The Predictive Value Of The Combination Of CHA2DS2-VASc Score Combined With D-dimer In Acute Pulmonary Embolism

Objective:To explore the predictive value of CHA2DS2-VASc score combined with D-dimer for the diagnosis of acute pulmonary embolism.Methods:A retrospective analysis was performed on inpatients suspected of acute pulmonary embolism(APE)in the second affiliated hospital of chongqing medical university from 2016 to 2018.The results of basic clinical data,D-dimer(DD)and computed tomographic pulmonary angiography(CTPA)were collected.Patients were divided into two groups with CTPA as gold standard,and were respectively evaluated with CHA2DS2-VASc score and modified Wells score.After mapping the receiver-operating characteristic curve(the ROC curve),we compared the predictive value of modified Wells score,CHA2DS2-VASc score,D-dimer,CHA2DS2-VASc score combined with D-dimer and modifiedWells score combined with D-dimer for diagnosis of acute pulmonary embolism.Results:A total of 216 suspected patients were collected,including 99 cases of pulmonary embolism confirmed by CTPA.According to the modified Wells score,prevalence in PE unlikely and PE likely are 34.2%and 52.6%respectively;16.7%,55.8%and 50%were the prevalent rate of low-risk group,medium-risk group and high-risk group for CHA2DS2-VASc score.The sensitivity of D-dimer testing was 76.8%,63.2V%for specificity,63.9%for positive predictive value,and 76.3%for negative predictive value,Meanwhile,the area under the carve(AUC)value was 0.607 ±0,039(95%CI:0.0531?0.682,P<0.01)for modified Wells score,0.736 ±0.034(95%CI:0.669~0.803,P<0.01)for CHA2DS2-VASc score,0.738±0.034(95%CI:0.671?0.805,P<0.01)for D-dimer,0.777±0.031(95%CI:0.716?0.839,P<0.01)for CHA2DS2-VASc score combined with D-dimer and 0.675±0.037(95%CI:0.603?0.746,P<0.01)for modified Wells score combined with D-dimer.Using Z test to compare the area under the curve,demonstrating that CHA2DS2-VASc score combined with D-dimer has differences with modified Wells score combined with D-dimer(P<0.05,Z = 0.05,95%Cl:0.024?0.181),and has significant differences with modified Wells score(P<0.01,Z = 0.01,95%CI:0.077?0.264)and D-dimer(P<0.01,Z = 0.01,95%CI:0.107?0.107).Conclusion:CHA2DS2-VASc score combined with D-dimer has high predictive value for the occurrence of acute pulmonary embolism in hospitalized patients.