Abstract
BackgroundContemporarily authoritative algorithms for the prediction of acute pulmonary embolism (PE) comprise the Standard algorithm, the Age-adjusted algorithm, the YEARS algorithm, the PERC algorithm, and the PEGeD algorithm. To date, little is known with respect to which algorithm is most appropriate for the PE prediction in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsThe patients with AECOPD who underwent the confirmed chest imaging investigations of PE due to the likelihood of PE predicted by the Standard algorithm were retrospectively reviewed. The patients were reassessed by the other four algorithms to reveal which algorithm had the best diagnostic accuracy for the likelihood prediction of PE for patients with AECOPD.ResultsThe results showed that the PEGeD algorithm(88.6, 80.7, 50.4, 97.0%, 4.591, 0.141, 0.693, 82.1%) performed better overall in the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, Youden index, and diagnostic accuracy, in comparison with the Age-adjusted algorithm (78.6, 74.1, 40.1, 94.0%, 3.034, 0.289, 0.527, 74.9%), the YEARS algorithm (71.4, 76.6, 40.3, 92.4%, 3.051, 0.373, 0.480,75.6%), the PERC algorithm (98.6, 1.6, 18.2, 83.3%, 1.002, 0.875, 0.002, 19.2%). The difference of number of patients who were necessary to undergo chest imaging examinations and missed diagnoses resulted from each algorithm between the PEGeD algorithm and the Standard algorithm, the Age-adjusted algorithm, the YEARS algorithm, as well as the PERC algorithm were [− 789 (− 68.1%), N/A], [− 42 (− 3.6%),-21 (− 1.8%)], [− 3 (− 0.3%),-36 (− 3.1%)],[− 771 (− 66.6%), 21 (1.8%)], respectively.ConclusionsTo date, the PEGeD algorithm is the most appropriate strategy among the authoritative algorithms for the likelihood prediction of pulmonary embolism in patients with AECOPD.
Highlights
Chronic obstructive pulmonary disease (COPD)is a leading cause of morbidity and mortality worldwide that induces a substantially and increasingly economic and social burden [1, 2]
The results showed that the Pulmonary Embolism Graduated D-dimer (PEGeD) algorithm(88.6, 80.7, 50.4, 97.0%, 4.591, 0.141, 0.693, 82.1%) performed better overall in the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, Youden index, and diagnostic accuracy, in comparison with the Age-adjusted algorithm (78.6, 74.1, 40.1, 94.0%, 3.034, 0.289, 0.527, 74.9%), the YEARS algorithm (71.4, 76.6, 40.3, 92.4%, 3.051, 0.373, 0.480,75.6%), the Pulmonary Embolism Rule-out Criteria (PERC) algorithm (98.6, 1.6, 18.2, 83.3%, 1.002, 0.875, 0.002, 19.2%)
Of a total of 1158 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) who underwent the decisive investigations of pulmonary embolism (PE), the absence of PE was found in 948 patients, whereas the presence of PE was found in the remaining 210 ones
Summary
Chronic obstructive pulmonary disease (COPD)is a leading cause of morbidity and mortality worldwide that induces a substantially and increasingly economic and social burden [1, 2]. The acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an acute worsening of respiratory symptoms that results in additional therapy [3, 4]. PE that has an explicit indication for anticoagulant treatment is frequently encountered in AECOPD [6]. If it happens, PE is significantly associated with increased mortality and length of hospital stay in patients with AECOPD [7–9]. Little is known with respect to which algorithm is most appropriate for the PE prediction in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)
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