Quezada-Feijoo Maribel, Ramos Mónica, Lozano-Montoya Isabel, Sarró Mónica, Cabo Muiños Verónica, Ayala Rocío, Gómez-Pavón Francisco J, Toro Rocío
Cardiology Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain.
Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain.
J Clin Med. 2021 Nov 20;10(22):5433. doi: 10.3390/jcm10225433.
Elderly COVID-19 patients have a high risk of pulmonary embolism (PE), but factors that predict PE are unknown in this population. This study assessed the Wells and revised Geneva scoring systems as predictors of PE and their relationships with D-dimer (DD) in this population.
This was a longitudinal, observational study that included patients ≥75 years old with COVID-19 and suspected PE. The performances of the Wells score, revised Geneva score and DD levels were assessed. The combinations of the DD level and the clinical scales were evaluated using positive rules for higher specificity.
Among 305 patients included in the OCTA-COVID study cohort, 50 had suspected PE based on computed tomography pulmonary arteriography (CTPA), and the prevalence was 5.6%. The frequencies of PE in the low-, intermediate- and high-probability categories were 5.9%, 88.2% and 5.9% for the Geneva model and 35.3%, 58.8% and 5.9% for the Wells model, respectively. The DD median was higher in the PE group (4.33 mg/L; interquartile range (IQR) 2.40-7.17) than in the no PE group (1.39 mg/L; IQR 1.01-2.75) ( < 0.001). The area under the curve (AUC) for DD was 0.789 (0.652-0.927). After changing the cutoff point for DD to 4.33 mg/L, the specificity increased from 42.5% to 93.9%.
The cutoff point DD > 4.33 mg/L has an increased specificity, which can discriminate false positives. The addition of the DD and the clinical probability scales increases the specificity and negative predictive value, which helps to avoid unnecessary invasive tests in this population.
老年新冠肺炎患者发生肺栓塞（PE）的风险较高，但该人群中预测PE的因素尚不清楚。本研究评估了Wells评分和修订的Geneva评分系统作为该人群中PE的预测指标及其与D-二聚体（DD）的关系。
这是一项纵向观察性研究，纳入了年龄≥75岁的新冠肺炎合并疑似PE患者。评估了Wells评分、修订的Geneva评分和DD水平的表现。使用提高特异性的阳性规则评估DD水平与临床量表的组合。
在OCTA-COVID研究队列纳入的305例患者中，50例基于计算机断层扫描肺动脉造影（CTPA）疑似PE，患病率为5.6%。Geneva模型中低、中、高概率类别中PE的频率分别为5.9%、88.2%和5.9%，Wells模型中分别为35.3%、58.8%和5.9%。PE组的DD中位数（4.33 mg/L；四分位间距（IQR）2.40-7.17）高于无PE组（1.39 mg/L；IQR 1.01-2.75）（<0.001）。DD的曲线下面积（AUC）为0.789（0.652-0.927）。将DD的截断点改为4.33 mg/L后，特异性从42.5%提高到93.9%。
截断点DD>4.33 mg/L时特异性增加，可区分假阳性。DD与临床概率量表的联合使用提高了特异性和阴性预测值，有助于避免对该人群进行不必要的侵入性检查。
