ABSTRACT
Objective:
To explore the clinical value of arterial
partial pressure of
carbon dioxide (PaCO 2) combined with Wells score in predicting acute
pulmonary embolism (PE).
Methods:
Patients with suspected acute PE admitted to
Emergency Department of
Beijing Chaoyang
Hospital,
Capital Medical
University from January 1, 2016 to August 31, 2021 were screened.
Patients with positive computed
tomography pulmonary
angiography (CTPA) results were classified as the PE group, and those with negative CTPA results were classified as the non-PE group. Demographic characteristics, symptoms,
vital signs, underlying
diseases,
risk factors for
venous thrombosis, arterial
blood gas analysis and Wells scores were statistically analyzed and compared between the two groups, and the
clinical efficacy of PaCO 2 combined with Wells score in predicting acute PE was evaluated.
Results:
A total of 1 869
patients with suspected acute PE were screened, and 1 492
patients were finally selected. There were 537 cases in the PE group and 955 cases in the non-PE group. The frequency of
chest pain,
dyspnea, unilateral
lower limb edema,
history of PE or
deep venous thrombosis,
history of
surgery or
immobilization within 3 months,
history of fracture within 3 months, active malignant
tumor, elevated Wells score and reduced PaCO 2 in the PE group was significantly higher than that in the non-PE group (all P< 0.05). The area under
receiver operating characteristic (ROC) curve (
AUC) of Wells score was 0.784 (95% CI 0.758-0.810), and the
sensitivity and specificity of predicting acute
pulmonary embolism were 61.64% and 88.48%, respectively. The
AUC of reduced PaCO 2 was 0.679 (95% CI 0.651-0.707), and the
sensitivity and specificity of predicting acute
pulmonary embolism were 79.89% and 55.92%, respectively. The
AUC of reduced PaCO 2 combined with Wells score was 0.837 (95% CI 0.816-0.858), and the
sensitivity and specificity of predicting acute
pulmonary embolism were 74.12% and 77.07%, respectively. The
AUC of reduced PaCO 2 combined with Wells score was significantly greater than the
AUC of Wells score ( P<0.001) and the
AUC of reduced PaCO 2 ( P<0.001).
Conclusions:
The
efficacy of PaCO 2 reduction combined with Wells score in predicting acute PE was superior to that of either of them alone. This was a beneficial supplement to the
screening of
patients with acute PE, and would also help reduce the abuse of CTPA in the
emergency department.