Investigation of a Possible Relationship Between Clinical and Laboratory Values of Acute Pulmonary Embolism and Thrombus Location

Yıl 2018, , 41 - 50, 30.04.2018

Cihan Bedel Sadiye Yolcu , Levent Albayrak , Nesrin Çetin Önder Tomruk

https://doi.org/10.24938/kutfd.324261

Cited By: 1

Öz

Objective: In this
study, we aimed to investigate whether a relationship existed between the
clinical and laboratory values of 132 patients with acute pulmonary embolism (PE)
diagnosed in the emergency department and the location of the thrombus.

Material and Methods: One hundred and thirty two patients with acute pulmonary
embolism diagnosed and treated in the emergency service between January 2013
and January 2015 were retrospectively investigated. Patients were divided into
two groups according to their age as below 65 and above 65 years-old. Wells and
Geneva scoring systems were used for clinical scoring purposes. Patient data
retrieved from hospital records were retrospectively analyzed in detail.

Results: A PE was
significantly higher in women over 65 years (p = 0.03). The incidence of PE was
significantly higher in patients with immobility, stroke, coronary artery
disease and in elderly patients with heart failure (p = 0.001, p = 0.017, p =
0.012, p = 0.036 respectively). PE was significantly higher in the group who
underwent surgical operation and had trauma (p = 0.015, p = 0.024). Well’s scoring system predicted pulmoner emboli
significantly better than the Geneva score (p <0.001). The Geneva score was
significantly lower in the younger group (p = 0.015). When serum D-dimer level was over 500 μg / mL, the
increase in pulmonary emboli incidence was significant (p = 0.022). Presence of proximally localized thrombus was found to be
significantly higher in patients with major trauma (p = 0.022). The proximal embolism rate in patients with high
D-dimer levels was significantly increased compared to patients with distal
embolus (p = 0.043). In patients
with a high Well's score, the rate of proximally located pulmonary embolus was
significantly higher than distally located pulmonary emboli (p = 0.004). In patients with high Geneva score, proximally located
pulmonary embolus was significantly common compared to distally located
pulmonary emboli (p=0.007).

Conclusion: According
to our study, in PE patients major trauma, increased D-Dimer levels, higher
Wells scores and higher Geneva scores indicate proximally located thrombus. We
think that more detailed prospective studies should be done in order to achieve
clearer results.

Anahtar Kelimeler

Pulmonary Embolism, Well's scoring, Geneva scoring

AKUT PULMONER EMBOLİDE KLİNİK VE LABORATUVAR DEĞERLERİ İLE TROMBÜS YERLEŞİM YERİ ARASINDAKİ İLİŞKİNİN ARAŞTIRILMASI

Öz

Amaç: Bu
çalışmada, acil serviste akut pulmoner emboli (PE) tanısı konulan 132 hastanın,
başvuru anındaki klinik ve laboratuvar değerleri ile trombüs yerleşim yeri
arasında anlamlı bir ilişki olup olmadığını araştırmayı hedefledik

Gereç ve Yöntem:
Acil
servise, Ocak 2013- Ocak 2015 tarihleri arasında akut pulmoner emboli tanısı
konularak tetkik ve tedavisi yapılan 132 hasta, retrospektif olarak incelendi.
Hastalar, 65 yaş altı ve üstü iki gruba ayrıldı. Klinik skorlama amacı ile
Well’s ve Cenevre skorlama sistemleri kullanıldı. Hastane kayıtlarından
hastaların tüm bulguları, geriye dönük olarak ayrıntılı olarak incelendi.

Bulgular: 65 yaş üstü
kadınlarda PE, istatistiksel olarak anlamlı fazla bulundu (p=0.03). İmmobilite,
inme, koroner arter hastalığı, kalp yetmezliği, yaşlı grupta, PE insidansı
anlamlı yüksek saptandı (sırasıyla p=0.001, p=0.017, p=0.012, p=0.036). PE,
cerrahi operasyon ve travma genç grupta anlamlı yüksek saptandı (p=0.015,
p=0.024). Well’s skorlamasının yüksek olasılıklı pulmoner emboli tahmin oranı
Cenevre skoruna göre anlamlı oranda fazlaydı (p<0.001). Cenevre skorlaması
genç grupta anlamlı düşük bulunmuştur (p=0.015). Serum D-Dimer değeri 500 μg/ml
üzerinde Wells skorunun klinik olasılığının artması arasında anlamlı fark
bulunmuştur (p=0.022). Majör travmalı olgularda proksimal yerleşimli trombüs
anlamlı bulundu (p=0.022). Serum D-Dimer düzeyi artışı ile proksimal yerleşimli
emboli oranı, distal yerleşimli emboliye oranla anlamlı olarak artmış bulundu
(p=0.043). Well’s skoru yüksek olan hastalarda pulmoner embolinin proksimal
yerleşimi distale göre istatistiksel olarak anlamlı fazlaydı (p=0.004). Cenevre
skoru yüksek olan hastalarda pulmoner embolinin proksimal yerleşimi distale
göre istatistiksel olarak anlamlı, fazlaydı (p=0.007).

Sonuç: Çalışmamızın
sonuçlarına göre, PE hastalarında, riskler açısından majör travma, laboratuvar
açısından D-Dimer yüksekliği, Wells skor yüksekliği, Cenevre skoru yüksekliği
trombüsün proksimal yerleşimine işaret etmektedir. Konu ile ilgili olarak, daha
net sonuçlara varabilmek için daha fazla ileriye dönük kapsamlı çalışmalar
yapılması gerektiğini düşünmekteyiz.

Anahtar Kelimeler

Pulmoner emboli, Well’s skorlaması, Cenevre skorlaması, Cenevre skorlaması

Kaynakça

• Prandoni P, ten Cate JW. Epidemiology, risk factors, and naturel history of venous thromboembolism. In: Oudkerk M, van Beek EJR, ten Cate JW, eds. Pulmonary embolism, diagnosis and treatment. Berlin: Blackwell. 1999:2-34.
• Stein PD, Huang Hl, Afzal A, Noor HA. Incidence of acute pulmonary embolism in a general hospital, relation to age, sex, and race. Chest. 1999;116:909-13.
• Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology. Eur Heart J. 2000;21:1301-36.
• Kadakal F, Çetinkaya E, Yıldız P, Soysal F, Tekin A, Yılmaz V. Klinik olarak yüksek olasılıklı pulmoner emboli olgularında tanı. Solunum Hastalıkları. 2000;11:140-3.
• Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999;353:1386-9.
• Punukollu H, Khan IA, Punukollu G, Gowda RM, Mendoza C, Sacchi TJ. Acute pulmonary embolism in elderly: clinical characteristics and outcome. Int J Cardiol. 2005;99:213-6.
• Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:338-400.
• Rosendaal FR, Helmerhorst FM, Vandenbroucke JP. Female hormones and thrombosis. Arterioscler Thromb Vasc Biol. 2002;22:201-10. Okyay K, Cemri M, Cengel A. Acute pulmonary embolism. Anadolu Kardiyol Derg. 2005;5:221-6.
• Timmons S, Kingston M, Hussain M, Kelly H, Liston R. Pulmonary embolism: differences in presentation between older and younger patients. Age Ageing. 2003;32:601-5.
• Masotti L, Ceccarelli E, Cappelli R, Guerrini M, Forconi S. Pulmonary embolism in the elderly: clinical, instrumental and laboratory aspects. Gerontology. 2000;46:205-11.
• Ramos A, Murillas J, Mascias C, Carretero B, Portero JL. Influence of age on clinical presentation of acute pulmonary embolism. ArchGerontol Geratr. 2000;30:189-98.
• The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA. 1990;263:2753-9.
• Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008;29:2276-315.
• Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med. 1999;159:864-71.
• Orhan Arseven: Akut Pulmoner Embolizm. Göğüs Hastalıkları Acilleri. Ekim N, Türktaş H (eds). Ankara. 2000:247-65.
• Stein PD, Terrin ML, Hales CA. Clinical, laboratory, roentgenographic and electrocardiographic findings in patient with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100:598.
• Kokturk N, Oguzulgen IK, Demir N, Demirel K, Ekim N. Differences in clinical presentation of pulmonary embolism in older vs younger patients. Circ J. 2005;69:981-6.
• Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest. 1997;112:974-9. Stein PD, Goldhaber SZ, Henry JW, Miller AC. Arterial blood gas analysis in the assesment of suspected acute pulmonary embolism. Chest. 1996;109:78-81.
• Lee S, Jeong H, In K, Yoo S, Kim S, Kim J, et al. Clinical characteristics of acute pulmonary thromboembolism in Korea. Int J Cardiol 2006;108:84-8.
• Şen N, Ermiş H, Altınkaya N. Genç ve yaşlı pulmoner embolili olgularımız: Klinik özellikler, laboratuvar ve instrumental bulgular ve yaş gruplarına göre farklılıklar. Tur Toraks Der. 2010;11:160-6.
• Ghanima W, Abdelnoor M, Holmen LO, Nielssen BE, Ross S, Sandset PM. D-Dimer level is associated with the extent of pulmonary embolism. Thromb Res. 2007;120:281-8.
• Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998;129:997-1005.
• Wicki J, Perneger TV, Junod AF, Bounameaux H, Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med. 2001;161:92-7.
• Righini M, Le Gal G, Perrier A, Bounameaux H. Effect of age on the assessment of clinical probability of pulmonary embolism by prediction rules. J Thromb Haemost. 2004;2:1206-8.
• De Monyé W, van Strijen MJ, Huisman MV, Kieft GJ, Pattynama PM. Suspected pulmonary embolism: Prevalence and anatomic distribution in 487 consecutive patients. Advances in New Technologies Evaluating the Localisation of Pulmonary Embolism (ANTELOPE) Group. Radiology. 2000;215:184-8.
• Oser RF, Zuckerman DA, Gutierrez FR, Brink JA. Anatomic distribution of pulmonary emboli at pulmonary angiography: Implications for cross-sectional imaging. Radiology 1996;199:31-5.