Pulmonary embolism was detected within 48 hours of admission in about 6% of patients with chronic obstructive pulmonary disease (COPD) hospitalized with acutely worsening respiratory symptoms in a recent cross-sectional study.
Researchers conducted the study with prospective follow-up at seven hospitals in France. Within 48 hours of admission in patients with COPD and acute respiratory symptoms, they applied a predefined pulmonary embolism diagnostic algorithm based on Geneva score, D-dimer levels, and spiral computed tomographic pulmonary angiography plus leg compression ultrasound. All patients had three-month follow-up. The primary outcome was pulmonary embolism diagnosed within 48 hours of admission. All pulmonary embolism events were adjudicated and confirmed by an independent clinical events committee. Secondary outcomes included pulmonary embolism during follow-up among patients who were deemed not to have venous thromboembolism (VTE) at admission and who did not receive anticoagulant treatment. Other outcomes were VTE (pulmonary embolism and/or deep venous thrombosis) at admission and during follow-up, as well as three-month mortality, irrespective of whether VTE was clinically suspected. Results were published online on Jan. 5 by JAMA.
A total of 740 patients (mean age, 68.2 years; 37.0% women) were included in the study. Pulmonary embolism was confirmed within 48 hours of admission in 44 patients (5.9%; 95% CI, 4.5% to 7.9%). Pulmonary embolism occurred during follow-up in five of the 670 patients who were deemed not to have VTE at admission and who did not receive anticoagulation (0.7%; 95% CI, 0.3% to 1.7%), including three deaths related to pulmonary embolism. The overall three-month mortality rate was 6.8% (95% CI, 5.2% to 8.8%; 50 of 740 patients). The proportion of patients who died during follow-up was higher among those with VTE at admission than in those without it (14 [25.9%] of 54 patients vs. 36 [5.2%] of 686 patients; risk difference, 20.7% [95% CI, 10.7% to 33.8%]; P<0.001). Six (42%) of the 14 deaths in the VTE group were related to cancer. The prevalence of VTE was 11.7% (95% CI, 8.6% to 15.9%) among patients with suspected pulmonary embolism (n=299) and 4.3% (95% CI, 2.8% to 6.6%) among those in whom pulmonary embolism was not suspected (n=441).
Among other limitations, patients with mild acutely worsening respiratory symptoms and those with severe respiratory failure were likely underrepresented in the study, the authors noted. They added that among the 686 patients deemed not to have VTE within 48 hours of admission, 121 (17.6%) did not complete the full initial assessment for pulmonary embolism, mostly due to limited access to leg ultrasound.
“In practice, clinicians should consider the probability of an underlying cancer when pulmonary embolism is diagnosed in patients with COPD exacerbation. … Further research is needed to understand the possible role of systematic screening for pulmonary embolism in this patient population,” the authors wrote.