Anatolian Journal of Emergency Medicine
Yazarlar: Nimet Gülen, Müge Günalp Eneyli
Konular:-
Anahtar Kelimeler:Pneumonia,CRP,Procalcitonin,Lactate,PSI,CURB-65,SMART-COP,Prognosis
Özet: Background: Several scoring systems have been used to predict severity and mortality in patients with community acquired pneumonia. However, no scoring system has the 100 % sensitivity and specificity. The aim of this study was to determine the prognosis and the benefits of the managing the treatment according to the different demographic features, etiology and co-morbidities by comparing the CRP, lactate and procalcitonin values with frequently used scoring systems. Methods: One hundred and fourty four patients ,who admitted to Ankara University Emergency Department between 1 December 2015 and 31 May 2016, and diagnosed as pneumonia were included in this study. Vital signs, blood tests and blood gas analysis results were analyzed. The treatment of patients were arranged according to the international guidelines. The end points of this study were accepted as hospitalization to the wards, intensive care units and also 28-day mortality. In the scope of the study, no intervention was made to guide the diagnosis and treatment of the patients. Results: The distribution of the male and female patients were equally and the mean age of patients was 71 (±20). All patients had at least one chronic disease, and there wasn’t determined direct relation between mortality and these diseases. No significant difference was found between the admission vital signs of survival and mortal patients; but confusion during the initial admittance was found associated with mortality. CRP, procalcitonin, lactate and WBC values weren’t represent statistically significant relationship between the mortality;however hypoalbuminemia (p = 0.092) and uremia (p=0,018) values had correlation. The comparison of the scoring systems showed that; CURB- 65, most commonly used system to distinguish outpatients was found as insufficient (p = 0.179) however PSI was successfull (p = 0.009). SMART- COP was found successfull to distinguish patients needed intensive care treatment (p = 0.007). Conclusion: Among all the parameters and scores investigated, PSI was superior in detecting outpatients, whereas SMART-COP could be used safely in detecting patients in need of intensive care.