Kombinovani bioskor je superiorniji u odnosu na rutinske biomarkere i skorove u predviđanju mortaliteta kod odraslih kritično obolelih bolesnika sa sekundarnom sepsom
Srpski
Sažetak
Uvod/Cilj. Sepsa predstavlja značajno globalno opterećenje, sa procenjenih 48,9 miliona slučajeva i 11 miliona smrtnih slučajeva povezanih sa sepsom godišnje širom sveta. Cilj prospektivne, opservacione studije bio je da se proceni prognostička vrednost nekih lako dostupnih, rutinskih biomarkera kao što su: presepsin, prokalcitonin, C-reaktivni
protein (CRP), broj leukocita, srednji volumen trombocita (MPV) i laktati kao i njihove kombinacije, u smislu predviđanja ishoda sekundarne sepse kod odraslih kritično obolelih bolesnika. Metode. Prospektivnim istraživanjem obuhvaćeno je ukupno 86 kritično obolelih bolesnika sa sekundarnom sepsom kao komplikacijom peritonitisa, pankreatitisa i teške traume, koji su bili primljeni u hiruršku jedinicu intenzivne terapije. Uzorci krvi za određivanje biomarkera uzimani su u tri vremena: na dan prijema – prvi dan, zatim trećeg i petog dana. Prvog dana izračunati su i zabeleženi sledeći skorovi: Sequential Organ Failure Assessment (SOFA) skor, Simplified Acute Physiology Score (SAPS) II i Acute Physiology and Chronic Health Evaluation (APACHE) II skor. SOFA i SAPS II skorovi su izračunavani i beleženi svakodnevno. Primarni ishod bio je bolnički mortalitet. Rezultati. Vrednosti svih primenjenih skorova u sva tri vremena su, očekivano, bile značajno veće kod obolelih sa smrtnim ishodom. Od svih ispitivanih parametara, samo su vrednosti presepsina u sva tri vremena bile značajno veće kod umrlih; vrednosti MPV trećeg i petog dana; vrednosti laktata trećeg dana; vrednosti CRP-a i broj leukocita petog dana. U svim vremenima ispitivana je preciznost parametra u smislu predviđanja smrtnog ishoda. Prvog dana, osim sva tri skora, samo je presepsin bio statistički značajan prediktor ishoda (AUC 0.670). Osim SAPS II i SOFA skora, trećeg dana statistički značajni prediktori ishoda bili su presepsin (AUC 0.716), MPV (AUC 0.667) i laktati (AUC 0.642), a petog dana presepsin (AUC 0.790), MPV (AUC 0.681), CRP (AUC 0.643) i broj leukocita (AUC 0.654). Kombinovani bioskor (presepsin, MPV i laktati) je trećeg dana bio najbolji prediktor ishoda (AUC 0.820) u poređenju sa individualnim skorovima i parametrima. Nezavisni prediktor smrtnog ishoda prvog dana bio je presepsin (p < 0.05), a trećeg dana MPV (p < 0.01). Zaključak. Kombinovani bioskor je superiorniji od rutinskih biomarkera i skorova u predviđanju mortaliteta kod odraslih kritično obolelih bolesnika sa sekundarnom sepsom.
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