KASMEJ
Kastamonu Medical Journal

Kastamonu Medical Journal regularly publishes internationally qualified issues in the field of Medicine in the light of up-to-date information.

eISSN: 2757-9336
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Efficacy of lipid, NT-proBNP and D-dimer biomarkers in the differential diagnosis of patients presenting to the emergency department with syncope
Abstract
Aims: Syncope is defined as a temporary loss of consciousness in any disorder characterized by a self-limited loss of consciousness, whatever the mechanism. It constitutes 3% of emergency service applications. NT-proBNP, D-dimer and lipids are important parameters in the diagnosis and differential diagnosis of patients with syncope. This study aims to determine the levels of these biomarkers during and after treatment in patients admitted to the emergency department(ED) due to syncope.
Methods: Forty-nine patients admitted to the emergency department due to syncope were included in this study. Forty-nine age- and sex-matched individuals without a history of syncope were taken as the control group. Blood samples were taken from the patient group three times, at the time of admission to the emergency department, 24 hours after admission, and on the day they were discharged from the hospital, and only once from the control group. The patient and control groups were compared in terms of NT-proBNP, D-dimer and lipids.
Results: The mean HDL level at discharge was 33.63±9.62 mg/dl, which was significantly lower than the mean HDL level in the control group (38.77±10.33 mg/dl) (t=2.14, p=0.012). Although the mean LDL levels at discharge (108.02±48.03 mg/dl) were higher than the control group (92.53±37.39 mg/dl), this increase was not statistically significant (t=1.78, p=0.078). However, the mean LDL levels during hospitalization and after 24 hours (126.08±51.88 mg/dl, 116.26±48.21 mg/dl, respectively) compared to the control group (92.53±7.39 mg/dl) were statistically significantly higher (t=3.67, p=0.001, t=2.73, p=0.008). NT proBNP and D-dimer median values at the time of admission to the emergency department (844.00 pg/ml, 616.50 mcg/L, respectively), after 24 hours (1985.00 pg/ml, 662.00 mcg/L, respectively) and at discharge (748.00 pg/ml, 702.50 mcg/L respectively) compared to the control group (85.00 pg/ml, 176.00 mcg/L, respectively), a statistically significant increase was detected (p=0.001).
Conclusion: In the patients admitted to the ED with a diagnosis of syncope, early treatment can be achieved getting the differential diagnosis of syncope in a short time with NT-proBNP, D-dimer and lipid blood levels that can be worked easily. In addition, the need for serious interventional procedures and further investigations in the diagnostic process will be reduced.

Keywords : Syncope, NT-proBNP, D-dimer, lipid profile

Download Article


1. Blanc JJ, L'Her C, Touiza A, et al. Prospective evaluation and outcomeof patients admitted for syncope over a 1 year period. Eur Heart J.2002;23:815-820.
2. Crane SD. Risk stratification of patients with syncope in an accident andemergency department. Emerg Med J. 2002;19:23-27.
3. Brignole M, Menozzi C, Bartoletti A, et al. A new management ofsyncope: prospective systematic guideline-based evaluation of patientsreferred urgently to general hospitals. Eur Heart J. 2006;27(1):76-82.
4. Koene RJ, Adkisson WO, Benditt DG. Syncope and the risk of suddencardiac death: Evaluation, management, and prevention. J Arrhythm.2017;33(6):533-544.
5. van Dijk N, Sprangers MA, Colman N, et al. Clinical factors associatedwith quality of life in patients with transient loss of consciousness. JCardiovasc Electrophysiol. 2006;17(9):998-1003.
6. Mitrani Raul D, Hendel RC. The Appropriateness of an IschemiaEvaluation for Syncope. Circulation: Cardiovascular Imaging. 2013;6(3):358-359.
7. Brignole M, Ungar A, Bartoletti A, et al. Standardized-care pathway vs.usual management of syncope patients presenting as emergencies atgeneral hospitals. EP Europace. 2006; 8(8):644-650.
8. Ammirati F, Colaceci R, Cesario A, et al. Management of syncope: clinicaland economic impact of a syncope unit. Europace. 2008;10:471-476.
9. Brignole M, Alboni P, Benditt DG, et al.; Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope--update 2004. Europace. 2004;6(6):467-537.
10. Schnipper JL, Kapoor WN. Diagnostic evaluation and management of patients with syncope. Med Clin North Am. 2001;85(2):423-456.
11. Tanriverdi F, Karaca Z, Unluhizarci K, et al. The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome.Stress. 2007;10(1):13-25.
12. Brignole M, Disertori M, Menozzi C, et al. On behalf of the Evaluation of Guidelines in Syncope Study (EGSYS) group. Management of syncope referred urgently to general hospitals with and without syncope units. Europace. 2003; 5: 293 –298.
13. Davis BR, Vogt T, Frost PH, et al. Risk factors for stroke and type of stroke in persons with isolated systolic hypertension. Stroke. 1998;29(7):1333- 1340.
14. Putaala J, Nieminen T. Stroke risk period after acute myocardial infarctionrevised. J Am Heart Assoc. 2018;7(22):e011200.
15. Kuriakose D, Xiao Z. Pathophysiology and treatment of stroke: presentstatus and future perspectives. Int J Mol Sci. 2020;21(20):7609.
16. Bo M, Del Rosso A. Syncope and electrocardiogram. Minerva Med.2022;113(2):234-242.
17. Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrialfibrillation: Virchow's triad revisited. Lancet. 2009;373(9658):155-166.
18. Go AS, Mozaffarian D, Roger VL, et al. Heart Disease and Stroke Statistics-2013 Update. A report from the American Heart Association. Circulation. 2013;127(1):e6-e245.
19. Demir Yİ, Ermiş C, Yılmaz H. Serum cholesterol levels in acute myocardial infarction and the effect of streptokinase on cholesterol. Arch Turk Soc Cardiol. 2000;28:734-739.
20. Rosenson RS. Myocardial injury: the acute phase response and lipoprotein metabolism. J Am Coll Cardiol. 1993;22(3):933-940.
21. Pfister R, Hagemeister J, Esser S, et al. NT-proBNP for diagnostic and prognostic evaluation in patients hospitalized for syncope. Int J Cardiol. 2012;155(2):268-272.
22. Talwar S, Squire IB, Downie PF, et al. Profile of plasma N-terminal proBNP following acute myocardial infarction; correlation with left ventricular systolic dysfunction. Eur Heart J. 2000;21(18):1514-1521.
23. de Denus S, Pharand C, Williamson DR. Brain natriuretic peptide in the management of heart failure: the versatile neurohormone. Chest. 2004;125(2):652-668.
24. Pulivarthi S, Gurram MK. Effectiveness of d-dimer as a screening test for venous thromboembolism: an update. N Am J Med Sci. 2014;6(10):491- 499.
25. Stockley CJ, Reed MJ, Newby DE, et al. The utility of routine D-dimer measurement in syncope. Eur J Emerg Med. 2009;16(5):256-260.
26. Calvo-Romero JM, Pérez-Miranda M, Bureo-Dacal P. Syncope in acute pulmonary embolism. Eur J Emerg Med. 2004;11(4):208-209.
27. Altınsoy B, Erboy F, Tanrıverdi H, et al. Syncope as a presentation of acute pulmonary embolism. Ther Clin Risk Manag. 2016;12:1023-1028.
28. Parlak İ, Erdur B, Türkçüer İ, et al. Senkop: pulmoner embolinin unutulan semptomu. Akademik Acil Tıp Derg. 2007;5(3):34-36.
29. Dellas C, Tschepe M, Seeber V, et al. A novel H-FABP assay and a fast prognostic score for risk assessment of normotensive pulmonary embolism. Thromb Haemost. 2014;111(5):996-1003.
30. Fon EA, Mackey A, Côté R, et al. Hemostatic markers in acute transient ischemic attacks. Stroke. 1994;25(2):282-286.
31. Danesh J, Whincup P, Walker M, et al. Fibrin D-dimer and coronary heart disease: prospective study and meta-analysis. Circulation. 2001;103(19):2323-2327.
32. Bayes-Genis A, Mateo J, Santaló M, et al. D-dimer is an early diagnostic marker of coronary ischemia in patients with chest pain. Am Heart J. 2000;140(3):379-384.
Article available in :
Volume 3, Issue 2, 2023
Page : 104-109
https://doi.org/10.51271/KMJ-0108
Article Information
Received : 25 May 2023
Accepted : 19 Haz 2023
Published : 26 Haz 2023
Corresponding Author :

Fatma Mutlu Kukul Güven: Department of Emergency Medicine, Faculty of Medicine, Kastamonu University, Kastamonu, Turkiye

[email protected]
Citation : Çelik Ş, Kukul Güven FM, Korkmaz İ. Efficacy of lipid, NT-proBNP and D-dimer biomarkers in the differential diagnosis of patients presenting to the emergency department with syncope. Kastamonu Med J. 2023;3(2):104-109

Read: 470
Cited: 0
Download : 531
_Footer