Jiao Xiaojing, Zhang Yixiao, Kuang Tuguang, Gong Juanni, Yuan Yadong, Zhen Guohua, Li Jifeng, Yang Suqiao, He Jianguo, Yang Yuanhua
Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Beijing Institute of Respiratory Medicine, Beijing 100020, China.
Int J Cardiol Heart Vasc. 2024 Nov 15;55:101533. doi: 10.1016/j.ijcha.2024.101533. eCollection 2024 Dec.
Identification of acute pulmonary embolism (APE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is challenging. Wells score and Revised Geneva score have been developed to diagnose APE. We aim to investigate the predictive accuracy of two clinical scoring systems combined with D-dimer for APE in patients with AECOPD.
A multicentre cross-sectional study was conducted in 13 China hospitals. A total of 731 patients were enrolled. Computed tomography pulmonary angiography (CTPA) was performed within 48 hours of admission. The performance of the clinical scoring systems was compared by calculating the area under the receiver operating characteristic curves (AUROC), sensitivities, and specificities.
731 patients were included with an average age of 68.9 years, with a male proportion of 585 (80.0 %). 112 (15.3 %) were diagnosed with APE. The optimal D-dimer cut-off value for identifying APE in AECOPD was 690.12 ng/mL. Analysis for assessing the clinical probability of APE using the 3-level Wells and Revised Geneva scores showed the AUC were 0.74 and 0.60, sensitivity were 61.61 % and 77.68 %, and specificity were 85.46 % and 38.29 %, respectively. Analysis using the 3-level Wells and Revised Geneva scores combined with a D-dimer cut-off value of 690.12 ng/mL showed the AUC were 0.909 and 0.869, sensitivity were 73.21 % and 91.96 %, specificity were 92.08 %and 72.70 %. The performance of the 3-level Wells score with D-dimer was significantly better than the performance of the 3-level Revised Geneva score with D-dimer ( = 0.01).
The 3-level Wells score combined with a D-dimer cut-off value of 690.12 ng/mL performed better than other clinical scoring algorithms for assessing clinical probability of APE in patients with AECOPD.
在慢性阻塞性肺疾病急性加重（AECOPD）患者中识别急性肺栓塞（APE）具有挑战性。Wells评分和修订的日内瓦评分已被用于诊断APE。我们旨在研究两种临床评分系统联合D-二聚体对AECOPD患者APE的预测准确性。
在中国13家医院进行了一项多中心横断面研究。共纳入731例患者。入院后48小时内进行了计算机断层扫描肺动脉造影（CTPA）。通过计算受试者工作特征曲线下面积（AUROC）、敏感性和特异性来比较临床评分系统的性能。
纳入731例患者，平均年龄68.9岁，男性585例（80.0%）。112例（15.3%）被诊断为APE。在AECOPD患者中识别APE的最佳D-二聚体临界值为690.12 ng/mL。使用3级Wells评分和修订的日内瓦评分评估APE临床概率的分析显示，AUC分别为0.74和0.60，敏感性分别为61.61%和77.68%，特异性分别为85.46%和38.29%。使用3级Wells评分和修订的日内瓦评分联合D-二聚体临界值690.12 ng/mL的分析显示，AUC分别为0.909和0.869，敏感性分别为73.21%和91.96%，特异性分别为92.08%和72.70%。3级Wells评分联合D-二聚体的性能明显优于3级修订的日内瓦评分联合D-二聚体的性能（P = 0.01）。
3级Wells评分联合D-二聚体临界值690.12 ng/mL在评估AECOPD患者APE临床概率方面比其他临床评分算法表现更好。
