Anahtar Kelimeler
Eşik değer
Adli toksikoloji
GC-MS
İmmünoassay
İdrarda madde testi
Retrospektif çalışma
Opiatlar
Hukuki sonuçlar
Öz
Amaç: Opiatlar, en sık kötüye kullanılan maddeler arasında yer almakta ve hem halk sağlığı hem de adli alan açısından artan bir endişe oluşturmaktadır. Son yıllarda opiat taramalarında kullanılan eşik değerlerinde değişikliklere gidilmiş ve tarama testlerindeki cut-off değerleri 300 ng/mL’den 2000 ng/mL’ye yükseltilmiştir. Bu çalışmanın amacı, sekiz yıllık opiat analiz sonuçlarını sunmak ve tarama cut-off değerinin 300 ng/mL’den 2000 ng/mL’ye yükseltilmesinin etkilerini değerlendirmektir.
Yöntem: 2014–2021 yılları arasında toplam 11.348 idrar örneği analiz edilmiştir. Ön tanılar, poliklinik başvuruları ve toksikolojik test sonuçları iki farklı cut-off değeri altında karşılaştırılmıştır. Tarama analizleri immünoassay yöntemleri (Randox Evidence ve CEDIA) ile, doğrulama analizleri ise Gaz Kromatografisi–Kütle Spektrometrisi (GC–MS) ile gerçekleştirilmiştir.
Bulgular: 300 ng/mL cut-off değeri kullanıldığında vakaların %3,45’i opiat pozitif bulunmuştur. Pozitif vakaların %69,1’inin bağımlılık ile ilişkili polikliniklerinden gelmiş olması, tedavi gereksinimi olan kişilerde madde kullanımının saptaması açısından cut-off değerlerinin klinik önemi ortaya konmuştur. Cut-off değeri 2000 ng/mL’ye yükseltildiğinde adli işleme konu olması gereken vakaların %39,8’inin saptanamadığı görülmüş ve bu durum adli bağlamda yanlış negatif sonuç riskinin belirgin şekilde arttığını göstermiştir.
Sonuç: Bulgular opiat cut-off değerlerinin ve analitik duyarlılığın hem klinik değerlendirmeleri hem de hukuki yorumları önemli ölçüde etkileyebileceğini ortaya koymaktadır. Bu nedenle cut-off değerlerinin seçimi, tıbbi ve adli süreçlerde doğru yorumlama yapılabilmesi açısından kritik öneme sahiptir
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