| Objective:Evaluation standard algorithm,AADD algorithm,YEARS algorithm,PERC algorithm and PEGeD algorithm five PE risk assessment algorithm for the predictive diagnostic value of inpatients with AECOPD suspected PE.To explore the most suitable clinical prediction method for AECOPD suspected PE.The aim of this study is to provide help for the diagnosis of PE,and initiation of anticoagulant therapy as soon as possible,in order to improving the survival rate of patients.Methods:The subjects was conducted from December 2019 to December 2020 in the first hospital of Shanxi Medical University.All patients underwent D-dimer(D-D)examination within 24 hours of admission and completed CTPA and/or lung V/Q.The clinical data of patients on admission day were recorded and divided into PE possible group and PE non-possible group according to AADD,YEARS,PERC and PEGeD evaluation criteria.Diagnostic criteria for each algorithm are as follows:(1)The negative diagnostic criteria of standard algorithm areD-D<500μg/l and low C-PTP,otherwise it is positive diagnostic criteria.(2)The negative diagnostic criteria of AADD are age≤50years,low or moderate C-PTP and D-D<500μg/L,or the patient’s age>50 years old,C-PTP is low or medium and D-D<(age×10)μg/L,otherwise it is positive diagnostic criteria.(3)The negative criteria of YEARS algorithm are no history of DVT,hemoptysis or most likely to develop PE and D-D<1000μg/L,while the negative criteria were no history of DVT and D-D<1000μg/L,and with one or more of the above three criteria and D-D<500μg/L,otherwise it is the positive diagnostic criterion.(4)The negative diagnostic criterion of PERC algorithm is that the patient is not more than 50 years old and has no hemoptysis and unilateral leg swelling,P<100cpm,Sa O2>94%,no history of VTE,recent trauma or surgery,or oral hormone use,otherwise it is positive diagnostic criteria.(5)The negative diagnostic criteria of PEGeD algorithm are low C-PTP with D-D<1000μg/L or moderate C-PTP with D-D<500μg/L,otherwise it is positive diagnostic criteria.The gold standard for PE diagnosis are CTPA positive and/or V/Q scan positive.The clinical predictive value of the standard algorithm,AADD,YERAS,PERC,PEGeD in inpatients with AECOPD was evaluated by the comprehensive evaluation index of diagnostic test.The evaluation indexes included: Se,PV+,LR+,Sp,PV-,LR-,YI.Results:A total of 116 in-patients with AECOPD suspected to be PE included effective cases,82 males(70.6%),34 females(29.3%),mean age(70.70±9.49)years.45 patients were diagnosed after CTPA and/or V/Q,the diagnostic rate was 38.8%,27 males(60.0%),18females(40.0%),and the mean age was(71.84±9.22)years.1.The predictive value of standard algorithm in patients with suspected PE in AECOPD.There were a total of 93 suspected patients in the positive group of the standard algorithm,of which 42 were diagnosed with PE.The negative group of the standard method had a total of 23 suspected patients,of which 3 were diagnosed with PE.The clinical predictive value of Se,PV+,LR+,Sp,PV-,LR-,YI were 93.3%,45.2%,1.30,28.2%,87.0%,0.24,0.22 respectively.2.Predictive value of AADD algorithm in patients with suspected PE in AECOPD There were a total of 42 suspected patients in the the positive group of AADD algorithm,of which 30 were diagnosed with PE.The negative group of the standard method had a total of 74 suspected patients,of which 18 were diagnosed with PE.The clinical predictive value of Se,PV+,LR+,Sp,PV-,LR-,YI were 66.7%,71.4%,3.94,83.1%,79.7%,0.40,0.50 respectively.3.The predictive value of YEARS algorithm in patients with suspected PE in AECOPD There were a total of 35 suspected patients in the the positive group of YEARS algorithm,of which 27 were diagnosed with PE.The negative group of the standard method had a total of 81 suspected patients,of which 18 were diagnosed with PE.The clinical predictive value of Se,PV+,LR+,Sp,PV-,LR-,YI were 60.0%,77.1%,5.33,88.7%,77.8%,0.45,0.49 respectively.4.The predictive value of PERC algorithm in patients with suspected PE in AECOPD There were a total of 116 suspected patients in the the positive group of YEARS algorithm,of which 45 were diagnosed with PE.The negative group of the standard method had a total of 0 suspected patients,of which 0 were diagnosed with PE.5.The predictive value of PEGeD algorithm in patients with suspected PE in AECOPD There were a total of 57 suspected patients in the the positive group of YEARS algorithm,of which 40 were diagnosed with PE.The negative group of the standard method had a total of 59 suspected patients,of which 5 were diagnosed with PE.The clinical predictive value of Se,PV+,LR+,Sp,PV-,LR-,YI were 81.6%,70.2%,3.71,76.1%,91.5%,0.15,0.58 respectively.Conclusion:1.The standard algorithm score is stricter,its sensitivity and negative predictive value are high.Its negative to inpatient AECOPD patients with suspected PE to have the important exclusion value.Due to the low true negative rate,it can cause the excessive image examination.2.AADD algorithm is highly specific for inpatient AECOPD patients with suspected PE and has certain diagnostic value.However,AADD algorithm is affected by age and may cause a high false positive rate for some patients(age<50 years),so it is in AECOPD patients predicting PE has limitations.3.YEARS algorithm is highly specific for inpatient AECOPD patients with suspected PE and has certain diagnostic value.However,the variables involved in YEARS algorithm are more difficult to evaluate,so it is in AECOPD patients predicting PE has limitations.4.The PERC algorithm score is strict,resulting in a high false positive rate,and it is not suitable for inpatient AECOPD patients with suspected PE.5.PEGeD algorithm has high sensitivity and negative predictive value for inpatient AECOPD patients with suspected PE.It combines the clinical prediction probability and D-dimer fully complementary,and among the above five methods,it is most suitable for inpatient AECOPD patients to predict PE. |
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