Akut Lösemi Hastalarında Venöz Tromboemboli Sıklığı ve Risk Değerlendirmesi
Küçük Resim Yok
Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Hematolojik malignitelerde daha çok sitopenilere bağlı kanama ve enfeksiyon komplikasyonları üzerinde durulmuştur. Venöz tromboemboli (VTE) kanser hastalarında sık görülen bir komplikasyon olsa da akut lösemilerin VTE ile ilişkisi hakkında yeterli çalışma yoktur. Akut lösemili hastalarda VTE sıklığını ve VTE’ye neden olan risk faktörlerinin belirlenmesi amaçlanmıştır.
Yöntem: Çalışmaya 01.07.2018- 01.07.2023 tarihleri arasında, Necmettin Erbakan Üniversitesi Tıp Fakültesi, Erişkin Hematoloji Bilim Dalında, akut lösemi tanısı ile yatışı yapılan akut myeloid lösemi (AML) ve akut lenfoblastik lösemi (ALL) tanılı sırasıyla 82 ve 3 hasta olmak üzere toplam 85 hasta dahil edildi. Hastaların her bir yatışındaki tromboflebit, pulmoner tromboemboli ve derin ven trombozu varlığı ve hasta bilgileri Necmettin Erbakan Üniversitesi Tıp Fakültesi Hastanesi elektronik veri tabanından, hasta dosyalarından ve epikrizlerinden geriye dönük incelendi.
Bulgular: Çalışmaya 166 farklı yatışı olan AML ve ALL tanılı toplam 85 hasta dahil edildi. Bu hastalardan 22’sinde (%25,8), yatışların ise 24’ünde (%14,5) VTE mevcuttu. En sık tromboemboli çeşidi tromboflebit olup 19 (%86,3) hastada kaydedildi. VTE zamanı medyan 21 (4-63) gün bulundu. Yatış süresi, VTE (+) hastalarda medyan 50 gün, VTE (-) hastalarda ise 25,5 gün olarak bulundu ve bu fark istatistiki olarak anlamlıdır (p< 0,001). Obezite, VTE (+) hastaların %45,8'inde mevcutken, VTE (-) hastaların %22,5'inde bulundu (p= 0,023), bu fark istatistiki olarak anlamlıdır. Lökosit sayısı, VTE (+) hastalarda medyan 5,795 x 10³/μL, VTE (-) hastalarda ise 1,245 x 10³/μL olarak bulundu ve bu fark istatistiksel olarak anlamlıdır (p= 0,008). Nötrofil, lenfosit ve monosit sayıları VTE (+) ve (-) hastalar arasında bakıldığında VTE (-) lerde anlamlı olarak düşük bulundu sırasıyla; (p= 0,018, p= 0,018, p= 0,010). Ürik asit düzeyleri VTE (+) hastalarda medyan 3,15 mg/dL, VTE (-) hastalarda ise 4,8 mg/dL olarak ölçülmüş ve bu fark çok anlamlıdır (p< 0,001). Kalsiyum (Ca) ve fosfor (P) değerlerinde anlamlı farklar gözlendi. Ca, VTE (+) hastalarda 8,3242 ± 0,69295 mg/dL, VTE (-) hastalarda ise 8,7375 ± 0,66913 mg/dL olarak bulundu ve bu fark anlamlıdır (p= 0,006). P ise VTE (+) hastalarda 3,1017 ± 1,24854 mg/dL, VTE (-) hastalarda ise 3,7053 ± 0,91418 mg/dL olarak ölçüldü ve anlamlı bir fark gösterildi (p= 0,031). Total protein ve albumin değerleri arasında VTE (+) ve VTE (-) hastalarda ise anlamlı fark bulundu (sırasıyla; p= 0,026, p= 0,001). CRP ise VTE (+) ve VTE (-) hastalarda sırasıyla ise medyan 56 mg/L ve 20,565 mg/L bulundu, bu fark istatistiki olarak anlamlıdır (p= 0,005).
Sonuç: Çalışmamızda akut lösemilerdeki VTE sıklığı ve risk faktörleri değerlendirilmiş olup hastanede yatış süresi ve obezitenin VTE için risk faktörü oluşturduğu, lökosit, nötrofil, lenfosit ve monosit sayılarındaki düşüklüklerin VTE gelişimi için anlamlı olduğu bulundu. Ürik asit, Ca, P, total protein, albümin, CRP seviyelerinde VTE gelişen ve gelişmeyen gruplardaki seviye farklılıkları anlamlı bulunmuştur.
Objective: In hematologic malignancies, bleeding and infection complications due to cytopenias have been emphasized. Although venous thromboembolism (VTE) is a common complication in cancer patients, there are not enough studies on the relationship between acute leukemia and VTE. We aimed to determine the frequency of VTE and the risk factors causing VTE in patients with acute leukemia. Method: Between 01.07.2018-01.07.2023, a total of 85 patients, 82 and 3 patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), respectively, who were hospitalized with the diagnosis of acute leukemia in the Department of Adult Hematology, Necmettin Erbakan University Faculty of Medicine, were included in the study. The presence of thrombophlebitis, pulmonary thromboembolism and deep vein thrombosis during each hospitalization and patient information were retrospectively analyzed from Necmettin Erbakan University Faculty of Medicine Hospital electronic database, patient files and epicrises. Results: A total of 85 patients diagnosed with AML and ALL with 166 different hospitalizations were included in the study. VTE was present in 22 (25.8%) of these patients and 24 (14.5%) of the hospitalizations. The most common type of thromboembolism was thrombophlebitis, recorded in 19 (86.3%) patients. The median time to VTE was 21 (4-63) days. The median length of hospitalization was 50 days in VTE (+) patients and 25.5 days in VTE (-) patients, and this difference was statistically significant (p< 0.001). Obesity was present in 45.8% of VTE (+) patients and 22.5% of VTE (-) patients (p= 0.023), this difference was statistically significant. The median leukocyte count was 5,795 x 10³/μL in VTE (+) patients and 1,245 x 10³/μL in VTE (-) patients and this difference was statistically significant (p= 0,008). Neutrophil, lymphocyte and monocyte counts were significantly lower in VTE (+) and (-) patients (p= 0.018, p= 0.018, p= 0.010). Uric acid levels were measured as median 3.15 mg/dL in VTE (+) patients and 4.8 mg/dL in VTE (-) patients and this difference was very significant (p< 0.001). Significant differences were observed in calcium (Ca) and phosphorus (P) values. Ca was 8.3242 ± 0.69295 mg/dL in VTE (+) patients and 8.7375 ± 0.66913 mg/dL in VTE (-) patients and this difference was significant (p= 0.006). P was 3.1017 ± 1.24854 mg/dL in VTE (+) patients and 3.7053 ± 0.91418 mg/dL in VTE (-) patients, showing a significant difference (p= 0.031). There was a significant difference between total protein and albumin values in VTE (+) and VTE (-) patients (p= 0.026, p= 0.001, respectively). CRP was median 56 mg/L and 20.565 mg/L in VTE (+) and VTE (-) patients, respectively, and this difference was statistically significant (p= 0.005). Conclusion: In our study, the frequency and risk factors for VTE in acute leukemias were evaluated and it was found that length of hospitalization and obesity were risk factors for VTE and low leukocyte, neutrophil, lymphocyte and monocyte counts were significant for the development of VTE. The differences in the levels
Objective: In hematologic malignancies, bleeding and infection complications due to cytopenias have been emphasized. Although venous thromboembolism (VTE) is a common complication in cancer patients, there are not enough studies on the relationship between acute leukemia and VTE. We aimed to determine the frequency of VTE and the risk factors causing VTE in patients with acute leukemia. Method: Between 01.07.2018-01.07.2023, a total of 85 patients, 82 and 3 patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), respectively, who were hospitalized with the diagnosis of acute leukemia in the Department of Adult Hematology, Necmettin Erbakan University Faculty of Medicine, were included in the study. The presence of thrombophlebitis, pulmonary thromboembolism and deep vein thrombosis during each hospitalization and patient information were retrospectively analyzed from Necmettin Erbakan University Faculty of Medicine Hospital electronic database, patient files and epicrises. Results: A total of 85 patients diagnosed with AML and ALL with 166 different hospitalizations were included in the study. VTE was present in 22 (25.8%) of these patients and 24 (14.5%) of the hospitalizations. The most common type of thromboembolism was thrombophlebitis, recorded in 19 (86.3%) patients. The median time to VTE was 21 (4-63) days. The median length of hospitalization was 50 days in VTE (+) patients and 25.5 days in VTE (-) patients, and this difference was statistically significant (p< 0.001). Obesity was present in 45.8% of VTE (+) patients and 22.5% of VTE (-) patients (p= 0.023), this difference was statistically significant. The median leukocyte count was 5,795 x 10³/μL in VTE (+) patients and 1,245 x 10³/μL in VTE (-) patients and this difference was statistically significant (p= 0,008). Neutrophil, lymphocyte and monocyte counts were significantly lower in VTE (+) and (-) patients (p= 0.018, p= 0.018, p= 0.010). Uric acid levels were measured as median 3.15 mg/dL in VTE (+) patients and 4.8 mg/dL in VTE (-) patients and this difference was very significant (p< 0.001). Significant differences were observed in calcium (Ca) and phosphorus (P) values. Ca was 8.3242 ± 0.69295 mg/dL in VTE (+) patients and 8.7375 ± 0.66913 mg/dL in VTE (-) patients and this difference was significant (p= 0.006). P was 3.1017 ± 1.24854 mg/dL in VTE (+) patients and 3.7053 ± 0.91418 mg/dL in VTE (-) patients, showing a significant difference (p= 0.031). There was a significant difference between total protein and albumin values in VTE (+) and VTE (-) patients (p= 0.026, p= 0.001, respectively). CRP was median 56 mg/L and 20.565 mg/L in VTE (+) and VTE (-) patients, respectively, and this difference was statistically significant (p= 0.005). Conclusion: In our study, the frequency and risk factors for VTE in acute leukemias were evaluated and it was found that length of hospitalization and obesity were risk factors for VTE and low leukocyte, neutrophil, lymphocyte and monocyte counts were significant for the development of VTE. The differences in the levels
Açıklama
Anahtar Kelimeler
akut lösemi, acute leukemia, akut myeloblastik lösemi, acute myeloblastic leukemia, akut lenfoblastik lösemi, acute lymphoblastic leukemia, venöz tromboemboli, venous thromboembolism, tromboflebit, thrombophlebitis
Kaynak
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Scopus Q Değeri
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Künye
Mert, B. E. (2025). Akut Lösemi Hastalarında Venöz Tromboemboli Sıklığı ve Risk Değerlendirmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
