.: ORİJİNAL ARAŞTIRMA
Fibrosis-4 Index for Prediction of the Severity of Acute Pulmary Embolism: Cross-sectional Research
Akut Pulmoner Embolinin Ciddiyetinin Tahmininde Fibrozis-4 İndeksi: Kesitsel Araştırma
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(2):78-84
doi: 10.5336/cardiosci.2020-78435
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: In this study, we investigated whether the index of fibrosis-4 (fib-4), which is a parameter indicating liver fibrosis and stiffness, is related to the severity of acute pulmonary embolism (APE). Material and Methods: A total of 118 patients who were diagnosed with APE were divided into two groups according to hemodynamic status at the time of admission to the emergency department. Group 1 patients were high-risk patients with hemodynamic instability (42 patients, 24 male, mean age 66.2±13.6 years). Group 2 patients were non high-risk patients without hemodynamic instability (76 patients, 24 male, mean age 61.2±16.9 years). Biochemical parameters and cardiac markers were measured from venous blood at the time of admission. Right and left ventricular functions were examined using echocardiography. Results: Fib-4 scores were significantly higher in Group 1 than Group 2 (2.35±1.32 vs. 1.41±0.96, p=0.005). D-dimer, troponin and aspartate transaminase were significantly higher in Group 1 than in Group 2, and platelet count was significantly lower in Group 1 than in Group 2. The ejection fraction, tricuspid annular plane systolic excursion and fractional areal change were significantly lower in Group 1 than in Group 2. Correlation analysis showed that the fib-4 index correlated with hemodynamic and echocardiographic parameters that show the severity of pulmonary embolism, such as the pulmonary embolism severity index score. Conclusion: In patients presenting with APE, the fib-4 index, calculated at the time of presentation, is a parameter that can be used to calculate the severity of the disease and the risk stratification.
Keywords: Fibrosis-4 index; pulmonary embolism; liver fibrosis; transaminase
Objective: In this study, we investigated whether the index of fibrosis-4 (fib-4), which is a parameter indicating liver fibrosis and stiffness, is related to the severity of acute pulmonary embolism (APE). Material and Methods: A total of 118 patients who were diagnosed with APE were divided into two groups according to hemodynamic status at the time of admission to the emergency department. Group 1 patients were high-risk patients with hemodynamic instability (42 patients, 24 male, mean age 66.2±13.6 years). Group 2 patients were non high-risk patients without hemodynamic instability (76 patients, 24 male, mean age 61.2±16.9 years). Biochemical parameters and cardiac markers were measured from venous blood at the time of admission. Right and left ventricular functions were examined using echocardiography. Results: Fib-4 scores were significantly higher in Group 1 than Group 2 (2.35±1.32 vs. 1.41±0.96, p=0.005). D-dimer, troponin and aspartate transaminase were significantly higher in Group 1 than in Group 2, and platelet count was significantly lower in Group 1 than in Group 2. The ejection fraction, tricuspid annular plane systolic excursion and fractional areal change were significantly lower in Group 1 than in Group 2. Correlation analysis showed that the fib-4 index correlated with hemodynamic and echocardiographic parameters that show the severity of pulmonary embolism, such as the pulmonary embolism severity index score. Conclusion: In patients presenting with APE, the fib-4 index, calculated at the time of presentation, is a parameter that can be used to calculate the severity of the disease and the risk stratification.
Keywords: Fibrosis-4 index; pulmonary embolism; liver fibrosis; transaminase
ÖZET
Amaç: Bu çalışmada, karaciğer fibrozunu ve sertliğini gösteren parametrelerden birisi olan fibrozis-4 (fib-4) indeksinin akut pulmoner emboli (APE) şiddeti ile ilişkili olup olmadığını araştırdık. Gereç ve Yöntemler: APE tanısı alan toplam 118 hasta acil servise başvuru sırasındaki hemodinamik durumlarına göre 2 gruba ayrıldı. Grup 1 hastaları, hemodinamik dengesizliği olan yüksek riskli hastalardı (42 hasta, 24 erkek, ortalama yaş 66,2±13,6 yıl). Grup 2 hastalar, hemodinamik dengesizliği olmayan yüksek riskli olmayan hastalardı (76 hasta, 24 erkek, ortalama yaş 61,2±16,9 yıl). Biyokimyasal parametreler ve kardiyak belirteçler başvuru sırasında venöz kandan ölçüldü. Sol ve sağ ventrikül fonksiyonları transtorasik ekokardiyografi ile incelendi. Bulgular: Grup 1'de fib-4 skorları Grup 2'ye göre anlamlı olarak yüksekti (2,35±1,32'ye karşı 1,41±0,96, p=0,005). Grup 1'de D-dimer, troponin ve aspartat transaminaz Grup 2'ye göre anlamlı olarak daha yüksekti ve trombosit sayısı Grup 1'de Grup 2'ye göre anlamlı olarak daha düşüktü. Grup 1'de ejeksiyon fraksiyonu, triküspid anüler düzlem sistolik ayrılma ve fraksiyonel alan değişikliği Grup 2'ye göre anlamlı olarak daha düşüktü Korelasyon analizi, fib-4 indeksinin, pulmoner embolizm şiddet indeks skoru gibi pulmoner embolinin şiddetini gösteren, hemodinamik ve ekokardiyografik parametrelerle ilişkili olduğunu gösterdi. Sonuç: APE ile başvuran hastalarda, başvuru anında hesaplanan fib-4 indeksi, hastalığın şiddetini ve risk sınıflandırmasını hesaplamak için kullanılabilecek bir parametredir.
Anahtar Kelimeler: Fibrozis 4-indeksi; pulmoner emboli; karaciğer fibrozu; transaminaz
Amaç: Bu çalışmada, karaciğer fibrozunu ve sertliğini gösteren parametrelerden birisi olan fibrozis-4 (fib-4) indeksinin akut pulmoner emboli (APE) şiddeti ile ilişkili olup olmadığını araştırdık. Gereç ve Yöntemler: APE tanısı alan toplam 118 hasta acil servise başvuru sırasındaki hemodinamik durumlarına göre 2 gruba ayrıldı. Grup 1 hastaları, hemodinamik dengesizliği olan yüksek riskli hastalardı (42 hasta, 24 erkek, ortalama yaş 66,2±13,6 yıl). Grup 2 hastalar, hemodinamik dengesizliği olmayan yüksek riskli olmayan hastalardı (76 hasta, 24 erkek, ortalama yaş 61,2±16,9 yıl). Biyokimyasal parametreler ve kardiyak belirteçler başvuru sırasında venöz kandan ölçüldü. Sol ve sağ ventrikül fonksiyonları transtorasik ekokardiyografi ile incelendi. Bulgular: Grup 1'de fib-4 skorları Grup 2'ye göre anlamlı olarak yüksekti (2,35±1,32'ye karşı 1,41±0,96, p=0,005). Grup 1'de D-dimer, troponin ve aspartat transaminaz Grup 2'ye göre anlamlı olarak daha yüksekti ve trombosit sayısı Grup 1'de Grup 2'ye göre anlamlı olarak daha düşüktü. Grup 1'de ejeksiyon fraksiyonu, triküspid anüler düzlem sistolik ayrılma ve fraksiyonel alan değişikliği Grup 2'ye göre anlamlı olarak daha düşüktü Korelasyon analizi, fib-4 indeksinin, pulmoner embolizm şiddet indeks skoru gibi pulmoner embolinin şiddetini gösteren, hemodinamik ve ekokardiyografik parametrelerle ilişkili olduğunu gösterdi. Sonuç: APE ile başvuran hastalarda, başvuru anında hesaplanan fib-4 indeksi, hastalığın şiddetini ve risk sınıflandırmasını hesaplamak için kullanılabilecek bir parametredir.
Anahtar Kelimeler: Fibrozis 4-indeksi; pulmoner emboli; karaciğer fibrozu; transaminaz
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