Department of Radiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Pancreatitis Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Acad Radiol. 2022 Aug;29(8):1169-1177. doi: 10.1016/j.acra.2021.11.021. Epub 2021 Dec 23.
Acute pulmonary embolism (APE) is a common disease with a high mortality, especially in the short term. Computed tomographic pulmonary angiography (CTPA) is a recommended method in the diagnostic workup for APE; thus, this study aimed to establish a CTPA-based radiological nomogram to predict the 30-day mortality in patients with APE, and to further compare this model with the pulmonary embolism severity index (PESI) and simplified pulmonary embolism severity index (SPESI).
We retrospectively recruited 158 adults with confirmed APE who underwent CTPA from August 1, 2017, to August 1, 2020. These adults were stratified into two groups according to their 30-day mortality. CTPA-based variables were analyzed using univariate and multivariate analyses, independent risk factors for 30-day mortality were established, and a radiological nomogram was constructed. Subsequently, PESI and SPESI were calculated. The performance of the radiological nomogram model was compared to that of the PESI and SPESI using decision curve analysis and receiver-operating characteristic curve analysis.
Thirty-three patients died within 30 days (30-day mortality rate, 20.9%). On logistic regression analysis, the right and left ventricular diameter ratio (odds ratio [OR] = 8.709, 95% confidence interval [CI]: 1.085-69.903, p = 0.042), ventricular septal bowing (OR = 8.085, 95% CI: 1.947-33.567, p = 0.004), chronic bronchitis (OR = 4.383, 95% CI: 1.025-18.740, p = 0.046), malignant lung lesions (OR = 17.530, 95% CI: 2.408-127.636, p = 0.005), and pneumonia (OR = 3.477, 95% CI: 1.123-10.766, p = 0.031) were identified as the independent predictors of 30-day mortality. The area under the curve of the radiological nomogram, PESI, and SPESI were 0.900 (95% CI: 0.828-0.971), 0.729 (95% CI: 0.642-0.815), and 0.718 (95% CI: 0.621-0.815), respectively.
The CTPA-based radiological nomogram appeared valuable for the prediction of 30-day mortality in patients with APE, and was superior to both PESI and SPESI.
急性肺栓塞（APE）是一种常见的高死亡率疾病，尤其是在短期内。计算机断层扫描肺动脉造影（CTPA）是 APE 诊断评估中的一种推荐方法；因此，本研究旨在建立一个基于 CTPA 的放射学列线图，以预测 APE 患者的 30 天死亡率，并进一步将该模型与肺栓塞严重指数（PESI）和简化肺栓塞严重指数（SPESI）进行比较。
我们回顾性招募了 158 名于 2017 年 8 月 1 日至 2020 年 8 月 1 日期间接受 CTPA 检查的确诊 APE 成人患者。这些患者根据其 30 天死亡率分为两组。使用单变量和多变量分析来分析基于 CTPA 的变量，确定 30 天死亡率的独立危险因素，并构建放射学列线图。随后计算 PESI 和 SPESI。使用决策曲线分析和受试者工作特征曲线分析比较放射学列线图模型与 PESI 和 SPESI 的性能。
33 例患者在 30 天内死亡（30 天死亡率，20.9%）。在逻辑回归分析中，右心室和左心室直径比（比值比[OR] = 8.709，95%置信区间[CI]：1.085-69.903，p = 0.042）、室间隔弯曲（OR = 8.085，95%CI：1.947-33.567，p = 0.004）、慢性支气管炎（OR = 4.383，95%CI：1.025-18.740，p = 0.046）、恶性肺病变（OR = 17.530，95%CI：2.408-127.636，p = 0.005）和肺炎（OR = 3.477，95%CI：1.123-10.766，p = 0.031）被确定为 30 天死亡率的独立预测因素。放射学列线图、PESI 和 SPESI 的曲线下面积分别为 0.900（95%CI：0.828-0.971）、0.729（95%CI：0.642-0.815）和 0.718（95%CI：0.621-0.815）。
基于 CTPA 的放射学列线图在预测 APE 患者 30 天死亡率方面具有较高的应用价值，优于 PESI 和 SPESI。
