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İzole KOAH Hastalarının Alevlenme Anında Pulmoner Tromboemboli İlişkisi Ve Labaratuvar Parametrelerinin (D-Dimer-Fibrinojen) Anlamlılığı

Year 2020, Volume: 10 Issue: 2, 237 - 242, 25.06.2020
https://doi.org/10.16899/jcm.687541

Abstract

Amaç: Dispne birçok hastalığın semptomu olabilir. Pulmoner tromboemboli (PTE) bu durumların en önemlilerinden birisidir. Kronik Obstruktiv Akciğer Hastalığı (KOAH) ve PTE birlikte bulunabilmekte ve semptomları birbirini maskeleyebilmektedir. KOAH alevlenme tanılı hastaların d-dimer seviyesi arasındaki ilişkinin tanımlanması ve bağlantı durumunda cut-off değeri belirlemektir. Klinisyenlere hasta yönetiminde yol gösterici olunabilmesi hedeflenmiştir.
Gereç ve Yöntem: Bu çalışma prospektif olarak yapılmıştır. 18 yaşından büyük, Diyabetes mellitus (DM), Konjestif Kalp Yetmezliği (KKY), malignite gibi ek hastalığı bulunmayan, gebeliği olmayan, Glasgow Koma Skalası (GKS) > 10 olan KOAH alevlenme ile acil servise başvuran 49 kişilik hasta grubu ve herhangi bir hastalığı olmayıp ve dispne ile acil servise başvuran 52 kişilik kontrol grubu ile oluşturuldu.
Bulgular: KOAH hastalarının %65'i erkekti. En sık eşlik eden ek hastalık; 7 kişide (%14,2) saptanan hipertansiyon oldu (p< .05). Fibrinojen ve d-dimer hasta grubunda daha yüksek bulunmuştur (p< .05). KOAH hastalarında d-dimer cut-off değeri 0,97 μg/ml olarak saptanmıştır (p< .05). KOAH atak ile başvuran 3 kişide (%6) pulmoner tromboemboli saptanmıştır (p< .05). KOAH alevlenmesi sırasında C-reaktif protein (CRP), D-dimer, fibrinojen gibi inflamatuar belirteçler artmaktadır.
Sonuç: KOAH alevlenmesi olan hastalarda PTE insidansı önemli ölçüde artmıştır. Acil servise dispne ile başvuran hastalarda PTE mutlaka ayırıcı tanıya dahil edilmeli ve ekartasyon için gerekli işlemler yapılmalıdır.

References

  • Referans 1- Paczek L, Nowak M. The paradox of the 21 st century is the really an epidemic of most common killers ?Int J Gen Med 2011 ;4:799-802
  • Referans 2 - S.A. Quaderi, J.R. Hurst. The unmet global burden of COPD. Global Health, Epidemiology and Genomics (2018), 3, e4, page 1 of 3. doi:10.1017/gheg.2018.1
  • Referans 3- GOLD 2017, Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease
  • Referans 4- Projections of mortality and causes of death, 2016 to 2060. Health statistics and information systems. WHO; Global Health Estimates (GHE) 2016: Deaths by age, sex and cause
  • Referans 5- Blomback B, Hessel B, Hogg D, Therkildsen L. A two-step fibrinogen–fibrin transition in blood coagulation. Nature. 1978; 275:501-505
  • Referans 6- Saka Karagöz İ, Serdar Z. D-dimer ve Tanısal Önemi, Uludağ Üniversitesi Tıp Fakültesi Dergisi 39 (3) 197-203, 2013
  • Referans 7- Akpınar E E, Hoşgün D, Akpınar S, Ataç G K, Doğanay B, Gülhan M. Incidence of pulmonary embolism during COPD exacerbation. J Bras Pneumol. 2014; 40(1): 38-45
  • Referans 8- Noyan T. Klinik Tanı ve Laboratuvar Pratiğinde D-dimer Testi. Türk Klinik Biyokimya Dergisi 2012; 10(1): 35-40
  • Referans 9- Buist AS, McBurnie MA, Vollmer WM et al. BOLD Collaborative Research Group. International variation in the prevalence of COPD (The BOLD Study): A population-based prevalence study. Lancet 2007;370:741-50
  • Referans 10- Kocabas A. Kronik Obstruktif Akciğer Hastalığı Epidemiyolojisi ve Risk Faktörleri. TTD Türk Toraks Cerrahisi Bülteni Cilt :1 Sayı :2 Mayıs 2010 ; 105-113
  • Referans 11- Choi S H, Rhee C K, Park Y B, Yoo K H, Lim SY. Metabolic Syndrome in Early Chronic Obstructive Pulmonary Disease: Gender Differences and Impact on Exacerbation and Medical Costs. International Journal of Chronic Obstructive Pulmonary Disease 2019:14 2873–2883
  • Referans 12- Y Imaizumi, K Eguchi, K Kario. Lung Disease and Hypertension. Pulse 2014; 2: 103–112. DOI: 10.1159/000381684
  • Referans 13- Fidan A, Tokmak M, Kıral N et al. Bir Sistemik Hastalık Olarak KOAH ile Anemi Birlikteliği. Solunum 2012; 14(1):18–26
  • Referans 14- Karakurt Z, Altınöz H, Yarkın T. Akut Solunum Yetmezliği Bulunan KOAH Olgularında Noninvaziv Pozitif Basınçlı Ventilasyon. Yoğun Bakım Dergisi 2004;4(1):50-56
  • Referans 15- Tudorache E, Oancea C, Avram C, Fira-Mladinescu O, Petrescu L, Timar B. Balance impairment and systemic inflammation in chronic obstructive pulmonary disease. International Journal of COPD 2015:10
  • Referans 16- Kronik obstrüktif akciğer hastalığı (KOAH) koruma, tanı ve tedavi raporu; Türk Toraks Dergisi 2014; 15 (suppl 2)
  • Referans 17- Thomsen M, Ingebrigtsen TS, Marott JL et al. Inflammatory biomarkers and exacerbations in chronic obstructive pulmonary disease. JAMA. 2013;309(22):2353-2361
  • Referans 18- Ozatli D. D-dimer Laboratuvardan Güncel Pratiğe. 35. Ulusal Hematoloji Kongresi ; 48-50.). (1-4)
  • Referans 19- Ford ES, Cunningham TJ, Mannino DM. Inflammatory markers and mortality among US adults with obstructive lung function. Respirology 2015;20(4): 587– 593
  • Referans 20- Arslantaş N, Uğurman F, Üçoluk G Ö, Samurkaşoğlu B. KOAH'lı hastalarda plazma Fibrinojen ve D-dimer Düzeyleri. Solunum Hastalıkları 2000; 11: 35-40
  • Referans 21- Wang S, Chen Y, Ren W et al. Effect of Qi Benefiting Blood Activating Method on Plasma Fibrinogen and D-dimer in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2015 May;35(5):537-40
  • Referans 22- Shapira-Rootman M, Beckerman M, Soimu U, Nachtigal A, Zeina AR. The Prevalence of Pulmonary Embolism Among Patients Suffering from Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Emergency Radiology 2015: 22(3); 257-260

Relation of pulmonary thromboembolism and significance of laboratory parameters (d-dimer-fibrinogen) of patients with isolated COPD during exacerbation

Year 2020, Volume: 10 Issue: 2, 237 - 242, 25.06.2020
https://doi.org/10.16899/jcm.687541

Abstract

Aim: Dyspnea can be a symptom of many diseases. Pulmonary thromboembolism (PTE) is the most important one of these conditions. It can occur together with COPD and PTE, and their symptoms may mask each other. Identify the relationship between d-dimer levels of patients diagnosed with COPD exacerbation; is to determine the cut-off value in case of connection. It is aimed to guide clinicians in their patient management according to the results.

Materials and Methods: This study was conducted prospectively. Patient group was 49 patients presenting to the emergency department with exacerbation of COPD who have no comorbid disease such as malignancy, Diabetes Mellitus (DM), Chronic Hearth Failure (CHF); were over than 18 years old, non-pregnant; and with Glasgow Coma Scale (GCS) > 10 points and the control group consisted of 52 patients who presented to the emergency department with dyspnea who haven't got any diseases.

Results: 65% of COPD patients are male. The most common comorbid disease was Hypertension (p <.05) in 7 patients (14,2%). Fibrinogen and d-dimer were higher in the patient group (p <.05). The D-dimer cut-off value in patients with COPD was 0.97 μg / ml (p<.05). Pulmonary thromboembolism was detected in 3 COPD attack patients (6%) (p <.05). During COPD exacerbation inflammatory markers such as C-reactive protein (CRP), D-dimer, fibrinogen increases.


Conclusions: The incidence of PTE was significantly increased in patients with COPD exacerbation. PTE should be absolutely included in the differential diagnosis in patients presenting to the emergency department with dyspnea and necessary examinations should be performed for the retraction.

References

  • Referans 1- Paczek L, Nowak M. The paradox of the 21 st century is the really an epidemic of most common killers ?Int J Gen Med 2011 ;4:799-802
  • Referans 2 - S.A. Quaderi, J.R. Hurst. The unmet global burden of COPD. Global Health, Epidemiology and Genomics (2018), 3, e4, page 1 of 3. doi:10.1017/gheg.2018.1
  • Referans 3- GOLD 2017, Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease
  • Referans 4- Projections of mortality and causes of death, 2016 to 2060. Health statistics and information systems. WHO; Global Health Estimates (GHE) 2016: Deaths by age, sex and cause
  • Referans 5- Blomback B, Hessel B, Hogg D, Therkildsen L. A two-step fibrinogen–fibrin transition in blood coagulation. Nature. 1978; 275:501-505
  • Referans 6- Saka Karagöz İ, Serdar Z. D-dimer ve Tanısal Önemi, Uludağ Üniversitesi Tıp Fakültesi Dergisi 39 (3) 197-203, 2013
  • Referans 7- Akpınar E E, Hoşgün D, Akpınar S, Ataç G K, Doğanay B, Gülhan M. Incidence of pulmonary embolism during COPD exacerbation. J Bras Pneumol. 2014; 40(1): 38-45
  • Referans 8- Noyan T. Klinik Tanı ve Laboratuvar Pratiğinde D-dimer Testi. Türk Klinik Biyokimya Dergisi 2012; 10(1): 35-40
  • Referans 9- Buist AS, McBurnie MA, Vollmer WM et al. BOLD Collaborative Research Group. International variation in the prevalence of COPD (The BOLD Study): A population-based prevalence study. Lancet 2007;370:741-50
  • Referans 10- Kocabas A. Kronik Obstruktif Akciğer Hastalığı Epidemiyolojisi ve Risk Faktörleri. TTD Türk Toraks Cerrahisi Bülteni Cilt :1 Sayı :2 Mayıs 2010 ; 105-113
  • Referans 11- Choi S H, Rhee C K, Park Y B, Yoo K H, Lim SY. Metabolic Syndrome in Early Chronic Obstructive Pulmonary Disease: Gender Differences and Impact on Exacerbation and Medical Costs. International Journal of Chronic Obstructive Pulmonary Disease 2019:14 2873–2883
  • Referans 12- Y Imaizumi, K Eguchi, K Kario. Lung Disease and Hypertension. Pulse 2014; 2: 103–112. DOI: 10.1159/000381684
  • Referans 13- Fidan A, Tokmak M, Kıral N et al. Bir Sistemik Hastalık Olarak KOAH ile Anemi Birlikteliği. Solunum 2012; 14(1):18–26
  • Referans 14- Karakurt Z, Altınöz H, Yarkın T. Akut Solunum Yetmezliği Bulunan KOAH Olgularında Noninvaziv Pozitif Basınçlı Ventilasyon. Yoğun Bakım Dergisi 2004;4(1):50-56
  • Referans 15- Tudorache E, Oancea C, Avram C, Fira-Mladinescu O, Petrescu L, Timar B. Balance impairment and systemic inflammation in chronic obstructive pulmonary disease. International Journal of COPD 2015:10
  • Referans 16- Kronik obstrüktif akciğer hastalığı (KOAH) koruma, tanı ve tedavi raporu; Türk Toraks Dergisi 2014; 15 (suppl 2)
  • Referans 17- Thomsen M, Ingebrigtsen TS, Marott JL et al. Inflammatory biomarkers and exacerbations in chronic obstructive pulmonary disease. JAMA. 2013;309(22):2353-2361
  • Referans 18- Ozatli D. D-dimer Laboratuvardan Güncel Pratiğe. 35. Ulusal Hematoloji Kongresi ; 48-50.). (1-4)
  • Referans 19- Ford ES, Cunningham TJ, Mannino DM. Inflammatory markers and mortality among US adults with obstructive lung function. Respirology 2015;20(4): 587– 593
  • Referans 20- Arslantaş N, Uğurman F, Üçoluk G Ö, Samurkaşoğlu B. KOAH'lı hastalarda plazma Fibrinojen ve D-dimer Düzeyleri. Solunum Hastalıkları 2000; 11: 35-40
  • Referans 21- Wang S, Chen Y, Ren W et al. Effect of Qi Benefiting Blood Activating Method on Plasma Fibrinogen and D-dimer in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2015 May;35(5):537-40
  • Referans 22- Shapira-Rootman M, Beckerman M, Soimu U, Nachtigal A, Zeina AR. The Prevalence of Pulmonary Embolism Among Patients Suffering from Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Emergency Radiology 2015: 22(3); 257-260
There are 22 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Tufan Alatlı 0000-0002-7858-8081

Murat Ayan 0000-0001-5670-5745

Publication Date June 25, 2020
Acceptance Date May 13, 2020
Published in Issue Year 2020 Volume: 10 Issue: 2

Cite

AMA Alatlı T, Ayan M. Relation of pulmonary thromboembolism and significance of laboratory parameters (d-dimer-fibrinogen) of patients with isolated COPD during exacerbation. J Contemp Med. June 2020;10(2):237-242. doi:10.16899/jcm.687541