Transkateter Aort Kapak Replasmanı Sonrası Mortaliteyi Öngörmede Glasgow Prognostik Skorunun Önemi

Öz

Öz Amaç Glasgow Prognostik Skoru (GPS) inflamatuar (C reaktif protein) ve nutrisyonel (albümin) parametrelerin birlikte kullanımı ile elde edilen bir skorlama sistemidir ve daha önce yapılan çalışmalarda çeşitli kardiyak patolojilerde prognostik değeri olduğu gösterilmiştir. Bu çalışmada, Transkateter aort kapak replasmanı (TAVR) yapılan hastalarda 1-yıllık mortaliteyi öngörmede Glasgow Prognostik Skoru (GPS)'nun kullanılabilirliğinin araştırılması amaçlanmıştır. Gereç ve Yöntem Hastanemizde, 2013-2017 yılları arasında ciddi, semptomatik aort darlığı tanısı ile TAVR uygulanan hastalar geriye dönük olarak çalışmaya dahil edilmiştir. Demografik, klinik ve laboratuvar verileri hasta dosyaları incelenerek elde edilmiştir. İşlem öncesi C-reaktif protein ve albumin değerleri kullanılarak GPS değeri hesaplanmıştır.Hastaların 1-yıllık mortalite verisine göre mortalite (+) ve mortalite (-) olmak üzere 2 grup oluşturulmuştur. Bulgular Bu çalışmaya toplam 170 hasta dahil edilmiş ve 59 hasta mortalite (+) grubu oluşturmuştur. Demografik verilerden kronik obstruktif akciğer hastalığı, serebrovasküler hastalık öyküsü olması, yüksek STS-TAVR, Euro SCORE II ve GPS mortalite grubunda daha yüksek saptanmıştır. İşlem öncesi verilerle hesaplanan GPS değerinin yüksek olması 1-yıllık mortalitenin öngördürücüsü olarak belirlenmiştir. Tartışma İnflamasyon ve nutrisyonel durumun birlikte değerlendirilmesine olanak sağlayan Glasgow Prognostik Skoru, rutin laboratuar tetkiklerinden elde edilebilen pratik bir yöntemdir. TAVR uygulanan hastalarda mortalite öngördürücüsü olarak kullanılabilir. İşlem öncesi mortaliteyi azaltabilmek yönünde koruyucu önlemlerin alınmasında klinisyenlere yol gösterebilir.

Anahtar Kelimeler

• Glasgow prognostik skoru
• C-reaktif protein
• albumin
• transkateter aort kapak implantasyonu

The Utility of Glasgow Prognostic Score as an Indicator of Mortality After Transcatheter Aortic Valve Implantation

Öz

Aim The Glasgow Prognostic Score (GPS) is a scoring system obtained by using inflammatory (C-reactive protein) and nutritional (albumin) parameters together, and it has been shown to have prognostic value in various cardiac pathologies in previous studies. In this study, we aimed to investigate the usability of the Glasgow Prognostic Score (GPS) in predicting 1-year mortality in patients who underwent transcatheter aortic valve implantation (TAVI). Method Patients who underwent TAVI with the diagnosis of severe, symptomatic aortic stenosis in our hospital between 2013 and 2017 were included in this single center study retrospectively. Demographic, clinical and laboratory data were obtained by reviewing patient files. GPS value was calculated by using C-reactive protein and albumin values which was obtained on admission to. Two groups were formed as survivors and non-survivors according to 1-year mortality data. Results A total of 170 patients were included in this retrospective study and 59 patients constituted the non-survivors group. History of chronic obstructive pulmonary disease and cerebrovascular disease were higher in non-survivors’ group. High STS-TAVR, Euro SCORE II and GPS levels were also higher in non-survivors group. High GPS value calculated with pre-procedural data was determined as a predictor of 1-year mortality. Conclusion The Glasgow Prognostic Score allows the evaluation of inflammation and nutritional status together, is a practical method that can be obtained from routine laboratory parameters. It can be used as a predictor of mortality in patients undergoing TAVI. It can guide clinicians in taking preventive measures to reduce mortality before the procedure.

Anahtar Kelimeler

• Glasgow Prognostic Score
• C-reactive protein
• albumin
• transcatheter aortic valve implantation

Kaynakça

1. 1. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol (Engl Ed). 2022;75(6):524.
2. 2. Yadgir S, Johnson CO, Aboyans V, Adebayo OM, Adedoyin RA, Afarideh M, et al. Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017. Circulation. 2020;141(21):1670-80.
3. 3. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597-607.
4. 4. Deeb GM, Reardon MJ, Chetcuti S, Patel HJ, Grossman PM, Yakubov SJ, et al. 3-Year Outcomes in High-Risk Patients Who Underwent Surgical or Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2016;67(22):2565-74.
5. 5. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187-98.
6. 6. Lauck SB, Yu M, Ding L, Hardiman S, Wong D, Sathananthan J, et al. Quality-of-Life Outcomes After Transcatheter Aortic Valve Implantation in a "Real World" Population: Insights From a Prospective Canadian Database. CJC Open. 2021;3(8):1033-42.
7. 7. Kim DH, Afilalo J, Shi SM, Popma JJ, Khabbaz KR, Laham RJ, et al. Evaluation of Changes in Functional Status in the Year After Aortic Valve Replacement. JAMA Intern Med. 2019;179(3):383-91.
8. 8. Anand A, Harley C, Visvanathan A, Shah ASV, Cowell J, MacLullich A, et al. The relationship between preoperative frailty and outcomes following transcatheter aortic valve implantation: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2017;3(2):123-32.

9. 9. Sepehri A, Beggs T, Hassan A, Rigatto C, Shaw-Daigle C, Tangri N, et al. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg. 2014;148(6):3110-7.
10. 10. Di Vito A, Donato A, Presta I, Mancuso T, Brunetti FS, Mastroroberto P, et al. Extracellular Matrix in Calcific Aortic Valve Disease: Architecture, Dynamic and Perspectives. Int J Mol Sci. 2021;22(2).
11. 11. Leopold JA. Cellular mechanisms of aortic valve calcification. Circ Cardiovasc Interv. 2012;5(4):605-14. 12. Garcia-Rodriguez C, Parra-Izquierdo I, Castanos-Mollor I, Lopez J, San Roman JA, Sanchez Crespo M. Toll-Like Receptors, Inflammation, and Calcific Aortic Valve Disease. Front Physiol. 2018;9:201.
12. 13. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149-63.
13. 14. Jia Y, Li D, Cao Y, Cheng Y, Xiao L, Gao Y, et al. Inflammation-based Glasgow Prognostic Score in patients with acute ST-segment elevation myocardial infarction: A prospective cohort study. Medicine (Baltimore). 2018;97(50):e13615.
14. 15. Cho A, Arfsten H, Goliasch G, Bartko PE, Wurm R, Strunk G, et al. The inflammation-based modified Glasgow prognostic score is associated with survival in stable heart failure patients. ESC Heart Fail. 2020;7(2):654-62.
15. 16. Nashef SA, Sharples LD, Roques F, Lockowandt U. EuroSCORE II and the art and science of risk modelling. Eur J Cardiothorac Surg. 2013;43(4):695-6.
16. 17. Khan AA, Murtaza G, Khalid MF, Khattak F. Risk Stratification for Transcatheter Aortic Valve Replacement. Cardiol Res. 2019;10(6):323-30.
17. 18. Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003;89(6):1028-30.
18. 19. Lee JH, Meng X, Weyant MJ, Reece TB, Cleveland JC, Jr., Fullerton DA. Stenotic aortic valves have dysfunctional mechanisms of anti-inflammation: implications for aortic stenosis. J Thorac Cardiovasc Surg. 2011;141(2):481-6.
19. 20. Dweck MR, Jones C, Joshi NV, Fletcher AM, Richardson H, White A, et al. Assessment of valvular calcification and inflammation by positron emission tomography in patients with aortic stenosis. Circulation. 2012;125(1):76-86.
20. 21. Zeng Q, Song R, Fullerton DA, Ao L, Zhai Y, Li S, et al. Interleukin-37 suppresses the osteogenic responses of human aortic valve interstitial cells in vitro and alleviates valve lesions in mice. Proc Natl Acad Sci U S A. 2017;114(7):1631-6.
21. 22. Panc C, Yilmaz E, Gurbak I, Uzun F, Erturk M. Effect of prognostic nutritional index on short-term survival after transcatheter aortic valve implantation. Turk Kardiyol Dern Ars. 2020;48(6):585-93.
22. 23. Yamamoto M, Shimura T, Kano S, Kagase A, Kodama A, Sago M, et al. Prognostic Value of Hypoalbuminemia After Transcatheter Aortic Valve Implantation (from the Japanese Multicenter OCEAN-TAVI Registry). Am J Cardiol. 2017;119(5):770-7.