Prevalence and Predictors of Pulmonary Embolism in Korean Patients with Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Background: Data concerning the rate of pulmonary embolism (PE) in Asian patients with chronic obstructive pulmonary disease (COPD) exacerbation are sparse, and no study has shown predictors of PE in these patients. Objectives: The purpose of the present study was to investigate the prevalence and predictors of PE in Korean patients with COPD exacerbation. Methods: Hospitalized patients with COPD exacerbations were prospectively enrolled into this study and underwent computed tomography (CT) pulmonary angiography and indirect CT venography. Results: The most common cause of COPD exacerbation was lower respiratory tract infection (82%; n = 84), followed by PE (5%; n = 5). Eight patients (8%) had venous thromboembolism, and deep vein thrombosis (DVT) was seen in 6%, with proximal DVT in 4%. On multivariate analysis, the absence of symptoms of respiratory infection and plasma D-dimer elevation (≥500 µg/l) were significant factors predicting PE in patients with COPD exacerbations (odds ratio 31, 95% confidence interval 2-563, p = 0.02, and odds ratio 25, 95% confidence interval 1-464, p = 0.03, respectively). Conclusions: PE comprises approximately 5% of the etiologies of COPD exacerbations in Koreans. The absence of symptoms suggestive of respiratory infection and elevated plasma D-dimer levels were significant predictors of PE in this population.

Pulmonary Embolism in Patients Hospitalized for Exacerbated COPD and Wheezing

“…When comparing our exacerbated COPD patients with wheezing at presentation, cough appeared less frequent with Wells or Geneva clinical scores higher in patients with PE than without PE suggesting that exacerbation in patients without PE might be related to a viral and/or bacterial bronchitis ( Table 2). As Choi et al [13], we found that increased values of plasma D-dimers (≥500 µg/L) was a significant predicting factor of PE but no correlations were found between unexpected VTE events and the severity of COPD assessed through the GOLD stages. This result invalidated our hypothesis that the most severe COPD patients are more exposed to VTE and that such VTE events could explain in part the increased mortality observed in the literature in patients from GOLD stage 1 to GOLD stage 4 [15][16][17].…”

“…According to the 2009 meta-analysis [8], the prevalence of PE in patients with exacerbated COPD ranges from 3.3% when evaluated in an emergency department [9] to 19-29% in outpatients and inpatients [10,11] reaching a maximum of 25-29% in patients requiring hospitalization [3,12]. In our study, subgroup analysis shows that VTE tended to be more frequent in COPD patients that required ICU hospitalization compared to those who were hospitalized in the pneumology ward (respectively, 20.5% vs. 9.8%, NS) but this assertion remains to be confirmed regarding the conflicting data recently published on PE prevalence in patients hospitalized in medical centers: 8% in a Korean population [13] versus 18% in an Israelite population [14]. These discrepancies suggest that other risk factors than COPD exacerbation by itself or hospitalization-induced immobilization lead to PE such as comorbidities exposing to a supplemental risk of PE (i.e.…”

Pulmonary embolism concurrent with lung cancer and central emboli predict mortality in patients with lung cancer and pulmonary embolism

“…PE was determined as unprovoked when no reversible provoking risk factors, such as surgery, trauma, pregnancy and puerperium within 3 months of the event, or immobilization (bed rest within the previous month for most of the day for ≥3 consecutive days) existed (16). The PESI score was retrospectively calculated (17).…”

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

“…The increase of DD concentration in COPD may be caused by infective exacerbation. Nevertheless, data from literature indicate that VTE has been responsible for DD increase in 5-38% of patients with COPD exacerbation [32,33]. Choi et al found that DD ≥ 500 ng/mL and the absence of symptoms of respiratory infection, were the significant predictors of PE in the Korean patients with COPD exacerbation [32].…”

“…Nevertheless, data from literature indicate that VTE has been responsible for DD increase in 5-38% of patients with COPD exacerbation [32,33]. Choi et al found that DD ≥ 500 ng/mL and the absence of symptoms of respiratory infection, were the significant predictors of PE in the Korean patients with COPD exacerbation [32]. Fruchter et al found that elevated DD was a reliable prognostic marker for those COPD patients in whom PE was excluded [34].…”