The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients
Yıl: 2023 Cilt: 28 Sayı: 3 Sayfa Aralığı: 518 - 526 Metin Dili: İngilizce DOI: 10.5578/flora.20239723 İndeks Tarihi: 30-10-2023
The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients
Öz: Introduction: Hospital-acquired pneumonia and ventilator-associated pneumonia are the major causes of death in hospitalized patients, particularly in the intensive care unit, and early diagnosis may contribute to the survival of the patients. Our aim in this study was to contribute to the rapid treatment of ventilator-associated pneumonia by providing an early diagnosis of pneumonia with alfa-defensin, and calprotectin as inflammation biomarkers. Materials and Methods: The study was designed as a single-center, prospective observational study involving mechanically ventilated patients who were admitted to the Internal Medicine Intensive Care Unit at Çukurova University Hospital between May 2018 and July 2019 and were above 18 years of age. Patients’ demographics and clinical parameters were noted. Serum alpha-defensin levels were measured with the Human Alpha-defensin ELISA kit (Bioassay Technology Laboratory, Jiaxing, China). Serum calprotectin levels were measured with the Human Calprotectin ELISA kit (Bioassay Technology Laboratory, Jiaxing, China). Deep tracheal aspirates (DTA) and blood specimens were collected on the day of ventilation, as well as on the first, third, and seventh days, prospectively. The patients were monitored for the development of ventilator-associated pneumonia (VAP). Infections other than ventilator-associated pneumonia were also noted. Results: During the study period, 822 patients were admitted to the intensive care unit, accumulating 5101 patient days and 1966 ventilator days. Of the included 88 patients who were intubated and mechanically ventilated, 59.1% were male and the mean age was 59.9 ± 18.4. Mean alpha defensin levels were higher in patients with pneumonia than those without (1679.21 ± 3398.17 vs 552.32 ± 243.67 respectively, p= 0.012). As for the ROC curve analysis, the area under the curve for alpha-defensin in pneumonia patients was 0.583 (p= 0.239). Mean calprotectin levels were higher in patients with pneumonia than those without (230.40 ± 150.6819 ng/ mL vs 163.80 ± 73.5819 ng/mL, p= 0.001). As for the ROC curve analysis, the area under the curve for calprotectin in pneumonia patients was 0.621 (p= 0.086). Conclusion: Serum and bronchoalveolar fluid levels of alpha defensin and calprotectin exhibited higher values in patients with pneumonia compared to those without pneumonia. However, due to the absence of statistical significance, larger-scale studies are necessaryto ascertain the clinical utility and benefits. In conclusion, it is recommended to plan a study with a larger number of patients, in which serum and bronchoalveolar fluid alpha defensin levels are measured simultaneously and molecular methods are used for more accurate diagnosis.
Anahtar Kelime: Ventilasyon Uygulanan Hastalarda Pnömoni Tanısında Kalprotektin ve Alfa-Defensininin Rolü
Öz: Giriş: Hastane kaynaklı pnömoni ve ventilatör ilişkili pnömoni, özellikle yoğun bakım ünitesinde yatan hastalarda başlıca ölüm nedenlerindendir ve erken tanı, hastaların hayatta kalmasına katkıda bulunabilir. Bu çalışmadaki amacımız alfa-defensin ve inflamasyon biyobelirteci olan kalprotektin ile pnömoninin erken tanısını sağlayarak ventilatör ilişkili pnömoninin hızlı tedavisine katkıda bulunmaktır. Materyal ve Metod: Çalışma tek merkezli, prospektif gözlemsel bir çalışma olarak planlanmıştır ve Mayıs 2018 ile Temmuz 2019 tarihleri arasında Çukurova Üniversitesi Tıp Fakültesi Hastanesi Dahiliye Yoğun Bakım Ünitesinde yatan, 18 yaşından büyük ve mekanik ventilatöre bağlı hastalar çalışmaya alınmıştır. Hastaların demografik özellikleri ve klinik parametreleri kaydedilmiştir. Serum alfa- defensin düzeyleri Human Alpha-defensin ELISA kiti ile ölçülmüştür. (Bioassay Teknoloji Laboratuvarı, Jiaxing, Çin). Serum kalprotektin düzeyleri Human Calprotectin ELISA kiti ile ölçülmüştür (Bioassay Teknoloji Laboratuvarı, Jiaxing, Çin). Derin trakeal aspiratlar (DTA) ve kan örnekleri, ventilasyon gününde ve prospektif olarak birinci, üçüncü ve yedinci günlerde alınmıştır. Hastalar ventilatör ilişkili pnömoni (VAP) gelişimi açısından izlenmiştir. Ventilatör ilişkili pnömoni dışındaki infeksiyonlar da kaydedilmiştir. Bulgular: Çalışma döneminde 822 hasta, 5101 hasta günü ve 1966 ventilatör günü ile yoğun bakım ünitesine yatırıldı. Entübe edilen ve mekanik olarak ventile edilen 88 hastanın %59.1’i erkekti ve ortalama yaş 59.9 ± 18.4 idi. Ortalama alfa defensin düzeyleri, pnömonisi olan hastalarda olmayanlara göre daha yüksekti (sırasıyla 1679.21 ± 3398.17 ve 552.32 ± 243.67, p= 0.012). ROC eğrisi analizine göre, pnömoni hastalarında alfa-defensin için eğri altında kalan alan 0.583 olarak hesaplandı (p= 0.239). Ortalama kalprotektin düzeyleri, pnömoni hastalarında pnömonisi olmayanlara göre daha yüksekti (230.40 ± 150.6819 ng/mL’ye karşı 163.80 ± 73.5819 ng/mL, p= 0.001). ROC eğrisi analizine göre, pnömoni hastalarında kalprotektin için eğri altında kalan alan 0.621 olarak bulundu (p= 0.086). Sonuç: Alfa defensin ve kalprotektinin serum ve bronkoalveolar sıvıdaki düzeyleri, pnömoni olanlarda olmayanlara göre daha yüksek saptanmıştır fakat istatistiksel anlamlılık saptanmadığından klinik kullanımda yararını tespit etmek için daha geniş çalışmalara ihtiyaç vardır. Daha doğru tanı koyma amacıyla serum ve bronkoalveolar sıvıda, alfa defensin ve kalprotektin düzeylerinin eş zamanlı olarak ölçüldüğü ve moleküler yöntemlerin kullanıldığı daha fazla sayıda hasta içeren bir çalışmanın planlanması önerilmektedir.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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| APA | ÖZKAN D, BAYRAKÇI S, Etiz P, Karakoc E, goruroglu ozturk o, OZYILMAZ E, Candevir A (2023). The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients. , 518 - 526. 10.5578/flora.20239723 |
| Chicago | ÖZKAN Dr. Özlem,BAYRAKÇI SİNEM,Etiz Pınar,Karakoc Emre,goruroglu ozturk ozlem,OZYILMAZ EZGI,Candevir Aslıhan The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients. (2023): 518 - 526. 10.5578/flora.20239723 |
| MLA | ÖZKAN Dr. Özlem,BAYRAKÇI SİNEM,Etiz Pınar,Karakoc Emre,goruroglu ozturk ozlem,OZYILMAZ EZGI,Candevir Aslıhan The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients. , 2023, ss.518 - 526. 10.5578/flora.20239723 |
| AMA | ÖZKAN D,BAYRAKÇI S,Etiz P,Karakoc E,goruroglu ozturk o,OZYILMAZ E,Candevir A The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients. . 2023; 518 - 526. 10.5578/flora.20239723 |
| Vancouver | ÖZKAN D,BAYRAKÇI S,Etiz P,Karakoc E,goruroglu ozturk o,OZYILMAZ E,Candevir A The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients. . 2023; 518 - 526. 10.5578/flora.20239723 |
| IEEE | ÖZKAN D,BAYRAKÇI S,Etiz P,Karakoc E,goruroglu ozturk o,OZYILMAZ E,Candevir A "The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients." , ss.518 - 526, 2023. 10.5578/flora.20239723 |
| ISNAD | ÖZKAN, Dr. Özlem vd. "The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients". (2023), 518-526. https://doi.org/10.5578/flora.20239723 |
| APA | ÖZKAN D, BAYRAKÇI S, Etiz P, Karakoc E, goruroglu ozturk o, OZYILMAZ E, Candevir A (2023). The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 28(3), 518 - 526. 10.5578/flora.20239723 |
| Chicago | ÖZKAN Dr. Özlem,BAYRAKÇI SİNEM,Etiz Pınar,Karakoc Emre,goruroglu ozturk ozlem,OZYILMAZ EZGI,Candevir Aslıhan The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi 28, no.3 (2023): 518 - 526. 10.5578/flora.20239723 |
| MLA | ÖZKAN Dr. Özlem,BAYRAKÇI SİNEM,Etiz Pınar,Karakoc Emre,goruroglu ozturk ozlem,OZYILMAZ EZGI,Candevir Aslıhan The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, vol.28, no.3, 2023, ss.518 - 526. 10.5578/flora.20239723 |
| AMA | ÖZKAN D,BAYRAKÇI S,Etiz P,Karakoc E,goruroglu ozturk o,OZYILMAZ E,Candevir A The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi. 2023; 28(3): 518 - 526. 10.5578/flora.20239723 |
| Vancouver | ÖZKAN D,BAYRAKÇI S,Etiz P,Karakoc E,goruroglu ozturk o,OZYILMAZ E,Candevir A The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi. 2023; 28(3): 518 - 526. 10.5578/flora.20239723 |
| IEEE | ÖZKAN D,BAYRAKÇI S,Etiz P,Karakoc E,goruroglu ozturk o,OZYILMAZ E,Candevir A "The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients." Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 28, ss.518 - 526, 2023. 10.5578/flora.20239723 |
| ISNAD | ÖZKAN, Dr. Özlem vd. "The Role of Calprotectin and Alpha-Defensin in the Diagnosis of Pneumonia in Ventilated Patients". Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi 28/3 (2023), 518-526. https://doi.org/10.5578/flora.20239723 |
