Correlation of alveolar–arterial gradient with Computed Tomography Pulmonary Artery Obstruction index in acute Pulmonary Embolism
Abstract
SUMMARY
Objektive: The purpose of our study was to investigate the relationship between the pulmonary artery obstruction index (PAOI) assessed with helical computed tomography (CT) and impairment in blood gases in patients with acute pulmonary embolism (PE).
Method: This retrospective study design was carried out in the Tertiary Training and Research Hospital Emergency Clinic over a 6-month period with patients in whom PE was detected. The Alveolar–arterial (A-a) oxygen gradient for oxygen was calculated according to the formula 150 – 1.25 (PaCO2 – PaO2), and the PAOI for each patient was measured with the Qanadli score at the mediastinal window using chest CT angiography (CTA).
Results: There were 113 patients included in the study; their mean age was 61.40 (±16.082) years and 51.4% of the patients were female. The mean Alveolar–arterial (A-a) oxygen gradient value was 65.13(±18.78) in massive embolism group. The mean PAOI was determined as 34.027 (min:7.5, max:83.7). The relationship between the radiologically measured PAOI and the Alveolar–arterial (A-a) oxygen gradient were compared, and an increase in the index was detected as the Alveolar–arterial (A-a) oxygen gradient level increased;this difference was found to be statistically significant (r=0.400; p<0.001).
Conclusions: This retrospective observational study found a weak but positive correlation between the PAOI and the Alveolar–arterial (A-a) oxygen gradient. Our study showed that consideration of the Alveolar–arterial (A-a) oxygen gradient increases the sensitivity of blood gas analysis in documented pulmonary embolism.All data showed that the Alveolar–arterial (A-a) oxygen gradient values may be clinically beneficial, as such testing is easy to perform and cost-effective.Moreover, it can be performed at the bedside to detect which patients should be treated with thrombolytics.
Keywords: Pulmonary Embolism, Arterial–Alveolar Gradient, Pulmonary Artery Obstruction Index
ÖZET
Amaç: Çalışmamızın amacı akut pulmoner emboli saptanan hastalarda helikal bilgisayarlı tomografi ile hesaplanan pulmoner arter obstruksiyon indeksinin (PAOI) kan gazı parametrelerinden alveolar-arterial oksijen gradienti ile ilişkisinin araştırılmasıdır.
Yöntem: Bu retrospektif çalışmaya 3. Basamak eğitim araştırma hastanesi acil tıp kliniğine 6 aylık dönemde başvuran ve pulmoner emboli tespit edilen hastalar dahil edildi. Alveolar-arterial oksijen gradient ‘’150-1,25(PaCO2-Pa02)’’ formülu ile hesaplandı.
Bulgular: Çalışmaya 113 hasta dahil edildi. Hastaların yaş ortalaması 61.40 (±16,082) ve %51.4’ ü bayandı. Alveolar-arterial oksijen gradient ortalaması masif emboli grubunda 65,13 (±18,78) saptandı. PAOI ortalaması 34,027 (min:7,5 max:83,7) idi. PAOI ile alveolar-arterial oksijen gradienti arasındaki ilişki karşılaştırıldığında alveolar-arterial oksijen gradienti yükseldikçe pulmoner arter obstruksiyon indeksinin arttığı ve bu ilişkinin istatistiksel olarak anlamlı olduğu görüldü (r=0,400 p<0,001).
Sonuç: Bu retrospektif gözlemsel çalışmada PAOI ile alveolar-arterial gradient arasında zayıf ancak pozitif bir korelasyon saptandı. Çalışmamız pulmoner emboli saptanan hastalarda kan gazı analizinde P(A-a) O2 gradientinin sensitivitesinin arttığını gösterdi. Bütün datalar alveolar-arterial oksijen gradientin kolay uygulanabilinir, düşük maliyetli ve faydalı olabileceğini göstermektedir. Dahası yatak başı uygulamada trombolitik tedavi planlanan hastalarda tanısal alternatif bir seçenek olarak kullanılabilir.
Anahtar sözcükler: Pulmoner Emboli, Alveolar-arterial gradient, Pulmoner Arter Obstruksiyon indeksi
Keywords
Abstract
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Medical Science Research Articles |
| Authors | |
| Publication Date | November 25, 2016 |
| Published in Issue | Year 2016Volume: 38 Issue: 4 |