Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, University of Lübeck, German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Intern Emerg Med. 2022 Nov;17(8):2245-2252. doi: 10.1007/s11739-022-03075-w. Epub 2022 Aug 17.
In patients with suspected pulmonary embolism (PE), the number of unnecessary computed tomography pulmonary angiography (CTPA) scans remains high, especially in patients with low pre-test probability (PTP). So far, no study showed any additional benefit of capillary blood gas analysis (BGA) in diagnostic algorithms for PE. In this retrospective analysis of patients with suspected PE and subsequent CTPA, clinical data, D-dimer levels and BGA parameters (including standardized PaO2) were analyzed. Logistic regression analyses were performed to identify independent predictors for PE and reduce unnecessary CTPA examinations in patients with low PTP according to Wells score. Of 1538 patients, PE was diagnosed in 433 patients (28.2%). The original Wells score (odds ratio: 1.381 [95% CI 1.300-1.467], p < 0.001) and standardized PaO2 (odds ratio: 0.987 [95% CI 0.978-0.996], p = 0.005) were independent predictors for PE. After cohort adjustment for low PTP a D-dimer cut-off < 1.5 mg/L (278 patients (18.1%) with 18 PE (6.5%)) was identified in which a standardized PaO2 > 65 mmHg reduced the number of unnecessary CTPA by 31.9% with a 100% sensitivity. This approach was further validated in additional 53 patients with low PTP. In this validation group CTPA examinations were reduced by 32.7%. No patient with PE was missed. With our novel algorithm combining BGA testing with low PTP according to Wells score, we were able to increase the D-Dimer threshold to 1.5 mg/L and reduce CTPA examinations by approximately 32%.
在疑似肺栓塞（PE）的患者中，仍有大量不必要的计算机断层肺动脉造影（CTPA）扫描，尤其是在低预检测概率（PTP）的患者中。迄今为止，尚无研究表明毛细血管血气分析（BGA）在 PE 的诊断算法中有任何额外的益处。在这项对疑似 PE 且随后进行 CTPA 的患者的回顾性分析中，分析了临床数据、D-二聚体水平和 BGA 参数（包括标准化 PaO2）。采用逻辑回归分析确定了根据 Wells 评分预测 PE 的独立预测因子，并减少低 PTP 患者不必要的 CTPA 检查。在 1538 名患者中，有 433 名患者（28.2%）被诊断为 PE。原始 Wells 评分（比值比：1.381 [95%CI 1.300-1.467]，p<0.001）和标准化 PaO2（比值比：0.987 [95%CI 0.978-0.996]，p=0.005）是 PE 的独立预测因子。在调整低 PTP 后，我们发现 D-二聚体截断值<1.5mg/L（278 名患者（18.1%）中有 18 名 PE（6.5%）），在标准化 PaO2>65mmHg 的情况下，可减少 31.9%的不必要 CTPA 检查，而敏感性为 100%。这一方法在另外 53 名低 PTP 的患者中进一步得到验证。在验证组中，CTPA 检查减少了 32.7%。没有遗漏任何 PE 患者。通过我们的新算法，根据 Wells 评分将 BGA 检测与低 PTP 相结合，我们能够将 D-二聚体的阈值提高到 1.5mg/L，并减少大约 32%的 CTPA 检查。
