Koroner Arter Baypas Cerrahisi Sonrası Hastalarda Mortalite Belirteci Olarak Preoperatif Kırmızı Küre Dağılım Hacmi

Yıl 2013, Cilt: 16 Sayı: 1, 1 - 6, 01.01.2012

İrfan Taşoğlu Osman Turak Fırat Özcan Yunus Nazlı Ersin Kadiroğulları Murat Songur Doğan Sert Metin Yılmaz Aslı Demir Alper Uzun

https://doi.org/10.5578/kkd.4603

Öz

Giriş: Biz kırmızı küre dağılım hacmi (RDW)'nin koroner arter hastalarında cerrahi revaskülarizasyon sonrası sonuçlarda belirleyici olduğunu düşündük. Gereç ve Yöntem: Ciddi koroner arter hastalığı olan koroner baypas cerrahisi geçirmiş 94 hasta çalışmaya dahil edildi. Toplam 94 hasta RDW değerlerine göre üç gruba ayrıldı (mean RDW: tertile 1, 12.68 ± 0.60; tertile 2: 13.64 ± 0.49; tertile 3, 16.47 ± 2.04). Bulgular: Ortalama 51 aylık takipte toplam 18 (%19.1) ölüm gözlendi. Yüksek RDW'li hastalar orta (%10) ve düşük (%13) RDW'li hastalara kıyasla yüksek mortalite gösterdi. Değişkenli regresyon analizinde RDW > 14.6 beş yıllık sonuçlar için önemli bağımsız risk faktörüdür. Sonuç: Sonuç olarak, koroner baypas cerrahisi geçirmiş hastaların preoperatif yüksek RDW değeri artmış uzun dönem mortalite riski ile ilişkilidir.

Anahtar Kelimeler

Koroner arter baypas; mortalite; morbidite; kırmızı küre dağılım hacmi.

Preoperative Red Cell Distribution Width as a Predictor of Mortality in Patients After Coronary Artery Bypass Grafting

Öz

Introduction: We hypothesized that the red cell distribution width (RDW) would predict the outcome of surgical revascularization of patients with coronary artery disease. Materials and Methods: Ninety four patients with severe coronary artery disease who underwent coronary artery bypass grafting were included in this study. A total of 94 patients were divided into tertiles based on their preprocedural RDW (mean RDW: tertile 1, 12.68 ± 0.60; tertile 2: 13.64 ± 0.49; tertile 3, 16.47 ± 2.04). Results: There were a total of 18 (19.1%) deaths over a mean follow-up of 51 months. Patients with a high RDW showed the highest mortality (34%) as compared to patients with medium (10%) and low RDW (13%). In multivariable regression modeling, RDW > 14.6 was a significant independent predictor of five year outcome in mortality. Conclusion: In conclusion, elevated preprocedural RDW in patients undergoing coronary artery bypass grafting is associated with increased risk of long-term mortality.

Anahtar Kelimeler

Coronary artery bypass grafting; mortality; morbidity; red cell distribution width.

Kaynakça

• Bridgewater B, Grayson AD, Jackson M, Brooks N, Grotte GJ, Keenan DJ, et al. Surgeon specific mortality in adult cardiac sur- gery: comparison between crude and risk stratified data. BMJ 2003;327:13-7.
• Van Kimmenade RR, Mohammed AA, Uthamalingam S, van der Meer P, Felker GM, Januzzi JL Jr.Red blood cell distribution width and 1-year mortality in acute heart failure. European Journal of Heart Failure 2010;12:129-36.
• Zalawadiya SK, Veeranna V, Niraj A, Pradhan J, Afonso L. Red cell distribution width and risk of coronary heart disease events. Am J Cardiol 2010;106:988-93.
• Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation 2008;117:163-8.
• Zorlu A, Bektasoglu G, Kukul Guven FM, Dogan OT, Gucuk E, et al. MB. Usefulness of admission red cell distribution width as pre- dictor of earlymortality in patients with acute pulmonary embolism. Am J Cardiol 2007;3:40-7.
• Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Preffer MA, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Da- tabank. J Am Coll Cardiol 2007;50:40-7.
• Cavusoglu E, Chopra V, Gupta A, Choski PU, Ruwende C, Yan- amadala S, et al. Relation between red blood cell distribution width (RDW) and all-cause mortality at two years in an unse- lected population referred for coronary angiography. Int J Cardiol 2010;141:141-6.
• Fukuta H, Ohte N, Mukai S, Saeki T, Asada K, Wakami K, et al. Elevated plasma levels of B-type natriuretic peptide but not C-re- active protein are associated with higher red cell distribution width in patients with coronary artery disease. Int Heart J 2009;50:301- 12.
• Karnad A, Poskitt TR, The automated complete blood cell count. Arch Intern Med 1985;145:1270-2.
• Thompson WG, Meola T, Lipkin M Jr, Freedman ML. Red cell distribution width, mean corpuscular volume, and transferrin saturation in the diagnosis of iron deficiency. Arch Intern Med 1988;148:2128-30.
• Comeaux L, Fife DJ, McKenzie SB. Instructor’s Guide for Clinical Laboratory Hematology. Upper Saddle River, New Jersey: Pear- son/Prentice-Hall, 2004.
• Pascual-Figal DA, Bonaque JC, Redondo B, Caro C, Manzano- Fernandez S, Sánchez-Mas J, et al. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail 2009;11:840-6.
• Hampole CV, Mehrotra AK, Thenappan T, Gomberg-Maitland M, Shah SJ. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol 2009;104:868- 72.
• Mautner GC, Mautner SL, Roberts WC. Amounts of coronary arte- rial narrowing by atherosclerotic plaque at necropsy in patients with lower extremity amputation. Am J Cardiol 1992;70:1147-51.
• Pereira IA, Borba EF. The role of inflammation, humoral and cell mediated autoimmunity in the pathogenesis of atherosclerosis. Swiss Med Wkly 2008;138:534-9.
• Croal BL, Hillis GS, Gibson PH, Fazal MT, El-Shafei H, Gibson G, et al. The relationship between post-operative cardiac tro- ponin I levels and outcome from cardiac surgery. Circulation 2006;114:1468-75.
• Gasz B, Lenard L, Benko L, Borsiczky B, Szanto Z, Lantos J, et al. Expression of CD97 and adhesion molecules on circulating leuko- cytes in patients undergoing coronary artery bypass surgery. Eur Surg Res 2005;37:281-9.
• Bagger JP, Zindrou D, Taylor KM. Leukocyte count: a risk factor for coronary artery bypass graft mortality. Am J Med 2003;115:660-3.