Acil Serviste Basitleştirilmiş Pulmoner Emboli Ciddiyet İndeksi’nin Mortaliteyi Öngörmesinin Değerlendirilmesi

Year 2019, , 314 - 319, 28.06.2019

Pınar Yeşim Akyol , Zeynep Karakaya , Fatih Esad Topal , Umut Payza , Eylem Kuday Kaykısız

https://doi.org/10.18521/ktd.511525

Abstract

Simplified Pulmonary Embolism Severity Index in Predicting Mortality in Emergency Department

Abstract

AMAÇ:
Pulmoner emboli (PE) mortalite, morbidite ve hastane yatışının en önemli
nedenlerinden biridir. Bu çalışmada pulmoner embolide Basitleştirilmiş Pulmoner
Emboli Ölçeği İndeksi (sPESI)  ile
hastaların 3 aylık mortalite ilişkisini araştırmayı amaçladık.

GEREÇ
VE YÖNTEM: Çalışmaya toplam 118 hasta dahil edildi. PE tanısından 3 ay sonra
ölen hastalar Grup 1 olarak tanımlandı. Diğer hastalar Grup 2 olarak
tanımlandı. SPESI skoru hesaplandı ve kaydedildi. Bu skorlama sistemlerinin 3
aylık mortalite üzerine etkisi araştırıldı.

BULGULAR:
Grup 1'de 31 hasta (% 26.3) ve Grup 2'de 87 hasta (% 73.7) vardı. Hastaların
sPESI skorları incelendiğinde Grup 1 ve 2 arasında 3 aylık mortalite açısından
fark vardı. 3 aylık mortaliteyi öngörmede sPESI% 43.3 duyarlılık ve% 79.4
özgüllük göstermiştir.

SONUÇ:
Acil serviste PE tanısı alan hastalarını risk profillerine göre ayırmak tedavi
ihtiyaçlarını belirlemek açısından önemlidir.

ABSTRACT

BACKGROUND:
Pulmonary embolism (PE) is one of the major causes of mortality, morbidity and
hospital admission. We aimed to investigate the association of the Simplified
Pulmonary Embolism Severity Index (sPESI) and mortality within 3 months.

MATERIALS
AND METHODS: A total of 118 patients were included in the study. Patients who
died within 3 months after PE diagnosis were defined as Group 1. Other patients
were defined as Group 2. The sPESI score was calculated and recorded. The
effect of these scoring systems on 3-month mortality rate was investigated.

RESULTS:  There were 31 patients (26.3%) in Group 1 and
87 patients (73.7%) in Group 2. When the sPESI scores of the patients were
examined, there was difference between Group 1 and 2 in terms of 3-month mortality.
The sPESI had a sensitivity of 43.3% and a specificity of 79.4% for predicting 3-month
mortality.

CONCLUSION:
It is important to categorize patients diagnosed with PE in the emergency
department according to their risk profiles in terms of their treatment needs.

Keywords

Pulmonary Embolism, emergency medicine

References

• REFERENCES1. Torbicki A, Perrier A, Konstantinides SV, et al. 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). Eur Heart J
• 2. Tapson VF. Acute pulmonary embolism. N Engl J Med 2008; 358: 1037–1052.
• 3. Kearon C, Kahn SR, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008; 133: 454S–545S. 4. Jime´nez D, Yusen RD. Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapy. Current Opin Pulm Med 2008; 14: 414–421.
• 5. Jime´nez D, Yusen RD, Otero R, et al. Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapy. Chest 2007; 132: 24–30.
• 6. Aujesky D, Roy PM, Le Manach CP, et al. Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J 2006; 27: 476–481.
• 7. Donze J, Le Gal G, Fine MJ, et al. Prospective validation of the Pulmonary Embolism Severity Index. A clinical prognostic model for pulmonary embolism. Thromb Haemost 2008; 100: 943–948.
• 8. Aujesky D, Perrier A, Roy PM, et al. Validation of a clinical prognostic model to identify low-risk patients with pulmonary embolism. J Intern Med 2007; 261: 597–604.
• 9. Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, Roy PM, Fine MJ. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172:1041–1046.
• 10. Aujesky D, Roy PM, Verschuren F, Righini M et all. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet. 2011 Jul 2;378(9785):41-8.
• 11. Jimenez D, Aujesky D, Moores L et all. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010;170-1383-9.
• 12. Lankeit M, Gómez V, Wagner C et all. A Strategy Combining Imaging and Laboratory Biomarkers in Comparison With a Simplifi ed Clinical Score for Risk Stratifi cation of Patients With Acute Pulmonary Embolism. Chest. 2011 Apr 10.1378/chest.11-1355 .
• 13. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism clinical outcomesin the International Cooperative Pulmonary Embolism Registry (ICOPER) Lancet 1999;353(9162 (apr(24))):1386-9.
• 14. Rozjabek HM, Coleman CI, Weeda ER et all. Effect of vital sign measurement timing on Pulmonary Embolism Severity Index (PESI) and simplified PESI 30-day mortality risk determination. Thrombosis research 2016 May;141:8-10. 15. Vinson D.R., Ballard D.W., Mark D.G. et all. Risk stratifying emergency department patients with acute pulmonay embolism: Does the simplified Pulmonary Embolism Severity Index perform as well as the original? Thrombosis research 2016 Dec;148:1-8. 16. Venetz C, Jimenez D, Mean M, Aujesky D. A comparison of the original and simplified Pulmonary Embolism Severity Index. Thromb Haemost 2011 sep: 106(3):423-8.
• 17. Can C, Topaçoğlu H, Uçku R. Investigation of relationship between blood hemoglobin level and acute pulmonary embolism in emergency setting. Intern Med J 2013; 20(5):584–6 [3 pp.].
• 18. John B. Harringa, BS a , Rebecca L., Bracken, BA , Scott K. Nagle et all. Anemia is not a risk factor for developing pulmonary embolism. Am J Emerg Med. 2017 Jan;35(1):146-149.
• 19. Jiménez D, Escobar C, Martí D, Díaz G, César J, García-Avello A, et al. Association of anaemia and mortality in patients with acute pulmonary embolism. Thromb Haemost 2009;102(1):153–8.
• 20. World Health Organization (2008). Worldwide prevalence of anaemia 1993–2005. Geneva: World Health Organization. ISBN 978-92-4-159665-7.
• 21. Cappellini MD, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015 Oct;52(4):261-9.