| Objective:To investigate the characteristics of patients with acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary thromboembolism.To compare the predictive power of Padua risk score,simplified Wells risk score and revised Geneva risk score for pulmonary thromboembolism in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease.Methods:A total of 157 hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease and suspected pulmonary thromboembolism in the Department of Respiratory Medicine of the First Hospital Affiliated to Dalian Medical University from January 2011 to January 2021 were retrospectively collected.According to the presence or absence of pulmonary thromboembolism,they were divided into pulmonary thromboembolism group and control group.General information(gender,age,BMI,smoking history)and past medical history(history of diabetes,hypertension,coronary heart disease,VTE,surgical trauma/fracture within 4weeks,tumor history,atrial fibrillation)were collected.Clinical data(chest pain,dyspnea,hemoptysis,syncope,asymmetric swelling of the lower extremity,unilateral lower extremity pain,varicose veins,deep vein thrombosis of the lower extremity,heart failure,respiratory failure,bed immobilization time),treatment data(hormones,anticoagulant drugs),Binary Logistic regression analysis was used to determine the risk factors of pulmonary thromboembolism in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease.Three risk assessment models were used for risk score and risk classification of patients,and receiver operating characteristic curve analysis was used to calculate the sensitivity,specificity,positive predictive value,negative predictive value,and draw the receiver operating characteristic curve.The area under the curve was compared to determine the predictive value of three risk assessment models in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary thromboembolism.Results:1.Comparison of general data: there was a significant difference in BMI between the pulmonary thromboembolism group and the control group(P<0.05),but there was no significant difference in gender,age,age,smoking history(P>0.05).2.The comparison of risk factors between the two groups showed that there were statistically significant differences in chest pain,asymmetric swelling of the lower extremities,varicose veins of the lower extremities,history of VTE,bed rest/immobilization time ≥3 days,and deep vein thrombosis of the lower extremities(P<0.05).Asymmetric swelling of the lower extremities(OR=10.15,95%CI:2.904-35.484,P<0.001),varicose veins(OR=6.87,95%CI:2.354-20.095,P<0.001),history of VTE(OR=44.73,95%CI 13.244-151.094,P<0.001),lower extremity deep venous thrombosis(OR=2.628,95%CI:1.229-5.619,P<0.05)were independent risk factors for pulmonary thromboembolism in patients with acute exacerbation of COPD.3.Grading ability of the three risk assessment models: According to Padua model,98 patients were rated as high risk and 59 patients as low risk.Fifty-four patients(55.1%)had PTE in the high risk group.According to the simplified Wells model,25 patients were rated as high-risk,132 patients were rated as low-risk,and 23 patients(92%)were PTE patients in the high-risk group.According to the revised Geneva model,29 patients were rated as high risk and 128 patients as low risk.58.6%(17cases)of the patients in the high risk group were PTE.Padua score had a positive predictive value of 55.1% and a negative predictive value of 91.5%.The positive predictive value of the simplified Wells score was 92.0%,and the negative predictive value was 72.7%.The positive predictive value of the revised Geneva score was58.6%,and the negative predictive value was 72.7%.4.Diagnostic value of three risk assessment models: The AUC of Padua score,simplified Wells score and revised Geneva score were 0.721,0.816 and 0.566,respectively.Padua score had a sensitivity of 91.53%,a specificity of 55.10%,a Youden index of 0.466 3,and a cut-off value of 3 for the diagnosis of pulmonary thromboembolism in COPD patients.The sensitivity and specificity of the simplified Wells score in the diagnosis of pulmonary thromboembolism in patients with chronic obstructive pulmonary disease were 79.66% and 75.51%,respectively.The Youden index was 0.551 7,and the best cut-off value was 0.The sensitivity and specificity of the revised Geneva score in the diagnosis of pulmonary thromboembolism in patients with chronic obstructive pulmonary disease were 28.81%,87.76%,Youden index was0.165 7,and the best cut-off value was 2 points.The sensitivity and specificity of age-adjusted D-dimer in the diagnosis of pulmonary thromboembolism in patients with COPD were 66.10%,57.14%,Youden index was 0.232 4,and the best cut-off value was 468.35.5.There was no significant difference between Padua assessment model and simplified Wells assessment model(P>0.0167).Padua score was significantly different from revised Geneva score(P<0.0167).The difference between the simplified Wells model and the revised Geneva model was statistically significant(P<0.0167).6.The AUC of Padua model combined with age-adjusted D-dimer for PTE diagnosis was 0.768(95%CI: 0.694-0.831).The AUC of the simplified Wells model combined with age-adjusted D-dimer for PTE diagnosis was 0.853(95%CI:0.788-0.904).The AUC of the revised Geneva model combined with age-adjusted D-dimer for PTE diagnosis was 0.662(95%CI: 0.582-0.735).The AUC of Padua risk assessment model combined with age-adjusted D-dimer was significantly different from that of Padua risk assessment model alone(P<0.05).The AUC of the simplified Wells evaluation model combined with age-adjusted D-dimer in the diagnosis of PTE was significantly different from that of the simplified Wells evaluation model alone(P<0.05).The AUC of the revised Geneva model combined with age-adjusted D-dimer in the diagnosis of PTE was significantly different from that of the revised Geneva model alone(P<0.05).7.There was no significant difference between Padua model combined with age-adjusted D-dimer and simplified Wells model combined with age-adjusted D-dimer(P>0.0167).Padua risk assessment model combined with age-adjusted D-dimer and revised Geneva risk assessment model combined with age-adjusted D-dimer were significantly different(P<0.0167).There was a significant difference between the simplified Wells assessment model combined with age-adjusted D-dimer and the revised Geneva assessment model combined with age-adjusted D-dimer(P<0.0167).Conclusions:1.Asymmetric swelling of lower extremities,varicose veins,deep venous thrombosis of lower extremities and history of VTE are independent risk factors for pulmonary thromboembolism in patients with acute exacerbation of chronic obstructive pulmonary disease.2.Among the three risk assessment models,Padua risk assessment model had the highest sensitivity.The revised Geneva model had the highest specificity.The simplified Wells model had the highest positive predictive value.Padua model had the highest negative predictive value.3.The predictive value of Padua risk score was higher than the revised Geneva risk score,and simplified Wells risk score was higher than the revised Geneva risk score.4.The predictive value of the three risk assessment models combined with age-adjusted D-dimer was higher than that of the three risk assessment models alone in predicting pulmonary thromboembolism in acute chronic obstructive pulmonary disease patients.5.The predictive value of Padua assessment model combined with age-adjusted D-dimer was higher than that of revised Geneva assessment model combined with age-adjusted D-dimer,and the predictive value of simplified Wells assessment model combined with age-adjusted D-dimer was higher than that of revised Geneva assessment model combined with age-adjusted D-dimer. |
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