The Predictive Value of Wells Score and D-dimer on Acute Pulmonary Embolism_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LiangYing ¹ ,  MiYuhong ¹ , YangGeng ¹ , YanShufeng ¹ , LiuShuang ²

1. Emergeney Intensive Care Unit, Affiliated Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China;
2. ;

Corresponding?author：

MiYuhong, Email: myhicu@163.com

Keywords：

Acute pulmonary embolism; Prediction; Wells score; D-dimer

DOI：

10.7507/1671-6205.2016058

Video：

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Objective To explore the early predictive value of Wells score and D-dimer for acute pulmonary embolism. Methods Eighty-two cases with acute pulmonary embolism comfirmed by computed tomography pulmonary angiography and (or) lung ventilation/perfusion scan were retrospectively studied from October 2013 to October 2014 in our hospital. Another 82 cases without acute pulmonary embolism in the chest pain center simultaneously were selected as control group. The data on admission were analyzed including Wells score, D-dimer, pH, PCO₂, PO₂, P_(A-a)O₂, brain natriuretic peptide, troponin I of two groups of patients. Relevant variables were selected by multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was made by sensitivity as the ordinate and 1 minus specificity as abscissa. The area under ROC curve (AUC) for relevant variables was calculated and the variable with higher AUC was selected. The best threshold, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were achieved from the ROC curves. Results The multivariate logistic regression analysis showed that Wells score (OR=8.114, 95%CI 1.894-34.761, P=0.005) and D-dimer (OR=1.009, 95%CI 1.001-1.017, P=0.021) could predict APE early. The AUC, sensitivity, specificity, PPV, NPV of Wells score for the early prediction of patients with acute pulmonary embolism were 0.990, 50.0%, 100.0%, 100.0%, 66.7%, respectively. The AUC, sensitivity, specificity, PPV, NPV of D-dimer for the early prediction of patients with acute pulmonary embolism were 0.986, 95.1%, 97.6%, 97.5%, 95.2%, respectively. Conclusion Wells score and D-dimer have high predictive value in patients with acute pulmonary embolism, and can be used in preliminary screening of acute pulmonary embolism in the emergency department.

Citation： Liang Ying, Mi Yuhong, Yang Geng, Yan Shufeng, Liu Shuang. The Predictive Value of Wells Score and D-dimer on Acute Pulmonary Embolism. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(3): 245-249. doi: 10.7507/1671-6205.2016058 Copy

1.	Torbiki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the task force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J, 2008, 29:2276-2315.
2.	Wells PS, Anderson DR, Rodger MA, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost, 2000, 83:416-420.
3.	Ho KM, Litton E. Venous thromboembolism prophylaxis in hospitalized elderly patients: time to consider a MUST strategy. J Geriatr Cardiol, 2011, 8:114-120.
4.	Enghers MJ, van Hylckama Vlieg A, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost, 2010, 8:2105-2112.
5.	Kabrhel C, Mark Courtney D, Camargo CA Jr, et al. Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Acad Emerg Med, 2010, 17:589-597.
6.	Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). Eur Heart J, 2014, 35:3033-3073.
7.	胡建華.肺栓塞的早期診斷探討.實用心腦肺血管病雜志, 2010, 18:1300-1301.
8.	吳本權, 張文先, 劉慧, 等.Wells量表和修正的Geneva評分對肺栓塞的預測價值.中山大學學報(醫學科學版), 2009, 30:477-481.
9.	Ota M, Nakamura M, Yamada N, et al. Prognostic significance of early diagnosis in acute pulmonary thromboembolism with circulatory failure. Heart and Vessels, 2002, 17:7-11.
10.	郭曉娟, 劉敏, 郭佑民, 等.三種臨床評分方法對急性肺栓塞預測價值的比較.中華結核和呼吸雜志, 2009, 32:119-123.
11.	Moores LK, Collen JF, Woods KM, et al. Practical utility of clinical prediction rules for suspected acute pulmonary embolism in a large academic institution.Thromb Res, 2004, 113:1-6.
12.	British thoracic society standards of care committee pulmonary embolism guideline department group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax, 2008, 58:470.
13.	羅真德, 徐平.D-二聚體在急診篩查急性主動脈夾層和肺栓塞的臨床價值.實用醫院臨床雜志, 2012, 9:84-86.
14.	葉曉芳, 劉雙, 楊京華.血漿D-二聚體水平測定在不同肺部疾病中的臨床意義.心肺血管病雜志, 2009, 28:7-9.
15.	謝偉.ROC曲線評價D-二聚體診斷肺動脈栓塞的應用.微循環學雜志, 2010, 20:53-54.
16.	時勇.肺動脈栓塞患者血漿D-二聚體水平測定的臨床價值.國際檢驗學雜志, 2013, 34:1447-1448.
17.	彭丁, 習昕, 劉雙, D-二聚體檢測在靜脈血栓栓塞癥診斷中應用的新進展.心肺血管病雜志, 2015, 34:422-424.
18.	De Monye W, Sanson BJ, Mac Gillavry MR, et al. Embolus location affects the sensitivity of a rapid quantitative D-dimer assay in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med, 2002, 165:345-348.

1. Torbiki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the task force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J, 2008, 29:2276-2315.
2. Wells PS, Anderson DR, Rodger MA, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost, 2000, 83:416-420.
3. Ho KM, Litton E. Venous thromboembolism prophylaxis in hospitalized elderly patients: time to consider a MUST strategy. J Geriatr Cardiol, 2011, 8:114-120.
4. Enghers MJ, van Hylckama Vlieg A, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost, 2010, 8:2105-2112.
5. Kabrhel C, Mark Courtney D, Camargo CA Jr, et al. Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Acad Emerg Med, 2010, 17:589-597.
6. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). Eur Heart J, 2014, 35:3033-3073.
7. 胡建華.肺栓塞的早期診斷探討.實用心腦肺血管病雜志, 2010, 18:1300-1301.
8. 吳本權, 張文先, 劉慧, 等.Wells量表和修正的Geneva評分對肺栓塞的預測價值.中山大學學報(醫學科學版), 2009, 30:477-481.
9. Ota M, Nakamura M, Yamada N, et al. Prognostic significance of early diagnosis in acute pulmonary thromboembolism with circulatory failure. Heart and Vessels, 2002, 17:7-11.
10. 郭曉娟, 劉敏, 郭佑民, 等.三種臨床評分方法對急性肺栓塞預測價值的比較.中華結核和呼吸雜志, 2009, 32:119-123.
11. Moores LK, Collen JF, Woods KM, et al. Practical utility of clinical prediction rules for suspected acute pulmonary embolism in a large academic institution.Thromb Res, 2004, 113:1-6.
12. British thoracic society standards of care committee pulmonary embolism guideline department group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax, 2008, 58:470.
13. 羅真德, 徐平.D-二聚體在急診篩查急性主動脈夾層和肺栓塞的臨床價值.實用醫院臨床雜志, 2012, 9:84-86.
14. 葉曉芳, 劉雙, 楊京華.血漿D-二聚體水平測定在不同肺部疾病中的臨床意義.心肺血管病雜志, 2009, 28:7-9.
15. 謝偉.ROC曲線評價D-二聚體診斷肺動脈栓塞的應用.微循環學雜志, 2010, 20:53-54.
16. 時勇.肺動脈栓塞患者血漿D-二聚體水平測定的臨床價值.國際檢驗學雜志, 2013, 34:1447-1448.
17. 彭丁, 習昕, 劉雙, D-二聚體檢測在靜脈血栓栓塞癥診斷中應用的新進展.心肺血管病雜志, 2015, 34:422-424.
18. De Monye W, Sanson BJ, Mac Gillavry MR, et al. Embolus location affects the sensitivity of a rapid quantitative D-dimer assay in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med, 2002, 165:345-348.

Chinese Journal of Respiratory and Critical Care Medicine

The Predictive Value of Wells Score and D-dimer on Acute Pulmonary Embolism

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