The Predictive Value Of Age-corrected D-dimer Combined With Wells Score,Modified Geneva Score For Pulmonary Embolism Risk Of Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective:This study aimed to compare the predictive value of age-adjusted D-dimer,Wells score,and modified Geneva score for the risk of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease.Methods:The patients who were admitted to the First Affiliated Hospital of Nanchang University and performed CT pulmonary angiography(CTPA)due to AECOPD from January 2012 to June 2019 were selected as the research object.According to the CTPA results,they were divided into AECOPD group and AECOPD combined with pulmonary embolism group.General clinical data of all included patients were collected: gender,age,smoking history,past history,Clinical features.Age-corrected D-dimer of the 2 groups of patients were used to performed Wells score and modified Geneva score for pulmonary embolism,ROC curve was drawn,and age correction was compared the area under the ROC curve(AUC)of post-D-dimer,Wells score,and modified Geneva score was used to evaluate its predictive value for the risk of pulmonary embolism in acutely exacerbated COPD patients.Result:The AUC of age-corrected D-dimer,Wells score,modified Geneva score,age-corrected D-dimer + Wells score,age-adjusted D-dimer + corrected Geneva score were 0.755(95% CI: 0.688 to 0.822),0.697(95% CI: 0.615 to 0.780),0.645(95% CI: 0.562 to 0.729),0.791(95% CI: 0.727 to 0.855),0.734(95% CI: 0.661 to 0.808).The Wells score is significantly greater than the modified Geneva score(Z = 2.598,P value 0.0094),the age-corrected D-dimer + Wells score is significantly greater than the age-corrected D-dimer + modified Geneva score(Z = 3.259,P values are all less than 0.05),but the age-adjusted D-dimer is not statistically different from the Wells score(P value greater than 0.05).The AUC of age-corrected D-dimer+Wells score was 0.791,the optimal cut-off value of age-corrected D-dimer is 813 ug / L and the Wells score is 0 point,corresponding sensitivity is 96.92%,the specificity is 47.69%,the positive predictive value was 48.05%,the negative predictive value was 96.88%,the missed diagnosis rate was 3.12%,and the Youden index is 0.4462.Conclusion:1.Age-corrected D-dimer + Wells score predicts the risk of AECOPD patients with pulmonary embolism The measured value is the largest.2.For patients with acute exacerbation of chronic obstructive pulmonary disease,when the Wells score is 0 and the D-dimer is less than 813 ug / L,the diagnosis of exclusion of pulmonary embolism is basically possible.