| Sažetak | Uvod: U kliničkoj obradi bolesnika s plućnom embolijom (PE), osim točne dijagnoze, presudno je i stupnjevanje bolesnika prema stupnju rizika za nepovoljan ishod na one s visokim, intermedijarnim i niskim rizikom.
Cilj: Odrediti može li se neki od rutinskih laboratorijskih parametara koristiti u stratifikaciji bolesnika s PE prema riziku.
Metode: Prospektivna, longitudinalna, kohortna, neintervencijska studija 104 bolesnika s PE dokazanom MSCT-om u razdoblju od 12 mjeseci te analiza kliničkih, laboratorijskih i elektrokardiografskih nalaza između rizičnih skupina i s obzirom na ishod bolesti.
Rezultati: Prema ehokardiografskom nalazu, 104 uključena bolesnika podijeljena su u skupinu s visokim (n=33; 31,7%), intermedijarnim (n=51, 49%) te niskim rizikom (n=20, 19,2%). Kod hemodinamski stabilnih bolesnika, učestalost dispneje (p=0,021), boli u prsima (p=0,028) i tahikardije (p=0,001) statistički je značajno korelirala s PE intermedijarnog rizika.
Uobičajena laboratorijska obrada nije se pokazala pouzdanom u stratifikaciji, KKS (p=0.318), CRP (p=0.080), AST (p=0.179), ALT (p=0.074), CPK (p=0.889), LDH (p=0.094) iako su postojale značajne korelacije za kreatinin (p=0.016), GUK (p=0.002), Na+ (p=0.002) i pH (p=0.016). Vrijednosti su bile unutar referentnih. cTnT je jasno diferencirao skupine hemodinamski stabilnih bolesnika (p=0.037.) EKG analiza pokazala je korelaciju za sinusnu tahikardiju (p,p*<0,001) i RBBB (p=0,0005) za sve skupine.
Zaključak: Jedini pouzdani laboratorijski parametar koji jasno odvaja bolesnike s PE intermedijarnog od onih s niskim rizikom bio je srčani troponin T (cTnT). |
| Sažetak (engleski) | Introduction: Clinical approach in patients with pulmonary embolism (PE), in addition to accurate diagnosis, requires a risk stratification depending on the probability of adverse outcome in groups with high-risk, intermediate-risk and low-risk PE.
Aim: To determine which of the routine laboratory test can be used in the risk stratification of patients with PE.
Methods: Prospective, longitudinal, non-intervention, cohort study of 104 patients with MSCT proven PE, in period of 12 months and analysis of clinical, laboratory and electrocardiographic signs between risk groups and patient outcome.
Results: According to echocardiography, the patients were divided in high-risk group (n=33, 31,7%), intermediate-risk group (n=51, 49%) and low-risk group (n=20, 19.2%). In hemodynamically stable patients, frequency of dyspnoea (p=0.021), chest pain (p=0.028) and tachycardia (p=0.001) were significantly correlated with intermediate-risk PE. Routine laboratory tests were not reliable in risk stratification, FBC (p=0.318), CRP (p=0.080), AST (p=0.179), ALT (p=0.074), CPK (p=0.889), LDH (p=0.094), although significant correlation was found for creatinine (p=0.016), glucose (p=0.002), sodium (p=0.002) and pH (p=0.016), values were within reference range. cTnT clearly distinguishes groups of hemodynamically stable patients (p=0.037). Analysis of electrocardiography shows significant correlation for sinus tachycardia (p,p*<0.001) and RBBB (p=0.0005) for all risk groups.
Conclusion: The only reliable laboratory test that clearly distinguishes patients with intermediate-risk PE from low-risk PE was cardiac troponin T (cTnT). |
