The 3-level Wells score combined with D-dimer can accurately diagnose acute pulmonary embolism in hospitalized patients with acute exacerbation of COPD: A multicentre cohort study

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2024-11-15 DOI:10.1016/j.ijcha.2024.101533

Xiaojing Jiao , Yixiao zhang , Tuguang Kuang , Juanni Gong , Yadong Yuan , Guohua Zhen , Jifeng Li , Suqiao Yang , Jianguo He , Yuanhua Yang

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Abstract

Background

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.

Methods

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.

Results

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 (P = 0.01).

Conclusions

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.

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3 级威尔斯评分结合 D-二聚体可准确诊断慢性阻塞性肺疾病急性加重住院患者的急性肺栓塞：一项多中心队列研究

背景在慢性阻塞性肺疾病（AECOPD）急性加重期患者中识别急性肺栓塞（APE）具有挑战性。目前已开发出威尔斯评分和修订版日内瓦评分来诊断急性肺栓塞。我们旨在研究两种临床评分系统结合 D-二聚体对 AECOPD 患者 APE 的预测准确性。共纳入 731 名患者。入院 48 小时内进行计算机断层扫描肺血管造影术（CTPA）。通过计算接收者操作特征曲线下面积（AUROC）、敏感性和特异性，比较了临床评分系统的性能。其中 112 人（15.3%）被诊断为 APE。确定 AECOPD 中 APE 的最佳 D-二聚体临界值为 690.12 纳克/毫升。使用 3 级威尔斯和修订版日内瓦评分评估 APE 临床可能性的分析表明，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 级威尔斯和修订版日内瓦评分结合 D-二聚体临界值 690.12 纳克/毫升进行的分析表明，AUC 分别为 0.909 和 0.869，灵敏度分别为 73.21 % 和 91.96 %，特异性分别为 92.08 % 和 72.70 %。在评估AECOPD患者APE的临床可能性时，3级Wells评分结合D-二聚体的表现明显优于3级Revised Geneva评分结合D-二聚体的表现（P = 0.01）。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.