Predictive Value Of Wells Scale,Revised Geneva Score And D-dimer For Pulmonary Embolism In Patients With Chronic Obstructive Pulmonary Disease

BackgroundChronic obstructive pulmonary disease(COPD)is an independent risk factor for pulmonary embolism(PE),due to the special pathophysiological status in acute exacerbation of chronic obstructive pulmonary disease(AECOPD),the risk of associated with PE is 2-4 times,compared with patients without COPD.Symptoms of AECOPD and associated with PE are similar,often missed and misdiagnosed,and treatment delay leading to worse prognosis,higher mortality.Therefore,diagnosis of PE in patients with AECOPD timely is particularly important.Compared with pulmonary angiography and CT pulmonary angiography(CTPA),clinical predictive evaluation methods such as Wells scale,revised Geneva score and D-dimer are more suitable as the preferred screening method for PE.Because of the effects of COPD,the predictive value of the Wells scale,the revised Geneva score,and the D-dimer for PE in patients with AECOPD is unknown,and further validation is required.ObjectivesIn this study,we retrospectively analyzed the clinical characteristics and riskfactors of PE in patients with AECOPD,and evaluated the predictive value of Wells scale,revised Geneva score and D-dimer method for PE in patients with AECOPD.The purpose is to provide more reference for the clinical evaluation of PE in patients with AECOPD.MethodsPatients with both AECOPD and CTPA were collected in the First Affiliated Hospital of Zhengzhou University from March 2013 to December 2015,and relevant clinical features and risk factors were recorded.According to the results of CTPA,the patients were divided into two groups: PE group and COPD group.c2 test and logistic multiple regression method were used to compare the clinical features and risk factors in two groups and identify high risk factors.The Wells scale score and the revised Geneva score for all patients included.The ROC curve and the Z-test were used to compare the predictive value of both scoring methods and D-dimer for acute exacerbation of chronic obstructive pulmonary disease with pulmonary embolism.ResultsIn this study,a total of 234 cases met the inclusion criteria and the prevalence of PE was 13.7%(32/234).Univariate analysis showed that following factors were significantly different between PE and COPD groups: lower extremity edema,hemoptysis,brake ?3d,dyspnea,combined with DVT,D-dimer positive,chronic pulmonary heart disease,pulmonary function class IV(P<0.05).Multivariate analysis showed that dyspnea,D-dimer positive,combined with DVT were high risk factors for PE in patients with AECOPD(P<0.05).Prevalence of PE in the low,moderate and high probability groups predicted by Wells scale and revised Geneva scores were 0.9%?20.1%?100% and 4.2%?14.7%?90.0%,respectively.The negative predictive value of the low probability group by Wells scale and revised Geneva scores were 99.1% and 95.8%,respectively.and theoptimal cut-off point of Wells scale and revised Geneva scores were 2.75 and 4.5,respectively.The negative predictive value of D-dimer was 94.6% and the optimal cut-off point was 1.12 mg / L.The area under the ROC curve by Wells scale,revised Geneva score,D-dimer,Wells scale combined with D-dimer,revised Geneva score combined with D-dimer were 0.869 ± 0.041,0.710 ± 0.062,0.866 ± 0.039,0.926 ± 0.026,0.855 ± 0.053,respectively(P<0.05).The differences of the area under the ROC curve between Wells scale and revised Geneva score,D-dimer and revised Geneva score were significantly(Z>1.96,P<0.05).There was no significant difference of the area under the ROC curve between Wells scale and D-dimer(Z<1.96,P>0.05).There was no significant difference of the area under the ROC curve between Wells scale combined with D-dimer and joint ago,revised Geneva score combined with D-dimer and joint ago(Z<1.96,P>0.05).Conclusion1.Patients with AECOPD should be considered for the presence of PE if they had the risk factors of: lower extremity edema,hemoptysis,brake ?3d,dyspnea,combined with DVT,D-dimer positive,chronic pulmonary heart disease,pulmonary function class IV,especially dyspnea,D-dimer positive,combined with DVT.2.The predictive value of Wells scale and D-dimer are higher than revised Geneva scores for PE in patients with AECOPD.3.The negative predictive values of D-dimer,low probability group of Wells scale and revised Geneva score,but can not completely eliminate the possibility of PE in patients with AECOPD.