Akut Pulmoner Emboli Hastalarında Troponin Değerlerinin Prognoza Etkisi

Year 2019, Volume: 2 Issue: 1, 7 - 12, 31.03.2019

Gizem Mangal Serkan Emre Eroğlu , Gökhan Aksel , Öner Bozan

Abstract

Giriş

Bu çalışmanın amacı
PTE tanısı alan hastalarda troponin değerlerinin prognoza etkisinin araştırılmasıdır.

Materyal ve metod

Toraks
BT anjiografi çekilerek radyolog tarafından pulmoner emboli olarak raporlanmış
ve göğüs hastalıkları uzman doktoru tarafından pulmoner tromboemboli olarak
kabul edilmiş hastalardan 18 yaşından büyük olanlar çalışmaya dahil edilmiştir.
18 yaşından küçük hastalar, fizik muayene, öykü ve laboratuvar verileri eksik
olan hastalar, akut koroner sendrom öyküsü olanlar, kronik böbrek yetmezliği
olanlar (kreatin klirensi <60), akut serebrovasküler olay olan hastalar ve
pulmoner emboli tanısı şüpheli olan hastalar çalışmadan dışlanmıştır.

PTE
tanısı olan hastalar iki gruba ayrıldı: Grup 1; PTE sonrası 30 Günlük dönemde
eksitus olan hastalar, grup 2: PTE sonrası 30 Günlük dönemde eksitus
olmayanlar. Gruplar karşılaştırılırken normal dağılıma uyan veriler için
Student-t testi, normal dağılıma uymayan veriler için Mann Whitney U testi
kullanıldı. Frekans veriler Ki-Kare testi ile karşılaştırıldı. Troponin ve
mortalite ilişkisinin istatistiksel olarak anlamlı olması sonucu troponin
prognoz seviyesini belirleyebilmek için ROC analizi yapıldı ve uygun duyarlılık
ve özgüllük cut-off değerleri belirlendi.

Bulgular

Acil serviste PTE tanısı alan hastaların troponin
değerlerinin 30 günlük dönemdeki prognoz ile ilişkisine bakıldığında troponin
değerlerinin mortal seyreden grupta istatistiksel olarak anlamlı şekilde daha
yüksek olduğu tespit edildi (p=0,031). Eğri altında kalan alan (Area Under Curve -AUC) değer 0,636
olarak hesaplanması nedeniyle troponin değerinin 30 günlük mortaliteyi öngörme
açısından zayıf-orta değerde bir anlamlılığa sahip olduğu saptandı.

 

Sonuç

Bir aylık dönemde
eksitus olan hastalarda troponin değerleri bu dönemde hayatta kalan gruba
oranla istatistiksel anlamlı şekilde daha yüksektir. Buna karşın düşük özgüllük
ve duyarlılık oranları sebebiyle troponin değerlerinin mortalite belirteci
olarak klinik kullanılabilir olmadığını düşünüyoruz. Ancak artmış mortalite ile
olan anlamlı ilişkisi sebebiyle troponin değerleri yüksek olan PTE’li
hastaların hastanede yatırılarak ve daha yakın takibi gerekmektedir.

Keywords

pulmoner emboli, troponin, prognoz

The Effect of Troponin Levels on Prognosis in Patients with Acute Pulmonary Embolism

Abstract

Introduction

The aim of this study is to investigate the effect of troponin levels on
the prognosis in patients diagnosed with PTE (Pulmonary Thromboembolism).

Materials and Methodology

Patients older than 18
years of age amongst the ones who were reported as pulmonary embolism by a
radiologist after going under Thorax CT angiography and accepted as with pulmonary
thromboembolism by a pulmonologist were included in the study. Patients under
18 years of age, patients without physical examination and history, patients
with missing laboratory data, patients with a history of acute coronary
syndrome, patients with chronic renal failure (creatine clearance <60),
patients with acute cerebrovascular events, and patients with suspected
pulmonary embolism were excluded from the study.

Patients with PTE diagnosis
were divided into two groups: Group 1: Patients who died in the 30-day period
after PTE, Group 2: those who did not die during 30-day period after PTE. When
comparing the groups, Student-t test was performed for data adhering to normal
distribution and Mann-Whitney U test was performed for data not adhering to
normal distribution. Frequency data were compared with Chi-Square test. ROC
analysis was performed to determine the troponin prognosis level as a result of
the statistically significant relationship between troponin and mortality and
appropriate sensitivity and specificity cut-off values were determined.

Results

When the relationship between the troponin levels and the prognosis of
patients with PTE in the emergency room was evaluated, it was found that the
troponin values were statistically higher in the group with mortality (p=0,031).
And because the Area Under Curve (AUC) value was calculated as 0.636, the
troponin value was found to have a weak-to-medium significance for predicting
30-day mortality.

 

Conclusion

Troponin levels were significantly higher in
patients who died in one-month period compared to the survivors in the same period.
However, we believe that troponin values are not clinically useful as a marker
of mortality due to low specificity and sensitivity ratios. Yet, because of its
significant relationship with increased mortality, PTE patients with high troponin
levels should be hospitalized and monitored more closely.

Keywords

Pulmonary Embolism, prognosis, troponin

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