Incidence Rate and Clinical Characteristics of Pulmonary Embolism in Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Objective To evaluate the prevalence of pulmonary embolism(PE)in acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to compare the auxiliary examinations and clinical features of AECOPD combined with PE.Methods A prospective,multicenter study was conducted on AECOPD patients admitted to the respiratory department in 8 Chinese hospitals from December 2016 to January 2023.Computed tomographic pulmonary angiography was performed to determine whether PE was present,and clinical data of patients were collected and compared.Results A total of 731 AECOPD patients were included,with a PE prevalence rate of 15.3％.The incidence of reduced sputum(81.3％vs 42.0％,P＜0.01),chest pain(24.1％vs 9.2％),hemoptysis(11.6％vs 2.0％),palpitations(24.1％vs 0.5％)and syncope(6.3％vs 0.2％)in AECOPD patients with PE were significantly higher than those in AECOPD patients alone(P＜0.001).Compared with the AECOPD group with PE alone,the PaO2 was(76.27±26.22)mm Hg vs(76.01±25.67)mm Hg and PaCO2 was(45.63±15.13)mm Hg vs(47.23±13.11)mm Hg,and there was no statistically significant difference between the two groups(P＞0.05).Multivariate logistic regression analysis showed that D-dimer(OR=52.608,95％CI 10.610～206.068),N-terminal pro-brain natriuretic peptide(OR=3.013,95％CI 1.532～4.013),and reduced sputum(OR=5.103,95％CI 2.953～8.635)were related factors for the occurrence of PE in AECOPD.In terms of imaging,among the 112 cases of PE,there were 69 cases(61.6％)of bilateral PE and 73 cases(65.2％)of multiple PE.There were 5 cases(4.5％)with thrombus located on the main pulmonary artery trunk,16 cases(14.3％)above the left and right pulmonary artery trunk,44 cases(39.3％)above the lobar pulmonary artery,and 13 cases(11.6％)above the segmental,subsegmental and lower pulmonary arteries.According to the risk stratification of PE,there were 0 case of high-risk PE;44 cases of medium risk PE(39.3％),among them,there were 15 cases of medium high risk PE(13.4％)and 29 cases of medium low risk PE(25.9％);68 cases of low risk PE(60.7％).Conclusion The proportion of AECOPD combined with PE is high,and the possibility of PE should be considered when chest pain,hemoptysis,palpitations and syncope occur.D-dimer,elevated N-terminal pro-brain natriuretic peptide,and reduced sputum are important factors related to the occurrence of PE in AECOPD.This suggests that hospitalized AECOPD patients with PE may not have obvious sputum symptoms,and the cause of chronic obstructive pulmonary disease with acute exacerbation is not infection,but may be combined with PE.The location of thrombosis in AECOPD patients with PE conforms to the anatomical characteristics of general PE,and the risk stratification is mainly low risk,with high risk being rare.
Acute exacerbation of chronic obstructive pulmonary diseasePulmonary embolismIncidence rateClinical features
万方数据
维普
