The Combination Of Troponin I And Pulmonary Embolism Severity Index For The Forecast Value Of Severity In Patients With Acute Pulmonary Embolism?

Objective To studay troponin additive to pulmonary embolism severityindex for the forecast value of severity in patients with actue pulmonary embolism.Methods we conducted a retrospecitive analysis of two hundred andforty-five patients admitted with PE confirmed by CT pulmonary angiogram orVentilation perfusion lung scanning in the NO 1 hosipital of shanxi medicaluniversity.According to the grouping of PESI,levels of troponin and a combination ofTroponin and PESI.After we have a comparision of the the incidence rate ofnon-massive,massive and sub-massive PE patients,we evaluate the forecast value ofthe PESI score and the levels of troponin and a combination of Troponin and PESI forthe severity in PE patients.We use the ROC curve to evaluate the forecast value of thePESI,cTnI and their combination for the severity in patients with PE.Results In the PESI classification,both classⅠand classⅡ(low-risk)are thenon-massive PE.The non-massive PE accounts for 42.5% of all the PE patients in theclassⅢ(intermediate-risk),but the massive and sub-massive PE accounts for57.5%.The the massive and sub-massive of the classⅣand classⅤ(high-risk)respectively accounts for 92.5%,100%. There is not statistical significance betweenthe incidence rate of classⅠand classⅡin the group of non-massive,massive andsub-massive PE(P＞0.05). There is either not statistical significance between theincidence rate of classⅣand classⅤin the group of non-massive,massive andsub-massive PE(P＞0.05).When we re-classificate the PESI groups intolow-,intermediate-,and high-risk groups,an increasing tendency toward the higherclass was observed(P＜0.001).In the grouping of the PESI,the positive predictivevalue(PPV), negative predictive value(NPV), sensitivity and specificity of thehigh-risk class respectively is 96.9%,3.1%,100% and 95.2%,of the intermediate-riskclass is 57.5%, 42.5%, 57.9%, 69.2%, of the low-risk class is 0%,100%,100%,28.7%.The incidence rate of massive and sub-massive PE,PPV and specificity respectively is98.2%,98.2% and 36.5% in the group of positive troponin,but incidence rate ofnon-massive PE,NPV and sensitivity respectively is 94.1%,94.1% and 48% in the group of negative troponin.In the group of the combination of the low-risk class andpositive troponin,the massive and sub-massive PE accouts for 0%,non-massive PEaccouts for 0%,PPV is 0%,NPV is 0%. In the group of the combination of thelow-risk class and negative troponin,the massive and sub-massive PE accouts for0%,non-massive PE accouts for 100%, PPV is 0%, NPV is 100%, sensitivity is 100%,specificity is 40.1%. In the group of the combination of the intermediate-risk classand positive troponin,the massive and sub-massive PE accouts for 94.1%,non-massivePE accouts for 5.9%,PPV is 94.1%,NPV is 5.9%,sensitivity is 30.1%,specificity is94.3%. In the group of the combination of the intermediate-risk class and negativetroponin,the massive and sub-massive PE accouts for 41.2%,non-massive PE accoutsfor 58.8%,PPV is 41.2%,NPV is 58.8%,sensitivity is 70.6%,specificity is 65.9%. Inthe group of the combination of the high-risk class and positive troponin,the massiveand sub-massive PE accouts for 98.9%,non-massive PE accouts for 1.1%,PPV is98.9%,NPV is 1.1%,sensitivity is 25.6%,specificity is 96.1%. In the group of thecombination of the high-risk class and negative troponin,the massive and sub-massivePE accouts for 33.3%,non-massive PE accouts for 66.7%,PPV is 33.3%,NPV is66.7%,sensitivity is 50.5%,specificity is 91.4%.About the ROC analysis,the areaunder curve(AUC) of the PESI score is 0.801(95%CI, 0.721-0.884).the AUC of thecTnI is 0.692(95%CI，0.610-0.775).The AUC of the combination of the PESI andcTnI is 0.904 (95%CI，0.820-0.981).Conclusions The high-risk group has a higher predictive value for theseverity of the massive and sub-massive PE.It has less predictive value for theseverity of PE to use the levels of troponin than the combination of Troponin andPESI.