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

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

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