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Takılabilir Kardiyoverter Defibrilatör ile Tedavi Edilen Kalp Yetersizliği Hastalarında Mortaliteyi Belirleyen Laboratuvar Paramaterleri: Tek Merkezli, Uzun Dönemli Sonuçlar
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CİLT: 74 SAYI: 1
P: 83-89
Nisan 2021

Takılabilir Kardiyoverter Defibrilatör ile Tedavi Edilen Kalp Yetersizliği Hastalarında Mortaliteyi Belirleyen Laboratuvar Paramaterleri: Tek Merkezli, Uzun Dönemli Sonuçlar

J Ankara Univ Fac Med 2021;74(1):83-89
DOI: 10.4274/atfm.galenos.2021.41033
Veysel Özgür Barış 1
Ahmet Büyük 2
Fatih Poyraz 1
Murat Can Güney 3
Sedat Sakallı 1
Bilgi mevcut değil.
Bilgi mevcut değil
Alındığı Tarih: 31.05.2020
Kabul Tarihi: 08.02.2021
Yayın Tarihi: 29.04.2021
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ÖZET

Amaç:

Nötrofil/lenfosit oranı (NLR), Monosit/HDL oranı (MHR), lenfosit/monosit oranı (LMR) ve platelet/lenfosit oranı (PLR) kardiyovasküler hastalıklarda prognostik değerleri kanıtlanmış olan enflamasyon belirteçleridir. Fakat bu belirteçlerin takılabilir kardiyoverter defibrillator (ICD) ile tedavi edilen kalp yetersizliği hastalarında prognostik değerini gösteren klinik çalışma henüz mevcut değildir. Bu çalışmada NLR, MHR, LMR, PLR oranları ile ICD’si olan kalp yetersizliği hastalarında mortalite gelişimi arasındaki ilişkinin gösterilmesi amaçlanmıştır.

Gereç ve Yöntem:

Çalışmaya, Ocak 2015-Aralık 2019 tarihleri arasında sistolik kalp yetersizliği nedeniyle ICD implantasyonu yapılmış 194 hasta dahil edildi.

Bulgular:

Hastaların ortalama yaşı 59,84±13,26 idi. Kadın cinsiyet oranı %25,3 idi. Medyan 27 aylık izlem sonrasında 16 hastada ölüm gelişti (%8). Exitus gelişen grupta bazal üre, ürik asit, gama-glutamil transferaz, C-reaktif protein, nötrofil düzeyleri yüksek saptanırken; hemoglobin ve lenfosit düzeyleri ise düşük saptandı. Takiplerde ölüm gelişen grupta NLR, MHR ve PLR oranları istatistiksel olarak anlamlı şekilde yüksek saptanırken (p=0,001, p=0,049, p=0,020, sırasıyla) LMR belirgin derecede düşük saptanmıştır (p<0,001). Yapılan ROC analizlerinde mortaliteyi NLR’nin 3,06 ve üzerindeki değerlerinin %81 sensitive ve % 61 spesifite [p=0,001 Eğri altında kalan alan (AUC)=0,76]; MHR’nin 0,0196 ve üzerindeki değerlerinin %86 sensitive ve %61 spesifite (p=0,046 AUC=0,723); LMR’nin 3,22 ve altındaki değerlerinin %81 sensitive ve %55 spesifite (p<0,001 AUC=0,784); PLR’nin 113,59 ve üzerindeki değerlerinin %75 sensitive ve %51 spesifite (p=0,020 AUC=0,68) ile öngördüğü saptandı. Bu oranların dahil edildiği multipl lojistik regresyon analizinde LMR değeri istatistiksel olarak anlamlı saptanmıştır (p=0,027).

Sonuç:

Çalışmamızda enflamasyon belirteçleri olan NLR, MHR, PLR ve LMR oranlarının ICD implante edilmiş kalp yetersizliği hastalarında mortaliteyi predikte edebileceği gösterilmiştir. Yapılan çok değişkenli analizde LMR değeri anlamlı bulunmuştur. Bu çalışma bu hasta grubunda bu parametrelerin prediktör gücünü gösteren ilk çalışmadır.

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