The 3-level Wells score combined with D-dimer can accurately diagnose acute pulmonary embolism in hospitalized patients with acute exacerbation of COPD: A multicentre cohort study

Xiaojing Jiao; Yixiao zhang; Tuguang Kuang; Juanni Gong; Yadong Yuan; Guohua Zhen; Jifeng Li; Suqiao Yang; Jianguo He; Yuanhua Yang

International Journal of Cardiology: Heart & Vasculature (Dec 2024)

The 3-level Wells score combined with D-dimer can accurately diagnose acute pulmonary embolism in hospitalized patients with acute exacerbation of COPD: A multicentre cohort study

Xiaojing Jiao,
Yixiao zhang,
Tuguang Kuang,
Juanni Gong,
Yadong Yuan,
Guohua Zhen,
Jifeng Li,
Suqiao Yang,
Jianguo He,
Yuanhua Yang

Affiliations

Xiaojing Jiao: Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Beijing Institute of Respiratory Medicine, Beijing 100020, China
Yixiao zhang: Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Beijing Institute of Respiratory Medicine, Beijing 100020, China
Tuguang Kuang: Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Beijing Institute of Respiratory Medicine, Beijing 100020, China
Juanni Gong: Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Beijing Institute of Respiratory Medicine, Beijing 100020, China
Yadong Yuan: The Second Affiliated Hospital of Hebei Medical University, Hebei 05000, China
Guohua Zhen: Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Jifeng Li: Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Beijing Institute of Respiratory Medicine, Beijing 100020, China
Suqiao Yang: Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Beijing Institute of Respiratory Medicine, Beijing 100020, China
Jianguo He: Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100020, China
Yuanhua Yang: Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Beijing Institute of Respiratory Medicine, Beijing 100020, China; Corresponding author at: Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing 100020, China.

Journal volume & issue: Vol. 55
p. 101533

Abstract

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Background: Identification of acute pulmonary embolism (APE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is challenging. Wells score and Revised Geneva score have been developed to diagnose APE. We aim to investigate the predictive accuracy of two clinical scoring systems combined with D-dimer for APE in patients with AECOPD. Methods: A multicentre cross-sectional study was conducted in 13 China hospitals. A total of 731 patients were enrolled. Computed tomography pulmonary angiography (CTPA) was performed within 48 hours of admission. The performance of the clinical scoring systems was compared by calculating the area under the receiver operating characteristic curves (AUROC), sensitivities, and specificities. Results: 731 patients were included with an average age of 68.9 years, with a male proportion of 585 (80.0 %). 112 (15.3 %) were diagnosed with APE. The optimal D-dimer cut-off value for identifying APE in AECOPD was 690.12 ng/mL. Analysis for assessing the clinical probability of APE using the 3-level Wells and Revised Geneva scores showed the AUC were 0.74 and 0.60, sensitivity were 61.61 % and 77.68 %, and specificity were 85.46 % and 38.29 %, respectively. Analysis using the 3-level Wells and Revised Geneva scores combined with a D-dimer cut-off value of 690.12 ng/mL showed the AUC were 0.909 and 0.869, sensitivity were 73.21 % and 91.96 %, specificity were 92.08 %and 72.70 %. The performance of the 3-level Wells score with D-dimer was significantly better than the performance of the 3-level Revised Geneva score with D-dimer (P = 0.01). Conclusions: The 3-level Wells score combined with a D-dimer cut-off value of 690.12 ng/mL performed better than other clinical scoring algorithms for assessing clinical probability of APE in patients with AECOPD.

Published in International Journal of Cardiology: Heart & Vasculature

ISSN: 2352-9067 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: http://www.journals.elsevier.com/ijc-heart-and-vasculature/

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