Pulmoner emboli tanısı alan hastalarda sistemik immün-inflamatuar indeksin hastalığın şiddeti ve mortalite ile ilişkisi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Pulmoner emboli (PE) çoğunlukla alt ekstremite derin venöz yapılarında veya kalbin sağ boşluklarında enfeksiyon, malignite, ve tromboza meyil oluşturan diğer faktörler neticesinde oluşan trombüsün akciğer damar yatağına embolize olarak obstrüksiyon neden olduğu durum olarak nitelendirilmektedir. PE'nin patogenezi oldukça kompleks olup inflamasyon, trombojenite, ve endotelyal disfonksiyon süreçte meydana gelen başlıca değişikliklerdir. İnflamasyonun en önemli komponentlerinden olan nötrofil, lenfosit, ve trombosit bu hücrelerin birbirine oranı günümüze kadar akut ya da kronik inflamasyonla seyreden çeşitli kanserler, koroner arter hastalığı, inflamatuar barsak hastalığı, COVID-19 enfeksiyonu, romatolojik hastalıklar, ve stroke gibi birçok hastalığın şiddetini ve prognozunu belirlemek amacıyla yaygın olarak kullanılmıştır. Biz bu çalışmamızda PE tanısı alan hastalarda sistemik immün-inflamatuar indeks (SII)'in hastalığın şiddeti ve mortalitesi ile olan ilişkisini araştırmayı ve bununla ilgili verileri sunmayı hedefledik. Gereç-Yöntem: Hastaların demografik verileri, klinik seyirleri, medikal öyküsü, radyolojik, laboratuar değerleri, ve hastane içi prognozları geriye yönelik olarak incelendi. Hastalar masif olmayan (hafif PE) ve submasif veya masif emboli saptanan (şiddetli PE) olarak iki gruba ayrıldı. Hastaların demografik, laboratuar, görüntüleme bulguları, hastane içi ve 1 aylık mortalite verileri retrospektif olarak incelenip analiz edildi. Bulgular: Çalışmaya bilgisayarlı tomografi (BT) anjiyografi bulguları itibariyle PE tanısı almış toplamda 310 hasta dahil edildi. Klinik açıdan hafif PE olan grupta 106 erkek, şiddetli PE olan grupta ise 36 erkek hasta olmak üzere toplamda 142 erkek hasta mevcuttu. Cinsiyet açısından iki grup arasında anlamlı bir fark izlenmedi. İncelenen hastaların genel yaş ortalaması 58 + 16.7 olup şiddetli PE grubunda yaş ortalaması anlamlı olarak daha fazlaydı (66 + 15.5 vs 55 + 16.2, p < 0.001). HT (p = 0.009), kronik obstrüktif akciğer hastalığı (KOAH) (p = 0.004), malignite (p = 0.003), DVT (p = 0.002) şiddetli PE grubunda anlamlı olarak daha fazla gözlendi. D-dimer, troponin, BNP, PAB, WBC, nötrofil, CRP, AST , ALT, ve SII değerleri şiddetli PE grubunda anlamlı olarak daha fazlaydı (AST için p = 0.011, ALT için p = 0.001, diğer parametreler için p < 0.001). GFH, Hb, lenfosit değerleri ise şiddetli PE grubunda anlamlı olarak daha düşük bulundu (hepsi için p = 0.001). Multivariate lojistik regresyon analizinde yaş ve GFH şiddetli emboliyi bağımsız öngördücü gücü anlamlı bulunmamıştır. BNP, CRP, ve SII nin şiddetli emboli açısından bağımsız öngördürücü olduğu bulunmuştur. Yapılan analizde mortalite sadece şiddetli PE grubunda gözlenmiş olup bu grupta mortalite mevcut olanların SII olmayanlara göre anlamlı şekilde daha yüksek bulunmuştur (p = 0.005). SII nin indeks değerlerinin şiddetli emboliyi ayırt etmede öngörücü değerlerinin analizinde ROC eğrisi altında kalan alan 0.936 (95% CI: 0.906-0.967, p < 0.001) olup SII cut-off değeri 1258 olarak baz alındığında şiddetli emboliyi %85.9 duyarlılık ve %85.4 özgüllük ile tahmin edebildiği hesaplanmıştır. Sonuç: SII pratik, ucuz, hızlı, kolay ulaşılabilir, ve güvenilir bir indeks olup akut PE'nin şiddeti, hastane içi ve kısa dönem mortalite risk tayini açısından bizlere önemli bir yol gösterici olabilir. Anahtar kelime: Pulmoner emboli, sistemik inflamatuar indeks, mortalite
Aim: Pulmonary embolism (PE) is defined as a situation in which thrombus, which mostly occurs in the deep venous structures of the lower extremities or in the right chambers of the heart as a result of infection, malignancy, and other factors that tend to thrombosis, embolizes into the lung vascular bed and causes obstruction. The pathogenesis of PE is quite complex and inflammation, thrombogenicity, and endothelial dysfunction are the main changes that occur in the process. The number of neutrophils, lymphocytes, and platelets, which are the most important components of inflammation, and the ratio of those cells to each other has been widely used to determine severity and prognosis of many diseases such as various types of cancers, coronary artery disease, inflammatory bowel disease, COVID-19 infection, rheumatological diseases, and stroke, which progress with acute or chronic inflammation. In this study, we aimed to investigate the relationship between systemic immune-inflammatory index (SII) and the severity of the disease and mortality in patients diagnosed with PE and to present relevant data. Materials and methods: The patients' demographic data, clinical course, medical history, radiological and laboratory values, and in-hospital prognoses were analysed retrospectively. Patients were divided into two groups: non-massive (mild PE) and those with submassive or massive embolism (severe PE). The patients' demographic, laboratory, imaging findings, in-hospital and 1-month mortality data were retrospectively reviewed and analyzed. Results: A total of 310 patients diagnosed with PE based on computed tomography (CT) angiography findings were included in the study. There were a total of 142 male patients, 106 male in the group with clinically mild PE and 36 male patients in the group with severe PE. No significant difference was observed between the two groups in terms of gender. The overall average age of the patients examined was 58 + 16.7, and the average age was significantly higher in the severe PE group (66 + 15.5 vs 55 + 16.2, p < 0.001). HT (p = 0.009), chronic obstructive pulmonary disease (COPD) (p = 0.004), malignancy (p = 0.003), DVT (p = 0.002) were observed significantly more in the severe PE group. D-dimer, troponin, BNP, PAB, WBC, neutrophil, CRP, AST, ALT, and SII values were significantly higher in the severe PE group (p = 0.011 for AST, p = 0.001 for ALT, p < 0.001 for other parameters). GFR, Hb, and lymphocyte values were found to be significantly lower in the severe PE group (p = 0.001 for all). In multivariate logistic regression analysis, the independent predictive power of age and GFR for severe embolism was not found to be significant. BNP, CRP, and SII were found to be independent predictors of severe embolism. In the analysis, mortality was observed only in the severe PE group, and in this group, mortality was found to be significantly higher in those with SII than in those without SII (p = 0.005). In the analysis of the predictive values of the index values of SII in distinguishing severe embolism, the area under the ROC curve was 0.936 (95% CI: 0.906-0.967, p < 0.001) and based on the SII cut-off value of 1258, it was found that SII predicted the severe embolism with 85.9% sensitivity and 85.4% specificity. Conclusion: SII is a practical, cheap, fast, easily accessible and reliable index and can be an important guide in terms of severity of acute PE and in-hospital and short-term mortality risk assessment. Keywords: Pulmonary embolism, systemic inflammatory index, mortality
Aim: Pulmonary embolism (PE) is defined as a situation in which thrombus, which mostly occurs in the deep venous structures of the lower extremities or in the right chambers of the heart as a result of infection, malignancy, and other factors that tend to thrombosis, embolizes into the lung vascular bed and causes obstruction. The pathogenesis of PE is quite complex and inflammation, thrombogenicity, and endothelial dysfunction are the main changes that occur in the process. The number of neutrophils, lymphocytes, and platelets, which are the most important components of inflammation, and the ratio of those cells to each other has been widely used to determine severity and prognosis of many diseases such as various types of cancers, coronary artery disease, inflammatory bowel disease, COVID-19 infection, rheumatological diseases, and stroke, which progress with acute or chronic inflammation. In this study, we aimed to investigate the relationship between systemic immune-inflammatory index (SII) and the severity of the disease and mortality in patients diagnosed with PE and to present relevant data. Materials and methods: The patients' demographic data, clinical course, medical history, radiological and laboratory values, and in-hospital prognoses were analysed retrospectively. Patients were divided into two groups: non-massive (mild PE) and those with submassive or massive embolism (severe PE). The patients' demographic, laboratory, imaging findings, in-hospital and 1-month mortality data were retrospectively reviewed and analyzed. Results: A total of 310 patients diagnosed with PE based on computed tomography (CT) angiography findings were included in the study. There were a total of 142 male patients, 106 male in the group with clinically mild PE and 36 male patients in the group with severe PE. No significant difference was observed between the two groups in terms of gender. The overall average age of the patients examined was 58 + 16.7, and the average age was significantly higher in the severe PE group (66 + 15.5 vs 55 + 16.2, p < 0.001). HT (p = 0.009), chronic obstructive pulmonary disease (COPD) (p = 0.004), malignancy (p = 0.003), DVT (p = 0.002) were observed significantly more in the severe PE group. D-dimer, troponin, BNP, PAB, WBC, neutrophil, CRP, AST, ALT, and SII values were significantly higher in the severe PE group (p = 0.011 for AST, p = 0.001 for ALT, p < 0.001 for other parameters). GFR, Hb, and lymphocyte values were found to be significantly lower in the severe PE group (p = 0.001 for all). In multivariate logistic regression analysis, the independent predictive power of age and GFR for severe embolism was not found to be significant. BNP, CRP, and SII were found to be independent predictors of severe embolism. In the analysis, mortality was observed only in the severe PE group, and in this group, mortality was found to be significantly higher in those with SII than in those without SII (p = 0.005). In the analysis of the predictive values of the index values of SII in distinguishing severe embolism, the area under the ROC curve was 0.936 (95% CI: 0.906-0.967, p < 0.001) and based on the SII cut-off value of 1258, it was found that SII predicted the severe embolism with 85.9% sensitivity and 85.4% specificity. Conclusion: SII is a practical, cheap, fast, easily accessible and reliable index and can be an important guide in terms of severity of acute PE and in-hospital and short-term mortality risk assessment. Keywords: Pulmonary embolism, systemic inflammatory index, mortality
Açıklama
Tıp Fakültesi, Göğüs Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
Göğüs Hastalıkları, Chest Diseases
