Pulmonary Embolism (PE) in patients with Chronic Obstructive Pulmonary Disease (COPD)

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.