Abolfotouh Mostafa A, Almadani Khaled, Al Rowaily Mohammed A
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
King Saud Bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Int J Gen Med. 2020 Dec 15;13:1537-1543. doi: 10.2147/IJGM.S289289. eCollection 2020.
Pulmonary embolism (PE) diagnosis can sometimes be challenging due to the disease having nonspecific signs and symptoms at the time of presentation. The present study aimed to evaluate the validity of the D-dimer in combination with the revised Geneva score (RGS) in the prediction of pulmonary embolism.
This is a retrospective study of 2010 patients with suspected PE who had undergone both D-dimer testing followed by chest CT angiography (CTPA), irrespective of the D-dimer test results, at King Abdulaziz Medical City, Riyadh, Saudi Arabia, over 3 years, from Jan. 2016 to Jan. 2019. The predictive accuracy of D-dimer, adjusted D-dimer, and RGS was calculated. The receiver operating characteristic "ROC" curve was applied to allocate the optimum RGS cutoff for PE prediction.
The overall prevalence of PE was 16%. It was 0%, 25.8%, and 88.9% in low, intermediate, and high clinical probability categories of RGS, respectively. Both conventional and age-adjusted D-dimer thresholds showed significant level of agreement (kappa=0.81, p<0.001), high sensitivity (94% and 92.8%), high negative predictive value "NPV" (91.2% and 91.4%), low specificity (12.3% and 15.3%), and low positive predictive value "PPV" (17.5% and 17.8%), respectively. Combination of the age-adjusted D-dimer threshold and RGS at a cut-off of 5 points would provide 100% sensitivity and 61.7% specificity 34.1% PPV, 100% NPV, and 0.87 area under the curve "AUC". At an RGS cutoff <5 points, PE could have been ruled out in more than one-half (1036, 51.5%) of all suspected cases, and would have saved the cost of CTPA.
Conventional and age-adjusted D-dimer tests showed high levels of agreement in the prediction of PE, high sensitivity, and low specificity. RGS has a good performance in PE prediction. Using the revised Geneva score alone rules out PE for more than one-half of all suspected without further imaging.
由于肺栓塞（PE）在发病时具有非特异性体征和症状，其诊断有时具有挑战性。本研究旨在评估D-二聚体联合修订的日内瓦评分（RGS）在预测肺栓塞方面的有效性。
这是一项对2010例疑似PE患者的回顾性研究，这些患者在沙特阿拉伯利雅得的阿卜杜勒阿齐兹国王医疗城于2016年1月至2019年1月的3年期间均接受了D-二聚体检测，随后进行了胸部CT血管造影（CTPA），无论D-二聚体检测结果如何。计算了D-二聚体、校正D-二聚体和RGS的预测准确性。应用受试者工作特征（ROC）曲线来确定预测PE的最佳RGS临界值。
PE的总体患病率为16%。在RGS的低、中、高临床概率类别中分别为0%、25.8%和88.9%。传统和年龄校正的D-二聚体阈值均显示出高度一致性（kappa=0.81，p<0.001），高敏感性（分别为94%和92.8%），高阴性预测值（NPV，分别为91.2%和91.4%），低特异性（分别为12.3%和15.3%），以及低阳性预测值（PPV，分别为17.5%和17.8%）。年龄校正的D-二聚体阈值与RGS在临界值为5分时的联合将提供100%的敏感性、61.7%的特异性、34.1%的PPV、100%的NPV以及曲线下面积（AUC）为0.87。在RGS临界值<5分时，在所有疑似病例中有超过一半（1036例，51.5%）可以排除PE，并且可以节省CTPA的费用。
传统和年龄校正的D-二聚体检测在预测PE方面显示出高度一致性、高敏感性和低特异性。RGS在PE预测中表现良好。仅使用修订的日内瓦评分可在无需进一步影像学检查的情况下排除超过一半的所有疑似病例中的PE。
