Selçuk KANAT, Hakan DEMİRCİ, Yasemin ÜSTÜNDAĞ, Fatma Ezgi CAN, Ufuk AYDIN, Gökhan OCAKOĞLU

Akut miyokard enfarktüsü geçiren hastalarda serum osmolalitesinin 6 yıllık sağkalım oranlarına etkisi

Amaç: Bu çalışmada akut miyokard enfarktüsü öyküsü olan hastalarda altı yıllık takipte serum osmolalite ve mortalite oranları arasındaki potansiyel ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Retrospektif bir çalışma tasarlandı. Katılımcılar, anjiyografi için üçüncü basamak sevk merkezimize yönlendirilen, ilk atak AMI atağı olan hastalardı. Ocak 2008 - Haziran 2009 arasında yatan hastaların biyokimyasal değerleri ile altı yıl içinde hayatta kalmaları arasındaki ilişki araştırıldı. Başlangıç özellikleri, hastane içi yönetim ve hastane içi olumsuz sonuçların klinik değişkenleri kaydedildi. Bulgular: İki yüz dört hasta, 174 erkek (% 85) ve 30 kadın (% 15) çalışmaya dahil edildi. Ortalama serum osmolalitesi 295.87 mOsm / kg idi. Ortalama takip süresi 61.31 ± 1.68 ay idi. Plazma osmolalitesinin 6 yıllık mortaliteyi tahmin etmek için en iyi kesme değeri 303.94 mOsmol / kg idi. Sonuç: Osmolalite ne kadar yüksek olursa, diyabetes mellitus ve kronik böbrek hastalığı olmasa bile ilk atak AMI'si olan hastalarda altı yıllık sağkalım daha kötüdür. Hiperosmolalitenin, kalp hastalıklarının sonuçlarını değerlendirirken kullanımının yanı sıra tedavi ve önleme çabalarına da hedeflenebileceğine inanıyoruz.

Anahtar Kelimeler:

kardiyak risk, kronik böbrek hastalığı, kesme noktası, mortalite, ozmolalite

Effect of serum osmolality on 6-year survival rates in patients with acute myocardial

Aim: In the present study, we aimed to evaluate the potential relationship between serum osmolality and mortality rates in a six year of follow-up in patients with a history of acute myocardial infarction. Material and Methods: A retrospective study was designed. Participants were the patients with a first attack AMI, who were referred to our tertiary referral center for angiography. The relationship between the biochemical values of patients who were hospitalized between the period January 2008 - June 2009 and their survival in six years was investigated. Clinical variables of baseline characteristics, in-hospital management, and in-hospital adverse outcomes were recorded. Results: Two hundred and four patients, 174 men (85%) and 30 women (15%), were included in the study. Median serum osmolality was 295.87 mOsm/kg. Mean follow-up time was 61.31±1.68 months. The best cut-off value of the plasma osmolality to predict the 6-year mortality was 303.94 mOsmol/kg. Conclusion: The higher the osmolality, the worse the six-year survival is in patients with first episode AMI even in the absence of diabetes mellitus and chronic kidney disease. We believe that hyperosmolality can be targeted in treatment and prevention efforts as well as its use when evaluating outcomes of the cardiac diseases.

Keywords:

cardiac risk, chronic kidney disease, cut off point, mortality, osmolality,

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1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Heart disease and stroke statistics-update: a report from the American Heart Association. Circulation 2014; 129: e28-e292.
2. Preis SR, Hwang SJ, Coady S, Pencina MJ, D'agostino RB, Savage PJ et al. Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005. Circulation 2009; 119: 1728-35.
3. Demirci H, Cinar Y. Serum osmolality is elevated in metabolic syndrome cases. Turk Neph Dial Transpl 2013; 22: 154-57.
4. Demirci H, Aydin U, Budak YU, Cinar Y. Estimated serum osmolality value as a risk predictor for coronary heart disease. Turkish Journal of Family Practice 2015; 19: 31-36.
5. Rasouli M, Kiasari AM, Arab S. Indicators of dehydration and haemoconcentration are associated with the prevalence and severity of coronary artery disease. Clinical and Experimental Pharmacology and Physiology 2008; 35: 889-94.
6. Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006; 332: 73–78.
7. Fox CS, Matsushita K, Woodward M, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet 2012; 380: 1662–73.
8. Bae MH, Kim JH, Jang SY, Park SH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC. Hyponatremia at discharge as a predictor of 12-month clinical outcomes in hospital survivors after acute myocardial infarction. Heart Vessels 2017; 32: 126-133.
9. Muhsin SA, Mount DB.Diagnosis and treatment of hypernatremia. Best Pract Res ClinEndocrinolMetab 2016; 30: 189-203.
10. Rasouli M, Nesarhosseini V, Kiasari AM, Arab S, Shariati R, Kazemi D, Daneshpour N, Heidari S. The multiplicative interactions of leukocyte counts with some other risk factors enhance the prognostic value for coronary artery disease. Cardiology journal 2011; 18: 246-53.
11. Rasouli, M. Basic concepts and practical equations on osmolality: Biochemical approach. Clinical Biochemistry 2016; 49: 936-41.
12. Wernly B, Lichtenauer M, Franz M et al. Differential Impact of Hyperglycemia in Critically Ill Patients: Significance in Acute Myocardial Infarction but Not in Sepsis? Cai L, ed. International Journal of Molecular Sciences 2016;17: 1586.
13. Liang H, Guo YC, Chen LM, Li M, Han WZ, Zhang X, Jiang SL. Relationship between fasting glucose levels and in-hospital mortality in Chinese patients with acute myocardial infarction and diabetes mellitus: a retrospective cohort study. BMC CardiovascDisord 2016: 2;16: 156.
14. Choi JS, Kim YA, Kim MJ, Kang YU, Kim CS, Bae EH, Ma SK, Ahn YK, Jeong MH, Kim SW. Relation between transient or persistent acute kidney injury and long-term mortality in patients with myocardial infarction. Am J Cardiol 2013 1;112: 41-45.
15. Beier K, Eppanapally S, Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB. Elevation of blood urea nitrogen is predictive of long-term mortality in critically ill patients independent of "normal" creatinine. Crit Care Med. 2011; 39: 305-13.
16. Kaya H, Yücel O, Ege MR, Zorlu A, Yücel H, Güneş H, Ekmekçi A, Yılmaz MB. Plasma osmolality predicts mortality in patients with heart failure with reduced ejection fraction. Kardiol Pol 2016: 13
17. Rohla M, Freynhofer MK, Tentzeris I, Farhan S, Wojta J, Huber K, Weiss TW. Plasma osmolality predicts clinical outcome in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Eur Heart J Acute Cardiovasc Care. 2014; 3: 84-92.
18. Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani, Met al. Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. European Heart Journal, 2007; 28: 2525-38.
19. Tatlisu MA, Kaya A, Keskin M, Uzman O, Borklu EB, Cinier G, Hayiroglu MI, Tatlisu K, Eren M. Can we use plasma hyperosmolity as a predictor of mortality for ST-segment elevation myocardial infarction? Coronar Artery Dis 2017; 28: 70-76.
20. Suleiman M, Khatib R, Agmon Y et al. Early inflammation and risk of long-term development of heart failure and mortality in survivors of acute myocardial infarction: predictive role of C-reactive protein. J Am Coll Cardiol 2006; 47: 962–968.
21. Chew DP, Bhatt DL, Robbins MA et al. Incremental prognostic value of elevated baseline C-reactive protein among established markers of risk in percutaneous coronary intervention. Circulation. 2001; 104: 992–97.
22. Heeschen C, Hamm CW, Bruemmer J, Simoons ML. Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis. CAPTURE Investigators. Chimeric c7E3 Antiplatelet Therapy in Unstable angina Refractory to standard treatment trial. J Am CollCardiol. 2000; 35: 1535–42.
23. Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. N Engl J Med 2000; 343: 1139–47.
24. Biasucci LM, Liuzzo G, Grillo RL et al. Elevated levels of C-reactive protein at discharge in patients with unstable angina predict recurrent instability. Circulation 1999; 99: 855–60.
25. Lee S,Kim IT, Park HB, Hyun YK, Kim YJ, Song SO, Kim H. High-sensitivity C-reactive Protein Can Predict Major Adverse Cardiovascular Events in Korean Patients with Type 2 Diabetes. J Korean Med Sci 2011; 26: 1322-27.