Construction Of Clinical Prediction Model For In-hospital Adverse Outcome In Patients With Pulmonary Thromboembolism

Objective To analyze the independent risk factors of in-hospital adverse outcomes in patients with pulmonary thromboembolism and then to construct a new clinical predictive model.The new model was compared with pulmonary embolism severity index（PESI）and Bova score to evaluate the efficacy in predicting short-term adverse prognosis,in order to put forward a comprehensive and reliable short-term prognosis model through which clinicians can identify risks earlier and make appropriate treatment decisions.Methods 197 patients with pulmonary thromboembolism in Zhongshan Hospital affiliated to Xiamen University from January 2012 to October 2020 were retrospectively analyzed and divided into favorable prognosis group and adverse prognosis group according to whether adverse events occurred during hospitalization.Logistic regression analysis was used to determine the independent risk factors associated with adverse outcomes in hospital.And to establish a clinical prediction model of adverse outcomes in patients with pulmonary thromboembolism based on these factors.The receiver operator characteristic curve was used to evaluate the predictive value of the new model and to compare it with PESI and Bova score.Results Multivariate logistic regression analysis showed that D-dimer（OR=1.121,P=0.006）,prothrombin time（PT）（OR=1.122,P=0.036）,cardiac troponin T（c TNT）（OR=2.965,P=0.026）,arterial partial pressure of oxygen（OR=0.973,P=0.007）,elevated N-terminal pro-B-type natriuretic peptide（NT-pro BNP）（OR=4.151,P=0.002）and echocardiography showed right ventricular insufficiency（OR=3.229,P=0.009）are independent risk factors for the adverse outcomes of hospitalization in patients with pulmonary thromboembolism.The clinical prediction model was established based on the above factors:P=ex/（1+ex）,x=-1.512+（0.114×D-D）+（0.115×PT）+（1.087×c TNT）+（1.423×NT-pro BNP）+（1.172×RVD）-（0.027×Pa O2）.Among them,E is the natural logarithm,D-dimer unit is mg/L,prothrombin time unit is sec,troponin T unit isμg/L,arterial oxygen partial pressure unit is mm Hg.And if NT-pro BNP is elevating,the assignment is 1,otherwise it is 0.If echocardiography indicates right ventricular insufficiency assigns 1,otherwise it is 0.The prediction model was tested by Hosmer-Lemeshow,and the fitting degree was good（P=0.612>0.05）.The area under the ROV curve（AUC）was 0.882,cutoff value of the area under the model curve was 0.498,and the corresponding sensitivity,specificity,positive predictive value and negative predictive value were 80.41%,85%,81.7%and 83.9%,respectively.Compared with pulmonary embolism severity index（PESI）and Bova score,the prediction efficiency of our model is better.Conclusion 1.In this study,univariate and multivariate logistic analysis showed that D-dimer,prothrombin time,cardiac troponin T,hypoxemia,elevated N-terminal pro-B-type natriuretic peptide and right ventricular insufficiency were independent risk factors for adverse events in patients with pulmonary thromboembolism.2.In this essay,clinical predictive model was established:P=e^x/（1+e^x）,x=-1.512+（0.114×D-D）+（0.115×PT）+（1.087×c TNT）+（1.423×NT-pro BNP）+（1.172×RVD）-（0.027×Pa O₂）.Among them,E is the natural logarithm,D-dimer unit is mg/L,prothrombin time unit is sec,troponin T unit isμg/L,arterial oxygen partial pressure unit is mm Hg.And if NT-pro BNP is elevating,the assignment is 1,otherwise it is 0.If echocardiography indicates right ventricular insufficiency assigns 1,otherwise it is 0.And 0.498 is taken as the best critical value.After verification and comparative analysis,the clinical prediction model has a good predictive value for the adverse outcomes of hospitalized patients with pulmonary thromboembolism,and can provide a reference basis for clinicians to find early risks and make corresponding treatment decisions.