Tolga Han EFE, Engin Deniz ARSLAN, Ahmet Göktuğ ERTEM, Çağrı YAYLA, Mehmet Ali FELEKOĞLU, Saadet İNCİ, Tolga ÇİMEN, Hilal ERKEN PAMUKCU, Macit AYDIN, Murat BİLGİN, Ekrem YETER

Akut Pulmoner Emboli Hastalarında Monosit/HDL Oranının Kısa Dönem Mortaliteyi Ön Gördürmedeki Prognostik Değeri

Giriş: Pulmoner emboli yüksek mortalite ve morbidite oranları ile giden akut acil bir durumdur. Monosit/yüksek yoğunluklu lipoprotein (HDL) oranının, inflamasyon ve oksidatif stresin yeni bir belirteci olabileceği, ayrıca bazı kardiyovasküler hastalıkların varlığı ve prognozu ile de yakından ilişkili olduğu gösterilmiştir. Pulmoner emboli fizyopatolojisinde inflamasyon ve oksitadif stres önemli bir rol oynamaktadır. Çalışmanın amacı akut pulmoner emboliden monosit/HDL oranının kısa dönemde prognostik değerini belirlemektir. Hastalar ve Yöntem: Acil servise başvuran ve akut pulmoner emboli tanısı çok kesitli bilgisayarlı tomografi ile teyit edilen 99 hasta çalışmaya retrospektif olarak dahil edildi. Bulgular: Pulmoner emboli tanısı alan 99 hastanın, tanı aldıktan sonra 26 (%25.2)’sı bir ay içinde eksitus oldu. Hastalar, tanı sonrası bir ay içinde ölenler (1. grup) ve hayatta kalanlar (2. grup) olmak üzere iki gruba ayrıldı. Yaş, malignite, koroner arter hastalığı, sağ ventrikül fonksiyon bozukluğu, beyaz kan hücresi, nötrofil, lenfosit, trombosit ve monosit sayımları, sistolik pulmoner arter basıncı, diyastolik kan basıncı, nötrofil/lenfosit oranı, monosit/HDL oranı, basitleştirilmiş pulmoner emboli ciddiyet indeksi 1. grupta 2. gruba göre anlamlı derecede yüksek bulundu. Monosit/HDL oranı, nötrofil/lenfosit oranı ve basitleştirilmiş pulmoner emboli ciddiyet indeksi akut pulmoner emboli tanısı almış hastalarda mortalitenin bağımsız bir belirleyicisi olduğu görüldü. Sonuç: Monosit /HDL oranı, pulmoner emboli sonrası erken dönemde mortalite gelişen hastalarda, mortalite gelişmeyenlere göre daha yüksekti. Bu nedenle, monosit/HDL oranı gibi ucuz ve pratik bir parametre akut pulmoner embolide mortalite risk tahmininde kullanılabilir.

Anahtar Kelimeler:

Monosit/HDL oranı, pulmoner emboli, mortalite

The Prognostic Value of the Monocyte/HDL Ratio in Predicting Short-term Mortality in Patients with Acute Pulmonary Embolism

Introduction: Pulmonary embolism is an acute emergency with high mortality and morbidity rates. The monocyte/high-density lipoprotein (HDL) ratio was suggested as a new marker of inflammation and oxidative stress. In addition, the monocyte/HDL ratio has been shown to be closely related with the presence and prognosis of some cardiovascular diseases. Inflammation and oxidative stress play an important role in the pathophysiology of pulmonary embolism. The aim of the present study was to determine the prognostic value of the monocyte/HDL ratio in determining the short-term mortality for patients with acute pulmonary embolism. Patients and Methods: Ninety-nine patients who were admitted to the emergency department and diagnosed with acute pulmonary embolism, which was confirmed by multidetector computed tomography, were included in this retrospective study. Results: Of the 99 patients, 26 (25.2%) died within 1 month after the diagnosis was made. Patients were divided into two groups as survivors (group 1) and (group 2) within 1 month after diagnosis. Age; malignancy; coronary artery disease; right ventricular dysfunction; white blood cell, neutrophil, lymphocyte, platelet and monocyte counts; systolic pulmonary artery pressure, diastolic blood pressure, neutrophil/lymphocyte ratio, monocyte/HDL ratio and simplified pulmonary embolism severity index were significantly higher in group 1 (patients died within 1 month after diagnosis) than those in group 2. The monocyte/HDL ratio, neutrophil/lymphocyte ratio, right ventricle dysfunction and simplified pulmonary embolism severity index were independent predictors of mortality in patients with acute pulmonary embolism. Conclusion: The monocyte/HDL ratio, neutrophil/lymphocyte ratio, right ventricle dysfunction and simplified pulmonary embolism severity index were independent predictors of mortality in patients with acute pulmonary embolism.

Keywords:

Monocyte/HDL ratio, pulmonary embolism, mortality,

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1. Goldhaber SZ. Pulmonary embolism thrombolysis: a clarion call for international collaboration. J Am Coll Cardiol 1992;19:246-7.
2. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P, et al; Guidelines ESCCfP. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008;29:2276-315.
3. Agrawal N, Ramegowda RT, Patra S, Hegde M, Agarwal A, Kolhari V, et al. Predictors of inhospital prognosis in acute pulmonary embolism: keeping it simple and effective! Blood Coagul Fibrinolysis 2014;25:492-500.
4. Ancuta P, Wang J, Gabuzda D. CD16+ monocytes produce IL-6, CCL2, and matrix metalloproteinase-9 upon interaction with CX3CL1-expressing endothelial cells. J Leukoc Biol 2006;80:1156-64.
5. Hessler JR, Robertson AL, Jr. Chisolm GM. LDL-induced cytotoxicity and its inhibition by HDL in human vascular smooth muscle and endothelial cells in culture. Atherosclerosis 1979;32:213-29.
6. Li XP, Zhao SP, Zhang XY, Liu L, Gao M, Zhou QC. Protective effect of high density lipoprotein on endothelium-dependent vasodilatation. Int J Cardiol 2000;73:231-6.
7. Parthasarathy S, Barnett J, Fong LG. High-density lipoprotein inhibits the oxidative modification of low-density lipoprotein. Biochim Biophys Acta 1990;1044:275-83.
8. Eagleton MJ, Henke PK, Luke CE, Hawley AE, Bedi A, Knipp BS, et al. Southern Association for Vascular Surgery William J. von Leibig Award. Inflammation and intimal hyperplasia associated with experimental pulmonary embolism. J Vasc Surg 2002;36:581-8.
9. Kayrak M, Erdogan HI, Solak Y, Akilli H, Gul EE, Yildirim O, et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a restrospective study. Heart Lung Circ 2014;23:56-62.
10. Canpolat U, Cetin EH, Cetin S, Aydin S, Akboga MK, Yayla C, et al. Association of monocyte-to-HDL cholesterol ratio with slow coronary Flow is Linked to Systemic Inflammation. Clin Appl Thromb Hemost 2016;22:476-82.
11. Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, Cetinkaya H, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol 2014;46:1619-25.
12. Cetin EH, Cetin MS, Canpolat U, Aydin S, Topaloglu S, Aras D, et al. Monocyte/HDL-cholesterol ratio predicts the definite stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Biomark Med 2015;9:967-77.
13. Canpolat U, Aytemir K, Yorgun H, Sahiner L, Kaya EB, Cay S, et al. The role of preprocedural monocyte-to-high-density lipoprotein ratio in prediction of atrial fibrillation recurrence after cryoballoon-based catheter ablation. Europace 2015;17:1807-15.
14. Konstantinides SV. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3145-6.
15. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999;353:1386-9.
16. Jimenez D, Aujesky D, Moores L, Gomez V, Lobo JL, Uresandi F, et al; Investigators R. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010;170:1383-9.
17. Venetz C, Jimenez D, Mean M, Aujesky D. A comparison of the original and simplified Pulmonary Embolism Severity Index. Thromb Haemost 2011;106:423-8.
18. Watts JA, Gellar MA, Obraztsova M, Kline JA, Zagorski J. Role of inflammation in right ventricular damage and repair following experimental pulmonary embolism in rats. Int J Exp Pathol 2008;89:389-99.
19. Chung T, Emmett L, Khoury V, Lau GT, Elsik M, Foo F, et al. Atrial and ventricular echocardiographic correlates of the extent of pulmonary embolism in the elderly. J Am Soc Echocardiogr 2006;19:347-53.
20. Barnard JW, Ward RA, Adkins WK, Taylor AE. Characterization of thromboxane and prostacyclin effects on pulmonary vascular resistance. J Appl Physiol (1985) 1992;72:1845-53.
21. Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest 2005;115:3378-84.
22. Ghattas A, Griffiths HR, Devitt A, Lip GY, Shantsila E. Monocytes in coronary artery disease and atherosclerosis: where are we now? J Am Coll Cardiol 2013;62:1541-51.
23. Rezende SM, Lijfering WM, Rosendaal FR, Cannegieter SC. Hematologic variables and venous thrombosis: red cell distribution width and blood monocyte count are associated with an increased risk. Haematologica 2014;99:194-200.
24. Muhl D, Furedi R, Cristofari J, Ghosh S, Bogar L, Borsiczki B, et al. Evaluation of oxidative stress in the thrombolysis of pulmonary embolism. J Thromb Thrombolysis 2006;22:221-8.
25. Ovechkin AV, Lominadze D, Sedoris KC, Robinson TW, Tyagi SC, Roberts AM. Lung ischemia-reperfusion injury: implications of oxidative stress and platelet-arteriolar wall interactions. Arch Physiol Biochem 2007;113:1-12.
26. Murphy AJ, Chin-Dusting JP, Sviridov D, Woollard KJ. The anti inflammatory effects of high density lipoproteins. Curr Med Chem 2009;16:667-75.
27. Murphy AJ, Woollard KJ. High-density lipoprotein: a potent inhibitor of inflammation. Clin Exp Pharmacol Physiol 2010;37:710-8.
28. Yvan-Charvet L, Pagler T, Gautier EL, Avagyan S, Siry RL, Han S, et al. ATP-binding cassette transporters and HDL suppress hematopoietic stem cell proliferation. Science 2010;328:1689-93.
29. Kuvin JT, Ramet ME, Patel AR, Pandian NG, Mendelsohn ME, Karas RH. A novel mechanism for the beneficial vascular effects of high-density lipoprotein cholesterol: enhanced vasorelaxation and increased endothelial nitric oxide synthase expression. Am Heart J 2002;144:165-72.
30. Karatas MB, Gungor B, Ipek G, Canga Y, Gunaydin ZY, Onuk T, et al. Association of serum cholesterol levels with short-term mortality in patients with acute pulmonary embolism. Heart Lung Circ 2016;25:365-70.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi