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The Clinical Importance of Hematological Parameters In Patients with Pulmonary Thromboembolism Diagnosed in The Emergency Department

Year 2021, Volume 3, Issue 3, 123 - 129, 01.11.2021
https://doi.org/10.38175/phnx.989396

Abstract

Objective: Acute pulmonary embolism (APE) is a highly fatal acute clinical condition. Herein, we aimed to determine the role of blood parameters in the diagnosis and prognostication of APE. Material and Method: This study was conducted retrospectively on patients who had been admitted to our hospital’s emergency department (ED) and diagnosed with APE. Patients with an RV/LV ratio greater than 0,9 on Computed tomography (CT) and hypotension were grouped as massive APE; patients with stable hemodynamics and an RV/LV ratio greater than 0,9 on CT were defined as submissive APE; and patients with stable hemodynamics and an RV/LV ratio smaller than 0,9 on CT were defined as non-massive APE. Results: This study enrolled a total of 200 patients, 82 of which were male (41%) and 118 were female (59%). APE group had a significantly greater D-dimer level than the control group (3.559,5±8.611.3 ng/ml vs 266.6±266.6 ng/ml) (p<0,001). Troponin I levels significantly greater in the patient group than control group (53.3±90 vs 332.9±32,9) (p= 0.013). Conclusion: Analysis of the hematological parameters between the APE subgroups showed that D-Dimer, leukocyte (WBC), neutrophil, lymphocyte, neutrophil to lymphocyte ratio (NLR), and troponin levels were significantly higher in the massive APE group than the sub-massive and non-massive APE groups.

References

  • Ates H, Ates I, Kundi H, Yilmaz FM. Diagnostic validity of hematologic parameters in evaluation of massive pulmonary embolism. J Clin Lab Anal. 2017;31(5): e22072.
  • Howard L. Acute pulmonary embolism. Clin Med (Lond). 2019;19(3):243-247.
  • Konstantinides S, Goldhaber SZ. Pulmonary embolism: Risk assessment and management. Eur Heart J. 2012;33:3014–3022.
  • Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(43):3033–69, 3069a-3069k.
  • Ates H, Ates I, Bozkurt B, Celik HT, Ozol D, Yldrm Z. What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia? Blood Coagul Fibrinolysis. 2016;27:252–258
  • Keller K, Beule J, Balzer JO, Dippold W. Typical symptoms for prediction of outcome and risk stratification in acute pulmonary embolism. International angiology: a journal of the International Union of Angiology. 2016;35(2):184-191.
  • De Moerloose P, Desmarais S, Bounameaux H, Reber G, Perrier A, Dupuy G, et al. Contribution of a new, rapid, individual and quantitative automated D-dimer ELISA to Exclude pulmonary embolism. Thromb Haemost. 1996;75(1):11–13.
  • Huang J, Chen Y, Cai Z, Chen P. Diagnostic value of platelet indexes for pulmonary embolism, American Journal of Emergency Medicine. 2015;33(6):760-763
  • Meyer M, Fink C, Roeger S, Apfaltrer P, Haghi D, Kaminski WE, et al. Benefit of combining quantitative cardiac CT parameters with troponin I for predicting right ventricular dysfunction and adverse clinical events in patients with acute pulmonary embolism. Eur J Radiol. 2012;81(11):3294- 3299
  • Celik A , Ozcan T , Gundes A, Topuz M, Pektas I, Yesile E, et al. Usefulness of admission hematologic parameters as diagnostic tools in acute pulmonary embolism. Kaohsiung Journal of Medical Sciences. 2015;31:145-149.
  • McPherson RA, Matthew R. Pincus MR. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. Elsevier Saunders: Philadelphia; 2011. pp. 254-255.
  • Burris CA, Ash wood ER, Burns DE. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th ed. St. Louis: Elsevier Saunders; 2006. pp. 962-967.
  • Talay F, Ocak T, Alcelik A, Erkuran K, Akkaya A, Duran A, et al. The new diagnostic marker for acute pulmonary embolism in emergency department; mean platelet volume. African Health sciences. 2014;14(1):94-9.
  • Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015;52:86-105.
  • Bucciarelli P, Maino A, Felicetta I, Abbattista M, Passamonti SM, Artoni A, et al. Association between red cell distribution width and risk of venous thromboembolism. Thromb Res. 2015;136:590-594.
  • Argun Barış S, Önyılmaz T, Kuşlu Uçar E, Çiftçi T, Başyiğit İ, Boyacı H, et al. The Role of The RDW Level on Characteristics of Hospitalization and Mortality Rates in Patients with Pulmonary Thromboembolism. Kocaeli Medical J. 2016;5;3:18-24.
  • Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest. 2005;115(12):3378-3384.
  • Erdogan D, Tayyar S, Icli A, Uysal BA, Varol E, Ozaydin M, et al. Elevated mean platelet volume is associated with impaired coronary microvascular function in patients with idiopathic dilated cardiomyopathy. Platelets. 2012;23(3):177-183.
  • Bath P, Algert C, Chapman N, Neal B. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke. 2004;35(3):622-626.
  • Yardan T, Meric M, Kati,C Celenk Y, Atici AG. Mean platelet volume and mean platelet volume/platelet count ratio in risk stratification of pulmonary embolism. Medicina (Kaunas). 2016;52(2):110-115.
  • Jo JY, Lee MY, Lee JV, Rho BH, Choi W. Leukocytes and systemic inflammatory response syndrome as prognostic factors in pulmonary embolism patients. BMC Pulm Med. 2013;13:74-81.
  • Afzal A, Noor HA, Gill SA, Brawner C, Stein PD. Leukocytosis in acute pulmonary embolism. Chest. 1999;115(5):1329-1332.
  • Kayrak M, Erdoğan HI, Solak Y, Akilli H, Gül EE , Yildirim O. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a restrospective study. Heart Lung Circ. 2014;23:56-62.

Acil Serviste Pulmoner Tromboemboli Tanısı Konulan Hastalarda Hematolojik Parametrelerin Klinik Önemi

Year 2021, Volume 3, Issue 3, 123 - 129, 01.11.2021
https://doi.org/10.38175/phnx.989396

Abstract

ÖZET Amaç: Akut pulmoner emboli (APE), oldukça ölümcül bir akut klinik durumdur. Burada APE’nin tanı ve prognozunda kan parametrelerinin rolünü belirlemeyi amaçladık. Gereç ve Yöntem: Bu çalışma hastanemizin Acil Servisine (AS) başvuran ve APE tanısı konulan hastalar üzerinde geriye dönük olarak yapıldı. Bilgisayarlı tomografi (BT)’de RV / LV oranı 0.9’dan büyük ve hipotansiyonu olan hastalar masif APE; BT’de RV / LV oranı 0,9’dan büyük olan ve stabil hemodinamik sahip hastalar submasif APE; BT’de RV / LV oranı 0,9’dan küçük ve hemodinamisi stabil olan hastalar masif olmayan APE olarak sınıflandırıldı. Bulgular: Bu çalışmaya 82’si erkek (%41), 118’i kadın (%59) olmak üzere toplam 200 hasta alındı. Hasta ve kontrol grubunun yaş ortalaması sırasıyla 65,2 ± 17,1 ve 60,5 ± 60,5 yıldı. APE grubu, kontrol grubuna göre anlamlı olarak daha yüksek D-dimer düzeyine sahipti (3559,5±8611,3 ng/ml’ye karşı 266,6±266,6 ng/ml) (p<0,001). Troponin I düzeyleri hasta grubunda anlamlı olarak daha yüksekti (53,3±90’a karşı 332,9±32,9) (p= 0,013). Sonuç: Hematolojik parametrelerin APE alt grupları arasındaki analizi, masif APE grubunda D-Dimer, lökosit (WBC), nötrofil, lenfosit, nötrofil / lenfosit oranı (NLR) ve troponin düzeylerinin sub-masif APE ve masif olmayan APE grubuna göre anlamlı olarak daha yüksek olduğunu gösterdi.

References

  • Ates H, Ates I, Kundi H, Yilmaz FM. Diagnostic validity of hematologic parameters in evaluation of massive pulmonary embolism. J Clin Lab Anal. 2017;31(5): e22072.
  • Howard L. Acute pulmonary embolism. Clin Med (Lond). 2019;19(3):243-247.
  • Konstantinides S, Goldhaber SZ. Pulmonary embolism: Risk assessment and management. Eur Heart J. 2012;33:3014–3022.
  • Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(43):3033–69, 3069a-3069k.
  • Ates H, Ates I, Bozkurt B, Celik HT, Ozol D, Yldrm Z. What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia? Blood Coagul Fibrinolysis. 2016;27:252–258
  • Keller K, Beule J, Balzer JO, Dippold W. Typical symptoms for prediction of outcome and risk stratification in acute pulmonary embolism. International angiology: a journal of the International Union of Angiology. 2016;35(2):184-191.
  • De Moerloose P, Desmarais S, Bounameaux H, Reber G, Perrier A, Dupuy G, et al. Contribution of a new, rapid, individual and quantitative automated D-dimer ELISA to Exclude pulmonary embolism. Thromb Haemost. 1996;75(1):11–13.
  • Huang J, Chen Y, Cai Z, Chen P. Diagnostic value of platelet indexes for pulmonary embolism, American Journal of Emergency Medicine. 2015;33(6):760-763
  • Meyer M, Fink C, Roeger S, Apfaltrer P, Haghi D, Kaminski WE, et al. Benefit of combining quantitative cardiac CT parameters with troponin I for predicting right ventricular dysfunction and adverse clinical events in patients with acute pulmonary embolism. Eur J Radiol. 2012;81(11):3294- 3299
  • Celik A , Ozcan T , Gundes A, Topuz M, Pektas I, Yesile E, et al. Usefulness of admission hematologic parameters as diagnostic tools in acute pulmonary embolism. Kaohsiung Journal of Medical Sciences. 2015;31:145-149.
  • McPherson RA, Matthew R. Pincus MR. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. Elsevier Saunders: Philadelphia; 2011. pp. 254-255.
  • Burris CA, Ash wood ER, Burns DE. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th ed. St. Louis: Elsevier Saunders; 2006. pp. 962-967.
  • Talay F, Ocak T, Alcelik A, Erkuran K, Akkaya A, Duran A, et al. The new diagnostic marker for acute pulmonary embolism in emergency department; mean platelet volume. African Health sciences. 2014;14(1):94-9.
  • Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015;52:86-105.
  • Bucciarelli P, Maino A, Felicetta I, Abbattista M, Passamonti SM, Artoni A, et al. Association between red cell distribution width and risk of venous thromboembolism. Thromb Res. 2015;136:590-594.
  • Argun Barış S, Önyılmaz T, Kuşlu Uçar E, Çiftçi T, Başyiğit İ, Boyacı H, et al. The Role of The RDW Level on Characteristics of Hospitalization and Mortality Rates in Patients with Pulmonary Thromboembolism. Kocaeli Medical J. 2016;5;3:18-24.
  • Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest. 2005;115(12):3378-3384.
  • Erdogan D, Tayyar S, Icli A, Uysal BA, Varol E, Ozaydin M, et al. Elevated mean platelet volume is associated with impaired coronary microvascular function in patients with idiopathic dilated cardiomyopathy. Platelets. 2012;23(3):177-183.
  • Bath P, Algert C, Chapman N, Neal B. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke. 2004;35(3):622-626.
  • Yardan T, Meric M, Kati,C Celenk Y, Atici AG. Mean platelet volume and mean platelet volume/platelet count ratio in risk stratification of pulmonary embolism. Medicina (Kaunas). 2016;52(2):110-115.
  • Jo JY, Lee MY, Lee JV, Rho BH, Choi W. Leukocytes and systemic inflammatory response syndrome as prognostic factors in pulmonary embolism patients. BMC Pulm Med. 2013;13:74-81.
  • Afzal A, Noor HA, Gill SA, Brawner C, Stein PD. Leukocytosis in acute pulmonary embolism. Chest. 1999;115(5):1329-1332.
  • Kayrak M, Erdoğan HI, Solak Y, Akilli H, Gül EE , Yildirim O. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a restrospective study. Heart Lung Circ. 2014;23:56-62.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Research Articles
Authors

Resmiye Nur OKUDAN
Gebze Fatıh State Hospıtal, Department of Emergency Medicine, Kocaeli /Turkey
0000-0003-4187-7928
Türkiye


Fevzi YILMAZ (Primary Author)
ANTALYA EĞİTİM VE ARAŞTIRMA HASTANESİ, ACİL TIP
0000-0002-3675-7457
Türkiye


Serkan YÜKSEL
Kahta State Hospıtal, Department of Radiology, Adıyaman /Turkey
0000-0002-6165-6455
Türkiye


Mehmet KARADAŞ
Baskent University, Alanya Research and Teaching Center, Department of Emergency Medicine, Alanya, Turkey
0000-0002-4719-2535
Türkiye


Adeviyye KARACA
Health Sciences University, Antalya Education and Research Hospital; Department of Emergency Medicine, Antalya /Turkey
0000-0002-5338-1826
Türkiye


Gizem AYAZ
Health Sciences University, Antalya Education and Research Hospital; Department of Emergency Medicine, Antalya /Turkey
0000-0002-4476-7989
Türkiye


Ömer Faruk KARAKOYUN
Muğla Training and Research Hospital; Department of Emergency Medicine, Muğla /Turkey
0000-0002-4476-7989
Türkiye

Publication Date November 1, 2021
Application Date September 2, 2021
Acceptance Date September 13, 2021
Published in Issue Year 2021, Volume 3, Issue 3

Cite

AMA Okudan R. N. , Yılmaz F. , Yüksel S. , Karadaş M. , Karaca A. , Ayaz G. , Karakoyun Ö. F. The Clinical Importance of Hematological Parameters In Patients with Pulmonary Thromboembolism Diagnosed in The Emergency Department. Phnx Med J. 2021; 3(3): 123-129.

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