High-Accuracy Identification of Asymptomatic Pulmonary Embolism Using Neutrophil-to-Lymphocyte Ratio (NLR), Systemic Immune-Inflammation Index (SII), Geneva Original Score, Smoking Duration, Thrombus Location, and Hypertension History: A Single-Center Retrospective Cohort Study

Background : Computed tomography pulmonary angiography (CTPA) is the diagnostic standard for asymptomatic pulmonary embolism (ASPE). However, routine CTPA screening in patients with deep vein thrombosis (DVT) faces challenges including resource utilization, cost-effectiveness, and contraindications to iodinated contrast (e.g., allergy, renal impairment, metformin-treated diabetes, pregnancy). The alternative biomarker D-dimer has limited specificity in comorbid patients, reducing its exclusionary value. These limitations highlight the need for novel, sensitive biomarkers or strategies to optimize clinical decision-making and reduce unnecessary CTPA. Methods : A retrospective single-center cohort study was conducted. Patients presenting with DVT to the Department of Vascular Surgery, Jining Medical University Affiliated Hospital (January 2022 - April 2024) were enrolled. Baseline data, bilateral lower extremity venous ultrasound, and CTPA results within 24 hours of admission were recorded. Binary logistic regression was used to predict ASPE. Results : After applying inclusion/exclusion criteria, 401 patients were analyzed (ASPE: n = 198; DVT only: n = 203). Significant differences were observed between groups for hypertension history, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), smoking duration, Geneva score, prior PE history, gender, D-dimer, and serum creatinine. Multivariate analysis identified hypertension history, elevated NLR, elevated SII, longer smoking duration, higher Geneva score, and the presence of right proximal or right distal lower extremity DVT as independent risk factors for ASPE (respective ORs: 3.106, 1.585, 0.999, 1.119, 2.728, 4.457). An integrated model combining these factors achieved an area under the curve (AUC) of 0.84 for identifying ASPE. Conclusion : The combination of NLR, Geneva score, hypertension history, and specific DVT locations forms a robust predictive model for ASPE. This integrated approach shows promise for assisting or potentially substituting D-dimer in the early screening of ASPE, particularly to identify patients warranting CTPA or those with contraindications.