Age-Adjusted D-dimer Combined With Simplified Wells And Simplified Geneva Scores In The Risk Assessment Of Pulmonary Thromboembolism

ObjectiveThe objective of this study was to investigate the application value of age-adjusted D-dimer threshold combined with simplified Wells score and simplified Geneva score scale in the risk assessment of pulmonary thromboembolism(PTE).By analyzing the correlation between patients’ blood routine and PTE,its role in evaluating the risk of PTE was verified,and its predictive value for pulmonary thromboembolism was compared with age-adjusted D-dimer critical value combined with simplified Wells score and simplified Geneva score scales.MethodsIn this study,a retrospective case-control study was conducted to collect suspected PTE patients hospitalized in the Affiliated Hospital of Yunnan University from January 2021 to December 2022,and 157 eligible suspected PTE patients were screened out according to the established inclusion and exclusion criteria.According to the results of CTPA examination,73 patients were divided into positive group(PTE group)and 84 patients were negative control group.Gender,age,underlying diseases(chronic obstructive pulmonary disease,hypertension,coronary heart disease,venous thromboembolism history,malignant tumors,operation history within 1 month,etc.),body mass index(BMI),smoking,major clinical symptoms and signs(dyspnea,chest pain,hemoptysis,unilateral lower limb pain,heart rate,etc.),D-dimer value,arterial oxygen partial pressure,red cell,mean volume of red cell,red cell distribution width(RDW),platelets,mean platelet volume,and platelet distribution width were analyzed and compared.Traditional D-dimer critical value,age-adjusted D-dimer critical value,simplified Wells score scale,simplified Geneva score scale,traditional D-dimer critical value+simplified Wells+simplified Geneva score scale,age-adjusted D-dimer critical value+simplified Wells+simplified Geneva score scale,were calculated respectively Sensitivity,specificity,positive predictive value,negative predictive value,missed diagnosis rate and Yoden index of the score scale.SPSS26.0 statistical software was used to make the ROC curve and the area under the curve(AUC)of each group,and the AUC was compared between groups.P<0.05 indicated that the difference was statistically significant.SPSS26.0 software was used to analyze the correlation between the two groups of indicators with statistical significance in blood routine and PTE.ROC curve was used to calculate the optimal critical value,sensitivity,and Yoden index,and then compared with the ROC curve AUC of the age-adjusted D-dimer critical value+simplified Wells score+simplified Geneva score scale.Results(1)There were no significant differences in age,sex and underlying diseases between PTE group and control group(P>0.05).(2)the traditional D-dimer in threshold sensitivity,specific and positive prediction,negative predictive value,the missed diagnosis,about an index were 94.52%,27.38%,53.07%,85.19%,5.48%,0.219.The sensitivity,specificity,positive prediction,negative prediction,missed diagnosis rate and Yoden index of D-dimer critical value after age-adjusted were 93.15%,45.24%,59.65%,88.37%,6.85%and 0.384,respectively.The ROC curve AUC of age-adjusted D-dimer[0.692(95%CI0.631-0.753)]was higher than that of conventional D-dimer critical value[0.610(95%CI0.555-0.664)].Compared with the AUC of the two,Z=-3.723,P<0.001,the difference was statistically significant(P<0.05).(3)The sensitivity,specificity,positive predictive value,negative predictive value,missed diagnosis rate and Yoden index of the simplified Wells score scale were 80.82%,72.62%,71.95%,81.33%,19.18%and 0.534,respectively.The sensitivity,specificity,positive predictive value,negative predictive value,missed diagnosis rate and Yoden index of simplified Geneva score scale were 58.90%,67.86%,61.43%,65.52%,41.10%and 0.268,respectively.The ROC curve AUC of Wells Scale[0.767(95%CI0.7010.833)]>the AUC of Geneva Scale[0.634(95%CI0.558-0.710)].Compared with the AUC of the two,Z=3.764,P<0.001,the difference was statistically significant(P<0.05).(4)The sensitivity,specificity,positive predictive value,negative predictive value,missed diagnosis rate and Yoden index of the traditional D-dimer critical value+simplified Wells+simplified Geneva score scale were 97.26%,16.67%,50.35%,87.50%,2.74%and 0.139,respectively.The sensitivity,specificity,positive predictive value,negative predictive value,missed diagnosis rate and Yoden index of D-dimer critical value+simplified Wells+Simplified Geneva scale after age-adjusted were 95.89%,28.57%,53.84%,88.89%,4.11%and 0.245,respectively.The ROC curve AUC of the age-adjusted D-dimer critical value+simplified Wells+simplified Geneva score Scale[0.622(95%CI0.569-0.676)]>traditional D-dimer critical value+reduced Wells+Reduced Geneva score Scale[0.570(95%CI0.525-0.614)]Compared with the AUC of the two,Z=-2.765,P=0.006,the difference was statistically significant(P<0.05).(5)Comparison of underlying diseases and clinical symptoms and signs between the two groups:There were no statistically significant differences in hypertension,coronary heart disease,malignant tumor,chronic obstructive pulmonary disease,venous thromboembolism,Operation within 1 month,dyspnea,hemoptysis,PTE triad(Concurrent symptoms of dyspnea,hemoptysis,and chest pain),smoking,heart rate(P>0.05),chest pain,unilateral lower limb pain,BMI were statistically significant(P<0.05).The symptoms of chest pain in the PTE group were less than those in the control group,while the symptoms of unilateral lower limb pain were more than those in the control group.The BMI of the PTE group was greater than that of the control group.(6)There was no statistical significance in the differences of laboratory indexes in RBC,mean RBC volume,mean platelet volume,platelet distribution width and arterial oxygen partial pressure;The differences of RDW,platelet and D-dimer value were statistically significant(P<0.05).The median of red blood cell width and D-dimer value in PTE group was higher than that in control group,and the median of platelet was lower than that in opposite group.(7)In univariate logistic regression analysis,RDW was significantly correlated with PTE occurrence(OR=1.316,95%CI1.053-1.644,P=0.016).RDW was closely associated with the occurrence of PTE after adjusting for hypertension,coronary heart disease,chronic obstructive pulmonary disease,malignant tumor,history of venous thromboembolism,surgical history within 1 month,smoking history,BMI,red blood cell,platelet,mean red blood cell volume,mean platelet volume,and platelet distribution width(OR=1.472,95%CI1.141-1.901,P=0.003),the greater the RDW,the higher the risk of PTE(P<0.05).In multivariate logistic regression analysis,the influence of BMI on PTE was statistically significant(OR=1.137,95%CI1.018-1.271,P=0.023),and the higher the BMI,the higher the risk of PTE(P<0.05).(8)The optimal critical value of RDW to predict the occurrence of PTE was 14.35%,with the sensitivity was 52.1%,the specificity 70.2%,the Yoden index was 0.223,and the ROC curve AUC was[0.607(95%CI0.518-0.696)].ROC curve AUC of age-adjusted D-dimer critical value+simplified Wells+simplified Geneva score Scale[0.622(95%CI0.569-0.676)]>ROC curve AUC ofRDW[0.607(95%CI0.518-0.696)].Conclusion(1)The age-adjusted D-dime threshold combined with simplified Wells and simplified Geneva score scales had better predictive value for PTE than the traditional D-dimer threshold combined with simplified Wells and simplified Geneva score scales.(2)BMI and RDW were independent risk factors for PTE.(3)The age-adjusted D-dime threshold combined with the simplified Wells and simplified Geneva scores showed higher predictive value for PTE than RDW.