Shiny Mispa Merlin, P (2023) Correlation of Serum Homocysteine in Patients with Venous Thromboembolism during COVID Pandemic in TVMCH. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
BACKGROUND: Venous Thromboembolism is the most common preventable mortality among hospitalized patients. VTE includes both Deep Venous Thrombosis and Pulmonary Embolism. In addition to Sr D dimer, Serum Homocysteine also plays an important role in VTE. There are some research studies which showed positive relationship between Serum homocysteine and VTE. Homocysteine interacts with lysyl residues of collagen interfering with collagen cross linking, thereby it produces endothelial dysfunction. It also alters the anticoagulant properties of endothelial cells to procoagulant state. So, study of serum homocysteine in VTE plays an important role. In 2020, COVID 19 causes a global pandemic. The most common clinical feature is a life threatening Acute Respiratory Syndrome requiring prolonged mechanical ventilation and causing a high fatality rate. This viral illness also causes extensive DVT and Pulmonary embolism, even when patients received standard pharmacological prophylaxis as soon as they are hospitalized. At autopsy, about one – fourth of patients have macrovascular and microvascular Pulmonary embolism. The contributing etiologies of this widespread thrombosis are cytokine storm, platelet activation and endothelial dysfunction and stasis. In this study, we are excluding COVID 19 patients with Venous Thromboembolism because this infection itself can cause hyperhomocysteinemia. Our knowledge of genetics in VTE is expanding rapidly. To date, atleast 17 genes have been demonstrated to harbor genetic variation associated with VTE risk. Common polymorphism account for atleast 5% of VTE heritability. AIMS AND OBJECTIVES: 1. To determine the relationship between Serum homocysteine in patients with VTE. 2. To study the risk factors and outcomes among VTE patients MATERIALS AND METHODS: This was a hospital based cross – sectional study done in Department of General Medicine and Department of Cardiology in Tirunelveli Medical College Hospital. Participants were recruited into the study based on inclusion and exclusion criteria. Along with routine blood investigation, ECG, CT Chest, CTPA, Sr. Homocysteine and Sr. D Dimer were taken. RESULTS: Mean age group of all patients in our study group was 52.4 and majority belongs to 45-60 years of age (66%). Males were more common than female in a ratio of 4.5 : 1 among our study group. Most of the patients in our study group were labourers and most common symptomatology prevalent among our population is breathlessness (46 patients). Among the risk factors prevalent in our study group, the most common is smoking (42%). WELL’s score predictive of venous thromboembolism was seen in only 30% of population. Hypoxemia was seen in 72% of patients and tachypnoea being prevalent in 94% of our study population. Hypotension was less common and seen in 40% of our study group. Among laboratory parameters, D-dimer was elevated in 34%, elevated serum creatinine seen in 18% among our study population. Among the signs, tachypnoea was the most prevalent sign. ECG findings suggestive or predictive of pulmonary embolism was seen in 30% of our study group. CT chest /Chest X-ray suggestive of pulmonary embolism was seen in only 10% of our population. Echocardiography was abnormal in 70% of our population. 92% of patients in our study group had positive findings in CT pulmonary angiography. In our study, prevalence of elevated homocysteine level was 88% in VTE patients. Among our study population, DVT was seen in 36% and pulmonary embolism was seen in 88% of population. Mortality is higher accounting to 22% of population. DISCUSSION: Elevated homocysteine levels were more prevalent among patients with hypoxemia, tachypnoea and hypotension of VTE group. However, association of elevated homocysteine levels being more common in patients with tachypnoea in VTE showed statistical significance. Similarly, elevated homocysteine were more commonly seen in patients with elevated D-dimer, positive ECG and CT chest/chest x-ray findings. All patients who had echocardiographic findings suggestive of pulmonary embolism had elevated homocysteine levels with statistical significance. Also, around 93.18% of patients with CT pulmonary angiogram positive finding had elevated serum homocysteine levels with statistical significance. Pulmonary embolism patients had more commonly elevated homocysteine levels (93.18%) than DVT patients in our study group. (66.66%) And this association had statistical significance. Importantly, Pulmonary embolism patients had more commonly elevated homocysteine levels (93.18%) than DVT patients in our study group.(66.66%) And this association had statistical significance. However, elevated serum homocysteine levels does not correlate with the outcome of VTE such as recovery/death. Hence, our study prevalence of serum homocysteine elevation in VTE was very high as 88% and its more commonly elevated in pulmonary embolism than deep vein thrombosis. Also elevated homocysteine levels significantly associated with clinical variable worsening like tachypnoea etc., correlated well with other diagnostic modalities like ECHO and CT pulmonary angiogram. Hence Elevated homocysteine levels can be considered as a efficient diagnostic tool in diagnosing VTE, particularly pulmonary embolism. However, serum homocysteine levels does not correlate with outcome in our study group. CONCLUSION: Venous thromboembolism is often a diagnostic challenge being always complemented by imaging modalities for confirmation of diagnosis. Early diagnostic markers are still needed for avoiding delay in initiation of treatment. Homocysteine can be considered as one such marker which is often found to be elevated in VTE patients in literature. Prevalance of Elevated homocysteine levels among our study population of VTE patients was 88% (much higher than other studies in literature). As estimation of serum homocysteine is easy than many imaging procedures, serum homocysteine can be considered as early screening test for patients suspected to have VTE. Screening by such faster tests helps us in early diagnosis and initiation of treatment which helps immensely in prevention of morbidity and mortality by VTE.
| Item Type: | Thesis (Masters) |
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| Additional Information: | Reg.No:200120104021 |
| Uncontrolled Keywords: | Homocysteine, Pulmonary embolism, CT Pulmonary angiogram. |
| Subjects: | MEDICAL > General Medicine > MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Apr 2021 12:55 |
| Last Modified: | 25 Mar 2024 03:13 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/15338 |
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