High sensitive modified Glasgow prognostic score for predicting ın-hospital mortality ın elderly patients with non-st elevation myocardial infarction

Öz

Aim: Inflammation and malnutrition are poor prognostic markers in acute coronary syndromes. In this study, we aimed to investigate the association between high sensitive modified Glasgow prognostic score (HS-mGPS), derived from C-reactive protein and serum albumin levels, and in-hospital mortality of elderly patients with non-ST elevation myocardial infarction (NSTEMI). Material and Methods: Included subjects were recruited from three different tertiary health centers. Totally, 282 eligible patients aged >65 years with diagnosis of NSTEMI were retrospectively enrolled. Global Registry of Acute Coronary Events (GRACE) risk score for in-hospital mortality and HS-mGPS was calculated for each patient. Subjects were categorized according to their inflammation-based scores ((high HS-mGPS group (HS-mGPS ≥1, n=124) vs. low HS-mGPS group (HS-mGPS =0, n=158)). Results: Both groups were similar regarding admission blood pressure levels, coronary angiography findings, treatment modalities and GRACE scores. Patients with high HS-mGPS had higher admission heart rate and longer hospitalization duration compared to low HS-mGPS group. In-hospital mortality rates were higher in high HS-mGPS group compared to low HS-mGPS group (21.8% (n=27) vs. 3.2% (n=5), respectively, P<0.001). GRACE risk score (HR:1.037, 95% CI: 1.009-1.065, P=0.008) and HS-mGPS ≥1 (HR:4.602, 95% CI: 1.581-13.391, P=0.005) were independent predictors of in-hospital mortality. Furthermore, in hospital mortality in HS-mGPS group was significantly higher than low HS-mGPS group in the Kaplan–Meier curve analysis (log rank P < 0.001). Conclusion: High HS-mGPS is independently associated with in-hospital mortality in elderly patients with NSTEMI. Using this inflammation-based simple score could help in more precise risk estimation in elderly patients daily practice.

Anahtar Kelimeler

• acute coronary syndrome
• albumin
• C-reactive protein
• elderly patients
• Glasgow prognostic score
• myocardial infarction

ST yükselmesiz miyokard enfarktüslü yaşlı hastalarda hastane içi mortaliteyi öngörmek için yüksek duyarlı modifiye Glasgow prognostik skoru

Öz

Amaç: Akut koroner sendromlarda inflamasyon ve malnütrisyon kötü prognostik belirteçlerdir. Bu çalışmada, ST yükselmesiz miyokard enfarktüslü (STYsizME) yaşlı hastalarda C-reaktif protein ve serum albümin düzeylerinden elde edilen yüksek duyarlı modifiye Glasgow prognostik skoru (HS-mGPS) ile hastane içi mortalite arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya dahil edilen hastalar üç farklı üçüncü basamak sağlık merkezinden alındı. 65 yaş üstü STYsizME tanısı almış 282 uygun hasta geriye dönük olarak kaydedildi. Hastane içi ölüm için GRACE risk skoru ve HS-mGPS her hasta için hesaplandı. Hastalar, inflamasyona dayalı skorlarına göre kategorize edildi (yüksek HS-mGPS grubu (HS-mGPS ≥1, n=124)’ e karşın düşük HS-mGPS grubu (HS-mGPS =0, n=158). Bulgular: Çalışma grupları arasında hastaneye yatış kan basıncı düzeyleri, koroner anjiyografi bulguları, tedavi modaliteleri ve GRACE skorları arasında fark yoktu. Yüksek HS-mGPS'li hastalar, düşük HS-mGPS grubuna kıyasla daha yüksek başvuru kalp hızına ve daha uzun hastanede kalış süresine sahipti. Hastane içi ölüm oranları yüksek HS-mGPS grubunda, düşük HS-mGPS grubuna kıyasla daha yüksekti (sırasıyla %21,8 (n=27)’ e karşın %3,2 (n=5), P<0.001). GRACE risk skoru (HR:1,037, %95 GA: 1,009-1,065, P=0,008) ve HS-mGPS ≥1 (HR:4,602, %95 GA: 1,581-13,391, P=0,005) hastane içi mortalitenin bağımsız öngörücüleriydi. Bununla beraber Kaplan Meier analizinde HS-mGPS ≥1 grubunda hastane içi mortalite HS-mGPS =0 grubuna göre beirgin olarak daha yüksekti (long rank testinde P<0,001). Sonuç: Yüksek HS-mGPS, STYsizME' lü yaşlı hastalarda hastane mortalitesi ile bağımsız olarak ilişkilidir. Hesaplaması basit olan bu inflamasyona dayalı skoru kullanmak, yaşlı hastalarda daha kesin risk tahminine yardımcı olabilir.

Anahtar Kelimeler

• akut koroner sendrom
• albümin
• C-reaktif protein
• Glasgow Prognostik Skoru
• miyokard enfarktüsü
• yaşlı hastalar

Kaynakça

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