The predictive value of 3 risk assessment models for pulmonary embolism in acute exacerbation of chronic obstructive pulmonary disease

This study evaluates the predictive value of the Caprini, Padua, and simplified Wells scoring systems for pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and determine the optimal risk assessment tool. A retrospective cohort of 162 hospitalized AECOPD patients from January 2023 to December 2024 was included (51 in the PE+ group and 111 in the PE- group). Demographic data, clinical features, laboratory indices, and imaging data were collected. Multivariate logistic regression was used to identify independent predictors, and the diagnostic performance of the 3 models was compared using receiver operating characteristic (ROC) curves (AUC and 95% CI). Model stability was assessed using the DeLong test and subgroup analysis. There were no significant differences between the 2 groups in age (70.3 ± 8.7 vs 67.6 ± 9.4 years, P = .063) and gender (male 68.6% vs 60.4%, P = .29). The simplified Wells score had the best predictive performance (AUC = 0.842, 95% CI: 0.776-0.908), significantly higher than the Padua (ΔAUC = 0.072, P = .032) and Caprini scores (ΔAUC = 0.162, P < .001). Multivariate regression showed that D-dimer (OR = 2.92, 95% CI: 1.97-4.33), history of VTE (OR = 4.55, 95% CI: 1.21-17.1), and reduced PaO2 (OR = 1.47/10 mm Hg, 95% CI: 1.05-2.06) were independent predictors. In subgroup analysis, the simplified Wells score had an AUC of 0.91 (95% CI: 0.83-0.99) in patients with low D-dimer (<2 mg/L), and the negative predictive value (NPV) was 95%. The simplified Wells score is the optimal tool for PE screening in AECOPD patients. Its high negative predictive value (89.5%) can reduce unnecessary imaging tests. It is recommended to combine dynamic D-dimer monitoring for clinical stratified management.