Yıl: 2010 Cilt: 10 Sayı: 4 Sayfa Aralığı: 346 - 352 Metin Dili: Türkçe

Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism

Öz:
İki farklı radyolojik parametre, pulmoner arter obstrüksiyon indeksi (PAOI) ve sağ ventrikül/sol ventrikül oranı (RV/LV) temel alınarak, radyolojik görüntüleme-esaslı pulmoner embolizm şiddet skoru ile D- dimer ve iskemi modifiye albümin (IMA) düzeyleri arasındaki muhtemel ilişkiyi incelemek. Yöntemler: Bu prospektif kohort çalışmasında, acil servise başvuran ve spiral bilgisayarlı tomografi (CT) ile PE kesin tanısı konulan kırk yedi hasta çalışmaya dahil edildi. D-dimer ve IMA düzeyleri sırasıyla immuno-turbidimetrik ve kolorimetrik metodlarla belirlendi. Bilgisayarlı tomografi görüntülerinden PAOI ve RV/LV oranları hesaplandı. Biyokimyasal parametrelerin gruplar arasındaki seviyeleri Mann-Whitney U test ve Kruskal-Wallis test kullanılarak karşılaştırıldı ve radyolojik skorlar ile ilişkileri Spearman korelasyon testi kullanılarak belirlendi. Bulgular: Hesaplanan PAOI ve RV/LV oranlarının analizi aralarında belirgin bir ilişki olduğunu yansıttı (r=0.036, p=0.023). PAOI temelinde oluşturulan hafif (< %40), orta (%40 - %60) ve şiddetli (> %60) PE grupları arasında D-dimer düzeyleri göze çarpan oranda farklıydı (p=0.039). Bu fark hafif grup, PAOI< %40, ile şiddetli grup, PAOI> %60 arasındaki D-dimer seviyelerindeki farklılıktan kaynaklanıyordu (p=0.02; Z= -2.328). Aynı zamanda, D-dimer düzeyleri ile PAOI pozitif bir korelasyon gösteriyordu, fakat D-dimer düzeyleri ile RV/LV oranı arasında benzer bir korelasyon yoktu. İskemi modifiye albümin düzeyleri ile D-dimer düzeyleri, PAOI ve RV/LV oranı arasında anlamlı bir korelasyon yoktu.Sonuç: Radyolojik parametreler temelinde PE’nin şiddetinin biyokimyasal olarak belirlenmesinde D-dimer, yeni bir marker olarak önerilen IMA’ya göre daha uygun bir marker olabilir.
Anahtar Kelime:

Akut pulmoner embolizmde D-dimer ve iskemi modifiye albümin değerleri ile radyolojik görüntüleme-esaslı pulmoner embolizm şiddet skoru arasındaki ilişkinin incelenmesi

Öz:
To investigate possible relationship between the D-dimer and ischemia-modified albumin (IMA) levels and radiological imaging-based severity scores in pulmonary embolism (PE) based on two different radiological characteristics; the pulmonary arterial obstruction index (PAOI) and the right ventricle/left ventricle (RV/LV) ratio. Methods: In this prospective cohort study, forty-seven patients presenting to the emergency department and definitively diagnosed with PE using spiral computerized tomography (CT) were initially enrolled in the study. Levels of IMA and D-dimer were assessed colorimetrical and immuno-turbidimetric methods, respectively. The PAOI and RV/LV ratios were calculated from CT images. The levels of biochemical parameters between the groups were compared with use of Mann-Whitney U and Kruskal-Wallis tests and relationship between the radiological scores were assessed using the Spearman correlation test. Results: Analysis of the calculated PAOI and RV/LV ratio revealed a significant correlation between them (r=0.36, p=0.023). D-dimer levels differed considerably among the mild (<40%), moderate (40%-60%) and severe (60%) groups constituted on the basis of PAOI (p=0.039). This difference stemmed from those in D-dimer levels in the mild group, PAOI <40% and the severe group, PAOI 60% (p=0.02; Z= -2.328). In addition, D-dimer levels and PAOI revealed a positive correlation, but no similar correlation was determined between D-dimer levels and RV/LV. There were no significant correlations between IMA and D-dimer levels, PAOI and RV/LV ratios. Conclusion: In the biochemical determination of severity of PE based on radiological characteristics, D-dimer may be a more relevant marker than IMA, which has been proposed as a new marker.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Demirkaya A, Kaynak K. Pulmonary embolism. Turkiye Klinikleri J Gen Surg-Special Topics 2008; 1: 83-90.
  • 2. Gottsater A, Berg A, Centergard J, Frennby B. Clinically suspected pulmonary embolism: Is it safe to withhold anticoagulation after a negative spiral CT? Eur Radiol 2001; 11: 65-72.
  • 3. Van der Meer RW, Pattynama PMT, Van den Berg-Huijsmans AA. Right ventricular dysfunction and pulmonary obstruction index at helical CT: Prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology 2005; 235: 798-803.
  • 4. Goldhaer SZ, Visani L, De RM. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353: 1386-9.
  • 5. Goldhaber SZ, Elliott CG. Acute pulmonary embolism: part II: risk stratification, treatment, and prevention. Circulation 2003; 108: 2834-8.
  • 6. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003; 58: 470-83.
  • 7. Wu AS, Pezzullo JA, Cronan JJ, Hou DD, Mayo-Smith WW. CT pulmonary angiography: quantification of pulmonary embolus as a predictor of patient outcome-initial experience. Radiology 2004; 230: 831-5.
  • 8. Ghanima W, Abdelnoor M, Holmen LO, Nielssen BE, Ross S, Sandset PM. D-dimer level is associated with the extent of pulmonary embolism. Thromb Res 2007; 120: 281-8.
  • 9. Roy D, Quiles J, Aldama G, Sinha M, Avanzas P, Arroyo-Espliguero R. Ischemia Modified Albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiograms and negative cardiac troponin T. Int J Cardiol 2004; 97: 297-301.
  • 10. Türedi S, Gündüz A, Menteşe A, Karahan SC, Yılmaz SE, Eroğlu O, et al. Value of ischemia-modified albumin in the diagnosis of pulmonary embolism. Am J Emerg Med 2007; 25: 770- 3.
  • 11. Bar-Or D, Lau E, Winker JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia- preliminary report. J Emerg Med 2000; 19: 311- 5.
  • 12. Qanadli SD, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Oliva VL, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. Am J Roentgenol 2001; 176: 1415-20.
  • 13. Ribeiro A, Lindmarker P, Juhlin-Dannfelt A, Johnsson H, Jorfeldt L. Echocardiography Doppler in pulmonary embolism: right ventricular dysfunction as a predictor of mortality rate. Am Heart J 1997; 134: 479-87.
  • 14. Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure and echocardiographic right ventricular dysfunction. Circulation 2000; 101: 2817-22.
  • 15. Collomb D, Paramelle PJ, Calaque O, Bosson JL, Vanzetto G, Barnoud D, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol 2003; 13: 1508-14.
  • 16. Reid JH, Murchison JT. Acute right ventricular dilatation: a new helical CT sign of massive pulmonary embolism. Clin Radiol 1998; 53: 694-8.
  • 17. Ghanima W, Abdelnoor M, Holmen LO, Nielssen BE, Sandset PM. The association between the proximal extension of the clot and the severity of pulmonary embolism (PE): a proposal for a new radiological score for PE. J Intern Med 2007; 261: 74-81.
  • 18. Kucher N, Schroeder V, Kohler HP. Role of blood coagulation factor XIII in patients with acute pulmonary embolism. Correlation of factor XIII antigen levels with pulmonary occlusion rate, fibrinogen, D-dimer, and clot firmness. Thromb Haemost 2003; 90: 434-8.
  • 19. Galle C, Papazyan JP, Miron MJ, Slosman D, Bounameaux H, Perrier A. Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound. Thromb Haemost 2001; 86: 1156-60.
  • 20. Keating L, Benger JR, Beetham R, Bateman S, Veysey S, Kendall J, et al. The PRIMA study: presentation ischemia-modified albumin in the emergency department. Emerg Med J 2006; 23: 764-8.
  • 21. Gündüz A, Türedi S, Menteşe A, Karahan SC, Hoş G, Tatlı O, et al. Ischemia-modified albumin in the diagnosis of acute mesenteric ischemia: a preliminary study. Am J Emerg Med 2008; 26: 202- 5.
  • 22. Gündüz A, Türkmen S, Türedi S, Menteşe A, Yuluğ E, Ulusoy H, et al. Time-dependent variations in ischemia-modified albumin levels in mesenteric ischemia. Acad Emerg Med 2009; 16: 539-43.
  • 23. Menteşe A, Menteşe U, Türedi S, Gündüz A, Karahan SC, Topbaş M, et al. Effect of deep vein thrombosis on ischemia-modified albumin levels. Emerg Med J 2008; 25: 811-4.
  • 24. Gündüz A, Menteşe A, Türedi S, Karahan SC, Menteşe U, Eroğlu O, et al. Serum ischemia-modified albumin increases in critical lower limb ischemia. Emerg Med J 2008; 25: 351-3.
  • 25. Gündüz A, Türedi S, Menteşe A, Altunayoğlu V, Turan I, Karahan SC, et al. Ischemia-modified albumin levels in cerebrovascular accidents. Am J Emerg Med 2008; 26: 874- 8.
  • 26. Türedi S, Gündüz A, Menteşe A, Topbaş M, Karahan SC, Yeniocak S, et al. The value of ischemia-modified albumin compared with D-dimer in the diagnosis of pulmonary embolism. Respir Res 2008 May 30; 9: 49.
  • 27. Mehta NJ, Jani K, Khan IA. Clinical usefulness and prognostic value of elevated cardiac troponin I levels in acute pulmonary embolism. Am Heart J 2003; 145: 751-3.
  • 28. Türedi S, Gündüz A, Menteşe A, Daşdibi B, Karahan SC, Şahin A, et al. Investigation of the possibility of using ischemia-modified albumin as a novel and early prognostic marker in cardiac arrest patients after cardiopulmonary resuscitation. Resuscitation 2009; 80: 994-9.
  • 29. Perrier A. Noninvasive diagnosis of pulmonary embolism. Haematologica 1997; 82: 328-31.
APA TÜREDİ S, KARAHAN S, MENTEŞE A, GÜNDÜZ A, TOPBAŞ M, KOŞUCU P, ÖZTUNA F, TATLI Ö (2010). Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism. Anadolu Kardiyoloji Dergisi, 10(4), 346 - 352.
Chicago TÜREDİ SÜLEYMAN,KARAHAN Süleyman Caner,MENTEŞE AHMET,GÜNDÜZ Abdülkadir,TOPBAŞ MURAT,KOŞUCU POLAT,ÖZTUNA Funda,TATLI ÖZGÜR Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism. Anadolu Kardiyoloji Dergisi 10, no.4 (2010): 346 - 352.
MLA TÜREDİ SÜLEYMAN,KARAHAN Süleyman Caner,MENTEŞE AHMET,GÜNDÜZ Abdülkadir,TOPBAŞ MURAT,KOŞUCU POLAT,ÖZTUNA Funda,TATLI ÖZGÜR Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism. Anadolu Kardiyoloji Dergisi, vol.10, no.4, 2010, ss.346 - 352.
AMA TÜREDİ S,KARAHAN S,MENTEŞE A,GÜNDÜZ A,TOPBAŞ M,KOŞUCU P,ÖZTUNA F,TATLI Ö Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism. Anadolu Kardiyoloji Dergisi. 2010; 10(4): 346 - 352.
Vancouver TÜREDİ S,KARAHAN S,MENTEŞE A,GÜNDÜZ A,TOPBAŞ M,KOŞUCU P,ÖZTUNA F,TATLI Ö Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism. Anadolu Kardiyoloji Dergisi. 2010; 10(4): 346 - 352.
IEEE TÜREDİ S,KARAHAN S,MENTEŞE A,GÜNDÜZ A,TOPBAŞ M,KOŞUCU P,ÖZTUNA F,TATLI Ö "Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism." Anadolu Kardiyoloji Dergisi, 10, ss.346 - 352, 2010.