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Mai V, Girardi L, de Wit K, Castellucci L, Aaron S, Couturaud F, Fergusson DA, Le Gal G. Chronic obstructive pulmonary disease exacerbation purulence status and its association with pulmonary embolism: protocol for a systematic review with meta-analysis. BMJ Open 2024; 14:e085328. [PMID: 38904133 PMCID: PMC11191811 DOI: 10.1136/bmjopen-2024-085328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of pulmonary embolism (PE). AECOPD and PE have similar symptoms which results in a high proportion of patients with AECOPD undergoing imaging to rule out PE. Finding predictors and explanatory factors of PE in AECOPD, such as purulence status, could help reduce the need for imaging. This systematic review with meta-analysis aims to evaluate if there is an association between purulence status in AECOPD and PE diagnosis. METHODS AND ANALYSIS MEDLINE, EMBASE and CENTRAL will be searched from database inception to April 2024. Randomised trials, cohort studies and cross-sectional studies on the prevalence of PE in patients with AECOPD will be included if the prevalence of PE based on the AECOPD purulence status is available. There will be no restriction on language. The primary outcome will be PE at the initial assessment and secondary outcomes will be all venous thromboembolism (deep venous thrombosis (DVT) and PE) and DVT, respectively, diagnosed at the initial assessment. Relative risks with their 95% CI will be calculated by using a Mantel-Haenszel random-effect model to compare the association between the risk of PE and the AECOPD purulence status (purulent vs non-purulent/unknown). Subgroup analyses will be performed based on the type of study, systematic search of PE versus no systematic search of PE and localisation of PE. Risk of bias will be evaluated by the ROBINS-E tool, publication bias will be evaluated with the funnel plot. The manuscript will be drafted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. ETHICS AND DISSEMINATION This study does not require ethics approval. This work will be submitted for presentation at an international conference and for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023459429.
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Affiliation(s)
- Vicky Mai
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Laura Girardi
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Kerstin de Wit
- Department of Emergency Medicine and Medicine, Queens University, Kingston, Ontario, Canada
| | - Lana Castellucci
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Shawn Aaron
- Department of Medicine, Faculty of Medicine, Division of Respirology, University of Ottawa, Ottawa, Ontario, Canada
| | - Francis Couturaud
- INSERM U1304-GETBO, CIC INSERM 1412, Univ_Brest, Département de Médecine Interne et Pneumologie, Centre Hospitalier Universitaire de Brest, Brest, FCRIN INNOVTE, France
| | - Dean A Fergusson
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Abdulfattah A, John S. Navigating Diagnostic Challenges: Severe Pulmonary Hypertension in Acute Exacerbation of Chronic Obstructive Pulmonary Disease vs. Pulmonary Embolism. Cureus 2024; 16:e56907. [PMID: 38659531 PMCID: PMC11042794 DOI: 10.7759/cureus.56907] [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] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
A 63-year-old male with an unremarkable medical history presented to the emergency room (ER) with shortness of breath and bilateral lower extremity edema. In the ER, he was found to be hypoxic and hypercapnic on an arterial blood gas. CT angiography of the chest revealed severe emphysematous changes and large right apical bullae. A bedside point-of-care ultrasound demonstrated many bilateral B-lines as well as normal ejection fraction (EF). An echocardiogram revealed a small left ventricular cavity with an EF of 65%, severely dilated right ventricle, severe right ventricular dysfunction, "D" shaped interventricular septum, severely dilated right atrium, and severe pulmonary arterial hypertension (PAH) with a calculated pulmonary artery systolic pressure of 72 mmHg. The patient was initiated on bilevel positive airway pressure, glucocorticoids, bronchodilator nebulization, and diuretics with symptomatic improvement. Herein, this case report discusses similarities and differences between presentations and echocardiographic manifestations of severe PAH in the setting of acute exacerbation of chronic obstructive pulmonary disease and pulmonary embolism in the acute setting.
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Affiliation(s)
- Ammar Abdulfattah
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Sabu John
- Department of Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
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Yang C, Tuo Y, Shi X, Duo J, Liu X, Zhang F, Feng X. Prevalence, risk factors, and clinical characteristics of pulmonary embolism in patients with acute exacerbation of COPD in Plateau regions: a prospective cohort study. BMC Pulm Med 2024; 24:102. [PMID: 38413975 PMCID: PMC10900782 DOI: 10.1186/s12890-024-02915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVE To investigate pulmonary thromboembolism (PE) in acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) patients in plateau regions, we performed a prospective cohort study to evaluate the prevalence, risk factors and clinical characteristics of PE in the cohort of hospitalized patients at high altitude. METHODS We did a prospective study with a total of 636 AE-COPD patients in plateau regions. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities and cardiac ultrasound, and computed tomographic pulmonary angiography (CTPA) variables were obtained, and comparisons were made between groups with and without PE. We also conducted logistic regression to explore the risk factors of PE. RESULTS Of the 636 patients hospitalized with AE-COPD (age 67.0 ± 10.7 years, 445[70.0%] male), 188 patients developed PE (29.6% [95% CI: 26.0%, 33.1%]). Multivariable logistic regression showed that ethnic minorities, D-dimer > 1 mg/L, AST > 40 U/L, chest pain, cardiac insufficiency or respiratory failure, Padua score > 3, and DVT were associated with a higher probability of PE. CONCLUSIONS The prevalence of PE is high and those with a higher Padua score, the occurrence of deep venous thrombosis, higher neutrophil count, chest pain, cardiac insufficiency or respiratory failure, higher levels of AST, and a higher level of D-dimer had a higher risk of PE. The analysis of AE-COPD may help to provide more accurate screening for PE and improve clinical outcomes of patients with AE-COPD in plateau regions.
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Affiliation(s)
- Chenlu Yang
- Department of Epidemiology and Biostatistics, School of Basic Medicine, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yajun Tuo
- Department of Respiratory and Critical Care Medicine, Qinghai Provincial People's Hospital, Qinghai, China
| | - Xuefeng Shi
- Department of Respiratory and Critical Care Medicine, Qinghai Provincial People's Hospital, Qinghai, China
| | - Jie Duo
- Department of Respiratory and Critical Care Medicine, Qinghai Provincial People's Hospital, Qinghai, China
| | - Xin Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Fang Zhang
- Department of Respiratory and Critical Care Medicine, Qinghai Provincial People's Hospital, Qinghai, China
| | - Xiaokai Feng
- Department of Respiratory and Critical Care Medicine, Qinghai Provincial People's Hospital, Qinghai, China.
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Rastoder E, Kamstrup P, Hedsund C, Jordan A, Sivapalan P, Rømer V, Falkvist F, Hamidi S, Bendstrup E, Sperling S, Dons M, Biering-Sørensen T, Falster C, Laursen CB, Carlsen J, Jensen JUS. Thrombelastography and Conventional Coagulation Markers in Chronic Obstructive Pulmonary Disease: A Prospective Paired-Measurements Study Comparing Exacerbation and Stable Phases. Int J Mol Sci 2024; 25:2051. [PMID: 38396728 PMCID: PMC10889576 DOI: 10.3390/ijms25042051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) exacerbation is known for its substantial impact on morbidity and mortality among affected patients, creating a significant healthcare burden worldwide. Coagulation abnormalities have emerged as potential contributors to exacerbation pathogenesis, raising concerns about increased thrombotic events during exacerbation. The aim of this study was to explore the differences in thrombelastography (TEG) parameters and coagulation markers in COPD patients during admission with exacerbation and at a follow-up after discharge. This was a multi-center cohort study. COPD patients were enrolled within 72 h of hospitalization. The baseline assessments were Kaolin-TEG and blood samples. Statistical analysis involved using descriptive statistics; the main analysis was a paired t-test comparing coagulation parameters between exacerbation and follow-up. One hundred patients participated, 66% of whom were female, with a median age of 78.5 years and comorbidities including atrial fibrillation (18%) and essential arterial hypertension (45%), and sixty-five individuals completed a follow-up after discharge. No significant variations were observed in Kaolin-TEG or conventional coagulation markers between exacerbation and follow-up. The Activated Partial Thromboplastin Clotting Time (APTT) results were near-significant, with p = 0.08. In conclusion, TEG parameters displayed no significant alterations between exacerbation and follow-up.
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Affiliation(s)
- Ema Rastoder
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Caroline Hedsund
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Alexander Jordan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Valdemar Rømer
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Frederikke Falkvist
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Sadaf Hamidi
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (S.S.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Søren Sperling
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (S.S.)
| | - Maria Dons
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark (T.B.-S.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2900 Hellerup, Denmark
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark (T.B.-S.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2900 Hellerup, Denmark
| | - Casper Falster
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of South Denmark, 5000 Odense, Denmark; (C.F.); (C.B.L.)
- Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Christian B. Laursen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of South Denmark, 5000 Odense, Denmark; (C.F.); (C.B.L.)
- Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Jørn Carlsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark; (E.R.); (A.J.); (P.S.); (V.R.); (F.F.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
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