Francesco Dentali1, Fulvio Pomero2, Pierpaolo Di Micco3, Micaela La Regina4, Federica Landini5, Nicola Mumoli6, Filippo Pieralli7, Matteo Giorgi-Pierfranceschi8, Roberta Re9, Josè Vitale10, Leonardo M Fabbri11, Andrea Fontanella12, Dimitriy Arioli13. 1. Department of Medicine and Surgery, Insubria University, Varese, Italy. Electronic address: fdentali@libero.it. 2. Department of Internal Medicine, S. Lazzaro Hospital, Alba, Cuneo Italy. 3. Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy. 4. Risk Management Unit, East Ligurian Hospital, La Spezia, ASL5 Liguria, La Spezia, Italy. 5. Department of Emergency Medicine, Azienda Ospedaliero-Universitaria, Parma, Italy. 6. Department of Internal Medicine, Ospedale Fornaroli, Magenta, Milan, Italy. 7. Medicina Interna e di Urgenza, Azienda Ospedaliera Universitaria 'Careggi', Firenze, Italy. 8. Internal Medicine Department, Istituti Ospedalieri, Cremona, Italy. 9. Department of Internal Medicine, Ospedale Maggiore della Carità, Novara, Italy. 10. Department of Medicine and Surgery, Insubria University, Varese, Italy. 11. Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy. 12. Department of Internal Medicine, Ospedale Fatebenefratelli, Napoli, Italy. 13. Internal Medicine, Centro Emostasi e Trombosi, Stroke Unit, Azienda Ospedaliera ASMN, Reggio Emilia, Italy.
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.
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 patientsdied 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.