The diagnostic value of wells score combined with age-adjusted D-dimer standard in acute pulmonary embolism patients

Abstract

Objective To investigate the diagnostic value of Wells score combined with age-adjusted D-dimer (AADD) standard in acute pulmonary embolism (APE) in inpatients. Methods A total of 555 inpatients (over 50 years old) with suspected APE from Shantou Central Hospital during October 2010 and November 2018 were divided into low risk groups (Wells score 6) according to Wells criteria, with spiral CT pulmonary angiography (CTPA) as the diagnostic mehtod of APE.Meanwhile, the plasma concentration of D-dimer was detected and analyzed by immunoturbidimetry in all patients.The AADD cut-off value was (a patint′s age×10) μg/L.Then the sensitivity, specificity, positive predictive value (PPV) and negative predictive value(NPV) of Wells criteria, AADD and their combination for APE diagnosis were calculated and compared respectively. Results Out of 555 cases, 213 cases were diagnosed as APE by the CTPA.There were 290, 224 and 41 suspected cases which had low, medium and high Wells score respectively.The sensitivity, specificity, PPV and NPV of APE diagnosis for low, medium and high Wells score were 24.41%, 57.28% and 18.31%, 30.41%, 70.18% and 99.42%, 17.93%, 54.46% and 95.12%, 82.07%, 45.54% and 4.88%, respectively.The sensitivity, specificity, PPV and NPV of AADD were 89.20%, 40.06%, 48.10% and 85.63% respectively.Combinning a low risk Wells score with a negative AADD improved the NPV to 93.04%. Conclusions Patients with low Wells score and negative AADD may have higher clinical value in eliminating suspected APE. Key words: Pulmonary embolisms; D-dimer; Age-adjusted; Wells score