Ağır toplum kökenli pnömonilerde kardiyak biyobelirteçlerde artışa neden olan faktörler
Factors causing an increase in cardiac biomarkers in severe community acquired pneumonia
- Tez No: 753109
- Danışmanlar: PROF. DR. FİSUN KARADAĞ
- Tez Türü: Tıpta Uzmanlık
- Konular: Göğüs Hastalıkları, Chest Diseases
- Anahtar Kelimeler: Cardiac Markers, CK-MB, Pneumonia, pro-BNP, Troponin
- Yıl: 2022
- Dil: Türkçe
- Üniversite: Aydın Adnan Menderes Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Göğüs Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Tıp Eğitimi Bilim Dalı
- Sayfa Sayısı: 53
Özet
Giriş ve Amaç: TKP, günümüzde halen yüksek morbidite ve mortalite nedenidir. İzlemi sırasında kardiyovasküler komplikasyon gelişen hastalarda mortalite daha da artabilmektedir. Bu nedenle çalışmamızda ağır toplum kökenli pnömoni hastalarında kardiyak fonksiyonu gösteren troponin, CK-MB, pro-BNP düzeylerini ve artışlarında etkisi olan faktörleri belirlemeyi amaçladık. Gereç ve Yöntem: Çalışmaya Eylül 2015-Şubat 2020 tarihleri arasında toplum kökenli pnömoni grup 2 ve 3 tanıları ile Aydın Adnan Menderes Üniversitesi Göğüs hastalıkları servisi veya Göğüs yoğun bakımında izlenen ve dışlama kriterlerini taşımayan 70 hasta retrospektif olarak alınmıştır. Olguların yaş, cinsiyet ve sigara öyküsü gibi demografik verileri, komorbiditeleri, başvuru anındaki vital bulguları, kan gazı, hemogram, biyokimya tetkikleri, troponin, CK-MB ve pro-BNP değerleri kaydedildi. Hastaların PSI ve CURB-65 skorlama sistemlerine göre gruplaması yapıldı. İstatistiksel değerlendirme için SPSS-23 yazılımı kullanıldı. Normal dağılım göstermeyenler için Mann-Whitney U-testi, değişkenler arasındaki ilişkilerin analizi için Spearman ve Pearson korelasyon analizinden faydalanıldı. p
Özet (Çeviri)
Introduction and Aim: CAP is still a cause of high morbidity and mortality. Although pneumonia mortality is high, mortality may increase in patients who develop cardiovascular complications during follow-up. For this reason we aimed to determine the troponin, CK-MB, and pro-BNP levels that show cardiac function in severe community-acquired pneumonia patients and the factors that affect their increase. Materials and Methods: Seventy patients with community-acquired pneumonia group 2 and 3and followed in the chest diseases service or pulmonary intensive care unit of Aydın Adnan Menderes University between September 2015 and February 2020, and who did not meet the exclusion criteria, were retrospectively scanned and admitted to the study. Demographic data such as age, gender and smoking history, comorbidities, vital signs at the time of admission, blood gas, complete blood count, biochemistry tests, troponin, CK-MB and pro-BNP value of the cases were recorded. Patients were grouped according to PSI and CURB-65 pneumonia scoring systems. SPSS-23 software was used for statistical analysis. Mann-Whitney U-test was used for those who did not show normal distribution and Spearman and Pearson correlation analysis was used for the analysis of the relationships between the variables. p < 0.05 was considered significant. Results: 48 (68.6%) of the patients were male and 22 (31.4%) were female. The age range of the patients ranged from 40 to 97 years, with a mean age of 73.05 ±13.77 years. When the groups were evaluated in terms of gender, age and smoking, there was no statistical difference. Among the cardiac biomarkers taken after hospitalization, troponin was found to be above the upper limit in 21 (30%) patients, CK-MB in 7 (10%) patients, and pro-BNP in 28 (40%) patients. When the patients were grouped as patients with and without COPD, the CK-MB value was found to be statistically significantly higher in patients with COPD than in patients without a diagnosis of COPD. The troponin level of patients with signs of altered consciousness was significantly higher than patients without change in consciousness. 38 Pro-BNP values of patients who had arrhythmia within 7 days were significantly higher than those who did not. When those with PSI score of 5 were compared with those with PSI score of 4, CK-MB value was found to be significantly higher. A correlation was found between CK-MB and CURB-65 score. A correlation was found between serum LDH levels and troponin and pro-BNP. A negative correlation was found between CK-MB and lymphocyte. A negative correlation was found between CK-MB and pH. Conclusion: The CK-MB value was found to be higher in patients with COPD than in patients without a diagnosis of COPD, and we think that cardiac markers should be followed up in case of pneumonia in COPD patients. The troponin level of patients with signs of altered consciousness was found to be higher than those without change in consciousness, indicating patients with altered consciousness should be paid attention for cardiovascular complications. The CK-MB value was found to be higher in those with a PSI score of 5 compared to those with a PSI score of 4; we suggest that patients with severe pneumonia should be observed for cardiac complications. A correlation was found between serum LDH levels and troponin and pro-BNP. This suggests that LDH can be evaluated together with cardiac enzymes in terms of cardiac complications in pneumonia patients. A negative correlation was found between CK-MB and lymphocyte count, that is why more studies should be conducted on lymphocyte count and cardiovascular complications in pneumonia patients. A negative correlation was found between CK-MB and pH, so we suggest that the pH value may decrease in severe pneumonia patients and secondary cardiovascular complications may develop. In conclusion, our findings support that severe community-acquired pneumonia should be approached as a systemic inflammation, not as local lung parenchymal inflammation. However, the limitations of this study are that it is a single-center, small-scale study and the small number of cases. Studies with more cases are needed.
Benzer Tezler
- Toplum kökenli pnömonilerde NT-PRO BNP( N-terminal pro-b tipi natriüretik peptid), D-dimer ve fibrinojen düzeylerinin prognoz ile ilişkisi
Relationship between NT-probnp (N-terminal PRO-B type natriuretic peptide), D-dimer and fibrinogene levels with prognosis in community acquired pneumonia
SÜMEYYE SIRAKAYA
Tıpta Uzmanlık
Türkçe
2024
Göğüs HastalıklarıSağlık Bilimleri ÜniversitesiGöğüs Hastalıkları Ana Bilim Dalı
PROF. DR. EBRU ÜNSAL
- Yoğun bakımda takip edilen pnömoni hastalarının endotrakeal aspirasyon örneklerinde atipik etkenlerin multipleks-pcr yöntemi ile araştırılması
Investigation of atypical pathogens by multiplex-pcr method in endotraceal aspiration samples of pneumonia patients followed in intensive care units
TALİHA KARAKÖK
Tıpta Uzmanlık
Türkçe
2020
Klinik Bakteriyoloji ve Enfeksiyon HastalıklarıSağlık Bilimleri ÜniversitesiEnfeksiyon Hastalıkları ve Klinik Bakteriyoloji Ana Bilim Dalı
DOÇ. DR. SALİH CESUR
- Çocukluk çağı toplum kökenli pnömonilerinde toll-like reseptör 2 ve toll-like reseptör 4'ün bir biyobelirteç olarak tanıda ve prognozdaki yerinin belirlenmesi
Başlık çevirisi yok
ÖZLEM NECİPOĞLU
Tıpta Uzmanlık
Türkçe
2022
Çocuk Sağlığı ve HastalıklarıHacettepe ÜniversitesiÇocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
DOÇ. DR. YASEMİN ÖZSÜREKCİ
- Nöropeptidlerin çocukluk çağı toplum kökenli pnömonilerin tanısındaki olası yeri
The role of neuropeptides in the diagnosis of childhood community-acquired pneumonia
BİLGİ SAYGI
Tıpta Uzmanlık
Türkçe
2023
Çocuk Sağlığı ve HastalıklarıBolu Abant İzzet Baysal ÜniversitesiÇocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
PROF. DR. MERVAN BEKDAŞ
- Erişkin astımlı hastalarda kronik chlamydia pneumoniae infeksiyonunun araştırılması
Investigation the chronic chlamydia pneumoniae infection in adult patients with asthma
TALAT ECEMİŞ
Doktora
Türkçe
2002
MikrobiyolojiCelal Bayar ÜniversitesiMikrobiyoloji ve Klinik Mikrobiyoloji Ana Bilim Dalı
DOÇ.DR. SÜHEYLA SÜRÜCÜOĞLU