Luo Linjie, Zheng Dan, Da Li, Cheng Jian, Cao Yirui, Wang Na
Department of Respiratory and Critical Care medicine, The Affiliated Hospital, Southwest Medical University, Chengdu City, Sichuan Province, PR China.
Department of Respiratory and Critical Care medicine, The Affiliated Hospital, Southwest Medical University, Chengdu City, Sichuan Province, PR China.
Clinics (Sao Paulo). 2025 Feb 27;80:100582. doi: 10.1016/j.clinsp.2025.100582. eCollection 2025.
This study investigated the predictive value of thrombin generation indices and Wells score in the development of Pulmonary Embolism (PE) in patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD).
160 patients who were admitted for AECOPD and underwent CT Pulmonary Arteriography (CTPA) were collected. Among them, a total of 62 cases were diagnosed with PE as the AECOPD with PE group, and the other 98 cases were not diagnosed with PE as the AECOPD group. The general data, past history and combined basic diseases, laboratory tests and other related clinical data of the two groups were compared, and the data collected were statistically analyzed to explore the diagnostic indexes that can predict PE in AECOPD.
History of venous thromboembolism, d-Dimer as well as Endogenous Thrombin Potential (ETP), Activated Partial Thromboplastin Time (APTT) coagulation indices, and Wells score was significantly higher in the AECOPD with PE group than in the AECOPD group, and Time to Peak (ttpeak), Albumin (ALB) and total protein were lower than those in the AECOPD group. The Wells score had a positive correlation with ETP and APTT and a negative correlation with ttpeak, which were all independent risk factors for PE in AECOPD. The Wells score had the best efficacy in predicting the occurrence of PE in patients with AECOPD with a cutoff value of 4.62.
Significant correlations were found between the thrombin generation indices (ETP, APTT and ttpeak) and the Wells score, which can also be used for early diagnosis of PE in patients with AECOPD.
本研究探讨凝血酶生成指标和Wells评分对慢性阻塞性肺疾病急性加重期（AECOPD）患者发生肺栓塞（PE）的预测价值。
收集160例因AECOPD入院并接受CT肺动脉造影（CTPA）的患者。其中，共62例被诊断为PE的AECOPD患者作为AECOPD合并PE组，另外98例未被诊断为PE的患者作为AECOPD组。比较两组的一般资料、既往史和合并基础疾病、实验室检查及其他相关临床资料，并对收集的数据进行统计学分析，以探索可预测AECOPD患者发生PE的诊断指标。
AECOPD合并PE组的静脉血栓栓塞病史、D-二聚体以及内源性凝血酶潜力（ETP）、活化部分凝血活酶时间（APTT）凝血指标和Wells评分均显著高于AECOPD组，而达峰时间（ttpeak）、白蛋白（ALB）和总蛋白则低于AECOPD组。Wells评分与ETP和APTT呈正相关，与ttpeak呈负相关，这些均为AECOPD患者发生PE的独立危险因素。Wells评分在预测AECOPD患者发生PE方面具有最佳效能，截断值为4.62。
凝血酶生成指标（ETP、APTT和ttpeak）与Wells评分之间存在显著相关性，其也可用于AECOPD患者PE的早期诊断。
