अमूर्त

Pulmonary embolism: single and multiple risk factors

Bilgehan Demir, Hakan Oguzturk, Muhammet Gokhan Turtay , Cemil Colak , Nur Kaplan Demir, Sukru Gurbuz

Purpose: This study aims to determine the effect of the coexistence of multiple risk factors on prevalence of pulmonary embolism (PE), which has a high mortality.

Method: We conscripted 220 patients who submitted to the emergency department of Turgut Özal Medical Center (TOTM) between January 2013 and January 2014. Of these, 110 patients were diagnosed with pulmonary embolism and they showed symptoms such as pain in the chest, sweating, coughing, hemoptysis and syncope, and 110 were healthy controls. A prospective study was conducted to obtain information on the patients regarding age, cerebrovascular disease (CVD), coronary artery disease (CAD), congestive heart failure (CHF), diabetes mellitus (DM), hypertension (HT), smoking, hormone replacement treatment (HRT), pregnancy, chronical obstructive pulmonary disease (COPD), previous surgical interventions and cancer history. We also analyzed various blood values such as white blood cell (WBC) count, hemoglobin, hematocrit, thrombocyte, glucose, urine, creatinine, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), Cholesterol, Very Low Density Lipoprotein (WLDL), INR, and CRP. We examined Protein C, Protein S and AT3 levels of all patients. We obtained electrocardiography (ECG), dynamic computed tomography, electrocardioscopy (ECHO) and venous lower extremity Doppler ultrasonography from all patients. Findings: Of 220 patients, 112 were male (50.9%) and 108 female (49.1%). We found DM (p: 0.017), HT (p: 0.020), CVD (p: 0.026) smoking (p: 0.014), dyslipidemia (p: 0.408) values statistically significant. We found only Protein S (p: 0.0001) and Troponin (p: 0.0002) levels significant among Protein C, Protein S, AT3, INR, Fibrinogen, D-dimer, troponin, blood gas parameters. We also found Doppler values significant (p: 0.001) among other radiologic parameters. When we applied univariate regression analysis on the risk factors, we determined hypertension (50.0%) and smoking (32.7%) as the most risky for PE. Other risk factors were surgical intervention, CVD, CHF, CAD, DM, COPD, CA, pregnancy and HRT, respectively. Most common symptom was the pain in the chest (88.2%). We found that DM and smoking poses greater risk together (OR: 8.67). Besides OR values for HT-CHF, DM-COPD, DM-pregnancy, and COPD-smoking pairs was 5.48, 5.14, 3.98, and 3.73, respectively. OR value was highest for syncope and sweating symptom pair (4.039).

Conclusion: We found that the prevalence of PE increase in case of coexistence of risk factors. Thus even small symptoms can help to diagnose and prevent this deadly disease. In this regard, a careful doctor can make a big difference. Following studies may concentrate on educating the patients.