Correlation and combined predictive value of pulmonary artery CTA,sPESI score,and DMC for short-term prognosis of acute pulmonary embolism
LIU Yazhen
XU Yang
LIU Xiaolei
ZHOU Ying
HU Jie
Abstract：Objective To investigate the correlation between pulmonary artery computed tomography angiography(CTA),simplified pulmonary embolism severity index(sPESI)score,D-dimer(DD)and myocardial injury composite(DMC)and the short-term prognosis of acute pulmonary embolism(APE),as well as the combined predictive value.Methods A total of 196 patients with APE admitted from January 2023 to January 2025 were selected and divided into poor prognosis group(n=35)and good prognosis group(n=161)according to the 30-day prognosis.The clinical data and pulmonary artery CTA parameters of the two groups were compared,and the characteristic variables of short-term prognosis of APE was screened using random forest and LASSO regression.A nomogram based on the screened characteristic variables to predict the short-term prognosis model was drawn,and the prediction model was validated.Results The proportion of patients with a sPESI score of≥1 score,D-D,cardiac Troponin I(cTnI),and DMC in the poor prognosis group was higher than that in the good prognosis group(P<0.05).The pulmonary artery obstruction index(PAOI),right ventricular diameter/left ventricular diameter ratio(RVd/LVd),main pulmonary artery diameter(MPAd),ratio of maximum diameter of MPAd to ascending aortic diameter(rPA),and the proportion of patients with contrast reflux into the inferior vena cava and abnormal bulging of the ventricular septum in the poor prognosis group were also higher than those in the good prognosis group(P<0.01).Random forest and LASSO regression identified PAOI,RVd/LVd,sPESI score,MPAd,rPA,and DMC as predictive variables.The area under the curve(AUC)values for predicting poor short-term prognosis using PAOI,RVd/LVd,sPESI score,MPAd,rPA,and DMC were 0.751,0.749,0.624,0.732,0.745,and 0.727,respectively.The AUC of the nomogram prediction model based on the above factors to predict the poor prognosis of patients was significantly greater than that of PAOI,RVd/LVd,sPESI score,MPAd,rPA and DMC for prediction alone.The calibration curve and clinical decision curve showed that the model had good consistency and positive net benefit.Conclusion The pulmonary artery CTA parameters,sPESI score and DMC are closely related to the short-term prognosis of APE patients.The nomogram model based on the above indicators has high predictive value for the short-term prognosis of patients.
Keywords：acute pulmonary embolismpulmonary artery CTAsimplified pulmonary embolism severity indexD-dimerTroponin Inomogramprognosis
Publication Date：2025-11-13
Online Publishing Date：2025-11-26(First online date of this platform, not the publication date of the document)
Pages：8( 51-57,70 )