Prognostic significance of inflammatory biomarkers in diabetic and non-diabetic patients with STEMI, treated with primary percutaneous coronary intervention

Milić, Veljko; Džudović, Boris; Obradović, Slobodan

doi:10.2298/VSP170905175M

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Vojnosanitetski pregled

2019, vol. 76, br. 10, str. 979-984

Prognostički značaj biomarkera inflamacije kod bolesnika sa i bez dijabetesa koji su lečeni primarnom perkutanom koronarnom intervencijom zbog akutnog infarkta miokarda sa elevacijom ST segmenta

Milić Veljko^a, Džudović Boris^a, Obradović Slobodan^b

^aVojnomedicinska akademija, Klinika za urgentnu internu medicinu, Beograd
^bVojnomedicinska akademija, Klinika za urgentnu internu medicinu, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd

e-adresa: veljkomdr@gmail.com

Ključne reči: biomarkeri; c-reaktivni protein; dijabetes melitus; fibrinogen; mortalitet; perkutana koronarna intervencija; prognoza; infarkt miokarda sa st elevacijom

Sažetak

Uvod/Cilj. Iako je poznat prognostički značaj inflamatornih biomarkera kao što su C-reaktivni protein (CRP) i fibrinogen, kod bolesnika sa akutnim infarktom miokarda sa elevacijom ST-segmenta (STEMI), postojanje razlike u zavisnosti od prisustva ili odsustva dijabetesa nije poznato. Metode. Istraživanje je sprovedeno u medicinskom centru tercijernog nivoa. Kod bolesnika sa STEMI, lečenih primarnom perkutanom koronarnom intervencijom (pPKI) merene su vrednosti CRP-a i fibrinogena, u toku prvih 48h od prijema. Bolesnici su bili podeljeni u dve grupe: grupu sa dijabetesom i grupu bez dijabetesa. Cilj rada bio je da se utvrdi prognostički značaj maksimalnih vrednosti ta dva biomarkera zapaljenja za nastanak intrahospitalne i šestomesečne smrtnosti u svakoj od grupa. Rezultati. Među 475 bolesnika, 126 (26,5%) je imalo dijabetes, a 349 (73,5%) nije imalo dijabetes. Bolesnici sa dijabetesom su imali značajno veću vrednost medijane CRP-a i fibrinogena u poređenju sa bolesnicima bez dijabetesa [29,6 (10,4-91,8) vs 22,4 (9,79-49,2) mg/L, p = 0,046 i 4,7 (3,6-6,3) g/L vs 4,3 (3,6-5,4) g/L, p = 0,026]. Međutim, korišćenjem Cox regresione multivarijantne analiza smrtnosti modela pokazano je da su kod bolesnika bez dijabetesa CRP i fibrinogen imali značajnu prognostičku vrednost za nastajanje intrahospitalne smrtnosti [hazard ratio - stopa rizika (HR) = 1,013 95% interval poverenja (CI) (1,004-1,022), p = 0.004 i HR = 1,529, 1,023-2,287 95%CI, p = 0,039]. Kada je u pitanju šestomesečna smrtnost, nije pronađena statistički značajna razlika. Ukupno preživljavanje je bilo najniže u četvrtom kvartilu CRP-a u grupi bolesnika bez dijabetesa. Zaključak. Visoke vrednosti CRP-a su nezavisan prediktor intrahospitalne i ukupne šestomesečne smrtnosti kod bolesnika sa STEMI koji nemaju dijabetes lečenih pPKI. Fibrinogen se takođe može koristiti kao prognostički marker za intrahospitalnu smrtnost kod nedijabetičara sa STEMI.

Abstract

Background/Aim. Although the prognostic significance of inflammatory biomarkers, C-reactive protein (CRP) and fibrinogen, in the patients with the ST-segment elevation myocardial infarction (STEMI) is already known, the specific difference between such patients according to diabetic status remains unknown. Methods. The study was conducted in a single tertiary center. The values of CRP and fibrinogen were measured during the first 48 h in consecutive patients with first STEMI treated with primary percutaneous coronary intervention (pPCI). The patients were divided into two groups: with diabetes and without diabetes. The aim of this study was to determine a prognostic significance of maximal values of these two inflammatory biomarkers for in-hospital and six-month mortality in these two groups. Results. Among 475 patients, 126 (26.5%) were with diabetes and 349 (73.5%) were without diabetes. The patients with diabetes had significantly higher median values of CRP and fibrinogen compared to the nondiabetic patients [29.6 (10.4-91.8) mg/L vs 22.4 (9.79-49.2) mg/L, p = 0.046 and 4.7 (3.6-6.3) g/L vs 4.3 (3.6-5.4) g/L, p = 0.026, respectively]. However, the multivariate survival analysis using the Cox regression model showed that in the nondiabetic STEMI patients CRP and fibrinogen had significant prognostic value for in-hospital mortality [hazard ratio (HR) = 1.013, 95% confidence interval (CI) (1.004-1.022), p = 0.004; HR = 1.529 (1.023-2.287), p = 0.039, respectively]. Regarding six-month mortality, no significant difference was achieved. Overall survival was the lowest in the fourth quartile of CRP in the patients without diabetes. Conclusion. The higher values of CRP are the significant independent predictor of in-hospital and overall mortality in the STEMI patients without diabetes treated with primary PCI. Fibrinogen can also be used as an additional prognostic inflammatory biomarker for in-hospital mortality in the non-diabetics with STEMI.

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O članku

jezik rada: engleski
vrsta rada: izvorni naučni članak
DOI: 10.2298/VSP170905175M
objavljen u SCIndeksu: 09.11.2019.
metod recenzije: dvostruko anoniman

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