Akut Koroner Sendromda Hastane İçi Mortalitenin İnflamatuar ve Klinik Tahmin Edicileri: Retrospektif Bir Kohort Çalışması
Abstract
Amaç: Bu çalışmanın amacı, akut koroner sendrom (AKS) tanısı alan hastalarda hastane içi mortalite oranlarını retrospektif olarak analiz etmek ve mortaliteyi artıran bağımsız risk faktörlerini belirlemek-tir.
Materyal ve Metod: 01 Ocak 2023 - 30 Aralık 2024 tarihleri arasında Aktif International Hospital Kardi-yoloji Kliniği’nde yürütülen retrospektif kohort çalışmasına 694 AKS hastası dahil edilmiştir. Hastaların demografik, klinik, laboratuvar ve görüntüleme verileri retrospektif olarak analiz edilmiştir. Hastane içi mortaliteyi etkileyen bağımsız risk faktörleri çok değişkenli lojistik regresyon analizi ile değerlendiril-miştir.
Bulgular: Hastane içi mortalite oranı %2,4 olarak bulundu. Yaş (p = 0.02), diyabetes mellitus (p = 0.03) ile hiperlipidemi (p = 0.04) sıklığı, kreatinin (p = 0.002) ve troponin-I (p < 0.001) mortalite grubunda anlamlı olarak daha yüksek iken, sol ventrikül ejeksiyon fraksiyonu (LVEF) ise daha düşük (p = 0.04) olarak tespit edildi. Ek olarak, hematolojik parametreler arasında yer alan nötrofil-lenfosit oranı (NLR) (p = 0.005) ve trombosit-lenfosit oranı (PLR) da (p = 0.01) mortalite grubunda anlamlı derecede yüksek bulundu. Çok değişkenli lojistik regresyon analizinde, yaş (OR = 1.05, p = 0.003), diabetes mellitus (OR=1.37, p = 0.002), hipertansiyon (OR=1.42, p = 0.001) and hiperlipidemi varlığı (OR= 1.28, p = 0.03), artmış troponin-I (OR = 2.34, p < 0.001), yükselmiş kreatinin seviyeleri (OR = 1.75, p = 0.002), düşük LVEF (OR = 0.89, p = 0.04), NLR (OR = 1.56, p = 0.005) ve PLR (OR = 1.42, p = 0.01) hastane içi mortalitenin bağımsız prediktörleri olarak belirlendi.
Sonuç: Çalışmamız ileri yaşın, hipertansiyon, diabetes mellitus, hiperlipidemi, renal disfonksiyon, yükselmiş inflamatuar belirteçlerin (NLR, PLR) ve azalmış LVEF'nin ACS hastalarında hastane içi mortali-tenin bağımsız öngörücüleri olduğunu ileri sürmektedir. Bulgularımız ayrıca ACS hastalarında mortalite oranlarını azaltmada erken revaskülarizasyonun kritik rolünü vurgulamaktadır.
Anahtar Kelimeler: Akut koroner sendrom, Hastane içi mortalite, Risk faktörleri, Nötrofil-lenfosit oranı, Trombosit-lenfosit oranı
Keywords
Akut koroner sendrom hastane içi mortalite risk faktörleri troponin inflamatuvar belirteçler nötrofil-lenfosit oranı trombosit-lenfosit oranı
References
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- 15. Li X, Chen Y, Yuan Q, Zhou H, Lu L, Guo R. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio associated with 28-day all-cause mortality in septic patients with coronary artery disease: a retrospec-tive analysis of MIMIC-IV database. BMC Infectious Diseases. 2024;24.
- 16. Kurniawan RB, Siahaan PP, Saputra PBT, Arnindita JN, Savitri CG, Faizah NN, et al. Neutrophil-to-lymphocyte ratio as a prognostic biomarker in patients with peripheral artery dis-ease: A systematic review and meta-analysis. Vascular Medi-cine. 2024;29:687-99.
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Inflammatory and Clinical Predictors of In-Hospital Mortality in Acute Coronary Syndrome: A Retrospective Cohort Study
Abstract
Background: This study aims to retrospectively analyze in-hospital mortality rates in patients diagnosed with acute coronary syndrome (ACS) and to identify independent risk factors contributing to increased mortality.
Materials and Methods: This Retrospective Single-Center Cohort Study was conducted at the Cardiolo-gy Clinic of Aktif International Hospital between January 1, 2023, and December 30, 2024. A total of 694 ACS patients were included in the study. Demographic, clinical, laboratory, and imaging data were collected. Independent risk factors for in-hospital mortality were assessed using multivariate logistic regression analysis.
Results: The in-hospital mortality rate was 2.4%. Age (p = 0.02), the frequency of diabetes mellitus (p = 0.03) and hyperlipidemia (p = 0.04), creatinine (p = 0.002) and troponin-I (p < 0.001) were significant-ly higher, whereas left ventricular ejection fraction (LVEF) was significantly lower (p = 0.04) in non-survivors compared to the survivors. In addition, hematological parameters such as neutrophil-to-lymphocyte ratio (NLR) (p = 0.005) and platelet-to-lymphocyte ratio (PLR) (p = 0.01) were significantly elevated in non-survivors. Multivariate logistic regression analysis demonstrated that age (odds ration [OR] = 1.05, p = 0.003), presence of diabetes mellitus (OR=1.37, p = 0.002), hypertension (OR=1.42, p = 0.001) and hyperlipidemia (OR= 1.28, p = 0.03), increased troponin-I (OR = 2.34, p < 0.001), ele-vated creatinine levels (OR = 1.75, p = 0.002), lower LVEF (OR = 0.89, p = 0.04), NLR (OR = 1.56, p = 0.005) and PLR (OR = 1.42, p = 0.01) were independent predictors of in-hospital mortality.
Conclusions: Our study suggests that older age, the presence of hypertension, diabetes mellitus, hy-perlipidemia, renal dysfunction, elevated inflammatory markers (NLR, PLR), and reduced LVEF are independent predictors of in-hospital mortality in ACS patients. Our findings further emphasize the critical role of early revascularization in reducing mortality rates in ACS patients.
Keywords: Acute coronary syndrome, In-hospital mortality, Risk factors, Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio
Keywords
Acute coronary syndrome in-hospital mortality risk factors troponin inflammatory markers neutrophil-to-lymphocyte ratio platelet-to-lymphocyte ratio
References
- 1. Kimura K, Kimura T, Ishihara M, Nakagawa Y, Nakao K, Miya-uchi K, et al. JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome. Circulation Journal. 2019;83:1085-196.
- 2. Bhatt DL, Lopes RD, Harrington RA. Diagnosis and Treatment of Acute Coronary Syndromes. Jama. 2022;327.
- 3. Topçu S, Ardahan M. Risk perception of cardiovascular disease among Turkish adults: a cross-sectional study. Primary Health Care Research & Development. 2023;24.
- 4. Zhang L, Hailati J, Ma X, Liu J, Liu Z, Yang Y, et al. Analysis of risk factors for different subtypes of acute coronary syn-drome. Journal of International Medical Research. 2021;49.
- 5. Avdikos G, Michas G, Smith SW. From Q/Non-Q Myocardial Infarction to STEMI/NSTEMI: Why It's Time to Consider Anoth-er Simplified Dichotomy; a Narrative Literature Review. Arch Acad Emerg Med. 2022;10.
- 6. Ciumărnean L, Milaciu MV, Negrean V, Orășan OH, Vesa SC, Sălăgean O, et al. Cardiovascular Risk Factors and Physical Ac-tivity for the Prevention of Cardiovascular Diseases in the El-derly. International Journal of Environmental Research and Public Health. 2021;19.
- 7. Yang Z, Qiao Y, Wang D, Yan G, Tang C. Association Between Inflammatory Biomarkers and Contrast-induced Acute Kidney Injury in ACS Patients Undergoing Percutaneous Coronary In-tervention: A Cross-sectional Study. Angiology. 2023;75:831-40.
- 8. Bilgin M, Akkaya E, Dokuyucu R. The Role of Triglyceride/HDL Ratio, Triglyceride–Glucose Index, and Pan-Immune-Inflammation Value in the Differential Diagnosis of Acute Coronary Syndrome and Predicting Mortality. Journal of Clin-ical Medicine. 2024;13.
- 9. Fox KAA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). Bmj. 2006;333.
- 10. 1McNamara RL, Kennedy KF, Cohen DJ, Diercks DB, Moscucci M, Ramee S, et al. Predicting In-Hospital Mortality in Pa-tients With Acute Myocardial Infarction. Journal of the Amer-ican College of Cardiology. 2016;68:626-35.
- 11. Martha JW, Sihite TA, Listina D. The Difference in Accuracy Between Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score in Predicting In-Hospital Mortality of Acute ST-Elevation Myocardial Infarction Patients. Cardiology Research. 2021;12:177-85.
- 12. Chang F-C, Hsieh M-J, Yeh J-K, Wu VC-C, Cheng Y-T, Chou A-H, et al. Longitudinal analysis of in-hospital cardiac arrest: trends in the incidence, mortality, and long-term survival of a na-tionwide cohort. Critical Care. 2025;29.
- 13. Nadarajah R, Gale C. The management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: key points from the ESC 2020 Clinical Practice Guidelines for the general and emergency physician. Clinical Medicine. 2021;21:e206-e11.
- 14. Damluji AA, Forman DE, Wang TY, Chikwe J, Kunadian V, Rich MW, et al. Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association. Circulation. 2023;147.
- 15. Li X, Chen Y, Yuan Q, Zhou H, Lu L, Guo R. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio associated with 28-day all-cause mortality in septic patients with coronary artery disease: a retrospec-tive analysis of MIMIC-IV database. BMC Infectious Diseases. 2024;24.
- 16. Kurniawan RB, Siahaan PP, Saputra PBT, Arnindita JN, Savitri CG, Faizah NN, et al. Neutrophil-to-lymphocyte ratio as a prognostic biomarker in patients with peripheral artery dis-ease: A systematic review and meta-analysis. Vascular Medi-cine. 2024;29:687-99.
- 17. Rajakumar HK, Coimbatore Sathyabal V, Vasanthan M, Dasara-than R. The predictive role of Systemic Inflammation Re-sponse Index (SIRI), Neutrophil-Lymphocyte Ratio (NLR), and Platelet-Lymphocyte Ratio (PLR) in the prognosis of acute coronary syndrome in a tertiary care hospital. Heliyon. 2024;10.
- 18. Kite TA, Ladwiniec A, Arnold JR, McCann GP, Moss AJ. Early invasive versus non-invasive assessment in patients with sus-pected non-ST-elevation acute coronary syndrome. Heart. 2022;108:500-6.
- 19. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA Guideline for the Manage-ment of ST-Elevation Myocardial Infarction: Executive Sum-mary. Journal of the American College of Cardiology. 2013;61:485-510.
- 20. Janjusevic M, Fluca AL, Gagno G, Pierri A, Padoan L, Sorrentino A, et al. Old and Novel Therapeutic Approaches in the Management of Hyperglycemia, an Important Risk Factor for Atherosclerosis. Int J Mol Sci. 2022;23.
- 21. Salvatore T, Galiero R, Caturano A, Vetrano E, Loffredo G, Rinaldi L, et al. Coronary Microvascular Dysfunction in Diabe-tes Mellitus: Pathogenetic Mechanisms and Potential Thera-peutic Options. Biomedicines. 2022;10.
Details
| Primary Language | English |
|---|---|
| Subjects | Cardiology |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | March 12, 2025 |
| Publication Date | March 26, 2025 |
| Submission Date | February 5, 2025 |
| Acceptance Date | March 3, 2025 |
| Published in Issue | Year 2025 Volume: 22 Issue: 1 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty