Is there Any Relationship Between Long-Term Mortality of Acute Pulmonary Embolism and Complete Blood Count Analysis?
Öz
Purpose:Acute pulmonary embolism (PE) is a challenging disease as the third most common cause of cardiovascular death. Despite various scoring systems and blood parameters, more simple and practical predictors are being investigated. The objective of this study is to investigate the relationship between hospital and long-term mortality and complete blood count parameters, neutrophil-to-lymphocyte ratio (PLR) and platelet-to-lymphocyte ratio (PLR) in patients with acute PE.
Patients and Methods:The present study is a retrospective observational study. Between June 2016 and June 2018, patients hospitalised in our chest diseases clinic with evident PE were included. Demographics, baseline complete blood count, D-dimer (mg/L) and C-reaktif protein (mg/L) values were recorded. In-hospital mortality and long-term mortality were investigated and predictors of mortality were analyzed.
Results:Of all the 74 pateints, 36 (49%) were male and the mean age was 65±18 (20-89). Embolus was localised in main pulmonary artery in 51%, right heart dysfunction were noted in 8 (10%) patients. Baseline NLR was significantly higher in patients who died in hospital (9.8±7.1 vs. 5.3±4.8, respectively) (P=0.037). Additionally NLR was found as a predictor of long-term mortality (P=.,047). The other predictors for long-term mortality were male gender (P=0.002), advanced age (P=0.023) and lower hemoglobin (P=0.013) values.
Conclusion:Acute PE may lead mortality and require close follow-up of patients. Higher NLR values relate both in-hospital and long-term mortality and may be used as a cheap, simple and useful prognostic predictor in patients with PE.
Anahtar Kelimeler
Kaynakça
- 1. Garcia-Sanz MT, Pena-Alvarez C, Lopez-Landeiro P, Bermo-Dominguez A, Fonturbel T, Gonzalez-Barcala FJ, et all. Symptoms, lo¬cation and prognosis of pulmonary embolism. Rev Port Pneumol 2014;20(4):194-9.
- 2. Arseven O, Sevinç C, Alataş F, Ekim N, Erkan L, Fındık S, et al. Türk Toraks Derneği Pulmoner Tromboembolizm Tanı ve Tedavi Uzlaşı Raporu. Turk Toraks Derg 2009;10(Suppl 11):1-47.
- 3. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998;158(6):585–93.
- 4. Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Berggvist D, Brecht JG, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98(04):756–64.
- 5. Wang Q, Ma J, Jiang Z, Ming L. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol 2018;37(1):4-11.
- 6. Balta S, Unlu M, Arslan Z, Demırkol S. Neutrophil-to-lymphocyte ratio in prognosis of gastric cancer. J Gastric Cancer 2013;13(3):196-97.
- 7. Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011;107(3):433-38.
- 8. Yıldız A, Kaya H, Ertaş F, Oylumlu M, Bilik MZ, Yüksel M, et al. Association between neutrophil to lymphocyte ratio and pulmonary arterial hypertension. Turk Kardiyol Dern Ars 2013;41(7):604-609.
- 9. Kayrak M, Erdoğan HI, Solak Y, Akilli H, Gül EE, Yildirim O, et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a restrospective study. Heart Lung Circ 2014; 23(1):56-62.
- 10. Ya Y, Mao Y, He X, Sun Y, Huang S, Qui J. The values of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting 30 day mortality in patients with acute pulmonary embolism. BMC Cardiovasc Disord 2016;4(16):123.
- 11. Soylu K, Gedikli Ö, Ekşi A, Avcıoğlu Y, Soylu Aİ, Yüksel S, et al. Neutrophil-to-lymphocyte ratio for the assessment of hospital mortality in patients with acute pulmonary embolism. Arch Med Sci 2016;12(1):95-100.
- 12. Aksu K, Donmez A, Keser G. Inflammation-induced thrombosis: mechanisms, disease associations and management. Curr Pharm Des 2012;18(11):1478–93.
- 13. Ovechkin AV, Lominadze D, Sedoris KC, Robinson TW, Tyagi SC, Roberts AM. Lung ischemia-reperfusion injury: implications of oxi¬dative stress and platelet-arteriolar wall interactions. Arch Physiol Biochem 2007;113(1):1-12.
- 14. Muhl D, Furedi R, Cristofari J, Ghosh S, Bogar L, Borsiczki B, et al. Evaluation of oxidative stress in the thrombolysis of pulmonary embolism. J Thromb Thrombolysis 2006;22(3):221-28.
- 15. Zorlu A, Bektasoglu G, Guven FM, Dogan OT, Gucuk E, Ege MR. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol 2012;109(1):128-34.
- 16. Marchena Yglesias PJ, Nieto Rodriguez JA, Serrano Martinez S, Belinchon Moya O, Cortes Carmona A, Diaz de Tuesta A, et al. Acute-phase reactants and markers of inflammation in venous thromboem¬bolic disease: correlation with clinical and evolution parameters. An Med Interna 2006;23(3):105-10.
- 17. Afzal A, Noor HA, Gill SA, Brawner C, Stein PD. Leukocytosis in acute pulmonary embolism. Chest 1999;115(5):1329-32.
- 18. Bovill EG, Bild DE, Heiss G, Kuller LH, Lee MH, Rock R, et al. White blood cell counts in persons aged 65 years or more from the Cardiovascular Health Study. Correlations with baseline clinical and demographic characteristics. Am J Epidemiol 1996;143(11):1107-15.
- 19. Hoffman M, Blum A, Baruch R, Kaplan E, Benjamin M. Leukocytes and coronary heart disease. Atherosclerosis 2004;172(1):1-6.
- 20. Jo JY, Lee MY, Lee JW, Rho B, Choi WI. Leukocytes and systemic inflammatory response syndrome as prognostic factors in pulmonary embolism patients. BMC Pulm Med 2013;13(1):74.
- 21. Balta S, Demirkol S, Kucuk U. The platelet lymphocyte ratio may be useful inflammatory indicator in clinical practice. Hemodial Int 2013;17(4):668-9.
- 22. lexandrakis MG, Passam FH, Moschandrea IA, Christophoridou AV, Pappa CA, Coulocheri SA, et al. Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol 2003;26(2):135-40.
- 23. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpen¬sive and rapid prognostic marker for cardiovascular events. Platelets 2015;26(7):680-1.
- 24. Cetin EHO, Cetin MS, Canpolat U, Akdi A, Aras D, Temizhan A, et al. Platelet-to-lymphocyte ratio as a novel marker of in-hos¬pital and long-term adverse outcomes among patients with acute pulmonary embolism: A single center large-scale study. Thromb Res 2017;150(2):33-40.
Öz
Amaç:Akut pulmoner emboli (PE) kardiyovasküler hastalıklar içinde üçüncü sıklıkta ölüme neden olan önemli bir hastalıktır. Prognoz tayininde çeşitli skorlamalar ve periferik kan belirteçleri tanımlanmış olsa da daha pratik ve kolay ulaşılabilecek belirteçlerin arayışı devam etmektedir. Bu çalışmanın amacı akut PE hastalarında tam kan sayımı parametreleri, nötrofillerin lenfositlere oranı (NLO) ve plateletlerin lenfositlere oranı (PLO) ile hastane ve uzun dönem mortalitesi arasındaki ilişkiyi araştırmaktır.
Hastalar ve Yöntem:Çalışma retrospektif, gözlemsel bir çalışmadır. Haziran 2016- Haziran 2018 tarihleri arasında göğüs hastalıkları kliniğimizde PE tanısı ile yatışı olan ve tanısı doğrulanan 74 hasta çalışmaya dahil edildi. Hastaların demografik özellikleri, bazal tam kan sayımı, D-dimer (mg/L) ve C-reaktif protein (mg/L) değerleri kaydedildi. Hastane ve uzun dönem mortalitesi ile ilişkili faktörler araştırıldı.
Bulgular:Çalışmaya dahil edilen 74 hastanın yaş ortalaması 65±18 (20-89) ve 36’sı erkek (%49) idi. Emboli lokalizasyonu hastaların %51’inde ana pulmoner arterdeydi ve sağ kalp yüklenme bulguları 8 (%10) hastada eşlik etmekteydi. NLO ortalaması hastanede ölen hastalarda 9,8±7,1 saptanırken taburcu edilenlerden anlamlı olarak daha yüksekti (NLO=5,3±4,8) (P=0,037). Yüksek NLO değerleri uzun dönem takiplerde mortalite ile ilişkili bulundu (P=0,047). Uzun dönem mortalitesi ile ilişkili diğer faktörler erkek cinsiyet (P=0,002), düşük hemoglobin (P=0,013) ve ileri yaş (P=0,023) olarak saptandı.
Sonuç:Akut PE yakın takip gerektiren mortalitesi yüksek bir hastalıktır. Yüksek NLO değerleri kısa ve uzun dönem mortalite ile ilişkilidir ve yüksek riskli hastaları belirlemek için kullanılabilecek ucuz, basit ve kullanışlı bir parametredir.
Anahtar Kelimeler
Kaynakça
- 1. Garcia-Sanz MT, Pena-Alvarez C, Lopez-Landeiro P, Bermo-Dominguez A, Fonturbel T, Gonzalez-Barcala FJ, et all. Symptoms, lo¬cation and prognosis of pulmonary embolism. Rev Port Pneumol 2014;20(4):194-9.
- 2. Arseven O, Sevinç C, Alataş F, Ekim N, Erkan L, Fındık S, et al. Türk Toraks Derneği Pulmoner Tromboembolizm Tanı ve Tedavi Uzlaşı Raporu. Turk Toraks Derg 2009;10(Suppl 11):1-47.
- 3. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998;158(6):585–93.
- 4. Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Berggvist D, Brecht JG, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98(04):756–64.
- 5. Wang Q, Ma J, Jiang Z, Ming L. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol 2018;37(1):4-11.
- 6. Balta S, Unlu M, Arslan Z, Demırkol S. Neutrophil-to-lymphocyte ratio in prognosis of gastric cancer. J Gastric Cancer 2013;13(3):196-97.
- 7. Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011;107(3):433-38.
- 8. Yıldız A, Kaya H, Ertaş F, Oylumlu M, Bilik MZ, Yüksel M, et al. Association between neutrophil to lymphocyte ratio and pulmonary arterial hypertension. Turk Kardiyol Dern Ars 2013;41(7):604-609.
- 9. Kayrak M, Erdoğan HI, Solak Y, Akilli H, Gül EE, Yildirim O, et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a restrospective study. Heart Lung Circ 2014; 23(1):56-62.
- 10. Ya Y, Mao Y, He X, Sun Y, Huang S, Qui J. The values of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting 30 day mortality in patients with acute pulmonary embolism. BMC Cardiovasc Disord 2016;4(16):123.
- 11. Soylu K, Gedikli Ö, Ekşi A, Avcıoğlu Y, Soylu Aİ, Yüksel S, et al. Neutrophil-to-lymphocyte ratio for the assessment of hospital mortality in patients with acute pulmonary embolism. Arch Med Sci 2016;12(1):95-100.
- 12. Aksu K, Donmez A, Keser G. Inflammation-induced thrombosis: mechanisms, disease associations and management. Curr Pharm Des 2012;18(11):1478–93.
- 13. Ovechkin AV, Lominadze D, Sedoris KC, Robinson TW, Tyagi SC, Roberts AM. Lung ischemia-reperfusion injury: implications of oxi¬dative stress and platelet-arteriolar wall interactions. Arch Physiol Biochem 2007;113(1):1-12.
- 14. Muhl D, Furedi R, Cristofari J, Ghosh S, Bogar L, Borsiczki B, et al. Evaluation of oxidative stress in the thrombolysis of pulmonary embolism. J Thromb Thrombolysis 2006;22(3):221-28.
- 15. Zorlu A, Bektasoglu G, Guven FM, Dogan OT, Gucuk E, Ege MR. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol 2012;109(1):128-34.
- 16. Marchena Yglesias PJ, Nieto Rodriguez JA, Serrano Martinez S, Belinchon Moya O, Cortes Carmona A, Diaz de Tuesta A, et al. Acute-phase reactants and markers of inflammation in venous thromboem¬bolic disease: correlation with clinical and evolution parameters. An Med Interna 2006;23(3):105-10.
- 17. Afzal A, Noor HA, Gill SA, Brawner C, Stein PD. Leukocytosis in acute pulmonary embolism. Chest 1999;115(5):1329-32.
- 18. Bovill EG, Bild DE, Heiss G, Kuller LH, Lee MH, Rock R, et al. White blood cell counts in persons aged 65 years or more from the Cardiovascular Health Study. Correlations with baseline clinical and demographic characteristics. Am J Epidemiol 1996;143(11):1107-15.
- 19. Hoffman M, Blum A, Baruch R, Kaplan E, Benjamin M. Leukocytes and coronary heart disease. Atherosclerosis 2004;172(1):1-6.
- 20. Jo JY, Lee MY, Lee JW, Rho B, Choi WI. Leukocytes and systemic inflammatory response syndrome as prognostic factors in pulmonary embolism patients. BMC Pulm Med 2013;13(1):74.
- 21. Balta S, Demirkol S, Kucuk U. The platelet lymphocyte ratio may be useful inflammatory indicator in clinical practice. Hemodial Int 2013;17(4):668-9.
- 22. lexandrakis MG, Passam FH, Moschandrea IA, Christophoridou AV, Pappa CA, Coulocheri SA, et al. Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol 2003;26(2):135-40.
- 23. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpen¬sive and rapid prognostic marker for cardiovascular events. Platelets 2015;26(7):680-1.
- 24. Cetin EHO, Cetin MS, Canpolat U, Akdi A, Aras D, Temizhan A, et al. Platelet-to-lymphocyte ratio as a novel marker of in-hos¬pital and long-term adverse outcomes among patients with acute pulmonary embolism: A single center large-scale study. Thromb Res 2017;150(2):33-40.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 16 Aralık 2020 |
| Gönderilme Tarihi | 11 Temmuz 2019 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 12 Sayı: 1 |
