Superior Predictive Value of D-Dimer to the Padua Prediction Score for Venous Thromboembolism in Inpatients with AECOPD: A Multicenter Cohort Study

Abstract

Background

The optimal tool for risk prediction of venous thromboembolism (VTE) in inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is still unknown. This study aimed to evaluate whether D-dimer could predict the risk of VTE in inpatients with AECOPD compared to the Padua Prediction Score (PPS).

Methods

Inpatients with AECOPD were prospectively enrolled from seven medical centers in China between December 2018 and June 2020. On admission, D-dimer was detected, PPS was calculated for each patient, and the incidence of 2-month VTE was investigated. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of D-dimer and PPS on VTE development, and the best cut-off value for both methods was evaluated through the Youden index.

Results

Among the 4468 eligible patients with AECOPD, 90 patients (2.01%) developed VTE within 2 months after admission. The area under the receiver operating characteristic curves (AUCs) of D-dimer for predicting VTE were significantly higher than those of the PPS both in the overall cohort (0.724, 95% CI 0.672–0.776 vs 0.620, 95% CI 0.562–0.679; P<0.05) and the subgroup of patients without thromboprophylaxis (0.747, 95% CI 0.695–0.799 vs 0.640, 95% CI 0.582–0.698; P<0.05). By calculating the Youden Index, the best cut-off value of D-dimer was determined to be 0.96 mg/L with an AUC of 0.689, which was also significantly better than that of the PPS with the best cut-off value of 2 (AUC 0.581, P=0.007). After the combination of D-dimer with PPS, the AUC (0.621) failed to surpass D-dimer alone (P=0.104).

Conclusion

D-dimer has a superior predictive value for VTE over PPS in inpatients with AECOPD, which might be a better choice to guide thromboprophylaxis in inpatients with AECOPD due to its effectiveness and convenience.

Clinical Trial Registration

Chinese Clinical Trail Registry NO. ChiCTR2100044625; URL: http://www.chictr.org.cn/showproj.aspx?proj=121626.

Keywords:

• acute exacerbation of chronic obstructive pulmonary disease
• inpatients
• D-dimer
• Padua Prediction Score
• venous thromboembolism

Abbreviation

AECOPD, acute exacerbation of chronic obstructive pulmonary disease; AUC, area under the curve; BMI, body mass index; COPD, chronic obstructive pulmonary disease; CTPA, computed tomography pulmonary angiography; CI, confidence interval; VTE, venous thromboembolism; DVT, deep venous thrombosis; PE, pulmonary embolism.

Data Sharing Statement

The original data of this manuscript will not be shared in public.

Ethical Statement

This study was performed in accordance with the Declaration of Helsinki. This human study was approved by Ethics Committee on Biomedical Research, West China Hospital of Sichuan University. All adult participants provided written informed consent to participate in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. We appreciate the support and collaboration of the co-investigators participating in MAGNET AECOPD Registry study.

Guarantor Statement

Haixia Zhou is the guarantor of the whole content of the manuscript.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the Sichuan Science and Technology Program (2022YFS0262), the National Natural Science Foundation of China (82170013) and the National Key Research Program of China (2016YFC1304202).