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BackgroundPulmonary embolism (PE) may be asymptomatic due to the compensatory function of the lungs themselves, which easily leads to missed diagnosis and increased risks. Although computed tomography pulmonary angiography (CTPA) can improve the detection rate, routine CTPA screening for patients with concurrent lower extremity deep vein thrombosis (DVT) still faces challenges. These include limited medical resources, restricted use of contrast agents (e.g., allergies, renal function issues), and low specificity of D-dimer. Therefore, there is a need to develop optimized diagnostic strategies based on inpatient DVT populations to accurately identify high-risk patients requiring CTPA, while acknowledging that these findings cannot be directly generalized to all DVT outpatients and reduce unnecessary contrast agent exposure.MethodsThis retrospective study analyzed patients admitted with lower extremity DVT (Jan 2022-Apr 2024). After excluding those with acute PE symptoms or other key confounders (e.g., recent anticoagulation), 401 patients were included. All underwent CTPA and were classified into asymptomatic PE (n=198) or isolated DVT (n=203) groups. Predictors of asymptomatic PE were identified using binary logistic regression.ResultsAfter screening based on inclusion and exclusion criteria, 401 patients were finally included in the analysis, with 198 cases in the asymptomatic PE group and 203 cases in the DVT group. Multivariate regression analysis showed that hypertension, neutrophil-to-lymphocyte ratio (NLR), smoking duration, right distal DVT, right proximal DVT, and lower extremity swelling and pain were independent risk factors for asymptomatic PE (OR = 3.461, 1.303, 1.103, 2.878, 4.495, 7.176,). The area under the curve (AUC) of the model was 0.874, with a sensitivity of 73.74% and a specificity of 82.27%.ConclusionThe combined detection of these independent risk factors-hypertension, NLR, smoking duration, right distal DVT, right proximal DVT, and lower extremity swelling and pain-is expected to facilitate early screening for asymptomatic PE in hospitalized DVT populations, with further external verification required to extend its applicability to broader DVT cohorts.