Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Published comments/rapid response letters    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search    Get Permissions  Google Scholar    Search for Related Content  Social Bookmarking

What's this?

PubMed

Articles in PubMed by Author:    Tillie-Leblond, I.    Remy-Jardin, M.    Related Articles in PubMed    PubMed Citation    PubMed

ARTICLE

Pulmonary Embolism in Patients with Unexplained Exacerbation of Chronic Obstructive Pulmonary Disease: Prevalence and Risk Factors

Isabelle Tillie-Leblond, MD, PhD; Charles-Hugo Marquette, MD, PhD; Thierry Perez, MD; Arnaud Scherpereel, MD, PhD; Christophe Zanetti, MD; André-Bernard Tonnel, MD, PhD; and Martine Remy-Jardin, MD, PhD

21 March 2006 | Volume 144 Issue 6 | Pages 390-396

Background: Diagnosis of pulmonary embolism (PE) is difficult in patients with chronic obstructive pulmonary disease (COPD) and exacerbation.

Objective: To evaluate PE in patients with COPD and exacerbation of unknown origin and explore factors associated with PE.

Design: Prospective cohort study.

Setting: University-affiliated hospital in France.

Patients: 211 consecutive patients, all current or former smokers with COPD, who were admitted to the hospital for severe exacerbation of unknown origin and did not require invasive mechanical ventilation.

Measurements: Spiral computed tomography angiography (CTA) and ultrasonography within 48 hours of admission and assessment of the Geneva score. Patients were classified as PE positive (positive results on CTA or negative results on CTA and positive results on ultrasonography) or PE negative (negative results on CTA and negative results on ultrasonography or negative results on CTA and no recurrence of PE at follow-up 3 months later).

Results: 49 of 197 patients (25% [95% CI, 19% to 32%]) met the diagnostic criteria for PE. Clinical factors associated with PE were previous thromboembolic disease (risk ratio, 2.43 [CI, 1.49 to 3.94]), malignant disease (risk ratio, 1.82 [CI, 1.13 to 2.92]), and decrease in PaCO₂ of at least 5 mm Hg (risk ratio, 2.10 [CI, 1.23 to 3.58]). A total of 9.2% (CI, 4.7% to 15.9%) of patients with a low-probability Geneva score received a diagnosis of PE. An exploratory analysis suggested that substituting malignant disease for recent surgery in the Geneva score might improve its performance in excluding PE in this sample who were more likely to have malignant disease than to have had recent surgery. However, this improvement seems insufficient to exclude PE with enough certainty to withhold therapy for low-risk patients on the basis of the modified score.

Limitations: This study was done in only 1 center. Patients with COPD requiring invasive mechanical ventilation in the intensive care unit were not included. The upper bound of the 95% CI for the low probability of PE according to the Geneva score is too high to rule out PE. The classification of COPD exacerbation of unknown origin was based on the clinician's assessment, not on a standard evaluation for all patients.

Conclusion: This study showed a 25% prevalence of PE in patients with COPD hospitalized for severe exacerbation of unknown origin. Three clinical factors are associated with the increased risk for PE. The Geneva score and the modified Geneva score should be prospectively evaluated in patients with COPD.

Editors' Notes Context Pulmonary embolism (PE) is common in patients with chronic obstructive pulmonary disease (COPD) exacerbations, and the 2 conditions present similarly. Content For 45 months, every patient presenting with severe COPD exacerbation of unknown cause received an evaluation for PE that included a spiral computed tomography scan and color Doppler ultrasonography of the legs. Twenty-five percent of 197 patients had PE. Malignant disease, history of thromboembolism, and a decrease in PaCO2 level relative to baseline were the only factors associated with PE. Cautions This was a single-center study. Implications We need additional studies to confirm the high prevalence of PE in unexplained severe exacerbations of COPD and to study the value of routine testing for PE in patients with this clinical presentation. —The Editors

 

Author and Article Information

From University Hospital A Calmette, Lille, France.

Acknowledgments: The authors thank Pierre Taupin for biostatistical help.

Grant Support: None.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Isabelle Tillie-Leblond, MD, PhD, Lung Department, University Hospital A Calmette, 1 rue Leclercq, CHRU, 59037 Lille Cedex, France.

Current Author Addresses: Drs. Tillie-Leblond, Marquette, Perez, Scherpereel, Zanetti, and Tonnel: Lung Department, University Hospital A Calmette, 1 rue Leclercq, CHRU, 59037 Lille Cedex, France.

Dr. Remy-Jardin: Department of Radiology, University Center Hospital Calmette, 1 rue Leclercq, CHRU, 59037 Lille Cedex, France.

Author Contributions: Conception and design: I. Tillie-Leblond.

Analysis and interpretation of the data: I. Tillie-Leblond, C.-H. Marquette, T. Perez, A.-B. Tonnel.

Drafting of the article: I. Tillie-Leblond, C.-H. Marquette, T. Perez, C. Zanetti, A.-B. Tonnel, M. Remy-Jardin.

Provision of study materials or patients: A. Scherpereel, C. Zanetti, A.-B. Tonnel.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Facebook

Reddit

Technorati

Twitter

Related articles in Annals:

Letters
Pulmonary Embolism in Patients with Unexplained Exacerbations of Chronic Obstructive Pulmonary Disease
Grégoire Le Gal AND Marc Righini

Annals 2006 145: 310. [Full Text]  

Letters
Pulmonary Embolism in Patients with Unexplained Exacerbations of Chronic Obstructive Pulmonary Disease
Isabelle Tillie-Leblond, Charles-Hugo Marquette, AND Thierry Perez

Annals 2006 145: 310. [Full Text]  

This article has been cited by other articles:

				C. M. Chan, G. L. Colice, and A. F. Shorr The Clot Thickens Chest, March 1, 2009; 135(3): 592 - 594. [Full Text] [PDF]

				J. Rizkallah, S. F. P. Man, and D. D. Sin Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD: A Systematic Review and Metaanalysis Chest, March 1, 2009; 135(3): 786 - 793. [Abstract] [Full Text] [PDF]

				G. Piazza, A. Seddighzadeh, and S. Z. Goldhaber Deep-Vein Thrombosis in the Elderly Clinical and Applied Thrombosis/Hemostasis, October 1, 2008; 14(4): 393 - 398. [Abstract] [PDF]

				W. M. Chatila, B. M. Thomashow, O. A. Minai, G. J. Criner, and B. J. Make Comorbidities in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, May 1, 2008; 5(4): 549 - 555. [Abstract] [Full Text] [PDF]

				W. MacNee Update in Chronic Obstructive Pulmonary Disease 2007 Am. J. Respir. Crit. Care Med., April 15, 2008; 177(8): 820 - 829. [Full Text] [PDF]

				P. H. Brekke, T. Omland, S. H. Holmedal, P. Smith, and V. Soyseth Troponin T elevation and long-term mortality after chronic obstructive pulmonary disease exacerbation Eur. Respir. J., March 1, 2008; 31(3): 563 - 570. [Abstract] [Full Text] [PDF]

				M. K. Han, V. V. McLaughlin, G. J. Criner, and F. J. Martinez Pulmonary Diseases and the Heart Circulation, December 18, 2007; 116(25): 2992 - 3005. [Abstract] [Full Text] [PDF]

				F. J. Martinez Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease Proceedings of the ATS, December 1, 2007; 4(8): 647 - 658. [Abstract] [Full Text] [PDF]

				M. Remy-Jardin, M. Pistolesi, L. R. Goodman, W. B. Gefter, A. Gottschalk, J. R. Mayo, and H. D. Sostman Management of Suspected Acute Pulmonary Embolism in the Era of CT Angiography: A Statement from the Fleischner Society Radiology, November 1, 2007; 245(2): 315 - 329. [Full Text] [PDF]

				A. Anzueto, S. Sethi, and F. J. Martinez Exacerbations of Chronic Obstructive Pulmonary Disease Proceedings of the ATS, October 1, 2007; 4(7): 554 - 564. [Abstract] [Full Text] [PDF]

				G. Tino, L. B. Ware, and M. Moss Clinical Year in Review IV: Chronic Obstructive Pulmonary Disease, Nonpulmonary Critical Care, Diagnostic Imaging, and Mycobacterial Disease Proceedings of the ATS, September 15, 2007; 4(6): 494 - 498. [Full Text] [PDF]

				G. Piazza, A. Seddighzadeh, and S. Z. Goldhaber Double Trouble for 2,609 Hospitalized Medical Patients Who Developed Deep Vein Thrombosis: Prophylaxis Omitted More Often and Pulmonary Embolism More Frequent Chest, August 1, 2007; 132(2): 554 - 561. [Abstract] [Full Text] [PDF]

				K. F. Rabe, B. Beghe, F. Luppi, and L. M. Fabbri Update in Chronic Obstructive Pulmonary Disease 2006 Am. J. Respir. Crit. Care Med., June 15, 2007; 175(12): 1222 - 1232. [Full Text] [PDF]

				B. R. Celli and P. J. Barnes Exacerbations of chronic obstructive pulmonary disease Eur. Respir. J., June 1, 2007; 29(6): 1224 - 1238. [Abstract] [Full Text] [PDF]

				P. J. Barnes, C. La Vecchia, L. M. Fabbri, M. Duerden, Y. Kupfer, S. Tessler, N. Keaney, P. Calverley, J. Anderson, and B. Celli Prevention of Death in COPD N. Engl. J. Med., May 24, 2007; 356(21): 2211 - 2214. [Full Text] [PDF]

				K. F. Rabe Treating COPD -- The TORCH Trial, P Values, and the Dodo N. Engl. J. Med., February 22, 2007; 356(8): 851 - 854. [Full Text] [PDF]

				J A Wedzicha and J R Hurst Chronic obstructive pulmonary disease exacerbation and risk of pulmonary embolism Thorax, February 1, 2007; 62(2): 103 - 104. [Full Text] [PDF]

				O. T Rutschmann, J. Cornuz, P.-A. Poletti, P.-O. Bridevaux, O. W Hugli, S. D Qanadli, and A. Perrier Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease? Thorax, February 1, 2007; 62(2): 121 - 125. [Abstract] [Full Text] [PDF]

				G. Le Gal and M. Righini Pulmonary Embolism in Patients with Unexplained Exacerbations of Chronic Obstructive Pulmonary Disease Ann Intern Med, August 15, 2006; 145(4): 310 - 310. [Full Text] [PDF]

				A Patel High prevalence of PE in patients with unexplained exacerbation of COPD Thorax, July 1, 2006; 61(7): 603 - 603. [Full Text] [PDF]

				PE Is Common in COPD Exacerbation Journal Watch (General), April 4, 2006; 2006(404): 2 - 2. [Full Text]

Rapid Responses: