Risk Factors of Pulmonary Embolism in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A retrospective clinical study

Abstract

BACKGROUND: The occurrence of pulmonary thromboembolism (PTE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not rare, which would seriously affect the prognosis and cause high mortality of patients. OBJECTIVE: To investigate the prevalence, risk factors, and clinical characteristics of AECOPD patients with pulmonary embolism (PE) complications in a tertiary care center, aiming to reduce the rate of missed diagnosis of PE in patients with AECOPD. MATERIALS AND METHODS: We performed a retrospective analysis of patients admitted to our hospital with the first diagnosis of AECOPD from January 2015 to November 2019. Patients were divided into AECOPD and AECOPD +PE groups according to whether or not they had PE complications. The clinical data of the two groups were compared and multiple regression analysis was used to explore the risk factors. RESULTS: From January 2015 to November 2019, a total of 636 AECOPD patients (aged 76.60±8.38 years, 529 males) were enrolled in this study. Of them, 7.4% (47/636) were diagnosed with PE. Clinical features including age, chest pain, dyspnea, hemoptysis, syncope, electrocardiogram (ECG), mMRC score, annual acute exacerbation times, history of thrombus, history of surgery within 6 weeks, prolonged immobility ≥3 days, wet rales, pleural effusion, asymmetrical lower extremity edema, history of stroke, pulmonary heart disease, pulmonary encephalopathy, hospitalization days, GOLD grade, total duration, PH, PaCO2, the level of plasma D-dimer and N-terminal pro-brain natriuretic peptide (NT-proBNP) were statistically significant between the two groups (P <0.05). Considering patients with PE as the dependent variables and statistically significant risk factors in the univariate analysis as independent variables, the logistic model analysis was performed. The results indicated that chest pain, syncope, premature ventricular contractions, prolonged immobility ≥3 days, history of stroke, pulmonary heart disease, pulmonary encephalopathy, hospitalization days, D-dimer levels, and acute exacerbation times were independent risk factors for AECOPD complicated with PE (P <0.05). CONCLUSION: Patients hospitalized for AECOPD should have multi-slice spiral computed tomography pulmonary angiography (CTPA) to determine whether they present PE complications as soon as possible when combined with chest pain, pulmonary heart disease, prolonged immobility ≥3 days, plasma D-dimer levels higher, and the times of acute exacerbations has increased significantly in the last year.

The arrival ward requiring help by wheelchair or medical cart, arterial oxygenation index, age, albumin and neutrophil count score: Predicting in-hospital mortality in Chinese patients with acute exacerbations of chronic obstructive pulmonary disease

“…32 Peng et al conducted a retrospective study with 6668 patients hospitalized for AECOPD, and reported that the in-hospital mortality was 1.9%. 33 Five other studies with relatively smaller samples reported inhospital mortality rates of 6.0%, 22 7.0%, 34 7.2%, 35 9.7%, 28 and 10.1%, 23 respectively. Therefore, the observed in-hospital mortality rate in our study is in accordance with previous studies.…”

“…31 However, the in-hospital mortality rates were slightly lower in China, which ranged from 1.4% to 10.1%. 22,23,28,[32][33][34][35] Pu et al conducted a prospective cohort study with 12831 AECOPD inpatients, and found that the in-hospital mortality rate was 1.4%. 32 Peng et al conducted a retrospective study with 6668 patients hospitalized for AECOPD, and reported that the in-hospital mortality was 1.9%.…”