简化肺栓塞严重程度指数评分对≥80岁非高危肺栓塞患者危险分层的应用价值

Use of simplified Pulmonary Embolism Severity Index in risk stratification of the elderly patients at 80 years and over with non-high-risk pulmonary embolism

摘要:

目的 探讨简化肺栓塞严重程度指数(sPESI)评分在≥80岁非高危肺栓塞(PE)患者危险分层中的应用价值。方法 连续选取近8年于北京同仁医院住院的141例≥80岁非高危PE患者,根据2019年欧洲指南标准将患者分为低危组53例,中低危组75例,中高危组13例。运用PESI评分、sPESI评分、Bova评分、PREP评分、肺栓塞风险评分(PERS)五种量表进行测评,对比各量表测评结果,并根据30d死亡情况判断五种量表的预后效果。结果 141例患者中,30d内死亡10例(7.09%)。PESI、sPESI、Bova评分、PREP评分、PERS 五个量表的受试者工作特征(ROC)曲线下面积(AUC)分别为0.687、0.802、0.786、0.769、0.668,差异有统计学意义(P<0.05),其中sPESI的AUC值最大。sPESI量表的灵敏度最高为0.951,PREP量表的特异度最高为0.905,PESI量表的Youden指数最大,为1.526。结论 sPESI评分、PREP评分和PESI评分各有优缺点,但PESI评分的灵敏度最高,AUC最大,可用于≥80岁群体的早期危险分层评估,但因其特异性较低,故临床应用时建议联合其他评分方法一起评估。

Abstract:

Objective To explore the value of simplified Pulmonary Embolism Severity Index (sPESI) in the risk stratification in the patients aged 80 years or over with non-high risk pulmonary embolism (PE). Methods A total of 141 patients with non-high-risk PE hospitalized in Beijing Tongren Hospital in the last eight years were divided into low-risk group (n=53), middle-low-risk group (n=75) and middle-high-risk group (n=13). The patients were assessed using PESI, sPESI, Bova score, PREP score and pulmonary embolism risk score (PERS). The five scales were compared, and their prognostic effects were judged based on the 30-day mortality. Results Among 141 patients, 10(7.09%) died at 30 days. The area under the receiver operating characteristic (ROC) curve (AUC) were 0.687 for PESI, 0.802 for sPESI, 0.786 for Bova, 0.769 for PREP, and 0.668 for PERS, with statistical significance among five scales (P<0.05), the AUC for sPESI being the largest. sPESI had the highest sensitivity of 0.951, PREP had the highest specificity of 0.905, and PESI had the highest Youden index of 1.526. Conclusions sPESI, PREP, and PESI have advantages and disadvantages, but sPESI, the most sensitive with the largest AUC, can be used for the early risk stratification in the population ≥80 years old. However, it is advisable to use it together with other methods because of its low specificity.