Polno zavisne razlike u prognostičkom značaju parametara dobijenih kompjuterizovanom tomografskom angiografijom pluća za intrahospitalnu smrtnost kod akutne plućne embolije

  • Jelena Bošković Sekulić University Clinical Center Kragujevac, Clinic of Emergency Medicine, Kragujevac, Serbia
  • Igor Sekulić University Clinical Center Kragujevac, Institute for Radiology, Belgrade, Serbia University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia;
  • Boris Džudović Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Bojana Subotić Military Medical Academy, Clinic for Cardiology, Belgrade, Serbia
  • Sonja Salinger University Clinical Center Niš, Clinic of Cardiology, Niš, Serbia; University of Niš, Faculty of Medicine, Niš , Serbia
  • Jovan Matijašević Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Tamara Kovačević Clinical Center Banja Luka, Clinic of Cardiology, Banja Luka, Republic of Srpska, Bosnia and Herzegovina; University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
  • Irena Mitevska University Cardiology Clinic, Intensive Care Unit, Skopje, North Macedonia
  • Vladimir Miloradović University Clinical Center Kragujevac, Clinic of Cardiology, Kragujevac, Serbia; University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Aleksandar Nešković University Clinical Hospital Center Zemun, Clinic of Cardiology, Belgrade , Serbia University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Slobodan Obradović Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP240109023B
Ključne reči: angiografija, tomografska, kompjuterizovana;, mortalitet;, tomografija, kompjuterizovana, multidetektor;, pluća, embolija;, pol;, lečenje, ishod

Sažetak


Uvod/Cilj. Metoda multidetektorske kompjuterizovane tomografske angiografije pluća (MKTAP) se pokazala kao najpogodnija metoda za dijagnostikovanje akutne plućne embolije (APE) kod hemodinamski stabilnih bolesnika. Pored svoje dijagnostičke uloge, MKTAP olakšava merenje i izračunavanje određenih parametara koji se mogu koristiti kao prognostički markeri za ishode APE. Od uvođenja metode, urađen je veliki broj studija koje su ukazivale na to da može postojati značajna polno zavisna razlika u prognostičkoj vrednosti MKTAP u odnosu na ishod APE. Metode. Ispitivanu populaciju činili su konsekutivni bolesnici sa dijagnozom APE potvrđenom primenom MKTAP. Pozitivni MKTAP nalazi i dijagnoza APE postavljani su ako je bolesnik imao najmanje jedan tromb segmentne arterije. Težina APE procenjivana je korišćenjem indeksa simplified Pulmonary Embolism Severity Index (sPESI). Primarni ishodi ove studije bili su intrahospitalni smrtni ishodi nastali kao posledica APE i smrtni ishodi izazvani svim ostalim uzrocima. Rezultati. U studiju je ukupno bilo uključeno 1 612 bolesnika (750 muškaraca i 862 žene). Kod žena koje su imale centralno postavljeni tromb u plućima, otkriven putem MKTAP, zabeležena je veća učestalost intrahospitalnih smrtnih ishoda usled plućne embolije (PE), nego kod onih bez centralno postavljenog tromba (10,4% vs. 4,2%, redom; p = 0,016). Kod žena kod kojih je odnos između prečnika desne komore (DK) i leve komore (LK) (DK/LK) iznosio > 1, smrtnost je bila skoro dva puta češća od onih kod kojh je taj odnos bio ≤ 1 (15,5% vs. 8,6%, redom; p = 0,017). Kod žena kod kojih je odnos DK/LK, detektovan metodom MKTAP, iznosio > 1, verovatnoća smrtnog ishoda usled PE bila je značajno veća u poređenju sa ženama kod kojih je taj odnos bio ≤ 1 (11,0 % vs. 5,2%, redom; p = 0,017). Žene koje su umrle od posledica PE, imale su značajno višu vrednost skora embolijskog opterećenja (embolic burden score system - EBSS) nego žene koje su preživele (18,00 vs. 11,00, redom; p = 0,025). Nezavisno od starosti, sPESI i funkcije bubrega, prisustvo centralno postavljenog plućnog tromba [odds ratio – (OR) 2,278; 95% confidence interval – (CI): 1,050–4,944; p = 0,037] i odnos DK/LK > 1 (OR 2,015; 95% CI: 1,042–3,893, p = 0,037) bili su kod žena povezani sa intrahospitalnim smrtnim ishodom koji je nastao usled PE. Zaključak. Kod žena, parametri MKTAP, centralno postavljeni tromb, odnos DK/LK prečnika i EBSS imali su prognostički značaj za mortalitet zavisan od PE. Odnos prečnika DK i LK imao je prognostički značaj i za smrtnost izazavnu svim uzrocima, tokom hospitalizacije. Kod muškaraca, MKTAP parametri nisu imali prognostički značaj za ukupni mortalitet i smrtnost od PE.

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2024/05/31
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Vol. 81 Br. 05 (2024): Vojnosanitetski pregled
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