Acil Serviste Kronik Obstrüktif Akciğer Hastalığı Tanılı Hastaların Yönetiminde Prokalsitoninin Kullanımı

Abstract

Dündar Y. E. Use of Procalcitonin in the Management of Patients with Chronic Obstructive Pulmonary Disease in the Emergency Department. Hacettepe University Faculty of Medicine, Thesis of Emergency Medicine, Ankara 2019. The emergency department, which is the first resort of COPD exacerbation patients, is also the place where antibiotic treatment is started for patients suspected of infection. However, one-third to two-thirds of these infections are caused by viruses and do not require antibiotherapy. The aim of this study was to investigate the efficacy of procalcitonin use in predicting the initiation, alteration and termination of antibiotic therapy in the management of COPD exacerbations between November 1, 2015 and November 1, 2018 in the Adult Emergency Department of Hacettepe University Faculty of Medicine Hospitals. Of the 284 patients included in the study, 89.8% (n = 255) were treated with at least one antibiotic during the hospital stay. Antibiotherapy was started before the procalcitonin results were available in 57% (n = 145) of these patients. The patients were divided into three groups according to procalcitonin level in order to examine the effect of procalcitonin value on clinician's decision on antibiotherapy. Procalcitonin levels below 0.1ng/ml were the first group, 0.1-0.5ng/ml were the second group, and those above 0.5ng/ml were the third group. In the first group (n = 65), only one patient’s antibiotic treatment was terminated. In this group, the rate of antibiotherapy change after procalcitonin result was 53.8% (n = 35). Antibiotherapy was changed in 50.8% (n = 65) of 128 people in the second group and in 46.8% (n = 29) of 62 people in the third group. No statistically significant difference was observed between the groups in the decisions regarding the discontinuation, continuation or change of antibiotherapy (p = 0.710). There was a weak correlation between procalcitonin level and total length of hospital stay. When the prognostic value of procalcitonin for in-hospital mortality was examined, the area under the ROC curve was 0.648 and procalcitonin predicted mortality with a sensitivity of 52% and specificity of 80% at the cut-off value of 0.54ng/ml. In conclusion, it was found that procalcitonin results were not used by the clinicians in the decision of antibiotherapy in the emergency department, instead, they considered the patient's medical state as a more important factor; and procalcitonin was a weak parameter in predicting in-hospital mortality and length of hospital stay.