Akut pulmoner emboli tanısı alan hastalarda basitleştirilmiş pulmoner emboli ağırlık indeksi'nin (spesı) biyokimyasal parametreler ile kombine kullanımının otuz (30) günlük mortalitede prognostik değeri
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ:Pulmoner emboli tedavi edilmemesi halinde mortalite oranları %20-25
civarında görülmekte iken, tedavi edilen vakalarda mortalite %2-8’e kadar
düşmektedir.Basitleştirilmiş pesi skoru, akut pulmoner emboli hastalarında 30 günlük
mortalite riskini belirlemeyi amaçlar. Çalışmamızda akut pulmoner emboli tanısı konulan
hastaların biyokimyasal belirteçlerinin mortaliteyi öngörebilmelerini tespit etmeye çalıştık.
YÖNTEM:Bu çalışma 01 Mayıs 2020 - 26 Mayıs 2021 tarihleri arasında
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesine acil servis ve göğüs hastalıkları
polikliniklerine başvuran ve bu hastalardan akut pulmoner emboli tanısı bilgisayarlı
tomografi pulmoner anjiografi ile kesinleşmiş hasta grubunu kapsamaktadır.Çalışmaya
alınan APE hastalarının tanısı bilgisayarlı tomografi (BT) anjiografi ile en az bir
subsegmenter tutulum tespit edilerek doğrulanmıştır. Çalışmada hastalar tanı aldıktan sonra
düşük (sPESI=0) ve yüksek riskli (sPESI≥1) olarak iki gruba ayrıldı. Hastaların
demografik verileri analiz edildikten sonra başta pro-BNP değerleri olmak üzere
mortaliteye etkisi olabileceği düşünülen parametreler bu iki grupta karşılaştırıldı.
Araştırma sonucu elde edilen veriler bilgisayar ortamında SPSS (Statistical Package for
Social Sciences) 18.0 paket programı ile analiz edildi.
BULGULAR:Çalışmaya alınan 87 hastanın 37’si (%42,5) erkek, 50’si (%57,5)
kadındı ve yaş ortalaması 64,95±15.06 saptandı. sPESI risk sınıflamasına göre düşük riskli
(sPESI=0) grupta 44 (%50,6), yüksek riskli (sPESI≥1) grupta43 (%49,4) hasta
bulunmaktaydı. Otuz günlük takip sonunda çalışmaya alınan 87 hastanın 76’sı (%87,4)
sağ, 11 (%12,6) hasta vefat etmiştir. 25 (%28,7) hastada eşlik eden DVT saptanmıştır.
Çalışmaya alınan hastaların eşlik eden hastalıklarına bakıldığında malignite 21(%24,1)
hastada, kronik akciğer hastalığı 11 (%12,6) hastada, kronik kalp hastalığı 32(%36,8)
hastada, diyabet 17 (%19,5) hastada saptanmıştır.
OBJECTİVE: If pulmonary embolism is not treated, mortality rates are around 20- 25%, while mortality decreases to 2-8% in treated cases. The simplified pesi score aims to determine the 30-day risk of mortality in patients with acute pulmonary embolism. In our study, we tried to determine whether the biochemical markers of patients diagnosed with acute pulmonary embolism could predict mortality. MATERİALS AND METHODS: This study includes a group of patients who applied to the emergency department and chest diseases outpatient clinics of Necmettin Erbakan University Meram Medical Faculty between 01 May 2020 and 26 May 2021, and the diagnosis of acute pulmonary embolism was confirmed by computed tomography pulmonary angiography. The diagnosis of APE patients included in the study was confirmed by detecting at least one subsegmental involvement by computed tomography (CT) angiography. In the study, patients were divided into two groups as low (sPESI=0) and high risk (sPESI≥1) after diagnosis. After analyzing the demographic data of the patients, the parameters thought to have an effect on mortality, especially pro-BNP values, were compared in these two groups. The data obtained as a result of the research were analyzed in computer environment with the SPSS (Statistical Package for Social Sciences) 18.0 package program. FİNDİNGS: Of the 87 patients included in the study, 37 (42.5%) were male, 50 (57.5%) were female, and the mean age was 64.95±15.06 years. According to the sPESI risk classification, there were 44 (50.6%) patients in the low-risk (sPESI=0) group and 43 (49.4%) patients in the high-risk (sPESI≥1) group. At the end of the 30-day follow-up, 76 (87.4%) of the 87 patients included in the study were alive and 11 (12.6%) patients died. Concomitant DVT was detected in 25 (28.7%) patients. viii Considering the comorbidities of the patients included in the study, malignancy was found in 21 (24.1%) patients, chronic lung disease in 11 (12.6%) patients, chronic heart disease in 32 (36.8%) patients, and diabetes in 17 (19.5%) patients. detected. Pro-BNP was calculated as 372 (70.5 –1692) in the low-risk group and 1029 (313.5 – 5789) in the highrisk group and was found to be statistically significant (p=0.027). Pro-BNP was calculated as 526 (114.25-1690) in the surviving group and 7194 (2790.50-11214.25) in the deceased group, statistically significant (p=0.001). RESULTS: In studies on prognosis, similar to our study, pro-BNP values in patients who died in the one-month period were statistically significantly higher than the survivors group. In our study, a clinically usable cut-off value could not be determined because of the low sensitivity and specificity values.Despite this, it can be said that the 30- day mortality is high in patients with high pro-BNP values, and we think that if the proBNP values of the patients in the high-risk group are found to be high as a result of the sPESI evaluation after diagnosis, the follow-up should be done more closely and carefully, and the length of stay in this patient group can be kept longer if necessary.
OBJECTİVE: If pulmonary embolism is not treated, mortality rates are around 20- 25%, while mortality decreases to 2-8% in treated cases. The simplified pesi score aims to determine the 30-day risk of mortality in patients with acute pulmonary embolism. In our study, we tried to determine whether the biochemical markers of patients diagnosed with acute pulmonary embolism could predict mortality. MATERİALS AND METHODS: This study includes a group of patients who applied to the emergency department and chest diseases outpatient clinics of Necmettin Erbakan University Meram Medical Faculty between 01 May 2020 and 26 May 2021, and the diagnosis of acute pulmonary embolism was confirmed by computed tomography pulmonary angiography. The diagnosis of APE patients included in the study was confirmed by detecting at least one subsegmental involvement by computed tomography (CT) angiography. In the study, patients were divided into two groups as low (sPESI=0) and high risk (sPESI≥1) after diagnosis. After analyzing the demographic data of the patients, the parameters thought to have an effect on mortality, especially pro-BNP values, were compared in these two groups. The data obtained as a result of the research were analyzed in computer environment with the SPSS (Statistical Package for Social Sciences) 18.0 package program. FİNDİNGS: Of the 87 patients included in the study, 37 (42.5%) were male, 50 (57.5%) were female, and the mean age was 64.95±15.06 years. According to the sPESI risk classification, there were 44 (50.6%) patients in the low-risk (sPESI=0) group and 43 (49.4%) patients in the high-risk (sPESI≥1) group. At the end of the 30-day follow-up, 76 (87.4%) of the 87 patients included in the study were alive and 11 (12.6%) patients died. Concomitant DVT was detected in 25 (28.7%) patients. viii Considering the comorbidities of the patients included in the study, malignancy was found in 21 (24.1%) patients, chronic lung disease in 11 (12.6%) patients, chronic heart disease in 32 (36.8%) patients, and diabetes in 17 (19.5%) patients. detected. Pro-BNP was calculated as 372 (70.5 –1692) in the low-risk group and 1029 (313.5 – 5789) in the highrisk group and was found to be statistically significant (p=0.027). Pro-BNP was calculated as 526 (114.25-1690) in the surviving group and 7194 (2790.50-11214.25) in the deceased group, statistically significant (p=0.001). RESULTS: In studies on prognosis, similar to our study, pro-BNP values in patients who died in the one-month period were statistically significantly higher than the survivors group. In our study, a clinically usable cut-off value could not be determined because of the low sensitivity and specificity values.Despite this, it can be said that the 30- day mortality is high in patients with high pro-BNP values, and we think that if the proBNP values of the patients in the high-risk group are found to be high as a result of the sPESI evaluation after diagnosis, the follow-up should be done more closely and carefully, and the length of stay in this patient group can be kept longer if necessary.
Açıklama
Anahtar Kelimeler
Akut pulmoner emboli, Prognoz, Mortalite, Acute pulmonary embolism, Prognosis, Mortality
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Koç, A. (2021). Akut pulmoner emboli tanısı alan hastalarda basitleştirilmiş pulmoner emboli ağırlık indeksi'nin (spesı) biyokimyasal parametreler ile kombine kullanımının otuz (30) günlük mortalitede prognostik değeri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Göğüs Hastalıkları Anabilim Dalı, Konya.
