Pulmoner emboli şiddeti ve mortalitesini öngörmede qanadli skoru ve modifiye şok indeksinin rolü
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Tarih
2024
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Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Pulmoner emboli, venöz sistemde meydana gelen trombüsün pulmoner arteryel sisteme embolize olmasıdır. Akut başlangıçlı bir tablo olup ciddi kalp yetmezliği ve ölümle sonuçlanabilir. Hastane içi ölüm oranı %4, 30 günlük mortalitede %13’tür. Hastalığın şiddetini ve mortlite riskini öngörecek yeni paramatrelere ihtiyaç vardır. Bu neden ile çalışmamızda acil servise başvuran pulmoner emboli hastalarının hastalık şiddetini, hastane içi mortalite ve 7 günlük erken mortaliteyi öngörmede Qanadli skoru ile Modifiye Şok İndeksinin rolünü göstermeyi amaçladık.
Gereç ve yöntem: ENLIL HBYS sistemi kullanılarak 1 Mart 2019 - 29 Şubat 2024 tarihleri arasında hastanemiz acil servisinde 18 yaş ve üstü PBTA çekilen 3401 hasta saptandı. 3401 hastadan 574 taneside PE saptandı. PE tanısı alan hastalardan travma nedeniyle başvuran 7 hasta, sistemde eksik verisi olan 1 hasta çalışmadan çıkarıldı. Çalışma 566 hasta ile gerçekleştirildi. Çalışmaya dahil olan hastalar retrospektif olarak incelendi. Hastaların PESI, sPESI, Şok İndeksi, Modifiye Şok İndeksi, Qanadli Skoru parametreleri hesaplandı. Bunlara ek olarak SI ve MSI’ne yeni bir çarpan olarak hastanın 1/arteriyel oksihemoglobin saturasyonu yüzdesi eklenip SI*1/SpO2 ve MSI*1/SpO2 skorları hesaplandı. Hasta grupları şiddetli/şiddetli olmayan ve mortal/mortal olmayan olarak gruplandırıldı. Şiddetli/şiddetli olmayan grup için PESI skorlaması referans alındı, PESI skorlamasından 85 puan ve altı hesaplananlar düşük, 86 puan ve üstü hesaplananlar yüksek risk kabul edildi. Mortal/mortal olmayan gruplar hastane içi mortalite var/yok ve 7 günlük mortalite var/yok şeklinde gruplandırıldı. Verilerin istatistiksel analizi IBM SPSS Version 25.0 (Armonk, NY: IBM Corp) programı kullanılarak gerçekleştirildi. Mortaliteyi (0-7 gün / hastane içi ) ayırt etmede araştırdığımız PESI, sPESI, SI, SI*1/SpO2, MSI, MSI*1/SpO2 ve QANADLI parametrelerinin belirleyiciliği ROC analizleri ile değerlendirildi. Şiddeti ayırt etmede araştırdığımız SI, SI*1/SpO2, MSI, MSI*1/SpO2 ve QANADLI parametrelerinin belirleyiciliği ROC analizleri ile değerlendirildi. İstatistiksel anlamlılık p<0,05 ve p<0,001 düzeyinde kabul edildi.
Bulgular: Hastaların ortalama yaşı 69,11 ± 15,77 yıldır. Vakaların 296’sı (%52,3) kadın, 270’i (%47,7) erkektir. Vakaların 443’ü (%78,3) yüksek risk, 123’ü (%21,7) düşük risktir. Vakaların %11,1’i 0-7 gün içinde mortaldir. Hastane içi mortalite oranı %22,1’dir. 0-7 gün içinde mortal olan grubun ortalama PESI, sPESI, SI, SI*1/SpO2, MSI ve MSI*1/SpO2 düzeyleri mortal olmayan gruptan istatistiksel olarak anlamlı düzeyde yüksek bulundu (p<0,001). 0-7 gün içinde mortal olan grubun QANADLI skoru, mortal olmayan gruptan istatistiksel olarak anlamlı düzeyde yüksek bulundu (p=0,005). 0-7 gün mortaliteyi ayırt etmede ROC analizi sonucunda PESI (AUC 0,807; p<0,001), sPESI (AUC 0,723; p<0,001), SI (AUC 0,775; p<0,001), SI*1/SpO2 (AUC 0,784; p<0,001), MSI (AUC 0,772; p<0,001), MSI*1/SpO2 (AUC 0,784; p<0,001) ve QANADLI (AUC 0,607; p 0,005) değerleri hesaplandı. Hastane içinde mortal olan grubun ortalama PESI, sPESI, SI, SI*1/SpO2, MSI, MSI*1/SpO2 ve QANADLİ skoru düzeyleri mortal olmayan gruptan istatistiksel olarak anlamlı düzeyde yüksek bulundu (p<0,001). Hastane içi mortaliteyi ayırt etmede ROC analizi sonucunda PESI (AUC 0,802; p<0,001), sPESI (AUC 0,762; p<0,001), SI (AUC 0,765; p<0,001), SI*1/SpO2 (AUC 0,796; p<0,001), MSI (AUC 0,767; p<0,001), MSI*1/SpO2 (AUC 0,800; p<0,001) ve QANADLI (AUC 0,655; p<0,001) değerleri hesaplandı. PESI yüksek risk grubun ortalama sPESI, SI, SI*1/SpO2, MSI ve MSI*1/SpO2 düzeyleri PESI düşük risk grubundan istatistiksel olarak anlamlı düzeyde yüksek bulundu (p<0,001). PESI risk kategorilerini ayırt etmede ROC analizi sonucunda SI (AUC 0,632; p<0,001), SI*1/SpO2 (AUC 0,708; p<0,001), MSI (AUC 0,647; p<0,001), MSI*1/SpO2 (AUC 0,725; p<0,001) ve QANADLI (AUC 0,727; p<0,001) değerleri hesaplandı.
Sonuç: PE tanısı alan hastaların şiddeti ve mortaliteyi değerlendirmede hastanın kliniği ve vital bulguları önemlidir. Acil serviste PE hastalarının hızlı yönetimi için vital bulgular üzerinden kolaylıkla hesaplanacak olan MSI*1/SpO2 skoru, embolinin o hastada oluşturduğu patofizyolojik etki ve klinik ciddiyeti ön görmede değerlidir. PE tanısı alan hastalarda şiddeti ve mortaliteyi ön görmede MSI*1/SpO2 skoru değerlidir. Qanadli skoru şiddeti ön görmede değerlidir, fakat MSI*1/SpO2 skoru mortaliteyi ön görmede Qanadli skorundan daha güçlüdür.
Introduction: Pulmonary embolism is the embolization of a venous thrombus into the pulmonary arterial system. It has an acute onset and may result in severe heart failure and death. In-hospital mortality is 4% and 30-day mortality is 13%. New parameters are needed to predict the severity of the disease and mortality risk. For this reason, we aimed to demonstrate the role and clinical correlation of Qanadli score and Modified Shock Index in predicting disease severity, in-hospital mortality and early 7-day mortality in pulmonary embolism patients admitted to the emergency department. Material and methods: Using the ENLIL HIS system, 3401 patients aged 18 years and older who underwent PBTA in the emergency department of our hospital between March 1, 2019 and February 29, 2024 were identified. PE was detected in 574 of 3401 patients. Among the patients diagnosed with PE, 7 patients admitted due to trauma and 1 patient with missing data in the system were excluded from the study. The study was performed with 566 patients. The patients included in the study were retrospectively analyzed. PESI, sPESI, Shock Index, Modified Shock Index and Qanadli Score parameters were calculated. In addition, SI*1/SpO2 and MSI*1/SpO2 scores were calculated by adding the patient's 1/arterial oxyhemoglobin saturation percentage as a new multiplier to SI and MSI. Patient groups were categorized as severe/non-severe and mortal/non-mortal. PESI scoring was taken as a reference for the severe/non-severe group; PESI scores of 85 points and below were considered low risk, and scores of 86 points and above were considered high risk. Mortal/non-mortal groups were grouped as with/without in-hospital mortality and with/without 7-day mortality. Statistical analysis of the data was performed using IBM SPSS Version 25.0 (Armonk, NY: IBM Corp). The predictive value of PESI, sPESI, SI, SI*1/SpO2, MSI, MSI*1/SpO2 and QANADLI parameters for differentiating mortality (0-7 days/in-hospital) were evaluated by ROC analyses. The predictive value of SI, SI*1/SpO2, MSI, MSI*1/SpO2, MSI*1/SpO2 and QANADLI parameters that we investigated in differentiating severity were evaluated by ROC analyses. Statistical significance was accepted at p<0.05 and p<0.001 levels. Results: The mean age of the patients was 69.11 ± 15.77 years. 296 (52.3%) were female and 270 (47.7%) were male. 443 (78.3%) of the cases were high risk and 123 (21.7%) were low risk. 11.1% of cases were mortal within 0-7 days. In-hospital mortality rate was 22.1%. The mean PESI, sPESI, SI, SI*1/SpO2, MSI and MSI*1/SpO2 levels of the group who died within 0-7 days were statistically significantly higher than the group who did not die (p<0.001). The QANADLI score of the mortal group within 0-7 days was statistically significantly higher than the non-mortal group (p=0.005). As a result of ROC analysis, PESI (AUC 0.807; p<0.001), sPESI (AUC 0.723; p<0.001), SI (AUC 0.775; p<0.001), SI*1/SpO2 (AUC 0.784; p<0.001), MSI (AUC 0.772; p<0.001), MSI*1/SpO2 (AUC 0.784; p<0.001) and QANADLI (AUC 0.607; p 0.005) values were calculated. The mean PESI, sPESI, SI, SI*1/SpO2, MSI and MSI*1/SpO2 and QANADLI score levels of the group with in-hospital mortality were found to be statistically significantly higher than the group without mortality (p<0.001). As a result of ROC analysis, PESI (AUC 0.802; p<0.001), sPESI (AUC 0.762; p<0.001), SI (AUC 0.765; p<0.001), SI*1/SpO2 (AUC 0.796; p<0.001), MSI (AUC 0.767; p<0.001), MSI*1/SpO2 (AUC 0.800; p<0.001) and QANADLI (AUC 0.655; p<0.001) values were calculated. The mean sPESI, SI, SI*1/SpO2, MSI and MSI*1/SpO2 levels of the PESI high-risk group were statistically significantly higher than those of the PESI low-risk group (p<0.001). SI (AUC 0.632; p<0.001), SI*1/SpO2 (AUC 0.708; p<0.001), MSI (AUC 0.647; p<0.001), MSI*1/SpO2 (AUC 0.725; p<0.001) and QANADLI (AUC 0.727; p<0.001) values were calculated as a result of ROC analysis to distinguish PESI risk categories. Conclusion: Clinical presentation and vital signs are important in assessing the severity and mortality of patients diagnosed with PE. The MSI*1/SpO2 score, which can be easily calculated on vital signs for the rapid management of PE patients in the emergency department, is valuable in predicting the pathophysiologic effect and clinical severity of the embolus in that patient. MSI*1/SpO2 score is valuable in predicting severity and mortality in patients diagnosed with PE. The Qanadli score is valuable in predicting severity, but the MSI*1/SpO2 score is more powerful than the Qanadli score in predicting mortality.
Introduction: Pulmonary embolism is the embolization of a venous thrombus into the pulmonary arterial system. It has an acute onset and may result in severe heart failure and death. In-hospital mortality is 4% and 30-day mortality is 13%. New parameters are needed to predict the severity of the disease and mortality risk. For this reason, we aimed to demonstrate the role and clinical correlation of Qanadli score and Modified Shock Index in predicting disease severity, in-hospital mortality and early 7-day mortality in pulmonary embolism patients admitted to the emergency department. Material and methods: Using the ENLIL HIS system, 3401 patients aged 18 years and older who underwent PBTA in the emergency department of our hospital between March 1, 2019 and February 29, 2024 were identified. PE was detected in 574 of 3401 patients. Among the patients diagnosed with PE, 7 patients admitted due to trauma and 1 patient with missing data in the system were excluded from the study. The study was performed with 566 patients. The patients included in the study were retrospectively analyzed. PESI, sPESI, Shock Index, Modified Shock Index and Qanadli Score parameters were calculated. In addition, SI*1/SpO2 and MSI*1/SpO2 scores were calculated by adding the patient's 1/arterial oxyhemoglobin saturation percentage as a new multiplier to SI and MSI. Patient groups were categorized as severe/non-severe and mortal/non-mortal. PESI scoring was taken as a reference for the severe/non-severe group; PESI scores of 85 points and below were considered low risk, and scores of 86 points and above were considered high risk. Mortal/non-mortal groups were grouped as with/without in-hospital mortality and with/without 7-day mortality. Statistical analysis of the data was performed using IBM SPSS Version 25.0 (Armonk, NY: IBM Corp). The predictive value of PESI, sPESI, SI, SI*1/SpO2, MSI, MSI*1/SpO2 and QANADLI parameters for differentiating mortality (0-7 days/in-hospital) were evaluated by ROC analyses. The predictive value of SI, SI*1/SpO2, MSI, MSI*1/SpO2, MSI*1/SpO2 and QANADLI parameters that we investigated in differentiating severity were evaluated by ROC analyses. Statistical significance was accepted at p<0.05 and p<0.001 levels. Results: The mean age of the patients was 69.11 ± 15.77 years. 296 (52.3%) were female and 270 (47.7%) were male. 443 (78.3%) of the cases were high risk and 123 (21.7%) were low risk. 11.1% of cases were mortal within 0-7 days. In-hospital mortality rate was 22.1%. The mean PESI, sPESI, SI, SI*1/SpO2, MSI and MSI*1/SpO2 levels of the group who died within 0-7 days were statistically significantly higher than the group who did not die (p<0.001). The QANADLI score of the mortal group within 0-7 days was statistically significantly higher than the non-mortal group (p=0.005). As a result of ROC analysis, PESI (AUC 0.807; p<0.001), sPESI (AUC 0.723; p<0.001), SI (AUC 0.775; p<0.001), SI*1/SpO2 (AUC 0.784; p<0.001), MSI (AUC 0.772; p<0.001), MSI*1/SpO2 (AUC 0.784; p<0.001) and QANADLI (AUC 0.607; p 0.005) values were calculated. The mean PESI, sPESI, SI, SI*1/SpO2, MSI and MSI*1/SpO2 and QANADLI score levels of the group with in-hospital mortality were found to be statistically significantly higher than the group without mortality (p<0.001). As a result of ROC analysis, PESI (AUC 0.802; p<0.001), sPESI (AUC 0.762; p<0.001), SI (AUC 0.765; p<0.001), SI*1/SpO2 (AUC 0.796; p<0.001), MSI (AUC 0.767; p<0.001), MSI*1/SpO2 (AUC 0.800; p<0.001) and QANADLI (AUC 0.655; p<0.001) values were calculated. The mean sPESI, SI, SI*1/SpO2, MSI and MSI*1/SpO2 levels of the PESI high-risk group were statistically significantly higher than those of the PESI low-risk group (p<0.001). SI (AUC 0.632; p<0.001), SI*1/SpO2 (AUC 0.708; p<0.001), MSI (AUC 0.647; p<0.001), MSI*1/SpO2 (AUC 0.725; p<0.001) and QANADLI (AUC 0.727; p<0.001) values were calculated as a result of ROC analysis to distinguish PESI risk categories. Conclusion: Clinical presentation and vital signs are important in assessing the severity and mortality of patients diagnosed with PE. The MSI*1/SpO2 score, which can be easily calculated on vital signs for the rapid management of PE patients in the emergency department, is valuable in predicting the pathophysiologic effect and clinical severity of the embolus in that patient. MSI*1/SpO2 score is valuable in predicting severity and mortality in patients diagnosed with PE. The Qanadli score is valuable in predicting severity, but the MSI*1/SpO2 score is more powerful than the Qanadli score in predicting mortality.
Açıklama
Anahtar Kelimeler
Pulmoner Emboli, Pulmonary Embolism, Pulmoner Emboli Şiddet İndeksi, Pulmonary Embolism Severity Index, Simplified Pulmonary Embolism Severity Index, Basitleştirilmiş Pulmoner Emboli Şiddet İndeksi, Şok İndeksi, Qanadli Score, Modifiye Şok İndeksi, Modified Shock Index, Qanadli Skoru, Shock Index
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Karaçadır, O. (2024). Pulmoner emboli şiddeti ve mortalitesini öngörmede qanadli skoru ve modifiye şok indeksinin rolü. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
