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Pulmoner Tromboembolide Plevral Efüzyon Sıklığı ve Efüzyonla İlişkili Faktörlerin Belirlenmesi: Retrospektif Kesitsel Çalışma
Determination of Pleural Effusion Frequency and Effusion Related Factors in Pulmonary Thromboembolism: A Retrospective Cross-Sectional Study
Turkiye Klinikleri Arch Lung. 2023;22(3):58-63
doi: 10.5336/archlung.2023-99751
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Pulmoner tromboembolizm (PTE); konjestif kalp yetersizliği, parapnömonik efüzyon ve maligniteden sonra plevral efüzyonun dördüncü en sık nedenidir. PTE; ayrıca tanısı konulamamış plevral efüzyonun önde gelen nedenlerinden biri kabul edilir. Bu çalışmada, PTE'de plevral efüzyon sıklığının saptanması, plevral efüzyon gelişen ve gelişmeyen hastaların klinik özelliklerinin belirlenmesi ve karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya Ocak 2016-Aralık 2021 tarihleri arasında göğüs hastalıkları servisinde pulmoner emboli tanısı ile hastaneye yatırılarak tedavi altına alınan hastalar dâhil edildi. Hastalara ait veriler retrospektif olarak incelenerek, hastane mortalitesi ve 1 aylık mortalite verileri kaydedildi. Toraks bilgisayarlı tomografileri plevral efüzyon açısından incelendi. Masif plevral efüzyonlar, pnömoni, malignite ve konjestif kalp yetersizliğine bağlı plevral sıvılar çalışma dışı bırakıldı. Veriler SPSS paket programına kaydedilerek analiz edildi ve p değeri <0,05 anlamlı kabul edildi. Bulgular: Yaş ortalaması 70±15 (18-99) olan 525 hastanın 315'i (%60) kadınlardan oluşmaktaydı. Plevral efüzyon 113 (%22) vakada saptandı. Plevral efüzyonu olan hastaların yaşları, plevral efüzyonu olmayanlara göre anlamlı yüksekti (p<0,001). Plevral efüzyonu olan grupta ortanca sistolik pulmoner arter basıncı 40 mmHg iken, efüzyonu olmayan grupta 36 mmHg olarak saptandı (p=0,030). Otuz günlük mortalite efüzyonu olan grupta daha fazla iken, istatistiksel olarak anlamlı saptanmadı (p=0,051). Sonuç: Çalışma sonuçlarımıza göre PTE vakalarında plevral efüzyon oranı %22 gibi azımsanmayacak bir yükseklikte saptanmıştır. Pulmoner arter obstrüksiyonu daha fazla olan bu hastalarda beklendiği gibi kan basınçları daha düşük ve hipoksemi daha belirgin saptanmıştır. Ayrıca PTE olgularında yaş arttıkça plevral efüzyon gelişme olasılığı artmaktadır.
Anahtar Kelimeler: Pulmoner emboli; plevral efüzyon; pulmoner hipertansiyon
Amaç: Pulmoner tromboembolizm (PTE); konjestif kalp yetersizliği, parapnömonik efüzyon ve maligniteden sonra plevral efüzyonun dördüncü en sık nedenidir. PTE; ayrıca tanısı konulamamış plevral efüzyonun önde gelen nedenlerinden biri kabul edilir. Bu çalışmada, PTE'de plevral efüzyon sıklığının saptanması, plevral efüzyon gelişen ve gelişmeyen hastaların klinik özelliklerinin belirlenmesi ve karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya Ocak 2016-Aralık 2021 tarihleri arasında göğüs hastalıkları servisinde pulmoner emboli tanısı ile hastaneye yatırılarak tedavi altına alınan hastalar dâhil edildi. Hastalara ait veriler retrospektif olarak incelenerek, hastane mortalitesi ve 1 aylık mortalite verileri kaydedildi. Toraks bilgisayarlı tomografileri plevral efüzyon açısından incelendi. Masif plevral efüzyonlar, pnömoni, malignite ve konjestif kalp yetersizliğine bağlı plevral sıvılar çalışma dışı bırakıldı. Veriler SPSS paket programına kaydedilerek analiz edildi ve p değeri <0,05 anlamlı kabul edildi. Bulgular: Yaş ortalaması 70±15 (18-99) olan 525 hastanın 315'i (%60) kadınlardan oluşmaktaydı. Plevral efüzyon 113 (%22) vakada saptandı. Plevral efüzyonu olan hastaların yaşları, plevral efüzyonu olmayanlara göre anlamlı yüksekti (p<0,001). Plevral efüzyonu olan grupta ortanca sistolik pulmoner arter basıncı 40 mmHg iken, efüzyonu olmayan grupta 36 mmHg olarak saptandı (p=0,030). Otuz günlük mortalite efüzyonu olan grupta daha fazla iken, istatistiksel olarak anlamlı saptanmadı (p=0,051). Sonuç: Çalışma sonuçlarımıza göre PTE vakalarında plevral efüzyon oranı %22 gibi azımsanmayacak bir yükseklikte saptanmıştır. Pulmoner arter obstrüksiyonu daha fazla olan bu hastalarda beklendiği gibi kan basınçları daha düşük ve hipoksemi daha belirgin saptanmıştır. Ayrıca PTE olgularında yaş arttıkça plevral efüzyon gelişme olasılığı artmaktadır.
Anahtar Kelimeler: Pulmoner emboli; plevral efüzyon; pulmoner hipertansiyon
ABSTRACT
Objective: Pulmonary thromboembolism (PTE); it is the fourth most common cause of pleural effusions after congestive heart failure, parapneumonic effusions and malignancy. PTE is also considered to be a leading cause of undiagnosed pleural effusion. The aim of this study was to determine the frequency of pleural effusion in PTE and to determine and compare the clinical characteristics of patients with and without pleural effusion. Material and Methods: Patients who were admitted and treated at the thoracic service with a diagnosis of pulmonary embolism between January 2016 and December 2021 were included in the study. The data of the patients were examined retrospectively, and hospital mortality and 1-month mortality data were recorded. Thorax computed tomographies were examined for pleural effusion. Massive pleural effusions and pleural effusions due to pneumonia, malignancy and congestive heart failure were excluded from the study. Data were recorded and analysed using the SPSS package, and a p value <0.05 was considered significant. Results: Of the 525 patients with an average age of 70±15 (18-99), 315 (60%) were women. Pleural effusion was detected in 113 (22%) cases. The ages of patients with pleural effusion were significantly higher than those without pleural effusion (p<0.001). While the median systolic pulmonary artery pressures was 40 mmHg in the group with pleural effusion, it was 36 mmHg in the group without effusion (p=0.030). Thirty-day mortality was higher in the effusion group, but not statistically significant (p=0.051). Conclusion: According to our study results, the rate of pleural effusion in PTE cases was found to be as high as 22%. As expected, blood pressures were lower and hypoxemia was more pronounced in these patients with more pulmonary artery obstruction. Additionally, as age increases in PTE cases, the likelihood of developing pleural effusion increases.
Keywords: Pulmonary embolism; pleural effusion; pulmonary hypertension
Objective: Pulmonary thromboembolism (PTE); it is the fourth most common cause of pleural effusions after congestive heart failure, parapneumonic effusions and malignancy. PTE is also considered to be a leading cause of undiagnosed pleural effusion. The aim of this study was to determine the frequency of pleural effusion in PTE and to determine and compare the clinical characteristics of patients with and without pleural effusion. Material and Methods: Patients who were admitted and treated at the thoracic service with a diagnosis of pulmonary embolism between January 2016 and December 2021 were included in the study. The data of the patients were examined retrospectively, and hospital mortality and 1-month mortality data were recorded. Thorax computed tomographies were examined for pleural effusion. Massive pleural effusions and pleural effusions due to pneumonia, malignancy and congestive heart failure were excluded from the study. Data were recorded and analysed using the SPSS package, and a p value <0.05 was considered significant. Results: Of the 525 patients with an average age of 70±15 (18-99), 315 (60%) were women. Pleural effusion was detected in 113 (22%) cases. The ages of patients with pleural effusion were significantly higher than those without pleural effusion (p<0.001). While the median systolic pulmonary artery pressures was 40 mmHg in the group with pleural effusion, it was 36 mmHg in the group without effusion (p=0.030). Thirty-day mortality was higher in the effusion group, but not statistically significant (p=0.051). Conclusion: According to our study results, the rate of pleural effusion in PTE cases was found to be as high as 22%. As expected, blood pressures were lower and hypoxemia was more pronounced in these patients with more pulmonary artery obstruction. Additionally, as age increases in PTE cases, the likelihood of developing pleural effusion increases.
Keywords: Pulmonary embolism; pleural effusion; pulmonary hypertension
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