Polno-specifične razlike i faktori rizika od 30-dnevne smrtnosti u akutnoj plućnoj emboliji – rezultati univerzitetskog multicentričnog registra za plućnu emboliju Srbije

  • Jovan Matijašević Institute for Pulmonary Diseases of Vojvodina, Emergency Pulmonology Clinic, Sremska Kamenica
  • Milica Mirić Institute for Pulmonary Diseases of Vojvodina, Emergency Pulmonology Clinic, Sremska Kamenica
  • Jadranka Vučićević Trobok Institute for Pulmonary Diseases of Vojvodina, Emergency Pulmonology Clinic, Sremska Kamenica
  • Sandra Peković Institute for Pulmonary Diseases of Vojvodina, Emergency Pulmonology Clinic, Sremska Kamenica
  • Ilija Andrijević Institute for Pulmonary Diseases of Vojvodina, Emergency Pulmonology Clinic, Sremska Kamenica
  • Boris Džudović Military Medical Academy, Clinic of Cardiology and Internal and Emergency Medicine, Belgrade
  • Bojana Subotić Military Medical Academy, Clinic of Cardiology and Internal and Emergency Medicine, Belgrade
  • Slobodan Obradović Military Medical Academy, Clinic of Cardiology and Internal and Emergency Medicine, Belgrade
DOI: https://doi.org/10.2298/VSP200830048M
Ključne reči: životno doba, faktor;, koronarna bolest;, imobilizacija;, mortalitet;, pluća, opstruktivne bolesti, hronične;, pluća, embolija;, faktori rizika;, pol, faktor;, tahikardija

Sažetak


Uvod/Cilj. Uloga pola u predviđanju rizika od ranog smrtnog ishoda kod obolelih od akutne plućne embolije (PE) je nedovoljno razjašnjena. Cilj rada bio je da se utvrde polno-specifični činioci za 30-dnevnu smrtnost od svih uzroka ukupno kod obolelih od akutne PE. Metode. Studija po tipu “real-life” opservacionog multicentričnog istraživanja je obuhvatila 532 obolelih od akutne PE (49,6% muškaraca). Primenom univarijantne Cox regresione analize ispitali smo prediktivnu vrednost nezavisnih faktora rizika od ranog (jednomesečnog) smrtnog ishoda kod muškaraca, žena i svih bolesnika ukupno. Rezultati. Razlike specifične prema polu bolesnika pokazale su se u uzrastu, gojaznosti, arterijskoj hipertenziji, bubrežnoj slabosti, anemiji, vanbolničkoj pneumoniji i pušačkom statusu. Stopa smrtnosti u prvih mesec dana je iznosila 13,7%, bez značajne razlike u preživljavanju zavisno od pola bolesnika (Log Rank test, p = 0,324). Stepen rizika (hazard ratio – HR) od 30-dnevne smrtnosti bio je značajno povišen kod žena koje su imale tahikardiju na prijemu (HR=2,61; p = 0,004), koronarnu arterijsku bolest (HR = 2,30; p = 0,047), imobilizaciju unutar četiri nedelje pre epizode PE (HR = 2,31; p = 0,018) i stariji uzrast (HR = 1,03; p = 0,017), dok je povišen stepen rizika kod muškaraca bio udružen sa hroničnom opstruktivnom bolešću pluća (HOBP) (HR = 4,03; p < 0,001) i leukocitozom (HR = 1,19; p < 0,001). Zaključak. Pol bolesnika se nije pokazao kao nezavisni prediktor 30-dnevne smrtnosti kod bolesnika sa PE. Utvrdili smo da su kod žena sa PE, tahikardija na prijemu, uzrast bolesnika, koronarna bolest i imobilizacija nogu četiri nedelje pre PE, a kod muškaraca sa PE, prisustvo HOBP i leukocitoze, povezani sa povećanim rizikom od ranog smrtnog ishoda.

Reference

Heit JA, Silverstein MD, Mohr DN, Petterson TM, Lohse CM, O’Fallon WM, et al. The epidemiology of venous thromboembolism in the community. Thromb Haemost. 2001;86(1):452–63.

Laporte S, Mismetti P, Décousus H, Uresandi F, Otero R, Lobo JL, et al. Clinical predictors for fatal pulmonary embolism in 15 520 patients with venous thromboembolism: Findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. Circulation. 2008;117(13):1711–6.

McHugh KB, Visani L, DeRosa M, Covezzoli A, Rossi E, Goldhaber SZ. Gender comparisons in pulmonary embolism (results from the International Cooperative Pulmonary Embolism Registry [ICOPER]). Am J Cardiol. 2002;89(5):616–9.

Konstantinides S V, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014 Nov 14;35(43):3033–69, 3069a–3069k.

Sam A, Sánchez D, Gómez V, Wagner C, Kopecna D, Zamarro C, et al. The shock index and the simplified PESI for identification of low-risk patients with acute pulmonary embolism. Eur Respir J. 2011;37(4):762–6.

Becattini C, Agnelli G, Lankeit M, Masotti L, Pruszczyk P, Casazza F, et al. Acute pulmonary embolism: Mortality prediction by the 2014 European Society of Cardiology risk stratification model. Eur Respir J. 2016;48(3):780–6.

Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172(8):1041–6.

Klok FA, Hösel V, Clemens A, Yollo WD, Tilke C, Schulman S, et al. Prediction of bleeding events in patients with venous thromboembolism on stable anticoagulation treatment. Eur Respir J. 2016;48(5):1369–76.

Agarwal S, Clark D, Sud K, Jaber WA, Cho L, Menon V. Gender disparities in outcomes and resource utilization for acute pulmonary embolism hospitalizations in the United States. Am J Cardiol. Elsevier Ltd; 2015;116(8):1270–6.

Horlander KT, Mannino DM, Leeper K V. Pulmonary Embolism Mortality in the United States, 1979-1998. Arch Intern Med. 2003;163(14):1711.

Sakuma M, Konno Y, Shirato K. Increasing mortality from pulmonary embolism in Japan, 1951-2000. Circ J. 2002;66(12):1144–9.

Obradovic S, Dzudovic B, Rusovic S, Subota V, Obradovic D. Gender-related differences in clinical presentation, electrocardiography signs, laboratory markers and outcome in patients with acute pulmonary embolism. Vojnosanit Pregl. 2016;73(9):844–9.

Cockcroft DW, Gault H. Prediction of Creatinine Clearance from Serum Creatinine. Nephron. 1976;16(1):31–41.

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and. J Am Soc Echocardiogr. Elsevier Inc; 2010;23(7):685–713.

Masotti L, Panigada G, Landini G, Pieralli F, Corradi F, Lenti S, et al. Simplified PESI score and sex difference in prognosis of acute pulmonary embolism: a brief report from a real life study. J Thromb Thrombolysis. Springer US; 2016;41(4):606–12.

Scherz N, Labarere J, Aujesky D, Mean M. Elevated Admission Glucose and Mortality in Patients With Acute Pulmonary Embolism. Diabetes Care. 2012 Jan 1;35(1):25–31.

Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, Lynch G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008;7(10):915–26.

Sowers MFR, Matthews KA, Jannausch M, Randolph JF, McConnell D, Sutton-Tyrrell K, et al. Hemostatic factors and estrogen during the menopausal transition. J Clin Endocrinol Metab. 2005;90(11):5942–8.

Gorton HJ, Warren ER, Simpson NAB, Lyons GR, Columb MO. Thromboelastography Identifies Sex-Related Differences in Coagulation. Anesth Analg. 2000 Nov;91(5):1279–81.

Braekkan S, Siegerink B, Lijfering W, Hansen JB, Cannegieter S, Rosendaal F. Role of obesity in the etiology of deep vein thrombosis and pulmonary embolism: Current epidemiological insights. Semin Thromb Hemost. 2013;39(5):533–40.

Sonnevi K, Tchaikovski SN, Holmström M, Antovic JP, Bremme K, Rosing J, et al. Obesity and thrombin-generation profiles in women with venous thromboembolism. Blood Coagul Fibrinolysis. 2013;24(5):547–53.

Borrero S, Aujesky D, Stone RA, Geng M, Fine MJ, Ibrahim SA. Gender Differences in 30-Day Mortality for Patients Hospitalized with Acute Pulmonary Embolism. J Women’s Heal. 2007;16(8):1165–70.

McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Heal Nutr. 2009;12(4):444–54.

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2022/01/25
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Vol. 78 Br. 12 (2021): Vojnosanitetski pregled
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