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.	胡建华.肺栓塞的早期诊断探讨.实用心脑肺血管病杂志, 2010, 18:1300-1301.
8.	吴本权, 张文先, 刘慧, 等.Wells量表和修正的Geneva评分对肺栓塞的预测价值.中山大学学报(医学科学版), 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.	郭晓娟, 刘敏, 郭佑民, 等.三种临床评分方法对急性肺栓塞预测价值的比较.中华结核和呼吸杂志, 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.	罗真德, 徐平.D-二聚体在急诊筛查急性主动脉夹层和肺栓塞的临床价值.实用医院临床杂志, 2012, 9:84-86.
14.	叶晓芳, 刘双, 杨京华.血浆D-二聚体水平测定在不同肺部疾病中的临床意义.心肺血管病杂志, 2009, 28:7-9.
15.	谢伟.ROC曲线评价D-二聚体诊断肺动脉栓塞的应用.微循环学杂志, 2010, 20:53-54.
16.	时勇.肺动脉栓塞患者血浆D-二聚体水平测定的临床价值.国际检验学杂志, 2013, 34:1447-1448.
17.	彭丁, 习昕, 刘双, D-二聚体检测在静脉血栓栓塞症诊断中应用的新进展.心肺血管病杂志, 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. 胡建华.肺栓塞的早期诊断探讨.实用心脑肺血管病杂志, 2010, 18:1300-1301.
8. 吴本权, 张文先, 刘慧, 等.Wells量表和修正的Geneva评分对肺栓塞的预测价值.中山大学学报(医学科学版), 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. 郭晓娟, 刘敏, 郭佑民, 等.三种临床评分方法对急性肺栓塞预测价值的比较.中华结核和呼吸杂志, 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. 罗真德, 徐平.D-二聚体在急诊筛查急性主动脉夹层和肺栓塞的临床价值.实用医院临床杂志, 2012, 9:84-86.
14. 叶晓芳, 刘双, 杨京华.血浆D-二聚体水平测定在不同肺部疾病中的临床意义.心肺血管病杂志, 2009, 28:7-9.
15. 谢伟.ROC曲线评价D-二聚体诊断肺动脉栓塞的应用.微循环学杂志, 2010, 20:53-54.
16. 时勇.肺动脉栓塞患者血浆D-二聚体水平测定的临床价值.国际检验学杂志, 2013, 34:1447-1448.
17. 彭丁, 习昕, 刘双, D-二聚体检测在静脉血栓栓塞症诊断中应用的新进展.心肺血管病杂志, 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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