| Objective:This study aimed to analyze the risk factors,clinical characteristics and survival time of malignant tumors complicated with pulmonary thromboembolism(PTE),to evaluate the predictive value of the simplified Wells score,the revised Geneva score and D-dimer for malignant tumors complicated with PTE,to provide more reference basis for the preliminary judgment of malignant tumors complicated with PTE,and to avoid excessive use of CT pulmonary angiography(CTPA).Methods:Through the inquiry system of record room and imaging department,the patients with malignancy suspected of PTE and CTPA during hospitalization in our hospital in the past 6 years were collected according to the inclusion and exclusion criteria.The diagnosis of PTE is based on the results of CTPA as the gold standard,the malignant tumors with PTE as the positive group and the malignant tumors without PTE as the negative group.The general data,medical history of underlying diseases,diagnosis and treatment data of malignant tumors and the data related to PTE are collected,and the above data are statistically analyzed.The variables with statistical significance in univariate analysis were incorporated into multivariate Logistic regression;The survival data were collected by telephone follow-up,and the survival time of patients less than 1 month after discharge was recorded and analyzed;The simplified Wells score and The revised Geneva score were used to make risk score for the enrolled patients,the ROC curve of the above score and D-dimer was made,the sensitivity,specificity,positive predictive value and negative predictive value were calculated.The area under the ROC curve was compared and analyzed by MedCalc software to evaluate the predictive value of clinical scales for the occurrence of PTE in patients with malignant tumors.Results:1.The general situation of the research object:Among 142 patients,72 cases were male,accounting for 50.7%.70 cases were female,accounting for 49.3%.The age was ranged from 31 to 89 years old,with a mean age of(63.43 ± 11.77)years.2.Malignant tumors complicated with PTE:Among 142 patients to be included,72 were positive for malignancy combined with PTE,and 70 were negative for without PTE.The occurrence time of PTE in malignant tumors was mainly within the first month of tumor diagnosis,accounting for 62.5%.3.Analysis of factors of malignant tumors complicated with PTE:Single factor screening showed hemoptysis,adenocarcinoma,tumor metastasis,DVT,lower limb swelling and pain,and D-dimer positive has statistically significant difference between the two groups(p<0.05);Multivariate logistic regression analysis revealed that adenocarcinoma;tumor metastasis,DVT and D-dimer positive were independent risk factors for PTE in patients with malignancy(p< 0.05).In addition,142 patients were followed up by telephone for survival at 1 month after discharge.The survival time of positive group was worse than that of negative group,and the difference was statistically significant(p < 0.05).4.Evaluation index of clinical scale and combined with D-dimer:The sensitivity,specificity,negative predictive value and positive predictive value of the simplified Wells score were 87.5%,37.1%,74.3% and 58.9%,respectively;The sensitivity,specificity,negative predictive value and positive predictive value of the revised Geneva score were 87.5%,30.0%,70.0% and 56.3%,respectively;The sensitivity,specificity,negative predictive value and positive predictive value of D-dimer were 97.2%,14.3%,83.3% and 53.8%,respectively;The sensitivity,specificity,negative predictive value and positive predictive value of the simplified Wells score combined with D-dimer were 100.0%,11.4%,100.0% and 59.2%,respectively;The sensitivity,specificity,negative predictive value and positive predictive value of the revised Geneva score combined with D-dimer in the revised edition were 100.0%,8.6%,100.0% and 57.5%,respectively.5.The area under ROC curve of the clinical scale and combined with D-dimer:The AUC of the simplified Wells score,the simplified Wells score combined with D-dimer and the revised Geneva score combined with D-dimer were higher,0.762(95%CI: 0.682-0.841,p< 0.001),0.786(95%CI: 0.708-0.863,p< 0.001)and 0.741(95%CI: 0.628-0.800,p< 0.001),respectively.The AUC of the revised Geneva score and D-dimer were 0.687(95%CI:0.600-0.774,p<0.001),0.649(95%CI:0.559-0.739,p=0.002),respectively.MedCalc software was used to compare the area under the ROC curve between the simplified Wells score combined with D-dimer and the simplified Wells score and the revised Geneva score combined with D-dimer,the difference was statistically significant(Z=1.967,p< 0.05;Z=2.143,p< 0.05);The difference of the area under the ROC curve between the simplified Wells score and the revised Geneva score and D-dimer were statistically significant(Z=2.184,p<0.05;Z=1.982,p<0.05).Conclusions:1.Adenocarcinoma,tumor metastasis,DVT and D-dimer positivity were independent risk factors for the occurrence of PTE in patients with malignant tumor(p< 0.05);2.The predictive value of the simplified Wells score in malignant tumors with PTE was better than that of the revised version of Geneva score,and the predictive value of the simplified Wells score combined with D-dimer was higher than that of the simplified Wells score alone.3.The simplified Wells score and the revised Geneva low probability score combined with D-dimer negative showed a very high exclusion value,The negative predictive value can reach 100%,which can significantly reduce the need for further diagnostic imaging. |
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