简化版Wells评分、修订版Geneva评分和D-二聚体水平在恶性肿瘤并发肺血栓栓塞症诊断中的应用价值

doi:10.13481/j.1671-587X.20210322

Abstract

Abstract: Objective

To explore the application values of simplified Wells score， revised Geneva score，and D-dimer（DD） level in the diagnosis of malignant tumor complicated with pulmonary thromboembolism （PTE），and to provide the reference for PTE diagnosis in clinic.

Methods

The clinical data of 142 cases of malignant tumor patients suspected of PTE and underwent CT pulmonary angiography （CTPA） examination were analyzed retrospectively. The diagnosis of PTE was based on the results of CTPA， and 72 patients with malignant tumor complicated with PTE were regarded as PTE group and 70 patients with malignant tumor without PTE were regarded as non-PTE group.The risk factors of all the enrolled patients were investigated through the statistical analysis，the receiver operating characteristic curves（ROC curves） were generated and the Z test was applied to compare the area under the ROC curve （AUC） of the above scores， and their values in the dignosis of malignant tumor complicated with PTE were evaluated.

Results

Adenocarcinoma，tumor metastasis，deep venous thrombosis （DVT） and positive DD were the independent risk factors for PTE in the patients with malignant tumor （P<0.05）.The sensitivities of simplified Wells score，revised Geneva score， and DD level were 87.5%，87.5%， and 97.2%，respectively；the negative predictive values were 74.3%， 70.0%， and 83.3%，respectively. The sensitivities of the two clinical score scales combined with DD level reached 100%，the misdiagnostic rate was lower，and the negative predictive value reached 100% which was of great value for exclusion. The AUC of simplified Wells score，revised Geneva score，DD level， revised Geneva score combined with DD level，and simplified Wells score combined with DD level were 0.762，0.687，0.649，0.741，and 0.786，respectively.The AUC of simplified Wells score combined with DD level was the greatest， which was larger than those of the other scales （P<0.05）.

Conclusion

Simplified Wells score combined with DD level shows a higher value in the diagnosis of malignant tumor complicated with PTE.

Key words: malignant tumor, pulmonary thromboembolism, simplified Wells score, revised Geneva score, D-dimer

CLC Number:

R563.5

Cong WANG, Xiu GUO, Hao CHI, Jie ZHANG, Mingyu XU, Chunling DONG. Application values of simplified Wells score, revised Geneva score and D-dimer level in diagnosis of malignant tumor complicated with pulmonary thromboembolism[J].Journal of Jilin University(Medicine Edition), 2021, 47(3): 707-713.

Figures/Tables 7

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References

1	DOUMA R A， MOS I C， ERKENS P M， et al. Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism： a prospective cohort study［J］. Ann Intern Med， 2011， 154（11）： 709-718.
2	MA Y X， WANG Y L， LIU D X， et al. A safe strategy to rule out pulmonary embolism： The combination of the Wells score and D-dimer test： One prospective study［J］. Thromb Res， 2017， 156： 160-162.
3	RAJI H， JAVADMOOSAVI S A， DASTOORPOOR M，et al. Overuse and underuse of pulmonary CT angiography in patients with suspected pulmonary embolism［J］. Med J Islam Repub Iran， 2018， 32： 3.
4	FILIPIAK-STRZECKA D，KASPRZAK J D，LIPIEC P.Brief cardiovascular imaging with pocket-size ultrasound devices improves the accuracy of the initial assessment of suspected pulmonary embolism［J］. Int J Cardiovasc Imaging， 2018， 34（10）： 1595-1605.
5	中华医学会呼吸病学分会肺栓塞与肺血管病学组. 肺血栓栓塞症诊治与预防指南［J］. 中华医学杂志， 2018， 98（14）：1060-1087.
6	阮小贞，何琳. Wells量表和修正的Geneva评分对肺栓塞的预测价值分析［J］.中国医学创新，2018，15（24）： 106-109.
7	晁慧娟，陈长强，陈聆，等. Wells量表和修正Geneva量表及其简化版对肺栓塞临床可能性评估的应用［J］. 诊断学理论与实践， 2017， 16（4）： 414-418.
8	CALISIR C， YAVAS U S， OZKAN I R， et al. Performance of the Wells and Revised Geneva scores for predicting pulmonary embolism［J］. Eur J Emerg Med， 2009， 16（1）： 49-52.
9	WONG D D，RAMASESHAN G，MENDELSON R M.Comparison of the Wells and Revised Geneva Scores for the diagnosis of pulmonary embolism： an Australian experience［J］. Intern Med J， 2011， 41（3）： 258-263.
10	LI Y P， SHANG Y， WANG W W， et al. Lung cancer and pulmonary embolism： what is the relationship？ A review［J］. J Cancer， 2018， 9（17）： 3046-3057.
11	李闯，刘弟世闻，石少波，等. 合并与未合并恶性肿瘤肺栓塞患者的临床分析［J］.中国医药，2020，15（11）：1704-1708.
12	TIMP J F， BRAEKKAN S K， VERSTEEG H H，et al. Epidemiology of cancer-associated venous thrombosis［J］. Blood， 2013， 122（10）： 1712-1723.
13	CUI Y Q， TAN X M， LIU B， et al. Analysis on risk factors of lung cancer complicated with pulmonary embolism［J］. Clin Respir J， 2021， 15（1）： 65-73.
14	SHEN J H， CHEN H L， CHEN J R， et al. Comparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism： a systematic review and meta-analysis［J］. J Thromb Thrombolysis， 2016， 41（3）： 482-492.
15	MA Y X， HUANG J L， WANG Y L， et al. Comparison of the Wells score with the revised Geneva score for assessing pretest probability of pulmonary embolism in hospitalized elderly patients［J］. Eur J Intern Med， 2016， 36： e18-e19.
16	GRUETTNER J， WALTER T， LANG S， et al. Importance of Wells score and Geneva score for the evaluation of patients suspected of pulmonary embolism［J］. In Vivo， 2015， 29（2）： 269-272.
17	QDAISAT A， WU C C， YEUNG S J. Normal D-dimer levels in cancer patients with radiologic evidence of pulmonary embolism［J］. J Thromb Thrombolysis， 2019， 48（1）： 174-179.
18	TANNOUS P， MUKADAM Z， KAMMARI C， et al. Yield of computed tomography pulmonary angiogram in the emergency department in cancer patients suspected to have pulmonary embolism［J］. Hematol Oncol Stem Cell Ther， 2016， 9（4）： 131-136.
19	RIGHINI M， LE GAL G， AUJESKY D， et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg： a randomised non-inferiority trial［J］. Lancet， 2008， 371（9621）： 1343-1352.
20	林茂煌，张伟林，张盛斌，等. Wells评分对恶性肿瘤患者的肺栓塞诊断价值［J］. 中华临床医师杂志（电子版）， 2016， 10（6）： 895-897.
21	VAN ES N， KRAAIJPOEL N， KLOK F A， et al. The original and simplified Wells rules and age-adjusted D-dimer testing to rule out pulmonary embolism： an individual patient data meta-analysis［J］. J Thromb Haemost， 2017， 15（4）： 678-684.

Group	n	Gender			Age(year)
Group	n	Male		Female	<45		45－59			60－74		≥75
Non- PTE	70	37（52.9）		33（47.1）	5(7.1)		20(28.6)			34(48.6)		11(15.7)
PTE	72	35（48.6）		37（51.4）	2(2.8)		22(30.6)			33(45.8)		15(20.8)
χ²		0.256			1.983
P		0.613			0.576
Group	n	Basic illness
Group	n	Cardiovascular diseases		Respiratory diseases	Diabetes	Thrombosis		Cerebrovascular disease			Liver Disease		Kidney disease
Non- PTE	70	35（50.0）		36（51.4）	7（10.0）	9（12.9）		12（17.1）			3（4.3）		2（2.9）
PTE	72	40（55.6）		38（52.8）	13（18.1）	6(8.3)		5(6.9)			2（2.8）		1(1.4)
χ²		0.440		0.026	1.903	0.769		3.503			0.238		0.370
P		0.507		0.872	0.168	0.381		0.061			0.626		0.543
Group	n	Malignant tumor information									PTE relevant information
Group	n	Respiratory system	Digestive system	Reproductive system	Urinary system	Hematological system		Breast cancer	Other systems		Chemotherapy		Tumor metastasis
Non- PTE	70	25（35.7）	14（20.0）	9（12.9）	4（5.7）	5（7.1）		6（8.6）	6（8.6）		19（27.1）		14（20.0）
PTE	72	32（44.4）	13（18.1）	14（19.4）	3（4.2）	3（4.2）		6（8.3）	2（2.8）		17（23.6）		32（44.4）
χ²		1.126	0.087	0.135	0.181	0.591		0.003	2.241		0.234		9.684
P		0.289	0.768	0.287	0.670	0.442		0.959	0.134		0.629		<0.05
Group	n	PTE relevant information
Group	n	Adenocarcinoma	Cough	Expectoration	Chest pain	Dyspnoea		Haemoptysis			Fever		Syncope
Non- PTE	70	19（27.1）	20（28.6）	16（22.9）	14（20.0）	45（64.3）		5（7.1）			14（20.0）		5（7.1）
PTE	72	38(52.8)	17(23.6)	13(18.1)	19(26.4)	50(69.4)		14(19.4)			10(13.9)		6(8.3)
χ²		9.707	0.453	0.504	0.812	0.427		4.634			0.944		0.070
P		<0.05	0.501	0.478	0.367	0.514		<0.05			0.331		0.791
Group	n	PTE relevant information
Group	n	Heart palpitation		Swelling and pain in lower limbs	DD（+）			Recent surgery within 3?month			Diagnosis of DVT
Non- PTE	70	1（1.4）		2（2.9）	60（85.7）			22（31.4）			8（11.4）
PTE	72	2（2.8）		9（12.5）	70（97.2）			26（36.1）			35（48.6）
χ²		0.312		4.618	6.076			0.348			23.243
P		0.576		<0.05	<0.05			0.555			<0.05

Variable	OR	95%CI	P
Pathological type (Adenocarcinoma)	2.325	1.017－5.314	<0.05
Tumor metastasis	2.595	1.130－5.961	<0.05
Haemoptysis	1.439	0.378－5.476	0.594
DD（+）	6.910	1.075－44.398	<0.05
Swelling and pain in lower limbs	1.805	0.297－10.962	0.521
Diagnosis of DVT	4.762	1.822－12.445	<0.05

Group	n	Simplified Wells score
Group	n	<2	≥2	<3	≥3
Non-PTE	70	26（37.1）	44（62.9）	21（30.0）	49（70.0）
PTE	72	9（12.5）	63（87.5）	9（12.5）	63（87.5）
P		0.001		0.011

Variable	Sensitivity	Specificity	Misdiagnostic rate	Missed diagnostic rate	Negative predictive value	Positive predictive value
Simplified Wells score	87.5	37.1	62.9	12.5	74.3	58.9
Revised Geneva score	87.5	30.0	70.0	12.5	70.0	56.3
DD level	97.2	14.3	85.7	2.8	83.3	53.8
Simplified Wells score+DD level	100.0	11.4	88.6	0.0	100.0	59.2
Revised Geneva score+DD level	100.0	8.6	91.4	0.0	100.0	57.5

Variable	AUC	Standard error	95%CI	P
DD	0.649	0.046	0.559－0.739	<0.01
Simplified Wells score	0.762	0.041	0.682－0.841	<0.01
Revised Geneva score	0.687	0.044	0.600－0.774	<0.01
Simplified Wells score+DD level Revised Geneva score+DD level	0.786 0.741	0.039 0.044	0.708－0.863 0.628－0.800	<0.01 <0.01

Application values of simplified Wells score, revised Geneva score and D-dimer level in diagnosis of malignant tumor complicated with pulmonary thromboembolism

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Variable		P
Simplified Wells score and revised Geneva score	2.184	0.029
Simplified Wells score+DD level	1.982	0.047
Simplified Wells score and simplified Wells score+DD level	1.969	0.048
Simplified Wells score and revised Geneva score+DD level	1.261	0.207
Simplified Wells score + DD level and DD level	2.704	0.006
Simplified Wells score + DD level and revised Geneva score	2.788	0.005
Simplified Wells score + DD level and revised Geneva score+DD level	2.143	0.032
DD level and revised Geneva score	0.612	0.540
DD level and revised Geneva score+DD level	1.282	0.199
Revised Geneva score and revised Geneva score+DD level	1.449	0.147

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