Sebih ALP, Songül ÖZYURT, Bilge YILMAZ KARA, Dilek KARADOĞAN, Neslihan ÖZÇELİK, Aziz GÜMÜŞ, Ünal ŞAHİN

Pulmoner Tromboembolili Hastalarda Sağkalımı Etkileyen Faktörlerin Belirlenmesi

Amaç: Pulmoner tromboemboli tanısı ile yatırılarak tedavisi yapılan hastalarda yatışında ve taburcu edildikten sonraki 6 ay boyunca devam eden tedavi sürecinde ortaya çıkabilecek komplikasyonlar ve sağ kalımı etkileyen faktörlerin araştırılması amaçlanmıştır.Materyal ve Metot: Çalışma Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Hastanesi Göğüs Hastalıkları Kliniğinde pulmoner emboli tanısı ile yatırılarak takip ve tedavi edilen hastalarda yapıldı. 01/01/2014 - 01/12/2016 tarihleri arasında, spiral toraks anjio bilgisayarlı tomografisinde en az segmental pulmoner arterde dolum defekti saptanan erişkin hastalar çalışmaya alındı..Bulgular: Çalışmaya alınan toplam 50 hastanın yaş ortalaması 73,04±13,313 yıl ve 13’ü (%26) erkek, 37’si (%74) kadındı. Eksitus olanlarda nabız, Modifiye Geneva ve Wells skorları, pulmoner emboli şiddet indeksi ve basitleştirilmiş pulmoner emboli şiddet indeksi skorları sağ kalanlara göre yüksekti. Eksitus olanlarda hem RDW (Red Cell Distribution With) hem de 1. ve 5. Gün MCV (Mean Corpusculer Volum) ve hematokrit düzeyleri daha düşüktü. Eksitus olanlarda platelet sayısı daha yüksek iken 1. ve 5. gün kan total protein ve albümin düzeyleri düşük bulundu. ALP (Alkalen fosfataz)’ın 1. günde yüksekliği, 5. günde total bilirubin ve CRP (C-Reaktif Protein) yüksekliği mortalite ile ilişkili bulundu. Sonuç: Çalışmamızda Basitleştirilmiş pulmoner emboli şiddet indeksi skorunun yüksekliği, taşikardi, 1. gün ve 5. gün bakılan hemoglobin, total protein, albümin düzeylerinin düşük olması, RDW düzeyi yüksekliği, ALP yüksekliği, 5. Günde WBC, CRP ve total bilirubin düzeylerinin hala yüksek seyretmesi mortalite ile ilişkili bulunmuştur.

Anahtar Kelimeler:

Pulmoner Tromboembolizm, Sağkalım, 6 aylık izlem

Determination of Factors Affecting the Survival in Patients with Pulmonary Thromboembolism

Objective: The aim of this study was to investigate the factors affecting survival of the patients hospitalized with pulmonary thromboembolism and complications that may emerge at admission or during 6-months treatment period. Material and Methods: The study was performed in patients who were hospitalized and followed up with pulmonary embolism and were treated at the Recep Tayyip Erdoğan University Faculty of Medicine Training and Research Hospital Chest Diseases Clinic. Patients who were diagnosed with at least segmental pulmonary artery filling defects between 01/01/2014 - 01/12/2016 over 20 years of age and spiral thorax angiography computed tomography were included in the study. Results: The mean age of the patients was 73.04 ± 13.313 and 13 (26%) were male and 37 (74%) were female. Pulse rate, modified Geneva and Wells scores, pulmonary embolism severity index and simplified pulmonary embolism severity index scores were higher in those who died than that of survivors. Both the RDW (Red Cell Distribution With) and the 1st and 5th day MCV (Mean Corpusculer Volume) and hematocrit levels were lower in those who died. While the number of platelets was higher in patients who died, blood total protein and albumin levels were found to be lower on the 1st and 5th days. The elevation of ALP (Alkaline phosphatase) on day 1, total bilirubin on day 5, and CRP (C-Reactive Protein) elevation were associated with mortality. Conclusion: High levels of simplified pulmonary embolism severity index score, tachycardia, hemoglobin, total protein, albumin levels, RDW level, ALP elevation, WBC, CRP and total bilirubin levels on the 5th day were all associated with mortality.

Keywords:

: Pulmonary Thromboembolism, Mortality, 6-month follow-up,

PDF

___

1. Rosendaal FR. Risk factors for venous thrombotic disease. Thromb Haemost 1999; 82: 610-9.
2. Palevsky HI, Kelley MA, Fishman AP. Pulmonary thromboembolik disease. In: Fishman AP, Elias JA, Fishman JA, Grippi MA (eds). Fishman’s Pulmonary Diseases and Disorders. New York: International Edition Mc Graw Hill, 1998; 1297-1329.
3. White RH. The epidemiology of venous thromboembolism. Circulation. 2003; 107 (Suppl1):14-18. DOI: 10.1161/01.CIR.0000078468.11849.66
4. Tormene D, Ferri V, Carraro S, Simioni P. Gender and the riskof venous thromboembolism. Semin Thromb Hemost 2011;37: 193-8.
5. Santosa F, Moysidis T, Moerchel C, et al. Pulmonary embolismin young people: Trends in Germany from 2005 to 2011. Hamostaseologie 2014;34: 88-92.
6. Keller K, Beule J, Balzer JO, Dippold W. Evaluation of Risk Stratification Markers and Models in Acute Pulmonary Embolism: Rationale and Design of the MARS-PE (Mainz Retrospective Study of Pulmonary Embolism) Study Programme. Acta Medica (Hradec Kralove). 2018;61(3):93-97.
7. Nijkeuter M, Söhne M, Tick LW, et al. The natural course of hemodynamically stable pulmonary embolism. Chest 2007;131:517-23.
8. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003;58: 470-84.
9. Agarwal S, Clark D 3rd, Sud K, Jaber WA, Cho L, Menon V. Gender Disparities in Outcomes and Resource Utilization for Acute Pulmonary Embolism Hospitalizations in the United States. Am J Cardiol. 2015 Oct 15;116(8):1270-6.
10. Arseven O. ve ark. Türk Toraks Derneği Pulmoner Embolizm Tanı ve Tedavi Uzlaşı Raporu, Mart 2015.
11. Özsu S, Özlü T, Bülbül Y. Ulusal verilerle pulmoner tromboemboli. Tüberküloz ve Toraks Dergisi 2009; 57: 466-82.
12. Erbaycu AE, Tuksavul F, Uçar H, Güçlü SZ. Kırk dokuz pulmoneremboli olgusunun retrospektif değerlendirilmesi. İzmir Göğüs Hastanesi Dergisi 2004;18: 113-8.
13. PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990; 263: 2753-9.
14. Duru S, Ergün R, Dilli A, Kaplan T, Kaplan B, Ardıç S, et al. Clinical, laboratory and computed tomography pulmonary angiography results in pulmonaryembolism: retrospective evaluation of 205 patients. Anadolu Kardiyoloji Dergisi 2012; 12: 142-9.
15. Omar HR, Mirsaeidi M, Weinstock MB, Enten G, Mangar D, Camporesi EM. Syncope on presentation is a surrogate for submassive and massive acute pulmonary embolism. Am J Emerg Med. 2018 Feb;36(2):297-300.
16. 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.
17. Konstantinides SV, Torbicki A, Agnelli G, Danchin N,Fitzmaurice D, Galiè N, et al; The Task Force for the Diagnosisand Management of Acute Pulmonary Embolismof the European Society of Cardiology (ESC) Endorsedby the European Respiratory Society (ESC). 2014 ESCGuidelines on the diagnosis and management of acutepulmonary embolism. Eur Heart J 2014; 35: 3033-69,3069a-3069k.
18. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001; 135: 98-107.
19. Ceriani E, Combescure C, Le Gal G, et al, Righini M. Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost 2010; 8: 957-70.
20. Palla A, Petruzzelli S, Donnamari V, et al. The role of suspicion in the diagnosis of pulmonary embolism. Chest 1995;107: 21-4.
21. Ishimaru N, Ohnishi H, Yoshimura S, Kinami S. The sensitivities and prognostic values of the Wells and revised Geneva scores in diagnosis of pulmonary embolism in the Japanese population. Respir Investig. 2018 Sep;56(5):399-404.
22. Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validationof a prognostic model for pulmonary embolism. AmJ Respir Crit Care Med 2005;172:1041-6.
23. Jimenez D, Aujesky D, Moores L, et al. Simplification of thepulmonary embolism severity index for prognostication inpatients with acute symptomatic pulmonary embolism. ArchIntern Med 2010;170:1383-9.
24. Righini M, Roy PM, Meyer G, et al. The Simplified PulmonaryEmbolismSeverity Index (PESI): validation of a clinical prognosticmodel for pulmonary embolism. J Thromb Haemost 2011;9: 2115-7.
25. Hauel NH, Nar H, Priepke H, Ries U, Stassen JM, WienenW. Structure-based design of novel potent nonpeptide thrombin inhibitors. J Med Chem 2002; 45: 1757.
26. Kline JA, Hernandez-Nino J, Newgard CD, Cowles DN, Jackson RE, Courtney DM. Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism. Am J Med 2003; 115: 203-8.
27. Donzé J, Labarère J, Méan M, Jiménez D, Aujesky D, et al. Prognostic importance of anaemia in patients with acute pulmonary embolism.Thromb Haemost. 2011 Aug;106(2):289-95.
28. Dabbah S, Hammerman H, Markiewicz W, Aronson D: Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. The American journal of cardiology 2010, 105(3):312-317.
29. Rhodes CJ, Wharton J, Howard LS, Gibbs JSR, Wilkins MR: Red cell distribution width outperforms other potential circulating biomarkers in predicting survival in idiopathic pulmonary arterial hypertension. Heart 2011, 97(13):1054-1060.
30. Zorlu A, Bektasoglu G, Kukul Guven FM, Dogan OT, Gucuk E, Refiker Ege M, Altay H, Cınar Z, Tandogan I, Yilmaz MB: Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. The American journal of cardiology 2012, 109(1):128-134.
31. Zhang Z, Xu X, Ni H, Deng H: Red cell distribution width is associated with hospital mortality in unselected critically ill patients. Journal of thoracic disease 2013, 5(6):730-736.
32. Sonsuz A. Karaciğer Fonksiyon Bozukluklarına Klinik Yaklaşım. İÜ. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri.2007: 69 78.
33. Marik P.E. The treatment of hypoalbuminaemia in the critically ill patient. Heart and Lung 1993; 22: 166 170.
34. Harold IP, Mark AK, Alfred PF, Pulmonary thromboembolic disease.n :Fishman AP (ed). Fishman’s Pulmonary Disease and Disorders. Ed: AP Fishman. Mc Graw Hill Newyork 1998; pp: 1297-1329.
35. Scherz N, Labarere J, Mean M, Ibrahim SA, Fine MJ, Aujesky D. Prognostic importance of hyponatremia in patients with acute pulmonary embolism. Am J Respir Crit Care Med 2010; 182: 1178-83.
36. Zacho J, Tybjaerg-Hansen A, Nordestgaard BG. C-reactive protein and risk of venous thromboembolism in the general population. Arterioscler Thromb Vasc Biol 2010; 30: 1672-8.
37. Abul Y, Karakurt S, Özben B, Toprak A, Çelikel T. C-reaktive protein in acute pulmonary embolism. J Investig Med. 2011 Ocak; 59 (1): 8-14.
38. Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta analysis. Circulation 2007;116:427-33.