Venous thromboemboli and exacerbations of COPD

Günen, Hakan; Gülbaş, Gazi; İn, Erdal; Yetkin, Özkan; Hacievlıyagıl, Süleyman Savaş

doi:10.1183/09031936.00120909

Cited by 95 publications

(113 citation statements)

References 18 publications

(20 reference statements)

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“…COPD is an independent risk factor for PE (8), so once patients with AECOPD develop PE, respiratory and circulatory functions may deteriorate further, potentially becoming life threatening. Consistent with this observation, the mortality rate also significantly increases for patients with AECOPD/PE (9,10). Thus, the early prediction and diagnosis for patients with AECOPD, with or without PE, is crucial.…”

Section: Introductionsupporting

confidence: 56%

Eosinophilic biomarkers for detection of acute exacerbation of chronic obstructive pulmonary disease with or without pulmonary embolism

Yang

Lü

Shu

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Eosinophilia has been implicated in the pathophysiology of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the role of eosinophil activation in the development of AECOPD remains unclear. In the present study, the reliability of plasma levels of eosinophil activation markers, including eosinophil cationic protein (ECP), major basic protein (MBP), eosinophil-derived neurotoxin (EDN) and eosinophil peroxidase (EPX), were measured and used as diagnostic biomarkers of AECOPD with or without pulmonary embolism (PE). A total of 47 patients with AECOPD, 30 patients with AECOPD/PE and 35 healthy adults were enrolled in the present study. Plasma levels of ECP, EDN, EPX and MBP were measured using commercial ELISA kits. The mean concentrations of plasma ECP, EDN, EPX and MBP in the patients with AECOPD was significantly 2.87-, 3.06-, 1.60-and 1.92-fold higher, respectively, compared with the control group (P<0.05). Similar results were obtained in patients with AECOPD/PE, for whom plasma levels of ECP, EDN, EPX and MBP were significantly 2.06-, 2.21-, 1.42-and 2.42-fold higher, respectively, compared with the controls (P<0.05). No significant differences were observed in the levels of these proteins between patients with AECOPD or AECOPD/PE. Among the four potential markers, ECP was determined to be the optimal marker for distinguishing patients with AECOPD or AECOPD/PE from the controls. No significant correlation was observed between marker concentrations and gender, age or disease severity. The results of the present study may have clinical applications in the diagnosis of AECOPD using these novel biomarkers.

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Section: Introductionsupporting

confidence: 56%

Eosinophilic biomarkers for detection of acute exacerbation of chronic obstructive pulmonary disease with or without pulmonary embolism

Yang

Lü

Shu

et al. 2017

Experimental and Therapeutic Medicine

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“…4 VTE has also been associated with COPD exacerbations with identifiable triggers, accounting for up to 16% of hospitalized patients with COPD exacerbations. 9 Another study found the incidence of PE in COPD exacerbations to be 29%. 8 In a population-based study of 2488 patients with VTE, 19.5% had a history of COPD.…”

Section: Discussionmentioning

confidence: 99%

“…One study found significantly higher 1 -year mortality in COPD exacerbation with VTE (61.9% vs. 31.8%, p=0.013). 9 Another showed increased duration of hospitalization and need for mechanical ventilation. 5 Based on current data, it is unclear what COPD risk factors or clinical characteristics places patients at increased VTE risk.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Venous Thromboembolism in Chronic Obstructive Pulmonary Disease

Kim¹,

Goel²,

Gangar³

et al. 2014

J COPD F

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Background COPD patients are at increased risk for venous thromboembolism (VTE). VTE however remains under-diagnosed in this population and the clinical profile of VTE in COPD is unclear. Methods Global initiative for chronic Obstructive Lung Disease (GOLD) stages II-IV participants in the COPD Genetic Epidemiology (COPDGene) study were divided into 2 groups: VTE+, those who reported a history of VTE by questionnaire, and VTE−, those who did not. We compared variables in these 2 groups with either t-test or chi-squared test for continuous and categorical variables, respectively. We performed a univariate logistic regression for VTE, and then a multivariate logistic regression using the significant predictors of interest in the univariate analysis to ascertain the determinants of VTE. Results The VTE+ group was older, more likely to be Caucasian, had a higher body mass index (BMI), smoking history, used oxygen, had a lower 6-minute walk distance, worse quality of life scores, and more dyspnea and respiratory exacerbations than the VTE− group. Lung function was not different between groups. A greater percentage of the VTE+ group described multiple medical comorbidities. On multivariate analysis, BMI, 6-minute walk distance, pneumothorax, peripheral vascular disease, and congestive heart failure significantly increased the odds for VTE by history. Conclusions BMI, exercise capacity, and medical comorbidities were significantly associated with VTE in moderate to severe COPD. Clinicians should suspect VTE in patients who present with dyspnea and should consider possibilities other than infection as causes of COPD exacerbation.

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“…4 Gunen studied 131 patients with known and unknown causes of COPD exacerbations and followed them for a year. 5 All patients were evaluated with Wells and Geneva criteria and D-dimer assays and underwent CTA to investigate for thrombi in the lower extremities and emboli in the lung and Doppler ultrasound studies of the lower limbs. The frequency of VTE was 16%.…”

Section: In This Issue Of the Southwest Respiratorymentioning

confidence: 99%

“…1 Since patients with COPD have reduced gas exchange and pulmonary vascular reserve, PE may have a worse outcome in these patients, and they have an increased one year mortality rate. 4,5 Some studies suggested that COPD may increase biological thrombotic activities. 6 In addition, during COPD exacerbations patients often have limited mobilization due to dyspnea, and most patients with COPD are either former or current smokers which increases the VTE risk.…”

Section: In This Issue Of the Southwest Respiratorymentioning

confidence: 99%

Pulmonary embolus and acute exacerbations of chronic obstructive pulmonary disease

Edriss¹,

Nugent

2014

SW Resp Crit Care Chron

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EditorialIn this issue of The Southwest Respiratory and Critical Care Chronicles, Thompkins and coworkers report a series of four patients with presumed chronic lung disease who presented with acute exacerbations of respiratory symptoms which did not respond to conventional therapy.1 Pulmonary angiography by computed tomography (CTA) eventually demonstrated bilateral pulmonary emboli (PE) in these patients. The authors then discuss the difficulty in making the diagnosis of PE in patients with established chronic lung disease, especially patients who have the diagnosis of COPD. This report raises several important questions, including the frequency of PE in patients with acute exacerbations of COPD, the diagnostic utility of Wells and other criteria in this patient group, the diagnostic utility of D-dimer assays, the best approach to diagnosis in these patients, and the outcomes in these patients.Tillie-Leblond et al investigated the frequency of PE in patients with COPD who were hospitalized with severe exacerbations of unknown origin and did not require invasive mechanical ventilation and investigated the factors associated with PE.2 One hundred and ninety-seven patients with COPD exacerbation were included; all patients had spiral CTAs and 180 had Doppler ultrasound studies of the lower extremities. Forty-three patients had a positive CTA. Six patients had a positive ultrasound study and a negative CTA; 19 of the 43 patients (44%) with confirmed PE by spiral CTA had positive results on the Doppler ultrasound studies. Overall 49 patients (25%) had PE by their criteria which included either a positive CTA or a positive Doppler study and a negative CTA. The risk factors for PE included a previous thromboembolic event, malignant disease, and a decrease in PaCO 2 >5 mmHg from the base line.2 Symptoms and signs, such as pleuritic chest pain, hemoptysis, palpitations, hypoxemia with a PaO 2 <60 mmHg, a PaCO 2 <39 mmHg, and HR >100 beats per minute, did not predict the diagnosis of PE in these patients. The presence of cough was not helpful in supporting the diagnosis of a typical COPD exacerbation.2 Eleven patients with low probability Geneva scores (9% of 119 with low probability in study cohort), 35 patients with intermediate probability scores (47% of 75 with intermediate probability), and three patients with high probability scores (100% of three with high probability) had confirmed PE.Bertoletti and his colleagues prospectively evaluated COPD patients who had venous thromboembolic disease (VTE, i.e., DVT and/or PE) and found that COPD patients presented more frequently with PE (59%) than with DVT (41%).3 Compared to non-COPD patients the three month prognosis in patients with COPD and PE was worse, and they had higher mortality rates and more VTE recurrences. 3 In 2013 Bertoletti et al reviewed 4036 patients with COPD enrolled in Registro Informatizado de la Enfermedad TromboEmbolica registry. 4 The patients presented with symptomatic VTE and were followed for three months. COPD patients with PE had a higher cum...

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Venous thromboemboli and exacerbations of COPD

Cited by 95 publications

References 18 publications

Eosinophilic biomarkers for detection of acute exacerbation of chronic obstructive pulmonary disease with or without pulmonary embolism

Eosinophilic biomarkers for detection of acute exacerbation of chronic obstructive pulmonary disease with or without pulmonary embolism

Risk Factors for Venous Thromboembolism in Chronic Obstructive Pulmonary Disease

Pulmonary embolus and acute exacerbations of chronic obstructive pulmonary disease

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