Perikardiyosentez Uygulanan Hastalarda Beslenme ve İnflamatuvar Durumun Mortalite Üzerindeki Birleşik Rolü: HALP Skoru

Öz

Kardiyak tamponadın temel tedavi seçeneği perkütan perikardiyosentezdir. Perikardiyosentez sonrası mortaliteyi öngören faktörler değişkenlik göstermektedir. Perikardiyal efüzyonun (PE) temelinde inflamatuvar süreç yer almaktadır. Devam eden inflamasyon, PE'li hastalarda kısa ve uzun dönem mortaliteyi etkileyebilir. HALP skoru (hemoglobin, albümin, lenfosit ve trombosit), inflamatuvar belirteçler ile beslenme durumunu birlikte değerlendiren bir skordur ve çeşitli hasta gruplarında mortaliteyi öngörmede yararlı olduğu gösterilmiştir. Bu çalışmanın amacı, kardiyak tamponad nedeniyle perikardiyosentez uygulanan hastalarda HALP skorunun uzun dönem klinik sonuçlar üzerindeki prognostik önemini değerlendirmektir. Çalışmaya, kardiyak tamponad nedeniyle acil perikardiyosentez uygulanan hastalar ile kronik perikardiyal efüzyon nedeniyle perikardiyosentez yapılan hastalar dahil edildi. Birincil sonlanım noktası uzun dönem mortaliteydi. Hastalar sağ kalanlar ve mortalite gelişenler olmak üzere iki gruba ayrıldı. Gruplar; klinik özellikler, laboratuvar bulguları ve girişimsel işlem özellikleri açısından karşılaştırıldı. Toplam 227 hasta çalışmaya dahil edildi. Yaş, cinsiyet, kronik obstrüktif akciğer hastalığı (KOAH), sol ventrikül ejeksiyon fraksiyonu (LVEF), malignite, hemodinamik instabilite, serum laktat düzeyi ve HALP skoru mortalitenin öngördürücüleri olarak saptandı. Karıştırıcı faktörler için düzeltme yapıldıktan sonra; LVEF [HR: 0,965, %95 GA: 0,939–0,991, p=0,01], hemodinamik instabilite [HR: 2,212, %95 GA: 1,279–3,827, p<0,001], malignite [HR: 3,374, %95 GA: 1,898–5,999, p=0,005] ve HALP skoru [HR: 0,129, %95 GA: 0,019–0,902, p=0,039] çok değişkenli regresyon analizinde mortalitenin bağımsız risk faktörleri olarak bulundu.HALP skoru, hastaların beslenme durumu ile inflamatuvar durumunu birlikte yansıtan bir göstergedir. Düşük HALP skorunun, uzun dönem mortalite riskinde artış ile bağımsız olarak ilişkili olduğu gösterilmiştir.

Anahtar Kelimeler

• perikardiyosentez
• mortalite
• HALP Skoru

The Combined Role of Nutritional and Inflammatory Status on Mortality in Patients underwent Pericardiocentesis: HALP Score

Öz

The main therapeutical option of cardiac tamponade based on percutaneous pericardiocentesis. The predictors of mortality following pericardiocentesis vary. Inflammatory process is the main background of pericardial effusion(PE). Ongoing inflammation may affect short term and long term mortality in patients with PE. HALP score (haemoglobin, albumin lymphocyte and platelet ) involves inflammatory markers and nutritional status and found to be beneficial to predict mortality in various patients. This study aimed to evaluate the prognostic significance of the HALP score for long-term clinical outcomes in patients undergoing pericardiocentesis for cardiac tamponade. The study involved the patients who underwent urgent pericardiocentesis due to cardiac tamponade and the patients who underwent pericadiocentesis due to chronic PE. Primary endpoint is long term mortality. The patients were divided into two groups: survivors group and mortality group. Each group was compared in terms of clinical features, laboratory values and procedural aspects. Results: 227 patients were enrolled into this study. Age, gender, chronic obstructive pulmonary disease, LVEF, malignancy, haemodynamic instability, serum lactate levels and HALP score have been represented as predictors of mortality. After adjusting confounding factors; LVEF [HR: 0.965, 95% CI: 0.939-0.991, p: 0.01],haemodynamic instability[HR: 2.212, 95% CI: 1.279-3.827, p<0.001], malignancy[HR: 3.374, 95% CI: 1.898-5.999, p: 0.005] and HALP [HR: 0.129, 95% CI: 0.019-0.902, p: 0.039] score have been found as independent risk factors of mortality in multivariate regression analysis. The HALP score reflects the combined nutritional and inflammatory status, and a lower HALP score was independently associated with an increased risk of long-term mortality.

Anahtar Kelimeler

• pericardiocentesis
• mortality
• HALP Score

Kaynakça

1. 1. Wybraniec MT, Kampka Z, Drabczyk M, Zielonka M, Urbaniec P, Wypych G, et al. Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis. Front Cardiovasc Med. 2023;10.
2. 2. Aruğaslan E, Zengin A, Karatas MB, Akyüz S. Prognostic Significance of Controlling Nutritional Status Score (CONUT) in Patients Undergoing Pericardiocentesis. Acta Cardiol Sin. 2022 Jan 1;38(1):84–90.
3. 3. Shih CT, Lee WC, Fang HY, Wu PJ, Fang YN, Chong SZ. Outcomes of Patients with and without Malignancy Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion. J Cardiovasc Dev Dis. 2021 Nov 6;8(11).
4. 4. Levy PY, Habib G, Collart F, Lepidi H, Raoult D. Etiological diagnosis of pericardial effusion. Future Microbiol. 2006 Aug;1(2):229–39.
5. 5. Badwan O, Berglund F, Rosenzveig A, Persits I, Gharaibeh A, Kumar A, et al. Pericardial Disease in Cardiac Amyloidosis: A Comprehensive Review. Am J Cardiol. 2024 May 11;223:100–8.
6. 6. Wilkes JD, Fidias P, Vaickus L, Perez RP. Malignancy-related pericardial effusion. 127 cases from the Roswell Park Cancer Institute. Cancer. 1995 Oct 15;76(8):1377–87.
7. 7. Assayag M, Abbas R, Chanson N, Perozziello A, Ducrocq G, Alexandra JF, et al. Diagnosis of systemic inflammatory diseases among patients admitted for acute pericarditis with pericardial effusion. J Cardiovasc Med (Hagerstown). 2017 Nov;18(11):875–80.
8. 8. Koyun E, Dindas F, Sahin A, Cerik IB, Dogdus M. Screening Tests Predicting Cancer Metastasis in the Etiology of Pericardial Effusion: HALP Score and PNI. Arq Bras Cardiol. 2024;121(1):e20230376.

9. 9. Kollu K, Akbudak Yerdelen E, Duran S, Kabatas B, Karakas F, Kizilarslanoglu MC. Comparison of nutritional risk indices (PNI, GNRI, mNUTRIC) and HALP score in predicting adverse clinical outcomes in older patients staying in an intensive care unit. Medicine. 2024 Jun 21;103(25):e38672.
10. 10. Karakayali M, Omar T, Artac I, Ilis D, Arslan A, Altunova M, et al. The prognostic value of HALP score in predicting in-hospital mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis. 2023 Nov 1;34(7):483–8.
11. 11. Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015 Nov 7;36(42):2921–64.
12. 12. Catherine Otto. Practice of Clinical Echocardiography. Elsevier; 2017.
13. 13. Maggiolini S, De Carlini CC, Imazio M. Evolution of the pericardiocentesis technique. J Cardiovasc Med (Hagerstown). 2018 Jun;19(6):267–73.
14. 14. Light RW, Macgregor MI, Luchsinger PC, Ball WC. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972 Oct;77(4):507–13.
15. 15. Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015 Dec 1;6(38):41370–82.
16. 16. Holmes DR, Nishimura R, Fountain R, Turi ZG. Iatrogenic pericardial effusion and tamponade in the percutaneous intracardiac intervention era. JACC Cardiovasc Interv. 2009 Aug;2(8):705–17.
17. 17. Pennacchioni A, Nanni G, Sgura FA, Imberti JF, Monopoli DE, Rossi R, et al. Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes. Intern Emerg Med. 2021 Oct 1;16(7):1771–7.
18. 18. Gad MM, Elgendy IY, Mahmoud AN, Elbadawi A, Tanavin T, Denktas A, et al. Temporal trends, outcomes, and predictors of mortality after pericardiocentesis in the United States. Catheter Cardiovasc Interv. 2020 Feb 15;95(3):375–86.
19. 19. Njoku K, Barr CE, Ramchander NC, Crosbie EJ. Impact of pre-treatment prognostic nutritional index and the haemoglobin, albumin, lymphocyte and platelet (HALP) score on endometrial cancer survival: A prospective database analysis. PLoS One. 2022;17(8):e0272232.
20. 20. Solmaz S, Uzun O, Sevindik OG, Demirkan F, Ozcan MA, Ozsan GH, et al. The effect of haemoglobin, albumin, lymphocyte and platelet score on the prognosis in patients with multiple myeloma. Int J Lab Hematol. 2023 Feb;45(1):13–9.
21. 21. Zhu Y, Xian X, Wang Z, Bi Y, Chen Q, Han X, et al. Research Progress on the Relationship between Atherosclerosis and Inflammation. Biomolecules. 2018 Aug 23;8(3):80.
22. 22. Özderya A, Şahin S, Koşmaz T, Maz MA, Yerlikaya MG, Akyüz AR, et al. Can HALP score predict post-contrast acute kidney injury and 6-year mortality in patients undergoing endovascular abdominal aneurysm repair? Vascular. 2024 Apr 12;17085381241246904.
23. 23. Zheng Y, Huang Y, Li H. Hemoglobin albumin lymphocyte and platelet score and all-cause mortality in coronary heart disease: a retrospective cohort study of NHANES database. Front Cardiovasc Med. 2023;10:1241217.