The Clinical Value Of Multiple Serological Markers Combined With Electrocardiogram In The Diagnosis Of Acute Pulmonary Embolism

Objective:The objective of this study was to construct a multi-index early diagnosis system by combining multiple serological markers and ECG waveforms through retrospective studies to assess its clinical value for the early diagnosis of acute pulmonary embolism,which will help clinicians,especially primary physicians,to have a more accurate early identification of the disease,so as to make correct clinical decisions,improve prognosis,and benefit patients.Method:Based on the inclusion and exclusion criteria,298 patients who underwent computed tomography at the First People’s Hospital of Zigong City from November 2018 to November 2021 were selected as the study subjects,based on CTPA results,of which 137 were in the pulmonary embolism group and 101 were non-pulmonary embolism.Univariate analysis and multi-factor logistic regression analysis were used to screen the indicators,and finally a multi-factor joint early diagnosis system was obtained,and the area under the ROC curve and the screening threshold of each index were compared,and the authenticity was evaluated by sensitivity,specificity and Yoden index.Results:1.(1)The one-way study of categorical variables was tested by Chi-square test:the differences in D-dimer,right bundle branch block,T-wave inversion of thoracic lead,S1Q3T3(including S1,Q3,T3,S1Q3,Q3T3 and S1Q3T3)between the two groups were statistically significant(P<0.05),and there was no statistically significant difference in the occurrence of right axis bias and atrial arrhythmia(P<0.05)。(2)The continuous variables were first normalized and then the method was selected:B-type natriuretic peptide,lipoprotein a,hypersensitivity C-reactive protein,uric acid,myocardial troponin I,creatine kinase isoenzyme,lactate dehydrogenase,platelet distribution width,red blood cell distribution width,average platelet volume,neutrophil count,platelet-lymphocyte specific level comparison,the difference is statistically significant(P<0.05).There was no significant difference in glomerular filtration rate,creatinine,fibrinogen,creatine kinase,and platelet count levels between the two groups(P<0.05).2.Multivariate binary Logistic regression analysis was performed on the selected indicators:S1Q3T3(including S1,Q3,T3,S1Q3,Q3T3 and S1Q3T3),right bundle branch block,D-dimer,type B natriuretic peptide,mean platelet volume,lipoprotein a,uric acid,lactate dehydrogenase,platelet-lymphocyte ratio were closely related to the early diagnosis of APE(P<0.05).3.The ROC curve was plotted to show that the AUC of each univariate and multivariate joint diagnostic system was greater than 50%(P<0.05),and the corresponding sensitivity and specificity were found according to the maximum value of yoden index.4.The AUC(96.5%)of the multifactorial combined diagnostic system was the largest,the sensitivity(88.2%)and specificity(91.9%)were also the highest,and the comprehensive diagnostic efficacy was the highest.Conclusions:1.S1Q3T3,right bundle branch block,D-dimer,type B natriuretic peptide,mean platelet volume,lipoprotein a,uric acid,lactate dehydrogenase,platelet-lymphocyte ratio are closely related to the early diagnosis of APE.2.The diagnostic efficacy of a single biomarker is limited,and the combined diagnostic system composed of multiple indicators can optimize the one-factor limitation and significantly improve the early diagnosis ability of acute pulmonary embolism.3.Simple,economical and rapid biomarkers have clinical application value in the early diagnosis of acute pulmonary embolism,and timely diagnosis can win treatment opportunities for patients,affecting prognosis and quality of life.