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Akut Pulmoner Emboli Hastalarında Troponin Değerlerinin Prognoza Etkisi

Yıl 2019, Cilt 2, Sayı 1, 7 - 12, 31.03.2019

Öz

Giriş

Bu çalışmanın amacı PTE tanısı alan hastalarda troponin değerlerinin prognoza etkisinin araştırılmasıdır.

Materyal ve metod

Toraks BT anjiografi çekilerek radyolog tarafından pulmoner emboli olarak raporlanmış ve göğüs hastalıkları uzman doktoru tarafından pulmoner tromboemboli olarak kabul edilmiş hastalardan 18 yaşından büyük olanlar çalışmaya dahil edilmiştir. 18 yaşından küçük hastalar, fizik muayene, öykü ve laboratuvar verileri eksik olan hastalar, akut koroner sendrom öyküsü olanlar, kronik böbrek yetmezliği olanlar (kreatin klirensi <60), akut serebrovasküler olay olan hastalar ve pulmoner emboli tanısı şüpheli olan hastalar çalışmadan dışlanmıştır.

PTE tanısı olan hastalar iki gruba ayrıldı: Grup 1; PTE sonrası 30 Günlük dönemde eksitus olan hastalar, grup 2: PTE sonrası 30 Günlük dönemde eksitus olmayanlar. Gruplar karşılaştırılırken normal dağılıma uyan veriler için Student-t testi, normal dağılıma uymayan veriler için Mann Whitney U testi kullanıldı. Frekans veriler Ki-Kare testi ile karşılaştırıldı. Troponin ve mortalite ilişkisinin istatistiksel olarak anlamlı olması sonucu troponin prognoz seviyesini belirleyebilmek için ROC analizi yapıldı ve uygun duyarlılık ve özgüllük cut-off değerleri belirlendi.

Bulgular

Acil serviste PTE tanısı alan hastaların troponin değerlerinin 30 günlük dönemdeki prognoz ile ilişkisine bakıldığında troponin değerlerinin mortal seyreden grupta istatistiksel olarak anlamlı şekilde daha yüksek olduğu tespit edildi (p=0,031). Eğri altında kalan alan (Area Under Curve -AUC) değer 0,636 olarak hesaplanması nedeniyle troponin değerinin 30 günlük mortaliteyi öngörme açısından zayıf-orta değerde bir anlamlılığa sahip olduğu saptandı.

 

Sonuç

Bir aylık dönemde eksitus olan hastalarda troponin değerleri bu dönemde hayatta kalan gruba oranla istatistiksel anlamlı şekilde daha yüksektir. Buna karşın düşük özgüllük ve duyarlılık oranları sebebiyle troponin değerlerinin mortalite belirteci olarak klinik kullanılabilir olmadığını düşünüyoruz. Ancak artmış mortalite ile olan anlamlı ilişkisi sebebiyle troponin değerleri yüksek olan PTE’li hastaların hastanede yatırılarak ve daha yakın takibi gerekmektedir.

Kaynakça

  • Hirsh J, Hoak J. Management of deep vein thrombozis and pulmonary embolism. A statement for healthcare professionals. Council an thrombosisCirculation 1996; 93: 2212-45.
  • Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest 2003; 123: 1947-52. .
  • Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007; 116:427-33. .
  • Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163(14):1711–7. doi: 10.1001/archinte.163.14.1711.
  • 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. doi: 10.1093/eurheartj/ehu283.
  • Tsai AW, Cushman M, Rosamond W.D, et al. Cardiovascular vascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboem bolism etiology. Arch Intern Med 2002;162:1182-1189.
  • Lee CH, Cheng CL, Lin LJ, et al. Epidemiology and predictors of short-term mortality in sympromatic venous thromboembolism-A nationwide population based stusy. Circ J 2011;75:1998-2004.
  • Talal Dahhan, Irfan Siddiqui,Victor F. Tapson,Eric J. Velazquez,Stephanie Sun, Clemontina A. Davenport,Zainab Samad,Sudarshan Rajagopal Clinical and echocardiographic predictorsof mortality in acute pulmonary embolism Cardiovasc Ultrasound.2016 Oct 28;14.
  • Yasuhiro Tanabe , Toru Obayashi , Takeshi Yamamoto Morimasa Takayama, Ken Nagao Predictive value of biomarkers for the prognosis of acute pulmonary embolism in Japanese patients: Results of the Tokyo CCU Network registry Journal of Cardiology 66 (2015) 46.
  • Emad U. Hakemi , MD ; Tareq Alyousef , MD ; Geetanjali Dang , MD ; Jalal Hakmei , MD ;Th e Prognostic Value of Undetectable Highly C HEST 2015; 1 47( 3) : 685- 694. .
  • Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation 2006;113:577-82. .
  • Stein PD, Henry JW. Prevalence of acute pulmonary embolismlism among patients in a general hospital and at autopsy. Chest 1995;108:978-81.
  • Kasper W, Konstantinides S, Geibel A, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 1997;30:1165-71.
  • Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353:1386-89. .
  • Ali Duman,Ömer Salt, Seda Özkan, Polat Durukan,mücahit Avcıl Demographic characteristics of patients with pulmonary thromboembolism Journal of Clinical and Experimental Investigations 2015; 6 (1): 10-15. .
  • Gulden Ozeren Yetgin,Şule Akkose Aydın,Özlem Koksal,Fatma Ozdemir,Dilek Kostak Mert,Gökhan torun Clinical probability and risk analysis of patients with suspected pulmonary embolism World J Emerg Med, Vol 5, No 4, 2014. .
  • The PIOPED investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. JAMA 1990;263:2753-9. .
  • Şükran ATİKCAN, Figen ATALAY, Dilek TURGUT, Ebru ÜNSALPulmoner Tromboemboli: 42 Olgunun Solunum Hastalıkları 2002; 13: 87-93. .
  • Ghanima W, Abdelnoor M, Mowinckel MC, Sandset PM. The performance of STA-Lia test D-Dimer assay in out-patients with suspected pulmonary embolism.Br J Haematol 2006:132;210-215. .
  • Süreyya Yılmaz, Füsun Topçu, Hadice Selimoğlu Şen, Özlem Abakay, Zülfükar Yılmaz Pulmoner emboli tanısında Wells klinik skorlaması ile yüksek D-dimer seviyesinin kombinasyonu 2014; 5 (4): 557-562Journal of Clinical and Experimental Investigations . .
  • Ali Kemal Kalkan, Derya Ozturk, Mehmet Erturk, Mehmet Emin Kalkan, Huseyin Altug Cakmak, Ender Oner, Fatih Uzun, Omer Tasbulak, Turab Yakisan, Ahmet Celik The diagnostic value of serum copeptin levels in an acute pulmonary embolism Cardiology Journal . . 2016 vol.23,No.1,42-50.
  • Ahmet Celik, Ismail Türkay Ozcan, Ahmet Gündes, Mustafa Topuz, Idris Pektas, Emrah Yesil, Selcuk Ayhan, Ataman Kose, Ahmet Camsari, Veli Gokhan Cin Usefulness of admission hematologic parameters as diagnostic tools in acute pulmonary embolism . Kaohsiung . Journal of Medical Sciences (2015) 31,145e149.
  • Mehta NJ, Jani K, Khan IA. Clinical usefulness and prognostic value of elevated cardiac Troponin I levels in acute pulmonary embolism. Am Heart J. 2003; 145: 821-25. .
  • Alonso Martinez JL, Anniccherico Sánchez FJ, Urbieta Echezarreta MA, García IV, Álvaro JR Central Versus Peripheral Pulmonary Embolism: Analysis of the Impact on the Physiological Parameters and Long-term Survival.N Am J Med Sci. 2016 Mar;8(3):134-42.doi.
  • Dursunoğlu N1, Dursunoğlu D, Yıldız Aİ, Rota S Evaluation of cardiac biomarkers and right ventricular dysfunction in patients with acute pulmonary embolism.Anatol J Cardiol. 2016 Apr;16(4):276-82. doi: 10.5152/akd.2014.5828. Epub 2014 Dec 31. .
  • Vuilleumier N, Simona A, Méan M, Limacher A, Lescuyer P, Gerstel E, Bounameaux H, Aujesky D, Righini M Comparison of Cardiac and Non-Cardiac Biomarkers for Risk Stratification in Elderly Patients with Non-Massive Pulmonary Embolism.PLoS One. 2016 May .doi. 10,5152/akd.2014.5828.Epub 2014 Dec 31.
  • Keller K, Geyer M, Beule J, Coldewey M, Balzer JO, Dippold W Impact of cancer on the effectiveness of cardiac Troponin I to predict right ventricular dysfunction in acute pulmonary embolism. 2015 Sep;6(5):584-8. doi: 10.1111/1759-7714.12226.Epub 2015 Jan.
  • Jiménez D, Díaz G, Molina J, Martí D, Del Rey J, García-Rull S, et al. Troponin I and risk stratification of patients with acute non massive pulmonary embolism. Eur Respir J. 2008;31: 847-53. .
  • Kucher N, Wallmann D, Carone A, Windecker S, Meier B, Hess OM. Incremental prognostic value of troponin I and echocardiography in patients with acute pulmonary embolism. Eur Heart J. 2003; 24: 1651-56. .
  • Giannitsis E, Müller-Bardorff M, Kurowski V, Weidtmann B, Wiegand U, Kampmann M, et al. Independent prognostic value of cardiac troponin T in patientwitk confirmed pulmonary embolism. Circulation 2000; 102:211-217. .
  • Yasuhiro Tanabe , Toru Obayashi , Takeshi Yamamoto Morimasa Takayama, Ken Nagao Predictive value of biomarkers for the prognosis of acute pulmonary embolism in Japanese patients: Results of the Tokyo CCU Network registry Journal of Cardiology 66 (2015)46.
  • Jiménez D, Aujesky D, Moores L, Gómez V, Martí D, Briongos S, etal. Combinations of prognostic tools for identification of high-risk normotensive patients with acute symptomatic pulmonary embolism. Thorax. 2011; 66: 75-81.

The Effect of Troponin Levels on Prognosis in Patients with Acute Pulmonary Embolism

Yıl 2019, Cilt 2, Sayı 1, 7 - 12, 31.03.2019

Öz

Introduction

The aim of this study is to investigate the effect of troponin levels on the prognosis in patients diagnosed with PTE (Pulmonary Thromboembolism).

Materials and Methodology

Patients older than 18 years of age amongst the ones who were reported as pulmonary embolism by a radiologist after going under Thorax CT angiography and accepted as with pulmonary thromboembolism by a pulmonologist were included in the study. Patients under 18 years of age, patients without physical examination and history, patients with missing laboratory data, patients with a history of acute coronary syndrome, patients with chronic renal failure (creatine clearance <60), patients with acute cerebrovascular events, and patients with suspected pulmonary embolism were excluded from the study.

Patients with PTE diagnosis were divided into two groups: Group 1: Patients who died in the 30-day period after PTE, Group 2: those who did not die during 30-day period after PTE. When comparing the groups, Student-t test was performed for data adhering to normal distribution and Mann-Whitney U test was performed for data not adhering to normal distribution. Frequency data were compared with Chi-Square test. ROC analysis was performed to determine the troponin prognosis level as a result of the statistically significant relationship between troponin and mortality and appropriate sensitivity and specificity cut-off values were determined.

Results

When the relationship between the troponin levels and the prognosis of patients with PTE in the emergency room was evaluated, it was found that the troponin values were statistically higher in the group with mortality (p=0,031). And because the Area Under Curve (AUC) value was calculated as 0.636, the troponin value was found to have a weak-to-medium significance for predicting 30-day mortality.

 

Conclusion

Troponin levels were significantly higher in patients who died in one-month period compared to the survivors in the same period. However, we believe that troponin values are not clinically useful as a marker of mortality due to low specificity and sensitivity ratios. Yet, because of its significant relationship with increased mortality, PTE patients with high troponin levels should be hospitalized and monitored more closely.

Kaynakça

  • Hirsh J, Hoak J. Management of deep vein thrombozis and pulmonary embolism. A statement for healthcare professionals. Council an thrombosisCirculation 1996; 93: 2212-45.
  • Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest 2003; 123: 1947-52. .
  • Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007; 116:427-33. .
  • Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163(14):1711–7. doi: 10.1001/archinte.163.14.1711.
  • 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. doi: 10.1093/eurheartj/ehu283.
  • Tsai AW, Cushman M, Rosamond W.D, et al. Cardiovascular vascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboem bolism etiology. Arch Intern Med 2002;162:1182-1189.
  • Lee CH, Cheng CL, Lin LJ, et al. Epidemiology and predictors of short-term mortality in sympromatic venous thromboembolism-A nationwide population based stusy. Circ J 2011;75:1998-2004.
  • Talal Dahhan, Irfan Siddiqui,Victor F. Tapson,Eric J. Velazquez,Stephanie Sun, Clemontina A. Davenport,Zainab Samad,Sudarshan Rajagopal Clinical and echocardiographic predictorsof mortality in acute pulmonary embolism Cardiovasc Ultrasound.2016 Oct 28;14.
  • Yasuhiro Tanabe , Toru Obayashi , Takeshi Yamamoto Morimasa Takayama, Ken Nagao Predictive value of biomarkers for the prognosis of acute pulmonary embolism in Japanese patients: Results of the Tokyo CCU Network registry Journal of Cardiology 66 (2015) 46.
  • Emad U. Hakemi , MD ; Tareq Alyousef , MD ; Geetanjali Dang , MD ; Jalal Hakmei , MD ;Th e Prognostic Value of Undetectable Highly C HEST 2015; 1 47( 3) : 685- 694. .
  • Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation 2006;113:577-82. .
  • Stein PD, Henry JW. Prevalence of acute pulmonary embolismlism among patients in a general hospital and at autopsy. Chest 1995;108:978-81.
  • Kasper W, Konstantinides S, Geibel A, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 1997;30:1165-71.
  • Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353:1386-89. .
  • Ali Duman,Ömer Salt, Seda Özkan, Polat Durukan,mücahit Avcıl Demographic characteristics of patients with pulmonary thromboembolism Journal of Clinical and Experimental Investigations 2015; 6 (1): 10-15. .
  • Gulden Ozeren Yetgin,Şule Akkose Aydın,Özlem Koksal,Fatma Ozdemir,Dilek Kostak Mert,Gökhan torun Clinical probability and risk analysis of patients with suspected pulmonary embolism World J Emerg Med, Vol 5, No 4, 2014. .
  • The PIOPED investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. JAMA 1990;263:2753-9. .
  • Şükran ATİKCAN, Figen ATALAY, Dilek TURGUT, Ebru ÜNSALPulmoner Tromboemboli: 42 Olgunun Solunum Hastalıkları 2002; 13: 87-93. .
  • Ghanima W, Abdelnoor M, Mowinckel MC, Sandset PM. The performance of STA-Lia test D-Dimer assay in out-patients with suspected pulmonary embolism.Br J Haematol 2006:132;210-215. .
  • Süreyya Yılmaz, Füsun Topçu, Hadice Selimoğlu Şen, Özlem Abakay, Zülfükar Yılmaz Pulmoner emboli tanısında Wells klinik skorlaması ile yüksek D-dimer seviyesinin kombinasyonu 2014; 5 (4): 557-562Journal of Clinical and Experimental Investigations . .
  • Ali Kemal Kalkan, Derya Ozturk, Mehmet Erturk, Mehmet Emin Kalkan, Huseyin Altug Cakmak, Ender Oner, Fatih Uzun, Omer Tasbulak, Turab Yakisan, Ahmet Celik The diagnostic value of serum copeptin levels in an acute pulmonary embolism Cardiology Journal . . 2016 vol.23,No.1,42-50.
  • Ahmet Celik, Ismail Türkay Ozcan, Ahmet Gündes, Mustafa Topuz, Idris Pektas, Emrah Yesil, Selcuk Ayhan, Ataman Kose, Ahmet Camsari, Veli Gokhan Cin Usefulness of admission hematologic parameters as diagnostic tools in acute pulmonary embolism . Kaohsiung . Journal of Medical Sciences (2015) 31,145e149.
  • Mehta NJ, Jani K, Khan IA. Clinical usefulness and prognostic value of elevated cardiac Troponin I levels in acute pulmonary embolism. Am Heart J. 2003; 145: 821-25. .
  • Alonso Martinez JL, Anniccherico Sánchez FJ, Urbieta Echezarreta MA, García IV, Álvaro JR Central Versus Peripheral Pulmonary Embolism: Analysis of the Impact on the Physiological Parameters and Long-term Survival.N Am J Med Sci. 2016 Mar;8(3):134-42.doi.
  • Dursunoğlu N1, Dursunoğlu D, Yıldız Aİ, Rota S Evaluation of cardiac biomarkers and right ventricular dysfunction in patients with acute pulmonary embolism.Anatol J Cardiol. 2016 Apr;16(4):276-82. doi: 10.5152/akd.2014.5828. Epub 2014 Dec 31. .
  • Vuilleumier N, Simona A, Méan M, Limacher A, Lescuyer P, Gerstel E, Bounameaux H, Aujesky D, Righini M Comparison of Cardiac and Non-Cardiac Biomarkers for Risk Stratification in Elderly Patients with Non-Massive Pulmonary Embolism.PLoS One. 2016 May .doi. 10,5152/akd.2014.5828.Epub 2014 Dec 31.
  • Keller K, Geyer M, Beule J, Coldewey M, Balzer JO, Dippold W Impact of cancer on the effectiveness of cardiac Troponin I to predict right ventricular dysfunction in acute pulmonary embolism. 2015 Sep;6(5):584-8. doi: 10.1111/1759-7714.12226.Epub 2015 Jan.
  • Jiménez D, Díaz G, Molina J, Martí D, Del Rey J, García-Rull S, et al. Troponin I and risk stratification of patients with acute non massive pulmonary embolism. Eur Respir J. 2008;31: 847-53. .
  • Kucher N, Wallmann D, Carone A, Windecker S, Meier B, Hess OM. Incremental prognostic value of troponin I and echocardiography in patients with acute pulmonary embolism. Eur Heart J. 2003; 24: 1651-56. .
  • Giannitsis E, Müller-Bardorff M, Kurowski V, Weidtmann B, Wiegand U, Kampmann M, et al. Independent prognostic value of cardiac troponin T in patientwitk confirmed pulmonary embolism. Circulation 2000; 102:211-217. .
  • Yasuhiro Tanabe , Toru Obayashi , Takeshi Yamamoto Morimasa Takayama, Ken Nagao Predictive value of biomarkers for the prognosis of acute pulmonary embolism in Japanese patients: Results of the Tokyo CCU Network registry Journal of Cardiology 66 (2015)46.
  • Jiménez D, Aujesky D, Moores L, Gómez V, Martí D, Briongos S, etal. Combinations of prognostic tools for identification of high-risk normotensive patients with acute symptomatic pulmonary embolism. Thorax. 2011; 66: 75-81.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Orijinal Çalışma
Yazarlar

Gizem MANGAL (Sorumlu Yazar)
0000-0002-4195-2601
Türkiye


Serkan Emre EROĞLU
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL ÜMRANİYE SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, ACİL TIP ANABİLİM DALI
0000-0002-3183-3713


Gökhan AKSEL
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL ÜMRANİYE SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, ACİL TIP ANABİLİM DALI
0000-0002-5580-3201


Öner BOZAN Bu kişi benim
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL OKMEYDANI SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, ACİL TIP ANABİLİM DALI
0000-0002-4195-2601

Yayımlanma Tarihi 31 Mart 2019
Yayınlandığı Sayı Yıl 2019, Cilt 2, Sayı 1

Kaynak Göster

AMA Mangal G. , Eroğlu S. E. , Aksel G. , Bozan Ö. Akut Pulmoner Emboli Hastalarında Troponin Değerlerinin Prognoza Etkisi. Anatolian J Emerg Med. 2019; 2(1): 7-12.

ISSN: 2651-4311

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