Značaj C-reaktivnog proteina u predviđanju ukupnog nepovoljnog kliničkog ishoda kod bolesnika sa akutnom plućnom embolijom

  • Rade Milić Military Medical Academy, Clinic for Pulmonology, Belgrade, Serbia
  • Boris Džudović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Bojana Subotić Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia
  • Slobodan Obradović University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Ivan Soldatović University of Belgrade, Institute for Biostatistics, Belgrade, Serbia
  • Marina Petrović University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia
DOI: https://doi.org/10.2298/VSP171213037M
Ključne reči: c-reaktivni protein, mortaltiet, prognoza, pluća, embolija, lečenje, ishod

Sažetak


Uvod/ Cilj. Akutna plućna embolija (APE) može imati različite kliničke manifestacije. Takođe, njen ishod može varirati od potpunog oporavka do rane smrti. Za sada nije poznato koji su najbolji prediktori kratkoročnog mortaliteta i velikih krvarenja među nekolicinom najčešće upotrebljavanih biomarkera. Cilj ovog istraživanja bio je da se utvrdi značaj C-reaktivnog proteina (CRP) i drugih biomarkera u predviđanju neželjenih kliničkih ishoda. Metode. Ova klinička, opservaciona, retrospektivno-prospek­tivna studija, obuhvatila je 219 uzastopnih odraslih bolesnika sa APE. Rezultati. Od 219 bolesnika 22 (10%) je umrlo unutar prvog meseca od postavljanja dijagnoze. Dvadeset sedam bolesnika (12.3%) imalo je najmanje jednu epizodu velikog krvarenja. Kompozitni cilj (ukupni ne­željeni klinički ishod) utvrđen je kod 47 (21.5%) bolesnika. Srednje vrednosti svih biomarkera bile su veće u grupi umrlih bolesnika, a razlika je bila statistički značajna. Slični rezultati su utvrđeni za kompozitni cilj. U pogledu velikih krvarenja, nijedan biomarker nije pokazao značajnost, mada je CRP imao trend ka značajnosti. Rezultati univarijantne regresione analize pokazali su da je troponin značajan prediktor 30-dnevnog mortaliteta. Međutim, posle prila­gođavanja sa drugim varijablama, multivarijantni logistički regresioni model nije potvrdio da je troponin značajan nezavisani prediktor 30-dnevnog mortaliteta. Za razliku od troponina, CRP i B-tip natriuretskog peptida (BNP) su značajni u svim modelima, univarijantnim i multivarijantnim (oni su nezavisni prediktori 30-dnevnog mortaliteta). Zaključak. Biomarker CRP ima dobru prediktivnu vrednost za 30-dnevni mortalitet i ukupan neželjeni klinički ishod, kao i potencijalnu prediktivnu vrednost za velika krvarenja kod bolesnika lečenih zbog APE.

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Objavljeno
2021/08/19
Broj časopisa
Vol. 77 Br. 1 (2020): Vojnosanitetski pregled
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Originalni članak