| Objetive:The clinical predictive model of acute pulmonary thromboembolism(PTE)is established by data analysis and compared with other clinical predictive scores.To explore the best clinical prediction method of acute PTE and achieve the best diagnostic efficiency for acute PTE.Methods:The clinical data of 529 patients in the Respiratory Medicine Department from January 2012 to February 2019 were collected retrospectively.All patients underwent pulmonary ventilation/perfusion(V/Q)imaging or computed tomography pulmonary angiography(CTPA)for clinically suspected acute pulmonary embolism(APE).According to the results of V/Q imaging or CTPA,154 patients with PTE were enrolled in the case group and 375 non-PTE patients in the control group.A clinical predictive model of acute PTE was constructed through relevant statistical analysis.The receiver operating characteristic curve(ROC)was used to evaluate its predictive value and compared it with three commonly used clinical predictive scores.Results:1.Univariate analysis showed that gender,smoking,history of deep vein thrombosis(DVT),history of lower extremity fractures in the past four weeks,bed rest>3 days,pulmonary infection,chronic obstructive pulmonary disease(COPD),cough,sputum,dyspnea,syncope,varicose veins in the lower limbs,swelling in the lower limbs,pain in the lower limbs,heart rate≥100 beats/min,serum troponin T(c Tn T)>0.022ug/L,N-terminal B-type natriuretic peptide precursor(NT-pro BNP)>415.900ng/L,platelet count≤212×10^9/L,prothrombin time(PT)>13.050 sec,activated partial thromboplastin time(APTT)>31.850 sec,D-dimer(D-D)>2.555mg/L between the tow groups had a statistics difference(P<0.05).2.Multivariate Logistic analysis showed that PT>13.050 sec,APTT>31.850 sec,D-D>2.555 mg/L,DVT,bed rest>3 days,and lower limb varicose veins were independent risk factors for acute PTE(P=0.015,0.000,0.000,0.000,0.024,0.042;OR=1.881,3.751,2.696,10.831,7.864,10.336).COPD and pulmonary infection were protective factors(P=0.002,0.024;OR=0.432,0.583).3.According to the results of Logistic analysis,prediction model of acute PTE was P=e~x/(1+e~x),e=2.71828183,x=-1.647+0.632×(PT>13.050sec)+1.322×(APTT>31.850sec)+0.992×(D-D>2.555mg/L)+2.382×DVT history+2.062×(bed rest>3 days)-0.838×COPD history+2.336×lower limb varicose vein-0.540×pulmonary infection.If PT is over 13.050 sec,the assignment is1,otherwise the assignment is 0;If APTT over 31.850sec is 1,otherwise the assignment is 0;If D-D over 2.555mg/L is 1,otherwise the assignment is 0;If you have DVT history is 1,otherwise the assignment is 0;If you have bed rest more than 3 days is 1,otherwise the assignment is 0;If you have COPD history is 1,otherwise the assignment is 0;If you have lower limb varicose vein is 1,otherwise the assignment is 0;If you have pulmonary infection is 1,otherwise the assignment is 0.Analysis of the area under the ROC curve found that the diagnostic value of the original version of the Wells score scale was slightly higher than the simplified version(AUC=0.646,0.637;P=0.0317<0.05).The diagnostic value of the Wells score scale(original and simplified versions)was higher than the simplified Geneva score scale(AUC=0.646,0.637,0.579;P=0.0020,0.0059<0.05).The acute PTE prediction model constructed in this study had AUC=0.826,which had better diagnostic value than the three existing rating scales(P<0.0001,P<0.0001,P<0.0001).When it was bounded by 0.370,the sensitivity,specificity,positive predictive value,and negative predictive value were 0.630,0.885,0.693,and 0.853,respectively.Hosmer-Lemeshow test showed that there was no significant difference between the predicted and observed values(P=0.815>0.05).So the prediction model passed the test.Conclusions:1.The diagnostic value of the original version of the Wells score scale for the clinical predictive efficacy of acute PTE is slightly higher than the simplified version.The diagnostic value of the Wells score scale(original and simplified versions)is higher than the simplified Geneva score scale;2.Acute PTE prediction model constructed with biological indicators is:P=e~x/(1+e~x),e=2.71828183,x=-1.647+0.632×(PT>13.050sec)+1.322×(APTT>31.850sec)+0.992×(D-D>2.555mg/L)+2.382×DVT history+2.062×(bed rest>3 days)-0.838×COPD history+2.336×lower limb varicose vein-0.540×pulmonary infection.If PT is over 13.050 sec,the assignment is1,otherwise the assignment is 0;If APTT over 31.850sec is 1,otherwise the assignment is 0;If D-D over 2.555mg/L is 1,otherwise the assignment is 0;If you have DVT history is 1,otherwise the assignment is 0;If you have bed rest more than 3 days is 1,otherwise the assignment is 0;If you have COPD history is 1,otherwise the assignment is 0;If you have lower limb varicose vein is 1,otherwise the assignment is 0;If you have pulmonary infection is 1,otherwise the assignment is 0.In this model,0.370 is the threshold.If P over 0.370 indicates acute PTE,and the higher the value,the more likely it is to indicate acute PTE.The predictive value calculated by the above model has good predictive efficiency for acute PTE. |
