Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit

İsmail Demir; Muammer Yücel

doi:10.22391/fppc.650570

Araştırma Makalesi

Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit

Yıl 2020, Cilt: 5 Sayı: 1, 12 - 17, 19.03.2020

İsmail Demir , Muammer Yücel

https://doi.org/10.22391/fppc.650570

Cited By: 2

Öz

Introduction: Sepsis is defined as life-threatening organ dysfunction caused by the body's irregular response to infection. Sepsis is the most common cause of death in intensive care units in elderly patients. The effect of CRP, procalcitonin levels and neutrophil/lymphocyte ratio at the time of admission on mortality of internal diseases patients in ICU over 65 years of age are investigated in this study.
Methods: The medical records of 207 patients with sepsis hospitalized between June 2018 and May 2019 in the Internal Medicine ICU of Bozyaka Training and Research Hospital were evaluated retrospectively in this cross-sectional study. Demographic data, APACHE II score, SOFA score, presence of systemic disease, CRP, procalcitonin, complete blood count, ICU stay and mortality status were recorded.
Results: The mean age of the geriatric patients with 207 sepsis hospitalized in the ICU over a 12-month period was 77.6±8.4 years. The study group consisted of 100 (48.3%) males and 107 (51.7%) females. In the study, 73(35.3%) of the patients died due to sepsis, 134(64.7%) were the surviving group. There was no difference between surviving and deceased patient groups in terms of length of stay (p=0.880). APACHE-II and SOFA scores were found to be statistically different between surviving and deceased patients (p<0.001). The mean procalcitonin level was 3.54±4.77µg/L among the surviving group and 20.83±12.18µg/L among the deceased patient group (p<0.001). The mean CRP was 97.7±77.4mg/L by the surviving group and 136.9±100.8 mg/L by the deceased patient group (p=0.002). The neutrophil/lymphocyte ratio was 7.49±6.83 in the surviving group and 12.73±15.09 in the deceased patient group (p=0.006).
Conclusion: Mortality rates of inpatients in ICU were higher than inpatients in other wards. Systematic evaluation of neutrophil/lymphocyte ratio, CRP and procalcitonin results, as well as complete blood count parameters during hospitalization, may be valuable in predicting intensive care outcomes of patients.

Anahtar Kelimeler

Sepsis , intensive care unit , procalcitonin , neutrophil/lymphocyte ratio , C-Reactive Protein , neutrophil/lymphocyte ratio

Kaynakça

1. Global Sepsis Alliance. Available at: https://www.global-sepsis-alliance.org/sepsis?rq=sepsis (Access Date: November 21, 2019)
2. 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. https://doi.org/10.1097/00003246-200107000-00002
3. Torio CM, Moore BJ. National inpatient hospital costs: The most expensive conditions by payer, 2013: Statistical Brief. https://www.ncbi.nlm.nih.gov/books/NBK52651/ 4. Turkish Statistics Association Population Projection Statistics. Available at: http://www.tuik.gov.tr/PreTablo.do?alt_id=1027(Access Date: November 21, 2019)
5. Ulger Z, Cankurtaran M. [Elderly patient in the intensive care unit] (in Turkish). Turk J Intensive Care Med. 2006;6(2):94-100. http://www.yogunbakimdergisi.org/managete/fu_folder/2006-02/2006-6-2-094-100.pdf
6. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: Can we meet the requirements of an aging population? JAMA. 2000;284(21):2762-70. https://doi/org/10.1001/jama.284.21.2762
7. Dogan S, Can H, Dogan N, Gonullu M. [Comparison of the mortality rates for patients aged 65 years and over and aged below 65 years, hospitalized in the intensive care unit] (in Turkish). Turkiye Klinikleri J Med Sci. 2013;33(6):1408-13. https://doi.org/10.5336/medsci.2013-34420
8. Ten Boekel E, Vroonhof K, Huisman A, van Kampen C, de Kieviet W. Clinical laboratory findings associated with in hospital mortality. Clin Chim Acta. 2006;372(1-2):1-13. https://doi.org/10.1016/j.cca.2006.03.024
9. Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. JAMA. 1995;274(12):968-74. https://doi.org/0.1001/jama.1995.03530120060042
10. Karakoc AE. [Standart and rapid microbiological methods in diagnosis of sepsis] (in Turkish). ANKEM Derg. 2014;28(ek2):46-51. http://www.ankemdernegi.org.tr/ANKEMJOURNALPDF/ANKEM_28_Ek2_46_51.pdf
11. Aygun G. [Sepsis and septic shock] (in Turkish). Sempozyum Dizisi 2002;31:131-40. Available at: http://www.ctf.edu.tr/stek/pdfs/31/3108GA.pdf
12. Pepys MB, Hirschfeld GM. C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805–12. https://doi.org/10.1172/JCI18921
13. Musunuru K, Kral BG, Blumenthal RS, Fuster V, Champell CY, Gluckman TJ, et al. The use of high-sensitivity assays for C-reactive protein in clinical practice. Nat Clin Pract Cardiovasc Med. 2008;5(10):621–35. https://doi.org/10.1038/ncpcardio1322
14. Carrol ED, Thomson AP, Hart CA. Procalcitonin as a marker of sepsis. Int J AntimicrobAgents. 2002;20(1): 1-9. https://doi.org/10.1016/s0924-8579(02)00047-x
15. Mustafić S, Brkić S, Prnjavorac B, Sinanović A, Porobić Jahić H, Salkić S. Diagnostic and prognostic value of procalcitonin in patients with sepsis. Med Glas (Zenica). 2018;15(2):93-100. https://doi.org/10.17392/963-18
16. Pierrakos C, Vincent JL. Sepsis biomarkers: A review. Crit Care. 2010;14(1):1-18. https://doi.org/10.1186/cc8872
17. Ni J, Wang H, Li Y, Shu Y, Liu Y. Neutrophil to lymphocyte ratio (NLR) as a prognostic marker for in-hospital mortality of patients with sepsis: A secondary analysis based on a single-center, retrospective, cohort study. Medicine. 2019;98(46):1-5. https://dx.doi.org/10.1097/MD.0000000000018029
18. Liu Y, Zheng J, Zhang D, Jing L. Neutrophil-lymphocyte ratio and plasma lactate predict 28-day mortality in patients with sepsis. J Clin Lab Anal. 2019;33(7):1-6. https://doi.org/10.1002/jcla.22942
19. Gurol G, Ciftci İH, Terizi HA, Atasoy AR, Ozbek A, Koroglu M. Are there standardized cut off values for neutrophil-lymphocyte ratios in bacteremia or sepsis? J Microbiol Biotechnol. 2015;25(4):521-5. https://doi.org/10.4014/jmb.1408.08060
20. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Melot C, et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest. 2003;123(6):2043-9. https://doi.org/10.1378/chest.123.6.2043
21. Schmit X, Vincent JL. The time course of blood C-reactive protein concentrations in relation to the response to initial antimicrobial therapy in patients with sepsis. Infection. 2008;36(3):213-9. https://doi.org/10.1007/s15010-007-7077-9
22. Gunal O, Ulutan F, Erkorkmaz U. [Prognostic Value of Procalcitonin in Sepsis Patients] (in Turkish). Klimik J. 2011;24(1):31-5. https://doi.org/10.5152/kd.2011.06
23. Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003;31(6):1737-41. https://doi.org/10.1097/01.CCM.0000063440.19188.ED
24. Akkoc I, Alpay N, Toptas M, Isitemiz I, Sunul H, Cebeci E, et al. [Effect of baseline datas on the survival of intensive care unit patients] (in Turkish). Med Bull Haseki. 2017;55(2):106-10. https://doi.org/10.4274/haseki.3464
25. Zimmerman JE, Wagner DP, Draper EA, Wright L, Alzola C, Knaus WA. Evaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database. Crit Care Med. 1998;26(8):1317-26. https://doi.org/10.1097/00003246-199808000-00012
26. Waheed U, Williams P, Brett S, Baldock G, Soni N. White cell count and intensive care unit outcome. Anaesthesia. 2003;58(2):180-2. https://doi.org/10.1046/j.1365-2044.2003.02964_5.x
27. Hamel MB, Davis RB, Teno JM, et al. Older age, aggressiveness of care and survival for seriously ill, hospitalized adults. Ann Intern Med. 1999;131(10):721-8. https://doi.org/10.7326/0003-4819-131-10-199911160-00002
28. Uysal N, Gundogdu N, Borekci S, Dikensoy O, Bayram N, Uyar M, et al. [Prognosis of Patients in a Medical Intensive Care Unit of a Tertiary Care Centre] (in Turkish). Turk J Intensive Care Med. 2010;1:1-5. http://www.dcyogunbakim.org/uploads/pdf/pdf_DCY_3.pdf
29. Esme M, Topeli A, Yavuz BB, Akova M. Infections in the elderly critically-ill patients. Front Med. 2019;6(118):1-5. https://doi.org/10.3389/fmed.2019.00118
30. Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000;28(4):977-83. https://doi.org/10.1097/00003246-200004000-00011.

Sepsisli geriatrik hastaların mortalitesi ile yoğun bakım ünitesine kabulündeki C-Reaktif Protein, Prokalsitonin ve Nötrofil/Lenfosit oranının ilişkisi

Yıl 2020, Cilt: 5 Sayı: 1, 12 - 17, 19.03.2020

İsmail Demir , Muammer Yücel

https://doi.org/10.22391/fppc.650570

Cited By: 2

Öz

Giriş: Sepsis, vücudun enfeksiyona karşı verdiği düzensiz yanıt nedeniyle oluşan, yaşamı tehdit eden organ fonksiyon bozukluğudur. Yaşlı hastalarda yoğun bakım ünitelerindeki (YBÜ) ölümlerin en sık sebebi sepsistir. Çalışmada Dahiliye YBÜ’de tedavi gören, sepsis tanılı 65 yaş ve üzeri hastalarda yatış esnasında CRP, prokalsitonin ve nötrofil/lenfosit oranının mortalite ile ilişkisi araştırılmıştır.
Yöntem: Kesitsel nitelikteki araştırmada SBÜ Bozyaka Eğitim Araştırma Hastanesi Dahiliye YBÜ’de Haziran 2018 ve Mayıs 2019 tarihleri arasında (12 ay) yatan sepsis tanılı 207 olgunun kayıtları geriye dönük olarak incelendi. Hastaların demografik verileri ile birlikte APACHE II skoru, SOFA skoru, sistemik hastalık varlığı, ilk alınan kan örneklerinden CRP, prokalsitonin, tam kan sayımı, yoğun bakım kalış süresi ve mortalite durumu kaydedildi.
Bulgular: Yoğun Bakım Ünitesinde 12 aylık süreçte izlenen sepsis tanılı 207 geriatrik hastanın yaş ortalaması 77,6±8,4 yıl olup %51.7’si (n=107) kadındı. Olguların 73’ü (%35,3) sepsis nedeniyle yaşamını yitirirken, 134’ü (%64,7) sağ kalan grubu oluşturdu. Sağkalan ve ölen hasta grupları arasında yatış süresi açısından fark saptanmadı (p=0,880). APACHE-II ve SOFA skorları, sağ kalan ve ölen hastalar arasında istatistiksel olarak farklı bulundu (p<0,001). Sağ kalan hasta grubunda prokalsitonin ortalaması 3,54±4,77 µg/L iken ölen hasta grubunda 20,83±12,18 µg/L olarak saptandı (p<0,001). Sağ kalan hasta grubunda CRP ortalaması 97,7±77,4 mg/L iken ölen hasta grubunda 136,9±100,8 mg/L idi (p=0,002). Sağ kalan ve ölen hasta gruplarının tam kan sayımı parametrelerinden lökosit, nötrofil, lenfosit sonuçlarında anlamlı fark yoktu. Nötrofil/lenfositoranı sağ kalan grupta 7,49±6,83 iken, ölen hasta grubunda 12,73±15,09 idi (p=0,006).
Sonuç: YBÜ’nde yatan hastaların mortalite oranları diğer servislerde yatan hastalara gore daha yüksektir. Yatış esnasındaki tam kan sayımı parametrelerinin yanında nötrofil/lenfositoranı, CRP ve prokalsitonin sonuçlarının sistematik bulgularla değerlendirilmesi hastaların yoğun bakım akıbetlerinin öngörülmesinde değerli olabilir.

Anahtar Kelimeler

Sepsis , yoğun bakım ünitesi , nötrofil/lenfosit oranı , prokalsitonin , C-Reaktif Protein , nötrofil/lenfosit oranı

Kaynakça

1. Global Sepsis Alliance. Available at: https://www.global-sepsis-alliance.org/sepsis?rq=sepsis (Access Date: November 21, 2019)
2. 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. https://doi.org/10.1097/00003246-200107000-00002
3. Torio CM, Moore BJ. National inpatient hospital costs: The most expensive conditions by payer, 2013: Statistical Brief. https://www.ncbi.nlm.nih.gov/books/NBK52651/ 4. Turkish Statistics Association Population Projection Statistics. Available at: http://www.tuik.gov.tr/PreTablo.do?alt_id=1027(Access Date: November 21, 2019)
5. Ulger Z, Cankurtaran M. [Elderly patient in the intensive care unit] (in Turkish). Turk J Intensive Care Med. 2006;6(2):94-100. http://www.yogunbakimdergisi.org/managete/fu_folder/2006-02/2006-6-2-094-100.pdf
6. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: Can we meet the requirements of an aging population? JAMA. 2000;284(21):2762-70. https://doi/org/10.1001/jama.284.21.2762
7. Dogan S, Can H, Dogan N, Gonullu M. [Comparison of the mortality rates for patients aged 65 years and over and aged below 65 years, hospitalized in the intensive care unit] (in Turkish). Turkiye Klinikleri J Med Sci. 2013;33(6):1408-13. https://doi.org/10.5336/medsci.2013-34420
8. Ten Boekel E, Vroonhof K, Huisman A, van Kampen C, de Kieviet W. Clinical laboratory findings associated with in hospital mortality. Clin Chim Acta. 2006;372(1-2):1-13. https://doi.org/10.1016/j.cca.2006.03.024
9. Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. JAMA. 1995;274(12):968-74. https://doi.org/0.1001/jama.1995.03530120060042
10. Karakoc AE. [Standart and rapid microbiological methods in diagnosis of sepsis] (in Turkish). ANKEM Derg. 2014;28(ek2):46-51. http://www.ankemdernegi.org.tr/ANKEMJOURNALPDF/ANKEM_28_Ek2_46_51.pdf
11. Aygun G. [Sepsis and septic shock] (in Turkish). Sempozyum Dizisi 2002;31:131-40. Available at: http://www.ctf.edu.tr/stek/pdfs/31/3108GA.pdf
12. Pepys MB, Hirschfeld GM. C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805–12. https://doi.org/10.1172/JCI18921
13. Musunuru K, Kral BG, Blumenthal RS, Fuster V, Champell CY, Gluckman TJ, et al. The use of high-sensitivity assays for C-reactive protein in clinical practice. Nat Clin Pract Cardiovasc Med. 2008;5(10):621–35. https://doi.org/10.1038/ncpcardio1322
14. Carrol ED, Thomson AP, Hart CA. Procalcitonin as a marker of sepsis. Int J AntimicrobAgents. 2002;20(1): 1-9. https://doi.org/10.1016/s0924-8579(02)00047-x
15. Mustafić S, Brkić S, Prnjavorac B, Sinanović A, Porobić Jahić H, Salkić S. Diagnostic and prognostic value of procalcitonin in patients with sepsis. Med Glas (Zenica). 2018;15(2):93-100. https://doi.org/10.17392/963-18
16. Pierrakos C, Vincent JL. Sepsis biomarkers: A review. Crit Care. 2010;14(1):1-18. https://doi.org/10.1186/cc8872
17. Ni J, Wang H, Li Y, Shu Y, Liu Y. Neutrophil to lymphocyte ratio (NLR) as a prognostic marker for in-hospital mortality of patients with sepsis: A secondary analysis based on a single-center, retrospective, cohort study. Medicine. 2019;98(46):1-5. https://dx.doi.org/10.1097/MD.0000000000018029
18. Liu Y, Zheng J, Zhang D, Jing L. Neutrophil-lymphocyte ratio and plasma lactate predict 28-day mortality in patients with sepsis. J Clin Lab Anal. 2019;33(7):1-6. https://doi.org/10.1002/jcla.22942
19. Gurol G, Ciftci İH, Terizi HA, Atasoy AR, Ozbek A, Koroglu M. Are there standardized cut off values for neutrophil-lymphocyte ratios in bacteremia or sepsis? J Microbiol Biotechnol. 2015;25(4):521-5. https://doi.org/10.4014/jmb.1408.08060
20. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Melot C, et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest. 2003;123(6):2043-9. https://doi.org/10.1378/chest.123.6.2043
21. Schmit X, Vincent JL. The time course of blood C-reactive protein concentrations in relation to the response to initial antimicrobial therapy in patients with sepsis. Infection. 2008;36(3):213-9. https://doi.org/10.1007/s15010-007-7077-9
22. Gunal O, Ulutan F, Erkorkmaz U. [Prognostic Value of Procalcitonin in Sepsis Patients] (in Turkish). Klimik J. 2011;24(1):31-5. https://doi.org/10.5152/kd.2011.06
23. Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003;31(6):1737-41. https://doi.org/10.1097/01.CCM.0000063440.19188.ED
24. Akkoc I, Alpay N, Toptas M, Isitemiz I, Sunul H, Cebeci E, et al. [Effect of baseline datas on the survival of intensive care unit patients] (in Turkish). Med Bull Haseki. 2017;55(2):106-10. https://doi.org/10.4274/haseki.3464
25. Zimmerman JE, Wagner DP, Draper EA, Wright L, Alzola C, Knaus WA. Evaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database. Crit Care Med. 1998;26(8):1317-26. https://doi.org/10.1097/00003246-199808000-00012
26. Waheed U, Williams P, Brett S, Baldock G, Soni N. White cell count and intensive care unit outcome. Anaesthesia. 2003;58(2):180-2. https://doi.org/10.1046/j.1365-2044.2003.02964_5.x
27. Hamel MB, Davis RB, Teno JM, et al. Older age, aggressiveness of care and survival for seriously ill, hospitalized adults. Ann Intern Med. 1999;131(10):721-8. https://doi.org/10.7326/0003-4819-131-10-199911160-00002
28. Uysal N, Gundogdu N, Borekci S, Dikensoy O, Bayram N, Uyar M, et al. [Prognosis of Patients in a Medical Intensive Care Unit of a Tertiary Care Centre] (in Turkish). Turk J Intensive Care Med. 2010;1:1-5. http://www.dcyogunbakim.org/uploads/pdf/pdf_DCY_3.pdf
29. Esme M, Topeli A, Yavuz BB, Akova M. Infections in the elderly critically-ill patients. Front Med. 2019;6(118):1-5. https://doi.org/10.3389/fmed.2019.00118
30. Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000;28(4):977-83. https://doi.org/10.1097/00003246-200004000-00011.

Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	İç Hastalıkları
Bölüm	Araştırma Makalesi (Original Article)
Yazarlar	İsmail Demir 0000-0001-7787-1443 Muammer Yücel 0000-0002-1646-3953
Yayımlanma Tarihi	19 Mart 2020
Gönderilme Tarihi	25 Kasım 2019
Kabul Tarihi	18 Mart 2020
Yayımlandığı Sayı	Yıl 2020 Cilt: 5 Sayı: 1

Kaynak Göster

APA	Demir, İ., & Yücel, M. (2020). Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit. Family Practice and Palliative Care, 5(1), 12-17. https://doi.org/10.22391/fppc.650570
AMA	Demir İ, Yücel M. Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit. Fam Pract Palliat Care. Nisan 2020;5(1):12-17. doi:10.22391/fppc.650570
Chicago	Demir, İsmail, ve Muammer Yücel. “Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit”. Family Practice and Palliative Care 5, sy. 1 (Nisan 2020): 12-17. https://doi.org/10.22391/fppc.650570.
EndNote	Demir İ, Yücel M (01 Nisan 2020) Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit. Family Practice and Palliative Care 5 1 12–17.
IEEE	İ. Demir ve M. Yücel, “Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit”, Fam Pract Palliat Care, c. 5, sy. 1, ss. 12–17, 2020, doi: 10.22391/fppc.650570.
ISNAD	Demir, İsmail - Yücel, Muammer. “Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit”. Family Practice and Palliative Care 5/1 (Nisan2020), 12-17. https://doi.org/10.22391/fppc.650570.
JAMA	Demir İ, Yücel M. Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit. Fam Pract Palliat Care. 2020;5:12–17.
MLA	Demir, İsmail ve Muammer Yücel. “Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit”. Family Practice and Palliative Care, c. 5, sy. 1, 2020, ss. 12-17, doi:10.22391/fppc.650570.
Vancouver	Demir İ, Yücel M. Investigation of relation between mortality of geriatric patients with sepsis and C-Reactive Protein, Procalcitonin and Neutrophil/Lymphocyte ratio in admission to intensive care unit. Fam Pract Palliat Care. 2020;5(1):12-7.