Acil serviste kardiyovasküler hastalık tanısı ( dekompanze kalp yetmezliği ve pulmoner tromboemboli) almış hastaların serum gama-glutamil transferaz düzeyinin hasta sonuçlanımına ve mortaliteye etkisi : retrospektif çalışma
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Pulmoner emboli (PE), pulmoner arterin veya dallarından birinin vücudun başka bir yerinden kaynaklanan bir materyal tarafından tıkanmasıdır. PE'deki son 30 yılda görülen gelişmelere rağmen erken ölüm oranları yüksektir, nispeten yaygın bir akut kardiyovasküler bozukluktur. Kalp yetmezliği (KY), yapısal veya foksiyonel bir kardiyak anormalliğin neden olduğu çeşitli belirtiler (yüksek juguler venöz basınç, pulmoner raller ve periferik ödem) ve çeşitli semptomlarla (nefes darlığı, ayak bileği şişmesi ve yorgunluk) karakterize bir klinik sendromdur). KY'de yeni ve kötüleşen semptomlar sıklıkla hastaneye yatış ve acil servis başvurusu ile sonuçlanmaktadır. Dünya genelinde yaşlanan popülasyonla birlikte salgın düzeyine gelmiştir. Gama-glutamil transpeptidaz (GGT), glutatyonun diğer peptitlere ve L-amino asitlere transferini katalize etmektedir. GGT, böbrek, pankreas, karaciğer, kalp, dalak, beyin ve seminal veziküller gibi pek çok dokunun hücre zarlarında yer almaktadır. Glutatyonun antioksidan etkisi ve GGT'ın glutatyon metabolizmasındaki önemi yapılan deneysel çalışmalarla gösterilmiştir. Bu özelliğinden dolayı GGT düzeyleri başta hipertansiyon ve diyabet olmak üzere birçok kardiyovasküler hastalık ile ilişkilendirilmiştir. Bu bilgilerden yola çıkarak tasarladığımız çalışmamızda hem akut PE hem de dekompanse KY hastalarında hastaneye başvuru anında ölçülen GGT düzeylerinin acil servis sonlanımı ve 28 günlük mortalite ile ilişkisini tespit etmek amaçlanmıştır. Gereç ve Yöntem: Çalışmamız bir retrospektif kohort çalışması olarak planlandı. Ege Üniversitesi Tıp Fakültesi Acil Servisi'ne 01.03.2022-31.08.2022 tarihleri arasında başvuran ve yapılan tetkikler sonucunda akut pulmoner emboli (n=274) ve/veya dekompanze kalp yetmezliği (n=365) tanısı almış hastalar çalışmaya alındı. Bu hastalar arasında dışlanma kriterlerinden en az birine sahip olan 98 PE hastası ve 40 dekompanse KY hastası çalışma dışı bırakıldı. Her iki hastalık popülasyonunu oluşturan hastaların bilgileri demografik veriler, klinik ve laboratuvar bulguları, ekokardiyografi bulguları, acil servis sonlanımı, 28 günlük mortalite ve tercih edilen tedavi yöntemi gibi parametreler açısından tarandı. Hastalar acil servis sonlanımına göre iyi prognoz ve kötü prognoz olarak 2 gruba ayrıldı. İyi prognoz taburculuk ve servis yatışını, kötü prognoz ise yoğun bakım yatışı ve exitusu ifade etmekteydi. Bağımsız değişkenler ile bağımlı değişkenlerin ilişkisi istatistiksel olarak analiz edildi. Analizde SPSS Windows 26.0 versiyon paket programı kullanıldı. Kategorik değişkenlerin analizinde Pearson Ki-Kare/Fisher'ın kesin testi kullanıldı. Bağımsız iki grup karşılaştırmalarında bağımsız örneklem t testi /Mann Whitney U testi uygulandı. Bulgular: Çalışmaya 126 'sı PE, 325'i dekompanse KY olmak üzere toplam 501 hasta alındı. PE hastalarında medyan yaş 76, DKY hastalarında ise 73'tü. Her iki grubun başvuru anı GGT seviyeleri incelendiğinde; PE hastalarında ortanca değer 31.5 U/L (8-290), DKY 8 hastalarında ise 45 U/L (5-589) idi. PE hastalarının 43'ü (%24.4), DKY hastalarının ise 57'si (%17.5) 28 günlük mortaliteye sahipti. PE hastalarının %47.2'sinin acil servis sonlanımı kötü iken, DKY hastalarında bu oran %53.6 idi. PE hastalarında ortalama yaş, 28 günlük mortalitesi olan grupta olmayan gruba göre istatistiksel olarak anlamlı düzeyde yüksekti (p=0.04). Başvuru anı oksijen satürasyonu, sistolik ve diyastolik kan basıncı düzeyi 28 günlük mortalitesi olan grupta diğer gruba göre anlamlı düzeyde düşüktü (sırasıyla p=0.001, p=0.020, p=0.004). DKY hastalarında ise sistolik ve diyastolik kan basıncı 28 günlük mortalite ile ilişkiliydi (p<0.01, p=0.01). Laboratuvar parametrelerinden AST, Troponin T ve NT-ProBNP PE hastalarında 28 günlük mortalite ile ilişkiliydi (sırayla p=0.012, p<0.001, p=0.018). Ancak GGT ile 28 günlük mortalite arasında da ilişki yoktu. DKY tanılı hastalarında 28 günlük mortaliteye sahip olanlarda GGT düzeyi anlamlı düzeyde yüksekti (p=0.008). GGT dışında AST, TropT, NT-proBNP, kreatinin ve D-dimer 28 gün içinde mortalite ile ilişkili parametrelerdi (sırasıyla p=0.003, p=0.005, p<0.001, p=0.035, p=0.001). GGT'nin 49 U/L değeri 28 günlük mortaliteyi ayırt ettirmede cut-off olarak bulundu. Bu değer %63.2 sensitivite %59.3 spesifiteye sahipti. Sonuç: Antioksidan mekanizmada görev alan enzimlerden biri olan GGT, KY hastalarında 28 günlük mortaliteyi öngörmede faydalı bir parametre olabilir. DKY hastalarında GGT'nin 49 değeri 28 günlük mortaliteyi ayırt ettirmede en uygun değer olarak bulunmuştur. Ancak rutin kullanıma girebilmesi için validasyon çalışmalarına ihtiyaç vardır. Anahtar kelimeler: pulmoner tromboemboli, dekompanse kalp yetmezliği, gama glutamil transferaz, acil servis sonlanımı, 28 günlük mortalite
Introduction and Objective: Pulmonary embolism (PE) is the obstruction of the pulmonary artery or one of its branches by a material originating from another part of the body. Despite advances in PE over the past 30 years, premature death rates are high, it is a relatively common acute cardiovascular disorder. Heart failure (HF) is a clinical syndrome characterized by a variety of signs (high jugular venous pressure, pulmonary rales, and peripheral edema) and various symptoms (shortness of breath, ankle swelling, and fatigue) caused by a structural or functional cardiac abnormality). New and worsening symptoms in HF often result in hospitalization and emergency room visits. It has reached the epidemic level with the aging population worldwide. Gamma-glutamyl transpeptidase (GGT) catalyzes the transfer of glutathione to other peptides and L-amino acids. GGT is located in the cell membranes of many tissues such as kidney, pancreas, liver, heart, spleen, brain and seminal vesicles. The antioxidant effect of glutathione and the importance of GGT in glutathione metabolism have been demonstrated by experimental studies. Because of this feature, GGT levels have been associated with many cardiovascular diseases, especially hypertension and diabetes. In our study, which we designed based on this information, it was aimed to determine the relationship of GGT levels measured at the time of admission to the hospital with emergency service outcome and 28-day mortality in both acute PE and decompensated HF patients. Materials and Methods: Our study was planned as a retrospective cohort study. Patients who applied to Ege University Medical Faculty Emergency Service between 01.03.2022 and 31.08.2022 and were diagnosed with acute pulmonary embolism (n=274) and/or decompensated heart failure (n=365) as a result of the tests were included in the study. Among these patients, 98 PE patients and 40 decompensated HF patients who had at least one of the exclusion criteria were excluded from the study. The information of the patients in both disease populations was scanned in terms of parameters such as demographic data, clinical and laboratory findings, echocardiographic findings, emergency room outcome, 28-day mortality, and preferred treatment method. The patients were divided into 2 groups as good prognosis and poor prognosis according to the emergency department outcome. Good prognosis was discharge and hospitalization, and poor prognosis was intensive care admission and exitus. The relationship between independent variables and dependent variables was statistically analyzed. SPSS Windows 26.0 version package program was used in the analysis. Pearson Chi-Square/Fisher's exact test was used in the analysis of categorical variables. 10 Independent sample t test / Mann Whitney U test was used for comparison of two independent groups. Results: A total of 501 patients, 126 with PE and 325 with decompensated HF, were included in the study. The median age was 76 in PE patients and 73 in DHF patients. When the GGT levels of both groups at the time of application were examined; The median value was 31.5 U/L (8-290) in PE patients and 45 U/L (5-589) in DHF patients. 43 ( 24.4% ) of PE patients and 57 (17.5%) of DHF patients had 28-day mortality. While 47.2% of PE patients had poor emergency room outcome, this rate was 53.6% in DHF patients. The mean age in PE patients was statistically significantly higher in the group with 28-day mortality compared to the group without (p=0.04). At admission, oxygen saturation, systolic and diastolic blood pressure levels were significantly lower in the group with 28-day mortality compared to the other group (p=0.001, p=0.020, p=0.004, respectively). Systolic and diastolic blood pressures were associated with 28-day mortality in DHF patients (p<0.01, p=0.01). Laboratory parameters such as AST, Troponin T and NT-ProBNP were associated with 28-day mortality in PE patients (p=0.012, p<0.001, p=0.018, respectively). However, there was no correlation between GGT and 28-day mortality. The GGT level was significantly higher in patients with DHF who had a 28-day mortality (p=0.008). Apart from GGT, AST, TropT, NT-proBNP, creatinine, and D-dimer were parameters associated with mortality at 28 days (p=0.003, p=0.005, p<0.001, p=0.035, p=0.001, respectively). 49 U/L value of GGT was found to be the cut-off in distinguishing 28-day mortality. This value had 63.2% sensitivity and 59.3% specificity. Conclusion: GGT, one of the enzymes involved in the antioxidant mechanism, may be a useful parameter in predicting 28-day mortality in patients with HF. 49 value of GGT was found to be the most appropriate value in differentiating 28-day mortality in DHF patients. However, validation studies are needed before it can be used routinely. Key words: pulmonary thromboembolism, decompensated heart failure, gamma glutamyl transferase, emergency department outcome, 28-day mortality
Introduction and Objective: Pulmonary embolism (PE) is the obstruction of the pulmonary artery or one of its branches by a material originating from another part of the body. Despite advances in PE over the past 30 years, premature death rates are high, it is a relatively common acute cardiovascular disorder. Heart failure (HF) is a clinical syndrome characterized by a variety of signs (high jugular venous pressure, pulmonary rales, and peripheral edema) and various symptoms (shortness of breath, ankle swelling, and fatigue) caused by a structural or functional cardiac abnormality). New and worsening symptoms in HF often result in hospitalization and emergency room visits. It has reached the epidemic level with the aging population worldwide. Gamma-glutamyl transpeptidase (GGT) catalyzes the transfer of glutathione to other peptides and L-amino acids. GGT is located in the cell membranes of many tissues such as kidney, pancreas, liver, heart, spleen, brain and seminal vesicles. The antioxidant effect of glutathione and the importance of GGT in glutathione metabolism have been demonstrated by experimental studies. Because of this feature, GGT levels have been associated with many cardiovascular diseases, especially hypertension and diabetes. In our study, which we designed based on this information, it was aimed to determine the relationship of GGT levels measured at the time of admission to the hospital with emergency service outcome and 28-day mortality in both acute PE and decompensated HF patients. Materials and Methods: Our study was planned as a retrospective cohort study. Patients who applied to Ege University Medical Faculty Emergency Service between 01.03.2022 and 31.08.2022 and were diagnosed with acute pulmonary embolism (n=274) and/or decompensated heart failure (n=365) as a result of the tests were included in the study. Among these patients, 98 PE patients and 40 decompensated HF patients who had at least one of the exclusion criteria were excluded from the study. The information of the patients in both disease populations was scanned in terms of parameters such as demographic data, clinical and laboratory findings, echocardiographic findings, emergency room outcome, 28-day mortality, and preferred treatment method. The patients were divided into 2 groups as good prognosis and poor prognosis according to the emergency department outcome. Good prognosis was discharge and hospitalization, and poor prognosis was intensive care admission and exitus. The relationship between independent variables and dependent variables was statistically analyzed. SPSS Windows 26.0 version package program was used in the analysis. Pearson Chi-Square/Fisher's exact test was used in the analysis of categorical variables. 10 Independent sample t test / Mann Whitney U test was used for comparison of two independent groups. Results: A total of 501 patients, 126 with PE and 325 with decompensated HF, were included in the study. The median age was 76 in PE patients and 73 in DHF patients. When the GGT levels of both groups at the time of application were examined; The median value was 31.5 U/L (8-290) in PE patients and 45 U/L (5-589) in DHF patients. 43 ( 24.4% ) of PE patients and 57 (17.5%) of DHF patients had 28-day mortality. While 47.2% of PE patients had poor emergency room outcome, this rate was 53.6% in DHF patients. The mean age in PE patients was statistically significantly higher in the group with 28-day mortality compared to the group without (p=0.04). At admission, oxygen saturation, systolic and diastolic blood pressure levels were significantly lower in the group with 28-day mortality compared to the other group (p=0.001, p=0.020, p=0.004, respectively). Systolic and diastolic blood pressures were associated with 28-day mortality in DHF patients (p<0.01, p=0.01). Laboratory parameters such as AST, Troponin T and NT-ProBNP were associated with 28-day mortality in PE patients (p=0.012, p<0.001, p=0.018, respectively). However, there was no correlation between GGT and 28-day mortality. The GGT level was significantly higher in patients with DHF who had a 28-day mortality (p=0.008). Apart from GGT, AST, TropT, NT-proBNP, creatinine, and D-dimer were parameters associated with mortality at 28 days (p=0.003, p=0.005, p<0.001, p=0.035, p=0.001, respectively). 49 U/L value of GGT was found to be the cut-off in distinguishing 28-day mortality. This value had 63.2% sensitivity and 59.3% specificity. Conclusion: GGT, one of the enzymes involved in the antioxidant mechanism, may be a useful parameter in predicting 28-day mortality in patients with HF. 49 value of GGT was found to be the most appropriate value in differentiating 28-day mortality in DHF patients. However, validation studies are needed before it can be used routinely. Key words: pulmonary thromboembolism, decompensated heart failure, gamma glutamyl transferase, emergency department outcome, 28-day mortality
Açıklama
Anahtar Kelimeler
Acil Tıp, Emergency Medicine ; Göğüs Hastalıkları, pulmoner tromboemboli, dekompanse kalp yetmezliği, gama glutamil transferaz, acil servis sonlanımı, 28 günlük mortalite
