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Prevalence of Pulmonary Embolism in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis.
Chest. 2008 Sep 23;
Authors: Rizkallah J, Man SF, Sin DD
Background Nearly 30% of all exacerbations of chronic obstructive pulmonary disease (COPD) do not have a clear etiology. Although pulmonary embolism (PE) can exacerbate respiratory symptoms such as dyspnea and chest pain and COPD patients are at a high risk of PE due to a variety of factors including limited mobility, inflammation and co-morbidities, the prevalence of PE during exacerbations is uncertain. Methods A systematic review of the literature was performed to determine the reported prevalence of PE in acute exacerbations of COPD in patients who do and do not require hospitalization. The literature search was performed using MEDLINE, CINAHL, and EMBASE and complemented by hand searches of bibliographies. Only cross-sectional or prospective studies that used computed tomographic scanning or pulmonary angiogram for PE diagnosis was included. Results Of the 2407 articles identified, 5 met the inclusion criteria (sample size, 550 patients). Overall, the prevalence of PE was 19.9% (95% CI, 6.7% to 33.0%; p= 0.014). In hospitalized patients, the prevalence was higher at 24.7% (95% CI, 17.9% to 31.4%; p=0.001) than those who were evaluated in the emergency department (3.3%). Presenting symptoms and signs were similar between patients who did and did not have PE. Conclusions One out of four COPD patients who require hospitalization for an acute exacerbation may have PE. A diagnosis of PE should be considered in patients with exacerbation severe enough to warrant hospitalization, especially in those with an intermediate to high pre-test probability of PE.
PMID: 18812453 [PubMed - as supplied by publisher]