Gastrointestinal sistem kanamalı hastalarda serum CD163 seviyelerinin ölçümü ve değerlendirilmesi
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Dosyalar
Tarih
2022
Yazarlar
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Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Treitz ligamentinin proksimalinden kaynaklanan kanamalar üst gastrointestinal sistem (GİS) kanaması, ligamentin distalinden kaynaklanan kanamalar ise alt GİS kanaması olarak tanımlanmaktadır. GİS kanamasından şüphelenildiğinde detaylı bir anamnez, vital bulguların değerlendirilmesi, rektal muayeneyi de içeren genel fizik muayene ve çeşitli laboratuvar testleri tanısal süreçte önem arz etmektedir. Çalışmamızda 20.05.2022 ve 29.08.2022 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Sağlık Uygulama Araştırma Merkezi Acil Servisi’nde tanı alan ve çalışma kriterlerimize uyan 40 hasta ve 40 sağlıklı gönüllünün demografik verileri, klinik bulguları, laboratuvar testleri ve serum CD163 seviyelerini inceledik. Bu çalışmada hemoglobinhaptoglobin kompleksi için çöpçü reseptör görevi gören sCD163 belirtecinin; GİS kanamalı hastalarda diagnostik etkisinin, endoskopi gibi girişimsel işlemler için beklenilen sürenin uzaması veya koşulların uygunluğu gibi subjektif parametrelerden bağımsız olarak araştırılması amaçlandı. Hastalarımızın %50’si kadın olup yaş ortalaması 69,47±13,98 yıl idi. Komorbiditeleri incelendiğinde geçirilmiş gastrointestinal kanama öyküsü ilk sırada tespit edildi. Hastaların %67,5’i melena, %30’u hematokezya, %27,5’i de hematemez ile başvurmuş olup endoskopi sonuçlarında %72,5’inin üst GİS kanaması olduğu saptandı. Mortalite oranı incelendiğinde %12,5 olarak bulundu. Çalışmamızda hastaların CD163 ortalama değeri 0,71±0,61 ng/mL iken sağlıklı bireylerden oluşan kontrol grubunun ortalama değeri 0,73±0,63 ng/mL olarak saptandı. Hastaların CD163 değerleriyle cinsiyet, komorbiditeler, ilaç kullanımı, şikayet, endoskopi sonucu, mortalite, yaş, tansiyon değerleri, nabız, GİS kanaması skorlamaları ve laboratuvar parametreleri arasında istatistiksel olarak anlamlı ilişki saptanamadı. Hastaların ve sağlıklı bireylerden oluşan kontrol grubunun gönüllülerinin CD163 değerleri karşılaştırıldığında da anlamlı farklılık bulunamadı. CD163 biyomarkerının GİS kanamayı saptayabileceği cut-off değerinin belirlenmesi için ROC analizi yapıldığında cut off değeri >0,387 ng/mL olarak bulundu (Sensivite %95, spesifite %35) . CD163 değerinin 0,387 ng/mL üzerinde ölçülmesi halinde, kişide GİS kanama bulunma olasılığı istatistiksel açıdan yüksek olarak saptandı. Bu bağlamda, GİS kanaması şüphesi ile acil servise başvuran hastalarda CD163 değerinin ölçülmesi neticesinde; 0,387 ng/mL altında kalan bir CD163 değeri, söz konusu parametrenin yüksek sensitivitesi sayesinde gereksiz endoskopik girişimlerden kaçınılmasını ve belki de başka ayırıcı tanıların daha ön planda irdelenmesini mümkün kılabilecektir. Öte yandan, GİS kanaması geçirmeyen kişilerde yüksek CD163 değerlerinde (>0,387 ng/mL) yalancı pozitiflik ile karşılaşılabileceği, dolayısı ile CD163’ün GİS kanamalı hastalarda tanısal amaçlarla kullanımının yanıltıcı da olabileceği bu veriler ile gösterilmiştir. Sonuç olarak GİS kanamalı hastalarda CD163’ün acil servislerde tanısal olarak kullanımını destekleyen yeterli veriye bizim çalışmamızda ulaşılamamış olsa da; söz konusu biyomarkerın GİS kanamaları ile olan ilişkisinin ileride planlanacak geniş kapsamlı çalışmalar neticesinde daha detaylı anlaşılabilceği kanaatindeyiz.
Whereas, bleeding arising from the proximal to the ligament of Treitz is defined as upper gastrointestinal system (GIS) bleeding; bleeding originating from the distal to the ligament is defined as lower GIS bleeding. When GIS bleeding is suspected; a detailed clinical history, evaluation of vital signs, a systemic physical examination (including rectal examination) and various laboratory tests are crucial through the diagnostic process. In our study, we examined the demographic data, clinical findings, laboratory tests and also serum CD163 levels of 40 enrolled patients who were diagnosed in the Emergency Medicine Clinic of Trakya University Medical Faculty Health Practice & Research Center between 20.05.2022- 29.08.2022 and whom met our study criteria. In an attempt to form a control group, 40 healthy volunteers were enrolled. In this study, the sCD163 biomarker, which acts as a scavenger receptor for the hemoglobin-haptoglobin complex, was studied to illuminate it’s possible diagnostic offerings in patients with GI bleeding, independently of subjective parameters such as expected length of time for interventional procedures (i.e. endoscopy) or favorability of any conditions. 50% of our patients were women and the mean age was 69.47±13.98 years. When the comorbidities were examined, leading condition was the history of previous gastrointestinal bleeding. Regarding referral symptoms; 67.5% of the patients presented with melena, 30% with hematochezia, and 27.5% with hematemesis. Consecutive endoscopy results revealed 72.5% of them were suffering from upper GIS bleeding. Mortality rate was calculated as 12.5%. In this study, mean CD163 value in the patients group was 0.71±0.61 ng/mL, while mean value of the control group consisting of healthy individuals was 0.73±0.63 ng/mL. No statistically significant correlation was found between the patients' CD163 values and the data of gender, comorbidities, drug use, complaints, endoscopy results, mortality, age, blood pressure values, heart rate range, GIS bleeding scores and laboratory parameters. There was no significant difference when the CD163 values of the patients and volunteers of the control group consisting of healthy individuals were compared. When ROC analysis was performed to determine a cutoff value in which the CD163 biomarker could detect GIS bleeding, the cut off value was found to be >0.387 ng/mL (Sensivity 95%, specificity 35%). In which case CD163 value was measured above 0.387 ng/mL, the probability of a GIS bleeding was found to be statistically high. In this context, as a result of measuring CD163 values in patients admitted to the emergency room on suspicion of GIS bleeding; a CD163 value below 0.387 ng/ml would enable to avoid unnecessary endoscopic interventions and perhaps to foreground other differential diagnoses, regarding the high sensitivity of the parameter. On the other hand, it has been shown with these data that people who do not have GIS bleeding may experience false positivity at high CD163 values (>0.387 ng/mL); thus, utilizing CD163 for diagnostic purposes may also be misleading in patients with GIS bleeding. As a result, although sufficient data supporting the diagnostic use of CD163 in emergency rooms in patients with GIS bleeding could not be obtained in our study; we are of the opinion that the relationship of the biomarker with GIS bleeding can be revealed by more comprehensive future studies.
Whereas, bleeding arising from the proximal to the ligament of Treitz is defined as upper gastrointestinal system (GIS) bleeding; bleeding originating from the distal to the ligament is defined as lower GIS bleeding. When GIS bleeding is suspected; a detailed clinical history, evaluation of vital signs, a systemic physical examination (including rectal examination) and various laboratory tests are crucial through the diagnostic process. In our study, we examined the demographic data, clinical findings, laboratory tests and also serum CD163 levels of 40 enrolled patients who were diagnosed in the Emergency Medicine Clinic of Trakya University Medical Faculty Health Practice & Research Center between 20.05.2022- 29.08.2022 and whom met our study criteria. In an attempt to form a control group, 40 healthy volunteers were enrolled. In this study, the sCD163 biomarker, which acts as a scavenger receptor for the hemoglobin-haptoglobin complex, was studied to illuminate it’s possible diagnostic offerings in patients with GI bleeding, independently of subjective parameters such as expected length of time for interventional procedures (i.e. endoscopy) or favorability of any conditions. 50% of our patients were women and the mean age was 69.47±13.98 years. When the comorbidities were examined, leading condition was the history of previous gastrointestinal bleeding. Regarding referral symptoms; 67.5% of the patients presented with melena, 30% with hematochezia, and 27.5% with hematemesis. Consecutive endoscopy results revealed 72.5% of them were suffering from upper GIS bleeding. Mortality rate was calculated as 12.5%. In this study, mean CD163 value in the patients group was 0.71±0.61 ng/mL, while mean value of the control group consisting of healthy individuals was 0.73±0.63 ng/mL. No statistically significant correlation was found between the patients' CD163 values and the data of gender, comorbidities, drug use, complaints, endoscopy results, mortality, age, blood pressure values, heart rate range, GIS bleeding scores and laboratory parameters. There was no significant difference when the CD163 values of the patients and volunteers of the control group consisting of healthy individuals were compared. When ROC analysis was performed to determine a cutoff value in which the CD163 biomarker could detect GIS bleeding, the cut off value was found to be >0.387 ng/mL (Sensivity 95%, specificity 35%). In which case CD163 value was measured above 0.387 ng/mL, the probability of a GIS bleeding was found to be statistically high. In this context, as a result of measuring CD163 values in patients admitted to the emergency room on suspicion of GIS bleeding; a CD163 value below 0.387 ng/ml would enable to avoid unnecessary endoscopic interventions and perhaps to foreground other differential diagnoses, regarding the high sensitivity of the parameter. On the other hand, it has been shown with these data that people who do not have GIS bleeding may experience false positivity at high CD163 values (>0.387 ng/mL); thus, utilizing CD163 for diagnostic purposes may also be misleading in patients with GIS bleeding. As a result, although sufficient data supporting the diagnostic use of CD163 in emergency rooms in patients with GIS bleeding could not be obtained in our study; we are of the opinion that the relationship of the biomarker with GIS bleeding can be revealed by more comprehensive future studies.
Açıklama
Anahtar Kelimeler
GİS kanaması, CD163, Mortalite, GIS bleeding, Mortality
