Prevalence of venous thromboembolic events and diagnostic performance of the wells score and revised geneva scores for pulmonary embolism in patients with interstitial lung disease: a prospective study

Abstract

Background: To determine the prevalence of venous thromboembolism (VTE) in patients with connective tissue disease-related interstitial lung diseases (CTD-ILD) and idiopathic interstitial pneumonia (IIP) and to further evaluate associated risk factors. To also examine the diagnostic performance of the Wells score and the revised Geneva scores for diagnosing pulmonary embolism (PE) in ILD patients.

Method: Fifty-seven patients with CTD-ILD and IIP were prospectively enrolled. Plasma D-dimer was measured by ELISA. Deep-vein thrombosis (DVT) was examined by venous ultrasonography and PE by computed tomography pulmonary angiography. PE prevalence was further assessed by the Wells score and the revised Geneva score.

Results: VTE was diagnosed in 15 (26.3%, 15/57) patients. Bivariate analysis revealed that dyspnoea (OR 3.750, 95%CI 1.095-12.842, P=0.035), lower extremity oedema (OR 8.667, 95%CI1.814-41.408, P=0.007), palpitations (OR 4.75, 95%CI1.073-21.032, P=0.040), and positive D-dimer (OR 5.087, 95%CI 1.015-25.485, P=0.048) were associated with VTE. Using the Wells Score, 46 (80.70%), eight (14.4%) and three (5.26%) patients had a low, intermediate and high probability of PE, respectively, with seven (15.22%), three (37.5%) and two (66.67%) of the respective cases confirmed. By the revised Geneva score, 23 (40.35%), 32 (56.14%) and two (3.51%) patients had a low, intermediate and high probability of PE, respectively, with two (8.70%), nine (28.13%) and one (50.00%) of the respective cases confirmed. The AUC for the Wells score and the revised Geneva score was 0.720±0.083 (CI 0.586 to 0.831) and 0.704± 0.081 (CI 0.568 to 0.817), respectively.

Conclusion: VTE can be seen in approximately one fourth of patients with CTD-ILD or IIP and the Wells score and the revised Geneva score can be used for categorising PE risk.

Keywords: Interstitial lung disease; Pulmonary embolism; Revised Geneva scores; Venous thromboembolism; Wells score.