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Original Investigation
January 5, 2021

Prevalence of Pulmonary Embolism Among Patients With COPD Hospitalized With Acutely Worsening Respiratory Symptoms

Author Affiliations
  • 1Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Brest, France
  • 2EA 3878, INSERM CIC 1412, Université de Bretagne Occidentale, Brest, France
  • 3FCRIN INNOVTE, France
  • 4Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France
  • 5INSERM CIC 1408, INSERM UMR 1059, Université Jean Monnet, Saint-Etienne, France
  • 6Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
  • 7INSERM UMR S 1140, Université de Paris; Paris, France
  • 8Service des urgences, Centre Hospitalo-Universitaire d’Angers, France
  • 9Institut MITOVASC, EA 3860, Université d'Angers, Angers, France
  • 10Département de Pneumologie, Centre Hospitalo-Universitaire d’Angers, France
  • 11INSERM UMR1063, Université d’Angers, Angers, France
  • 12Service de pneumologie-allergologie-cancérologie thoracique, HIA Sainte Anne, Toulon, France
  • 13Service des urgences, Centre Hospitalo-Universitaire de Clermont-Ferrand, France
  • 14UMR 6024 UCA-CNRS, Université de Clermont-Ferrand, Clermont-Ferrand, France
  • 15Service des urgences, Centre Hospitalier de Quimper, Quimper, France
  • 16Service d’Echo-doppler Vasculaire, Centre Hospitalo-Universitaire de Brest, Brest, France
  • 17Service de radiologie, Centre Hospitalo-Universitaire de Brest, Brest, France
  • 18Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de Brest, France
  • 19EA 3878, Université de Bretagne Occidentale, Brest, France
  • 20INSERM CIC 1412, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
  • 21Département Thoracique, Institut Mutualiste Montsouris, Paris, France
  • 22INSERM 1078, Université de Bretagne Occidentale, Brest, France
  • 23INSERM UMR S 970, Université de Paris, Paris, France
JAMA. 2021;325(1):59-68. doi:10.1001/jama.2020.23567
Key Points

Question  How common is pulmonary embolism among patients with chronic obstructive pulmonary disease who are admitted to the hospital with acutely worsening respiratory symptoms?

Findings  In this cross-sectional study with prospective follow-up that used a predefined pulmonary embolism diagnostic algorithm and included 740 consecutive patients with chronic obstructive pulmonary disease, pulmonary embolism was detected in 5.9% of patients.

Meaning  Among patients with chronic obstructive pulmonary disease admitted to the hospital with an acute worsening of respiratory symptoms, pulmonary embolism was detected in 5.9% patients using a predefined diagnostic algorithm.

Abstract

Importance  The prevalence of pulmonary embolism in patients with chronic obstructive pulmonary disease (COPD) and acutely worsening respiratory symptoms remains uncertain.

Objective  To determine the prevalence of pulmonary embolism in patients with COPD admitted to the hospital for acutely worsening respiratory symptoms.

Design, Setting, and Participants  Multicenter cross-sectional study with prospective follow-up conducted in 7 French hospitals. A predefined pulmonary embolism diagnostic algorithm based on Geneva score, D-dimer levels, and spiral computed tomographic pulmonary angiography plus leg compression ultrasound was applied within 48 hours of admission; all patients had 3-month follow-up. Patients were recruited from January 2014 to May 2017 and the final date of follow-up was August 22, 2017.

Exposures  Acutely worsening respiratory symptoms in patients with COPD.

Main Outcomes and Measures  The primary outcome was pulmonary embolism diagnosed within 48 hours of admission. Key secondary outcome was pulmonary embolism during a 3-month follow-up among patients deemed not to have venous thromboembolism at admission and who did not receive anticoagulant treatment. Other outcomes were venous thromboembolism (pulmonary embolism and/or deep vein thrombosis) at admission and during follow-up, and 3-month mortality, whether venous thromboembolism was clinically suspected or not.

Results  Among 740 included patients (mean age, 68.2 years [SD, 10.9 years]; 274 women [37.0%]), pulmonary embolism was confirmed within 48 hours of admission in 44 patients (5.9%; 95% CI, 4.5%-7.9%). Among the 670 patients deemed not to have venous thromboembolism at admission and who did not receive anticoagulation, pulmonary embolism occurred in 5 patients (0.7%; 95% CI, 0.3%-1.7%) during follow-up, including 3 deaths related to pulmonary embolism. The overall 3-month mortality rate was 6.8% (50 of 740; 95% CI, 5.2%-8.8%). The proportion of patients who died during follow-up was higher among those with venous thromboembolism at admission than the proportion of those without it at admission (14 [25.9%] of 54 patients vs 36 [5.2%] of 686; risk difference, 20.7%, 95% CI, 10.7%-33.8%; P < .001). The prevalence of venous thromboembolism was 11.7% (95% CI, 8.6%-15.9%) among patients in whom pulmonary embolism was suspected (n = 299) and was 4.3% (95% CI, 2.8%-6.6%) among those in whom pulmonary embolism was not suspected (n = 441).

Conclusions and Relevance  Among patients with chronic obstructive pulmonary disease admitted to the hospital with an acute worsening of respiratory symptoms, pulmonary embolism was detected in 5.9% of patients using a predefined diagnostic algorithm. Further research is needed to understand the possible role of systematic screening for pulmonary embolism in this patient population.

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