Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, and EA 3878, CIC INSERM 1412, Brest, France; McMaster University, Hamilton, Ontario, Canada.
Unité de Recherche Clinique, Innovation et Pharmacologie, Centre Hospitalo-Universitaire de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, France; F-CRIN INNOVTE, Saint Etienne, France.
Am J Med. 2020 Aug;133(8):e406-e421. doi: 10.1016/j.amjmed.2020.03.040. Epub 2020 Apr 22.
We aimed to validate the Men Continue and HERDOO2 (HERDOO2), D-dimer, age, sex, hormonal therapy (DASH), and updated Vienna recurrent venous thromboembolism prediction models in a population composed entirely of first unprovoked pulmonary embolism, and to analyze the impact of the addition of the pulmonary vascular obstruction index (PVOI) on score accuracy.
Analyses were based on the double-blind, randomized PADIS-PE trial, which included 371 unprovoked pulmonary embolism patients initially treated for 6 months, successively randomized to receive an additional 18 months of warfarin or placebo, and subsequently followed-up for 2 years.
The HERDOO2, DASH, and updated Vienna scores displayed C-statistics of 0.61 (95% CI 0.54-0.68), 0.60 (95% CI 0.53-0.66), and 0.58 (95% CI 0.51-0.66), respectively. Only the HERDOO2 score identified low recurrence risk patients (<3%/year) after anticoagulation was stopped. When added to either of the prediction models, PVOI measured at pulmonary embolism diagnosis, after 6 months of anticoagulation, or both, improved scores' C-statistics between +0.06 and +0.11 points and consistently led to identifying at least 50% of patients who experienced recurrence but in whom the scores would have indicated against extended anticoagulation.
In patients with a first unprovoked pulmonary embolism, the HERDOO2 score is able to identify patients with a low recurrence risk after treatment discontinuation. Addition of PVOI improves accuracy of all scores.
URL: http://www.controlled-trials.com. Unique identifier: NCT00740883.
我们旨在验证完全由首次无诱因性肺栓塞组成的人群中 Men Continue 和 HERDOO2（HERDOO2）、D-二聚体、年龄、性别、激素治疗（DASH）和更新的维也纳复发性静脉血栓栓塞预测模型的有效性，并分析添加肺血管阻塞指数（PVOI）对评分准确性的影响。
分析基于双盲、随机的 PADIS-PE 试验，该试验纳入了 371 例首次无诱因性肺栓塞患者，最初接受 6 个月的治疗，随后连续随机接受 18 个月的华法林或安慰剂治疗，随后随访 2 年。
HERDOO2、DASH 和更新的维也纳评分的 C 统计量分别为 0.61（95%CI 0.54-0.68）、0.60（95%CI 0.53-0.66）和 0.58（95%CI 0.51-0.66）。只有 HERDOO2 评分能够在停止抗凝后识别低复发风险患者（<3%/年）。当添加到任何一种预测模型中时，PVOI 在肺栓塞诊断时、抗凝 6 个月后或两者都测量，可使评分的 C 统计量提高 0.06 至 0.11 点，并始终能够识别至少 50%的复发患者，但这些患者的评分表明应延长抗凝。
在首次无诱因性肺栓塞患者中，HERDOO2 评分能够识别治疗停止后复发风险低的患者。添加 PVOI 可提高所有评分的准确性。
