Incidence and Impact of Pulmonary Embolism During Severe COPD Exacerbation

Abstract

BACKGROUND:

Patients with COPD are at a high risk for pulmonary embolism (PE) because of systemic inflammation and co-existing comorbidities. We aimed to determine the incidence, risk factors, and impact of PE during COPD exacerbation requiring mechanical ventilation.

METHODS:

This prospective cohort study was conducted between March 2013 and May 2017. Subjects with severe COPD exacerbation requiring mechanical ventilation were included. A lower-limb ultrasonography or a multidetector helical computed tomography scan (MDCT) was performed according to Wells score. Subjects with ultrasonographic signs of phlebitis underwent MDCT to confirm PE.

RESULTS:

During the study period, 131 COPD subjects were admitted to the ICU for severe COPD exacerbation. The incidence of PE was 13.7%. Factors independently associated with PE were increased sputum volume (odds ratio [OR] = 0.106, 95% CI 0.029–0.385, P = .001), recent immobilization ≥ 7 d (OR = 5.024, 95% CI 1.470–17.170, P = .01), age ≥ 70 y (OR = 5.483, 95% CI 1.269–23.688, P = .02), and invasive mechanical ventilation at ICU admission (OR = 3.615, 95% CI 1.005–13.007, P = .049). ICU mortality was higher in the PE group (44% vs 11%). Predictive factors of mortality were PE (OR = 7.135, 95% CI 2.042–24.931, P = .002), SAPS II score at admission OR = 1.040, 95% CI 1.005–1.077, P = .02), and duration of mechanical ventilation (OR = 1.098, 95% CI 1.044–1.154, P < .001).

CONCLUSION:

PE was found to be a common etiology of severe exacerbation of COPD, leading to high mortality. Age, invasive mechanical ventilation, and immobilization were risk factors for PE.