Analysis of the Predictive Value of 4-level Clinical Pretest Probability Score in Elderly Patients with Acute Pulmonary Embolism

Abstract

Background The elderly are at high risk for acute pulmonary embolism (APE) , and the difficulty of early identification and diagnosis of APE in the elderly has made the active search for an optimal prediction method for elderly patients with suspected APE a medical problem that must be faced. Objective To investigate the predictive value of the 4-level Clinical Pretest Probability Score (4PEPS) for pulmonary embolism (PE) in elderly patients with suspected APE. Methods Basic information and related clinical data were collected from elderly (age≥60 years) hospitalized patients who completed spiral CT pulmonary arteriography (CTPA) examinations in the Third Affiliated Hospital of Zunyi Medical University from 2017 to 2021. The study subjects were divided into the APE group and non-APE group according to the CTPA criteria for the diagnosis of PE in 2018 Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism. The 4PEPS, Standard algorithm, age-adjusted D-dimer (AADD) algorithm, YEARS algorithm and pulmonary embolism graduated D-dimer (PEGeD) algorithm were used to predict the APE of the study subjects, respectively, who were divided into the positive and negative groups, and the number of true positives, true negatives, false positives and false negatives of each prediction method was counted. The efficacy evaluation indexes of the five prediction method were calculated and their prediction values were compared. Results Among 1 193 elderly hospitalized patients who completed CTPA examination, 608 (50.96%) were male and 585 (49.04%) were female, with a median age of 74 (68, 81) years; 323 (27.07%) were APE patients and 870 (72.93%) were non-APE patients; there was no statistically significant difference between elderly APE patients and elderly non-APE patients in terms of gender and age (P>0.05) . 4PEPS, AADD algorithm, Standard algorithm, YEARS algorithm and PEGeD algorithm for elderly patients with suspected APE had a sensitivity of 95.05%, 97.83%, 98.76%, 97.21%, 97.83%, the specificity of 31.84%, 18.16%, 12.87%, 22.41%, 22.41%, the correctness of 48.95%, 39.73%, 36.13%, 42.67%, 42.83%, Youden index of 0.27, 0.16, 0.12, 0.20, 0.20. The net reclassification improvement (NRI) of 4PEPS, Standard algorithm, YEARS algorithm and PEGeD algorithm compared to AADD algorithm were 0.218, -0.087, 0.073, and 0.085, the difference of the NRI of 4PEPS compared to AADD algorithm was statistically significant (P<0.05) . Conclusion 4PEPS predicts elderly patients with suspected APE with high specificity, correctness, and Youden index, and the overall predictive value is significantly better than the remaining four methods, which may be the optimal prediction method for elderly patients with APE.

Keywords

• pulmonary embolism|acute pulmonary embolism|4-level clinical pretest probability score|computed tomography pulmonary angiogram|aged|predictive value