Acil Serviste Pulmoner Emboli Tanısı Alan Hastalarda Laktat ve Laktat Klerensinin Mortalite Üzerine Etkisinin Retrospektif Değerlendirilmesi

Öz

Amaç: Pulmoner emboli, kardiyovasküler hastalığa bağlı ölümlerin üçüncü önde gelen nedenidir. Pulmoner emboli de şok veya hipotansiyon varlığı ana prognostik klinik belirteç olmaya devam etmektedir ve bugüne kadar agresif tedavi ihtiyacını gösteren tek faktördür. Pulmoner embolili hastaların çoğu normotansiftir. Pulmoner emboli hastalarını daha iyi sınıflandırmak için prognostik göstergelere ihtiyaç vardır. Bu çalışmada, acil serviste pulmoner emboli tanısı konulan hastalarda laktat düzeyinin hastane mortalitesini öngörmedeki etkisi ve laktat düzeyi yüksek (laktat ≥2 mmol/L) hastalarda laktat klirensinin mortaliteye etkisi araştırıldı.

Gereç ve Yöntemler: Bu çalışma retrospektif bir çalışma olarak tasarlanmıştır. 1 Ocak 2018-31 Aralık 2019 tarihleri arasında üniversite hastanesi acilinde bilgisayarlı tomografi anjiyografisi ile pulmoner emboli tanısı alan erişkin (>18 yaş) hastalar analiz edilmiştir.

Bulgular: Acil serviste toplam 367 hastaya pulmoner emboli tanısı kondu. Hastaların hastane içi mortalite oranı %29,8, pulmoner emboli ile ilişkili mortalite oranı ise %12,4 idi. Laktat klirensi mortalite riskini öngörmede anlamlı değildi. Pulmoner emboli hastalarında mortaliteyi etkileyen risk faktörleri arasında yapılan lojistik regresyon analizinde laktat ≥3 mmol/L ve normotansif + laktat ≥3 mmol/L hastane içi mortaliteyi öngörmede anlamlı bulundu.

Sonuç: Acil serviste laktat düzeyi akut pulmoner emboli hastalarında mortaliteyi belirlemede etkili bir tarama yöntemi olabilir.

Anahtar Kelimeler

• Mortalite
• pulmoner emboli
• acil servis

The Effect of Lactate and Lactate Clearance on Mortality in Patients with Acute Pulmonary Embolism in Emergency Department

Öz

Aim: Pulmonary embolism (PE) is the third leading cause of death due to cardiovascular disease. The presence of shock or hypotension remains the main prognostic clinical marker and to date, it is the only factor that indicates the need for aggressive treatment. Most patients with pulmonary embolism are normotensive. Prognostic indicators are needed to better classify patients with pulmonary embolism. This study aimed to investigate the effect of lactate level on predicting hospital mortality in patients diagnosed with pulmonary embolism in the emergency department, and the effect of lactate clearance on mortality in patients with high lactate levels (lactate ≥2 mmol/L).

Material and Methods: This study was designed as a retrospective study. Adult patients (>18-years old) who were diagnosed with PE by computed tomography angiography of the thorax in the university hospital emergency between January 1, 2018, and December 31, 2019, were analyzed.

Results: A total of 367 patients were diagnosed with pulmonary embolism in the emergency department. In-hospital mortality rate of the patients was 29.8% and the pulmonary embolism-related mortality rate was 12.4%. Lactate clearance was not significant in predicting mortality risk. In the logistic regression analysis performed among the risk factors affecting mortality in patients with pulmonary embolism, lactate ≥3 mmol/L and normotensive + lactate ≥3 mmol/L were significant in predicting in-hospital mortality.

Conclusion: The lactate level in the emergency department could be an effective screening method for identifying mortality in acute pulmonary embolism patients.

Anahtar Kelimeler

• Mortality
• pulmonary embolism
• emergency medicine

Kaynakça

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