Pulmonary embolism detected in 6% of patients with COPD, worsening respiratory symptoms

Using a diagnostic algorithm, pulmonary embolism was detected in nearly 6% of patients hospitalized with COPD with acute worsening of respiratory symptoms, according to a study published in JAMA.

“Patients with COPD more often develop pulmonary embolism than deep vein thrombosis,” Francis Couturaud, MD, PhD, professor of internal medicine in the department of internal medicine and pulmonology at the Center Brest University Hospital and the University of Western Brittany in Brest, France, and colleagues wrote. “However, how and when patients admitted to the hospital for an acute COPD exacerbation should be screened for pulmonary embolism remains challenging.”

Researchers for the multicenter, cross-sectional study recruited 740 patients (mean age, 68.2 years; 37% women) with COPD who were hospitalized with acute worsening of respiratory symptoms at seven French hospitals from 2014 to May 2017. To determine the prevalence of PE in this population, the researchers utilized a predefined PE diagnostic algorithm within 48 hours of admission. The algorithm incorporated Geneva score, D-dimer, spiral CT pulmonary angiography and leg compression ultrasound.

All patients completed 3-month follow-up. The primary outcome was PE diagnosed within 48 hours of admission. The key secondary outcome was PE in the 3-month follow-up in patients without venous thromboembolism and no anticoagulant use.

Researchers detected PE in 5.9% of patients (95% CI, 4.5-7.9) within 48 hours of admission. PE during follow-up was detected in five of 670 patients (0.7%; 95% CI, 0.3-1.7) without VTE at admission and no anticoagulant use, according to the results.

Three deaths related to PE occurred; the overall 3-month mortality rate was 6.8% (95% CI, 5.2-8.8). A higher proportion of patients with VTE at admission died during follow-up compared with patients without VTE (25.9% vs. 5.2%; risk difference, 20.7 percentage points; 95% CI, 10.7-33.8; P < .001), according to the results.

Among patients in whom PE was suspected (n = 299), the prevalence of VTE was 11.7% (95% CI, 8.6-15.9), while the prevalence was 4.3% (95% CI, 2.8-6.6) among those in whom PE was not suspected (n = 441), according to the results.

The researchers noted several limitations of the study, including underrepresentation of patients with mild acutely worsening respiratory symptoms, incomplete assessment of PE in select patients deemed not to have VTE and possible bias as a result of clinical suspicion of PE by ED physicians, among others.

“Further research is needed to understand the possible role of systematic screening for pulmonary embolism in this patient population,” the researchers wrote.