Berrin CEYHAN, Umut Sabri KASAPOĞLU, Şehnaz OLGUN YILDIZELİ, Canan ÇİMŞİT, Nuri Çagatay ÇİMŞİT, Emel ERYÜKSEL, Sait KARAKURT, Derya KOCAKAYA, Melek SÜZER ASLAN, Hüseyin ARIKAN

Akut pulmoner embolide erken dönem mortalitenin göstergesi olarak plevral efüzyon

Giriş: Pulmoner emboli (PE), kardiyovasküler morbidite ve mortalitenin başlıca nedenlerinden biri olarak bilinmektedir. Yüksek riskli hastaların belirlenmesi kısa dönem ve uzun dönem mortalitesi açısından çok önemlidir. Materyal ve Metod: Bu çalışmanın amacı, akut pulmoner emboli tanısı alan hastalarda, basitleştirilmiş pulmoner emboli şiddet indeksinin (sPESI), radyolojik araştırmaların ve komorbiditelerin kısa dönem mortalitesi açısından prognostik önemini göstermektir. Bilgisayarlı tomografi pulmoner anjiyografi (BTPA) ile akut PE tanısı alan 570 hastayı retrospektif olarak değerlendirdik. Komorbiditeler kaydedildi, sPESI skorları hesaplandı ve BTPA verileri değerlendirildi. Gereç ve Yöntem: Bilgisayarlı tomografi pulmoner anjiyografi (BTPA) ile akut PE tanısı alan 570 hastayı retrospektif olarak değerlendirdik. Komorbiditeler kaydedildi, sPESI skorları hesaplandı ve BTPA verileri değerlendirildi. Bulgular: Çalışmaya alınan toplam 570 PE tanılı hastanın 292'si (%51.2) kadındı, 74 hastada (%12.9) tanı aldıktan sonra 30 gün içinde öldü. Tek değişkenli analizde tanı anında ana pulmoner arter tutulumu (p= 0.045), plevral efüzyon varlığı (p= 0.001) ve perikardiyal efüzyon (p= 0.004) erkek cinsiyet (p= 0.031), konjestif kalp yetmezliği (KKY) yüksek riskli sPESI grubu (p< 0.001) mortalite üzerinde anlamlı bir etkiye sahipti. Çok değişkenli analizde plevral efüzyon (HR, 1.67; CI, 1.05-2.66; p< 0.030) ve sPESI yüksek risk grubu (HR, 9.56; CI, 4.71-19.43; p< 0.001) sağkalım üzerinde anlamlı ve bağımsız birer risk faktörü olarak saptandı. Sonuç: Bu çalışma, akut pulmoner emboli tanısı alan hastalarda tanı anında plevral efüzyon varlığının varlığı ve yüksek riskli bir sPESI skorunun kısa dönem mortalitenin belirleyicileri olduğunun altını çizmektedir.

Pleural effusion as an indicator of short term mortality in acute pulmonary embolism

Introduction: Pulmonary embolism (PE) is known as one of the major causes of cardiovascular morbidity and mortality. Identificationof high risk patients for short term and long-term mortality is crucial. The purpose of this study is to demonstrate the prognosticimportance of simplified pulmonary embolism severity index (sPESI), radiological investigations and comorbidities in terms of shortterm mortality by simultaneous assessment of sPESI score, pulmonary computed tomography (CT) angiography findings andunderlying comorbidities in patients diagnosed with acute pulmonary embolism.Materials and Methods: We retrospectively evaluated 570 patients diagnosed with acute PE confirmed by computer tomographypulmonary angiography (CTPA). Comorbidities were recorded, pulmonary embolism severity index scores were calculated and CTPAdata were evaluated as predictors for short-term mortality.Results: The study population consisted of 570 patients, 292 (51.2%) patients were female and 74 patients (12.9%) died within 30days due to PE diagnosis. In univariate analysis male gender (p=0.031), congestive heart failure (CHF)(p< 0.029), main pulmonaryartery involvement (p= 0.045), presence of pleural effusion (p=0.001) and pericardial effusion (p= 0.004) at time of diagnosis andhigh risk sPESI group (p< 0.001) had a significant influence onmortality. In the multivariate analysis, pleural effusions (HR, 1.67;CI, 1.05-2.66; p< 0.030) and sPESI high risk group (HR, 9.56; CI,4.71-19.43; p< 0.001) were remained significant and independentprognostic factors for survival.Conclusion: The present study underlined that presence of pleural effusion at the time of diagnosis in patients with massive pulmonary embolism and a high sPESI score in other patients were significant predictors of short-term mortality.

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Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98:756- 64.
Ng AC, Chung T, Yong AS, Wong HS, Chow V, Celermajer DS, et al. Long-term cardiovascular and noncardiovascular mortality of 1023 patients with confirmed acute pulmonary embolism. Circ Cardiovasc Qual Outcomes 2011;4:122-8.
Sanchez O TL, Colombet I, Durieux P, Huisman MV, Chatelllier G. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. European Heart Journal 2008;29:1569-77.
Dentali F, Cei M, Mumoli N, Gianni M. How to predict short- and long-term mortality in patients with pulmonary embolism? Pol Arch Med Wewn 2015;125:82-8.
Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 2005;172:1041-6.
Masotti L, Righini M, Vuilleumier N, Antonelli F, Landini G, Cappelli R, et al. Prognostic stratification of acute pulmonary embolism: focus on clinical aspects, imaging, and biomarkers. Vasc Health Risk Manag 2009;5:567-75.
Henzler T, Roeger S, Meyer M, Schoepf UJ, Nance JW Jr, Haghi D, et al. Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction. Eur Respir J 2012;39:919-26.
Jimenez D, Lobo JL, Monreal M, Moores L, Oribe M, Barron M, et al. Prognostic significance of multidetector CT in normotensive patients with pulmonary embolism: results of the protect study. Thorax 2014;69:109-15.
Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3033-69, 3069a-3069k.
Jimenez D, Aujesky D, Moores L, Gomez V, Lobo JL, Uresandi F, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010;170:1383-9.
Lobo JL, Zorrilla V, Aizpuru F, Uresandi F, Garcia-Bragado F, Conget F, et al. Clinical syndromes and clinical outcome in patients with pulmonary embolism: findings from the RIETE registry. Chest 2006;130:1817-22.
Findik S. Pleural effusion in pulmonary embolism. Curr Opin Pulm Med 2012;18:347-54.
Light RW. Pleural effusion due to pulmonary emboli. Curr Opin Pulm Med 2001;7:198-201.
Cimsit NC, Cimsit C, Onaygil C, Kuzan TY. Correlation of clot distribution with morphometric measurements and pleuroparenchymal findings in acute pulmonary embolism: experience with 692 cases. Clin Imaging 2015;39:1012-7.
Zhou X, Zhang Z, Zhai Z, Zhang Y, Miao R, Yang Y, et al. Pleural effusions as a predictive parameter for poor prognosis for patients with acute pulmonary thromboembolism. J Thromb Thrombolysis 2016;42:432- 40.
Kiris T, Yazici S, Koc A, Koprulu C, Ilke Akyildiz Z, Karaca M, et al. Prognostic impact of pleural effusion in acute pulmonary embolism. Acta Radiol 2016.
Vedovati MC, Germini F, Agnelli G, Becattini C. Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost 2013;11:2092-102.
Choi KJ, Cha SI, Shin KM, Lim JK, Yoo SS, Lee J, et al. Central emboli rather than saddle emboli predict adverse outcomes in patients with acute pulmonary embolism. Thromb Res 2014;134:991-6.
Trujillo-Santos J, den Exter PL, Gomez V, Del Castillo H, Moreno C, van der Hulle T, et al. Computed tomographyassessed right ventricular dysfunction and risk stratification of patients with acute non-massive pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost 2013;11:1823-32.
Oz, II, Altinsoy B, Serifoglu I, Sayin R, Buyukuysal MC, Erboy F, et al. Evaluation of right atrium-to-right ventricle diameter ratio on computed tomography pulmonary angiography: Prediction of adverse outcome and 30-day mortality. Eur J Radiol 2015;84:2526-32.
Jimenez D, Lobo JL, Barrios D, Prandoni P, Yusen RD. Risk stratification of patients with acute symptomatic pulmonary embolism. Intern Emerg Med 2016;11:11-8.
Zhou XY, Ben SQ, Chen HL, Ni SS. The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: a meta-analysis. Respir Res 2012;13:111.
Dentali F, Riva N, Turato S, Grazioli S, Squizzato A, Steidl L, et al. Pulmonary embolism severity index accurately predicts long-term mortality rate in patients hospitalized for acute pulmonary embolism. J Thromb Haemost 2013;11:2103-10.
Kumamaru KK, Saboo SS, Aghayev A, Cai P, Quesada CG, George E, et al. CT pulmonary angiography-based scoring system to predict the prognosis of acute pulmonary embolism. J Cardiovasc Comput Tomogr 2016.