Acil Serviste Pulmoner Emboli Tanısı Alan Hastalarda Laboratuar ve Görüntüleme Yöntemlerinin Tanısal Değeri

Öz

Amaç: Pulmoner Emboli (PE) pulmoner arter veya dallarının trombüsle aniden tıkanması sonucu ortaya çıkan mortalitesi yüksek bir hastalıktır. Bu çalışmada acil servise gelen PE olan hastalardaki tanı konulmadan santral ve periferik dal tutulumunu tespit etmedeki anamnez, laboratuar ve görüntüleme yöntemlerinin etkinliğinin analiz edilmesi amaçlanmıştır.

Materyal ve Metot: Çalışmamızda PE tanısı alan 103 hastanın anamnez,laboratuar ve görüntüleme yöntemleri santarl ve periferik dal tutulumu açısından karşılaştırıldı.

Bulgular: Santral ve periferik dal tutulumu karşılaştırıldığında hs-Troponin I ve laktat değerlerde anlamlı fark bulundu (p değerleri sırasıyla: p=0,003; p=0,003). Santral dal tutulumu olan grubun optimal laktat kesme değeri ROC analizi ile 2,45 bulundu.

Sonuç: hs-Troponin ve laktat değerlerinin santral ve periferik dal tutulumu karşılaştırıldığında anlamlı farklı olduğu bulunmuştur ve bunun PE tanısında santral ve periferik tutulum ayrımı için kullanılabileceği ön görülmüştür. Ancak bu sonucu destekleyecek ilave çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• acil,emboli,pulmoner

Diagnostic Values of Laboratory and Imaging Methods for the Patients with Pulmonary Embolism in the Emergency Service

Abstract

Objective: Pulmonary Embolism (PE) is a disease with high mortality caused by sudden blockage of the pulmonary artery or its branches with thrombus. In this study, it was aimed to analyze the effectiveness of anamnesis, laboratory and imaging methods in detecting central and peripheral branch involvement in patients with PE who came to the emergency department without making a diagnosis.

Materials and Methods: The study has been implemented 103 patients, who received the diagnose of PE, in terms of anamnesis, laboratory and imaging methods after they have been dived into central and peripheral branch involvement.

Results: When central and peripheral branch involvement were compared, a significant difference was found in hs-Troponin I and lactate values (p values, respectively: p = 0.003; p = 0.003). The optimal lactate cut-off value of the group with central branch involvement was 2.45 by ROC analysis.

Conclusion: hs-Troponin and lactate values were found to be significantly different when compared to central and peripheral branch involvement, and it was proposed that this could be used for central and peripheral involvement in the diagnosis of PE. However, additional studies which will bolster this outcome are needed.

Keywords

• Emergency,embolism,pulmonary

Kaynakça

1. 1. Gong JN, Yang YH. Current clinical management status of pulmonary embolism in china. Chin Med J (Engl). 2017;20;130(4):379–381. doi: 10.4103/0366-6999.199841
2. 2. Gülşen Z, Koşar PN, Gökharman FD. Comparison of multidetector computed tomography findings with clinical and laboratory data pulmonary thrombo embolism. Pol J Radiol. 2015;80:252-258. doi: 10.12659/PJR.893793
3. 3. Well PS, Anderson DR, Rodger M, et al. Derivation of a simpleclinical model to categorize patients probability of pulmonary embolism incrising the models utility with the Simpli RED D-dimer. Thromb Haemost. 2000;83 (3):416-20.
4. 4. Crane S, Jaconelli T, Eragat M. Retrospective validation of the pulmonary embolism rule-out criteria rule in 'PE unlikely' patients with suspected pulmonary embolism. European Journal of Emergency Medicine. 2016;0969-9546. doi: 10.1097/MEJ.0000000000000442
5. 5. Konstantinides SV, Torbicki A, Agnelli G, et al. Spyropoulos, 2014 ESC 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). European Heart Journal. 2014;35(43):3033–3080. doi: https://doi.org/10.1093/eurheartj/ehu283
6. 6. Remy JM, Deschildre F, Artaud D, et al. Diagnosis of pulmonary embolism with spiral CT comparison with pulmonary arteriography and scintigraphy. Radiology. 1996;200(3):699-706.
7. 7. Alhassan S, Sayf AA, Arsene C, Kreyem H. Suboptimal implementaion of diagnostic algorithms and over use of computed tomography pulmonary angiography in patients with suspected pulmonary embolism. Annals of Toracic Medicine. 2016;11:254-60. doi: 10.4103/1817-1737.191875
8. 8. Türk Toraks Derneği Pulmoner Tromboembolizm Tanı Ve Tedavi Uzlaşı Raporu – 2015. www.toraks.org.tr/book.aspx?list=1875&menu=269&menu=269.Accessed March 3, 2019.

9. 9. Apfaltrer P, Walter T, Gruettner J, et al. Prediction of adverse clinical outcome in patients with acute pulmonary embolism: evaluation of high-sensitivity troponin I andquantitative CT parameters. European Journal of Radiology. 2013;82 (3):563-7. doi: 10.1016/j.ejrad.2012.11.009
10. 10. Carson JL, Kelley MA, Duff A. The clinical course of pulmonary embolism. N EnglMed. 1992;326:1240-1245.
11. 11. Janke RM, Mcgovern PG, Folsom Ar. Mortality, hospital discharges, and case fatality for pulmonary embolism in the Twin Cities 1980-1995. J Clin Epidemiol. 2000;53(1):103-9.
12. 12. Siddique RM, Siddique MI, Rimm AA. Trends in pulmonary embolism in the US elderly population 1984- through 1991. Am J Public Health. 1998;88(3):478-480.
13. 13. Stein PD, Hsiu Ling H, Afzal A. İncidence of acute pulmonary embolism in a general hospital. Chest. 1999;210:689-91.
14. 14. Exter PL, Es JV, Klok AF. et al. Risk profile and clinical outcome of symptomatic subsegmental acute pulmonary embolism. Blood. 2013;122(7):1144-1149. doi: 10.1182/blood-2013-04-497545
15. 15. Lau JK, Chow V, Brown A, Kritharides L, Ng ACC. Predicting in-hospital death during acute presantation with pulmonary embolism to facilitate early discharge and outpatient manegement. PLos One. 2017;12(7):e0179755. doi: 10.1371/journal.pone.0179755
16. 16. Jain CC, Chang Y, Kabrhel C, et al. Impact of pulmonary arterial clot location on pulmonary embolism treatment and outcomes (90 days). The American Journal of Cardiology. 2016;119(5):802-807. doi: 10.1016/j.amjcard.2016.11.018
17. 17. Kubak MP, Lauritzen PM, Arne Borthne A, et al.elevated d-dimer cut-off values for computed tomography pulmonary angiography d-dimer correlates with location of embolism. Ann Transl Med. 2016;4(11):212. doi: 10.21037/atm.2016.05.55
18. 18. Özsu S, Bektas H, Abul Y, Ozlu T, Örem A.Valueof cardiac troponin and sPESI in treatment of pulmonary thromboembolism at outpatient setting. Lung. 2015;193(4):559-65. doi: 10.1007/s00408-015-9727-5
19. 19. Pruszczyk P, Kostrubiec M, Bochowicz A, et al. N-terminal pro-brain natriuretic peptide in patients with pulmonary embolism. Eur Respir J. 2003;22(4):649-53.
20. 20. Walter T, Apfaltrer P, Weilbacher F, et al. Predictive value og high-sensitivity troponin I and D-dimer assays for adverse outcome in patients with acute pulmonary embolism. Exp Ther Med. 2013;5(2):586-590. doi: 10.3892/etm.2012.825
21. 21. Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation. 2007;116(4):427-33. doi: 10.1161/CIRCULATIONAHA.106.680421
22. 22. Giannitsis E, Müller-Bardorff M, Kurowski V, et al. Independent prognostic value of cardiac troponin T in patients with comfirmed pulmonary embolism. Circulation. 2000;102(2):211-7.
23. 23. In E, Aydın AM, Özdemir C, Sökücü SN, Dağlı MN. The efficacy of CT for detection of right ventricular dysfunction in acute pulmonary embolism, and comparison with cardiac biyomarkers. Japanese Journal of Radiology. 2015;33(8):471–478. doi: 10.1007/s11604-015-0447-9
24. 24. Maskel NA, Butland RJ.A normal serum CRP measurement does not exclude deep vein thrombosis. Thromb Haemost. 2001;86(6):1582-3.
25. 25. Bucek RA, Reiter M, Quehenberger P, Minar E. C-reactive protein in the diagnosis of deep vein thrombosis. Br J Haematol. 2002;119(2):385-9.
26. 26. Aujesky D, Hayoz D, Yersin B, et al. Exclusion of pulmonaryembolismusing C-reactive protein and D-dimer. A prospective comparison. Thromb Haemost. 2003;90(6):1198-203. doi: 10.1160/TH03-03-0175
27. 27. Araz Ö, Yılmazel Uçar E, Yalcin A, et al. Predictive value of serum Hs-CRP levels for outcomes of pulmonary embolism. Clin Respir J. 2016;10(2):163-7. doi: 10.1111/crj.12196
28. 28. Ateş H, Ateş İ, Bozkurt B, et al. What is the most reliable marker in the differantial diagnosis of pulmonary embolism and community-acquired pneumonia? Blood Coagulation & Fibrinolysis. 2016;27(3):252–258. doi: 10.1097/MBC.0000000000000391
29. 29. Crop MJ, Siemes C, Berendes P, et al. Influence of C-reactive protein levels anda ge on the value of D-dimer in diagnosing pulmonary embolism. Eur J Haematol. 2014;92(2):147-55. doi: 10.1111/ejh.12218
30. 30. PIOPED investigators. PİOPED-ΙΙ Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006. doi: 10.1056/NEJMoa052367