Pulmonary Embolism (PE) in patients with Chronic Obstructive Pulmonary Disease (COPD)
Date Issued
2020-12
Author(s)
Abstract
Introduction: Many studies have shown that COPD is a moderate and independent
factor for PE. Patients with COPD are at a high risk for PE because of systemic
inflammation, limited mobility and co-existing comorbidities: cardiovascular disease,
anemia, polycythemia, malnutrition, muscle disorder, osteoporosis, metabolic
syndrome, diabetes, gastroesophageal reflux, anxiety, depression, hormonal
imbalance, infections, lung cancer, thrombosis.
Methods: Prospective, observational study of 50 hospitalized patients with COPD,
diagnosed according to GOLD criteria (stages I-IV), 40-75 years (mean age 65.4±12.3
divided in subgroups (PE-diagnosed/non-PE and with known/undetermined
exacerbation etiology). Investigations: clinical risk assessment, laboratory, spirometry,
gas-analysis, electrocardiogram, D-dimer (DD), chest X-ray, chest ultrasound. Dopplerultrasonography of deep-veins of lower-extremities. Patients with high DD and
deep vein thrombosis (DVT) or high DD and abnormal chest ultrasound underwent
computed-tomography pulmonary-angiography.
Results: PE was diagnosed in 13(26%) of 50 hospitalized COPD patients. Frequencies
of PE in PE-diagnosed group according to GOLD-stages I-IV, were 0(0.0%), 1(7.7%),
4(30.8%), 8(61.5%) respectively with positive correlation between airflow limitation
and PE. Patients with pleuritic chest-pain, chest ultrasound abnormality, DVT and high
DD were more likely to develop PE. DD was significantly higher among patients with
PE than those without (2.14±1.4μg/ml vs. 1.5±0.4μg/ml, P<0.0001). There was positive
correlation between the presence of PE and elevated DD>2.0μg/ml (P<0.05). 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<0.05 and P<0,0001 respectively.
Conclusion: Clinical manifestations of PE like pleuritic chest pain, dyspnoea are
nonspecific, and easily could be underestimated in COPD patients, which leads to
disease worsening, delay of anticoagulant therapy and higher mortality rate.
factor for PE. Patients with COPD are at a high risk for PE because of systemic
inflammation, limited mobility and co-existing comorbidities: cardiovascular disease,
anemia, polycythemia, malnutrition, muscle disorder, osteoporosis, metabolic
syndrome, diabetes, gastroesophageal reflux, anxiety, depression, hormonal
imbalance, infections, lung cancer, thrombosis.
Methods: Prospective, observational study of 50 hospitalized patients with COPD,
diagnosed according to GOLD criteria (stages I-IV), 40-75 years (mean age 65.4±12.3
divided in subgroups (PE-diagnosed/non-PE and with known/undetermined
exacerbation etiology). Investigations: clinical risk assessment, laboratory, spirometry,
gas-analysis, electrocardiogram, D-dimer (DD), chest X-ray, chest ultrasound. Dopplerultrasonography of deep-veins of lower-extremities. Patients with high DD and
deep vein thrombosis (DVT) or high DD and abnormal chest ultrasound underwent
computed-tomography pulmonary-angiography.
Results: PE was diagnosed in 13(26%) of 50 hospitalized COPD patients. Frequencies
of PE in PE-diagnosed group according to GOLD-stages I-IV, were 0(0.0%), 1(7.7%),
4(30.8%), 8(61.5%) respectively with positive correlation between airflow limitation
and PE. Patients with pleuritic chest-pain, chest ultrasound abnormality, DVT and high
DD were more likely to develop PE. DD was significantly higher among patients with
PE than those without (2.14±1.4μg/ml vs. 1.5±0.4μg/ml, P<0.0001). There was positive
correlation between the presence of PE and elevated DD>2.0μg/ml (P<0.05). 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<0.05 and P<0,0001 respectively.
Conclusion: Clinical manifestations of PE like pleuritic chest pain, dyspnoea are
nonspecific, and easily could be underestimated in COPD patients, which leads to
disease worsening, delay of anticoagulant therapy and higher mortality rate.
Subjects
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