综合CTPA与肺栓塞的临床和血液学参数的预后图

IF 2.5 4区综合性期刊 Q2 MULTIDISCIPLINARY SCIENCES

Journal of Radiation Research and Applied Sciences Pub Date : 2025-09-10 DOI:10.1016/j.jrras.2025.101935

Lu Zhang, Kejing Ying

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引用次数: 0

摘要

目的肺栓塞（PE）是一种危及生命的疾病，需要精确的风险分层以进行最佳治疗。本研究旨在开发和验证一种预后图，该图结合了计算机断层扫描肺血管造影（CTPA）、血液生物标志物和临床特征，以预测PE患者的不良结局。方法对2017年10月至2024年10月诊断为PE的患者进行回顾性队列研究。根据患者6个月内不良结局分为预后良好组和预后不良组。CTPA测量包括右心室与左心室比（RV/LV）、肺动脉直径、奇静脉直径、冠状窦直径和Qanadli评分。血液学参数分析包括一组全面的生物标志物，包括d -二聚体、肌钙蛋白I和炎症标志物，如HsCRP和未成熟粒细胞计数（IG）。临床评估记录胸痛的存在和测量肺动脉收缩压。结果纳入513例患者，其中预后好410例，预后差103例。多因素分析确定了5个预后不良的独立预测因素：胸痛（OR = 1.962, p = 0.024）、RV/LV比（OR = 4.920, p = 0.001）、肌钙蛋白I （OR = 178.133, p < 0.001）、HsCRP （OR = 1.015, p = 0.044）和IG （OR = 10.966, p = 0.038）。该图具有良好的鉴别性（AUC = 0.809）和校准性。外部验证（n = 102，预后好82例，预后差20例）证实了其稳健性（AUC = 0.814）。结论结合CTPA、血液学和临床参数的新nomogram诊断方法为临床提供了一种准确的风险分层工具。这可能有助于指导高危PE患者的处置、监测强度和先进治疗方法的使用。

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A prognostic nomogram integrating CTPA with clinical and hematological parameters for pulmonary embolism

Purpose

Pulmonary embolism (PE) is a life-threatening condition requiring precise risk stratification for optimal management. This study aimed to develop and validate a prognostic nomogram that incorporated computed tomography pulmonary angiography (CTPA), blood biomarkers, and clinical characteristics to predict adverse outcomes in PE patients.

Methods

A retrospective cohort study was conducted on patients diagnosed with PE from October 2017 to October 2024. Patients were divided into two groups based on adverse outcomes within six months: good prognosis and poor prognosis. CTPA measurements included the right ventricular to left ventricular ratio (RV/LV), pulmonary artery diameter, azygos vein diameter, coronary sinus diameter, and Qanadli score. Hematological parameters analyzed consisted of a comprehensive panel of biomarkers, including D-dimer, troponin I, and inflammatory markers like HsCRP and immature granulocyte count (IG). Clinical assessments recorded the presence of chest pain and measured pulmonary artery systolic pressure.

Results

The cohort included 513 patients (410 with good prognosis and 103 with poor prognosis). Multivariate analysis identified five independent predictors of poor prognosis: chest pain (OR = 1.962, p = 0.024), RV/LV ratio (OR = 4.920, p = 0.001), troponin I (OR = 178.133, p < 0.001), HsCRP (OR = 1.015, p = 0.044), and IG (OR = 10.966, p = 0.038). The nomogram demonstrated excellent discrimination (AUC = 0.809) and calibration. External validation (n = 102; 82 with good prognosis and 20 with poor prognosis) confirmed its robustness (AUC = 0.814).

Conclusion

The novel nomogram that integrated CTPA, hematological, and clinical parameters offered a clinically applicable tool for accurately stratifying risk. This may help guide decisions regarding patient disposition, monitoring intensity, and the use of advanced therapies in high-risk PE patients.

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来源期刊

Journal of Radiation Research and Applied Sciences MULTIDISCIPLINARY SCIENCES-

自引率

5.90%

发文量

130

审稿时长

16 weeks

期刊介绍： Journal of Radiation Research and Applied Sciences provides a high quality medium for the publication of substantial, original and scientific and technological papers on the development and applications of nuclear, radiation and isotopes in biology, medicine, drugs, biochemistry, microbiology, agriculture, entomology, food technology, chemistry, physics, solid states, engineering, environmental and applied sciences.