Diagnostic Value Of Age-adjusted D-dimer Combined With Simplified Geneva Score In Elderly Patients With Pulmonary Embolism

Background: Pulmonary embolism(PE)is a general term for a group of diseases or clinical syndromes in which the embolus is blocked by various embolisms and their branches.PE has a high morbidity and mortality,and with the increase of age,the incidence of PE also increases.Elderly patients with pulmonary embolism often have more basic diseases,and the clinical features are also lack of specificity.This has caused certain difficulties in the early diagnosis and treatment of the disease,increasing the rate of misdiagnosis and missed diagnosis of clinical diagnosis,resulting in poor prognosis of elderly patients with pulmonary embolism.At present,the diagnosis of PE is various,and CT pulmonary angiography(CTPA)has high sensitivity and specificity,which is the main examination method for the diagnosis of PE.However,for elderly PE with renal insufficiency,CTPA contrast agent will increase the burden on the kidney,making it difficult to diagnose.Therefore,early routine screening and diagnosis of suspected elderly PE is the key.According to the 2014 European Society of Cardiology guidelines,clinical scoring has gradually become an important step in the diagnosis of PE.It is also pointed out that age-corrected D-dimers mers do not significantly reduce the diagnostic sensitivity and improve the diagnostic specificity in PE diagnosis.The current simplify the Geneva score combined with agecorrected D-dimers have been included in the guidelines for the diagnosis of PE,and the combined data on the diagnosis of elderly PE are less.Objective: To explore the diagnostic value of age-adjusted D-dimer combined with simplified Geneva score in the diagnosis of elderly PE,and provide a reference for the clinical diagnosis of pulmonary embolism in the elderly.Methods: A retrospective collection of 313 hospitalized patients with suspected pulmonary embolism in the Department of Respiratory and Critical Care Medicine from September 2013 to September 2017 at the Henan University of Science and Technology First Affiliated Hospital.CTPA and immunoturbidimetric assays were used to determine D-dimer concentrations in all selected cases,and CTPA results were used as diagnostic criteria for the diagnosis of pulmonary embolism.Collect basic information,clinical symptoms,auxiliary examinations,and risk factors for all subjects.The age was adjusted according to the guidelines,and the simplified Geneva score was based on clinical data.The sensitivity,specificity,positive predictive value,negative predictive value,and Youden index of the simplified Geneva score and Ddimer and the combination of the two were calculated separately.The receiver operating characteristic curve(ROC)was prepared,and the age-adjusted D-dimer,simplified Geneva score,and the combined value of the two were compared for the diagnosis of elderly PE.Results: The sensitivity of age-corrected D-dimer to elderly PE diagnosis was 93% and specificity was 55%.According to the simplified Geneva score diagnosis,the sensitivity was 77% and the specificity was 71%.The age-adjusted D-dimer combined with simplified Geneva scores were positive for a diagnosis of 97% for elderly PE and 44% for specificity.The age-adjusted D-dimer + simplified Geneva score was negative,with a sensitivity of 90% and a specificity of 82%.The simplified Geneva score,the age-corrected D-dime,and the combined ROC curves were plotted.The area under the curve was 0.827±0.024,0.881±0.21,and 0.920±0.17(P < 0.001).Conclusion: Age-adjusted D-dimer combined with simplified Geneva score diagnostic value is better than separate simplified Geneva score,age-corrected Ddimer;and the combined negative predictive value of the two is a safer method for early exclusion of elderly PE.