Antimicrob Chemother. 2012; 67(11): 2560-9.
  • Radiometer Medical ApS. Rapid procalcitonin (PCT) test product information. Brønshøj, Denmark; 2020 March [cited 2020 March 29]. Available from: https://www.radiometer.com/en/products/immunoassay-testing/aqt90-flex immunoassay-analyzer/pct-on-the-aqt90-flex-immunoassay-analyzer
  • Pagaduan JV, Tam E, Devaraj S. Validation of the Procalcitonin Assay on the Abbott Architect i1000. J Appl Lab Med. 2019; 3(6): 936-42.
  • Chen Z, Luo Z, Zhao X, Chen Q, Hu J, Qin H, et al. Association of vitamin D status of septic patients in intensive care units with altered procalcitonin levels and mortality. J Clin Endocrinol Metab. 2015; 100(2): 516-23.
  • Bell CM, Brener SS, Gunraj N, Huo C, Bierman AS, Scales DC, et al. Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. JAMA. 2011; 306(8): 840-7.
  • Kunnoor NS, Devi P, Kamath DY, Anthony N, George J. Age- and gender-related differences in drug utilisation and adverse drug reaction patterns among patients in a coronary care unit. Singapore Med J. 2014; 55(4): 221-8.
  • Kutz A, Grolimund E, Christ-Crain M, Thomann R, Falconnier C, Hoess C, et al. Pre-analytic factors and initial biomarker levels in community-acquired pneumonia patient. BMC Anesthesiology 2014; 14: 102.
  • Theisen E, McDougal CE, Nakanishi M, Stevenson DM, Amador-Noguez D, Rosenberg DW, et al. Cyclooxygenase-1 and -2 Play Contrasting Roles in Listeria-Stimulated Immunity. J Immunol. 2018; 200(11): 3729-38.

The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients with Sepsis

Year 2020, Issue: 2, 216 - 222, 04.06.2020
https://doi.org/10.18521/ktd.715702

Abstract

Objective: Procalcitonin(PCT) is a biomarker used in early diagnosis of sepsis and gaining more value day by day. This study aimed to research the effect of polypharmacy on PCT levels in admission to intensive care unit(ICU) of elderly patients pre-diagnosed with sepsis.
Methods: Data of the elderly patients who admitted to intensive care due to sepsis were recorded, such as demographic features like age and gender, sepsis-related laboratory results, SOFA and APACHE II scores, medications they used, were recorded.
Results: The percentage of young-old, middle-old, and very-old patients was %41%, 35.7%, and 23.3%, respectively. In young-old patients those who are polypharmacy form 39.8% and non-polypharmacy form 60.2%. In middle-old patients, the rates are 56.8%-43.2%, and in very-old patients are 58.5%-41.5%, respectively. According to age groups, there is a significant difference in the polypharmacy in terms of prevalence in the young-old groups and the other groups(p<0.05). In the polypharmacy group, there is a significant decrease in PCT values compared to the non-polypharmacy group. In old patients with polypharmacy, that has serious infection, at the risk of sepsis and will be admitted to the ICU, PCT values above 5 ng/mL, found significantly lower than patients without polypharmacy(p<0.05).
Conclusions: PCT levels are significantly lower in the elderly who are admitted to ICU, especially those with severe infection and polypharmacy who have sepsis risk, compared to those without polypharmacy. Care should be taken in the diagnosis and follow-up of sepsis in elderly patients with polypharmacy, PCT levels should be evaluated together with clinical findings.

References

  • Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002; 55(8): 809-17.
  • Fuchs L, Chronaki CE, Park S, Novack V, Baumfeld Y, Scott D, et al. ICU admission characteristics and mortality rates among elderly and very elderly patients. Intensive Care Med. 2012; 38(10): 1654-61.
  • Ozturk GZ, Ardic C, Toprak D. Frequency of polypharmacy and use of potentially inappropriate medications in the elderly. Turk J Geriatr. 2017; 20(4): 296-305.
  • Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018; 10: 289-98.
  • Biswal S, Mishra P, Malhotra S, Puri GD, Pandhi P. Drug utilization pattern in the intensive care unit of a tertiary care hospital. J Clin Pharmacol. 2006; 46(8): 945-51.
  • Yesil Y, Cankurtaran M, Kuyumcu ME. Polifarmasi. Klinik Gelisim Dergisi. 2012; 25: 18-23.
  • Garpestad E, Devlin JW. Polypharmacy and Delirium in Critically Ill Older Adults: Recognition and Prevention. Clin Geriatr Med. 2017; 33(2): 189-203.
  • Yao H, Rayburn ER, Shi Q, Gao L, Hu W, Li H. FDA-approved drugs that interfere with laboratory tests: A systematic search of US drug labels. Crit Rev Clin Lab Sci. 2017; 54(1): 1-17.
  • Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29(7): 1303-10.
  • Genga KR, Russell JA. Update of Sepsis in the Intensive Care Unit. J Innate Immun. 2017; 9(5): 441-5.
  • Sakr Y, Sponholz C, Tuche F, Brunkhorst F, Reinhart K. The role of procalcitonin in febrile neutropenic patients: review of the literature. Infection. 2008; 36(5): 396-407.
  • Hatzistilianou M. Diagnostic and Prognostic Role of Procalcitonin in Infections. Scientific World Journal. 2010; 10: 1941-6.
  • Matwiyoff GN, Prahl JD, Miller RJ, Carmichael JJ, Amundson DE, Seda G, et al. Immune regulation of procalcitonin: a biomarker and mediator of infection. Inflamm Res. 2012; 61(5): 401-9.
  • Schuetz P, Bretscher C, Bernasconi L, Mueller B. Overview of procalcitonin assays and procalcitonin-guided protocols for the management of patients with infections and sepsis. Expert Rev Mol Diagn. 2017; 17(6): 593-601.
  • Dupuy AM, Chevrier Q, Olejnik Y, Bargnoux AS, Badiou S, Cristol JP. Analytical evaluation of point-of-care procalcitonin (PCT) and clinical performances in an unselected population as compared with central lab PCT assay. Clin Chem Lab Med. 2017; 55(8): e167-e171.
  • Wolf TA, Wimalawansa SJ, Razzaque MS. Procalcitonin as a biomarker for critically ill patients with sepsis: Effects of vitamin D supplementation. J Steroid Biochem Mol Biol. 2019; 193: 105428.
  • Foushee JA, Hope NH, Grace EE. Applying biomarkers to clinical practice: a guide for utilizing procalcitonin assays. J Antimicrob Chemother. 2012; 67(11): 2560-9.
  • Radiometer Medical ApS. Rapid procalcitonin (PCT) test product information. Brønshøj, Denmark; 2020 March [cited 2020 March 29]. Available from: https://www.radiometer.com/en/products/immunoassay-testing/aqt90-flex immunoassay-analyzer/pct-on-the-aqt90-flex-immunoassay-analyzer
  • Pagaduan JV, Tam E, Devaraj S. Validation of the Procalcitonin Assay on the Abbott Architect i1000. J Appl Lab Med. 2019; 3(6): 936-42.
  • Chen Z, Luo Z, Zhao X, Chen Q, Hu J, Qin H, et al. Association of vitamin D status of septic patients in intensive care units with altered procalcitonin levels and mortality. J Clin Endocrinol Metab. 2015; 100(2): 516-23.
  • Bell CM, Brener SS, Gunraj N, Huo C, Bierman AS, Scales DC, et al. Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. JAMA. 2011; 306(8): 840-7.
  • Kunnoor NS, Devi P, Kamath DY, Anthony N, George J. Age- and gender-related differences in drug utilisation and adverse drug reaction patterns among patients in a coronary care unit. Singapore Med J. 2014; 55(4): 221-8.
  • Kutz A, Grolimund E, Christ-Crain M, Thomann R, Falconnier C, Hoess C, et al. Pre-analytic factors and initial biomarker levels in community-acquired pneumonia patient. BMC Anesthesiology 2014; 14: 102.
  • Theisen E, McDougal CE, Nakanishi M, Stevenson DM, Amador-Noguez D, Rosenberg DW, et al. Cyclooxygenase-1 and -2 Play Contrasting Roles in Listeria-Stimulated Immunity. J Immunol. 2018; 200(11): 3729-38.
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

İsmail Demir 0000-0001-7787-1443

İsmail Yılmaz 0000-0002-4474-9617

Publication Date June 4, 2020
Acceptance Date May 22, 2020
Published in Issue Year 2020 Issue: 2

Cite

APA Demir, İ., & Yılmaz, İ. (2020). The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients with Sepsis. Konuralp Medical Journal, 12(2), 216-222. https://doi.org/10.18521/ktd.715702
AMA Demir İ, Yılmaz İ. The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients with Sepsis. Konuralp Medical Journal. June 2020;12(2):216-222. doi:10.18521/ktd.715702
Chicago Demir, İsmail, and İsmail Yılmaz. “The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients With Sepsis”. Konuralp Medical Journal 12, no. 2 (June 2020): 216-22. https://doi.org/10.18521/ktd.715702.
EndNote Demir İ, Yılmaz İ (June 1, 2020) The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients with Sepsis. Konuralp Medical Journal 12 2 216–222.
IEEE İ. Demir and İ. Yılmaz, “The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients with Sepsis”, Konuralp Medical Journal, vol. 12, no. 2, pp. 216–222, 2020, doi: 10.18521/ktd.715702.
ISNAD Demir, İsmail - Yılmaz, İsmail. “The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients With Sepsis”. Konuralp Medical Journal 12/2 (June 2020), 216-222. https://doi.org/10.18521/ktd.715702.
JAMA Demir İ, Yılmaz İ. The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients with Sepsis. Konuralp Medical Journal. 2020;12:216–222.
MLA Demir, İsmail and İsmail Yılmaz. “The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients With Sepsis”. Konuralp Medical Journal, vol. 12, no. 2, 2020, pp. 216-22, doi:10.18521/ktd.715702.
Vancouver Demir İ, Yılmaz İ. The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients with Sepsis. Konuralp Medical Journal. 2020;12(2):216-22.