Yıl 2021, Cilt 11 , Sayı 2, Sayfalar 203 - 207 2021-03-25

Acil servise kardiyojenik pulmoner ödem ile başvuran hastalarda hastane içi mortalitenin belirleyicileri
Predictors of in-hospital mortality in patients admitted to the emergency department with cardiogenic pulmonary edema

Ekrem Taha SERT [1] , Kamil KOKULU [2] , Murat GÜL [3] , Hüseyin MUTLU [4]


Amaç: Kalp yetmezliği tedavisindeki önemli ilerlemelere rağmen akut kardiyojenik pulmoner ödemin (AKPÖ) prognozu ciddi bir sorun olmaya devam etmektedir. Bu çalışmanın amacı, ACPE gelişen hastalarda hastane içi mortaliteyi etkileyen risk faktörlerini belirlemektir. Yöntem: Çalışmamıza AKPÖ nedeniyle hastaneye yatırılan 305 hastayı dahil ettik. Klinik, biyokimyasal ve ekokardiyografik bulgular analiz edildi. Hastalar, mortalite varlığına göre iki gruba ayrıldı. Her iki grup acil servise (AS) başvurudaki klinik özellikler ve hastane içi mortaliteye etki eden faktörler açısından değerlendirildi. Bulgular: Hastaların %13.8’i hayatını kaybetti. Mortaliteye etki eden faktörleri belirlemek için çoklu lojistik regresyon analizi yapıldı. Yapılan regresyon analizinde, AS’ye kabulündeki yaş (OR:1.75, %95 CI 1.18-3.05, p:0.014), sistolik kan basıncı (OR: 0.95, %95 CI 0.31-0.98, p:0.040), akut miyokard infarktüsü varlığı OR:4.17, %95 CI 1.85-7.13, p:0.001), pozitif troponin (OR:5.47, %95CI 1.07-7.46, p:0.011), atriyal fibrilasyon (OR;3.16, %95 CI 1.81-8.02, p: 0.010), inotropik ilaç kullanımının (OR;5.61, %95 CI 1.87-9.24, p: 0.013) hastane içi mortaliteyi arttırdığı görüldü. Sonuç: Bulgularımız, tanımlanan risk faktörlerinin varlığında, klinisyenlerin kötü prognoza sahip olacak hastaları erken dönemde tanımlamasına yardımcı olabilir.
Background: Despite significant advances in the treatment of heart failure, the prognosis of acute cardiogenic pulmonary edema (ACPE) continues to be a serious problem. The objective of this study is to determine the risk factors affecting in-hospital mortality in patients with ACPE. Methods: We enrolled 305 patients who were hospitalized with cardiogenic pulmonary edema as a diagnosis. Clinical, biochemical and echocardiographic variables were collected and analysed. The patients were divided into two groups according to the presence of mortality. Both groups were evaluated in terms of clinical features during admission to the emergency department (ED) and factors affecting in-hospital mortality. Results: Forty-two patients died and the mortality rate was 13.8%. To determine the factors affecting mortality, multiple logistic regression analysis was performed. In the regression analysis, it was seen that age at admission to the ED (OR:1.75, 95% CI 1.18-3.05, p:0.014), systolic blood pressure (OR:0.95, 95% CI 0.31-0.98, p:0.040), presence of acute myocardial infarction (OR:4.17, 95% CI 1.85-7.13, p:0.001), positive troponin (OR:5.47, 95% Cl 1.07-7.46, p:0.011), atrial fibrillation rhythm (OR;3.16, 95% CI 1.81-8.02, p:0.010), inotropic drug usage (OR;5.61, 95% CI 1.87-9.24, p:0.013) increased in-hospital mortality. Conclusion: Our findings could help clinicians in identifying patients with poor prognosis early in the presence of identified risk factors.
  • 1. Ezekowitz JA, Bakal J, Kaul P, Westerhout C, Armstrong P. Acute heart failure in the emergency department: short and long-term outcomes of elderly patients with heart failure. Eur J Heart Fail 2008;10:308–314.
  • 2. Gheorghiade M, Filippatos G, De Luca L, Burnett J. Congestion in acute heart failure syndromes: an essential target of evaluation and treatment. Am J Med. 2006;119(12 Suppl 1):S3-S10.
  • 3. Samsky MD, Ambrosy AP, Youngson E, et al. Trends in readmissions and length of stay for patients hospitalized with heart failure in Canada and the United States. JAMA Cardiol. 2019;4(5):444-453.
  • 4. Llorens P, Javaloyes P, Masip J, et al. Prognostic value of chest radiographs in patients with acute heart failure: The Radiology in Acute Heart Failure (RAD-ICA) study. Emergencias. 2019;31(5):318-326.
  • 5. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37(3):267-315.
  • 6. Douglas PS, DeCara JM, Devereux RB, et al. Echocardiographic imaging in clinical trials: American Society of Echocardiography Standards for echocardiography core laboratories: Endorsed by the American College of Cardiology Foundation. American Society of Echocardiography Standards; American College of Cardiology Foundation. J Am Soc Echocardiogr. 2009;22(7):755-65.
  • 7. Maggioni AP, Dahlström U, Filippatos G, et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 2013;15(7):808-17.
  • 8. Gheorghiade M, Abraham WT, Albert NM, et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 2006;296(18):2217-26.
  • 9. Farmakis D, Parissis J, Filippatos G. Acute heart failure: epidemiology, classification and pathophysiology. The ESC textbook of intensive and acute cardiovascular care. Oxford University Press, 2nd ed. 2015:459-469.
  • 10. Parissis JT, Nikolaou M, Mebazaa A, et al. Acute pulmonary oedema: clinical characteristics, prognostic factors, and in-hospital management. Eur J Heart Fail 2010;12(11):1193-202.
  • 11. Attias D, Mansencal N, Auvert B, et al. Prevalence, characteristics, and outcomes of patients presenting with cardiogenic unilateral pulmonary edema. Circulation 2010;122(11):1109-15.
  • 12. Gray A, Goodacre S, Nicholl J, et al. The development of a simple risk score to predict early outcome in severe acute acidotic cardiogenic pulmonary edema: the 3CPO score. Circ Heart Fail 2010;3(1):111-7.
  • 13. Fonarow GC. Clinical risk prediction tools in patients hospitalized with heart failure. Rev Cardiovasc Med 2012;13(1):e14-23.
  • 14. Sridharan L, Klein L. Prognostic factors in patients hospitalized for heart failure. Curr Heart Fail Rep 2013;10(4):380-6.
  • 15. Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ; ADHERE Scientific Advisory Committee Study Group and Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA 2005;293(5):572-80.
  • 16. Nieminen MS, Brutsaert D, Dickstein K, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 2006;27(22):2725-36.
  • 17. Girou E, Brun-Buisson C, Taillé S, Lemaire F, Brochard L. Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema. JAMA 2003;290(22):2985-91.
  • 18. Nohria A, Tsang SW, Fang JC, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol 2003;41(10):1797-804.
  • 19. Agarwal R, Aggarwal AN, Gupta D. Is noninvasive pressure support ventilation as effective and safe as continuous positive airway pressure in cardiogenic pulmonary oedema? Singapore Med J 2009;50(6):595-603.
  • 20. Teke T, Feyzioglu B, Tosun M, Dogan M, Yesildag K, Ozdemir M. The role of torque teno virus (TTV) viremia in sarcoidosis etiology. Kuwait Medical Journal 2019;51(2):157-162.
  • 21. Winck JC, Azevedo LF, Costa-Pereira A, Antonelli M, Wyatt JC. Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema-a systematic review and meta-analysis. Crit Care 2006;10(2):R69.
  • 22. Masip J, Roque M, Sánchez B, Fernández R, Subirana M, Expósito JA. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 2005;294(24):3124-30.
Birincil Dil en
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Orjinal Araştırma
Yazarlar

Orcid: 0000-0002-7208-2186
Yazar: Ekrem Taha SERT (Sorumlu Yazar)
Kurum: Aksaray Üniversity Medical School
Ülke: Turkey


Orcid: 0000-0002-6132-0898
Yazar: Kamil KOKULU
Kurum: Aksaray University Medical School
Ülke: Turkey


Orcid: 0000-0001-6841-1998
Yazar: Murat GÜL
Kurum: Aksaray University Medical School
Ülke: Turkey


Orcid: 0000-0002-1930-3293
Yazar: Hüseyin MUTLU
Kurum: Aksaray University Medical School
Ülke: Turkey


Tarihler

Kabul Tarihi : 1 Şubat 2021
Yayımlanma Tarihi : 25 Mart 2021

AMA Sert E , Kokulu K , Gül M , Mutlu H . Predictors of in-hospital mortality in patients admitted to the emergency department with cardiogenic pulmonary edema. J Contemp Med. 2021; 11(2): 203-207.