Cardiology Department, Bilecik Training and Research Hospital, Floor 2, 11230, Bilecik, Turkey.
Emergency Medicine, Bilecik Training and Research Hospital, Bilecik, Turkey.
J Thromb Thrombolysis. 2024 Apr;57(4):683-690. doi: 10.1007/s11239-024-02952-9. Epub 2024 Feb 28.
Acute pulmonary embolism (APE) is a thromboembolism situation that can be central or peripheral. APE risk analysis and classification are essential for therapy planning. Our aim is to determine the novel MAPH score (including age, mean platelet volume (MPV), total protein, and hematocrit parameters) that can distinguish APE subtypes. Our retrospective cohort analysis includes 97 APE patients referred to the emergency medicine department who underwent pulmonary computed tomography angiography (CTA) in 24 h from 2020 to 2022. The hospital information system provided demographic, clinical, laboratory, and pulmonary CTA data. APE was classified into central (46 patients) and peripheral (51 patients) depending on the area of vascular involvement. The central APE group had higher hypertension (HT) (67.4%) and atrial fibrillation (AF) (39.1%) incidence than the peripheral APE group (all p values > 0.05). The central APE had higher total protein and platelet counts (p = 0.003 and p = 0.036), but peripheral APE had higher troponin values (p = 0.029). Central APE had 2.17 ± 0.85 MAPH and peripheral APE 1.76 ± 0.95 (p = 0.029). HT, AF, platelet count, and MAPH score differed significantly in univariate logistic regression (all p values < 0.05). However, only platelet count varied in multivariate logistic regression (p = 0.042). ROC curve analysis revealed that the MAPH score predicts central APE with 83% sensitivity and 45% specificity at a cut-off level of 1.5. The new MAPH score as an indicator of blood viscosity may distinguish between central and peripheral APE. Our result is significant, especially for centers with limited examinations, as it may accelerate the diagnosis and treatment processes. We think that our results might guide future investigations.
急性肺栓塞（APE）是一种血栓栓塞情况，可以是中央型或外周型。APE 的风险分析和分类对于治疗计划至关重要。我们的目的是确定新的 MAPH 评分（包括年龄、平均血小板体积（MPV）、总蛋白和红细胞压积参数），以区分 APE 亚型。我们的回顾性队列分析包括 97 名在 2020 年至 2022 年期间因急诊就诊并在 24 小时内行肺部计算机断层血管造影（CTA）检查的 APE 患者。医院信息系统提供了人口统计学、临床、实验室和肺部 CTA 数据。根据血管受累的部位将 APE 分为中央型（46 例）和外周型（51 例）。中央 APE 组高血压（HT）（67.4%）和心房颤动（AF）（39.1%）的发生率高于外周 APE 组（所有 p 值均>0.05）。中央 APE 的总蛋白和血小板计数较高（p=0.003 和 p=0.036），但外周 APE 的肌钙蛋白值较高（p=0.029）。中央 APE 的 MAPH 评分为 2.17±0.85，外周 APE 的 MAPH 评分为 1.76±0.95（p=0.029）。在单因素逻辑回归中，HT、AF、血小板计数和 MAPH 评分差异有统计学意义（所有 p 值均<0.05）。然而，只有血小板计数在多因素逻辑回归中差异有统计学意义（p=0.042）。ROC 曲线分析表明，MAPH 评分预测中央型 APE 的敏感性为 83%，特异性为 45%，截断值为 1.5。新的 MAPH 评分作为血液粘度的指标可能有助于区分中央型和外周型 APE。我们的研究结果具有重要意义，特别是对于检查受限的中心，因为它可能加速诊断和治疗过程。我们认为我们的结果可能为未来的研究提供指导。
