Klinik und Hochschulambulanz für Radiologie, Charité - Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité - Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
Eur Radiol. 2019 Sep;29(9):4563-4571. doi: 10.1007/s00330-019-06039-5. Epub 2019 Feb 19.
The aim of this study was to compare the age-dependent diagnostic performance of clinical scores and D-dimer testing to identify patients with suspected pulmonary embolism (PE).
Consecutive patients with suspected PE referred from the emergency department for computed tomography pulmonary angiography (CTPA) were retrospectively evaluated. Diagnostic scores (classic Wells score (WS), modified WS, simplified WS, revised Geneva score (GS), simplified GS, and YEARS score) were calculated from medical records. Results of D-dimer testing were retrieved from the laboratory database. CTPA was the diagnostic reference standard. Four age groups were analyzed (< 50, 50-64, 65-74, and ≥ 75 years). Statistical analysis used receiver operating characteristics as well as uni- and multivariate analyses with calculation of prediction models. The study was IRB approved.
One thousand consecutive patients were included. Areas under the curve (AUC) and accuracies were superior in patients < 50 years. For the classic WS, the AUC decreased by 11% with the optimal cutoff dropping 1.5 points in patients ≥ 75 years; for D-dimer levels, the optimal cutoff was 900 μg/L higher in both ≥ 65 years groups with a max. decrease of the AUC of 9%. In terms of accuracy, the YEARS score performed best across all groups. Classic WS and D-dimer level showed a significant interaction with patient age in prediction models.
D-dimer measurement and clinical scores perform best in patients < 50 years. The YEARS score performs best across all age groups and is therefore recommended.
• The probability of pulmonary embolism predicted by fibrin fibrinogen degradation products and clinical scores shows the highest accuracy in patients < 50 years. • The probability of pulmonary embolism predicted by the YEARS score shows the highest accuracy in each age group. • Classic Wells score and fibrin fibrinogen degradation products show a significant interaction with patient age in a logistic regression model.
本研究旨在比较临床评分和 D-二聚体检测在识别疑似肺栓塞（PE）患者中的年龄依赖性诊断性能。
回顾性评估因疑似 PE 从急诊科转介行计算机断层肺动脉造影（CTPA）的连续患者。从病历中计算诊断评分（经典 Wells 评分（WS）、改良 WS、简化 WS、修订 Geneva 评分（GS）、简化 GS 和 YEARS 评分）。从实验室数据库中检索 D-二聚体检测结果。CTPA 为诊断参考标准。分析了 4 个年龄组（<50 岁、50-64 岁、65-74 岁和≥75 岁）。统计分析采用受试者工作特征曲线以及单变量和多变量分析，并计算预测模型。该研究获得了 IRB 批准。
共纳入 1000 例连续患者。在<50 岁的患者中，曲线下面积（AUC）和准确率更高。对于经典 WS，在≥75 岁的患者中，AUC 下降了 11%，最佳截断值下降了 1.5 分；对于 D-二聚体水平，≥65 岁的两个年龄组的最佳截断值均升高了 900μg/L，AUC 的最大降幅为 9%。就准确性而言，YEARS 评分在所有组中表现最佳。经典 WS 和 D-二聚体水平在预测模型中与患者年龄存在显著交互作用。
在<50 岁的患者中，D-二聚体测量和临床评分的诊断效果最佳。YEARS 评分在所有年龄组中的诊断效果最佳，因此推荐使用。
在<50 岁的患者中，纤维蛋白原降解产物和临床评分预测肺栓塞的概率具有最高的准确性。
在每个年龄组中，YEARS 评分预测肺栓塞的概率具有最高的准确性。
在逻辑回归模型中，经典 Wells 评分和纤维蛋白原降解产物与患者年龄存在显著交互作用。
