The Prognostic Value Of SPESI Combined With Fibrinogen To Albumin Ratio In Patients With Acute Non-high-risk Pulmonary Embolism

Background:Pulmonary embolism(PE)is a potentially life-threatening pulmonary vascular disease,which has the characteristics of hidden onset,various symptoms,and a high rate of death and disability.In recent years,with the deepening of the understanding of this disease,great progress has been made in its diagnosis and treatment.At present,guidelines at home and abroad emphasize the early rapid and accurate prognostic risk assessment of diagnosed patients,so as to guide clinicians to make individualized treatment plans for patients.Patients with hemodynamically unstable pulmonary embolism were consistently assigned to the high-risk group by domestic and foreign guidelines and the treatment plan was clear.For the patients with pulmonary embolism in the non-high-risk group with stable hemodynamics,as some of them may deteriorate at any time,further prognostic risk assessment is needed.At present,the evaluation methods in the guidelines at home and abroad are inseparable from the evaluation of right ventricular function,but the evaluation of right ventricular function mainly depends on echocardiography or CT,which can not be completed in time because of the patient’s condition and medical conditions.Therefore,it is of great clinical significance to explore a simple,economical and effective evaluation method for prognostic risk assessment of patients with acute non-high-risk pulmonary embolism.Objective:To explore the prognostic value of fibrinogen to albumin ratio(FAR)in patients with acute non-high-risk pulmonary embolism,and the prognostic value of combined simplified pulmonary embolism severity index(sPESI)in patients with acute non-high-risk pulmonary embolism.Methods:The baseline clinical data of patients with acute non-high-risk pulmonary embolism hospitalized in the Respiratory Department of Shandong Provincial Hospital from January 2017 to June 2020 were collected retrospectively,and the final patients were selected according to the enrollment criteria.The selected patients were followed up for 6 months by telephone or outpatient revisit.The adverse events occurred during the 6-month follow-up period as the end event.The patients were divided into groups according to whether adverse events occurred during the 6-month follow-up period,the mean of baseline FAR and sPESI score,and then the differences of clinical data among the groups were compared.Draw Kaplan-Meier survival curve and compare the difference of curve among different groups.Multivariate Cox regression analysis was used to explore the predictors of adverse events within 6 months in patients with acute non-high-risk pulmonary embolism.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of each predictive factor and the combination of predictive factors.Results:According to the inclusion and exclusion criteria,1 54 patients with acute non-high-risk pulmonary embolism were included in the study,including 82(53.25%)males and 72(46.75%)females,with an age of 57.87±15.27 years.During the 6-month follow-up period,141 patients(91.56%)had no adverse events,and 13 patients(8.44%)had adverse events.(1)According to whether adverse events occurred during the 6-month follow-up period,the patients were divided into the control group and the adverse events group.The comparison of the baseline clinical data between the two groups showed that the age of the patients in the adverse events group was older than that in the control group(69.3 1±9.90years,vs.56.82 ± 15.27years,P<0.05).Compared with the control group,the adverse events group had a higher proportion of malignant tumor history and faster pulse(P<0.05).There were also significant differences in neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR),red cell distribution width(RDW),fibrinogen(FIB),arterial oxygen saturation(SaO2),FAR,and sPESI between the two groups.According to the mean of FAR,the patients were divided into low FAR group and high FAR group.The comparison of baseline clinical data between the two groups showed that the history of malignant tumor,pulse,MLR,RDW,D-dimer,and fibrinogen in the high FAR group were higher than those in the low FAR group(P<0.05).In addition,the level of albumin in the high FAR group was significantly lower than that in the low FAR group(P<0.05).(2)Kaplan-Meier survival curve analysis showed that the 6-month cumulative adverse events rate of patients with low FAR was 3.26%,and that of patients with high FAR was 16.13%.The difference was statistically significant(P<0.05).The 6-month cumulative adverse events rate of patients in the low-risk group(sPESI=0 score)was 1.74%,while that of the high-risk group(sPESI≥ 1 score)was 28.21%.The difference was statistically significant(P<0.05).(3)Univariate Cox regression analysis showed that age,malignant tumor,pulse,NLR,Platelets to lymphocyte ratio(PLR),MLR,RDW,FIB,SaO2,FAR,and sPESI had statistical significance(P<0.05).Because the calculation of sPESI includes age,malignant tumor,and pulse,the calculation of FAR includes FIB,in order to avoid collinearity,NLR,PLR,MLR,RDW,FAR,and sPESI are finally included in multivariate Cox regression analysis.The analysis showed that RDW,FAR,and sPESI were independent predictors of adverse events within 6 months in patients with acute non-high-risk pulmonary embolism(P<0.05).(4)ROC curve analysis shows that the area under the curve(AUC)of sPESI is 0.848(95%CI 0.725-0.971).When sPESI takes the best cutoff value of 0.5,the sensitivity is 84.60%,and the specificity is 80.10%.The AUC of FAR is 0.783(95%CI0.649-0.916).When the best cutoff value of FAR is 10.88,the sensitivity is 76.90%and the specificity is 75.90%.Assign a score of 1 when FAR≥ 10.88,then calculate the score of sPESI combined with FAR,and draw the ROC curve.The AUC of sPESI combined with FAR is 0.906(95%CI 0.800-1.000).When sPESI combined with FAR takes the best cut-off value of 1.5,the sensitivity is 84.60%and the specificity is 94.30%.The combination of the two has a larger area under the curve than their respective,and significantly improves the specificity without reducing the sensitivity,indicating that the combination of the two has a higher value in predicting the prognosis of patients with acute non-high-risk pulmonary embolism within 6 months.Conclusion:(1)FAR has a certain predictive value in the prognosis of acute non-high-risk pulmonary embolism.(2)The prognostic value of sPESI combined with FAR for acute non-high-risk pulmonary embolism is higher than that of both alone.