Incidence of pulmonary embolism during COPD exacerbation

Evrim Eylem Akpinar, Derya Hoşgün, Serdar Akpinar, Gökçe Kaan Ataç, Beyza Doğanay, Meral Gülhan, Evrim Eylem Akpinar, Derya Hoşgün, Serdar Akpinar, Gökçe Kaan Ataç, Beyza Doğanay, Meral Gülhan

Abstract

Objective: Because pulmonary embolism (PE) and COPD exacerbation have similar presentations and symptoms, PE can be overlooked in COPD patients. Our objective was to determine the prevalence of PE during COPD exacerbation and to describe the clinical aspects in COPD patients diagnosed with PE.

Methods: This was a prospective study conducted at a university hospital in the city of Ankara, Turkey. We included all COPD patients who were hospitalized due to acute exacerbation of COPD between May of 2011 and May of 2013. All patients underwent clinical risk assessment, arterial blood gas analysis, chest CT angiography, and Doppler ultrasonography of the lower extremities. In addition, we measured D-dimer levels and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels.

Results: We included 172 patients with COPD. The prevalence of PE was 29.1%. The patients with pleuritic chest pain, lower limb asymmetry, and high NT-pro-BNP levels were more likely to develop PE, as were those who were obese or immobile. Obesity and lower limb asymmetry were independent predictors of PE during COPD exacerbation (OR = 4.97; 95% CI, 1.775-13.931 and OR = 2.329; 95% CI, 1.127-7.105, respectively).

Conclusions: The prevalence of PE in patients with COPD exacerbation was higher than expected. The association between PE and COPD exacerbation should be considered, especially in patients who are immobile or obese.

Figures

Figure 1. Study design.
Figure 1. Study design.
Figura 1. Desenho do estudo.
Figura 1. Desenho do estudo.

References

    1. Sapey E, Stockley RA. COPD exacerbations . 2: Aetiology . Thorax. 2006;61(3):250–258.
    1. Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA. 1995;274(23):1852–1857.
    1. Rizkallah J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: A systematic review and metanalysis. Chest. 2009;135(3):786–793.
    1. Gunen H, Gulbas G, In E, Yetkin O, Hacievliyagil SS. Venous thromboemboli and exacerbations of COPD. Eur Respir J. 2010;35(6):1243–1248.
    1. Baum GL, Fisher FD. The relationship of fatal pulmonary insufficiency with cor pulmonale, rightsided mural thrombi and pulmonary emboli: a preliminary report. Am J Med Sci. 1960;240:609–612.
    1. Mitchell RS, Silvers GW, Dart GA, Petty TL, Vincent TN, Ryan SF, et al. Clinical and morphologic correlations in chronic airway obstruction. Aspen Emphysema Conf. 1968;9:109–123.
    1. Poulsen SH, Noer I, Møller JE, Knudsen TE, Frandsen JL. Clinical outcome of patients with suspected pulmonary embolism. A follow-up study of 588 consecutive patients. J Intern Med. 2001;250(2):137–143.
    1. Fernández C, Jiménez D, De Miguel J, Martí D, Díaz G, Sueiro A. Chronic obstructive pulmonary disease in patients with acute symptomatic pulmonary embolism [Article in Spanish] Arch Bronconeumol. 2009;45(6):286–290.
    1. Tillie-Leblond I, Marquette CH, Perez T, Scherpereel A, Zanetti C, Tonnel AB, et al. Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors. Ann Intern Med. 2006;144(6):390–396.
    1. Global Initiative for Chronic Obstructive Lung Disease - GOLD . [homepage on the Internet] Bethesda: Global Initiative for Chronic Obstructive Lung Disease ; Global Strategy for the Diagnosis, Management, and Prevention of COPD - Revised 2011. [Adobe Acrobat document, 90p.]; [cited 2013 Aug 26]. 2011. a Available from:
    1. Klok FA, Mos IC, Nijkeuter M, Righini M, Perrier A, Le Gal G, et al. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med. 2008;168(19):2131–2136.
    1. Wells PS, Owen C, Doucette S, Ferguson D, Tran H. Does this patient have deep vein thrombosis? JAMA. 2006;295(2):199–207.
    1. Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med. 1999;159(3):864–871.
    1. Rose BD, TW Post. Clinical physiology of acid-base and electrolyte disorders. New York: McGraw Hill; 1999.
    1. NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Obesity in Adults. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda: National Heart, Lung, and Blood Institute; 1998.
    1. Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr. 2005;82(1):53–59.
    1. Carretero OA, Oparil S. Essential hypertension. Part I: definition and etiology . Circulation. 2000; 101(3):329–335.
    1. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33 Suppl 1:S62–S69.
    1. White CT, Barrett BJ, Madore F, Moist LM, Klarenbach SW, Foley RN, et al. Clinical practice guidelines for evaluation of anemia. Kidney Int Suppl. 2008;(110):S4–S6.
    1. Rutschmann OT, Cornuz J, Poletti PA, Bridevaux PO, Hugli OW, Qanadli SD, et al. Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease? Thorax. 2007;62(2):121–125.
    1. Choi KJ, Cha SI, Shin KM, Lee J, Hwangbo Y, Yoo SS, et al. Prevalence and predictors of pulmonary embolism in Korean patients with exacerbation of chronic obstructive pulmonary disease. Respiration. 2013;85(3):203–209.
    1. Lippmann M, Fein A. Pulmonary embolism in the patient with chronic obstructive pulmonary disease A diagnostic dilemma. Chest. 1981;79(1):39–42.
    1. Rodger MA, Jones G, Rasuli P, Raymond F, Djunaedi H, Bredeson CN, et al. Steady-state end-tidal alveolar dead space fraction and D-dimer: bedside tests to exclude pulmonary embolism. Chest. 2001;120(1):115–119.
    1. Klok FA, Mos IC, Huisman MV. Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism: a systematic review and meta-analysis. Am J Respir Crit Care Med. 2008;178(4):425–430.
    1. Yetkin Ö, In E, Aksoy Y, Hacıevliyagil SS, Günen H. Brain natriuretic peptide in acute pulmonary embolism: its association with pulmonary artery pressure and oxygen saturations. Turkish Resp J. 2006;7(3):105–108.

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