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

Year 2024, Volume: 26 Issue: 2, 169 - 174, 20.08.2024

Maşide Arı , Eren Usul , Emrah Arı , Ayşenur Özkaya İbiş , Uğur Kahveci , Fatma Yıldırım

https://doi.org/10.24938/kutfd.1434903

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

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

References

• Keller K, Hobohm L, Ebner M, et al. Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany. Eur Heart J. 2020;41(4):522-529.
• Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603.
• Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172(8):1041-1046.
• Pollack CV, Schreiber D, Goldhaber SZ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: Initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol. 2011;8;57(6):700-706.
• Co I, Eilbert W, Chiganos T. New electrocardiographic changes in patients diagnosed with pulmonary embolism. J Emerg Med. 2017;52(3):280-285.
• Geibel A, Zehender M, Kasper W, Olschewski M, Klima C, Konstantinides SV. Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. Eur Respir J. 2005;25(5):843-848.
• Slajus B, Brailovsky Y, Darwish I, Fareed J, Darki A. Utility of blood cellular indices in the risk stratification of patients presenting with acute pulmonary embolism. Clin. Appl. Thromb. Hemost. 2021;27:1-8.
• Kundi H, Balun A, Cicekcioglu H, et al. The relation between platelet-to-lymphocyte ratio and pulmonary embolism severity index in acute pulmonary embolism. Heart Lung. 2015;44(4):340-343.
• Wang Q, Ma J, Jiang Z, Ming L. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: A systematic review and meta-analysis. Int Angiol. 2018;37(1):4-11.
• von Ungern-Sternberg SNI, Vogel S, Walker-Allgaier B, et al. Extracellular Cyclophilin A augments platelet- dependent thrombosis and thromboinflammation. Thromb Haemost. 2017;117(11):2063-2078.
• Kim KH, Barazia A, Cho J. Real-time imaging of heterotypic platelet-neutrophil interactions on the activated endothelium during vascular inflammation and thrombus formation in live mice. J Vis Exp. 2013;74:50329.
• Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune- inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol. 2017;23(34):6261-6272.
• Huang H, Liu Q, Zhu L, et al. Prognostic value of preoperative systemic immune-inflammation index in patients with cervical cancer. Sci Rep. 2019;9(1):3284.
• Kars A, Sahin A, Kılıc K, Sakat MS, Bilen A. Systemic immune inflammation index in differentiated thyroid cancers. Acta Otorhinolaryngol Ital. 2022;42(2):150-154.
• Bittoni A, Pecci F, Mentrasti G, et al. Systemic immune- inflammation index: A prognostic tiebreaker among all in advanced pancreatic cancer. Ann Transl Med. 2021;9(3):251.
• Kınar A, Ulu Ş, Bucak A, Kazan E. Can Systemic Immune- Inflammation Index (SII) be a prognostic factor of Bell's palsy patients? Neurol Sc. 2021;42(8):3197-3201.
• Xia Y, Xia C, Wu L, Li Z, Li H, Zhang J. Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and risk of all-cause mortality and cardiovascular mortality: A 20-year follow-up cohort study of 42,875 US adults. J Clin Med. 2023;12(3):1128.
• Cheng W, Bu X, Xu C, et al. Higher systemic immune- inflammation index and systemic inflammation response index levels are associated with stroke prevalence in the asthmatic population: A cross-sectional analysis of the NHANES 1999-2018. Front Immunol. 2023;14:1191130.
• Zhao Z, Zhang X, Sun T, et al. Prognostic value of systemic immune-inflammation index in CAD patients: Systematic review and meta-analyses. Eur J Clin Invest. 2024;54(2):e14100.
• Gok M, Kurtul A. A novel marker for predicting severity of acute pulmonary embolism: Systemic immune- inflammation index. Scand Cardiovasc J. 2021;55(2):91- 96.
• Iwadate K, Tanno K, Doi M, Takatori T, Ito Y. Two cases of right ventricular ischemic injury due to massive pulmonary embolism. Forensic Sci Int. 2001;116(2- 3):189-195.
• Venetz C, Labarère J, Jiménez D, Aujesky D. White blood cell count and mortality in patients with acute pulmonary embolism. Am J Hematol. 2013;88(8):677-681.
• Bovill EG, Bild DE, Heiss G, et al. White blood cell counts in persons aged 65 years or more from the Cardiovascular Health Study. Correlations with baseline clinical and demographic characteristics. Am J Epidemiol. 1996;143(11):1107-1115.
• Wang Q, Ma J, Jiang Z, Ming L. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: A systematic review and meta-analysis. Int Angiol. 2018;37(1):4-11.
• Balta S, Demirkol S, Kucuk U. The platelet lymphocyte ratio may be useful inflammatory indicator in clinical practice. Hemodial Int. 2013;17(4):668-669.
• Ma Y, Mao Y, He X, Sun Y, Huang S, Qiu J. The values of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting 30 day mortality in patients with acute pulmonary embolism. BMC Cardiovasc Disord. 2016;16:123.
• Kayrak M, Erdoğan HI, Solak Y, et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: A restrospective study. Heart Lung Circ. 2014;23(1):56-62.
• Kurtul A, Ornek E. Platelet to lymphocyte ratio in cardiovascular diseases: A systematic review. Angiology. 2019;70(9):802-818.
• Hu B, Yang XR, Xu Y. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-6222.
• Chen X, Ou Y, Wang Z, Liu H, Liu Y, Liu M. Association between systemic immune-inflammation index and risk of lower extremity deep venous thrombosis in hospitalized patients: A 10-year retrospective analysis. Front Cardiovasc Med. 2023;10:1211294.