Ejeksiyon Fraksiyonu Azalmış Kalp Yetmezliği Olan Hastalarda İmmün Enflamasyon İndeksi ile Majör Kardiyovasküler Olaylar Arasındaki İlişki
Öz
Amaç: Sistemik immün inflamasyon indeksi (SII)’nin, düşük ejeksiyon fraksiyonuna sahip Kalp yetmezliği (HFrEF) hastalarında, exitus, stroke ve hospitalizasyon gibi majör kardiyovaskuler olayları öngörmede, prognozu belirlemede prediktif değeri olup olmadığını araştırmayı amaçladık.
Materyel Metod: Çalışmaya Ocak 2019- Ocak 2022 arası kardiyoloji ve acil polikliniğine başvuran 18 yaş üstü, HFrEF’li (Ejeksiyon Fraksiyonu <% 40) tanısı olan hastalar retrospektif olarak tarandı. Güvenilir klinik verileri olan 597 hasta analiz edilmek üzere çalışmaya grubu olarak kabul edildi. Hastaların ilk başvuru sırasındaki sosyodemografik özellikleri, kronik hastalıkları, sigara kullanımı ve hemogram, biyokimya parametreleri, sol ventrikül ejeksiyon fraksiyonları kullandığı ilaçlar kaydedildi. Tam kan sayımları ve biyokimyasal parametreleri incelendi. Sistemik immun inflamasyon indeksi hesaplandı. ). Major kardiyak olaylar ile SII arasındaki ilişki değerlendirildi. Major kardiak olaylar olarak exitus, stroke ve hospitalize olma durumu olarak kabul edildi.
Bulgular: , HFrEF’li hastalarda ,SII indeksi açısından gruplar karşılaştırıldığında exitus olan grupta (1504,34±1722,74) exitus olmayan gruba göre ( 893,94±972,13) anlamlı olarak daha yüksek bulundu (p=0,014). Stroke olan ve olmayan, hastaneye yatış olan ve olmayan gruplar SII indeksi açısından karşılaştırıldığında anlamlı bir fark bulunamadı (tablo 2). Exitus varlığı, stroke varlığı ve hastaneye yatış varlığı ile SII indeksi arasında korelasyon bakıldığında exitus varlığı ile SII indeksi arasında anlamlı pozitif korelasyon bulundu (r=0.165 p<0,001) . SII indeksi 697,29 değeri kalp yetmezliği hastalarında Exitusu %604 sensivit, %607 spesivite ile pretikte ettirdiği saptandı (AUC: 0.621, 95%CI 0.539-0.704, p=0.04)
Sonuç: HFrEF’lı hastalarda, kolayca bakılan bir tam kan sayımındaki lenfosit, trombosit ve nötrofil sayısından kolayca hesaplanabilen, SII indexinin mortaliteyi, predikte ettirdiğinin saptanmasıdır. Bu indexin HFrEF hastalarında prognostik önemi olduğu, özellikle yaşlı ve SII indexi yüksek hastaların daha yakın izlenmesinin faydalı olabileceğini düşündürmektedir.
Anahtar Kelimeler
immun enflamasyon indeksi kalp yetersizliği ejeksiyon fraksiyonu
Etik Beyan
Etik kurul onayı Ordu Üniversitesi Klinik Araştırmalar Etik Kurulundan alınmıştır.
Proje Numarası
2023/26
Kaynakça
- Ardahanli I, Celik M. Serum Uric Acid Levels among Patients who Died in Recent Year due to Heart Failure with Reduced Ejection Fraction. J Coll Physicians Surg Pak. 2020 Aug;30(8):780-784. doi: 10.29271/jcpsp.2020.08.780. PMID: 32893785.
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. EurHeartJ. 2021;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368.
- Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev.2017;3(1):7-11. doi: 10.15420/cfr.2016:25:2
- Hartupee J, Mann DL. Neurohormonal activation in heart failure with reduced ejection fraction. Nat Rev Cardiol. 2017;14(1):3038. doi: 10.1038/nrcardio.2016.163.
- Adamo L, Rocha-Resende C, Prabhu SD, Mann DL. Reappraising the role of inflammation in heart failure. Nat Rev Cardiol. 2020;17(5):269285. doi: 10.1038/s41569-019-0315-x.
- Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of systemic immune-inflammation index in cancer:ameta-analysis. J Cancer. 2018;9(18):3295-3302 doi: 10.7150/jca.25691.
- Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease.Eur J Clin Invest.2020;50(5):e13230. doi: 10.1111/eci.13230.
- Su G, Zhang Y, Xiao R, Zhang T, Gong B. Systemic immune inflammation index as a promising predictor of mortality in patients with acute coronary syndrome: a real-world study. J Int Med Res. 2021;49(5):3000605211016274. doi: 10.1177/03000605211016274
- Yurdam FS, Kış M. The Predictive Role of Systemic Immune Inflammation Index to the Aortic Valve Calcification in the Elderly Population with Chronic Renal Failure. E J Cardiovasc Med 2023;11:11-16.
- Güzel T, Kış M. Correlation Between Coronary Lesion Severity Detected in Fractional Flow Reserve with Systemic Immune Inflammation Index and Atherogenic Plasma Index 10.4274/BMB.galenos.2022.2022-04-036.
- Oikonomou E, Tousoulis D, Siasos G, Zaromitidou M, Papavassiliou AG, Stefanadis C. The role of inflammation in heart failure: new therapeutic approaches. Hellenic J Cardiol 2011; 52: 30-40. PMID: 21292605.
- Uthamalingam S, Patvardhan EA, Subramanian S, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol. 2011;107(3):433438. doi: 10.1016/j.amjcard.2010.09.039.
- Curran FM, Bhalraam U, Mohan M, et al. Neutrophil-to-lymphocyte ratio and outcomes in patients with new-onset or worsening heart failure with reduced and preserved ejection fraction. ESC Heart Fail. 2021;8(4):3168-3179. doi: 10.1002/ehf2.13424.
- Demir M, Duyuler PT, Guray U, Celik MC. Platelet to lymphocyte ratio on admission and prognosis in patients with acute cardiogenic pulmonary edema.JEmergMed.2018;55(4):465-471. doi: 10.1016/j.jemermed.2018.06.021
- Heidarpour M, Bashiri S, Vakhshoori M, et al. The association between platelet-to-lymphocyte ratio with mortality among patients suffering from acute decompensated heart failure. BMC Cardiovasc Disord. 2021;21(1):454 doi: 10.1186/s12872-021-02260-7.
- Durmus E, Kivrak T, Gerin F, Sunbul M, Sari I, Erdogan O. Neutrophilto-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure. Arq Bras Cardiol 2015; 105: 606-13 doi: 10.5935/abc.20150126.
- Hayıroglu M˙I, ÇınarT, Çinier G, et al. Evaluating systemic immune-inflammation index in patients with ICD for heart failure with reduced ejection fraction. Pacing Clin Electrophysiol.2022;45:188–195. https://doi.org/10.1111/pace.14436.
- Adelborg, K.; Szépligeti, S.; Sundbøll, J.; et al. Risk of Stroke in Patients With Heart Failure: A Population-Based 30-Year Cohort Study. Stroke 2017, 48, 1161–1168. doi: 10.1161/STROKEAHA.116.016022.
- Pullicino, P.M.; Halperin, J.L.; Thompson, J.L. Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology 2000, 54, 288–294. doi: 10.1212/wnl.54.2.288.
- Sartipy, U.; Dahlström, U.; Fu, M.; Lund, L.H. Atrial Fibrillation in Heart Failure with Preserved, Mid-Range, and Reduced Ejection Fraction. JACC Heart Fail. 2017, 5, 565–574 doi: 10.1016/j.jchf.2017.05.001.
- Pullicino, P.M.; Halperin, J.L.; Thompson, J.L. Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology 2000, 54, 288–294. doi: 10.1212/wnl.54.2.288.
- Paolillo, S.; Ruocco, G.; Filardi, P.P.; et al. “Right and Left Heart Failure Study Group” of the Italian Society of Cardiology. Direct oral anticoagulants across the heart failure spectrum: The precision medicine era. Heart Fail. Rev. 2020, doi:10.1007/s10741-020-09994-0.
- Jug, B.; Vene, N.; Salobir, B.G.; Sebestjen, M.; Sabovic, M.; Keber, I. Procoagulant state in heart failure with preserved left ventricular ejection fraction. Int. Heart. J. 2009, 50, 591–600. doi: 10.1536/ihj.50.591.
- Jekell, A.; Kalani, M.; Kahan, T. The interrelation of endothelial function and microvascular reactivity in different vascular beds, and risk assessment in hypertension: Results from the Doxazosin-ramipril study. Heart Vessels. 2019, 34, 484–495. doi: 10.1007/s00380-018-1265-7.
- Scherbakov, N.; Sandek, A.; Martens-Lobenhoffer, J.; et al. Endothelial dysfunction of the peripheral vascular bed in the acute phase after ischemic stroke. Cereb. Dis. 2012, 33, 37–46. doi: 10.1159/000332809.
The Relationship Between Immune Inflammation Index and Major Cardiovascular Adverse Events in Patients with Heart Failure with Reduced Ejection Fraction.
Öz
Aim: We aimed to investigate whether systemic immune inflammation index (SII) has a predictive value in predicting prognosis and major adverse cardiovascular events such as exitus, stroke and hospitalization in heart failure patients with reduced ejection fraction (HFrEF).
Methods: Patients over the age of 18 who applied to the cardiology and emergency outpatient clinics between January 2019 and January 2022 and diagnosed with HFrEF (Ejection Fraction <40%) were retrospectively screened. A total of 597 patients with reliable clinical data were included in the study.The relationship between major adverse cardiovascular events and SII was evaluated. Exitus, stroke and hospitalization were accepted as major adverse cardiovascular events.
Result: In patients with HFrEF, SII index was found to be significantly higher in the Exitus (+) group (1504.34±1722.74) when compared with the Exitus (-) group (893.94±972.13) (p=0.014). On the other hand, SII index was not found to be different between the patients with or without stroke and between those with or without hospitalization. When the correlation between the SII index and presence of exitus, stroke, and hospitalization was evaluated, a significant positive correlation was found between the presence of exitus and SII index (r=0.165 p<0.001). A SII index value of 697.29 was found to predict exitus with 604% sensitivity and 607% specificity in heart failure patients (AUC: 0.621,95%CI 0.539-0.704, p=0.04)
Conclusion: SII index, which can be calculated easily from lymphocyte, platelet and neutrophil counts, predicts mortality in patients with HFrEF. This index has prognostic significance in patients with HFrEF, suggesting that closer monitoring of elderly patients with a high SII index may be beneficial.
Anahtar Kelimeler
Proje Numarası
2023/26
Kaynakça
- Ardahanli I, Celik M. Serum Uric Acid Levels among Patients who Died in Recent Year due to Heart Failure with Reduced Ejection Fraction. J Coll Physicians Surg Pak. 2020 Aug;30(8):780-784. doi: 10.29271/jcpsp.2020.08.780. PMID: 32893785.
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. EurHeartJ. 2021;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368.
- Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev.2017;3(1):7-11. doi: 10.15420/cfr.2016:25:2
- Hartupee J, Mann DL. Neurohormonal activation in heart failure with reduced ejection fraction. Nat Rev Cardiol. 2017;14(1):3038. doi: 10.1038/nrcardio.2016.163.
- Adamo L, Rocha-Resende C, Prabhu SD, Mann DL. Reappraising the role of inflammation in heart failure. Nat Rev Cardiol. 2020;17(5):269285. doi: 10.1038/s41569-019-0315-x.
- Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of systemic immune-inflammation index in cancer:ameta-analysis. J Cancer. 2018;9(18):3295-3302 doi: 10.7150/jca.25691.
- Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease.Eur J Clin Invest.2020;50(5):e13230. doi: 10.1111/eci.13230.
- Su G, Zhang Y, Xiao R, Zhang T, Gong B. Systemic immune inflammation index as a promising predictor of mortality in patients with acute coronary syndrome: a real-world study. J Int Med Res. 2021;49(5):3000605211016274. doi: 10.1177/03000605211016274
- Yurdam FS, Kış M. The Predictive Role of Systemic Immune Inflammation Index to the Aortic Valve Calcification in the Elderly Population with Chronic Renal Failure. E J Cardiovasc Med 2023;11:11-16.
- Güzel T, Kış M. Correlation Between Coronary Lesion Severity Detected in Fractional Flow Reserve with Systemic Immune Inflammation Index and Atherogenic Plasma Index 10.4274/BMB.galenos.2022.2022-04-036.
- Oikonomou E, Tousoulis D, Siasos G, Zaromitidou M, Papavassiliou AG, Stefanadis C. The role of inflammation in heart failure: new therapeutic approaches. Hellenic J Cardiol 2011; 52: 30-40. PMID: 21292605.
- Uthamalingam S, Patvardhan EA, Subramanian S, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol. 2011;107(3):433438. doi: 10.1016/j.amjcard.2010.09.039.
- Curran FM, Bhalraam U, Mohan M, et al. Neutrophil-to-lymphocyte ratio and outcomes in patients with new-onset or worsening heart failure with reduced and preserved ejection fraction. ESC Heart Fail. 2021;8(4):3168-3179. doi: 10.1002/ehf2.13424.
- Demir M, Duyuler PT, Guray U, Celik MC. Platelet to lymphocyte ratio on admission and prognosis in patients with acute cardiogenic pulmonary edema.JEmergMed.2018;55(4):465-471. doi: 10.1016/j.jemermed.2018.06.021
- Heidarpour M, Bashiri S, Vakhshoori M, et al. The association between platelet-to-lymphocyte ratio with mortality among patients suffering from acute decompensated heart failure. BMC Cardiovasc Disord. 2021;21(1):454 doi: 10.1186/s12872-021-02260-7.
- Durmus E, Kivrak T, Gerin F, Sunbul M, Sari I, Erdogan O. Neutrophilto-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure. Arq Bras Cardiol 2015; 105: 606-13 doi: 10.5935/abc.20150126.
- Hayıroglu M˙I, ÇınarT, Çinier G, et al. Evaluating systemic immune-inflammation index in patients with ICD for heart failure with reduced ejection fraction. Pacing Clin Electrophysiol.2022;45:188–195. https://doi.org/10.1111/pace.14436.
- Adelborg, K.; Szépligeti, S.; Sundbøll, J.; et al. Risk of Stroke in Patients With Heart Failure: A Population-Based 30-Year Cohort Study. Stroke 2017, 48, 1161–1168. doi: 10.1161/STROKEAHA.116.016022.
- Pullicino, P.M.; Halperin, J.L.; Thompson, J.L. Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology 2000, 54, 288–294. doi: 10.1212/wnl.54.2.288.
- Sartipy, U.; Dahlström, U.; Fu, M.; Lund, L.H. Atrial Fibrillation in Heart Failure with Preserved, Mid-Range, and Reduced Ejection Fraction. JACC Heart Fail. 2017, 5, 565–574 doi: 10.1016/j.jchf.2017.05.001.
- Pullicino, P.M.; Halperin, J.L.; Thompson, J.L. Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology 2000, 54, 288–294. doi: 10.1212/wnl.54.2.288.
- Paolillo, S.; Ruocco, G.; Filardi, P.P.; et al. “Right and Left Heart Failure Study Group” of the Italian Society of Cardiology. Direct oral anticoagulants across the heart failure spectrum: The precision medicine era. Heart Fail. Rev. 2020, doi:10.1007/s10741-020-09994-0.
- Jug, B.; Vene, N.; Salobir, B.G.; Sebestjen, M.; Sabovic, M.; Keber, I. Procoagulant state in heart failure with preserved left ventricular ejection fraction. Int. Heart. J. 2009, 50, 591–600. doi: 10.1536/ihj.50.591.
- Jekell, A.; Kalani, M.; Kahan, T. The interrelation of endothelial function and microvascular reactivity in different vascular beds, and risk assessment in hypertension: Results from the Doxazosin-ramipril study. Heart Vessels. 2019, 34, 484–495. doi: 10.1007/s00380-018-1265-7.
- Scherbakov, N.; Sandek, A.; Martens-Lobenhoffer, J.; et al. Endothelial dysfunction of the peripheral vascular bed in the acute phase after ischemic stroke. Cereb. Dis. 2012, 33, 37–46. doi: 10.1159/000332809.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Orijinal Araştırma |
| Yazarlar | |
| Proje Numarası | 2023/26 |
| Erken Görünüm Tarihi | 14 Mayıs 2024 |
| Yayımlanma Tarihi | 14 Mayıs 2024 |
| Gönderilme Tarihi | 30 Aralık 2023 |
| Kabul Tarihi | 25 Ocak 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 7 Sayı: 1 |
