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Johnson A, Piplani S, Akpan E, Zinobia K, Bachan M, Radulovic M. Impact of connective tissue diseases on inpatient outcomes in gastrointestinal bleeding: insights from a national database analysis. Transl Gastroenterol Hepatol 2024; 9:35. [PMID: 39091649 PMCID: PMC11292097 DOI: 10.21037/tgh-24-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/18/2024] [Indexed: 08/04/2024] Open
Abstract
Background Connective tissue diseases (CTDs) are characterized by immune system dysregulation, which can profoundly impact the gastrointestinal (GI) system. While GI bleeding is a well-recognized cause of mortality and morbidity in the USA, its occurrence in patients with CTD remains documented but underexplored in terms of inpatient outcomes. GI bleeding in CTD is attributed to factors such as vasculopathy and drug-related risks, notably steroids and non-steroidal anti-inflammatory drugs (NSAIDs). This research seeks to conduct a comprehensive national-level analysis, utilizing the National Inpatient Sample (NIS), to compare GI bleeding outcomes between patients with CTD and those without this condition. Methods Utilizing the extensive NIS database covering 2020, we conducted a retrospective analysis of GI bleeding patients with CTD, identified through the International Classification of Diseases, 10th Revision (ICD-10). The primary outcome was in-hospital mortality. The secondary outcomes included rate of urgent esophagogastroduodenoscopy (EGD) and colonoscopy-endoscopy in 1 day or less, total rate of EGD and colonoscopy, rate of EGD and Colonoscopy with intervention, rate of complications including acute kidney injury (AKI), blood transfusion, sepsis, pneumonia, pulmonary embolism (PE) and healthcare utilization. Employing Stata software, we utilized multivariate logistic and linear regression analyses to adjust for confounders. Results There were 455,494 hospitalizations for GI bleeding and 19,874 involved patients with CTDs. The in-hospital mortality rate was significantly lower for CTD patients at 2.1%, compared to 2.4% for non-CTD patients [adjusted odds ratio (aOR): 0.79, 95% confidence interval (CI): 0.63-0.99, P=0.04]. CTD patients showed increased odds of total EGD, urgent colonoscopy, and total colonoscopy; however, these changes were not statistically significant. CTD patients had higher odds of complications, including PE (6.87% vs. 4.12%, P=0.009). However, there were no significant differences in mean length of hospital stay and total hospital charges (THCs) compared to non-CTD patients. Conclusions Patients with CTD exhibited a lower in-hospital mortality rate compared to those without CTD. The elevated risk of PE underscores the importance of implementing prophylactic measures for these patients.
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Affiliation(s)
- Adejoke Johnson
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx Hospital, New York, NY, USA
| | - Shobhit Piplani
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx Hospital, New York, NY, USA
| | - Ezekiel Akpan
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx Hospital, New York, NY, USA
| | - Khan Zinobia
- Department of Internal Medicine, James J Peters VA Medical Center, New York, NY, USA
| | - Moses Bachan
- Department of Internal Medicine, James J Peters VA Medical Center, New York, NY, USA
| | - Miroslav Radulovic
- Department of Internal Medicine, Jacobi Medical Center/North Central Bronx Hospital, New York, NY, USA
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Li R, Zeng J, Sun D, Li D. The challenges of identifying pulmonary embolism in patients hospitalized for exacerbations of COPD. Respir Med Res 2024; 86:101122. [PMID: 38972110 DOI: 10.1016/j.resmer.2024.101122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 06/15/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with airflow obstruction that threatens global health. During the hospitalization of patients with acute exacerbations of COPD (AECOPD), the high prevalence of pulmonary embolism (PE) seriously affects the prognosis of disease. This study aims to assess the differences in clinical data between patients with AECOPD and patients with AECOPD-PE, and to identify the relevant factors of PE. METHODS We performed a retrospective case-control study in AECOPD patients between January 2018 and December 2021. Due to suspected PE, all patients underwent radiological examination. Patients without PE were included as controls. Clinical data and laboratory tests were recorded. Univariate analysis and multivariate logistic regression analysis were used to investigate the independent predictors of PE. Receiver operating characteristics (ROC) curves was performed to evaluate the effect of risk factors on PE prediction. RESULTS A total of 191 patients were included for analysis, divided into the AECOPD group (96 cases) and AECOPD-PE group (95 cases). No statistic differences were detected in demographic characteristics between patients with AECOPD and patients with AECOPD and PE. Average PO2 and PCO2 levels, lung function, and Echocardiographic indicator were not associated with PE. The concentration of D-dimer, the proportion of simplified wells score ≥ 2, and the incidence rate of lower extremity deep vein thrombosis (DVT) remarkably increased in AECOPD-PE group than AECOPD individuals. At multivariate analysis, the above three indicators were closely relevant to the occurrence of PE. The AUC value for D-dimer combined with lower extremity DVT and Simplified Wells Score was 0.729. CONCLUSIONS D-dimer, lower extremity DVT, and simplified wells score ≥ 2 were relevant to higher risks of PE, which will help to improve clinicians' understanding of PE secondary to AECOPD.
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Affiliation(s)
- Rufang Li
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology. Kunming 650022, China
| | - Jie Zeng
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology. Kunming 650022, China
| | - DanXiong Sun
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology. Kunming 650022, China
| | - Dengyuan Li
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology. Kunming 650022, China.
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Akhoundi N, Amirbakhtiarvand M, Goli M, Naseri Z, Siami A. Assessing the Prevalence of Pulmonary Embolism and the Clot Burden in Hospitalized Patients with Chronic Obstructive Pulmonary Disease Exacerbation. THORACIC RESEARCH AND PRACTICE 2024; 25:57-61. [PMID: 38454200 PMCID: PMC11114191 DOI: 10.5152/thoracrespract.2024.23097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/18/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE This prospective cohort study aimed to assess the pulmonary embolism (PE) rate and clot burden in patients with chronic obstructive pulmonary disease (COPD) exacerbation. MATERIAL AND METHODS A total of 248 patients entered the study, and their clinical probability of PE was assessed using the Geneva score. Patients with high clinical probability underwent computed tomographic pulmonary angiography, while those with low or intermediate probability underwent a d-dimer test. RESULTS Among the patients analyzed, 14 individuals (5.6%) were confirmed to have PE using computed tomographic pulmonary angiography. A 3-month follow-up revealed 3 cases of PE out of 232 patients initially deemed PE-free. Mortality rates were higher among patients with venous thromboembolism at admission than those diagnosed with PE during follow-up. Pulmonary embolism (PE) prevalence among patients with COPD exacerbation was 5.6%. CONCLUSION The results of this study show the importance of screening for PE in patients with COPD presenting with dyspnea. Not all of them are due to COPD exacerbation; a small minority of them can be due to PE, which needs prompt screening, confirmation, and therapy. However, further research with larger cohorts is required to understand better the potential benefits and implications of systematic screening for pulmonary embolism in this specific patient population.
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Affiliation(s)
- Neda Akhoundi
- Department of Radiology, Hillcrest Hospital, University of California San Diego, San Diego, CA, USA
| | | | - Mobina Goli
- Islamic Azad University School of Medicine, Shahroud, Iran
| | - Zahra Naseri
- Department of Radiology, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Alireza Siami
- Biostatistical Analyzer, Amirkabir University of Technology, Tehran, Iran
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Bell J, Lim S, Mikami T, Bahk J, Argiro S, Steiger D. The impact on thirty day readmissions for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease admitted to an observation unit versus an inpatient medical unit: A retrospective observational study. Chron Respir Dis 2024; 21:14799731241242490. [PMID: 38545901 PMCID: PMC10981268 DOI: 10.1177/14799731241242490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/01/2023] [Accepted: 02/19/2024] [Indexed: 04/01/2024] Open
Abstract
OBJECTIVES We aimed to evaluate the utility of an Observation Unit (OU) in management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and to identify the clinical characteristics of patients readmitted within 30-days for AECOPD following index admission to the OU or inpatient floor from the OU. METHODS This is a retrospective observational study of patients admitted from January to December 2017 for AECOPD to an OU in an urban-based tertiary care hospital. Primary outcome was rate of 30-day readmission after admission for AECOPD for patients discharged from the OU versus inpatient service after failing OU management. Regression analyses were used to define risk factors. RESULTS 163 OU encounters from 92 unique patients were included. There was a lower readmission rate (33%) for patients converted from OU to inpatient care versus patients readmitted after direct discharge from the OU (44%). Patients with 30-day readmissions were more likely to be undomiciled, with history of congestive heart failure (CHF), pulmonary embolism (PE), or had previous admissions for AECOPD. Patients with >6 annual OU visits for AECOPD had higher rates of substance abuse, psychiatric diagnosis, and prior PE; when these patients were excluded, the 30-day readmission rate decreased to 13.5%. CONCLUSION Patients admitted for AECOPD with a history of PE, CHF, prior AECOPD admissions, and socioeconomic deprivation are at higher risk of readmission and should be prioritized for direct inpatient admission. Further prospective studies should be conducted to determine the clinical impact of this approach on readmission rates.
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Affiliation(s)
- Jacob Bell
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel Hospital, New York, NY, USA
- Department of Pulmonary and Critical Care Medicine, Mount Sinai West Hospital, New York, NY, USA
| | - Steven Lim
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel Hospital, New York, NY, USA
- Department of Pulmonary and Critical Care Medicine, Mount Sinai West Hospital, New York, NY, USA
| | - Takahisa Mikami
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel Hospital, New York, NY, USA
| | - Jeeyune Bahk
- Department of Internal Medicine, Mount Sinai West Hospital, New York, NY, USA
| | - Stephen Argiro
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel Hospital, New York, NY, USA
| | - David Steiger
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel Hospital, New York, NY, USA
- Department of Pulmonary and Critical Care Medicine, Mount Sinai West Hospital, New York, NY, USA
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Cai S, Li Y, Sun B, Wang K, Wan Z, Yang D, Tian X, Wu L, Zhu R. Red blood cell distribution width combined with age as a predictor of acute ischemic stroke in stable COPD patients. Front Neurol 2023; 14:1165181. [PMID: 37342782 PMCID: PMC10277555 DOI: 10.3389/fneur.2023.1165181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/11/2023] [Indexed: 06/23/2023] Open
Abstract
Aim This retrospective study aimed to investigate the independent clinical variables associated with the onset of acute cerebral ischemic stroke (AIS) in patients with stable chronic obstructive pulmonary disease (COPD). Method A total of 244 patients with COPD who had not experienced a relapse within 6 months were included in this retrospective study. Of these, 94 patients hospitalized with AIS were enrolled in the study group, and the remaining 150 were enrolled in the control group. Clinical data and laboratory parameters were collected for both groups within 24 h after hospitalization, and the data of the two groups were statistically analyzed. Results The levels of age, white blood cell (WBC), neutrophil (NEUT), glucose (GLU), prothrombin time (PT), albumin (ALB), and red blood cell distribution width (RDW) were different in the two groups (P < 0.01). Logistic regression analysis showed that age, WBC, RDW, PT, and GLU were independent risk factors for the occurrence of AIS in patients with stable COPD. Age and RDW were selected as new predictors, and the receiver operating characteristic curves (ROC) were plotted accordingly. The areas under the ROC curves of age, RDW, and age + RDW were 0.7122, 0.7184, and 0.7852, respectively. The sensitivity was 60.5, 59.6, and 70.2%, and the specificity was 72.4, 86.0, and 60.0%, respectively. Conclusion The combination of RDW and age in patients with stable COPD might be a potential predictor for the onset of AIS.
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Affiliation(s)
- Shikun Cai
- Department of Neurology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Yao Li
- Department of Respiratory Medicine, The Huaian Clinical College of Xuzhou Medical University, Huaian, China
| | - Bo Sun
- Department of Neurology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Kai Wang
- Department of Rheumatology and Immunology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Zongren Wan
- Department of Respiratory Medicine, The Huaian Clinical College of Xuzhou Medical University, Huaian, China
| | - Dan Yang
- Department of Respiratory Medicine, The Huaian Clinical College of Xuzhou Medical University, Huaian, China
| | - Xiangyang Tian
- Department of Neurology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Liao Wu
- Department of Neurology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Rong Zhu
- Department of Respiratory Medicine, The Huaian Clinical College of Xuzhou Medical University, Huaian, China
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Liu X, Jiao X, Gong X, Nie Q, Li Y, Zhen G, Cheng M, He J, Yuan Y, Yang Y. Prevalence, Risk Factor and Clinical Characteristics of Venous Thrombus Embolism in Patients with Acute Exacerbation of COPD: A Prospective Multicenter Study. Int J Chron Obstruct Pulmon Dis 2023; 18:907-917. [PMID: 37223656 PMCID: PMC10202142 DOI: 10.2147/copd.s410954] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/29/2023] [Indexed: 05/25/2023] Open
Abstract
Background and Objective The prevalence of venous thrombus embolism (VTE) in patients with chronic obstructive pulmonary disease (COPD) is higher than in patients without COPD. Owing to the similarity of clinical symptoms between PE and acute exacerbation COPD (AECOPD), PE is likely to be overlooked or underdiagnosed in patients with AECOPD. The aim of the study was to investigate the prevalence, risk factor, clinical characteristics, and prognostic impact of VTE in patients with AECOPD. Methods This multicenter, prospective, cohort study was conducted in 11 research centers of China. Data on the baseline characteristics, VTE-related risk factors, clinical symptoms, laboratory examination results, computed tomography pulmonary angiography (CTPA) and lower limb venous ultrasound of AECOPD patients were collected. Patients were followed up for 1 year. Results A total of 1580 AECOPD patients were included in the study. The mean (SD) age was 70.4 (9.9) years and 195 (26%) patients were women. The prevalence of VTE was 24.5% (387/1580) and PE was 16.8% (266/1580). VTE patients were older; had higher BMI; and longer course of COPD than non-VTE patients. The history of VTE, cor pulmonale, less purulent sputum, increased respiratory rate, higher D-dimer, and higher NT-proBNP/BNP were independently associated with VTE in hospitalized patients with AECOPD. The mortality at 1-year was higher in patients with VTE than patients without VTE (12.9% vs 4.5%, p<0.01). There was no significant difference in the prognosis of patients with PE in segmental or subsegmental arteries and in main pulmonary arteries or lobar arteries (P>0.05). Conclusion VTE is common in COPD patients and is associated with poor prognosis. Patients with PE at different locations had poorer prognosis than patients without PE. It is necessary to perform active screening strategy for VTE in AECOPD patients with risk factors.
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Affiliation(s)
- Xia Liu
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Capital Medical University Daxing Teaching Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiaojing Jiao
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiaowei Gong
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Qingrong Nie
- Department of Respiratory and Critical Care Medicine, Beijing Fangshan District Liangxiang Hospital, Beijing, People’s Republic of China
| | - Yang Li
- Department of Respiratory and Critical Care Medicine, Capital Medical University Daxing Teaching Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guohua Zhen
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Mengyu Cheng
- Department of Respiratory and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jianguo He
- Department of Cardiovascular Medicine, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yadong Yuan
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
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Pulmonary Embolism and Respiratory Deterioration in Chronic Cardiopulmonary Disease: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13010141. [PMID: 36611433 PMCID: PMC9818351 DOI: 10.3390/diagnostics13010141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Patients with chronic cardiopulmonary pathologies have an increased risk of developing venous thromboembolic events. The worsening of dyspnoea is a frequent occurrence and often leads patients to consult the emergency department. Pulmonary embolism can then be an exacerbation factor, a differential diagnosis or even a secondary diagnosis. The prevalence of pulmonary embolism in these patients is unknown, especially in cases of chronic heart failure. The challenge lies in needing to carry out a systematic or targeted diagnostic strategy for pulmonary embolism. The occurrence of a pulmonary embolism in patients with chronic cardiopulmonary disease clearly worsens their prognosis. In this narrative review, we study pulmonary embolism and chronic obstructive pulmonary disease, after which we turn to pulmonary embolism and chronic heart failure.
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Kristensen A, Sivapalan P, Bagge K, Biering-Sørensen T, Sørensen R, Eklöf J, Jensen JUS. Association between anticoagulant therapy, exacerbations and mortality in a Danish cohort of patients with Chronic Obstructive Pulmonary Disease. Sci Prog 2022; 105:368504221104331. [PMID: 35673760 PMCID: PMC10358626 DOI: 10.1177/00368504221104331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVES Pulmonary Embolism has been frequently reported in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AE-COPD). The study aimed to determine whether COPD patients who receive anticoagulant (AC) therapy have a reduced risk of hospitalization due to AE-COPD and death. METHODS This nationwide population-based study was based on data from the Danish Register of COPD (DrCOPD), which contains complete data on COPD outpatients between 1st January 2010 and 31st December 2018. National registers were used to obtain information regarding comorbidities and vital status. Propensity-score matching and Cox proportional hazards models were used to assess AE-COPD and death after one year. RESULTS The study cohort consisted of 58,067 patients with COPD. Of these, 5194 patients were on AC therapy. The population was matched 1:1 based on clinical confounders and AC therapy, resulting in two groups of 5180 patients. We found no association between AC therapy and AE-COPD or all-cause mortality in the propensity-score matched population (HR 1.03, 95% CI 0.96-1.10, p = 0.37). These findings were confirmed in a competing risk analysis. In the sensitivity analysis, we performed an adjusted analysis of the complete cohort and found a slightly increased risk of AE-COPD or death in patients treated with AC therapy. This study found a low incidence of pulmonary embolisms and deep venous thrombosis in both groups. CONCLUSIONS AC therapy was not associated with the risk of hospitalization due to AE-COPD or all-cause mortality.
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Affiliation(s)
- A Kristensen
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - P Sivapalan
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - K Bagge
- Department of Clinical Microbiology, Amager and Hvidovre University Hospital, Copenhagen, Denmark
| | - T Biering-Sørensen
- Department of Internal Medicine, Section of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - R Sørensen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J Eklöf
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - JUS Jensen
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- PERSIMUNE: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, institution-id-type="Ringgold" />Faculty of Health Sciences, University of Copenhagen, Denmark
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Han W, Wang M, Xie Y, Ruan H, Zhao H, Li J. Prevalence of Pulmonary Embolism and Deep Venous Thromboembolism in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:732855. [PMID: 35355978 PMCID: PMC8959435 DOI: 10.3389/fcvm.2022.732855] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of pulmonary embolism (PE) and deep venous thrombosis (DVT). AECOPD combined with PE and DVT poses challenges for treatment and management. This necessitates prevention and management to estimate the overall prevalence of PE and DVT among patients with AECOPD and to identify the risk factors. Methods We searched the PubMed, Embase, and Cochrane Library databases from their inception to January 9, 2021 and extracted the data from the included studies. The risk of bias was assessed for each study. We separately calculated the prevalence of PE and DVT in patients with AECOPD. Subgroup analysis and meta-regression analyses were performed to determine the sources of heterogeneity. Furthermore, we assessed the publication bias. Results The meta-analysis included 20 studies involving 5,854 people. The overall prevalence of PE and DVT among patients with AECOPD was 11% (95% CI: 0.06–0.17) and 9% (95% CI: 0.06–0.12), respectively. Subgroup analysis demonstrated that the prevalence of PE among patients with AECOPD was 12, 2, 7, and 16% in the European, South-East Asia, Western Pacific, and Eastern Mediterranean regions, respectively, and the DVT was 10, 9, 9, and 4%, respectively. The prevalence of PE among patients with AECOPD aged ≥ 70 and <70 years old was 6 and 15%, respectively, and the DVT was 8 and 9%, respectively. The prevalence of PE among patients with AECOPD diagnosed within 48 h and other times (beyond 48 h or not mentioned) was 16 and 6%, respectively, and DVT was 10 and 7%, respectively. Conclusion The pooled prevalence of PE and DVT among patients with AECOPD was insignificantly different between the different age groups and the WHO regions. However, the early diagnosis was associated with a higher prevalence of PE. Clinicians and the public need to further improve the awareness of prevention and management for PE and DVT among patients with AECOPD. Systematic Review Registration PROSPERO, identifier CRD42021260827.
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Affiliation(s)
- Weihong Han
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Minghang Wang
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yang Xie
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Huanrong Ruan
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Hulei Zhao
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- *Correspondence: Hulei Zhao
| | - Jiansheng Li
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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10
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Prevalence of pulmonary embolism in patients with acute exacerbations of COPD: A systematic review and meta-analysis. Am J Emerg Med 2021; 50:606-617. [PMID: 34879475 DOI: 10.1016/j.ajem.2021.09.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022] Open
Abstract
STUDY OBJECTIVE Identification of pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) carries significant therapeutic implications. We aimed to investigate the prevalence of PE in patients with AECOPD. METHODS We searched MEDLINE, the Cochrane Central Register of Controlled Trials, and Embase. We registered the protocol at the PROSPERO (CRD42021230481). Two authors independently evaluated whether titles and abstracts met the eligibility criteria, which were as follows: (1), prospective study or cross-sectional study in case the protocol for workup of PE was specified in advance, (2) patients with AECOPD aged ≥ 18 years, and (3) investigated the prevalence of PE or venous thromboembolism (VTE). Two authors independently extracted the selected patient and study characteristics and outcomes. We presented the results of all analyses with the use of random-effects models. The primary outcome was the prevalence of PE. RESULTS We included 16 studies (N = 4093 patients) in this meta-analysis. The prevalence of PE in patients with AECOPD was 12% [95% confidence interval (CI), 9 to 16%]. Substantial heterogeneity was observed (I2 = 94.8%). The pooled mortality was higher in patients with PE than those without (odds ratio 5.30, 95%CI: 2.48-11.30, p-value < 0.001). CONCLUSION In this meta-analysis, the prevalence of PE in patients with AECOPD was 12% and the mortality of patients with PE was higher than those without. This suggests an acute necessity to develop validated diagnostic strategies for identifying PE in patients with AECOPD.
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Chaudhary N, Khan UH, Shah TH, Shaheen F, Mantoo S, Qadri SM, Mehfooz N, Shabir A, Siraj F, Shah S, Koul PA, Jan RA. Prevalence and predictors of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease. Lung India 2021; 38:533-539. [PMID: 34747735 PMCID: PMC8614611 DOI: 10.4103/lungindia.lungindia_79_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: The prevalence of pulmonary embolism (PE) in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) varies over a wide range. Early detection and treatment of PE in AECOPD is a key to improve patient outcome. The purpose of the study was to investigate the prevalence and predictors of PE in patients of AECOPD in a high burden region of North India. Materials and Methods: This prospective study included patients of AECOPD with no obvious cause of exacerbation on initial evaluation. Apart from routine workup, the participants underwent assessment of D-dimer, compression ultrasound and venous Doppler ultrasound of the lower limbs and pelvic veins, and a multidetector computed tomography pulmonary angiography. Results: A total of 100 patients of AECOPD with unknown etiology were included. PE as a possible cause of AE-COPD was observed in 14% of patients. Among the participants with PE, 63% (n = 9) had a concomitant presence of lower extremity deep venous thrombosis. Hemoptysis and chest pain were significantly higher in patients of AECOPD with PE ([35.7% vs. 7%, P = 0.002] and [92.9% vs. 38.4%, P = 0.001]). Likelihood of PE was significantly higher in patients who presented with tachycardia, tachypnea, respiratory alkalosis (PaCO2 <45 mmHg and pH >7.45), and hypotension. No difference was observed between the two groups in terms of in-hospital mortality, age, sex distribution, and risk factors for embolism except for the previous history of venous thromboembolism (35.7% vs. 12.8% P = 0.03). Conclusion: PE was probably responsible for AECOPD in 14% of patients with no obvious cause on initial assessment. Patients who present with chest pain, hemoptysis, tachypnea, tachycardia, and respiratory alkalosis should be particularly screened for PE.
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Affiliation(s)
- Nasir Chaudhary
- Department of Cardiology, GMC, Jammu, Jammu and Kashmir, India
| | - Umar Hafiz Khan
- Department of Geriatric Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Tajamul Hussain Shah
- Department of Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Feroze Shaheen
- Department of Radiology, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Suhail Mantoo
- Department of Internal Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Syed Mudasir Qadri
- Department of Internal Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nazia Mehfooz
- Department of Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Afshan Shabir
- Department of Geriatric Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Farhana Siraj
- Department of Internal Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sonaullah Shah
- Department of Internal and Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rafi Ahmed Jan
- Department of Internal and Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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12
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Fu X, Zhong Y, Xu W, Ju J, Yu M, Ge M, Gu X, Chen Q, Sun Y, Huang H, Shen L. The prevalence and clinical features of pulmonary embolism in patients with AE-COPD: A meta-analysis and systematic review. PLoS One 2021; 16:e0256480. [PMID: 34473738 PMCID: PMC8412363 DOI: 10.1371/journal.pone.0256480] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The prevalence of pulmonary embolism (PE) in the acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is highly controversial. We conducted a systematic review and meta-analysis to summarize the epidemiology and characteristics of PE with AE-COPD for current studies. METHODS We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies published prior to October 21, 2020. Pooled proportions with 95% confidence intervals (95% CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals were used as effect measures for dichotomous and continuous variables, respectively. RESULTS A total of 17 studies involving 3170 patients were included. The prevalence of PE and deep vein thrombosis (DVT) in AE-COPD patients was 17.2% (95% CI: 13.4%-21.3%) and 7.1% (95% CI: 3.7%-11.4%%), respectively. Dyspnea (OR = 6.77, 95% CI: 1.97-23.22), pleuritic chest pain (OR = 3.25, 95% CI: 2.06-5.12), lower limb asymmetry or edema (OR = 2.46, 95% CI:1.51-4.00), higher heart rates (MD = 20.51, 95% CI: 4.95-36.08), longer hospital stays (MD = 3.66, 95% CI: 3.01-4.31) were associated with the PE in the AE-COPD patients. Levels of D-dimer (MD = 1.51, 95% CI: 0.80-2.23), WBC counts (MD = 1.42, 95% CI: 0.14-2.70) were significantly higher and levels of PaO2 was lower (MD = -17.20, 95% CI: -33.94- -0.45, P<0.05) in the AE-COPD with PE group. The AE-COPD with PE group had increased risk of fatal outcome than the AE-COPD group (OR = 2.23, 95% CI: 1.43-3.50). CONCLUSIONS The prevalence of PE during AE-COPD varies considerably among the studies. AE-COPD patients with PE experienced an increased risk of death, especially among the ICU patients. Understanding the potential risk factors for PE may help clinicians identify AE-COPD patients at increased risk of PE. PROSPERO REGISTRATION NUMBER CRD42021226568.
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Affiliation(s)
- Xiaofang Fu
- Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
| | - Yonghong Zhong
- Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
| | - Wucheng Xu
- Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
| | - Jiangang Ju
- Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
| | - Min Yu
- Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
| | - Minjie Ge
- Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
| | - Xiaofei Gu
- Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
| | - Qingqing Chen
- Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
| | - Yibo Sun
- Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
| | - Huaqiong Huang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Linfeng Shen
- Department of Respiratory, First People’s Hospital of Yuhang, Hangzhou, China
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13
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Yang R, Liu G, Deng C. Pulmonary embolism with chronic obstructive pulmonary disease. Chronic Dis Transl Med 2021; 7:149-156. [PMID: 34505015 PMCID: PMC8413125 DOI: 10.1016/j.cdtm.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Indexed: 11/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease. The incidence of COPD is growing annually in China, and it is a significant and growing public health burden. Multivariate analysis showed that COPD was one of the independent risk factors for the occurrence of pulmonary embolism (PE), and the incidence of PE was significantly higher in COPD patients than in normal subjects. However, PE is often overlooked in patients with acute exacerbation of COPD (AECOPD) because there are many similarities in clinical symptoms between PE and AECOPD, which are difficult to distinguish, resulting in the failure of timely treatment and poor prognosis. Therefore, it is of great significance to understand the clinical manifestations, diagnosis, and treatment of COPD combined with PE for making a more accurate diagnosis, providing timely and effective treatment, and improving the prognosis of such patients.
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Affiliation(s)
- Ruohan Yang
- Institute of Respiratory Disease, Fujian Medical University, Division of Respiratory and Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
| | - Guiqing Liu
- The Hammersmith Hospital, London W12 0NN, United Kingdom
| | - Chaosheng Deng
- Institute of Respiratory Disease, Fujian Medical University, Division of Respiratory and Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, China
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Castellana G, Intiglietta P, Dragonieri S, Carratù P, Buonamico P, Peragine M, Capozzolo A, Carone M, Carpagnano GE, Resta O. Incidence of deep venous thrombosis in patients with both Pulmonary Embolism and COPD. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021210. [PMID: 34212912 PMCID: PMC8343729 DOI: 10.23750/abm.v92i3.11258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are no studies investigating populations of patients with both pulmonary embolism and chronic obstructive pulmonary disease (PE-COPD) with and without deep venous thrombosis (DVT). AIM OF THE STUDY To define prevalence of DVT in COPD with PE and to compare characteristics of COPD patients who develop PE, with and without DVT. Secondly, we aimed to assess differences in the localization of PE among study groups. METHODS. 116 patients with PE were enrolled in a retrospective study. Clinical data as well as echocardiographic and lower limb ultrasonography records were collected for all subjects. Subjects were divided into two groups according to the presence of COPD: Group 1, 54 patients with diagnosis of PE without COPD and Group 2, 66 patients diagnosed of PE with COPD. Then, individuals of Group 2 were subdivided in two subgroups according to the presence (n=21) or absence (n=45) of DVT. RESULTS 33% of patients with COPD and PE showed DVT. These subjects had higher PaCO2 and ejection fraction (p<0.05 for all) and higher percentage of chronic renal failure and diabetes mellitus compared to those without DVT (p<0.05 for all). Moreover, in COPD-PE patients with DVT, the most frequent localization was proximal (54% of total), whereas COPD-PE patients without DVT showed a more frequent segmental localization (60% of total). No difference was found in clinical presentation and blood-chemistry tests. CONCLUSIONS DVT was non-common in PE-COPD patients. Chronic renal failure, and type 2 diabetes mellitus are more frequent in PE-COPD patients with DVT, that showed a higher frequency of proximal localization, thereby indicating a greater risk of more severe clinical implications. Conversely, PE- COPD subjects without DVT showed a more frequent segmental localization and were less hypercapnic. PE should be taken into account in COPD with worsening of respiratory symptoms, also in absence of DVT.
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Affiliation(s)
- Giorgio Castellana
- Pulmonary Division, Istituti Clinici Scientifici Maugeri SpA SB Pavia, IRCCS, Institute of Bari, Bari, Italy.
| | | | | | | | | | - Maria Peragine
- Internal Medicine "A. Murri", University of Bari, Italy.
| | - Alberto Capozzolo
- Pulmonary Division, Istituti Clinici Scientifici Maugeri SpA SB Pavia, IRCCS, Institute of Bari, Bari, Italy.
| | - Mauro Carone
- Pulmonary Division, Istituti Clinici Scientifici Maugeri SpA SB Pavia, IRCCS, Institute of Bari, Bari, Italy.
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15
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Rao AK, Del Carpio-Cano F, Janapati S, Zhao H, Voelker H, Lu X, Criner G. Effects of simvastatin on tissue factor pathway of blood coagulation in STATCOPE (Simvastatin in the prevention of COPD exacerbations) trial. J Thromb Haemost 2021; 19:1709-1717. [PMID: 33638931 PMCID: PMC8238804 DOI: 10.1111/jth.15282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Statins are widely used to lower lipids and reduce cardiovascular events. In vitro studies and small studies in patients with hyperlipidemias show statins inhibit tissue factor (TF) and blood coagulation mechanisms. We assessed the effects of simvastatin on TF and coagulation biomarkers in patients entered in STATCOPE, a multicenter, randomized, placebo-controlled trial of simvastatin (40 mg daily) versus placebo on exacerbation rates in patients with chronic obstructive pulmonary disease (COPD). METHODS In 227 patients (114 simvastatin, 113 placebo; mean [± standard error of the mean] age 62 ± 0.53 years, 44.5% women) we measured (baseline, and 6 and 12 months): whole blood membrane TF-procoagulant activity (TF-PCA) and plasma factors VIIa, VII, VIII, fibrinogen, TF antigen, tissue factor pathway inhibitor (TFPI), thrombin-antithrombin complexes (TAT), and D-dimer. We excluded patients with diabetes, cardiovascular disease, and those taking or requiring a statin. RESULTS In the statin group, there was a small increase in TF-PCA (from 25.18 ± 1.08 to 30.36 ± 1.10 U/ml; p = .03) over 12 months; factors VIIa and VIII, fibrinogen, TAT, and D-dimer did not change. Plasma TFPI (from 52.4 ± 1.75 to 44.7 ± 1.78 ng/ml; p < .0001) and FVIIC (1.23 ± 0.04 to 1.15 ± 0.03 U/ml; p = .03) decreased and correlated with total cholesterol levels. No changes in biomarkers were observed with placebo. CONCLUSIONS In contrast to previous studies on statins, in COPD patients without diabetes, cardiovascular disease, or requiring a statin treatment, simvastatin (40 mg per day) did not decrease TF or factors VIIa and VIII, fibrinogen, TAT, or D-dimer. The decreases in TFPI and factor VII reflect the decrease in serum lipids.
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Affiliation(s)
- A. Koneti Rao
- Sol Sherry Thrombosis Research Center and Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia
| | - Fabiola Del Carpio-Cano
- Sol Sherry Thrombosis Research Center and Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia
| | - Sumalaxmi Janapati
- Sol Sherry Thrombosis Research Center and Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia
| | - Huaqing Zhao
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia
| | - Helen Voelker
- Biostatistics Department of the University of Minnesota, Minnesota, Lewis Katz School of Medicine at Temple University, Philadelphia United States
| | - Xiaoning Lu
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia
| | - Gerard Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia United States
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16
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Venous Thromboembolic Disease in Chronic Inflammatory Lung Diseases: Knowns and Unknowns. J Clin Med 2021; 10:jcm10102061. [PMID: 34064992 PMCID: PMC8151562 DOI: 10.3390/jcm10102061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
Persistent inflammation within the respiratory tract underlies the pathogenesis of numerous chronic pulmonary diseases. There is evidence supporting that chronic lung diseases are associated with a higher risk of venous thromboembolism (VTE). However, the relationship between lung diseases and/or lung function with VTE is unclear. Understanding the role of chronic lung inflammation as a predisposing factor for VTE may help determine the optimal management and aid in the development of future preventative strategies. We aimed to provide an overview of the relationship between the most common chronic inflammatory lung diseases and VTE. Asthma, chronic obstructive pulmonary disease, interstitial lung diseases, or tuberculosis increase the VTE risk, especially pulmonary embolism (PE), compared to the general population. However, high suspicion is needed to diagnose a thrombotic event early as the clinical presentation inevitably overlaps with respiratory disorders. PE risk increases with disease severity and exacerbations. Hence, hospitalized patients should be considered for thromboprophylaxis administration. Conversely, all VTE patients should be asked for lung comorbidities before determining anticoagulant therapy duration, as those patients are at increased risk of recurrent PE episodes rather than DVT. Further research is needed to understand the underlying pathophysiology of in-situ thrombosis in those patients.
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17
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de-Miguel-Diez J, Albaladejo-Vicente R, Jiménez-García R, Hernandez-Barrera V, Villanueva-Orbaiz R, Carabantes-Alarcon D, Jimenez D, Monreal M, López-de-Andrés A. The effect of COPD on the incidence and mortality of hospitalized patients with pulmonary embolism: A nationwide population-based study (2016-2018). Eur J Intern Med 2021; 84:18-23. [PMID: 33250339 DOI: 10.1016/j.ejim.2020.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND To examine the incidence, clinical characteristics, and in-hospital outcomes of pulmonary embolism (PE) among hospitalized patients with or without chronic obstructive pulmonary disease (COPD) in Spain, and to identify predictors of in-hospital-mortality (IHM) after PE among patients with and without COPD. METHODS We included all patients aged ≥ 40 years who were hospitalised for PE between 2016 and 2018. Data were collected from the Spanish National Hospital Discharge Database. RESULTS We identified 47,190 hospitalizations for PE during the study period, 7.49% with COPD. Adjusted incidence of PE was higher in COPD patients than in those without COPD (IRR 1.16; 95%CI 1.13-1.19). Crude IHM was significantly higher in PE hospitalized patients with COPD than in those without COPD (9.86% vs 3.59%; p<0.001). Predictor factors of IHM in COPD patients with PE included older age, higher Charlson comorbidity index, atrial fibrillation, massive PE and dependence on oxygen prior to hospital admission. However, obesity was associated with lower IHM. For PE hospitalized patients, suffering COPD increased the probability of dying in the hospital (adjusted OR 2.84; 95%CI 2.27-3.55). CONCLUSIONS Our results revealed that incidence of PE was higher in COPD patients than in those without COPD. Furthermore, COPD was a risk factor for IHM after PE.
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Affiliation(s)
- Javier de-Miguel-Diez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, CIBER de Enfermedades Respiratorias (CIBERES), Madrid. Spain
| | - Romana Albaladejo-Vicente
- Department of Public Health & Maternal and Child Health. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Valentín Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Rosa Villanueva-Orbaiz
- Department of Public Health & Maternal and Child Health. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Jimenez
- Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Medicine Department, Universidad de Alcalá, CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, CIBER de Enfermedades Respiratorias (CIBERES), Badalona, Barcelona, Spain
| | - Ana López-de-Andrés
- Department of Public Health & Maternal and Child Health. Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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18
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Couturaud F, Bertoletti L, Pastre J, Roy PM, Le Mao R, Gagnadoux F, Paleiron N, Schmidt J, Sanchez O, De Magalhaes E, Kamara M, Hoffmann C, Bressollette L, Nonent M, Tromeur C, Salaun PY, Barillot S, Gatineau F, Mismetti P, Girard P, Lacut K, Lemarié CA, Meyer G, Leroyer C. Prevalence of Pulmonary Embolism Among Patients With COPD Hospitalized With Acutely Worsening Respiratory Symptoms. JAMA 2021; 325:59-68. [PMID: 33399840 PMCID: PMC7786241 DOI: 10.1001/jama.2020.23567] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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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Affiliation(s)
- Francis Couturaud
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Brest, France
- EA 3878, INSERM CIC 1412, Université de Bretagne Occidentale, Brest, France
- FCRIN INNOVTE, France
| | - Laurent Bertoletti
- FCRIN INNOVTE, France
- Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France
- INSERM CIC 1408, INSERM UMR 1059, Université Jean Monnet, Saint-Etienne, France
| | - Jean Pastre
- Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- INSERM UMR S 1140, Université de Paris; Paris, France
| | - Pierre-Marie Roy
- FCRIN INNOVTE, France
- Service des urgences, Centre Hospitalo-Universitaire d’Angers, France
- Institut MITOVASC, EA 3860, Université d'Angers, Angers, France
| | - Raphael Le Mao
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Brest, France
- EA 3878, INSERM CIC 1412, Université de Bretagne Occidentale, Brest, France
- FCRIN INNOVTE, France
| | - Frédéric Gagnadoux
- Département de Pneumologie, Centre Hospitalo-Universitaire d’Angers, France
- INSERM UMR1063, Université d’Angers, Angers, France
| | - Nicolas Paleiron
- Service de pneumologie-allergologie-cancérologie thoracique, HIA Sainte Anne, Toulon, France
| | - Jeannot Schmidt
- FCRIN INNOVTE, France
- Service des urgences, Centre Hospitalo-Universitaire de Clermont-Ferrand, France
- UMR 6024 UCA-CNRS, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Sanchez
- FCRIN INNOVTE, France
- Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- INSERM UMR S 1140, Université de Paris; Paris, France
| | - Elodie De Magalhaes
- FCRIN INNOVTE, France
- Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France
- INSERM CIC 1408, INSERM UMR 1059, Université Jean Monnet, Saint-Etienne, France
| | - Mariam Kamara
- Service des urgences, Centre Hospitalier de Quimper, Quimper, France
| | - Clément Hoffmann
- EA 3878, INSERM CIC 1412, Université de Bretagne Occidentale, Brest, France
- Service d’Echo-doppler Vasculaire, Centre Hospitalo-Universitaire de Brest, Brest, France
| | - Luc Bressollette
- EA 3878, INSERM CIC 1412, Université de Bretagne Occidentale, Brest, France
- FCRIN INNOVTE, France
- Service d’Echo-doppler Vasculaire, Centre Hospitalo-Universitaire de Brest, Brest, France
| | - Michel Nonent
- EA 3878, INSERM CIC 1412, Université de Bretagne Occidentale, Brest, France
- Service de radiologie, Centre Hospitalo-Universitaire de Brest, Brest, France
| | - Cécile Tromeur
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Brest, France
- EA 3878, INSERM CIC 1412, Université de Bretagne Occidentale, Brest, France
- FCRIN INNOVTE, France
| | - Pierre-Yves Salaun
- FCRIN INNOVTE, France
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de Brest, France
- EA 3878, Université de Bretagne Occidentale, Brest, France
| | - Sophie Barillot
- INSERM CIC 1412, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Florence Gatineau
- INSERM CIC 1412, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Patrick Mismetti
- FCRIN INNOVTE, France
- Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France
- INSERM CIC 1408, INSERM UMR 1059, Université Jean Monnet, Saint-Etienne, France
| | - Philippe Girard
- FCRIN INNOVTE, France
- Département Thoracique, Institut Mutualiste Montsouris, Paris, France
| | - Karine Lacut
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Brest, France
- EA 3878, INSERM CIC 1412, Université de Bretagne Occidentale, Brest, France
- FCRIN INNOVTE, France
| | - Catherine A. Lemarié
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Brest, France
- EA 3878, INSERM CIC 1412, Université de Bretagne Occidentale, Brest, France
- FCRIN INNOVTE, France
- INSERM 1078, Université de Bretagne Occidentale, Brest, France
| | - Guy Meyer
- FCRIN INNOVTE, France
- Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- INSERM UMR S 970, Université de Paris, Paris, France
| | - Christophe Leroyer
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Brest, France
- EA 3878, INSERM CIC 1412, Université de Bretagne Occidentale, Brest, France
- FCRIN INNOVTE, France
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Sadeghi S, Emami Ardestani M, Raofi E, Jalaie Esfandabadi A. Diagnostic Value of D-dimer in Detecting Pulmonary Embolism in Patients with Acute COPD Exacerbation. TANAFFOS 2020; 19:371-379. [PMID: 33959175 PMCID: PMC8088144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Signs and symptoms of chronic obstructive pulmonary disease (COPD) exacerbation may overlap with pulmonary embolism. Patients with acute COPD exacerbations have higher level of D-dimer which may D-dimer lead to false detection of pulmonary thromboembolism (PTE). In this study diagnostic value of D-dimer for diagnosis of pulmonary embolism during acute exacerbation in patients with COPD was investigated. MATERIALS AND METHODS This study was performed on 112 patients with acute COPD exacerbations. In all patients, Wells criteria and D-dimer serum levels were evaluated. Then, all cases were subjected to CT angiography (CTA) and ultrasonography. The diagnostic value of serum D-dimer level and Wells criteria and also their combination for PTE was compared to the gold standard method. RESULTS Of 112 patients, 17%, diagnosed with PTE using CTA. The D-dimer cut-off value in COPD patients was higher than 990 μg/L, which was higher than 3 for the Wells score while D-dimer alone showed no good diagnostic value for PTE diagnosis, but Wells score was acceptable (P-value = 0.019). Moreover, the combination of cut-off values, Wells score, and D-dimer level, as a new criterion, with a sensitivity and specificity rate of 47.37% and 88.17% respectively, had an acceptable diagnostic value in PTE diagnosis (AUC=0.678, P value=0.004). CONCLUSION It is suggested that D-dimer concentration alone could not make a good PTE diagnosis, but the simultaneous combination of this test with the Wells criterion can detect the PTE risk with better confidence. To obtain more accurate findings and to get the best criterion, further studies are needed in this field.
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Affiliation(s)
- Somayeh Sadeghi
- Acquired Immunodeficiency Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Elham Raofi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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20
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Maritano Furcada J, Castro HM, De Vito EL, Grande Ratti MF, Posadas-Martínez ML, Giunta DH, Vazquez FJ, Ferreyro BL. Diagnosis of pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease: A cross-sectional study. CLINICAL RESPIRATORY JOURNAL 2020; 14:1176-1181. [PMID: 32780471 DOI: 10.1111/crj.13257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pulmonary embolism (PE) remains a frequent complication in patients with chronic obstructive pulmonary disease (COPD). It is unclear that the extent to which the traditional risk stratifying scores for PE are accurate in this population. METHODS Cross-sectional study of adult patients with COPD and suspected PE included in an Institutional Registry of Thromboembolic Disease at a tertiary teaching hospital in the city of Buenos Aires, Argentina. We estimated the area under the receiver operating characteristic curves (AU-ROC), sensitivity and specificity of the Wells and Geneva scores using a positive computed tomography angiography as the gold standard for PE. We also estimated the sensitivity and specificity for the presence of isolated worsening of dyspnea at presentation, without other cardinal symptoms of acute exacerbation of COPD. RESULTS A total of 168 patients were included, of which 22% had confirmed PE. The AUC was 0.66 (95% CI 0.56-0.76) and 0.56 (95% CI 0.45-0.67) for the Wells and Geneva, respectively. Considering the most widely used cutoff points, the sensitivity and specificity were 24% and 90% for the Wells and 59% and 43% for the Geneva score, respectively. Isolated worsening of dyspnea on presentation had a sensitivity of 92% and specificity of 37%. CONCLUSIONS Both Wells and Geneva scores exhibit poor diagnostic accuracy for the diagnosis of PE in patients with COPD. The presence of isolated worsening of dyspnea on presentation could be an easy to identify criteria for the initial triage in this population. Further validation of our findings remains warranted.
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Affiliation(s)
| | | | - Eduardo Luis De Vito
- Institute of Medical Research Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Diego Hernán Giunta
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Leonel Ferreyro
- Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Sinai Health System/University Health Network and Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
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21
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Dentali F, Pomero F, Micco PD, La Regina M, Landini F, Mumoli N, Pieralli F, Giorgi-Pierfranceschi M, Re R, Vitale J, Fabbri LM, Fontanella A, Arioli D. Prevalence and risk factors for pulmonary embolism in patients with suspected acute exacerbation of COPD: a multi-center study. Eur J Intern Med 2020; 80:54-59. [PMID: 32474052 DOI: 10.1016/j.ejim.2020.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Pulmonary embolism (PE) prevalence in acute exacerbations of COPD is highly variable. METHODS To investigate the prevalence and risk factors of PE in patients hospitalized in Departments of Internal Medicine because of AECOPD and suspected PE we conducted a retrospective multicenter study in patients with an AECOPD undergoing chest angio-computed tomography (angio-CT) because of clinical suspect of PE. RESULTS 1043 patients (mean age 75.8 years ± 9.7 years, 34.5 % women) were included; 132 patients had PE (mean prevalence 12.66%, 95% confidence interval 10.73, 14.77%).) confirmed by angio-CT and 54 patients died during hospitalization (5.18 %). At multivariate analysis, age, female gender, clinical signs and symptoms suggestive of deep vein thrombosis, hypertension, PaCO2 ≤ 40 mmHg, and normal chest-x-ray were significantly associated with a higher PE prevalence. Prevalence of PE in patients with 0, 1, 2, 3 or ≥4 risk factors progressively increase from 1.76 to 30.43%. Mean length of hospitalization (LOH) (15.7 vs 14.2 days, p 0.07) and in-hospital mortality (6.1% vs 5.1%, P=0.62) were slightly but not significantly higher in in patients with PE (6.1% vs 5.1%, P=0.62). CONCLUSIONS PE prevalence is not negligible in this setting. A number of risk factors may help clinicians in identification of patients at increased risk of PE.
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Affiliation(s)
- Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy.
| | - Fulvio Pomero
- Department of Internal Medicine, S. Lazzaro Hospital, Alba, Cuneo Italy
| | - Pierpaolo Di Micco
- Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | - Micaela La Regina
- Risk Management Unit, East Ligurian Hospital, La Spezia, ASL5 Liguria, La Spezia, Italy
| | - Federica Landini
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Nicola Mumoli
- Department of Internal Medicine, Ospedale Fornaroli, Magenta, Milan, Italy
| | - Filippo Pieralli
- Medicina Interna e di Urgenza, Azienda Ospedaliera Universitaria 'Careggi', Firenze, Italy
| | | | - Roberta Re
- Department of Internal Medicine, Ospedale Maggiore della Carità, Novara, Italy
| | - Josè Vitale
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Leonardo M Fabbri
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Fontanella
- Department of Internal Medicine, Ospedale Fatebenefratelli, Napoli, Italy
| | - Dimitriy Arioli
- Internal Medicine, Centro Emostasi e Trombosi, Stroke Unit, Azienda Ospedaliera ASMN, Reggio Emilia, Italy
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22
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Rangelov BA, Young AL, Jacob J, Cahn AP, Lee S, Wilson FJ, Hawkes DJ, Hurst JR. Thoracic Imaging at Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2020; 15:1751-1787. [PMID: 32801677 PMCID: PMC7385406 DOI: 10.2147/copd.s250746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/03/2020] [Indexed: 01/20/2023] Open
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are currently diagnosed based on changes in respiratory symptoms. Characterizing the imaging manifestation of exacerbations could be useful for objective diagnosis of exacerbations in the clinic and clinical trials, as well as provide a mechanism for monitoring exacerbation treatment and recovery. In this systematic review, we employed a comprehensive search across three databases (Medline, EMBASE, Web of Science) to identify studies that performed imaging of the thorax at COPD exacerbation. We included 51 from a total of 5,047 articles which met all our inclusion criteria. We used an adapted version of the Modified Newcastle-Ottawa Quality Assessment Scale for cohort studies to assess the quality of the included studies. Conclusions were weighted towards higher-quality articles. We identified a total of 36 thoracic imaging features studied at exacerbation of COPD. Studies were generally heterogeneous in their measurements and focus. Nevertheless, considering studies which performed consecutive imaging at stable state and exacerbation, which scored highest for quality, we identified salient imaging biomarkers of exacerbations. An exacerbation is characterized by airway wall and airway calibre changes, hyperinflation, pulmonary vasoconstriction and imaging features suggestive of pulmonary arterial hypertension. Most information was gained from CT studies. We present the first ever composite imaging signature of COPD exacerbations. While imaging during an exacerbation is comparatively new and not comprehensively studied, it may uncover important insights into the acute pathophysiologic changes in the cardiorespiratory system during exacerbations of COPD, providing objective confirmation of events and a biomarker of recovery and treatment response.
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Affiliation(s)
- Bojidar A Rangelov
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Alexandra L Young
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Department of Computer Science, University College London, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Jacob
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,UCL Respiratory, University College London, London, UK
| | | | | | | | - David J Hawkes
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
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23
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Porembskaya O, Toropova Y, Tomson V, Lobastov K, Laberko L, Kravchuk V, Saiganov S, Brill A. Pulmonary Artery Thrombosis: A Diagnosis That Strives for Its Independence. Int J Mol Sci 2020; 21:ijms21145086. [PMID: 32708482 PMCID: PMC7404175 DOI: 10.3390/ijms21145086] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022] Open
Abstract
According to a widespread theory, thrombotic masses are not formed in the pulmonary artery (PA) but result from migration of blood clots from the venous system. This concept has prevailed in clinical practice for more than a century. However, a new technologic era has brought forth more diagnostic possibilities, and it has been shown that thrombotic masses in the PA could, in many cases, be found without any obvious source of emboli. Chronic obstructive pulmonary disease, asthma, sickle cell anemia, emergency and elective surgery, viral pneumonia, and other conditions could be complicated by PA thrombosis development without concomitant deep vein thrombosis (DVT). Different pathologies have different causes for local PA thrombotic process. As evidenced by experimental results and clinical observations, endothelial and platelet activation are the crucial mechanisms of this process. Endothelial dysfunction can impair antithrombotic function of the arterial wall through downregulation of endothelial nitric oxide synthase (eNOS) or via stimulation of adhesion receptor expression. Hypoxia, proinflammatory cytokines, or genetic mutations may underlie the procoagulant phenotype of the PA endothelium. Both endotheliocytes and platelets could be activated by protease mediated receptor (PAR)- and receptors for advanced glycation end (RAGE)-dependent mechanisms. Hypoxia, in particular induced by high altitudes, could play a role in thrombotic complications as a trigger of platelet activity. In this review, we discuss potential mechanisms of PA thrombosis in situ.
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Affiliation(s)
- Olga Porembskaya
- Mechnikov North-Western State Medical University, Saint Petersburg 191015, Russia; (V.K.); (S.S.)
- Institute of Experimental Medicine, Saint Petersburg 197376, Russia
- Correspondence: (O.P.); (A.B.); Tel.: +7-92-1310-6629 (O.P.); Tel.: +44-12-1415-8679 (A.B.)
| | - Yana Toropova
- Institute of Experimental Medicine, Almazov National Medical Research Center, Saint Petersburg 197341, Russia;
| | | | - Kirill Lobastov
- Pirogov Russian National Research Medical University, Moscow 117997, Russia; (K.L.); (L.L.)
| | - Leonid Laberko
- Pirogov Russian National Research Medical University, Moscow 117997, Russia; (K.L.); (L.L.)
| | - Viacheslav Kravchuk
- Mechnikov North-Western State Medical University, Saint Petersburg 191015, Russia; (V.K.); (S.S.)
| | - Sergey Saiganov
- Mechnikov North-Western State Medical University, Saint Petersburg 191015, Russia; (V.K.); (S.S.)
| | - Alexander Brill
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B152TT, UK
- Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia
- Correspondence: (O.P.); (A.B.); Tel.: +7-92-1310-6629 (O.P.); Tel.: +44-12-1415-8679 (A.B.)
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24
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RELATION OF PULMONARY THROMBOEMBOLISM AND SIGNIFICANCE OF LABORATORY PARAMETERS (D-DIMER-FIBRINOGEN) OF PATIENTS WITH ISOLATED COPD DURING EXACERBATION. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.687541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Cao YQ, Dong LX, Cao J. Pulmonary Embolism in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Chin Med J (Engl) 2018; 131:1732-1737. [PMID: 29998894 PMCID: PMC6048924 DOI: 10.4103/0366-6999.235865] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective In most countries, nearly 6% of the adults are suffering from chronic obstructive pulmonary disease (COPD), which puts a huge economic burden on the society. Moreover, COPD has been considered as an independent risk factor for pulmonary embolism (PE). In this review, we summarized the existing evidence that demonstrates the associations between COPD exacerbation and PE from various aspects, including epidemiology, pathophysiological changes, risk factors, clinical features, management, and prognosis. Data Sources We searched the terms "chronic obstructive pulmonary disease," "pulmonary embolism," "exacerbations," and "thromboembolic" in PubMed database and collected the results up to April 2018. The language was limited to English. Study Selection We thoroughly examined the titles and abstracts of all studies that met our search strategy. The data from prospective studies, meta-analyses, retrospective studies, and recent reviews were selected for preparing this review. Results The prevalence of PE in patients with COPD exacerbation varied a lot among different studies, mainly due to the variations in race, sample size, study design, research setting, and enrollment criteria. Overall, whites and African Americans showed significantly higher prevalence of PE than Asian people, and the hospitalized patients showed higher prevalence of PE compared to those who were evaluated in emergency department. PE is easily overlooked in patients with COPD exacerbation due to the similar clinical symptoms. However, several factors have been identified to contribute to the increased risk of PE during COPD exacerbation. Obesity and lower limb asymmetry were described as independent predictors for PE. Moreover, due to the high risk of PE, thromboprophylaxis has been used as an important treatment for hospitalized patients with COPD exacerbation. Conclusions According to the previous studies, COPD patients with PE experienced an increased risk of death and prolonged length of hospital stay. Therefore, the thromboembolic risk in patients with acute exacerbation of COPD, especially in the hospitalized patients, should carefully be evaluated.
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Affiliation(s)
- Yao-Qian Cao
- Department of Respiratory, General Hospital, Tianjin Medical University, Tianjin 300052, China
| | - Li-Xia Dong
- Department of Respiratory, General Hospital, Tianjin Medical University, Tianjin 300052, China
| | - Jie Cao
- Department of Respiratory, General Hospital, Tianjin Medical University, Tianjin 300052, China
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26
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Pourmand A, Robinson H, Mazer-Amirshahi M, Pines JM. Pulmonary Embolism Among Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease: Implications For Emergency Medicine. J Emerg Med 2018; 55:339-346. [PMID: 29945817 DOI: 10.1016/j.jemermed.2018.05.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/01/2018] [Accepted: 05/30/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Common in COPD are acute exacerbations (AE-COPD) that cause acute dyspnea, cough, and bronchospasm. Symptoms of AE-COPD mimic pulmonary embolism (PE). METHODS We conducted a systematic review of the literature to assess the prevalence of PE in patients admitted to the hospital with a clinical diagnosis of AE-COPD. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we queried PubMed and MEDLINE databases from 1990 to 2017. The search term "prevalence pulmonary embolism, COPD" was used, and Boolean operators were used to combine search terms. Data were extracted from each article, specifically the sample size, study setting, design, and the prevalence of PE. RESULTS A total of 5 articles were included that demonstrated a prevalence of PE among patients with a clinical diagnosis of AE-COPD that ranged from 3.3-29.1%. Sample sizes varied from 49-197 patients. Studies occurred in both emergency department and inpatient settings, including intensive care units. Among the studies that reported patient characteristics associated with PE in AE-COPD, both obesity and immobility were important. CONCLUSION Studies reporting the prevalence of PE during AE-COPD vary considerably in their methods and results. Because of the relatively high prevalence of PE during AE-COPD, it is important for providers to be aware of this linkage between the 2 conditions and to screen patients using clinical gestalt and validated screening tools until more emergency department data are available.
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Affiliation(s)
- Ali Pourmand
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Hannah Robinson
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, District of Columbia
| | - Jesse M Pines
- Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
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27
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Diagnosis and Exclusion of Pulmonary Embolism. Thromb Res 2018; 163:207-220. [DOI: 10.1016/j.thromres.2017.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022]
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28
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Norris HC, Mangum TS, Kern JP, Elliott JE, Beasley KM, Goodman RD, Mladinov S, Barak OF, Bakovic D, Dujic Z, Lovering AT. Intrapulmonary arteriovenous anastomoses in humans with chronic obstructive pulmonary disease: implications for cryptogenic stroke? Exp Physiol 2018; 101:1128-42. [PMID: 27339093 DOI: 10.1113/ep085811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/20/2016] [Indexed: 12/13/2022]
Abstract
What is the central question of this study? Do individuals with chronic obstructive pulmonary disease have blood flow through intrapulmonary arteriovenous anastomoses at rest or during exercise? What is the main finding and its importance? Individuals with chronic obstructive pulmonary disease have a greater prevalence of blood flow through intrapulmonary arteriovenous anastomoses at rest than age-matched control subjects. Given that the intrapulmonary arteriovenous anastomoses are large enough to permit venous emboli to pass into the arterial circulation, patients with chronic obstructive pulmonary disease and an elevated risk of thrombus formation may be at risk of intrapulmonary arteriovenous anastomosis-facilitated embolic injury (e.g. stroke or transient ischaemic attack). The pulmonary capillaries prevent stroke by filtering venous emboli from the circulation. Intrapulmonary arteriovenous anastomoses are large-diameter (≥50 μm) vascular connections in the lung that may compromise the integrity of the pulmonary capillary filter and have recently been linked to cryptogenic stroke and transient ischaemic attack. Prothrombotic populations, such as individuals with chronic obstructive pulmonary disease (COPD), may be at increased risk of stroke and transient ischaemic attack facilitated by intrapulmonary arteriovenous anastomoses, but the prevalence and degree of blood flow through intrapulmonary arteriovenous anastomoses in this population has not been fully examined and compared with age-matched healthy control subjects. We used saline contrast echocardiography to assess blood flow through intrapulmonary arteriovenous anastomoses at rest (n = 29 COPD and 19 control subjects) and during exercise (n = 10 COPD and 10 control subjects) in subjects with COPD and age-matched healthy control subjects. Blood flow through intrapulmonary arteriovenous anastomoses was detected in 23% of subjects with COPD at rest and was significantly higher compared with age-matched healthy control subjects. Blood flow through intrapulmonary arteriovenous anastomoses at rest was reduced or eliminated in subjects with COPD after breathing hyperoxic gas. Sixty per cent of subjects with COPD who did not have blood flow through the intrapulmonary arteriovenous anastomoses at rest had blood flow through them during exercise. The combination of blood flow through intrapulmonary arteriovenous anastomoses and potential for thrombus formation in individuals with COPD may permit venous emboli to pass into the arterial circulation and cause stroke and transient ischaemic attack. Breathing supplemental oxygen may reduce this risk in COPD. The link between blood flow through intrapulmonary arteriovenous anastomoses, stroke and transient ischaemic attack is worthy of future investigation in COPD and other populations.
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Affiliation(s)
- H Cameron Norris
- Department of Human Physiology, University of Oregon, Eugene, OR, UK
| | - Tyler S Mangum
- Department of Human Physiology, University of Oregon, Eugene, OR, UK
| | - Julia P Kern
- Department of Human Physiology, University of Oregon, Eugene, OR, UK
| | | | - Kara M Beasley
- Department of Human Physiology, University of Oregon, Eugene, OR, UK
| | | | - Suzana Mladinov
- Clinical Department for Pulmonary Diseases, University Hospital Center Split, Split, Croatia
| | - Otto F Barak
- Department of Physiology, University of Novi Sad, Novi Sad, Serbia
| | - Darija Bakovic
- Division of Cardiology, Department of Internal Medicine, University Hospital Center Split, Split, Croatia.,Department of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - Zeljko Dujic
- Department of Integrative Physiology, University of Split School of Medicine, Split, Croatia
| | - Andrew T Lovering
- Department of Human Physiology, University of Oregon, Eugene, OR, UK
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29
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Yang QF, Lu TT, Shu CM, Feng LF, Chang HT, Ji QY. Eosinophilic biomarkers for detection of acute exacerbation of chronic obstructive pulmonary disease with or without pulmonary embolism. Exp Ther Med 2017; 14:3198-3206. [PMID: 28912870 DOI: 10.3892/etm.2017.4876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/19/2017] [Indexed: 01/09/2023] Open
Abstract
Eosinophilia has been implicated in the pathophysiology of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the role of eosinophil activation in the development of AECOPD remains unclear. In the present study, the reliability of plasma levels of eosinophil activation markers, including eosinophil cationic protein (ECP), major basic protein (MBP), eosinophil-derived neurotoxin (EDN) and eosinophil peroxidase (EPX), were measured and used as diagnostic biomarkers of AECOPD with or without pulmonary embolism (PE). A total of 47 patients with AECOPD, 30 patients with AECOPD/PE and 35 healthy adults were enrolled in the present study. Plasma levels of ECP, EDN, EPX and MBP were measured using commercial ELISA kits. The mean concentrations of plasma ECP, EDN, EPX and MBP in the patients with AECOPD was significantly 2.87-, 3.06-, 1.60- and 1.92-fold higher, respectively, compared with the control group (P<0.05). Similar results were obtained in patients with AECOPD/PE, for whom plasma levels of ECP, EDN, EPX and MBP were significantly 2.06-, 2.21-, 1.42- and 2.42-fold higher, respectively, compared with the controls (P<0.05). No significant differences were observed in the levels of these proteins between patients with AECOPD or AECOPD/PE. Among the four potential markers, ECP was determined to be the optimal marker for distinguishing patients with AECOPD or AECOPD/PE from the controls. No significant correlation was observed between marker concentrations and gender, age or disease severity. The results of the present study may have clinical applications in the diagnosis of AECOPD using these novel biomarkers.
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Affiliation(s)
- Qiong-Fang Yang
- Department of Respiratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Ting-Ting Lu
- Department of Science Education, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Cai-Min Shu
- Department of Respiratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Lan-Fang Feng
- Department of Respiratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Hao-Teng Chang
- Graduate Institute of Basic Medical Science, China Medical University, Taichung 404, Taiwan, R.O.C.,Department of Computer Science and Information Engineering, Asia University, Taichung 413, Taiwan, R.O.C
| | - Qiao-Ying Ji
- Department of Respiratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
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Carlier N. [Differential diagnosis of acute COPD exacerbations]. Rev Mal Respir 2017; 34:369-372. [PMID: 28502370 DOI: 10.1016/j.rmr.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- N Carlier
- Service de pneumologie, hôpital Cochin, université Paris Descartes, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Recent Progress in Research on the Pathogenesis of Pulmonary Thromboembolism: An Old Story with New Perspectives. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6516791. [PMID: 28484717 PMCID: PMC5397627 DOI: 10.1155/2017/6516791] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/26/2017] [Accepted: 03/27/2017] [Indexed: 12/25/2022]
Abstract
Pulmonary thromboembolism (PTE) is part of a larger clinicopathological entity, venous thromboembolism. It is also a complex, multifactorial disorder divided into four major disease processes including venous thrombosis, thrombus in transit, acute pulmonary embolism, and pulmonary circulation reconstruction. Even when treated, some patients develop chronic thromboembolic pulmonary hypertension. PTE is also a common fatal type of pulmonary vascular disease worldwide, but earlier studies primarily focused on the pathological changes in the blood component of the disease. With contemporary advances in molecular and cellular biology, people are becoming increasingly aware of coagulation pathways, the function of vascular smooth muscle cells, microparticles, and the inflammatory pathways that play key roles in PTE. Combined hypoxia and immune research has revealed that PTE should be regarded as a class of complex diseases caused by multiple factors involving the vascular microenvironment and vascular cell dysfunction.
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AbdelHalim HA, AboElNaga HH. Acute exacerbation of COPD with pulmonary embolism: A new D-dimer cut-off value. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2017.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hawkins NM, Khosla A, Virani SA, McMurray JJV, FitzGerald JM. B-type natriuretic peptides in chronic obstructive pulmonary disease: a systematic review. BMC Pulm Med 2017; 17:11. [PMID: 28073350 PMCID: PMC5223538 DOI: 10.1186/s12890-016-0345-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/09/2016] [Indexed: 12/29/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) have increased cardiovascular risk. Natriuretic peptides (NP) in other populations are useful in identifying cardiovascular disease, stratifying risk, and guiding therapy. Methods We performed a systematic literature review to examine NP in COPD, utilising Medline, EMBASE, and the Cochrane Library. Results Fifty one studies were identified. NP levels were lower in stable compared to exacerbation of COPD, and significantly increased with concomitant left ventricular systolic dysfunction or cor pulmonale. Elevation occurred in 16 to 60% of exacerbations and persisted in approximately one half of patients at discharge. Cardiovascular comorbidities were associated with increased levels. Levels consistently correlated with pulmonary artery pressure and left ventricular ejection fraction, but not pulmonary function or oxygen saturation. NP demonstrated high negative predictive values (0.80 to 0.98) to exclude left ventricular dysfunction in both stable and exacerbation of COPD, but relatively low positive predictive values. NP elevation predicted early adverse outcomes, but the association with long term mortality was inconsistent. Conclusion NP reflect diverse aspects of the cardiopulmonary continuum which limits utility when applied in isolation. Strategies integrating NP with additional variables, biomarkers and imaging require further investigation.
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Affiliation(s)
- Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada.
| | - Amit Khosla
- Division of Cardiology, University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada
| | - Sean A Virani
- Division of Cardiology, University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada
| | - John J V McMurray
- Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - J Mark FitzGerald
- Division of Respiratory Medicine, University of British Columbia and Institute for Heart and Lung Health, Vancouver, Canada
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Lankeit M, Held M. Incidence of venous thromboembolism in COPD: linking inflammation and thrombosis? Eur Respir J 2016; 47:369-73. [DOI: 10.1183/13993003.01679-2015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Zhang M, Zhang J, Zhang Q, Yang X, Shan H, Ming Z, Chen H, Liu Y, Yin J, Li Y. D-dimer as a potential biomarker for the progression of COPD. Clin Chim Acta 2016; 455:55-9. [PMID: 26826394 DOI: 10.1016/j.cca.2016.01.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/07/2016] [Accepted: 01/25/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND D-dimer is a manifestation of endogenous fibrinolytic activity and associated with inflammation process. Despite chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease characterized by a hypercoagulable state, D-dimer levels in COPD patients are still conflicting. METHODS Forty-three participants were investigated at admission for an acute exacerbation of COPD, and reassessed when stable. Forty-three controls were matched for age, gender, body mass index, smoking index, comorbidities and medication use. Participants underwent pulmonary function and laboratory testing, including the measurements of D-dimer and high-sensitivity C-reactive protein (hsCRP). RESULTS The median of D-dimer was 2839 μg/l (IQR: 2078-4389 μg/l) and 1799 μg/l (IQR: 1205-2196 μg/l) in exacerbated and stable COPD patients respectively. The median of D-dimer in the control subjects was 433 μg/l (IQR: 369-456 μg/l). D-dimer level was significantly increased in stable COPD patients compared with healthy controls, and further increased in those patients with an acute exacerbation (both P<0.001). D-dimer was positively correlated with the well-known inflammatory marker hsCRP both in the exacerbated and stable phases of COPD (r=0.392 P=0.009 and r=0.411 P=0.006, respectively), and negatively correlated with FEV1% predicted and FEV1/FVC in stable COPD (r=-0.409 P=0.006 and r=-0.343 P=0.024, respectively). CONCLUSIONS D-dimer is increased in COPD patients, and could be considered as an inflammatory marker for the assessment of inflammation in the progression of COPD.
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Affiliation(s)
- Ming Zhang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jie Zhang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiuhong Zhang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xia Yang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hu Shan
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zongjuan Ming
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Haijuan Chen
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yanqin Liu
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiafeng Yin
- Department of Laboratory Examination, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yali Li
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Madsen PH, Hess S. Symptomatology, Clinical Presentation and Basic Work up in Patients with Suspected Pulmonary Embolism. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 906:33-48. [DOI: 10.1007/5584_2016_104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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