Development and Validation of Prediction Model to Estimate Risk of Acute Pulmonary Embolism: Retrospective Cohort Study

Abstract Background: Venous thromboembolism (VTE), clinically presenting as deep vein thrombosis (DVT) or pulmonary embolism (PE). Not all DVT patients carry the same risk of developing acute pulmonary embolism (APE).Methods: Patients who were diagnosed as symptomatic VTE between June 2013 and June 2018 (n=1582) at the First Affiliated Hospital of Xi’an Jiaotong University were enrolled in this study, of whom 783 had the DVT and APE confirmed by angiography or computed tomography pulmonary angiography (CTPA). Using the LASSO and logistics regression, we derived predictive model with 16 candidate variables to predict the risk of APE and completed internal validation.Results: Overall, 52.9% patients had DVT+APE (773 vs 1460), 47.1% patients only had DVT (687 vs 1460). The APE risk prediction model included one pre-existing disease or condition (respiratory failure), one risk factors(infection), three symptoms (dyspnea, hemoptysis, syncope), five signs (skin cold clammy, tachycardia, diminished respiration, pulmonary rales, accentuation/splitting of P2, tricuspid murmur), and six ECG indicators (SⅠQⅢTⅢ, right axis deviation, left axis deviation, S1S2S3, T wave inversion, Q/q wave), of which all were positively associated with APE. The ROC curves of the model showed AUC of 0.79 (95% CI, 0.77-0.82) and 0.80 (95% CI, 0.76-0.84) in the training set and testing set. The model showed good predictive accuracy (calibration slope, 0.83 and Brier score, 0.18).Conclusion: Based on a retrospective single-center population study, we developed a novel prediction model to identify patients with different risks for APE in DVT patients, which may be useful for quickly estimating the probability of APE before obtaining definitive test results and speeding up emergency management processes.

Download Full-text

Development and validation of a prediction model to estimate risk of acute pulmonary embolism in deep vein thrombosis patients

Scientific Reports ◽

10.1038/s41598-021-04657-y ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

You Li ◽

Yuncong He ◽

Yan Meng ◽

Bowen Fu ◽

Shuanglong Xue ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Prediction Model ◽

Acute Pulmonary Embolism ◽

Predictive Accuracy ◽

Pulmonary Angiography ◽

Brier Score ◽

Axis Deviation ◽

Vein Thrombosis ◽

Deep Vein

AbstractVenous thromboembolism (VTE), clinically presenting as deep vein thrombosis (DVT) or pulmonary embolism (PE). Not all DVT patients carry the same risk of developing acute pulmonary embolism (APE). To develop and validate a prediction model to estimate risk of APE in DVT patients combined with past medical history, clinical symptoms, physical signs, and the sign of the electrocardiogram. We analyzed data from a retrospective cohort of patients who were diagnosed as symptomatic VTE from 2013 to 2018 (n = 1582). Among them, 122 patients were excluded. All enrolled patients confirmed by pulmonary angiography or computed tomography pulmonary angiography (CTPA) and compression venous ultrasonography. Using the LASSO and logistics regression, we derived a predictive model with 16 candidate variables to predict the risk of APE and completed internal validation. Overall, 52.9% patients had DVT + APE (773 vs 1460), 47.1% patients only had DVT (687 vs 1460). The APE risk prediction model included one pre-existing disease or condition (respiratory failure), one risk factors (infection), three symptoms (dyspnea, hemoptysis and syncope), five signs (skin cold clammy, tachycardia, diminished respiration, pulmonary rales and accentuation/splitting of P2), and six ECG indicators (SIQIIITIII, right axis deviation, left axis deviation, S1S2S3, T wave inversion and Q/q wave), of which all were positively associated with APE. The ROC curves of the model showed AUC of 0.79 (95% CI, 0.77–0.82) and 0.80 (95% CI, 0.76–0.84) in the training set and testing set. The model showed good predictive accuracy (calibration slope, 0.83 and Brier score, 0.18). Based on a retrospective single-center population study, we developed a novel prediction model to identify patients with different risks for APE in DVT patients, which may be useful for quickly estimating the probability of APE before obtaining definitive test results and speeding up emergency management processes.

Download Full-text

Left axis deviation as an electrocardiographic manifestation of acute pulmonary embolism

Journal of Electrocardiology ◽

10.1016/s0022-0736(71)80053-5 ◽

1971 ◽

Vol 4 (1) ◽

pp. 67-69 ◽

Cited By ~ 4

Author(s):

Paul D. Stein ◽

Thomas A. Bruce

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Axis Deviation

Download Full-text

COVID-19-induced vascular angiopathy: CTPA signs in critically ill patients other than acute pulmonary embolism and high-lung opacity scores

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00491-4 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Mohamed Hossameldin khalifa ◽

Ahmed Samir ◽

Ayman Ibrahim Baess ◽

Sara Samy Hendawi

Keyword(s):

Artificial Intelligence ◽

Pulmonary Embolism ◽

Lung Volume ◽

Acute Pulmonary Embolism ◽

Pulmonary Angiography ◽

Vascular Tree ◽

Ct Pulmonary Angiography ◽

Artificial Intelligence System ◽

Intelligence System ◽

Severity Scores

Abstract Background Vascular angiopathy is suggested to be the major cause of silent hypoxia among COVID-19 patients without severe parenchymal involvement. However, pulmonologists and clinicians in intensive care units become confused when they encounter acute respiratory deterioration with neither severe parenchymal lung involvement nor acute pulmonary embolism. Other radiological vascular signs might solve this confusion. This study investigated other indirect vascular angiopathy signs on CT pulmonary angiography (CTPA) and involved a novel statistical analysis that was performed to determine the significance of associations between these signs and the CT opacity score of the pathological lung volume, which is calculated by an artificial intelligence system. Results The study was conducted retrospectively, during September and October 2020, on 73 patients with critical COVID-19 who were admitted to the ICU with progressive dyspnea and low O2 saturation on room air (PaO2 < 93%). They included 53 males and 20 females (73%:27%), and their age ranged from 18 to 88 years (mean ± SD=53.3 ± 13.5). CT-pulmonary angiography was performed for all patients, and an artificial intelligence system was utilized to quantitatively assess the diseased lung volume. The radiological data were analyzed by three expert consultant radiologists to reach consensus. A low CT opacity score (≤10) was found in 18 patients (24.7%), while a high CT opacity score (>10) was found in 55 patients (75.3%). Pulmonary embolism was found in 24 patients (32.9%); three of them had low CT opacity scores. Four other indirect vasculopathy CTPA signs were identified: (1) pulmonary vascular enlargement (57 patients—78.1%), (2) pulmonary hypertension (14 patients—19.2%), (3) vascular tree-in-bud pattern (10 patients—13.7%), and (4) pulmonary infarction (three patients—4.1%). There were no significant associations between these signs and the CT opacity score (0.3205–0.7551, all >0.05). Furthermore, both pulmonary vascular enlargement and the vascular tree-in-bud sign were found in patients without pulmonary embolism and low CT-severity scores (13/15–86.7% and 2/15–13.3%, respectively). Conclusion Pulmonary vascular enlargement or, less commonly, vascular tree-in-bud pattern are both indirect vascular angiopathy signs on CTPA that can explain the respiratory deterioration which complicates COVID-19 in the absence of severe parenchymal involvement or acute pulmonary embolism.

Download Full-text

Usefulness of an imaging tool on CT pulmonary angiography in the prognostic stratification of patients with acute pulmonary embolism

International Journal of Cardiology ◽

10.1016/j.ijcard.2021.08.016 ◽

2021 ◽

Author(s):

Iolanda Enea

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Imaging Tool ◽

Prognostic Stratification

Download Full-text

A visualized pulmonary arterial thrombus by using a new echocardiographic view in an intermediate-risk a cute pulmonary embolism patient: a case report

10.21203/rs.2.19164/v1 ◽

2019 ◽

Author(s):

Guanyu Mu ◽

Feixue Li ◽

Xiaolin Chen ◽

Bo Zhao ◽

Guangping Li ◽

...

Keyword(s):

Blood Pressure ◽

Pulmonary Embolism ◽

Pulmonary Artery ◽

Acute Pulmonary Embolism ◽

Clinical Signs ◽

Signs And Symptoms ◽

Pulmonary Angiography ◽

Normal Blood ◽

Intermediate Risk ◽

Normal Blood Pressure

Abstract BackgroundAcute pulmonary embolism (APE) is a life-threatening disease with nonspecific clinical signs and symptoms. Rapid and accurate diagnosis is crucial for the clinical management of patients with acute pulmonary embolism. A new recommended echocardiography view may be of further help in the diagnosis, evaluate the change of the thrombosis and treatment effect.Case presentationWe report a case of a 74-year-old man with a 12-day history of decreased exercise capacity and dyspnoea. The patient was diagnosed intermediate-risk APE as several pulmonary emboli in pulmonary artery were seen in multidetector computed tomographic pulmonary angiography with normal blood pressure and echocardiographic right ventricular overload. And we found a pulmonary artery clot in the right pulmonary artery through transthoracic echocardiography. After 11-days anticoagulation, the patient underwent a reassessment, showed decrease in RV diameter and pulmonary artery thrombus. ConclusionThis case highlights the significant role that echocardiography played in a patient who presented pulmonary embolism with a stable hemodynamic situation and normal blood pressure. The new echocardiographic view could provide correct diagnoses by identifying the clot size and location visually. Knowledge of the echocardiography results of APE would aid the diagnosis.

Download Full-text

Gender-related differences in clinical presentation, electrocardiography signs, laboratory markers and outcome in patients with acute pulmonary embolism

Vojnosanitetski pregled ◽

10.2298/vsp150716093o ◽

2016 ◽

Vol 73 (9) ◽

pp. 844-849 ◽

Cited By ~ 1

Author(s):

Slobodan Obradovic ◽

Boris Dzudovic ◽

Sinisa Rusovic ◽

Vesna Subota ◽

Dragana Obradovic

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Clinical Presentation ◽

Univariate Analysis ◽

Pulmonary Angiography ◽

Laboratory Findings ◽

Laboratory Markers ◽

Significant Difference ◽

Echocardiographic Examination ◽

Gender Specific Differences

Background/Aim. Acute pulmonary embolism (PE) is a potentially life threating event, but there are scarce data about genderrelated differences in this condition. The aim of this study was to identify gender-specific differences in clinical presentation, the diagnosis and outcome between male and female patients with PE. Methods. We analysed the data of 144 consecutive patients with PE (50% women) and compared female and male patients regarding clinical presentation, electrocardiography (ECG) signs, basic laboratory markers and six-month outcome. All the patients confirmed PE by visualized thrombus on the multidetector computed tomography with pulmonary angiography (MDCTPA), ECG and echocardiographic examination at admission. Results. Compared to the men, the women were older and a larger proportion of them was in the third tertile of age (66.0% vs 34.0%, p = 0.008). In univariate analysis the men more often had hemoptysis [OR (95% CI) 3.75 (1.16-12.11)], chest pain [OR (95% CI) 3.31 (1.57-7.00)] febrile state [OR (95% CI) 2.41 (1.12-5.22)] and pneumonia at PE presentation [OR (95% CI) 3.40 (1.25-9.22)] and less likely had heart decompensation early in the course of the disease [OR (95%CI) 0.48 (0.24-0.97)]. In the multivariate analysis a significant difference in the rate of pneumonia and acute heart failure between genders disappeared due to strong influence of age. There was no significant difference in the occurrence of typical ECG signs for PE between the genders. Women had higher level of admission glycaemia [7.7 mmol/L (5.5-8.2 mmol/L) vs 6.9 mmol/L (6.3-9.6 mmol/L), p = 0.006] and total number of leukocytes [10.5 x 109/L (8.8-12.7 x 109/L vs 8.7 x 109/L (7.0-11.6 x 109/L)), p = 0.007]. There was a trend toward higher plasma level of brain natriuretic peptide in women compared to men 127.1 pg/mL (55.0-484.0 pg/mL), p = 0.092] vs [90.3 pg/mL (39.2-308.5 pg/mL). The main 6-month outcomes, death and major bleeding, had similar frequencies in both sexes. Conclusion. There are several important differences between men and women in the clinical presentation of PE and basic laboratory findings which can influence the diagnosis and treatment of PE.

Download Full-text

CT Pulmonary Angiography is the First-Line Imaging Test for Acute Pulmonary Embolism: A Survey of US Clinicians

Academic Radiology ◽

10.1016/j.acra.2006.01.002 ◽

2006 ◽

Vol 13 (4) ◽

pp. 434-446 ◽

Cited By ~ 69

Author(s):

Clifford R. Weiss ◽

John C. Scatarige ◽

Gregory B. Diette ◽

Edward F. Haponik ◽

Barry Merriman ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Pulmonary Angiography ◽

First Line ◽

Ct Pulmonary Angiography ◽

Imaging Test ◽

Line Imaging

Download Full-text

Development and Validation of a Clostridium difficile Infection Risk Prediction Model

Infection Control and Hospital Epidemiology ◽

10.1086/658944 ◽

2011 ◽

Vol 32 (4) ◽

pp. 360-366 ◽

Cited By ~ 62

Author(s):

Erik R. Dubberke ◽

Yan Yan ◽

Kimberly A. Reske ◽

Anne M. Butler ◽

Joshua Doherty ◽

...

Keyword(s):

High Risk ◽

Clostridium Difficile ◽

Prediction Model ◽

Risk Prediction ◽

Predictive Accuracy ◽

Medical Center ◽

Tertiary Care ◽

Risk Prediction Model ◽

Brier Score ◽

Tertiary Care Medical Center

Objective.To develop and validate a risk prediction model that could identify patients at high risk for Clostridium difficile infection (CDI) before they develop disease.Design and Setting.Retrospective cohort study in a tertiary care medical center.Patients.Patients admitted to the hospital for at least 48 hours during the calendar year 2003.Methods.Data were collected electronically from the hospital's Medical Informatics database and analyzed with logistic regression to determine variables that best predicted patients' risk for development of CDI. Model discrimination and calibration were calculated. The model was bootstrapped 500 times to validate the predictive accuracy. A receiver operating characteristic curve was calculated to evaluate potential risk cutoffs.Results.A total of 35,350 admitted patients, including 329 with CDI, were studied. Variables in the risk prediction model were age, CDI pressure, times admitted to hospital in the previous 60 days, modified Acute Physiology Score, days of treatment with high-risk antibiotics, whether albumin level was low, admission to an intensive care unit, and receipt of laxatives, gastric acid suppressors, or antimotility drugs. The calibration and discrimination of the model were very good to excellent (C index, 0.88; Brier score, 0.009).Conclusions.The CDI risk prediction model performed well. Further study is needed to determine whether it could be used in a clinical setting to prevent CDI-associated outcomes and reduce costs.

Download Full-text