Original Research

Evaluation of the modified Wells score in predicting venous thromboembolic disease in patients with tuberculosis or HIV in a South African setting

Tweedy Keokgale, Sarah A. van Blydenstein, Ishmail S. Kalla
Southern African Journal of HIV Medicine | Vol 23, No 1 | a1349 | DOI: https://doi.org/10.4102/sajhivmed.v23i1.1349 | © 2022 Tweedy Keokgale, Sarah Alexandra van Blydenstein, Ishmail Sikander Kalla | This work is licensed under CC Attribution 4.0
Submitted: 21 November 2021 | Published: 23 March 2022

About the author(s)

Tweedy Keokgale, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; and, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Sarah A. van Blydenstein, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; and, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Division of Pulmonology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Ishmail S. Kalla, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Division of Critical care, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa


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Abstract

Background: There is paucity of data on the modified Wells score (MWS) utility on patients with venous thromboembolism (VTE) in a South African setting where there is a high burden of HIV and tuberculosis (TB). This study analyses the performance of this score in HIV/TB-infected patients compared with non-infected patients.

Objectives: To assess the performance of the MWS as an additional risk factor for VTE in hospitalised patients with a high burden of HIV/TB infections.

Method: This study was a retrospective cross-sectional cohort analysis of the utility of the MWS in 156 HIV/TB-infected and non-infected adult patients diagnosed with VTE on compression ultrasonography (CUS) or computed tomography pulmonary angiography (CTPA) in a medical inpatient setting over six months. Patients with HIV and/or TB were assessed as having an additional risk factor (1 point for each), and this was compared with the MWS. A McNeymar’s paired sample chi-squared test was used to compare the sensitivity of this score against the MWS.

Results: Of the 156 patients with VTE who were enrolled, HIV was the commonest risk factor (42.31%) with TB accounting for 10.90% of cases. When the MWS adjusted for HIV/TB was used, the sensitivity increased from 25% to 100% for the HIV–/TB+ category, it increased from 77.36% to 98.11% in the HIV+/TB– category and it increased from 84.62% to 92.95% in the HIV+/TB+ category. These differences were statistically significant at P < 0.05 in all categories.

Conclusion: The MWS performs better when the infectivity of HIV/TB is included as an additional risk factor in the score.


Keywords

modified Wells score; HIV; tuberculosis; pulmonary embolism; deep vein thrombosis

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