Perić Aneta, Šurbatović Maja, Kovačević Sandra Vezmar, Antunović Mirjana, Veljović Milić, Djordjević Dragan, Andjelić Tamara, Zeba Snježana, Dobrić Silva
Vojnosanit Pregl. 2014 Dec;71(12):1102-8. doi: 10.2298/vsp1412102p.
BACKGROUND/AIM. Critically ill patients are at very high risk of developing severe infections in intensive care units (ICUs). Procalcitonin (PCT) levels are eleveted in the circulation in patients with bacterial sepsis and PCT might be useful in guiding antibiotic treatment. The aim of this study was to estimate factors influencing patients survival and treatment cost in ICU with special emphasis on the impact of PCT serum levels use in guiding antimicrobial therapy.
The study was conducted from August 2010 to May 2012 in the Intensive Therapy Unit, Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy (MMA), Belgrade, Serbia. All adult critically ill patients with sepsis and/or trauma admitted in the ICU were included in the study. This study included only the cost of antimicrobial therapy in the ICU and the cost for PCT analysis. We used prices valid in the MMA for the year 2012. PCT in serum was measured by homogeneous immunoassay on a Brahms Kryptor analyzer.
A total of 102 patients were enrolled. The mean patients age was 55 ± 19 years and 61.8% of patients were male. The mean length of stay (LOS) in the ICU was 12 ± 21 days. There was a statistically significant difference (p < 0.001) between the sepsis and trauma group regarding outcome (higher mortality rate was in the sepsis group, particularly in the patients with peritonitis who were mostly women). The patients younger than 70 years had better chance of survival. LOS, the use of carbapenems and PCT-measurement influenced the cost of therapy in the ICU.
The obtained results show that age, the diagnosis and gender were the main predictors of survival of critically ill patients in the ICU. The cost of ICU stay was dependent on LOS, use of carbapenems and PCT-measurement although the influence of these three factors on the outcome in the patients did not reach a statistical significance.
背景/目的。重症患者在重症监护病房（ICU）发生严重感染的风险极高。细菌性脓毒症患者循环中的降钙素原（PCT）水平会升高，PCT可能有助于指导抗生素治疗。本研究的目的是评估影响ICU患者生存和治疗费用的因素，特别强调PCT血清水平用于指导抗菌治疗的影响。
该研究于2010年8月至2012年5月在塞尔维亚贝尔格莱德军事医学院麻醉学与重症治疗诊所的重症治疗病房进行。所有入住ICU的成年重症脓毒症和/或创伤患者均纳入研究。本研究仅包括ICU中抗菌治疗的费用以及PCT分析的费用。我们使用了2012年军事医学院有效的价格。血清PCT通过在Brahms Kryptor分析仪上进行均相免疫测定来测量。
共纳入102例患者。患者的平均年龄为55±19岁，61.8%的患者为男性。ICU的平均住院时间（LOS）为12±21天。脓毒症组和创伤组在结局方面存在统计学显著差异（p<0.001）（脓毒症组的死亡率更高，尤其是腹膜炎患者，其中大多数为女性）。70岁以下的患者生存机会更好。LOS、碳青霉烯类药物的使用和PCT测量影响了ICU的治疗费用。
获得的结果表明，年龄、诊断和性别是ICU中重症患者生存的主要预测因素。ICU住院费用取决于LOS、碳青霉烯类药物的使用和PCT测量，尽管这三个因素对患者结局的影响未达到统计学显著意义。
