The preseptic period and inflammatory markers in the prediction of the course of sepsis
Ömer Faruk Boran1, Mehmet Fatih Yazar2, Aykut Urfalıoğlu1, Maruf Boran3, Zeyneb Bakacak4, Mürşide Yıldız5, Fethi Gül5
1Sütçü Imam University School of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaraş, Turkey.
2Sütçü Imam University School of Medicine, Department of General Surgery, Kahramanmaraş, Turkey.
3Sabuncuoglu Serafettin University, Faculty of Medicine, Department of Internal Medicine, Amasya, Turkey.
4Private Vatan Hospital, Department of Obstetrics and Gynecology, Kahramanmaraş, Turkey.
5Marmara University, Pendik Educational Research Hospital, Department of Anesthesiology and Reanimation, İstanbul, Turkey
BACKGROUND AND AIM: It was aimed to find a simple and easily accessible scoring system which could predict the development of sepsis in the preseptic period.
MATERIAL AND METHODS: The study included 161 patients with a basal SOFA value of 2 or more. Group 1 (n:83) comprised patients with infection reported in culture results and Group 2 (n:78) comprised patients not showing production in blood, urine and phlegm cultures in samples taken on 3 consecutive days. Data were stated as mean±standard deviation (SD). The variance analysis of Repeated Measures ANOVA with Bonferroni was applied for repeated measurements. Linear regression models were used for the evaluaton of factors related to sepsis.
RESULTS AND DISCUSSION: The patients in both groups were divided into subgroups of non-survivor and survivor patients. The preseptic and septic SOFA, NLR, procalcitonin and lactate values were determined to be statistically significantly higher in the sepsis group than in the control group (Figure 1). When the values related to sepsis were examined, a strong relationship was determined between sepsis and SOFA, PRC and lactate values in the preseptic period and a weak relationship with NLR. In the model formed with multiple regression analysis, with the defined cutoff values for the preseptic and septic periods, it was seen that in the septic period a diagnosis of sepsis could be made with 83.8% accuracy. The diagnostic value of the same parameters evaluated in the preseptic period was 77.9% (Figure 2).In the reclassification analyses, NLR, Lac and PRC values added to the SOFA score showed higher prognostic value than the SOFA score alone (Figure 3).
CONCLUSION(S): The diagnostic value of the combination of preseptic lactate, PRC, the SOFA score and NLR values was found to be similar in the sepsis period and thus it was seen that they could safely be used for the early diagnosis of sepsis.
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