Limited predictive value of Padua and Caprini scores for venous thromboembolism in AECOPD patients with atrial fibrillation

Venous thromboembolism (VTE) risk is elevated in acute exacerbations of COPD (AECOPD), especially with coexisting atrial fibrillation (AF). However, the Caprini and Padua scores, validated in surgical or general medical populations, may not capture thrombotic risk in AECOPD-AF patients, and their predictive performance in this subgroup remains unclear. In this multicenter prospective cohort study, we analyzed 13,108 AECOPD patients (including 755 with AF and 12,353 without AF) from ten tertiary hospitals in China. Propensity score matching (1:4 ratio) was performed based on age, gender, smoking status, hypertension, stroke, and chronic renal insufficiency. Multivariable logistic regression was used to assess VTE risk factors, and the discriminatory performance of the Caprini and Padua scores was evaluated through receiver operating characteristic analysis. AF independently increased VTE risk (adjusted OR 1.55, 95% CI 1.03–2.33). Both scores showed suboptimal discrimination (Caprini AUC 0.616; Padua AUC 0.593), with no significant difference (DeLong’s P = 0.349). AECOPD-AF patients exhibited higher VTE events (72/755, 9.5% vs. 150/3020, 5.0%, P < 0.001). AF constitutes an independent risk factor for VTE in the AECOPD-AF population. However, the Caprini and Padua scores show limited predictive value in this subgroup, underscoring the need for a tailored risk assessment tool specifically designed for AECOPD-AF patients. Trial registration: Chinese clinical trial registry, ChiCTR2100044625.