Does the Serum Immuno-Inflammation Index, Guide the Treatment of Medium and High Risk Pulmonary Thromboembolism Patients?

Abstract

Objective: Pulmonary thromboembolism(PTE) is an emergency condition with high mortality, although it has effective treatment. Most deaths occur in the first hour. Therefore, early diagnosis is lifesaving. Serum immune- inflammation index (SII) is a parameter derived from neutrophils, lymphocytes and platelets. It has been reported to be an important biomarker determining mortality in ischemic diseases. In this article, we aimed to evaluate the role of easily accessible and rapid SII in predicting thrombolytic therapy. Material and Methods: This study was conducted retrospectively in the single-center Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital Emergency Service, in patients diagnosed with medium and high risk PTE between 01.10.2020 and 01.08.2022. The patients vitals at the time of admission and routine blood tests were evaluated. Risk groups were determined with imaging and echocardiography findings. Treatment and outcomes for PTE were recorded. Results: 204 patients were included in the study. 63.7% of the patients were women. The average age of the patients was 71.7 years. 33 (16.1%) of the patients died within 30 days of follow- up. 28.9% of the patients were included in the high risk group. 30% were in the medium-high risk group and 41.1% were in the medium-low risk group. 49 (24%) patients included in the study required thrombolytic therapy. The cut-off value for SII was determined as 2187, with 34.7% sensitivity and 96.1% specificity. SII was found to be predictive of the need for thrombolytic therapy (AUC: 0.615, 95% CI 0.513-0.717, p<0.001). Conclusion: The serum immune-inflammation index, which is a rapid and easily accessible biomarker, is a guide in determining patients in need of thrombolysis.

Keywords

• Pulmonary embolism
• reperfusion
• serum immune inflammation index

SERUM İMMÜN-İNFLAMASYON İNDEKSİ ORTA VE YÜKSEK RİSKLİ PULMONER TROMBOEMBOLİ HASTALARININ TEDAVİSİNDE YOL GÖSTERİCİ MİDİR?

Abstract

Amaç: Pulmoner tromboemboli (PTE), etkin tedavisi olmasına rağmen mortalitesi yüksek acil bir durumdur. Ölümlerin çoğu ilk bir saatte görülmektedir. Bu nedenle erken tanı hayat kurtarıcıdır. Serum immun-inflamasyon indeksi (Sİİ), nötrofil, lenfosit ve trombositten türetilen bir parametredir. İskemik hastalıklarda mortaliteyi belirleyen önemli bir biyobelirteç olduğu bildirilmiştir. Bu makalede kolay ulaşılabilir ve hızlı sonuçlanan Sİİ’nin trombolitik tedaviyi ön görmedeki rolünün değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu çalışma, tek merkezli Sağlık Bilimler Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Acil Servisi’nde, 01.10.2020 ve 01.08.2022 tarihleri arasında orta ve yüksek riskli PTE tanısı alan hastalarda retrospektif olarak gerçekleştirildi. Hastaların başvuru anındaki vital bulguları, rutin bakılan kan tetkikleri değerlendirildi. Görüntüleme ve ekokardiyografi bulguları ile birlikte risk grupları belirlendi. PTE için uygulanan tedavi ve sonlanım durumları kaydedildi. Bulgular: Çalışmaya 204 hasta dahil edildi. Hastaların %63.7’si kadındı. Hastaların ortalama yaşı 71,7 idi. Hastaların 33’ü (%16.1) takipleri sırasındaki 30 gün içerisinde vefat etti. Hastaların %28.9’u yüksek risk grubuna dahil edildi. %30’u orta yüksek ve %41.1’i orta düşük riskli gruptaydı. Çalışmaya dahil edilen 49 (%24) hastanın trombolitik tedaviye ihtiyacı oldu. Sİİ için %34.7 sensitivite ve %96.1 spesifisite ile sınır değer 2187 olarak belirlendi. Sİİ’nin trombolitik tedavi ihtiyacında belirleyici olduğu saptandı (AUC: 0.615, %95 CI 0.513-0.717, p<0.001). Sonuç: Hızlı sonuçlanan ve kolay ulaşılabilir bir biyobelirteç olan serum immun-inflamasyon indeksi trombolitik ihtiyacı olan hastaların belirlenmesinde yol göstericidir.

Keywords

• Pulmoner emboli
• reperfüzyon
• serum immun-inflamasyon indeksi

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