open access
Prevalence and risk factors for Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT) during Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)
, 1, 1
Affiliations- General Hospital ,,8-th September, Pariska bb, 1000 Skopje, North Macedonia
open access
Abstract
Introduction: COPD patients are at high risk for PE and DVT due to immobility, inflammation, comorbidities.
Prevalence of PE during AECOPD is uncertain and often under-diagnosed.
Material and methods: Single-center, prospective, an observational trial of 100 hospitalized patients with AECOPD, diagnosed according to GOLD criteria, 40–75 years, stratified according to airflow limitation (I–IV), divided into subgroups (PE-diagnosed/non-PE and with known/ undetermined exacerbation etiology).
Investigations: clinical risk assessment, electrocardiogram (ECG), laboratory, spirometry, gas-analysis, D-dimer (DD), chest X-ray, thoracic ultrasonography (TUS), Doppler-ultrasonography of deep-veins of lower-extremities (DULE). Patients with high DD and DVT or high DD and abnormal TUS underwent computed-tomography pulmonary-angiography (CTPA).
Results: PE was diagnosed in 26 (26.0%), DVT in 5 (5.0%) of hospitalized AECOPD patients. There was a positive correlation between COPD-severity and PE. Frequencies of PE in GOLD-stages I, IV, were 0 (0.0%), 3 (11.5%), 8 (30.7%), 15 (57.7%) respectively. Patients with pleuritic chest-pain, TUS abnormality, phlebitis and high DD were more likely to develop PE. Localization was subsegmental in 9 (34.6%), in one of the main pulmonary arteries 7 (26.9%), lobar and interlobar arteries in 10 (38.5%). DD was significantly higher among patients with PE than those without (3.34 ± 1.1 μg/mL vs. 2.2 ± 0.8μg/mL, P < 0.0001). There was positive correlation between the presence of PE and elevated DD > 2.0 μg/mL (P = 0.02). There was no statistically significant difference between patients with PE and without, according to age, gender and comorbidities (P > 0.05). Immobility and obesity were significantly higher among PE patients, P = 0.032 and P < 0.0001 respectively.
Conclusion: AECOPD associated with pleuritic chest pain, immobility, high DD, should be considered for PE. Chest-ultrasound, as a low-cost and safe procedure, can be a very helpful investigation.
Abstract
Introduction: COPD patients are at high risk for PE and DVT due to immobility, inflammation, comorbidities.
Prevalence of PE during AECOPD is uncertain and often under-diagnosed.
Material and methods: Single-center, prospective, an observational trial of 100 hospitalized patients with AECOPD, diagnosed according to GOLD criteria, 40–75 years, stratified according to airflow limitation (I–IV), divided into subgroups (PE-diagnosed/non-PE and with known/ undetermined exacerbation etiology).
Investigations: clinical risk assessment, electrocardiogram (ECG), laboratory, spirometry, gas-analysis, D-dimer (DD), chest X-ray, thoracic ultrasonography (TUS), Doppler-ultrasonography of deep-veins of lower-extremities (DULE). Patients with high DD and DVT or high DD and abnormal TUS underwent computed-tomography pulmonary-angiography (CTPA).
Results: PE was diagnosed in 26 (26.0%), DVT in 5 (5.0%) of hospitalized AECOPD patients. There was a positive correlation between COPD-severity and PE. Frequencies of PE in GOLD-stages I, IV, were 0 (0.0%), 3 (11.5%), 8 (30.7%), 15 (57.7%) respectively. Patients with pleuritic chest-pain, TUS abnormality, phlebitis and high DD were more likely to develop PE. Localization was subsegmental in 9 (34.6%), in one of the main pulmonary arteries 7 (26.9%), lobar and interlobar arteries in 10 (38.5%). DD was significantly higher among patients with PE than those without (3.34 ± 1.1 μg/mL vs. 2.2 ± 0.8μg/mL, P < 0.0001). There was positive correlation between the presence of PE and elevated DD > 2.0 μg/mL (P = 0.02). There was no statistically significant difference between patients with PE and without, according to age, gender and comorbidities (P > 0.05). Immobility and obesity were significantly higher among PE patients, P = 0.032 and P < 0.0001 respectively.
Conclusion: AECOPD associated with pleuritic chest pain, immobility, high DD, should be considered for PE. Chest-ultrasound, as a low-cost and safe procedure, can be a very helpful investigation.
Keywords
COPD, D-dimer, pulmonary embolism, deep vein thrombosis, chest ultrasonography, lung computed tomography angiography
About this articleTitle
Prevalence and risk factors for Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT) during Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)
Journal
Issue
Article type
Original article
Pages
79-85
Published online
2020-06-15
Page views
709
Article views/downloads
778
DOI
Bibliographic record
Medical Research Journal 2020;5(2):79-85.
Keywords
COPD
D-dimer
pulmonary embolism
deep vein thrombosis
chest ultrasonography
lung computed tomography angiography
Authors
Daniela Buklioska Ilievska
Ivana Trajkovska
Melina Kuzmanovska Dimitrovska
References (22)- Global Initiative for Chronic Obstructive Lung Disease (GOLD). Executive Summary: Global Strategy for Diagnosis, Management, and Prevention of COPD - Updated 2020.
- Akpinar EE, Hoşgün D, Akpinar S, et al. Incidence of pulmonary embolism during COPD exacerbation. J Bras Pneumol. 2014; 40(1): 38–45.
- Hassen MF, Tilouche N, Jaoued O, et al. Incidence and Impact of Pulmonary Embolism During Severe COPD Exacerbation. Respir Care. 2019; 64(12): 1531–1536.
- Couturaud F, Bertoletti L, Sanchez O, et al. Frequency Pulmonary embolism (PE) in patients with an acute Exacerbation of chronic obstructive Pulmonary disease (COPD). PEP prospective trial. Eur Respir J. 2019; 54(63): PA3637.
- Perrier A, Perneger T, Cornuz J, et al. COPD-PE study. [The COPD-PE study: prevalence and prediction of pulmonary embolism in acute exacerbations of chronic obstructive pulmonary disease]. Rev Mal Respir. 2004; 21(4 Pt 1): 791–796.
- Tompkins R, Harris V, Brown C, et al. Diagnosing Pulmonary Embolism in Patients with Suspected or Established Chronic Lung Disease. The Southwest Respiratory and Critical Care Chronicles. 2014; 2(8): 5.
- MacNee W. Systemic inflammatory biomarkers and co-morbidities of chronic obstructive pulmonary disease. Ann Med. 2013; 45(3): 291–300.
- Szturmowicz M, Kacprzak A, Wyrostkiewicz D, et al. Non-high risk PE in the patients with acute or exacerbated respiratory disease: the value of the algorithm based on D-dimer evaluation and Revised Geneva Score. Pneumonol Alergol Pol. 2015; 83(6): 445–452.
- Silva DR, Coelho AC, Gazzana MB, et al. D-dimer levels in stable COPD patients: a case-control study. COPD. 2012; 9(4): 426–431.
- Gunen H, Gulbas G, In E, et al. Venous thromboemboli and exacerbations of COPD. Eur Respir J. 2010; 35(6): 1243–1248.
- Comert SS, Caglayan B, Akturk U, et al. The role of thoracic ultrasonography in the diagnosis of pulmonary embolism. Ann Thorac Med. 2013; 8(2): 99–104.
- Reissig A, Copetti R, Kroegel C. Current role of emergency ultrasound of the chest. Crit Care Med. 2011; 39(4): 839–845.
- Jiménez D, Aujesky D, Moores L, et al. RIETE Investigators. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010; 170(15): 1383–1389.
- Bertoletti L, Quenet S, Mismetti P, et al. RIETE Investigators. Clinical presentation and outcome of venous thromboembolism in COPD. Eur Respir J. 2012; 39(4): 862–868.
- Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006; 144(3): 165–171.
- Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001; 135(2): 98–107.
- Tillie-Leblond I, Marquette CH, Perez T, 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.
- Choi KJ, Cha SI, Shin KM, et al. Prevalence and predictors of pulmonary embolism in Korean patients with exacerbation of chronic obstructive pulmonary disease. Respiration. 2013; 85(3): 203–209.
- Rizkallah J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis. Chest. 2009; 135(3): 786–793.
- Bertoletti L, Quenet S, Laporte S, et al. RIETE Investigators. Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry. Respir Res. 2013; 14: 75.
- Pang H, Wang L, Liu J, et al. The prevalence and risk factors of venous thromboembolism in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease. Clin Respir J. 2018; 12(11): 2573–2580.
- Baz A, Hamdy I, Mohammed A, et al. Diagnostic validity of thoracic ultrasound in the assessment of pulmonary embolism. Egypt J Radiol Nucl Med. 2019; 50(1).