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AKUT DEKOMPANSE KALP YETMEZLİĞİNDE SERUM SODYUM VE KLOR SEVİYESİNİN PROGNOSTİK DEĞERİ

Yıl 2022, , 134 - 141, 29.12.2022
https://doi.org/10.56728/dustad.1210632

Öz

Amaç: Akut kalp yetmezliği acil servislerde sık karşılaşılan önemli bir morbidite ve mortalite nedenidir. Biz yapmış olduğumuz bu çalışma ile akut dekompanse kalp yetmezliği olan hastalarda hastaneye yatış veya taburculukta serum sodyum ve klor düzeyinin etkinliğini araştırmayı amaçladık.
Materyal ve Metod: Çalışmamız SBÜ Acil Tıp ABD Ankara SUAM Acil Tıp Kliniğinde 1.12.2018 ile 1.12.2019 tarihleri arasında etik kurulu onayı alınarak yapıldı. Çalışmamız prospektif, gözlemsel bir klinik çalışma olarak gerçekleştirildi. Çalışmaya acil servisimize başvuran akut kalp yetmezliği ve kronik kalp yetmezliğinin akut dekompanzasyonu tanılı aydınlatılmış onamı alınan, 18 yaşın üzerindeki dışlama kriteri olmayan 120 hasta dahil edildi. Çalışmamıza dahil edilen hastalar acil servisten tedavi alıp taburcu olanlar, servise yatış yapılanlar ve yoğun bakım yatışı yapılanlar olarak 3 gruba ayrılmıştır. Bu 3 grubun acil servise başvurduğu sırada alınan kan örneklerindeki serum sodyum ve klor düzeyleri karşılaştırılaştırılmıştır.
Bulgular: Hastaların % 48,3’ü (n:58) acil servisten taburcu olurken, % 26,7’sine (n:32) servis yatışı, % 25’ine (n:30) yoğun bakım yatışı yapıldı. Klor değeri 98,5 mmol/L ve altında olan hastaların daha çok hastaneye yatış ihtiyacı olduğu tespit edilirken, sodyum değeri ile hastaneye yatış arasında herhangi bir anlamlı ilişki tespit edilememiştir. (p=0,041; p=0,810)
Sonuç: Akut kalp yetmezliği ile acil servislere başvuran hastaların yatış ihtiyacını öngörmede ve prognoz değerlendirmesinde düşük serum klor seviyesi değerli bir göstergedir. Sodyum seviyesi ile yatış ihtiyacı ve prognoz arasında herhangi bir ilişki yoktur.

Destekleyen Kurum

yoktur

Proje Numarası

yoktur

Kaynakça

  • Benjamin, E. J., Munter, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P. … Virani, S. S. (2019). Heart disease and stroke statistics-2019 update: A report from the American Heart Association. Circulation, 139, e56-e528.
  • Degertekin, M., Erol, Ç., Ergene, O., Tokgözoğlu, L., Aksoy, M. …, & Erol, M. K. (2012). Türkiye’deki kalp yetersizliği prevalansı ve öngördürücüleri: HAPPY çalışması. Turk Kardiyol Dern Ars, 40(4), 298-308.
  • Gheorghiade, M., Abraham, W. T., Albert, N. M., Gattis Stough, W., Greenberg, B. H., O'Connor, C. M. … & Fonarow, G. C. (2007). Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J, 28(8):980-8.
  • Grodin, J. L., Simon, J., Hachamovitch, R., Wu, Y., Jackson, G., Halkar, M. … & Wilson Tang, W. H. (2015). Prognostic role of serum chloride levels in acute decompensated heart failure. J Am Coll Cardiol, 66(6), 659-66.
  • Grodin, J. L., Testani, J. M., Pandey, A., Sambandam, K., Drazner, M. H., Fang, J. C. … & Wilson Tang, W. H. (2018). Perturbations in serum chloride homeostasis in heart failure with preserved ejection fraction: insights from TOPCAT. European Journal of Heart Failure, 20(10), 1436-1443.
  • Grodin, J. L., Verbrugge, F. H., Ellis, S. G., Mullens, W., Testani, J. M., & Wilson Tang, W. H. (2016). Importance of abnormal chloride homeostasis in stable chronic heart failure. Circ Heart Fail, 9(1), e002453.
  • Heidenreich, P. A., Albert, N. M., Allen, L. A., Bluemke, D. A., Butler, J. … & Fonarow, G. C. (2013). Forecasting the impact of heart failure in the United States: A policy statement from the American Heart Association. Circ Heart Fail, 6(3):606-19.
  • Kearney, M. T., Fox, K. A., Lee, A. J, Prescott, R. J., Shah, A. M., Batin, P. D. … & Nolan, J. (2002). Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure. J Am Coll Cardiol, 40(10), 1801-8.
  • Klein, L, O'Connor, C. M., Leimberger, J. D., Gattis-Stough, W., Piña, I. L. Felker, G. M. … & Gheorghiade, M. (2005). Lower serum sodium is associated. with increased short-term mortality in hospitalized patients with worsening heart failure. Circulation, 111(19), 2454-60.
  • Mohan, S., Gu, S., Parikh, A., & Radhakrishnan, J. (2013). Prevalence of hyponatremia and association with mortality: results from NHANES. Am J Med, 126(12), 1127-37.e1.
  • Park, J. J., Chae, I. H., Choi, D. J., Kang, S. M., Yoo, B. S., Hwang, J. J. … & Ge, J. (2016). Renal function, serum sodium level, and outcomes in hospitalized systolic heart failure patients: An analysis of the COAST study. Medicine (Baltimore), 95(25), e3898.
  • Ter Maaten, J. M., Damman, K., Hanberg, J. S., Givertz, M. M., Metra, M., O’Connor, C. M. ... & Testani, J. M. (2016). Hypochloremia, diuretic resistance, and outcome in patients with acute heart failure. Circulation: Heart Failure, 9(8), e003109.
  • Walls, R., Hockberger, R., Gausche-Hill, M., FACEP., & FAAP. (2017). Rosen’s emergency medicine: concepts and clinical practice, 9th edt, part 3, section three: heat failure, Elsevier.
  • Weintraub, N. L., Collins, S. P., Pang, P. S., Levy, P. D., Anderson, A. S. … & Arslanian-Engoren, C. (2010). Acute heart failure syndromes: Emergency department presentation, treatment, and disposition: Current approaches and future aims a scientific statement from the American Heart Association. Circulation, 122(19), 1975-96.
  • Zhang, Y., Peng, R., Li, X., Yu, J., Chen, X., & Zhou, Z. (2018). Serum chloride as a novel marker for adding prognostic information of mortality in chronic heart failure. Clinica Chimica Acta, 483, 112-118.

PROGNOSTIC VALUE OF SERUM SODIUM AND CHLORINE LEVEL IN ACUTE DECOMPANSE HEART FAILURE

Yıl 2022, , 134 - 141, 29.12.2022
https://doi.org/10.56728/dustad.1210632

Öz

ABSTRACT
Aim: Acute heat failure is a significant reason of morbidity and mortality that is commonly seen in the emergency department. In our study, we aimed to investigate the effectiveness of serum sodium and chloride levels for predicting the prognosis of the patients with acute decompensated heart failure.
Material and Method: Our study has been conducted in Health Sciences University Emergency Medicine Department Ankara Health Application and Research Center Emergency Clinic (SBÜ Acil Tıp ABD Ankara SUAM Acil Tıp Kliniği) between 1.12.2018 and 1.12.2019 after receiving ethics committee’s approval. Our study is a prospective, observational clinical trial. 120 patients older than 18 years old with informed consent who admitted to emergency department with the diagnoses of acute heart failure and acute decompensation of chronic heart failure were included without any exclusion criteria. The cases included in our study were divided into 3 groups; the patients who had got treated in the emergency department and discharged from the hospital, the patients who were hospitalized in cardiology clinic and the patients who were hospitalized in intensive care unit. Serum sodium and chloride levels in blood samples were compared when these 3 groups of patients were admitted to the emergency department.
Results: 48.3% (n:58) of patients were discharged from the hospital while 26.7% (n:32) of patients were hospitalized and 25% (n:30) of patients were hospitalized in intensive care unit. The patients with serum chloride levels below than 98.5 mmol/l needed longer hospitalization while no significant correlation between serum sodium levels and hospitalization ratio was detected.
Conclusion: Lower serum chloride level is a valuable indicator for evaluating the prognosis and predicting the need of hospitalization of the patients who were admitted to the emergency department with acute heart failure. There was no correlation between the serum sodium levels and prognosis and the need for hospitalization.

Proje Numarası

yoktur

Kaynakça

  • Benjamin, E. J., Munter, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P. … Virani, S. S. (2019). Heart disease and stroke statistics-2019 update: A report from the American Heart Association. Circulation, 139, e56-e528.
  • Degertekin, M., Erol, Ç., Ergene, O., Tokgözoğlu, L., Aksoy, M. …, & Erol, M. K. (2012). Türkiye’deki kalp yetersizliği prevalansı ve öngördürücüleri: HAPPY çalışması. Turk Kardiyol Dern Ars, 40(4), 298-308.
  • Gheorghiade, M., Abraham, W. T., Albert, N. M., Gattis Stough, W., Greenberg, B. H., O'Connor, C. M. … & Fonarow, G. C. (2007). Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J, 28(8):980-8.
  • Grodin, J. L., Simon, J., Hachamovitch, R., Wu, Y., Jackson, G., Halkar, M. … & Wilson Tang, W. H. (2015). Prognostic role of serum chloride levels in acute decompensated heart failure. J Am Coll Cardiol, 66(6), 659-66.
  • Grodin, J. L., Testani, J. M., Pandey, A., Sambandam, K., Drazner, M. H., Fang, J. C. … & Wilson Tang, W. H. (2018). Perturbations in serum chloride homeostasis in heart failure with preserved ejection fraction: insights from TOPCAT. European Journal of Heart Failure, 20(10), 1436-1443.
  • Grodin, J. L., Verbrugge, F. H., Ellis, S. G., Mullens, W., Testani, J. M., & Wilson Tang, W. H. (2016). Importance of abnormal chloride homeostasis in stable chronic heart failure. Circ Heart Fail, 9(1), e002453.
  • Heidenreich, P. A., Albert, N. M., Allen, L. A., Bluemke, D. A., Butler, J. … & Fonarow, G. C. (2013). Forecasting the impact of heart failure in the United States: A policy statement from the American Heart Association. Circ Heart Fail, 6(3):606-19.
  • Kearney, M. T., Fox, K. A., Lee, A. J, Prescott, R. J., Shah, A. M., Batin, P. D. … & Nolan, J. (2002). Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure. J Am Coll Cardiol, 40(10), 1801-8.
  • Klein, L, O'Connor, C. M., Leimberger, J. D., Gattis-Stough, W., Piña, I. L. Felker, G. M. … & Gheorghiade, M. (2005). Lower serum sodium is associated. with increased short-term mortality in hospitalized patients with worsening heart failure. Circulation, 111(19), 2454-60.
  • Mohan, S., Gu, S., Parikh, A., & Radhakrishnan, J. (2013). Prevalence of hyponatremia and association with mortality: results from NHANES. Am J Med, 126(12), 1127-37.e1.
  • Park, J. J., Chae, I. H., Choi, D. J., Kang, S. M., Yoo, B. S., Hwang, J. J. … & Ge, J. (2016). Renal function, serum sodium level, and outcomes in hospitalized systolic heart failure patients: An analysis of the COAST study. Medicine (Baltimore), 95(25), e3898.
  • Ter Maaten, J. M., Damman, K., Hanberg, J. S., Givertz, M. M., Metra, M., O’Connor, C. M. ... & Testani, J. M. (2016). Hypochloremia, diuretic resistance, and outcome in patients with acute heart failure. Circulation: Heart Failure, 9(8), e003109.
  • Walls, R., Hockberger, R., Gausche-Hill, M., FACEP., & FAAP. (2017). Rosen’s emergency medicine: concepts and clinical practice, 9th edt, part 3, section three: heat failure, Elsevier.
  • Weintraub, N. L., Collins, S. P., Pang, P. S., Levy, P. D., Anderson, A. S. … & Arslanian-Engoren, C. (2010). Acute heart failure syndromes: Emergency department presentation, treatment, and disposition: Current approaches and future aims a scientific statement from the American Heart Association. Circulation, 122(19), 1975-96.
  • Zhang, Y., Peng, R., Li, X., Yu, J., Chen, X., & Zhou, Z. (2018). Serum chloride as a novel marker for adding prognostic information of mortality in chronic heart failure. Clinica Chimica Acta, 483, 112-118.
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Makaleler
Yazarlar

Sinan Özdemir 0000-0001-7396-0529

Yahya Kemal Günaydın

Proje Numarası yoktur
Yayımlanma Tarihi 29 Aralık 2022
Yayımlandığı Sayı Yıl 2022

Kaynak Göster

APA Özdemir, S., & Günaydın, Y. K. (2022). PROGNOSTIC VALUE OF SERUM SODIUM AND CHLORINE LEVEL IN ACUTE DECOMPANSE HEART FAILURE. Dünya Sağlık Ve Tabiat Bilimleri Dergisi, 5(2), 134-141. https://doi.org/10.56728/dustad.1210632