Različite prediktivne vrednosti rutinskih biomarkera u proceni smrtnosti obolelih od plućne embolije u odnosu na njen uzrok

  • Ljiljana Jovanović Military Medical Academy, Institute of Medical Biochemistry, Belgrade, Serbia
  • Vesna Subota Military Medical Academy, Institute of Medical Biochemistry, Belgrade, Serbia
  • Milena Stavrić Military Medical Academy, Institute of Medical Biochemistry, Belgrade, Serbia
  • Boris Džudović Military Medical Academy, Clinic for Cardiology and Emergency Internal Medicine, Belgrade, Serbia
  • Bojana Subotić Military Medical Academy, Clinic for Cardiology and Emergency Internal Medicine, Belgrade, Serbia
  • Nataša Novčić Military Medical Academy Clinic for Cardiology and Emergency Internal Medicine, Belgrade, Serbia
  • Milica Mirić University of Novi Sad, Faculty of Medicine, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
  • Jovan Matijašević University of Novi Sad, Faculty of Medicine, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
  • Maja Nikolić University of Kragujevac, Faculty of Medicine, Clinical Center Kragujevac, Clinic for Cardiology, Kragujevac, Serbia
  • Vladimir Miloradović University of Kragujevac, Faculty of Medicine, Clinical Center Kragujevac, Clinic for Cardiology, Kragujevac, Serbia
  • Sonja Salinger University of Niš, Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Nataša Marković Nikolić University of Belgrade, Faculty of Medicine, University Clinical Center Zvezdara, Belgrade, Serbia
  • Ljiljana Kos University of Banja Luka, Faculty of Medicine, Clinical Center Banja Luka, Clinic for Cardiology, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
  • Tamara Preradović Kovačević University of Banja Luka, Faculty of Medicine, Clinical Center Banja Luka, Clinic for Cardiology, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
  • Slobodan Obradović Military Medical Academy, Clinic for Cardiology and Emergency Internal Medicine, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP190226103J
Ključne reči: plućna embolija, biološki faktori, mortalitet, rizik, procena, natriuretski peptid, troponin I, c-reaktivni protein

Sažetak


Uvod/Cilj. Rutinski dijagnostički proces i procena rizika od smrtnosti tokom prijema i lečenja plućne embolije (PE) obuhvata i analizu nivoa kardijalnog troponina I (cTnI), D-dimera, natriuretičnog peptida B-tipa (BNP) i C-reaktivnog proteina (CRP). Cilj ove studije bio je utvrđivanje prediktivne moći ovih biomarkera kako bi se odredio rizik od 30-to dnevne smrtnosti kod bolesnika obolelih od PE i to u odnosu na različite uzroke bolesti koji mogu biti spontani ili kratkotrajno i dugotrajno provocirani. Metode. Ova retrospektivna studija obuhvatila je 590 bolesnika obolelih od PE, iz multicentričnog Registra za plućnu emboliju. Tokom prvih 24 časa od prijema, bolesnicima je vršeno merenje bar

 

jednog od analiziranih biomarkera (BNP, CRP, cTnI i D-dimer). Rezultati. Receiver operating characteristic (ROC) analiza je pokazala da BNP ima najvišu prognostičku vrednost u proceni 30-dnevne smrtnosti kod bolesnika (n = 219) kod kojih su bile poznate vrednosti svih analiziranih biomarkera. BNP je imao AUC od 0,785 (p < 0,001). Pojedinačno posmatrano, BNP je imao najvišu c-statistiku (concordance) za sve tri grupe bolesnika. CRP je pokazao skromnu prediktivnu moć za 30-dnevnu smrtnost u grupi bolesnika kod kojih je PE bila izazvana prolaznim faktorom. Troponin I je imao malu prediktivnu vrednost za 30-dnevnu smrtnost samo kod bolesnika sa spontanom PE, dok je D-dimer bio veoma slab prediktor i to kod bolesnika kod kojih je PE bila rezultat stalnih provocirajućih faktora. Zaključak. U odnosu na spontane, prolazne ili stalne provocirajuće uzroke nastanka PE, biohemijski profil ovih grupa bolesnika značajno je različit, kao i prognostički značaj biomarkera u proceni rane smrtnosti.

Reference

Konstantinides SV, Barco S, Lankeit M, Meyer G. Management of Pulmonary Embolism: An Update. J Am Coll Cardiol 2016; 67(8): 976‒90.

Pernod G, Caterino J, Maignan M, Tissier C, Kassis J, Lazarchick J. DIET study group. D-Dimer Use and Pulmonary Embolism Diagnosis in Emergency Units: Why Is There Such a Differ-ence in Pulmonary Embolism Prevalence between the United States of America and Countries Outside USA? PLoS One 2017; 12(1): e0169268.

Dudzinski DM, Giri J, Rosenfield K. Interventional Treatment of Pulmonary Embolism.Circ Cardiovasc Interv 2017; 10(2): pii: e004345.

Hendriksen JM, Lucassen WA, Erkens PM, Stoffers HE, van We-ert HC, Büller HR, et al. Ruling Out Pulmonary Embolism in Primary Care: Comparison of the Diagnostic Performance of "Gestalt" and the Wells Rule. Ann Fam Med 2016; 14(3): 227‒34.

Jaber WA, Fong PP, Weisz G, Lattouf O, Jenkins J, Rosenfield K, et al. Acute Pulmonary Embolism: With an Emphasis on an Interventional Approach. J Am Coll Cardiol 2016; 67(8): 991‒1002.

Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2014; 35(43): 3033‒69, 3069a‒69k.

Kunutsor SK, Seidu S, Blom AW, Khunti K, Laukkanen JA. Serum C-reactive protein increases the risk of venous thromboembo-lism: a prospective study and meta-analysis of published pro-spective evidence. Eur J Epidemiol 2017; 32(8): 657‒67.

Meyer G, Planquette B, Sanchez O. Risk stratification of pulmo-nary embolism: clinical evaluation, biomarkers or both? Eur Respir J 2015; 46(6): 1551‒3.

Wang Q, Ma J, Jiang Z, Ming L. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acutepulmonary embolism: a systematic review and meta-analysis. Int Angiol 2018; 37(1): 4‒11.

Gjonbrataj E, Kim JN, Gjonbrataj J, Jung HI, Kim HJ, Choi WI. Risk factors associated with provoked pulmonary embolism. Korean J Intern Med 2017; 32(1): 95‒101.

Donnellan E, Khorana AA. Cancer and Venous Thromboembol-ic Disease: A Review. Oncologist 2017; 22(2): 199‒207.

Jovanovic L, Subota V, Stavric M, Subotic B, Dzudovic B, Novicic N, et al. Biomarkers for the prediction of early pulmonary embo-lism related mortality in spontaneous and provoked thrombot-ic disease. Clin Chim Acta 2019; 492: 78‒83.

Tanabe Y, Obayashi T, Yamamoto T, Takayama M, Nagao K. Pre-dictive value of biomarkers for the prognosis of acute pulmo-nary embolism in Japanese patients: Results of the Tokyo CCU Network registry. J Cardiol 2015; 66(6): 460‒5.

Ay MO, Kozaci N, Avci M, Cekic B, Cerit N, Keskin O, et al. Utility of biochemical markers and RVD/LVD ratio in acute pulmonary embolism risk classification in Emergency Depart-ment. Eur Rev Med Pharmacol Sci 2017; 21(19): 4391‒7.

Expert Group on Biomarkers. Biomarkers in Cardiology - Part 2: In Coronary Heart Disease, Valve Disease and Special Situa-tions. Arq Bras Cardiol 2015; 104(5): 337‒46.

Li W, Tang Y, Song Y, Chen SH, Sisliyan N, Ni M, et al. Prog-nostic Role of Pretreatment Plasma D-Dimer in Patients with Solid Tumors: a Systematic Review and Meta-Analysis. Cell Physiol Biochem 2018; 45(4): 1663‒76.

Zhang J, Guo Z, Yang W, Zhu Z, Kong W, Zheng S, et al. D-dimer levels are correlated with disease activity in Chron’s pa-tients. Oncotarget 2017; 8(38): 63971‒7.

Liang Y, Xie SB, Wu CH, Hu Y, Zhang Q, Li S, et al. Coagula-tion cascade and complement system in systemic lupus ery-thematosus. Oncotarget 2018; 9(19): 14862‒81.

Bajaj A, Rathor P, Sehgal V, Kabak B, Shetty A, Al Masalmeh O, et al. Prognostic value of biomarkers in acute non-massive pulmonary embolism: a systemic review and meta-analysis. Lung 2015; 193(5): 639‒51.

Objavljeno
2021/06/14
Broj časopisa
Vol. 78 Br. 5 (2021): Vojnosanitetski pregled
Rubrika
Originalni članak