Age-Adjusted D-Dimer Combing With Wells Score And Revised Geneva Score In The Diagnosis Of Pulmonary Embolism

Objective:By analyzing the correlation between age-adjusted D-dimer,Wells Score,and Revised Geneva Score at admission,acquiring the application value of age-adjusted D-dimer,Wells Score and Revised Geneva Score in the diagnosis of pulmonary embolismMethods:Patients suspected of pulmonary embolism were enrolled who were admitted to the Emergency Department of the Second Affiliated Hospital of Kunming Medical University from April 2016 to May 2018.At admission,Wells Score and Revised Geneva Score were examined immediately.Age-adjusted D-dimer were obtained by age-corrected calculation formula.According to results of computed tomographic pulmonary angiography,patients were divided into pulmonary embolism group and non-pulmonary embolism group.The positive rate of the age-adjusted D-dimer,Wells Score and Revised Geneva Score after age correction were compared between the two groups.The cut-off value of Wells Score and Revised Geneva Score in the diagnosis of pulmonary embolism were obtained.ROC curve and non-parametric single sample test were used to compare the specificity of the age-adjusted D-dimer combined with Wells Score,Revised Geneva Score or both of them in the diagnosis of pulmonary embolism.Results:1.129 patients were enrolled,including 69 patients in the pulmonary embolism group(53.5%)and 60 patients in the non-pulmonary embolism group(46.5%).There was no significant difference in gender,age and diseases history between the two groups(P>0.05),2.The positive rate of age-adjusted D-dimer in the pulmonary embolism group was 94.2%and in the non-pulmonary emboism group was 70.0%.There was a significant difference between the two groups(p<0.05).3.In Wells Score,the area under ROC curve was 0.733,and the 95%confidence interval was(0.646,0.820).The sensitivity in the diagnosis of pulmonary embolism was 56.5%,and the specificity in the diagnosis of pulmonary embolism was 78.3%,p=0.000.The cut-off value was 4.In Revised Geneva Score,the area under ROC curve was 0.671,and the 95%confidence interval was(0.578,0.764).The sensitivity in the diagnosis of pulmonary embolism was 53.6%,and the specificity in the diagnosis of pulmonary embolism was 71.7%,P=0.001.The cut-off value is 6 points.4.The area under ROC curve of age-adjusted D-dimer combined with Wells Score was 0,662,95%confidence interval was(0.568,0.756).The sensitivity in the diagnosis of pulmonary embolism was 50.7%,and the specificity in the diagnosis of pulmonary embolism was 81.7%.The area under ROC curve of age-adjusted D-dimer combined with Revised Geneva Score was 0.646,95%confidence interval was(0.551,0.742).The sensitivity in the diagnosis of pulmonary embolism was 49.3%and the specificity in the diagnosis of pulmonary embolism was 80.0%.The area under ROC curve of age-adjusted D-dimer combined with Wells Score and Revised Geneva Score was 0.631,and 95%confidence interval was(0.535,0.727).The sensitivity in the diagnosis of pulmonary embolism was 36.2%,and the specificity in the diagnosis of pulmonary embolism was 90.0%.There was no significant difference in the area under ROC curve between the three groups(Z=0.307,P=1.000).But there was significant difference in the specificity among the three groups(Z=0.323,P=0.008).Age-adjusted D-dimer combined with Wells Score and Revised Geneva Score had the highest specificity in the diagnosis of pulmonary embolism.Conclusions:1.The cut-off value of Wells Score in the diagnosis of pulmonary embolism was 4,and the cut-off value of Revised Geneva Score in the diagnosis of pulmonary embolism was 6.2.Age-adjusted D-dimer combined with Wells Score and Revised Geneva Score had the highest specificity in the diagnosis of pulmonary embolism.